Ebba Wergeland

Job adjustment and absence from work in mid-pregnancy in the Norwegian Mother and Child Cohort Study (MoBa)

Background: Pregnant women at work have special needs, and sick leave is common. However, job adjustment in pregnancy is addressed in European legislation. Our main objective was to examine if job adjustment was associated with reduced absence. Methods: This study is based on the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. 28 611 employed women filled in questionnaires in weeks 17 and 30 in pregnancy. The risk of absence for more than 2 weeks was studied among those who were not absent in week 17 (n = 22 932), and the probability of return to work in week 30 among those who were absent in week 17 (n = 5679). Data were based on self-report. The influence of job adjustment (three categories: not needed, needed but not obtained, needed and obtained) was analysed in additive models in multivariable binomial regression. Associations with other job characteristics and work environment factors were also analysed. Results: The risk of absence for more than 2 weeks was 0.308 and the probability of return to work was 0.137. Compared with women who needed but did not achieve job adjustment, obtained job adjustment was associated with a 0.107 decreased risk of absence (95% confidence interval 0.090 to 0.125) in a model including other job characteristics and work environment factors. Job adjustment was correspondingly associated with a 0.041 (0.023 to 0.059) increased probability of return to work. Absence was associated with adverse work environment, whereas the opposite pattern was found for return to work among those who started off being absent. Conclusions: Job adjustment was associated with reduced absence from work in pregnancy. Results should be interpreted cautiously because of low participation in MoBa and potential information bias from self-reported data.

Strenuous working conditions and birthweight, Norway 1989

OBJECTIVE To examine whether strenuous working conditions in pregnancy are associated with reduced birthweight. METHOD Cross-sectional, population based study. Retrospective data collection by questionnaire to parturients in all maternity wards in Norway 16.10-26.11.89, completed before discharge from hospital, with response rate 87.2%. The study population consists of the 5388 women with singleton births, of whom 3321 were in paid work beyond the third month of pregnancy. Main outcome measures are prevalence of birthweight <2500 grams (LBW) and mean birthweight. RESULTS Strenuous working conditions increased risk of LBW, but only for nullipara, particularly non-smoking nullipara. Odds ratios with 95% confidence intervals for non-smoking nullipara, adjusted for age, education and income, were 0.3 (0.1,0.9) for influence on work pace, 2.8 (1.2,6.5) for exposure to heavy lifting and 2.2 (0.8,5.8) for twisting/bending. Four groups of occupations were defined according to exposure, solely based on reports from mothers with non-LBW children in order to avoid recall bias. Prevalence of LBW increased from 0.8% in the least exposed to 8.3% in the most exposed group. (Test for trend: p<0.05, after adjustment for age, education and income.) Strenuous working conditions had no independent effect on mean birthweight after adjustment for age, education, income and smoking. CONCLUSION Strenuous work increased the risk of LBW in nulliparae, particularly in non-smokers. Lack of influence on work pace was the strongest risk factor. The preventive effect of job modification in pregnancy may parallel smoking cessation.

Work load, job control and risk of leaving work by sickness certification before delivery, Norway 1989

Sickness absence in pregnancy has been shown to be associated with strenuous working conditions and parity. So far, few studies have made adjustments for possible interaction and confounding. Such adjustments are needed to more precisely identify targets for preventive measures. We have, therefore, in a representative population of pregnant employees in Norway 1989, computed adjusted odds ratios for leaving work by sickness absence more than three (LSC> 3) and eight (LSC> 8) weeks before delivery according to working conditions identified as risk factors in earlier studies; adjusted for job control, domestic conditions and sickness absence the year prior to pregnancy. The cumulative percentage of LSC>8 and LSC>3 was 26.4 and 51.1. Economically strenuous postures and heavy lifting increased the risk of both outcomes. In addition, shift work and hectic work pace increased the risk of LSC > 3. Influence on breaks reduced risk. Only para experienced reduced risk of LSC when working part-time. Sicklisting the year prior to pregnancy had no confounding effect, which suggest that pregnancy represents a new incompatibility with work. Preventive measures should address work postures and heavy lifting, as well as conditions influencing the womans control with her time.

NEED FOR JOB ADJUSTMENT IN PREGNANCY : EARLY PREDICTION BASED ON WORK HISTORY

OBJECTIVE To examine whether a womans need for job adjustment in pregnancy can be predicted by a short interview on working conditions at the first prenatal visit. DESIGN Midwives included a semi-structured work history during the interview of unselected first prenatal visits. Their early prediction about the womans need for job adjustment was compared with the womans own later report of such need and the need expressed as a risk score for preterm birth based on the womans self-reported working conditions. Data on both were collected by a questionnaire presented to the woman at about the 36th week of pregnancy. SETTING Seven maternity centres in Oslo, Norway, April 1993-March 1994. SUBJECTS 160 pregnant women in paid work. MAIN OUTCOME MEASURES The proportion of predictions of presence (positive predictive value) or absence (negative predictive value) of need that was confirmed by the womans later report, or the risk score. RESULTS The positive predictive value was 86% and the negative predictive value 50% with the womans later report as reference, and 56 and 79%, respectively, with the risk score for preterm birth as reference. CONCLUSION The work history allows early prediction of need for job adjustment in pregnancy.

Smoking in pregnancy: A way to cope with excessive workload?

OBJECTIVE To examine if abstention from smoking in pregnancy increases with opportunities to limit workload. DESIGN Cross-sectional study based on self-administered questionnaires to women post partum. SETTING All maternity wards in Norway, 16 October-26 November 1989. SUBJECTS 5 438 women, or 87.2% of all parturients in Norway during the study period. MAIN OUTCOME MEASURE The abstention fraction (AF) defined as percentage of nonsmokers in pregnancy among prepregnancy daily smokers. RESULTS The abstention fraction was lower for women with lack of influence on work pace, with hectic work pace, exhaustion after work or work schedules other than daytime, for women with children <16 years of age in the household, and for women in paid work with 20 hours or more of housework weekly, than for women without these conditions. Adjusted odds ratios (OR) for abstention were low for women with children <16 years both when in paid work (OR 0.4) and as housewives (OR 0.3). Women who received extra help with housework had a high abstention fraction (OR 1.6) both when in paid work and as housewives. The abstention fraction was high for women with daytime work (OR 1.5) and low with hectic work pace (OR 0.7), compared with women without these conditions. CONCLUSION Abstention from smoking in pregnancy increases with opportunities to limit total workload.

Mortality due to occupational injury is underreported

BACKGROUND The Norwegian Labour Inspection Authority records fatal occupational injuries in mainland bases activities, i.e. all sectors except offshore, aviation, shipping, hunting and fishing; the Registrys information on these injuries has been considered complete. The present study aimed at testing this assumption. MATERIAL AND METHODS In 2000 - 03, the Labour Inspection Authority recorded 183 fatal occupational injuries; 171 of the deceased were residents in Norway. Each of these deaths were compared with fatal occupational injuries in the Norwegian Cause of Death Registry. A capture-recapture model was used to estimate the real number of fatal occupational injuries. RESULTS In 2000 - 03, 214 fatal occupational injuries were recorded among residents in Norway employed in all sectors (except offshore, aviation, shipping, hunting and fishing) in at least one of the two registries (98 cases were reported in both registries). The Norwegian Labour Inspection Authority mainly lacked information about (in comparison with the Death Registry) deaths in the military (1 of 9), in the health and social services (3 of 7), road traffic accidents (36 of 52) and deaths in Northern Norway/Spitsbergen (17 of 28). One third of all recorded cases (77 of 214) were caused by transport accidents. Risk by industry (deaths per 100 million work hours) was highest for primary industries (7.0) and for <<transport and communication>> (4.1). The real number of fatal injuries was estimated to 246, or 44 % more than the 171 deaths registered by the Labour Inspection Authority. INTERPRETATION Fatal occupational injuries are much more frequent than reported in the official registries. Underreporting, particularly of road traffic accidents/transport accidents, may lead to misinterpretation of risks and time trends and of need for preventive action.

Cause-specific mortality and cancer morbidity in 390 male workers exposed to high purity talc, a six-decade follow-up

BACKGROUND This study updates information on mortality and cancer morbidity in a cohort of Norwegian talc workers. METHODS Follow-up was extended with 24 years, covering 1953-2011. Comparisons were made with the general population and between subgroups within the cohort. RESULTS Standardized mortality ratio for non-malignant respiratory disease (NMRD) was 0.38 (95%CI: 0.18, 0.69) and for diseases of the circulatory system (CVD) 0.98 (95%CI: 0.82, 1.16). A non-significantly increased NMRD risk was observed at high dust exposures. There were no deaths from pneumoconiosis. CONCLUSIONS With the clear limitations of a small cohort, our results do hint at an effect of talc dust on mortality from NMRD other than pneumoconiosis, covered by a strong and persisting healthy worker effect. Also, an effect on CVD mortality, masked by a healthy worker selection into the cohort cannot be ruled out. Excess mortality from pneumoconiosis seen in other studies, may reflect exposure to quartz and, possibly, bias due to comparability problems.

Estimating work-related amputations in the Norwegian manufacturing sector: a 10-year retrospective study based on two-source capture-recapture method.

Abstract Background: Work-related amputations are serious yet preventable injuries. Workers in the manufacturing sector in particular are vulnerable to amputation injuries compared to workers in other sectors. Methods: In this study, we used a two-source capture recapture method to estimate the true number of annual work-related amputations in the Norwegian manufacturing sector for a 10-year study period (1998–2007). The two-sources utilized in this study were the Norwegian Labor Inspection Authorities Registry of Work-Related Injuries (RWI) and the Association of Norwegian Private Insurance Companies registry for occupational injuries (ANPIC). Results: We estimated an annual incidence rate that ranged from 21/100 000 to 62/100 000 workers during the study period. Our findings indicate an undercount of amputations reported to the Norwegian Labour Inspection Authoritys registry ranging from 16% to 58% during the study period. Conclusions: Work-related amputations remain a challenge in the Norwegian manufacturing sector. This study underscores the need of robust epidemiological surveillance infrastructure and effective interventions to prevent amputations at work.

Fertility patterns according to occupational grouping in Norway, 1989

In the early 1990s, most pregnant women in Norway were in gainful employment. This led to increased interest in the possible consequences for reproductive health, and a growing concern for the need to accommodate the pregnancy. We have therefore investigated how accurately general fertility rates predict the number of pregnancies in the workforce. Fertility rates (FR) among employed women and standardized fertility ratios (SFR) in occupational groups were estimated on the basis of information from the Labour Market Statistics and the national survey “Pregnancy and Work”, Norway, 1989. The fertility rate among employed women was 17% higher than the general fertility rate. Two occupational groups had significantly different SFRs: technical/professional workers (SFR 118) and transport/communication workers (SFR 82). In addition, differences were found for parity-specific SFRs in administrative/executive work (SFR nullipara 80, SFR para 125) and service work (SFR nullipara 114, SFR para 80). We suggest that work status and occupation should be included among the variables registered in the Medical Birth Registry of Norway, in order to facilitate routine presentations of fertility rates and pregnancy outcomes for women in paid work. The results further indicate that work-specific conditions influence first-birth fertility. This should be explored in demographic studies of the relation between womens fertility and participation in paid work.

What's in a name? Accidents or injuries?

An occupational accident is an unpleasant “event” which occurs unexpectedly and causes injury or damage. Accident also denotes a range of different phenomena such as fate, coincidence, luck, misfortune and thus is a vague term. The word injury means a harm, wound or trauma done to a persons body. Our aim is to highlight the somewhat erroneous use of the word “accident” instead of injury. Methodically it is important to know what are we measuring? In case of occupational diseases a cogent distinction is globally accepted. Exposure measures are not disease measures. Similarly, an accident statistic is not necessarily an injury statistic. In medieval times, Black Death was a phenomenon that was poorly understood and was explained as punishment for our sins. However, modern science distinguished between the cause (Y. Pestis) and the outcome (Bubonic Plague) and measures to prevent the outcome followed. History shows that successful prevention mandates a demarcation between the preceding event and the following outcome. An occupational car accident implies both event and injury. The extent of the injury is a result of the car crash which could be restricted by airbags. Isolation of the event (car crash) and the outcome (injury) is therefore critical to prevention technologies. All potential causes of the injury may be impossible to eliminate, but the outcome could be modified by targeted interventions. “Incident” is perhaps a precise term instead of accident for epidemiological applications. Regardless, if the word accident is indispensible, we recommend a more appraised use of the words accident and injury in epidemiology.