National Institute of Occupational Health (STAMI)

Objectives A lack of tools for the systematic identification of frontline health workers' changing occupational risks, characteristics, and needs, poses a major barrier to supporting vital personnel to stay in practice through health emergencies and beyond. The current study reports on the development and psychometric evaluation of the Frontline health workers’ Occupational Risk and Characteristics in Emergencies index (FORCE-index). Study design The Covid hospital study is a large, multisite, four-wave, open cohort study of frontline health workers responding to the first four waves of the COVID-19 pandemic (2020–2022). Methods 2496 frontline health workers responded to questionnaires assessing various aspects of their work environment. Using exploratory factor analysis, we estimated the latent structure of the FORCE-index at the first and second waves. This structure was evaluated using confirmatory factor analysis at the third and fourth waves. The internal consistency of the instrument's subscales (e.g., factors) was evaluated using omega reliability, Cronbach's alpha coefficient, and mean inter-item correlation. Results A nine-factor solution provided best fit to the data. These factors mapped onto the following aspects of the work environment; competency, stress management, familiarity, workload manageability, work performance, infection safety, personal protective equipment, social safety, and social support. Internal consistency for the full FORCE-index and the nine factors was satisfactory. Conclusions The initial psychometric validation indicates that the FORCE-index is a valid measure which can be used by health authorities, services, and institutions to adequately and systematically assess central aspects of frontline health workers’ work environment that are commonly challenged in health emergencies.

Background The association between insufficient sleep and migraine is largely unexplained. In this blinded cross-over study we investigate whether insufficient sleep disturbs processing of nociceptive signals more in individuals with migraine compared to those without migraine. Methods Evoked potentials to nociceptive laser stimuli and high density electrical dermal stimuli were recorded in migraine and control subjects after two nights of habitual sleep and after two nights of sleep restriction (4 h sleep/night). Researchers conducting the measurements and data processing were blinded to diagnosis and sleep condition. Both recordings were interictal in 21 migraine subjects. Amplitudes, amplitude habituation and latencies were compared to measurements in 31 controls. Results Electrically induced N2P2 amplitude showed more habituation after sleep restriction compared to habitual sleep in the migraine group (p < 0.025). The migraine group also had less N2P2 amplitude habituation after habitual sleep compared to the control group (p < 0.035). We found no effect of sleep restriction on N2P2 amplitude habituation to laser stimulation, and no effect of sleep restriction on N2P2 amplitudes. Conclusion Insufficient sleep may slightly increase cortical inhibitory responses in migraine. Our findings support that migraine is associated with a vulnerability for insufficient sleep between attacks.

Exposure to hazardous microorganisms during waste handling is a potential health concern. Molecular biological techniques provide means of profiling the microbial community at high taxonomic resolution, allow the identification of critical human pathogens on the species level and thereby aid the risk assessment of work tasks. The present study used high-throughput sequencing to characterise the microbiome in personal full-shift air samples collected at contemporary waste sorting plants (WSPs) and identified large variations in community composition within (alpha diversity) and between (beta diversity) WSPs. Seasonality did not contribute to differences in the community composition. Cladosporium sp. was dominant among fungi, whereas Aerococcus sp. was dominant among bacteria. The personal air-samples contained potential human pathogens, such as Aspergillus sp., Fusarium sp. and Enterobacteriaceae, that encompass strains with the potential to develop drug-resistance. This study provided characterization of the microbial community composition of personal bioaerosol samples and provided evidence for the occurrence of potential human pathogens in contemporary waste sorting plants. Furthermore, this study highlighted the potential of microbial metabarcoding to detect critical human pathogens that may be encountered in working environments.

The Nordic countries benefited from declines in cervical cancer incidence rates due to the implementation of screening programmes. However, it is unclear whether all social groups have equally benefited from these preventive services. We provide an assessment of the temporal trends in cervical cancer incidence by socioeconomic position (SEP) in Denmark, Norway, Finland and Sweden, using data from the Nordic Occupational Cancer Study. Truncated age‐standardized incidence rates and 95% confidence intervals (CI) of cervical cancer per 100,000 person‐years were computed for women aged 50–69 by SEP and country within the period 1961–2005. We used Poisson regression models to compute relative risks (RRs) and 95% CIs of cervical cancer across SEP, pooling data for the three most recent 5‐year periods (except for Denmark 1991–1995 and Norway 1991–2003). Throughout the study period, declines in the rates of cervical cancer were observed among all SEP groups. Lower SEP rates, which started from higher values, declined faster than those for higher SEP. At the conclusion of the study period, we still observed a social gradient, with higher rates seen in lower SEP women. Farmers had the lowest risk in all four countries. The RRs for lowest versus highest SEP ranged from 1.33 (95% CI 1.05–1.69) in Sweden to 1.76 (95% CI 1.13–2.85) in Denmark, with a pooled RR of 1.41 (95% CI 1.22–1.64). Lower SEP women still face the highest risks, indicating a need for continued efforts to provide equitable access to preventive services.

Objective The potential contribution of psychosocial work exposures to skin problems is largely overlooked in the occupational health literature. To address this knowledge gap, we examined cross-sectional and prospective associations between six psychosocial work exposures (i.e., quantitative demands, job control, social support, emotional demands, role conflict, and interpersonal conflict) and self-reported skin problems. Methods Data came from a probability sample of the general working population in Norway surveyed in 2016 (N = 7833) and 2019 (N = 8038). The prospective sample comprised 3430 participants. Data were analysed with ordered logistic regression, adjusting for age, sex, occupation, and exposure to cleaning products, water, and dry indoor air. Results Cross-sectional analyses indicated statistically significant associations with skin problems for emotional demands, role conflict, and interpersonal conflict in 2016 and 2019, and for social support in 2019. In prospective analyses, emotional demands (OR 1.12, 95% CI 1.01–1.23), role conflict (OR 1.14, 95% CI 1.00–1.29), and interpersonal conflict (OR 1.24, 95% CI 1.01–1.52) significantly predicted subsequent skin problems. Interpersonal conflict (OR 1.26, 95% CI 1.01–1.57) was a significant predictor above and beyond baseline levels of skin problems. Quantitative demands and job control was generally non-significant, except for a significant interaction in the 2019 sample. Conclusion Exposure to certain psychosocial work stressors may be a risk factor for experiencing skin problems, particularly if you are exposed to interpersonal conflict. Preventive efforts to reduce the occurrence of skin problems in work settings should also target psychosocial stressors.

Revictimization research has largely ignored bullying victimization, and knowledge of the association between childhood bullying and adulthood revictimization is scarce. Research is also needed to explore whether bullying exposure in combination with childhood violence exacerbates the risk of revictimization. This study sought to address these research gaps in a national probability sample of Norwegian adults ( N = 4,299, age range: 18–74 years). One in five ( n = 838) reported that they had experienced bullying in childhood or adolescence. Approximately half of these individuals (49.0%, n = 459) reported new victimization in adulthood, including controlling behavior from a partner, rape, and/or severe physical violence. Regression analyses confirmed that survivors of bullying had significantly higher odds of experiencing victimization in adulthood compared to individuals who did not experience any form of childhood victimization, a OR = 1.52, 95% CI [1.24, 1.87], p < .001, highlighting the unique association between bullying and adult revictimization in this population‐based sample. This risk was exacerbated for individuals who had experienced both childhood violence and bullying ( n = 879, 8.9%), with four‐fold higher odds of experiencing new victimization as an adult, compared to those who did not experience childhood violence or bullying, a OR = 4.16, 95% CI [3.23, 5.35], p < .001. Bullying and violence have typically been studied in separate research fields and traditions. These findings call for integrated research and prevention efforts at both the individual and contextual levels to address multiple forms of violence and prevent repeated violence exposure throughout the lifespan.

Several studies have examined how sickness absence varies across different office concepts, but the potential role of sickness presenteeism (i.e., attending work when faced with health complaints) is poorly understood. We discuss how different office concepts may influence the decision between attending and not attending work when faced with health complaints, and the implications this may have for how observed differences in sickness absence are interpreted. We then use data from a nationwide probability sample from Norway (N = 3112) to explore (i) differences in presenteeism among employees in different office concepts with and without assigned workstations (i.e., private, conventional shared-room, conventional open-plan, non-territorial) and (ii) whether and how perceived health status moderates these differences. Based on a frequency measure of presenteeism, we infer about likely differences in presenteeism propensity by adjusting for perceived health status and self-certified sickness absence, in addition to important demographic and occupational covariates. Results from Bayesian cumulative probit models indicated similar levels of presenteeism among employees in private and conventional shared-room and open-plan offices and lower levels among employees in non-territorial offices. Differences in presenteeism between private and non-territorial offices increased as perceived health status deteriorated. Our study represents an important step towards a complete picture of attendance patterns across different office concepts. Our findings suggest that whether you have a personalized workstation may be relevant for attending or not attending work when faced with health complaints. Future studies should take this into account when interpreting differences in sickness absence observed across office concepts.

Kidney cancer has been a suspected occupational disease in petroleum workers. Health conditions that are linked to kidney cancer may prompt termination or change of work, and thereby restrict occupational exposures in high-risk individuals, creating a healthy worker survivor bias (HWSB). We examined associations between occupational exposures and kidney cancer among males in the Norwegian Offshore Petroleum Workers (NOPW) cohort using a case-cohort design, with 169 incident cancers identified by linkage to national registry data (1999–2021) and a subcohort of 2090 non-cases, all employed 1965–1998. Relative risks (hazard ratios, HRs) by cumulative exposure to benzene, crude oil, chlorinated degreasing agents (CDA), asbestos, welding fumes, or surface treatment (priming, painting), were estimated by weighted Cox regression. Inverse exposure-response trends suggested HWSB, reinforced by analyses of necessary components of HWSB. Bias was partly alleviated by adjustment for total employment duration, and by 20-year lagging of cumulative exposure to benzene, crude oil, or CDA. Workers in surface treatment (ever vs. never) showed increased HR=2.22, 95% confidence interval 1.04–4.72 (9 cases, only). For asbestos and welding fumes, the initial inverse trends largely remained after adjustment. In sum, we could neither confirm nor exclude an occupational impact on kidney cancer.

Introduction Waste management represents an occupational setting where fungi are significant contaminants. This study aimed to assess the exposure of waste workers to mycotoxins through a human biomonitoring study. Methods A total of 33 workers and 19 controls provided spot urine samples to determine 10 mycotoxins’ urinary biomarkers using liquid chromatography coupled with mass spectrometry. Risk characterization was performed using hazard quotient and margin of exposure assessments. Results The results indicated that workers were exposed to six out of the 10 mycotoxins tested, with the following detection rates: deoxynivalenol (91%, 30/33), ochratoxin A (33%, 11/33), zearalenone (17%, 5/33), α-zearalenol (12%, 4/33), β-zearalenol (12%, 4/33), and HT-2 toxin (3%, 1/33). Within controls and outwith controls, were exposed to 5/10 and 2/10 mycotoxins, respectively. All participants exhibited hazard quotients for deoxynivalenol and zearalenone below one, indicating that the exposure is unlikely to pose a health risk. However, when considering the margin of exposure determined for ochratoxin A, 18% of the total participants presented results below 200 for non-neoplastic effects, and 100% of the total participants presented values below 10,000 for neoplastic effects, suggesting potential health concerns that require further assessment. Discussion This study highlights the need for future research on occupational exposure to mycotoxins in waste management settings.

Background Despite legislation aimed to protect the population against skin sensitization in the European Union (EU), over one quarter of the general population is sensitised to at least one chemical. Objectives To provide an overview and comparison of European legislation concerning skin sensitization. In addition, we gathered the opinions of experts and stakeholders regarding improvements in the legislation and risk assessment process in the EU, to provide suggestions for improvement. Methods Legislation was identified and compared. Four questionnaires were created towards industry, competent authorities and regulators, researchers/clinicians, and non‐governmental organisations. The questions concerned the legislation, the risk assessment process, data collection and potential improvements. Results Seven areas of legislation were analysed. The legislation was found to be unharmonised, for example, differing modes of restriction and accepted tests for skin sensitization. Approximately 40% of the questionnaire respondents found that the EU legislation and tools were not sufficiently protective. To improve the legislation 83% suggested harmonisation and 68% suggested better data sharing. Other areas were: improved exposure data (78%), better understanding of the skin sensitization mechanism (67%) and non‐animal tests (66%). Conclusions Stakeholders had varying confidence towards the protection of European citizens against skin sensitization. Multiple areas for improvement regarding the legislations and the risk assessment process were identified.

Background The association between occupational titles and lung function has mostly been examined through cross-sectional studies. Preventive measures are expected to mitigate adverse effects; hence, updated estimates are necessary. Aims To study change in lung function measured by spirometry across occupations. Methods This population-based prospective cohort study comprised 5618 working adult participants of the Trøndelag Health Study (HUNT3, 2005–07), Norway. Among these, 3800 individuals (43% men, mean age 42 years, range 20–55) also attended HUNT4 (2017–19). We analysed longitudinal decline in forced expiratory volume in 1 second (FEV1) z-score during the 11-year follow-up by occupation (white-collar workers as reference category), in mixed models, adjusting for age, sex and smoking. We assessed the prevalence of self-reported respiratory symptoms and disease in the working population in HUNT4 (n = 32 124) and HUNT3 (n = 32 070). Results Compared with white-collar workers, agricultural workers and ‘drivers and mobile plant operators’, had larger declines in FEV1 z-score during follow-up. In sex-stratified analyses, men defined as agricultural workers and ‘drivers and mobile plant operators’ had larger declines than white-collar workers. Among women, who were underrepresented in many blue-collar jobs, workers classified as ‘machine operators and assemblers’ experienced greater declines. In the working population in HUNT4, the prevalence of respiratory symptoms in connection with work was 8%, and lower among white-collar workers (6%) than blue-collar workers (14%). Conclusions Although certain workers in Norway remain at risk for occupational lung function decline, there were modest differences between occupations. The findings encourage continuous efforts to implement preventive measures in high-risk jobs.

During public health crises such as pandemics, governments must rapidly adopt and implement wide-reaching policies and programs (“public policy interventions”). A key takeaway from the coronavirus disease 2019 (COVID-19) pandemic was that although numerous randomized controlled trials (RCTs) focussed on drugs and vaccines, few policy experiments were conducted to evaluate effects of public policy interventions across various sectors on viral transmission and other consequences. Moreover, many quasi-experimental studies were of spurious quality, thus proving unhelpful for informing public policy. The pandemic highlighted the need to continuously develop competence, capacity and a robust legal–ethical foundation for impact evaluations well before crises occur. It raised a crucial question: how can governments in non-crisis times develop capabilities to generate evidence on the effects of public policy interventions, thus enabling a rapid and effective research response during public health crises? We conducted a mapping to explore how government agencies in Norway use RCTs and quasi-experimental methods to strengthen the evidence base for public policy interventions and to identify barriers and facilitators to their use. Contributing to the study were 10 government agencies across sectors such as development assistance, education, health, social welfare, statistics and taxation. Many of these agencies have conducted or commissioned RCTs or quasi-experimental studies in the past 5 years, with evaluations ranging from 1 or 2 to more than 15 per agency. The measures evaluated included organizational, educational and financial interventions and interventions for oversight and sanctions. Some agencies have internal capabilities for designing and conducting evaluations, while others commissioned such studies to universities and other research institutions. Agencies reported examples where enhanced communication among implementers, researchers, ministries and political leaders facilitated impact evaluations, and these lessons offer opportunities for cross-sector knowledge-sharing to help strengthen rigorous evaluations of public policy interventions. Despite their potential, various government agencies report that randomized and quasi-experimental studies face legal, ethical, political and practical barriers that affect their use. For instance, the urgency of politicians to implement policies at scale has led to the discontinuation of trials and hindered learning from their effects. The surveyed agencies stressed the importance of legislation providing clear guidelines on when differential treatment can be justified and when informed consent requirements can be waived, as well as faster and clearer processes for managing privacy concerns related to data access. Crucially, greater political acceptance for systematically and gradually implementing reforms, including using randomization, could strengthen evidence-informed public policy, enhancing the scaling-up of effective interventions and deprioritizing ineffective ones.

Background We aimed to estimate the effect of the voluntary Norwegian Agreement on a More Inclusive Working Life (IA Agreement) on use of sickness absence (SA) and pregnancy benefits among pregnant women. Methods Pregnant women (n = 112,486) with a birth during 1.12.2003–31.12.2010 were followed from 6 to 37 gestational weeks in a continuous time multistate model with the following states: work, full SA, graded SA, pregnancy benefits, maternity leave, and other. Women working in IA companies were compared to those in non-IA companies regarding incidence and duration of SA and pregnancy benefits. Differences between groups with respect to calendar year, age, civil status, education, industry, and number of employees in the company were adjusted for using inverse probability of treatment weighting. Absolute differences in probabilities over time, expected length of stay (ELOS) in each state and differences in ELOS between IA and non-IA were calculated. 95% confidence intervals (CI) were generated using bootstrapping (1,000 repetitions). Results Adjusted analyses suggest that women working in IA companies were more likely to be in full SA in the first and last trimesters, but less likely between 14 and 28 weeks, than those in non-IA companies. The probability of being in work mirrored this, with women in IA companies tending to spend half a day more in work (ELOS difference 0.55, 95% CI -1.79, 3.02). Differences were not statistically significant. The use of graded SA was slightly higher (ELOS difference 0.46, 95% CI -0.87, 1.72) and the use of pregnancy benefits slightly lower (ELOS difference − 0.43, 95% CI -1.32, 0.42) among those in IA companies compared to non-IA companies. Conclusions Women in IA companies tended to spend more time in work and graded SA, but less time on pregnancy benefits. Differences in full SA varied during pregnancy and were most positive mid-pregnancy. This indicates that IA measures could be more effective for conditions experienced at this point. However, effects were small and not statistically significant, which may indicate the IA Agreement has not focused much on pregnant women. Key terms IA Agreement, MBRN, MoBa, multistate models, pregnancy, pregnancy benefits, sickness absence, work participation.

Objectives Exposure to microorganisms is a known contributor to occupational disease. This study assessed drilling waste workers’ health status and investigated the potential of inhalable bioaerosols to elicit an immune response in vitro and in vivo. Methods Venous blood and self-reported health data were collected from 56 and 73 Norwegian drilling waste workers, respectively. Immunological effects were assessed as Toll-like receptor (TLR) activation potential of personal air samples in vitro and biomarker expression in workers’ plasma samples in vivo. Parameters, such as BMI, sex, and smoking habits, were considered along with factors such as purification technology of drilling waste when biomarker expression was interpreted. Symptom prevalence among exposed workers was compared to an unexposed control group. Results Personal air samples activated TLR signalling in vitro in 90% of all cases. The activation potential correlated significantly with work exposure to microbial agents and total dust. Significant differences in biomarker expression and symptom prevalence were identified between purification technologies and exposure groups. Drilling waste workers had significantly increased OR of skin irritation and respiratory symptoms compared to the control group. Conclusions Exposure to microorganisms during the treatment of offshore drilling waste is an occupational health concern.