Epidemiological challenges to exposure assessment by a9342032

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									Parallel 1
Chemical and Biological exposure and analysis
Chair: Kari Heldal




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Epidemiological challenges to exposure assessment

Wijnand Eduard, National Institute of Occupational health, Oslo
Quantitative exposure assessment in epidemiological studies consists of five steps: selection
of workers to be measured, selection of the sampling time, collection and analysis of the
samples and statistical analysis. The exposure assessment thus involves personnel with skills
in epidemiology, sampling strategy, sampling techniques, analytical techniques and statistics
that have to communicate properly to obtain optimal results. As this may seem obvious, the
needs of exposure assessment in epidemiological studies are not always understood by all
professions and represent a challenge to the research team. This presentation will therefore
focus on some of these challenges.

The success of an epidemiological study is strongly dependent on differences in exposure
level in the study population as the statistical power increases with increasing exposure
differences between groups. A major goal is therefore to identify groups of workers with
different exposure levels and to quantify their exposure. This is different from exposure
assessments commonly carried out by occupational hygienists that generally focus on groups
with high exposure. In epidemiological studies is the quantification of workers with low
exposure equally important. Quantification of workplace exposure is complicated by high
variability. For studies of short-term effects such as cross-shift changes of symptoms, lung
function and blood parameters all exposed time during the shift can be monitored and
exposure variability is less of a problem. However, in studies of long-term effects usually a
subset of the workers can be monitored and only a fraction exposure time of interest. Sources
of variation have therefore to be quantified, such as the exposure variability between and
within groups and workers, and temporal changes.

Cost of sampling and analysis usually constrains the number of measurements that can be
performed and thereby the precision of estimated exposure levels. There is therefore a need
for development of cost-effective measurement methods in epidemiological studies. As the
exposure variability usually is much larger than the sampling and analytical variability loss of
precision is a minor problem and can be sacrificed if the sampling and analytical effort can be
reduced. Self-administrated sampling has therefore been pioneered, but so far been applied in
few studies. However, the detection limit is important if a substantial number of samples
cannot be quantified. A special topic is that of some analysts refuse to report values below
the detection limit. There are no statistical reasons for not reporting such values when
exposure data are used in an epidemiological study. It is strongly recommended to use the
actual values as it will inevitably lead to loss of data and may create problems in the statistical
analysis.




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Occupational exposure to anesthetic gases in operating rooms and delivery
suites in Finnish hospitals
Beatrice Bäck1, Ulla-Maija Hellgren1, Henri Riuttala1, Kati Maksimainen2, Pirjo Korhonen1,
Kari Reijula1, Tapani Tuomi1
1
    Finnish Institute of Occupational Health (FIOH), Finland
2
    Neste Oil Corporation, Finland
*Corresponding email:beatrice.back@ttl.fi
Description of the problem
Sevoflurane and nitrous oxide (N2O, laughing gas) are commonly used anesthetic gases in Finnish
operating rooms and laughing gas is frequently used for analgesia during delivery. Exposure to N2O
during pregnancy should not exceed 10% of the Finnish eight hour Occupational Exposure Limit
value, (OEL; HTP-value in Finland, Concentration Known to be Harmful), which for N2O is 100 ppm.
The OEL value for exposure to sevoflurane is 10 ppm (1), and the same value is valid for pregnant and
non-pregnant workers. These values are based on national legislation. There is limited knowledge
about the exposure and effects of anesthetic gases. In Finland in 2007, five persons had been granted
the special maternity leave due to exposure to anesthetic gases.


Objectives
According to the revised Sickness Insurance Act (2) the anesthetic gases constitute a health risk to
pregnant workers and fetuses. In the directives (3) given for estimating the need of special maternity
leave, the limit value of N2O gas was lowered to one tenth of OEL8h. The aim of the present study was
to determine present and past exposure status of hospital workers using anesthetic gases. Taking into
account the revised legislation, we aimed to determine whether present practices to dispense and
scavenge N2O and sevoflurane gases are sufficiently safe to enable midwives and workers in operating
rooms to work during pregnancy.


Materials/Methods
The data concerning measurements of sevoflurane and N2O gases in operating and recovery rooms are
based on the occupational hygienic surveys performed by specialists at the Finnish Institute of
Occupational Health during 1997–2006. The results from delivery rooms extend from surveys done
during 1997-2007. The data was analyzed taking into account the working area (operating rooms,
recovery rooms and delivery rooms), the tasks of hospital workers, and the additive effects. Altogether
332 measurements of N2O gas and 308 measurements of sevoflurane gas were included in the present
study. Particular attention was paid on exposure levels exceeding 10% of the eight hour OEL value for
N2O.

Results
Out of the nitrous oxide measurements in operating rooms, 47% exceeded 10% of the OEL8h value and
8% the eight hour value. In 32% of recovery rooms, N2O levels exceeded 10% of the OEL8h value. In
84% of delivery rooms, nitrous oxide concentration exceeded 10% of the OEL8h value, whereas the
limit value was exceeded in 40%. The exposure in operating rooms exceeded eight hour OEL only in
1% of the sevoflurane measurements and in recovery rooms it never reached the limit value. Taking
into account the additive effect, there occurred overexposure in 6% of the cases in operating rooms.
There were no significant differences in the assessed time weighted average median exposures during
the work shift between anesthetists, anesthetic nurses, instrument nurses, recovery nurses, and
surgeons. The range within the group was the largest with anesthetists.




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Conclusions
Simultaneous exposure to anesthetic gases (Sevoflurane and laughing gas) in operating rooms caused
overexposure only in a few cases. Exposure to N2O in delivery rooms exceeded the 10% level of OEL
for pregnant workers regularly and topped the stated OEL8h in nearly half of the cases. Special efforts
should be made to reduce exposure for laughing gas in delivery rooms. Further studies are needed to
determine the technical equipment necessary to reach acceptable work-air concentrations of N2O, also
for pregnant workers. Midwives need instructions and guidance in the proper and safe use of N2O gas
and related equipments.

References
   1. HTP Values 2007. Concentrations Known to be Harmful. Publications of Social Affairs and Health
       2007:4. Helsinki, 2007. (in Finnish/Swedish)
   2. Sickness Insurance Act 1335/2004 of the Council of State
       http://www.finlex.fi/sv/laki/alkup/2004/20041335 (In Finnish/Swedish)
   3. Guidelines for assessing danger considering special maternity leave. H. Taskinen,
       M-L. Lindbohm, H. Frilander. FIOH and Ministry of Social Affairs and Health. Helsinki
       2006. (In Finnish).




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                     Nordic Work Environment meeting


Abstract

The Exposure Scenarios of REACH
Vemund Digernes dr. med.
Federation of Norwegian Industries
Information generated in the REACH processes is mediated to down-stream users of
chemicals by means of Expose Scenarios. The Exposure Scenarios are annexed to or
integrated in material safety data sheets, and are thereby designed to be a widespread and
important instrument in the future management of chemicals.
Essential elements of Exposure Scenarios are the descriptors of use, the estimates of exposure,
the risk assessment, and finally the recommended risk management measures. The quality and
the relevance of exposure scenarios is in each case highly dependant on the exchange of
information along the supply chain.
The practical implications of the development and use of exposure scenarios will be discussed
Available methods and tools will be presented.

Topic: Chemical exposure

Key words: REACH, Exposure Scenarios




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Exposure to thermal degradation products in welding and straightening

Objectives

Thermal degradation products in the welding industry may occur in many different situations.
The objectives on this project were:
1. To identify and evaluate thermal degradation products formed when welding or
   straightening painted or coated steel plates
2. To evaluate the exposure of welders to degradation products on site
3. To together with collaboration partners (HSL and TWI from UK and ArcelorMittal
   Research Industry) produce recommendations for a standard test procedure for testing
   degradation products in welding and allied processes.

Methodology

Initially a survey was made to choose representative industrial welding sites. The products to
be tested were chosen in co-operation with industrial representatives and with project partner's
abroad. Two different heating methods were tested in the laboratory, an oven heating method
and a pyrolysis method. At first different heating and sample preparation conditions were
tested after which degradation products from 14 paints and 4 other products were analysed.
According to the results from the laboratory tests 8 different kinds of paints and the 4 other
products were chosen for tests on working sites. Thermal degradation products most critical to
health was measured on site in 6 shipyards and machine shops. All together 28 different work
situations were investigated.

Results and conclusions
For most of the tested products over fifty different organic degradation products could be
detected. Most of them were found in a very small amount. Despite the difference in heating
techniques and testing conditions, the oven method and pyrolysis method compared gave
similar results. Because the pyrolysis method is faster and more easy to use it is recommended
method. The choice of sampling techniques for field experiments depends on the degradation
products expected to be formed and/or the compound(s) chosen as possible indicator
compound(s). The degradation products in workplaces investigated were mostly at a very low
level, fairly below respective occupational limit values. When straightening and when you
have to weld on primed or top-painted steel you are most likely to find hazardous substances.
Especially urethane products will emit isocyanates. For most products one or a few marker or
key compounds could be found that can be chosen to indicate and measure possible risks from
the degradation products generated at workplaces. Although the choice of a valid method for
the overall assessment of exposure suited for prevented measures is far from self-evident,
termodesorption tubes is in many cases a good choice for workplace sampling of thermal
degradation products. The application of comparing these key or marker compounds to
possible health effects is however often problematic. The overall health risk analysis should
not only include the identified compounds, but also risk factors that could not be measured.




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The results gained from this project will be compared to those of other participating research
groups. The usability of the best testing method as a standard test method will be evaluated.
The participants represent different European countries and operate in a working group which
acts under the subordination of the welding standardisation committee (ISO). Therefore, the
results obtained can be utilized when preparing the standard. The standard is meant to be a
tool for manufacturers and importers, helping them to produce more detailed safety
information sheets on the materials which are used in welding. This enables a better risk
assessment of the health aspects involved in welding processes.


Authors: Bernt Engström and Peter Backlund, Finnish Institute of Occupational
Health

Topic: Chemical and biological exposure and analysis

Key words: Welding, straightening, shop primer, thermal degradation products,
workplace sampling

Prefered method of presentation: Oral presentation in Swedish




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Work environment measurements in old and new goat houses

Ann-Helen Olsen, Gerd Sissel Andorsen, Eva Kramvik, Randi Olsen, Arild
Øvrum

Department of Occupational and Environmental Medicine, University Hospital
of Northern Norway, Tromsø, Norway

The project “Noras HUS”, in management of the County Governors in Nordland and Troms,
planned raising new goat houses for four already established farmers. The object of that
project was to improve the welfare of the animals, the quality of the milk and the farmers
working environment. The project management requested an evaluation in which way the
new buildings resulted in wanted improvement. In this case we were asked to contribute to the
project.

The aim of our study was to investigate in which way the farmers working environment were
improved. Several elements in the working environment in four old goat houses were
explored in April and May 2006 and in two new goat houses in April and May 2008. The last
two houses are not yet constructed.

Stationary and personal measurements were performed both times. The farmers were also
interviewed about improvements in their working conditions.

The personal measurements were carried out by portable equipment monitoring respirabel
particles, microorganisms and noise. Measurements were accomplished over six shifts, three
in the morning and three in the evening. At the stationary point we measured gases,
temperature, relative humidity, dust, microorganisms and mould fungus. These measurements
were accomplished continuously.

From the first measurement period we can see differences between the four goat houses.
Comparing results from 2006 with those collected in 2008 indicates among other factors a
lower level of ammonia in the new buildings.

We have not yet a final conclusion, i.e. in which way the farmers working conditions are
improved. Building the new goat houses has changed the working conditions for the farmers
in many ways. Now they spend less time in the main room with the animals, and feeding the
animals is done more automatically. The stationary measurements performed in 2006 and
2008 are not quite comparable.



Key words
Goat house, exposure measurement, microorganisms, particles, noise




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Exposure to mutagenic aldehydes during frying of beefsteak


Ann Kristin Sjaastad1,2 and Kristin Svendsen2
1 = Department of Occupational Medicine, St. Olav’s University Hospital,
Trondheim, Norway
2 = Department of Industrial Economics and Technology Management,
Norwegian University of Science and Technology, Trondheim, Norway

Background
Emissions from high-temperature frying have recently been classified as “probably
carcinogenic to humans (Group 2A)” by the International Agency for research on Cancer
(IARC). An increased risk of respiratory tract cancer in cooks and bakers has been reported.
In a study on mutagenic compounds in fumes from peanut oil heated to about 100˚C, the
following compounds were identified as the ones with the strongest mutagenicity in the Ames
test (in descending order): trans,trans-2,4-decadienal, trans,trans-2,4-nonadienal, trans-2-
decenal and trans-2-undecenal.


Objectives
The aim of the study was to see if a cook could be exposed to detectable concentrations of the
mutagenic aldehydes mentioned in fumes from frying of beefsteak using margarine, rapeseed
oil, soybean oil or virgin olive oil as frying fat. In addition, levels of particle exposure were
measured to make the results comparable to previous studies.


Methodology
The levels of higher aldehydes and total particles were measured in the breathing zone of the
cook during the pan-frying of beefsteak with the four different frying fats. Frying was
performed in a model kitchen, according to an experimental, standardized procedure
mimicking “normal frying procedures”.


Results
Table 1: Aldehydes (µg/m3) measured in the breathing zone of the cook during pan frying of
beefsteak using four different kinds of frying fat. The results are given as arithmetic mean (sd)
for every 10 min frying period. The number of repetitions of the standard frying procedure



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using each kind of frying fat is listed. Trans, trans-2,4-nonadienal and trans-2-undecenal were
not registered above the detection limit in any of the samples collected.
Frying      # of      t,t-2,4-    2,4-       t-2-       s-2-        2-
fat        repet.   decadienal decadienal  decenal    decenal   undecenal Alkanalsa    Alkenalsa
                    (mean(sd)) (mean(sd)) (mean(sd)) (mean(sd)) (mean(sd)) (mean(sd)) (mean(sd))
Marga-       3        10.33s     25.33s     25.33s       nd       20.67s    426.00s      55.70s
rine                   (2.52)    (4.51)     (9.70)                (7.64)     (70.00)    (11.00)
Rape-        5          0.63       nd        3.60       0.82       3.81      107.00       1.80
seed                   (1.32)               (6.40)     (1.08)     (5.21)     (75.00)     (4.00)
oil
Soy-         6        0.52             nd     0.50            2.20     2.02       128.00           4.00
bean                  (0.8)                  (1.20)          (5.29)   (3.62)      (53.00)         (2.70)
oil
Olive        6         nd              nd     0.50            3.67     3.33       121.00           0.90
oil                                          (1.20)          (2.94)   (2.34)      (85.00)         (1.30)
a = The total sum of alkanales/alkenals other than the ones listed separately in the table
s = The level is statistically significantly (p<0.05) different from the levels measured during
frying with the other three frying fats
nd = No single results above detection limit (0.05 µg/m3)

Table 2: The levels of total particles (mg/m3) measured in the breathing zone of the cook
during pan frying with four different kinds of frying fat. The levels are given as arithmetic
mean (sd) level of total particles measured during one day of frying (one sample/day), each
day including two or three repetitions of the standard frying procedure. The number of
samples for each kind of frying fat is listed.
     Frying fat               # of samples       Total particles
                                                  (mean (sd))
     Margarine                     2               11.6 (0.7)
    Rapeseed oil                   3                1.0 (0.3)
    Soybean oil                    3                1.4 (0.7)
     Olive oil                     3                1.0 (1.1)


Conclusions
Higher aldehydes were detected in all samples from this study, and mutagenic aldehydes were
detected in most of the samples. The levels of total particles in the breathing zone of the cook
measured during frying with cooking oils in the present study are comparable to those
measured in the restaurants in previous studies. According to the present results, frying with
rapeseed oil, soybean oil or virgin olive oil instead of margarine is one way of reducing
personal exposure to some of the components in cooking fumes that may cause adverse health
effects.




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Parallel 2
Risk factors for work-related musculoskeletal disorders
Chair: Bo Veierstedt




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Workshop:
Risk factors for work-related musculoskeletal disorders.

What do we know about physical, organizational and psychosocial factors?

Bo Veiersted and Stein Knardahl,
National Institute of Occupational Health (NIOH), Norway

The Norwegian Labour Inspection Authorities have ordered from NIOH a critical
systematic review of risk factors for work-related musculoskeletal disorders. They will
use this kind of updated information on physical, organizational and psychosocial risk
factors as well as the effect of interventions to improve knowledge-based formulation
of prescriptions and practice at inspections.
A search was performed concerning work-related factors and different MSDs. 15000
references were primarily retrieved, but a survey over titles made it possible to
exclude 2/3 of the references as irrelevant. The rest, approximately 5000 references
were screened and further selection was based on reading abstracts, resulting in 320
full-papers that were critically reviewed. The quality of the papers was assessed by a
checklist dealing with study population, exposure assessment, outcome
measurement, analyses and data presentation.
Up to this date (2008-05-29), the 320 papers have been quality assessed but results
not yet fully gathered and evaluated. We have a general impression that the result of
previous reviews on this subject will be confirmed, e.g. that forceful and repetitive
manual work may increase the risk for tennis elbow and forearm tendinitis. However,
we hope that the included studies in the present review will give more information on
dose-response relationships; how repetitive, what level and duration of exerted force,
which amount of lifting and duration of work with elevated arms increases the risk for
MSD? The results of this evaluation will be presented at the conference.




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What do authorities need to know for work-related musculoskeletal
disorders prevention?
Drøyvold, WB1, Hegdal, B1, Gran, H1
1
    The Norwegian Labour Inspection Authority


         Muscle pain is the most frequent source of sickness absence and permanent disability
         in Norway. 20 % of Norwegian employees report of severe musculoskeletal disorders
         (MSDs). 30 % of the total amount of self reported MSDs is estimated to be work-
         related.

         The Norwegian Labour Inspection Authority’s (NLIA) central task is to execute the
         regulations in accord with the Working Environment Act. Laws and regulations are
         the foundation of all the agency’s activities.

         The employer is responsible for complying with the requirements of the Working
         Environment Act, and for ensuring that the enterprise maintains a healthy and safe
         working environment.

         The NLIA has designated work related musculoskeletal disorders (MSDs) as one of
         seven areas to be prioritised in our occupational health and safety efforts for the next
         four years. The NLIA wants the numbers of companies, who systematically prevent
         work-related MSDs, to increase. The companies are complied to do risk-assessments
         and make an action plan on how to prevent MSDs and how to rehabilitate employees
         suffering from musculoskeletal pain. The agency’s contribution is mainly to be done
         by supervisions, guidance and information. For the next period, 2008 – 2011, the
         numbers of supervisions shall increase. The Authority shall contribute to increased
         knowledge and know-how about prevention of MSDs in working life.

         If the new strategy shall succeed it is important to take into account that different
         groups of factors may contribute to MSDs, including biomechanical, organisational
         and psychosocial factors. A comprehensive approach is therefore necessary.

         The NLIAs actions shall be knowledge based and our qualified evaluations must be
         anchored in laws and regulations that are built on a solid and competent foundation. In
         order to achieve this we need both information about the effect of our actions and
         results from applied research.




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Genetic susceptibility and development of chronic back pain
By Johannes Gjerstad, NIOH
It is now well documented that many work factors increase the risk for musculoskeletal pain.
In particular, low back pain and sciatic pain is often an underlying cause of workplace
absenteeism and disability pensioning. However, development of chronic low back pain and
sciatic pain also partly results from functional changes in the peripheral and central nervous
system. These changes increase the activity in the pain pathways projecting to the brain and
may be important for long lasting suffering and functional impairment.

Several recently described human genetic variants affect these processes. Hence, individual
genetic variability may be essential to understanding of persistent pain conditions including
chronic back pain. To be effective, prevention and treatment of pain should be based on the
underlying individual mechanisms, not only on the data of exposure and symptoms.
Therefore, translating knowledge from basic research into clinical applications is necessary.
The lecture ends with the conclusion that early intervention, based on the inter-individual
differences, may be crucial to prevent a chronic outcome.




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Session on
"Risk factors for (WR-MSD) - primary prevention in the workplace and aspects of prevention
on individual basis."

Work site physical activity as prevention of Work-Related MusculoSkeletal Disorders. Presentation
of current RCT studies based on the concept of “Intelligent Physical Activity”.

Karen Søgaard1,2, Andreas Holtermann2, Mette Zebis2, Lars L Andersen2, Gisela Sjøgaard1,2

1) Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark
2) National Research Center for the Working Environment, Copenhagen, Denmark.

Physical activity has been shown to have a beneficial effect in prevention of a number of life style
diseases such as cardiovascular and metabolic diseases, while for MSD’s, there is less evidence for
a positive effect. Our research group has worked with development and evaluation of work place
exercise programs for prevention of MSD. The exercise programs are composed to match job
demands, individual capacity and frequent types of disorders in jobs with different exposure
profiles, a concept termed Intelligent Physical Activity. The purpose is to provide evidence for the
importance of specificity of training regarding type, frequency, intensity, and duration in relation to
both work exposure profile as well as the particular body region prone for disorders within each job
sector. This presentation will describe two randomized controlled trials that have been conducted
among office workers, as well as a number of ongoing studies concerning job sectors with
contrasting exposure profiles.

The project “Health promotion at the work place” (SPA) is a one year randomised controlled study
with 549 office workers allocated to either specific resistance training, general physical activity or a
reference group. Both physical activity interventions relieved pain, and increased muscle strength in
the neck/shoulder region. However, only specific resistance training lowered the incidence of new
cases of neck pain (1).

The project “Rehabilitation of muscle pain in neck and shoulder” (RAMIN) is a randomized
controlled trial comprising 48 women with clinically diagnosed trapezius myalgia, recruited from 7
workplaces characterized by monotonous jobs. The women were randomly assigned to 10 weeks of
specific resistance training, bicycle training or a reference group. The specific resistance training
group had a long lasting reduction in pain, while bicycle training experienced an acute effect
immediately after each training session (2).

The project “Company adapted intervention on intelligent physical activity in the prevention of
neck/shoulder pain” (VIMS) is designed to further elaborate on the knowledge gained in SPA and
RAMIN regarding the positive effects of physical activity on neck shoulder pain. It involves a large
intervention study including 1200 employees mainly performing computer work or industrial
repetitive work. Among the computer workers the main aim is to evaluate the benefit of supervised
training as well as to find the optimal duration and frequency of the training. The main outcome is
the incidence of neck-shoulder pain. Furthermore, VIMS aims to compare the effect of the physical
activity program on workers with industrial repetitive work loads and computer workers.

The program “Frame for Interventions for preserved work Ability. Longterm Effect” (FINALE)
addresses prevention of musculoskeletal disorders among workers in sectors with physically heavy



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work, and how reduced work ability is associated with long-term sickness absence and risk of early
exit from the labour market.
The overall aim of the program is to generate knowledge that may answer two central questions:
1) What characterizes the progress of reduced physical work ability among employees in different
exposed occupations with different risk profiles? and 2) what specific interventions in the
workplaces can prevent a reduced work ability within these exposed occupations?
The program comprises studies with epidemiologic, random controlled trials and case control
designs.
The epidemiology studies investigate the relation between musculoskeletal disorders, self-reported
work ability and sickness absence in a prospective design. Data are based on the Danish Work
Environment Cohort Study (DWECS) coupled with information of sickness absence and disability
pension from the Danish database The Register-based Evaluation of Marginalization (DREAM).
The random controlled intervention trials are carried out within 4 occupations with high, but
different physical exposure profiles (i.e. industrial workers, cleaning assistants, health care
assistants, and offshore workers). Within each occupation, the interventions include approximately
400 workers. The intervention period will last one year, with the main purpose to improve work
ability by participatory, ergonomic guidance, physical training and cognitive behavioral guidance
The case control design is applied to focus on differences in physiological or cognitive aspects in
persons (cleaners and social health care assistants) with neck/shoulder disorders being long term
sickness listed (cases) compared to those continuing work (controls). Multi-modal functional test,
physical capacity measurements and tissue quality analyses are carried out on cases and controls.

In conclusion
Work site physical activity designed to match the specific work demand and region of complain are
shown to prevent and relieve pain among office workers. Ongoing studies aim for optimizing the
effects of physical activity training with regard to duration, frequency and specificity of training
schedules, and revealing if similar effects can be achieved among workers with physically heavy
job exposure profiles

   1) Blangsted A.K., Søgaard K., Hansen E.A., Hannerz H., Sjøgaard G. (2008) A one year randomized
       controlled trial with different activity programs to reduce musculoskeletal symptoms in neck and
       shoulder among office workers. Scand J Work Environ Health 2008 Feb;34(1):55-65
   2) Andersen LL, Kjær M, Søgaard K, Hansen L, Kryger AI, Sjøgaard G. (2008) Effect of two contrasting
      types of physical exercise on chronic neck muscle pain. Arthritis Care & Research 2008 Jan;59(1): 84–
      91




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Coordination training and cognitive behavioral training to reduce and prevent deterioration
and maintain work ability. A randomised controlled trial among cleaners.

Marie B Jørgensen1, Anne Faber1, Klaus Hansen1, Lea Sell1, Dorte Ekner1, Andreas
Holtermann1, Karen Søgaard2.
1) National Research Center for the Working Environment, Copenhagen, Denmark.
2) Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark

Cleaning is a physically heavy job exposing workers to a large number of well known
physical risk factors for musculoskeletal disorders such as bended or twisted spine, flexed
wrists, arms elevated over shoulder level, squatting, pushing, pulling and lifting. Moreover,
almost all tasks during the workday are performed while walking or standing. In accordance,
cleaners frequently report musculoskeletal disorders, has a high percentage of sick leave days,
and one of the highest frequencies of early retirement. This combination is a clear indication
that cleaners are at risk of deterioration and adverse health outcome that impair their work
ability.
Earlier studies have shown a lower physical capacity as well as a lower coordination among
workers in physically heavy jobs compared to for instance computer workers. This is
combined with a lower participation in leisure time physical activities among workers with
the lowest educational level. This may in part be due to lack of energy after a strenuous work
day but may also be a consequence of fear avoidance e.g. that the subject fears that further
activity may worsen a pain condition and further increase deterioration.
The aim of the present study was to investigate whether coordination training or cognitive
behavioral training may reduce or prevent deterioration, and maintain work ability among
cleaners.

The study is designed as an intervention with 3 arms involving 400 cleaners cluster
randomized into either coordination training, cognitive training, or a reference group offered a
health check. The two training groups receive supervised training corresponding to 1 hour a
week in the first 12 weeks, 30 min a week in the next 12 weeks and for the last 24 weeks only
1 hour a month. The idea is to achieve a long lasting effect beyond the intensive intervention
period by gradually letting the cleaners take more and more responsibility for maintaining
their work ability.

The coordination training is performed in supervised groups of 6 to 8 participants and consists
of exercises aiming to strengthen stability and coordination of trunk and shoulder muscles at
intensity levels of 50-80% of maximal activity in the involved muscle groups. Half of the
exercises involve the use of Body Blades, mostly to facilitate a transfer effect to the working
situation by simulating the exposure but also to increase intensity and make the training more
attractive. In phase 2 and 3 the participants are also offered help with practical arrangements
to maintain training and other types of health enhancing physical activity. This is a
participatory process involving both the employers and the employees.

The cognitive training is conducted in groups of 6 to 8 participants and consist of sessions
focused on topics such as understanding the protective function of pain, coping strategies
regarding pain and disorders, the importance of discriminating between injury and pain, how
to find an individual injury preventing behavior, etc. Participants are encouraged to state
personal goals of achievements in daily life and are offered help and coaching to find
individual ways to reach these goals.




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The health check consist of a 1 hour session with a clinical examination of neck, shoulder and
arms, a test for respiratory function and a submaximal bicycle test for aerobic capacity. The
participants were informed about the result and the interpretation but received no health
advice about life style changes.

A questionnaire and a number of physical tests are performed at baseline, after the three
months constituting phase one with intensive intervention and again after phase 2 and 3
twelve months from baseline.
Primary outcomes of the study are sick leave data provided by the company, self reported
work ability and musculoskeletal disorders. Secondary outcomes are physical capacity (MVC
in trunk flexion, trunk extension, shoulder elevation, shoulder abduction and handgrip),
postural control (postural sway, perturbation test and force steadiness) and kinesiophobia
measured by the Tampa scale of kinesiophobia.

Until now 120 cleaners (74% females) from 4 companies are enrolled in the study and data
from baseline questionnaire and physical test are available for this subpopulation of the whole
study. Among the female cleaners the 12 month prevalence of more than 30 days of disorder
exceeds 20% for all body regions except the hips. Correspondingly, among the males this is
the case for neck-shoulder, low back and feet-ankles.
Moreover, hand grip strength was about 20% lower than for the general population. A large
fraction of 48% of the cleaners were excluded from further MVC test due to adverse health
conditions most frequently hypertension or diagnosed low back disorders. This is a rather
high percentage compared to 12% in an earlier study on Danish wage earners in general (1).
The primary outcome of work ability showed a lower estimation of work ability among the
women compared to men. About one third of the cleaners answered that when considering
their health condition they did not expect or were not sure that they could still work as a
cleaner in a 2 years perspective. However, the cleaners in general scored high on job
satisfaction.
All in all the baseline data confirmed that cleaners are at risk of adverse health effects,
musculoskeletal disorders and decreased work ability. An intervention focused on maintained
or improved work ability within this sector is therefore highly justified.

1) Faber A, Hansen K, Christensen H. Muscle strength and aerobic capacity in a representative sample of
   employees with and without repetitive monotonous work. Int Arch Occup Environ Health 2006; 79(1):33-
   41.




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Parallel 3
NEG 30 years anniversary seminar
Chair: Vidar Skaug

The Nordic Expert Group for Criteria Documentation of Health Risks from Chemicals (NEG)
has as its main task to produce criteria documents to be used by the regulatory authorities of
the Nordic countries as the scientific basis for setting occupational exposure limits (OELs) for
chemical substances. The group includes scientific experts from the Nordic countries
representing different fields of science, such as toxicology, occupational hygiene and
occupational medicine and epidemiology. The secretariat is run by the Swedish Work
Environment Authority (SWEA) and is located at Karolinska Institutet in Stockholm, Sweden.
NEG is mainly financed by SWEA and the Norwegian Ministry of Labour and Social
Inclusion. All countries contribute with scientific expertise. The documents, written in
English, are published by Göteborg university in the scientific serial Arbete och Hälsa. The
documents are also available as pdf downloads via this website under Publications.

 At the Anniversary seminar, Professor Jorma Rantanen, Chairman of ICOH, Finnish Institute
of Occupational Health, Helsinki will remind us in opening lecture about the Origin and
maturation of NEG - a Nordic Effort for Chemical Safety. Looking into the near future,
Professor Gunnar Johanson, Chairman of NEG, Karolinska Institutet, Stockholm will discuss
the role of NEG related to SCOEL and REACH under the EU regulation of chemicals. Some
recent criteria documents, dealing with updated information on issues of concern, such as
occupational exposure to chemicals and hearing impairment, as well as on fungal spores will
also be presented. The seminar invites all attendants to the 53th Nordic Work Environment
meeting to join this parallel session.




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Title:
Occupational exposure to chemicals and hearing impairment - the need for noise
notation




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The concept of ototoxicity after occupational exposure to chemicals is not well known.
The new European Noise directive 2003/10/EC specifies that “the employer shall give
particular attention, when carrying out the risk assessment, to, among other, any effects on
workers’ health and safety resulting from interactions between noise and work-related
ototoxic substances, and between noise and vibrations” (EU, 2003).




Hoet P and Lison D. Ototoxicity of Toluene and Styrene: State of Current Knowledge.
Critical Reviews in Toxicology, 38:127–170, 2008

EU. (2003). Directive 2003/10/EC of the European Parliament and of the Council of 6
February 2003on the minimum health and safety requirements regarding the exposure of
workers to the risks arising from physical agents (noise). Official Journal L 042, 15/02/2003
P.0038–0044.




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Fungal spores – Time for an OEL?


Wijnand Eduard, National Institute of Occupational health, Oslo
Introduction
This document, that was prepared for the Nordic Expert Group, is the first health-based
criteria document that has been published on fungal spore exposure in working populations.
It was a major challenge for all participants because of the many scientific disciplines
involved, including fungal biology, which is not common knowledge among the NEG
members. Furthermore, competence in exposure assessment, toxicology and epidemiology is
required when writing criteria documents, which is seldom present in the same individual,
leading to major effort by the NEG members supervising the preparation of these documents.

Methods
This document is based on a comprehensive literature search, references found in the
publications and the author’s own literature base.

Biological properties
The fungal kingdom represents a large group of eukaryotic organisms and includes broad
groups as mushrooms, moulds and yeasts. Fungi develop different stages including single
vegetative cells, hyphae, which are multi-cellular filamentous structures that collectively form
the mycelium, and spores, which are the main structures for reproduction and dispersal.
Exposure to fungi is assumed to be dominated by spores that are produced by many species in
large numbers and that become easily airborne. Their size is typically below 10 m so that
they may stay airborne for a long time and transported over long distances. Fungal spores are
therefore ubiquitous in indoor and outdoor air all across the globe

Exposure
Although fungal spores are present in indoor and outdoor air, exposure levels in workplaces
where mouldy material is handled as in agriculture and in the wood and waste handling
industries are commonly in the range of 104-107 spores/m3, which is much higher than in the
outdoor environment where exposure levels seldom exceed 104 spores/m3. Such populations
are suitable for epidemiological studies of health effects from fungal spores. In indoor air
spore levels are often lower than in outdoor air, even in damp and “mouldy” buildings.

Toxicological properties
Due to their small size are fungal spores easily inhaled and deposit in the airways and in the
alveoli. Fungi may produce and/or contain enzymes, toxins and allergens that may differ
between species and can be expected to affect their toxicity. Of the same reason the toxicity
of viable and non-viable organisms and different fungal structures may be expected to be
different. In experimental studies non-allergic inflammation dominated, although viable and
mycotoxin producing species also induced allergic effects, especially after repeated exposure.
Fungi may also represent an infection risk, but this is mainly restricted to immunodeficient
individuals.




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Although in vitro experiment showed differences between species, strains and even growth
conditions, spores from most species showed fairly similar toxicity in animal studies.
However, according to expectations, mycotoxin producing Stachybotrys chartarum and the
opportunistic pathogen Aspergillus fumigatus were substantially more toxic.

Human studies




Conclusions




Impact of the document
Most interest for this document has come from the indoor air field although few studies were
available in this area. The results were presented at a NIVA course on Occupational indoor
air problems caused by mouldy buildings, a lengthy discussion evolved with Swedish scientist
after a “case” with newly built apartments with mould problems and the detection of
mycotoxins in settled indoor dust by a group at Lund University, and a Letter to the Editor
that was published in Indoor Air.

References


Eduard W. A health-based criteria document on fungal spore exposure in the working
      population. Is it relevant for the general population? Indoor Air 2008; 18: 257–258.



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NEG under REACH and SCOEL

Gunnar Johanson

Work Environment Toxicology, Institute of Environmental Health, Karolinska
Institutet, Stockholm, Sweden
During its 30 years of existence, the Nordic Expert Group for Criteria Documentation of
Health Risks from Chemicals (NEG) has published roughly 150 criteria documents covering a
variety of workplace contaminants. In parallel, NEG has become increasingly acknowledged
by national and international bodies in the field. NEG has strived to become more visible, e.g.
by launching a web site (www.nordicexpertgroup.org) and by presenting the group and its
criteria documents, for example at the NAM, the American Society of Toxicology and other
relevant conferences. NEG has a long-standing collaboration with the Dutch DECOS
committee and NIOSH in the production of joint criteria documents. Being the chairman of
NEG I have been invited, for example, by the American (ACGIH-TLV), European (SCOEL),
French (AFSSET) and German (MAK) committees on occupational exposure limits (OELs),
by the European Agency for Safety and Health at Work, and by the international (ICOH,
IOHA), American (SOT), Dutch, Swedish and Swiss organisations of toxicology,
occupational and environmental medicine and/or hygiene. Other contact points include
invitations to NAM meetings, to NIVA courses on toxicology, biomonitoring and peak
exposures, and to working groups or committees working for the European Commission, the
International Commission for Occupational Health (ICOH), the US National Academies of
Science and the Swedish Chemicals Inspectorate. Issues have been to share experiences and
express views related to OELs, use of human toxicological data, skin notations, biomarkers of
exposure, use of assessment factors, derivation of DNELs (see below) etc.

The impact of NEG is reflected by frequent and increased use in the more recent summary
documents produced by the Scientific Committee for Occupational Exposure Limits (SCOEL)
of the European Commission, as a basis for recommending Indicative Occupational Exposure
Limit Values (IOELVs). Thus, the SCOEL summary documents on acrolein, flour dust,
formaldehyde, hydrogen sulphide, lithium and lithium hydride, phtalic anhydride, platinum
(now being drafted) and tetrachloroethylene are based on, or cite, NEG criteria documents.

The role of NEG under the new REACH legislation remains to be defined. Under REACH,
risk assessment and management, including derivation of Derived No-effect Levels (DNELs)
and Derived Minimal Effect Levels (DMELs), are the responsibility of the
importers/producers. However, the draft technical guideline of REACH states that no
DNEL/DMEL is needed if an OEL has been set at the European level. This means that the
SCOEL procedure, and the need for NEG documents, is likely to continue at least for the
foreseeable future. NEG criteria documents may also be useful for companies directly, when
setting DNELs and DMELs for data-rich chemicals. Default rules for handling of data-poor
chemicals and other general principles may be a new field for NEG. Another important task is
to disseminate knowledge on how OELs, DNELs and DMELs are established. Together with
NIVA, NEG arranges one-week courses with 3-4 years intervals. The most recent one,
“Occupational exposure limits and implications of REACH”, is held in August 2008.




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Parallel 4
Organisational and psychosocial work environment
Chair: Kristinn Tómasson




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Title
Mental well-being and the workplace
Abstract
Objective,
Mental well-being is one of key factors that are necessary for good
functioning both at work and in other areas of life. The workplace offers
both positive and negative challenges for the mental well-being of the
employee and employer alike. Organization and the nature of the tasks or
work and provided and received support are key elements in forming the
mental well-being of all at the workplace. These factors are becoming
more and more evident as the main health risk factor associated with
work is the psycho-social work environment. The objective of this paper is
to demonstrate how mental well being is cross-sectionally associated with
different psycho-social demands depending and the position held by the
employee.
Methodology:
The Public Health Institute of Iceland conducted in 2007 in cooperation
with number of others, including the Administration of Occupational Health
and Safety a general health survey of 10.000 Icelanders aged from 18 to
79 years. A total of 5906 responses were returned. The present paper will
focus on several questions regarding the psycho-social work environment
based on the QPS- Nordic and general questions pertaining to mental
well-being among employed responders and number of hours spent at
work
Results:
Mental wellbeing was heavily dependent on position, with among men
54% of the highest ranking officials, and managers ranking their mental
health as excellent, correspondingly specialists, and office workers ranked
their mental health as excellent in 41 to 45% of cases, skilled workers,
farmers, sale and service employees ranked their mental health as
excellent in 30 to 35% of cases. However other groups ranked their
mental health as excellent only in 23% to 29% of cases. Those not
employed ranking their mental health as excellent in 24% of cases.
Among women the scenario was similar with the highest ranking officials,
and managers ranking their mental health as excellent in 52% of cases,
university educated specialist and skilled workers ranking their mental
health as excellent in 44% to 47 of cases, while other groups ranking their
mental health as excellent in 30 to 37% of cases. Those women who were
not employed ranked their mental health as excellent in 24% of cases
Mental well being was not associated with irregular workload, extra work
or having to perform work at a high pace. However, having to do
something that the worker feels at should be done differently, or tasks
that the worker does not have the means to complete, being faced with
conflicting demands, not getting support when needed, the workers
superior not being willing to listen to problems about work, not being



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appreciated by the boss, having the superior assign work in an objective
and just manner, and being treated fairly by the boss were all significantly
related to mental well being
Conclusion.
Good mental health is one of leading priorities that needs to be placed
high on the agenda of all involved in occupational health. The need for this
is most clearly seen from data showing mental disorders as the leading
cause for long-term sick leave and disability. Both the current data and
data from other countries show how closely mental well – being is linked
to the occupational position and secondly how closely mental well-being is
linked to psycho-social work environment. Given this information setting
priorities in providing service counselling for different occupational groups
is needed with increased focus on better service for the unskilled and
semi-skilled worker. Furthermore, managers need to organize their firms
in a manner that is clearly linked to better mental well-being of the
worker.
Authors
Kristinn Tómasson1, Hólmfríður K Gunnarsdóttir1, Guðbjörg L.
Rafnsdóttir2
      1.    Administration for the Occupational Health and Safety
            Bíldshöfða16
            110 Reykjavík
            Iceland
            kristinn@ver.is; hkg@ver.is
      2,    University of Iceland
            Department of Social Science
            Sudurgata
            101 Reykjavík
            Iceland

Topics
Organisatorisk og psykososialt arbeidsmiljø
Key words
Mental well-being, psycho-social work environment, occupation
Preferred method of presentation:
Oral presentation,
Language
English.




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Public home care – timeless, durable, day and night

Edle Utaaker, Head Engineer, Norwegian Labour Inspection Authority, Bergen

Background and goals
In 2002, the Norwegian Labour Inspection Authorities chose to launch a country-wide
campaign to improve the workings conditions in the home care sector. The decision was
based upon a broad risk assessment of a number of sectors, public and private. According to
the Labour Inspection Authority’s objectives and strategies, the main goal of the campaign
was to reduce the different kinds of work overload that contribute the most to work related
illness and injuries.

Problems
The home care sector has a substantial number of employees, more then 100 000, many of
whom work alone, under very different and often difficult and stressful working conditions.
Time pressure and work overload in general is frequent. Early retirement caused by disability
due to working conditions is not uncommon.

Most of the workers are employed directly by the municipal authorities, some are employed
by private contractors. The campaign was focussed on the duties and responsibilities of both
employers and employees under the Working Environment Act. Organizing the work in a way
that reduces the risk factors and promotes health, safety and well-being at work has been one
of the main topics. A special challenge in the home care sector is the fact that the employers
have very limited control over the physical workplace – i.e. the clients’ home.

One of the initial tasks was to gather information on the working conditions within the home
care service from different sources – trade unions and employers’ associations, research
institutions, literature search and the Labour Inspection Authorities’ own experience.

The result of these initial investigations was that three main areas should be addressed:
   – Time pressure
   – Ergonomics (lifting heavy objects/persons, awkward working positions etc)
   – Violence and threats

At the turn of the year 2002 – 2003, a telephone survey among employees (1000) and
employers’ representatives (300) was carried out by the institute Opinion AS asking them
about their perception of working conditions in the home care system. The survey showed,
among other things, that one of three employees had been on sick leave (more than three
days) due to work related illness or injuries the last two years. The survey also confirmed the
choice of the main areas of the campaign.

The campaign was carried out in three stages during the years 2002 – 2007. The first stage
(2002 – 2003) comprised 1230 comprehensive inspections in all 434 municipalities in
Norway. The second stage (2003 – 2004) 612 inspections were carried out in the 328
municipalities which had been given a written order to improve the working conditions.
In the third stage (2007) 473 inspections were done in 277 municipalities where working
conditions were still not satisfactory according to law and regulations.


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Results
The development over the five years shows a significant improvement of working conditions,
from first to third round of inspections. 161 enterprises – obviously those with the most severe
problems – were subject to inspections in all three rounds. Even if there still are a lot of
problems to solve in these units, they have had an overall improvement in all areas examined.
The percentage of enterprises where working conditions are not seen as a problem has
increased significantly in all areas, whereas the number of units where there still are unsolved
problems and no measures undertaken has been reduced by approximately 50 percent. In one
unit (Sortland kommune) sick leave was reduced from 27 to 7 percent in one and a half year.

Conclusions
Inspections, demands and guidance from the Labour Inspection Authorities have been
decisive in the improvement seen during the campaign period. There is now a general accept
among all parties that the Working Environment Act and Regulations also apply when work is
done in private homes.

Improvements of working conditions in the home care sector also depend largely on the
following factors:

       – Top management, political and administrative, must acknowledge the problems
         and be committed to solving them
       – Leaders in all levels, as well as employees, must engage personally in the process
       – Improvement should be a systematic and continuous process involving all parties
         concerned
       – Information- and discussion forums must be established

Work environment problems described above are not likely to go away, but can - hopefully -
be held at a minimum through positive cooperation between employers, employees and health
and safety officers and ombudsmen.

Key words:
Time pressure
Awkward working positions
Threats and violence
Systematic approach
Committed management




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Validation of an effort-reward imbalance questionnaire.
Bjørn Lau, NIOH, Norway

Background: The aim of this study was to validate a Norwegian version of the Effort–Reward
Imbalance Questionnaire (ERI-Q).

Methods: One thousand eight-hundred and three employees in a medium-sized Norwegian
municipality replied to the ERI-Q, and health-related variables such as self-reported general
health, psychological distress, musculoskeletal complaints, and work-related burnout were
examined.

Results: Sound psychometric properties were found for this Norwegian version of the ERI-Q.

When the two dimensions of ERI and overcommitment were analyzed in four types of
employees, the results showed that employees characterized by a combination of high values
on ERI and overcommitment had more unfavorable health scores than others. Employees with
low effort– reward and overcommitment scores had more favorable health scores. Employees
with scores on the overcommitment and the effort–reward scales that are supposed to have
opposite effects on health (that is, the combination of low overcommitment with a high
effort–reward score and vice versa), had health scores somewhere in between the two other
groups.

Conclusions: Satisfactory psychometric properties were found for most of the latent factors in
the ERI-Q. The findings also indicate that it may be fruitful to explore health conditions
among employees with different combinations of effort–reward and overcommitment.




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MANAGEMENT SUPPORT IN CHANGE AND TRANSITION

Sigurborg Óskarsdóttir and Ragnhild Ruland, Occupational Health and Working
Environment, StatoilHydro ASA 5020 Bergen
Corresponding author: Sigurborg Óskarsdóttir: siosk@statoilhydro.com Tel.: no +47 92607646

Background
StatoilHydro has carried out the largest company merger in the Nordic history. As the two
companies are known for having strong profiles within health, safety and environment, there
are high expectations for the completion of the merger in relation to taking care of people
during this process. According to research - There is too little focus on people during
mergers and transitions, - Leadership plays a critical role in how co-workers tackle
transition.
It is therefore of great importance to improve the quality of leadership in these matters, and
make sure leaders have the necessary knowledge and confidence in managing change and at
the same time appreciate emotions and support employee integrity. Focus on the working
environment is a prerequisite for achieving a successful merger. Based on feedback from
participants on workshops in change and transition conducted during the spring of 2007, a
project has been established to run through 2008. The Health and Working Environment
Network in StatoilHydro, is responsible for running the project.

Objective
For the participants:
   • To acquire insight into the challenges intrinsic to change and transition, and how to
        handle these at an individual and group level
   • To be able to implement actions which contribute to health, well-being and a good
        working environment
   • To strengthen the leadership in dealing with his own and the coworker challenges

Methodology
The project is organised as a project group, who has developed and prepared the content of a
3,5 hours workshop. The time is divided between a theoretical part, where evidence based
knowledge is emphasized, and a practical part with group exercises and dialog, based on
solution focused approach.
A resource-group of people from The Health and Working Environment Network is
established to run the workshops. For this group we have organized a two days training. All
leaders with personnel responsibility are invited to participate.

Results
So far, 400 managers have completed the workshop. The feedback from the participants
underlined the relevance, the dialog and being able to exchange experience with other
participants, as especially valuable. Experience collected in the workshops will be a
contribution to a 3 year long research program on the merger process in StatoilHydro. In the
continuation of the program

Conclusion
The merger is in progress. The research program that follows the process will gain more
results in time to come.


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Parallel 5
Epidemiology I
Chair: Tore Tynes




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Occupational health epidemiology in the Nordic countries, status and trends

Maria Albin, MD, PhD, Department of Occupational and Environmental
Medicine, Lund University Hospital, Lund, Sweden (maria.albin@med.lu.se)

Problem
The future of occupational epidemiology was recently questioned by J Siemiatycki (OEM
2007). An international evaluation of Swedish work environment research highlighted
substantial strengths, but also considerable weaknesses and threats.

Objectives
To give indications of the current status and trends as a basis for a discussion on challenges
and priorities

Methodology
The evaluation of Swedish work environment research (Scand J Work Environ Health
2007;33:suppl 1) provides an overview of basic trends and status also for Danish, Finnish and
Norwegian research. This was supplemented with additional searches, and consideration of
likely trends in the work environment and challenges from scientific findings in other areas.

Results
Publications: Denmark, Finland, Norway and Sweden contributed in 2001-2005 18.5% of the
publications in 10 selected international occupational health and ergonomics journal (table),
with a slightly increasing trend since 1986-90. The largest proportion contributed by country
was from Sweden (8%), ranking third after the US (36%) and England (12%). The
productivity expressed as publications per year per million inhabitants was globally highest in
Finland, followed by Sweden, Denmark, Norway and the Netherlands. The mean number of
citations (impact) for those publications were globally lead by the Netherlands, followed by
Denmark, the US and Sweden. The international collaboration index was highest for
Germany, followed by Denmark, Finland and Norway.

Researchers: Occupational health epidemiology expanded markedly during the 1970-ies and
1980ies in the Nordic countries, introducing a birth-cohort effect with a substantial part of the
senior researchers close to retirement age. Training of a new generation of excellent
researchers is a major task for the next decade. Structures for funding should be adapted to
this. Rapid institutional change (like the closing of NIWL in Sweden) may be a menace,
unless substituted with other clear and sustainable national strategies.

Changes in working life: Demographic change will face the Nordic countries with an ageing
population. Preservation of work-ability will be a major issue to explore from a
multidisciplinary perspective. Recent statistics from Sweden indicate a difference in expected
keeping of work-ability from age 35 between the best and worst jobs of more than 11 years
for women and 8 years for men. In developing countries the extremely young work-force can
be expected to be especially vulnerable to adverse working-conditions.

It is likely that international institutions concerned with workers safety will remain weaker
than those dealing with consumers’ safety – as is the case for instance within the EU.
Moreover, so called Evidence-based toxicology launched by the chemical industry, objects to
restrictions in the absence of human evidence for adverse effect. This indicates more need of


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national toxicological competence than may have been previously fore-seen. The implication
for occupational health is that gaps in the assessment of safety of new products are likely to
occur in the occupational setting, challenging our capability do detect adverse effects.

A continuing increase in migration of labour, goods and capital across national boundaries, is
likely to globally increase the informal sector, increase the industrial sector in developing
countries, and the service sector in OECD countries. This indicates that an increasing
proportion of workers in dangerous trades will not be covered by minimal occupational safety
measures, neither in the Nordic countries, nor in developing countries. This calls for
reconsideration of the present occupational safety structures, which were developed mainly
for work at big industrial plants: Can they be efficiently applied also to the service sector?
What strategies should be tried in the informal sector? Also, the major research centres and
publishing agencies should consider what they can do to assist in eradicating the world-wide
epidemics of severe silicosis, occupational intoxications and injuries. The success-story of
fighting exposure to environmental tobacco smoke indicates that society, as well as singular
individuals, is prepared to accept far-going restrictions, given the right conditions are there!

This adds up to increased demand on development of validated surveillance-systems for
working conditions, research on implementation, and being well-prepared to perform basic,
but care-full, cross-sectional studies of workers exposure and health. The single aspect that
would most increase the usefulness of these studies would be inclusion of state-of-the-art
occupational hygiene. Valid assessment of the exposures associated with a certain prevalence
of disease is crucial as a basis for the setting of occupational standards and other regulatory
measures. Research on occupational health services remains remarkably scant, especially
since we consider it to be crucial for primary prevention and rehabilitation.

Challenges from other disciplines: Mental ill-health is a growing problem, especially among
young women, where the interaction between structural societal change (as for instance an
increased proportion of poor households with lone mothers), individual vulnerability and the
work-environment can now be studied using new data-bases in the Scandinavian countries.
Exposure to small particles at low levels increases mortality and morbidity in the general
environment. We need to know how the risk varies with particle and subject characteristics
(such as age) in order to know how this can be generalized to the work environment.

New suggested disease mechanisms potentially important with regard to occupational
exposure need to be assessed with regard to their health relevance. This applies to oxidative
stress, epigenetic change (“you are what your grand-father was exposed to”), and intrauterine
priming of sensitivity to postnatal exposure (childhood leukaemia, attention disorders).

Conclusion
Occupational health epidemiology is now delivering the harvest of the funds contributed to
the field especially during the 1980-ies. The investments have resulted in a number of highly
qualified research groups covering an astonishingly wide spectrum of diseases and research
tools. As indicated by a recent biometric review, the output from the Nordic countries is
globally ranked among the top five, using different quality indices. However, birth-cohort
effects and rapid change in institutions and funding may seriously jeopardize these assets
during the coming 10 years. Consensus between worker-employer-government was the basis
for the Nordic success story. It needs to be restated (at least in Sweden) to survive us. Given
adequate infrastructure, we are well equipped to answer to both challenges from changes in
the work environment, and advances in other scientific disciplines.


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Incidence of COPD – experience with cross-sectional analysis

Terje Grimstad, Med. director, Dep. occup. med.
Monica Eftedal, cand. polit.
Herøya Bedriftshelsetjeneste, Porsgrunn, Norway

Update for Occupational Health Services (Oral presentation)

Problem
Chronic obstructive pulmonary disease (COPD) has become one of the leading diseases of
our time. During the last decades there have been a growing number of studies indicating a
possible occupational effect in the development of COPD.

Objective
In 2003 Herøya BHT wanted to answer the questions: “What is the incidence of COPD
among the employees at Herøya Industripark?i Can cross-sectional analysis be used to reveal
a possible occupational ethiology of COPD?

Methodology
A cross-sectional study based on data from all employees that had taken a spirometric test at
Herøya BHT in the period 2000 – 2003, a total of 2.325 individuals, was conducted. The lung
function tests were taken on Vitalograph bellows spirometer (volumetric storage), measuring
forced expiratory volume first second (FEV1) and forced vital capacity after six seconds
(FVC6). Classifications of the severity of COPD were made according to the GOLD criteria.
We were looking at the incidence of moderate and severe COPD in relation to gender, age-
groups, smoking habit, worksite and occupation. The two last-mentioned were seen as
indirect measures of exposure. Multivariate logistic and linear regression analyses, with
respectively obstructive lung function (dichotomised) and FEV1 as dependent variables, were
also conducted.

Results
A total of 4.6 % of the workforce met the Gold criteria of moderate or severe COPD. As
expected the number of COPD cases increased with age and smoking habit. We found a
higher incidence among men than women, and among shift workers compared to others. We
also found rather large differences between different enterprises. 9 % of the shift workers in
one production unit could be classified as COPD cases according to GOLD. Among shift
workers who smoked the incidence was 20 %. Also welders seemed to be a vulnerable group.
Multivariate analyses, controlling for possible confounding factors, showed that individuals in
work-sites with exposure for dust and gas, seemed to be at higher risk of obstruction and
reduced FEV1 than those working at the Research Center at Herøya Industripark (mainly
office and laboratory workers).

The analyses and presentation of results to the enterprises have stimulated a lot of activity on
individual, group and organizational level. Ranging from quitting smoking, increased use of
protective equipment, initiative to reduce gas and dust exposure, cooperation with Sykehuset
Telemark (the county hospital) in individual COPD-rehabilitation, increased knowledge for


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everyone involved, and start-up of a larger research project to investigate more thoroughly a
possible connection between occupational exposure and COPD development etc.

Conclusion
Our use of cross-sectional analysis has been a successful instrument in getting overview of the
lung function among employees, and has helped us generating hypotheses regarding possible
causes of COPD-development in different work-sites. We look at this research method as
necessary in an occupational health service to detect possible problems and to stimulate
prevention activities at different levels.


     Obstructive lung-function and work area at HIP 2003
       (FEV1 < 80% and FEV1 /FVC< 70%)


                                                    %       Average 4,6% (N=2325)
                                                    9

     1.        Factory A (N=517)                    8
               Total and among it’s shift workers
     2.        Diverse background (N=101)           7

     3.        Factory B (N=54)                     6
     4.        Factory C (N=190)                    5
     5.        Administrative personnel A (N=173)
                                                    4
     6.        Factory D (N=110)
                                                    3
     7.        Administrative personnel B (N=225)
     8.        Workshop engineering and transport 2
               (N=496)
                                                    1
     9.        Higher educated office workers
               (N=156)
                                                    0
     10. Research centre (N=301)                        1   2   3   4   5   6   7   8   9   10




     Date: 2008-05-13 • Page: 2




i
 What’s today called Herøya Industripark (HIP) was until 2003 one of Norway’s largest industrial
worksites with a conglomerate of different enterprises, all belonging to Norsk Hydro ASA. Today
there are even more enterprises at this industrial site, but Norsk Hydro is a minor employer.




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   Airway inflammation in cement dust exposed workers

   A.K.M. Fell1,3. L.I.B. Sikkeland2,3 and J. Kongerud3
   1
    Department of Occupational and Environmental Medicine, Telemark
   Hospital 3710 Skien, Norway. 2Centre for Occupational and Environmental
   Medicine, Rikshospitalet University Hospital, Oslo, Norway. 3Department
   of Respiratory Medicine, Rikshospitalet University Hospital, Oslo, Norway.

   Introduction: Former studies have presented conflicting data on the association
   between exposure to Portland cement dust and respiratory effects [1-4]. Our aim was to
   examine the association between airway inflammation and exposure to cement-dust.

   Subjects: 35 cement plant workers (respirable dust concentration from personal
   samplers 1.3 (0.2-8.1) mg/m3 (mean, range), 15 ‘white collar’ workers (internal
   controls) and 39 external unexposed controls were included.

   Material and Methods: The workers performed spirometry and induced sputum after a
   period of regular cement dust exposed work and again after 5 days without exposure.
   Information on respiratory symptoms, allergy and former respiratory disease was given
   on a self-reported questionnaire. Differential cell counts and measurements of
   inflammatory markers in sputum were carried out.

   Results: 35 non-smoking cement plant workers, aged 18-62 (mean 38), 15 ‘white collar’
   workers (internal controls) aged 18-57 (mean 51) and 29 external unexposed controls
   aged 19-69 (mean 38) were included. The mean percentages of neutrophils are shown in
   fig 1. The mean levels of IL-1β in sputum after exposure compared with external
   controls was 28 pg/ml (95 % CI 21-36) and 17 (13-21), respectively (p = 0.006).

   Discussion and conclusions: The percentage of neutrophils was significantly elevated
   among cement workers during an exposed period compared to an unexposed period, and
   it appears to be an effect gradient from the exposed workers through internal controls to
   external controls Furthermore the cement workers had a higher percentage of
   neutrophils and a higher level of IL-1β in sputum after exposure, than external controls.
   The mean age in internal controls is higher than among exposed, this may explain the
   similar level of neutrophils and IL-1 β compared to the exposed group. Our results
   indicate that cement dust exposure in concentrations below the Norwegian occupational
   limit (respirable dust: 5 mg/m3, total dust: 10 mg/m3) may cause airway inflammation.

   References:
   1. Abrons HL, Petersen MR, Sanderson WT, Engelberg AL, Harber P. Symptoms, ventilatory function, and environmental
   exposures in Portland cement workers. Br J Ind Med 1998;45:368-375.2. Fell AKM, Thomassen TR, Kristensen P, Egeland T,
   Kongerud J. Respiratory symptoms and ventilatory function in workers exposed to Portland cement dust. J Occup Environ Med
   2003;45:1008-1014. 3. Al-Neaimi TI, Gomes j, Lioyd OL. Respiratory illness and ventilatory function among workers at a cement
   factory in a rapid developing country. Occup Med 2001;6:367-373.
   4. Mwaiselage J, Braatveit M, Moen B, Marshalla Y. Cement dust exposure and ventilatory function impairment: an exposure-
   response study. J Occup Med 2004;46:658-667.




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   Figure 1. % neutrophils in sputum.


                                  p = 0.05

                                             p = 0.001
                                                         p = 0.001




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Short term exposure to cooking fumes and pulmonary function

Sindre Svedahl2, Kristin Svendsen3, Torgunn Qvenild1, Ann Kristin Sjaastad1,3,
Bjørn Hilt1,2

   1) Department of occupational medicine, St. Olavs University Hospital in
      Trondheim, Norway
   2) Department of cancer research and molecular medicine, Faculty of
      medicine, Norwegian University of Science and Technology (NUST),
      Trondheim, Norway.
   3) Department of industrial economics and technology managements,
      NUST, Trondheim, Norway.

Exposure to cooking fumes is abundant both in domestic homes and among professional
cooks and entails a possible risk of deleterious respiratory health effects including irritation,
obstruction, pneumonia, and respiratory cancer.

Objective: To study possible short term effects of cooking fumes on pulmonary function.

Methods: Two groups of 12 healthy volunteers (groups A and B) stayed in a model kitchen
for two and four hours respectively, and were monitored with spirometry four times during
twenty four hours (1) In the morning before entering the kitchen, 2) when leaving the kitchen
after two or four hours, 3) six hours after entering the kitchen, and 4) next morning 24 hours
after entering the kitchen), on one occasion without any exposure, and on another with
exposure to controlled levels of cooking fumes. The exposure to cooking fumes was
monitored by personal sampling during the day of exposure and showed a mean exposure of
group A of 19.5 mg/m3 (range 13.8-32.9) and of group B of 42.8 mg/m3 (range 31.9-54.9)

Results: Table 1 shows the differences of spirometric measures in percent between the
different points in time on the days without and with exposure. For the whole group, there
were no statistically significant differences in changes in spirometric values during the day
with exposure to cooking fumes and the day without exposure, with the exception of forced
expiratory time (FET). The change in FET from entering the kitchen (point 1) until six hours
later (point 3), was significantly longer on the exposed day with a 15.7 % increase, compared
to a 3.2 % decrease during the “blind day” (p-value = 0.03). The same tendency could be seen
for FET measurements done immediately after the exposure (point 2) and on the next morning
(point 4), but this was not statistically significant. For Forced expiratory flow when 25 % of
the vital capacity is exhaled (FEF25) and FEF50 (when 50% is exhaled) group B showed a
statistically significant increase during the day with exposure when compared to the day
without between the measurement 3 and 1, and both measurements 3-1 and 2-1, respectively.

Consideration: In this study we aimed to determine short term changes in lung function in
healthy subjects subsequent to exposure to cooking fumes in an experimental setting. In such
a setting we did not expect to find dramatic changes in crude spirometric measures like FVC,
FEV1 or PEF, but rather hypothesised that there might be changes in measures more reflecting



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Table 3. Percentual changes in spirometric values at different points in time in the groups and
during periods with (E) and without (B) exposure to cooking fumes.

      Spirometric        Group A (n=12)          Group B (n=12)              All (n=24)
      measure
                       2-1#     3-1      4-1    2-1    3-1   4-1       2-1      3-1       4-1

      FVC         B    -1.1 -0.6        +0.1   -1.7   -1.3   -2.3     -1.4    -0.9        -1.1
                  E    +0.2 -0.5        -0.8   -1.3   -0.9   +0.1     -0.6    -0.7        -0.4
      FEV1        B    +1.1 +1.3        +0.6   -0.8   -0.6   -1.6     +0.2 +0.4           -0.5
                  E    +0.5 -0.5        -1.2   -0.8   -0.5   -0.5     -0.2 -0.5           -0.9
      FEV%        B    +2.3 +1.9        +0.6   +0.9   +0.8   +0.7     +1.6 +1.4           +0.7
                  E    +0.3 +0.0        -0.3   +0.5   +0.5   -0.6     +0.4 +0.2           -0.5
      PEF         B    +2.4 -0.5        -1.7   -1.7   -1.7   -3.0     +0.4 -1.1           -2.3
                  E    -0.8 -0.2        -0.6   +0.9   +2.6   +1.4     +0.1 +1.2           +0.4
      FEF25       B    +3.8 +5.9        +3.6   -5.0   -5.4  -4.2      -0.6    +0.3        -0.3
                  E    -0.9 +0.5        -0.4   -1.4   +1.9* +0.7      -1.2    +1.2        +0.1
      FEF50       B    +0.6 +3.4        -0.2   -2.6  -4.5  -4.6       -1.0 -0.6           -2.4
                  E    -0.6 +0.7        -2.5   +6.5* +6.1* +0.6       +2.9 +3.4           -1.0
      FEF75       B    -0.7 +3.7        -0.9   +3.8   +3.8   +0.1     +1.6 +3.7           -0.4
                  E    +2.3 +0.6        +0.9   +1.3   -1.0   -0.6     +1.8 -0.2           +0.1
      FET         B    +1.0 +0.2 -4.5          -0.7  -6.7  +8.7       +0.1 -3.2   +2.1
                  E    +1.0 +16.9 +1.0         +12.8 +14.6 +7.3       +6.9 +15.7* +4.2


the function of the small airways like FEF 75 and FET. In our paired analysis it was shown
that FET developed differently during the day of exposure, compared with the ”blind day”.
Prolonged FET has been associated with obstructive disorders, and the increase in FET during
the day of exposure might be explained by inflammatory responses and obstruction in the
distant peribronchiolar tissue caused by inhalation of cooking fumes.

Conclusion: In our experimental setting, there seems to be minor short term spirometric
effects, mainly affecting FET, from exposure to cooking fumes.

Key words:
Cooking fumes, lung function, spiromtry, forced expiratory time (FET).

Corresponding author:
Bjørn Hilt
Department of occupational medicine
St. Olavs University Hospital in Trondheim
N-7006 Trondheim, Norway
Phone +47 72571407 / +47 90069490




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e-mail: bjørn.hilt@stolav.no




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Abstract regarding acoustic rhinometry and spirometry to NAM 2008.

Title:
Is there any correlation between lung function and nasal patency?
Authors:
Hovland, K, MD, mail kristin.hovland@stami.no
Skogstad, M, MD, PhD
Skyberg, K, MD, PhD,

National Institute of Occupational Health, Oslo

Topic:
Epidemiology

Key words:
Lung function, spirometry, nasal patency, acoustic rhinometry

Preferred method of presentation:
Poster

Introduction and background:
This is part of a larger study on occupational exposure and lung function among employees at
a fertilizer plant. The study was initiated by the company, after the occupational health service
had observed a possible elevated risk of COPD among the workers.
An interaction between upper and lower airways function has been demonstrated among
patients with COPD(1). Rhinometry is non-invasive and an easy way to measure nasal
patency. It has previously also been used in occupational settings. (2-4)

Aim:
To see if employees in a fertilizer production plant show any correlation between pulmonary
function and nasal patency.

Material and methods:
This is a spin-off cross-sectional study, where the correlation between lung function and nasal
patency is studied. The main study include a prospective study of lung function among
fertilizer workers. The study started in 2006 and will continue through 2010. The first part of
the data collection took place in January-April 2007. It included spirometry, rhinometry and
gas diffusion.
All the employees were invited, and 349 persons (85%) attended.
Spirometry (Vitalograph 2160) was performed in accordance with ATS/ERS standard, 2005.
Acoustic rhinometry (SRE Rhin2100, Rhino Scan version 2.6, Rhino Metrics AS, Denmark)
was performed with the subject in a seated position, using a handheld sound wave tube and an
anatomical nasal adapter.

Results:
Will be presented at the conference.



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                                     Reference List

 1. Hurst JR, Kuchai R, Michael P, Perera WR, Wilkinson TMA, Wedzicha JA. Nasal

    symptoms, airway obstruction and disease severity in chronic obstructive pulmonary

    disease. Clinical Physiology & Functional Imaging Vol 26(4)()(pp 251-256), 2006.

    2006;251-256.



 2. Ulvestad B, Lund MB, Bakke B, Djupesland PG, Kongerud J, Boe J. Gas and dust

    exposure in underground construction is associated with signs of airway inflammation.

    Eur Respir J. 2001;17:416-421.



 3. Heldal KK, Halstensen AS, Thorn J, et al. Upper airway inflammation in waste handlers

    exposed to bioaerosols. Occup Environ Med. 2003;60:444-450.



 4. Schlunssen V, Schaumburg I, Andersen NT, Sigsgaard T, Pedersen OF. Nasal patency is

    related to dust exposure in woodworkers. Occup Environ Med. 2002;59:23-29.




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52 av 99
Parallel 6
Sick leave and exclusion from working life
Chair: Odd Bjørnstad




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54 av 99
Sickness absence in Denmark – research, results and reflections


Merete Labriola, Senior Researcher, PhD, National Research Centre for the Working Environment,
Denmark
Thomas Lund, Senior Researcher, PhD, The Danish National Centre for Social Research, Denmark


The Danish Government has recently estimated sickness absence in Denmark to have increased to
the equal to 150,000 full-time jobs yearly based on a composite of diverse statistical material. It
affects most of the working population: two thirds of employees during a given year experience
sickness absence. As a consequence of the vast cost to employees, employers and society, the
Danish Government launched a plan in 2003 for reducing sickness absence and facilitating return to
work, addressing the roles of, and challenges for, various stakeholders, including workplaces,
employers’ and employees’ organizations, the healthcare system, and the case-managing municipal
authorities, as well as researchers from a broad array of disciplines.


At the time of launch of the Governmental plan of action, here were relatively few studies
addressing the situation in the Danish labour market. A multidisciplinary research unit was
established in 2003 and closed again in 2006. From an occupational health research perspective,
there were several challenging questions: How important is the work environment in relation to
sickness absence and is it possible to identify members of sub-populations who are at greatest risk?
The overall aim of the research was to contribute to reduction of sickness absence and permanent
exclusion from work, through identifying risk factors and subgroups of excess risk for sickness
absence, in order to target and optimize future evidence based interventions.


The presentation synthesizes and interprets the findings from 20 papers published by this research
unit in the period 2003-2008. Topics covered range from associations between for example socio-
demographic characteristics, through work environment to health behaviour, their interactions, and
how they affect various measures of sickness absence. Furthermore, the presenters will attempt to
explain the social gradient in sickness absence, and pinpoint threshold levels of sickness absence
indicating increased risk for future disability retirement and mortality.




   55 av 99
  Sickness absence and disability pension: Individual and work related factors

         Foss L1, Kristensen P1, Gravseth HM1 , Claussen B2 , Skyberg K1
 1
   National Institute of Occupational Health, Oslo, Norway, 2 University of Oslo,
      Institute of General Practice and Community Medicine, Oslo, Norway


Objectives. In 2001 the social partners and the government of Norway signed an agreement on
Inclusive Working Life (IWL). The agreement was initiated to combat the trend of increasing
sickness absence and disability pensioning. Reduction of social inequalities in health through
focusing on trades with heavy strains on their work environment has been one out of several
important objectives in this perspective. We wanted to examine different work and health
related and other socioeconomic factors, and their relationship to sickness absence and
disability pension (DP).

Methods. We linked individual based data from a comprehensive questionnaire and health
screening program, The Oslo Health Study (2000-2001), with official incidence data on
sickness absence and disability pension. This provided longitudinal individual data updated
through 2005. Selecting persons without DP born between 1940 and 1970, 12 524 persons
were followed for 5 years (2001-2005). Data analysis was performed by binary regression in
STATA. We computed crude and adjusted risk ratios for long term (more than 8 weeks)
sickness absence and odds ratios for DP. All analyses were stratified on gender.

Results. 40.9% of the females and 23.5% of the males had one or more long term sickness
absence spell during follow-up. Among males the sickness absence risk increased with
increasing age (RR for 60 year olds (95% CI) 1.78 (1.56-2.03)), whereas for females the
highest rates were found among 30 year olds, due to a high incidence of pregnancy related
sickness absences in this age group. For both genders the highest sickness absence rates were
found among unskilled manual workers (RR for females (95% CI) 1.50 (1.29-1.74), for males
2.57 (2.18-3.03), with higher service class as reference category). Risk factors that were
identified were work related health problems, lack of recognition from superiors, poor job
security, mental health problems and musculoskeletal pain (all self reported). However, in the
adjusted analyses, work related health problems and poor job security did not reach
significance for females, and for males, poor job security and mental health problems were
not significant risk factors.
4.9% of the females and 4.2% of the males were granted a DP. For this outcome, the age
gradient was steep, with OR about 30 for 60 year olds for both genders. Also for DP, the
highest risks were found among unskilled manual workers, but for males, only after
adjustment and did then not reach significance. For both genders, self reported mental health
problems and musculoskeletal pain were significant risk factors in adjusted models. For
females, this was the case also for self reported work related health problems.
Both sickness absence and DP increased with decreasing educational level. For sickness
absence, this gradient was strongest in males, whereas for DP, the gradient was strongest in
females. Trades with high risks for sickness absence were the health sector (especially for
females) and construction (especially for males), whereas the highest DP risks were found in
the hotel and restaurant sector (females) and in construction (males).


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Conclusions. We have identified several health related, socioeconomic and work related risk
factors for sickness absence and DP, risk factors that differ between the outcome studied and
between genders. On the conference, more comprehensive results will be presented. Among
other things we will look closer upon diagnosis specific sickness absence and DP. A broad
approach, which includes focus on individual as well as work related factors, is necessary to
reverse the trend of increasing sickness absence and disability pensioning and to reduce the
still large social inequalities in health.




Keywords: Sickness absence, Disability, Workplace exposure


Line Foss
National Institute of Occupational Health
PO Box 8149 Dep
N-0032 Oslo, Norway
Telephone: +47 23195307
Fax +47 23195200
e-mail: lfo@stami.no




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                                 Abstract for NAM 2008

            Social inequalities in disability pension in a life course perspective

       Gravseth HM1, Kristensen P1, Bjerkedal T2, Irgens LM3, Aalen OO4, Selmer R5
1
  National Institute of Occupational Health, Oslo, Norway
2
  Institute of Epidemiology, Norwegian Armed Forces Medical Services, Oslo, Norway
3
  Medical Birth Registry of Norway, Locus of Registry Based Epidemiology, University of
Bergen, Norway
4
  Institute of Basic Medical Sciences, Dept. of Biostatistics, University of Oslo, Norway
5
  Norwegian Institute of Public Health, Oslo, Norway

Objectives: Reduction of disability pension (DP) and sickness absence represents important
political objectives. A special concern is people who are granted a DP during the first years
after entering gainful employment. We wanted to examine determinants for such early
disability pension with a broad life course approach.
Methods: Through linkage of several national registers containing personal information from
birth into adult age we established a longitudinal, population-based cohort. Study participants
were all persons born in Norway in the period 1967-1976, as registered by the Medical Birth
Registry of Norway. Persons who died, emigrated or were granted a DP before age 20 years
(at which age follow-up started) and persons who did not become gainfully employed during
the study period (which lasted until the end of 2003) were excluded. “Delayed entry” was
used, i.e. persons entered the study in the year of their first income above the level entitling
sickness absence compensation after start of follow-up. The main independent variables were
different early factors: perinatal and childhood health and some social and health related
parental characteristics. We also considered educational achievement, which was
dichotomized into a low (11 years or less) and high educated group (12 years or more). The
study outcome was granting a DP. After exclucions the study population consisted of 595,393
persons. They were categorized into four strata according to gender and educational
attainment. Adjusted hazard ratios were computed using Cox regression analyses, and we also
computed the corresponding population attributable risks (PAR). We made additional
analyses on the men to make use of data from conscription: intellectual performance, mental
function, BMI and height. We especially focused on the interaction between intellectual
performance and educational attainment in these analyses. 302 330 men were included in this
sub-study, where follow-up started at age 23 years.
Results: A total of 9,649 persons (1.6%) were granted a DP during follow-up. The disability
risk was slightly higher among women than among men (1.7% vs. 1,5%). 48 % of the DPs
were due to psychiatric disorders, whereas 12% had musculoskeletal diagnoses. Low
educational achievement was highly associated with DP: With high educated men as
reference category, the HRs for the strata high educated women, low educated men and low
educated women (95 % confidence intervals) were: 1.53 (1.40-1.68) – 4.34 (4.01-4.70) – 5.53
(5.11-5.99). The relatively small group of people who received chronic disease benefit as
children had high disability risk, with a HR higher than 15 in one stratum. We also found
excess risk for birth weight below the mean, parents not being married and parental disability.
However, parental educational level only had a small effect in adjusted analyses. The
following PARs were found: birth weight below the mean 5.7%, chronic childhood disease
6.8%, maternal marital status 4.4% and parental disability 8.8%. Low educational
achievement had a PAR more than twice as high as the overall PAR for the childhood factors.
Results from the sub-study that included conscription data (men only): 3651 men (1.2 %)


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were granted a DP. The DP risk was inversely associated with both educational level and
intellectual performance. The adjusted PAR values of these two factors were respectively
47% and 35%. We found an almost threefold increased risk in low vs. high educated men
with intellectual performance at the mean (score=5), also when controlled for a wide range of
life course factors. We also found that high educated men with an intellectual performance
one standard deviation below the mean had similar risks as low educated men with an almost
top intellectual performance score. Impaired mental function, over- and underweight and short
stature were other risk factors, but the effect of these factors were largely reduced after
adjusting for educational level and intellectual performance. Impaired mental function seemed
to have a more independent effect, though.
Conclusions: Early DP is associated with several biological and social background factors
from childhood. It also shows a strong dependency on educational achievement and
educational attainment. High education can modify some of the effects of low intellectual
performance and might thus be regarded as a possible preventive measure. Considering life
course events may add to our understanding of DP.

Keywords: disability pension, education, intellectual performance

Hans Magne Gravseth
National Institute of Occupational Health
PO Box 8149 Dep
N-0032 Oslo, Norway
Telephone: +47 23195147
Fax +47 23195200
e-mail: hmg@stami.no

Preferred Presentation Mode: Oral




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Social inequality in sickness absence and early life influences.
Petter Kristensen1, Hans Magne Gravseth1, Tor Bjerkedal2
1
  National Institute of Occupational Health, Oslo, Norway; 2 Norwegian Armed
Forces Medical Services, Institute of Epidemiology, Oslo, Norway

Introduction and objectives: The determinants of sickness absence are multi-faceted. In the
workplace setting the quality of the work environment receive main emphasis. The gradient in
several work-place exposures, physical, chemical, organisational or psycho-social, are
considered to be important explanations of social inequalities in major disease categories.
However, life course studies indicate that social and individual factors early in life may
determine adult health. Our aim was to assess if this applies to major sickness absence
categories in young males as well. Specifically, we wanted to estimate the social inequality in
musculoskeletal and psychiatric sickness absence, and to find out to what degree early-life
parental and individual factors explained these gradients.
Methods: We established a cohort of all live born males in Norway, 1967-1971 (N=170 678).
Information, mostly as annual updates, on index subjects and their parents were retrieved in
national registers through linkage (Medical Birth Registry of Norway, National Insurance
Administration, Statistics Norway, the National Conscript Service, and the Central Population
Register). The indicator of social position (SEP) was educational attainment at age 28 years,
recorded either as education level (five categories), or by number of years under education
based on the standard classification of Statistics Norway. Parental factors were derived from
variables collected during the index person’s childhood and adolescence: educational
attainment, income level, marital history, disability pension, and vital status. Individual
factors were birth weight, chronic disease in childhood, and characteristics at military
conscription (intellectual level, mental health, physical health, height, body mass index).
Study outcomes were the first sickness absence spell with a musculoskeletal or psychiatric
diagnosis during 2000-2003, defined as absence resulting in Insurance Administration
compensation (spells usually lasting more than 16 days). We applied tabular analysis and
multiple linear regression. Analysis was restricted to 126 124 men who had finished their
education, did not receive disability pension, had income above the level entitling
compensation, and did not have a sickness absence at Jan 1, 2000.
Results: Men who had at least one musculoskeletal absence spell in 2000-2003 numbered
17 006 (four-year risk 13.5%). The corresponding number of men with absence spell(s) with a
psychiatric diagnosis was 4955 (risk, 3.9%). Absence was strongly associated with SEP in a
dose dependent fashion, stronger for musculoskeletal spells than for psychiatric spells (table).
Intellectual level at conscription was the most influential factor in association with SEP as
well as both absence groups. Parental factors were strongly associated with SEP but less
strongly with sickness absence. The strong negative association between SEP and sickness
absence was reduced by 36.2% for musculoskeletal diagnoses and by 22.4% for psychiatric
diagnoses. Intellectual level played a major role for this reduction, followed by parental
education level.
Conclusions: There is a strong negative association between SEP and risk of the two main
groups of sickness absence lasting more than 16 days among young adult men in Norway.
This gradient can partly be explained by individual factors and parental factors established
early in life. Considering life course events may add to our understanding of sickness absence.




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                                                    Musculoskeletal       Psychiatric
             Category              Number Percent           Four-year            Four-year
                                                    Cases               Cases
                                                             risk (%)             risk (%)
   Total                           126 124    100 17 006         13.5     4955          3.9
   Education level
                  Tertiary, long      8378    6.6     104         1.2      108          1.3
                 Tertiary, short    25 545   20.3     896         3.5      598          2.3
   Upper secondary, complete        53 825   42.7    7488        13.9     2003          3.7
       Upper secondary, basic       28 667   22.7    6295        22.0     1627          5.7
      Lower secondary or less         9709    7.7    2223        22.9      619          6.4




Key words: Life course; Musculoskeletal; Psychiatry; Sickness absence; Social
inequality in health

Topic: Sykefravær og ekskludering fra arbeidslivet

Preferred Presentation Mode: Oral. Preferred language of presentation: Norwegian

Dr Petter Kristensen
National Institute of Occupational Health
POB 8149 Dep
N-0032 Oslo, Norway
Telephone: (0047) 23195373
Fax (0047) 23195205
email: petter.kristensen@stami.no




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A more inclusive worklife
Experiences in the industry

The Agreement on a more inclusive worklife was established in 2001 due to increased sick-
leave absence and an increasing number of people outside the ordinary working market.

This three party agreement between The Emplyers Organisation, NHO, the workers
organisation, LO and the government, represents an alternative to the traditional instruments
like increased control, reduced salary and/or higher costs for the employers. For the
employers and the emplyees, this agreement secured continuation of the existing system.

As part of NHO, and as the most dominant federation within the NHO, The Federation of
Norwegian Industry (Norsk Industri) saw the importance of taking a leading role in this work.

In my presentation I will tell about the activities (networking, conferences, courses) we have
pursued from 2002 and our experiences. Finally I will discuss what an agreement as this three
party agreement on a more inclusive work life means for the working life, compared to
regulation by law.

Pernille Vogt
Norsk Industri
15.mai 2008




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Functional capacity evaluation at the work place.

Background
Because the rates of sickness and disability benefits in Norway were increasing, the
government appointed in 1999 a committee with the task to examine the challenges towards
the sick leave and disability pensions (NOU 2000:27). A major focus in the governmental
committee’s report was on measures to prevent and reduce the number on sick leave. The
committee concluded that the measures must be based in the individual workplace, and
responsibility for them must lie with the employer and employee. It also proposed earlier
intervention and follow-up of employees on sick leave, more emphasis on evaluation of the
person’s work capacity. The occupational health services were intended to have a major role
in assisting the workplaces in follow-up of sick leave and work capacity evaluation.

The political authorities followed the committee’s advice and this resulted in the Tripate
Agreement on a More Inclusive Workplace in October 2001. Active dialogue between
employer and employee is one of the important measures to achieve a more inclusive
workplace, as is use of functional capacity evaluation. This is no problem in situations with
“simple” sick leave, but in more complicated cases the workplace might ask for assistance
from an occupational health service.

An expert conference on functional capacity evaluation in 2003 in Norway concluded that
none of the existing tools for functional capacity evaluation were appropriate and they
recommended testing of new tools.

Method
With financial support of the Work Environment Funding of the Confederation of Norwegian
Business and Industry (NHO), we tested a tool for functional capacity evaluation at the
workplace used by an occupational health expert in dialogue with employer and employee.
The tool consists of a questionnaire based on the Dutch List of Functional Capacities, used in
occupational medicine and disability benefits. The list consists of 6 groups of functions that
are based on the ICF (International Classification of Functions). These groups are: personal
functioning, social functioning, adjusting to physical environment, dynamic movement, static
positions, working hours. The Dutch questionnaire was translated in Norwegian and was
adjusted for use at the workplace. The new questionnaire invites the employer and employee
to agree on the level of demands in the actual job and to compare that with the level of
functioning of the employee. By doing so with all items, it becomes obvious on what items
there is a gap between job demands and personal functioning. This again is the basis for a
plan of action on possible measurements at the workplace and /or on the medical treatment of
the employee.

6 occupational health services participated in the study and used the questionnaire in dialogue
with employer and employee with sick leave from Octoberl 2004 to October 2005. We were
able to evaluate 29 dialogues.

Aim of the study
Aim of the study was to test whether using a questionnaire at the work place, in a dialogue
concerning functional capacity evaluation with sick leave, was perceived useful in making a
plan of action to get the employee back to work.



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Results
The questionnaire tested was perceived useful in drawing up a plan of action by both
employee, employer and occupational health expert. All partners found it to be a useful tool in
dialogue between employee and employer and it gave new information in many situations.
The majority was inclined to use it again in appropriate situations. Full text of the report in
Norwegian is to be found at http://www.funksjonsvurdering-bht.no/rapporter_lenker.php:
Funksjonsvurdering på arbeidsplassen, et hjelpemiddel ved spesialvurdering i regi av
bedriftshelsetjenesten, test av krav og funksjonsskjema i praksis.



Abstract to 53. Nordiske arbeidsmiljømøte.
Author: Marijke Engbers
Key words: Functional capacity evaluation, sick leave, occupational health service




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Parallel 7
Epidemiology II
Chair: Tore Tynnes




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Euroquest questionnaire in chronic solvent encephalopathy - item and
factor analysis and symptom cut-off points

Ari Kaukiainen, Hanna Kaisa Hyvärinen, Ritva Akila, Markku Sainio

Finnish Institute of Occupational Health (FIOH), Helsinki, Finland



Background

Along with declining exposure, neurotoxic effects may manifest as mild cognitive
dysfunction, which makes the detection of chronic solvent encephalopathy (CSE) very
demanding. The empirical sensitivity of neurotoxic symptom questionnaires suggests
usability in screening or assessing of adverse solvent effects [1]. Cut-off values are needed to
proceed from epidemiological use of symptom questions to screening and diagnostics of
solvent-related effects at individual level. So far, no cut-off points for Euroquest (EQ) have
been proposed [2-4].


Objectives

To study how EQ questions distinguish workers with verified occupational CSE from
unexposed workers of equal age distribution and to evaluate symptom cut-off points for CSE.
In order to study the persistence of symptomatology, the symptoms of subjects with
previously diagnosed CSE were compared to cases entering the diagnostic procedure.


Methods

A questionnaire included questions on work and exposure history, alcohol consumption, and
medical history. Neurotoxic symptom frequency was inquired with 59 core EQ -questions.
Workers were eligible for the study if there was the questionnaire in the initial phase of the
standard CSE investigation procedure at FIOH and the subsequent diagnosis of CSE (CSE-1
group, n = 33), or the questionnaire in a routine control of previously diagnosed CSE (CSE-2,
n = 43). Non-exposed construction carpenters with similar age distribution served as referents
(n=305).

Item and factor analysis of EQ was performed. Single questions were studied as dichotomized
responses (symptom present if it occurred "often" or "very often", otherwise absent). The
factors examined were the core EQ, the original EQ symptom domains and the factors
revealed by the exploratory factor analysis. To study symptom cut-off points, one of the EQ
factors with the highest AUC (Area under the ROC curve) values was chosen for further
investigations.




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Results

Both CSE groups reported nearly all symptoms more frequently than the carpenters did. The
CSE-1 group reported 55 out of 59 items more often than the carpenters. CSE-1 cases
reported only 12 symptoms more often than CSE-2 cases where no significant differences
were found in the domain of memory and concentration.

The complete core EQ and the memory and concentration domain had AUC values well
above 0.9. In the exploratory factor analysis, the factor with the highest AUC closely
resembled the original memory and concentration domain. Therefore, the cut-offs were
determined for the number of memory and concentration symptoms in the original domain. At
a ≥ 3 symptom cut-off point, 97% (95% CI 83% to 99%) of the CSE-1 cases were classified
correctly, and 80% (74% to 85%) of the carpenters were also classified correctly. If the cut-
off point was ≥ 4, the sensitivity was 93% (78% to 99%) and specificity 87% (82% to 91%).


Conclusions

Euroquest (EQ) questions distinguished CSE cases from unexposed workers. The results
strengthen the status of memory and concentration as the core of the main symptomatology.
The core symptoms remain after cessation of exposure whereas changes in psychosocial or
work stress may reduce other symptoms. In addition to epidemiological use, EQ can be
recommended as clinical screening instrument in active solvent-exposed work-force. For
screening purposes a cut-off point of at least three memory and concentration symptoms is
proposed. When it comes to diagnosis, symptoms are a necessary component of CSE, but not
sufficient alone without evaluation of exposure, standardized psychological tests and
differential diagnostic process.


Key words: questionnaire, occupational, solvents, screening, encephalopathy



1.        Williamson, A., Using self-report measures in neurobehavioural toxicology: can they be trusted?
          Neurotoxicology, 2007. 28(2): p. 227-34.

2.        Chouaniere, D., et al., An international questionnaire to explore neurotoxic symptoms. Environ Res,
          1997. 73(1-2): p. 70-2.

3.        Carter, N., et al., EUROQUEST--a questionnaire for solvent related symptoms: factor structure, item
          analysis and predictive validity. Neurotoxicology, 2002. 23(6): p. 711-7.

4.        Karlson, B., K. Österberg, and P. Orbaek, Euroquest: the validity of a new symptom questionnaire.
          Neurotoxicology, 2000. 21(5): p. 783-9.




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             53. Nordiske arbeidsmiljømøte (NAM) Oslo, 2008
Are occupational factors important determinants for socio-economic
inequalities in musculoskeletal pain?

Ingrid Sivesind Mehlum1, Petter Kristensen1, Helge Kjuus1, Ebba Wergeland2
1
  National Institute of Occupational Health, Pb 8149 Dep., 0033 Oslo, Norway
2
  Norwegian Labour Inspection Authority, Pb 8174 Dep., 0034 Oslo, Norway
E-mail: ism@stami.no Tel: 23 19 53 27

Background
Socio-economic inequalities in health are well documented, but the impact of different
determinants needs to be further explored. The aim of this study was to quantify socio-
economic inequalities in low back pain, neck/shoulder pain and arm pain in the general
working population in Oslo, and to examine the impact of job characteristics on these
inequalities.

Methods
All economically active 30-, 40-, and 45-year-old subjects who attended the Oslo Health
Study 2000–2001 and answered questions on physical job demands, job autonomy, and
musculoskeletal pain were included (N = 7,293). Occupational class was used as an indicator
of socio-economic position. The lower occupational classes were compared to higher grade
professionals, and prevalences, prevalence differences (PD), and population attributable
fractions (PAF) were calculated.

Results
There were marked socio-economic differences in musculoskeletal pain, larger in men than in
women. The absolute differences (PD) were largest for low back pain. The prevalence of low
back pain in male non-skilled workers was 25 percent points (pp) higher than in higher-grade
professionals, compared to a difference of 15 pp in women. For neck/shoulder pain and arm
pain the corresponding differences were approximately 15 pp in men and 10 pp in women.

                                                                            I Higher-grade
                                                                          professionals

                                                                            II Lower-grade
   Men                                                                    professionals

                                                                           IIIa Routine non-
                                                                          manual, higher

                                                                           IIIb Routine non-
                                                                          manual, lower

                                                                           IV Self-employed
                                                                          workers
Women
                                                                           V+VI Skilled
                                                                          workers

                                                                           VII Non-skilled
                                                                          workers
         0      10     20      30     40      50      60     70      80
                                    Percent
Figure: Prevalences of self-reported low back pain according to occupational class in men and women


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Physical job demands and job autonomy explained a substantial proportion of absolute
occupational class inequalities in musculoskeletal pain, particularly in low back pain (38 % in
male skilled and non-skilled workers combined and 47 % in females) and in neck/shoulder
pain in men (44 %). When analysed separately physical job demands explained a larger
proportion of occupational class inequalities in low back pain (29 % in men and 40 % in
women), while job autonomy was more important in explaining inequalities in neck/shoulder
pain (38 % and 24 %, respectively). PAF estimates supported the impact of the job
characteristics at the working population level, particularly for low back pain.

Conclusions
In this cross-sectional study, physical job demands and job autonomy explained a substantial
proportion of occupational class inequalities in self-reported musculoskeletal pain in the
working population in Oslo. This indicates that the workplace may be an important arena for
preventive efforts to reduce socio-economic inequalities in musculoskeletal pain.


Topic: Epidemiology
Key words: Socio-economic inequalities, musculoskeletal disorders, working conditions
Preferred method of presentation: Oral
Language: English/Norwegian




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Ischemic heart disease among kitchen workers

B Sjögren1, J Weiner2
1. Work Environment Toxicology, Institute of Environmental Medicine,
Karolinska Institutet, SE-171 77 Stockholm, Sweden
2. Swedish Work Environment Authority, SE-171 84 Solna, Sweden
Food is prepared under high temperature when grilled and fried. This process degrades sugar,
protein, and fat and other compounds are generated. Some of these new chemicals are
transferred as aerosols to the environment and may have irritating properties (e.g.
formaldehyde, acetaldehyde and acrolein) (1). Inhalation of these air pollutants retained in the
lungs will hypothetically create a low grade inflammation associated with an increase in
plasma fibrinogen and inflammatory markers. The high concentration of fibrinogen will
increase the likelihood for blood clotting and thereby the risk for myocardial infarction and
ischemic heart disease (IHD) (2, 3).

Objective
The aim of this study was to investigate the occurrence of IHD among potentially air pollutant
exposed kitchen workers. The study is a comparison of cooks, cold buffet managers and
kitchen assistants with gainfully employed men and women in Sweden in order to investigate
the occurrence of fatal IHD.

Methods
Male and female cooks, cold buffet managers and kitchen assistants were identified in the
Swedish National Census of 1970. The cohort was followed from 1970 until December 31,
1995. The workers were identified and linked to the Cause of Death Register during the
period of follow-up. The referent group comprised all gainfully employed men and women
identified in the same census. The age of the exposed as well as referents were 20-64 years at
the time of entry. Ischemic heart disease (IHD) was defined as code 410-414 of the
International Classification of Diseases (ICD 7 and 8). The Standardized Mortality Ratio
(SMR) was calculated as the ratio between observed and expected numbers of deaths.

Result
An increased risk due to IHD was observed among females exposed to air pollutants in
kitchens but not among waiters, table 1. Male kitchen workers had also an increased risk of
IHD, table 2. However, male waiters had an increased risk of IHD but not female waiters.


Table 1. Standardized Mortality Ratios (SMR) of IHD in different cohorts of females exposed
to kitchen and restaurant air pollutants and identified in the 1970 Census and followed until
the end of 1995.

Cohort                            Observed    Expected    SMR 95% confidence limits
Cooks and cold buffet               852         662.9      1.29      1.20-1.37
managers
Kitchen assistants                   1905       1577.6     1.21            1.15-1.26

Waiters and head waiters             1343       1333.8     1.01            0.95-1.06



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Table 2. Standardized Mortality Ratios (SMR) of IHD in different cohorts of males exposed
to kitchen and restaurant air pollutants and identified in the 1970 Census and followed until
the end of 1995.

Cohort                             Observed     Expected    SMR 95% confidence limits
Cooks and cold buffet                142          107.0      1.33      1.12-1.56
managers
Kitchen assistants                     96          61.8      1.55            1.26-1.90

Waiters and head waiters              243         198.0      1.23            1.08-1.39


Discussion
The increased risk of IHD among female cooks and kitchen workers may be explained by
exposure to air pollutants generated during preparation of food. A previous Norwegian study
found an increase of respiratory symptoms in relation to kitchen work (4). Male and female
workers in the service sector smoke more compared with the general population. Smoking
and shift work are related to IHD. Smoking habits and shift work might explain some of the
increased risk in these occupational groups but it is assumed to be equally common among
kitchen workers and waiters. Psychological strain (control and demand) is probably not
differing too much between the groups.

In a Finnish study female cooks and kitchen workers were identified in 1970 and followed
until 1991. The reference population consisted of all economically active persons. Fatal IHD
was more common among female cooks and other kitchen staff (SMR 1.30, 95% CI 1.11-
1.54) and among kitchen assistants (SMR 1.40, 95% CI 1.18-1.65) (5). An increased risk of
IHD has also been found among male British army cooks (6).

The difference between kitchen workers and non-kitchen workers was more marked among
women than among men. The indicative results in this study must be further explored in
studies with better estimates of exposure and control for confounding factors such as smoking
habits.

Literature
1. Vainiotalo S, Matveinen K. Cooking fumes as a hygienic problem in the food and catering
industries. Am Ind Hyg Assoc J 1993; 54: 376-382.

2. Seaton A, MacNee W, Donaldson K, Goddon D. Particulate air pollution and acute health effects.
Lancet 1995; 345: 176-178

3. Sjögren B. Occupational exposure to dust: inflammation and ischaemic heart disease. Occup
Environ Health 1997; 54: 466-469.

4. Svendsen K, Sjaastad AK, Sivertsen I. Respiratory symptoms in kitchen workers. Am J Ind Med
2003; 43: 436-439.

5. Notkola V, Pajunen A, Leino-Arjas P. Occupational mortality by cause in Finland 1971-91 and
Occupational Mobility. Statistics Finland, Health 1997:1, Helsinki.

6. Coggon D, Wield G. Mortality of army cooks. Scand J Work Environ Health 1993; 19: 85-88.


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Computed tomography of the lung among workers in a dusty industry

Bugge,M.D.1, Åløkken,T.M.2, Hering,K.G.3, Kjuus,H.1
1
  National Institute of Occupational Health, Oslo, Norway
2
  Rikshospitalet University Hospital, Oslo, Norway
3
  Knappschaftskrankenhaus, Dortmund, Germany

Background
According to Norwegian law (the regulations for asbestos and chemicals) employees who are
exposed of chemicals shall be offered regular health examination. In dusty industries this
traditionally has implied pulmonary radiography with a few years interval. During the last
years the methods for surveillance have been discussed, and computed tomography has been
proposed as a better method for screening than traditional radiographs. Others argue that a
thorough health examination and questionnaire in addition to spirometry will be sufficient as
surveillance for a large group of workers, and that exposure to x-rays should be limited as
much as possible.

Methods
As part of a larger cohort study in a Norwegian industry, we asked all former and present
employees between 50-75 years of age, with at least 5 years working experience from the
industry, to participate in examination of the lungs by means of computed tomography. The
participants filled in a questionnaire, and they were examined with multi detector computed
tomography (CT) in addition to ordinary radiographs of the lungs. Altogether, 414 men were
asked to participate, 275 men were examined with CT and radiograph and 173 of the
participants were also examined with spirometry. The CT films were classified according to a
standardized scheme by two independent, experienced readers.

Results
The frequency of positive findings at the CT classification was very high, with only 17 films
(6%) classified as absolutely negative by both readers. The concordance between the readers
showed a kappa of 0.38, a fair agreement. The concordance between readers was higher for
some categories of findings such as emphysema (0.63) and pleural plaque (0.61). For nodules
the kappa was 0.37. Among the 275 CT participants, 29% needed a follow-up of the findings.
We suspect that a large proportion of these findings were of no clinical relevance.

Discussion
The traditional reason for health surveillance in the dusty industries has been the risk of
pneumoconiosis. With new and more effective methods for screening the possibility for
diagnosing lung cancer in an early (and possibly curable) stage has increased, and the
arguments for CT screening relates to this possibility. Arguments against CT screening will




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be the costs, priorities in the community health service, and the burden of fear among the
people with findings that have to be controlled, but are of no clinical relevance.



Topic: Other topics

Keywords: Screening, Computed tomography, Lung cancer

Preferred method of presentation: Oral

Language: Scandinavian (Norwegian)




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Parallel 8
Update for occupational health services
Chair: Kaj Husman




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           Occupational health services and risk assessment at workplaces
           Hakkola M.
           Finnish Institute of Occupational Health, Helsinki, Finland

           Introduction
           The aim of the project was to promote occupational health services as medical
           expert for risk assessment at workplaces. Since the new Occupational Safety
           and Health Act (783/2002) came into force in 2003, it has been the duty of
           employers to carry out risk assessments at workplaces. Occupational health
           services (OHS) can function in the role of an expert in these processes. The
           aim of this project was to prepare a model for collaboration between the
           employer and occupational heath services in risk assessment. Two experts from
           the Finnish Institute of Occupational Health and three inspectors from
           Occupational Safety and Health Inspectorate of Uusimaa participated in the
           project. The duration of the project was three years. The work was financially
           supported by the Ministry of Social Affairs and Health.
           Objectives
           Nine workplaces and their occupational health services participated in the
           project (Table 1).
           Table 1. Sector, number of employees, structure and contents of occupational
           health services provided.

                 sector         number of            producer of           contents of occupational health
                                employees         occupational health                  services
                                in the firm            services
                             <10 < 100 > 300
           commerce           1      2      1   private service provider   fixed by law, prevention,
                                                                           include medical treatment
           church                         1     private service provider   fixed by law, prevention,
           community work                                                  include medical treatment
           metal industry           1           municipal occupational     fixed by law, prevention
                                                health service
           logistics                      1     Firm's own OHS unit        fixed by law, prevention,
                                                                           include medical treatment
           paper industry                 1     Firm's own OHS unit        fixed by law, prevention,
                                                                           include medical treatment
           wholesale trade          1           Firm's own HOS unit        fixed by law, prevention,
                                                                           include medical treatment




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           Methodology
           The interviews
           The project began with group interviews of representatives of the employer and
           occupational health services. The objects of this interview were 1) to determine
           the objectives and functions of OHS at the workplace 2) to analyse the
           significance of workplace surveys 3) to identify the main targets for
           development.
            A group interview of occupational health service personnel focused on
           workplace surveys, risk assessments, and the role of OHS in the risk
           assessment process.
           Subsequent interviews brought together representatives from both groups. The
           aim of this interview was to identify the development tasks to be carried out by
           occupational health services in collaboration with the employer. A follow-up
           interview was held at the end of the project. The main topics in this interview
           were the development that had taken place during the follow-up of the project.
           Meetings were held together with occupational health services to discuss the
           targets of development. The meetings were led by experts from FIOH. The
           aims of the meetings were practical.
           Work seminars
           Three work seminars were arranged during the whole project. Representatives
           from all firms and occupational health services involved in the project were
           invited to attend the seminars, the main topic of which were development tasks.
           The meetings also included outside experts on good occupational health
           practice.
           Results
           The changes induced by the project regarding occupational health surveys
           mainly concerned the usefulness of the information gained in workplace
           surveys for risk assessments carried out by the employer. Changes were thus
           made in the methods of implementing occupational health surveys.
           The most important change during the project took place in workplace
           communication between employers, workers, and occupational health services.
           Also the content of the information conveyed was adjusted.
           Conclusions
           The main points in the model produced in this project were:

           1) identification of the needs for co-operation between experts, workplace and
           employers.
           2) stressing the significance of the work environment to the health of workers
           3) locating better means to transmit essential information




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Preventive Service in Denmark – what is happening now?
Maskell, Kim, Association of Preventive and Health Services in Denmark
Abstract:
The regulation of the Danish occupational health service has totally changed through 2005-
2008. The old regulation from 1978, adjusted in 1998 and 2001, obliged enterprises in
specific sectors (manufacturing, social and healthcare, construction etc. covering
approximately 40 % of the working population) to be affiliated to an occupational health
service unit. This obligation has been out phased in the period 2005-2008 sector by sector and
the old regulation will finally be terminated by start of 2009.
The new regulation builds on a more intensive labour inspection. It is planned, that the labour
inspection shall visit every enterprise in Denmark before the end of 2011. If the inspected
enterprise does not comply with the rules of the Safety and Health Act, the labour inspector
can give them an order to seek advisory by a preventive service provider authorized by the
National Safety and Health Authorities. It is specified in the legislation exactly which rules a
break of will result in an order to seek advisory.
The authorized preventive service unit must the give advisory about how to solve the problem
and how to prevent, that similar problems will appear in the future, and after this the
preventive service unit have to check, that the problem is solved and complying with the
legislation and do have to attest this to the authorities.
The old occupational health service system had a size of approximately 380 mil dkk (50 mil
euros) per year for obligate affiliation and approximately 75 mil dkk (10 mil euros) per year
for voluntary advisory.
The new advisory system based at labour inspection orders have until now only shown
proportions of not more than 25 mil dkk (3 mil euros), though the prize of one hour of
advisory has been rising about 20 % due to the providers adoption to their new market
conditions.
This means that the preventive service providers must operate on normal market conditions
selling advisory to enterprises that voluntary wants to by advisory in the fields of safety and
health, workplace health promotion, work life development, safety and health certification,
sick leave reduction etc.
The market has still a size of approximately 400 mil dkk per year (53 mil euros). This is
caused by a increasing management interest for good working conditions, due to a serious
lack of working power in Denmark, and a general interest for the psychosocial aspects of the
working life in the public debate – and maybe also a fear for bad reputation due to the tight
control from the Labour inspection.
On top of that there is now established a foundation for prevention opening possibilities for
enterprises in certain risky sectors to get financial support to investments and development of
their working environment. In total the foundation 340 mil dkk per year (45 mil euros) to
support the enterprises. This is a good support to the voluntary use of safety and health
advisory by preventive service providers.
The structure of the preventive service sector has changed through these fundamental changes
of the conditions for providing preventive service. Many of the old occupational health
service units have been bought up by other advisory enterprises – mostly consulting engineers
and environment pollution consultants – and others have made fusions. On the other hand a
lot of new small enterprises with one, two or three consultants have turned up – often in
networks with other small enterprises.



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In total there are now approximately 75 external preventive services and 25 internal safety
and health departments operating as internal consultants. 45 of these preventive services are
authorized by the National Safety and Health Authorities.
One result of this new regulation – and deregulation – is that many enterprises with
experiences from the old occupational health system and with financial resources and
ambitions to develop a good working environment for their employees still uses advisory
from preventive services. These kinds of enterprises often increase their internal safety and
health competence, normally related to their human resource department. This gives more
challenging tasks for the preventive services and a much better dialog with the enterprises.
The consultancy tasks are now moving to be concentrated in three areas related to health
promotion and sick leave reduction, organisational development of good working conditions
and workspace improvement related to ergonomics, noise, indoor climate etc.
Another result is that the tight control from the Labour inspection really does reach many of
the very bad enterprises. This gives a new and challenging market for the preventive services,
but often it is very difficult to establish a preventive approach in these kinds of enterprises
sustainable after the task is done and the specified problems pointed out by the Labour
inspector has been solved.
The majority of enterprises, who neither are very good or remarkable bad, in reality no longer
have any access to preventive service. The legislation in Demark contains many good
opportunities to develop a good market oriented preventive advisory system, but
unfortunately there is no political interest to use these opportunities to day.
The fundamental problem is that this new philosophy of regulation implies that safety and
health problems can be avoided through a command-control regulation with exact measures
and limit values. This is not realistic related to e.g. stress, accidents and indoor climate etc.
All regulation experience tells that the regulation must be a combination of control, co-
operation and expertise. Without the external expertise the enterprises will have a lack of
challenge to develop their working environment.
An interesting problem is that the deregulation changes the activities inside the enterprises
from a human health point of view based in the safety and health co-operation to a production
and human resource point of view based in the management and personnel administration
staff. Will these kinds of staff respect and ask for safety and health expertise, and will they
still keep focus at safety and health, when there some day no longer will be lack of personnel?

Topic:
Occupational health services

Key words:
occupational health service, preventive service, Denmark, occupational safety and health
regulation

Preferred method of presentation:
oral presentation

Language of presentation:
Scandinavian preferred (or English if the other presentations in the session will be in English)




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Occupational Health Services in Norway –current trends and perspectives.
Lie,A., Bjørnstad,O: National Institute of Occupational Health, Oslo, Norway

Occupational health services (OHS) in Norway are multidisciplinary. The OHS units are quite
small compared to other European countries with an average of 4 OHS full time professionals
covering 2000 employees. All are financed by the employers. Approximately 50% of the
working population is covered by an OHS. The Work Environment Act states which
enterprises are obliged to have an OHS, what types of services are to be delivered and the
importance of the impartiality of the OHS.
According to the legislation, the main focus should be an expert and advisory role to the
health, environment and safety (HES) policy and work of the enterprise.
Currently there is a trend towards developing larger OHS units which cooperate with each
other in a chain structure. Competition has increased, and OHS have become more market
dependent. The focus has been moved away from health, environment and safety to other
types of services which are easier to sell at a reasonable price. Concurrently, the impartiality
of the OHS has been questioned.
A recent governmental report has proposed a certification system for OHS in Norway and a
further expansion of obligatory OHS to include some new lines of businesses as for example
the healthcare and school sector. The main focus and tasks for future OHS should be the same
as today, but with an increased effort on the reduction of sickness absence and promotion of
early return to work.
The proposal is now being audited.

Key words:
Legislation, Norway, objectives, occupational health services.

Topic:
Occupational health services

Preferred presentation:
Oral

Language:
Scandinavian or English depending on the other presentations of the session.




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Occupational Health Services of Sweden (OHS) – a scenario under change

Peter Westerholm and Lars Hjalmarson , Uppsala and Stockholm August 13th 2008

The present organization of Swedish OHS is facing new expectations on basis of renewed expectations
from the State to contribute in coping with the rising costs of sickness absenteeism and pre-term early
retirements from the labour market.

     • The OHS professionals are at the present time (rough numbers):
  - 700 occupational physicians
  - 1.300 occupational nurses
  - 600 physiotherapists/ergonomists
  - 600 psychologists and behavioural specialists
  - 500 safety engineers/ occupational hygienists
  - 100 – 150 others (Health Promoters, Health Pedagogues, Health Instructors, Occupational therapists
etc)

Status: The establishment of affiliation to an OHS service organization is currently entirely voluntary.
There is no legal obligation for employers to arrange for OHS services. OHS receives no financial support
from public funding sources
Vocational training of OHS professionals was earlier organized by the National Institute for Working Life
which was closed and disbanded in 2007
The bottom line condition of OHS existence is a market dependence - ”cafeteria basis” - in the health
market

In the face of rising costs in social security expenditure the Government initiated a public investigation on
OHS (Committee Chair: Anna Hedborg) which has published its report in December 2007 (SOU 2007:91)
providing important points of departure in a reappraisal of OHS roles and tasks in Sweden. In summing up
the committee deliberations the following observations and conclusions emerge

    •   OHS role and tasks made visible
    •   Recognition of OHS competencies in management of work-related health needs
    •   OHS contribution to primary health care legitimate and desirable
    •   OHS a competent actor in assessments of work ability
    •   Universities to be given task of vocational training of OHS professionals
    •   Recognition of importance of Research & Development (R & D) focussing OHS

The new role and place of OHS in the national health service system of Sweden is summarized as follows
           Active contribution by OHS to primary health care services
           Agreement between the State (Government) and the Swedish Association of Local Authorities
           and Regions (Sw: Sveriges Kommuner och Landsting (SKL) on principles for integrating OHS
           with public Health Care organization. Decisions on this integration are to be taken on the
           regional (county council) level of public administration in Sweden
           OHS provides assistance to Social Security agencies in assessments of work ability and matters
           of Return-to-Work and rehabilitation
           Implications for financing of OH, involving related aspects of certification and quality
           surveillance – to be negociated with county councils (capitation basis) and social security
           agencies (fee-for-service basis)
           Role and tasks in occupational health prevention and health promotion to be agreed on local
           level with employers and trade unions.




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Poster abstracts
Poster presentations 10.30 – 11.00 Tuesday 26. August




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84 av 99
  Skriftserien Arbete och Hälsa – en vital 42 åring

  Kjell Torén, professor, Arbets- och miljömedicin, Sahlgrenska Akademien,
  Göteborg

  Bakgrund
  Arbete och Hälsa började att utges 1973, och den har varit en av Arbetslivsinstitutets
  (ALI) vetenskapliga skriftserier. I samband med ALI:s nedläggning har Göteborgs
  Universitet (GU) och ALI kommit överens om att utgivningen av Arbete och Hälsa
  flyttas över till GU. I skriftserien har Kriteriegruppen för hygieniska gränsvärden
  publicerat Vetenskapliga underlag för Hygieniska gränsvärden och den Nordiska
  Expertgruppen för Hygieniska gränsvärden publicerar också sina kriteriedokument i
  Arbete och Hälsa. De nordiska dokumenten publiceras på engelska. Därutöver har det
  publicerats ett flertal upplagor av olika expertgenomgångar avseende
  försäkringsmedicinsk sambandsbeömning vid misstänkta arbetsskador. Dessa skrifter har
  omfattat belastningssjukdomar, psykiatriska sjukdomar och en samling av sju olika
  skaeområden (Nervsystemet, cancer, astma, hjärta-kärl, hudsjukdomar, hörselskada och
  exponering för vibrerande verktyg). Dessa utgåvor och fått stor spridning och har varit
  viktiga för att få fram en gemensam syn på arbetsskadebegreppet inom olika områden.

  Totalt sett har Arbete och Hälsa mellan åren 1973 och 2006 givit ut 988 nummer. Åren
  1990-1995 låg utgivningen på mellan 40 och 50 utgåvor årligen, 1995-2000 var det ca 30
  per år och 2001-2006 har det varit 15-20 per år. Normalupplagan ligger idag på mellan
  350 och 450 ex, men vissa utgåvor kan gå ut i upp till 10.000 exemplar.

  Målsättning
  Huvudmålsättningen med skriftserien är att publicera referentgranskade
  kriteriedokument, konsensusdokument och översiktsartiklar inom det arbetsvetenskapliga
  området, med särskild tonvikt på arbetsmedicin. Dessutom kommer vi att publicera vissa
  avhandlingar och en del originalarbeten. Huvudspråket är svenska, norska eller danska
  men vissa dokument kan publiceras på engelska. Skriftserien skall dock inte vara någon
  konkurrent till existerande engelskspråkiga ”referee” baserade vetenskapliga tidskrifter.

  Verksamhet
  Vi avser att ytterligare öka kontakten med våra Nordiska grannländer, framför allt Norge
  och Danmark. Arbete och Hälsa är redan i dag en skrift som är spridd och läst inom det
  arbetsmedicinska fältet i både Norge och Danmark.

  Skriftserien placeras på Göteborgs Universitet vid Avdelningen för Arbets- och
  miljömedicin, och kommer att vara helt tillgänglig som ”open access” via en länk på
  Arbets- och miljömedicins hemsida, http://www.amm.se/aoh. Via den länken finns även
  tidigare utgivna skrifter tillgängliga som PDF-filer.




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  Vi har hittills under 2008 givit ut sju utgåvor;
  2008;42:1 P Westerholm (red) Psykisk arbetsskada
  2008;42:2 G Johanson, M Rauma. Basis för skin notation. Part 1. Dermal penetration
                 data for substances on the Swedish OEL list.
  2008;42:3 J Montelius (ed) Vetenskapligt Underlag för Hygieniska Gränsvärden 28.
                 Kriteriegruppen för hygienska gränsvärden.
  2008;42:4 P Wiebert. The impact of airway-irritating exposure and wet work on
                 subjcects with allergy or other sensitivity – epidemiology and mechanisms.
  2008;42:5 E Månsson. Att skapa en känsla av sammanhang – om resultatet av
                 hälsofrämjande strategier bland lärare.
  2008;42:6 J Montelius (ed) Scientific Basis for Swedish Occupational Standards.
                 XXVIII
  2008;42:7 B Melin. Experimentell och epidemiologisk forskning: relationen
                 psykosocial exponering, stress, psykisk belastning, muskelaktivitet och värk
                 i nacke-skuldra


  Prenumeration och ekonomi
  Vi har cirka 60 betalande prenumeranter. Prenumerationspriset för 2009 kommer att bli
  600 SEK (67 €). Skriftserien stöds också ekonomiskt av VINOVA och FAS.

  Redaktion
  Redaktionen består av Kjell Torén, chefredaktör, och övriga medlemmar i redaktionen är
  Maria Albin, Lund, Eva Wigeaeus, Stockholm, Marianne Törner, Göteborg, Lotta Dellve,
  Göteborg, Wajnand Edward, Oslo och Roger Persson, Köpenhamn.




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Determinants of exposure in the Norwegian silicon carbide industry
Solveig Føreland1,2,3, Erik Bye1, Roel Vermeulen4, Berit Bakke1 and Wijnand
Eduard1
1
  The National Institute of Occupational Health, Oslo, Norway
2
  Department of Chemistry, University of Oslo, Norway
3
  Department of Occupational Medicine, University Hospital of Trondheim,
Norway
4
  Institute of Risk Assessment Sciences, Utrecht University, the Netherlands

Introduction
Earlier studies have found increased risks for lung cancer and other lung diseases among
workers in the silicon carbide (SiC) industry.1,2 The objective of this study is to further
explore associations between lung diseases and exposure to the complex mixture of
particulate material in the SiC industry. The exposure measurements will be used to develop
empirical models to assess the exposures in retrospective epidemiological studies.
Identification of exposure determinants is important to understand the exposure pattern.

Methods
The three Norwegian silicon carbide plants have been assessed for exposure to fibre, quartz,
cristobalite, silicon carbide, respirable dust and total dust. A total of 4400 personal
measurements were performed on 293 randomly chosen workers from the furnace, processing
and maintenance departments. Each plant was sampled twice to determine variations in
exposure due to seasonal and process related changes. In addition information on different
production parameters, work tasks and weather conditions were collected. Mixed effect
models were constructed to evaluate determinants of exposure. Exposure determinants were
treated as fixed effects, whereas worker and day (error) were treated as random effects. Tasks
were modelled as dummy variables (task performed yes/no). Statistical analyses were
executed in SAS 9.1 utilizing proc. mixed.

Results
Of the 293 workers participating in the exposure study, 77% were monitored on more than
one occasion for the same exposure component. Table 1 gives an overview over the geometric
mean exposure for the components analyzed.

Table 1: Geometric mean exposures     and geometric standard deviation for the six exposure
components analyzed.
Component          GM*                GSD¤
Fibre              0,037 fibre/cm3    4,7
Quartz             1,2 µg/mg3         5,1
Cristobalite       0,93 µg/mg3        9,3
SiC                0,078 mg/m3        4,5
Respirable dust 0,30 mg/m3            2,5
Total dust         1,6 mg/m3          3,2
*
  geometric mean
¤
  geometric standard deviation

The main results of the modelling of exposure determinants were that work in the furnace
department was associated with increased exposure to fibres, quartz and cristobalite. For
workers in the furnace department the tasks manually sorting of crude silicon carbide and

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cleaning were associated with increased exposure to all exposure components; constructing
furnace was related to increased exposure to all exposure components except quartz. Work in
the processing department was associated with increased exposure to SiC, respirable dust and
total dust. For workers in the processing department was the task filling of boxes related to
increased exposure to total dust and SiC. Maintenance work in the furnace department was an
important determinant of increased exposure to fibres, quartz and cristobalite for mechanics
and electricians, while maintenance work in the processing department was related to
increased exposure levels to SiC.

Conclusion
Maintenance and work in the furnace department was associated with increased exposure to
fibres, quartz and cristobalite, especially under cleaning, furnace construction and manually
sorting. Maintenance and work in the processing department was related to increased
exposure levels to SiC, especially under filling of boxes.

Literature
1
  Romunstad, P., Andersen, Å. and Haldorsen, T. (2001) Cancer incidence among workers in
the Norwegian silicon carbide industry. Am. J. Epidem., 153, 978-986.
2
  Romunstad , P., Andersen, Å. and Haldorsen, T. (2002) Non-malignant mortality among
  Norwegian silicon carbide smelter workers. Occup. Environ. Med, 59, (5), 345-34.




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DETERMINANTS OF (1 3) -D-GLUCAN EXPOSURE IN GRAIN HANDLING

Halstensen AS1,2, Nordby KC1, Wouters I3 and Eduard W1.
1
  National Institute of Occupational Health, Dept. of Occupational Hygiene, Oslo, Norway.
2
  Department of Plant and Environmental Sciences, Norwegian University of Life Sciences,
Ås, Norway.
3
  University of Utrecht, Institute of Risk Assessment Sciences, Utrecht, The Netherlands.

During grain handling, farmers are exposed to grain dust containing multiple microbial
components. One group of such components is glucans, major carbohydrate constituents of
fungal cell walls and some bacterial and plant cell walls. Glucans activate the
proinflammatory and immunoregulatory intracellular signalling pathways leading to cytokine
expression in mammalian cells. It is therefore important to map the glucan exposure and
possible determinants in grain production practices, which is the purpose of this study.

Personal sampling of airborne grain dust (n=113) was carried out on 92 farms in 3
climatically different regions in Norway during threshing and storage work in 1999 and 2000.
Information of grain production practices of relevance for fungal growth was obtained
through personal interviews of each farmer. The concentration of (1 3) -D-glucans in the
airborne grain dust was measured by EIA, whereas fungal spores and the presence of hyphae
were quantified by SEM.

Glucans were found in all the samples, whereas 96% of the samples contained spores and
hyphae. The concentration of glucans was median 160 g/m3 (range 1-6 200), whereas the
concentration of mould spores and hyphae was median 4.2 106 spores/m3 (range 0-5200) and
median 0.5 106 arbitrary units/m3 (range 0-199), respectively. Glucans were strongly
correlated with mould spores (r=0.7, p<0.01) and hyphae (r=0.6, p<0.01), but also to
inhalable dust (r=0.9, p<0.01), that predominantly explained the glucan exposure variability
as assessed by linear regression analysis (R2=0.7, p<0.001). The individual contribution of
mould spores and hyphae was hard to identify due to strong mutual correlations. The glucan
exposure was correlated with storage work (p<0.001) and handling barley (p<0.02), whereas
visible mould damage of the grain on the field was associated with increased concentration of
airborne glucan during later work with the damaged grain.

Frequent observation of hyphae indicated that hyphae may be important exposure factors that
should be included in bioaerosol exposure studies. Correlation analysis suggested that both
spores and hyphae can be important sources of glucan exposure, but the dust overrode their
predictive effects. As a substantial amount of glucans probably was grain-derived, glucans
should not be used as fungal exposure markers in grain handling, but the grain-derived glucan
should rather be included in health effect considerations of inhaled glucans.




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                                                                                           1
  AIRWAY INFLAMMATION IN COMPOST WORKERS EXPOSED TO
  BIOAEROSOLS

  HELDAL1 KK , MADSØ L, HUSER PO, KRUSE K, SEBERG EA
  1
    National Institute of Occupational Health, Oslo

  Introduction
  Exposure to bioaerosols can cause respiratory health problems. So far, the health risk
  from exposure to bioaerosols at compost plants is less known, although
  hypersensitive pneumonitis, organic dust toxic syndrome (ODTS), airway irritation
  and occupational asthma have been reported among workers handling the compost.
  More information on exposure-response associations is therefore needed. Different
  methods have been used to measure health effects and exposure. The objectives of
  this work are to examine airway inflammation by use of several objective methods
  and to correlate the findings with the exposure during composting.

  Methods
  In total 47 workers and 24 controls from ten different compost plants in Norway
  participated in the survey. Each worker underwent spirometry, nitrogen monoxide
  measurements in exhaled air before and after work. Personal exposure was
  monitored during the work between the health examinations. Inhalable aerosols were
  collected with PAS-6 cassettes, one for determination of endotoxins (LAL assay)
  and (1 3)-glucans (EIA), and the other for determination of total microorganisms
  and fungal and bacterial spores (fluorescence microscopy and scanning electron
  microscopy).

  Results and conclusions
  The results show that compost workers may be exposed to high levels of total
  microorganisms (range 0.01-460 x 106 counts/m3), actinomycetes (range 0-592 x 106
  counts/m3) and fungal spores (range 0-41 x 106 counts/m3). During work shift a
  decline in FEV1/FVC (93.8 to 92.9, p<0.05) was observed among the workers.
  Compared to controls also FEV1 decreased (1.42% and -0.03% respectively, p<0.05)
  after a working day. Unexpectedly, NO in expired air was lower both before (median
  12.6 and 20.9 ppb, p<0.05) and after work (median 9.9 and 19.6 ppb, p<0.05) in
  workers compared to controls, and a work shift NO decline (-0.4 ppb, p<0.1) was
  indicted in workers. Preliminary results show no correlation between lung
  functions- and NO data and the exposure to bioaerosols during the working day. The
  results indicate that compost workers are exposed to levels of bioaerosols during
  work that may have effect on the lung function and NO in expired air.

  Key words: bioaerosols, compost workers, NO, spirometry

  Presentation: Poster




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Psychosocial work environment and

self-perceived health among penitentiary workers

Authors: Ali Ghaddar, 1 Elena Ronda 1 Inmaculada Mateo 2
1
    Preventive Medicine and Public Health Area, University of Alicante, Spain
2
    Escuela Andaluza de Salud Pública, Granada, Spain

Key words: work conditions, penitentiary workers, psychosocial risks, occupational stress, Spain.

Topic: Organisational and psychological work environment

Preferred method of presentation: Oral communication

Preferred language of presentation: English



Abstract

Introduction The influence of psychosocial risks at work on health has been explored in various
working environments, yet studies addressing penitentiary workers are lacking. Objectives The
present study tested Demand-Control-Support model’s components in a Spanish prison and
explored the association between psychosocial risks and self-perceived health of penitentiary
workers according to their sex and occupational group.
Methods In a cross-sectional study among 384 workers administered with an anonymous self-
administered questionnaire, 164 participated (response rate 43%). Vitality and psychosocial risks
(psychological demands, low control and low social support) were measured using SF-36 survey
and ISTAS21 (Spanish version of Copenhagen Psychosocial Questionnaire) respectively. Linear
regression was employed to study the association between psychosocial risks (independent
variables) and self-perceived mental health, general health and vitality (dependent variables).
Logistic regression was employed to study the distribution of psychosocial risks (dependent
variables) according to occupational group (independent variable).
Results Women had risk for low control and low social support and V1 guards (with night shift and
direct contact with detainees) for psychological demands and low control. Significant association
was found between psychological demands and vitality (b= -12.64).
Conclusions Psychological demands, particularly high among V1 guards, associated with low
vitality. This category should be a concern of health promotion interventions in prisons.


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Relation between oil vapour concentrations and its other physical properties

Torill Woldbæk and Kristin Halgard

Department of Chemical and Biological Working Environment, National
Institute of Occupational Health, Pb 8149 Dep, N-0033 Oslo, Norway

Keywords: oil mist; oil vapour; volatility; exposure database

Introduction
Oil mist and/or vapour can be found in the working atmosphere in many different workplaces
like metal working industries, offshore industry, entertainment industry, cable production,
ships engineer work, underground mine work and tunnel construction work.
Oils can be divided into groups like petroleum oils, vegetable oils, semi-synthetic and
synthetic fluids. The semi-synthetics are usually soluble in water and exist as emulsions.
Synthetic oils can have very different chemical compositions, but will usually consist of fewer
components than the very complex petroleum oils. In this work we have included samples
from all these categories.
A mixture of oil droplets and vapour can often be found in the work atmosphere depending on
the industrial process and the oils volatility. The amount of mist compared to vapour depends
highly on the physical properties of the oil and the temperature at the premises.
In Norway the OEL for mineral oil mist is today 1 mg m-3 while for oil vapour it is 50 mg m-3.
Oil mist is most commonly sampled on filters in a closed filter cassette with air drawn
through the cassette by a pump at constant airflow. The vapour is collected in a sorbent
sample tube attached between the filter cassette and the pump. Depending on the oils
volatility, mist can vaporise from the filters during sampling. This effect has been discussed in
many papers during the years1,2, but today there is still no good solution to the problem. The
relationship between flashpoint or viscosity and the ability of oil mist to vaporise from the
filters has been described for a small number of metal working fluids on spiked filters 3.
In our work oil vapour concentrations from real workplace sampling are compared to the oil’s
volatility to try to find criteria for which oils it is important to measure the vapour.

Methods
Since 1984 samples analysed at the Department of Chemical and Biological Working
Environment at NIOH in Norway have been registered in a database (EXPO). Today EXPO
contains app. 500.000 analysis results (i.e. component with a measured value) from 120.000
samples.
Among the air samples in EXPO 2517 samples have been collected because oil was suspected
in the work atmosphere.
Since 1992 physical data from the data sheets for different oils is registered in a smaller
database that can be combined with EXPO. In this work the oil vapour concentrations
registered in EXPO are compared with the oil’s volatility expressed by boiling point, viscosity
and flash point for 80 oils registered in the oil database.
All oil mist samples in consideration have been collected on a glass fibre filter with a back up
filter of cellulose acetate with a pore size of 0.8 µm in a closed-faced 37 mm aerosol cassette
(Millipore Corp., Bedford, MA, USA). Portable pumps with a flow rate of 1.4 – 1.8 l/min




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have been used for two hours sampling time. Oil vapour has been collected in a charcoal tube
placed between the filter cassette and the pump.
Oil vapour samples have been desorbed in CS2 and analysed with FTIR and/or gas
chromatography (GC-FID). When GC-FID is used, both a solution of the pure oil and a
mixture of n-hydrocarbons have been recorded together with the samples.

Results
When sampling of oil mist and vapour has been performed the primary concern has been the
mist. The vapour concentrations have been considered important to get a more complete view
of the air pollution. For volatile oils, oil mist that originally is trapped on the filters can
evaporate during sampling and be caught in the charcoal tube.
The proportion between mist and vapour depends on the oil’s physical properties as well as
on the room temperature where the sampling is performed. In this regard the boiling point, the
viscosity and the flash point are especially important 3.
Figure 1 shows the relation between boiling point and vapour concentration measured for 80
different oils. No vapour is found for oils with boiling point above 280 ºC. For more volatile
oils the vapour concentration can be quite high as seen from Figure 1.
Cut-off points for the formation of vapour are also found for the viscosity (Figure 1) and for
the flash point. No vapour is detected for oils with viscosity above 30 cSt at 40 ºC and for oils
with flash point above 210 ºC.

Fig. 1. Measured oil vapour concentrations for oils with different boiling points, viscosities
and flash points.




Conclusions
When the boiling point is below 280 ºC, the flash point below 210 ºC or the viscosity below
30 cSt at 40 ºC, oil vapour ought to be sampled together with the mist. When oil vapour is
observed, the mist concentration should be considered as a minimum.

References
1. Menichini E. (1986) Sampling and analytical methods for determining oil mist
concentrations. Ann Occup Hyg; 30: 335-348.
2.Volckens J, Boundy M, Leith D. (2000) Mist concentration measurements II: laboratory and
field evaluations. Appl Occup Environ Hyg; 15: 370-79.
3.Simpson AT, Groves JA, Unwin J et al. (2000) Mineral oil metal working fluids (MWFs) –
development of practical criteria for mist sampling. Ann Occup Hyg; 44: 165-72.




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SICKNESS ABSENCE FOLLOW UP – DESCRIPTION OF A COMPLEX
NATIONAL INTERVENTION

By Grete Damberg, MD and Sigrun Andenæs MD, Norwegian Labour and Welfare
Administration (NAV)

In the poster to be presented we intend to describe some major events and activities which
have been taking place during the last 7 years, aiming at reducing sickness absence in
Norway.

The background for the focus on sickness absence is partly economical with increasing cost of
sick benefits for the state administration as well as a desire to aid persons with illness or
handicap to a more active – and hopefully better quality of life.

Sickness absence has complex causes and no single intervention can be held responsible for
an increase or decrease in sickness absence. It is nevertheless our belief that looking at
sickness absence in a broader perspective and putting into action a number of interactions
simultaneously, we may be able to interfere in the best positive way. We are not presenting
statistics or scientific proof, but merely describing a set of measures taken.

During the last few years with increased focus on sickness absence there has been
considerable attention and political involvement1.
One important event concerning sickness absence intervention was the agreement on “An
including working life for all”2 made by the different trade-unions and the Norwegian state
back in 2001. The main goal of this agreement is to reduce the total sickness absence in
Norway by 20% during the period 2001-2009. This was followed up by the establishment by
NAV of 19 regional competence centres of Including Working Life to guide and teach
employers and support enterprises.

Changes in the Working Environment Act (Arbeidsmiljøloven) as well as in the National
Insurance Act (Folketrygdloven)3 are supportive of the effort to decrease unwanted sickness
absence. Changes in the working environment legislation have increased the pressure on
employers to adjust the work-place and make it more functional for people in need.
In 2006 a new chapter was added to the National Insurance Act demanding compulsory
contact between employer, worker and the general practitioner, so called Dialogue meetings 4.

During the period 2001-2008 three succeeding forms for medical certification have been
drawn up in accordance with changes in legislation. The last one is due September 2008.
Work is going on for preparing factual information about the form for physicians as well as
patients/workers. And a short e-learning program is worked out.

The activities and changes that are mentioned above are some of the items we plan to describe
in more detail in a poster. Although the decrease in sickness absence rate has not reached the
desired result, there has been a decrease in total sickness absence from 8 percent in 2001 to
5.9 percent in 2008.

1
  Sykefraværsutvalgets rapport av 06.11.06 (Stoltenbergutvalget). Statsministerens kontor
2
  Letter of intent regarding a more inclusive working life (2006-2009) Ministry of Labour and Social inclusion
(Intensjonsavtalen om et mer inkluderende arbeidsliv (IA-avtalen)
3
  Ot. Prp. Nr. 6 (2006-2007) Lov om endring i Arbeidsmiljøloven og Folketrygdloven. Arbeids- og
inkluderingsdepartementet
4
  Veileder for sykmeldende behandlere i dialogmøter. www.nav.no
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Risk assessment of nanotechnology at the NRCWE

Thomas Schneider, Keld Alstrup Jensen, Håkan Wallin, Lars Andrup, Per Axel
Clausen, Peder Wolkoff, Karin Sørig Hougaard.

National Research Centre for the Working Environment (NRCWE), Denmark

By a concerted effort, the NRCWE has developed methods and models tailored for risk
assessment of nanoparticles during the last four years. This has enabled the nanoparticle
research group at the NRCWE to initiate, or become involved in, major research projects on
nanoparticles. The total nanoparticle research budget for the last four years has been DKK 30
mill.

The nanoparticle research group currently consists of
       2 professors, 1 adjunct professor
       9 senior and other researchers
       4 PhD students

The research group covers the disciplines
       Aerosol physics
       Applied mineralogy
       Analytical and atmospheric chemistry
       Occupational exposure assessment
       Toxicology (inflammation, cancer, immunology, development)
       Molecular biology

The research fields involved in nanoparticle research at the NRCWE are shown in Figure 1.


                                              Toxicology and
                                               Occupational
                                                 hygiene




         Exposure and         Chemical           Molecular     Allergy and    Reproductive
           physical           structural       biology, DNA     adjuvants      toxicology
        characterization   characterization    damage, and     toxicology
          of particles       and reactive      occupational
                              chemistry           cancer



                           Risk assessment of nanotechnology

                  Figure 1. The research fields of the nanoparticle research group




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The group has established methods and models for
       Physico-chemical characterization of nanoparticles (size, shape, composition and
       reactivity)
       Exposure assessment during handling and use of NP containing materials
       Testing and modelling potential health effects including airway irritation,
       inflammation, and adjuvant effects, DNA damage, mutagenicity, cancer, cardio-
       vascular diseases, reproductive health, and effects on the central nervous system
       Overall risk assessment and management

The areas of excellence are
       In vivo exposure by inhalation and intratracheal instillation in different mouse models
       In vitro exposure in a number of different cell lines
       Physico-chemical characterization of powders and air-borne nanoparticles as well as
       particles suspended in liquid
       Chemical composition and hydrous and gas-phase reactivity
       Toxicology of chemicals

The NRCWE has initiated or become involved in the following major ongoing research
projects
        AIRPOLIFE (Air-Pollution in a Lifetime Perspective)
        Particle Risk
        Translocation of nanoparticles and ultrafine air pollution particles across tissue
        barriers in mice
        NanoFilm, Characterization and toxicological analysis of nanoparticles in liquid-based
        nanofilm products
        NanoKem, Toxicological evaluation of nanoparticles containing paints
        WOODUSE, wood-stove emissions, users risks and environment
        NanoPlast, toxicologically relevant physical and chemical properties of nanoclay,
        carbon nanotubes and carbon nanofibres
        Chemical characterization of nanoparticles
        Effects of prenatal exposure to carbon-based nanoparticles and diesel exhaust particles
        on growth and development of the offspring
        Pending: NANODEVICE, “Novel Concepts, Methods, and Technologies for the
        Production of Portable, Easy-to-Use Devices for the Measurement and Analysis of
        Airborne Engineered Nanoparticles in Workplace Air”


Developing the scientific background for evidence-based risk assessment and management of
exposure to nanoparticles requires a multidisciplinary effort. Thus, it is a continued effort of
the NRCWE to establish strong collaboration with universities and other major research
institutions in Denmark.




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CHEMIRiSK – a Norwegian Control Banding tool. Evaluation of one main
assumption.

Hans Thore Smedbold1, MSc, CIH
1
 Occupational Hygiene Solutions AS, Postbox 8034 NO-4068 Stavanger, Norway,
www.ohs.no, e-mail: hts@ohs.no

Objective
The aim of this study was to evaluate one of the main assumptions in CHEMIRiSK - that there is a
relationship between the severity of the hazards expressed by R- and S- phrases and the acceptable
exposure level at the workplace.

Background
A foundation of the modern movement for control banding (CB) strategies is derived from programs
initiated in the United Kingdom (UK) by the Health and Safety Executive (HSE). The need to provide
guidance and assistance to small and medium-sized enterprises in meeting requirements to conduct
risk assessments of chemical exposures led to the HSE development of a program known as the
Control of Substances Hazardous to Health (COSHH) Essentials [1]. The concept of CB has since
been widely adopted within several disciplines and branches and more than twenty tools have been
developed [2]. CHEMIRiSK is an example of a web-based control banding tool developed in Norway
for chemical health risk assessment [3].

In CHEMIRiSK risk is defined as a function of health hazard and exposure (R=f(hazard, exposure)),
where the hazard is defined by the product’s R- and S- phrases from the MSDS (EU-standard). This
definition differ from the traditional Industrial Hygiene (IH) approaches based on Occupational
Exposure Levels (OEL), where risk is defined as a fraction of the OEL (R=Exposure level/OEL) [4].

Method
The Norwegian OEL list comprises 559 chemical substances [5]. Of these 403 chemicals had an
official classification according to 67/584/EEC Annex I and 156 had been given a classification based
on available toxicological information, according to 67/584/EEC Annex VI [6]. Information about the
chemicals was gathered from Kemiske Ämnen – Chemical Substances [7]. The severity of the hazards
was then rated according to the five health hazard categories (Table 1) defined in CHEMIRiSK [3].
The substances were classified according to hazards considered relevant to workplace exposure (e.g.
skin and airway exposure). Hazards related to swallowing were omitted.

Table 1: Criteria for Health Hazard Categorization of chemicals [3]
                 HEALTH
 CATEGORY                           R- and S- phrases
                 HAZARD
       5         Very serious       R26, R27, R28, R39, R45, R49, R46, R60, R61, R42
       4        Serious             R23, R24, R25, R48, R35, R40, R68, R62, R63, R43, R33, R64

       3        Moderate            R34, R20, R21, R22, R65, R41
                                    R36, R37, R38, R66, R67, S22, S23, S24, S25, S36, S37, S38,
       2        Low
                                    S39, S51, S52
       1        Insignificant       Not subject to classification requirement

Results
In Figure 1 and Figure 2 the relationship between the health hazard categorization (HHC) and the
OELs are presented for substances initially defined as solid (n=188) and for liquids (n=303). The
Figures shows that for substances defined in HHC 1 and 2 there are no correlation between the hazard
categorization and the range of OEL. For these substances the OELs ranges from very low levels to


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very high levels. For substances defined in HHC 3, 4 and 5 there are a downward trend in OELs as
expected. The picture was the same both for substances with and without an official R- and S-
classification.

                              Liquids (n=303)                                                               Solids (n=188)
              1000                                                                         10000



                                                                                            1000
               100



                                                                                             100
                10


                                                                                              10
                 1




                                                                             OEL (mg/m3)
 OEL (ppm)




                                                                                               1

                0,1

                                                                                              0,1


               0,01
                                                                                             0,01



              0,001
                                                                                            0,001



             0,0001                                                                        0,0001
                      0   1        2                         3       4   5                          0   1    2                         3    4   5
                                Health Hazard Categorisation (HHC)                                           Health Hazard Category (HHC)



Figure 1 and 2: Health Hazard Categorization vs Occupational Exposure Limits for liquids (n=303)
and solids (n=188).

Discussion and conclusion
This initial analysis shows that for chemicals characterized as having a low hazard according to
official EU classification scheme there was no correlation between this classification and the
Norwegian OELs.

This might be related to the fact that the two sources for hazard and risk information have origin from
different sources. The Norwegian OELs was first defined by NLI in 1978 and was based mainly on
ACGIH TLVs and Danish OELs. New chemicals have been added, and limits have been changed, but
the list has not been subject to any systematic review. The chemical index list was defined by EU and
introduced along with the EU chemical directive [7]. One other aspect is that R- and S- phrases relates
to the hazard and the OEL more to the total risk related to the substances, however this could not
explain the lack of relationship between low hazardous chemicals and the OELs.

Further studies are therefore needed to elucidate the background this lack of relationship and to ensure
a sound basis for chemical health risk assessment.

Litterature
[1] Garrod, A., and R. Rajan-Sithamparananadarajah (2003) ‘Developing COSHH essentials; dermal
    exposure, personal protective equipment and first aid. Annals of Occupational Hygiene. 47:7,
    577–88 .
[2] Zalk, David M. and Nelson, Deborah Imel (2008) 'History and Evolution of Control Banding: A
    Review', Journal of Occupational and Environmental Hygiene, 5:5, 330 — 46
[3] Smedbold, Hans Thore (2007) ’Basis for risk assessment of work involving chemicals. ChemiRisk
    method. Rev. 2.1.’ Occupational Hygiene Solutions AS. www.chemirisk.no
[4] Smedbold, Hans Thore (2008) ’Risikovurdering for yrkeshygienikere.’ OHS-41-0090.
    Occupational Hygiene Solutions AS (under utarbeidelse).
[5] NLI order nr 361 (2008)’ Veiledning om administrative normer for forurensning i
arbeidsatmosfære (Norwegian). Direktoratet for arbeidstilsynet.
[6] EEC COUNCIL DIRECTIVE of 27 June 1967 on the approximation of laws, regulations and
administrative provisions relating to the classification, packaging and labelling of dangerous
substances (67/548/EEC). Annex I and VI
[7] Kemiska Ämnen – Chemical substanses (2008). http://kemi.prevent.se/




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Title
Ergonomic Effects of Glossy LCD Displays

Authors
The study was carried out for by Katarina Josefsson as a degree project as a part of the
Optometry program at Karolinska Institutet in collaboration with TCO Development and
Acreo Research Institute, Stockholm, Sweden. Contact and presenter: Hasse
Storebakken, TCO Development. E-mail: Hasse@baerekraft.as, Phone: +47 92028460.

Abstract
Introduction
Glossy computer displays (also known as glare panels) are increasingly popular with
consumers for gaming, entertainment, video etc. The gloss trend is moving into the
workplace but there are concerns about the effect on visual ergonomics, comfort and
human performance. An initial user study was conducted to identify and analyze the
effects of glossy screens on visual comfort and performance under typical office or
workspace conditions. Of particular concern was the reflection from surrounding light
sources on the screen, which proved to outweigh the benefits of the glossy screen in
certain lighting environments.

The experiment
20 test subjects, between 25-61 years of age, were asked to view a series of materials
(Web pages, Word docs, spreadsheets, photos, text, illustrations) at a distance of 65cm
from the LCD. Both glossy and matte screen surfaces were used.
Subjects viewed and evaluated the level of comfort and work performance when viewing
the images on each screen at 2 lighting levels: a subdued lighting level (100 lux) and a
brighter level (600 lux) representing many common office environments. The LCDs were
also exposed to a series of reflections from external light sources during the experiment
and subjects evaluated their comfort level at each level of reflection on the matte and
glossy surfaces.

Conclusions
A glossy LCD computer screen surface can have a negative effect on the visual
ergonomics for the user. In darker ambient lighting situations, a glossy screen can give
better color rendering and is often preferred.
However in brighter environments, such as an office, a matte screen is preferable as
disturbing reflections from ambient light sources negatively affect visual comfort and
work performance when using a gloss screen. User comfort is also dependent on the
type of image shown on the display.

Topic
Ergonomics.
Key words
LCD, gloss, visual comfort, ergonomics
Preferred method of presentation
Poster presentation.
Language
English.




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