Trends in workplace homicides in the U.S., 1994-2021: An end to years of decline

Workplace and non-workplace homicides in the United States (U.S.) have declined for over 30 years until recently. This study was conducted to address the change in trends for both workplace and non-workplace homicides and to evaluate the homogeneity of the change in workplace homicides by specified categories. Joinpoint and autoregressive models were used to assess trends of U.S. workplace and non-workplace homicides utilizing surveillance data collected by the Bureau of Labor Statistics and the Federal Bureau of Investigation from 1994 through 2021. Both workplace and non-workplace homicides decreased significantly from 1994 through 2014. Workplace homicides showed no significant trend from 2014 through 2021 (p = 0.79), while non-workplace homicides showed a significant average annual increase of 4.1% from 2014 through 2020 (p = 0.0013). The large decreases in the trend of workplace homicides occurring during a criminal act, such as robbery, leveled off and started to increase by the end of the study period (p < 0.0001). Declines in workplace homicides due to shootings also leveled off and started to increase by the end of the study period (p < 0.0001). U.S. workplace and non-workplace homicide rates declined from the 1990s until around 2014. Trends in workplace homicides varied by the types of the homicide committed and by the type of employee that was the victim. Criminal-intent-related events, such as robbery, appear to be the largest contributor to changes in workplace homicides. Researchers and industry leaders could develop and evaluate interventions that further address criminal-intent-related workplace homicides.

Lifetime Upward Economic Mobility and US-Born Latina Women's Preterm Birth Rates

OBJECTIVES

To determine whether Latina women's upward economic mobility from early-life residence in impoverished urban neighborhoods is associated with preterm birth (< 37 weeks, PTB) .

METHODS

Multivariate logistic regression analyses were performed on the Illinois transgenerational birth-file with appended US census income information for Hispanic infants (born 1989-1991) and their mothers (born 1956-1976).

RESULTS

In Chicago, modestly impoverished-born Latina women (n = 1,674) who experienced upward economic mobility had a PTB rate of 8.5% versus 13.1% for those (n = 3,760) with a lifelong residence in modestly impoverished neighborhoods; the unadjusted and adjusted (controlling for age, marital status, adequacy of prenatal care, and cigarette smoking) RR equaled 0.65 (0.47, 0.90) and 0.66 (0.47, 0.93), respectively. Extremely impoverished-born Latina women (n = 2,507) who experienced upward economic mobility across their life-course had a PTB rate of 12.7% versus 15.9% for those (n = 3,849) who had a lifelong residence in extremely impoverished neighborhoods, the unadjusted and adjusted RR equaled 0.8 (0.63. 1.01) and 0.95 (0.75, 1.22), respectively.

CONCLUSIONS FOR PRACTICE

Latina women's upward economic mobility from early-life residence in modestly impoverished urban neighborhoods is associated with a decreased risk of PTB. A similar trend is absent among their peers with an early-life residence in extremely impoverished areas.

The association between safety climate and noncombat injury events among United States Air Force workers

INTRODUCTION

Work-related injuries are a common lagging safety indicator whereas safety climate assessments can help identify constructs serving as leading indicators. The National Institute for Occupational Safety and Health (NIOSH) partnered with the U.S. Department of the Air Force (DAF) Safety Center to examine the association between perceptions of safety climate survey constructs and the number of injury events within the DAF workforce.

METHODS

The DAF administers voluntary, anonymous, occupation-specific safety climate surveys to DAF workers using the internal Air Force Combined Mishap Reduction System (AFCMRS). Survey responses from 2014 to 2018 provided by DAF workers and injury events in maintenance, support, and operations occupations were shared with NIOSH. Exploratory Factor Analysis revealed five constructs: Leadership and Communication; Organizational Safety Priority; Error Management; Resource Adequacy; and Deployment/Official Travel Impact. Squadron-level analysis included bivariate correlations and estimated Rate Ratios (RRs).

RESULTS

1,547 squadrons administered the survey, averaging 144 workers and 15.8 reportable injuries per squadron. Higher (more favorable) squadron-level construct scores were consistently correlated with fewer reported injuries (p < 0.001). Controlling for the number of workers, RRs revealed significant reductions in injury rates with each one-unit increase in responses: Leadership and Communication RR = 0.40 (95%CI: 0.32-0.48); Organizational Safety Priority RR = 0.50 (95%CI: 0.40-0.64); Error Management RR = 0.37 (95%CI: 0.30-0.47); Deployment/Official Travel Impact RR = 0.36 (95%CI: 0.29-0.45). Resource Adequacy revealed a non-significant lower injury rate RR = 0.87 (95%CI: 0.73-1.04).

CONCLUSIONS

This unique study quantified safety climate and the association with injuries across a multi-year period. While safety climate measurements may be limited by frequent turnover and the self-reported, voluntary, anonymous nature of AFCMRS, the strength of this study is in the census of injuries.

PRACTICAL APPLICATIONS

Future research should include longitudinal analyses to examine the impact on injuries when squadron leaders are provided feedback on safety climate survey results.

Mexican-American Women's Lifelong Residence in the United States Is Associated with an Increased Risk of Gastroschisis: A Population-Based Study

OBJECTIVE

To determine whether nativity is associated with abdominal wall defects among births to Mexican-American women.

STUDY DESIGN

Using a cross-sectional, population-based design, stratified and multivariable logistic regression analyses were performed on the 2014-2017 National Center for Health Statistics live-birth cohort dataset of infants of US-born (n = 1 398 719) and foreign-born (n = 1 221 411) Mexican-American women.

RESULTS

The incidence of gastroschisis was greater among births to US-born compared with Mexico-born Mexican-American women: 36.7/100 000 vs 15.5/100 000, RR = 2.4 (2.0, 2.9). US-born (compared with Mexico-born) Mexican-American mothers had a greater percentage of teens and cigarette smokers, P < .0001. In both subgroups, gastroschisis rates were greatest among teens and decreased with advancing maternal age. Adjusting for maternal age, parity, education, cigarette smoking, pre-pregnancy body mass index, prenatal care usage, and infant sex), OR of gastroschisis for US-born (compared with Mexico-born) Mexican-American women was 1.7 (95% CI 1.4-2.0). The population attributable risk of maternal birth in the US for gastroschisis equaled 43%. The incidence of omphalocele did not vary by maternal nativity.

CONCLUSIONS

Mexican-American women's birth in the US vs Mexico is an independent risk factor for gastroschisis but not omphalocele. Moreover, a substantial proportion of gastroschisis lesions among Mexican-American infants is attributable to factors closely related to their mother's nativity.

Explaining the Link Between Paternal Socioeconomic Position and Small for Gestational Age Birth: The Effect of Maternal Unhealthy Behaviors

OBJECTIVE

To determine the proportion of small for gestational age (weight < 10th percentile, SGA) births among fathers with lifelong low (compared to high) socioeconomic position (SEP) attributable to white and African-American women's unhealthy pregnancy-related behaviors.

METHODS

Oaxaca-Blinder decomposition methods were conducted on the Illinois transgenerational dataset of infants (1989-1991) and their Chicago-born parents (1956-1976) with appended US census income data. The neighborhood income of father's residence at the time of his birth and at the time of his infant's birth were used to estimate his lifetime SEP. Maternal unhealthy pregnancy-related behaviors were defined as cigarette smoking, inadequate prenatal care, and/or low weight gain during pregnancy.

RESULTS

Among African-American women, births (n = 4426) to fathers with lifetime low SEP had an SGA rate of 14.8% compared to 12.1% for those (n = 365) born to fathers with lifetime high SEP (p < 0.0001). Among white women, births (n = 1430) to fathers with lifetime low SEP had an SGA rate of 9.8% compared to 6.2% for those (n = 9141) born to fathers with lifetime high SEP (p < 0.0001). Adjusting for maternal age, marital status, education, and parity, African-American and white women's unhealthy pregnancy behaviors accounted for 25% and 33%, respectively, of the disparity in SGA rates among infants of lifetime low (compared to high) SEP fathers.

CONCLUSION

A significant proportion of the disparity in SGA rates between fathers with lifelong low (compared to high) SEP is explained in both races by maternal unhealthy pregnancy behaviors.

Disparities in 1-Year-Mortality in Infants With Cyanotic Congenital Heart Disease: Insights From Contemporary National Data

BACKGROUND

Racial inequities in congenital heart disease (CHD) outcomes are well documented, but contributing factors warrant further investigation. We examined the interplay between race, socioeconomic position, and neonatal variables (prematurity and small for gestational age) on 1-year death in infants with CHD. We hypothesize that socioeconomic position mediates a significant part of observed racial disparities in CHD outcomes.

METHODS

Linked birth/death files from the Natality database for all liveborn neonates in the United States were examined from 2014 to 2018. Infants with cyanotic CHD were identified. Non-Hispanic Black (NHB) and Hispanic infants were compared with non-Hispanic White (NHW) infants. The primary outcome was 1-year death. Socioeconomic position was defined as maternal education and insurance status. Variables included as mediators were prematurity, small for gestational age, and socioeconomic position. Structural equation modeling was used to calculate the contribution of each mediator to the disparity in 1-year death.

RESULTS

We identified 7167 NHW, 1393 NHB, and 1920 Hispanic infants with cyanotic CHD. NHB race and Hispanic ethnicity were associated with increased 1-year death compared to NHW (OR, 1.43 [95% CI, 1.25-1.64] and 1.17 [95% CI, 1.03-1.33], respectively). The effect of socioeconomic position explained 28.2% (CI, 15.1-54.8) of the death disparity between NHB and NHW race and 100% (CI, 42.0-368) of the disparity between Hispanic and NHW. This was mainly driven by maternal education (21.3% [CI, 12.1-43.3] and 82.8% [CI, 33.1-317.8], respectively) while insurance status alone did not explain a significant percentage. The direct effect of race or ethnicity became nonsignificant: NHB versus NHW 43.1% (CI, -0.3 to 63.6) and Hispanic versus NHW -19.0% (CI, -329.4 to 45.3).

CONCLUSIONS

Less privileged socioeconomic position, especially lower maternal education, explains a large portion of the 1-year death disparity in Black and Hispanic infants with CHD. These findings identify targets for social interventions to decrease racial disparities.

Women's Economic Mobility and Small for Gestational Age Rates: The Effect of Paternal Early-Life Socioeconomic Position

OBJECTIVE

To determine whether paternal early-life socioeconomic position (defined by neighborhood income) modifies the association of maternal economic mobility and infant small for gestational age (weight for gestational age < 10th percentile, SGA) rates.

METHODS

Stratified and multilevel binomial regression analyses were executed on the Illinois transgenerational dataset of parents (born 1956-1976) and their infants (born 1989-1991) with appended U.S. census income information. Only Chicago-born women with an early-life residence in impoverished or affluent neighborhoods were studied.

RESULTS

The incidence of impoverished-born women's upward economic mobility among births (n = 3777) with early-life low socioeconomic position (SEP) fathers was less than that of those (n = 576) with early-life high SEP fathers: 56% vs 71%, respectively, p < 0.01. The incidence of affluent-born women's downward economic mobility among births (n = 2370) with early-life low SEP fathers exceeded that of those (n = 3822) with early-life high SEP fathers: 79% vs 66%, respectively, p < 0.01. The adjusted RR of infant SGA for maternal upward (compared to lifelong impoverishment) economic mobility among fathers with early-life low and high SEP equaled 0.68 (0.56, 0.82) and 0.81 (0.47, 1.42), respectively. The adjusted RR of infant SGA for maternal downward (compared to lifelong residence in affluent neighborhoods) economic mobility among fathers with early-life low and high SEP were 1.37 (0.91, 2.05) and 1.17 (0.86, 1.59), respectively.

CONCLUSIONS

Paternal early-life SEP is associated with maternal economic mobility (both upward and downward); however, it does not modify the relationship between maternal economic mobility and infant SGA rates.

Fetal Origins of Health Disparities: Transgenerational Consequences of Racism

Despite advances in perinatal medicine, racial disparity in birth outcomes remains a public health problem in the USA. The underlying mechanisms for this long-standing racial disparity are incompletely understood. This review presents transgenerational risk factors for racial disparities in preterm birth, exploring the impact of interpersonal and structural racism, theoretical models of stress, and biological markers of racial disparities.

The Relation of Neighborhood Racial and Income Polarity to Preterm Birth Rates in Chicago

OBJECTIVES

To investigate the extent to which spatial social polarization is associated with preterm birth among urban African-American and non-Latinx white women, and whether prenatal care modifies this relationship.

METHODS

We performed multilevel logistic regression analyses on a 2013-2017 dataset of Chicago vital records (N = 29,179) with appended Index of Concentration at the Extremes (ICE) values for race and income.

RESULTS

Women who resided in the bottom ICE quintile neighborhoods had a preterm birth rate of 11.5%, compared to 7.3% for those who live in the top ICE quintile areas; adjusted odds ratio (aOR) equaled 1.72 (95% confidence interval [CI] = 1.39, 2.12). This disparity widened for early (< 34 weeks) preterm birth rates, aOR = 2.60 (1.77, 3.81). These associations persisted among women with adequate prenatal care utilization.

CONCLUSIONS FOR PRACTICE

Spatial polarization of race and income in urban African-American and non-Latinx white women's residential environment is strongly associated with preterm birth rates, even among those who receive adequate prenatal care. These findings highlight the benefit of using ICE to contextualize the impact of urban neighborhood-level characteristics on preterm birth rates.

Adverse Maternal Fetal Environment Partially Mediates Disparate Outcomes in Non-White Neonates with Major Congenital Heart Disease

OBJECTIVE

To determine whether differential exposure to an adverse maternal fetal environment partially explains disparate outcomes in infants with major congenital heart disease (CHD).

STUDY DESIGN

Retrospective cohort study utilizing a population-based administrative California database (2011-2017). Primary exposure: Race/ethnicity. Primary mediator: Adverse maternal fetal environment (evidence of maternal metabolic syndrome and/or maternal placental syndrome).

OUTCOMES

Composite of 1-year mortality or severe morbidity and days alive out of hospital in the first year of life (DAOOH). Mediation analyses determined the percent contributions of mediators on pathways between race/ethnicity and outcomes after adjusting for CHD severity.

RESULTS

Included were 2747 non-Hispanic White infants (reference group), 5244 Hispanic, and 625 non-Hispanic Black infants. Hispanic and non-Hispanic Black infants had a higher risk for composite outcome (crude OR: 1.18; crude OR: 1.25, respectively) and fewer DAOOH (-6 & -12 days, respectively). Compared with the reference group, Hispanic infants had higher maternal metabolic syndrome exposure (43% vs 28%, OR: 1.89), and non-Hispanic Black infants had higher maternal metabolic syndrome (44% vs 28%; OR: 1.97) and maternal placental syndrome exposure (18% vs 12%; OR, 1.66). Both maternal metabolic syndrome exposure (OR: 1.21) and maternal placental syndrome exposure (OR: 1.56) were related to composite outcome and fewer DAOOH (-25 & -16 days, respectively). Adverse maternal fetal environment explained 25% of the disparate relationship between non-Hispanic Black race and composite outcome and 18% of the disparate relationship between Hispanic ethnicity and composite outcome. Adverse maternal fetal environment explained 16% (non-Hispanic Black race) and 21% (Hispanic ethnicity) of the association with DAOOH.

CONCLUSIONS

Increased exposure to adverse maternal fetal environment contributes to racial and ethnic disparities in major CHD outcomes.

Nativity and perinatal outcome disparities in the United States: Beyond the immigrant paradox

In the United States (US), epidemiologists have long documented paradoxically lower rates of adverse perinatal health outcomes among immigrant birthing people than what might be expected in light of socioeconomic and language barriers to healthcare, especially as compared to their US-born racial and ethnic counterparts. However, researchers have also documented significant variability in this immigrant birth paradox when examining within and across racial and ethnic subgroups. This review paper summarizes fifty years of research regarding differences in low, preterm birth, and infant mortality in the US, according to the nativity status of the birthing person. While there is ample evidence of the importance of nativity in delineating a pregnant person's risk of adverse infant outcomes, this review also highlights the relative paucity of research exploring the intersection of acculturation, ethnic enclaves, and structural segregation. We also provide recommendations for advancing the study of perinatal outcomes among immigrants.

Risk factors for death during newborn and post-newborn hospitalizations among preterm infants

OBJECTIVES

To examine risk factors for mortality among preterm infants during newborn and subsequent hospitalizations, and whether they differ by race/ethnicity.

STUDY DESIGN

We conducted a cross-sectional analysis using the 2016 Kids Inpatient Database. Hospitalizations of preterm infants were categorized as "newborn" for birth admissions, and "post-newborn" for all others. Multivariate logistic regression was performed to calculate associations of mortality with sociodemographic factors.

RESULTS

Of 285915 hospitalizations, there were 7827 (2.7%) deaths. During newborn hospitalizations, adjusted OR (aOR) of death equaled 1.14 (95% CI 1.09-1.20) for males, 68.73 (61.91-76.30) for &lt;29 weeks GA, and 0.81 (0.71-0.92) for transfer. Stratified by race/ethnicity, aOR was 0.69 (0.61-0.71) for Medicaid only among black infants. During post-newborn hospitalizations, death was associated with transfer (aOR 5.02, 3.31-7.61).

CONCLUSIONS

Risk factors for death differ by hospitalization types and race/ethnicity. Analysis by hospitalization types may identify risk factors that inform public health interventions for reducing infant mortality.

Black Babies Matter

Despite dramatic advancements in neonatal intensive care since the 1960s, African-American infants still have more than a two-fold higher first-year mortality rate than non-Latinx White infants. Our essay examines the impact of upstream factors closely linked to the historical and contemporary context of structural racism in the United States on the African-American women's birth outcome disadvantage. In the process, we propose a paradigm to address the racial health inequity in adverse birth outcome by considering the interplay of racism and social class.

Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes

In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.

The Excess Preterm Birth Rate Among US-Born (Compared to Foreign-Born) Black Women: The Role of Father's Education

OBJECTIVE

To ascertain the component of the excess preterm birth (< 37 weeks, PTB) rate among US-born (compared to foreign-born) Black women attributable to differences in acknowledged father's education attainment.

METHODS

Stratified analyses and Oaxaca-Blinder decomposition methods were performed on the 2013 National Center for Health Statistics birth certificate files of singleton infants with acknowledged fathers.

RESULTS

US-born Black women (N = 196,472) had a PTB rate of 13.3%, compared to 10.8% for foreign-born Black women (N = 51,334; Risk Difference (95% confidence interval) = 2.5 (2.3, 2.8). Infants of US-born black women had a greater a percentage of fathers with a high school diploma or less and a lower percentage of fathers with bachelor's degrees or higher than their counterparts of foreign-born women. In both subgroups, PTB rates tended to decline as the level of paternal education attainment rose. In an Oaxaca model (controlling for maternal age, education, marital status, parity, adequacy of prenatal care utilization, and chronic medical conditions), differences in paternal education attainment explained 15% of the maternal nativity disparity in PTB rates. In contrast, maternal education attainment accounted for approximately 4% of the disparity in PTB rates.

CONCLUSIONS FOR PRACTICE

Acknowledged father's low level of education attainment, or something closely related to it, explains a notable proportion of the disparity in PTB rates between US-born and foreign-born Black women.

Understanding Racial Disparities of Preterm Birth Through the Placenta

The racial disparity associated with preterm birth is a public health concern in the United States. The placenta is the principal metabolic, respiratory, and endocrine organ of the fetus and a key route by which environmental exposures are transmitted from mother to offspring. Available at every delivery, it may serve as a marker of differences in prenatal exposures that manifest differently by race. Recently, we described differences in placental pathology between African-American and White preterm births: the prevalence of chronic inflammation was higher among African-American women's placentas compared with those of White women. Similarly, racial differences have been shown in placental malperfusion and placental weight. Social determinants such as poverty and stress from discrimination have been implicated in racial disparities in preterm birth. To date, however, the underlying biological mechanisms, whether through inflammatory, oxidative stress, or other pathways involving epigenetic programming, remain largely unknown. The placenta, complemented by maternal and umbilical cord blood biomarkers, may provide important information on the perinatal environment that explains the origins of racial disparities in preterm birth rates and subsequent health outcomes. This article reviews existing literature and current research gaps. Opportunities are discussed for future placental research that may reveal novel mechanisms leading to the development of new approaches in the prevention and management of preterm birth and its outcomes.

Adverse birth outcome across the generations: the contribution of paternal factors

PURPOSE

There is literature suggesting an intergenerational relationship between maternal and infant size for gestational age status and preterm birth, but much less is known about the contribution of paternal birth outcome to infant birth outcome. This study seeks to determine the association between paternal and infant small-for-gestational-age status (weight for gestational age < 10th percentile, SGA) and preterm birth (< 37 weeks gestation, PTB) in a large, diverse population-based sample in the United States.

METHODS

Stratified and log-binomial multivariable regression analyses were computed on the vital records of Illinois-born infants (1989-1991) and their Illinois-born parents (born 1956-1976).

RESULTS

Among non-Hispanic Whites (n = 83,218), the adjusted (controlling for maternal SGA or PTB, age, parity, education, marital status, prenatal care, and cigarette smoking) relative risk (95% confidence interval) of infant SGA and PTB for former SGA (compared to non-SGA) and preterm (compared to term) fathers equaled 1.65 (1.53, 1.77) and 1.07 (0.92, 1.24), respectively. Among African-Americans (n = 8401), the adjusted relative risk (95% confidence interval) of infant SGA and PTB for former SGA (compared to non-SGA) and preterm (compared to term) fathers equaled 1.32 (1.14, 1.52) and 1.19 (0.98, 1.45), respectively.

CONCLUSION

Paternal adverse birth outcome, particularly SGA, is a modest risk factor for corresponding adverse infant outcome, independent of maternal risk status. This phenomenon appears to occur similarly among non-Hispanic White and African-American women.

Neighborhood Gun Violence and Birth Outcomes in Chicago

OBJECTIVES

To examine the association between gun violence and birth outcomes among women in Chicago.

METHODS

Using a 5-year set of birth files (2011-2015) merged with census and police data, birth outcomes including low birth weight (LBW, BW < 2500 g), preterm birth (PTB, < 37 weeks gestation), and small-for-gestational-age (SGA, BW < 10th percentile) were examined among non-Hispanic (NH) white, NH black, and Hispanic women in Chicago. Gun violence rates were categorized into tertiles. Multilevel, multiple logistic regression examined the effects of gun violence and race/ethnicity on birth outcomes.

RESULTS

Of 175,065 births, 10.6% of LBW, 10.6% of PTB, and 9.1% of SGA occurred in high violence tertile. Using white women in low violence tertile as reference, the OR for LBW among black women ranged 1.9-2.1 across all tertiles, and 0.8-1.2 among Hispanic women. OR for PTB for black women were 1.6-1.7 and 1.0-1.2 for Hispanic women, and OR for SGA for black women were 1.6-1.7 and for Hispanic women 0.9-1.0.

CONCLUSIONS FOR PRACTICE

In Chicago, race/ethnicity was associated with birth outcomes, regardless of the level of exposure to gun violence, in 2011-2015. The differences in racial/ethnic composition across the violence exposure levels suggest that, rather than gun violence alone, residential segregation and the geographic inequities likely contribute to disparate birth outcomes.

Racial differences in placental pathology among very preterm births

INTRODUCTION

African American women are at higher risk for preterm birth compared to white women, but no placental pathology has characterized this disparity. The objective of this study was to examine the association of race with placental pathology among very preterm births.

METHODS

We conducted an eight-year retrospective cohort study of very preterm infants born at ≤32 weeks at Northwestern Prentice Women's Hospital in Chicago, Illinois. Archived placental slides underwent standardized masked histopathologic review. Logistic regression was performed for placental pathology, adjusting for available relevant covariates and stratified by infant sex and gestational age.

RESULTS

Placentas were available for 296 white and 224 African American mother-infant pairs among births at ≤32 weeks gestation. Compared to placentas from white births, the adjusted OR (aOR) for acute inflammation in placentas from African American births was 1.95 (95% CI 0.87-4.37), the aOR for chronic inflammation was 3.35 (1.49-7.54), the aOR for fetal vascular pathology was 0.82 (0.29-2.32), and the aOR for maternal vascular pathology was 1.01 (0.51-1.99). Stratified analysis showed associations between all placental pathologies and race among male births. Across gestational age groups (<28 and ≥ 28 weeks), the association between race and placental pathology was present for chronic inflammation and fetal vascular pathology.

DISCUSSION

Race is associated with placental pathology, and in particular, with chronic inflammation among very preterm births. The effect is modified by infant sex and gestational age. Placental histopathology may be useful markers for understanding the biological processes that shape disparities in pregnancy outcomes.

Low Birth Weight Among Infants Born to Black Latina Women in the United States

Objectives To explore associations between race, nativity, and low birth weight (LBW) among Latina and non-Latina women, with special attention to the Black Latina subgroup. Methods Using US natality data from 2011 to 2013, we designed a population-based study to compare LBW (< 2500 g) rates across six groups of women with self-identified race (N = 7,865,264)-White and Black Latina, foreign-born and US-born; non-Latina Black; and non-Latina White-creating 4 models for analysis: unadjusted (Model 1) and adjusted for sociodemographic factors (Model 2), sociodemographic plus medical risk factors (Model 3), and Model 3 factors plus smoking (Model 4). Results Infant LBW rate for Black Latinas (7.9%) was higher than White Latinas (5.6%) and varied by nativity: US-born (8.9%) versus foreign-born (6.1%). Among all study groups, US-born Black Latinas' LBW rate (8.9%) was second only to non-Latina Blacks (11.0%). In unadjusted Model 1, US-born Black Latinas had 81% (odds ratio [OR]: 1.81; 95% confidence interval [CI]: 1.74-1.88) and foreign-born Black Latinas had 22% (OR: 1.22; 95% CI 1.15-1.29) higher odds of LBW than non-Latina White women (reference group). However, in Model 2, ORs for foreign-born Black Latinas were nearly identical to non-Latina Whites (OR: 1.03; 95% CI 0.97-1.1), while US-born Black Latinas' odds were still 47% higher (OR: 1.47; 95% CI 1.42-1.53). Model 3 ORs for each group were similar to Model 2. Conclusions for Practice A significant subgroup of Latina women self-identify as Black, and their LBW rates are higher than White Latinas. Black Latinas born in the United States fare worse than their foreign-born counterparts, implicating negative effects of Black race specific to the US context.

Recommendations for a standardised educational program in robot assisted gynaecological surgery: Consensus from the Society of European Robotic Gynaecological Surgery (SERGS)

BACKGROUND

The Society of European Robotic Gynaecological Surgery (SERGS) aims at developing a European consensus on core components of a curriculum for training and assessment in robot assisted gynaecological surgery.

METHODS

A Delphi process was initiated among a panel of 12 experts in robot assisted surgery invited through the SERGS. An online questionnaire survey was based on a literature search for standards in education in gynaecological robot assisted surgery. The survey was performed in three consecutive rounds to reach optimal consensus. The results of this survey were discussed by the panel and led to consensus recommendations on 39 issues, adhering to general principles of medical education.

RESULTS

On review there appeared to be no accredited training programs in Europe, and few in the USA. Recommendations for requirements of training centres, educational tools and assessment of proficiency varied widely. Stepwise and structured training together with validated assessment based on competencies rather than on volume emerged as prerequisites for adequate and safe learning. An appropriate educational environment and tools for training were defined. Although certification should be competence based, the panel recommended additional volume based criteria for both accreditation of training centres and certification of individual surgeons.

CONCLUSIONS

Consensus was reached on minimum criteria for training in robot assisted gynaecological surgery. To transfer results into clinical practice, experts recommended a curriculum and guidelines that have now been endorsed by SERGS to be used to establish training programmes for robot assisted surgery.

African-American women's Upward Economic Mobility and Small for Gestational Age Births: A Population-Based Study

Background The relationship between African-American women's upward economic mobility and small for gestational age (weight for gestational < 10th percentile, SGA) rates is incompletely understood. Objective To ascertain the extent to which African-American women's upward economic mobility from early-life impoverishment is coupled with reduced SGA rates. Methods Stratified and multilevel logistic regression analyses were completed on the Illinois transgenerational dataset of African-American infants (1989-1991) and their Chicago-born mothers (1956-1976) with linked U.S. census income information. Results Impoverished-born (defined as lowest quartile of neighborhood income distribution) African-American women (n = 4891) who remained impoverished by the time of delivery had a SGA rate of 19.7%. Individuals who achieved low (n = 5827), modest (n = 2254), or high (n = 732) upward economic mobility by adulthood had lower SGA rates of 17.2, 14.8, and 13.7%, respectively; RR = 0.9 (0.8-0.9), 0.8 (0.7-0.8), and 0.7 (0.6-0.8), respectively. In adjusted (controlling for traditional individual-level risk factors) multilevel regression models, there was a decreasing linear trend in SGA rates with increasing levels of upward economic mobility; the adjusted RR of SGA birth for impoverished-born African-American women who experienced low, modest, of high (compared to no) upward mobility equaled 0.95 (0.91, 0.99), 0.90 (0.83, 0.98), and 0.86 (0.75, 0.98), respectively, p < 0.05. Conclusions African-American women's upward economic mobility from early-life residence in poor urban communities is associated with lower SGA rates independent of adulthood risk status.

Father's Lifetime Socioeconomic Status, Small for Gestational Age Infants, and Infant Mortality: A Population-Based Study

Objective

To ascertain the association between father's lifetime socioeconomic status (SES) and rates of small for gestational age (SGA, defined as weight for gestational age <10th percentile) and infant mortality (defined as <365 days).

Methods

The study sample was limited to the singleton births of African American (n=8,331), non-Latina White (n=18,200), and Latina (n=2,637) women. Stratified and multilevel, multivariable logistic regression analyses were conducted on the Illinois transgenerational dataset of infants (1989-1991) and their Chicago-born parents (1956-1976) with appended US census income data (n=29,168). The median family income of father's census tract residence during childhood and parenthood were used to assess lifetime SES.

Results

Births (n=8,113) to fathers with a lifetime low SES had a SGA rate of 13.3% compared with 6.6% for those (n=10,329) born to fathers with a lifetime high SES, RR = 1.97 (1.79, 2.17). The infant mortality rate of births to fathers with a lifetime low SES exceeded that of infant mortality rate of births to fathers with a lifetime high SES: 13/1,000 vs 5/1,000, respectively; RR = 2.71 (1.94, 3.77). The adjusted (controlling for mother's age, education, marital status, and race/ethnicity) OR of SGA for fathers with childhood, parenthood, and lifetime low (vs high) SES were 1.15 (1.01, 1.31), 1.13 (1.02, 1.26), and 1.19 (1.05, 1.34), respectively. The adjusted OR of infant mortality for births to fathers with childhood, parenthood, and lifetime low (vs high) SES were 1.14 (.78, 1.67), 1.40 (.90, 2.18), and 1.31 (.90, 1.92), respectively.

Conclusions

Low paternal socioeconomic status is a previously unrecognized determinant of SGA birth regardless of mother's demographic status.

A Universal Assay for Aminopeptidase Activity and Its Application for Dipeptidyl Peptidase-4 Drug Discovery

Aminopeptidases, such as dipeptidyl peptidase-4 (DPP-4, CD26), are potent therapeutic targets for pharmacological interventions because they play key roles in many important pathological pathways. To analyze aminopeptidase activity in vitro (including high-throughput screening [HTS]), in vivo, and ex vivo, we developed a highly sensitive and quantitative bioluminescence-based readout method. We successfully applied this method to screening drugs with potential DPP-4 inhibitory activity. Using this method, we found that cancer drug mitoxantrone possesses significant DPP-4 inhibitory activity both in vitro and in vivo. The pharmacophore of mitoxantrone was further investigated by testing a variety of its structural analogues.

Effectiveness of a no-cost-to-workers, slip-resistant footwear program for reducing slipping-related injuries in food service workers: a cluster randomized trial

Objective This study evaluated the effectiveness of a no-cost-to-workers, slip-resistant footwear (SRF) program in preventing workers' compensation injury claims caused by slipping on wet or greasy floors. Methods The study population was a dynamic cohort of food service workers from 226 school districts' kindergarten through 12th grade food service operations. A two-arm cluster randomized controlled study design was implemented, with school districts randomized to the intervention group receiving SRF. Data were analyzed according to the intent-to-treat principle. Logistic regression was used to analyze dichotomous response data (injured based on workers' compensation injury claims data, or not injured, for each month worked). Changes in slipping injury rates from baseline to post-intervention follow-up periods were compared between treatment groups. Results The probability of a slipping injury was reduced significantly in the intervention group, from a baseline measure of 3.54 slipping injuries per 10 000 worker-months to 1.18 slipping injuries per 10 000 worker-months in the follow-up period [adjusted odds ratio (OR _adj) 0.33, 95% confidence interval (CI) 0.17-0.63]. In the control group, slipping injuries were 2.01 per 10 000 worker-months in the baseline, and 2.30 per 10 000 worker-months in the follow-up. The interaction between treatment group and time period (baseline or follow-up) indicated that the decline seen in the intervention group was significantly different than the increase seen in the control group (OR _adj0.29, 95% CI 0.11-0.74, adjusted for age >55 years). Conclusions This study provides evidence for the effectiveness of a no-cost-to-workers SRF program in reducing slipping-related workers' compensation injury claims in food service workers.

Citrobacter rodentium Relies on Commensals for Colonization of the Colonic Mucosa

We investigated the role of commensals at the peak of infection with the colonic mouse pathogen Citrobacter rodentium. Bioluminescent and kanamycin (Kan)-resistant C. rodentium persisted avirulently in the cecal lumen of mice continuously treated with Kan. A single Kan treatment was sufficient to displace C. rodentium from the colonic mucosa, a phenomenon not observed following treatment with vancomycin (Van) or metronidazole (Met). Kan, Van, and Met induce distinct dysbiosis, suggesting C. rodentium relies on specific commensals for colonic colonization. Expression of the master virulence regulator ler is induced in germ-free mice, yet C. rodentium is only seen in the cecal lumen. Moreover, in conventional mice, a single Kan treatment was sufficient to displace C. rodentium constitutively expressing Ler from the colonic mucosa. These results show that expression of virulence genes is not sufficient for colonization of the colonic mucosa and that commensals are essential for a physiological infection course.

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Specific dysbiosis rapidly displaces Citrobacter rodentium from the colonic mucosa

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Mucosal exclusion is independent of C. rodentium virulence gene expression

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Extended antibiotic treatment causes accumulation of luminal avirulent C. rodentium

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C. rodentium relies on commensals for survival at the colonic mucosa

The age-related patterns of preterm birth among urban African-American and non-Latina White mothers: The effect of paternal involvement

Few studies have examined contributions of paternal factors to birth outcomes. Weathering is a pattern of increasing rates of adverse birth outcome with increasing maternal age. This study evaluates for an association between paternal involvement and weathering in the context of preterm birth (PTB, <37 weeks) among non-Hispanic African-American and non-Hispanic White women with and without lifelong exposure to neighborhood poverty. Using the Illinois transgenerational dataset with appended US census income information of infants (1989-1991) and their mothers (1956-1976), we compared infants of women by degree of paternal involvement: married, unmarried with father named on birth certificate, and unnamed father. Data were stratified by maternal residence in higher or lower income neighborhoods at both the time of mothers' birth and infants' birth, estimating maternal lifelong economic context. We computed race-specific PTB rates according to maternal age, lifelong neighborhood income, and paternal involvement. We calculated Mantel-Haenszel chi-square tests of linear trend from contingency tables to evaluate weathering. Among African-Americans (n = 39,991) with unnamed fathers and lifelong residence in lower income neighborhoods, PTB rate was lowest among teens at 18.8%, compared to 21.5% for 30-35 year-old mothers (p for linear trend <0.05). Among African-Americans with unnamed fathers and lifelong residence in higher income neighborhoods, PTB rate among teens was 16%, compared to 25% for 30-35 year-old mothers (p = 0.21). Among married African-Americans with lifelong residence in lower income neighborhoods, PTB rate among teens was 16.4%, compared to 12.5% for 30-35 year-old mothers (p = 0.79). Among married African-Americans with lifelong residence in higher income neighborhoods, PTB rate among teens was 20%, compared to 11.4% for 30-35 year-old mothers (p = 0.40). White mothers (n = 31,981) did not demonstrate weathering, regardless of paternal involvement and neighborhood poverty. We conclude that weathering was not seen among married African-Americans, independent of neighborhood income, suggesting a potentially protective mechanism associated with paternal involvement.

Experience with an Acuity Adaptable Care Model for Pediatric Cardiac Surgery

BACKGROUND

We describe the implementation of and outcomes associated with an acuity adaptable care model for pediatric patients undergoing cardiac surgery.

METHODS

Consecutive patients undergoing an index cardiac operation between July 2007 and June 2015 were included. From July 2007 through June 2010, a conventional model existed in which patients moved among units and care teams based on age, severity of illness, and operative status (conventional group). A transitional period existed between July 2010 and June 8, 2012 (transitional group). From June 9, 2012, through June 2015, an acuity adaptable model was used in which patients remained in the cardiac care unit and received care from the same clinical team throughout their hospitalization (acuity adaptable group).

RESULTS

Included were 2,363 patients: 925 in the conventional group, 520 in the transitional group, and 918 in the acuity adaptable group. In relation to the conventional group, the adjusted odds of operative mortality in the acuity adaptable group was 0.55 (95% confidence interval: 0.26-1.18; P = .12). The failure to rescue rate (ie, number of deaths in patients with any complication divided by the number of total patients with any complication) decreased (conventional group, 8.7%; acuity adaptable group, 4.2%; P = .04). In relation to the conventional group, postoperative hospital length of stay tended to be shorter in the acuity adaptable group ( P = .07).

CONCLUSIONS

The implementation of an acuity adaptable care model was feasible in our pediatric cardiac program. The favorable associations identified between the new model and outcomes are promising but warrant confirmation in a larger, multicenter study.

Racial disparity in infant mortality

In the United States, African-American infants have significantly higher mortality than white infants. Previous work has identified associations between individual socioeconomic factors and select community-level factors. In this review, the authors look beyond traditional risk factors for infant mortality and examine the social context of race in this country, in an effort to understand African-American women's long-standing birth outcome disadvantage. In the process, recent insights are highlighted concerning neighborhood-level factors such as crime, segregation, built environment, and institutional racism, other likely causes for the poor outcomes of African-American infants in this country compared with infants in most other industrialized nations.

African-American:White Disparity in Infant Mortality due to Congenital Heart Disease

OBJECTIVE

To determine the importance of infant factors, maternal prenatal care use, and demographic characteristics in explaining the racial disparity in infant (age <365 days) mortality due to congenital heart defects (CHD).

STUDY DESIGN

In this cross-sectional population-based study, stratified and multivariable logistic regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort files of term infants with non-Hispanic white (n = 3 684 569) and African-American (n = 782 452) US-born mothers. Infant mortality rate, including its neonatal (<28 day) and postneonatal (28-364 day) components, due to CHD was the outcome measured.

RESULTS

The infant mortality rate due to CHD for African-American infants (296 deaths; 3.78 per 10 000 live births) exceeded that of white infants (1025 deaths; 2.78 per 10 000 live births) (relative risk [RR], 1.36; 95% CI, 1.20-1.55). The racial disparity was wider in the postneonatal period (2.08 per 10 000 vs 1.42 per 10 000; RR, 1.53; 95% CI, 1.29-1.83) compared with the neonatal period (1.70 per 10 000 vs 1.44 per 10 000; RR, 1.20; 95% CI, 0.99-1.45). Compared with white mothers, African-American mothers had a higher percentage of high-risk characteristics. In multivariable logistic regression models, the adjusted OR of postneonatal and neonatal mortality due to CHD for African-American mothers compared with white mothers was 1.20 (95% CI, 0.98-1.48) and 0.95 (95% CI, 0.77-1.19), respectively.

CONCLUSION

The racial disparity in infant mortality rate due to CHD among term infants with US-born mothers is driven predominately by the postneonatal survival disadvantage of African-American infants. Commonly cited individual-level risk factors partly explain this phenomenon. The study is limited by the lack of information on neighborhood factors.

p16INK4a , a Senescence Marker, Influences Tenofovir/Emtricitabine Metabolite Disposition in HIV-Infected Subjects

The goal of this study was to explore the relationships between tenofovir (TFV) and emtricitabine (FTC) disposition and markers of biologic aging, such as the frailty phenotype and p16^INK4a gene expression. Chronologic age is often explored in population pharmacokinetic (PK) analyses, and can be uninformative in capturing the impact of aging on physiology, particularly in human immunodeficiency virus (HIV)‐infected patients. Ninety‐one HIV‐infected participants provided samples to quantify plasma concentrations of TFV/FTC, as well as peripheral blood mononuclear cell (PBMC) samples for intracellular metabolite concentrations; 12 participants provided 11 samples, and 79 participants provided 4 samples, over a dosing interval. Nonlinear mixed effects modeling of TFV/FTC and their metabolites suggests a relationship between TFV/FTC metabolite clearance (CL) from PBMCs and the expression of p16^INK4a, a marker of cellular senescence. This novel approach to quantifying the influence of aging on PKs provides rationale for further work investigating the relationships between senescence and nucleoside phosphorylation and transport.

Citrobacter rodentium mouse model of bacterial infection

Infection of mice with Citrobacter rodentium is a robust model to study bacterial pathogenesis, mucosal immunology, the health benefits of probiotics and the role of the microbiota during infection. C. rodentium was first isolated by Barthold from an outbreak of mouse diarrhea in Yale University in 1972 and was 'rediscovered' by Falkow and Schauer in 1993. Since then the use of the model has proliferated, and it is now the gold standard for studying virulence of the closely related human pathogens enteropathogenic and enterohemorrhagic Escherichia coli (EPEC and EHEC, respectively). Here we provide a detailed protocol for various applications of the model, including bacterial growth, site-directed mutagenesis, mouse inoculation (from cultured cells and after cohabitation), monitoring of bacterial colonization, tissue extraction and analysis, immune responses, probiotic treatment and microbiota analysis. The main protocol, from mouse infection to clearance and analysis of tissues and host responses, takes ∼5 weeks to complete.

Bioluminescent imaging reveals novel patterns of colonization and invasion in systemic Escherichia coli K1 experimental infection in the neonatal rat

Key features of Escherichia coli K1-mediated neonatal sepsis and meningitis, such as a strong age dependency and development along the gut-mesentery-blood-brain course of infection, can be replicated in the newborn rat. We examined temporal and spatial aspects of E. coli K1 infection following initiation of gastrointestinal colonization in 2-day-old (P2) rats after oral administration of E. coli K1 strain A192PP and a virulent bioluminescent derivative, E. coli A192PP-lux2. A combination of bacterial enumeration in the major organs, two-dimensional bioluminescence imaging, and three-dimensional diffuse light imaging tomography with integrated micro-computed tomography indicated multiple sites of colonization within the alimentary canal; these included the tongue, esophagus, and stomach in addition to the small intestine and colon. After invasion of the blood compartment, the bacteria entered the central nervous system, with restricted colonization of the brain, and also invaded the major organs, in line with increases in the severity of symptoms of infection. Both keratinized and nonkeratinized surfaces of esophagi were colonized to a considerably greater extent in susceptible P2 neonates than in corresponding tissues from infection-resistant 9-day-old rat pups; the bacteria appeared to damage and penetrate the nonkeratinized esophageal epithelium of infection-susceptible P2 animals, suggesting the esophagus represents a portal of entry for E. coli K1 into the systemic circulation. Thus, multimodality imaging of experimental systemic infections in real time indicates complex dynamic patterns of colonization and dissemination that provide new insights into the E. coli K1 infection of the neonatal rat.

NIOSH national survey of long-haul truck drivers: Injury and safety

Approximately 1,701,500 people were employed as heavy and tractor-trailer truck drivers in the United States in 2012. The majority of them were long-haul truck drivers (LHTDs). There are limited data on occupational injury and safety in LHTDs, which prompted a targeted national survey. The National Institute of Occupational Safety and Health conducted a nationally representative survey of 1265 LHTDs at 32 truck stops across the contiguous United States in 2010. Data were collected on truck crashes, near misses, moving violations, work-related injuries, work environment, safety climate, driver training, job satisfaction, and driving behaviors. Results suggested that an estimated 2.6% of LHTDs reported a truck crash in 2010, 35% reported at least one crash while working as an LHTD, 24% reported at least one near miss in the previous 7 days, 17% reported at least one moving violation ticket and 4.7% reported a non-crash injury involving days away from work in the previous 12 months. The majority (68%) of non-crash injuries among company drivers were not reported to employers. An estimate of 73% of LHTDs (16% often and 58% sometimes) perceived their delivery schedules unrealistically tight; 24% often continued driving despite fatigue, bad weather, or heavy traffic because they needed to deliver or pick up a load at a given time; 4.5% often drove 10miles per hours or more over the speed limit; 6.0% never wore a seatbelt; 36% were often frustrated by other drivers on the road; 35% often had to wait for access to a loading dock; 37% reported being noncompliant with hours-of-service rules (10% often and 27% sometimes); 38% of LHTDs perceived their entry-level training inadequate; and 15% did not feel that safety of workers was a high priority with their management. This survey brings to light a number of important safety issues for further research and interventions, e.g., high prevalence of truck crashes, injury underreporting, unrealistically tight delivery schedules, noncompliance with hours-of-service rules, and inadequate entry-level training.

Small-for-gestational age and preterm birth across generations: a population-based study of Illinois births

Small for gestational age (weight for gestational age <10th percentile, SGA) and preterm birth (<37 weeks, PTB) are the major determinants of infant mortality rates and racial disparities therein. To determine the generational inheritance patterns of SGA and PTB among non-Hispanic Whites and African-Americans. Stratified and multivariable binominal regression analyses were performed on an Illinois transgenerational dataset of White and African-American infants (1989-1991) and their mothers (1956-1976) with appended US census income information. Former SGA White mothers (N = 8,993) had a twofold greater infant SGA frequency than former non-SGA White mothers (N = 101,312); 14.4 versus 6.9 %, RR = 2.1 (2.0-2.2). Former SGA African American (N = 4,861) mothers had a SGA birth frequency of 25.7 % compared to 16.1 % for former non-SGA mothers (N = 28,090); RR = 1.5 (1.5-1.6). The adjusted (controlling for maternal age, education, marital status, parity, prenatal care usage, cigarette smoking, and hypertension) RR (95 % CI) of infant SGA for former SGA (compared to non-SGA) White and African-American mothers equaled 2.0 (1.9-2.1 and 1.5 (1.5-1.6), respectively. The adjusted RR (95 % CI) of infant preterm birth for former preterm (compared to term) White and African-American mothers were 1.1 (1.0-1.2). The findings were minimally changed among mothers with a lifelong residence in impoverished or affluent neighborhoods. In both races, approximately 8 % of SGA births were attributable to maternal SGA. There is a transgenerational association of SGA but not preterm birth among non-Hispanic Whites and African-Americans. In both races, a similar proportion of SGA births are attributable to maternal SGA.

Vital signs: seat belt use among long-haul truck drivers--United States, 2010

BACKGROUND

Motor vehicle crashes were the leading cause of occupational fatalities in the United States in 2012, accounting for 25% of deaths. Truck drivers accounted for 46% of these deaths. This study estimates the prevalence of seat belt use and identifies factors associated with nonuse of seat belts among long-haul truck drivers (LHTDs), a group of workers at high risk for fatalities resulting from truck crashes.

METHODS

CDC analyzed data from its 2010 national survey of LHTD health and injury. A total of 1,265 drivers completed the survey interview. Logistic regression was used to examine the association between seat belt nonuse and risk factors.

RESULTS

An estimated 86.1% of LHTDs reported often using a seat belt, 7.8% used it sometimes, and 6.0% never. Reporting never using a belt was associated with often driving ≥10 mph (16 kph) over the speed limit (adjusted odds ratio [AOR] = 2.9), working for a company with no written safety program (AOR = 2.8), receiving two or more tickets for moving violations in the preceding 12 months (AOR = 2.2), living in a state without a primary belt law (AOR = 2.1); and being female (AOR = 2.3).

CONCLUSIONS

Approximately 14% of LHTDs are at increased risk for injury and death because they do not use a seat belt on every trip. Safety programs and other management interventions, engineering changes, and design changes might increase seat belt use among LHTDs.

IMPLICATIONS FOR PUBLIC HEALTH

Primary state belt laws can help increase belt use among LHTDs. Manufacturers can use recently collected anthropometric data to design better-fitting and more comfortable seat belt systems.

Occupational injuries in Ohio wood product manufacturing: a descriptive analysis with emphasis on saw-related injuries and associated causes

BACKGROUND

Stationary sawing machinery is often a basic tool in the wood product manufacturing industry and was the source for over 2,500 injury/illness events that resulted in days away from work in 2010.

METHODS

We examined 9 years of workers' compensation claims for the state of Ohio in wood product manufacturing with specific attention to saw-related claims. For the study period, 8,547 claims were evaluated; from this group, 716 saw-related cases were examined.

RESULTS

The sawmills and wood preservation sub-sector experienced a 71% reduction in average incidence rate and an 87% reduction in average lost-time incidence rate from 2001 to 2009. The top three injury category descriptions for lost-time incidents within saw-related claims were fracture (35.8%), open wounds (29.6%), and amputation (14.8%).

CONCLUSIONS

For saw-related injuries, preventing blade contact remains important but securing the work piece to prevent kickback is also important.

Occupational ladder fall injuries - United States, 2011

Falls remain a leading cause of unintentional injury mortality nationwide [corrected].Among workers, approximately 20% of fall injuries involve ladders. Among construction workers, an estimated 81% of fall injuries treated in U.S. emergency departments (EDs) involve a ladder. To fully characterize fatal and nonfatal injuries associated with ladder falls among workers in the United States, CDC's National Institute for Occupational Safety and Health (NIOSH) analyzed data across multiple surveillance systems: 1) the Census of Fatal Occupational Injuries (CFOI), 2) the Survey of Occupational Injuries and Illnesses (SOII), and 3) the National Electronic Injury Surveillance System-occupational supplement (NEISS-Work). In 2011, work-related ladder fall injuries (LFIs) resulted in 113 fatalities (0.09 per 100,000 full-time equivalent [FTE] workers), an estimated 15,460 nonfatal injuries reported by employers that involved ≥1 days away from work (DAFW), and an estimated 34,000 nonfatal injuries treated in EDs. Rates for nonfatal, work-related, ED-treated LFIs were higher (2.6 per 10,000 FTE) than those for such injuries reported by employers (1.2 per 10,000 FTE). LFIs represent a substantial public health burden of preventable injuries for workers. Because falls are the leading cause of work-related injuries and deaths in construction, NIOSH, the Occupational Safety and Health Administration, and the Center for Construction Research and Training are promoting a national campaign to prevent workplace falls. NIOSH is also developing innovative technologies to complement safe ladder use.