The contract-of-employment test renewed. A Scandinavian approach to platform work

Platform work blurs the scope of labour law and challenges the contract-of-employment test, threatening effective labour law protection. This article analyses this challenge from a Scandinavian perspective, where the contract-of-employment tests share common features and where a core common challenge is the ambiguous nature of worker freedom: When does the freedom to choose tasks and hours indicate autonomy and when does it indicate (extreme) precarity?As the criteria guiding the test leave this issue unresolved, the article argues that a renewal is required and suggests how it can be achieved. The purposive approach rooted in Scandinavian jurisprudence allows for both an individual and a market perspective, and provides a basis for a careful renewal of the test. The article concludes by suggesting new –or updated– criteria guiding the contract-of-employment test when dealing with platform work

The "Romsås in Motion" community intervention: program exposure and psychosocial mediated relationships to change in stages of change in physical activity

<p>Abstract</p> <p>Background</p> <p>Conducting process evaluations of health promoting interventions, and measuring the effectiveness of specific intervention components, may help in the understanding of program failure or success. The purposes of the present study were to examine adults' exposure to and involvement in specific components of a three year long pseudo-experimental community-based physical activity intervention, and to examine the relationship between such exposure and participation and changes in stages of change in physical activity and psychosocial mediators.</p> <p>Methods</p> <p>1497 persons in the intervention group attended the baseline survey in 2000 (50.6%) and 1204 (80.4 of baseline attendees) provided data on the outcome variables of the present study. In 2003, 1089 were still living in the area, and were re-invited to follow-up assessments. Current analyses are based on the 603 persons (mean age 49 ± 10 years) who provided baseline and follow-up data for the current purposes (56.6% follow-up rate). Process data, stages of change in physical activity, and potential psychosocial mediators of change in physical activity were assessed by questionnaires. The theory-based intervention was composed of communication, physical activity, environmental and participatory components. Data were analysed using frequency and descriptive statistics, Chi-square and t-tests, and regression analyses.</p> <p>Results</p> <p>Exposure and participation rates in the various intervention components varied greatly (1.5–92.7%). Participation in walking groups and aerobic exercise groups, as well as having seen the "Walk the stairs"-poster were significantly and positively related to change in stages of change in physical activity (β = .12, p = .011; β = .211, p < .001; β = .105, p = .014, respectively). Additionally, having used the walk path was significantly and positively related to change in stages in women (β = .209, p = .001) but not in men (β = -.011, p = .879), and in Western people (β = .149, p = .003) but not in non-Westerners (β = -.293, p = .092). Observed significant relations were partly mediated by positive changes in psychosocial factors as social support from friends, perceived control, and physical activity identity.</p> <p>Conclusion</p> <p>Findings revealed that particular intervention components, such as participation in physical activity groups, were more strongly related to forward transition in stages of change in physical activity than others. These findings together with results indicating that such transitions were mediated by specific psychosocial influences may improve theory and help to prioritize among specific intervention components in future programs.</p

Doctor-certified sickness absence in first and second trimesters of pregnancy among native and immigrant women in Norway

Aims: The authors sought to estimate differences in doctor-certified sickness absence during pregnancy among immigrant and native women. Methods: Population-based cohort study of pregnant women attending three Child Health Clinics in Groruddalen, Oslo, and their offspring. Questionnaire data were collected at gestational weeks 10–20 and 28. The participation rate was 74%. A multivariate Poisson regression was used to analyse differences in sickness absence in pregnancy between immigrant and native women. Results: A total of 573 women who were employed prior to their pregnancies were included, 51% were immigrants. After adjusting for age, years of education, marital status, number of children, occupation, part-time/full-time work, health status, severe pregnancy-induced emesis and language proficiency, the immigrant/native differences in number of weeks with sickness absence decreased from 2.0 to 1.2 weeks. Part-time/full-time work, health status, severe pregnancy-induced emesis and language proficiency were significant predictors of sickness absence. Conclusion: Immigrant women had higher sickness absence than native women during pregnancy. The difference in average number of weeks between native and immigrant women was partly explained by poorer health status prior to pregnancy, severe pregnancy-induced emesis and poorer proficiency in the Norwegian language among the immigrant women

Gestational diabetes, insulin resistance and physical activity in pregnancy in a multi-ethnic population - a public health perspective

Aims: To summarize findings from the STORK-Groruddalen Study regarding ethnic differences in the prevalence of gestational diabetes (GDM) by the WHO and modified International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria (no one hour value), insulin resistance, β-cell function and physical activity (PA) level. Methods: Population-based cohort study of 823 healthy pregnant women (59% ethnic minorities). Data from questionnaires, fasting blood samples, anthropometrics and objectively recorded PA level (SenseWear Armband), were collected at <20 (Visit 1) and 28±2 (Visit 2) weeks of gestation. The 75-g OGTT was performed at Visit 2. Insulin resistance (HOMA-IR) and β-cell function (HOMA-β) were estimated from venous fasting plasma glucose and C-peptide. Results: The GDM prevalence was 13.0% with the WHO and 31.5% with the IADPSG criteria. The ethnic minority women, especially South Asians, had highest figures. South and East Asian women had highest HOMA-IR at Visit 1 after adjustment for BMI. HOMA-IR increased from Visit 1 to Visit 2 irrespective of ethnic origin. Compared with Western European women, the absolute and percentage increase in HOMA-β from Visit 1 to Visit 2 was poorest for the South and East Asian women. All ethnic groups walked less and spent less time in moderate-to-vigorous physical activity (MVPA) during weekend days compared with weekdays. South Asian women were least active, measured by steps and by time spent in MVPA. Conclusion: Alarmingly high rates of GDM were found, highest among South Asians. South Asian women were less physically active, more insulin resistant and showed poorer β-cell compensation compared with Western European

Extended-spectrum beta-lactamase-producing bacteria are not detected in supragingival plaque samples from human fecal carriers of ESBL-producing Enterobacteriaceae

Background: The prevalence of infections caused by Cefotaximase-Munich (CTX-M)-type extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) has rapidly increased during the past 15 years. Enterobacteriaceae are commonly found in the gastrointestinal tract and long-term intestinal carriage is considered important for the spread of ESBL and as a source of clinical infections. Oral biofilm such as supragingival plaque is known to contain numerous antibiotic resistance determinants and may also represent a poorly investigated site for ESBL carriage and further spread. Objective: To investigate possible carriage of ESBL-producing bacteria in supragingival plaque of known fecal carriers of these bacteria. Design: We screened for the presence of aerobic and anaerobic ESBL-producing bacteria and blaCTX-M in supragingival plaque samples from healthy human adults with culture-verified fecal carriage of CTX-M-producing Escherichia coli. The presence or absence of Enterobacteriaceae and ESBL-producing bacteria in plaque samples was evaluated using culture-based methods and consensus CTX-M PCR. Results: Oral samples were obtained from 17 participants with known previous carriage of ESBL-producing E. coli. No ESBL-producing bacteria or ESBL genes were detected using culture-based and molecular methods. One colony of Rahnella aquatilis harboring the class A ESBL gene bla RAHN-1/2 was identified in an oral sample from one of the participants. Conclusion: This pilot study supports the notion that the presence of CTX-M-producing bacteria is uncommon in oral plaque of healthy human adult fecal carriers. Due to the limited number of persons tested, a low prevalence of oral ESBL-carriage in healthy adults or carriage in selected groups of patients cannot be excluded. To our knowledge, this is the first description of an R. aquatilis with the RAHN-1/2 gene in the oral cavity

Improving Assignments for Therapeutic and Prophylactic Treatment Within TB Households. A Potential for Immuno-Diagnosis?

Delays in diagnosis and treatment of pulmonary tuberculosis (TB) can lead to more severe disease and increased transmission. Contact investigation among household contacts (HHCs) of TB patients is crucial to ensure optimal outcomes. In the context of a prospective cohort study in Palamaner, Southern India, this study attempted to assess the potential of 27 different soluble immune markers to accurately assign HHCs for appropriate treatment. A multiplex bead assay was applied on QuantiFERON (QFT)-nil supernatants collected from 89 HHCs grouped by longitudinal QFT status; M. tuberculosis (Mtb) infected (QFT positive at baseline and follow-up, n = 30), recent QFT converters (QFT-negative at baseline, n = 27) and converted to QFT-positivity within 6 months of exposure (at follow-up, n = 24) and QFT consistent negatives (n = 32). The 29 TB index cases represented Active TB. Active TB cases and HHCs with Mtb infection produced significantly different levels of both pro-inflammatory (IFNγ, IL17, IL8, IP10, MIP-1α, MIP1β, and VEGF) and anti-inflammatory (IL9 and IL1RA) cytokines. We identified a 4-protein signature (bFGF, IFNγ, IL9, and IP10) that correctly classified HHCs with Mtb infection vs. Active TB with a specificity of 92.6%, suggesting that this 4-protein signature has the potential to assign HHCs for either full-length TB treatment or preventive TB treatment. We further identified a 4-protein signature (bFGF, GCSF, IFNγ, and IL1RA) that differentiated HHCs with Mtb infection from QFT consistent negatives with a specificity of 62.5%, but not satisfactory to safely assign HHCs to no preventive TB treatment. QFT conversion, reflecting new Mtb infection, induced an elevated median concentration in nearly two-thirds (19/27) of the analyzed soluble markers compared to the levels measured at baseline. Validation in other studies is warranted in order to establish the potential of the immune biosignatures for optimized TB case detection and assignment to therapeutic and preventive treatment of Mtb infected individuals.publishedVersio

Added value of IP-10 as a read-out of <em>Mycobacterium tuberculosis</em>:Specific immunity in young children

We have explored the added value of interferon-γ (IFNγ)–inducible protein 10 as a read-out of Mycobacterium tuberculosis–specific immunity in young Indian children, where the sensitivity of the IFNγ release assays for tuberculosis is poor. Reduced frequency of indeterminate results and an increased sensitivity for tuberculosis suggest a potential for fewer missed cases with a combined IFNγ/inducible protein 10 read-out in a 4th generation IFNγ release assays

Adiposity and hyperglycaemia in pregnancy and related health outcomes in European ethnic minorities of Asian and African origin: a review.

Background: Ethnic minorities in Europe have high susceptibility to type 2 diabetes (T2DM) and, in some groups, also cardiovascular disease (CVD). Pregnancy can be considered a stress test that predicts future morbidity patterns in women and that affects future health of the child. Objective: To review ethnic differences in: 1) adiposity, hyperglycaemia, and pre-eclampsia during pregnancy; 2) future risk in the mother of obesity, T2DM and CVD; and 3) prenatal development and possible influences of maternal obesity, hyperglycaemia, and pre-eclampsia on offspring’s future disease risk, as relevant for ethnic minorities in Europe of Asian and African origin. Design: Literature review. Results: Maternal health among ethnic minorities is still sparsely documented. Higher pre-pregnant body mass index (BMI) is found in women of African and Middle Eastern descent, and lower BMI in women from East and South Asia compared with women from the majority population. Within study populations, risk of gestational diabetes mellitus (GDM) is considerably higher in many minority groups, particularly South Asians, than in the majority population. This increased risk is apparent at lower BMI and younger ages. Women of African origin have higher risk of pre-eclampsia. A GDM pregnancy implies approximately seven-fold higher risk of T2DM than normal pregnancies, and both GDM and pre-eclampsia increase later risk of CVD. Asian neonates have lower birth weights, and mostly also African neonates. This may translate into increased risks of later obesity, T2DM, and CVD. Foetal overgrowth can promote the same conditions. Breastfeeding represents a possible strategy to reduce risk of T2DM in both the mother and the child. Conclusions: Ethnic minority women in Europe with Asian and African origin and their offspring seem to be at increased risk of T2DM and CVD, both currently and in the future. Pregnancy is an important window of opportunity for short and long-term disease prevention

Quality of Care for Patients With Type 2 Diabetes in Primary Care in Norway Is Improving: Results of cross-sectional surveys of 33 general practices in 1995 and 2005

OBJECTIVE—To assess changes in the quality of care in Norway for patients with type 2 diabetes

Ethnic differences in maternal dietary patterns are largely explained by socioeconomic score and integration score: a population-based study

Background: The impact of socio-economic position and integration level on the observed ethnic differences in dietary habits has received little attention. Objectives: To identify and describe dietary patterns in a multi-ethnic population of pregnant women, to explore ethnic differences in odds ratio (OR) for belonging to a dietary pattern, when adjusted for socioeconomic status and integration level and to examine whether the dietary patterns were reflected in levels of biomarkers related to obesity and hyperglycaemia. Design: This cross-sectional study was a part of the STORK Groruddalen study. In total, 757 pregnant women, of whom 59% were of a non-Western origin, completed a food frequency questionnaire in gestational week 28 ± 2. Dietary patterns were extracted through cluster analysis using Ward’s method. Results: Four robust clusters were identified where cluster 4 was considered the healthier dietary pattern and cluster 1 the least healthy. All non-European women as compared to Europeans had higher OR for belonging to the unhealthier dietary patterns 1-3 vs. cluster 4. Women from the Middle East and Africa had the highest OR, 21.5 (95% CI 10.6-43.7), of falling into cluster 1 vs. 4 as compared to Europeans. The ORs decreased substantially after adjusting for socio-economic score and integration score. A non-European ethnic origin, low socio-economic and integration scores, conduced higher OR for belonging to clusters 1, 2, and 3 as compared to cluster 4. Significant differences in fasting and 2-h glucose, fasting insulin, glycosylated haemoglobin (HbA1c), insulin resistance (HOMA-IR), and total cholesterol were observed across the dietary patterns. After adjusting for ethnicity, differences in fasting insulin (p=0.015) and HOMA-IR (p=0.040) across clusters remained significant, despite low power. Conclusion: The results indicate that socio-economic and integration level may explain a large proportion of the ethnic differences in dietary patterns.Norges forskningsråd SPH 19454