International consensus criteria for diagnosing and staging hand-arm vibration syndrome.

PURPOSE: In the 30 years since the Stockholm Workshop Scale (SWS) was published, the scientific literature on hand-arm vibration syndrome (HAVS) has grown and experience has been gained in its practical application. This research was undertaken to develop an up-to-date evidence-based classification for HAVS by seeking consensus between experts in the field. METHODS: Seven occupational physicians who are clinically active and have had work published on HAVS in the last 10 years were asked to independently take part in a three-round iterative Delphi process. Consensus was taken when 5/7 (72%) agreed with a particular statement. Experts were asked to provide evidence from the literature or data from their own research to support their views. RESULTS: Consensus was achieved for most of the questions that were used to develop an updated staging system for HAVS. The vascular and neurological components from the SWS are retained, but ambiguous descriptors and tests without adequately developed methodology such as tactile discrimination, or discriminating power such as grip strength, are not included in the new staging system. A blanching score taken from photographs of the hands during vasospastic episodes is recommended in place of self-recall and frequency of attacks to stage vascular HAVS. Methods with the best evidence base are described for assessing sensory perception and dexterity. CONCLUSIONS: A new classification has been developed with three stages for the clinical classification of vascular and neurological HAVS based on international consensus. We recommend it replaces the SWS for clinical and research purposes.

The occupational risk of tuberculosis in a low-prevalence population.

BACKGROUND: The incidence of tuberculosis (TB) infection in low-prevalence countries has been declining. Estimates of the risk of occupational TB in these countries are contradictory. AIMS: To evaluate the risk of occupational TB in a low-prevalence population using a comprehensive database. METHODS: All compensation claims in British Columbia (BC), Canada, reporting workplace TB exposure for the years 1999-2008 were reviewed. Cases with TB infection were identified for all occupational groups with five or more claims in the decade and analysis provided estimates of incidence rates of active TB and relative risks of latent TB (LTB) infections. RESULTS: There were 70 occupational groups making 639 claims including 100 with LTB and eight with active TB. Only 18 occupations had five or more claims. Four occupational groups had a significantly increased relative risk of infection compared with all other occupational groups. These were employment counsellors, registered nurses, x-ray technicians and home support workers. Active TB infections were relatively rare compared with the general population (1-4 compared with 7-10/100000 person-years, respectively). CONCLUSIONS: Few occupational groups were at risk of TB exposure at work on a regular basis. Only a handful had an apparent increased risk of contracting TB and these should be the focus of prevention efforts. Work-related active TB infections are rare hence the burden of occupational TB disease is low in BC.

The compensation experience of hand-arm vibration syndrome in British Columbia.

BACKGROUND: Hand-arm vibration syndrome (HAVS) is a relatively common occupational disease, especially in certain industrial sectors. Affected workers in many jurisdictions are eligible for compensation, but little is known about the behaviour and characteristics of workers seeking compensation for HAVS. AIMS: To characterize the workers seeking compensation for HAVS based on demographics, occupation and disease characteristics. METHODS: All accepted claims for HAVS from 1999 to 2008 in British Columbia were reviewed. RESULTS: The average claimant was 50 years old and had worked 25 years. The average latency period for developing HAVS symptoms was 18 years, and half the number of symptomatic workers waited 5 years or more before filing a claim. Loggers developed symptoms, on average, after 17 years of exposure, significantly earlier than mechanics, who developed symptoms after 24 years of work. Loggers waited longer than mechanics to file claims, with a median delay of 6 years, compared with 3 years for mechanics. The majority of HAVS claims involved severer vascular and sensorineural symptoms. CONCLUSIONS: Claimants commonly delay filing compensation claims and this may result in severer symptoms when the claims are filed. Further study is required to explain this delay.

Infrared thermometry in the diagnosis of hand-arm vibration syndrome.

BACKGROUND: Clinicians need an accurate diagnostic test for hand-arm vibration syndrome (HAVS). AIMS: To validate a simple thermometric method to diagnose HAVS-related Raynaud's phenomenon. METHODS: Fifteen workers with photographically confirmed HAVS-related Raynaud's phenomenon were compared to controls without Raynaud's phenomenon and an occupational history of hand-arm vibration exposure. Digit temperatures were measured using an infrared thermometer before and after immersion in 5 degrees C water for 1 min. RESULTS: The HAVS patients differed significantly from the controls in terms of baseline temperature, rewarming time and rate. The fingertip-base temperature gradient was more commonly positive among the controls. CONCLUSIONS: The test method evaluated in this study is simple, cheap and accurate. If the pre-test probability is at least 35%, the best test variable to confirm the diagnosis of HAVS-related Raynaud's phenomenon is the time to rewarm to baseline of the first three fingertips providing the interval is > or =8-9 min.

Spiritual healing in elderly psychiatric patients: a case-control study in an Egyptian psychiatric hospital.

In some cultures, mental illness and its treatment may be closely linked to beliefs relating to sin, suffering, and separation from the divine, or even possession by evil. The aim of this study was to explore whether there was an association between receiving spiritual healing and the occurrence of schizophrenic relapses in a sample of elderly Egyptian patients. The method used was a case-control study, comparing patients with an ICD 10 diagnosis of schizophrenia who received spiritual healing and those without spiritual healing, in terms of the occurrence of relapses during a specified period. Patients who received spiritual healing relapsed more frequently than those who did not (adjusted OR 3.5 p < 0.05). Relapse was also associated with age and certain methods of healing. The risk of relapse was independent of gender, duration of illness and type of religion. The study found spiritual healing to be positively associated with relapse of schizophrenia in a sample of elderly Egyptian patients. It is however difficult to ascertain that the relapse actually started after the process of spiritual healing and not before it. The study findings may suggest that religious history, at least in some cases, should be taken into consideration when planning future management.

Work-related asthma.

Work-related asthma accounts for at least 10 percent of all cases of adult asthma. Work-related asthma includes work aggravation of preexisting asthma and new-onset asthma induced by occupational exposure. Occupational exposure to very high concentrations of an irritant substance can produce reactive airway dysfunction syndrome, while exposure to allergenic substances can result in allergic occupational asthma. An important step in the diagnosis of work-related asthma is recognition by the physician of the work relatedness of the illness. A thorough history can elucidate the work relation and etiology. Objective tests, including pulmonary function, nonspecific and specific bronchial hyperresponsiveness, serial peak expiratory flow rates, and skin allergies, should be performed to confirm the diagnosis of asthma and demonstrate a work correlation. Treatment for occupational asthma--use of anti-inflammatory medications such as inhaled steroids and bronchodilators--is the same as that for nonoccupational asthma. Prevention is an integral part of good medical management. In patients with work-aggravated or irritant-induced asthma, reduction of exposure to aggravating factors is essential. In patients with allergic occupational asthma, exposure should be eliminated because exposure to even minute concentrations of the offending agent can trigger a potentially fatal allergic reaction.