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Background: The feedback of the surveillance results to the employee and the employer largely determines the impact of workers’ health surveillance on workers’ health and exposure. We are unaware of any guidebooks or articles on performing feedback on regulated workers’ health surveillance, e.g., for vibration-exposed workers.

Objectives: To identify existing knowledge of the communication aspects related to workers’ health surveillance feedback in hand-arm vibration exposure, considering the perspectives of employees, employers, and groups.

Eligibility criteria: We followed the extension for the Scoping Reviews (PRISMA-ScR) checklist. No time limits were set, so the databases were searched from their start (MEDLINE 1946 and EMBASE 1947) until the date of the full search (March 2024). Relevant information was extracted from 30 articles—none concerned hand-arm vibration but covered aspects of workers’ health surveillance feedback.

Sources of evidence: Two authors screened all abstracts in random pairs. They were blinded to each other’s results. The third author resolved conflicts. Inclusion criteria were full-text articles, humans, workers’ health surveillance, and aspects of communication reporting results to the employee, the workplace, or a health surveillance system. Altogether, 1914 abstracts were screened, and 84 full-text articles were assessed, of which 54 were excluded as they did not fulfill the criteria. The final publications selected included 30 articles published between 1980 and 2023; two blinded authors extracted relevant information in random pairs. Results: We found 16 of the included studies of longitudinal design, seven qualitative studies, four studies were cross-sectional, and three publications were reviews. The studies reported on workers’ health surveillance that addressed musculoskeletal disorders and pain (n=8), risk of cardiovascular disorders (n=4) or hearing disorder (n=3), workability and fitness for duty (n=3), mental health (n=2), allergy/ asthma (n=2), and cancer (n=1). Additionally, seven studies addressed a mixture of disorders and general health (n=7).

Conclusions: No publications addressed communication in workers’ health surveillance due to hand-arm vibration exposure. However, we identified 30 studies addressing feedback from workers’ health surveillance that were also relevant to workers’ health surveillance due to hand-arm vibration exposure.

Background: There is a need for efficient screening for hand-arm vibration injury.

Aims: To evaluate the diagnostic test performance of screening questions for neurosensory injury in relation to clinical testing among hand-arm vibration (HAV)-exposed workers.

Methods: HAV-exposed subjects responded to a screening survey on subjective perception of touch, warmth, cold, and vibration, as well as grip strength and manual dexterity. Perception of monofilament, two-point discrimination, temperature rollers, and tuning fork was tested on the index and little fingers of both hands, while grip strength was tested using a hydraulic dynamometer. Diagnostic test performance characteristics were calculated based on crosstabulation of survey responses and outcomes of clinical testing.

Results: Our study recruited 225 subjects with exposure durations between one and 43 years. The sensitivity and specificity for the question about impaired ability to feel touch compared with monofilament was 65% and 71%; impaired ability to feel heat compared with temperature rollers 50% and 75%; impaired ability to feel cold compared with temperature rollers 39% and 77%; impaired ability to feel vibration compared with tuning fork 49% and 84%; reduced grip strength compared with hydraulic dynamometer 83% and 58%; and difficulty fastening buttons compared with two-point discrimination 40% and 76%, respectively.

Conclusions: The diagnostic test performance of the currently used screening survey for neurosensory injury among HAV-exposed workers needs to be improved. Future development should focus on establishing more specific questions, balanced response alternatives, and a more sophisticated interpretation of the responses, possibly using an index made up of several screening questions.

Objective: Workers exposed to hand-arm vibration (HAV) commonly experience discomfort in their hands when cold. There is a lack of diagnostic tests for such abnormal cold sensitivity. The main aim of our study was to evaluate the results of cold stress testing in relation to self-reported cold sensitivity among HAV-exposed workers.

Methods: We recruited 225 workers exposed to HAV who responded to a written screening question about cold sensitivity. Cold stress testing was conducted, where the right hand was immersed in 3.0 °C circulating water for up to 60 seconds. The tolerance time for immersion as well as continuous pain ratings on a digital visual analog scale (ranging from 0 to 100 millimeters) were recorded.

Results: The study sample consisted of 208 males (92.4 %) and 17 females, with a mean (SD) age of 40.6 (13.7) years. Among the 190 workers that completed cold stress testing, the mean (SD) tolerance time was 43.7 (16.4) seconds, mean (SD) maximum pain rating 69.8 (27.6) millimeters, and mean (SD) time to maximum pain 38.7 (15.9) seconds. Cold sensitivity was reported by 54 workers (24.1 %). Cold sensitivity was not statistically significantly associated with tolerance time or maximum pain rating, but symptomatic workers had a shorter time to maximum pain (p = 0.018).

Conclusions: Workers who reported cold sensitivity experienced a more rapid increase in cold-related pain, had a tendency towards shorter tolerance time but did not differ in maximum pain ratings. Further studies are needed to determine how to effectively investigate cold sensitivity among HAV-exposed workers.

Millions of people are exposed to cold environments daily. Adverse health risks are prominent for outdoor and cold storage workers. Therefore, a systematic risk management approach is highly motivated. This scoping review aimed to describe the current knowledge regarding risk management of cold exposure hazards in the occupational setting. We also examined differences between sexes in risk management practices regarding cold exposure.

The review included 25 peer-reviewed papers from 1980 to current in English and the Nordic languages, which could be divided into two categories: risk assessment and risk treatment. The risk assessment category included 17 papers, which investigated specific topics such as personal protective equipment, models for thermal balance, and individual differences regarding sex and body mass index. The risk treatment category included eight peer-reviewed papers, which emphasised the use of different protective or preventive measures and highlighted the importance of successful implementation and improvement of good practices.

To conclude, the previous literature on risk management of cold work was mainly oriented around technical risk assessment. However, there seems to be a lack of knowledge regarding implementation, resulting in inadequate protection for workers. Moreover, research was scarce regarding sex-dependent differences in risk management among workers exposed to cold.

Workers who use handheld vibrating machines such as grinders, hammers and chainsaws expose themselves to hand-arm vibration (HAV). Exposure to HAV may cause injuries to both the neurological and the vascular system. The occupational health services (OHS) in Sweden use a formal guideline for secondary prevention focusing on early detection of vibration-related injuries. The guide includes several screening tools, such as a screening questionnaire, clinical examinations, and laboratory tests. There are no studies, to our knowledge, on the diagnostic value of the separate items on symptoms in the screening questionnaire in relation to the laboratory tests or the clinical examinations performed during a medical examination among patients exposed to HAV. Furthermore, the recently presented ISO standard for HAV measurements (ISO/TR 18,750) has only been tested for vascular injuries and not neurological injuries. This research roadmap aims to evaluate separate items in a screening questionnaire on neurological symptoms in relation to laboratory and clinical tests among HAV exposed workers in the Arctic region of Northern Sweden. It also covers a comparison of the dose-response of the current ISO 5349-1 measurement standard and the new suggested standard ISO/TR 18,750 with the neurosensory outcomes. This manuscript describes the study rationale, design, methods, and significance.

Det övergripande syftet med denna narrativa kunskapsöversikt var att beskriva hur hälsorisker förknippade med arbete i kyla påverkas av ålder och sjukdom. En systematisk litteratursökning genomfördes i Medline, Embase och World of Science för perioden 1980–2023 med tre huvudsakliga block: kall miljö, arbete och riskbedömning. Sökningen resulterade i 6965 artiklar varav 277 granskades i sin helhet och 13 av dessa inkluderades i översikten över riskbedömning och riskhantering av arbete i kyla. I tillägg till den systematiska litteratursökningen gjordes en fri sökning av vetenskaplig litteratur med fokus på åldrande och sjukdomar samt en genomgång av andra kunskapskällor.

Den systematiska litteratursökningen visade att det finns etablerade metoder för strukturerad riskbedömning av arbete i kyla även om arbetsmiljöerna kan se väldigt olika ut. De flesta rapporterar att både ålder och sjukdom kan påverka sårbarheten för kyla.

I den fria sökningen återfanns små experimentella studier som visar att sårbarheten för kyla ökar med åldern. Denna sårbarhet kan betingas av förändringar i värmeproduktion, isolerande förmåga, perifer vasoreglering samt temperaturdiskriminering.

Vad gäller hjärt-kärlsjukdom fanns vetenskapligt underlag för att exponering för kyla leder till högre blodtryck, både hos dem med och utan läkemedelsbehandling mot hypertoni. Personer med befintlig hjärt-kärlsjukdom uppvisar en lägre fysisk arbetsförmåga och en ökad sannolikhet att insjukna i akuta ischemiska hjärthändelser och arytmier vid exponering för kyla. Exponering för kyla förefaller även öka sannolikheten för stroke.

För obstruktiv lungsjukdom visade litteraturen att exponering för kyla kan öka symptombördan hos personer med astma eller kroniskt obstruktiv lungsjukdom. Särskilt exponering av ansiktet för kyla kan framkalla obstruktiva luftvägsbesvär. Det finns även vissa hållpunkter för att tidigare friska personer som exponeras för kyla kan insjukna i obstruktiva luftvägsbesvär.

Vad gäller diabetes fanns beskrivet att exponering för kyla kan leda till försämrad metabol kontroll, ökad risk för hypoglykemier, ökad benägenhet till hypotermi samt möjligen även ökad risk för lokala kylskador och onormal köldkänslighet.

För rörelseapparaten fanns studier som visade att arbete i kyla ökar sannolikheten att rapportera muskuloskeletala smärttillstånd. Arbete i kyla kan också öka sannolikheten att rapportera nervrelaterade besvär som ischias och karpaltunnelsyndrom.

Sammanfattningsvis finns vetenskapligt underlag för att arbete i kyla kan vara förknippat med ökade hälsorisker för personer i högre arbetsför ålder och med befintliga sjukdomar. Hur arbete i kyla påverkar arbetsförmågan och den fortsatta prognosen är mindre tydligt. I Sverige saknas enhetlig reglering av arbete i kyla utomhus. Det finns metoder för riskbedömning och riskhantering av arbete i kyla samt förslag på praktiska tillvägagångssätt för arbetare, arbetsgivare och företagshälsor. Bland identifierade kunskapsluckor kan nämnas hälsoeffekter av långvarig men låggradig yrkesexponering för kyla, könsskillnader, acklimatisering, exponerings-responssamband samt samverkande effekter av kyla tillsammans med andra exponeringar.

Objectives: This study aimed to evaluate the influence of individual characteristics (sex, age, body mass index [BMI] and smoking habits) on the tolerance time, pain ratings and rewarming time of hand cold stress testing (CST).

Methods: We included 153 subjects (63% men) working in a Swedish open-pit mine (participation rate 41%). The right hand was immersed in 3 °C circulating water for up to 45 s. Pain ratings were registered every fifth second using a visual analog scale.

Results: The tolerance time (mean ± standard deviation) was 35 ± 12 s for men and 29 ± 14 s for women (p = 0.007). The youngest age group (18–29 years) had the longest tolerance time, while the oldest group (54–65 years) had the shortest (p = 0.005). Women had significantly higher pain ratings than men after 5, 10 and 25 s. The group with the highest BMI had the shortest rewarming time (p < 0.001).

Conclusions: Age and sex influenced the tolerance time of hand CST, while only sex affected the pain ratings and BMI the rewarming time. When performing CST in future studies, these parameters should be considered.

The literature on Raynaud’s phenomenon (RP) in the feet is scarce, especially in the occupational setting. The primary aim of our study was to investigate the occurrence of RP in the feet of miners. As part of the MineHealth project, written surveys and clinical examinations were completed by 260 Arctic open-pit miners working in northern Sweden and Norway (participation rate 53.6%). Data on RP were collected using standardised colour charts and questionnaire items. Clinical examination included assessing the perception of vibration and pain in both feet. There were eight women and three men who reported RP in the feet. Four also had RP in their hands but none acknowledged any first-degree relatives with the condition. Nine reported exposure to foot-transmitted vibration and one to hand-arm vibration. Seven showed signs of neurosensory injury in the feet. To conclude, the occurrence of RP in the feet of miners was 4.4%. Most cases with RP in the feet did not report the condition in the hands and were exposed to vibration transmitted directly to the feet. There were no reports of a hereditary component. Most cases with RP in the feet also had clinical findings suggestive of peripheral neuropathy in the feet.

Hand-arm vibration injury is a well-known occupational disorder that affects many workers globally. The diagnosis is based mainly on quantitative psychophysical tests and medical history. Typical manifestations of hand-arm vibration injury entail episodes of finger blanching, Raynaud’s phenomenon (RP) and sensorineural symptoms from affected nerve fibres and mechanoreceptors in the skin. Differences in serum levels of 17 different biomarkers between 92 patients with hand-arm vibration injury and 51 controls were analysed. Patients with hand-arm vibration injury entailing RP and sensorineural manifestations showed elevated levels of biomarkers associated with endothelial injury or dysfunction, inflammation, vaso- or neuroprotective compensatory, or apoptotic mechanisms: intercellular adhesion molecule-1 (ICAM-1), monocyte chemoattractant protein-1 (MCP-1); thrombomodulin (TM), heat shock protein 27 (HSP27); von Willebrand factor, calcitonin gene-related peptide (CGRP) and caspase-3. This study adds important knowledge on pathophysiological mechanisms that can contribute to the implementation of a more objective method for diagnosis of hand-arm vibration injury.

Our aim was to explore possible relationships between serum levels of biomarkers in patients with hand-arm vibration injury in relation to the severity of the vascular, i.e., Raynaud’s phenomenon (RP), and neurosensory manifestations, the current exposure level, and the duration of exposure. This study was of case series design and involved 92 patients diagnosed with hand-arm vibration injury. Jonckheere’s trend test was used to assess any association between serum levels of biomarkers and RP as well as neurosensory manifestations, graded by the International Consensus Criteria. Generalized linear models with adjustment for possible confounders were also used for associations between serum levels of biomarkers and; (1) severity of RP recorded as the extent of finger blanching calculated with Griffin score, (2) vibration perception thresholds, (3) magnitude of current exposure as [A(8); (m/s²)] value, and (4) the duration of exposure in years. Serum levels of thrombomodulin, von Willebrand factor, calcitonin gene related peptide (CGRP), heat shock protein 27, and caspase-3 were positively associated with severity of RP. Serum levels of CGRP were positively associated with the neurosensory component. No associations with exposure were shown for these biomarkers. For Intercellular adhesion molecule 1 and monocyte chemoattractant protein 1, no associations were found with neither severity nor exposure. Levels of serum biomarkers associated with endothelial injury or dysfunction, inflammation, vasodilation, neuroprotection, and apoptosis were positively associated with the severity of hand-arm vibration injury.