Exposure to tetrachloroethylene in dry cleaning shops in the Nordic countries.

OBJECTIVES: Tetrachloroethylene is the dominant solvent used in dry cleaning worldwide and many workers are potentially exposed. We report here on results of 1296 measurements of tetrachloroethylene undertaken in Nordic dry cleaning shops 1947-2001. METHODS: We searched documents and files in the Nordic institutes of occupational health for air measurements of tetrachloroethylene. Repeated measurements from the same facility during a short time interval were registered only once using the time-weighted average. We registered also changes over time in occupational exposure limits (OELs) to tetrachloroethylene. RESULTS: Only scattered measurements were available from the early years, and the exposure level seemed fairly stable up until the mid 1970s. The median exposure level was 20 p.p.m. in 1976 and decreased to 3 p.p.m. in 2000. Exposure levels in the four Nordic countries followed similar trends. In the late 1960s, the OELs varied between the Nordic countries from 30 to 100 p.p.m. Sweden was first to lower the limit, but limits gradually converged over time. At present, Denmark, Finland, and Sweden use 10 p.p.m., while Norway uses 6 p.p.m. Over time, the average observed exposure level was lower than the OEL in all countries, but in Denmark and Sweden, up to one-third of measured exposures exceeded the OEL. Overall, the stationary measurements for maintenance work showed 36 p.p.m., while the personal measurements showed 7.5 p.p.m. for dry cleaners and 6.25 p.p.m. for shop assistants. CONCLUSION: The Nordic data illustrate that it is possible over time to control chemical exposures even in an industry consisting of many small and scattered work places.

Decision making and co-operation between stakeholders within the process of sick leave. A case study in a Danish municipality.

The study addresses how recent reforms of the Sickness Benefit Act in Denmark are put into practice. A single case study embedded with five subunits of analysis based on "real life" cases has been conducted in a Danish municipality. Five "sick-listed" citizens and their respective municipal case manager and general practitioner (GP) were interviewed. Two key persons within the municipality were interviewed as background informants. The GPs and case managers ability to co-operate was hampered by lack of time, frequent staff turnover, lack of financial resources, and low accessibility. The motivation for co-operation was low due to low status of social medical issues, lack of feedback and lack of trust. The co-operation was characterized by sequential task integration. The stakeholders encountered difficulties when reciprocal task integration was needed. The decision making was affected by legal constraints and conflicting paradigms of key stakeholders. Rather than forcing co-operation, policymakers should increase the stakeholders' abilities and improve the conditions that create the low level of trust and hamper the willingness to co-operate.

Trends in sickness absence in Denmark.

OBJECTIVE: Based on the prevailing view that it has become a more common behavior, sickness absence is -presently a topic of considerable concern in many European countries. Using sickness absence data from Denmark, we aimed to show whether this assumption holds true or not. METHODS: We used a linear regression analysis to analyze time trends in sickness absence based on datasets from the Danish Employers Confederation, the State Employer's Authority, the Labour Force Survey, and Statistics Denmark. RESULTS: The findings from the Confederation of Danish Employers, the State Employer's Authority, and the Labor Force Survey indicated a stable and largely unaltered pattern of sickness absence during the last 20 years. Findings from Statistics Denmark showed an increase in the cumulative incidence proportion from 6.6 to 7.5% among employed people between 2000 and 2007. CONCLUSION: Our data did not indicate that sickness absence behavior has become more common in Denmark during the past 20 years; although, an increase was seen in the beginning of this century. It is apparent that the many reports on sickness absence that highlight an increasing trend are based on sickness benefit reimbursement data and have overlooked the underlying changes over time in the risk population and the entitlement to reimbursement.

Controlling sickness absence: a study of changes in the Danish sickness absence legislation since 1973.

OBJECTIVES: To outline the principles underlying changes overtime in entitlement to sickness absence benefit in Denmark. METHODS: The Danish sickness benefit scheme during the past 30 years has been studied based on a comprehensive review of the Sickness Benefit Act from 1973, and all later amendments to the act. RESULTS: Entitlement to sickness benefit in Denmark has undergone considerable changes during the past 30 years. The guiding principles of the reforms have been financial savings in combination with an assumption that human behaviour can be controlled through bureaucratic administration with focus on monitoring and evaluation. CONCLUSIONS: The Sickness Benefit Act was initially based on a broad concept of disease but the implementation underwent major changes. In the 1970s and 1980s entitlement to benefit depended very much on medical diagnosis. This practice changed and today's policy is to some extent a return to the biopsychosocial approach in the sense that the citizen is not regarded a passive victim of disease but an active player in influencing own working capacity. Added to this is, however, a new element of much tighter control leaving less room for autonomy.

Cancer in persons working in dry cleaning in the Nordic countries.

U.S. studies have reported an increased risk of esophageal and some other cancers in dry cleaners exposed to tetrachloroethylene. We investigated whether the U.S. findings could be reproduced in the Nordic countries using a series of case-control studies nested in cohorts of laundry and dry-cleaning workers identified from the 1970 censuses in Denmark, Norway, Sweden, and Finland. Dry-cleaning work in the Nordic countries during the period when tetrachloroethylene was the dominant solvent was not associated with an increased risk of esophageal cancer [rate ratio (RR) = 0.76; 95% confidence interval (CI), 0.34-1.69], but our study was hampered by some unclassifiable cases. The risks of cancer of the gastric cardia, liver, pancreas, and kidney and non-Hodgkin lymphoma were not significantly increased. Assistants in dry-cleaning shops had a borderline significant excess risk of cervical cancer not found in women directly involved in dry cleaning. We found an excess risk of bladder cancer (RR = 1.44; 95% CI, 1.07-1.93) not associated with length of employment. The finding of no excess risk of esophageal cancer in Nordic dry cleaners differs from U.S. findings. Chance, differences in level of exposure to tetrachloroethylene, and confounding may explain the findings. The overall evidence on bladder cancer in dry cleaners is equivocal.