The environmental somatization syndrome.

Patients with environmental somatization syndrome (ESS) believe that their symptoms are caused by exposure to tangible components of the external environment or by ergonomic stress at work. ESS is distinguishable by mental contagiousness and by the patients' focus on the external environment as cause of the illness. The presentation is often polysymptomatic, and epidemic outbreaks may appear. The patients usually refuse alternative explanations of their symptoms and discredit and reject any suggestion of a psychogenic etiology. It is important to distinguish between hygienic problems and ESS problems, particularly when poor and inadequate hygienic factors are present simultaneously with an ESS epidemic.

Surgical treatment of carpal tunnel syndrome in patients exposed to vibration from handheld tools.

During 1985 at Sabbatsberg Hospital in Stockholm, carpal tunnel decompression was done for 50 men (58 hands) with carpal tunnel syndrome (CTS). In 1988 2.5 to 3 years after the operations, a questionnaire about their present health was answered by 43 men (50 hands). In 10/17 (59%) hands exposed to vibrations and 26/33 (79%) not exposed, carpal tunnel decompression had resulted in no recurrence of neurological symptoms at follow up. Preoperative signs of neurophysiological dysfunction of the ulnar nerve, which might indicate a more widespread neuropathy, did not correlate with poor postoperative function of the median nerve. We recommend that patients with carpal tunnel syndrome should be operated on, whether or not they have been exposed to vibration.

[Environmental somatization syndrome. How to deal with the external milieu syndrome?]. / Environmental somatization syndrome. Hur hanteras det yttre miljösyndromet?

Somatization is a tendency to experience and communicate psychogenic distress in the form of somatic symptoms and to seek medical help for them. Patients suffering from environmental somatization syndrome (ESS) consider their symptoms to be caused by exposure to chemical or physical components of the external environment or by ergonomic stress at work. ESS is distinguished by mental contagiousness and a tendency to cluster. Sometimes it explodes in wide-spread epidemics that may be escalated by mass-media campaigns. Extensive ESS epidemics have been connected to, i.a., arsenic, carbon monoxide ("generator gas poisoning"), mercury ("oral galvanism"), carbon-free copy papers, electromagnetic fields ("electric allergy") and repetitive movements ("repetition strain injury", RSI). The typical patient directs the interest on the external environment, refuses alternative explanations of his symptoms and abhors any suggestion of a psychogenic etiology. The community is often placed in difficult positions by lobby groups calling for drastic measures to eliminate alleged disease-inducing exposures. When hygienic evils occur simultaneously with an ESS epidemic, it is essential to strictly differ the hygienic problems from the ESS problems. If mismanaged, measures aimed at reducing hygienic inconveniences may aggravate the complex of ESS problems.

Longitudinal changes in hearing ability among Swedish conscripts.

An analysis of a military database of about 36,000 tone audiograms from male Swedish conscripts aged 18 to 19 and recorded from 1969 to 1977 demonstrates a successively decreasing prevalence of hearing loss during this period. This might reflect improved therapy during the 1950s and 1960s of ear disorders causing hearing loss in small children. If observations in other studies on a reverse trend during the 1980s are confirmed, they indicate, together with the present study, that around 1980 young people began to be harmfully exposed to an environmental factor causing hearing loss. If this is the case, the causative factor would probably be non-occupational exposure to electronically amplified sounds from loudspeakers and headphones.

Spontaneous abortions and work in day nurseries.

420 pregnancies were recorded between 1962 and 1987 among 202 women working for at least one month in day nurseries during 1984. During that time 230 pregnant mothers had worked as childminders in day nurseries ('exposed' pregnancies). The remaining 190 pregnancies were classified as 'unexposed'. 27 spontaneous abortions were exposed and 7 unexposed corresponding to abortion rates of 11.7% and 3.9%, respectively, which is a significant difference. Also 'threatened' abortions during the first trimester of pregnancies ending up in live-born children were accumulated in exposed pregnancies, and the miscarriage rate was possibly increased in unexposed pregnancies of women with their own children in day nurseries. Significant differences were not observed with regard to premature birth, congenital malformations, number of live-born children and sex ratio of live-born children. The cause of the increased frequency of spontaneous and 'threatened' abortions in exposed pregnancies could be a contagious agent.

Sleep disturbances and exposure to organic solvents.

An inquiry about sleep habits and sleep disturbances revealed a significantly higher prevalence of insomnia in a solvent-exposed group than in a comparable group that had no occupational exposure to organic solvents. In the solvent-exposed group was also registered an increased consumption of hypnotics, and a significant increase occurred in the number of individuals who had consulted physicians because of sleep disorders. The results indicate that solvent exposure could induce sleep disturbance.

Biological monitoring of environmental and occupational exposure to mercury.

Biological monitoring was used to assess mercury exposure from occupational and environmental sources in a group of chloralkali workers (n = 89) and in a control group (n = 75). In the control group, the median value for blood mercury (B-Hg) was 15 nmol/l, that for serum mercury (S-Hg) was 4 nmol/l and that for urinary mercury (U-Hg) was 1.1 nmol/mmol creatinine. Corresponding levels in the chloralkali group were 55 nmol/l, 45 nmol/l and 14.3 nmol/mmol creatinine, respectively. In the control group, there were statistically significant relationships between fish consumption and both B-Hg and S-Hg values (P less than 0.001), whereas U-Hg correlated best with the individual amalgam burden (P less than 0.01). In the chloralkali group, the mercury levels in blood and urine were significantly related to the type of work (P less than 0.001) but not to the length of employment, to fish consumption or to the quantity of dental amalgam fillings. In both groups there were poor correlations between smoking or alcohol intake and the mercury levels in blood and urine. The results strongly suggest that fish is an important source of methylmercury exposure and that amalgam fillings are probably the most important source of inorganic mercury exposure among occupationally unexposed individuals. In the chloralkali group, mercury exposure from fish and amalgam was overshadowed by occupational exposure to inorganic mercury.

Local exhaust ventilation and exposure to nitrous oxide in ambulances.

Under extreme conditions, ambulance attendants and drivers could be exposed to nitrous oxide administered to transported patients in concentrations causing acute effects. Special arrangements are necessary to prevent such exposure, which is influenced by travelling speed, local exhaust ventilation and the use of an excess gas transfer tube evacuating expired air and overflow gas from the face mask to the outside. The separate eliminative effects of travelling speed and local exhaust varied considerably with the experimental conditions. The excess gas transfer tube reduced the levels of nitrous oxide in the air by 86 to 97% inside the ambulance at different experimental conditions. The combination of excess gas transfer tube and local exhaust resulted in a relatively constant reduction of the airborne nitrous oxide levels by about 98% when the ambulance was at a standstill and 99% when it was running.

Carpal tunnel syndrome (CTS) and exposure to vibration, repetitive wrist movements, and heavy manual work: a case-referent study.

Possible connections between carpal tunnel syndrome (CTS) and exposure to vibrating handheld tools, repetitive wrist movements, and heavy manual work were examined in a case-referent study. The cases were 38 men operated on for CTS between 1974 and 1980. For each case, two referents were drawn from among other surgical cases (hospital referents) and two further referents from the population register and telephone directory, respectively (population referents). Thirty four of 38 cases (89%) and 143 of 152 referents (94%) were interviewed by telephone. An increased prevalence of obesity, rheumatoid disease, diabetes, or thyroid disease was observed among the cases but most did not suffer from any of these disorders. CTS was significantly correlated with exposure to vibration from handheld tools and to repetitive wrist movements but showed a weaker correlation with work producing a heavy load on the wrist. A cause-effect relation between CTS and exposures to handheld vibrating tools and to work causing repetitive movements of the wrist seems probable. Some differences between hospital and population referents indicate that a case-referent study of this type could be biased by inappropriate selection of referents.