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

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

Work pace control and pregnancy health in a population-based sample of employed women in Norway.

OBJECTIVES: This study explored the possible effects of power to control one's own work pace on pregnancy health. METHODS: Questionnaires were sent to all parturients in Norway between 16 October and 26 November 1989 for completion prior to discharge from the hospital; 87.2% responded. The study population comprised 3321 respondents with singleton pregnancies and paid work beyond the 3rd month of pregnancy. Power to control work pace was measured as self-reported influence on breaks and work pace and absence of external pacing. Pregnancy health was defined by the prevalence of preeclampsia, disabling posterior pelvic pain, low-back pain, and birthweight of <2500 g for the offspring. RESULTS: Pregnancy health improved with increasing power to control work pace, both in manual and nonmanual work. The risk decreased with increasing control for all 4 outcomes, but the impact on birthweight was restricted to nullipara. After adjustment for age, parity, education, smoking, and manual work, the decreasing trend remained significant for preeclampsia and low birthweight of the first born. In a comparison with women with the highest level of control, the adjusted odds ratios for women with no control were 1.6 [95% confidence interval (95% CI) 0.9-3.1] for preeclampsia, 1.6 (95% CI 1.0-2.4) for disabling posterior pelvic pain, 1.3 (95% CI 1.0-1.8) for low-back pain, and 2.5 (95% CI 0.9-6.8) for low birthweight (nullipara). CONCLUSIONS: Women with power to control their own work pace had better pregnancy health than women without such power. The results suggest increased individual control over work pace as a prime target for job adjustment during pregnancy.

Job adjustment as a means to reduce sickness absence during pregnancy.

OBJECTIVES: This study examined the effect of job adjustment on sickness absence during pregnancy and also determined the conditions under which such adjustments are obtained. METHODS: Data were derived from a nationally representative survey on work conditions during pregnancy in Norway in 1989. For employees (N = 2713) remaining in the same job throughout pregnancy, the percentage of women on sick leave immediately before delivery was determined according to the need for job adjustment and the obtainment of job adjustment. Those obtaining job adjustment were grouped according to workplace size, labor-market sector, co-worker gender, educational level, work schedules, weekly workhours, children under 16 years of age in the household, and age. RESULTS: All told, 1691 women (62.3%) needed job adjustment, among whom 936 (55.4%) obtained such adjustment. The proportions of those on sick leave before delivery were 45.2% for "no need", 67.9% for "need - adjustment obtained", and 79.2% for "need - adjustment not obtained". In the last category, the difference (versus "adjustment obtained") constituted 44.5% of the weeks lost because of sickness absence in the last half of pregnancy. The odds ratio (OR) for obtaining job adjustment was larger for workplaces with more than 50 employees (OR 1.4) and smaller for jobs with work schedules other than daytime or shift work (OR 0.5) and also for women living with children under 16 years of age (OR 0.8). CONCLUSIONS: Job adjustment is associated with reduced sickness absence during pregnancy. Further studies should explore workplace characteristics that make it difficult to obtain such adjustments, as required by law.

Working conditions and prevalence of pre-eclampsia, Norway 1989.

OBJECTIVE: To study the associations between working conditions and pre-eclampsia. METHODS: A cross-sectional study based on questionnaires to all parturients was conducted in Norway from 16 October 1989 to 26 November 1989, with an 87.2% response rate. Of the 5388 responders with singleton pregnancies, 3321 continued in paid work beyond the 3rd month of pregnancy. Pre-eclampsia was recorded if the woman reported hospitalization for hypertension, or if proteinuria and hypertension were diagnosed more than once in the pregnancy. RESULTS: The prevalence of pre-eclampsia was increased in work involving the lifting of heavy loads of 10-20 kg (adjusted odds ratio (OR), 1.8; 95% CI, 1.2-2.5), hectic work pace (OR, 1.4; 95% CI, 1.0-2.0, P < 0.05), work with hands above shoulder level (OR, 1.4; 95% CI, 1.0-2.2; P = 0.07) and for parous women, shift work (OR, 2.0; 95% CI, 1.1-3.6). It was reduced when the woman had an influence on work pace (OR, 0.7; 95% CI, 0.5-1.0; P = 0.07). Prevalence was also increased with daily consumption of more than four cups of coffee (OR, 1.6; 95% CI, 1.1-2.3). CONCLUSION: Prenatal care should include assessment of working conditions, as early improvements may reduce the risk of pre-eclampsia.

[Disability pensions because of musculoskeletal diseases among women of different occupations]. / Uførepensjonering av kvinner i ulike yrker på grunn av muskel- og skjelettsykdommer.

Altogether 9,516 women, 16-67 years of age, were granted a disability pension in Norway in 1993. Musculoskeletal disease was registered as the main diagnosis for 3,730. Employment status is known for 3,125 of these 3,730 women. Analyses, based on age standardized incidence rates--SIR's, pointed to shop assistants, practical nurses and charladies as the three major occupational groups with high risk of being disability pensioned because of musculoskeletal disease. These three occupations accounted for more than one third of all women in paid employment who were granted a disability pension for musculoskeletal disease 1993. Compensation will amount to about NOK 600 million before these women reach the normal retirement age of 67 years. Prevention of musculoskeletal diseases in the labour force would appear to be potentially cost-effective. So far, prevention of work-related musculoskeletal diseases has focused mainly on the technical ergonomic aspects of the working conditions. It is recommended that more attention be given to organizational aspects, such as daily hours of work, the timing and duration of breaks, work pace and potential to influence one's own work situation.

Need for job adjustment in pregnancy. Early prediction based on work history.

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

Morbidity and mortality in talc-exposed workers.

Cancer incidence and cause-specific mortality were studied in a male cohort of 94 talc miners and 295 talc millers, exposed to non-asbestiform talc with low quartz content. No excess risk was found compared with national age-specific incidence. Six cases of lung cancer occurred versus 6.49 expected (miners: observed 2, expected 1.27; millers: observed 4, expected 5.22). There were 3 deaths due to non-malignant respiratory disease against 10.9 expected (miners: observed 1, expected 2.5; millers: observed 2, expected 8.4). Mesothelioma, tuberculosis, or pneumoconiosis were not recorded as causes of death. Pneumoconiosis was noted as a contributory cause in three cases (silicosis two, talcosis one). Further follow-up will reduce any potential impact of "healthy worker" selection.

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

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

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

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

Fertility patterns according to occupational grouping in Norway, 1989.

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

PIP: This study examines age specific fertility rate differences among employed women by occupation in 1989 in Norway. The aim was to determine whether the number of pregnant women within specific occupations could be estimated from general fertility rates. Data are obtained from a survey among women registered in Statistics Norway who had given birth during 1989. 495,000 women 16-39 years old were employed in paid work in 1989. 77.3% or 4205 women responded to the survey and indicated that they had been working for pay during their pregnancy. The sample underrepresented women with no or very low income or non-Nordic citizenship. Occupation was grouped according to the International Standard Classification of Occupations. Findings indicate that fertility rates were higher among women under 25 years old and somewhat lower for women older than 30 than Statistics Norway data. Employed women had higher fertility rates for all age groups than comparable general fertility rates among the total female population. The exception was fertility rates among women over 30 years. The differences between employed fertility rates and general fertility rates was 17%. Estimation of employed women's fertility from general fertility rates would yield underestimation of about 7000 pregnancies. 75% of pregnant employed women worked in three occupations: technical/professional, clerical, and service work. Fertility rates ranged from 111.6/1000 in technical/professional work to 71.7/1000 in agricultural work. Fertility rates that were adjusted for age and parity ranged from 118 in technical/professional work to 82 in transportation and communication work. Standardized fertility rates were 114 in administrative/executive work among women with a first birth and 125 for women with multiple births, and 114 in service work among women with a first birth and 80 among parous women. It is recommended that work status and occupation be included in Birth Registry files.

Respiratory dysfunction after potroom asthma.

Thirty-five men developed bronchial asthma while working in the potrooms in a primary aluminum production plant. Their asthma was diagnosed as work-related ("potroom asthma"). When examined 1-43 months after cessation of exposure (average follow-up period 2.5 yr), the group had an increased relative risk of morning cough (RR 1.7 CL95% 0.6-5.1), dyspnea on exertion (RR 2.8 CL95% 0.9-8.4), and wheezing (RR 6.1 CL95% 2.3-16.3) compared to controls from the same plant, in a 1:2 matched analysis. Matching criteria were age, smoking habits, and time of employment in the plant. The group means for FEV1 and MMEF were lower than for the controls, but the differences were not statistically significant. Ten of the 35 reported persisting asthma, dyspnea at night, or dyspnea on exertion. The study indicates an increased risk of respiratory dysfunction after potroom asthma. Medical follow-up after cessation of exposure is recommended.

[Use of occupational disease benefits]. / Bruk av yrkesskadetrygd ved yrkessykdom.

Persons with pleuramesothelioma were studied to find out the share receiving occupational injury benefit from the National Insurance Scheme. This disease, caused by inhaling asbestos, was chosen because it has been estimated that between 70 and 80 per cent of persons with pleuramesothelioma fulfil the criteria for compensation. During the period 1970-93, 662 men and 104 women were recorded as having this disease. Up to June 1996, the National Insurance Administration had considered the cases of only 163 men, and no women. A further 25-30 patients may have filed claims with the local national insurance office. This implies that, overall, maximum one third of those entitled to occupational injury benefit have received it. The fraction would probably be even lower in the case of diseases where the association with occupation is less certain. It is recommended that national disease registries, such as the Cancer Registry, should report possible cases of occupational disease to the National Insurance Administration.

Strenuous working conditions and birthweight, Norway 1989.

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

[Occupational anamnesis in general practice. Does it yield useful information for preventive procedures?]. / Yrkesanamnesen i allmennpraksis. Gir den brukbar informasjon for forebyggende arbeid?

To what extent can general practitioners elucidate connections between working conditions and patterns of health and disease for preventive purposes? Data were collected by means of questionnaires to general practitioners, interviews with patients and by testing out questions to establish an occupational history. Questions covering seven key topics revealed a multitude of possible causal links between working conditions and symptoms. The information may appear irrelevant to the general practitioner, however, if the Labour Inspection (Arbeidstilsynet) or the companies' health services fail to assist.