Lower participation among immigrants in colorectal cancer screening in Norway

IntroductionOrganized cancer screening programs should be equally accessible for all groups in society. We assessed differences in participation in colorectal cancer (CRC) screening among different immigrant groups.MethodsBetween 2012 and 2019, 140,000 individuals aged 50 to 74 years were randomly invited to sigmoidoscopy or repeated faecal immunochemical test (FIT) in a CRC screening trial. In this study, we included 46,919 individuals invited to sigmoidoscopy and 70,018 invited to the first round of FIT between 2012 and 2017. We examined difference in participation between non-immigrants and immigrants, and within different immigrant groups by geographic area of origin, using logistic regression models, adjusted for several sociodemographic factors and health factors.ResultsIn total, we included 106,695 non-immigrants and 10,242 immigrants. The participation rate for FIT was 60% among non-immigrants, 58% among immigrants from Western countries and 37% among immigrants from non-Western countries. The participation rate for sigmoidoscopy was 53% among non-immigrants, 48% among immigrants from Western countries and 23% among immigrants from non-Western countries. Compared to non-immigrants, multivariate adjusted odds ratio for non-participation in FIT screening was 1.13 (95% confidence interval 1.04–1.23) and 1.82 (1.69–1.96) for immigrants from Western and non-Western countries. The corresponding numbers in sigmoidoscopy screening were 1.34 (1.21–1.48) and 2.83 (2.55–3.14). The lowest participation was observed in immigrants from Eastern Europe, Northern Africa and Western Asia, and South-Central Asia.ConclusionParticipation in CRC screening in Norway was particularly low among non-Western immigrants, which could put them at increased risk for late stage diagnosis of CRC. Participation was lower in sigmoidoscopy screening than in FIT screening, especially among immigrants from non-Western countries

Effects of shift work and psychological and social work factors on mental distress. Studies of onshore/offshore workers and nurses in Norway

Many services depend on having staff 24 hours a day, including petroleum onshore and offshore facilities, and the health care sector. Employees engaged in shift work are exposed to working hours outside the standard 8-16 working day. Working at evenings or nights, or rotating between different combinations of daytime, evening time, and nights may be challenging to the individual in terms of regulation of circadian rhythm, sleep deprivation or challenges to work-family balance, which in turn may affect the mental health of workers. Work is a central part of most peoples' lives. Thus, events occurring in relation to work may affect the mental health of workers in both positive and negative ways. The overall aims of the current thesis were to elucidate the ways shift schedules in combination with psychological and social conditions at work may influence the mental health of workers. To gain such knowledge a range of different shift schedules employed in the petroleum industry and within the health-care sector were studied. Furthermore, emphasis was on how working conditions relate to mental health by studying working conditions as predictors of mental health and mental health as predictor of working conditions. Participants were recruited from six companies operating in the Norwegian onshore- and offshore petroleum industry, and from members registered in the Norwegian Nurses Organization. Study 1 analyzed 1471 employees operating at onshore and offshore facilities. Differences in mental distress between various shift schedules were elucidated by comparing offshore shift types with zero, seven or 14 consecutive nights. Permanent-daytime (14 days) was compared with permanent-night shift (14 days), and swing shift (7 nights / 7days) was compared with permanent-night shifts. Among onshore workers, permanent-day shift was compared with rotating-shift work (day, evening and night). No statistical significant differences in mental distress between workers in different shift schedules were demonstrated. Six psychological and social work exposures were studied. Differences in work exposures between the shift schedules were demonstrated. Onshore revolving-shift workers reported lower job control compared with onshore daytime workers. Offshore swing-shift workers reported lower job control compared to permanent-night and -day workers offshore. Permanent night-workers reported higher job control, fair- and empowering leadership, and support from co-workers and superior compared to swing-shift workers. Associations between the six work factors and mental distress were analyzed separately for onshore and offshore workers, and with increasing level of adjustment. A specific hypothesis for study 1, was to elucidate whether the personality trait neuroticism influenced associations between work factors and mental distress. Onshore workers exhibited associations between job demands, job control, role conflict, and support and mental distress. Adjusted for neuroticism only role conflict reached statistical significance, whereas adjusted for all work factors only job control reached statistical significance. Among offshore workers all six work factors were associated with mental distress, also when adjusted for neuroticism. When adjusted for all work factors, role conflict and support were no longer statistically significant. In the fully adjusted model job demands, role clarity, and support reached statistical significance. Study 2 elucidated prospective effects of shift work, and six psychological and social work factors on mental distress among nurses. Specific to this study were the elucidation of moderating effects between shift work, and work factors on mental distress, elucidation of cross-lagged effects between work exposures and mental distress, and analyzing symptoms of anxiety and depression as separate outcomes. A total of 1582 nurses responded both at baseline and follow-up, and were included in the study. This study analyzed effects of night work compared to non-night work, and rotating-shifts with permanent-shifts. No statistical significant effects of shift schedules on anxiety and depression were demonstrated. However, differences in work exposures between shift schedules were demonstrated. Nurses working nights reported higher levels of role clarity and job demands, and lower levels of decision authority compared to non-night workers. Nurses working rotating-shifts reported higher levels of job demands, role clarity, and skill discretion, and lower levels of role clarity and decision authority compared to permanent-shift nurses. No statistically significant moderation effects between night work and rotating-shift work, and work content on mental distress were demonstrated. Study 2 demonstrated distress-to-work effects, where baseline symptoms of anxiety and depression predicted follow-up reporting of role clarity, role conflict, fair leadership, and social support. Work-to-distress effects were also demonstrated between job demands and symptoms of depression. Study 3 elucidated prospective effects of shift work, job type, psychological, social and physical work factors on mental distress among offshore workers. Both direct effects and interaction effects were examined. Unlike the two other studies, study 3 included job type, and exposure to noise and cold as predictors of mental distress. Furthermore, effects of 12 specific psychological and social work factors on mental distress were elucidated. Study 3 also examined reverse effects, but not with cross-lagged models as in paper 2. A total of 531 offshore workers responded both at baseline and follow-up, and were included in the study. In this study swing-shift was compared to permanent-day time. No statistically significant effects of shift work, or job type on mental distress were detected. Furthermore, no statistically significant moderation effects between shift work, and work exposures, or job type and work exposures on mental distress were detected. However, work-to-distress and distress-to-work effects were demonstrated. Nine out of twelve psychological and social work factors, and exposure to noise and cold were associated with follow-up mental distress. Adjusted for baseline distress, only exposure to noise reached statistical significance. Adjusted for all work exposures, only quantitative demands reached statistical significance. Baseline mental distress was associated with 11 out of 12 follow-up psychological and social work exposures, and exposure to noise. Adjusted for baseline work factor only learning demands was predicted by baseline mental distress. In conclusion, none of the shift schedules studied in the current thesis seems to affect the mental health of workers. However, this does not mean that such effects do not exist. The current thesis has pointed to several methodological challenges of studying mental health effects of shift work. Among these factors the healthy worker effect is central. Another possible explanation for the current findings may be that shift work may not be as important for mental health as hypothesized, at least not in Norway. Effects of shift work on mental distress seem not to be moderated by work content. However, this does not mean that such effects do not exist. The lack of moderating effects may be explained by methodological short comings such as restricted variance in exposures and outcome, or the healthy worker effect. Work content seems to affect the mental health of workers, and the mental health of workers seems to affect the perception of work content. However, the study of the reciprocal relationship between work content and mental health problems would benefit from employing longitudinal designs with different follow-up intervals in order to capture both short- and long term effects of work exposure. It seems reasonable that mental health problems may affect the perception of working conditions more promptly than exposure to adverse working conditions affect the mental health of workers

Sick leave before and after a work-place targeted terror attack

Objectives: To estimate the rate of sick leave and sick leave diagnosis among employees before and after a work-place targeted terror attack, and to compare sick leave in subgroups of employees based on gender and trauma exposure. Methods: Data on sick leave and diagnosis in ministerial employees from the period 3 years before to 3 years after the 2011 bombing in the governmental district of Oslo was retrieved from the Norwegian Social Insurance Administration Registries. Results: Prior to the attack, sick leave was twice as high in women as in men. Compared to the period prior to the attack, sick leave increased the first year after the attack, for both women and men that were directly exposed to the event. Sick leave stabilized to the initial level 3 years after the incident. For indirectly exposed employees, i.e., those who were not present at the site of the attack, there was no significant increase in sick leave from before to after the attack. There were no statistical significant changes in diagnoses applied before and after the terrorist attack. However, there was a tendency towards an increase in sick leave due to psychological diagnoses among the directly exposed women. Conclusions: After a work-place terrorist attack a transient increase in sick leave may occur among employees who were present at the site of the attack. The increase may seem relatively modest and last for 1–3 years

Post-traumatic stress reactions and doctor-certified sick leave after a workplace terrorist attack: Norwegian cohort study

To explore the association between the psychosocial work environment and the risk of sick leave among governmental employees with symptom-defined post-traumatic stress disorder (PTSD) after a workplace bomb attack.A prospective study on employees who met the symptom criteria for PTSD. Questionnaire data on the psychosocial work environment 10 months after the terrorist attack was linked to registry data on doctor-certified sick leave in the period 12–22 months after the attack.The bombing of the government ministries in Oslo, Norway, 22 July 2011.The study sample consists of 94 Norwegian governmental employees, all with symptom-defined PTSD from the Norwegian version of the PTSD checklist (Post-traumatic Stress Disorder Checklist-Specific) measured 10 months after the attack.After adjustment for sex and severity of PTSD symptoms, predictability at work reduced the odds of sick leave (adjusted OR=0.62, 95% CI 0.40 to 0.98). Sense of control over decisions at work was associated with fewer absence days for employees with sick leave (adjusted rate ratio=0.61, 95% CI 0.38 to 0.98).Employees with PTSD after workplace terrorism would benefit from control over their workplace conditions and increased predictability to reduce the risk of sick leave. The findings suggest that the work environment can facilitate employees’ work ability after stressful events, independent of severity of PTSD symptoms

Psychosocial work factors and sick leave risk after a terrorist bomb attack: a survey and registry-based longitudinal study of governmental employees in Norway

Objectives Studies show that social support may reduce the negative psychological effects of terror. The aim was to explore the effects of the psychosocial work environment on sick leave risk among governmental employees after a workplace bomb attack. Design We linked longitudinal survey data collected at 10 and 22 months after the bombing with registry data on doctor-certified sick leave collected from 42 months before the attack to 33 months after the attack. ORs and rate ratios were estimated with mixed effects hurdle models. Setting The bombing of the government ministries in Oslo, Norway, 22 July 2011. Participants We identified 1625 participants from a cohort of 3520 employees working in the ministries during the bombing in 2011. Results After adjustment for confounders, social support from coworkers reduced the odds of sick leave (OR 0.80, 95% CI 0.68 to 0.93), and there was marginal evidence for reduced odds with support from superior (OR 0.87, 95% CI 0.87 to 1.03). A social work climate, an innovative climate and a human resource primacy climate (HRP) reduced the sick leave risk (eg, HRP OR 0.77, 95% CI 0.66 to 0.90). The hurdle model found no associations between psychosocial support at work and the duration of sick leave. Conclusions Psychosocial support at work can enhance employees’ work ability after terror and reduce the sick leave risk by more than 20%. However, a supportive psychosocial work environment did not reduce the duration of sickness absence. The protective role of psychosocial work factors on sick leave may be most significant when employees are at work and interact with their work environment

Is perceived safety and threat after workplace terrorism linked to employee sick-leave? A registry-based longitudinal study of governmental employees in Norway

Background A large body of research has shown that terrorism enhances fears and undermines perceived safety in a high proportion of both directly exposed individuals and individuals without any form of direct exposure (i.e. no geographical proximity to an attack). Some studies have further suggested that fear of terrorism may adversely affect health in those without direct exposure and that this may constitute an important public health burden because of the number who are indirectly exposed. Limited studies have investigated threat and safety perception after workplace terrorism and the possible consequences for employee health. Objective To explore whether perceived safety and threat in employees whose workplace was subjected to a terrorist attack are associated with subsequent sick-leave. Method A longitudinal questionnaire survey on governmental employees’ perceived safety and threat at work one (T1) and two (T2) years after the 2011 terrorist attack on the Norwegian ministries was linked to registry data on doctor-certified sick-leave for two 9-month periods following T1 and T2 (N = 1703). Results There was fairly strong evidence (0.004 < p < 0.034) that higher perceived safety was associated with a close to 30% reduction in sick-leave in fully adjusted models which included terror exposure and symptom-based PTSD. There was inconclusive evidence that lower perceived threat was associated with reduced sick-leave in the full models. Conclusions Reduced perceived safety in employees following workplace terrorism may have adverse health consequences of public health significance given how prevalent this perception seems to be. The study supports that post-terrorism response plans should include strategies on how to address the potentially large number of individuals suffering ill health after terror even if they were not directly exposed and do not meet criteria for PTSD

The impact of a workplace terrorist attack on the psychosocial work environment. A longitudinal study from pre- to post-disaster

The psychosocial work environment is of great importance for regaining health and productivity after a workplace disaster. Still, there is a lack of knowledge about the impact of a disaster on the psychosocial work environment. The purpose of this study was to examine whether employees' perceptions of role clarity, role conflicts, and predictability in their work situation changed from before to after a workplace terrorist attack. We combined data from two prospective work environment surveys of employees in three governmental ministries that were the target of the 2011 Oslo terrorist attack. A first two-wave survey was conducted 4–5 years and 2–3 years before the attack, and a second three-wave survey took place 10 months, 2 years, and 3 years after the attack. Of 504 individuals who were employed at the time of the bombing, 220 were employed in both pre- and post-disaster periods, participated in both the first and the second survey, and consented to the linking of data from the two surveys. We found no significant changes in levels of role clarity, role conflict, and predictability from before to after the terrorist attack. Adjusting for sex, age and education had no effect on the results. The findings suggest that perceptions of the psychosocial working environment are likely to be maintained at previous levels in the aftermath of a workplace disaster. Considering the importance of the psychosocial work environment for regaining health and productivity, the findings are important for the preparation for, and management of, future crises