1
|
Shankar MB, Rodríguez-Acosta RL, Sharp TM, Tomashek KM, Margolis HS, Meltzer MI. Estimating dengue under-reporting in Puerto Rico using a multiplier model. PLoS Negl Trop Dis 2018; 12:e0006650. [PMID: 30080848 PMCID: PMC6095627 DOI: 10.1371/journal.pntd.0006650] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 08/16/2018] [Accepted: 06/29/2018] [Indexed: 12/24/2022] Open
Abstract
Dengue is a mosquito-borne viral illness that causes a variety of health outcomes, from a mild acute febrile illness to potentially fatal severe dengue. Between 2005 and 2010, the annual number of suspected dengue cases reported to the Passive Dengue Surveillance System (PDSS) in Puerto Rico ranged from 2,346 in 2006 to 22,496 in 2010. Like other passive surveillance systems, PDSS is subject to under-reporting. To estimate the degree of under-reporting in Puerto Rico, we built separate inpatient and outpatient probability-based multiplier models, using data from two different surveillance systems—PDSS and the enhanced dengue surveillance system (EDSS). We adjusted reported cases to account for sensitivity of diagnostic tests, specimens with indeterminate results, and differences between PDSS and EDSS in numbers of reported dengue cases. In addition, for outpatients, we adjusted for the fact that less than 100% of medical providers submit diagnostic specimens from suspected cases. We estimated that a multiplication factor of between 5 (for 2010 data) to 9 (for 2006 data) must be used to correct for the under-reporting of the number of laboratory-positive dengue inpatients. Multiplication factors of between 21 (for 2010 data) to 115 (for 2008 data) must be used to correct for the under-reporting of laboratory-positive dengue outpatients. We also estimated that, after correcting for underreporting, the mean annual rate, for 2005–2010, of medically attended dengue in Puerto Rico to be between 2.1 (for dengue inpatients) to 7.8 (for dengue outpatients) per 1,000 population. These estimated rates compare to the reported rates of 0.4 (dengue outpatients) to 0.1 (dengue inpatients) per 1,000 population. The multipliers, while subject to limitations, will help public health officials correct for underreporting of dengue cases, and thus better evaluate the cost-and-benefits of possible interventions. The number of global cases of dengue has increased an estimated 30-fold from 1962 to 2012, and two-fifths of the world’s population are thought to be at risk for dengue. It has been recently estimated that the global incidence of dengue is between 50 and 100 million cases per year. These estimates of burden and impact are, however, are not considered very reliable. It has been previously established and reported that there is notable under-reporting of clinical cases of dengue, even those who sought medical treatment. This includes under-reporting of those hospitalized with laboratory-confirmed dengue. This lack of reliable estimates hampers efforts of public health officials in determining the of burden of disease and the costs-and-benefits of potential interventions. We estimated that multiplication factors ranging from 5 to 9 must be used to correct for under-reporting of laboratory-positive dengue inpatient cases reported to public health officials in Puerto Rico. Multiplication factors ranging from 21 to 115 must be used to correct for the underreporting of laboratory-positive dengue outpatients. Our results illustrate the need for, and thus potential benefits of, using our methodology to estimate the degree of under-reporting in passive dengue systems during epidemic and non-epidemic years.
Collapse
Affiliation(s)
- Manjunath B. Shankar
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Rosa L. Rodríguez-Acosta
- Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Tyler M. Sharp
- Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Kay M. Tomashek
- Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Harold S. Margolis
- Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Martin I. Meltzer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| |
Collapse
|
2
|
Byler C, Kesy L, Richardson S, Pratt SG, Rodríguez-Acosta RL. Work-related fatal motor vehicle traffic crashes: Matching of 2010 data from the Census of Fatal Occupational Injuries and the Fatality Analysis Reporting System. Accid Anal Prev 2016; 92:97-106. [PMID: 27054483 DOI: 10.1016/j.aap.2016.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 01/07/2016] [Accepted: 02/02/2016] [Indexed: 06/05/2023]
Abstract
Motor vehicle traffic crashes (MVTCs) remain the leading cause of work-related fatal injuries in the United States, with crashes on public roadways accounting for 25% of all work-related deaths in 2012. In the United States, the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) provides accurate counts of fatal work injuries based on confirmation of work relationship from multiple sources, while the National Highway Traffic Safety Administration (NHTSA) Fatality Analysis Reporting System (FARS) provides detailed data on fatal MVTCs based on police reports. Characterization of fatal work-related MVTCs is currently limited by data sources that lack either data on potential risk factors (CFOI) or work-relatedness confirmation and employment characteristics (FARS). BLS and the National Institute for Occupational Safety and Health (NIOSH) collaborated to analyze a merged data file created by BLS using CFOI and FARS data. A matching algorithm was created to link 2010 data from CFOI and FARS using date of incident and other case characteristics, allowing for flexibility in variables to address coding discrepancies. Using the matching algorithm, 953 of the 1044 CFOI "Highway" cases (91%) for 2010 were successfully linked to FARS. Further analysis revealed systematic differences between cases identified as work-related by both systems and by CFOI alone. Among cases identified as work-related by CFOI alone, the fatally-injured worker was considerably more likely to have been employed outside the transportation and warehousing industry or transportation-related occupations, and to have been the occupant of a vehicle other than a heavy truck. This study is the first step of a collaboration between BLS, NHTSA, and NIOSH to improve the completeness and quality of data on fatal work-related MVTCs. It has demonstrated the feasibility and value of matching data on fatal work-related traffic crashes from CFOI and FARS. The results will lead to improvements in CFOI and FARS case capture, while also providing researchers with a better description of fatal work-related MVTCs than would be available from the two data sources separately.
Collapse
Affiliation(s)
- Christen Byler
- Bureau of Labor Statistics, Census of Fatal Occupational Injuries, 2 Massachusetts Avenue NE, Room 3180, Washington, DC 20212 USA.
| | - Laura Kesy
- Bureau of Labor Statistics, Census of Fatal Occupational Injuries, 2 Massachusetts Avenue NE, Room 3180, Washington, DC 20212 USA.
| | - Scott Richardson
- Bureau of Labor Statistics, Census of Fatal Occupational Injuries, 2 Massachusetts Avenue NE, Room 3180, Washington, DC 20212 USA.
| | - Stephanie G Pratt
- National Institute for Occupational Safety and Health, Division of Safety Research, 1095 Willowdale Road, Mail Stop H-1808, Morgantown, WV 26505 USA.
| | - Rosa L Rodríguez-Acosta
- National Institute for Occupational Safety and Health, Division of Safety Research, 1095 Willowdale Road, Mail Stop H-1808, Morgantown, WV 26505 USA.
| |
Collapse
|
3
|
Chen GX, Collins JW, Sieber WK, Pratt SG, Rodríguez-Acosta RL, Lincoln JE, Birdsey J, Hitchcock EM, Robinson CF. Vital signs: seat belt use among long-haul truck drivers--United States, 2010. MMWR Morb Mortal Wkly Rep 2015; 64:217-21. [PMID: 25742382 PMCID: PMC4584718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
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.
Collapse
Affiliation(s)
- Guang X. Chen
- Division of Safety Research, National Institute for Occupational Safety and Health, CDC,Corresponding author: Guang-Xiang Chen, , 304-285-5995
| | - James W. Collins
- Division of Safety Research, National Institute for Occupational Safety and Health, CDC
| | - W. Karl Sieber
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC
| | - Stephanie G. Pratt
- Division of Safety Research, National Institute for Occupational Safety and Health, CDC
| | | | - Jennifer E. Lincoln
- Division of Safety Research, National Institute for Occupational Safety and Health, CDC
| | - Jan Birdsey
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC
| | - Edward M. Hitchcock
- Division of Applied Research and Technology, National Institute for Occupational Safety and Health, CDC
| | - Cynthia F. Robinson
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC
| |
Collapse
|
4
|
Pratt SG, Rodríguez-Acosta RL. Occupational highway transportation deaths among workers aged≥55 years--United States, 2003-2010. MMWR Morb Mortal Wkly Rep 2013; 62:653-7. [PMID: 23965827 PMCID: PMC4604795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Highway transportation incidents are the leading cause of occupational fatalities in the United States, with the highest fatality rates occurring among workers aged ≥65 years. To characterize older workers at highest risk, CDC analyzed data from the Census of Fatal Occupational Injuries (CFOI) for the period 2003-2010 and compared occupational highway transportation deaths among workers aged 55-64 years and ≥65 years with those among workers aged 18-54 years. This report describes the results of that analysis, which indicated that workers aged ≥65 years had the highest overall fatality rate (3.1 highway transportation deaths per 100,000 full-time-equivalent [FTE] workers per year), more than three times that of workers aged 18-54 years (0.9 per 100,000 FTE workers). This pattern held across demographic and occupational categories. These results demonstrate the need to further implement interventions that consider road safety risks specific to older workers.
Collapse
|
5
|
Sharp TM, Hunsperger E, Santiago GA, Muñoz-Jordan JL, Santiago LM, Rivera A, Rodríguez-Acosta RL, Gonzalez Feliciano L, Margolis HS, Tomashek KM. Virus-specific differences in rates of disease during the 2010 Dengue epidemic in Puerto Rico. PLoS Negl Trop Dis 2013; 7:e2159. [PMID: 23593526 PMCID: PMC3617145 DOI: 10.1371/journal.pntd.0002159] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 02/26/2013] [Indexed: 11/21/2022] Open
Abstract
Background Dengue is a potentially fatal acute febrile illness (AFI) caused by four mosquito-transmitted dengue viruses (DENV-1–4) that are endemic in Puerto Rico. In January 2010, the number of suspected dengue cases reported to the passive dengue surveillance system exceeded the epidemic threshold and an epidemic was declared soon after. Methodology/Principal Findings To characterize the epidemic, surveillance and laboratory diagnostic data were compiled. A suspected case was a dengue-like AFI in a person reported by a health care provider with or without a specimen submitted for diagnostic testing. Laboratory-positive cases had: (i) DENV nucleic acid detected by reverse transcriptase-polymerase chain reaction (RT-PCR) in an acute serum specimen; (ii) anti-DENV IgM antibody detected by ELISA in any serum specimen; or (iii) DENV antigen or nucleic acid detected in an autopsy-tissue specimen. In 2010, a total of 26,766 suspected dengue cases (7.2 per 1,000 residents) were identified, of which 46.6% were laboratory-positive. Of 7,426 RT-PCR-positive specimens, DENV-1 (69.0%) and DENV-4 (23.6%) were detected more frequently than DENV-2 (7.3%) and DENV-3 (<0.1%). Nearly half (47.1%) of all laboratory-positive cases were adults, 49.7% had dengue with warning signs, 11.1% had severe dengue, and 40 died. Approximately 21% of cases were primary DENV infections, and 1–4 year olds were the only age group for which primary infection was more common than secondary. Individuals infected with DENV-1 were 4.2 (95% confidence interval [CI]: 1.7–9.8) and 4.0 (95% CI: 2.4–6.5) times more likely to have primary infection than those infected with DENV-2 or -4, respectively. Conclusions/Significance This epidemic was long in duration and yielded the highest incidence of reported dengue cases and deaths since surveillance began in Puerto Rico in the late 1960's. This epidemic re-emphasizes the need for more effective primary prevention interventions to reduce the morbidity and mortality of dengue. Dengue is a potentially fatal acute febrile illness that is endemic throughout the tropics and sub-tropics. Dengue has been endemic in Puerto Rico for several decades and recent epidemics occurred in 1994–5, 1998 and 2007. In January 2010, dengue surveillance indicated that an epidemic had begun. The epidemic peaked in early August and ended in December with a total of 26,766 suspected dengue cases identified, of which 128 were fatal. The 2010 epidemic was one of the longest in Puerto Rico history and resulted in the greatest number of cases and deaths ever detected. We analyzed the epidemiologic and immunologic characteristics of laboratory-confirmed dengue cases and age group-specific attack rates, and determined the frequency of first DENV infection and DENV-types among persons experiencing their first infection. This analysis indicated that 10–19 year-olds were most affected during the epidemic, and that DENV-1 was roughly four times more likely to be associated with clinically apparent illness upon first DENV infection than were DENV-2 or -4. The 2010 dengue epidemic demonstrated the heavy burden of illness due to dengue in Puerto Rico, re-emphasizing the critical need for effective primary prevention tools to reduce the morbidity and mortality due to dengue worldwide.
Collapse
Affiliation(s)
- Tyler M Sharp
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Pérez-Guerra CL, Rodríguez-Acosta RL, Soto-Gómez E, Zielinski-Gutierrez E, Peña-Orellana M, Santiago LM, Rivera R, Cruz RR, Ramírez V, Tomashek KM, Dayan G. Assessing the interest to participate in a dengue vaccine efficacy trial among residents of Puerto Rico. Hum Vaccin Immunother 2012; 8:905-15. [PMID: 22832259 DOI: 10.4161/hv.20056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Dengue, endemic in Puerto Rico, is a major public health problem. Vaccines are thought the best means to prevent dengue because vector control alone has been largely ineffective. We implemented qualitative studies in 2006 and 2010 to determine the acceptability of conducting placebo-controlled dengue vaccine efficacy trials in Puerto Rican children. Key informant interviews and focus groups with parents and children were conducted in municipalities with high dengue incidence. We used structured open-ended questions to determine motivators and attitudes regarding vaccine trial participation. Knowledge about dengue risk and prevention, and knowledge, attitudes, and beliefs regarding vaccines and vaccine trials were assessed. Using grounded theory, we conducted content analysis and established categories and sub-categories of participant responses. All participants were knowledgeable about dengue prevention and perceived children as most affected age groups. Participants were aware of vaccines benefits and they thought a vaccine could prevent dengue. However, most would not allow their children to participate in a placebo-controlled vaccine trial. Barriers included lack of trust in new vaccines and vaccine trial procedures; fear of developing dengue or side effects from the vaccine and lack of information about candidate dengue vaccines. Participants thought information, including results of previous trials might overcome barriers to participation. Motivators for participation were altruism, protection from dengue, free medical attention, and compensation for transportation and participation. Parents would consider children participation if accurate vaccine trial information is provided.
Collapse
Affiliation(s)
- Carmen L Pérez-Guerra
- Dengue Branch, Division of Vector Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Rodríguez-Acosta RL, Myers DJ, Richardson DB, Lipscomb HJ, Chen JC, Dement JM. Physical assault among nursing staff employed in acute care. Work 2010; 35:191-200. [PMID: 20164614 DOI: 10.3233/wor-2010-0971] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hospital workers are known to be at risk of physical assault. The objective of this study is to characterize injuries resulting from physical assault among hospital nursing staff and to identify associated risk factors. Workers' compensation reports linked to human resources data were used to identify a cohort of aides and nurses employed in acute care units at a major healthcare system from 1997 to 2004 and their reported physical assault events. Poisson regression methods were used to estimate rates and rate ratios (RR) by occupation, gender, race, age, tenure, and hospital unit. During the study period 220 assaults were reported; the overall incidence rate was 1.65 (95% CI: 1.45-1.89) per 100 full-time-equivalent employees (FTEs). Assault risk was higher among those with shorter tenure (< 5 years vs. 15 or more) (RR=1.35, 95% CI: 0.83-2.19) and younger workers (under age 30 vs. 50 or older) (RR=1.30, 95% CI: 0.78-2.19), and lower among Black workers (vs. non-Blacks) (RR=0.63, 95% CI: 0.45-0.90). Incidence rates were highest in Psychiatry (12.65, 95% CI: 8.90-17.99), Neurology (4.43, 95% CI: 3.17-6.20) and Rehabilitation (3.63, 95% CI: 1.51-8.71) units. Interventions targeting Psychiatry, Neurology, and Rehabilitation units, and younger and newly hired staff are warranted. More detailed data are needed to develop targeted interventions.
Collapse
Affiliation(s)
- R L Rodríguez-Acosta
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | |
Collapse
|
8
|
Rodríguez-Acosta RL, Richardson DB, Lipscomb HJ, Chen JC, Dement JM, Myers DJ, Loomis DP. Occupational injuries among aides and nurses in acute care. Am J Ind Med 2009; 52:953-64. [PMID: 19852018 DOI: 10.1002/ajim.20762] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Occupational injuries are common among nursing personnel. Most epidemiologic research on nursing aides comes from long-term care settings. Reports from acute care settings often combine data on nurses and aides even though their job requirements and personal characteristics are quite different. Our objective was to assess risk of work-related injuries in an acute care setting while contrasting injuries of aides and nurses. METHODS A retrospective cohort of aides (n = 1,689) and nurses (n = 5,082) working in acute care at a large healthcare system between 1997 and 2004 were identified via personnel records. Workers' compensation filings were used to ascertain occupational injuries. Poisson regression was used to estimate rate ratios (RR) and 95% confidence intervals (95% CI). RESULTS Aides had higher overall injury rates than nurses for no-lost work time (RR = 1.2, 95% CI: 1.1-1.3) and lost work time (RR = 2.8, 95% CI: 2.1-3.8) injuries. The risk of an injury due to lifting was greater among aides compared to nurses for both non-lost work time and lost work time injuries. Injury rates among aides were particularly high in rehabilitation and orthopedics units. Most of the injuries requiring time away from work for both groups were related to the process of delivering direct patient care. CONCLUSIONS Our findings illustrate the importance of evaluating work-related injuries separately for aides and nurses, given differences in injury risk profiles and injury outcomes. It is particularly important that occupational safety needs of aides be addressed as this occupation experiences significant job growth.
Collapse
Affiliation(s)
- R L Rodríguez-Acosta
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | | | | | | | | |
Collapse
|
9
|
Schoenfisch AL, Dement JM, Rodríguez-Acosta RL. Demographic, clinical and occupational characteristics associated with early onset of delivery: findings from the Duke Health and Safety Surveillance System, 2001-2004. Am J Ind Med 2008; 51:911-22. [PMID: 18942663 DOI: 10.1002/ajim.20637] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This cross-sectional study explores associations between preterm delivery and demographic, clinical and occupational characteristics of women employed within a university and health system. METHODS A comprehensive surveillance system linking individual-level data from Human Resources, medical insurance claims and a job-exposure matrix was used to identify women with a single live birth between 2001 and 2004 and describe maternal characteristics during pregnancy. RESULTS Preterm delivery occurred in 7.1% (n = 74) of the 1,040 women, a lower preterm delivery prevalence than observed in the general U.S. population. Nearly all (>99.5%) women utilized prenatal care services. Prevalence of preterm delivery was highest for inpatient nurses, nurses' aides and office staff. In multivariate analyses, preterm delivery was positively associated with several clinical conditions: placenta previa, diabetes and cardiovascular disorder/disease. CONCLUSIONS We observed associations between preterm delivery and several previously indicated clinical conditions. Further study of the effect of job characteristics on preterm delivery is warranted.
Collapse
Affiliation(s)
- Ashley L Schoenfisch
- Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina 27705, USA.
| | | | | |
Collapse
|