Publications by authors named "Patricia McGovern"

84 Publications

Access to Workplace Accommodations to Support Breastfeeding after Passage of the Affordable Care Act.

Womens Health Issues 2016 Jan-Feb;26(1):6-13. Epub 2015 Oct 13.

Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota.

Objectives: This study examines access to workplace accommodations for breastfeeding, as mandated by the Affordable Care Act, and its associations with breastfeeding initiation and duration. We hypothesize that women with access to reasonable break time and private space to express breast milk would be more likely to breastfeed exclusively at 6 months and to continue breastfeeding for a longer duration.

Methods: Data are from Listening to Mothers III, a national survey of women ages 18 to 45 who gave birth in 2011 and 2012. The study population included women who were employed full or part time at the time of survey. Using two-way tabulation, logistic regression, and survival analysis, we characterized women with access to breastfeeding accommodations and assessed the associations between these accommodations and breastfeeding outcomes.

Results: Only 40% of women had access to both break time and private space. Women with both adequate break time and private space were 2.3 times (95% CI, 1.03-4.95) as likely to be breastfeeding exclusively at 6 months and 1.5 times (95% CI, 1.08-2.06) as likely to continue breastfeeding exclusively with each passing month compared with women without access to these accommodations.

Conclusions: Employed women face unique barriers to breastfeeding and have lower rates of breastfeeding initiation and shorter durations, despite compelling evidence of associated health benefits. Expanded access to workplace accommodations for breastfeeding will likely entail collaborative efforts between public health agencies, employers, insurers, and clinicians to ensure effective workplace policies and improved breastfeeding outcomes.
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http://dx.doi.org/10.1016/j.whi.2015.08.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4690749PMC
August 2016

Incidence Rates and Trend of Serious Farm-Related Injury in Minnesota, 2000-2011.

J Agromedicine 2015 ;20(4):419-26

a Center for Occupational Health and Safety , Minnesota Department of Health , St. Paul , Minnesota , USA.

Only about 2% of Minnesota's workers were employed in agriculture for the years 2005-2012, this small portion of the workforce accounted for 31% of the 563 work-related deaths that occurred in Minnesota during that same time period. Agricultural fatalities in Minnesota and elsewhere are well documented; however, nonfatal injuries are not. To explore the burden of injury, Minnesota hospital discharge data were used to examine rates and trends of farm injury for the years 2000-2011. Cases were identified through the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), injury codes and external cause of injury codes (E codes). Probable cases were defined as E code E849.1 (occurred on a farm) or E919.0 (involving agricultural machinery). Possible cases were based on five less specific E codes primarily involving animals or pesticides. Multiple data sources were used to estimate the agricultural population. An annual average of over 500 cases was identified as probable, whereas 2,000 cases were identified as possible. Trend analysis of all identified cases indicated a small but significant average annual increase of 1.5% for the time period 2000-2011. Probable cases were predominantly male (81.5%), whereas possible cases were predominantly female (63.9%). The average age of an injury case was 38.5 years, with the majority of injuries occurring in late summer and fall months. Despite the undercount of less serious injuries, hospital discharge data provide a meaningful data source for the identification and surveillance of nonfatal agricultural injuries. These methods could be utilized by other states for ongoing surveillance for nonfatal agricultural injuries.
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http://dx.doi.org/10.1080/1059924X.2015.1075449DOI Listing
April 2016

Diaminopyrimidines, diaminopyridines and diaminopyridazines as histamine H4 receptor modulators.

Bioorg Med Chem Lett 2015 Feb 23;25(4):956-9. Epub 2014 Dec 23.

Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, CA 92121, United States.

Previously disclosed H4 receptor modulators, the triamino substituted pyridines and pyrimidines, contain a free primary amino (-NH2) group. In this Letter we demonstrate that an exocyclic amine (NH2) is not needed to maintain affinity, and also show a significant divergence in the SAR of the pendant diamine component. These des-NH2 azacycles also show a distinct functional spectrum, that appears to be influenced by the diamine component; in the case of the 1,3-amino pyrimidines, the preferred diamine is the amino pyrrolidine instead of the more common piperazines. Finally, we introduce 3,5-diamino pyridazines as novel histamine H4 antagonists.
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http://dx.doi.org/10.1016/j.bmcl.2014.12.027DOI Listing
February 2015

The effect of pK(a) on pyrimidine/pyridine-derived histamine H4 ligands.

Bioorg Med Chem Lett 2014 Dec 13;24(23):5489-92. Epub 2014 Oct 13.

Janssen Pharmaceutical Research & Development, LLC, 3210 Merryfield Row, San Diego, CA 92121, United States.

During the course of our efforts toward the discovery of human histamine H4 antagonists from a series of 2-aminiopyrimidines, it was noted that a 6-trifluoromethyl group dramatically reduced affinity of the series toward the histamine H4 receptor. This observation was further investigated by synthesizing a series of ligands that varied in pKa of the pyrimidine derived H4 ligands by over five orders of magnitude and the effect on histamine H4 affinity. This trend was then extended to the discovery of C-linked piperidinyl-2-amino pyridines as histamine H4 receptor antagonists.
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http://dx.doi.org/10.1016/j.bmcl.2014.10.013DOI Listing
December 2014

Employment during pregnancy and obstetric intervention without medical reason: labor induction and cesarean delivery.

Womens Health Issues 2014 Sep-Oct;24(5):469-76

Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota.

Background: Rising rates of labor induction and cesarean delivery, especially when used without a medical reason, have generated concern among clinicians, women, and policymakers. Whether employment status affects pregnant women's childbirth-related care is not known. We estimated the relationship between prenatal employment and obstetric procedures, distinguishing whether women reported that the induction or cesarean was performed for medical reasons.

Methods: Using data from a nationally representative sample of women who gave birth in U.S. hospitals (n = 1,573), we used propensity score matching to reduce potential bias from nonrandom selection into employment. Outcomes were cesarean delivery and labor induction, with and without a self-reported medical reason. Exposure was prenatal employment status (full-time employment, not employed). We conducted separate analyses for unmatched and matched cohorts using multivariable regression models.

Findings: There were no differences in labor induction based on employment status. In unmatched analyses, employed women had higher odds of cesarean delivery overall (adjusted odds ratio [AOR], 1.45; p = .046) and cesarean delivery without medical reason (AOR, 1.94; p = .024). Adding an interaction term between employment and college education revealed no effects on cesarean delivery without medical reason. There were no differences in cesarean delivery by employment status in the propensity score-matched analysis.

Conclusions: Full-time prenatal employment is associated with higher odds of cesarean delivery, but this association was not explained by socioeconomic status and no longer existed after accounting for sociodemographic differences by matching women employed full time with similar women not employed during pregnancy.
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http://dx.doi.org/10.1016/j.whi.2014.06.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163009PMC
April 2015

Medically complex pregnancies and early breastfeeding behaviors: a retrospective analysis.

PLoS One 2014 13;9(8):e104820. Epub 2014 Aug 13.

Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America.

Background: Breastfeeding is beneficial for women and infants, and medical contraindications are rare. Prenatal and labor-related complications may hinder breastfeeding, but supportive hospital practices may encourage women who intend to breastfeed. We measured the relationship between having a complex pregnancy (entering pregnancy with hypertension, diabetes, or obesity) and early infant feeding, accounting for breastfeeding intentions and supportive hospital practices.

Methods: We performed a retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011-2012 in a US hospital (N = 2400). We used logistic regression to examine the relationship between pregnancy complexity and breastfeeding. Self-reported prepregnancy diabetes or hypertension, gestational diabetes, or obesity indicated a complex pregnancy. The outcome was feeding status 1 week postpartum; any breastfeeding was evaluated among women intending to breastfeed (N = 1990), and exclusive breastfeeding among women who intended to exclusively breastfeed (N = 1418). We also tested whether breastfeeding intentions or supportive hospital practices mediated the relationship between pregnancy complexity and infant feeding status.

Results: More than 33% of women had a complex pregnancy; these women had 30% lower odds of intending to breastfeed (AOR = 0.71; 95% CI, 0.52-0.98). Rates of intention to exclusively breastfeed were similar for women with and without complex pregnancies. Women who intended to breastfeed had similar rates of any breastfeeding 1 week postpartum regardless of pregnancy complexity, but complexity was associated with >30% lower odds of exclusive breastfeeding 1 week among women who intended to exclusively breastfeed (AOR = 0.68; 95% CI, 0.47-0.98). Supportive hospital practices were strongly associated with higher odds of any or exclusive breastfeeding 1 week postpartum (AOR = 4.03; 95% CI, 1.81-8.94; and AOR = 2.68; 95% CI, 1.70-4.23, respectively).

Conclusions: Improving clinical and hospital support for women with complex pregnancies may increase breastfeeding rates and the benefits of breastfeeding for women and infants.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0104820PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4132072PMC
May 2015

Case-control study of student-perpetrated physical violence against educators.

Ann Epidemiol 2014 May 15;24(5):325-32. Epub 2014 Feb 15.

Midwest Center for Occupational Health and Safety Education and Research Center, Regional Injury Prevention Research Center and Center for Violence Prevention and Control, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis.

Purpose: Although prior research focused primarily on student-on-student school violence, educators are also at risk. This study was designed to identify risk factors for assaults against educators.

Methods: Kindergarten-grade 12 educators (n = 26,000), randomly selected from a state license database, were screened for eligibility (6,469, eligible) by mailed questionnaire. Phase 1 (12-month recall) identified eligible assault cases (n = 372) and controls (n = 1,116), June 2004 to December 2005; phase 2 (case-control study; response, 78%) enabled identification of exposures through 1-month recall before student-perpetrated assaults (cases) and randomly selected months (controls). Directed acyclic graphs enabled confounder selection for multivariable logistic regression analyses; reweighting adjusted for potential biases.

Results: Risks (odds ratios, 95% confidence intervals) increased for working in: Special Education (5.84; 4.07-8.39) and School Social Work (7.18; 2.72-18.91); kindergarten to second grade (1.81; 1.18-2.77); urban (1.95; 1.38-2.76) schools; schools with less than 50 (8.40; 3.12-22.63), 50-200 (3.67; 1.84-7.34), 201-500 (2.09; 1.32-3.29), and 501-1000 (1.94; 1.25-3.01) students versus more than 1000; schools with inadequate resources always/frequently (1.62; 1.05-2.48) versus infrequently/never; inadequate building safety always/frequently (4.48; 2.54-7.90) versus infrequently/never; and environments with physical barriers (1.50; 1.07-2.10). Risks decreased with routine locker searches (0.49; 0.29-0.85) and accessible exits (0.36; 0.17-0.74).

Conclusions: Identification of assault risk factors provides a basis for further investigation and interventions.
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http://dx.doi.org/10.1016/j.annepidem.2014.02.006DOI Listing
May 2014

Establishing the value of occupational health nurses' contributions to worker health and safety: a pilot test of a user-friendly estimation tool.

Workplace Health Saf 2014 Jan;62(1):36-41; quiz 42

Occupational health nurses use their knowledge and skills to improve the health and safety of the working population; however, companies increasingly face budget constraints and may eliminate health and safety programs. Occupational health nurses must be prepared to document their services and outcomes, and use quantitative tools to demonstrate their value to employers. The aim of this project was to create and pilot test a quantitative tool for occupational health nurses to track their activities and potential cost savings for on-site occupational health nursing services. Tool developments included a pilot test in which semi-structured interviews with occupational health and safety leaders were conducted to identify currents issues and products used for estimating the value of occupational health nursing services. The outcome was the creation of a tool that estimates the economic value of occupational health nursing services. The feasibility and potential value of this tool is described.
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http://dx.doi.org/10.1177/216507991406200106DOI Listing
January 2014

Maternal depressive symptoms, employment, and social support.

J Am Board Fam Med 2014 Jan-Feb;27(1):87-96

the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis; Medica Research Institute and Divisions of Environmental Health Sciences, Health Policy and Management, and Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis.

Objective: The purpose of this study was to characterize the relationship between maternal depressive symptoms and employment and whether it is mediated by social support.

Methods: We used data from a nationally representative sample of 700 US women who gave birth in 2005 and completed 2 surveys in the Listening to Mothers series, the first in early 2006, an average of 7.3 months postpartum, and the second an average of 13.4 months postpartum. A dichotomous measure of depressive symptoms was calculated from the 2-item Patient Health Questionnaire, and women reported their employment status and levels of social support from partners and others. We modeled the association between maternal employment and depressive symptoms using multivariate logistic regression, including social support and other control variables.

Results: Maternal employment and high support from a nonpartner source were both independently associated with significantly lower odds of depressive symptoms (adjusted odds ratio [AOR], 0.35 and P = .011, and AOR, 0.40, P = .011, respectively). These relationships remained significant after controlling for mothers' baseline mental and physical health, babies' health, and demographic characteristics (AOR, 0.326 and P = .015, and AOR, 0.267 and P = .025, respectively).

Conclusions: Maternal employment and strong social support, particularly nonpartner support, were independently associated with fewer depressive symptoms. Clinicians should encourage mothers of young children who are at risk for depression to consider ways to optimize their employment circumstances and "other" social support.
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http://dx.doi.org/10.3122/jabfm.2014.01.130126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3882899PMC
September 2014

Use of nonmedical methods of labor induction and pain management among U.S. women.

Birth 2013 Dec;40(4):227-36

Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.

Background: There exists limited documentation of nonmedical methods of labor induction and pain management during childbirth in the United States. We estimated the prevalence of nonmedical interventions for induction and pain management and examined the association between medical and nonmedical care during labor.

Methods: We used a nationally representative survey of U.S. women who gave birth in 2005 (N = 1,382) to examine use of nonmedical methods of labor induction and pain management. Using logistic regression, we calculated odds of nonmedical and medical interventions to induce labor or mitigate pain, and the odds of medical induction and obstetric analgesia by whether nonmedical methods were reported.

Results: Nearly 30 percent of women used nonmedical methods to start labor, and over 70 percent of women used nonmedical pain management. Doula support was the strongest predictor of nonmedical methods of labor induction (Adjusted Odds Ratio [AOR] = 3.0) and labor pain management (AOR = 5.7). Use of nonmedical pain management was significantly associated with decreased odds of medical pain management (OR = 0.65); this relationship was attenuated with covariate adjustment.

Conclusions: Nonmedical methods to induce labor and manage pain during childbirth are commonly used by U.S. women. Future research should examine effectiveness of these strategies and their influence on medical services use.
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http://dx.doi.org/10.1111/birt.12064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868990PMC
December 2013

Maternity leave duration and postpartum mental and physical health: implications for leave policies.

J Health Polit Policy Law 2014 Apr 4;39(2):369-416. Epub 2013 Dec 4.

University of Maryland.

This study examines the association of leave duration with depressive symptoms, mental health, physical health, and maternal symptoms in the first postpartum year, using a prospective cohort design. Eligible employed women, eighteen years or older, were interviewed in person at three Minnesota hospitals while hospitalized for childbirth in 2001. Telephone interviews were conducted at six weeks (N = 716), twelve weeks (N = 661), six months (N = 625), and twelve months (N = 575) after delivery. Depressive symptoms (Edinburgh Postnatal Depression Scale), mental and physical health (SF-12 Health Survey), and maternal childbirth-related symptoms were measured at each time period. Two-stage least squares analysis showed that the relationship between leave duration and postpartum depressive symptoms is U-shaped, with a minimum at six months. In the first postpartum year, an increase in leave duration is associated with a decrease in depressive symptoms until six months postpartum. Moreover, ordinary least squares analysis showed a marginally significant linear positive association between leave duration and physical health. Taking leave from work provides time for mothers to rest and recover from pregnancy and childbirth. Findings indicate that the current leave duration provided by the Family and Medical Leave Act, twelve weeks, may not be sufficient for mothers at risk for or experiencing postpartum depression.
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http://dx.doi.org/10.1215/03616878-2416247DOI Listing
April 2014

The impact of prenatal employment on breastfeeding intentions and breastfeeding status at 1 week postpartum.

J Hum Lact 2013 Nov 18;29(4):620-8. Epub 2013 Sep 18.

1Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.

Background: Postpartum employment is associated with non-initiation and early cessation of breastfeeding, but less is known about the relationship between prenatal employment and breastfeeding intentions and behaviors.

Objective: This study aimed to estimate the relationship between prenatal employment status, a strong predictor of postpartum return to work, and breastfeeding intentions and behaviors.

Methods: Using data from the Listening to Mothers II national survey (N = 1573), we used propensity score matching methods to account for non-random selection into employment patterns and to measure the impact of prenatal employment status on breastfeeding intentions and behaviors. We also examined whether hospital practices consistent with the Baby-Friendly Hospital Initiative (BFHI), assessed based on maternal perception, were differentially associated with breastfeeding by employment status.

Results: Women who were employed (vs unemployed) during pregnancy were older, were more educated, were less likely to have had a previous cesarean delivery, and had fewer children. After matching, these differences were eliminated. Although breastfeeding intention did not differ by employment, full-time employment (vs no employment) during pregnancy was associated with decreased odds of exclusive breastfeeding 1 week postpartum (adjusted odds ratio = 0.48; 95% confidence interval, 0.25-0.92; P = .028). Higher BFHI scores were associated with higher odds of breastfeeding at 1 week but did not differentially impact women by employment status.

Conclusion: Women employed full-time during pregnancy were less likely to fulfill their intention to exclusively breastfeed, compared to women who were not employed during pregnancy. Clinicians should be aware that employment circumstances may impact women's breastfeeding decisions; this may help guide discussions during clinical encounters.
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http://dx.doi.org/10.1177/0890334413504149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835540PMC
November 2013

Lymph node evaluation for colon cancer in an era of quality guidelines: who improves?

J Oncol Pract 2013 Jul 19;9(4):e164-71. Epub 2013 Mar 19.

University of Texas Health Science Center at San Antonio, San Antonio, TX; University of Minnesota; and Masonic Cancer Center, Minneapolis, MN.

Introduction: In the 1990s, several organizations began recommending evaluation of > 12 lymph nodes during colon resection because of its association with improved survival. We examined practice implications of multispecialty quality guidelines over the past 20 years recommending evaluation of ≥ 12 lymph nodes during colon resection for adequate staging.

Materials And Methods: We used the 1988 to 2009 Surveillance, Epidemiology, and End Results program to conduct a retrospective observational cohort study of 90,203 surgically treated patients with colon cancer. We used Cochran-Armitage tests to examine trends in lymph node examination over time and multivariate logistic regression to identify patient characteristics associated with guideline-recommended lymph node evaluation.

Results: The introduction of practice guidelines was associated with gradual increases in guideline-recommended lymph node evaluation. From 1988 to 1990, 34% of patients had > 12 lymph nodes evaluated, increasing to 38% in 1994 to 1996 and to > 75% from 2006 to 2009. Younger, white patients and those with more-extensive bowel penetration (T3/4 nonmetastatic) and high tumor grade saw more-rapid increases in lymph node evaluation (P < .001). Multivariate analyses demonstrated a significant interaction between year of diagnosis and both T stage and grade, indicating that those with higher T stage and higher grade were more likely to receive guideline-recommended care earlier.

Conclusion: The implementation of lymph node evaluation guidelines was accepted gradually into practice but adopted more quickly among higher risk patients. By identifying patients who are least likely to receive guideline-recommended care, these findings present a starting point for promoting targeted improvements in cancer care and further understanding underlying contributors to these disparities.
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http://dx.doi.org/10.1200/JOP.2012.000812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710184PMC
July 2013

Postpartum doula and peer telephone support for postpartum depression: a pilot randomized controlled trial.

J Prim Care Community Health 2013 Jan 20;4(1):36-43. Epub 2012 Jun 20.

Department of Family Medicine & Community Health, University of Minnesota, Minneapolis, MN 55414, USA.

Objectives: This research provides the first test of feasibility of recruiting postpartum doulas and depressed mothers for a peer support intervention study and begins to evaluate the benefit of postpartum doula support and peer telephone support for at-risk mothers.

Methods: The authors recruited postpartum doulas from national doula organizations, peer telephone supporters from nursing referrals, and mothers with depressive symptoms from 3 local hospitals, local medical practices, Web sites, and community organizations. Participating mothers were randomized to 3 groups--postpartum doula, peer telephone support, and control group. Surveys were completed at 0, 3, and 6 months postenrollment.

Results: Thirty-nine mothers with depressive symptoms, 6 postpartum doulas, and 6 peer telephone supporters participated. The postpartum doula group, compared with the other 2 groups, had a higher proportion of women with a previous history of depression, and similarly, a higher proportion of women who were depressed and receiving depression treatment at the 6-month follow-up. Satisfaction with study-sponsored support was greater in the postpartum doula group than in the telephone support group.

Conclusions: It is feasible to recruit postpartum doulas, peer telephone supporters, and mothers with depressive symptoms for a peer support intervention trial. Mothers were more satisfied with postpartum doulas than peer telephone support. The authors recommend further research to assess the benefit of postpartum doula support for postpartum depression as adjunctive or alternative therapy.
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http://dx.doi.org/10.1177/2150131912451598DOI Listing
January 2013

Reevaluating the relationship between prenatal employment and birth outcomes: a policy-relevant application of propensity score matching.

Womens Health Issues 2013 Mar-Apr;23(2):e77-85. Epub 2012 Dec 21.

Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota 55455, USA.

Background: Prior research shows an association between prenatal employment characteristics and adverse birth outcomes, but suffers methodological challenges in disentangling women's employment choices from birth outcomes, and little U.S.-based prior research compares outcomes for employed women with those not employed. This study assessed the effect of prenatal employment status on birth outcomes.

Methods: With data from the Listening to Mothers II survey, conducted among a nationally representative sample of women who delivered a singleton baby in a U.S. hospital in 2005 (n = 1,573), we used propensity score matching to reduce potential selection bias. Primary outcomes were low birth weight (<2,500 g) and preterm birth (gestational age <37 weeks). Exposure was prenatal employment status (full time, part time, not employed). We conducted separate outcomes analyses for each matched cohort using multivariable regression models.

Findings: Comparing full-time employees with women who were not employed, full-time employment was not causally associated with preterm birth (adjusted odds ratio [AOR], 1.37; p = .47) or low birth weight (AOR, 0.73; p = .41). Results were similar comparing full- and part-time workers. Consistent with prior research, Black women, regardless of employment status, had increased odds of low birth weight compared with White women (AOR, 5.07; p = .002).

Conclusions: Prenatal employment does not independently contribute to preterm births or low birth weight after accounting for characteristics of women with different employment statuses. Efforts to improve birth outcomes should focus on the characteristics of pregnant women (employed or not) that render them vulnerable.
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http://dx.doi.org/10.1016/j.whi.2012.11.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596463PMC
July 2013

Hospital characteristics associated with maintenance or improvement of guideline-recommended lymph node evaluation for colon cancer.

Med Care 2013 Jan;51(1):60-7

Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.

Background: Over the past 20 years, surgical practice organizations have recommended the identification of ≥12 lymph nodes from surgically treated colon cancer patients as an indicator of quality performance for adequate staging; however, studies suggest that significant variation exists among hospitals in their level of adherence to this recommendation. We examined hospital-level factors that were associated with institutional improvement or maintenance of adequate lymph node evaluation after the introduction of surgical quality guidelines.

Research Design: Using the 1996-2007 SEER-Medicare data, we evaluated hospital characteristics associated with short-term (1999-2001), medium-term (2002-2004), and long-term (2005-2007) guideline-recommended (≥12) lymph node evaluation compared with initial evaluation levels (1996-1998) using χ tests and multivariate logistic regression analysis, adjusting for patient case-mix.

Results: We identified 228 hospitals that performed ≥6 colon cancer surgeries during each study period from 1996-2007. In the initial study period (1996-1998), 26.3% (n=60) of hospitals were performing guideline-recommended evaluation, which increased to 28.1% in 1999-2001, 44.7% in 2002-2004, and 70.6% in 2005-2007. In multivariate analyses, a hospital's prior guideline performance [odds ratio (OR) (95% confidence interval (CI)): 4.02 (1.92, 8.42)], teaching status [OR (95% CI): 2.33 (1.03, 5.28)], and American College of Surgeon's Oncology Group membership [OR (95% CI): 3.39 (1.39, 8.31)] were significantly associated with short-term guideline-recommended lymph node evaluation. Prior hospital performance [OR (95% CI): 2.41 (1.17, 4.94)], urban location [OR (95% CI): 2.66 (1.12, 6.31)], and American College of Surgeon's Oncology Group membership [OR (95% CI): 6.05 (2.32, 15.77)] were associated with medium-term performance; however, these factors were not associated with long-term performance.

Conclusions: Over the 12-year period, there were marked improvements in hospital performance for guideline-recommended lymph node evaluation. Understanding patterns in improvement over time contributes to debates over optimal designs of quality-improvement programs.
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http://dx.doi.org/10.1097/MLR.0b013e318270ba0dDOI Listing
January 2013

Quality of care along the cancer continuum: does receiving adequate lymph node evaluation for colon cancer lead to comprehensive postsurgical care?

J Am Coll Surg 2012 Sep 8;215(3):400-11. Epub 2012 Jun 8.

Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.

Background: Among surgically treated patients with colon cancer, lower long-term mortality has been demonstrated in those with 12 or more lymph nodes evaluated. We examined whether patients receiving adequate lymph node evaluation were also more likely to receive comprehensive postsurgical care, leading to lower mortality.

Study Design: We used the 1992 to 2007 Surveillance, Epidemiology, and End Results (SEER)-Medicare data to identify surgically treated American Joint Committee on Cancer (AJCC) stage III colon cancer patients. We used chi-square analyses and logistic regression to evaluate the association between adequate (≥12) lymph node evaluation and receipt of postsurgical care (adjuvant chemotherapy, surveillance colonoscopy, CT scans, and CEA testing) and Cox proportional hazards regression to evaluate 10-year all-cause mortality, adjusting for postsurgical care.

Results: Among 17,906 surgically treated stage III colon cancer patients, adequate (≥12) lymph node evaluation was not associated with receiving comprehensive postsurgical care after adjustment for patient and tumor characteristics (p > 0.05 for all). Initially, adequate lymph node evaluation was associated with lower all-cause mortality (hazard ratio [HR] 0.88; 95% CI [0.85 to 0.91]), but among 3-year survivors, the impact of adequate lymph node evaluation on lower mortality was diminished (HR 0.94; 95% CI [0.88 to 1.01]). However, receiving comprehensive postsurgical care was associated with continued lower mortality in 3-year survivors.

Conclusions: Adequate lymph node evaluation for colon cancer was associated with lower mortality among all patients. However, among 3-year survivors, the association between lymph node evaluation and lower hazard of death was no longer significant, while postsurgical care remained strongly associated with lower long-term mortality, indicating that postsurgical care may partially explain the relationship between lymph node evaluation and mortality.
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http://dx.doi.org/10.1016/j.jamcollsurg.2012.05.014DOI Listing
September 2012

Risk of physical assault against school educators with histories of occupational and other violence: a case-control study.

Work 2012 ;42(1):39-46

Midwest Center for Occupational Health and Safety Education and Research Center, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.

A case-control study design was used to investigate risks of work-related physical assault (PA) associated with a history of violent victimization among educators. A total of 6,469 state-licensed educators (Kindergarten - Grade 12) worked in the previous 12~months and were eligible to participate. Exposure data were collected from cases (reporting a PA event in previous 12 months, n=290) for the month before PA, and from controls (no work-related PA in previous 12 months; n=867) for a randomly selected working month. Odds ratios and 95% confidence intervals identified increased risks for educators with any prior history of work-related (17.3, 11.4-26.3) or non-work-related PA (2.0, 1.2-3.5). In addition, PA risk in the previous twelve months increased with the number of previous victimizations, and risk also increased for educators with histories of non-physical violence (work- and non work-related). The results present a compelling case for targeted interventions and further research.
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http://dx.doi.org/10.3233/WOR-2012-1331DOI Listing
August 2012

Postpartum depression and health services expenditures among employed women.

J Occup Environ Med 2012 Feb;54(2):210-5

Department of Health Services Administration, School of Public Health, University of Maryland, College Park, MD 20742, USA.

Objective: To investigate the association of postpartum depression with health services expenditures among employed women.

Methods: Women, aged 18 years and older, were recruited from three community hospitals in Minnesota while hospitalized for childbirth in 2001. Using Andersen's Behavioral Model, we regressed the natural log of the price-weighted sum of self-reported health services used from hospital discharge until 11 weeks postpartum on depression status at 5 weeks postpartum (Edinburgh Postnatal Depression Scale).

Results: Five percent of the women met the depression threshold. Two-stage least squares analyses showed that depressed women incurred 90% higher health services expenditures than nondepressed women. Older age, poverty, non-public assistance insurance status, and increased maternal symptoms also were associated with higher expenditures.

Conclusions: Higher health expenditures among postpartum depressed women highlight the importance of addressing mental health issues in the workplace.
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http://dx.doi.org/10.1097/JOM.0b013e31823fdf85DOI Listing
February 2012

Photovoice in the Red River Basin of the north: a systematic evaluation of a community-academic partnership.

Health Promot Pract 2012 Sep 18;13(5):599-607. Epub 2011 Nov 18.

Environmental Health Sciences, College of Public Health, Kent State University, Ohio 44242, USA.

A community-academic partnership was formed in Minnesota's Red River Basin for a 1-year planning grant preceding a larger intervention to reduce pesticide exposure among children. Photovoice, developed by Dr. Caroline Wang, was used by mothers to document pathways to pesticide exposure for their children along with other health and safety concerns. An evaluation of the partnership was conducted for mothers, and for the research team of local stakeholders and academics. Surveys consisting of structured and open-ended questions elicited information on the perception of the process and short-term outcomes. Questions were created based on objectives of the Photovoice project, satisfaction, and principles of community-based participatory research (CBPR). A high percentage of study participants and researchers indicated that the objectives of the effort had been met, the principles of CBPR had been realized and they were satisfied with the benefits of participation. A need for more thorough planning was identified related to long-term dissemination of knowledge generated. The evaluation provides insight on the strengths and weaknesses of the project, demonstrates to team members and funders that formative and summative outcomes were met, and serves as a model for community-academic partnerships utilizing Photovoice as one CBPR method.
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http://dx.doi.org/10.1177/1524839910370737DOI Listing
September 2012

Association between lymph node evaluation for colon cancer and node positivity over the past 20 years.

JAMA 2011 Sep;306(10):1089-97

Applied Research Program, National Cancer Institute, Executive Plaza North, 6130 Executive Blvd, MSC 7344, Bethesda, MD 20892-7344, USA.

Context: Among patients surgically treated for colon cancer, better survival has been demonstrated in those with more lymph nodes evaluated. The presumed mechanism behind this association suggests that a more extensive lymph node evaluation reduces the risk of understaging, leading to improved survival.

Objective: To further evaluate the mechanism behind lymph node evaluation and survival by examining the association between more extensive lymph node evaluation, identification of lymph node-positive cancers, and hazard of death.

Design: Observational cohort study.

Setting: Surveillance, Epidemiology, and End Results (SEER) program data from 1988 through 2008.

Patients: 86,394 patients surgically treated for colon cancer.

Main Outcome Measure: We examined the relationship between lymph node evaluation and node positivity using Cochran-Armitage tests and multivariate logistic regression. The association between lymph node evaluation and hazard of death was evaluated using Cox proportional hazards modeling.

Results: The number of lymph nodes evaluated increased from 1988 to 2008 but did not result in a significant overall increase in lymph node positivity. During 1988-1990, 34.6% of patients (3875/11,200) had 12 or more lymph nodes evaluated, increasing to 73.6% (9798/13,310) during 2006-2008 (P < .001); however, the proportion of node-positive cancers did not change with time (40% in 1988-1990, 42% in 2006-2008, P = .53). Although patients with high levels of lymph node evaluation were only slightly more likely to be node positive (adjusted odds ratio for 30-39 nodes vs 1-8 nodes, 1.11; 95% CI, 1.02-1.20), these patients experienced significantly lower hazard of death compared with those with fewer nodes evaluated (adjusted hazard ratio for 30-39 nodes vs 1-8 nodes, 0.66; 95% CI, 0.62-0.71; unadjusted 5-year mortality, 35.3%).

Conclusion: The number of lymph nodes evaluated for colon cancer has markedly increased in the past 2 decades but was not associated with an overall shift toward higher-staged cancers, questioning the upstaging mechanism as the primary basis for improved survival in patients with more lymph nodes evaluated.
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http://dx.doi.org/10.1001/jama.2011.1285DOI Listing
September 2011

A longitudinal analysis of total workload and women's health after childbirth.

J Occup Environ Med 2011 May;53(5):497-505

Division of Environmental Sciences, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.

Objectives: To examine the association of women's postpartum health with total workload (TWL), work and personal factors in the year after childbirth.

Methods: Employed women from Minneapolis and St Paul, Minnesota, were recruited while hospitalized for childbirth. Longitudinal analyses, using fixed effects regression models, estimated the associations of TWL, job satisfaction and stress, social support, perceived control, breastfeeding and infant characteristics with women's health at 5 weeks, 11 weeks, 6 months, and 12 months postpartum.

Results: Increased TWL over time was associated with significantly poorer mental health and increased symptoms.

Conclusions: High TWL--including reduced time for rest, recovery, and sleep--is a risk factor for women's mental health and symptoms 12 months after childbirth. Women's postpartum health was positively associated with social support, which may help to decrease the negative effects of excess work.
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http://dx.doi.org/10.1097/JOM.0b013e318217197bDOI Listing
May 2011

Triamino pyrimidines and pyridines as histamine H(4) receptor modulators.

Bioorg Med Chem Lett 2011 May 30;21(10):3113-6. Epub 2011 Mar 30.

Johnson & Johnson Pharmaceutical Research & Development, L.L.C., 3210 Merryfield Row, San Diego, CA 92121, USA.

Two series of triamino pyrimidines and a series of triamino pyridines have been synthesized and their structure-activity relationships evaluated for activity at the H(4) receptor in competitive binding and functional assays. Small structural changes in these three hetereoaromatic cores influenced the functional activity of these compounds.
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http://dx.doi.org/10.1016/j.bmcl.2011.03.017DOI Listing
May 2011

Problems with a diagnostic depression interview in a postpartum depression trial.

J Am Board Fam Med 2011 Mar-Apr;24(2):187-93

Department of Family Medicine and Community Health, University of Minnesota, St. Paul, MN 55103, USA.

Background: Diagnostic and Statistical Manual (DSM) IV-based depression interviews, valued for their diagnostic accuracy, are often considered to be essential for depression treatment trials. However, this requirement can be problematic because of participant burden. The purpose of this article is to describe our experience with the depression component of the Structured Clinical Interview for DSM Disorders (SCID) in a postpartum depression treatment trial.

Methods: In this prospective cohort study of 506 mothers of infants from 7 primary care clinics, participants were asked to complete the depression module of the SCID interview soon after enrollment. They were asked to complete the 9-item Patient Health Questionnaire (PHQ-9) depression survey at 0 to 1, 2, 4, 6, and 9 months postpartum.

Results: Forty-five women (8.9%) had a positive SCID interview and 112 (22.1%) had a positive PHQ-9 during 0 to 9 months postpartum. Problems encountered when using the SCID depression interview included (1) lower than expected SCID-based rates of depression diagnosis (8.9%); (2) SCID noncompletion by 75 women (14.8%); SCID noncompleters (vs completers) were younger, poorer, less educated, and more likely to be single and black (vs white); and (3) inconsistent SCID/PHQ-9 results. Nineteen women with moderately severe to severe PHQ-9 score elevations (≥15) had negative SCID scores; all of these women were functionally impaired. More than 90% of women with positive PHQ-9 scores reported some degree of impairment because of their depressive symptoms.

Conclusions: The requirement of a diagnostic depression interview resulted in selection bias and missed opportunities for depression diagnosis; these are problems that detract from the interview's key strength-its diagnostic accuracy. These problems should be considered when electing to use a DSM-IV-based depression interview in research.
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http://dx.doi.org/10.3122/jabfm.2011.02.100197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3097469PMC
July 2011

Postpartum depressive symptoms and the combined load of paid and unpaid work: a longitudinal analysis.

Int Arch Occup Environ Health 2011 Oct 5;84(7):735-43. Epub 2011 Mar 5.

Department of Health Services Administration, University of Maryland, College Park, MD 20742, USA.

Purpose: To investigate the effects of total workload and other work-related factors on postpartum depression in the first 6 months after childbirth, utilizing a hybrid model of health and workforce participation.

Methods: We utilized data from the Maternal Postpartum Health Study collected in 2001 from a prospective cohort of 817 employed women who delivered in three community hospitals in Minnesota. Interviewers collected data at enrollment and 5 weeks, 11 weeks, and 6 months after childbirth. The Edinburgh Postnatal Depression Scale measured postpartum depression. Independent variables included total workload (paid and unpaid work), job flexibility, supervisor and coworker support, available social support, job satisfaction, infant sleep problems, infant irritable temperament, and breastfeeding.

Results: Total average daily workload increased from 14.4 h (6.8 h of paid work; 7.1% working at 5 weeks postpartum) to 15.0 h (7.9 h of paid work; 87% working at 6 months postpartum) over the 6 months. Fixed effects regression analyses showed worse depression scores were associated with higher total workload, lower job flexibility, lower social support, an infant with sleep problems, and breastfeeding.

Conclusions: Working mothers of reproductive years may find the study results valuable as they consider merging their work and parenting roles after childbirth. Future studies should examine the specific mechanisms through which total workload affects postpartum depressive symptoms.
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http://dx.doi.org/10.1007/s00420-011-0626-7DOI Listing
October 2011

Changes in depressive symptoms over 0-9 months postpartum.

J Womens Health (Larchmt) 2011 Mar 25;20(3):381-6. Epub 2011 Feb 25.

Department of Family Medicine & Community Health, University of Minnesota, 580 Rice Street, St. Paul, MN 55103, USA.

Objective: To investigate mothers' changes in prevalence of postpartum depression (PPD) symptoms over 0-9 months postpartum and determine which symptoms best distinguish depressed from nondepressed women.

Methods: This was a prospective study of English-literate mothers of newborns, recruited from four family medicine clinics and three pediatric clinics. Mothers completed surveys at 0-1, 2, 4, 6, and 9 months postpartum, and surveys included demographic characteristics, a two-question depression screen, the 9-Item Patient Health Questionnaire (PHQ-9), and other health and work characteristics.

Results: There were 506 participants (33% response rate), and 112 (22.1%) had a positive PHQ-9 (score ≥10) at some time within the first 9 months after delivery. The proportion of women with a positive PHQ-9 was greatest at 0-1 month (12.5%), then fell to between 5.0% and 7.1% at 2-6 months, and rose again to 10.2% at 9 months postpartum. Most of the PHQ-9 symptoms differentiated well between depressed and nondepressed women; items that were less discriminating were abnormal sleep, abnormal appetite/eating, and fatigue. Assessment of possible predictors of a change from negative to positive PHQ-9 between 6 and 9 months postpartum revealed only one significant predictor: prior history of depression.

Conclusions: Depressive symptoms in this sample were most frequent at 0-1 month and 9 months postpartum. Most PHQ-9 items differentiated well between depressed and nondepressed mothers; these findings support the use of the PHQ-9 for PPD screening. Future research is needed to confirm our observed secondary peak in depressive symptoms at 9 months postpartum and to investigate possible causes.
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http://dx.doi.org/10.1089/jwh.2010.2355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058896PMC
March 2011

Violence against educators: a population-based study.

J Occup Environ Med 2011 Mar;53(3):294-302

Regional Injury Prevention Research Center and Center for Violence Prevention and Control, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN55455, USA.

Objective: Identify the magnitude and risk factors for occupational physical assault (PA) and nonphysical violence (NPV) against Minnesota educators.

Methods: Among 26,000 randomly selected licensed kindergarten to grade 12 educators, 6469 eligible educators reported whether they experienced PA or NPV during the prior year. Multiple logistic regression models were based on directed acyclic graphs.

Results: Respective PA and NPV annual rates per 100 educators were 8.3 and 38.4. Work changes resulted among PA (13% to 20%) and NPV (22%) victims. Risks increased for master's prepared or education specialists who worked in public alternative schools and special education. Risks decreased for those working for more than 20 years, part time, and in private schools. Physical assault risk decreased when teaching grades 3 to 12 (vs kindergarten to grade 2), but NPV risk increased.

Conclusion: Targeted efforts on specific violence risk and protective factors are essential to improve educators' work environments.
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http://dx.doi.org/10.1097/JOM.0b013e31820c3fa1DOI Listing
March 2011

Balancing work and family after childbirth: a longitudinal analysis.

Womens Health Issues 2011 Jan-Feb;21(1):19-27

SUNY Downstate Medical Center, Department of Environmental and Occupational Health, Brooklyn, New York 11203, USA.

Background: in the United States, women with young children have dramatically increased their participation in the workforce, resulting in greater potential conflict between work and family roles. However, few studies have examined postpartum work-family conflict. This study examined associations between work-family conflict and women's health after childbirth.

Methods: employed women, 18 years of age and older, were recruited while hospitalized for childbirth and followed for 18 months (n = 541; 66% response rate). Health outcomes were measured using the Short Form 12, version 2. Longitudinal fixed-effects models estimated the associations between work-family conflict (modeled as job and home spillover) and health.

Results: women who reported high levels of job spillover to home had mental health scores slightly, but significantly, worse than women who reported low levels of spillover (β = -1.26; SE = 0.47). Women with medium and high levels of home spillover to job also reported worse mental health (β = -0.81, SE = 0.30; and β = -1.52, SE = 0.78) relative to those with low spillover. Women who reported medium (versus low) levels of home spillover reported slightly improved physical health (β = 0.64, SE = 0.30). There was no significant association between job spillover and physical health.

Conclusion: this study focused exclusively on employed postpartum women. Results illustrate that job and home spillover are associated with maternal mental and physical health. Findings also revealed that flexible work arrangements were associated with poorer postpartum mental health scores, which may reflect unintended consequences, such as increasing the amount of work brought home.
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http://dx.doi.org/10.1016/j.whi.2010.08.003DOI Listing
March 2011

Written violence policies and risk of physical assault against Minnesota educators.

J Public Health Policy 2010 Dec;31(4):461-77

University at Buffalo, Farber Hall G56, 3435 Main Street, Building #26, Buffalo, New York 14214, USA.

Few research studies on school violence policies use quantitative methods to evaluate the impact of policies on workplace violence. This study analyzed nine different written violence policies and their impact on work-related physical assault in educational settings. Data were from the Minnesota Educators' Study. This large, nested case control study included cases (n=372) who reported physical assaults within the last year, and controls (n=1116) who did not. Multivariate logistic regression analyses, using directed acyclic graphs, estimated risk of assault. Results of the adjusted multivariate model suggested decreased risks of physical assault were associated with the presence of policies regarding how to report sexual harassment, verbal abuse, and threat (OR 0.53; 95 per cent CI: 0.30-0.95); assurance of confidential reporting of events (OR 0.67; 95 per cent CI: 0.44-1.04); and zero tolerance for violence (OR 0.70; 95 per cent CI: 0.47-1.04).
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http://dx.doi.org/10.1057/jphp.2010.32DOI Listing
December 2010

Agonist/antagonist modulation in a series of 2-aryl benzimidazole H4 receptor ligands.

Bioorg Med Chem Lett 2010 Jun 11;20(11):3367-71. Epub 2010 Apr 11.

Johnson & Johnson Pharmaceutical Research & Development, L.L.C, 3210 Merryfield Row, San Diego, CA 92121, USA.

The present work details the transformation of a series of human histamine H(4) agonists into potent functional antagonists. Replacement of the aminopyrrolidine diamine functionality with a 5,6-fused pyrrolopiperidine ring system led to an antagonist. The dissection of this fused diamine led to the eventual replacement with heterocycles. The incorporation of histamine as the terminal amine led to a very potent and selective histamine H(4) agonist; whereas incorporation of the constrained histamine analog, spinacamine, modulated the functional activity to give a partial agonist. In two separate series, we demonstrate that constraining the terminal amino portion modulated the spectrum of functional activity of histamine H(4) ligands.
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http://dx.doi.org/10.1016/j.bmcl.2010.04.017DOI Listing
June 2010
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