Publications by authors named "Mary Anne McDonald"

18 Publications

  • Page 1 of 1

Cardiologists' Perspectives on Race-Based Drug Labels and Prescribing Within the Context of Treating Heart Failure.

Health Equity 2019 22;3(1):246-253. Epub 2019 May 22.

Center on Genomics, Race, Identity, Difference, Duke University, Durham, North Carolina.

Cardiologists are known to consider patients' race when treating heart failure, but their views on the benefits and harms of this practice are largely undocumented. We set out to explore cardiologists' perspectives on the benefits and harms of race-based drug labels and guidelines. Specifically, we focused on isosorbide dinitrate and hydralazine hydrochloride (sold in a patented form as BiDil), a combination of drugs recommended for the treatment of black patients receiving optimal medical therapy for symptomatic heart failure and reduced ejection fraction. We conducted 81 semistructured interviews at an American College of Cardiology Annual meeting to assess cardiologists' and cardiology fellows' attitudes toward the use of race in drug prescribing. Investigators reviewed and coded the interviews using inductive qualitative analysis techniques. Many participants believed that race-based drug labels might help doctors prescribe effective medications to patients sooner. More than half of the participants expressed concerns, however, that considering race within the context of treating heart failure could potentially harm patients as well. Harms identified included the likelihood that patients who could benefit from a drug may not receive it because of their race; insufficient understanding about gene-drug-environment interactions; and simplistic applications of race in the clinic. Few participants expressed approval of using race in drug prescribing without recognizing the potential harms, yet most participants stated that they continue to consider race when prescribing isosorbide dinitrate and hydralazine hydrochloride. Within the context of treating heart failure, more open discussions about the benefits and harms of race-based drug labels and prescribing are needed to address cardiologists' concerns.
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http://dx.doi.org/10.1089/heq.2018.0074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6608680PMC
May 2019

Acceptability of two- versus three-dose human papillomavirus vaccination schedule among providers and mothers of adolescent girls: a mixed-methods study in five countries.

Cancer Causes Control 2018 Nov 4;29(11):1115-1130. Epub 2018 Oct 4.

Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.

Purpose: The World Health Organization revised its human papillomavirus (HPV) vaccination recommendations to include a two (2-) dose schedule for girls aged ≤ 15 years. We investigated acceptability of 2- versus 3-dose schedule among adolescent vaccination providers and mothers of adolescent girls in five countries.

Methods: Adolescent vaccination providers (N = 151) and mothers of adolescent girls aged 9-14 years (N = 118) were recruited from Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers' preference for a 2- versus 3-dose HPV vaccination schedule via quantitative surveys. Mothers' attitudes towards a 2-dose schedule were assessed through focus group discussions.

Results: Most adolescent providers preferred a 2- over a 3-dose HPV vaccination schedule (overall: 74%), with preference ranging from 45.2% (South Africa) to 90.0% (South Korea). Lower cost, fewer clinic visits, and higher series completion were commonly cited reasons for 2-dose preference among providers and mothers. Safety and efficacy concerns were commonly cited barriers to accepting a 2-dose HPV vaccination schedule among providers and mothers. Mothers generally accepted the reduced schedule, however requested further information from a trusted source.

Conclusions: Adolescent vaccination providers and mothers preferred the 2-dose over 3-dose HPV vaccination schedule. Acceptability of a 2-dose HPV vaccination could be improved with additional information to providers and mothers on HPV vaccination safety and efficacy.
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http://dx.doi.org/10.1007/s10552-018-1085-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589352PMC
November 2018

Implementation of the NCAA Sickle Cell Trait Screening Policy: A Survey of Athletic Staff and Student-athletes.

J Natl Med Assoc 2018 Dec 7;110(6):564-573. Epub 2018 Apr 7.

Center on Genomics, Race, Identity, Difference (GRID), Social Science Research Institute, Duke University, Box 90420 Durham, NC 27708-0420, USA; Department of African and African American Studies, Duke University, 234 Ernestine Friedl Building, Box 90252, Durham, NC 27708, USA.

Objective: To describe the perspectives and experiences of athletic trainers, coaches, and student-athletes approximately three years post-implementation of the NCAA sickle cell trait (SCT) screening policy.

Participants: Two-hundred and eight student-athletes, 32 athletic trainers, and 43 coaches from 10 NCAA Division I (DI) institutions in North Carolina from January to June 2014.

Methods: Two online surveys were used to assess knowledge, perspectives, and experiences.

Results: Athletic staff were more supportive than student-athletes of the need for the policy. Noted challenges included variation in implementation and follow-up for SCT-positive athletes, financial costs to institutions and athletes, and timing of the screening.

Conclusions: More education about SCT is needed for student-athletes and athletic staff in order to help make the implementation more successful. All parties need to be in agreement regarding the importance of knowing which student-athletes have SCT and how that information will be utilized.
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http://dx.doi.org/10.1016/j.jnma.2018.03.004DOI Listing
December 2018

Acceptability of multipurpose human papillomavirus vaccines among providers and mothers of adolescent girls: A mixed-methods study in five countries.

Papillomavirus Res 2017 Jun 6;3:126-133. Epub 2017 Apr 6.

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC 27599, USA; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.

Introduction: Multipurpose vaccines (MPVs) could be formulated to prevent multiple sexually transmitted infections simultaneously. Little is known about acceptability of MPVs among vaccine health care providers (HCPs) or mothers of adolescent girls.

Methods: 151 adolescent vaccine providers and 118 mothers of adolescent girls aged 9-14 were recruited from five geographically-diverse countries: Argentina, Malaysia, South Africa, South Korea, and Spain. We assessed providers' preferences for single-purpose human papillomavirus (HPV) vaccine versus MPVs (including HPV+herpes simplex virus (HSV)-2, HPV+HIV, or HPV+HSV-2+HIV) via quantitative surveys. Maternal MPV attitudes were assessed in four focus group discussions (FGDs) in each country.

Results: Most providers preferred MPVs over single-purpose HPV vaccination, with preference ranging from 61% in Malaysia to 96% in South Africa. HPV+HSV-2+HIV was the most preferred MPV formulation (56-82%). Overall, 53% of the mothers preferred MPVs over single-purpose HPV vaccines, with strongest support in South Africa (90%) and lowest support in South Korea (29%). Convenience and trust in the health care system were commonly-cited reasons for MPV acceptability. Safety and efficacy concerns were common barriers to accepting MPVs, though specific concerns differed by country. Across FGDs, additional safety and efficacy information on MPVs were requested, particularly from trusted sources like HCPs.

Conclusions: Though maternal acceptability of MPVs varied by country, MPV acceptability would be enhanced by having HCPs provide parents with additional MPV vaccine safety and efficacy information. While most providers preferred MPVs, future health behavior research should identify acceptability barriers, and targeted provider interventions should equip providers to improve vaccination discussions with parents.
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http://dx.doi.org/10.1016/j.pvr.2017.04.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608022PMC
June 2017

Perspectives and Practices of Athletic Trainers and Team Physicians Implementing the 2010 NCAA Sickle Cell Trait Screening Policy.

J Genet Couns 2017 Dec 3;26(6):1292-1300. Epub 2017 Jun 3.

Center on Genomics, Race, Identity, Difference, Duke University, Durham, NC, USA.

Sickle cell trait (SCT) is usually benign. However, there are some conditions that may lead to SCT-related problems and put athletes with the trait at particular risk. In 2010 the National Collegiate Athletic Association (NCAA) issued a policy that required all Division I (DI) student-athletes to confirm their SCT status or sign a liability waiver to opt out of testing. Athletic trainers and team physicians play key roles in the policy implementation and we examined their perceptions and practices. Between December 2013 and March 2014 we interviewed 13 head athletic trainers and team physicians at NCAA Division I colleges and universities in North Carolina. We used an interview guide with open-ended questions covering knowledge of SCT, historical screening and education practices, current implementation, and policy benefits and challenges. Participants were knowledgeable about SCT and thought the policy was beneficial in providing SCT health information to and for student-athletes. Schools varied in provision of genetic counseling, offering the waiver, SCT tests administered, and other aspects. Challenges included: insufficient guidance from the NCAA; financial considerations; and misunderstanding of the relationships of race and ancestry to SCT risk. Athletic staff found the policy valuable, but felt it needs clarity and standardization.
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http://dx.doi.org/10.1007/s10897-017-0107-6DOI Listing
December 2017

Faculty perceptions of how community-engaged research is valued in tenure, promotion, and retention decisions.

Clin Transl Sci 2013 Aug;6(4):259-66

Hunter College, CUNY, Hunter-Bellevue School of Nursing, Weill Cornell CTSA, New York, New York, USA.

Purpose: We assessed the perceptions of community core faculty in academic medical center institutions that received Clinical and Translational Science Awards (CTSA) about how these institutions consider community-engaged scholarship (CES) when tenure, promotion, and retention decisions are made.

Method: An assessment tool was adapted to create an 18-item survey that was sent during November and December 2011 via the Internet to the 369 members of the community-engagement core mailing list of the CTSA.

Results: Fifty-nine responses were received which represented 37 of the possible 60 different funded institutions. The mean score was 48.14 (SD = 11.18); range of 23-74; and Cronbach's alpha was .91 About half reported that support for CES and its inclusion in the academic decision process increased since the institution was awarded a CTSA. Open-ended responses indicated some confusion with terminology although a definition of CES had been provided in the instrument instructions.

Conclusion: Respondents overall agreed there was moderate support for CES in tenure, promotion, and retention decisions which may have been influenced by the CTSA application requirements. This survey could be used to identify if there are differences in institutional and departments and measure changes over time.
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http://dx.doi.org/10.1111/cts.12077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3740454PMC
August 2013

Land application of treated sewage sludge: community health and environmental justice.

Environ Health Perspect 2013 May 11;121(5):537-42. Epub 2013 Mar 11.

Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina 27599, USA.

Background: In the United States, most of the treated sewage sludge (biosolids) is applied to farmland as a soil amendment. Critics suggest that rules regulating sewage sludge treatment and land application may be insufficient to protect public health and the environment. Neighbors of land application sites report illness following land application events.

Objectives: We used qualitative research methods to evaluate health and quality of life near land application sites.

Methods: We conducted in-depth interviews with neighbors of land application sites and used qualitative analytic software and team-based methods to analyze interview transcripts and identify themes.

Results: Thirty-four people in North Carolina, South Carolina, and Virginia responded to interviews. Key themes were health impacts, environmental impacts, and environmental justice. Over half of the respondents attributed physical symptoms to application events. Most noted offensive sludge odors that interfere with daily activities and opportunities to socialize with family and friends. Several questioned the fairness of disposing of urban waste in rural neighborhoods. Although a few respondents were satisfied with the responsiveness of public officials regarding sludge, many reported a lack of public notification about land application in their neighborhoods, as well as difficulty reporting concerns to public officials and influencing decisions about how the practice is conducted where they live.

Conclusions: Community members are key witnesses of land application events and their potential impacts on health, quality of life, and the environment. Meaningful involvement of community members in decision making about land application of sewage sludge will strengthen environmental health protections.
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http://dx.doi.org/10.1289/ehp.1205470DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673187PMC
May 2013

Teaching population health: a competency map approach to education.

Acad Med 2013 May;88(5):626-37

Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina, USA.

A 2012 Institute of Medicine report is the latest in the growing number of calls to incorporate a population health approach in health professionals' training. Over the last decade, Duke University, particularly its Department of Community and Family Medicine, has been heavily involved with community partners in Durham, North Carolina, to improve the local community's health. On the basis of these initiatives, a group of interprofessional faculty began tackling the need to fill the curriculum gap to train future health professionals in public health practice, community engagement, critical thinking, and team skills to improve population health effectively in Durham and elsewhere. The Department of Community and Family Medicine has spent years in care delivery redesign and curriculum experimentation, design, and evaluation to distinguish the skills trainees and faculty need for population health improvement and to integrate them into educational programs. These clinical and educational experiences have led to a set of competencies that form an organizational framework for curricular planning and training. This framework delineates which learning objectives are appropriate and necessary for each learning level, from novice through expert, across multiple disciplines and domains. The resulting competency map has guided Duke's efforts to develop, implement, and assess training in population health for learners and faculty. In this article, the authors describe the competency map development process as well as examples of its application and evaluation at Duke and limitations to its use with the hope that other institutions will apply it in different settings.
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http://dx.doi.org/10.1097/ACM.0b013e31828acf27DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636155PMC
May 2013

Report on CTSA consortium use of the community engagement consulting service.

Clin Transl Sci 2013 Feb 6;6(1):34-9. Epub 2012 Dec 6.

UNC Center for Health Promotion and Disease Prevention, Chapel Hill, NC, USA.

Introduction: The CTSA Community Engagement Consultative Service (CECS) is a national partnership designed to improve community engaged research (CEnR) through expert consultation. This report assesses the feasibility of CECS and presents findings from 2008 to 2009.

Methodology: A coordinating center and five regional coordinating sites managed the service. CTSAs identified a primary previsit CE best practice for consultants to address and completed self-assessments, postvisit evaluations, and action plans. Feasibility was assessed as the percent of CTSAs participating and completing evaluations. Frequencies were calculated for evaluation responses.

Results: Of the 38 CTSAs, 36 (95%) completed a self-assessment. Of these 36 sites, 83%, 53%, and 44% completed a consultant visit, evaluation, and action plan, respectively, and 56% of the consultants completed an evaluation. The most common best practice identified previsit was improvement in CEnR (addressing outcomes that matter); however, relationship building with communities was most commonly addressed during consulting visits. Although 90% of the consultants were very confident sites could develop an action plan, only 35% were very confident in the CTSAs' abilities to implement one.

Conclusions: Academic medical centers interested in collaborating with communities and translating research to improve health need to further develop their capacity for CE and CEnR within their institutions.
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http://dx.doi.org/10.1111/cts.12006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578440PMC
February 2013

Training and career development for comparative effectiveness research workforce development: CTSA Consortium Strategic Goal Committee on comparative effectiveness research workgroup on workforce development.

Clin Transl Sci 2010 Oct;3(5):258-62

Department of Medicine, Indiana Clinical and Translational Sciences Institute, IN, USA.

As comparative effectiveness research (CER) increasingly becomes a national priority, there are increased needs for training and workforce development in this area. Particularly important CER competencies include clinical epidemiology, biomedical informatics, economic analyses, systematic reviews, clinical practice guideline development, use of large databases and electronic health records for research, practice-based research, implementation and dissemination, health services research, and decision analysis. Institutions funded by Clinical and Translational Science Awards (CTSAs) should be one of the central stakeholders in providing training and career development in CER. Survey results regarding the current CER capacity and needs of CTSAs are presented, and recommendations are provided. Volume 5: 258-262.
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http://dx.doi.org/10.1111/j.1752-8062.2010.00221.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2965561PMC
October 2010

Clinical and translational science awards and community engagement: now is the time to mainstream prevention into the nation's health research agenda.

Am J Prev Med 2009 Nov;37(5):464-7

Duke University Medical Center, Department of Community and Family Medicine, Duke Center for Community Research, Durham NC 27710, USA.

Although much attention is devoted to the slow process of cutting-edge "bench science" finding its way to clinical translation, less attention is paid to the fact that basic prevention messages, tests, and interventions never find their way into communities. The NIH Clinical & Translational Science Awards program seeks to address a broad mission of improving health, including both speeding up the incorporation of basic science discoveries throughout the clinical research pipeline and incorporating concerns of communities and practices into research agendas. The preventive medicine community now has an important opportunity to marry their mission of promoting and expanding prevention in communities to the nation's medical research agenda. This article suggests opportunities for collaboration.
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http://dx.doi.org/10.1016/j.amepre.2009.06.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575113PMC
November 2009

"Safety is everyone's job:" the key to safety on a large university construction site.

J Safety Res 2009 8;40(1):53-61. Epub 2009 Feb 8.

Division of Community Health, Department of Community and Family Medicine, Duke University Medical Center, Durham, N.C., USA.

Problem: Construction risk management is challenging.

Method: We combined data on injuries, costs, and hours worked, obtained through a Rolling Owner-Controlled Insurance Program (ROCIP), with data from focus groups, interviews, and field observations, to prospectively study injuries and hazard control on a large university construction project.

Results: Lost-time injury rates (1.0/200,000 hours worked) were considerably lower than reported for the industry, and there were no serious falls from height. Safety was considered in the awarding of contracts and project timeline development; hazard management was iterative. A top-down management commitment to safety was clearly communicated to, and embraced by, workers throughout the site. DISCUSSION AND IMPACT: A better understanding of how contracting relationships, workers' compensation, and liability insurance arrangements influence safety could shift risk management efforts from worker behaviors to a broader focus on how these programs and relationships affect incentives and disincentives for workplace safety and health.
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http://dx.doi.org/10.1016/j.jsr.2008.12.005DOI Listing
August 2009

Depressive symptoms among working women in rural North Carolina: a comparison of women in poultry processing and other low-wage jobs.

Int J Law Psychiatry 2007 Jul-Oct;30(4-5):284-98. Epub 2007 Jul 31.

Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710, USA.

We report on the prevalence of self-reported depressive symptoms and associated factors among women employed in a poultry processing plant and a community comparison group of other employed women in northeastern North Carolina in the southern United States. The rural area is poor and sparsely populated with an African American majority. The largest employer of women in the area is a poultry processing plant. The goals of the analyses were 1) to evaluate whether women employed in poultry processing had a higher prevalence of depressive symptoms than other working women from the same geographic area, and 2) to evaluate factors which might be associated with depression among all of these working women, including specific characteristics of their work environment. Recruitment of participants (n=590) and data collection were by community-based staff who were also African American women. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Work organization factors were measured with the Job Content Questionnaire (JCQ). Log-binomial regression was used to calculate crude and adjusted prevalence ratios. The prevalence of depressive symptoms, based on a CES-D measure of sixteen or more, was 47.8% among the poultry workers and 19.7% among the other working women (prevalence ratio=2.3). After adjusting for socioeconomic variables, health-related quality of life and coping style, the prevalence of depressive symptoms remained 80% higher among the poultry workers. The prevalence of symptoms was also higher among those who perceived low social support at work, hazardous work conditions, job insecurity, and high levels of isometric load. These factors were all more common among the women employed in the poultry plant. The concentration of this low-wage industry in economically depressed rural areas illuminates how class exploitation and racial discrimination may influence disparities in health among working women.
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http://dx.doi.org/10.1016/j.ijlp.2007.06.003DOI Listing
January 2008

Understanding non-industrialized workers' approaches to safety: how do commercial fishermen "stay safe"?

J Safety Res 2007 29;38(3):289-97. Epub 2007 May 29.

Division of Community Health, Department of Community and Family Medicine, Duke University Medical Center, DUMC Box 2914, Durham, NC 27710, USA.

Background: Commercial fishing is carried out worldwide, often in non-industrialized forms, and is associated with high rates of fatal and non-fatal occupational injury.

Problem: Fishermen who work independently in non-industrialized settings do not have access to union or industry sponsored safety services and must make their own decisions about safety practices. Learning the meaning of safety for them and the safety measures they employ is important before developing interventions.

Methods: Two fieldworkers conducted in-depth ethnographic interviews with 31 commercial fishermen in North Carolina. Interviews and fieldnotes were analyzed using QSR N5.

Results: Fishermen primarily related staying safe to work practices and attitudes. They identified specific safety measures, appropriate gear and boat maintenance, weather decisions, and working cooperatively when ocean fishing.

Discussion: The ethnographic research process can produce information about a group's norms of preventive behavior and safety concerns. Knowledge of workers' concepts and practices will inform researchers' inquiries.
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http://dx.doi.org/10.1016/j.jsr.2006.10.009DOI Listing
September 2007

A conceptual model of work and health disparities in the United States.

Int J Health Serv 2006 ;36(1):25-50

Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, NC 27705, USA.

Recent research in medicine and public health highlights differences in health related to race, ethnicity, socioeconomic status, and gender. These inequalities, often labeled "disparities," are pervasive and pertain to the major causes of morbidity, mortality, and lost life years. Often ignored in discussions of health disparities is the complex role of work, including not only occupational exposures and working conditions, but also benefits associated with work, effects of work on families and communities, and policies that determine where and how people work. The authors argue that work should be considered explicitly as a determinant of health disparities. Their conceptual model and empirical evidence, built on previous contributions, describe how work contributes to disparities in health on multiple levels. The examples focus on the United States, but many of the key conceptual features can also be applied to other countries. The model emphasizes behaviors and characteristics of institutions rather than individual workers. This approach avoids a focus on individual responsibility alone, which may lead to victim blaming and failure to emphasize policies and institutional factors that affect large populations and systematically create and maintain racial, gender, and socioeconomic disparities in health.
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http://dx.doi.org/10.2190/BRED-NRJ7-3LV7-2QCGDOI Listing
July 2006

Exploration of work and health disparities among black women employed in poultry processing in the rural south.

Environ Health Perspect 2005 Dec;113(12):1833-40

Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA.

We describe an ongoing collaboration that developed as academic investigators responded to a specific request from community members to document health effects on black women of employment in poultry-processing plants in rural North Carolina. Primary outcomes of interest are upper extremity musculoskeletal disorders and function as well as quality of life. Because of concerns of community women and the history of poor labor relations, we decided to conduct this longitudinal study in a manner that did not require involvement of the employer. To provide more detailed insights into the effects of this type of employment, the epidemiologic analyses are supplemented by ethnographic interviews. The resulting approach requires community collaboration. Community-based staff, as paid members of the research team, manage the local project office, recruit and retain participants, conduct interviews, coordinate physical assessments, and participate in outreach. Other community members assisted in the design of the data collection tools and the recruitment of longitudinal study participants and took part in the ethnographic component of the study. This presentation provides an example of one model through which academic researchers and community members can work together productively under challenging circumstances. Notable accomplishments include the recruitment and retention of a cohort of low-income rural black women, often considered hard to reach in research studies. This community-based project includes a number of elements associated with community-based participatory research.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314930PMC
http://dx.doi.org/10.1289/ehp.7912DOI Listing
December 2005

Musculoskeletal symptoms among commercial fishers in North Carolina.

Appl Ergon 2004 Sep;35(5):417-26

Division of Occupational and Environmental Medicine, Community and Family Medicine, Box 3834, Duke University Medical Center, Durham, NC 27710, USA.

Musculoskeletal symptoms were reported by 215 fishermen followed at 6-month intervals over 18 months. Exposure information was collected through field observation and in-depth ethnographic interviews allowing potential ergonomic stressors to be identified and catalogued by task and stage of work. Symptoms causing work interference in the last 12 months were reported by 38.5% of the cohort at baseline. Low back symptoms were the most common cause of work impairment (17.7%), followed equally by pain in the hands or wrists and shoulders (7%). Symptoms in any body region were more likely to have been reported among individuals who did not fish full-time and those who worked other jobs part or all year had significantly lower symptom prevalence; both likely reflect a healthy worker effect. A number of ergonomic stressors were identified in all stages of fishing with exposure variability dictated by some unpredictable factors such as weather; but also by type of boat, gear, crew size, and level of experience. Reducing ergonomic exposures associated with work among these traditional workers is important, regardless of whether they directly cause or contribute to their musculoskeletal symptoms, or aggravate existing pathology.
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http://dx.doi.org/10.1016/j.apergo.2004.04.004DOI Listing
September 2004

Use of qualitative methods to map job tasks and exposures to occupational hazards for commercial fishermen.

Am J Ind Med 2004 Jul;46(1):23-31

Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.

Background: Understanding job tasks and estimating occupational exposures is difficult for self-employed or autonomous workers, who tend to be dispersed, with no fixed workplace, employment records, or historical exposure measurements.

Methods: We used ethnographic methods to collect work information for southern commercial fishermen. Major activities were mapped using the seasonal round, an anthropological tool that records activities of groups whose lifeways depend on natural cycles.

Results: Fishermen's work schedules depended on boat size, gear, market fluctuations, and regulations, as well as season. The seasonal round guided the analysis of qualitative data on annual cycles of activities increasing understanding of exposures and their variation.

Conclusions: Combined with detailed exposure information this framework for organizing and categorizing seasonal activities could improve accuracy of exposure information and guide quantitative analysis in work settings that challenge standard exposure assessment methods.
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http://dx.doi.org/10.1002/ajim.20031DOI Listing
July 2004
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