Neurosensory and Vascular Function after 14 Months of Military Training Comprising Cold Winter Conditions

By Carlsson, Daniel; Pettersson, Hans et al. | Scandinavian Journal of Work, Environment & Health, January 1, 2016 | Go to article overview

Neurosensory and Vascular Function after 14 Months of Military Training Comprising Cold Winter Conditions


Carlsson, Daniel, Pettersson, Hans, Burström, Lage, Nilsson, Tohr, Wahlström, Jens, Scandinavian Journal of Work, Environment & Health


Lifetime prevalence of severe local cold injury in Finland has been estimated at 11% of the entire population and up to 16% among those in occupational groups exposed to cold (1). Official statistics from 2013 show that 22% of all men and 11% of all women in Sweden are exposed to cold at work for more than 1/4 of their working hours (2). Exposure to cold, often in combination with insufficient coping strategies (ie, clothing), can lead to local cold injuries. Local cold injuries are categorized into freezing cold injuries, occurring at temperatures <0 °C, and non-freezing cold injuries which occur after prolonged exposure to temperatures >0 °C together with wet conditions and local pressure (3). Previous studies have described both short- and long-term sequelae after local cold injury (4-8), the majority of the studies involved military personnel. Remaining sequelae entails neurosensory (cold sensitivity, hypoesthesia, local pain etc), vascular (exaggerated vasospastic reaction to cold stimulus, abnormal skin color etc) (4, 6, 7), musculoskeletal (stiff and painful joints) (7) or most often a combination of the symptoms stated above. Knowledge derived from prospective studies on how long-term exposure to ambient cold could affect quantifiable neurosensory and vascular function in the limbs is lacking. The term "cold sensitivity" in this study describes an abnormal reaction to cold exposure causing discomfort or the avoidance of cold as suggested by Kay (9).

The aim of this study was to examine the effects on neurosensory and vascular function in the hands and feet after 14 months of military training comprising cold winter conditions. Our hypothesis was that the subjects would suffer from quantifiable impairments in neurosensory and vascular function in the hands and feet as a result of enduring severe cold exposure during the study period. This has been shown among cold injury victims (8) and since our subjects are exposed to similar repeated tissue cooling and local ischemia (10) similar symptoms could be expected.

Methods

Study design

We conducted a prospective study with 14 months followup. Our subjects were military conscripts in the north of Sweden (Arvidsjaur, Norrbotten Regiment I19), called up for 14 months Ranger training from April 2009 to June 2010. Eighty-one gave written consent to participate. At baseline during the first week of training, data on the participants' age, height, weight, tobacco use, previous cold injuries, and earlier vibration exposure were collected. The participants completed a questionnaire and went through a test set of quantitative sensory testing (QST) consisting of thermal perception, thermal pain perception, vibrotactile perception, and touch perception thresholds. A subset of the participants also underwent a finger systolic blood pressure (FSBP) test after local cooling. The number of participants completing each part of the study is shown in figure 1. At follow-up 14 months later, in May/June 2010, 54 of the participants remained in military service. They went through the same QST tests and FSBP and completed the same questionnaire as at baseline with a few additional questions regarding events during their military training. Due to data loss at individual measurement sites, the number of participants included in the analysis differs between the various tests and measurement sites. At follow-up, a specialist in occupational medicine noted the retrospective medical history and performed a physical examination in order to identify possible medical conditions that could affect the results. None were found.

The same test leaders performed all tests at baseline and follow-up with one exception. Two test leaders performed the thermal perception tests at follow-up due to logistical circumstances. Only participants who took part both at baseline and follow-up were included in the analysis.

The Regional Ethical Review Board at the medical faculty at Umeå University, Sweden, approved the study. …

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