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Risks of Occupational Vibration Exposures

FP5 Project No QLK4-2002-02650

Second Annual Report: January 2004 to December 2004

European Commission Quality of Life and Management of Living Resources Programme

Key Action 4 - Environment and Health

Report No. D5b: February 2005

Partners: Institute of Sound and Vibration Research, University of Southampton, U.K. Institute of Occupational Medicine University of Trieste, Italy Federal Institute for Occupational Safety and Health, Germany Department of Biomedical Engineering & Informatics University Hospital of Northern Sweden Coronel Institute, Academic Medical Center University of Amsterdam, The Netherlands Institut National de Recherché et de Sécurité, France

Universityof Southampton

FIOSH

Risks of OccupationalVibration Exposures

Contents

1 Objectives and Expected Achievements ..........................................................................1 1.1 Objectives .......................................................................................................................1

2 Project Work Plan ................................................................................................................2 2.1 Introduction .....................................................................................................................2 2.2 Project Structure, Planning and Timetable.....................................................................2

2.2.1 Progress during the second reporting period .........................................................2 2.2.2 Milestones and Deliverables ...................................................................................3

2.3 Description of the Work Packages .................................................................................6 2.3.1 Work Package 1 - HTV support and integration of results .....................................6

2.3.1.1 Objectives ........................................................................................................6 2.3.1.2 Status and progress during the second reporting period................................6 2.3.1.3 Work Package 1 reporting schedule ...............................................................7

2.3.2 Work Package 2 - HTV epidemiological studies ....................................................8 2.3.2.1 Objectives ........................................................................................................8 2.3.2.2 Epidemiological studies in Italy........................................................................8 2.3.2.3 Epidemiological studies in Sweden...............................................................13 2.3.2.4 Epidemiological studies in the United Kingdom............................................16 2.3.2.5 Work Package Reporting Schedule ..............................................................18

2.3.3 Work Package 3 - HTV experimental work...........................................................19 2.3.3.1 Laboratory studies of vascular and neurological effects of HTV (task 3.1) ..19 2.3.3.2 Laboratory studies of effects of HTV on detection of symptoms (task 3.2)..21 2.3.3.3 Biodynamic modelling of the hand-arm system (Task 3.3)...........................25 2.3.3.4 Work Package 3 Reporting Schedule ...........................................................28

2.3.4 Work Package 4 - WBV support and integration of results ..................................29 2.3.4.1 Objectives ......................................................................................................29 2.3.4.2 Status and progress during the second reporting period..............................29 2.3.4.3 Work Package 4 Reporting Schedule ...........................................................30

2.3.5 Work Package 5 - WBV Epidemiological Studies ................................................31 2.3.5.1 Objectives ......................................................................................................31 2.3.5.2 Longitudinal surveys of WBV-exposed workers in the Netherlands.............32 2.3.5.3 Longitudinal surveys of WBV-exposed workers in Italy ................................32 2.3.5.4 Longitudinal surveys of WBV-exposed workers in Sweden .........................36 2.3.5.5 Longitudinal surveys of WBV-exposed workers in United Kingdom.............37 2.3.5.6 Case control study of WBV-exposed workers in the United Kingdom..........38 2.3.5.7 Work Package 5 Reporting Schedule ...........................................................40

2.3.6 Work Package 6 - WBV experimental work..........................................................41 2.3.6.1 Objectives ......................................................................................................41 2.3.6.2 WBV Laboratory studies and biodynamic modelling (task 6.1) ....................41 2.3.6.3 Analysis of the field measurements from WP5 to provide stress predictions (task 6.2) 45 2.3.6.4 Work Package 6 Reporting Schedule ...........................................................46

QLK4-2002-02650 VIBRISKS 2004 Annual Report

3 Role of Participants ...........................................................................................................47 3.1 Details of participating organisations............................................................................47 3.2 Participant 1. UoS (Co-ordinator) .................................................................................47

3.2.1 Objectives and Workplan ......................................................................................47 3.2.2 Research activities during the second reporting period .......................................48 3.2.3 Significant difficulties or delays during the second reporting period ....................49

3.3 Participant 2: Trieste.....................................................................................................50 3.3.1 Objectives and Workplan: .....................................................................................50 3.3.2 Research activities during the second reporting period .......................................50 3.3.3 Significant difficulties or delays during the second reporting period ....................52 3.3.4 Subcontracted activities during the second reporting period ...............................53

3.4 Participant 3: FIOSH....................................................................................................54 3.4.1 Objectives and Workplan: .....................................................................................54 3.4.2 Research activities during the second reporting period .......................................54 3.4.3 Significant difficulties or delays during the second reporting period ....................54 3.4.4 Subcontracted activities during the second reporting period ...............................55

3.5 Participant 4. UMUH.....................................................................................................56 3.5.1 Research activities during the second reporting period .......................................56 3.5.1 Significant difficulties or delays during the second reporting period ....................58

3.6 Participant 5: AMC........................................................................................................60 3.6.1 Research activities during the second reporting period .......................................60 3.6.2 Significant difficulties or delays during the second reporting period ....................60

3.7 Participant 6. INRS .......................................................................................................61 3.7.1 Research activities during the second reporting period .......................................61 3.7.2 Significant difficulties or delays during the second reporting period ....................61

4 Project Management and Coordination ..........................................................................62 4.1 VIBRISKS Web Pages .................................................................................................62 4.2 Project Meetings ...........................................................................................................62

4.2.1 Six-monthly Progress Meetings ............................................................................62 4.2.2 Mid-term Review ...................................................................................................62

4.3 Costs .............................................................................................................................62 5 Exploitation and Dissemination .......................................................................................63

5.1 Presentations and publications.....................................................................................63 5.1.1 Tenth International Conference on Hand-arm Vibration ......................................63 5.1.2 Annual UK Conference on Human Response to Vibration ..................................63 5.1.3 Publications in peer-review journals .....................................................................63

5.2 Third International Conference on Whole-body Vibration............................................63 5.3 Dissemination to national societies of occupational medicine.....................................64

Appendix 1. Contact details of participating organisations.................................................65 Appendix 2. An Experimental Study of the Acute Effects of Vibration and Force on Finger Blood Flow .....................................................................................................................68 Appendix 3. Project costs for the period 1st January 2004 to 31st December 2004...........70


1 Objectives and Expected Achievements

1.1 Objectives

VIBRISKS aims to advance understanding of injuries from hand-transmitted vibration and whole-

body vibration by epidemiological studies and laboratory research. The work will enhance primary

prevention (technical and administrative controls) and inform secondary prevention (health

surveillance, reducing exposure in affected workers). There are three areas of work:

1. Epidemiological studies of the dose-response relationships and the natural histories for

adverse outcomes known to arise from exposure to vibration:

• Co-ordinated longitudinal epidemiological studies in workers exposed to hand-transmitted

vibration in Italy, Sweden and the U.K. so as to: (i) characterise dose-response

relationships and factors responsible for the development of vibration-induced white finger

and sensorineural disease; (ii) determine the natural history of the hand-arm vibration

syndrome and factors causing, or predicting, a worsening of disease and the risk of

disablement.

• Coordinated longitudinal studies of workers occupationally exposed to whole-body

vibration in Italy, Sweden, the Netherlands and the U.K. so as to (i) characterise any

exposure-response relationship between whole-body vibration and the development or

recurrence of disorders and (ii) identify factors that combine to result in the development

or progression of the symptoms of disorders so as to improve understanding of the

benefits of health surveillance and other intervention measures.

• Case-control studies to determine whether exposure to whole-body vibration contributes

to prolapsed intervertebral discs, and to establish procedures for predicting risk

2. Laboratory studies to support the field investigations, by supplying alternative metrics of

exposure that are credible in physiological and biodynamic terms and which warrant

evaluation:

• Experimental studies of the acute vascular and neurological effects of hand-transmitted

vibration, and biodynamic modelling, so as to provide improved measures of vibration

dose for the establishment of appropriate exposure response models.

• Experimental and modelling studies to guide the measurements of body posture and

vibration exposure in the epidemiological studies and assist the interpretation of spinal

risk from exposure to whole-body vibration.

3. Integration of the results of the experimental studies with the epidemiological findings so as to

provide practical assistance to the community in the form of improved occupational health

guidance.

February 2005 Page 1


2 Project Work Plan

2.1 Introduction

The project involves three packages devoted to hand-transmitted vibration, three packages

devoted to whole-body vibration and a seventh work package to manage the project. The

work is being accomplished by a consortium of six partners, from six European countries.

The research involves coordinated longitudinal epidemiological studies in workers exposed

to hand-transmitted vibration and workers exposed to whole-body vibration. The participants

involved in the epidemiological studies are surveying subject groups within their own

countries. Surveys were designed for the first year of the project, with three follow-up surveys

at annual intervals. The plan allowed subject groups to be studies in four different European

countries (U.K., Italy, Sweden and the Netherlands), covering a range of different activities

and climatic conditions. The studies of hand-transmitted vibration and whole-body vibration

are designed to be mutually beneficial since they involve many common tools and

procedures.

2.2 Project Structure, Planning and Timetable

2.2.1 Progress during the second reporting period

The contracts for the VIBRISKS project were concluded with the European Commission

during December 2002, and the work officially began on 1st February 2003. This report

covers the second year of the project, from 1st January 2004 up to 31st December 2004.

Following some changes during the first year to the schedule of the epidemiological surveys

in the U.K., Sweden and the Netherlands, The longitudinal epidemiological studies of both

hand-transmitted and whole-body vibration are now progressing. Initial surveys were

completed in Italy early in 2004, and have now been started in all the other planned

locations. Follow-up surveys are already in progress in Italy. Deliverable reports are being

prepared to describe detailed progress in the VIBRISKS epidemiological studies up to the

end of 2004.

Experimental studies of the acute vascular effects of hand-transmitted vibration in WP3 are

now almost complete. The start of similar work on neurological effects was delayed during

the first reporting period, but is now in progress.

The original plans for biodynamic modelling in WP3 called for the development of numerical

models for predicting forces at the level of muscles and joints (Task 3.3). Following

discussions early in the project, this requirement has been changed to a numerical model for



predicting the effects of vibration magnitude, frequency and applied force on finger internal

stress, strain and pressure mapping. Following these changes, the work is now progressing

to schedule.

Biodynamic work on whole-body vibration in WP6 is also expected to deliver its results on

time, despite some delays to the experimental work due to some problems with the FIOSH

simulator.

2.2.2 Milestones and Deliverables

The project milestones, or measurable objectives, are shown in Table 2.2.1. Project

deliverables are described with their due dates in Table 2.2.2. In each table, shaded cells

indicate completed items.

It was necessary in the last reporting period to make some changes to the scheduling of

some work items – particularly the initial and follow-up epidemiological surveys in U.K.,

Sweden and the Netherlands. Some minor adjustments to the schedule have been

necessary during 2004, and these are detailed in the reporting schedules at the end of each

work package progress report in Section 2.3.

The WBV laboratory experiments at FIOSH have been delayed by about 6 months, due to

problems with the FIOSH HEXAPOD simulator, and results are now expected to be delivered

around the middle of 2005 (see Section 2.3.6.4). However, these difficulties are not expected

to affect the final dates of the deliverables from WP6.



Table 2.2.1 List of milestones No. Month Objective M1.1 6 Provision of methodology, equipment, training and calibration for the objective diagnosis of

vascular and neurological disorders caused by hand-transmitted vibration M1.2.1 45 The investigation of whether a measure of vibration exposure severity, partly based on

laboratory studies of the acute vascular effects of hand-transmitted vibration, can be used to predict the chronic vascular effects of hand-transmitted vibration.

M1.2.2 45 The investigation of whether a measure of the severity of vibration exposure can be found that predicts the severity of the symptoms and signs of neurological disorders caused by hand-transmitted vibration.

M1.2.3 45 Knowledge of whether the factors that cause, or predict, the onset of disease also predict the progression of disease in mild cases.

M1.3 48 Provision of occupational health surveillance guidance for HTV exposed workers 142638

M2.1

48

Completion of initial and follow-up longitudinal surveys of HTV exposed workers.

2638

M2.2

48

Completion of initial and follow-up natural history surveys of HTV exposed workers.

M3.1 6 Definition of the test conditions for measuring vascular responses to cold during the diagnosis of vibration-induced white finger.

M3.2.1 36 Definition of improved procedures for predicting how the acute vascular response to hand-transmitted vibration depends on vibration frequency, magnitude, direction, and duration.

M3.2.2 36 Definition of improved procedures for predicting how the acute neurological response to hand-transmitted vibration depends on vibration frequency, magnitude, direction, and duration.

M3.3 36 Method for the prediction of forces at the level of joints and muscles during selected exposures to hand transmitted vibration, based on a combination of grip forces and vibration exposures

M4.1 6 Agreement on common methods to be used in the epidemiological and case-control studies of workers exposed to whole-body vibration.

M4.2.1 45 Knowledge of whether disorders, especially back pain, can be related to predictions of spinal stress, including exposure to whole-body vibration.

M4.2.2 45 Evidence that whether back pain (either the incidence of new cases or the extent of disease among those with vibration-induced disorders) can be influenced by intervention in association with health surveillance at work.

M4.2.3 45 Knowledge of the contribution, if any, of exposure to whole-body vibration to the risk of prolapsed intervertebral discs.

M4.3 48 Provision of health surveillance guidance for WBV exposed workers 142638

M5.1

48

Completion of initial and follow-up longitudinal surveys of WBV exposed workers.

M5.2 36 Completion of case control survey of WBV exposed workers. M6.1 33 Definition of a practical method for the prediction of spinal stress during selected exposures

to whole-body vibration, based on a combination of postural forces and vibration exposure. M6.2 39 The provision of measures of predicted stress for the analysis of the field measurements in

WP5. M7.1 1 Consortium agreement signed M7.2 30 Organisation of 3rd International Conference on whole-body vibration injuries M7.3 24 Mid-term review completed M7.4 42 Organisation of International workshop on hand-transmitted vibration injuries M7.5 48 Work completed and supplied to coordinator for final reporting



Table 2.2.2 List of deliverables Key to Type: R=report; T=training; Q=questionnaire; D=data set; M=meeting proceedings

No. Task Month Description Lead partner Type

D1 7.3 3 VIBRISKS web pages UoS O D2 7.3 4 Brochure describing project UoS O D3 1.1 6 Hand-transmitted vibration diagnosis package UoS Q,T,RD4 4.1 6 Whole-body vibration diagnosis package UMUH Q,R

12 24 36

HTV dose response data sets comprising vibration measures and exposure history with signs and symptoms of vascular and neurological disorders

48 Subject groups in Italy [D5(I)a-d] Trieste D,R D5a-d 2.1

Subject groups in Sweden [D5(S)b-d] UMUH D,R 24 36 D6a-d 2.2 48

HTV natural history data sets (subject groups in UK). UoS D,R

12 Longitudinal WBV data sets. 24 Subject groups in UK [D7(UK)b-c] UoS D,R 36 Subject groups in Italy [D7(I)a-d] Trieste D,R

Subject groups in Sweden [D7(S)b-d] UMUH D,R D7a-d 5.1

48 Subject groups in the Netherlands [D7(NL)b-d] AMC D,R

D8 5.2 36 Case control WBV data sets (UK subjects). UoS D,R 12 24 D9a-c 7.1 36

Annual Technical Reports UoS R

D10 7.2 30 3rd International Conference on WBV injuries INRS M D11 7.1 24 Mid-term review of project UoS O D12 7.2 42 2nd International workshop on HTV injuries UoS M

D13 1.2 45 Model for predicting the onset, severity and progression of injuries over time with exposure to HTV accounting for effects of confounding variables

UoS R

Improved methods for evaluating hand-transmitted vibration so as to predict effects on vascular and neurological function

Vascular effects [D14(V)] Trieste R D14 3.1 36

Neurological effects [D14(N)] UMUH R Definition of the test conditions for objective measurement of the signs of vascular and neurological disorders

Vascular disorders [D15(V)] UoS R D15 3.2 36

Neurological disorders [D15(N)] UMUH R

D16 3.3 36 Numerical model for prediction of forces at the level of muscles and joints INRS R

D17 4.2 45 Models describing any association between the onset, severity and progression of symptoms of spinal injury with exposure to WBV, accounting for effects of confounding variables.

UoS R

D18 6.1 36 Mathematical model for prediction of spinal stress FIOSH R D19 6.2 39 Stress predictions from field measurements FIOSH R

D20 7.3 42 Updated informative brochures on occupational vibration risks for employers and employees INRS O

D21 1.3 48

Common procedures that can be applied by occupational health workers across Europe for minimizing risk, screening exposed individuals and management of individuals who already have symptoms of hand-transmitted vibration injuries

Trieste R

D22 4.3 48

Common procedures that can be applied by occupational health workers across Europe for minimizing risk, screening WBV exposed individuals and management of individuals who already have back pain or other symptoms

AMC R

D23 7.1 48 Final report (including electronic version on VIBRISKS web pages) UoS R



2.3 Description of the Work Packages

2.3.1 Work Package 1 - HTV support and integration of results

Start (month): 1 Duration (months): 48 Partner responsible: UoS

Partners: UoS Trieste UMUH INRS Total

Man-months: 8.5 4 4 0.5 17

2.3.1.1 Objectives

Initially, Work package 1 supported the development of the studies of disorders caused by

hand-transmitted vibration in WP2 and the experimental and modelling studies in WP3.

Later, WP1 will integrate the findings from WP2 and WP3 into procedures for minimizing risk,

screening exposed individuals and the management of individuals who already have the

Hand-arm Vibration Syndrome (HAVS).

The specific objectives of WP1 are to: (i) define and agree methods to be used in the

epidemiological studies in WP2; (ii) integrate the findings from epidemiological studies in

WP2 with the results of experimental studies in WP3 so as to define predictive dose-

response models; (iii) provide improved health surveillance guidance for primary prevention

(prevention of injuries in workers exposed to hand-transmitted vibration) and secondary

prevention (preventing the progression of disorders).

2.3.1.2 Status and progress during the second reporting period

2.3.1.2.1 Task 1.1 Preparation for epidemiological studies of HTV

The scheduled work in Task 1.1 was completed with production of a protocol for

epidemiological studies on hand-transmitted vibration (HTV) to be conducted in WP2. The

final version of this document was supplied as a work package deliverable (D3) in February

2004.

During the fourth consortium meeting in Umeå some consideration was given to possible future

additions and improvements to the protocol, which may include:

• the addition of finger-rewarming times;

• some additional questions to be inserted in the questionnaires for initial assessment,

and for follow-up surveys;

• incorporation of revised colour charts after the questionnaires;

• information on exposure measures to predict dose



2.3.1.2.2 Task 1.2 Integration of findings and model development

The next scheduled task in WP1 is the integration of results from epidemiological studies, as

they become available, so as to develop improved dose-response models. The first action

has been to establish a common format, defining the information to be provided by the

epidemiological study groups in WP2. For each study group this comprises:

• Summary of tool vibration measurements

• Summary of questionnaire responses – tool use

• Summary of questionnaire responses – symptoms

These formats have been used to report summaries of the initial Italian survey, in Tables

2.3.1 to 2.3.4.

2.3.1.2.3 Task 1.3 Provision of health surveillance guidelines

This task has not started yet.

2.3.1.3 Work Package 1 reporting schedule

Task Description Inputs (task #)

Outputs (task #)

Delivery date

Type of deliverable

Project deliverable

Delivered by

Delivered to

1.1.1 Provision of equipment and training in objective testing 2.1;

2.2 30-Jun-03 internal resource UoS(ISVR)UoS(MRC);

Trieste; UMUH

1.1.2 Provision of methodology and training in epidemiological methods

2.1;2.2 30-Jun-03 internal resource Trieste;

UoS(MRC)

UoS(ISVR); UoS(MRC);

Trieste; UMUH

1.1.3 Methodology, equipment, training and calibration: final definition 2.1;

2.2 30-Jul-03 internal report UoS (ISVR)

UoS(coord); UoS(MRC);

Trieste; UMUH

1.1.5 Hand-transmitted vibration diagnosis package: procedure manual for HTV epidemiological studies 30-Nov-03 technical report D3 UoS (ISVR) UoS(coord)

1.1.6Hand-transmitted vibration diagnosis package: updated procedure manual for HTV epidemiological studies

31-May-05 technical report D3.1 UoS (ISVR) UoS(coord)

1.1.5Hand-transmitted vibration diagnosis package: updated procedure manual for HTV epidemiological studies

31-May-06 technical report D3.2 UoS (ISVR) UoS(coord)

1.2.2 Statistical analysis and development of dose-response models: 1st technical progress report 2.0 31-Dec-05 annual report UoS(ISVR) UoS(coord)

1.2.4

Models for predicting onset, severity and progression of injuries over time, with exposure to HTV, accounting for effects of confounding variables: final report

2.03.3 1.3 30-Sep-06 technical report D13 UoS(ISVR) UoS(coord)

1.3.1 Investigation of measures of severity for predicting chronic vascular effects

1.2; 2.0 30-Oct-06 internal report Trieste UoS (ISVR)

1.3.2 Investigation of measures of severity for predicting symptoms and signs of neurological disorders

1.2; 2.0 30-Oct-06 internal report UMUH UoS (ISVR)

1.3.3 Health surveillance guidance for HTV exposed workers 30-Oct-06 internal report Trieste UoS (ISVR)

1.3.5 Common procedures for occupational health screening and management: final report 30-Dec-06 technical report D21 UoS(ISVR) UoS(coord)

Work Package 1. HTV Support and integration of results

1.2 Integration of findings and model development

1.1 Preparation for epidemiological studies of HTV

1.3 Provision of health surveillance guidelines



2.3.2 Work Package 2 - HTV epidemiological studies

Start (month): 3 Duration (months): 42 Partner responsible: Trieste

Partners: UoS Trieste UMUH Total

Man-months: 14 12.5 21 47.5

2.3.2.1 Objectives

The objectives of Work Package 2 are to improve knowledge of the dose-response

relationship between vibration exposure and development of: (a) vascular disorders (VWF)

and (b) neurological disorders (e.g. numbness, tingling and elevated vibrotactile and

thermotactile thresholds) of the upper limb. This is to be achieved by epidemiological studies

of upper limb disorders (vascular, neurological, and musculoskeletal) caused by hand-

transmitted vibration. This work involves investigators from three countries (Italy, Sweden,

United Kingdom).

2.3.2.2 Epidemiological studies in Italy

In the calendar period from 31 October 2003 to 30 June 2004, the Italian research team has

completed the initial (cross-sectional) survey of 257 workers occupationally exposed to hand-

transmitted vibration and 139 control manual workers.

In the same period, vibration measurements have been carried out in the field by the

Physical Agents Laboratory of the Department of Prevention of NHS in Siena (USL7, a

subcontractor of the University of Trieste). Vibration data, in terms of r.m.s. frequency-

weighted and unweighted r.m.s. acceleration, are now available for 29 chain saws, 7 brush

saws, 4 chipping hammers, 16 breakers, 5 grinders/cutters, 2 polishers, and 3 inline

hammers.

Among the investigated vibration exposed workers, 184 are lumberjacks using chain saws

and brush saws and employed in several forestry companies in Tuscany Region (central

Italy) and Trento Province (northern Italy); 37 are mixed forest and public service workers

using chain saws, chipping hammers, and breakers and employed in Trento Province

(northern Italy); 36 are stone processing workers using grinders/cutters, polishers, and inline

hammers and employed in Versilia district (Tuscany Region).

The controls are manual workers unexposed to hand transmitted vibration, who have been

recruited from various industrial and administrative activities

Approval to the study has been obtained by all forestry and stone worker companies.



The vibration-exposed workers, as well as the control workers, have been investigated by a

research physician specialist in Occupational Medicine and Industrial Hygiene. She has used

the medical procedures included in the VIBRISKS protocol for epidemiological studies of

hand-transmitted vibration.

The vibration-exposed workers and the controls subjects examined in Italy have been

investigated using the following diagnostic tools:

(a) clinically administered questionnaire;

(b) administration of colour charts for Raynaud’s phenomenon;

(c) complete physical examination;

(d) cold test with measurement of finger systolic blood pressures at 30°C and 10°C

(plethysmographic technique);

(e) hand grip strength (Jamar grip meter);

(f) manual dexterity (Purdue pegboard test).

Colour charts for the diagnosis of Raynaud’s phenomenon have been tested on 255

subjects.

Findings from baseline clinical questionnaire, physical examination and objective tests have

been stored in an ad-hoc Access database. Data from measurement and assessment of

vibration exposure have been stored in an Excel spreadsheet.

Data analysis have been performed using the statistical software Stata (version 8.2 SE, Stata

Corporation, 2003).

The results of vibration measurements in terms of frequency-weighted rms acceleration (ISO

5349-1), the characteristics of the study populations, and the findings of clinical investigation

of vascular and neurological symptoms and signs, are summarised in Tables 2.3.1 to 2.3.4.

Detailed comments on the findings of the initial cross-sectional survey will be reported in the

project deliverables D5b – D6b which will be included in the 2nd Annual Technical Report.

The 1st follow up investigation of the vibration exposed workers and the controls has started

in October 2004. The follow up will consist of re-examination of the vibration exposed

workers and the control using the same procedures adopted in the cross-sectional survey.



Table 2.3.1. VIBRISKS epidemiological studies of HTV workers in Italy: cross-sectional survey, 2003-2004. Population - Forestry Workers

Population 1 Forestry workers Number of exposed 184 (age: 42.9 ± 9.4 yrs) Tool Chain saw ( ms-2 r.m.s.)

(n=22) Brush saw ( ms-2 r.m.s.) (n=7)

From measurement on each tool Average acceleration (ahw) xh 3.20 3.77 Average acceleration (ahw) yh 2.65 2.48 Average acceleration (ahw) zh 3.43 3.13 Average acceleration total value (av) 5.47 5.69 SD acceleration (ahw) xh 0.98 1.69 SD acceleration (ahw) yh 0.77 0.50 SD acceleration (ahw) zh 1.08 1.30 Max acceleration (ahw) xh 5.77 6.66 Max acceleration (ahw) yh 4.89 3.25 Max acceleration (ahw) zh 6.20 5.03 Max acceleration total value (av) 9.12 9.02 Min acceleration (ahw) xh 1.88 2.36 Min acceleration (ahw) yh 1.59 2.01 Min acceleration (ahw) zh 1.94 1.77 Min acceleration total value (av) 3.36 3.91 From questionnaire (exposure) Average daily exposure duration 143 mins SD daily exposure duration 77 mins Max daily exposure duration 403 mins Min daily exposure duration 30 min Average years of exposure 15.2 yrs SD years exposure 9.0 yrs Max years exposure 37.0 yrs Min years exposure 1.0 yrs Percent with more than 1 yr HTV exposure prior to current job

31.5% (n=58)

Spare time regular of tools making hands vibrate (% responding “Yes”)

40.8% (n=75)

From questionnaire (symptoms) % with whiteness 17.9% (n=33) average whiteness score in those with whiteness

20 (median: 12)

% with tingling 39.1% (n=72) average tingling score in those with tingling 39 (median: 44) % with numbness 28.3% (n=52) average numbness score in those with numbness

39 (median: 33)

% with suspected CTS 6.0% (n=11) % with neck pain (trouble) 37.5% (40.8%) % with shoulder pain (trouble) 34.8% (35.3%) % with elbow pain (trouble) 22.3% (23.4%) % with wrist pain (trouble) 12.5% (13.0%) % with hand or finger pain (trouble) 8.7% ( 9.8%) % with any hand-wrist pain (trouble) 19.6% (21.2%)



Table 2.3.2. VIBRISKS epidemiological studies of HTV workers in Italy, Cross-sectional survey, 2003-2004. Population 2 – Mixed forest and public service workers

Population 2 Mixed forest and public service workers Number of exposed 37 (age: 38.3 ± 6.5 yrs) Tool Chain saw

( ms-2 r.m.s.) (n=7)

Chipping hammer ( ms-2 r.m.s.) (n=4)

Breaker ( ms-2 r.m.s.) (n=16)

From measurement on each tool Average acceleration (ahw) xh 3.05 9.06 13.0 Average acceleration (ahw) yh 2.50 20.7 8.61 Average acceleration (ahw) zh 3.26 9.27 15.2 Average acceleration total value (av) 5.16 24.7 22.1 SD acceleration (ahw) xh 1.18 2.95 3.06 SD acceleration (ahw) yh 0.85 2.82 2.90 SD acceleration (ahw) zh 1.23 3.08 2.28 Max acceleration (ahw) xh 6.75 13.7 17.8 Max acceleration (ahw) yh 5.70 23.1 14.3 Max acceleration (ahw) zh 7.10 14.2 20.4 Max acceleration total value (av) 2.57 26.3 27.8 Min acceleration (ahw) xh 1.35 6.15 8.85 Min acceleration (ahw) yh 1.25 15.9 5.60 Min acceleration (ahw) zh 1.45 5.85 13.2 Min acceleration total value (av) 10.1 22.7 18.5 From questionnaire (exposure) Average daily exposure duration 61 mins SD daily exposure duration 56 mins Max daily exposure duration 205 mins Min daily exposure duration 15 mins Average years of exposure 15.0 yrs SD years exposure 6.6 yrs Max years exposure 31.0 yrs Min years exposure 2.0 yrs Percent with more than 1 yr HTV exposure prior to current job

48.6% (n=18)


37.8% (n=14)

From questionnaire (symptoms) % with whiteness 2.7% (n=1) average whiteness score in those with whiteness 1 (median: 1) % with tingling 35.1% (n=13) average tingling score in those with tingling 25 (median: 24) % with numbness 21.6% (n=8) average numbness score in those with numbness 35 (median: 33) % with suspected CTS 18.9% (n=7) % with neck pain (trouble) 43.2% (46.0%) % with shoulder pain (trouble) 21.6% (27.0%) % with elbow pain (trouble) 5.4% (10.8%) % with wrist pain (trouble) 2.7% ( 2.7%) % with hand or finger pain (trouble) 0% ( 5.4%) % with any hand-wrist pain (trouble) 2.7% ( 8.1%)



Table 2.3.3. VIBRISKS epidemiological studies of HTV workers in Italy, Cross-sectional survey, 2003-2004. Population 3 – Stone workers

Population 3 Stone workers Number of exposed 36

(age: 38.9 ± 11.0 yrs) Tool Grinder/cutter

( ms-2 r.m.s.) (n=5)

Polisher (ms-2 r.m.s.) (n=2)

Inline hammer ( ms-2 r.m.s.) (n=3)

From measurement on each tool Average acceleration (ahw) xh 2.63 0.72 6.48 Average acceleration (ahw) yh 2.31 0.78 16.0 Average acceleration (ahw) zh 2.76 1.21 8.02 Average acceleration total value (av) 4.57 1.63 19.5 SD acceleration (ahw) xh 0.25 0.12 1.44 SD acceleration (ahw) yh 0.23 0.11 2.70 SD acceleration (ahw) zh 0.37 0.11 1.02 Max acceleration (ahw) xh 2.86 0.86 8.68 Max acceleration (ahw) yh 2.81 1.00 18.9 Max acceleration (ahw) zh 2.92 1.34 9.20 Max acceleration total value (av) 5.14 1.89 23.1 Min acceleration (ahw) xh 2.38 0.62 5.02 Min acceleration (ahw) yh 1.96 0.65 13.9 Min acceleration (ahw) zh 2.44 0.82 7.11 Min acceleration total value (av) 4.04 1.42 16.9 From questionnaire (exposure) Average daily exposure duration 230 mins SD daily exposure duration 90 mins Max daily exposure duration 440 mins Min daily exposure duration 25 mins Average years of exposure 17.7 yrs SD years exposure 10.5 yrs Max years exposure 46.0 yrs Min years exposure 2.0 yrs Percent with more than 1 yr HTV exposure prior to current job

30.6% (n=11)


8.3% (n=3)


22 (median: 19)


33 (median: 33)

% with suspected CTS 8.3% (n=3) % with neck pain (trouble) 38.9% (44.4%) % with shoulder pain (trouble) 13.9% (13.9%) % with elbow pain (trouble) 16.7% (16.7%) % with wrist pain (trouble) 2.8% ( 2.8%) % with hand or finger pain (trouble) 5.6% ( 8.3%) % with any hand-wrist pain (trouble) 8.3% (11.1%)



Table 2.3.4. VIBRISKS epidemiological studies of HTV workers in Italy, Cross-sectional survey, 2003-2004. Population 4 – Control workers

Population 4 Control workers Number of subjects 139

(age: 40.7 ± 8.2 yrs) From questionnaire (exposure) Percent with more than 1 yr HTV exposure prior to current job

5.0% (n=7)


28.8% (n=40)


13 (median: 7)


37 (median: 38)

% with suspected CTS 1.4% (n=2) % with neck pain (trouble) 31.7% (39.6%) % with shoulder pain (trouble) 10.1% (11.5%) % with elbow pain (trouble) 5.8% ( 5.8%) % with wrist pain (trouble) 5.8% ( 5.8%) % with hand or finger pain (trouble) 2.9% ( 4.3%) % with any hand-wrist pain (trouble) 7.9% ( 9.4%)

2.3.2.3 Epidemiological studies in Sweden

The Swedish study group, to be surveyed by Partner 4 (UMUH), will consist of users of

vibrating handheld tools (grinders and polishers) in heavy industrial production workshops

and in car workshops. About 100 male subjects will be randomly recruited from regional

companies within these categories. A control group will also be recruited with a similar size to

the study group. The selection criteria will be based on age (20-30 years) and vibration

exposure. Workers will be divided in to sub groups with high/moderate/low levels of exposure

with respect to both magnitude and duration.

Differentiating criteria between low, medium and high vibration exposure will be tentatively

based on the action value and the exposure limit value suggested by the new EU Directive

on vibration, e.g. low = A(8) < 2.5 ms-2; medium= A(8) 2.5-5 ms-2; high=A(8) > 5 ms-2

2.3.2.3.1 Modification of original study plan

Partner 4 wanted a larger cohort to follow to increase the power to model the dose-response

relationship. Thus they have made baseline measurements in a cohort of 1083 of young



workers instead of only using 200 workers. The reason to target young workers is because

they wanted workers entering exposure in order to enhance ability to detect development of

vibration syndrome without being biased by the healthy worker effect. The healthy worker

effect would tend to underestimate the hazardous effects of vibration by the tendency for

workers developing vibration syndrome to leave the work early.

A cohort of 1083 with different levels of exposure received the Self Administered

Questionnaire (SAQ) developed in WP1. This modification has increased the number of

study person and exposure time. In the original plan we had less than 600 person years for

analysis. By this modification they expect to be able use about 2400 exposure years.

From the expanded cohort 200 healthy workers have been recruited with different levels of

HTV exposure (including controls). In this subcohort the original planned physical and

laboratory examinations are done. Since the workers are young with few years of previous

HTV exposure they have modified the follow up time by increasing it from 1 to 2 years. This

modifies the original plan so that fewer follow ups are done. The base line examination of the

200 workers are now (December 2004) almost complete.

The establishing of the cohort is described below with preliminary results.

2.3.2.3.2 Future actions

The expanded cohort will be follow up in October 2005 and in October 2006. The subcohort

of 200 workers will be followed in October-December 2006. Vibration measurements will be

performed during 2005 for the workers in the subcohort. All instruments and methodology are

up and running. It is not foreseen that there will be any problems to continue as planned.

2.3.2.3.3 Establishing the Swedish HTV cohort

Registers of students that graduated from vocational high schools in 2001, 2002 and in 2003

in northern and western Sweden have been obtained . The programs were construction, auto

mechanics and restaurant (originally 3000 asked). A short screening questionnaire was used

with questions comparable to SAQ but less detailed. A study base of 1868 young workers

(1561 men and 307 women) that answered the screening questionnaire was the base for

setting up the Swedish VIBRISKS HTV cohort. there are young workers with different levels

of HTV exposure. A total 1083 workers from the screening questionnaire volunteered and

were given a baseline questionnaire according to the SAQ VIBRISKS protocol (WP1).

Annual follow-ups are planned so the 1st follow up will be in October 2005 and the 2nd in

October 2006. From the 1068 base 200 healthy young workers have been enlisted in a

subcohort (according to original plan). These 200 workers have different levels of HTV



exposures. Effect measurements includes physical examination and testing (FSP finger

systolic blood pressure, temperature perception thresholds, vibrotactile perception

thresholds, manual dexterity, muscle strength). Examination and measurement are done

according to the VIBRISKS protocol (WP1). Data collection is going on at present and 120

examinations have been performed now (December 2004). The remaining 80 examinations

will be done in January-February. Follow-up with the same measurements will be done

October-November 2006. Exposure assessment includes measurements at the young

workers work-places during 2005.

2.3.2.3.4 Results from the study base from which the cohort was established.

There were 1868 (1561 men and 307 women) persons that answered the screening

questionnaire. The median age was the same in exposed and not exposed (controls) men

and women (Table 2.3.5). The range of daily exposure among the HTV exposed had a large

range (Table 2.3.5). Thus it was possible to enlist workers with different levels in the 200

workers sub cohort for the effect examination and laboratory tests.

Table 2.3.5. Characteristics of the study population “young workers”(VIBRISKS Sweden cross-sectional survey). Data are given as medians and (range= lowest and highest value) or numbers (%). Controls men

(n=498) HTV exposed men (n=1060)

Controls women (n=204)

HTV exposed women (n=102)

Age (yrs) 21 (19-27) 21 (19-27) 21 (18-24) 20 (18-26) Height (cm) 180 (165-196) 182 (165-197) 167 (150-184) 167 (150-185) Weight (kg) 77 (55-118) 78 (65-116) 62 (44-102) 62 (45-115) BMI (Kg/m2) 23,6 (17,8-35,1) 23,6 (18,2-35,1) 22,3 (16,6-38,7) 22,1 (17,2-39,1) Smokers (n) 74 (15%) 151 (14%) 51 (25%) 33 (32%) Total abstainers of alcohol (n)

46 (9%) 61 (6%) 7 (3%) 5 (6%)

Daily HTV exposure (min)

0 45 (1-540) 0 20 (1-480)

The prevalences of white fingers in exposed and not exposed men and women were low and

as expected in the age category in the different groups (Table 2.3.6). The prevalences of

possible CTS (night tingling) in exposed and not exposed men and women were high in all

the different groups (Table 2.3.6).

There were associations between HTV exposure and night tingling and wrist pain for men,

neck, arm and low back pain for women (Table 2.3.7).



Table 2.3.6. Prevalence of upper limb disorders in the controls and the HTV exposed in the study population “young workers” (VIBRISKS Sweden cross-sectional survey): numbers and (%). Controls

men (n=498)

HTV exposed men (n=1060)

Controls women (n=204)

HTV exposed women (n=102)

Tingling/numbness in hands/fingers (7d last year)

41 (8%) 90 (8%) 22 (11%) 19 (18%)

At night tingling/numbness in hands/fingers (possible CTS 30d)

49 (10%) 152 (14%) 33 (16%) 25 (24%)

Coldness in hands/fingers (30d)

111 (22%) 274 (26%) 109 (53%) 64 (62%)

Finger whiteness colour chart (30d)

17 (3%) 42 (4%) 7 (3%) 7 (7%)

Neck pain (7d last y) 160 (32%) 350 (33%) 89 (44%) 64 (62%) Arm pain (7d last y) 126 (25%) 304 (29%) 67 (33%) 62 (60%) Wrist pain (7d last y) 71 (14%) 246 (23%) 62 (30%) 42 (41%) Low back pain (7d last y) 174 (35%) 381 (36%) 93 (46%) 60 (58%) Stress (burn out) 182 (37%) 405 (38%) 109 (53%) 57 (56%)

Table 2.3.7. Associations of upper limb disorders and HTV exposure in the study population “young workers” (VIBRISKS Sweden cross-sectional survey). Prevalence ratios (PR) and 95% confidence intervals (95% CI) are reported, assuming the controls as the reference category (PR=1,0). Prevalence

ratio HTV exposed men

95%CI Prevalence ratio HTV exposed women

95%CI

Tingling/numbness in hands/fingers (7d last y)

1,03 0,70-1,52 1,71 0,97-3,01

At night tingling/numbness in hands/fingers (possible CTS 30d)

1,45 1,07-1,97 1,50 0,94-2,38

Coldness in hands/fingers (30d)

1,16 0,95-1,40 1,16 0,95-1,42

Finger whiteness color chart(30d)

1,16 0,67-2,01 1,98 0,71-5,50

Neck pain (7d last y) 1,02 0,88-1,20 1,42 1,15-1,77 Arm pain (7d last y) 1,13 0,95-1,35 1,54 1,17-2,02 Wrist pain (7d last y) 1,62 1,27-2,07 1,34 0,98-1,83 Low back pain (7d last y) 1,03 0,89-1,19 1,28 1,02-1,60 Stress (burn out) 1,04 0,91-1,20 1,04 0,74-1,24

2.3.2.4 Epidemiological studies in the United Kingdom

This study aims to optimise the advice that can be offered to medical practitioners who

organise health surveillance for hand-arm vibration syndrome (HAVS) and to aid secondary

prevention of the disease by characterising the disorder’s natural history and predictors of

progressive disease.



This study will take place at BAE plc, a major company of shipbuilders and refitters that

already conducts a substantial programme of health surveillance for HAVS. The company

employs 1374 individuals, of whom 90% are exposed to hand-transmitted vibration (HTV).

Exposures arise mainly from hand-held portable grinders, drills and metal-working saws. In

collaboration with BAE plc, we will modify the existing health surveillance programme at the

Glasgow shipyards so that it meets the needs of the research. Data collection will be

undertaken primarily by BAE’s occupational health provider Wellwork, under research

supervision and with research support. A more detailed history of symptoms, risk factors for

progression and exposures to HTV has been incorporated into the existing routine health

assessment. Simple clinic-based tests of hand function will be included on all participants.

In a subset, more detailed hand function tests will be conducted (namely vibrotactile and

thermal thresholds and finger blood flow).

Analysis will focus on the changes in the hand function tests and in symptoms over time. All

subjects will be followed up at annual intervals over a 3-year period.

Since the study’s conception, there have been a number of delays. Firstly, co-funding for the

project by HSE was only secured in June 2004 and therefore impeded progression of the

planning of the project. Initially, it was intended that the company UK Coal would be the

industrial collaborators in the project. Unfortunately, after many months of negotiation, a lack

of agreement to the study on the part of the unions ruled this out. Inevitably, this caused

considerable delay in terms of seeking an alternative industrial partner. Once communication

with BAE plc was established, a period of lengthy negotiation was necessary to seek both

management and union approval.

These delays have provided the opportunity to reconsider the protocol and incorporate a

number of modifications that will result in a more appropriately designed and thus more

comprehensive study. The changes are principally to do with which participants will be

followed up over the study period of 3 years and that clinic tests of hand function will be

performed on all participants throughout the course of the study.

Progress made to date includes: gaining ethical approval to conduct the study from HSE

(September 2004) and securing formal BAE management and union approval to conduct the

study. Final drafts of consent forms, questionnaires and instruction sheets for staff have been

produced.

It is anticipated that the software for data capture will be installed by the end of this year.

Appropriate staff training in questionnaire completion and performance of the hand function

tests will be completed by December 2004. Other aspects of the study that are outstanding



include compiling a picture album of tools for assessment of HTV exposure. It is anticipated

that this will be finalised by December and that baseline testing will commence between

January and March 2005. Final follow-up of the study will take place in January-March 2008.

2.3.2.5 Work Package Reporting Schedule


Outputs (task #)

Delivery date

Type of deliverable

Project deliverable

Delivered by

Delivered to

2.1.1.1 Initial dose-response epidemiological surveys in Italy 1.1 1.2 30-Nov-03 annual report Trieste Trieste;

UoS(ISVR)

2.0.1.1 HTV epidemiological surveys - 1st year: annual report 30-Nov-03 annual report Trieste UoS(Coord)

2.1.1.2 First follow-up dose-response epidemiological surveys in Italy 2.1.1.1 1.2 30-Nov-04 annual report Trieste Trieste;

UoS(ISVR)

2.1.2.2 Initial dose-response epidemiological surveys in Sweden 1.2 30-Nov-04 annual report UMUH Trieste;

UoS(ISVR)

2.2.1.2 Planning of natural history epidemiological surveys in UK 1.2 30-Nov-04 annual report UoS (MRC) Trieste;

UoS(ISVR)

2.0.1.2 HTV epidemiological surveys - 2nd year: annual report 31-Jan-05 technical report D5b; D6b Trieste UoS(Coord)

2.1.1.3 2nd follow-up dose-response epidemiological surveys in Italy 2.1.1.2 1.2 30-Nov-05 annual report Trieste Trieste;

UoS(ISVR)

2.1.2.3 1st follow-up dose-response epidemiological surveys in Sweden 2.1.2.2 1.2 30-Nov-05 annual report UMUH Trieste;

UoS(ISVR)

2.2.1.3 Initial natural history epidemiological surveys in UK 2.2.1.2 1.2 30-Nov-05 annual report UoS (MRC) Trieste;

UoS(ISVR)

2.0.1.3 HTV epidemiological surveys - 3rd year: annual report 31-Jan-06 technical report D5c; D6c Trieste UoS(Coord)

2.1.1.4 3rd follow-up dose-response epidemiological surveys in Italy 2.1.1.3 1.2 30-Nov-06 annual report Trieste Trieste;

UoS(ISVR)

2.1.2.4 2nd follow-up dose-response epidemiological surveys in Sweden 2.1.2.3 1.2 30-Nov-06 annual report UMUH Trieste;

UoS(ISVR)

2.2.1.4 1st follow-up natural history epidemiological surveys in UK 2.2.1.3 1.2 30-Nov-06 annual report UoS (MRC) Trieste;

UoS(ISVR)

2.0.1.4 HTV epidemiological surveys - 4th year: final report 31-Dec-06 technical report D5d; D6d Trieste UoS(Coord)

Work Package 2. Epidemiological studies of HTV exposed workers

HTV epidemiological studies - first year

HTV epidemiological studies - second year

HTV epidemiological studies - fourth year

HTV epidemiological studies - third year



2.3.3 Work Package 3 - HTV experimental work

Start (month): 1 Duration (months): 36 Partner responsible: INRS

Partners: UoS Trieste UMUH INRS Total

Man-months: 9.5 7 9 4 29.5

2.3.3.1 Laboratory studies of vascular and neurological effects of HTV (task 3.1)

2.3.3.1.1 Objectives

The objectives of task 3.1 are to conduct experimental studies of the acute effects of hand-

transmitted vibration to provide improved ‘weightings’ for the effects of the frequency and

duration and direction of hand-tool vibration, and grip force exerted by operators. These are

required for the interpretation of the epidemiological data and the establishment of

appropriate dose response models in WP1.

2.3.3.1.2 Vascular effects

The following experiments have been designed by Partner 2 (University of Trieste) and

Partner 1 (UoS, ISVR):

Experiment 1

Experiment 1 consists of re-analysis of the findings of previous investigations of the vascular

effects of 125 Hz vibration with different magnitudes (from 1 to 176 ms-2 r.m.s.) and durations

(from 0.03 to 1 hour). The various exposure conditions will be combined to obtain alternative

measures of vibration dose with different time dependencies according to the expression:

dose = amtn

where a is r.m.s. acceleration and t is duration of exposure

The relation between acute vascular effects and (i) vibration magnitude, (ii) exposure

duration, and (iii) alternative measures of vibration dose will be assessed. The aim is to

investigate the form of vibration dose that better predicts the acute effects on finger

circulation. Acute vascular effects will be expressed in terms of changes in finger blood flow

in ipsilateral and contralateral fingers

Experiment 2

The results of experiment 2, devoted to the acute response of finger circulation to continuous

and intermittent vibration having the same total duration of vibration exposure and the same



energy-equivalent acceleration magnitude, have already been reported at the 3rd VIBRISKS

consortium meeting (Versilia, Italy) in November 2003. The findings of this experimental

study (“Acute effects of continuous and intermittent vibration on finger circulation“, authors:

M. Bovenzi, A.J.L. Welsh, M.J. Griffin) has been published in the peer-reviewed journal

“International Archives of Occupational and Environmental Health” 2004; 77:255-263.

Experiment 3

Experiment 3, devoted to the combined effects of force and vibration on finger circulation,

was conducted at ISVR by Italian and UK researchers during March 2004. In this experiment

the acute vascular effects of push forces of three magnitudes (0, 2, and 5 N) and vibration

with two frequencies (31.5 and 125 Hz) and two acceleration magnitudes (2 and 8 ms-2

frequency weighted) have been investigated.

This study was designed to investigate whether the force applied to the finger affected finger

blood flow and whether the effects of force interacted with the acute effects of vibration.

Specifically, it was hypothesised that finger blood flow would be affected by the application of

force and that the effects of vibration frequency would be dependent on the force applied to

the finger.

The study design included the participation of 10 healthy male subjects and the use of

instrumentation for generating the vibration, controlling the contact force and measuring

finger circulation.

A detailed summary of the methods and findings of experiment 3 is reported in Appendix 2.

2.3.3.1.3 Neurological effects

Specific Objectives

The objective is to investigate the acute effects of hand-transmitted vibration on measures of

neurological function (vibration perception thresholds and thermotactile thresholds) in order

to confirm current knowledge and better define the effects of vibration magnitude, frequency

and duration.

Two controlled laboratory experiments have been set up, with similar designs to the studies

of vascular effects in Task 3.1.1. The first experiment will address acute effects of HTV on

vibrotactile and thermotactile perception thresholds as a result of different combinations of

two exposures magnitude (2.5 and 5 ms-2 frequency weighted), four durations (2, 4, 8. 16

min) and two frequencies (31.5 and 125 Hz). The relation between various vibration doses

and acute effects will be assessed.



In the second experiment, the acute effects of continuous and intermittent vibration will be

investigated by different combinations of vibration with different periods of exposure and rest

periods. The following combinations will be investigated: 1 period of 16-min continuous

vibration, 2 periods of 8 min, separated by a 8-min period with no vibration, 4 periods of 4

min, separated by 4 min periods with no vibration and 8 periods of 2 min, separated by 2-min

periods with no vibration.

Twelve “normal” subjects (6 females and 6 male), with low test and re-test variations in

thresholds, will participate in both experiments. The subjects will grasp a vibrating handle

mounted on an electrodynamic shaker. By use of the handle it is possible to measure and

monitor the grip force. The instrumentation for the measurements of the threshold shift will be

HVLab Vibrotactile perception meter and HVLab Thermal Aesthesiometer. For the vibration

perception thresholds measurements the test frequencies will be 31.5 and 125 Hz.

Progress during the second reporting period

During this reporting period the laboratory experiments have been planned in detail and the

experimental set up have been tested. Additional support funding has been approved from

the Swedish council for working life and social research. The Ethical Committee of Umeå

University has approved the studies.

Future actions

The first laboratory experiment will start during January 2005 and the subtask will be

complete by month 38.

2.3.3.2 Laboratory studies of effects of HTV on detection of symptoms (task 3.2)

2.3.3.2.1 Objectives:

Task 3.2 is concerned with the influence of prior vibration exposure on the diagnostic tests to

be used in epidemiological investigations. Experimental laboratory studies will be designed to

investigate the conditions in the field are likely to influence the results obtained from the

objective diagnostic tests (i.e. whether prior exposure to vibration on the day of the test may

influence vascular and neurological function).

2.3.3.2.2 Vascular effects

An experimental study was completed by Italian and UK researchers at ISVR, University of

Southampton, during March 2004. The design and results of the experiment has been

reported and discussed among partners at the 4th VIBRISKS consortium meeting which took

place in Umeå (Sweden) on May 2004.



This study explored the effects of exposure to either force alone with a magnitude of 5

newtons (80 minutes) or a combination of force with 5 N (80 minutes) and vibration with a

frequency of 125 Hz and an acceleration magnitude of 64 ms-2 r.m.s. (60 minutes) on finger

systolic blood pressure during local cooling to 30° and 10°C in both an exposed hand and an

unexposed (contralateral) hand. Finger systolic blood pressures were measured in ten

healthy subjects by a plethysmographic technique (HVLab Multi-channel Plethysmograph)

before, and 30 and 70 minutes after the end of exposure to push force alone or to a

combination of push force and vibration.

Figure 2.3.1 shows the experimental setup for generating vibration, controlling push force

and measuring finger systolic blood pressure during local cooling. Table 2.3.8 provides

information on the experimental design of the study.

Figure 2.3.1. Experimental setup for generating vibration, controlling push force and measuring finger systolic blood pressure during local cooling.

The cold response in the digital arteries was expressed using two standardised pressure

indices:

1. FSBP%10° = (FSBPt,10° ´ 100)/[FSBPt,30° – (FSBPc,30° – FSBPc,10°)] (%)

2. R-FSBP10° = (FSBPt,30° – FSBPt,10°) – (FSBPc,30° – FSBPc,10°) (mmHg)



The hypothesis of no difference in the vascular responses in different exposure conditions

was tested by using an autoregressive model for repeated measures. Data analysis was

performed using the statistical software Stata (version 8.2 SE, Stata Corporation, 2003).

Table 2.3.8. Experimental design of the study: condition of exposures to push force alone (newtons) and combination of push force and vibration with a frequency of 125 Hz and an unweighted acceleration magnitude of 64 ms-2 r.m.s.

Condition 1 Condition 2 Exposure period

Time (min) Force Vibration Force Vibration

1* 30 0 0 0 0 2 10 0 0 0 0 3 10 5 N 0 5 N 0 4 60 5 N 0 5 N 125 Hz, 64 ms-2

5 10 5 N 0 5 N 0 6 10 0 0 0 0 7* 20 0 0 0 0 8 20 0 0 0 0 9* 20 0 0 0 0

*Cold test at 30° and 10°C at the end of the exposure period

The results of this experiment are reported in Table 2.3.9 (effects of 5 N push force alone for

80 minutes) and Table 2.3.10 [effects of combined exposure to both push force (5 N for 80

minutes) and 125-Hz vibration (unweighted acceleration magnitude of 64 ms-2 r.m.s. for 60

minutes)].

Repeated measures analysis by autoregressive modelling shows no significant differences in

the cold pressure indices over time in both the middle right (exposed) finger and the middle

left (unexposed) finger after exposure to either push force alone (Table 2.3.9) or push force

combined with 125 Hz vibration with an unweighted acceleration magnitude of 64 ms-2 r.m.s.

(Table 2.3.9).

Table 2.3.9. Finger systolic blood pressure indices after cold test at 10°C in 10 healthy men before and after exposure of the right hand to push force (5 N). Data are given as means (SD) [range]. P-values for repeated measures of FSBP over exposure periods by autoregressive modelling are reported.

2nd right finger (exposed) 2nd left finger (unexposed) Condition 1: Push force (5 N)

FSBP%10° (%)

R-FSBP10° (mmHg)

FSBP%10° (%)

R-FSBP10° (mmHg)

Period 1 (pre-exposure)

100.4 (9.4) [82.3 – 118.2]

0 (8.4) [-12 – 18]

89.7 (10.5)* [74.6 – 105.3]

11.5 (11.8)* [-5 – 29]

Period 7 (30 min after exposure)

99.4 (16.1) [74.4 – 130.5]

0.7 (15.6) [-29 – 23]

92.4 (13.2) [66.3 – 111.6]

8.5 (13.7) [-10 – 34]


88.8 (10.4) [67.0 – 102.7]

13.0 (11.9) [-3 – 36]

87.8 (12.1) [67.6 – 103.6]

13.8 (13.4) [-3 – 36]

P-value 0.20 0.14 0.24 0.14



The results of this experimental study suggest that in healthy subjects recent exposure to

hand-transmitted vibration does not seem to influence negatively the response of finger

circulation to cold provocation.

This finding tends to confirm the suggestion included in the VIBRISKS protocol for

epidemiological studies of hand-transmitted vibration that a time period of 2 hours between

the last exposure of HTV and the commencement of objective testing is adequate to avoid

acute circulatory effects caused by recent exposure to HTV.

Table 2.3.10. Finger systolic blood pressure indices after cold test at 10°C in 10 healthy men before and after combined exposure of the right hand to both push force (5 N for 80 minutes) and 125-Hz vibration (unweighted acceleration magnitude of 64 ms-2 r.m.s. for 60 minutes). Data are given as means (SD) [range]. P-values for repeated measures of FSBP over exposure periods by autoregressive modelling are reported.

2nd right finger (exposed) 2nd left finger (unexposed) Condition 2: Push force (5 N) & Vibration (125 Hz, 64 ms-2)

FSBP%10°

(%)

R-FSBP10° (mmHg)

FSBP%10°

(%)

R-FSBP10° (mmHg)

Period 1 (pre-exposure)

91.7 (8.1) [73.9 – 99.0]

8.5 (7.5) [1 – 24]

90.6 (11.2) [79.0 – 108.9]

10.0 (12.0) [-8 – 28]


89.3 (13.0) [58.1 – 104.0]

11.7 (13.9) [-4 – 44]

84.3 (6.9) [72.3 – 91.7]

16.8 (6.8) [9 – 29]


93.2 (11.1) [75.4 – 117.4]

8.0 (12.1) [-17 – 28]

87.4 (14.7) [61.2 – 105.3]

15.1 (19.1) [-6 – 50]

P-value 0.32 0.32 0.12 0.30

2.3.3.2.3 Neurological effects

Specific Objectives

The objective is to investigate whether the conditions in the field are likely to influence the

results obtained from the objective diagnostic tests that are used to detect symptoms (i.e.

whether prior exposure to vibration on the day of the test may influence neurological

function). The findings will be used to establish an improved definition of test conditions,

especially the length of time required between the last occupational exposure to tool vibration

and the commencement of objective testing.

One controlled laboratory experiments are set up similar to Task 3.1.2. Post stimulatory

vibrotactile and thermotactile threshold shifts during the first 75 seconds after controlled

provocative exposure by gripping a vibrating handle with a given force (20 or 50 N) will be

measured. Threafter the threshold shifts will be followed by periodic measures after each 30

s up to 10 minutes followed by measurements each 5 minutes up 30 minutes. In the

experiment the 12 “normal” subjects (6 females and 6 males) will participate. The

instrumentation for the measurements of the threshold shift will be HVLab Vibrotactile



perception meter and HVLab Thermal Aesthesiometer (ISVR, Southampton). For the

vibration perception thresholds measurements the test frequencies will be 31.5 and 125 Hz.

Progress during the second reporting period

During this reporting period the laboratory experiments have been planed in detail and the

experimental set up have been tested. Additional support funding has been approved from

the Swedish council for working life and social research. The Ethical Committee of Umeå

University has approved the study.

Future actions

The first laboratory experiment will start during April 2005 and the subtask will be complete

by month 38.

2.3.3.3 Biodynamic modelling of the hand-arm system (Task 3.3)

The work content of task 3.3 has changed from the original description. In the first proposal,

it had been proposed to develop a model of the upper limb (including the hand, the arm and

the shoulder) and to solve the inverse problem formulated as: calculate the internal forces

(exerted by the muscles) knowing the external forces (gripping, pushing, loads, etc.).

Because the flexibility of the human tissues is not taken into account, this type of model is of

interest to assess the impedance of the upper limb at only low frequencies. However, since

neurological and vascular effects occur at higher frequencies, any correlation or comparison

could be expected between experimental work of WP3 and the model output.

Therefore it has been decided to focus on the modelling of the dynamic behaviour of soft

tissues: the idea is now to develop a model able to predict how vibration propagate in the

human tissues and to calculate internal mechanical properties such as pressure-field or

strain, whose measurement is technically impossible to perform. Then, the objective is to

correlate the physiological response to vibration (output from WP3.1 and WP3.2) with local

high levels of pressure or strain. In that way, it is expected to bring keys to the understanding

of the vascular and neurological effect of vibration.

A preliminary study has been performed to check if it was feasible to take into account both

complex constitutive laws, large displacement and contacts, in the Finite Element code used

by INRS in order to compute modal response of a simplified geometry of a fingertip.

The fingertip was modelled in two dimensions. Because of symmetry, only the half of a

cross-section was meshed. Bone was modelled as a pure rigid geometry (see Figure 2.3.2).



Fig 2.3.2. Description of the fingertip meshing.

The constitutive law used for the soft tissues takes into account both dissipative effect

(viscoelastic law) and incompressibility (hyperelastic law). Several quasi-static deflections

were imposed and the corresponding static deformed shapes have been calculated.

0

50

100

150

0 0.5 1 1.5 2 2.5 3 3.5

imposed deflection (mm)

cont

act f

orce

(N/m

)

Figure 2.3.3. Calculation of contact forces for 4 values of deflections (Force units of the 2D model are N/m).

Then for different given deflections, the mode shapes were computed. All the calculations

were compared to the results obtained by Wu et al. [1] (same study carried out with a

different FEM code).

A three-dimensional finite element model is currently under development. The objective is

now to develop a realistic model of the whole finger, to compute dynamic responses and to

validate this calculations with impedance measurements under different controlled boundary

conditions. The 3D finite element model is based on the geometry of the forefinger. The

shape is assumed to be symmetric. Simulations will be performed with symmetric loading

conditions. In order to simplify the model and to reduce the running-time of the simulation,



only half of the finger is modelled. The forefinger is modelled with an initial curvature to reach

an position as much relaxed as possible. Other initial positions may be required in order to

make easier the convergence of the calculation.

1.5 mm deflection , f = 52 Hz 3 mm deflection, f = 65 Hz

Figure 2.3.4. 1st mode shape for two different deflections.

Soft tissues include subcutaneous tissues and the skin. The subcutaneous tissue is modelled

with continuum elements. The skin is modelled by mean of shell elements covering the free

surface of the whole finger.

Deformations of the three phalanges are small compared to the deformations of other

tissues. They are assumed to be rigid and their shape is modelled by nodes located on their

outer surface. These nodes are directly connected to continuum elements of the

subcutaneous tissue, so that the bond between the bone and the tissue is considered to be

perfect.

The whole finger is meshed by mean of hexahedral elements for continuum and quadrangles

for the shell element. Meshing complex volume shape with tetrahedral elements can easily

be achieved with automatic tools. This is not the case while meshing with hexahedral

elements. The use of hexahedrons compared to tetrahedrons reduce the number of

elements to achieve the same precision and therefore to reduce the running-time of the

calculation, which depends on the capacity (processors and memory) of the machine used.

The size element is a parameter of the mesh.

It is intended to perform simulations with identical loading conditions used for the 2D model.

The feasibility of the 3D calculations will be first investigated with simple extruded 3D

meshes. Based on the practical experience gained from the 2D model and the conclusions

from this preliminary study, the 3D model will be developed to improve its bio-fidelity

regarding the dynamic behaviour of a pre-compressed forefinger.

[1] Effects of static compression on the vibration modes of a fingertip. J. Z. Wu et al. Journal

of low frequency noise, vibration and active contol (vol 21,n°4), 2002.



Element size of 1 mm Element size of 2 mm

Figure 2.3.5. Meshes of the whole finger with different element size

2.3.3.4 Work Package 3 Reporting Schedule


Outputs (task #)

Delivery date

Type of deliverable

Project deliverable Delivered by Delivered to

3.1.1 Laboratory experiments to investigate acute effects of HTV on measures of vascular function . 1.2 31-Oct-05 final internal

reportTrieste;

UoS(ISVR)INRS;

UoS(coord)

3.1.2Laboratory experiments to investigate acute effects of HTV on measures of neurological function

. 1.2 31-Mar-06 internal report UMUH INRS; UoS(coord)

3.1.4Methods for evaluating HTV to predict effects on vascular and neurological function: 1st annual report

. . 30-Nov-03 annual reportTrieste;UMUH;INRS

UoS(coord)

3.1.6Methods for evaluating HTV to predict effects on vascular and neurological function: 2nd annual report

. . 30-Nov-04 annual reportTrieste;UMUH;INRS

UoS(coord)

3.1.8 Methods for evaluating HTV to predict effects on vascular function: final report . 31-Dec-05 technical report D14a Trieste;

INRSUoS(coord);UoS(ISVR)

3.1.9 Methods for evaluating HTV to predict effects on neurological function: final report . 31-May-06 technical report D14b UMUH;

INRSUoS(coord);UoS(ISVR)

3.2.1 Improved definition of test conditions for vascular responses to cold . 1.1 31-Oct-05 final internal

report TriesteINRS;

UoS(ISVR); UoS(coord)

3.2.2 Improved definition of test conditions for neurological symptoms . 1.1 31-Mar-06 internal report UMUH

INRS; UoS(ISVR); UoS(coord)

3.2.4 Improved definition of test conditions: 1st annual report . . 30-Nov-03 annual report

Trieste;UMUH;INRS

UoS(coord)

3.2.6 Improved definition of test conditions: 2nd annual report . . 30-Nov-04 annual report

Trieste;UMUH;INRS

UoS(coord)

3.2.8 Improved definition of test conditions: final report . . 31-Dec-05 technical report D15Trieste;UMUH;INRS

UoS(coord)

3.3.1 Numerical model for predicting forces in muscles and joints

2.1;2.2

1.2;3.3.2;3.3.3

30-Jun-05 internal report INRSUoS(coord); UoS(ISVR);

UMUH

3.3.2 Supply of ISVR biodynamic data for verifications of model 3.3.1 . 30-Jun-05 internal report UoS(ISVR) INRS;

UoS(coord)

3.1.3 Data for verifications of model provided from UMUH biodynamic data 3.3.1 . 30-Jun-05 internal report UMUH INRS;

UoS(coord)

3.3.5 Practical model for predicting stresses in finger: 1st annual report . . 30-Nov-03 annual report INRS UoS(coord)

3.3.7 Practical model for predicting stresses in finger: 2nd annual report . . 30-Nov-04 annual report INRS UoS(coord)

3.3.9 Practical model for predicting forces in muscles and joints: final report . 1.2 31-Mar-06 technical report D16 INRS UoS(coord)

Work Package 3. HTV experimental work

3.2 Laboratory studies of effects of HTV on detection of symptoms

3.1 Laboratory studies of vascular and neurological effects of HTV

3.3 Biodynamic modelling of the hand-arm system



2.3.4 Work Package 4 - WBV support and integration of results

Start (month): 1 Duration (months): 48 Partner responsible: UMUH

Partners: UoS Trieste FIOSH UMUH AMC Total

Man-months: 6 4 3 3.5 5 21.5

2.3.4.1 Objectives

The objectives of Work Package 4 are to define and agree methods to be used in the

epidemiological studies in WP5 and WP6. In the reporting period (2004-01-01 to 2004-12-

08), work has been focussed on methodology related to the preparation for the

epidemiological studies of WBV (i.e. sub-task 4.1) to be conducted in WP5 as well as for the

WBV experimental work to be conducted in WP6 (i.e. sub-task 4.2). Partners involved in this

work are UoS, Trieste, FIOSH, AMC and UMUH (Work package leader).

2.3.4.2 Status and progress during the second reporting period

2.3.4.2.1 Task 4.1 Preparation for epidemiological studies of HTV

The process of establishing the study manual for the epidemiological and the experimental

studies were finished during the first reporting period. The outcome deliverables; the

epidemiological protocol (D3) and adherent subtasks (N1-N10) have been integrated in the

subsequent studies. Different matters related to work within this subtask has thereafter been

communicated between partners as well as addressed at the fourth consortium meetings in

Umeå (May 2004). The integration of information and the development of the whole-body

vibration questionnaire were specifically addressed at that meeting.

The questionnaire has been translated to native language for Italy, the Netherlands, and

Sweden. A template database in Microsoft Access adopted for the questionnaires has been

developed in collaboration between the Italian and the Dutch partners.

The protocol for the assessment of whole body vibration exposure is included in the

epidemiological protocol (D4).

Future actions

Within the work package 4 (WBV support and integration of results) the subtask “preparation

for epidemiological and case studies of wbv” has delivered the intended material and is

thereby finished.

2.3.4.2.2 Task 4.2 Integration of findings and model development



The proposal for the measurements to be used as input for the FE-model in order to predict

spinal stress (WP6-N1) has resulted in a protocol adjusted to the epidemiological studies

conducted within the WP5. This proposal developed by FIOSH in interaction with the co-

partners specifies and defines measurements and documentation of exposure,

anthropometric and postural data to be obtained within the epidemiological studies

conducted in WP5 as basis of future modelling of spinal stress. The results have been

delivered to the German partners.

Future actions

The modelling to come within the forthcoming periods will integrate health outcomes with

predictive dose-response models based on statistical and mathematical methods.

2.3.4.2.3 Task 4.3 Provision of health surveillance guidelines

Future actions

The subtask of providing health surveillance guidelines is founded on the outcome of the

integration of findings from the epidemiological studies (WP5) and the modelling predictions.

This subtask starts during the last year of the project period,



Outputs (task #)

Delivery date

Type of deliverable

Project deliverable

Delivered by Delivered to

4.1.1Common methods for collection of data of WBV exposure, postural stress, signs & symptoms of spinal injury

6.2.1 5.1; 5.2 30-Jun-03 internal

resourcesUMUH; FIOSH


Trieste; AMC

4.1.2 Common methods: final definition 6.2.1 5.1; 5.2 30-Aug-03 internal report UMUH;

FIOSH


Trieste; AMC

4.1.4 Whole-body vibration methodology: procedure manual for WBV epidemiological studies . . 30-Nov-03 technical

report D4 UMUH UoS(coord)

4.1.5 Whole-body vibration methodology: updated procedure manual . . 31-May-05 technical

report D4.1 UMUH UoS(coord)

4.1.6 Whole-body vibration methodology: updated procedure manual . . 31-May-06 technical

report D4.2 UMUH UoS(coord)

4.2.2Statistical analysis, identification of important factors and model development: 1st technical progress report

5.0 . 31-Dec-05 annual report UoS(ISVR); UMUH UoS(coord)

4.2.4

Models describing associations between onset, severity and progression of spinal injury with exposure to WBV, and confounding variables: final report

5.0;6.1;6.2

4.3 30-Sep-06 technical report D17 UoS(ISVR);

UMUH UoS(coord)

4.3.1Investigation of whether disorders can be related to predictions of spinal stress, including WBV exposure

4.2; 5.0 30-Oct-06 internal report AMC UMUH,

UoS(coord)

4.3.2Investigation of measures of whether back pain can be influenced by intervention in association with health surveillance

4.2; 5.0 . 30-Oct-06 internal report AMC UMUH,

UoS(coord)

4.3.3 Health surveillance guidance for WBV exposed workers . . 30-Oct-06 internal report AMC UMUH,

UoS(coord)

4.3.5 Common procedures for occupational health screening and management: final report . . 31-Dec-06 technical

report D22 AMC; UMUH UoS(coord)

Work Package 4. WBV Support and integration of results

4.2 Integration of findings and model development

4.1 Preparation for epidemiological studies of WBV

4.3 Provision of health surveillance guidelines



2.3.5 Work Package 5 - WBV Epidemiological Studies

Start (month): 4 Duration (months): 42 Partner responsible: AMC

Partners: UoS Trieste UMUH AMC Total

Man-months: 28 12 21 24.5 85.5

2.3.5.1 Objectives

The objectives of Work Package 5 are to improve knowledge of the exposure-response

relationship between whole-body vibration and the development or recurrence of disorders

and identify factors that combine to result in the development or progression of the

symptoms of disorders so as to improve understanding of the benefits of health surveillance

and other intervention measures.

This is to be achieved by means of longitudinal epidemiological studies involving

investigators from four countries UoS(ISVR), Trieste, UMUH, AMC, and a case control study

of low back pain and intervertebral disc pathology by UoS(MRC).

2.3.5.1.1 Status and progress during the reporting period

In the reporting period (2004-01-01 to 2004-12-08), work has been focussed on the last

preparations for the initial studies, the (further) recruitment of the populations, and the

starting and conducting of the studies. First initial longitudinal studies of WBV exposed

workers were finished by Trieste, almost finished by UMUH, and started by AMC and by

UoS(ISVR). The case control study by UoS(MRC) is well on its way. Although, according to

the original Project Work Plan, there has been a delay in the recruitment of the populations

and the starting of some of the studies, the recruitment has, in general, resulted in higher

numbers of participating populations of exposed workers than originally was expected. This

will enable an analysis of the project results with a higher statistical power. Furthermore, data

from the WP5 epidemiological studies concerning exposure, anthropometric data, and

postural data have been forwarded as an input for model predictions in WP6.

2.3.5.1.2 Future actions

In the forthcoming year, the initial survey by UoS(ISVR) will be finished, and the 1st follow-up

surveys by Trieste, UMUH, and AMC will be started and (partly) finished by the end of the

year. In the case-control study, data collection and ongoing data entry will continue.



2.3.5.2 Longitudinal surveys of WBV-exposed workers in the Netherlands

After a delay in the planning of the studies due to a delay in completing of a vacancy in the

project team and a delay in the recruitment of populations during the first year, the initial

longitudinal survey is now well under way and almost finished. The survey is conducted in

three different industrial areas: construction industry, transportation industry, and

greenkeeping. So far, 359 exposed workers (drivers of earth moving machines, lawn mowing

machines, lorries and cranes) from 10 companies have received questionnaires; 3 additional

companies, all in construction industry, have recently confirmed participation. This will result

in an initial recruitment of a source population of, in total, more than 500 exposed workers.

Some of the populations, in particular in transportation, can be regarded as a low exposed

population. After an informative and instructing visit of Ivo Tiemessen, PhD-student in charge

of the longitudinal epidemiological study, to USL in Siena, vibration measurements at the

workplace and assessment of vibration exposure according to the Protocol of WP4 have

been carried out. Observation of tasks and posture in the participating companies was

conducted by use of the Palmtrac recording and analysis system. All questionnaire data have

been stored in an Access database.

For the purpose of the intervention study in a randomised part of the population, a brochure

and a leaflet for employers and employees have been developed. The intervention study will

start after the finishing of the initial survey in the first part of 2005.

2.3.5.3 Longitudinal surveys of WBV-exposed workers in Italy

In the calendar period from March 2003 to 30 June 2004, the Italian research team has

completed the initial (cross-sectional) survey of 598 workers occupationally exposed to WBV.

The study population shows a slight, positive, deviation compared to the original plan and

this is due to the inclusion of some additional vibration exposed worker groups: (i) 171 bus

drivers employed in Chiavari public utilities (Genoa, Italy); (ii) 42 drivers employed in Trieste

dockyard; (iii) 24 drivers employed in Modena public utilities.

In the same calendar period, vibration measurements have been carried out in the field by

the Physical Agents Laboratory of the Department of Prevention of NHS in Siena (a

subcontractor of UTRS). Vibration data, in terms of rms frequency-weighted and unweighted

rms acceleration, are now available for 12 fork-lift trucks, 6 wheel loader, 4 excavators, 3

track-type loader, 1 articulated truck, 1 off-road car, 1 mobile rock crusher, 1 container stake

truck, 1 freighter container truck, 5 mobile cranes, 5 garbage trucks, 1 garbage compactor, 7

mini-bus, and 12 city bus. Overall, vibration measurements were performed on 60 industrial

vehicles or machines.



Among the investigated WBV exposed workers, 110 are drivers employed in quarries (driving

of earth moving machines such as wheel loaders, excavators, track-type loaders, mobile rock

crusher, articulated trucks), 65 are drivers employed in stone laboratories (driving of fork-lift

trucks, mobile cranes), 77 are drivers employed in dockyards (driving of fork-lift trucks,

container stake trucks, freighter container trucks), 113 are drivers employed in paper mills

(driving of fork-lift trucks), 62 are drivers employed in public utilities (driving of garbage

trucks, garbage compactor, track-type loaders), and 171 are bus drivers (driving of mini-

buses, city buses).

Table 2.3.11 reports the distribution of the study populations by industry, machine, and

Province in Italy.

To investigate the effects of WBV on the neck-shoulder and the lower back, the Italian

research team has used the final version of the VIBRISKS WBV questionnaire prepared by

WP4. This questionnaire has been administered by trained occupational health physicians. A

Microsoft Access database has been created to include WBV questionnaire data. Vibration

measurement data have been stored in an Excel spreadsheet.

Data analysis has been performed using the statistical software Stata (version 8.2 SE, Stata

Corporation, 2003).

Table 2.3.11. Distribution of WBV exposed workers by industry, machine, and Province (Italy).

171 Chiavari Bus Public utilities

62 Siena Modena

Garbage truck, Garbage compactor, Track-type loader

Public utilities

65 Viareggio Mobile crane, Fork-lift truck Stone laboratory

110 Massa Carrara Lucca

Viareggio Trieste

Wheel loader, Excavator, Track-type loader, Articulated truck,

Rock crusher, Off-road car

Stone quarry

77 Massa Carrara Trieste

Fork-lift truck, Container stake truck, Freighter container tractor

Dockyard

113 Lucca Fork-lift truck Paper mill

No. Province Machine Industry



Table 2.3.12 reports the characteristics of the driver groups investigated by means of the

VIBRISKS WBV questionnaire. A one-way analysis of variance showed significant

differences in age (years), WBV exposure in current job (years), total WBV exposure (years),

and daily exposure to WBV (hours) among the various driver groups (p<0.001). On average,

bus drivers were older and had longer work seniority in previous and current jobs with WBV

exposure than the other groups. In addition to bus drivers, an important previous exposure to

WBV was also found in other drivers employed in public utilities (garbage machines).

Frequency-weighted r.m.s. acceleration of machines, in terms of either vector sum of

frequency-weighted accelerations according to ISO 2631-1 (Av, ms-2 r.m.s.) or dominant

acceleration component according to the EU Directive on mechanical vibration (Amax, ms-2

r.m.s.), was also significant different in the various driver groups. The highest WBV exposure

was found in drivers of earth moving machines employed in quarries.

Table 2.3.13 reports the prevalence of musculo-skeletal outcomes in the neck-shoulder and

the lower back of the driver groups. The prevalence of low back pain ranged between 6.2

and 42.1% in the last 7 days and between 53.3 and 70.8% in the last 12 months. The

prevalence of sciatic pain varied from 1.5 to 15.8% in the last 7 days and from 14.6 to 26.9%.

For neck pain, the prevalence was 9.1 to 28.1% in the last 7 days, and 35.5 to 52.1% in the

last 12 months. For shoulder pain, the prevalence was 1.5 to 15.2% in the last 7 days, and

12.3 to 31.0% in the last 12 months.

Table 2.3.12. Epidemiological studies of WBV exposed workers (Italy, cross-sectional survey, 2003-2004). Data are given as means (SD) or percentages.

Driver groups Variables Quarries

(n=110) Stone Labs (n=65)

Dockyards (n=77)

Paper mills (n=113)

Public utility (garbabe) (n=62)

Public utility (bus) (n=171)

Age (yrs) 41.0 (8.5) 40.7 (9.6) 37.5 (7.8) 41.8 (8.1) 42.2 (8.3) 43.6 (6.6)* WBV exp. in current job (yrs)

14.9 (9.8) 13.5 (8.8) 8.5 (7.7) 12.5 (8.7) 7.9 (6.1) 16.1 (8.5)*

Total WBV exp. (yrs)

16.9 (10.0) 16.5 (8.9) 9.4 (8.5) 14.9 (9.2) 16.1 (9.5) 19.9 (8.3)*

Daily exposure (hrs)

5.7 (2.6) 4.4 (2.9) 6.3 (1.0) 6.4 (2.0) 5.5 (0.8) 6.0 (0.8)*

AV (ms-2 rms) 0.65 (0.20) 0.72 (0.42) 0.56 (0.17) NA 0.35 (0.11) 0.56 (0.21)* Amax (ms-2 rms) 0.48 (0.17) 0.62 (0.36) 0.42 (0.14) NA 0.26 (0.07) 0.47 (0.19)*

% previous WBV exp.

26.4% 27.7% 19.5% 31.9% 71.0% 55.6%†

Oneway anova: *p<0.001; χ2 test: † p<0.001

The bus drivers showed the highest prevalence of neck pain, shoulder pain, low back pain,

and sciatic pain in the last 7 days and 12 months compared with the other driver groups. In



opposite, the severity score (VAS) and the Roland score for musculo-skeletal complaints was

lower in the bus drivers than in the other groups.

In addition to bus drivers, elevated prevalence of neck, shoulder and low back troubles was

also found in drivers employed in paper mills and garbage utilities. It is worth noting that the

proportion of subjects with WBV exposure prior to current job was significantly greater in

these three driver groups than in the other study populations.

The assessment of vibration exposure in terms of frequency-weighted energy-equivalent

r.m.s. acceleration magnitude (A(8)), as well as the assessment of postural overload, in the

various driver groups are in progress. Further data analysis will evaluate the relation between

neck-shoulder and lower back musculo-skeletal outcomes and exposure to WBV and

postural overload, adjusted for potential confounders such as age, anthropometric

characteristics, smoking and drinking habits, and other personal risk factors.

Table 2.3.13. Musculo-skeletal outcomes in the WBV exposed workers (Italy, cross-sectional survey, 2003-2004). Data are given as percentages or medians. LBP is low back pain. VAS is visual analogic scale.

Driver groups Outcome Quarries

(n=110) Stone Labs (n=65)

Dockyards (n=77)

Paper mills (n=113)

Public utility (garbage) (n=62)

Public utility (bus) (n=171)

LBP in the last 7 days 15.5 6.2 26.0 27.4 25.8 42.1‡ LBP in the last 12 months

56.4 53.9 53.3 62.8 61.3 70.8†

Sciatic pain 7days 4.6 1.5 3.9 7.1 4.8 15.8‡ Sciatic pain 12 months

14.6 16.9 22.1 19.5 19.4 26.9

VAS LBP (median) 4.0 2.5 4.5 5.0 5.0 4.0** Roland score (median)

12 9 11 5 4 4**

Neck pain 7 days 9.1 13.9 13.0 17.7 24.2 28.1‡ Neck pain 12 months 35.5 41.5 32.5 44.3 46.8 52.1† VAS neck (median) 5.5 3.0 3.0 6.0 5.0 3.0** Shoulder pain 7 days 8.2 1.5 2.6 10.6 8.1 15.2‡ Shoulder pain 12 months

20.0 12.3 13.0 27.4 22.6 31.0‡

VAS shoulder (median) 6.0 5.0 7.5 4.0 5.0 2.5*

Kruskal-Wallis test: *p<0.01; **p<0.001; χ2 test: † p<0.05; ‡ p<0.001

Meanwhile, the 1st follow up has started on September 2004. The follow up will consist of re-

examination of the drivers groups using a follow up questionnaire prepared by VIBRISKS

WP4. Changes in personal attributes, exposure conditions and musculo-skeletal complaints

will be monitored by the follow up questionnaire. Similarly, any change in vibration exposure

(e.g. introduction of new machines) will be evaluated performing vibration measurements in

real operating conditions, if necessary.



2.3.5.4 Longitudinal surveys of WBV-exposed workers in Sweden

The Swedish study base encompasses 320 male professional drivers of forestry vehicles,

such as harvesters and forwarders, recruited from a source population of about 500 men,

with three planned annual follow-ups.

The mean age of the study group was 43 years, standard deviation 12.2 years (minimum-

maximum range 19 - 65 years). The drivers were randomly selected from the general

population of drivers in the northern region of Sweden.

The base-line study was conducted, with respect to the assessment of health and exposure

for vibration and postural stressor, according to the protocol for epidemiological studies

developed in VIBRISKS WP4 (WP4-D4. WBV Epidemiological protocol). Symptoms of

disorders, after some minor adjustments for study group characteristics and local test

conditions, were determined using a Swedish translation of the “VIBRISKS” self administered

questionnaire (WP4-N6 Self administrated questionnaire in Swedish). The questionnaire was

mailed together with a prepaid return envelope to the workers home addresses.

The study plan with suggested methodological developments were included in the final study

protocol and has been approved by the local ethical committee (Um dnr.03-353).

A sub-sample of 10 drivers (5 foresters and 5 harvesters) has been measured according to

the extended measurement protocol to be used in WP6 as input for the FE-model in order to

predict spinal stress (an integral part of the draft protocol for epidemiological studies

developed in VIBRISKS WP4). Preliminary results indicate a r.m.s. (ms-2) of 0.6-1-1 and a

Crest factor of 4->9 for forwarders. The mean duration of the exposure estimated as working

hours / week, assessed as exposure to WBV based on data obtained from the VIBRISKS

self administered Questionnaire (Section 2 Occupational history) was 32,2 (1-55) and 24,8

(1-65) for harvesters and forwarders respectively.

The preliminary results from health outcome indicates a 7 days prevalence of 30-40 for pain

and discomfort in the area off the neck, lower back, wrist /hands and knees. The rated

intensity of pain, on a 0-10 scale, during a typical day in the last 7 days was close to 4 for

neck and shoulders and a little bit lower for the back. The results from the baseline

questionnaire are coded in a dataset and the cases where supplementary information was

needed has been gained by additional interviews by telephone. The results are as yet

presented as descriptive statistics (e.g. Tables 2.3.13 and 2.3.14). The posture and vibration

exposure measurements has been collected and delivered. The preparation for a report has

started.



Table 2.3.13. Characteristics of the study population “forestry workers”(VIBRISKS Sweden cross-sectional survey. Data are given as medians and (range= lowest and highest value) or numbers (%).

Non exposed (n=137) WBV exposed (n=192) Age (yrs) 44,5 (19-65) 42,5 (21-64) Height (cm) 178 (159-195) 179 (164-198) Weight (kg) 83 (60-130) 85 (60-130) BMI (Kg/m2) 26,1 (20,0-42,5) 26,9 (19,6-36,3) Smokers (n) 31 (26,7%) 45 (23,8%) Drinkers (n) 105 (92,1%) 176 (93,1%) Daily WBV exposure (min) car 465 (90-1215) 375 (75-900) Daily WBV exposure (min) forestry 3600 (2400- 4800) 2520 (1020-4200)

The baseline information was collected during the spring of 2004. The initial base-line

assessment was initially delayed by slow responses. The drivers of forestry vehicles work

long days and many work away from their home address, which also contributed to additional

delays. Introducing additional compensation by sending lottery tickets increased the

response speed and rate.

The initial study protocol was based on a study group of 100 male drivers. An expected

possible low response rate and a fear of loss to follow-up might jeopardize the power of the

study. An additional 400 drivers were therefore merged to the study group.

Table 2.3.14. Prevalence of upper limb disorders in the ”no exposed” and “exposed” forestry workers in the study population “workers”(VIBRISKS Sweden cross-sectional survey). Numbers and (%). Prevalence ratios (PR) and 95% confidence intervals (95% CI) are reported, assuming the controls as the reference category (PR=1,0).

Non exposed (n=137)

WBV exposed (n=192)

Prevalence ratio WBV exposed

95%CI

Low back pain (7d last y) 20 (16,8%) 80 (41,7%) 1,51 1,13-2,01 Neck pain (7d last y) 29 (24,4%) 91 (47,4%) 1,43 1,08-1,90 Shoulder (7d last y) 19 (16,0%) 62 (32,3%) 1,35 1,00-1,83 Stress (burn out) 21 (21,2%) 55 (37,9%) 1,35 0,97-1,89

2.3.5.5 Longitudinal surveys of WBV-exposed workers in United Kingdom

The ISVR/MRC at Southampton is proceeding with a cross-sectional study involving one

initial survey and one follow-up after a year. The study involves three groups occupationally

exposed to low levels of vibration: (i) 861 Southampton taxi drivers, (ii) 810 police car drivers.



In addition, (iv) 105 police control operators, and (v) 100 traffic wardens will be used as

control groups.

The self-administered questionnaire conforms to the structure of questionnaires used by

VIBRISKS research partners and determines:

• Occupational history, current job, employment status and weekly working hours

• Current and historical exposure to WBV at work (details of vehicle, amount of driving,

drive environment, presence of back support, etc.)

• Potential risk factors which can load the back (frequent heavy lifting, twisting,

bending, seating position in the job)

• History of LBP in past year, past month, past week and when last present

• Lost work time due to LBP over past 12 months

• Psychosocial well-being, health beliefs, illness behaviour

• Information about risk factors (age, anthropometry, smoking habits, etc.)

Field Measurements are also being performed to determine:

• Vibration exposure

• Driving durations

• Physical risk factors (posture, twisting in seat, lifting tasks, etc.)

Data collection commenced from taxi drivers in November 2004, with the distribution of the

first questionnaires. The first results will be available during March 2005. Ethical approval for

the surveys of police populations was obtained during December 2004, allowing data

collection to commence during early 2005. It is expected that the first results will be available

during May 2005.

2.3.5.6 Case control study of WBV-exposed workers in the United Kingdom

This case-control study has the objective to determine whether exposure to whole-body

vibration contributes to prolapsed intervertebral discs, and to establish procedures for

predicting risk. It concerns patients presenting to Southampton hospitals for MRI scan of the

lumbar spine because of low back pain. The history of exposure to whole-body vibration and

other physical and psychosocial risk factors for back pain will be compared with that of



controls presenting to accident and emergency department radiology services with other

diagnoses.

Since the last annual report we have (i) obtained ethical approval for the study for the

inclusion of cases from two local private hospitals, (ii) obtained permission to approach

patients from the referring consultants in rheumatology and orthopaedics, (iii) had the

questionnaires and return envelopes professionally printed, (iv) carried out pilot surveys to

find the most suitable way of obtaining lists of cases (different at each hospital) and of

controls, (v) ensured MRI films will be retained and be available for assessment at a later

date in the study, (vi) sent questionnaire mailings and reminders out to cases and controls

from November 2003 to July 2004, and (vii) entered data to the computer database as it is

received (ongoing).

Initial delays relating to obtaining ethical permission have been overcome with both private

hospitals now providing data too (one since December 2003 and one since March 2004).

Recruitment, based on the first nine months, is better than in the original study plan. In nine

months we have sent questionnaires to 212 cases and 638 controls, with a response rate of

54% for cases and 43% for controls. This means the power of the study is improved over the

original plan (Table 2.3.15).

Our expected timetable is that data collection and ongoing data entry will continue until

October 2006 with analysis from December 2006.

Table 2.3.15. Power of the study compared with the original plan

Exposure (eVDV) Prevalence of exposure* OR to be detected (original plan)

> 8.5 15.3% 1.6 (1.8) > 15 3.5% 2.2 (2.5)

*Palmer et al . Occup Environ Med 2000; 57: 229-236




Activity Description Inputs (task #)

Outputs (task #)

Delivery date

Type of deliverable

Project deliverable

Delivered by

Delivered to

5.1.1.1 Initial dose-response epidemiological surveys in Italy 4.1 4.2 30-Nov-03 annual report Trieste AMC;

UMUH

5.2.1.1 Planning of case-control epidemiological survey in UK 4.2 30-Nov-04 annual report UoS(MRC) AMC;

UMUH

5.0.1.1 WBV dose-response epidemiological surveys 1st year: annual report 30-Nov-03 annual report AMC UoS(Coord)

5.1.1.2 1st follow-up epidemiological surveys in Italy 5.1.1.1 4.2 30-Nov-04 annual report Trieste AMC; UMUH

5.1.2.2 Initial dose-response epidemiological surveys in Sweden 4.2 30-Nov-04 annual report UMUH AMC;

UMUH

5.1.3.2 Inititial dose-response epidemiological surveys in the Netherlands 4.2 30-Nov-04 annual report AMC AMC;

UMUH

5.1.4.2 Initial dose-response epidemiological surveys in UK 4.2 30-Nov-04 annual report UoS(ISVR) AMC;

UMUH

5.2.1.2 Progress in case-control epidemiological survey in UK 5.2.1.1 4.2 30-Nov-04 annual report UoS(MRC) AMC;

UMUH

5.0.1.2 WBV dose-response epidemiological surveys 2nd year: annual report 31-Jan-05 technical report D7b AMC UoS(Coord)

5.0.3.2 Anthropometric and postural data for model predictions

5.1;5.2. 6.2 28-Feb-05 internal report Trieste,

AMC UoS(Coord)

5.1.1.3 2nd follow-up epidemiological surveys in Italy 5.1.1.2 4.2 30-Nov-05 annual report Trieste AMC; UMUH

5.1.2.3 1st follow-up dose-response epidemiological surveys in Sweden 5.1.2.2 4.2 30-Nov-05 annual report UMUH AMC;

UMUH

5.1.3.3 1st follow-up dose-response epidemiological surveys in the Netherlands 5.1.3.2 4.2 30-Nov-05 annual report AMC AMC;

UMUH

5.1.4.3 1st follow-up dose-response epidemiological surveys in UK 5.1.4.2 4.2 30-Nov-05 annual report UoS(ISVR) AMC;

UMUH

5.2.1.3 Progress in case-control epidemiological survey in UK 5.2.1.2 4.2 30-Nov-05 annual report UoS(MRC) AMC;

UMUH

5.0.1.3 WBV dose-response epidemiological surveys 3rd year: annual report 31-Jan-06 technical report D7c AMC UoS(Coord)

5.0.2.3 WBV case-control epidemiological surveys: final report 31-Jan-06 technical report D8 AMC UoS(Coord)

5.0.3.3 Acceleration data over typical work cycles for model predictions

5.1;5.2. 6.2 31-Aug-05 internal report AMC UoS(Coord)

5.1.1.4 Third follow-up epidemiological surveys in Italy 5.1.1.3 4.2 30-Nov-06 annual report Trieste AMC;

UMUH

5.1.2.4 2nd follow-up dose-response epidemiological surveys in Sweden 5.1.2.3 4.2 30-Nov-06 annual report UMUH AMC;

UMUH

5.1.3.4 2nd follow-up dose-response epidemiological surveys in the Netherlands 5.1.3.3 4.2 30-Nov-06 annual report AMC AMC;

UMUH

5.1.4.4 2nd follow-up dose-response epidemiological surveys in UK 5.1.4.3 4.2 30-Nov-06 annual report UoS(ISVR) AMC;

UMUH

5.2.1.4 Final Report on case-control epidemiological surveys in UK 5.2.1.3 4.2 30-Nov-06 annual report UoS(MRC) AMC;

UMUH

5.0.1.4 WBV dose-response epidemiological surveys 4th year: final report 31-Dec-06 technical report D7d AMC UoS(Coord)

Work Package 5. Epidemiological studies of WBV exposed workers

WBV epidemiological studies - second year

WBV epidemiological studies - first year

WBV epidemiological studies - fourth year

WBV epidemiological studies - third year



2.3.6 Work Package 6 - WBV experimental work

Start (month): 1 Duration (months): 39 Partner responsible: FIOSH

Partners: UoS FIOSH UMUH Total

Man-months: 5 20.5 1 26.5

2.3.6.1 Objectives

The overall objectives of Work Package 6 are to develop a practical method for the prediction

of spinal stress during selected exposures to whole-body vibration, based on a combination

of postural forces and vibration exposure.

2.3.6.2 WBV Laboratory studies and biodynamic modelling (task 6.1)

2.3.6.2.1 Laboratory experiments

Specific objectives and summary of achievements in the reporting period

Specific objectives in the reporting period were (1) to elaborate a basis for the selection of

subjects for laboratory experiments, (2) to implement new methods for the control of the six

degree of freedom (6 DOF) motion simulator (“FIOSH-Hexapod”) duly considering the

Standard ISO 13090-1, (3) to realise all methods for measurements of human biodynamics

under the condition of the 6 DOF-simulator, and (4) to elaborate and put into operation a

real-time synchronisation system.

Selection of subjects for laboratory experiments

The anthropometric characteristics of drivers were derived from a literature review and

compared with the data of the normal population in Germany (Figure 2.3.6). They are clearly

different from those of the normal population. Differences and anthropometric data obtained

with WP5 will be considered with the design of laboratory experiments and modelling.

Control of the HEXAPOD simulator

A method for the control of the FIOSH Hexapod simulator, with a time-sliced iteration

procedure, was successfully implemented. By this method, the desired acceleration signal

can be accurately reproduced in the time domain (Figure 2.3.7). The safety of the subjects is

ensured by an additional new “guarding”-procedure that allows the specification of a

response tunnel. This is a response file that is used as a guard around the realised response

during drive file playback. This safety measure (that works purely in the time domain, without

any frequency weighting) is better than the current regulations in ISO 13090-1, because it is



the only possibility to permit - without any risk - relatively high peak accelerations with a high

frequency content, without the risk of permitting similar, but much more dangerous, high

peak values at lower frequencies. Its implementation is an essential prerequisite for the safe

exposure to high transients and repetitive shocks.

Figure 2.3.6. Average body mass of 3 percentiles (P) of drivers and normal population

Figure 2.3.7. Control of the FIOSH-Hexapod. Example of the difference (green) between fragments of the target drive file acceleration (red) and measured final acceleration response after the last iteration (blue).

Measurements of human biodynamics, and operation of a real-time synchronisation system

Methods for measurements of accelerations (WBV input and accelerations of body parts),

forces at the interfaces with the subject (foot support and seat), and motion analysis

(measurement of postures) were elaborated. Figure 2.3.8 shows the newly developed rigid

seat with test masses.

The recently developed synchronization system is based on a National Instruments Real

Time PC with a special software elaborated exclusively for the use with human vibration

experiments in the FIOSH. Within certain restrictions, the system permits an automatic start,

stop and timing of the 6 DOF simulator and numerous devices for data acquisition at freely

programmable intervals, thus ensuring a high quality of experimental work.

The whole equipment was successfully tested in a human experiment (Figure 2.3.9). The first

results show the expected results, e.g. the maximum magnitude of the apparent mass

decreased with the increase of the intensity and occurred at lower frequencies (Figure

2.3.10).

This pilot experiment was performed with a white noise acceleration input in the frequency

range 0.3 – 30 Hz for a duration of about 65 seconds and magnitudes of 0.3, 1.0 and 2.0

ms-2 rms (non-weighted).



Figure 2.3.8. Newly developed rigid test seat with rigid masses for testing the stiffness of the force measurement system

Figure 2.3.9. Subject during the pre-test of the experimental study

Figure 2.3.10. Magnitude of the apparent mass in x- (top), y- (middle), and z-direction (bottom) during the exposure with three intensitities (0.3 ms-2 rms, 1.0 ms-2 rms and 2.0 ms-2 r.m.s.)



2.3.6.2.2 Extension of an existing numerical model to predict spinal load from combinations of

force arising from posture and WBV


Specific objectives were (1) the extension of an existing numerical model to predict the load

on the spine from combinations of forces arising from body postures found in field conditions

(WP 5) and whole-body vibration, (2) elaboration and providing parameters enabling a

verification of the model by other partners.

Extension of an existing numerical model

Based on the results of an experimental study, the existing FE-model to predict the load on

the spine was extended with respect to its applicability with WBV in x- and y-axes, the

consideration of more anthropometric characteristics, seven angles describing the sitting

posture, and a more detailed reflection of muscles, i.e. the model considered 51 fascicles

each side. The extended model was adapted to 5 different postures derived on the basis of

picture documents (delivered by WP5) showing drivers of different machines at their

workplace, examples see Figure 2.3.11. A higher health risks is supposed at the workplaces

chosen.

Figure 2.3.11. Biodynamic models adapted to the postures of drivers

Model parameters and verification

Model calculations of the impedance and transmissibility were performed and will be

provided to UoS (ISVR) and UMUH for verifications against their own biodynamic data.

Examples are presented in Figure 2.3.12.



Figure 2.3.12. Magnitude and phase calculated for Model No. 1 shown in Figure 2.3.11.

2.3.6.3 Analysis of the field measurements from WP5 to provide stress predictions (task 6.2)


FIOSH and partners in WP5 agreed on measurements and data that are required for this

task and will be provided until the end of 2004 and the middle of 2005, respectively. First

results of WP5 have been analysed, and parameters for the adaptation of FE-models that will

provide stress prediction were derived. Adapted models were developed that reflect the

postures of drivers during the field measurements. Postures were characterised by typical

angles, see Table 2.3.16.

Table 2.3.16. Angles describing the sitting postures of drivers of 5 different field conditions





Outputs (task #)

Delivery date

Type of deliverable

Project deliverable

Delivered by Delivered to

6.1.1 Laboratory experiments involving a minimum of 20 subjects . 6.1.2 31-Jul-05 internal report FIOSH

UoS(coord); UoS(ISVR);

UMUH

6.1.2

Extension of existing numerical model to predict spinal load from combinations of force arsing from posture and WBV

6.1.1 6.1.3;6.1.4 30-Apr-05 internal report FIOSH

UoS(coord); UoS(ISVR);

UMUH

6.1.3 Supply of ISVR biodynamic data for testing of model 6.1.2 . 30-Aug-05 internal report UoS(ISVR) FIOSH;

UoS(coord)

6.1.4 Supply of UMUH biodynamic data for testing of model 6.1.2 . 30-Aug-05 internal report UMUH FIOSH;

UoS(coord)

6.1.5 Practical model for prediction of spinal stress: 1st annual report . . 30-Nov-03 annual report FIOSH UoS(coord)

6.1.6 Practical model for prediction of spinal stress: 2nd annual report . . 30-Nov-04 annual report FIOSH UoS(coord)

6.1.7 Practical model for prediction of spinal stress: 3rd annual report . . 30-Nov-05 annual report FIOSH UoS(coord)

6.1.8 Practical model for prediction of spinal stress: final report . 4.2 31-Jan-06 technical report D18 FIOSH UoS(coord);

UMUH

6.2.1Application of model to representative time histories measured in WP5

6.1;5.1;5.2.

4.2 30-Nov-05 internal report FIOSH UoS(coord); UMUH

6.2.3 Modelled stress predictions: final report . 4.2 30-Apr-06 technical report D19 FIOSH UoS(coord);

UMUH

Work Package 6. WBV experimental work

6.2 Stress predictions from field measurements

6.1 WBV experimental and modelling studies



3 Role of Participants

3.1 Details of participating organisations

Details of the participating organisations are shown in Appendix 1.

3.2 Participant 1. UoS (Co-ordinator)

Institute of Sound and Vibration Research (ISVR) and Medical Research Council (MRC) Environmental Epidemiology Unit at the University of Southampton, U.K.

3.2.1 Objectives and Workplan

WP Effort (months) RTD Roles and Objectives Deliverables Month

1 8.5 Work Package Leader. Definition of protocol for HTV epidemiological studies Provision of expertise and training in objective testing and epidemiological methods. Statistical analysis and definition of dose-response models.

D3, D13 6, 45

2 14 Epidemiological HTV natural history surveys in U.K. Analysis of vibration exposure data.

D5a-d 24, 36, 48

3 9.5 Experimental investigations of vascular effects (in collaboration with Trieste). Definition of the test conditions for objective measurement. Verification of biodynamic models.

D15 36

4 6 Provision of expertise and training in epidemiological methods. Statistical analysis and definition of exposure-response models.

D17 45

5 28 Epidemiological WBV surveys and case control studies in U.K.

D7(UK)b-d, D8

24, 36, 48

6 5 Verification of biodynamic models. 7 20 Work Package Leader

Project co-ordination and reporting. Authoring and hosting of project web pages. Organisation of 2nd international workshop on the diagnosis of hand-transmitted vibration injuries. Dissemination to Standards organisations. Scientific publications and conference presentations.

D1, D2, D9(a-c), D11, D12, D23

4, 6, 12, 24, 27, 36, 48

Total 91



3.2.2 Research activities during the second reporting period

Work Package 2

Ethical permission to conduct the HTV natural history survey has been sought and obtained

from the Health and Safety Executive (HSE). Formal negotiations with management and

trade unions have resulted in approval to conduct the study at BAE plc. Consent forms,

questionnaires and instruction sheets have been drafted and approved and produced for the

staff at BAE.

Work Package 3

Experimental studies of the acute vascular effects of exposure to push force and vibration,

and of the influence of prior vibration exposure were jointly conducted with Partner 2

(Trieste), at ISVR during March 2004. Data analysis has been performed and results have

been presented at the mid-term review and the 5th Consortium meeting held in Trieste on 9 -

11 December 2004.

Work Package 5

Data collection for the cross-sectional WBV survey commenced from taxi drivers in

November 2004, with the distribution of the first questionnaires. The first results will be

available during March 2005. Ethical approval for the surveys of police populations was

obtained during December 2004, allowing data collection to commence in early 2005. It is

expected that the first results will be available during May 2005.

Case selection for the WBV case-control study has been ongoing from the three participating

hospitals, including control selection from Southampton General Hospital since November

2003 as cases have arisen. Postal questionnaires have been sent to all participants with

reminders as necessary. Information is being entered on the study database as

questionnaires are returned. All MRI films have been secured for later examination. The

number of cases and controls being included in the study is currently on target.

Dissemination

A paper was presented to the 10th International Conference on Hand-arm Vibration,

presented a paper describing the VIBRISKS project. A paper acknowledging support of the

project was also presented at the 2004 UK Conference on Human Response to Vibration.



3.2.3 Significant difficulties or delays during the second reporting period

Additional funding for the WP2 Epidemiological HTV natural history survey was only secured

from the HSE in June 2004 and the original industrial partner withdrew from the project

resulting in the need to renegotiate a suitable industrial partner and a delay to the starting

date. However, this has resulted in a more comprehensive study plan with the entire sub-

sample of workers with mild-disease at base-line to be followed up and extra office tests

being incorporated at all time points.



3.3 Participant 2: Trieste

Clinical Unit of Occupational Medicine, Trieste General Hospitals, National Health Service and University of Trieste, Italy

3.3.1 Objectives and Workplan:


1 4 Definition of questionnaires for HTV surveys Provision of expertise and training in objective testing and epidemiological methods. Statistical analysis Definition of improved occupational health guidelines for HTV.

D21 48

2 12.5 Work Package Leader Epidemiological HTV dose-response surveys in Italy. Analysis of vibration exposure data.

D5(I)a-d 14, 24, 36, 48

3 7 Experimental investigations of vascular effects (in collaboration with UoS). Definition of improved methods for evaluating HTV.

D14 36

4 4 Provision of expertise and training in epidemiological methods. Statistical analysis.

5 12 Epidemiological WBV dose-response surveys in Italy.

D7(I)a-d 14, 24, 36, 48

7 0.5 Dissemination to national societies of occupational medicine for preparation of national guidelines for assessment of vibration exposure. Scientific publications and conference presentations.

Total 40


Work Package 1

(i) (ii) A final version of the HTV questionnaire for the initial cross-sectional survey

has been prepared and distributed to the WP2 task leaders. A draft version of the

HTV questionnaire for follow up studies has also been implemented and discussed

with the WP1 Leader. A pilot follow up questionnaire will be tested in the 1st follow

up study of Italian HTV workers;

(iv) Expertise and training in objective testing has been provided to occupational health

physicians, technicians and nurses involved in epidemiological studies in Italy.

About 2.5 man-months have been devoted to WP1 so far.



Work Package 2

(i) The initial cross-sectional study of Italian HTV workers (n=257) and controls (n=139)

has been completed on June 2004. Questionnaire data, findings of cold provocation

test with measurement of finger systolic blood pressures, findings of grip force and

manual dexterity have been stored in an ad-hoc Access database. Descriptive

analysis of questionnaire data and cold provocation test results, as well as some

aspects of exposure – response relationship of cross-sectional data, have been

performed by using the statistical software Stata v. 8.2 SE in July – October 2004.

The results have been presented at the mid-term review and the 5th Consortium

meeting held in Trieste on 9 – 11 December 2004. The 1st follow up study was

started in November 2004. Vibration measurement data have been stored in an Excel

spreadsheet and processed in terms of frequency-weighted and unweighted r.m.s.

acceleration magnitudes.

About 6 man-months have been devoted to WP 2 so far.

Work Package 3

(i) An experimental study of the acute vascular effects of exposure to push force and

vibration (experiment 3 of the workplan) was conducted at ISVR (UK) in March 2004.

Data analysis have been performed and results have been presented at the mid-term

review and the 5th Consortium meeting held in Trieste on 9 – 11 December 2004.

(ii) An experimental study of the influence of prior vibration exposure on the diagnostic

test to be used in epidemiological investigations (cold provocation test with

measurement of fingers systolic blood pressure) was conducted at ISVR (UK) in

March 2004. Data analysis have been performed and results have been presented at

the mid-term review and the 4th Consortium meeting held in Umea (Sweden) on May

2004.


Work Package 4

(i) Trieste has contributed to the preparation of the WP1 manual for the protocol to be

adopted for WBV epidemiological studies.

About 1.0 man-months have been devoted to WP 3 so far.



Work Package 5

(i) The initial cross-sectional study of Italian WBV workers (n=598) has been completed

on July 2004. The results have been presented at the mid-term review and the 5th

Consortium meeting held in Trieste on 9 – 11 December 2004. The 1st follow up

study was started in September 2004.


Dissemination

(i) Guidelines for evaluation and assessment of vibration exposure and for medical

surveillance of HTV and WBV workers have been prepared by the Italian research

team. The guidelines have been adopted officially by the Italian Society of

Occupational Medicine and Industrial Hygiene and a manual has been published

(Publisher: Maugeri Foundation books, vol. 5, 2003, ISBN 88-7963-158-6).

(ii) The results of experiment 2 within WP3 (“Acute effects of continuous and intermittent

vibration on finger circulation “, authors: M. Bovenzi, A.J.L. Welsh, M.J. Griffin) has

been published in the peer-reviewed journal International Archives of Occupational

and Environmental Health 2004; 77: 255-263.

(iii) A paper with acknowledgement to the European Commission under the VIBRISKS

project has been presented at the 10th International Conference on Hand-Arm

Vibration held in Las Vegas (US) on June 2004.

(iv) The Subcontrator of Trieste (USL7, Siena) has organised in Siena a Workshop

dedicated to human vibration and the development of the VIBRISKS project on 10 –

11 November 2004. The Workshop was attended by about 80 occupational health

physicians, technicians and nurses coming from the Italian Regions involved in the

VIBRISKS project (Tuscany, Friuli Venezia Giulia).

About 0.5 man-months have been devoted to WP 7 so far.


No particular difficulties or delays have been registered in the second reporting period. A

slight delay in the final implementation of the HTV follow up questionnaire occurred, but this

may be due to the fact that the various WP2 partners have started the cross-sectional

studies at different times.



3.3.4 Subcontracted activities during the second reporting period

The subcontractor of Trieste) is the Laboratory of Physical Agents, Department of

Prevention, AUSL 7, Regione Toscana, National Health Service, Siena, Italy.

The services to be performed by the Subcontractor are the following: (i) vibration

measurement in the field and assessment of vibration exposure; (ii) data acquisition, data

analysis, data reports; (iii) measurement campaigns to characterise vibration exposure in

work activities with exposure to HTV and WBV.

So far, the Subcontractor has provided vibration measurement data for 66 hand-held

vibrating tools (WP2 – HTV epidemiological studies) and 60 industrial vehicles or machines

(WP5 – WBV epidemiological studies). At least three vibration measurements for each tool

and machine have been performed in different operating conditions. Vibration spectra have

been stored and processed in terms of frequency-weighted r.m.s. acceleration magnitude

(ISO 5349-1, ISO 2631-1) and unweighted r.m.s. acceleration magnitude.

For all vehicles or machines measured, the Subcontractor is providing FIOSH (WP6 – WBV

experimental work) with samples of acceleration time histories, as well as with drivers’

anthropometric data and digital photos of drivers’ posture while driving, for the

implementation of biodynamic models spinal force predictions.



3.4 Participant 3: FIOSH

Federal Institute for Occupational Health, Berlin, Germany

3.4.1 Objectives and Workplan:


4 3 Integration of experimental and epidemiological results into exposure-response models

6 20.5 Work Package Leader Laboratory experiments. Modelling of spinal system. Analysis of vibration exposure data.

D18, D19 36, 39

7 0.5 Dissemination to Standards organisations and national societies of occupational medicine for preparation of national guidelines for assessment of vibration exposure. Dissemination to industry. Scientific publications and conference presentations.

Total 24


Laboratory experiments were carefully prepared up to the stage of a first successful human

experiment with a rigid seat in order to determine the impedance with an excitation of white

noise in 3 translational axes, 3 magnitudes, and using two force plates. The implementation

of safety and ethical aspects required considerable effort, due to the conditions of a powerful

six-degree-of-freedom electro-hydraulic simulator. An anthropometric data base was created

in FIOSH as the basis for the selection of subjects and model calculations. An existing

mathematical model was significantly extended. From this extended model, special models

were derived that reflect postures observed under field conditions. A concept for the

processing of predicted spinal forces consisting of static and dynamic components was

developed and discussed with partners.


The use of the FIOSH-Hexapod simulator has been disturbed by a series of events that

happened between November 2003 and March 2004. Events started with a failure of the

pump and proceeded by a failure of the bypass valve, of the actuators, and further technical

devices. Due to these failures, the control upgrade of FIOSH-Hexapod was delayed, too.

Considering these difficulties, an adjustment of the time schedule for the internal report

"Laboratory experiments involving a minimum of 20 subjects" (delivery date: 31-Dec-04) is

desirable. A postponement by about six month is proposed.



3.4.4 Subcontracted activities during the second reporting period

The activities of the subcontractor WBI covered the extension and adjustment of an existing

numerical model to predict the load on the spine from combinations of forces arising from

body postures and whole-body vibration. The subcontractor provided model calculations of

the impedance and transmissibility that will be used by other partners for verifications against

their own biodynamic data.



3.5 Participant 4. UMUH

Department of Biomedical Engineering and Informatics, University Hospital of Northern Sweden.

Objectives and Workplan:


1 4 Assistance with integration of HTV data and dose-response model development.

2 21 Epidemiological HTV dose-response surveys in Sweden. Analysis of vibration exposure data.

D5(S)b-d 24, 36, 48

3 9 Experimental investigations of sensorineural effects of HTV. Assistance with definition of the test conditions for objective measurement. Verification of biodynamic models.

4 3.5 Work Package Leader Definition of protocol for WBV epidemiological studies Assistance with integration of WBV data and dose-response model development.

D4 6

5 21 Epidemiological WBV dose-response and intervention surveys in Sweden.

D7(S)b-d 24, 36, 48

6 1 Verification of biodynamic models. 7 0.5 Assistance (to INRS) with organisation of 3rd

international conference on whole-body vibration injuries. Dissemination to Standards organisations. Scientific publications and conference presentations.

Total 60


Work Package 1

The protocol for clinical examination of the HTV exposed workers and controls and self-

administered questionnaire have been translated into Swedish and tested. The partner has

participated in development of a dose-response model. A matrix for assessment of HTV data

has been developed.

Work Package 2

We obtained registries of students that had graduated from vocational high schools in 2001,

2002 and in 2003 in northern and western Sweden. The programs were construction, auto

mechanics and restaurant (originally 3000 asked). We used a short screening questionnaire

with questions comparable to SAQ but less detailed. A study base of 1868 young workers



(1561 men and 307 women) that answered the screening questionnaire was the base for

setting up the Swedish VIBRISKS HTV cohort. The results from the screening have been

analysed and presented. We have young workers with different levels of HTV exposure. A

total of 1083 workers from the screening questionnaire volunteered and were given a

baseline questionnaire according to the SAQ VIBRISKS protocol (WP1). Annual follow-ups

were scheduled so that the 1st follow up will be in October 2005 and the 2nd in October

2006. From the 1068 base we have enlisted 200 healthy young workers in a sub-cohort

(according to original plan). These 200 workers have different level of HTV exposures. The

effect measurement includes physical examination and testing (FSP finger systolic blood

pressure, temperature perception thresholds, vibrotactile perception thresholds, manual

dexterity, muscle strength). Examination and measurement are done according to the

VIBRISKS protocol (WP1). Data collection is going on at present and 120 examinations have

been performed now (December 2004). The remaining 80 examinations were scheduled to

January-February. Follow-ups with the same measurements were scheduled to be

completed in October-November 2006. Exposure assessment includes measurements at the

young workers work-places during 2005.

Work Package 3

The design of the experimental studies has been completed. Three controlled laboratory

experiments were set up. Additional support funding has been approved from the Swedish

council for working life and social research. The Ethical Committee of Umeå University has

approved the studies. Laboratory studies on neurological effects of HTV have been

scheduled January – October in Umeå 2005.

Work Package 4

Epidemiological protocol for WBV exposed workers has been developed together with a self-

administered questionnaire for workers exposed to WBV and controls. The questionnaire has

been translated into Dutch, Italian and Swedish and tested. A phone conference concerning

effect measures of low back pain was held with participating partners together with

orthopedic surgeons with expertise in low back pain epidemiology. A main conclusion was

that clinical examination of cases (defined by the criteria in the self-administered

questionnaire) would not add significant value to the epidemiologic studies.

Work Package 5

A cohort of 340 drivers of forestry was created. The drivers were randomly selected from the

general population of drivers in the northern region of Sweden. The base-line study was



conducted according to the protocol for epidemiological studies developed in VIBRISKS WP4

(WP4-D4. WBV Epidemiological protocol). The preliminary results from health outcome

indicates a 7 days prevalence of 30-40 for pain and discomfort in the area off the neck, lower

back, wrist /hands and knees. The rated intensity of pain, on a 0-10 scale, during a typical

day in the last 7 days was close to 4 for neck and shoulders and a little bit lower for the back.

The results from the baseline questionnaire were coded in a dataset and additional

interviews were done for the cases where supplementary information was needed.

A sub-sample of 10 drivers (5 foresters and 5 harvesters) has been measured according to

the extended measurement protocol to be used in WP6 as input for the FE-model in order to

predict spinal stress (an integral part of the draft protocol for epidemiological studies

developed in VIBRISKS WP4). Preliminary results indicate a r.m.s. (ms-2) of 0.6-1-1 and a

Crest factor of 4->9 for forwarders. The mean duration of the exposure estimated as working

hours / week, assessed as exposure to WBV based on data obtained from the VIBRISKS

self administered Questionnaire (Section 2 Occupational history) was 32,2 (1-55) and 24,8

(1-65) for harvesters and forwarders respectively. The posture and vibration exposure

measurements has been collected and delivered. The preparation for a report has started.

Work Package 6

We have delivered results to FIOSH. Vibration time histories have delivered in specified

format. Vibration exposure with recording synchronized video clips has been delivered.

Anthropometric data for drivers have been recorded and delivered to FIOSH.

Dissemination

We have assisted INRS in making the 2nd announcement to the 3rd international conference

on Whole-Body Vibration Injuries in Nancy June 7-9 2005. INRS is also part of the local

arranging committee.


Work Package 2

Fewer follow ups of medical examinations and physiological measurements was scheduled

than originally planned 2 compared to 3 due to delays in FSP equipment delivery. However,

a larger cohort 1083 was enrolled than the originally planned (N=200). A longer duration of

follow-up have been scheduled for the medical examinations and physiological

measurements of the cohort to maximize expected changes



Work Package 5

The initial study protocol was based on a study group of 100 male drivers. An expected

possible low response rate and a fear of loss to follow-up might jeopardize the power of the

study. An additional 400 drivers were therefore merged to the study group. The baseline

information was collected during the spring of 2004. The initial base-line assessment was

initially delayed by slow responses. The drivers of forestry vehicles work long days and many

work away from their home address, which also contributed to additional delays. Introducing

additional compensation by sending lottery tickets increased the response speed and rate.



3.6 Participant 5: AMC

Coronel Institute, Academic Medical Centre, University of Amsterdam, the Netherlands


4 5 Definition of Questionnaires for WBV surveys Provision of expertise and training in epidemiological methods. Assistance with definition of exposure-response models. Definition of improved occupational health guidelines for WBV.

D22 48

5 24.5 Work Package Leader. Epidemiological WBV surveys and intervention studies in the Netherlands.

D7(NL)b-d, 24, 36, 48

7 0.5 Dissemination to national societies of occupational medicine for preparation of national guidelines for assessment of vibration exposure. Preparation of guidance for employers and employees (informative brochures). Education of occupational health workers. Scientific publications and conference presentations.

Total 30


Research activities in the second reporting period have concentrated on finalising of the

questionnaire for WBV surveys, establishing of an Access Database for storing of the data of

the questionnaire and last preparation, further recruitment and starting of the first initial

survey. So far, 13 companies in construction, transport industry, and green keeping are

participating in the study.


After the substantial delay reported in the first reporting period, no significant difficulties or

further delay can be reported in this second reporting period.



3.7 Participant 6. INRS

Institut National de Recherche et de Sécurité, Nancy, France


1 0.5 Integration of experimental and epidemiological results into HTV dose-response models

3 4 Work Package Leader Laboratory experiments. Modelling of hand-arm system.

D16 36

7 1 Organisation of 3rd international conference on whole-body vibration injuries. Dissemination to Standards organisations. Dissemination to industry. Preparation of guidance for employers and employees. Scientific publications and conference presentations.

D10 30

Total 5.5


Work Package 3

The first period was mainly devoted to the development of a two dimension biodynamic

model of the fingertip using finite elements. The model was made and run. During the second

period more calculations were done (internal mechanics parameters, contact forces, mode

shapes).

INRS also started the development of a 3D finite element model of the whole forefinger.

Different meshing were tested to optimise the calculation time while achieving precision.

Dissemination

The second announcement for an international conference on whole body vibration injuries in

June 2005 was elaborated in French and English. 2000 copies were sent through the world

to possible participants.


No significant difficulty was met during this period.



4 Project Management and Coordination

4.1 VIBRISKS Web Pages

The project website (http://www.vibrisks.soton.co.uk) includes a public area, with a summary

of the objectives and scientific approach of the project, and a password-protected area for

consortium members. The members’ pages are being regularly updated with the latest

working documents for each work package, as well as other important information.

4.2 Project Meetings

Minutes of all consortium meetings are available on the “meetings” page of the VIBRISKS

web site (see Section 4.1).

4.2.1 Six-monthly Progress Meetings

The fourth six-monthly consortium meeting of the project was held in Umeå, Sweden, on 7th

and 8th May 2004, hosted by the University Hospital of Northern Sweden (UMUH). The fifth

consortium meeting was hosted by the University of Trieste, in Trieste, Italy, on 10th and 11th

December 2004. This meeting was preceded on 9th December by the mid-term review of the

project.

Representatives attended the above meetings from all the partners. The minutes of both

meetings, and the presentations given by each of the participants, are available on the

VIBRISKS website (see Section 2.3, below).

4.2.2 Mid-term Review

The mid-term review meeting was held in Trieste on 9th December 2004. The project

partners gratefully acknowledge the active participation of the reviewers, Dr Ladislav Louda

and Dr Barbara Harazin.

Presentations were made by all partners concerning their role and the progress their work.

All the presentations can be viewed from the “meetings” page of the project web site.

4.3 Costs

The consolidated cost statement for the period 1st January 2004 to 31st December 2004 is

reproduced in Appendix 3.


http://www.vibrisks.soton.co.uk/


5 Exploitation and Dissemination

5.1 Presentations and publications

5.1.1 Tenth International Conference on Hand-arm Vibration

Two papers were presented by VIBRISKS consortium members to the 10th International

Conference on Hand-arm Vibration, which was held in Las Vega, USA on 7th - 11th June

2004. Professor Michael Griffin (UoS) presented a paper describing the VIBRISKS project

(1), and Professor Massimo Bovenzi (Trieste) presented results from the Italian

epidemiological surveys in WP2 (2).

1. Griffin M J, Lewis C H, Bovenzi M, Lemerle P, Lundström R. Risks of Occupational

Exposures to Hand-transmitted Vibration: VIBRISKS. 10th International Conference on

Hand-arm Vibration, Las Vegas, June 2004.

2. Bovenzi M, Vedova A D, Negro C. A Follow Up Study of Vibration-Induced White Finger

in Compensation Claimants. 10th International Conference on Hand-arm Vibration, Las

Vegas, June 2004.

5.1.2 Annual UK Conference on Human Response to Vibration

A paper acknowledging support of the project was presented at the 2004 UK Conference on

Human Response to Vibration, which was held in Ludlow, Shropshire:

Justinova L. Back problems among car drivers: a summary of studies during the last 30

years. Annual UK Conference on Human Response to Vibration, Ludlow, September

2004.

5.1.3 Publications in peer-review journals

The following paper has so far been published in a peer-review journal, describing work in

Task 3.1:

Bovenzi M, Welsh A J, Griffin M J (2004) Acute effects of continuous and intermittent

vibration on finger circulation. Int. Arch. Occup. Environ. Health, 77, 255-263

5.2 Third International Conference on Whole-body Vibration

A second announcement and call for papers has now been distributed (and is available on

the VIBRISKS website) for the 3rd International Conference on Whole-body Vibration Injuries,



which is to be partly supported by VIBRISKS. This meeting will be held in Nancy, France

from 7th to 9th June 2005 and is being jointly organised by partners INRS and UMUH.

5.3 Dissemination to national societies of occupational medicine

Guidelines for the assessment of vibration exposure and for medical surveillance of HTV and

WBV workers, have been adopted officially by the Italian Society of Occupational Medicine

and Industrial Hygiene, and a manual has been published (Publisher: Maugeri Foundation

books, vol. 5, 2003, ISBN 88-7963-158-6)

The Sub-contractor of Trieste (Laboratory of Physical Agents, AUSL 7, Siena) organised a

Workshop on 10 – 11 November 2004, which was attended by about 80 occupational health

physicians, technicians and nurses coming from the Italian Regions involved in the

VIBRISKS project. The objectives of the workshop were as follows.

a) To summarize the current state of knowledge regarding risks of vibration exposures at

work.

b) To update labour inspectors and occupational physicians on the European vibration

directive, which should be promulgated in Italy in June 2005.

c) To identify practical tools for risk assessment and prevention, including the VIBRISKS

questionnaires for health surveillance.

d) Training of NHS personnel for the administration of HTV and WBV questionnaire and to

perform objective tests (cold test with FSBP measurement, muscle strength,

manipulative dexterity).

e) To update participants on the preliminary results of the VIBRISKS surveys in Tuscany,

and future work plans.



Appendix 1. Contact details of participating organisations

Group Principal roles Contact Details

Participant 1. UoS (Coordinator)

UoS UoS (ISVR)

Project coordinator Scientist-in-charge WP1 Work Package Leader WP7 Work Package Leader Lead partner in task 5.1.4.

Professor Michael GRIFFIN Human Factors Research Unit ISVR University of Southampton Southampton SO17 1BJ, U.K. Phone: +44 (0)23 8059 2277 Fax: +44 (0)23 8059 2927 E-mail: [email protected]

UoS (MRC) Lead partner in tasks 2.2 and 5.2. Other key researchers

Dr Keith Palmer MRC Environmental Epidemiology Unit (University of Southampton) Southampton General Hospital Southampton SO16 6YD, U.K. Tel: +44 (0) 23 8077 7624 Fax: +44 (0) 23 8070 4021 Email: [email protected] Dr E. Clare Harris Tel: +44 (0) 23 8077 7624 Fax: +44 (0) 23 8070 4021 Email: [email protected]

UoS (coord) Administration and reporting Dr Christopher Lewis Human Factors Research Unit ISVR University of Southampton Southampton SO17 1BJ, U.K. Phone: +44 (0)23 8059 4958 Fax: +44 (0)23 8059 2927 E-mail: [email protected]

Participant 2. Trieste

Trieste

WP2 Work Package Leader Lead partner in tasks 2.1.1 and 5.1.1. Other key researchers

Professor Massimo BOVENZI Clinical Unit of Occupational Medicine, Department of Public Health Sciences, University of Trieste, c/o Centro Tumori, Via della Pietà 19, I-34129 Trieste, Italy Phone: +39 (0)40 3992313 Fax: +39 (0)40 368199 E-mail: [email protected] Dr Anna Della Vedova Phone: +39 (0)40 632797 Fax: +39 (0)40 368199 E-mail: [email protected]


mailto:[email protected]







Trieste (USL7)

Sub-contractor to Trieste Dr Iole Pinto USL7 - Department of Prevention Physical Agents Laboratory Strada del Rufolo 53100 Siena Italy Phone: +39 (0)577 586097 Fax: +39 (0)577 586104 E-mail: [email protected]

Participant 3. FIOSH

FIOSH WP6 Work Package Leader Other key researchers

Dr Helmut SEIDEL Federal Institute for Occupational Safety and Health Noeldnerstr. 40-42 D-10317 Berlin, Germany Phone: +49 30 515 484430 Fax: +49 30 515 484170 E-mail: [email protected] Dr Barbara Hinz Phone: +49 30 515 484431 Fax: +49 30 515 484170 E-mail: [email protected]

Participant 4.UMUH

UMUH WP4 Work Package Leader Lead partner in tasks 2.1.2 and 5.1.2.

Professor Ronnie LUNDSTRÖM Department of Biomedical Engineering & Informatics University Hospital of Northern Sweden SE-901 85, Umeå, Sweden Phone: +46 90 7854000 Mobile: +46 70 3055040 Fax: +46 90 136717 E-mail: [email protected]

UMUH (NIWL) Professor Lage Burström Arbetslivsinstitutet (National Institute for Working Life) Technical Risk Factors P.O. Box 7654 S-907 13 Umeå, Sweden Phone: +46 90 17 6014 Fax: +46 90 17 6116 E-mail: [email protected]

UMUH (Göteborg)

Professor Mats Hagberg Dept. of Occupational and Environmental Medicine Sahlgrenska University Hospital St Sigfridsg 6 SE 41266 Göteborg, Sweden Phone: +46 31 3438171 Fax: +46 31 409728 E-mail: [email protected]









UMUH (Sundsvall)

Dr Tohr Nilsson Dept. of Occupational Medicine Sundsvall Hospital SE 85186 Sundsvall, Sweden Phone: +46 60 181927 Fax: +46 60 181980 E-mail: [email protected]

Partner 5. AMC

AMC WP5 Work Package Leader Lead partner in task 5.1.3. Other key researchers

Dr Carel HULSHOFF Coronel Institute Academic Medical Center (K0-068) University of Amsterdam PO 22700 1100DE Amsterdam, The Netherlands Phone: +31 20 5665333 Fax: +31 20 6977161 E-mail: [email protected] Mr Ivo Tiemessen Phone: +31 20 5665333 Fax: +31 20 6977161 E-mail: [email protected]

Partner 6. INRS

INRS WP3 Work Package Leader Other key researchers

Dr Patrice DONATI Institut National de Recherche et de Sécurité Département IET Avenue de Bourgogne F-54501 Vandoeuvre France Phone: +33 3 8350 2049 Fax: +33 3 8350 2103 E-mail: [email protected] Dr Pierre Lemerle Phone: +33 3 8350 2125 Fax: +33 3 8350 2186 E-mail: [email protected]








Appendix 2. An Experimental Study of the Acute Effects of Vibration and Force on Finger Blood Flow

Further details of the third experiment reported in Section 2.3.3.1.2 (WP3 – Vascular effects)

by Partners Trieste and UoS(ISVR)

Objectives: To investigate the effects of contact force at the finger on acute changes in finger circulation during exposure to vibration.

Methods: Each of 10 subjects attended 11 sessions in which they experienced five successive experimental 5-minute periods: (i) no force and no vibration; (ii) force and no vibration; (iii) force and vibration; (iv) force and no vibration; (v) no force and no vibration. During periods (ii) to (iv), the intermediate phalanx of the right middle finger applied one of two forces (2 N or 5 N) on a platform that vibrated during period (iii) at one of two frequencies: 31.5 Hz (at 4 or 16 ms-2 r.m.s.) or 125 Hz (at 16 or 64 ms-2 r.m.s.). Table 1 reports the experimental design of the study. Finger blood flow was measured in the exposed right middle finger, the unexposed right little finger and the unexposed left middle fingers throughout the 25 minutes of each session. Figure 1 shows the experimental set up for generating the vibration, controlling the contact force and measuring finger blood flow.

Results: Figure 2 shows the overall pattern of the mean values of FBF (expressed as ml/100 ml/s and as percent of the pre-exposure values) in the middle right (exposed, ipsilateral) finger, the little right (unexposed, ipsilateral) finger and the middle left (unexposed, contralateral) finger across the five exposure periods and the eleven exposure conditions.

The application of force alone caused a reduction in finger blood flow in the exposed finger, but not other fingers. There were additional reductions in finger blood flow caused by vibration, with greater reductions at the high vibration magnitudes at both frequencies but no difference between the two frequencies. After eliminating the effects of force, there was evidence in all fingers (exposed and not exposed to vibration) and at both magnitudes (low and high) of a greater reduction in FBF with the higher frequency of vibration. The low vibration magnitudes (4 ms-2 r.m.s. at 31.5 Hz and 16 ms-2 r.m.s. at 125 Hz) had the same frequency-weighted acceleration magnitude (2 ms-2 r.m.s.) according to current standards and the high vibration magnitudes (16 ms-2 r.m.s. at 31.5 Hz and 64 ms-2 r.m.s. at 125 Hz) had the same frequency-weighted acceleration magnitude (8 ms-2 r.m.s.). The high vibration magnitude at 31.5 Hz and the low vibration magnitude at 125 Hz were the same (i.e. 16 ms-2 r.m.s.), and it may be seen that these conditions resulted in similar reductions in FBF relative to the corresponding conditions without vibration. The finding that the same unweighted acceleration gives broadly similar vasoconstriction whereas the same frequency-weighted acceleration does not, is consistent with our previous studies of acute changes in FBF caused by hand-transmitted vibration. It is also consistent with some epidemiological studies of the development of finger blanching in users of vibratory tools. The vibration caused a similar vasoconstriction in vibrated and non-vibrated fingers.



Conclusions: Modest levels of force applied by a finger can have a large effect on the finger blood flow, possibly due to the constriction of local blood vessels. The acute vascular effects of vibration cause additional reductions in finger blood flow that are not limited to the finger experiencing force and vibration.

Table 1. Experimental design of the study: condition of exposures to push force alone (newtons) and combinations of push force and vibration with two frequencies (Hz) and three unweighted acceleration magnitudes (ms-2 r.m.s.) having two identical frequency-weighted acceleration magnitudes according to the International Standard ISO 5349 (2 and 8 ms-2 r.m.s., see methods). Condition 1 is a control condition.

Exposure periods (i) (1-5 min)

(ii) (6-10 min)

(iii) (11-15 min)

(iv) (16-20 min)

(v) (21-25 min)

Condition

Force (N)

Force (N)

Force (N)

Vibration (Hz) (ms-2)

Force (N)

Force (N)

1 0 0 0 - - 0 0 2 0 2 2 - - 2 0 3 0 5 5 - - 5 0 4 0 2 2 31.5 4 2 0 5 0 5 5 31.5 4 5 0 6 0 2 2 31.5 16 2 0 7 0 5 5 31.5 16 5 0 8 0 2 2 125 16 2 0 9 0 5 5 125 16 5 0 10 0 2 2 125 64 2 0 11 0 5 5 125 64 5 0

Figure 1 Experimental set up for generating the vibration, controlling the contact force and measuring finger circulation.


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