Brage (Statens arbeidsmiljøinstitutt)
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Contact Urticaria and Related Conditions. Clinical Review
Full text linkContact urticaria (CoU) is an immediate contact reaction occurring within minutes to an hour after exposure to specific pro-teins or chemicals. CoU is categorised into non-immunologic (NI- CoU) and immunologic (I- CoU) types, with I- CoU potentiallyleading to anaphylaxis. Both forms of CoU can be associated with protein contact dermatitis and the CoU syndrome. Patientswith I- CoU may also have other type I (immediate) allergic diseases, such as allergic conjunctivitis, rhinitis, asthma or foodallergy. This review provides a detailed overview of CoU and related conditions, focusing on triggers, diagnostic methods andmanagement strategies. NI- CoU is typically triggered by low molecular weight chemicals, while I- CoU involves IgE-mediatedhypersensitivity to both high molecular weight proteins and low molecular weight chemicals. Early diagnosis is crucial, thoughCoU is often underrecognized. The diagnostic approach includes a thorough medical history, physical examination, evaluationof photographs, (non)invasive skin tests and in vitro assessments. Management strategies prioritise trigger avoidance and phar-macological treatments when avoidance is not fully possible. For I- CoU, second-generation H 1-antihistamines are the first-linetreatment. Severe cases of I- CoU may benefit from anti-IgE therapy (omalizumab). Patients at risk of anaphylaxis should carryan adrenaline auto-injector and wear a medical alert bracelet.Contact Urticaria and Related Conditions. Clinical ReviewpublishedVersio
Burnout trajectories among healthcare workers during a pandemic, and predictors of change
Full text linkBackground While several cross-sectional studies have suggested high burnout levels among health-care workers (HCW) during the Covid-19 pandemic, fewer studies have examined longitudinal trajectories of burnout. Objectives To examine (1) trajectories of change in levels of burnout among Norwegian HCW during a one-year period in the mid-phase of the Covid-19 pandemic (second, third, and fourth incidence rate peaks), and (2) how demographic and occupational variables, and pandemic-related experiences (e.g., own infection, severe infection in family, friend, or colleague, caring for deceased patient with Covid-19) were associated with such change. Methods Burnout was measured by the Copenhagen Burnout Inventory. Latent growth curve modeling was used to estimate trajectories of burnout symptoms, and predictors of starting point and rate of change in burnout levels. Results Starting points of burnout scores were, on average, low-to-moderate. Women, younger HCW, those living alone, and nurses had higher initial scores. Overall, burnout scores remained mostly unchanged across the study period. However, lower burnout scores at the initial assessment were associated with increasing scores over time. Being exposed to patients with Covid-19 and having a Covid-19 infection were associated with increased burnout over time. Conclusions While burnout symptoms among frontline health workers remained stable across the peaks of the Covid-19 pandemic overall, the study identified higher risk of worsening symptoms over time among certain demographic (younger personnel, females, and nurses) and highly exposed individuals and groups. These findings may be helpful for identifying frontline workers at particular risk of burnout during future public health emergencies.publishedVersio
Validation of the Norwegian version of the Munich ChronoType Questionnaire for shift workers (MCTQShift)
Full text linkChronotype may play a role in the association between shift work and health risks. An important and widely used questionnaire for measuring chronotype is the Munich Chronotype Questionnaire for Shift workers (MCTQShift); however, it has neither been validated nor is it available in Norwegian or any other Scandinavian language. Therefore, we translated the MCTQShift into Norwegian and assessed its validity against subjective and objective sleep measures. We adhered to established methodological guidelines to translate the questionnaire. The final Norwegian version was administered to 60 workers (85% responders) on a three-shift schedule (21.7% women, median age 28 y) at an industrial plant. Sleep duration and mid-sleep from the MCTQShift were compared with sleep diary and a multisensory sleep tracker (the Oura ring). Construct and criterion validity were evaluated. Sleep duration measured by the MCTQShift was highly correlated (r > 0.6) with sleep duration calculated from both the Oura ring and sleep diaries after morning shifts. On free days, the MCTQShift correlated moderately with the sleep diary but weakly with the Oura ring. Mid-sleep correlations from MCTQShift compared to the Oura ring data were high (r > 0.7) for sleep periods after morning and night shifts, and moderate (r = 0.5) sleep periods between free days following morning shift. Bland-Altman analyses indicated that the MCTQShift overestimated sleep duration and underestimated mid-sleep, with the largest discrepancies on free days after morning shifts. Night shifts showed the most pronounced outliers. The Norwegian MCTQShift shows promising validity for assessing sleep habits in shift workers, particularly on workdays. However, reduced accuracy on free days after morning shifts suggests limitations in capturing sleep patterns across all shift types. © 2025 The Author(s). Published with license by Taylor & Francis Group, LLC.Validation of the Norwegian version of the Munich ChronoType Questionnaire for shift workers (MCTQShift)publishedVersio
Development of a gender-specific European job exposure matrix (EuroJEM) for physical workload and its validation against musculoskeletal pain
Full text linkObjectives The aim was to develop a gender-specific European job exposure matrix (EuroJEM) for occupational physical workload and study its predictive validity for musculoskeletal pain in four European cohorts. Methods National, gender-specific JEM from Finland, France, Norway and Sweden, based on self-reported exposure information, were evaluated for similarities in exposures, exposure definitions, and occupational coding. The EuroJEM harmonized five exposures: heavy lifting, faster breathing due to heavy workload, kneeling/ squatting, forward bent posture, and working with hands above shoulder level. Our expert panel addressed disagreements and missing information to reach consensus on exposure levels across occupations. To assess predictive validity of the EuroJEM, we examined associations between the harmonized exposure measures and self-reported musculoskeletal pain across the four cohorts. Results The EuroJEM provides semi-quantitative exposure estimates for 374 ISCO-88 (COM) occupational codes. Five categories of exposure were defined by the proportion of workers exposed within each occupation. Comparable and statistically significant associations were found between EuroJEM exposures and low back, shoulder, and knee pain across all cohorts and genders, except for knee pain among women in the Finnish cohort. For instance, in both genders heavy lifting, faster breathing due to heavy workload, and forward bent posture were statistically significantly associated with low-back pain in all four cohorts, with OR ranging from 1.25–2.18 (men) and 1.23–2.04 (women). Conclusions Despite differences in study populations and outcome definitions, good predictive validity was observed in each national cohort, suggesting that EuroJEM can be an effective tool for exposure assessment in large-scale European epidemiological studies.publishedVersio
Development and psychometric validation of the frontline health workers’ occupational risk and characteristics in emergencies index (FORCE-index) – The covid Hospital cohort study
Full text linkObjectives A lack of tools for the systematic identification of frontline health workers' changing occupational risks, characteristics, and needs, poses a major barrier to supporting vital personnel to stay in practice through health emergencies and beyond. The current study reports on the development and psychometric evaluation of the Frontline health workers’ Occupational Risk and Characteristics in Emergencies index (FORCE-index). Study design The Covid hospital study is a large, multisite, four-wave, open cohort study of frontline health workers responding to the first four waves of the COVID-19 pandemic (2020–2022). Methods 2496 frontline health workers responded to questionnaires assessing various aspects of their work environment. Using exploratory factor analysis, we estimated the latent structure of the FORCE-index at the first and second waves. This structure was evaluated using confirmatory factor analysis at the third and fourth waves. The internal consistency of the instrument's subscales (e.g., factors) was evaluated using omega reliability, Cronbach's alpha coefficient, and mean inter-item correlation. Results A nine-factor solution provided best fit to the data. These factors mapped onto the following aspects of the work environment; competency, stress management, familiarity, workload manageability, work performance, infection safety, personal protective equipment, social safety, and social support. Internal consistency for the full FORCE-index and the nine factors was satisfactory. Conclusions The initial psychometric validation indicates that the FORCE-index is a valid measure which can be used by health authorities, services, and institutions to adequately and systematically assess central aspects of frontline health workers’ work environment that are commonly challenged in health emergencies.Development and psychometric validation of the frontline health workers’ occupational risk and characteristics in emergencies index (FORCE-index) – The covid Hospital cohort studypublishedVersio
Education and training interventions for healthcare workers to prevent sexual harassment
Full text linkThis is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness of education and training interventions on improving knowledge and skills for managing sexual harassment, and to assess their impact on the incidence of sexual harassment towards healthcare workers in healthcare settings. We will include all forms of sexual harassment committed by patients, visitors, and co-workers.Education and training interventions for healthcare workers to prevent sexual harassmentpublishedVersio
The effect of the Labour Inspection Authority's regulatory tools on compliance with regulations in the Norwegian home care services. A post-test-only control group study
Full text linkOccupational Safety and Health (OSH) laws and regulations serves as fundamental pillars for OSH practices, playing a crucial role in safeguarding employee safety and wellbeing. However, little is known about the efficiency of regulatory tools intending to ensure compliance with OSH laws and regulations, especially within the health and social care sector. The current experimental study aimed to determine the effect of two specific regulatory tools on compliance. Municipal home-care services were allocated to one of three groups: (I) “Inspection”, (II) “Guidance-through-workshops”, and (III) “Control”. At 24–30 months after the interventions all groups underwent formal inspections which recorded the numbers of contraventions with regulations to determine the difference in regulatory compliance between the groups. Analyses comparing the two intervention groups with the control group showed overall increased compliance in the inspection group (I), while no significant effects were found for the guidance group (II). The inspection group underwent inspections twice, and analyses of changes from the first to the second inspection also revealed improved compliance, but only statistically significantly for requirements pertaining to the addressed psychosocial factors. Future research should investigate how labour inspections can more effectively increase compliance and how to develop guidance as a tool for improving complianceThe effect of the Labour Inspection Authority's regulatory tools on compliance with regulations in the Norwegian home care services. A post-test-only control group studypublishedVersio
Hybrid work and mental distress. A cross‑sectional study of 24,763 ofce workers in the Norwegian public sector
Full text linkObjective Few studies have investigated the relationship between post-pandemic hybrid work-from-home (WFH), mental health, and work-life balance. We examined the association between hybrid WFH, mental distress, availability demands, work-life conflict, and life-work conflict. Methods Data from 24,763 office workers in the public sector in Norway were analyzed by linear and logistic regressions. Results Employees practicing flexible hybrid WFH (i.e., when needed/desired) were less likely to report mental distress (measured by the Hopkins Symptom-Checklist; HSCL-5) than those not practicing WFH. WFH being self-chosen was associated with less distress. Flexible WFH was also associated with availability demands, work-life conflict, and life-work conflict, which were, in turn, linked to distress. The risk of distress increased with the number of weekly days of flexible WFH. Workers with fixed agreements to regularly WFH did not report significantly less distress than those with no WFH. However, fixed WFH was associated with lower availability demands, not with work-life conflict, and was more often self-chosen than flexible WFH. Conclusion Flexible WFH may alleviate distress but may also indicate attempts to cope with taxing availability demands, and may even introduce stressors that could reverse beneficial effects. Our results should motivate nuanced, multifactorial assessments of WFH in organizational practice and research.publishedVersio
Predicting prolonged work absence due to musculoskeletal disorders: development, validation, and clinical usefulness of prognostic prediction models
Full text linkPurpose: Given the lack of robust prognostic models for early identification of individuals at risk of work disability, this study aimed to develop and externally validate three models for prolonged work absence among individuals on sick leave due to musculoskeletal disorders. Methods: We developed three multivariable logistic regression models using data from 934 individuals on sick leave for 4–12 weeks due to musculoskeletal disorders, recruited through the Norwegian Labour and Welfare Administration. The models predicted three outcomes: (1) > 90 consecutive sick days, (2) > 180 consecutive sick days, and (3) any new or increased work assessment allowance or disability pension within 12 months. Each model was externally validated in a separate cohort of participants (8–12 weeks of sick leave) from a different geographical region in Norway. We evaluated model performance using discrimination (c-statistic), calibration, and assessed clinical usefulness using decision curve analysis (net benefit). Bootstrapping was used to adjust for overoptimism. Results: All three models showed good predictive performance in the external validation sample, with c-statistics exceeding 0.76. The model predicting > 180 days performed best, demonstrating good calibration and discrimination (c-statistic 0.79 (95% CI 0.73–0.85), and providing net benefit across a range of decision thresholds from 0.10 to 0.80. Conclusions: These models, particularly the one predicting > 180 days, may facilitate secondary prevention strategies and guide future clinical trials. Further validation and refinement are necessary to optimise the models and to test their performance in larger samplesPredicting prolonged work absence due to musculoskeletal disorders: development, validation, and clinical usefulness of prognostic prediction modelspublishedVersio
Impact of air recirculation and humidification systems on wood dust exposure during woodworking
Full text linkEmployees in the woodworking industry, including carpentry workshops, wood product factories, and the wooden house industry, are exposed to wood dust at work. In Norway, this industry is exempt from regulations banning air recirculation, intended to prevent harmful substance buildup in working environments. While wood dust exposure is linked to increased risks of cancer and respiratory diseases, eliminating the exemption could have significant economic consequences for companies reliant on heated air recirculation during winter. A detailed characterization of the exposure is needed to evaluate the health risks associated with recirculated air. Wood dust contains components like resin acids, endotoxins, fungi, bacteria, monoterpenes, and aldehydes, which can irritate the skin, eyes, and respiratory system. Understanding these exposures is crucial for evaluating whether existing occupational exposure limits (OELs) adequately protect workers’ health. This study aimed to assess wood dust and associated exposures in companies with and without air recirculation or humidification. Between 2019 and 2023, full-shift personal aerosol sampling was conducted in 23 companies during winter. Samples were analyzed for wood dust mass, endotoxin, bacteria and fungi, resin acid, monoterpenes, and aldehydes. Log-transformed exposure data were analyzed by mixed models using company types and work-related conditions as fixed effects. Results showed average exposure below OELs but with significant variability. About 25% of measurements exceeded the OEL for inhalable wood dust of 1 mg/m3. Air recirculation had mixed effects; it lowered the monoterpene exposure by 95% (from GM 597 µg/m3 to GM 27 µg/m3) but increased the GM microbial exposure 2 to 5 times across companies. The impact of air recirculation varied across company types. For building element production, it nearly doubled the wood dust exposure from soft woods (from GM 0.15 mg/m3 to GM 0.27 mg/m3), while for door/window manufacturers, exposure was nearly halved compared to those not using air recirculation (from GM 0.44 mg/m3 to GM 0.25 mg/m3). Air humidification lowered the inhalable dust exposure by 59% across the company (from GM 1.36 mg/m3 to 0.56 mg/m3) but led to increases in monoterpene by 90 % (from GM 86 µg/m3 to GM 792 µg/m3) and microbial exposure by up to 64%. Companies manufacturing interior products without a humidification system had resin acid exposure levels that were 10 times higher (GM 3323 ng/m3) compared to those with a humidification system (GM 344 ng/m3). The variability in exposures was mostly influenced by company-specific practices. Evaluation of preventive measures should therefore be tailored to the individual company.publishedVersio