Maternal occupational noise exposure during pregnancy and children's early language acquisition.

INTRODUCTION: Noise exposure during pregnancy may affect a child's auditory system, which may disturb fetal learning and language development. We examined the impact of occupational noise exposure during pregnancy on children's language acquisition at the age of one. METHODS: A cohort study was conducted among women working in the food industry, as kindergarten teachers, musicians, dental nurses, or pharmacists who had a child aged <1 year. The analyses covered 408 mother-child pairs. Language acquisition was measured using the Infant-Toddler Checklist. An occupational hygienist assessed noise exposure individually as no (N = 180), low (70-78 dB; N = 108) or moderate/high exposure (>79 dB; N = 120). RESULTS: Among the boys, the adjusted mean differences in language acquisition scores were -0.4 (95% CI -2.5, 1.8) for low, and -0.7 (95% CI -2.9, 1.4) for moderate/high exposure compared to no exposure. Among the girls the respective scores were +0.1 (95% CI -2.2, 2.5) and -0.1 (95% CI -2.3, 2.2). Among the children of kindergarten teachers, who were mainly exposed to human noise, low or moderate exposure was associated with lower language acquisition scores. The adjusted mean differences were -3.8 (95% CI -7.2, -0.4) for low and -4.9 (95% CI -8.6, -1.2) for moderate exposure. CONCLUSIONS: In general, we did not detect an association between maternal noise exposure and children's language acquisition among one-year-old children. However, the children of kindergarten teachers exposed to human noise had lower language acquisition scores than the children of the non-exposed participants. These suggestive findings merit further investigation by level and type of exposure.

Trust as a multidimensional phenomenon in LMX relationships.

PURPOSE: The purpose of this study is to address the construction of trust in leader member exchange (LMX) relationships as a multidimensional phenomenon and identify the importance of emotional and collective factors contributing to this phenomenon. DESIGN/METHODOLOGY/APPROACH: Ten health care professionals (five leaders and five members) were interviewed to subject to qualitative thematic analysis. FINDINGS: Four main themes in the data were identified (work roles, collectivity, interaction and participation) and linked to two main elements of LMX trust relations: core and contextual. The results extend understanding of the construction and maintenance of trust in LMX relationships, indicating that it is a more complex and socially constructed phenomenon than previously described. RESEARCH LIMITATIONS/IMPLICATIONS: Despite identified limitations of the study (the small amount of empirical material, interpretive research method and purposive sampling of participants), the findings reveal that constructing trust in LMX relationships is more multidimensional than generally portrayed in traditional LMX theory and its three-stage continuum. This study suggests that a broader perspective should be adopted in LMX research, treating it not only as a collective phenomenon but also considering leaders and members as emotional individuals. PRACTICAL IMPLICATIONS: Understanding the multidimensional nature of LMX relationships is helpful for developing interpersonal relationships in organizations and leadership practices through recognition of the importance of the transparency, practices and adequacy of mutual interaction. The results presented here may contribute to such understanding and help leaders to relate to members as both subjective individuals and parts of a complex social network. The results may also increase members' awareness of possible ways that they can promote the development of good LMX relationships in organizations. ORIGINALITY/VALUE: The novelty of the study relates to the identification of the collective, emotional and multidimensional nature of LMX relationships.

Nurses' Time Use in Forensic Psychiatry: Core Interventions Outlined in the Finnish Clinical Practice Guideline on Schizophrenia.

Forensic psychiatric nurses are key in implementing the core interventions outlined in the clinical practice guideline on schizophrenia. This study endeavors to ascertain how these were implemented in routine practice in forensic psychiatry by measuring how nurses use their time. Data were collected from registered nurses and practical mental nurses in all forensic psychiatric facilities in Finland using self-report diary forms for 1 week. In total, nurses used 20% of their weekly working hours on core interventions. The differences between the nurse groups were statistically significant (p ≤ 0.05) regarding the following core interventions: (a) care planning with physicians, (b) pharmacotherapy, and (c) basic clinical care. Nurses' qualifications, types of facilities and units, working experience, gender, and staffing levels explained the time used on core interventions. In summary, forensic psychiatric inpatients received insufficient appropriate nursing services according to the relevant guideline regarding schizophrenia. Furthermore, managerial recommendations need to restructure nurses' time use to increase the proportion of productive working hours spent with patients.

Increased risk of human parvovirus B19 infection in day-care employees: a cohort study among pregnant workers during an epidemic in Finland.

BACKGROUND: Human parvovirus B19 (B19V) infection during early pregnancy increases the risk of miscarriage. Studies have inconsistently shown an elevated risk of infection among women with occupational contacts with children. Methodological differences, particularly in defining occupational exposure and in the type of reference group, may explain the conflicting findings. METHODS: This cohort study compared B19V infections in pregnant day-care employees and healthcare professionals during a B19V epidemic in Finland. Women were identified from the files of nationwide trade unions and the National Supervisory Authority for Welfare and Health. Early-pregnancy maternal B19V IgG was analysed in 3710 women, and infections were defined as seroconversions after analysing in parallel the available umbilical cord blood samples of the 847 seronegative mothers. Independently of the serological status, the actual employment during pregnancy was assessed using registered information on employment history. RESULTS: B19V infections were more common among day-care employees (22/331, 6.6%), than among those working in healthcare (12/326, 3.7%). The adjusted HRs of B19V infection, using proportional hazard regression, was 2.63 (95% CI 1.27 to 5.46) among all women and 5.59 (95% CI 1.40 to 22.4) among nulliparous women. CONCLUSIONS: Day-care employees are at an increased risk of B19V infection, which warrants preventive measures.

People with multimorbidity: forgotten outsiders or dynamic self-managers?

PURPOSE: The purpose of this paper is to draw attention to the discursive construction of multimorbidity. The study illustrates how the social reality of multimorbidity and the agency of patients are discursively constructed in scientific articles addressing care for people with multiple chronic conditions. DESIGN/METHODOLOGY/APPROACH: The study is based on the postmodern assumptions about the power of talk and language in the construction of reality. Totally 20, scientific articles were analysed by critically oriented discourse analysis. The interpretations of the findings draw on the agency theories and principals of critical management studies. FINDINGS: Four discourses were identified: medical, technical, collaborative and individual. The individual discourse challenges patients to become self-managers of their health. It may, however, go too far in the pursuit of patients' active agency. The potential restrictions and consequences of a "business-like" orientation must be paid careful attention when dealing with patients with multimorbidity. RESEARCH LIMITATIONS/IMPLICATIONS: The data consisted solely of scientific texts and findings therefore serve as limited illustrations of the discursive construction of multimorbidity. In future, research focusing for example on political documents and practice talk of professionals and patients is needed. Social implications - The findings highlight the power of talk and importance of ethical considerations in the development of care for challenging patient groups. ORIGINALITY/VALUE: By identifying the prevailing discourses the study attempts to cast doubt on the taken-for-granted understandings about the agency of patients with multimorbidity.

Newly discovered KI, WU, and Merkel cell polyomaviruses: no evidence of mother-to-fetus transmission.

BACKGROUND: Three* human polyomaviruses have been discovered recently, KIPyV, WUPyV and MCPyV. These viruses appear to circulate ubiquitously; however, their clinical significance beyond Merkel cell carcinoma is almost completely unknown. In particular, nothing is known about their preponderance in vertical transmission. The aim of this study was to investigate the frequency of fetal infections by these viruses. We sought the three by PCR, and MCPyV also by real-time quantitative PCR (qPCR), from 535 fetal autopsy samples (heart, liver, placenta) from intrauterine fetal deaths (IUFDs) (N = 169), miscarriages (120) or induced abortions (246). We also measured the MCPyV IgG antibodies in the corresponding maternal sera (N = 462) mostly from the first trimester. RESULTS: No sample showed KIPyV or WUPyV DNA. Interestingly, one placenta was reproducibly PCR positive for MCPyV. Among the 462 corresponding pregnant women, 212 (45.9%) were MCPyV IgG seropositive. CONCLUSIONS: Our data suggest that none of the three emerging polyomaviruses often cause miscarriages or IUFDs, nor are they transmitted to fetuses. Yet, more than half the expectant mothers were susceptible to infection by the MCPyV.

Pregnancy outcomes among daycare employees in Finland.

OBJECTIVE: The aim of this study was to investigate whether working as a daycare employee increases the risk of perinatal death, pre-term birth, low birth weight, smallness for gestational age, or congenital malformations. METHODS: We conducted a register-based cohort study among daycare employees and women from various occupations of healthcare (reference group). Study subjects were identified from the files of Finnish trade unions and the National Authority for Medicolegal Affairs. Pregnancy outcomes, antenatal occupation, and working status were obtained by linkage to national registers. The final data consisted of 13 299 and 12 182 singleton births in the study and reference groups, respectively. We analyzed pregnancy outcome data using generalized estimating equations and linear regression. RESULTS: The occurrences of pre-term birth [odds ratio (OR) 0.91, 95% confidence interval (95% CI) 0.79-1.06], perinatal death (OR 0.91, 95% CI 0.62-1.34), smallness for gestational age (OR 1.01, 95% CI 0.91-1.12), and congenital malformation (OR 1.10, 95% CI 0.92-1.32) were similar among the children of the daycare employees and the reference group. The adjusted mean birth weight of the children of the daycare employees was slightly higher (14 g, 95% CI -1-29) than that of the reference group, but the difference was attenuated to 6 g in the subset of the first births. CONCLUSION: Daycare employees were not, in general, at an increased risk of an adverse pregnancy outcome. However, efforts should nevertheless be made to prevent their exposure to harmful viruses and heavy physical load during pregnancy.

Absence of human bocavirus from deceased fetuses and their mothers.

BACKGROUND: The human bocavirus (HBoV), a newly discovered parvovirus, is closely related to the bovine parvovirus and the canine minute virus, which are known to cause adverse pregnancy outcomes. Another human parvovirus, B19, can lead to fetal hydrops, miscarriage and intrauterine fetal death (IUFD). OBJECTIVES: To determine the prevalence of HBoV DNA in aborted fetuses and IUFDs. The HBoV serology of the mothers was also studied. STUDY DESIGN: We retrospectively studied all available fetuses (N=535) autopsied during 7/1992-12/1995, and 1/2003-12/2005 in Helsinki, Finland. All available formalin-fixed paraffin-embedded fetal tissues - placenta, heart and liver - of 120 miscarriages, 169 IUFDs, and 246 induced abortions were studied by quantitative PCR. We also measured the HBoV IgM and IgG antibodies in the corresponding maternal sera (N=462) mostly of the first trimester. The IgM-positive sera underwent HBoV PCR. RESULTS: None of the fetal tissues harbored HBoV DNA. A total of 97% (448/462) of the mothers were positive for IgG antibodies to HBoV, while only 0.9% (4/462) exhibited HBoV-specific IgM antibodies without viremia or respiratory symptoms. One IgM-positive mother had an unexplained fetal loss. CONCLUSIONS: We did not find HBoV DNA in any of the deceased fetuses. Almost all pregnant women were HBoV-IgG positive.

Parvovirus b19 infection in fetal deaths.

BACKGROUND: Parvovirus B19 infection during pregnancy can lead to nonimmune fetal hydrops, miscarriage, and intrauterine fetal death (IUFD). Some studies have suggested that parvovirus B19 infection may surprisingly often result in nonhydropic fetal death during the third trimester, in the absence of maternal serological evidence of acute infection. This study was conducted to investigate the prevalence of parvovirus B19 DNA among fetuses from miscarriages and IUFDs. METHODS: We retrospectively studied 535 unborn fetuses, including 120 fetuses from miscarriages and 169 from IUFDs. The control fetuses were 246 fetuses from induced abortions. All fetuses were autopsied from July 1992 through December 1995 and from January 2003 through December 2005 in Helsinki, Finland. The period included a major epidemic of parvovirus B19 infection in 1993. Formalin-fixed, paraffin-embedded fetal tissues were studied with use of a highly sensitive and specific PCR that was capable of detecting all 3 parvovirus B19 genotypes and by histologic examination. In addition, maternal parvovirus B19 serological status was determined. RESULTS: Parvovirus B19 DNA was detected in 5 fetuses with gestational ages of 14, 22, 23, 30, and 39 weeks; these included fetuses from 4 (2.4%) of the 169 IUFDs and 1 (0.8%) of the 120 miscarriages. During the epidemic year 1993, the prevalence of parvovirus B19 DNA-positive fetal deaths was 6 times the prevalence during nonepidemic years. All 5 mothers of the parvovirus B19 DNA-positive fetuses had serological signs of acute parvovirus B19 infection close to the time of fetal death. The only nonhydropic fetus was full-term. CONCLUSIONS: Our findings indicate that the prevalence of parvovirus B19 infection among fetuses from IUFDs is low. In particular, our findings did not verify the claimed high prevalence of third-trimester nonhydropic IUFDs associated with parvovirus B19.

Occupational exposure in dentistry and miscarriage.

BACKGROUND: Information on the reproductive effects of chemical exposures in dental work is sparse or inconsistent. AIM: To investigate whether dental workers exposed to acrylate compounds, mercury amalgam, solvents or disinfectants are at an increased risk of miscarriage. METHODS: The study was conducted among women dental workers and a comparison group of workers occupationally unexposed to dental restorative materials. Information on pregnancies was obtained from national registers and outpatient units of hospitals. Data on occupational exposure were obtained using postal questionnaires. The final study population included 222 cases of miscarriage and 498 controls (births). An occupational hygienist assessed exposure to acrylate compounds, disinfectants and solvents. Exposure to other agents was assessed on the basis of the questionnaire data. Odds ratios (ORs) and confidence intervals (CIs) were estimated using conditional logistic regression. RESULTS: The ORs adjusted for confounding factors were increased for moderate-exposure and high-exposure categories of mercury amalgam (OR 2.0, 95% CI 1.0 to 4.1 and OR 1.3, 95% CI 0.6 to 2.5, respectively). The risk was slightly increased for the highest-exposure category of 2-hydroxyethylmethacrylate (OR 1.4, 95% CI 0.7 to 2.6) and polymethylmethacrylate dust (OR 1.4, 95% CI 0.8 to 2.4). A slightly increased risk was also detected for likely exposure to organic solvents (OR 1.4, 95% CI 0.8 to 2.3) and disinfectants (OR 1.5, 95% CI 0.9 to 2.7). CONCLUSIONS: No strong association or consistent dose-response relationship was observed between exposure to chemical agents in dental work and the risk of miscarriage. A slightly increased risk was found for exposure to mercury amalgam, some acrylate compounds, solvents and disinfectants. These findings indicate that the possibility of a weak association between exposure to these agents and an increased risk of miscarriage cannot be excluded.

Liver echogenicity: measurement or visual grading?

OBJECTIVE: Two methods to assess liver echogenicity were compared. METHODS: Liver/kidney echogenicity ratio was measured in 41 persons with the ultrasound software and visually graded by two radiologists and a radiographer. These echogenicity ratios and grades were related to risk factors for fatty liver and to liver enzyme levels. RESULTS: These determinants explained 55% of the radiologists' mean grades, 14% of the radiographer's and 31% of the measured echogenicity ratios. CONCLUSION: Radiologists' visual gradings correlated best with the indirect determinants of early liver pathology. Computerized measurements may be inferior to visual grading due to the lack of holistic tissue diagnostics.

Results of common laboratory tests in solvent-exposed workers.

OBJECTIVES: The screening and identification of occupational liver or other organ-system injury related to long-term, low-level solvent exposure are difficult in clinical practice. We studied the feasibility of the use of common laboratory tests combined with a detailed exposure history. METHODS: The relationships between laboratory tests and exposure to organic solvents were studied in regression modelling adjusted to age, alcohol consumption, gender and body mass index (BMI). The subjects were 29 solvent-exposed workers and 19 referents. Laboratory tests included serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), carbohydrate-deficient transferrin (CDT), alkaline phosphatase (ALP), creatinine, cholesterol, HDL-cholesterol, triglycerides, blood glucose and total and conjugated bilirubin. Positive hepatitis serology, systemic diseases or medications with known hepatic effects and current pregnancy were exclusion criteria. The main exposures of each subject were identified. Current solvent exposure status, exposure during the past 3 months, exposure during the past 5 and 10 years, and total life-time exposure were recorded. RESULTS: AST (P=0.0031), ALT (P=0.0015) and cholesterol (P=0.0110) correlated positively with cumulative solvent exposure in the past 5 years, total bilirubin with current exposure (P=0.0380), and glucose with exposure in the past 5 (P<0.0001) and 10 (P=0.0003) years. Triglycerides correlated positively with exposure in the past 5 (P=0.0025) and 10 (P=0.0059) years and with life-time exposure (P=0.0005). Creatinine correlated negatively with exposure in the past 10 years (P=0.0300) and life-time exposure (P=0.0005). Most laboratory values were within the normal range. CONCLUSIONS: These results suggest a multi-system health effect of solvents. The laboratory data had some similarities with those in the metabolic syndrome. The screening and diagnostics of solvent-related conditions should be based on a thorough work history and a set of carefully selected laboratory tests. No single test seems sufficient for this purpose.

Work environment and occupational health of Finnish veterinarians.

BACKGROUND: Health and work environment of Finnish veterinarians was evaluated by The Finnish Veterinary Association and the Finnish Institute of Occupational Health in a questionnaire survey. METHODS: The questionnaire was mailed in the spring of 2000 to all veterinarians under 65 years of age and working in Finland (n = 1169); 785 (67%) responded. RESULTS: A veterinarian's work was physically demanding, and often involved an elevated risk of accident. The risks were considered moderately or considerably high by over half of the respondents, and the highest risks occurred among veterinarians working in equine, mixed (both small and large animals), or in production animal practice. The veterinarians were committed to their work, although, at the same time they experienced work-related stress and fatigue. Particularly veterinarians working in towns, or those involved in education and research, reported the most stress. Serious work-related exhaustion was experienced most often by women in the youngest and by men in the oldest age groups. On average, the veterinarians spent over 100 hr a month on call. Over two-thirds of the participants in the survey reported their general state of health as good or fairly good, while less than 5% of the participants reported their health as rather poor or poor. CONCLUSIONS: The work of a Finnish veterinarian, the work environment, and the risks of the work varied greatly depending on the tasks assigned to the veterinarian. This has to be taken into consideration when occupational health services are planned for veterinarians.

Time to pregnancy among the wives of Finnish greenhouse workers.

OBJECTIVES: This study investigated the possibility of men's work in greenhouses and their exposure to pesticides being associated with reduced fertility. METHODS: A study on time to pregnancy was conducted among the families of Finnish male greenhouse employers and employees. Exposure to pesticides was assessed on the basis of questionnaire information and data gathered from the enterprises. Fecundability density ratios (FDR) for occupational exposure were calculated with discrete proportional hazards regression analyses. RESULTS: After three mailings, 578 (43%) couples participated. Fecundability was suggestively decreased for exposed greenhouse workers who were inefficiently protected, with FDR values of 0.67 [95% confidence interval (95% CI) 0.33-1.35], 0.92 [95% CI 0.45-1.88] and 0.77 [95% CI 0.46-1.29] for high exposure, moderate exposure and low exposure, respectively, as compared with unexposed greenhouse workers. The exposed men who efficiently used personal protective equipment were as fertile as the unexposed greenhouse workers. Exposure to pyrethroids (FDR 0.40, 95% CI 0.19-0.85) was related to decreased fecundability. Suggestive associations were observed for organophosphates (FDR 0.70, 95% CI 0.42-1.17) and carbamates (FDR 0.55, 95% CI 0.27-1.11). CONCLUSIONS: The findings of the study provide limited support for the hypothesis that exposure to pesticides is associated with reduced fertility. The findings for pyrethroids, organophosphates, and carbamates can serve as a basis for a hypothesis for future studies.

Effects of exposure to environmental tobacco smoke on reproductive health.

The scientific evidence on the effects of preconceptional and prenatal exposure to environmental tobacco smoke on reproductive health is reviewed in this article. The evidence is the most convincing for the adverse effects of environmental tobacco smoke on birthweight. In meta-analyses, exposure to environmental tobacco smoke has been estimated to reduce mean birthweight by about 25-40 grams. The majority of the studies on low birthweight also show a moderately or slightly increased risk among infants of exposed women. There is also some support for an association between high exposure to environmental tobacco smoke and preterm birth. The evidence on the effects of environmental tobacco smoke on spontaneous abortion and birth defects is weak and inconsistent. Very little is known about the impact of exposure on fertility, menstrual function, reproductive health of men, and childhood cancer. Further studies, paying attention to study design and careful exposure assessment, are therefore needed on these associations.