Nerve conduction and vibrotactile perception thresholds in female computer workers and hand-arm vibration-exposed male manual workers

Upper limb pain and disability are common problems, especially among working populations. The overall aim of this thesis was to investigate peripheral nerve function in the upper limb by nerve conduction test and vibration threshold test in working populations including female computer users (n = 82), hand-arm vibration-exposed male manual workers (n = 116), and female workers with chronic diffuse upper limb pain (n = 35). The studies have a cross-sectional design regarding peripheral nerve function measurements. Exposure assessments regarding computer work were made using questionnaires, and the cumulative hand-arm vibration dose in manual workers was calculated as the product of self-reported occupational exposure, as collected by questionnaire and interviews, and the measured or estimated hand-arm vibration exposure in 1987, 1992, 1997, 2002, and 2008. In contrast to nerve conduction measurements, the vibration threshold test is a psychophysical test. To investigate whether mood influences the measurements, perceived stress and energy were assessed using a two-dimensional mood adjective checklist, before the vibration threshold test. Adequate control of tissue temperature is a crucial factor in nerve conduction studies, and a bicycle ergometer test proved to be a simple and effective method of raising hand temperature. Nerve conduction measurements revealed no signs of early neural deficits of large myelinated nerve fibres measured in the upper limbs of either women who intensively use computer keyboard equipment or hand-arm vibration-exposed male manual workers, or female workers with chronic diffuse upper limb pain. In the present studies, the majority of the subjects did not have severe neurological symptoms and most subjects had not been referred to a clinic. Vibration threshold test revealed no signs of early nerve affliction in the upper limbs in women who intensively used computer keyboard equipment. Women with chronic pain had a small elevation of vibrotactile perception thresholds in the territories of the ulnar and radial nerves. Perceived stress and energy before the vibration threshold testing did not influence the thresholds. Although a peripheral mechanism cannot be excluded, the findings support the idea that increased vibration perception thresholds in chronic diffuse upper limb pain may be secondary to pain

Fördomar eller okunskap - könsasymmetrier i handläggning?

Kvinnor har något svårare att få ersättning än män från arbetsskadeförsäkringen. Tidigare studier fokuserar främst på egenskaper hos de försäkrade, vi undersöker istället om bedömningar i handläggningen kan bidra till skillnaderna genom omedvetna bias och/eller kunskapsluckor. Vi använder ett datamaterial bestående dels av en enkät med ett vinjettexperiment som riktats till samtliga handläggare och dels reellaarbetsskadeakter. Undersökningen ger inte stöd för att handläggarna diskriminerar utifrån kön, men att den medicinska bedömningen ofta är undermålig. Vi rekommenderar utökad utbildning av handläggare för att undvika rättsosäkra bedömningar och risk för ojämlikhet i utfall av arbetsskadeärenden med avseende på kön.Women have difficulties to obtain compensation from occupational injuryinsurance on pair with men. Previous studies focus on the characteristics of the insured, while we investigate the assessments and unconscious bias or knowledge gaps in management. We use two types of data; a questionnaire with a vignette experiment addressed to management as well as work injury archive acts. The study does not provide support for management discriminating on the basis of gender, but the medical assessment is often substandard. We recommend extended training to avoid legal uncertainty and the risk of inequality in the outcome with regard to gender

The physical and psychological aspects of quality of life mediates the effect of radiation‐induced urgency syndrome on disability pension in gynecological cancer survivors

Abstract Background Radiation‐induced fecal urgency syndrome is highly prevalent in gynecological cancer survivors. It is associated with decreased quality of life (QoL) and with disability pension. The literature remains unclear about the mediating role of physical and psychological aspects of QoL in the association between urgency syndrome and disability pension. Identifying the pathways between urgency syndrome and disability pension may help to create effective and timely interventions for increasing QoL and reducing disability pension among gynecological cancer survivors. Methods We used patient‐reported outcome measures from working‐age gynecological cancer survivors (n = 247) and data on their disability pension from the official register. The mediating role of physical and psychological aspects of QoL was studied by utilizing mediation analysis based on the counterfactual framework, appropriate for binary outcome, binary mediator with an exposure–mediator interaction. The total effect (TE) was divided into direct and indirect effects using single mediation analysis. Adjusted relative risks and percentage mediated (95% confidence intervals) were calculated. All statistical tests were two‐sided. Results Urgency syndrome increased the risk of disability pension both directly and indirectly (via QoL). Satisfaction with sleep mediated half of the TE (RR = 2.2 (1.1–4.1)) of urgency syndrome on disability pension. Physical health also mediated a similar proportion of the TE (RR = 2.1 (1.2–3.9)). The proportions mediated were higher for physical aspects of QoL (35%–71%) than for psychological aspects (2%–47%). Conclusions The investigated aspects of the self‐assessed QoL of gynecological cancer survivors may play a role in these women's continuing work‐life. It appears that physical health, satisfaction with sleep, psychological well‐being, and other investigated aspects of QoL mediate the urgency syndrome–disability pension association

Low myelinated nerve-fibre density may lead to symptoms associated with nerve entrapment in vibration-induced neuropathy.

Prolonged exposure to hand-held vibrating tools may cause a hand-arm vibration syndrome (HAVS), sometimes with individual susceptibility. The neurological symptoms seen in HAVS are similar to symptoms seen in patients with carpal tunnel syndrome (CTS) and there is a strong relationship between CTS and the use of vibrating tools. Vibration exposure to the hand is known to induce demyelination of nerve fibres and to reduce the density of myelinated nerve fibres in the nerve trunks. In view of current knowledge regarding the clinical effects of low nerve-fibre density in patients with neuropathies of varying aetiologies, such as diabetes, and that such a low density may lead to nerve entrapment symptoms, a reduction in myelinated nerve fibres may be a key factor behind the symptoms also seen in patients with HAVS and CTS. Furthermore, a reduced nerve-fibre density may result in a changed afferent signal pattern, resulting in turn in alterations in the brain, further prompting the symptoms seen in patients with HAVS and CTS. We conclude that a low nerve-fibre density lead to symptoms associated with nerve entrapment, such as CTS, in some patients with HAVS

A prospective cohort study investigating an exposure-response relationship among vibration-exposed male workers with numbness of the hands

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

Re-evaluation of HER2 status in 606 breast cancers—gene protein assay on tissue microarrays versus routine pathological assessment

Human epidermal growth factor receptor 2 (HER2) status in breast cancer is routinely determined through immunohistochemistry (IHC) and/or in situ hybridisation (ISH) performed on whole tissue sections (WS). The purpose was to evaluate whether a gene protein assay (GPA) combining IHC with ISH, performed on breast cancer tissue microarray (TMA), is suitable for large-scale retrospective HER2 status evaluation. TMAs from 606 tumours from a Swedish population-based cohort (2005–2012) were stained with GPA. GPA IHC on TMA yielded weaker staining than IHC on WS during routine pathological assessment (86.0% agreement). However, final HER2 status agreement between GPA on TMA and WS based on both IHC and ISH was 97.7%. Only 14 tumours were discordant and one tumour with IHC score 1+ on both TMA and WS was HER2 amplified on TMA. In conclusion, GPA on TMA is suitable for large-scale retrospective evaluation of HER2 status