title: Dose-response relationship between exposure to hand-arm vibration and health effects among metalworkers.
abstract: OBJECTIVE
  The aim of this study was to explore the relationship of exposure to hand-arm vibration (HAV) and vascular, sensorineural and musculoskeletal symptoms and symptoms of carpal tunnel syndrome (CTS) in a population of Finnish metalworkers.
  
  
  METHODS
  A questionnaire on HAV exposure and symptoms was sent to 530 metalworkers. Those who reported finger blanching, numbness or tingling of the fingers or symptoms of CTS were invited to further examinations (n = 133). Their cumulative lifelong exposure to HAV, the level of current exposure and the history of use of tools causing impulse vibration were evaluated. The association of different symptoms with the HAV exposure was assessed with logistic regression analyses adjusted for age and smoking. The vibration perception thresholds (VPTs) were tested according to ISO 13091-1:2001.
  
  
  RESULTS
  The cumulative exposure index varied between 0 and 115,000 m(2) years d s(-4), the mean being 20,591 m(2) years d s(-4). The average of current daily vibration exposure was 1.6 m s(-2) and 39% of the participants had a history of exposure to impulse vibration. Of the respondents, 49% reported white fingers, 66% neurosensory symptoms, 56% symptoms of CTS and 75% musculoskeletal symptoms. The cumulative exposure index was associated with symptoms of white fingers [odds ratio (OR) 2.4-4.5], with symptoms of CTS (OR 4.6-6.1), with neurosensory symptoms (OR 5.7-17.3) and with musculoskeletal symptoms (OR 4.7-5.4). The risk of all these symptoms increased as the cumulative vibration dose increased. The history of exposure to impulse vibration had a significant effect on the occurrence of neurosensory symptoms (P = 0.024). The current exposure to HAV correlated significantly with all of the above-mentioned symptoms. The results of the VPT test were associated with the level of cumulative exposure to HAV.
  
  
  CONCLUSIONS
  There seems to be a dose-response relationship between the cumulative lifetime vibration dose of the HAV and finger blanching, sensorineural symptoms, symptoms of CTS and musculoskeletal symptoms of upper limbs and neck in the group of metalworkers of the study. The risk for neurosensory symptoms was the most significantly related to exposure to HAV and also to impulse vibration. Further studies are needed to confirm the present results also in other occupational groups taking into account the possible synergistic effect of workload as well.
authors.affiliation: Clinic of Occupational Medicine, Tampere University Hospital, FI 33521 Tampere , Finland. riitta.sauni@ttl.fi
authors.forename: Riitta
authors.initials: R
authors.lastname: Sauni
authors.forename: Rauno
authors.initials: R
authors.lastname: Pääkkönen
authors.forename: Pauliina
authors.initials: P
authors.lastname: Virtema
authors.forename: Esko
authors.initials: E
authors.lastname: Toppila
authors.forename: Jukka
authors.initials: J
authors.lastname: Uitti
mesh_terms: D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000209:etiology*; D004784:Environmental Monitoring / Q000379:methods; D005260:Female; D053421:Hand-Arm Vibration Syndrome / Q000209:etiology*; D006801:Humans; D008297:Male; D008669:Metallurgy; D008875:Middle Aged; D009784:Occupational Diseases / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis; D014732:Vibration / Q000009:adverse effects