Recognition of COVID-19 with occupational origin: a comparison between European countries.

OBJECTIVES: This study aims to present an overview of the formal recognition of COVID-19 as occupational disease (OD) or injury (OI) across Europe. METHODS: A COVID-19 questionnaire was designed by a task group within COST-funded OMEGA-NET and sent to occupational health experts of 37 countries in WHO European region, with a last update in April 2022. RESULTS: The questionnaire was filled out by experts from 35 countries. There are large differences between national systems regarding the recognition of OD and OI: 40% of countries have a list system, 57% a mixed system and one country an open system. In most countries, COVID-19 can be recognised as an OD (57%). In four countries, COVID-19 can be recognised as OI (11%) and in seven countries as either OD or OI (20%). In two countries, there is no recognition possible to date. Thirty-two countries (91%) recognise COVID-19 as OD/OI among healthcare workers. Working in certain jobs is considered proof of occupational exposure in 25 countries, contact with a colleague with confirmed infection in 19 countries, and contact with clients with confirmed infection in 21 countries. In most countries (57%), a positive PCR test is considered proof of disease. The three most common compensation benefits for COVID-19 as OI/OD are disability pension, treatment and rehabilitation. Long COVID is included in 26 countries. CONCLUSIONS: COVID-19 can be recognised as OD or OI in 94% of the European countries completing this survey, across different social security and embedded occupational health systems.

Landmark estimation of transition probabilities in non-Markov multi-state models with covariates.

In non-Markov multi-state models, the traditional Aalen-Johansen (AJ) estimator for state transition probabilities is generally not valid. An alternative, suggested by Putter and Spitioni, is to analyse a subsample of the full data, consisting of the individuals present in a specific state at a given landmark time-point. The AJ estimator of occupation probabilities is then applied to the landmark subsample. Exploiting the result by Datta and Satten, that the AJ estimator is consistent for state occupation probabilities even in non-Markov models given that censoring is independent of state occupancy and times of transition between states, the landmark Aalen-Johansen (LMAJ) estimator provides consistent estimates of transition probabilities. So far, this approach has only been studied for non-parametric estimation without covariates. In this paper, we show how semi-parametric regression models and inverse probability weights can be used in combination with the LMAJ estimator to perform covariate adjusted analyses. The methods are illustrated by a simulation study and an application to population-wide registry data on work, education and health-related absence in Norway. Results using the traditional AJ estimator and the LMAJ estimator are compared, and show large differences in estimated transition probabilities for highly non-Markov multi-state models.

Burnout syndrome in Europe: towards a harmonized approach in occupational health practice and research.

Health practitioners and decision makers in the medical and insurance systems need knowledge on the work-relatedness of burnout. To gather the most reliable information regarding burnout diagnosis and recognition in Europe, we used an 8-item standard questionnaire sent by e-mail to occupational health specialists identified via the Network on the Coordination and Harmonization of European Occupational Cohorts (OMEGA-NET) within the European Cooperation in Science and Technology (COST) Action. Participation rate was 100%, and the questionnaire was completed for 37 countries. In 14 (38%) countries burnout syndrome can be acknowledged as an occupational disease. However, only one country included burnout on the list of occupational diseases. The results showed a high variability in burnout diagnosis, in assessment of its work-relatedness, and in conditions allowing compensation of patients. These results reflect a lack of graded evidence on burnout and its determinants. The ongoing research on burnout conducted in the frame of the OMEGA-NET COST Action should be helpful through facilitating standardization of both existing and new data on burnout, a priority outcome requiring harmonization.

Occupational health examinations of patients in Norway. / Arbeidsmedisinsk pasientutredning i Norge.

BACKGROUND: In 2009, the hospital departments of occupational medicine and the National Institute of Occupational Health established a joint, anonymous examination register. The objective was to achieve a better overview of occupational health examinations of patients in Norway, including changes in occupationally related exposure and illness over time. MATERIAL AND METHOD: After the patient consultation the examining doctor completes a form, which is subsequently registered electronically. This article is based on analyses of patient examinations registered in the period 2010 ­ 2015. RESULTS: A total of 8 775 patient examinations had been recorded. The majority of those examined were men (75 %) and the most commonly occurring age group was 50 ­ 69 years (52 %). The most frequent exposures involved irritants/allergens (18 %) and organic solvents (15 %), which were recorded in a slightly increasing and slightly declining frequency respectively through the period. Manufacturing and mining were the top industries (30 %). The most common symptom organs were the lungs/respiratory tract (57 %), with asthma, COPD and lung cancer as the most frequent diagnoses. The proportion of cases that were deemed to be likely or possibly related to work remained stable at 40 % and 23 % respectively. At the time of the examination altogether 16 % of the patients were receiving sickness benefit, 10 % were receiving work assessment allowance and 13 % disability benefit. INTERPRETATION: Occupationally related illness entails significant consequences for individuals as well as society. The examination register provides a good overview of the patient examinations in the occupational health departments in Norway and may reveal changes in occupationally related exposure over time. In this way, the register may contribute to targeted preventive efforts.

Adult social position and sick leave: the mediating effect of physical workload.

OBJECTIVE: This study aimed to quantify how much of the adult social gradient in sick leave can be attributed to the mediating role of physical workload while accounting for the role of childhood and adolescent social position and neuroticism. METHODS: Our sample consisted of 2099 women and 1229 men from a Norwegian birth cohort study (born 1967-1976) who participated in the Nord-Trøndelag Health Study (2006-2008) (HUNT3). Data on sick leave (defined as >16 calendar days; 2006-2009) and social position during childhood, adolescence, and adulthood were obtained from national registers. Study outcome was time-to-first sick leave spell. Physical workload and neuroticism were self-reported in HUNT3. Mediating effects through physical workload were estimated using a method based on the additive hazards survival model. RESULTS: A hypothetical change from highest to lowest group in adult social position was, for women, associated with 51.6 [95% confidence interval (95% CI) 24.7-78.5] additional spells per 100,000 person-days at risk, in a model adjusted for childhood and adolescent social position and neuroticism. The corresponding rate increase for men was 41.1 (95% CI 21.4-60.8). Of these additional spells, the proportion mediated through physical workload was 24% (95% CI 10-49) and 30% (95% CI 10-63) for women and men, respectively. CONCLUSIONS: The effect of adult social position on sick leave was partly mediated through physical workload, even while accounting for earlier life course factors. Our findings provide support that interventions aimed at reducing physical workload among those with lower adult social position could reduce sick leave risk.

The gender gap in sickness absence from work and the influence of parental absence on offspring absence 15 years later: register-based cohort of Norwegians born in 1974-1976.

BACKGROUND: Women have shown consistently higher levels of sickness absence from work in comparison to men, but explanations for this gender gap have not been completely understood. Life-course studies suggest that health and health-related social benefits in adult age are influenced by early life experiences. We aimed to estimate intergenerational associations with a 15-year time gap between parents' and offspring sickness absences, pursuing the hypothesis that this parental influence would have a stronger impact for women than for men. METHODS: All persons born alive between 1974 and 1976 in Norway were followed up in several national registries. Employed persons considered to be at risk of sickness absence and also with parents at risk of sickness absence (n = 78,878) were followed in the calendar year of their 33(rd) birthday with respect to spells lasting >16 days. The probability of one or more spells during this year constituted the one-year risk under study. Additive risk differences in association with an exposure (parental sickness absence 15 years earlier) were estimated in a binomial regression analysis. The estimates were adjusted for parental socioeconomic factors. RESULTS: The 1-year sickness absence risk was higher for women (30.4%) than for men (12.3%). The crude risk differences between those exposed and those unexposed to parental sickness absence were similar in percentage points (PP) for women (3.8; 95% confidence interval (CI) 2.6 to 4.9) and men (3.8; 95% CI 2.9 to 4.6). The risk differences were moderately attenuated after adjustment for parental education and father's income to 3.4 PP (2.2 to 4.5) for women and 2.8 PP (2.0 to 3.7) for men. Male absence was more strongly associated with the father's than with the mother's sickness absence, while associations for women were stronger for the same diagnostic groups as their parents. CONCLUSIONS: Parental sickness absence was moderately associated with sickness absence in the next generation. Bias from unmeasured confounders cannot be entirely dismissed. Contrary to our hypothesis, associations were not stronger for women than for men. If parental sickness absence has a long-term causal effect, preventive measures could have an impact over generations.

Does the threshold for reporting musculoskeletal pain or the probability of attributing work-relatedness vary by socioeconomic position or sex?

OBJECTIVE: To examine the effect of sex and socioeconomic position (SEP) on individuals' perceptions of pain and its work-relatedness. METHODS: We compared self-reported pain in neck-shoulder or arm with clinical diagnoses and workers' judgments of work-relatedness with physicians' assessments based on specific criteria, between sexes and high- and low-SEP participants in the Oslo Health Study (n = 217). RESULTS: Clinical diagnoses were more frequent in low-SEP subjects than high-SEP subjects with pain and generally higher in women than in men. Pain attributed to work was more frequently assessed as work-related by the physicians in low-SEP subjects than high-SEP subjects and in men than in women of low SEP. CONCLUSIONS: The threshold for reporting pain seemed higher in low-SEP subjects and among women. Physicians were more likely to agree with low-SEP workers about work-relatedness.

Are occupational factors important determinants of socioeconomic inequalities in musculoskeletal pain?

OBJECTIVES: The aim of this study was to quantify socioeconomic 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 persons who attended the Oslo health study in 2000-2001 and answered questions on physical job demands, job autonomy, and musculoskeletal pain were included (N=7293). Occupational class was used as an indicator of socioeconomic status. The lower occupational classes were compared with higher grade professionals, and prevalences, prevalence ratios, prevalence differences, and population attributable fractions were calculated. RESULTS: There were marked, stepwise socioeconomic gradients for musculoskeletal pain, steeper for the men than for the women. The relative differences (prevalence ratios) were larger for low-back pain and arm pain than for neck-shoulder pain. The absolute differences (prevalence differences) were the largest for low-back pain. Physical job demands explained a substantial proportion of the absolute occupational class inequalities in low-back pain, while job autonomy was more important in explaining the inequalities in neck-shoulder pain and arm pain. The estimated population attributable fractions supported the impact of job characteristics at the working population level, especially 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 finding indicates that the workplace may be an important arena for preventive efforts to reduce socioeconomic inequalities in musculoskeletal pain.