Parenting pain away: Quasi-experimental study of an eHealth learning platform to evaluate acceptability, feasibility, and utilisation of parent-led pain management.

AIM: To evaluate the impact of an eHealth educational resource about infant procedural pain management, given during the prenatal period, on feasibility, acceptability, knowledge, self-efficacy, and involvement. BACKGROUND: Routine health care requires newborns to have painful procedures (e.g., intramuscular injection). The impacts of untreated pain in neonates are widely recognised but adoption of effective procedural pain management strategies in clinical practice varies. There is clear evidence supporting the effectiveness of parent-led pain management during procedures (e.g., skin-to-skin care) and reputable resources to raise awareness among parents are warranted. Our team co-created Parenting Pain Away, a website to equip parents with evidence to assist with managing the pain of procedures and empower them to be involved. METHODS: A quasi-experimental evaluation using a pre/post intervention design with low-risk expectant parents. RESULTS: Of the 41 participants, before intervention exposure participants were familiar or had used skin-to-skin care (n = 33), breastfeeding (n = 30) and sucrose (n = 13) as pain management. Most participants (n = 38) desired more information on how to be involved. Providing access to Parenting Pain Away during pregnancy was supported and participants ranked the website above average using the System Usability Scale. Parenting Pain Away did not have a statistically significant influence on outcomes. Participants reported variation in clinical support with parent-led pain management. CONCLUSION: A multifaceted approach is recommended to maintain infant procedural pain management. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Equipping parents with knowledge related to infant pain management using an eHealth approach satisfied their information desires. The study findings are important considerations for perinatal care providers, policy makers, and families to finally achieve adequate procedural pain management. REPORTING METHOD: This study used the STROBE checklist, adhering to EQUATOR guidelines. PATIENT AND PUBLIC CONTRIBUTION: A stakeholder group (expectant parents, parents, perinatal researchers, clinicians, and administrators) was created to inform the study design and intervention.

Impact of COVID-19 restrictions on the postpartum experience of women living in Eastern Canada during the early pandemic period: A cross-sectional study.

OBJECTIVES: To (1) compare changes in parenting self-efficacy, social support, postpartum anxiety, and postpartum depression in Canadian women before and during the early COVID-19 pandemic; (2) explore how women with a newborn felt during the pandemic; (3) explore ways that women coped with challenges faced. METHODS: A cross-sectional design was used. Prior to the pandemic, an online survey was conducted with women who an infant 6 months old or less in one of the three Eastern Canadian Maritime provinces. A similar survey was conducted during the pandemic in mid-2020. RESULTS: Pre-COVID, 561 women completed the survey, and 331 women during the pandemic. There were no significant differences in parenting self-efficacy, social support, postpartum anxiety, and depression between the cohorts. Difficulties that women reported because of COVID-19 restrictions included lack of support from family and friends, fear of COVID-19 exposure, feeling isolated and uncertain, negative impact on perinatal care experience, and hospital restrictions. Having support from partners and families, in-person/virtual support, as well as engaging in self-care and the low prevalence of COVID-19 during the summer of 2020 helped women cope. CLINICAL RELEVANCE: Women identified challenges and negative impacts due to the COVID-19 pandemic, although no differences in psychosocial outcomes were found. Consideration of public health policy during the postpartum period for the ongoing COVID-19 pandemic is needed. CONCLUSION: While there were no significant differences in psychosocial outcomes, there were still challenges and negative impacts that women identified.

Parental Perspectives on Impact of Parental Presence Restrictions in the Neonatal Intensive Care Unit During the COVID-19 pandemic: A Cross-Sectional Study.

PURPOSE: To describe parental experiences in the neonatal intensive care unit (NICU) during the COVID-19 restrictions. We explore what parents found most challenging, the impact these restrictions had on them and their infant, and how they coped. METHODS: A cross-sectional online survey was completed by parents of infants who required care in a Canadian NICU during the early period of the COVID-19 pandemic. Data from 3 questions were coded using thematic analysis. RESULTS: Participants ( n = 161) were primarily mothers (93%), with an average length of stay of 32.1 days. Three themes were identified from responses: (1) emotional and physical closeness of the parents to their infant; (2) physical and psychosocial well-being of the infant and parent; and (3) how parents coped, and strategies for moving forward. Parents reported that parental restriction policies adversely impacted their perceived physical and emotional closeness with their infant and their infant's physical and psychosocial well-being. Parents reported that being able to be present with their infant, having their partner able to be present with them, and effective communication helped them cope. CONCLUSION: Despite the need for some restrictive policies to control the spread of the virus, the benefits and risks to the overall well-being of the parents and infants must be weighed.

The Impact of Parental Presence Restrictions on Canadian Parents in the NICU During COVID-19: A National Survey.

The purpose of this research was to explore parental perspectives on the impact of parent restrictions imposed in response to the COVID-19 pandemic across Canadian Neonatal Intensive Care Units (NICUs). A co-designed online survey was conducted targeting parents (n = 235) of infants admitted to a Canadian NICU from March 1, 2020, until March 5, 2021. Parents completed the survey from 38 Canadian NICUs. Large variation in the severity of policies regarding parental presence was reported. Most respondents (68.9%) were classified as experiencing high restrictions, with one or no support people allowed in the NICU, and felt that policies were less easy to understand, felt less valued and respected, and found it more challenging to access medicine or health care. Parents reported gaps in care related to self-care, accessibility, and mental health outcomes. There is significant variation in parental restrictions implemented across Canadian NICUs. National guidelines are needed to support consistent and equitable care practices.

Parental perspectives on technology use to enhance communication and closeness during the COVID-19 parental presence restrictions.

Objective: To explore parental perspectives on the use of technology in neonatal intensive care units (NICU), and its impact during COVID-19 parental presence restrictions. Methods: Co-designed online survey targeting parents of infants admitted to a Canadian NICU from March 1st, 2020 until March 5th, 2021. Results: Parents (n = 117) completed the survey from 38 NICUs. Large variation in policies regarding parental permission to use technology across sites was reported. Restrictive use of technology was reported as a source of parental stress. While families felt that technology helped them feel close to their infant when they could not be in the NICU, it did not replace being in-person. Conclusion: Large variation in policies were reported. Despite concerns about devices in NICUs, evidence on how to mitigate these concerns exists. Benefits of using technology to enhance parental experiences appear substantial. Future study is needed to inform recommendations on technology use in the NICU.

Practice recommendations regarding parental presence in NICUs during pandemics caused by respiratory pathogens like COVID-19.

Aim: To co-create parental presence practice recommendations across Canadian NICUs during pandemics caused by respiratory pathogens such as COVID-19. Methods: Recommendations were developed through evidence, context, Delphi and Values and Preferences methods. For Delphi 1 and 2, participants rated 50 items and 20 items respectively on a scale from 1 (very low importance) to 5 (very high). To determine consensus, evidence and context of benefits and harms were presented and discussed within the Values and Preference framework for the top-ranked items. An agreement of 80% or more was deemed consensus. Results: After two Delphi rounds (n = 59 participants), 13 recommendations with the highest rated importance were identified. Consensus recommendations included 6 strong recommendations (parents as essential caregivers, providing skin-to-skin contact, direct or mothers' own expressed milk feeding, attending medical rounds, mental health and psychosocial services access, and inclusion of parent partners in pandemic response planning) and 7 conditional recommendations (providing hands-on care tasks, providing touch, two parents present at the same time, food and drink access, use of communication devices, and in-person access to medical rounds and mental health and psychosocial services). Conclusion: These recommendations can guide institutions in developing strategies for parental presence during pandemics caused by respiratory pathogens like COVID-19.

Timing of neonatal mortality and severe morbidity during the postnatal period: a systematic review.

OBJECTIVE: The objective of this review was to determine the timing of overall and cause-specific neonatal mortality and severe morbidity during the postnatal period (1-28 days). INTRODUCTION: Despite significant focus on improving neonatal outcomes, many newborns continue to die or experience adverse health outcomes. While evidence on neonatal mortality and severe morbidity rates and causes are regularly updated, less is known on the specific timing of when they occur in the neonatal period. INCLUSION CRITERIA: This review considered studies that reported on neonatal mortality daily in the first week; weekly in the first month; or day 1, days 2-7, and days 8-28. It also considered studies that reported on timing of severe neonatal morbidity. Studies that reported solely on preterm or high-risk infants were excluded, as these infants require specialized care. Due to the available evidence, mixed samples were included (eg, both preterm and full-term infants), reflecting a neonatal population that may include both low-risk and high-risk infants. METHODS: MEDLINE, Embase, Web of Science, and CINAHL were searched for published studies on December 20, 2019, and updated on May 10, 2021. Critical appraisal was undertaken by 2 independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by 2 reviewers using a study-specific data extraction form. All conflicts were resolved through consensus or discussion with a third reviewer. Where possible, quantitative data were pooled in statistical meta-analysis. Where statistical pooling was not possible, findings were reported narratively. RESULTS: A total of 51 studies from 36 articles reported on relevant outcomes. Of the 48 studies that reported on timing of mortality, there were 6,760,731 live births and 47,551 neonatal deaths with timing known. Of the 34 studies that reported daily deaths in the first week, the highest proportion of deaths occurred on the first day (first 24 hours, 38.8%), followed by day 2 (24-48 hours, 12.3%). Considering weekly mortality within the first month (n = 16 studies), the first week had the highest mortality (71.7%). Based on data from 46 studies, the highest proportion of deaths occurred on day 1 (39.5%), followed closely by days 2-7 (36.8%), with the remainder occurring between days 8 and 28 (23.0%). In terms of causes, birth asphyxia accounted for the highest proportion of deaths on day 1 (68.1%), severe infection between days 2 and 7 (48.1%), and diarrhea between days 8 and 28 (62.7%). Due to heterogeneity, neonatal morbidity data were described narratively. The mean critical appraisal score of all studies was 84% (SD = 16%). CONCLUSION: Newborns experience high mortality throughout the entire postnatal period, with the highest mortality rate in the first week, particularly on the first day. Ensuring regular high-quality postnatal visits, particularly within the first week after birth, is paramount to reduce neonatal mortality and severe morbidity.

Canadian Women's Experience of Postnatal Care: A Mixed Method Study.

BACKGROUND: The postnatal period remains unstandardized in terms of care and postnatal visits with a dearth of information on the experience from Canadian women. PURPOSE: To explore (1) with whom and how often women receive postnatal follow-up visits and (2) the postnatal care experiences of Canadian mothers. METHODS: Using a cross-sectional design, women who had given birth within the past 6 months were recruited to complete an online survey. Frequencies were computed for quantitative outcomes and thematic analysis was used for qualitative responses. RESULTS: A total of 561 mothers completed the survey. Women saw on average 1.9 different postnatal healthcare providers, primarily family doctors (72.4%). 3.2% had no postnatal visits and 37.6% had 4 or more within 6 weeks. 76.1% women were satisfied with their postnatal care. Women's satisfactory care in the postnatal period was associated with in-person and at home follow-ups, receiving support, and receiving timely, appropriate care for self and newborn. Unsatisfactory care was associated with challenges accessing care, experiencing gaps in follow-up visits, and having unsatisfactory assessment for their own recovery. CONCLUSION: There is considerable variation in the timing and frequency of postnatal visits. While many women are experiencing satisfactory care, women are still reporting dissatisfaction and are facing challenges.

Timing of maternal mortality and severe morbidity during the postpartum period: a systematic review.

OBJECTIVE: The objective of this review was to determine the timing of overall and cause-specific maternal mortality and severe morbidity during the postpartum period. INTRODUCTION: Many women continue to die or experience adverse health outcomes in the postpartum period; however, limited work has explored the timing of when women die or present complications during this period globally. INCLUSION CRITERIA: This review considered studies that reported on women after birth up to 6 weeks postpartum and included data on mortality and/or morbidity on the first day, days 2-7, and days 8-42. Studies that reported solely on high-risk women (eg, those with antenatal or intrapartum complications) were excluded, but mixed population samples were included (eg, low-risk and high-risk women). METHODS: MEDLINE, Embase, Web of Science, and CINAHL were searched for published studies on December 20, 2019, and searches were updated on May 11, 2021. Critical appraisal was undertaken by 2 independent reviewers using standardized critical appraisal instruments from JBI. Quantitative data were extracted from included studies independently by at least 2 reviewers using a study-specific data extraction form. Quantitative data were pooled, where possible. Identified studies were used to obtain the summary estimate (proportion) for each time point. Maternal mortality was calculated as the maternal deaths during a given period over the total number of maternal deaths known during the postpartum period. For cause-specific analysis, number of deaths due to a specific cause was the numerator, while the total number of women who died due to the same cause in that period was the denominator. Random effects models were run to pool incidence proportion for relative risk of overall maternal deaths. Subgroup analysis was conducted according to country income classification and by date (ie, data collection before or after 2010). Where statistical pooling was not possible, the findings were reported narratively. RESULTS: A total of 32 studies reported on maternal outcomes from 17 reports, all reporting on mixed populations. Most maternal deaths occurred on the first day (48.9%), with 24.5% of deaths occurring between days 2 and 7, and 24.9% occurring between days 8 and 42. Maternal mortality due to postpartum hemorrhage and embolism occurred predominantly on the first day (79.1% and 58.2%, respectively). Most deaths due to postpartum eclampsia and hypertensive disorders occurred within the first week (44.3% on day 1 and 37.1% on days 2-7). Most deaths due to infection occurred between days 8 and 42 (61.3%). Due to heterogeneity, maternal morbidity data are described narratively, with morbidity predominantly occurring within the first 2 weeks. The mean critical appraisal score across all included studies was 85.9% (standard deviation = 13.6%). CONCLUSION: Women experience mortality throughout the entire postpartum period, with the highest mortality rate on the first day. Access to high-quality care during the postpartum period, including enhanced frequency and quality of postpartum assessments during the first 42 days after birth, is essential to improving maternal outcomes and to continue reducing maternal mortality and morbidity worldwide. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020187341.

Polyphenol Stability and Physical Characteristics of Sweetened Dried Cranberries.

There is little research on how product matrix and processing affect phenolic compounds in sweetened dried cranberries over time. The objective of this research was to assess polyphenol content and stability in sweetened dried cranberries between product matrix types. This research assessed five commercially available sweetened dried cranberry matrices: (1) sliced apple juice infused, (2) whole apple juice infused, (3) sliced sucrose infused, (4) whole sucrose infused, and (5) sliced soluble corn fiber, glycerin, sucrose, and sucralose infused (three replicates/treatment). Proanthocyanidins, anthocyanins (HPLC), total phenolic content (Folin-Ciocalteu), water activity, moisture content, color, and texture were evaluated over 12 months at 21 °C. Data were analyzed by ANOVA (p < 0.05). Results demonstrate that sweetened dried cranberry polyphenols are unstable regardless of product matrix. More research is needed to determine optimal processing parameters for sweetened dried cranberries to maintain polyphenol stability as healthier food options for consumers.

Impact of post-rigor high pressure processing on the physicochemical and microbial shelf-life of cultured red abalone (Haliotis rufescens).

High pressure processing (HPP) of post-rigor abalone at 300MPa for 10min extended the refrigerated shelf-life to four times that of unprocessed controls. Shucked abalone meats were processed at 100 or 300MPa for 5 or 10min, and stored at 2°C for 35days. Treatments were analyzed for aerobic plate count (APC), total volatile base nitrogen (TVBN), K-value, biogenic amines, color, and texture. APC did not exceed 10(6) and TVBN levels remained below 35mg/100g for 35days for the 300MPa treatments. No biogenic amines were detected in the 300MPa treatments, but putrescine and cadaverine were detected in the control and 100MPa treatments. Color and texture were not affected by HPP or storage time. These results indicate that post-rigor processing at 300MPa for 10min can significantly increase refrigerated shelf-life of abalone without affecting chemical or physical quality characteristics important to consumers.

Effects of rigor status during high-pressure processing on the physical qualities of farm-raised abalone (Haliotis rufescens).

High-pressure processing (HPP) is used to increase meat safety and shelf-life, with conflicting quality effects depending on rigor status during HPP. In the seafood industry, HPP is used to shuck and pasteurize oysters, but its use on abalones has only been minimally evaluated and the effect of rigor status during HPP on abalone quality has not been reported. Farm-raised abalones (Haliotis rufescens) were divided into 12 HPP treatments and 1 unprocessed control treatment. Treatments were processed pre-rigor or post-rigor at 2 pressures (100 and 300 MPa) and 3 processing times (1, 3, and 5 min). The control was analyzed post-rigor. Uniform plugs were cut from adductor and foot meat for texture profile analysis, shear force, and color analysis. Subsamples were used for scanning electron microscopy of muscle ultrastructure. Texture profile analysis revealed that post-rigor processed abalone was significantly (P < 0.05) less firm and chewy than pre-rigor processed irrespective of muscle type, processing time, or pressure. L values increased with pressure to 68.9 at 300 MPa for pre-rigor processed foot, 73.8 for post-rigor processed foot, 90.9 for pre-rigor processed adductor, and 89.0 for post-rigor processed adductor. Scanning electron microscopy images showed fraying of collagen fibers in processed adductor, but did not show pressure-induced compaction of the foot myofibrils. Post-rigor processed abalone meat was more tender than pre-rigor processed meat, and post-rigor processed foot meat was lighter in color than pre-rigor processed foot meat, suggesting that waiting for rigor to resolve prior to processing abalones may improve consumer perceptions of quality and market value.

The final unadorned tris(azolyl)borate: finishing what Trofimenko started in 1966.

The final addition to the tris(azolyl)borate ligand family, tris(1,2,3-triazolyl)borate, has been synthesized. The sodium salt of the ligand forms a complex polymeric structure where both N2 and N3 bind to crystallographically independent sodium ions. Depending on the divalent transition metal, tris(1,2,3-triazolyl)borate forms either molecular homoleptic complexes or coordination polymers.

Fish oil fortification of soft goat cheese.

UNLABELLED: Soft goat cheese was fortified with four levels of purified fish oil (0, 60, 80, and 100 g fish oil per 3600 g goat milk) prior to curd formation to deliver high levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per serving. The cheese was evaluated for proximate composition, EPA+DHA content, oxidative stability, color, pH, and consumer acceptability. The cheese was partially vacuum packed and stored at 2 °C for four weeks. The fat content was significantly (p < 0.05) higher in the fortified treatments compared to the control, but was not significantly different among fortified treatments. Likewise, EPA+DHA contents were not significantly different among fortified samples, averaging 127 mg EPA+DHA per 28 g serving. No significant lipid oxidation was detected by thiobarbituric acid reactive substances (TBARS) or hexanal and propanal headspace analyses over the four week refrigerated shelf-life study for any treatments. The fortified cheeses were all liked 'moderately' by consumers (n = 105) for overall acceptability, although the 60 g fortification level did rate significantly higher. The control cheese and the 60 g fortification level had no significant differences in consumer purchase intent. These results demonstrate that fortification levels of up to 127 mg EPA+DHA per serving may be added to soft cheese without negatively affecting shelf-life or consumer purchase intent. PRACTICAL APPLICATION: Omega-3 fatty acids have been shown to have strong associations with health and well-being, and fish oil is a rich source of these fatty acids. In this study, goat cheese was successfully fortified to deliver 127 mg omega-3 fatty acids per 28 g serving without affecting shelf life or consumer purchase intent.

Oxidative stability and consumer acceptance of fish oil fortified nutrition bars.

UNLABELLED: Oat and soy-based nutrition bars were fortified with 4 levels of fish oil (0, 6, 12, or 18 g per approximately 600 g batch), representing 0%, 20%, 40%, or 60% replacement of canola oil. The commercially available purified fish oil was not emulsified nor encapsulated, and contained tocopherols. Baked nutrition bars were evaluated for proximate composition, water activity, alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic (DHA) content, and consumer acceptance using a 9-point hedonic scale. The bars were sealed in opaque bags and stored in a stability chamber at 25 °C and 50% relative humidity for 10 wk to assess oxidative stability. There were no significant (P > 0.05) differences in proximate composition, water activity, or ALA levels among treatments. EPA and DHA levels were significantly (P < 0.05) different among treatments, averaging 178.1 mg/serving (20-FO), 488.3 mg/serving (40-FO), and 664.6 mg/serving (60-FO), but none changed during storage. Headspace hexanal and propanal levels decreased over time but were not significantly different among treatments until week 10. Peroxide values were not significantly different except between the control and 60-FO bars. Low values obtained for these analyses suggest negligible oxidation in the bars. Consumer acceptance scores did not differ significantly between the control and lowest fortification level (20-FO), ranging from 6.4 to 6.6 for aroma, texture, flavor, and overall acceptability. These results suggest that nonemulsified, nonencapsulated fish oil can successfully replace canola oil in intermediate moisture nutrition bars to provide EPA and DHA levels as high as 178 mg/serving without affecting consumer acceptability or oxidative stability. PRACTICAL APPLICATION: Omega-3 fatty acid rich fish oil has been shown to have numerous health benefits, but there are limitations to its use in shelf-stable food products. In this study, nutrition bars were successfully fortified with nonencapsulated, nonemulsified fish oil to deliver 178 mg EPA and DHA per 35 g serving. The fortified bars were oxidatively stable over 10 wk and acceptable to consumers.

The effectiveness of ozone and acidulant treatments in extending the refrigerated shelf life of fresh-cut potatoes.

The objective of the study was to determine the effectiveness of acidulant dip treatments (with or without aqueous ozone) to reduce enzymatic browning and to extend the shelf life of fresh-cut potato slices during refrigerated storage (4 °C) for 28 d. Potato slices subjected to aqueous ozone (2 ppm) had significantly (P≤ 0.05) higher L-values and lower a-values, but ozone did not appear to have any effect on aerobic plate counts (APCs) or polyphenol oxidase (PPO) activity. NatureSeal (NS) and sodium acid sulfate (SAS) were the most effective acidulant treatments in reducing browning (significantly [P≤ 0.05] higher L-values, lower a-values, and browning index values) regardless of ozone treatment. NS and SAS also had lower PPO activity compared to other treatments on days 0 and 28, and significantly (P≤ 0.05) lower APCs (≤2.00 log CFU/g) over refrigerated storage. Therefore, the SAS treatment was comparable to NS, a commercially available product, and showed promise as an effective antibrowning dip to reduce browning and spoilage in fresh-cut potato products. Practical Application: A 1% SAS dip treatment which included 1% citric and 1% ascorbic acid was found to be an effective antibrowning dip for fresh-cut potatoes along with NatureSeal®'s PS-10, compared to other treatments. They were both effective in maintaining low microbial counts over refrigerated storage. Additionally, aqueous ozone washes (2 ppm) showed significant benefits to reduce browning; however, ozone did not affect microbial counts or PPO enzyme activity. Therefore, the SAS treatment could have potential use in the fruit and vegetable industry to reduce browning and spoilage in fresh-cut potato products.