Effect of Mandatory and Voluntary Overtime Hours on Stress Among 9-1-1 Telecommunicators.

BACKGROUND: 9-1-1 telecommunicators are frequently exposed to indirect traumatic events that impact their mental and physical health and are often required to work overtime with rotating shifts. Previous studies reported various harmful effects of overtime on the health and well-being of workers, such as musculoskeletal injuries, burnout, low job satisfaction, fatigue, and intent to leave. However, there is limited research on the impact of overtime hours on 9-1-1 telecommunicators' stress symptoms, especially mandatory overtime hours. This study aimed to examine the relationship between overtime hours-mandatory and voluntary-and the level of stress symptoms among 9-1-1 telecommunicators. METHODS: We used secondary data from the surveys of the "Multi-tasking to hyper-tasking: Investigating the impact of Next Generation 9-1-1" study for analysis. Linear mixed-effects regression was applied to examine the association of overtime hours with the stress level. RESULTS: Of the 403 participants, 47.6% reported that they were required to work mandatory overtime, and the mean mandatory overtime was 7.51 (SD = 12.78) hours in the past month. 58.3% reported working voluntary overtime, and the mean voluntary overtime was 11.63 (SD = 17.48) hours. This study found that mandatory overtime hours were associated with an increase in self-reported stress symptoms (ß = 0.30, p = .002), whereas no significant association was found between voluntary overtime and the level of stress symptoms (ß = -0.01, p = .885). CONCLUSION/APPLICATION TO PRACTICE: Study results highlight the importance of reducing mandatory overtime in call centers as one possible strategy for reducing stress levels among this critical workforce.

Disability and Emergency Department Visits: A Path Analysis of the Mediating Effects of Unmet Healthcare Needs and Chronic Diseases.

Previous studies identified disabilities and unmet healthcare needs, especially those related to primary healthcare, as predictors of ED use. This study examined the relationship between disability, unmet healthcare needs, chronic diseases, and ED visits in South Korea. This study was a cross-sectional study using the Korean Health Panel Survey collected in 2018. A path analysis was used. Our research found a significant association between disability and ED visits mediated by unmet healthcare needs and chronic diseases. Disability had a significant direct effect on unmet healthcare needs (ß = .04, P ≤ .001) and chronic diseases (ß = .10, P ≤ .001). However, there was no mediating effect of unmet healthcare needs between disability and ED visits. While barriers to access to care among people with disabilities are widely acknowledged, this study suggests that interventions or programs to reduce ED visits should consider the unique healthcare needs of people with disabilities.

Supporting rural public health practice to address local-level social determinants of health across Northwest states: Development of an interactive visualization dashboard.

BACKGROUND: Rural local health departments (LHDs) lack adequate capacity and funding to effectively make data-driven decisions to support their communities that face greater health disparities compared to urban counterparts. The need, therefore, exists for informatics solutions to support rural LHDs. PURPOSE: We describe the user-centered design (UCD) of SHARE-NW: Solutions in Health Analytics for Rural Equity across the Northwest, a website (sharenw.nwcphp.org) with data visualization dashboards for rural LHD practitioners in Alaska, Idaho, Oregon, and Washington to help them identify health disparities in their jurisdictions. METHODS: In this UCD study guided by Munzner's Nested Model for Visualization Design and Validation, we (1) completed a needs assessment, (2) created and evaluated mockups, and (3) conducted usability testing of a functional alpha testing website. Potential end-users (rural LHD practitioners) and Equity Advisory Committee members (public health experts from state, rural local, and tribal public health agencies) across our four-state catchment area were engaged throughout the website development and testing. We adapted traditional in-person UCD methods to be remote to reach participants across a large geographic area and in rural/frontier areas of Alaska, Idaho, Oregon, and Washington. RESULTS: We recruited participants from all four states to engage in each stage of the project. Needs assessment findings informed the mockup development, and findings from the mockup evaluations informed the development of the functional website. Usability testing of the website overall was positive, with priority usability issues identified. CONCLUSIONS: By applying Munzner's Nested Model and UCD, we could purposefully and intentionally design evidence-based solutions, specifically for rural LHD practitioners. Adaptations of traditional UCD methods were successful and allowed us to reach end-users across a large geographic area. Future work on SHARE-NW will involve the evaluation of the website. We provide insights on our lessons learned to support future public health informatics solution development.

Impact of data visualization on decision-making and its implications for public health practice: a systematic literature review.

Data visualization tools have the potential to support decision-making for public health professionals. This review summarizes the science and evidence regarding data visualization and its impact on decision-making behavior as informed by cognitive processes such as understanding, attitude, or perception.An electronic literature search was conducted using six databases, including reference list reviews. Search terms were pre-defined based on research questions.Sixteen studies were included in the final analysis. Data visualization interventions in this review were found to impact attitude, perception, and decision-making compared to controls. These relationships between the interventions and outcomes appear to be explained by mediating factors such as perceived trustworthiness and quality, domain-specific knowledge, basic beliefs shared by social groups, and political beliefs.Visualization appears to bring advantages by increasing the amount of information delivered and decreasing the cognitive and intellectual burden to interpret information for decision-making. However, understanding data visualization interventions specific to public health leaders' decision-making is lacking, and there is little guidance for understanding a participant's characteristics and tasks. The evidence from this review suggests positive effects of data visualization can be identified, depending on the control of confounding factors on attitude, perception, and decision-making.

Understanding data use and preference of data visualization for public health professionals: A qualitative study.

OBJECTIVE: This study aimed to assess public health professionals' use of data, information, and evidence and to understand perceptions and preferences regarding data visualization to inform future design of data visualization tools. DESIGN: We conducted qualitative interviews with public health professionals who use data for decision making as part of community health assessment and program planning from state and local health departments across six states. RESULTS: We identified four themes: 1) collection of data, information, and evidence; 2) management and analysis of data and information to inform decisions; 3) use of data to support public health practice; and 4) preferences for data visualization and how visualization is being used. Public health professionals use data, information, and evidence from various resources for communicating with co-workers, stakeholders, and the public, and decision making regarding their programs and services. CONCLUSION: Data visualization tools can help public health professionals improve their understanding and communication, their education of stakeholders, and their decision making using data, information, and evidence. Public health professionals believe in the value of using data, information, and evidence. Opportunities exist in ways to support public health professionals' data use by adopting data visualization tools and by mitigating systematic challenges in public health information systems.

Challenges and lessons learned in promoting adoption of standardized local public health service delivery data through the application of the Public Health Activities and Services Tracking model.

Population-level prevention activities are often publicly invisible and excluded in planning and policymaking. This creates an incomplete picture of prevention service-related inputs, particularly at the local level. We describe the process and lessons learned by the Public Health Activities and Services Tracking team in promoting adoption of standardized service delivery measures developed to assess public health inputs and guide system transformations. The 3 factors depicted in our Public Health Activities and Services Tracking model-data need and use, data access, and standardized measures-must be realized to promote collection of standard public health system data. Bureaucratic, resource, system, and policy challenges hampered our efforts toward adoption of the standardized measures we promoted. Substantial investments of time, resources, and coordination appear necessary for systems to adopt changes needed for collecting comparable service delivery data. Lessons from our process of promoting adoption of standardized measures provide recommendations to support future efforts to measure public health system contributions to the public's health.

Data, capacity-building, and training needs to address rural health inequities in the Northwest United States: a qualitative study.

OBJECTIVE: Rural public health system leaders struggle to access and use data for understanding local health inequities and to effectively allocate scarce resources to populations in need. This study sought to determine these rural public health system leaders' data access, capacity, and training needs. MATERIALS AND METHODS: We conducted qualitative interviews across Alaska, Idaho, Oregon, and Washington with individuals expected to use population data for analysis or decision-making in rural communities. We used content analysis to identify themes. RESULTS: We identified 2 broad themes: (1) challenges in accessing or using data to monitor and address health disparities and (2) needs for training in data use to address health inequities. Participants faced challenges accessing or using data to address rural disparities due to (a) limited availability or access to data, (b) data quality issues, (c) limited staff with expertise and resources for analyzing data, and (d) the diversity within rural jurisdictions. Participants also expressed opportunities for filling capacity gaps through training-particularly for displaying and communicating data. DISCUSSION: Rural public health system leaders expressed data challenges, many of which can be aided by informatics solutions. These include interoperable, accessible, and usable tools that help capture, access, analyze, and display data to support health equity efforts in rural communities. CONCLUSION: Informatics has the potential to address some of the daunting data-related challenges faced by rural public health system leaders working to enhance health equity. Future research should focus on developing informatics solutions to support data access and use in rural communities.

Perceived Need Versus Current Spending: Gaps in Providing Foundational Public Health Services in Communities.

OBJECTIVE: Our objective was to estimate the gap between the costs for local health jurisdictions (LHJs) to provide foundational public health services (FPHS) and actual spending on FPHS and to examine factors associated with that gap. DESIGN: We employed resource-based cost estimation methods for this observational study and conducted multivariate analyses with measures derived from secondary administrative data. We used primary data collected from LHJ leaders that depicted 2014 spending and perceived need. We also included secondary administrative data depicting annual 2000-2013 expenditures organized into categories containing key elements of FPHS areas. SETTING: We included primary data from a representative sample of 10 LHJs in Washington State and secondary data for all 35 LHJs in Washington. PARTICIPANTS: Participants were public health practice leaders from each sample LHJ. MAIN OUTCOME MEASURE: Our main outcome of interest was the gap identified between current spending and the perceived spending needed to provide FPHS in a jurisdiction. RESULTS: Actual FPHS spending was approximately 65% of spending needed to provide overall FPHS for our sample LHJs, but the size of the gap varied substantially by program. Some gaps also varied widely by LHJ, with spending gaps widest among rural and high poverty communities. Percent poverty and the metropolitan nature of a jurisdiction were factors significantly related to FPHS spending in our multivariate analyses. CONCLUSIONS: Actual spending lags far behind local officials' estimates of spending needed to provide FPHS and is likely influenced by local conditions. Major apparent gaps between spending and need, particularly in areas such as costly Business Competencies, underscore the need for cross-cutting capabilities to support public health system responsiveness and for attention to be paid to local conditions.

Development of the PHAST model: generating standard public health services data and evidence for decision-making.

Objective: Standardized data regarding the distribution, quality, reach, and variation in public health services provided at the community level and in wide use across states and communities do not exist. This leaves a major gap in our nation's understanding of the value of prevention activities and, in particular, the contributions of our government public health agencies charged with assuring community health promotion and protection. Public health and community leaders, therefore, are eager for accessible and comparable data regarding preventive services that can inform policy decisions about where to invest resources. Methods: We used literature review and a practice-based approach, employing an iterative process to identify factors that facilitate data provision among public health practitioners. Results: This paper describes the model, systematically developed by our research team and with input from practice partners, that guides our process toward maximizing the uptake and integration of these standardized measures into state and local data collection systems. Discussion: The model we developed, using a dissemination and implementation science framework, is intended to foster greater interest in and accountability for data collection around local health department services and to facilitate spatial exploration and statistical analysis of local health department service distribution, change, and performance. Conclusion: Our model is the first of its kind to thoroughly develop a means to guide research and practice in realizing the National Academy of Medicine's recommendation for developing systems to measure and track state and local public health system contributions to population health.

Improved development of ICR mouse 2-cell embryos by the addition of amino acids to a serum-, phosphate-and glucose-free medium.

This study was conducted to evaluate how exogenous amino acids could affect preimplantation development of ICR mouse embryos. Two-cell embryos collected from naturally mated mice were cultured in amino acid-, glucose- and phosphate-free preimplantation (P)-1 medium. In Experiments 1, 19 amino acids (aa; 1% and 0.5% of MEM essential and nonessential amino acid solutions, respectively) were added to P-1 medium supplemented with either fatty acid-free bovine serum albumin (BSA; 3 mg/mL) or human follicular fluid (hFF; 10%). Regardless of BSA or hFF addition, embryo development to the morula (84 to 86% vs. 97 to 100%) and the blastocyst (54% vs. 93 to 94%) stages was significantly (P<0.05) enhanced by the addition of aa compared with no addition. In Experiment 2, the cell number of blastomeres and inner cell mass (ICM) cells in blastocysts and the ratio of ICM cell to trophectodermal cell (TE) were evaluated after aa addition. In both BSA- and hFF-containing P-1 medium, a significant increase in total blastomere number were found after aa addition (47 to 52 vs. 62 to 63 cells) compared with no addition. However, the ICM/TE ratio was not significantly affected by aa supplementation in both media, while ICM cell number was greatly increased after aa addition in hFF-containing medium (12 vs. 17 cells). When blastocysts were further cultured up to 162 hr post-hCG injection, development to the hatched blastocyst stage was significantly promoted by aa addition (0% vs. 11 to 20%) in both BSA- and hFF-containing media. In conclusion, aa significantly promote the preimplantation development to the hatched blastocyst stage and such effect mainly exerted on supporting blastomere proliferation.