0068 Occupational exposure to hand-transmitted vibration and risk of Dupuytren’s contracture

AimsThe relation between Dupuytren's contracture and occupational exposure to hand-transmitted vibration (HTV) has frequently been debated. We explored associations in a representative national sample of workers with well-characterised exposure to...

Workers exposed to hand-transmitted vibration (HTV) often experience aches and pains in the upper limbs, but there have been few studies of the pattern and severity of symptoms, or their relationship to the estimated dose of vibration. As part of a wider survey of vibration, we mailed a questionnaire about exposures to HTV and pain in the neck and upper limbs to a sample of men selected at random from the registration lists of 34 British general practices and the pay records of the armed services. Analysis was confined to the 1856 male respondents who had been employed in manual occupations for a year or more and who reported the last week as being representative of their job. Inquiry was made about pain in the neck, shoulder, elbow and wrist/hand over the past week and past year (including pains that limited normal activity). Subjects were classed according to their lifetime exposure to HTV and their estimated average daily vibration dose [A(8) r.m.s.] in the previous week. A total of 283 men had a minimum estimated A(8) greater than a proposed action level of 2.8 m/s(2), and in this group symptoms were about twice as prevalent as in manual workers who had never used vibratory tools. The excess risk was somewhat higher for distal sites than for proximal ones (e.g. the prevalence ratio for hand/wrist pain in the past week was 2.7 versus 1.8 for neck pain). This accords with the pattern of transmission of HTV to the upper limb, although a confounding effect from other ergonomic risk factors cannot be discounted.

OBJECTIVESTo estimate the number of workers in Great Britain with significant occupational exposure to hand transmitted vibration (HTV). Also, to identify the occupations and industries where such exposures arise, and...

Exposure to hand-transmitted vibration (HTV) can cause sensorineural symptoms in the upper limb, but its impact has not previously been assessed in the general population. To investigate, we mailed a questionnaire about exposures to HTV, finger blanching and sensory symptoms (numbness or tingling) in the upper limbs to a population sample comprising 21,201 working-aged men and women selected at random from the age-sex registers of 34 British general practices, and a further 993 randomly selected from the pay records of the armed services. Associations were explored using multiple logistic regression models to adjust for confounding, with the resultant odds ratios converted into prevalence rate ratios (PRs). Of 12,907 respondents, 2,607 (20.2%) reported sensory symptoms in the upper limb during the past week. Sensory symptoms were more prevalent in those with blanching, and were commonly associated with exposure to HTV, especially in men. In comparison with men who had never been exposed to HTV, the PR in men exposed both at work and in leisure was 2.2 (95% CI 1.9-2.4). Associations were found even in those who had never blanched. Sensorineural symptoms in the upper limbs are common. HTV is an important risk factor for such complaints in the general population.

Background/Purpose:To determine the incidence of vertebral fracture (VF) in the three years following glucocorticoid (GC) initiation, and the effect of GC on the risk of incident VF in children with rheumatic disorders (RD).Methods:Children with RD were enrolled within 30 days of GC initiation and followed for 3 years, with VF assessed at baseline and then annually using the Genant method on lateral spine radiographs. An incident VF was defined as a new fracture in a previously normal vertebral body or worsening of an existing VF. The annual and the 3 year cumulative incidences were calculated as the number of new cases divided by the number of subjects who completed VF assessment at the specified time periods. Six different time‐dependent GC exposure measures were constructed: cumulative dose, average daily dose, duration on GC therapy, dose intensity (cumulative dose divided by duration on GC therapy) over 3 years, recent average daily dose and duration on GC therapy over the preceding 12 months. Extended Cox's models were used with alternative time‐dependent variables, adjusting for factors at baseline including age, gender, body mass index, vitamin D and calcium supplementation, disease activity, bone mineral density, physical activity, and presence of prevalent VF.Results:136 enrolled children (mean ± SD age 9.9 ± 4.4 years, 65% girls) held the following diagnoses: 22% juvenile dermatomyositis (JDM), 21% non‐systemic juvenile idiopathic arthritis (JIA), 19% systemic lupus erythematosus (SLE), 18% systemic JIA, 12% systemic vasculitis, and 9% other RD. 9 children had VF at baseline (3 JDM, 2 systemic JIA, 2 SLE, 1 systemic vasculitis, 1 localized scleroderma), with an estimated prevalence of 6.6% (95% confidence interval (CI) 2.4–10.8%). 18 incident VF were identified in 15 children during the 3 years following GC initiation (6 JDM, 4 SLE, 2 systemic vasculitis, 2 systemic JIA, and 1 non‐systemic JIA). The 3‐year cumulative VF incidence was 13.0%, at a rate of 4.9 per 100 person‐years. Of the 18 incident VF events, 7 occurred during the first year at an annual incidence of 6.0% (95% CI 1.7–10.3%); 6 VF occurred during the second year (annual incidence 5.6%; 95% CI 1.2–9.9%); 5 VF occurred during the third year (annual incidence 4.3%; 95% CI 1.0–8.1%). 64% of patients had mild incident VF as the worst grade, 36% had moderate fractures, and none had severe fractures. Of those with incident fractures, 21% had no complaints of back pain in the preceding 12 months. Multivariable models showed that every 100 mg/kg increase in cumulative GC dose was associated with a 30% increased incident VF risk (hazard ratio (HR) = 1.3, 95% CI 1.1, 1.6). Every 0.5mg/kg increase in average daily dose over the 3 year period was associated with a 4.2 fold increased VF risk (HR = 4.2, 95% CI 2.3, 7.7), and every 0.5 mg/kg increase in daily dose during the preceding 12 months was associated with a 2.7 fold increased incident VF risk (HR =2.7, 95% CI 1.3, 5.2).Conclusion:We have shown that 13.0% of children with RD sustained VF within three years followingGC initiation, of which 36% had moderate fractures. Cumulative dose, average daily GC dose, and recent average daily GC dose were associated with a significantly increased VF risk.Funded by CIHR FRN 64285

Novel Measure of Opioid Dose and Costs of Care for Diabetes Mellitus: Opioid Dose and Health Care Costs.

Objective:To examine medication dosing patterns of duloxetine and pregabalin among patients with fibromyalgia.Methods:From a large US administrative claims database, commercially insured fibromyalgia patients aged 18–64 who initiated duloxetine or pregabalin in 2006 were selected. Initiation was defined as a 90-day medication gap, with the dispense date of the first initiation as the index date. All patients selected had continuous enrollment over the 12-month pre- and post-index periods, and were classified into the duloxetine or pregabalin cohorts based on their index agent. Initial daily dose, average daily dose over the 12-month post-index period, mean and median daily doses and daily costs of each of the first 12 prescriptions were examined for both the duloxetine and pregabalin cohorts.Results:Both the duloxetine (n = 3773) and pregabalin (n = 4189) cohorts had a mean age of 50 years (median age: 52 vs. 53). The average initial daily dose was 55.7 mg for duloxetine and 161.5 mg for pregabalin. Over the 12-month post-index period, the average daily dose per patient was 55.6 mg for duloxetine and 195.7 mg for pregabalin. The average daily doses for the first 12 duloxetine prescriptions ranged 55.7–60.3 mg, with the mean daily costs between $3.77 and $4.59. For the first 12 pregabalin prescriptions, the average daily dose increased from 161.5 mg to 282.4 mg, while the average daily costs ranged between $4.30–4.61.Conclusions:Among patients with fibromyalgia, duloxetine and pregabalin initiators had different dosing patterns. The average daily dose for duloxetine was relatively stable over time, while pregabalin patients had significant dose increase over the 12-month post-index period.

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample

Serious adverse effects associated with glucocorticoid therapy in patients with giant cell arteritis (GCA): A nested case-control analysis.

Studies to estimate tumor incidence are generally conducted in rodents exposed to a chemical for approximately two years. Exposure of humans to some carcinogens may occur for less than a lifetime from occupations, changing lifestyles, or accidents. A simplifying assumption often is made in risk estimation that risk is proportional to total dose and the age at the time of exposure is ignored. Hence, the estimated cancer risk from an exposure for a fraction (1/F) of a lifetime is the lifetime tumor incidence divided by F, where the daily exposure rates are the same. Based on the multistage model, Kodell et al. (1987) show that the risk from a short-term exposure to a carcinogen is less than k/r times the risk predicted from the total dose, where r out of k stages are affected by the carcinogen, whereas at low dosages the transition rate for a stage affected by the carcinogen is assumed to be proportional to the dosage rate. Based on an initiation-growth model, Chen et al. (1988) show that greater discrepancies may exist between the true incidence and the estimate based on average daily lifetime dose. There is a rather limited bioassay database in which tumor incidence at the same age can be compared for different lengths of exposure at the same daily dose rate. From 10 such studies, the observed tumor rates from shorter exposures were from near zero up to 12 times the rates predicted from the average daily dose. Within this very limited database, estimates of short-term tumor incidence were generally less than 10 times the estimate based on average daily lifetime dose.

To compare medication dosing patterns of duloxetine and pregabalin among patients with diabetic peripheral neuropathic pain (DPNP). Applying a retrospective cohort study design on a large U.S. healthcare claims database, we examined the dosing patterns of duloxetine and pregabalin among commercially insured patients with DPNP aged 18 to 64 who initiated (a 90-day medication gap) duloxetine or pregabalin therapy in 2006. Selected patients had continuous enrollment during the 12-month pre- and post-index periods. The index mediation was used to classified individuals into the duloxetine or pregabalin cohorts. Initial daily dose, average daily dose over the first post-index year, and average daily dose of the first several prescriptions were estimated and compared across the cohorts. The study sample included 828 duloxetine and 1934 pregabalin-treated patients with a mean age of 50 years. Cardiovascular diseases, neuropathic pain other than DPNP, osteoarthritis, and diabetic retinopathy were the most common comorbid conditions. The average initial daily doses were 54.3 and 171.8 mg for duloxetine and pregabalin, respectively. The average daily dose over the first post-index year was 55.2 mg for duloxetine and 173.8 mg for pregabalin. The average daily dose for the first 10 duloxetine prescriptions ranged between 54.3 and 61.9 mg, but increased from 171.8 to 264.3 mg for pregabalin. The commercially insured patients with DPNP who initiated duloxetine or pregabalin therapy had different dosing patterns. The average daily dose for duloxetine was relatively stable over time, while pregabalin-treated patients had significant dose increase over the 12-month post-index period.

The risk of developing Dupuytren’s disease among workers exposed to occupational mechanical exposures has been reported in few systematic reviews, mainly related to vibration. Expanding the investigation to all occupational...

The hazards arising from long-term hand-transmitted vibration operations can cause significant damage to the human body. As China is a populous country, understanding the current situation of vibration exposure among workers in various related fields in China holds significant reference value. To this end, this paper analyzes data from core journal literature in China from the 1980s to the present based on the keywords hand-arm vibration disease, hand-transmitted vibration, and occupational exposure. This paper provides an overview of the current status of hand-transmitted vibration hazards, including the distribution characteristics, hazards, and diagnostic methods of hand-arm vibration disease, as well as the deficiencies in these diagnostic methods. It also integrates data on the vibration intensity, frequency, and prevalence of vibration tools to analyze the relationship between the prevalence of hand-arm vibration disease and the vibration intensity and frequency of vibration tools. The results indicate that the vibration tools causing occupational hand-arm vibration disease are primarily found in the mining and manufacturing industries, with rock drilling jobs and positions being dominant in the mining industry and grinding jobs and positions being dominant in the manufacturing industry. The A(4) values of grinding tools, jobs, or positions are significantly higher than China’s limit value of 5 m/s2 for hand-transmitted vibration. The A(4) distribution of rock drilling tools is more concentrated, while the A(4) distribution of grinding tools is broader. The current diagnostic methods have poor specificity and sensitivity. There is insufficient awareness of the hazards of hand-transmitted vibration. There is no significant correlation between A(4) and the prevalence of vibration white finger (P>0.05), and A(4) alone is insufficient to reflect the extent of harm caused by hand-transmitted vibration operations to the human body. Both low-frequency and high-frequency vibrations may be harmful to the human body, and there may be a positive correlation between the fundamental frequency of vibration tools and the prevalence of disease (r>0,P<0.05).

Chronic obstructive pulmonary disease (COPD) results from a complex interaction between genes and the environment, and occupational exposures are an underappreciated risk factor. Until now, little research attention has been paid to the potential impact of occupational risk factor exposure on the COPD in China. The aim of this retrospective study was to analyze the role of occupational risk factor exposure on the severity and progression of COPD for exploring new prevention strategies for this disease. This study adopted a random cluster-sampling method. Five grade-A tertiary hospitals that met the inclusion criteria were selected as the survey sites, and patients with COPD hospitalized in these hospitals from January 1, 2019, to December 31, 2019, were selected as the research subjects. Data of the patients diagnosed with COPD met the Global Initiative for Chronic Obstructive Lung Disease (2019) criteria and were collected from the computerized medical record databases. Among 4082 investigated COPD patients, 1063 (26%) were found to have occupational risk factor exposure history. The top 3 industries with a large COPD case number and a history of occupational risk factor exposure ranked in the order of agriculture (including farming, forestry, animal husbandry, and fishery), manufacturing, and mining. Further multivariate logistic regression analysis indicated that when setting a low exposure level as a reference, medium and high exposure levels were correlated with the severity of COPD (odds ratio values were 2.837 and 6.201, respectively, P < .05). Linear regression analysis showed that cumulative exposure to occupational risk factors was negatively correlated with the forced expiratory volume in 1-second percentage of COPD patients, with a correlation coefficient of 0.68. Our results indicated that occupational risk factor exposure levels were related to the severity of COPD significantly. The incubation period of COPD in the exposure group was significantly shorter than that in the non-exposure group. To prevent worked-related COPD, special attention and control efforts should be taken to reduce the level of occupational risk factors such as organic dust, irritating chemicals, etc in the work environments, especially in the industries of agriculture, forestry, animal husbandry and fishery, manufacturing, and mining.

There is growing evidence for the risk of Dupuytren's disease (DD) from occupational exposure. For workers exposed to hand-transmitted vibrations (HTVs) and heavy manual work (HMW) who develop the disease, the inclusion of DD in hand-arm vibration syndrome and diseases of skeletal muscle overload could be beneficial for compensation purposes. To assess the risk of DD in workers exposed to HTVs and HMW, and to evaluate the length of exposure times that may significantly affect the development of DD. This study included male workers in Košice, Slovak Republic. Participants were divided into three groups: those exposed to HTVs, those exposed to HMW and controls. We evaluated the association between DD and HTVs, HMW, cardiovascular diseases, metabolic diseases, epilepsy, smoking and alcohol consumption for all groups. We also compared the length of exposure time to HTV and HMW between workers with and without DD. The sample was comprised of 515 men, with 13% suffering from DD. Significant associations were found between DD and HTVs (OR 4.59 [95% CI 2.05-10.32]) and HMV (OR 3.10 [95% CI 1.21-7.91]). Highly significant associations were found between DD and older ages and alcohol consumption as well. No associations were found for the other variables. Exposure times greater than 15 years significantly increased the risk for DD (P < 0.01). This study confirms a significant association between DD and both HTVs and HMW after long exposures. We suggest that DD should be considered as an occupational disease.