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author:("Moen, bence E")
1.  Inter‐rater agreement in the assessment of exposure to carcinogens in the offshore petroleum industry 
Objectives
To evaluate the reliability of an expert team assessing exposure to carcinogens in the offshore petroleum industry and to study how the information provided influenced the agreement among raters.
Methods
Eight experts individually assessed the likelihood of exposure for combinations of 17 carcinogens, 27 job categories and four time periods (1970–1979, 1980–1989, 1990–1999 and 2000–2005). Each rater assessed 1836 combinations based on summary documents on carcinogenic agents, which included descriptions of sources of exposure and products, descriptions of work processes carried out within the different job categories, and monitoring data. Inter‐rater agreement was calculated using Cohen's kappa index and single and average score intraclass correlation coefficients (ICC) (ICC(2,1) and ICC(2,8), respectively). Differences in inter‐rater agreement for time periods, raters, International Agency for Research on Cancer groups and the amount of information provided were consequently studied.
Results
Overall, 18% of the combinations were denoted as possible exposure, and 14% scored probable exposure. Stratified by the 17 carcinogenic agents, the probable exposure prevalence ranged from 3.8% for refractory ceramic fibres to 30% for crude oil. Overall mean kappa was 0.42 (ICC(2,1) = 0.62 and ICC(2,8) = 0.93). Providing limited quantitative measurement data was associated with less agreement than for equally well described carcinogens without sampling data.
Conclusion
The overall κ and single‐score ICC indicate that the raters agree on exposure estimates well above the chance level. The levels of inter‐rater agreement were higher than in other comparable studies. The average score ICC indicates reliable mean estimates and implies that sufficient raters were involved. The raters seemed to have enough documentation on which to base their estimates, but provision of limited monitoring data leads to more incongruence among raters. Having real exposure data, with the inherent variability of such data, apparently makes estimating exposure in a rigid semiquantitative manner more difficult.
doi:10.1136/oem.2006.030528
PMCID: PMC2092566  PMID: 17227837
reliability; Cohen's kappa index; intraclass correlation coefficients
2.  Exposure to carcinogens for defined job categories in Norway's offshore petroleum industry, 1970 to 2005 
Objectives
To identify and describe the exposure to selected known and suspected carcinogenic agents, mixtures and exposure circumstances for defined job categories in Norway's offshore petroleum industry from 1970 to 2005, in order to provide exposure information for a planned cohort study on cancer.
Methods
Background information on possible exposure was obtained through company visits, including interviewing key personnel (n = 83) and collecting monitoring reports (n = 118) and other relevant documents (n = 329). On the basis of a previous questionnaire administered to present and former offshore employees in 1998, 27 job categories were defined.
Results
This study indicated possible exposure to 18 known and suspected carcinogenic agents, mixtures or exposure circumstances. Monitoring reports were obtained on seven agents (benzene, mineral oil mist and vapour, respirable and total dust, asbestos fibres, refractory ceramic fibres, formaldehyde and tetrachloroethylene). The mean exposure level of 367 personal samples of benzene was 0.037 ppm (range: less than the limit of detection to 2.6 ppm). Asbestos fibres were detected (0.03 fibres/cm3) when asbestos‐containing brake bands were used in drilling draw work in 1988. Personal samples of formaldehyde in the process area ranged from 0.06 to 0.29 mg/m3. Descriptions of products containing known and suspected carcinogens, exposure sources and processes were extracted from the collected documentation and the interviews of key personnel.
Conclusions
This study described exposure to 18 known and suspected carcinogenic agents, mixtures and exposure circumstances for 27 job categories in Norway's offshore petroleum industry. For a planned cohort study on cancer, quantitative estimates of exposure to benzene, and mineral oil mist and vapour might be developed. For the other agents, information in the present study can be used for further assessment of exposure, for instance, by expert judgement. More systematic exposure surveillance is needed in this industry. For future studies, new monitoring programmes need to be implemented.
doi:10.1136/oem.2006.028225
PMCID: PMC2078458  PMID: 17043075
3.  Gender inequalities in occupational health related to the unequal distribution of working and employment conditions: a systematic review 
Introduction
Gender inequalities exist in work life, but little is known about their presence in relation to factors examined in occupation health settings. The aim of this study was to identify and summarize the working and employment conditions described as determinants of gender inequalities in occupational health in studies related to occupational health published between 1999 and 2010.
Methods
A systematic literature review was undertaken of studies available in MEDLINE, EMBASE, Sociological Abstracts, LILACS, EconLit and CINAHL between 1999 and 2010. Epidemiologic studies were selected by applying a set of inclusion criteria to the title, abstract, and complete text. The quality of the studies was also assessed. Selected studies were qualitatively analysed, resulting in a compilation of all differences between women and men in the prevalence of exposure to working and employment conditions and work-related health problems as outcomes.
Results
Most of the 30 studies included were conducted in Europe (n=19) and had a cross-sectional design (n=24). The most common topic analysed was related to the exposure to work-related psychosocial hazards (n=8). Employed women had more job insecurity, lower control, worse contractual working conditions and poorer self-perceived physical and mental health than men did. Conversely, employed men had a higher degree of physically demanding work, lower support, higher levels of effort-reward imbalance, higher job status, were more exposed to noise and worked longer hours than women did.
Conclusions
This systematic review has identified a set of working and employment conditions as determinants of gender inequalities in occupational health from the occupational health literature. These results may be useful to policy makers seeking to reduce gender inequalities in occupational health, and to researchers wishing to analyse these determinants in greater depth.
doi:10.1186/1475-9276-12-57
PMCID: PMC3765149  PMID: 23915121
Gender identity; Occupational health; Socioeconomic factors; Work
4.  Increased risk of oesophageal adenocarcinoma among upstream petroleum workers 
Objectives
To investigate cancer risk, particularly oesophageal cancer, among male upstream petroleum workers offshore potentially exposed to various carcinogenic agents.
Methods
Using the Norwegian Registry of Employers and Employees, 24 765 male offshore workers registered from 1981 to 2003 was compared with 283 002 male referents from the general working population matched by age and community of residence. The historical cohort was linked to the Cancer Registry of Norway and the Norwegian Cause of Death Registry.
Results
Male offshore workers had excess risk of oesophageal cancer (RR 2.6, 95% CI 1.4 to 4.8) compared with the reference population. Only the adenocarcinoma type had a significantly increased risk (RR 2.7, 95% CI 1.0 to 7.0), mainly because of an increased risk among upstream operators (RR 4.3, 95% CI 1.3 to 14.5). Upstream operators did not have significant excess of respiratory system or colon cancer or mortality from any other lifestyle-related diseases investigated.
Conclusion
We found a fourfold excess risk of oesophageal adenocarcinoma among male workers assumed to have had the most extensive contact with crude oil. Due to the small number of cases, and a lack of detailed data on occupational exposure and lifestyle factors associated with oesophageal adenocarcinoma, the results must be interpreted with caution. Nevertheless, given the low risk of lifestyle-related cancers and causes of death in this working group, the results add to the observations in other low-powered studies on oesophageal cancer, further suggesting that factors related to the petroleum stream or carcinogenic agents used in the production process might be associated with risk of oesophageal adenocarcinoma.
doi:10.1136/oem.2009.046953
PMCID: PMC3728278  PMID: 19858535
5.  Personal Exposure to Dust and Endotoxin in Robusta and Arabica Coffee Processing Factories in Tanzania 
Annals of Occupational Hygiene  2012;57(2):173-183.
Introduction:
Endotoxin exposure associated with organic dust exposure has been studied in several industries. Coffee cherries that are dried directly after harvest may differ in dust and endotoxin emissions to those that are peeled and washed before drying. The aim of this study was to measure personal total dust and endotoxin levels and to evaluate their determinants of exposure in coffee processing factories.
Methods:
Using Sidekick Casella pumps at a flow rate of 2l/min, total dust levels were measured in the workers’ breathing zone throughout the shift. Endotoxin was analyzed using the kinetic chromogenic Limulus amebocyte lysate assay. Separate linear mixed-effects models were used to evaluate exposure determinants for dust and endotoxin.
Results:
Total dust and endotoxin exposure were significantly higher in Robusta than in Arabica coffee factories (geometric mean 3.41mg/m3 and 10 800 EU/m3 versus 2.10mg/m3 and 1400 EU/m3, respectively). Dry pre-processed coffee and differences in work tasks explained 30% of the total variance for total dust and 71% of the variance for endotoxin exposure. High exposure in Robusta processing is associated with the dry pre-processing method used after harvest.
Conclusions:
Dust and endotoxin exposure is high, in particular when processing dry pre-processed coffee. Minimization of dust emissions and use of efficient dust exhaust systems are important to prevent the development of respiratory system impairment in workers.
doi:10.1093/annhyg/mes064
PMCID: PMC3567811  PMID: 23028014
coffee dust; coffee processing factories; endotoxin; exposure determinants
6.  Dust exposure and chronic respiratory symptoms among coffee curing workers in Kilimanjaro: a cross sectional study 
Background
Coffee processing causes organic dust exposure which may lead to development of respiratory symptoms. Previous studies have mainly focused on workers involved in roasting coffee in importing countries. This study was carried out to determine total dust exposure and respiratory health of workers in Tanzanian primary coffee-processing factories.
Methods
A cross sectional study was conducted among 79 workers in two coffee factories, and among 73 control workers in a beverage factory. Personal samples of total dust (n = 45 from the coffee factories and n = 19 from the control factory) were collected throughout the working shift from the breathing zone of the workers. A questionnaire with modified questions from the American Thoracic Society questionnaire was used to assess chronic respiratory symptoms. Differences between groups were tested by using independent t-tests and Chi square tests. Poisson Regression Model was used to estimate prevalence ratio, adjusting for age, smoking, presence of previous lung diseases and years worked in dusty factories.
Results
All participants were male. The coffee workers had a mean age of 40 years and were older than the controls (31 years). Personal total dust exposure in the coffee factories were significantly higher than in the control factory (geometric mean (GM) 1.23 mg/m3, geometric standard deviation (GSD) (0.8) vs. 0.21(2.4) mg/m3). Coffee workers had significantly higher prevalence than controls for cough with sputum (23% vs. 10%; Prevalence ratio (PR); 2.5, 95% CI 1.0 - 5.9) and chest tightness (27% vs. 13%; PR; 2.4, 95% CI 1.1 - 5.2). The prevalence of morning cough, cough with and without sputum for 4 days or more in a week was also higher among coffee workers than among controls. However, these differences were not statistically significant.
Conclusion
Workers exposed to coffee dust reported more respiratory symptoms than did the controls. This might relate to their exposure to coffee dust. Interventions for reduction of dust levels and provision of respiratory protective equipment are recommended.
doi:10.1186/1471-2466-11-54
PMCID: PMC3247191  PMID: 22114929
7.  Lung function reduction and chronic respiratory symptoms among workers in the cement industry: a follow up study 
Background
There are only a few follow-up studies of respiratory function among cement workers. The main aims of this study were to measure total dust exposure, to examine chronic respiratory symptoms and changes in lung function among cement factory workers and controls that were followed for one year.
Methods
The study was conducted in two cement factories in Ethiopia. Totally, 262 personal measurements of total dust among 105 randomly selected workers were performed. Samples of total dust were collected on 37-mm cellulose acetate filters placed in closed faced Millipore-cassettes. Totally 127 workers; 56 cleaners, 44 cement production workers and 27 controls were randomly selected from two factories and examined for lung function and interviewed for chronic respiratory symptoms in 2009. Of these, 91 workers; 38 cement cleaners (mean age 32 years), 33 cement production workers (36 years) and 20 controls (38 years) were examined with the same measurements in 2010.
Results
Total geometric mean dust exposure among cleaners was 432 mg/m3. The fraction of samples exceeding the Threshold Limit Value (TLV) of 10 mg/m3 for the cleaners varied from 84-97% in the four departments. The levels were considerably lower among the production workers (GM = 8.2 mg/m3), but still 48% exceeded 10 mg/m3.
The prevalence of all the chronic respiratory symptoms among both cleaners and production workers was significantly higher than among the controls.
Forced Expiratory Volume in one second (FEV1) and FEV1/Forced Vital Capacity (FEV1/FVC) were significantly reduced from 2009 to 2010 among the cleaners (p < 0.002 and p < 0.004, respectively) and production workers (p < 0.05 and p < 0.02, respectively), but not among the controls.
Conclusions
The high prevalence of chronic respiratory symptoms and reduction in lung function is probably associated with high cement dust exposure. Preventive measures are needed to reduce the dust exposure.
doi:10.1186/1471-2466-11-50
PMCID: PMC3247867  PMID: 22067264
8.  Can air pollution affect tear film stability? a cross-sectional study in the aftermath of an explosion accident 
BMC Public Health  2011;11:235.
Background
After an explosion and fire in two tanks containing contaminated oil and sulphur products in a Norwegian industrial harbour in 2007, the surrounding area was polluted. This caused an intense smell, lasting until the waste was removed two years later. The present study reports examinations of tear film break up time among the population. The examinations were carried out because many of the people in the area complained of sore eyes. The purpose of the study was to assess the relationship between living or working close to the polluted area and tear film stability one and a half years after the explosion.
Methods
All persons working or living in an area less than six kilometres from the explosion site were invited to take part in the study together with a similar number of persons matched for age and gender living more than 20 kilometres away. Three groups were established: workers in the explosion area and inhabitants near the explosion area (but not working there) were considered to have been exposed, and inhabitants far away (who did not work in the explosion area) were considered to be unexposed. A total of 734 people were examined, and the response rate was 76 percent. Tear film stability was studied by assessing non-invasive break-up time (NIBUT) using ocular microscopy. In addition Self-reported Break Up Time (SBUT) was assessed by recording the time the subject could keep his or hers eyes open without blinking when watching a fixed point on a wall. Background information was obtained using a questionnaire. Non-parametric Wilcoxon-Mann-Whitney-tests with exact p-values and multiple logistic regression analyses were performed.
Results
Both NIBUT and SBUT were shorter among the male exposed workers than among the inhabitants both near and far away from the explosion area. This was also found for SBUT among males in a multiple logistic regression analysis, adjusting for age and smoking.
Conclusions
Reduced tear film stability was found among workers in an area where an explosion accident had occurred.
doi:10.1186/1471-2458-11-235
PMCID: PMC3101178  PMID: 21492464
9.  Cement dust exposure and acute lung function: A cross shift study 
Background
Few studies have been carried out on acute effects of cement dust exposure. This study is conducted to investigate the associations between current "total" dust exposure and acute respiratory symptoms and respiratory function among cement factory workers.
Methods
A combined cross-sectional and cross-shift study was conducted in Dire Dawa cement factory in Ethiopia. 40 exposed production workers from the crusher and packing sections and 20 controls from the guards were included. Personal "total" dust was measured in the workers' breathing zone and peak expiratory flow (PEF) was measured for all selected workers before and after the shift. When the day shift ended, the acute respiratory symptoms experienced were scored and recorded on a five-point Likert scale using a modified respiratory symptom score questionnaire.
Results
The highest geometric mean dust exposure was found in the crusher section (38.6 mg/m3) followed by the packing section (18.5 mg/m3) and the guards (0.4 mg/m3). The highest prevalence of respiratory symptoms for the high exposed workers was stuffy nose (85%) followed by shortness of breath (47%) and "sneezing" (45%). PEF decreased significantly across the shift in the high exposed group. Multiple linear regression showed a significant negative association between the percentage cross-shift change in PEF and total dust exposure. The number of years of work in high-exposure sections and current smoking were also associated with cross-shift decrease in PEF.
Conclusions
Total cement dust exposure was related to acute respiratory symptoms and acute ventilatory effects. Implementing measures to control dust and providing adequate personal respiratory protective equipment for the production workers are highly recommended.
doi:10.1186/1471-2466-10-19
PMCID: PMC2865447  PMID: 20398255
10.  Physical activity is associated with a low prevalence of musculoskeletal disorders in the Royal Norwegian Navy: a cross sectional study 
Background
Despite considerable knowledge about musculoskeletal disorders (MSD) and physical, psychosocial and individual risk factors there is limited knowledge about physical activity as a factor in preventing MSD. In addition, studies of physical activity are often limited to either leisure activity or physical activity at work. Studies among military personnel on the association between physical activity at work and at leisure and MSD are lacking. This study was conducted to find the prevalence of MSD among personnel in the Royal Norwegian Navy and to assess the association between physical activity at work and at leisure and MSD.
Methods
A questionnaire about musculoskeletal disorders, physical activity and background data (employment status, age, gender, body mass index, smoking, education and physical stressors) was completed by 2265 workers (58%) 18 to 70 years old in the Royal Norwegian Navy. Multiple logistic regression with 95% confidence intervals was used to assess the relationship between physical activity and musculoskeletal disorders.
Results
A total of 32% of the workers reported musculoskeletal disorders often or very often in one or more parts of the body in the past year. The most common musculoskeletal disorders were in the lower back (15% often or very often), shoulders (12% often or very often) and neck (11% often or very often). After adjustment for confounders, physical activity was inversely associated with musculoskeletal disorders for all body sites except elbows, knees and feet.
Conclusion
The one-year prevalence of musculoskeletal disorders among workers in the Royal Norwegian Navy was rather low. A physically active lifestyle both at work and at leisure was associated with fewer musculoskeletal disorders among personnel in the Royal Norwegian Navy. Prospective studies are necessary to confirm the cause and effect in this association.
doi:10.1186/1471-2474-8-56
PMCID: PMC1929072  PMID: 17601352
11.  High prevalence of respiratory symptoms among workers in the development section of a manually operated coal mine in a developing country: A cross sectional study 
BMC Public Health  2007;7:17.
Background
Few studies of miners have been carried out in African countries; most are from South Africa, where the working conditions are assumed to be better than in the rest of Africa. Several studies have focused on respiratory disorders among miners, but development workers responsible for creating underground road ways have not been studied explicitly. This is the first study assessing the associations between exposure to dust and quartz and respiratory symptoms among coal mine workers in a manually operated coal mine in Tanzania, focusing on development workers, as they have the highest exposure to coal dust.
Methods
A cross-sectional study was carried out among 250 production workers from a coal mine. Interviews were performed using modified standardized questionnaires to elicit information on occupational history, demographics, smoking habits and acute and chronic respiratory symptoms. The relationships between current dust exposure as well as cumulative respirable dust and quartz and symptoms were studied by group comparisons as well as logistic regression.
Results
Workers from the development group had the highest dust exposure, with arithmetic mean of 10.3 mg/m3 for current respirable dust and 1.268 mg/m3 for quartz. Analogous exposure results for mine workers were 0.66 mg/m3 and 0.03 mg/m3, respectively; and for other development workers were 0.88 mg/m3 and 0.10 mg/m3, respectively.
The workers from the development section had significantly higher prevalence of the acute symptoms of dry cough (45.7%), breathlessness (34.8%) and blocked nose (23.9%). In addition, development workers had significantly more chronic symptoms of breathlessness (17.0%) than the mine workers (6.4%) and the other production workers (2.4%). The highest decile of cumulative exposure to respirable dust was significantly associated with cough (OR = 2.91, 95% CI 1.06, 7.97) as were cumulative exposure to quartz and cough (OR = 2.87, CI 1.05, 7.88), compared with the reference consisting of the group of workers with the lowest quartile of the respective cumulative exposure.
Conclusion
The development workers in a coal mine had more acute and chronic respiratory symptoms than the mine and the other production workers. In addition, there was an association between high cumulative coal dust and respiratory symptoms.
doi:10.1186/1471-2458-7-17
PMCID: PMC1797009  PMID: 17270039
12.  Fractional exhaled nitric oxide among cement factory workers: a cross sectional study 
Background
It has been suggested that dust exposure causes airway inflammation among cement factory workers. However, there is limited information on the mechanisms of this effect. We explored any associations between total dust exposure and fractional exhaled nitric oxide (FENO) as a marker of airway eosinophilic inflammation among cement production workers in Tanzania. We also examined possible differences in FENO concentration between workers in different parts of the production line.
Methodology
We examined 127 cement workers and 28 controls from a mineral water factory. An electrochemistry-based NIOX MINO device was used to examine FENO concentration. Personal total dust was collected from the breathing zone of the study participants using 37 mm cellulose acetate filters placed in three-piece plastic cassettes. Interviews on workers’ background information were conducted in the Swahili language.
Results
We found equal concentrations of FENO among exposed workers and controls (geometric mean (GM)=16 ppb). The GM for total dust among the exposed workers and controls was 5.0 and 0.6 mg/m3, respectively. The FENO concentrations did not differ between the exposed workers with high (GM≥5 mg/m3) and low (GM<5 mg/m3) total dust exposure. There was no significant difference in FENO concentration between workers in the two main stages of the cement production process.
Conclusions
We did not find any difference in FENO concentration between dust-exposed cement workers and controls, and there were similar FENO concentrations among workers in the two main stages of cement production.
doi:10.1136/oemed-2012-100879
PMCID: PMC3623031  PMID: 23243102
Total dust; Airway inflammation; Fractional Exhaled Nitric Oxide

Results 1-12 (12)