Prevalence of neural tube defects among pregnant women in Addis Ababa: a community-based study using prenatal ultrasound examination.

PURPOSE: The primary aim of this study was to estimate the prevalence of NTDs at ultrasound examination in communities of Addis Ababa and secondarily to provide a description of the dysmorphology of the NTD cases. METHODS: We enrolled 958 pregnant women from 20 randomly selected health centers in Addis Ababa during the period from October 1, 2018, to April 30, 2019. Of these 958 women, 891 had an ultrasound examination after enrollment, with a special focus on NTDs. We estimated the prevalence of NTDs and compared it with previously reported hospital-based birth prevalence estimates from Addis Ababa. RESULTS: Among 891 women, 13 had twin pregnancies. We identified 15 NTD cases among 904 fetuses, corresponding to an ultrasound-based prevalence of 166 per 10,000 (95% CI: 100-274). There were no NTD cases among the 26 twins. Eleven had spina bifida (122 per 10,000, 95% CI: 67-219). Among the 11 fetuses with spina bifida, three had a cervical and one had a thoracolumbar defect while the anatomical site for 7 was not registered. Seven of the 11 spina bifida defects had skin covering, while two of the cervical lesions were uncovered. CONCLUSION: We report a high prevalence of NTDs among pregnancies in communities of Addis Ababa based on screening by ultrasound. The prevalence was higher than in previous hospital-based studies in Addis, and the prevalence of spina bifida was particularly high.

Surgical treatment and outcome of chronic subdural hematoma: a comparative study between Ethiopia and Norway.

BACKGROUND: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Here, we studied differences in demographics, treatment, and outcome for CSDH patients in low-income (Ethiopia) and high-income (Norway) countries and assessed potential outcome determinants. METHODS: We included patients from Addis Ababa University Hospitals (AAUH) and Haukeland University Hospital (HUH) who had surgery for CSDH (2013-2017). Patients were included prospectively in Ethiopia and retrospectively in Norway. RESULTS: We enrolled 314 patients from AAUH and 284 patients from HUH, with a median age of 60 and 75 years, respectively. Trauma history was more common in AAUH (72%) than in HUH patients (64.1%). More patients at HUH (45.1%) used anticoagulants/antiplatelets than at AAUH (3.2%). Comorbidities were more frequent in HUH (77.5%) than in AAUH patients (30.3%). Burr hole craniostomy under local anesthesia and postoperative drainage was the standard treatment in both countries. Postoperative CT scanning was more common at HUH (99.3%) than at AAUH (5.2%). Reoperations were more frequent at HUH (10.9%) than at AAUH (6.1%), and in both countries, mostly due to hematoma recurrence. Medical complications were more common at HUH (6.7%) than at AAUH (1.3%). The 1-year mortality rate at HUH was 7% and at AAUH 3.5%. At the end of follow-up (> 3 years), the Glasgow Outcome Scale Extended (GOSE) score was 8 in 82.9% of AAUH and 46.8% of HUH patients. CONCLUSION: The surgical treatment was similar at AAUH and HUH. The poorer outcome in Norway could largely be explained by age, comorbidity, medication, and complication rates.

The association between shift work disorder and turnover intention among nurses.

BACKGROUND: Shift work disorder (SWD) is highly prevalent among shift-working nurses and has multiple negative health-related effects. There is a dearth of insight into career-related decisions made by nurses suffering from SWD, for instance in terms of their intention to quit work (turnover intention). In this study, we aimed to investigate the association between SWD and turnover intention among nurses, and the individual and work-related correlates of turnover intention. METHOD: Data were derived from the ongoing longitudinal cohort study "SUrvey of Shift work, Sleep and Health (SUSSH)" among Norwegian nurses. An annual survey was initiated in 2008/2009 (N = 2965). The present study used data collected in year 2015 (wave 7) and 2016 (wave 8). Nurses were included if: 1) they were working as nurses in both 2015 and 2016, and 2) had completed a three-item scale adapted from the Michigan Organizational Assessment Questionnaire assessing turnover intention (in wave 8), and 3) did not only work day-shifts. SWD was measured in wave 7 with three questions based on the minimal criteria from the third edition of the International Classification of Sleep Disorders. Job demands, decision latitude, and social support at the workplace were measured with subscales of the Swedish Demand-Control-Support Questionnaire. RESULTS: Eight Hundred eighty-nine nurses were included. The results from the hierarchical linear regression showed that SWD predicted turnover intention one year later, i.e. from 2015 to 2016 (F1,835 = 6.00, p < 0.05; ß = 0.084, p = 0.015). The findings remained significant when controlling for age, sex, organizational tenure, number of nights worked, shift work schedule and workplace social support, job demands and decision latitude. CONCLUSION: This study showed that SWD is associated with turnover intention, even when controlling for individual and work-related variables.

Registered health problems and demographic profile of integrated textile factory workers in Ethiopia: a cross-sectional study.

BACKGROUND: Textile and garment factories are growing in low and middle-income countries as worldwide demand for inexpensive clothing increases each year. These integrated textile and garment production factories are often built-in areas with few workplaces and environmental regulations, and employees can be regularly exposed to workplace hazards with little regulatory oversight. Consequently, workers' health may be significantly affected due to long term exposure to hazards. This study describes registered health problems and their association to work-related and personal factors among workers in integrated textile factories in Ethiopia. METHODS: Institution-based cross-sectional study design was employed for this analysis. A one-year recording of worker's clinical diagnoses (between March 2016 and February 2017) was gathered from the factory clinics of three integrated textile factories. Clinical diagnosis data was obtained as factory workers visited the clinics if feeling unwell. Sociodemographic characteristics and work-related information were obtained from the factory's human resource departments. The sociodemographic and clinical diagnosis statuses of 7992 workers were analyzed. The association between the registered diagnoses and workplace factors (work in textile production, garment production and support process) and personal factors (age, sex and educational status) were studied using logistic regression analysis. RESULTS: The average employee age and years of service were 40 years and 11 years respectively. 60% of workers were females, comprising of 4778 women. 66% of all workers (5276) had 27,320 clinical diagnoses. In total, this caused 16,993 absent working days due to sick leave. Respiratory diseases (34%) and musculoskeletal disorders (29%) were the most prevalent diagnoses, while bodily injuries were the cause of most work absences. Work department, sex and educational status are variables that were most significantly associated with higher prevalence of disease groups. CONCLUSIONS: About two-thirds of the integrated textile factory workers were diagnosed with different types of disease. The textile and garment production department workers were affected at a greater rate than the support process workers, indicating that some diseases may be related to workplace exposure. Further study should investigate rare chronic diseases such as cancer, heart diseases, renal diseases and diabetes.

Short rest between shifts (quick returns) and night work is associated with work-related accidents.

PURPOSE: The aim of this study was to examine whether less than 11 h between shifts (i.e., quick returns, QRs) and night shifts is associated with self-reported work-related accidents, near accidents or dozing off at work in a sample of nurses. METHODS: The study was based on cross-sectional data from 1784 nurses (response rate = 60%; mean age = 40.1 years, SD = 8.4; 91% female). Negative binomial regression analyses were conducted to investigate the association between the shift exposures, and eight different self-reported work-related items on accidents, near accidents and dozing off at work, controlling for demographics and work factors. RESULTS: The number of QRs during a year was positively associated with seven of the eight items on work-related accidents, near-accidents and dozing off at work, and number of night shifts was positively associated with five items. Some of the key findings were that QRs were associated with nurses causing harm to themselves (incidence rate ratio [IRR] = 1.009; 95% CI = 1.005-1.013), causing harm to patients/others (IRR = 1.006; 95% CI = 1.002-1.010) and causing harm to equipment (IRR = 1.004; 95% CI = 1.001-1.007); while night shifts were associated with nurses involuntarily dozing off at work (IRR = 1.015; 95% CI = 1.013-1.018), dozing off while driving to/from work (IRR = 1.009; 95% CI = 1.006-1.011), and harming patients/others (IRR = 1.005; 95% CI = 1.001-1.009). CONCLUSION: QRs and night shifts were both associated with the self-reported work-related accidents, near-accidents and dozing off at work. Studies that can establish the causal relationship between QRs and accidents are called for.

Intimate partner violence associated with low quality of life - a cross-sectional study.

BACKGROUND: Quality of life among abused women in Norway in 2006 was found to be significantly low compared to women at the same age in general. The aim of this study was to examine how quality of life is associated with experience of psychological and physical violence intimate partner violence among abused women seeking help after domestic partner abuse comparted to quality of life in a random sample of women in Norway. METHODS: A cross-sectional study in a random sample of 1500 women (response rate 36%, n = 469) in Norway were performed. In addition, 191 women who sought help after domestic partner abuse were invited (44%, n = 84). The experience of intimate partner violence (IPV) and health-related quality of life were measured in both samples. The participants were divided into: "Women seeking help" after domestic partner abuse (n = 84); "Random sample, abused women" (n = 127); and "Random sample, not abused women" (n = 342). RESULTS: The experience of psychological and physical violence was significantly different between the groups (p <  0.0001). The domains in SF-12 were significantly below (p <  0.001) the norm for the female population in Norway in all dimensions among the abused women in the random population sample, and even lower among the women seeking help because of IPV. CONCLUSION: Intimate partner violence is clearly associated with low quality of life. The pattern found in this study is similar to the pattern found in the previous Norwegian study among abused women seeking help.

Ocular surface and tear film status among contact lens wearers and non-wearers who use VDT at work: comparing three different lens types.

PURPOSE: To analyze differences in the ocular surface appearance and tear film status of contact lens wearers and non-wearers in a group of visual display terminals (VDT) workers and additionally to assess differences between lens materials. METHODS: Cross-sectional study of 236 office workers, of whom 92 were contact lens wearers. Workers provided information on their contact lenses (conventional hydrogel, silicone hydrogel or rigid gas permeable lenses) and exposure to VDT at work. Ocular surface and tear film status were determined by the presence of bulbar, limbal and lid redness, lid roughness and corneal staining type, and by Schirmer's and tear break-up time tests (TBUT). A generalized linear model was used to calculate the crude (cRR) and age- and sex-adjusted (aRR) relative risk to measure the association between ocular surface and tear film abnormalities and contact lens use and type. RESULTS: The aRR of ocular surface abnormalities was higher in contact lens wearers compared to non-wearers: bulbar redness (aRR 1.69; 95% CI 1.25-2.30), limbal redness (aRR 2.87; 1.88-4.37), lid redness (aRR 2.53; 1.35-4.73) and lid roughness (aRR 7.03; 1.31-37.82). VDT exposure > 4 h/day increased wearers' risk of limbal and lid redness. Conventional hydrogel wearers had the highest risk of ocular surface abnormalities, followed by silicone hydrogel wearers. Both contact and non-contact lens wearers had a high prevalence of altered TBUT (77.3 and 75.7% respectively) and Schirmer (51.8 and 41.3%). CONCLUSIONS: Regular contact lens use during VDT exposure at work increases risk of bulbar, limbal and lid redness, and lid roughness, especially in soft contact lens wearers. The high prevalence of altered TBUT and Schirmer's results in all participants suggests that VDT use greatly affects tear film characteristics.

Psychosocial work environment and mental health-related long-term sickness absence among nurses.

PURPOSE: We investigated which job demands and job resources were predictive of mental health-related long-term sickness absence (LTSA) in nurses. METHODS: The data of 2059 nurses were obtained from the Norwegian survey of Shift work, Sleep and Health. Job demands (psychological demands, role conflict, and harassment at the workplace) and job resources (social support at work, role clarity, and fair leadership) were measured at baseline and linked to mental health-related LTSA during 2-year follow-up. Cox regression models estimated hazard ratios (HR) and related 95% confidence intervals (CI). The c-statistic was used to investigate the discriminative ability of the Cox regression models. RESULTS: A total of 1533 (75%) nurses were included in the analyses; 103 (7%) of them had mental health-related LTSA during 2-year follow-up. Harassment (HR = 1.07; 95% CI 1.01-1.17) and social support (HR = 0.92; 95% CI 0.87-0.98) were associated with mental health-related LTSA. However, the Cox regression model did not discriminate between nurses with and without mental health-related LTSA (c = 0.59; 95% CI 0.53-0.65). CONCLUSIONS: Harassment was positively and social support at the workplace was negatively related to mental health-related LTSA, but both failed to discriminate between nurses with and without mental health-related LTSA during 2-year follow-up.

Labour trafficking: Challenges and opportunities from an occupational health perspective.

In this essay for the collection on Human Trafficking, Exploitation, and Health, Elena Ronda-Perez and colleague discuss ways occupational health services can detect and address labour trafficking.

Self-reported acute pesticide intoxications in Ethiopia.

BACKGROUND: Pesticide exposure is an important public health concern in Ethiopia, but there is limited information on pesticide intoxications. Residents may have an increased risk of pesticide exposure through proximity of their homes to farms using pesticides. Also the pesticide exposure might be related to employment at these farms. This study investigated the prevalence of acute pesticide intoxications (API) by residence proximity to a nearby flower farm and assessed if intoxications were related to working in these farms or not. METHODS: A cross-sectional survey involving 516 persons was conducted. Participants were grouped according to their residence proximity from a large flower farm; living within 5 kilometers and 5-12 kilometers away, respectively. In a structured interview, participants were asked if they had health symptoms within 48 h of pesticide exposure in the past year. Those who had experienced this, and reported two or more typical pesticide intoxication symptoms, were considered as having had API. Chi-square and independent t-tests were used to compare categorical and continuous variables, respectively. Confounding variables were adjusted by using binomial regression model. RESULTS: The prevalence of API in the past year among the residents in the study area was 26 %, and it was higher in the population living close to the flower farm (42 %) compared to those living far away (11 %), prevalence ratio (PR) = 3.2, 95 % CI: 2.2-4.8, adjusted for age, gender & education. A subgroup living close to the farm & working there had significantly more API (56 %) than those living close & didn't work there (16 %), adjusted PR = 3.0, 95 % CI: 1.8-4.9. Flower farm workers reported more API (56 %) than those not working in the flower farm (13 %,), adjusted PR = 4.0, 95 % CI: 2.9-5.6. CONCLUSION: Our study indicates a 26 % prevalence of self-reported symptoms attributable to API. The residents living closer than 5 kilometers to the flower farm reported significantly higher prevalence of self-reported API than those living 5-12 kilometers away. This increased risk of API was associated with work at the flower farm.

Comparison of menstrual disorders in hospital nursing staff according to shift work pattern.

AIM AND OBJECTIVE: To assess the association between work in a rotating shift schedule and menstruation characteristics among nurse staff in a prospective study. BACKGROUND: Rotating shifts have been linked to alterations in the reproductive cycle. In the case of menstrual alterations, the conclusions are not clear. DESIGN: Prospective epidemiological study with follow-up over four months. METHOD: All the female nurse staff (<40 years) in a hospital were interviewed, collecting sociodemographic and employment information. They were given a menstrual diary to keep a record of their shifts and characteristics of their menstruation (duration, amount of blood, dysmenorrhoea). They had two types of shifts: (1) Rotating shift schedule (two mornings, two afternoons, one night and two days off) including morning shifts (8:00-15:00), afternoon/evening shifts (15:00-22:00) and night shifts (22:00-8:00), and (2) Day shift schedule including morning shifts (8:00-15:00) and/or afternoon/evening shifts (15:00-22:00). The crude and adjusted odds ratios with 95% confidence interval were calculated using logistic generalised estimating equations (GEE) taking into account the correlations of multiple cycles per worker. RESULTS: One hundred and thirteen workers on the rotating shift and 75 on the day shift participated, and information from 730 menstrual cycles were obtained. There were no differences in prolonged duration, dysmenorrhoea, prolonged duration dysmenorrhoea and excessive bleeding among nurses on rotating shift compared to those on the day shift. For prolonged duration of menstruation, workers with more than five years on the rotating shift showed a slightly lower (nonsignificant) risk compared with those with <5 years. CONCLUSIONS: Nurse staff on the rotating shift did not show increased risk of having menstrual disorders comparing with day staff. RELEVANCE TO CLINICAL PRACTICE: Shifts with short rotation cycles and a progressive sequence do not appear to cause menstrual disorders in nurse staff who work rotating shifts.

Hearing loss in the Royal Norwegian Navy: A longitudinal study.

The aims of this longitudinal study were to investigate a significant threshold shift (STS) among personnel working on board the Royal Norwegian Navy's (RNoN) vessels between 2012 and 2014 and to identify possible determinants of STS. Hearing thresholds were measured by pure tone audiometry in two consecutive examinations (n = 226). STS was defined as an average change in hearing thresholds ≥ + 10 dB at 2,000 Hz, 3,000 Hz, and 4,000 Hz in either ear. Determinants of STS were assessed through a questionnaire. The incidence of STS was 23.0%. Significant determinants of STS were the number of episodes of temporary threshold shifts (TTS) in the Navy, exposure to continuous loud noise during work on board, and the number of gun shots (in the Navy, hunting, and sports). This study indicated a significant association between noise exposure on board Navy vessels and development of STS.

Prospective study of pregnancy outcomes after parental cell phone exposure: the Norwegian Mother and Child Cohort Study.

BACKGROUND: Research about prenatal exposure to electromagnetic fields from cell phones among expectant parents and reproductive outcome is limited. The aim of this article is to investigate the association between pregnancy outcome and parental cell phone exposure in a large prospective study. METHODS: The study was based on the Norwegian Mother and Child Cohort Study conducted during the decade 1999-2009. In that study, pregnant women were recruited before a routine ultrasound examination during gestational week 15; they answered a questionnaire at that time and again around gestational week 30. The expectant father was invited to answer a questionnaire during gestational week 15 (2001-2009). The forms contained questions regarding cell phone use. The response rate was 38.7% and the cohort comprised 100,730 singleton births. Pregnancy outcomes were obtained by linkage to the Medical Birth Registry of Norway. RESULTS: The risk of preeclampsia was slightly lower among women with medium and high cell phone exposure compared with low exposure after adjusting for potential confounders. Fathers with testis exposure when using cell phones had a borderline increased risk of perinatal mortality among offspring and a slightly decreased risk of partner developing preeclampsia during pregnancy compared with no cell phone exposure of head or testis. None of the other pregnancy outcomes was associated with cell phone exposure. CONCLUSIONS: We found no association between maternal prenatal or paternal preconceptional cell phone exposure and any of the studied pregnancy outcomes. The only risk estimate suggesting a potential increased risk was not consistent with other findings.

Noise and exposure of personnel aboard vessels in the Royal Norwegian Navy.

Despite awareness of noise aboard vessels at sea, few studies have reported measured noise levels aboard ships. This study aimed to describe the noise levels aboard vessels in the Royal Norwegian Navy (RNoN), and to assess the noise exposure of personnel aboard RNoN vessels. In 2012/2013 noise measurements were conducted aboard 14 RNoN vessels from four different vessel classes (frigates, coastal corvettes, mine vessels, and coast guard vessels) which were included in this study. Mean and median A-weighted noise levels (L p,A) in decibel (dB(A)) were calculated for different locations in each vessel class. The noise exposure of RNoN personnel was assessed by dosimeter measurements, and with a task-based (TB) strategy. The TB strategy used means of area measured noise levels in locations and the personnel's mean reported time spent in the respective locations to estimate the exposure. Area measurements of noise during sailing with typical operating modes, showed that for all vessel classes the noise levels were high in engine rooms with median L p,A ranging from 86.4 to 105.3 dB(A). In all the other locations the vessel class with the highest noise levels (coastal corvettes) had a median L p,A ranging from 71.7 to 95.0 dB(A), while the vessel class with the lowest noise levels (coast guard vessels) had a median L p,A ranging from 41.5 to 57.8 dB(A). For all vessel classes the engineers and electricians had amongst the highest 24-hour noise exposure (L p,A,24h), both before and after adjusting for estimated use of hearing protective devices (L p,A,24h > 67.3 dB(A)). The vessel class with the highest personnel exposure levels (coastal corvettes) had L p,A,24h ranging from 76.6 to 79.3 dB(A). The vessel class with the lowest personnel exposure levels (coast guard vessels) had an L p,A,24h ranging from 47.4 to 67.3 dB(A). In general, the dosimeter measurements gave higher exposure levels than those estimated with the TB strategy. All vessel classes, except the coast guard vessels, had noise levels exceeding the RNoN standard's recommended maximum noise levels. The area measured noise levels and the personnel's exposure estimates indicate that navy personnel aboard RNoN vessels are at risk of acquiring adverse health effects from exposure to noise, and that a program to reduce the noise levels should be implemented.

Health measures in prediction models for high sickness absence: single-item self-rated health versus multi-item SF-12.

BACKGROUND: Self-rated health (SRH) has been found to predict sickness absence (SA). The present study investigated the effect of replacing single-item SRH by a multi-item health measure on SA predictions. METHODS: Longitudinal study of 2059 Norwegian nurses with assessments in three waves each separated by 1 year. Health was measured by single-item SRH and multi-item SF-12 in waves 1 and 2. SA was self-reported in all three waves and high SA was defined as more than or equal to 31 SA days within the last 12 months. Predictions of high SA by a model including age, prior SA and single-item SRH were compared with predictions by a model including age, prior SA and multi-item SF-12. Both models were bootstrapped to correct for over-optimism and prospectively validated for their predictions in a new time frame. RESULTS: 1253 nurses (61%) had complete data for analysis. The SF-12 model predicted the risk of high SA more accurately (χ(2) = 4.294; df = 8) and was more stable over time than the SRH model (model χ(2) = 14.495; df = 8). Both prediction models correctly discriminated between high-risk and low-risk individuals in 73% of the cases at wave 2 and in 71% of the cases at wave 3. CONCLUSIONS: The accuracy of predictions increased when single-item SRH was replaced by multi-item SF-12, but the discriminative ability did not improve. Single-item SRH suffices to identify employees at increased risk of high SA.

Noise exposure and cognitive performance: A study on personnel on board Royal Norwegian Navy vessels.

Prior research shows that work on board vessels of the Royal Norwegian Navy (RNoN) is associated with noise exposure levels above recommended standards. Further, noise exposure has been found to impair cognitive performance in environmental, occupational, and experimental settings, although prior research in naval and maritime settings is sparse. The aim of this study was to evaluate cognitive performance after exposure to noise among personnel working on board vessels in the RNoN. Altogether 87 Navy personnel (80 men, 7 women; 31 ± 9 years) from 24 RNoN vessels were included. Noise exposure was recorded by personal noise dosimeters at a minimum of 4 h prior to testing, and categorized into 4 groups for the analysis: <72.6 dB(A), 72.6-77.0 dB(A), 77.1-85.2 dB(A), and >85.2 dB(A). The participants performed a visual attention test based on the Posner cue-target paradigm. Multivariable general linear model (GLM) analyses were performed to analyze whether noise exposure was associated with response time (RT) when adjusting for the covariates age, alertness, workload, noise exposure in test location, sleep the night before testing, use of hearing protection device (HPD), and percentage of errors. When adjusting for covariates, RT was significantly increased among personnel exposed to >85.2 dB(A) and 77.1-85.2 dB(A) compared to personnel exposed to <72.6 dB(A).

The relationship between shift work schedules and spillover in a sample of nurses.

The aim of the present study was to estimate spillover effects between the work and the family sphere in a sample of nurses (N = 2058). Hierarchical regression analyses investigated whether shift work schedules were associated with negative or positive spillover, both from family to work and vice versa, controlling for demographic factors, job demands and decision latitude. With daytime work as a reference group, all types of shift work (day and evening shift, night shift only and rotating 3 shift) were associated with higher negative work-to-family spillover. Night work was associated with significantly less negative family-to-work spillover. None of the different shift work schedules were related to any type of positive spillover. The results indicate that working outside of daytime hours is less compatible with workers' family lives, compared to working ordinary day shifts. On the other hand, working night shifts only was associated with reduced negative family-to-work spillover.

Risk Factors for Neural-Tube Defects Detected in Utero: A Prospective Community-Based Study from Addis Ababa.

BACKGROUND: A recent community-based study from Addis Ababa identifying Neural Tube Defect (NTD) cases by ultrasound examination of pregnant women showed a higher prevalence of 17 per 1000 fetuses. The risk factors behind the high prevalence remain unclear. METHODS: Altogether 891 of the 958 women participated in the ultrasound examination. Thirteen with unaffected twin pregnancies were excluded. Among 878 singleton pregnancies, 15 NTD cases were identified. Serum Folate, vitamin B12, and homocysteine levels were measured in case-mothers and a sub-set of 28 noncase mothers. Because of the modest sample size, exact logistic regression analysis was used to estimate associations between risk factors and NTDs. RESULTS: Serum vitamin status was generally poor for participants in the study. Still, relatively higher values of folate or vitamin B12 in serum, appeared to be protective for NTD (odds ratio [OR] = 0.61 per ng/ml, 95% Confidence interval [CI]: 0.42-0.85 and OR = 0.67 per 100 pg/ml, 95% CI: 0.41-1.02, respectively). High serum homocysteine was associated with higher risk of NTD (OR = 1.3 per µmol/l, 95% CI: 1.02-1.8). Women aged 30 years or more had an OR of 3.5 (95% CI: 1.1-12) for having a NTD child, and families with NTD children had lower household income. Women in the NTD group also had more spontaneous abortions or stillbirths in previous pregnancies. Self-reported intake of folate did not appear to protect against NTDs. CONCLUSIONS: Within this high-prevalence community, poor vitamin status was identified as a risk factor for NTDs detected at ultrasound examination. Improving food security and fortification of foods or food ingredients could be alternative measures.

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.