Arild Vaktskjold

Prophylactic mesh at end-colostomy construction reduces parastomal hernia rate: A randomized trial

Parastomal hernia (PSH) is the most common complication of an end‐colostomy and about one‐quarter of patients need operative repair, which is often unsuccessful. A randomized trial was carried out to compare the results of using mesh or no mesh at the time of formation of a colostomy with the clinical identification of PSH as the primary outcome.

The Kola Birth Registry and perinatal mortality in Mončegorsk, Russia

Background.  A population‐based birth registry has been set up for the Arctic town of Mončegorsk in north‐western Russia. In this investigation, the quality and the content of the registry are assessed and the perinatal mortality (PM) rates in the period 1973–97 estimated.

Maternal nickel exposure and congenital musculoskeletal defects.

OBJECTIVE To investigate whether women occupationally exposed to nickel in early pregnancy are at elevated risk of delivering a newborn with a malformation or deformation of the musculoskeletal system (ICD-10: Q65-Q79). METHODS Data about the newborn, maternal occupation and workplace were obtained using the Kola Birth Register (KBR). Each record in the KBR was assigned a categorical nickel (Ni) exposure rating according to the occupation the delivering woman had at the time of becoming pregnant. This was achieved by using as a guideline the water-soluble Ni subfraction of the inhalable aerosol fraction obtained by personal monitoring for nickel- and copper-refinery workers or/and measured urinary-Ni concentrations. The reference population was delivering women from the source population with background exposure level. In total, the study population consisted of 22,965 births. RESULTS Three hundred and four infants (13.3/1,000 births; 95% confidence interval (CI): 11.9-14.7) were diagnosed with isolated musculoskeletal defect(s) at birth. The adjusted odds ratio for the association between the maternal exposure to Ni and this outcome was 0.96 (95% CI: 0.76-1.21) per unit increase in exposure category. CONCLUSION The incidence of defects in the musculoskeletal system at birth was high, especially for feet deformities, but we found no effect of maternal exposure to water-soluble Ni on the risk of delivering a newborn with a defect. However, the incidence among women working in the copper refinery was higher than in the other employment groups.

Spontaneous abortions among nickel-exposed female refinery workers

A case-control study to investigate whether women employed in nickel-exposed work areas in early pregnancy are at elevated risk of spontaneous abortion (SA). Data about pregnancy outcome and maternal factors were obtained about each delivery and SA from women in selected work places. Each pregnancy record was assigned a categorical nickel (Ni) exposure rating according to the womens occupations at pregnancy onset. The guidelines were the water-soluble Ni subfraction of the inhalable aerosol fraction obtained by personal monitoring for nickel- and copper-refinery workers or/and measured urinary-Ni concentrations. The unadjusted odds ratio for the association between the maternal exposure to Ni and an SA for Ni-exposed women was 1.38 (95% confidence interval: 1.04–1.84), and the adjusted was 1.14 (0.95–1.37). In conclusion, there was no statistical association between maternal occupational exposure to water-soluble Ni in early pregnancy and the risk of self-reported SA. The findings do not exclude the possibility of a weak excess risk, or a risk in the first weeks of pregnancy.

The incidence of neural tube defects in Norway and the Arkhangelskaja Oblast in Russia and the association with maternal age.

Objective. To determine the incidence of isolated anencephaly and spina bifida in the Arkhangelskaja Oblast (AO) in Russia and in Norway, and to study the maternal age distribution of these congenital defects. Design. A register‐based incidence study. Setting. Two different populations in Northern Europe. Population. All registered fetuses and newborns with at least 12 weeks’ gestation in the populations of AO (1995–2004) and Norway (1999–2003) were included. A total of 141,159 in AO and 293,708 in Norway. Methods. Data were obtained from the malformation register in AO and the Medical Birth Registry of Norway. Main outcome measures. Total and maternal age‐group specific incidence of anencephaly and spina bifida. Results. A total of 298 newborns and abortuses had one of the defects in AO (21.1/10,000 (95% confidence interval:±3.4)) and 317 (10.8/10,000 (±1.2)) in Norway. The incidence of anencephaly was 10.7/10,000 in AO and 5.5 in Norway, and of spina bifida 10.4 and 5.3, respectively. An inverse association between the age of the pregnant women and the incidence of neural tube defects was observed in both populations; for both anencephaly and spina bifida in AO; but only for anencephaly (age < 30 years) in Norway. Conclusions. The incidence of both anencephaly and spina bifida was higher in a northern population of Russia than in Norway. The burden of anencephaly was highest in the youngest maternal age group in both populations. The relatively high incidence of both anencephaly and spina bifida in the Russian population warrants further studies.

SMALL-FOR-GESTATIONAL-AGE NEWBORNS OF FEMALE REFINERY WORKERS EXPOSED TO NICKEL

OBJECTIVES It has not yet been established whether exposure to nickel (Ni) compounds may cause reproductive toxicity. The objective of this study was to investigate whether women employed under conditions of nickel exposure in early pregnancy were at elevated risk of delivering a newborn small-for-gestational-age (SGA). MATERIALS AND METHODS A register-based study of a well defined population. Data on pregnancy outcome and maternal occupation were obtained from the Kola Birth Registry. Each birth record was assigned a Ni exposure rating category according to maternal occupation at the time of becoming pregnant. Nickel exposure assessment was based on determining the water-soluble Ni subfraction of respirable aerosol fraction obtained by personal monitoring, and/or on measurements of urine Ni concentration. The reference population were the delivering women with background exposure level. The study population consisted of 22 836 births (>27 weeks of gestation) and the SGA infants were defined as below the 10th percentile birth weight for gestational age in the source population. Multiple logistic regression was used to analyze the association of the outcome with the assigned exposure rating category. RESULTS The adjusted odds ratio for Ni-exposed women for giving birth to an SGA newborn was 0.84 (95% CI: 0.75-0.93). CONCLUSIONS We found no adverse effect of maternal occupational exposure to water-soluble Ni in the first part of pregnancy on the risk of delivering an SGA newborn without trisomy. The finding does not exclude a possibility that exposure throughout pregnancy might produce such an effect.

Low back pain among mineworkers in relation to driving, cold environment and ergonomics.

Objectives: We aimed to study the association between low back pain (LBP) and exposure to low temperature, wet clothes, heavy lifting and jobs that involve whole body vibration (WBV) in a population of miners. Methods: Health and personal data were collected in a population study by a questionnaire. A total of 3530 workers from four mines participated in the study. Results: 51% of the workers reported LBP within the last 12 months. The adjusted odds ratio for LBP was above unity for working with wet clothes (1.82), working in cold conditions (1.52), lifting heavy (1.54), having worked as a driver previously (1.79) and driving Toro400 (2.61) or train (1.69). Conclusion: Wet clothing, cold working conditions, heavy lifting, previous work as a driver and driving certain vehicles were associated with LBP, but vehicles with WBV levels above action value were not. For better prevention of LBP, improved cabin conditions and clothing should be emphasised. Practitioner Summary: To address risk factors for low back pain (LBP) in miners, a population study measured exposures and LBP. Cold work conditions, wet clothes and awkward postures appeared to be more strongly associated with LBP than exposure to whole body vibration from driving heavy vehicles. Prevention strategies must focus more on clothing and ergonomics.

PREGNANCy HEALTH AND OUTCOME IN TWO CITIES IN THE KOLA PENINSULA, NORTHWESTERN RUSSIA

Objectives. The aims of the study were to compare the prevalence of selected maternal and lifestyle factors as well as the reproductive outcome of working women in two cities in Northwestern Russia (Moncegorsk and Apatity), and to assess the quality of pregnancy-outcome data obtained in an interview with registered information. Study Design. A retrospective questionnaire study in an interview format. Women (n =1696) from selected workplaces in Apatity and Moncegorsk participated (85% of those available). Information was collected about past pregnancies, including information about the pregnancy outcome, newborn, occupation, health and life-style. Results. The investigated groups had experienced 7,254 pregnancies in total, corresponding to 4.3 pregnancies on average per woman. In both groups, about one-half of the reported pregnancies were terminated, and three-quarters of the women had undergone an induced abortion. Spontaneous abortions had been experienced by 23% of the women in the Apatity group, which was higher than in the Moniegorsk group (16%). Previous spontaneous abortions appear more likely to be disclosed than induced abortions. The smoking prevalence was 37% in the Moncegorsk group and 24% in the Apatity group. Thirteen percent of all participants had been diagnosed with a pelvic inflammatory disease. Conclusions. Induced abortions were common in Northwestern Russia regardless of city of residency, and the majority of the abortions appear to have occurred after the women had their attainable or desired number of children. The proportion of pregnancies resulting in a spontaneous abortion was higher in the investigated group in Apatity than in Moncegorsk, which should be investigated further. This study also confirmed that smoking has become more widespread among women in the Kola Peninsula, as elsewhere in Russia.

Congenital anomalies in newborns to women employed in jobs with frequent exposure to organic solvents - a register-based prospective study

BackgroundThe foetal effects of occupational exposure to organic solvents in pregnancy are still unclear. Our aim was to study the risk of non-chromosomal congenital anomalies at birth in a well-defined population of singletons born to women employed as painters and spoolers in early pregnancy, compared to women in non-hazardous occupations.MethodThe study population for this prospective cohort study was singleton newborns delivered to working mothers in the industrial community of Mončegorsk in the period 1973-2005. Occupational information and characteristics of the women and their newborns was obtained from the local population-based birth register.ResultsThe 597 women employed as painters, painter-plasterers or spoolers had 712 singleton births, whereof 31 (4.4%) were perinatally diagnosed with 37 malformations. Among the 10 561 newborns in the group classified as non-exposed, 397 (3.9%) had one or more malformations. The overall prevalence in the exposed group was 520/10 000 births [95% confidence limits (CL): 476, 564], and 436/10 000 births (95% CL: 396, 476) in the unexposed. Adjusted for young maternal age, smoking during pregnancy, maternal congenital malformation and year of birth, the odds ratio (OR) was 1.24 (95% CL: 0.85, 1.82); for multiple anomalies it was 1.54 (95% CL: 0.66, 3.59).The largest organ-system specific difference in prevalence between the two groups was observed for malformations of the circulatory system: 112/10 000 (95% CL: 35, 190) in the exposed group, and 42/10 000 (95% CL: 29, 54) in the unexposed, with an adjusted OR of 2.03 (95% CL: 0.85, 4.84). The adjusted ORs for malformations of the genital organs and musculoskeletal system were 2.24 (95% CI: 0.95, 5.31) and 1.12 (95% CI: (0.62, 2.02), respectively.ConclusionThere appeared to be a higher risk of malformations of the circulatory system and genital organs at birth among newborns to women in occupations with organic solvent exposure during early pregnancy (predominantly employed as painters). However, the findings were not statistically conclusive. Considering that these two categories of malformations are not readily diagnosed perinatally, the difference in prevalence between the exposed and unexposed may have been underestimated.

The incidence and maternal age distribution of abdominal wall defects in Norway and Arkhangelskaja Oblast in Russia

Abstract Objectives. To determine the foetal incidence of isolated anterior abdominal wall defects (gastroschisis and omphalocele) in the Arkhangelskaja Oblast (AO) in Russia and in Norway, as well as to study the maternal - age distribution of these defects. Study Design. A register - based incidence study. Methods. All registered foetuses and newborns with at least 12 weeks of gestation in the populations of AO (141,159) and Norway (293,708) were included. The data covered the period 1995–2004 in AO and 1999–2003 in Norway and were obtained from the malformation register in AO and the Medical Birth Registry of Norway. Results. The majority of the outcomes with a defect were liveborn in Norway (65%), while in AO the majority were spontaneously or medically aborted (59%). The incidence of anterior abdominal wall defects was 5.4/10,000 (95% confidence limits: ±1.7) in AO and 5.1/10,000 (±0.8) in Norway, and the ratio of omphalocele to gastroschisis was 1.2 in AO vs. 0.9 in Norway. Gastroschisis was inversely associated with maternal age in Norway. Conclusions. Despite a difference in maternal age distribution, there was no difference in the incidence of abdominal wall defects in AO and Norway. Gastroschisis was associated with young maternal age only in Norway, and the higher incidence in maternal age groups younger than 25 warrants further studies about aetiological factors associated with young maternal age.