Type 1 von Willebrand disease (vWD) is generally regarded clinically as 'mild' and the obstetrical-gynaecological features have not been fully described. We administered a patient questionnaire and provider survey of the medical and quality of life aspects of childbirth and menstruation to 99 type 1 vWD patients and compared the patients presently menstruating (n=81) to a cohort of 150 menstruating females in the general population. The following measurements had a statistically higher proportion in the vWD group: number of tampons/towels used for a typical menstrual cycle (P=0. 002); percentage reporting that clothes are stained by menses (P = 0. 001); past or present history of anaemia (P = 0.001); childbirth-related bleeding (P=0.001); and childbirth-related bleeding necessitating RBC transfusion (P=0.002). Quality of life assessment of the impact of menses in both of the above cohorts was measured by a Likert scale using seven quality of life parameters. Compared to the control group, the vWD patients had a significantly higher score, with P-values of < 0.0001 for each parameter. Hormonal interventions for menorrhagia in the vWD patients were < or = 50% effective. Menorrhagia resulted in red blood cell transfusions in 6% of patients, dilatation and curettage in 17% and hysterectomy in 13%. Despite the common connotation of type 1 vWD as clinically 'mild', childbirth and the monthly challenge to haemostasis presented by menstruation result in a substantial degree of morbidity in females with type 1 vWD. These results support the rationale for ongoing international efforts to increase awareness of vWD as a cause for menorrhagia and to improve the quality of life in females with known vWD.

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The possible impact of occupational factors on the furtherance of congenital defects has been under study at our department for the past four years, and it has assumed a special interest because of the importance to understand the etiology of these disorders and a good possibility for prevention by elimination of the causative factor from the work environment. In connection with a register based case-referent study utilizing supplementary information, acquired by a single interviewer, we analyzed various occupational factors related to pregnancy. We found that organic solvent exposure and exposure to various dusts during the pregnant period were more common among the case mothers than among their matched referents. These findings may offer further rough guidance in the quest for the identification of possibly embryotoxic agents that may occur in occupational life.

Finland leads the world in per capita coffee consumption. To evaluate the hypothesis that coffee consumption during pregnancy is teratogenic, 755 pairs of mothers of malformed children and their controls were personally interviewed soon after delivery. After excluding tea drinkers and pairs with inadequate information, the study group included 706 pairs. Study subjects consisted of mothers of children with 112 defects of the central nervous system, 241 orofacial clefts, 210 structural defects of the skeleton, and 143 cardiovascular malformations. The coffee consumption during pregnancy was similar for the mothers of malformed or non-malformed children. The comparison of the mothers drinking at least four cups of coffee a day during pregnancy with those not consuming coffee at all showed a relative risk point estimate of 1.0 with the 95 per cent confidence limits of 0.7 and 1.3.

Objectives-To assess the exposure to enzymes and prevalence of enzyme sensitisation in the baking industry. Methods-A cross sectional study was conducted in four bakeries, one flour mill, and one crispbread factory. Sensitisation to enzymes, flours, and storage mites was examined by skin prick and radioallergosorbent (RAST) tests. 365 workers were tested. The workers were interviewed for work related respiratory and skin symptoms. Total dust concentrations were measured by a gravimetric method, and the concentration of a-amylase in air was measured by a catalytic method. An immunochemical method was used for measuring cellulose and xylanase in air. Results-Total measured dust concentrations were from 0-1 to 18 mg/ml, with highest values in dough making areas of bakeries. The a-amylase concentrations generally followed the total dust concentrations and reached the highest values < 66 YugIm' in the same areas. Cellulase and xylanase varied with concentrations < 180 ng/m' and < 40 nglm3, respectively, in the flour mill and the crispbread factory. No cellulase, but concentrations of 1-200 nglm' xylanase, were found in the bakeries, probably indicating the natural xylanase activity of wheat. 12 workers (8%) in the bakeries, three (5%/6) in the flour mill, and four (3%) in the crispbread factory were skin prick positive to enzymes. The corresponding percentages of positive reactions to flours were 12%, 5%, and 8%.Conclusions-The study confirmed that industrial enzymes in baking used as additives in a powdered form pose a risk of sensitisation. The no effect air concentrations for industrial enzymes are not known. Based on present knowledge, however, lowering exposures and eliminating short and high peaks by technical measures would lower the risk of sensitisation. This would be most effectively accomplished by shifting to non-dusty products.