Student midwives' duty hours: risks, standards, and recommendations.

INTRODUCTION: A growing body of literature has emerged describing the risks of extended-duty shifts and sleep deprivation. Worldwide, midwifery organizations have not adopted standards for practitioner or student duty shifts. This project reviews the literature related to extended-duty shifts in an effort to develop evidence-based recommendations for student nurse-midwives/student midwives (SNMs/SMs). METHODS: A comprehensive literature search was conducted through electronic databases, major journals, and reference lists published in English since January 2001. Primary research studies evaluating sleep deprivation and shift duration were included. Studies that did not include the target population (shift workers) and those that formed conclusions related to extended-duty shifts greater than 30 hours were excluded. In addition, an extensive worldwide review of duty-hour recommendations from more than 300 health care organizations was conducted. RESULTS: A total of 40 studies met the inclusion criteria. Extended-duty shifts (those greater than 12 hours) increased the risk for cognitive and physical functional errors, safety concerns, and decreased quality of life from sleep deprivation. Cognitive function errors included attention lapses, visual tracking errors, decreased mentation and immediate recall, and decreased learning capacity. Physical errors included decreased motor skills and slowed reaction times in clinical simulations. These deficits led to an increased risk of motor vehicle accidents, needle sticks, and performance equivalent to unsafe blood alcohol concentrations. An overall decrease in quality of life and job satisfaction was linked to extended-duty shifts. Seven organizations for medical residents or advanced practice nurses have developed policy statements on duty shifts, with extended-duty shift limitations between 12 and 24 hours. DISCUSSION: The risks associated with extended-duty shifts may inhibit the development of SNMs/SMs into competent practitioners and place patients at risk. It is recommended that midwifery education programs adopt evidence-based limitations for the duty shifts of SNMs/SMs.

Responses to CES-D: European American versus Korean American adolescents.

PROBLEM: No study has examined variations in the responses to CES-D (Center for Epidemiologic Studies Depression Scale) scoring among different ethnic group adolescents. METHODS: This study compared response differences to CES-D between 51 European American and 58 Korean American (KA) adolescents. FINDINGS: Thirty-nine percent of KA adolescents reported higher depressive symptoms compared to 33% European American adolescents. Controlling for child age, significant mean differences were found on six items between the two groups. When within-group difference was examined among KA adolescents using a bi-dimensional acculturation approach, no differences were found except one item. CONCLUSIONS: KA adolescents did not show response bias toward positive affect items in CES-D when compared to European American adolescents.

Sleep, hunger, satiety, food cravings, and caloric intake in adolescents.

BACKGROUND AND PURPOSE: Prevalence of adolescent obesity has increased worldwide. Although diet and exercise patterns are major determinants of weight, recent studies with adults and children have shown that total amount of sleep is inversely associated with body mass index (BMI). The purpose of this study was to examine associations among total sleep time (TST), hunger, satiety, food cravings, and caloric intake in a sample of healthy adolescents. DESIGN-METHODS: Participants were recruited from the community and a local high school. Demographic data such as sleeping habits, pubertal status, food cravings, caloric intake, physical activity, height, and weight were collected between October 2006 and April 2007. Participants also completed a 7-day sleep-hunger-satiety diary. Descriptive and parametric procedures were used for data analyses (alpha=.05). FINDINGS: The sample (N=85) included 56% females (n=48), 76% African American (n=65) adolescents. Mean age was 15.6+/-1.4 years and mean BMI was 24.3+/-5.4 kg/m(2). Mean reported 7-day cumulative nocturnal sleep was 52.9 (+/-6.0) hours; mean reported cumulative daytime sleep (or napping) was 3.7 (+/-3.4) hours. Multiple regression analyses showed age, gender, and race were associated with feelings of hunger, satiety, total food cravings and caloric intake. A greater total food-cravings score was associated with increased daytime sleep. CONCLUSIONS: These findings indicate an unexpected association between increased daytime sleep and eating behaviors that potentially lead to obesity. Longitudinal studies using objective measures of sleep, appetite regulation, and caloric intake are needed to better understand relationships between appetite and sleep in adolescents from varying racial and gender groups. CLINICAL RELEVANCE: By carefully considering adolescent sleep (especially daytime sleep), race, and gender, clinicians and school health nurses in the US and other countries are in a unique position to develop novel approaches to prevent and reduce obesity.

The moderating influence of mother-adolescent discussion on early and middle African-American adolescent sexual behavior.

We examined how African-American mothers' discussions with their adolescents about sex moderated the relationship between adolescents' sex-based discussions with their friends and adolescents' involvement in sexual behaviors. The 425 African-American adolescents were 12 through 15 years of age and had participated in an HIV prevention research project with their mothers. Linear and logistic regression analyses showed that, for girls, age, discussions with friends, and the interaction between mother and friend's sex-based discussions were statistically significant predictors of sexual behaviors. These findings suggest that the level of discussion with mothers had a moderating effect on the relationship between friends' discussions about sex and a girl's involvement in sexual behaviors. Although these results were not apparent for boys, there was a strong relationship between discussions with friends about sex and sexual behaviors among boys.

A retrospective examination of the relationship between body mass index and polysomnographic measures of sleep in adolescents.

Total sleep time is inversely related to body mass index (BMI) in adults and children, an observation not well characterized in the adolescent population. We conducted a retrospective chart review that indicated certain sleep disruptions were associated with increased BMI by polysomnography in this group.