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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.

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.

Studies on the effect from biobased materials and products on humans have indicated positive effects. This has earlier been shown in studies for e.g. hospitals, where indications of lower stress and pain in patients with wood as part ofinterior solutions. This paper describes the first step of a larger study that investigates the interior environment and the response of patients. The study presented here measured RH, temperature, emissions of volatile organic compounds (VOC) and microbial activities in two rooms at a hospital in Skellefteá, Orthopaedic ward. One room had a cross-laminated wood panel covering 42% ofwalls, window reveal and doors, and the other a control room with standard coverings. Results indicated only a small difference between the rooms in terms of temperature and RH. VOC emissions varied in both rooms but all concentrations were lower or much lower than threshold values for interior air quality standard limits. Biological contamination ofthe surfaces and from air sampling was also performed. Conclusions of this experimental study shows that from a regulatory perspective it is possible and safe to use wood as interior product.

This cross-sectional study aimed to describe exposure to cold climate and hand-arm vibration (HAV) as well as neurosensory and vascular symptoms and clinical findings among open-pit Arctic miners. It was based on data from questionnaires and physical examinations, including 177 men and 75 women from two open-pit mines in Sweden and Norway (response rate 54%). Working outdoors or in an unheated building or machine for at least two hours per day was reported by 44% and HAV exposure of the same duration by 10%. Neurosensory symptoms (e.g. reduced perception of touch) in the hands were reported by 47% and Raynaud’s phenomenon by 14%. In brief conclusion, the study showed that Arctic miners were commonly exposed to both cold temperatures and HAV. They also reported a broad range of neurosensory and vascular symptoms in their hands and had abnormal clinical findings related to the symptoms. The results emphasise the need for additional preventive measures in this occupational setting.

OBJECTIVE: This study investigates different aspects of stress and sleep in medically examined individuals with varying severity of building-related symptoms (BRS).

METHODS: Three questionnaires were used to assess acute and long-term stress and sleep (Perceived Stress Scale; Shirom Melamed Burnout Questionnaire, and Karolinska Sleep Questionnaire).

RESULTS: Individuals with BRS, regardless of severity, did not differ in level of perceived stress (indicator of short-term stress). The indicators of long-term stress differed between the groups where an increased severity was associated with higher levels of burnout and sleep problems.

CONCLUSIONS: The study suggests an association between symptom severity and measures of long-term stress and sleep quality. This has implications for the treatment of persons affected by BRS, because not only the environment needs to be treated, but also the concurrent signs of distress, such as burnout or sleep problems.

Background: Raynaud’s phenomenon is common condition, but little is known about the natural course. The primary aim of this study was to determine the incidence, remission, and persistence proportions of Raynaud’s phenomenon in the general population of northern Sweden. Secondary aims were to determine how individual and exposure factors affect the course of Raynaud’s phenomenon, and to assess gender differences.

Methods: A prospective, survey-based, closed-cohort study was conducted on a sample of men and women between 18–70 years of age, living in northern Sweden. Data on Raynaud’s phenomenon characteristics and general health status were collected during the winters of 2015 (baseline) and 2021 (follow-up). Rates of incidence, remission, and persistence were calculated. Binary logistic regression was used to determine the association between baseline variables and the course of Raynaud’s phenomenon. Results: The study population consisted of 2703 women (53.9%) and 2314 men. There were 390 women (14.5%) and 290 men (12.7%) reporting Raynaud’s phenomenon in the follow-up survey. The annual incidence proportion was 0.7% among women and 0.9% among men (gender difference p = 0.04). The annual remission proportion was 4.4% and 5.5%, respectively (p = 0.05). Having sustained a cold injury affecting the hands since baseline was significantly associated with incident Raynaud’s phenomenon (OR 3.92; 95% CI 2.60–5.90), after adjusting for age and gender.

Conclusions: In the general population of northern Sweden, Raynaud’s phenomenon is a common but variable condition, where symptoms may remit over time. Men had a higher incidence proportion than women. The results support a possible causal pathway where cold injury can precede the onset of Raynaud’s phenomenon.

OBJECTIVE: To determine if occupational exposure to cold environments is associated with incident airway symptoms in previously healthy workers.

METHODS: A prospective, survey-based, closed-cohort study was conducted on a sample of 5017 men and women between 18 and 70 years of age, living in northern Sweden. Data on occupation, occupational and leisure-time cold exposure, airway symptoms, general health, and tobacco habits were collected during the winters of 2015 (baseline) and 2021 (follow-up). Stepwise multiple logistic regression was used to determine associations between baseline variables and incident airway symptoms.

RESULTS: For individuals working at baseline, without physician-diagnosed asthma or chronic obstructive pulmonary disease, reporting any occupational cold exposure was associated with incident wheeze (OR 1.41; 95% CI 1.06-1.87) and incident productive cough (OR 1.37; 95% CI 1.06-1.77), but not incident long-standing cough (OR 0.98; 95% CI 0.74-1.29), after adjusting for age, body mass index, daily smoking, and occupational physical workload. Detailed analysis of the occupational cold exposure rating did not reveal clear exposure-response patterns for any of the outcomes.

CONCLUSIONS: Occupational cold exposure was robustly associated with incident wheeze and productive cough in previously healthy workers. This adds further support to the notion that cold air is harmful for the airways, and that a structured risk assessment regarding occupational cold exposure could be considered for inclusion in the Swedish workplace legislation. Further studies are needed to elaborate on exposure-response functions, as well as suggest thresholds for hazardous cold exposure.

The aim of this study was to investigate if there are differences in symptom ratings and plasma concentrations of oxylipins as a measure of acute inflammation between individuals with building-related symptoms (BRS) and referents during exposure to rooms where people experienced BRS and rooms where they did not experience BRS. Medically examined individuals with BRS and healthy, age and sex matched referents working in the same building were exposed for 60 min. Ratings of symptoms and collection of blood to measure oxylipins in plasma were performed before and after each exposure. Individuals with BRS reported more symptoms (mostly mucosal) than the referents in the problem rooms and there was a tendency towards a difference between the groups in concentration of metabolites from the cyclooxygenase pathway (COX). The mean reported intensity of symptoms among all participants was also found to be positively correlated with both COX and lipoxygenase (LOX-15) oxylipins in problem rooms.

Cold sensitivity, a common and disabling sequela of hand injury, can be assessed using the Cold Intolerance Symptom Severity (CISS) questionnaire, rating symptoms on a scale from 4 to 100. The primary objective of this study was to define a clinical cut-off for abnormal cold sensitivity based on the CISS score in a healthy working-age population. The secondary objective was to investigate how age, gender and previous injuries and diseases influence CISS scoring. In this study, 1239 out of 1582 selected healthy subjects of working age living in northern Sweden completed the questionnaire, yielding a response rate of 78%. The 95th percentile for the CISS score was 49.5 for men and 53.0 for women. The effects of age, gender and previous injuries and diseases were minor and not considered clinically relevant. The results support that a CISS score above 50 should be considered as abnormal cold sensitivity. Level of evidence: III

Purpose: The purpose was to develop a questionnaire instrument to measure difficulties in activities and participation, and impact of environmental factors in chemical intolerance, based on the International Classification of Functioning, Disability and Health, and to assess its validity and reliability.

Method: Development in three steps: (1) choosing items of relevance for chemical intolerance with an expert group, (2) conducting interviews with persons with chemical intolerance, using sampling to redundancy, (3) conducting a survey with 112 respondents at a first assessment and 91 at a second assessment for test-retest.

Results: The final version of the instrument consists of 57 items divided in three parts, which showed good internal consistency in each part, Cronbach alpha: 0.73-0.87. It had good content validity, readability and face validity. Test-retest showed good to very good (≥0.61) Kappa agreement for 37 items, and moderate (0.41-0.60) for 17 items. Three items had poor or fair (<0.41) Kappa agreement.

Conclusion: The instrument was found to be valid and reliable. It can be used as a clinical tool to help persons with chemical intolerance to receive the best suited help and support for each individual, identify key points in rehabilitation, measure rehabilitation outcome and establish priority for treatment.