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.
Objectives
The United States is one of only three countries worldwide with no national policy guaranteeing paid leave to employed women who give birth. While maternity leave has been linked to ...improved maternal and child outcomes in international contexts, up-to-date research evidence in the U.S. context is needed to inform current policy debates on paid family leave.
Methods
Using data from
Listening to Mothers III
, a national survey of women ages 18–45 who gave birth in 2011–2012, we conducted multivariate logistic regression to predict the likelihood of outcomes related to infant health, maternal physical and mental health, and maternal health behaviors by the use and duration of paid maternity leave.
Results
Use of paid and unpaid leave varied significantly by race/ethnicity and household income. Women who took paid maternity leave experienced a 47% decrease in the odds of re-hospitalizing their infants (95% CI 0.3, 1.0) and a 51% decrease in the odds of being re-hospitalized themselves (95% CI 0.3, 0.9) at 21 months postpartum, compared to women taking unpaid or no leave. They also had 1.8 times the odds of doing well with exercise (95% CI 1.1, 3.0) and stress management (95% CI 1.1, 2.8), compared to women taking only unpaid leave.
Conclusions for Practice
Paid maternity leave significantly predicts lower odds of maternal and infant re-hospitalization and higher odds of doing well with exercise and stress management. Policies aimed at expanding access to paid maternity and family leave may contribute toward reducing socio-demographic disparities in paid leave use and its associated health benefits.
The U.S. continues to have one of the lowest breastfeeding rates in the industrialized world. Studies have shown that full-time employment and early return to work decreased breastfeeding duration, ...but little is known about the relationship between leave policies and breastfeeding initiation and cessation. This study aimed to identify workplace-related barriers and facilitators associated with breastfeeding initiation and cessation in the first 6 months postpartum.
A prospective cohort study design was utilized to recruit 817 Minnesota women aged 18 and older while hospitalized for childbirth. Selection criteria included English-speaking, employed mothers with a healthy, singleton birth. These women were followed up using telephone interviews at 6 weeks, 12 weeks, and 6 months after childbirth. The main study outcomes were breastfeeding initiation, measured during hospital enrollment, and breastfeeding cessation by 6 months postpartum.
Women were 30 years old; 86 % were White, and 73 % were married. Breastfeeding rates were 81 % at childbirth, 67 % at 6 weeks, 49 % at 12 weeks, and 33 % at 6 months postpartum. Logistic regression revealed the odds of breastfeeding initiation were higher for women who: held professional jobs, were primiparae, had graduate degree, did not smoke prenatally, had no breastfeeding problems, and had family or friends who breastfeed. Survival analyses showed the hazard for breastfeeding cessation by 6 months was: higher for women who returned to work at any time during the 6 months postpartum versus those who did not return, lower for professional workers, higher among single than married women, higher for every educational category compared to graduate school, and higher for those with no family or friends who breastfeed.
While employer paid leave policy did not affect breastfeeding initiation or cessation, women who took shorter leaves were more likely to stop breastfeeding in the first 6 months postpartum. Future research should examine women's awareness of employer policies regarding paid and unpaid leave.
Maternal pregnancy nutrition influences fetal growth. Evidence is limited, however, on the relationship of maternal diet during pregnancy and lactation on infant postnatal growth and adiposity. Our ...purpose was to examine associations between maternal diet quality during pregnancy and lactation with offspring growth and body composition from birth to six months. Maternal diet quality was serially assessed in pregnancy and at one and three months postpartum, using the Healthy Eating Index⁻2015 in a cohort of 354 fully breastfeeding mother⁻infant dyads. Infant length-for-age (LAZ), weight-for-age (WAZ), and weight-for-length (WLZ) Z-scores were assessed at birth, one, three, and six months. Infant body fat percent (BF%), fat mass (FM), and fat-free mass (FFM) were measured at six months using dual-energy X-ray absorptiometry. Higher maternal diet quality from pregnancy through three months postpartum was associated with lower infant WLZ from birth to six months (
= 0.02) and BF% at six months (
≤ 0.05). Higher maternal diet quality at one and three months postpartum was also associated with lower infant FM at six months (
< 0.01). In summary, maternal diet quality during pregnancy and lactation was inversely associated with infant relative weight and adiposity in early postnatal life. Additional research is needed to explore whether associations persist across the life course.
Abstract 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.
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 (
= 716), twelve weeks (
= 661), six months (
= 625), and twelve months (
= 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.
Despite extensive evidence of work as a key social determinant of hypertension, risk prediction equations incorporating this information are lacking. Such limitations hinder clinicians' ability to ...tailor patient care and comprehensively address hypertension risk factors. This study examined whether including work characteristics in hypertension risk equations improves their predictive accuracy. Using occupation ratings from the Occupational Information Network database, we measured job demand, job control, and supportiveness of supervisors and coworkers for occupations in the United States economy. We linked these occupation-based measures with the employment status and health data of participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study. We fit logistic regression equations to estimate the probability of hypertension onset in five years among CARDIA participants with and without variables reflecting work characteristics. Based on the Harrell's c- and Hosmer-Lemeshow's goodness-of-fit statistics, we found that our logistic regression models that include work characteristics predict hypertension onset more accurately than those that do not incorporate these variables. We also found that the models that rely on occupation-based measures predict hypertension onset more accurately for White than Black participants, even after accounting for a sample size difference. Including other aspects of work, such as workers' experience in the workplace, and other social determinants of health in risk equations may eliminate this discrepancy. Overall, our study showed that clinicians should examine workers' work-related characteristics to tailor hypertension care plans appropriately.
Objective
The goal of this study was to examine the associations of maternal weight status before, during, and after pregnancy with breast milk C‐reactive protein (CRP) and interleukin 6 (IL‐6), two ...bioactive markers of inflammation, measured at 1 and 3 months post partum.
Methods
Participants were 134 exclusively breastfeeding mother‐infant dyads taking part in the Mothers and Infants Linked for Health (MILK) study, who provided breast milk samples. Pre‐pregnancy body mass index (BMI) and gestational weight gain (GWG) were assessed by chart ion; postpartum weight loss was measured at the 1‐ and 3‐month study visits. Linear regression was used to examine the associations of maternal weight status with repeated measures of breast milk CRP and IL‐6 at 1 and 3 months, after adjustment for potential confounders.
Results
Pre‐pregnancy BMI and excessive GWG, but not total GWG or postpartum weight loss, were independently associated with breast milk CRP after adjustment (β = 0.49, P < 0.001 and β = 0.51, P = 0.011, respectively). No associations were observed for IL‐6.
Conclusions
High pre‐pregnancy BMI and excessive GWG are associated with elevated levels of breast milk CRP. The consequences of infants receiving varying concentrations of breast milk inflammatory markers are unknown; however, it is speculated that there are implications for the intergenerational transmission of disease risk.
Children's exposure to manganese (Mn) is a public health concern and consistent policy guidelines for safe levels of Mn exposure is lacking. The complexity of establishing exposure thresholds for Mn ...partially relates to its dual role as an essential micronutrient with low levels required for good health, but also as a neurotoxin at high levels. Questions exist about the age-related susceptibility to excess Mn, particularly for children, and how best to measure chronic exposures. To address this concern we conducted a systematic review of studies examining children's exposure to Mn and neurodevelopmental outcomes focused on selection of biomarker-based and environmental measurements of Mn exposure to identify the scientific advances and research gaps.
PubMed and EMBASE databases were searched through March 2016 for studies that were published in English, used a biomarker-based or environmental measurement of Mn exposure, and measured at least one neurological outcome for children aged 0-18 years. Ultimately, thirty-six papers from 13 countries were selected. Study designs were cross-sectional (24), prospective cohorts (9), and case control (3). Neurodevelopmental outcomes were first assessed for Mn exposure in infants (6 papers), toddlers or preschoolers (3 papers) and school-age children (27 papers).
Studies of school-aged children most frequently measured Intelligence Quotient (IQ) scores using Mn biomarkers of hair or blood. Higher hair concentrations of Mn were consistently associated with lower IQ scores while studies of blood biomarkers and IQ scores had inconsistent findings. Studies of infants and toddlers most frequently measured mental and psychomotor development; findings were inconsistent across biomarkers of Mn (hair, cord blood, tooth enamel, maternal or child blood and dentin). Although few studies measured environmental sources of Mn, hair biomarkers were associated with Mn in drinking water and infant formula. Only one paper quantified the associations between environmental sources of Mn and blood concentrations.
Hair-Mn was the more consistent and valid biomarker of Mn exposure in school-aged children. Accurate measurement of children's exposure to Mn is crucial for addressing these knowledge gaps in future studies. However, research on biomarkers feasible for fetuses and infants is urgently needed given their unique vulnerability to excessive Mn.
To develop and test a worksite intervention that protects healthcare workers who handle antineoplastic drugs from work-related exposures. .
Intervention study. .
A university hospital in a large ...midwestern metropolitan area and its outpatient chemotherapy infusion clinic. .
163 staff (nurses, pharmacists, and pharmacy technicians) who work with antineoplastic agents. .
A self-report survey measured workplace and individual factors to assess use of personal protective equipment (PPE). Wipe samples were tested for surface contamination. An intervention incorporating study findings and worker input was developed. .
PPE use was the dependent variable, and the independent variables included knowledge of the hazard, perceived risk, perceived barriers, interpersonal influence, self-efficacy, conflict of interest, and workplace safety climate. .
PPE use was lower than recommended and improved slightly postintervention. Self-efficacy and perceived risk increased on the post-test survey. Chemical residue was found in several areas. Awareness of safe-handling precautions improved postintervention. The unit where nurses worked was an important predictor of safety climate and PPE use on the pretest but less so following the intervention. .
Involving staff in developing an intervention for safety ensures that changes made will be feasible. Units that implemented workflow changes had decreased contamination. .
Worksite analysis identifies specific targets for interventions to improve antineoplastic drug handling safety.
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