Did rest breaks help with acute fatigue among nursing staff on 12-h shifts during the COVID-19 pandemic? A cross-sectional study.

AIM: This study aimed to explore whether 30-min rest breaks were as effective at lowering acute fatigue among 12-h shift hospital nursing staff who cared for patients with COVID-19 as among those who did not. DESIGN: The study was cross-sectional in design. METHODS: Data from the SAFE-CARE study collected online between May and June 2020 were used. A subsample (N = 338) comprised of nursing staff who reported working 12-h shifts, and providing direct patient care in hospitals was used in this study. Data on socio-demographics, work and rest breaks, and subjective measures of fatigue, psychological distress, sleep and health were used. Hierarchical multiple linear regression followed by stratified analyses was conducted to explore the relationships between rest breaks and acute fatigue among nursing staff groups with and without COVID-19 patient care. RESULTS: The sample, on average, had high acute fatigue. Around 72% reported providing care to patients with COVID-19, and 71% reported taking rest breaks 'sometimes', 'often' or 'always'. In the group that cared for patients with COVID-19, there was no significant relationship between rest breaks and acute fatigue (p = .507). In the group that cared for patients hospitalized for other reasons, rest breaks were associated with lower acute fatigue (p = .010). CONCLUSION: Our findings showed both the importance and inadequacy of rest breaks in reducing acute fatigue. The process of within-work recovery is complex, and routine rest breaks should be facilitated by nursing management on hospital units during and after the COVID-19 pandemic. IMPACT: Rest breaks may present an effective strategy in lowering fatigue. Although rest breaks were not associated with less fatigue among staff caring for patients with COVID-19, other co-workers experienced some fatigue recovery. For frontline nursing staff, routine rest breaks are encouraged, and a systematic evaluation pertaining the sufficiency of rest breaks during high work demands in future research is needed.

Long-Term Effects of Truancy Diversion on School Attendance: a Quasi-Experimental Study with Linked Administrative Data.

Over 60% of US school districts implement court diversion programs to address chronic unexcused absenteeism, yet the effectiveness of these programs is not known. We evaluated whether the Truancy Intervention Program (TIP) improved the school attendance of students in grades 7-10 in a metropolitan county in the Midwestern USA. Similar to most truancy court diversion programs, TIP consisted of three increasingly intrusive steps: (1) a parent meeting, (2) a hearing to develop an attendance contract, and (3) a petition to juvenile court. The intervention group consisted of students from the intervention county who had been referred to TIP between 2006 and 2009. The comparison group was drawn from a contiguous, same-sized, and socio-demographically similar county that petitioned truant students directly to court. To construct the comparison group, we applied multi-level matching procedures to linked, individual-level administrative data from eight state and local agencies for all public school students in the state between 2004 and 2015. Using the matched samples, we conducted difference-in-differences analyses to identify program effects for two intervention groups: all students referred to TIP and students whose family participated in the group parent meeting. In the 4 years after the intervention, the intervention groups had similar or slightly lower attendance than the comparison groups. However, most coefficients were not statistically significant, and there was no consistent pattern of effects across different samples and different specifications of the intervention. This pattern of findings was not robust enough to conclude that the program influenced school attendance.

Expanding Contraceptive Access for Women With Substance Use Disorders: Partnerships Between Public Health Departments and County Jails.

CONTEXT: Law enforcement has been the primary strategy for addressing the opioid epidemic. As a result, the incarceration rate for women in county jails has increased more than 800% since 1980, and most women inmates struggle with substance use disorders. There is a large unmet need for contraception among women in county jails. PROGRAM: The East Region of the Tennessee Department of Health partnered with county correctional facilities to provide comprehensive family planning education and voluntary long-acting reversible contraception (LARC) to women in 15 jails. IMPLEMENTATION: Incarcerated women were invited to attend a comprehensive family planning education session conducted in the jail by health department nurses. The sessions included information on neonatal abstinence syndrome. The nurses explained that the women could receive intrauterine devices, implants, and injectable progesterone while incarcerated and come to the health department for all contraceptive methods upon release. Between January 2014 and June 2017, nurses conducted 182 education sessions, and 794 women received a LARC. Method placement occurred in the jails or at the local health department. No adverse effects were known to have occurred. EVALUATION: We collected pilot data to explore the accuracy and the comprehensiveness of the family planning education session and whether the incarcerated women experienced the program as voluntary. All 18 women inmates interviewed reported experiencing the program as voluntary. Using published and administrative data, we roughly estimated that the program prevented between 270 and 460 unintended pregnancies and between 40 and 52 cases of neonatal abstinence syndrome in the first year after the women received a method. This represents a cost savings to Medicaid of $1.4 million. DISCUSSION: The partnership demonstrated the feasibility of providing voluntary comprehensive family planning education and access to highly effective contraception for women inmates who, as a group, face a host of political, socioeconomic, and personal barriers to reproductive health care.

Long-Term Health Consequences of Movement Restrictions for Palestinians, 1987-2011.

OBJECTIVES: To estimate the long-term association between Israeli-imposed restrictions on travel for medical care in the occupied Palestinian territory and health status in adulthood. METHODS: Using event history calendar methods, we collected annual data from 1987 to 2011 from a representative sample of 1778 Palestinians aged 32 to 43 years and analyzed the subsample of whomever had a serious medical condition and needed to travel for medical care (n = 246; contributing 1163 person-years). We used ordered logistic regression with person-year data to test the association between movement restrictions from 1987 to 2011 and health status in 2011. RESULTS: Two thirds (65%; n = 161) of participants reported travel restrictions, and 38% (n = 92) reported ever being barred from travel for medical care. Compared with study participants who experienced no travel restrictions in a year (n = 559 person-years), those who were barred from travel in that same year (n = 122 person-years) reported worse self-rated health (57% vs 22% reported bad or very bad self-rated health; P < .05) and greater limits on daily functioning caused by physical health (41% vs 16% reported regular limits; P < .05). CONCLUSIONS: Being barred from travel for medical care was associated with poor health as long as 25 years later.

A Logic Model for Evaluating the Academic Health Department.

Academic Health Departments (AHDs) are collaborative partnerships between academic programs and practice settings. While case studies have informed our understanding of the development and activities of AHDs, there has been no formal published evaluation of AHDs, either singularly or collectively. Developing a framework for evaluating AHDs has potential to further aid our understanding of how these relationships may matter. In this article, we present a general theory of change, in the form of a logic model, for how AHDs impact public health at the community level. We then present a specific example of how the logic model has been customized for a specific AHD. Finally, we end with potential research questions on the AHD based on these concepts. We conclude that logic models are valuable tools, which can be used to assess the value and ultimate impact of the AHD.

Political Imprisonment and Adult Functioning: A Life Event History Analysis of Palestinians.

Political imprisonment is a traumatic event, often accompanied by torture and deprivation. This study explores the association of political imprisonment between 1987 and 2011 with political, economic, community, psychological, physical, and family functioning in a population-based sample of Palestinian men ages 32-43 years (N = 884) derived from a dataset collected in 2011. Twenty-six percent (n = 233) had been politically imprisoned. Men imprisoned between 1987 and 2005 reported functioning as well as never-imprisoned men in most domains, suggesting that men imprisoned as youth have moved forward with their lives in ways similar to their nonimprisoned counterparts. In an exception to this pattern, men imprisoned during the Oslo Accords period (1994-1999) reported higher levels of trauma-related stress (B = 0.24, p = .027) compared to never-imprisoned men. Men imprisoned since 2006 reported lower functioning in multiple domains: human insecurity (B = 0.33, p = .023), freedom of public expression (B = -0.48, p = .017), perceived government stability (B = -0.38, p = .009), feeling broken or destroyed (B = 0.59, p = .001), physical limitations (B = 0.55, p = .002), and community belonging (B = -0.33, p = .048). Findings pointed to the value of examining the effects of imprisonment on functioning in multiple domains.

HIV/AIDS disparity between African-American and Caucasian men who have sex with men: intervention strategies for the black church.

This manuscript examines the HIV/AIDS health disparity among African-American (AA) men who have sex with men (MSM) as compared to non-Hispanic White (NHW) MSM, and proposes faith-based intervention strategies as a means of reducing the disparity. Effective faith-based HIV/AIDS intervention programs to encompass AA MSM must include community-based participatory research; engage the faith community through data sharing; specifically target and equip church leaders in addition to laity; involve effective collaboration and compromise between public health practitioners and faith leaders; emphasize spirituality and compassion; utilize popular opinion leaders; and be intergenerational.

Nurses' Rest Breaks and Fatigue: The Roles of Psychological Detachment and Workload.

BACKGROUND: Rest breaks have been shown to reduce acute fatigue, yet not all nurses who take rest breaks report lower fatigue. Psychological detachment-letting go of work-related thoughts-during rest breaks and workload may be key factors in explaining this phenomenon. OBJECTIVE: To examine the mediating role of psychological detachment during rest breaks and determine how workload moderated that pathway to lower acute fatigue among hospital nurses. METHODS: In this cross-sectional study, data were collected from 1861 12-hour shift nurses who answered an online survey between July and September 2021. The survey included measures of occupational fatigue, psychological detachment from work, workload, and questions on breaks, work, health, and demographics. Structural equation modeling was used in Mplus 8.9 software to estimate the direct and indirect effects of rest breaks on acute fatigue at 3 levels of workload. RESULTS: Nurses, on average, reported high acute fatigue, rarely experienced psychological detachment during rest breaks, and reported heavy workloads. Around 60% were able to sit down for a break on their last shift but with patient-care responsibilities. The relationship between taking a rest break and acute fatigue was fully mediated by psychological detachment from work. However, this relationship only held in the context of manageable workloads. CONCLUSION: Our findings showed that within-shift recovery is possible when nurses can psychologically detach from work during rest breaks. However, this within-shift recovery mechanism was disrupted for nurses with heavy workloads.

Feeling disrespected by parents: refining the measurement and understanding of psychological control.

This study investigated parental psychological control of adolescents when construed as disrespect of individuality. First, 120 adolescents from 5 cultures were interviewed and asked to identify specific parental behaviors that communicated to them that they were disrespected as individuals. The interview data were coded and 8 new survey items were constructed to reflect key content. These items were then administered to 2100 adolescents in the same cultures along with a traditional measure of psychological control (PCS). Confirmatory factor analyses indicated that model fit was better when the two scales were kept separate, across culture and sex of parent. In structural equation models, the new scale - labeled Psychological Control - Disrespect - accounted for all and more of the variance in youth depression and antisocial behavior than the PCS did. The discussion centers on the validation the study makes of the construct and offers several suggestions for future research.

Barriers to recruitment and retention of undergraduate men as college sexual assault prevention peer educators.

Objective: Male allies play an important role in sexual assault prevention, yet many college sexual assault prevention programs struggle to recruit and retain men. This study aims to identify barriers to recruitment and retention of male sexual assault prevention peer educators. Participants: Seventeen undergraduate male student leaders participated in this study during summer 2018. Methods: Semi-structured phone interviews were conducted, recorded, and transcribed. Response data were thematically analyzed. Results: Barriers to recruitment include perceived gender norms and discomfort with the topic of sexual assault. Barriers to retention include male peer educators' perception that women are resistant to men discussing sexual assault. Suggestions for improving recruitment and retention efforts are also identified. Conclusions: Recruitment and retention of male sexual assault prevention peer educators may require recruitment approaches that are tailored to men and programmatic changes that position men as allies in sexual assault prevention.

The role of structure versus individual agency in churches' responses to HIV/AIDS: a case study of Baltimore City churches.

This paper examines the activities of churches in Baltimore, Maryland, concerning the issues of sexuality, whether they potentially stigmatize persons with or at risk for HIV/AIDS, and to what extent individual agency versus institutional forces influence churches in this regard. In-depth interviews were conducted with 20 leaders from 16 churches and analyzed using a grounded theory methodology. Although many churches were involved in HIV/AIDS-related activities, the content of such initiatives was sometimes limited due to organizational constraints. Church leaders varied, however, in the extent to which they responded in accordance with or resisted these constraints, highlighting the importance of individual agency influencing churches' responses to HIV/AIDS.

Identifying Essential Components of School-Linked Mental Health Services for Refugee and Immigrant Children: A Comparative Case Study.

BACKGROUND: Foreign-born children rarely use traditional school mental health services. Comprehensive programs that combine mental health services with academic, economic, and socioemotional supports reach more foreign-born children and improve wellbeing. However, little practical guidance exists regarding how to best combine these diverse services. METHODS: To identify essential service components and their organization, we interviewed 92 parents, school staff, mental health providers, and community agency staff from 5 school-linked mental health programs designed specifically to serve immigrant and refugee youth. RESULTS: Foreign-born parents did not distinguish between academic, behavioral, and emotional help for their children; these western categorizations of functioning were not meaningful to them. Consequently, programs needed to combine 4 components, organized in a pyramid: family engagement, assistance with basic needs, assistance with adaptation to a new culture, and emotional and behavioral supports. Family engagement was the foundation upon which all other services depended. Assistance with economic and cultural stressors directly promoted emotional wellbeing and helped parents trust clinical mental health interventions. CONCLUSIONS: Specific strategies to implement the 4 essential components include home visits by program staff, a one-stop parent center located in the school to help with basic needs, working with cultural brokers, and informed consent procedures that clearly explain recommended care without requiring immigrant and refugee parents to internalize western conceptualizations of psychopathology. Future evaluations should assess the cost and effectiveness of these strategies. These data are essential to advocate payment for these nonclinical services by traditional funding mechanisms.

Peer relations, adolescent behavior, and public health research and practice.

Peer relations are central to adolescent life and, therefore, are crucial to understanding adolescents' engagement in various behaviors. In recent years, public health research has increasingly devoted attention to the implications of peer relations for the kinds of adolescent behaviors that have a direct impact on health. This article advocates for a continuation of this trend. With this aim, we highlight key themes in the rich literature on the general developmental significance of adolescent-peer relations, provide an overview of how these themes have been incorporated into public health research and practice, and suggest future avenues for peer-focused public health research that can inform adolescent health promotion in the United States.

Core competencies and the prevention of school failure and early school leaving.

There is an increasing awareness that school failure and early school leaving are processes, rather than discrete events, that often co-occur and can have lasting negative effects on children's development. Most of the literature has focused on risk factors for failure and dropout rather than on the promotion of competencies that can increase youths' likelihood of successfully completing high school. This chapter applies the core competencies framework to the promotion of youths' success within the school environment. We conclude with a brief review of evidence-based prevention strategies that address the five competencies and identify avenues for future research.

Reproductive Health Knowledge, Attitudes, and Behaviors Among Women Enrolled in Medication-Assisted Treatment for Opioid Use Disorder.

BACKGROUND: The lifetime prevalence of unintentional pregnancy among women enrolled in medically assisted treatment (MAT) for opioid use disorder (OUD) has been reported to exceed 80%. Consistent voluntary contraception use by women enrolled in MAT programs can reduce their risk of unintended pregnancies and increase their opportunity to plan the family size they want, yet little is understood about past and current contraception use or associated barriers and facilitators for this population of women. MATERIALS AND METHODS: Women enrolled in treatment for OUD at two MAT clinics in East Tennessee were invited to participate in an anonymous survey about contraception. We describe the sociodemographic and health characteristics of the women (N = 287; estimated response rate of 81.0%), report on their contraception knowledge and attitudes, and assess how these characteristics are associated with current contraception use. RESULTS: Most of the 287 women had been sexually active in the past 12 months (88%), were pregnant at least once (98%), and were insured (58%). Women having undergone bilateral tubal ligation had a greater average number of pregnancies (including those while on birth control), lower mean levels of depressed mood, and higher mean level of agreement that avoiding pregnancy now was important and that pregnant women should not use painkillers, compared to the women not using contraception. CONCLUSIONS: Strategies to ensure all women enrolled in MAT for OUD have knowledge of effective contraception and affordable, quality contraception care that is responsive to their complicated and oftentimes traumatic histories are necessary to enhance the women's reproductive health.

Do restrictive omnibus immigration laws reduce enrollment in public health insurance by Latino citizen children? A comparative interrupted time series study.

In the United States, there is concern that recent state laws restricting undocumented immigrants' rights could threaten access to Medicaid and the Children's Health Insurance Program (CHIP) for citizen children of immigrant parents. Of particular concern are omnibus immigration laws, state laws that include multiple provisions increasing immigration enforcement and restricting rights for undocumented immigrants. These laws could limit Medicaid/CHIP access for citizen children in immigrant families by creating misinformation about their eligibility and fostering fear and mistrust of government among immigrant parents. This study uses nationally-representative data from the National Health Interview Survey (2005-2014; n = 70,187) and comparative interrupted time series methods to assess whether passage of state omnibus immigration laws reduced access to Medicaid/CHIP for US citizen Latino children. We found that law passage did not reduce enrollment for children with noncitizen parents and actually resulted in temporary increases in coverage among Latino children with at least one citizen parent. These findings are surprising in light of prior research. We offer potential explanations for this finding and conclude with a call for future research to be expanded in three ways: 1) examine whether policy effects vary for children of undocumented parents, compared to children whose noncitizen parents are legally present; 2) examine the joint effects of immigration-related policies at different levels, from the city or county to the state to the federal; and 3) draw on the large social movements and political mobilization literature that describes when and how Latinos and immigrants push back against restrictive immigration laws.