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Nilsson, Tohr
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Carlsson, D., Wahlström, J., Burström, L., Hagberg, M., Lundström, R., Pettersson, H. & Nilsson, T. (2018). Can sensation of cold hands predict Raynaud’s phenomenon or paresthesia?. Occupational Medicine, 68(5), 314-319
Open this publication in new window or tab >>Can sensation of cold hands predict Raynaud’s phenomenon or paresthesia?
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2018 (English)In: Occupational Medicine, ISSN 0962-7480, E-ISSN 1471-8405, Vol. 68, no 5, p. 314-319Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
Hand-arm vibration, hand-arm vibration syndrome, Raynaud's phenomenon, paresthesia, sensation of cold
National Category
Occupational Health and Environmental Health
Research subject
Occupational and Environmental Medicine
Identifiers
urn:nbn:se:umu:diva-141012 (URN)10.1093/occmed/kqy053 (DOI)000439653500005 ()
Note

Originally published in thesis in manuscript form.

Available from: 2017-10-20 Created: 2017-10-20 Last updated: 2018-11-01Bibliographically approved
Stjernbrandt, A., Carlsson, D., Pettersson, H., Liljelind, I., Nilsson, T. & Wahlström, J. (2018). Cold sensitivity and associated factors: a nested case–control study performed in Northern Sweden. International Archives of Occupational and Environmental Health, 91(7), 785-797
Open this publication in new window or tab >>Cold sensitivity and associated factors: a nested case–control study performed in Northern Sweden
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2018 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 91, no 7, p. 785-797Article in journal (Refereed) Published
Abstract [en]

Aim To identify possible risk factors for cold sensitivity, by comparing cases to controls with regard to demographic and anthropometric characteristics, previous illnesses and injuries as well as ambient exposures.

Methods Through a questionnaire responded to by the general population (n=12,627) cold sensitivity cases (n=502) and matched controls (n=1,004) were identified and asked to respond to a second questionnaire with focus on different aspects of cold sensitivity, hereditary factors, previous diseases, medication, tobacco use as well as exposure to ambient cold climate and hand-arm vibration (HAV).

Results In total, 997 out of 1506 study subjects answered the second questionnaire, 374 cases and 623 match controls. Identified risk factors among the cases were frostbite of the hands Odds Ratio (OR) 10.3 (95% confidence interval (CI) 5.5-19.3), rheumatic disease OR 3.1 (95% CI 1.7-5.7), upper extremity nerve injury OR 2.0 (95% CI 1.3-3.0), and vascular disease OR 1.9 (95% CI 1.2-2.9). Sex differences in risk factors were HAV exposure for men and cold exposure for women increased the risk of cold sensitivity. Rheumatic diseases and migraine increased the risk of cold sensitivity among women but not among men.

Conclusions The present study shows that cold sensitivity is associated with both inherent factors, acquired conditions and external exposures. Among acquired conditions, frostbite, vascular disease, nerve injury, joint disorders and migraine are significantly related to the reporting of cold sensitivity. Among external exposures, both cold climate and HAV exposure are significantly associated to cold sensitivity, and thus suitable targets for primary preventive measures. There was a difference in risk factors related to sex. HAV exposure for men and cold exposure for women increased the risk of cold sensitivity.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2018
Keywords
Cold exposure, Cold sensitivity, Frostbite, Hand, Raynaud’s phenomenon, Sweden
National Category
Occupational Health and Environmental Health
Research subject
Occupational and Environmental Medicine
Identifiers
urn:nbn:se:umu:diva-141016 (URN)10.1007/s00420-018-1327-2 (DOI)000443357600002 ()29808434 (PubMedID)2-s2.0-85047665099 (Scopus ID)
Projects
CHINS
Note

Originally included in thesis in manuscript form with title [Cold sensitivity and associated factors: a case-control study performed in northern Sweden]

Available from: 2017-10-20 Created: 2017-10-20 Last updated: 2018-11-05Bibliographically approved
Wahlström, J., Burström, L., Johnson, P. W., Nilsson, T. & Järvholm, B. (2018). Exposure to whole-body vibration and hospitalization due to lumbar disc herniation. International Archives of Occupational and Environmental Health, 91(6), 689-694
Open this publication in new window or tab >>Exposure to whole-body vibration and hospitalization due to lumbar disc herniation
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2018 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 91, no 6, p. 689-694Article in journal (Refereed) Published
Abstract [en]

Objective: The aim was to examine if exposure to whole-body vibration (WBV) increases the risk for hospitalization due to lumbar disc herniation.

Methods: The study basis is a cohort of 288,926 Swedish construction workers who participated in a national occupational health surveillance programme from 1971 until 1992. Job title, smoking habits, body weight, height and age were registered at the examinations. Assessment of WBV were made for each of the constituent occupations by constructing a job-exposure matrix (JEM). Exposure to WBV was graded on a scale from 0 to 5. In addition, the occurrence of hospitalization due to lumbar disc herniation from January 1st 1987 until December 31st 2010 was collected from a linkage with the Swedish Hospital Discharge Register. Poisson regressions were used to estimate relative risk with 95 percent confidence intervals (95% CI), adjusting for age, height, weight and smoking, using white-collar workers and foremen as a reference group.

Results: There was an increased risk for hospitalization due to lumbar disc herniation for workers in the construction industry exposed to medium to high WBV compared to white-collar workers and foremen 1.35 (1.12-1.63). When restricting the analyses to include workers 30-49 years of age at the time of the hospital admission the risk was 1.69 (95% CI 1.29-2.21).

Conclusion: This study further supports that occupational exposure to whole-body vibration increases the risk for hospitalization due to lumbar disc herniation.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
epidemiology, low back pain, lumbar disc disease, lumbar radiculopathy, occupational drivers, sciatica, whole-body vibration
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-148400 (URN)10.1007/s00420-018-1316-5 (DOI)000438571100003 ()29855719 (PubMedID)2-s2.0-85047906460 (Scopus ID)
Available from: 2018-06-05 Created: 2018-06-05 Last updated: 2018-09-19Bibliographically approved
Poole, C. J., Bovenzi, M., Nilsson, T., Lawson, I. J., House, R., Thompson, A. & Youakim, S. (2018). International consensus criteria for diagnosing and staging hand-arm vibration syndrome. International Archives of Occupational and Environmental Health
Open this publication in new window or tab >>International consensus criteria for diagnosing and staging hand-arm vibration syndrome
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2018 (English)In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose: In the 30 years since the Stockholm Workshop Scale (SWS) was published, the scientific literature on hand-arm vibration syndrome (HAVS) has grown and experience has been gained in its practical application. This research was undertaken to develop an up-to-date evidence-based classification for HAVS by seeking consensus between experts in the field.

Methods: Seven occupational physicians who are clinically active and have had work published on HAVS in the last 10 years were asked to independently take part in a three-round iterative Delphi process. Consensus was taken when 5/7 (72%) agreed with a particular statement. Experts were asked to provide evidence from the literature or data from their own research to support their views.

Results: Consensus was achieved for most of the questions that were used to develop an updated staging system for HAVS. The vascular and neurological components from the SWS are retained, but ambiguous descriptors and tests without adequately developed methodology such as tactile discrimination, or discriminating power such as grip strength, are not included in the new staging system. A blanching score taken from photographs of the hands during vasospastic episodes is recommended in place of self-recall and frequency of attacks to stage vascular HAVS. Methods with the best evidence base are described for assessing sensory perception and dexterity.

Conclusions: A new classification has been developed with three stages for the clinical classification of vascular and neurological HAVS based on international consensus. We recommend it replaces the SWS for clinical and research purposes.

Keywords
Delphi method, HAVS, Health surveillance, Stockholm Workshop Scale
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-152189 (URN)10.1007/s00420-018-1359-7 (DOI)30264331 (PubMedID)
Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2018-10-01
Lundström, R., Baloch, A. N., Hagberg, M., Nilsson, T. & Gerhardsson, L. (2018). Long-term effect of hand-arm vibration on thermotactile perception thresholds. Journal of Occupational Medicine and Toxicology, 13, Article ID 19.
Open this publication in new window or tab >>Long-term effect of hand-arm vibration on thermotactile perception thresholds
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2018 (English)In: Journal of Occupational Medicine and Toxicology, ISSN 1745-6673, E-ISSN 1745-6673, Vol. 13, article id 19Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Hand-arm vibration, Hand-transmitted vibration, Hand, Thermotactile perception
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-150776 (URN)10.1186/s12995-018-0201-1 (DOI)000435915300001 ()29977321 (PubMedID)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-08-31Bibliographically approved
Stjernbrandt, A., Pettersson, H., Liljelind, I., Nilsson, T. & Wahlström, J. (2018). Raynaud's phenomenon in Northern Sweden: a population-based nested case-control study. Rheumatology International
Open this publication in new window or tab >>Raynaud's phenomenon in Northern Sweden: a population-based nested case-control study
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2018 (English)In: Rheumatology International, ISSN 0172-8172, E-ISSN 1437-160XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

The aim of this study was to determine the association between individual and external exposure factors, and the reporting of Raynaud’s phenomenon, with or without concomitant cold sensitivity. In a population-based nested case–control study, cases with Raynaud’s phenomenon (N = 578), and matched controls (N = 1156), were asked to respond to a questionnaire focusing on different risk factors. Univariate and multiple conditional logistic regression were performed. Analyses were stratified according to whether the cases reported cold sensitivity or not. In total, 1400 out of 1734 study subjects answered the questionnaire (response rate 80.7%). In the final multiple model, the factor with the strongest association to Raynaud’s phenomenon, with and without cold sensitivity, was previous frostbite affecting the hands (OR 12.44; 95% CI 5.84–26.52 and OR 4.01; 95% CI 1.78–9.01, respectively). Upper extremity nerve injury was associated to reporting Raynaud’s phenomenon and cold sensitivity (OR 2.23; 95% CI 1.29–3.85), but not Raynaud’s phenomenon alone. Reporting any exposure to hand-arm vibration or cumulative cold exposure was significant in univariate analyses for cases with both Raynaud’s phenomenon and cold sensitivity, but not in the multiple model. Raynaud’s phenomenon is strongly associated to previous cold injury, with a larger effect size among those who also report cold sensitivity. The fact that only upper extremity nerve injury differed significantly between case groups in our multiple model offers additional support to the neural basis for cold sensitivity.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Cold exposure, Epidemiology, Frostbite, Hand, Occupational exposure, Risk factors
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-152083 (URN)10.1007/s00296-018-4133-y (DOI)30128730 (PubMedID)
Available from: 2018-09-26 Created: 2018-09-26 Last updated: 2018-09-26
Lundström, R., Dahlqvist, H., Hagberg, M. & Nilsson, T. (2018). Vibrotactile and thermal perception and its relation to finger skin thickness. Clinical Neurophysiology Practice, 3, 33-39
Open this publication in new window or tab >>Vibrotactile and thermal perception and its relation to finger skin thickness
2018 (English)In: Clinical Neurophysiology Practice, ISSN 2467-981X, Vol. 3, p. 33-39Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Perception, Skin thickness, Thermotactile, Threshold, Vibration, Vibrotactile
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-152082 (URN)10.1016/j.cnp.2018.01.001 (DOI)30215005 (PubMedID)2-s2.0-85044675168 (Scopus ID)
Available from: 2018-09-26 Created: 2018-09-26 Last updated: 2018-09-26Bibliographically approved
Jonsson, D., Burström, L., Nilsson, T., Wahlström, J. & Pettersson, H. (2017). Association between Pain in Adolescence and Low Back Pain in Adulthood: Studying a Cohort of Mine Workers. Pain Research and Treatment, 2017, Article ID 3569231.
Open this publication in new window or tab >>Association between Pain in Adolescence and Low Back Pain in Adulthood: Studying a Cohort of Mine Workers
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2017 (English)In: Pain Research and Treatment, ISSN 2090-1542, E-ISSN 2090-1550, Vol. 2017, article id 3569231Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2017
National Category
Occupational Health and Environmental Health Neurology
Identifiers
urn:nbn:se:umu:diva-133324 (URN)10.1155/2017/3569231 (DOI)000397914300001 ()28367328 (PubMedID)
Available from: 2017-04-05 Created: 2017-04-05 Last updated: 2018-06-09Bibliographically approved
Nilsson, T., Wahlström, J. & Burström, L. (2017). Hand-arm vibration and the risk of vascular and neurological diseases: a systematic review and meta-analysis. PLoS ONE, 12(7), Article ID e0180795.
Open this publication in new window or tab >>Hand-arm vibration and the risk of vascular and neurological diseases: a systematic review and meta-analysis
2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 7, article id e0180795Article, review/survey (Refereed) Published
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.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2017
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-138225 (URN)10.1371/journal.pone.0180795 (DOI)000405649700050 ()28704466 (PubMedID)
Available from: 2017-08-16 Created: 2017-08-16 Last updated: 2018-06-09Bibliographically approved
Burström, L., Aminoff, A., Björ, B., Manttari, S., Nilsson, T., Pettersson, H., . . . Wahlström, J. (2017). Musculoskeletal symptoms and exposure to whole-body vibration among open-pit mine workers in the arctic. International Journal of Occupational Medicine and Environmental Health, 30(4), 553-564
Open this publication in new window or tab >>Musculoskeletal symptoms and exposure to whole-body vibration among open-pit mine workers in the arctic
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2017 (English)In: 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) Published
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.

Keywords
Questionnaire, Mining, Vibration, MSD, Whole-body, Barents
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-137900 (URN)10.13075/ijomeh.1896.00975 (DOI)000404445900003 ()28584322 (PubMedID)
Available from: 2017-08-02 Created: 2017-08-02 Last updated: 2018-06-09Bibliographically approved
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