Ari Kaukiainen

Symptoms of chronic solvent encephalopathy: Euroquest questionnaire study

The aim was to study the symptomatology of chronic solvent encephalopathy (CSE), and the persistence of the symptoms. We examined how Euroquest, a neurotoxic symptom questionnaire, distinguished workers with verified CSE from unexposed employees, and evaluated symptom cut-off for CSE. Another aim was to study the effect of age on the responses. CSE cases confirmed at the Finnish Institute of Occupational Health had completed Euroquest either before their first investigation procedure (CSE-1 group, n=33), or before attending a routine control for previously diagnosed CSE (CSE-2, n=43). Non-exposed carpenters served as referents (n=292). We studied responses to single questions and to symptom domains. The domain with the highest AUC (area under the ROC: Receiver Operating Characteristic Curve) value was chosen to study cut-off points. CSE groups reported nearly all 59 symptoms more frequently than the carpenters. There was only little difference between younger and older carpenters. CSE-1 reported 12 symptoms more often than CSE-2, but no significant differences were found in the memory and concentration domain, which had the highest AUC, above 0.9. Using a three out of 10 symptoms cut-off point, 97% of the CSE-1 cases and 80% of the carpenters were classified correctly. At a four-symptom cut-off, the sensitivity was 93% and specificity 87%. The memory and concentration as core symptoms distinguished CSE cases from unexposed workers and remain, even after cessation of exposure. The effect of age on Euroquest was minor. Euroquest is recommended for the screening of CSE in solvent-exposed work-force and in the diagnostic process of CSE. We propose three memory and concentration symptoms as cut-off to minimize under-detection.

Memory performance profile in occupational chronic solvent encephalopathy suggests working memory dysfunction.

This pilot study characterizes memory functioning of 11 men with occupational chronic solvent encephalopathy (CSE). Pattern (PRM) and spatial recognition (SRM), spatial span (SSP), spatial working memory (SWM), and paired associate learning (PAL) from Cambridge Neuropsychological Test Automated Battery were performed twice. The most sensitive variables to show impairment were PAL trials, SRM total correct, and SWM number of between-search errors. The majority of the CSE patients demonstrated mild deficits. The most persistent dysfunction was in tasks demanding working memory processing, which predicted well the CSE status. Qualitatively, the memory deficits resemble those seen in moderate or severe Parkinsons disease.

Detecting chronic solvent encephalopathy in occupations at risk

Chronic solvent encephalopathy (CSE) is under-reported worldwide due to difficulties in recognition and differences in national legislation. Although its occurrence in developed countries has declined, new cases continue to be detected. Our aim was to determine whether CSE can be detected in risk trades, using a stepwise screening procedure. Another aim was to evaluate if this method detects more cases than present occupational health service (OHS) practices do in Finland, a country with decreasing exposures, high OHS coverage and an annual rate of around forty cases of suspected CSE and seven cases of occupational CSE. The studied fields, based on the national occurrence of CSE, were industrial and construction painting, floor layering, the printing press industry, boat construction, reinforced plastic laminating and the metal industry. We obtained contact information from trade union registers and municipal OHS. A postal survey including the Euroquest (EQ) neurotoxic symptom questionnaire, Becks Depression Inventory (BDI) and the Alcohol Use Disorders Identification Test-Consumption (Audit-C), and questions on exposure and medical conditions, was sent to 3,640 workers in the age range of 30-65 years in two Finnish provinces. The survey resulted in 1,730 responses (48%). This was followed by a clinical examination, with methods applicable to OHS, of subjects fulfilling the criteria: three or more EQ memory and concentration symptoms and sufficient exposure, a BDI score≤18, an AUDIT-C score≤8, and no evident medical condition explaining their symptoms. Of 338 respondents with memory and concentration symptoms, 129 subjects fulfilled all the criteria, of which 83 participated in clinical examinations. We found 38 CSE compatible cases. The study shows that more CSE compatible cases can be detected when the screening is directed towards the occupational fields at greatest risk. This stepwise method is more effective for finding CSE compatible cases than regular OHS activity. The number of cases was similar to the total annual occurrence, of new CSE-suspected cases, although the sample represented approximately 18% of the abundantly exposed workforce in Finland. Combining of exposure and medical differential diagnostics to neurotoxic symptom questionnaire, decreases the amount of cases needing clinical examinations. This two-step procedure can be carried out with methods suitable for OHS and other primary health care, both in industrialized and developed countries.

Cost of detecting a chronic solvent encephalopathy case by screening.

BACKGROUND Stepwise screening of chronic solvent encephalopathy (CSE), using a postal survey followed by clinical examinations, has been shown to detect symptomatic exposed workers with an occupational disease even in industrialized countries with long-term, but relatively low dose exposure. Previous studies have suggested under-detection and late recognition of CSE, when work ability is already markedly reduced. AIMS The aim was to estimate the cost of detecting one new CSE case by screening and diagnostics, to estimate the career extension needed to cover the cost of screening, and to study the work ability of the CSE cases. METHODS A financial analysis of stepwise postal CSE screening followed by clinical examinations (SPC screening) was carried out, and the results were compared to those of the group of CSE cases referred to the Finnish Institute of Occupational Health (FIOH) by the existing national practice of occupational health services (OHS screening). The work ability of the SPC screened CSE cases was studied in relation to the retirement rate and the Work Ability Index (WAI). RESULTS An analysis of the costs of detecting a new verified CSE case revealed them to be approximately 16,500 USD. Using the mean monthly wages in the fields concerned, we showed that if a worker is able to continue working for four months longer, the screening covers these costs. The cost for detecting a CSE case was twenty times higher with the existing OHS routine, when actualized according to the national guidelines. A CSE case detected at an early stage enables occupational rehabilitation or measures to decrease solvent exposure. The retirement rate of the SPC screened CSE cases was significantly lower than that of the OHS screened cases (6.7% vs. 74%). The results suggest that SPC screening detects patients at an earlier stage of the disease, when they are still capable of working. Their WAI sores were nevertheless lower than those of the general population, implying a greater risk of becoming excluded from the labor market. CONCLUSION Stepwise screening of CSE using a postal survey followed by clinical examinations detected new CSE cases at lower costs than existing OHS screening routines. Detecting CSE at an early stage prevents early retirement.

Work ability score of solvent-exposed workers

PurposeOccupational chronic solvent encephalopathy (CSE), characterized by neurocognitive dysfunction, often leads to early retirement. However, only the more severe cases are diagnosed with CSE, and little is known about the work ability of solvent-exposed workers in general. The aim was to study memory and concentration symptoms, work ability and the effect of both solvent-related and non-occupational factors on work ability, in an actively working solvent-exposed population.MethodsA questionnaire on exposure and health was sent to 3640 workers in four solvent-exposed fields, i.e. painters and floor-layers, boat builders, printers, and metal workers. The total number of responses was 1730. We determined the work ability score (WAS), a single question item of the Work Ability Index, and studied solvent exposure, demographic factors, Euroquest memory and concentration symptoms, chronic diseases, and employment status using univariate and multivariate analyses. The findings were compared to those of a corresponding national blue-collar reference population (n = 221), and a small cohort of workers with CSE (n = 18).ResultsThe proportion of workers with memory and concentration symptoms was significantly associated with solvent exposure. The WAS of solvent-exposed workers was lower than that of the national blue-collar reference group, and the difference was significant in the oldest age group (those aged over 60). Solvent-exposed worker’s WAS were higher than those of workers diagnosed with CSE. The WAS were lowest among painters and floor-layers, followed by metal workers and printers, and highest among boat builders. The strongest explanatory factors for poor work ability were the number of chronic diseases, age and employment status. Solvent exposure was a weak independent risk factor for reduced WAS, comparable to a level of high alcohol consumption.ConclusionsEven if memory and concentration symptoms were associated with higher solvent exposure, the effect of solvents on self-experienced work ability was relatively weak. This in line with the improved occupational hygiene and reduced solvent exposure levels in industrialized countries, thus the effect may be stronger in high-level exposure environments. As a single question, WAS is easily included, applicable, and recommendable in occupational screening questionnaires.

0183 Predictors of work ability in solvent exposed workers

Introduction Occupational chronic solvent encephalopathy (CSE) often leads to early retirement. However, little is known about work ability in solvent exposed workers in general. The aim was to study the effect of work-related and non-occupational factors on work ability in active solvent exposed population. Methods A questionnaire on exposure and health was sent to 3640 workers in four solvent-exposed fields, i.e. painters and floor-layers, boat builders, printers, and metal workers, resulting in 1730 responses. Work Ability Score (WAS), a single question item of Work Ability Index, solvent exposure, demographic factors, chronic diseases, and employment status were considered in univariate and multivariate analysis. The findings were compared to those of corresponding national blue-collar reference population (n=221), and in addition to a small cohort of workers with CSE (n=18). Results WAS of solvent-exposed workers was lower than that of national reference group, the difference being significant in the oldest age group, but higher than that of workers diagnosed with CSE. Number of chronic diseases and age were the strongest explanatory factors of poor work ability. Solvent exposure was a weak independent risk factor for reduced WAS. Work ability was highest in boat builders, followed by metal workers and printers, and lowest in painters and floor layers. Conclusions In general, the strongest explanatory factors of reduced WAS were chronic diseases, age, and working status. The weak effect of solvents on work ability is in line with improved occupational hygiene and declined solvent exposure levels in an industrialised country. As a single question WAS is easily included in occupational screening questionnaires.