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A potential health crisis looms large in the Punjab, India where alcohol consumption has risen dramatically. Adolescents are especially vulnerable to the toxic effects of alcohol. This empirical study presents a pedagogical intervention, Children as Agents of Social Change (CASC), which aimed to raise awareness about the effects of alcohol using an ICT-supported educational dialogue among adolescent students and alcohol-experts from multiple domains. Primary data consists of pre- and post-test questionnaires from the control and experimental groups (N=379) and an interview of the teacher-in-charge of one experimental school. Results indicate that the intervention significantly improved students’ scientific knowledge about alcohol; changed their attitudes towards media and celebrity promotion of alcohol; and enabled them to surmount the odds to spread information - acquired during the CASC intervention- to people outside the school, including adult drinkers. Learner-centric pedagogy combined with ICT clearly amplified transformative learning. CASC appears to be a promising approach in Education for Sustainable Development (ESD). It can be used for multiple sustainability issues.

Aim: To explore public health nurses' competence (namely knowledge, skills, and attitudes) in relation to long-term breastfeeding and their experience of the need for additional training on the subject., Design: The study design was quantitative, descriptive, and cross-sectional., Sample: Public health nurses (n = 270)., Methods: Data were collected with the Long-Term Breastfeeding Competence Scale (LBCS) online survey. Data analysis was done with Spearman's correlation analysis and binary logistic regression analysis., Results: Slightly more than half of the respondents had a good level of knowledge and skills. The majority had a baseline positive attitude toward long-term breastfeeding, but the attitude became more negative as the age of the breastfed child increased. Better competence was associated with younger age, parenthood, an additional degree in midwifery, and breastfeeding specialist certification. Knowledge and skills, and attitudes revealed a high correlation: the higher the knowledge and skills level, the more positive attitudes. Respondents with better knowledge and skills experienced more often the need for additional training on the subject., Conclusions: This study addresses that public health nurses lack competence in relation to long-term breastfeeding. This may compromise the quality of breastfeeding guidance for families in healthcare settings., (© 2024 The Author(s). Public Health Nursing published by Wiley Periodicals LLC.)

Aim: To explore what Internet-based breastfeeding peer support offers to breastfeeding parents., Design: Integrative review., Data Sources and Review Methods: A systematic literature search was conducted in March 2024 using the following electronic databases: CINAHL, The Cochrane Library, PubMed/MEDLINE and PsycINFO. Database searches yielded 717 results. Two researchers removed the duplicates (n = 256) and screened the remaining titles (n = 461), abstracts (n = 197) and full texts (n = 60) independently. Eventually, 19 studies were included in the review. The chosen studies had qualitative (n = 11), quantitative (n = 6), or mixed methods designs (n = 2) and were published between 2015 and 2024. Qualitative content analysis was conducted., Results: The main categories were supplying support that is responsive to the needs of parents and belonging to a breastfeeding community. The parents looked for and received breastfeeding support, advice, information, emotional support, reassurance and access to shared experiences from various online breastfeeding peer support groups. The support groups helped them in their breastfeeding decisions, thus making a difference in their breastfeeding experience. The support groups created breastfeeding communities for these parents and they were able to bond with others, feel like they belonged and share experiences. Additionally, these breastfeeding communities helped to normalize various breastfeeding practices., Conclusion: Breastfeeding peer support groups can offer parents the support and guidance they seek and a sense that they are part of a breastfeeding community. However, it is vital these groups are efficiently moderated to ensure the advice parents receive is evidence-based and the support is encouraging., Impact: These findings show that well-moderated online breastfeeding peer support can offer parents high-quality support. It is essential for health care professionals to be aware of the various options available in order to recommend high-quality support groups for breastfeeding parents., Reporting Method: PRISMA., Patient or Public Contribution: This was an integrative review therefore no patient or public contribution was necessary., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Aim: To describe nursing students' perceptions of interaction in a multiplayer virtual reality (MPVR) simulation., Design: A qualitative descriptive study., Methods: Second-semester nursing students (n = 24) participated in pairs in MPVR simulations and semi-structured interviews. Data were analysed deductively and inductively., Results: Four types of interaction in a MPVR simulation were identified: interaction between the students, interaction between the student and the virtual environment (VE), interaction between the student and the virtual patient (VP), and interaction between the student and the simulation facilitator. Interaction consisted of verbal and nonverbal interaction, as well as object manipulation and movement in the VE. The reasons for interaction were to coordinate the care, to assess the VP, and to implement VPs' care., Conclusions: MPVR simulation offered nursing students an opportunity to practice nurse-to-nurse interaction and interaction related to nurses' collaboration, which are essential skills in nursing practice. Students were also able to interact with the VP, which can promote students' nurse-patient interaction skills. Therefore, MPVR simulations can be utilized as a platform to enhance interaction skills of future healthcare professionals, which could improve patient safety., Patient or Public Contribution: None., (© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.)

Background: Health professionals need adequate competence to support breastfeeding beyond infancy. There is no established instrument to measure health professionals' competence regarding long-term breastfeeding. To respond to this shortcoming, the Long-Term Breastfeeding Competence Scale (LBCS) was developed., Research Aim: To develop and pilot an instrument that measures public health nurses' competence related to breastfeeding beyond 12 months in order to provide adequate breastfeeding counseling for families., Methods: This study was conducted as a cross-sectional online survey on public health nurses working in maternity and/or child health clinics. The relevance and clarity of the LBCS were assessed by an expert panel ( N  = 6). Public health nurses ( N  = 197) completed the LBCS, which consisted of a knowledge and skills dimension and an attitude dimension. Descriptive statistics were used to describe the characteristics of the study sample. The conceptual validity of the knowledge and skills dimension was assessed using the dichotomous Rasch analysis, and attitude dimension using the exploratory factor analysis. Internal consistency was evaluated using Cronbach's alpha. The distribution of the items was summarized by descriptive statistics., Results: According to expert panel evaluations, the LBCS was found to meet the requirements for relevance and clarity (S-CVI 0.90). The internal consistency of the instrument was at a good level ( α  = 0.796) and met the requirements set for a new instrument., Conclusion: The LBCS is appropriate to determine public health nurses' competence related to breastfeeding beyond 12 months. The LBCS can be used to identify the need for education concerning breastfeeding beyond 12 months., Competing Interests: Disclosures and Conflicts of InterestThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors disclosed no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Dr. Katri Vehviläinen-Julkunen and Dr. Riikka Ikonen served on the Master’s Degree Program Committee for co-corresponding author Niina Pöyhönen. In addition, Dr. Marja Kaunonen and Dr. Riikka Ikonen served on the Doctoral Committee for co-corresponding author Oona Ojantausta during her doctoral program.

Background: Development of skills in peer-to-peer feedback in multicultural and global contexts is important to excellent teaching practice in nursing education., Purpose: This study identified student attitudes toward giving and receiving peer-to-peer feedback between international peers in a graduate-level online instructional design course., Methods: Twenty-one graduate nursing students in 2 nurse educator programs from the United States and Finland participated in this descriptive study. Pre- and postcourse Feedback Orientation Scale (FOS) scores were analyzed in combination with student reflections on learning experiences related to peer-review course activities., Results: Mean pre- to postcourse overall FOS scores increased, suggesting greater student receptiveness to peer feedback, particularly in the dimensions of utility and self-efficacy. Postcourse reflections demonstrated increased appreciation for opportunities to triangulate feedback from multiple, diverse sources., Conclusions: Opportunities for graduate students in nurse educator programs to exchange peer-to-peer feedback with international peers foster growth in positive attitudes toward receiving and using peer feedback., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Breastfeeding up to two years and beyond supports the health and neurobiological development of a child. Nevertheless, mothers experience criticism from health professionals towards breastfeeding beyond 12 months. Competence related to breastfeeding counselling is defined as minimum knowledge, skills and attitudes that all health professionals should have to protect, promote and support breastfeeding. Professionals' education related to breastfeeding beyond 12 months is insufficient worldwide which challenges the competent and evidence-based support mothers wish for., Methods: This systematic review aimed to synthesize the existing literature on health professionals' competencies regarding breastfeeding beyond 12 months. The search was limited to peer-reviewed scientific papers published between 2000 and 2022 that focused on the competencies of health professionals regarding breastfeeding beyond 12 months. Seven databases were searched, and of the 884 studies retrieved, seven were included in the review. The studies were subjected to the Joanna Briggs Institute (JBI) critical appraisal checklists. The data were analyzed using deductive thematic analysis, driven by the concept of competence., Results: All the dimensions of competence could be found in the data. Health professionals' knowledge or skills related to breastfeeding beyond 12 months were explored in all seven studies, and attitudes towards breastfeeding beyond 12 months were explored in four studies. The main themes identified were Knowledge Combined with Skills, and Attitudes. The main theme, Knowledge Combined with Skills, was formed out of eight themes: perceptions regarding nutritional value, perceptions regarding economic value, perceptions regarding family interaction, perceptions regarding impacts on the mother's wellbeing, perceptions regarding impacts on the child's wellbeing, perceptions regarding suitable duration, perceptions regarding recommendations, and counseling skills. The attitudes varied and therefore the Attitudes main theme consisted of three themes: promotive attitudes, hostile attitudes, and passive attitudes towards breastfeeding beyond 12 months., Conclusions: Health professionals' knowledge and skills include several dimensions and vary substantially. Health professionals' attitudes vary between hostile and supportive and influence professionals' advice regarding breastfeeding beyond 12 months. The results suggested that there is considerable variation in health professionals' competencies, which emphasizes the importance of education regarding breastfeeding beyond 12 months., (© 2023. The Author(s).)

Background: The Baby-Friendly Hospital Initiative suggests that in-hospital supplementation should be avoided unless medically indicated. The supporting evidence is contradictory, as nonexperimental studies have shown an association between supplementation and decreased breastfeeding rates, whereas trials have failed to do so. The aim of this study was to investigate whether in-hospital supplementation is associated with exclusive breastfeeding to the age of 5 months and any breastfeeding to the age of 12 months in full-term, normal-weight singleton infants., Methods: This is a secondary analysis of national-level, cross-sectional survey data. The data were collected in child health clinics in Finland. Families attending a regular health examination with a child aged 2 weeks to 12 months were eligible to participate. Full-term, normal-weight, singleton infants (n = 3025) were included in this study. Multivariate logistic regression was performed using in-hospital supplementation and socioeconomic characteristics as covariates and exclusive and any breastfeeding as outcomes., Results: In total, 55.3% (n = 1631) of the infants received in-hospital supplementation. After controlling for socioeconomic factors, in-hospital supplementation was associated with decreased exclusive breastfeeding to the age of 5 months and with a decrease in any breastfeeding to the age of 7 months., Conclusions: Our findings suggest that noncontrolled supplementation, without a trial's rigorous procedures of care, is associated with decreased breastfeeding postdischarge. Both donor milk and infant formula use were associated with lower breastfeeding rates, although the association was stronger with formula use. In clinical settings, liberal, nonmedically indicated supplementation should be avoided., (© 2022 The Authors. Birth published by Wiley Periodicals LLC.)

Background: Depressive mood is a common problem among children in Western countries. Professionals in school and other health services have an important role in identifying children at increased risk for depression. The Short Mood and Feelings Questionnaire (SMFQ) is a widely used screening tool, but its 13 items still make it quite time-consuming to complete. There is an urgent need for a quick and easy-to-complete self-report depressive mood scale for use in school health examinations., Aim: This paper aims to describe and validate a revised version of SMFQ: FsMFQ-6 is intended as a short screening tool for the early identification of depressive symptoms in children., Methods: Nationally representative data (n = 95,725) were drawn from the 2017 School Health Promotion Study. The respondents were fourth- and fifth-grade pupils (aged 10-12) in Finnish primary schools. The data were analysed separately by gender. The construct validity of the scale was studied by principal component analysis and confirmatory factor analysis (CFA), convergent validity by both receiver operating characteristic (ROC) analysis and Spearman's correlation coefficient. Reliability was tested by Cronbach's alpha coefficient., Results: Principal component analysis yielded a one-component model: the Finnish Short Mood and Feelings Questionnaire 6 (FsMFQ-6). CFA confirmed the validity of FsMFQ-6. Compared with mood at home (AUC = 0.80) and mood at school (AUC = 0.85), overall sensitivity and specificity were optimal at cut-off point 0. Cronbach's alpha coefficient was 0.73, indicating good internal consistency. The results for girls and boys were almost identical., Conclusion: The results confirmed the validity and reliability of FsMFQ-6. FsMFQ-6 recognises depressive mood in children and is suitable for screening depressive symptoms in fourth- and fifth-grade pupils in Finland. However, it is important to pay close attention to children who choose the 'Sometimes' response option more than once, for that can be a sign of depressive symptoms., (© 2021 Nordic College of Caring Science.)

Moisture damage can influence the subjective assessment of indoor air quality (subjective IAQ) in various ways. We studied whether the frequency of symptoms reported across students at school level mediates the relationship between observed mold and dampness in a school building and students' subjective IAQ. To answer this research question, we tested a multilevel path model. The analyzed data were created by merging two nationwide data sets: (a) survey data from students, including information on subjective IAQ (N = 24,786 students); (b) data from schools, including information on mold and dampness in a school building (N = 222). After the background variables were adjusted, schools' observed mold and dampness were directly and significantly related to poor subjective IAQ (standardized beta (β)= 0.22, P = .002). In addition, in schools with mold and dampness, students reported significantly more symptoms (β = 0.22, P = .023) than in schools without; the higher the prevalence of symptoms at school level, the worse the students' subjective IAQ (β = 0.60, P < .001). This indirect path was significant (P = .023). In total, schools' observed mold and dampness and student-reported symptoms explained 52% of the between-school variance in subjective IAQ., (© 2020 The Authors. Indoor Air published by John Wiley & Sons Ltd.)

Aims and Objectives: To describe preterm infants' mothers' expressing practices and exclusive use of mother's breast milk in neonatal intensive care settings, as well as to explore whether mothers' and infants' characteristics are predictors of the mother's inadequate expressing practices and nonexclusive use of mothers' breast milk., Background: Use of their own mother's milk decreases preterm infants' mortality and morbidity, but expression is exhausting for the mothers. Mothers' and infants' characteristics are associated with milk output and exclusive breastfeeding at discharge, as well as later in infancy., Design: Cross-sectional study., Methods: The data were collected through questionnaires in two neonatal units. Multiple logistic regression was used to determine whether mothers' and infants' characteristics are predictors of late expression initiation (>6 hr from birth), inadequate expression frequency (≤6 times per a day) and nonexclusive use of own mother's milk., Results: The sample consisted of 129 mothers. One-third of the mothers had adequate expression practices. Half of the infants exclusively received their mother's own breast milk. Previous neonatal intensive care unit experience, poor psychological well-being, an infant's male gender, caesarean section and high gestational birth age were significant predictors of late expression initiation. None of the studied variables were significant predictors of inadequate expression frequency. Furthermore, lack of previous expression experience, financial woes and high gestational age were predictors of nonexclusive use of own mother's milk., Conclusions: Expression practices, as well as use of own mother's milk, were suboptimal. High gestational age was associated with both late expression initiation and nonexclusive breast milk use. The mothers maintained expression regardless of their well-being., Relevance to Clinical Practice: Counselling and support are needed to avoid suboptimal expression practices. Special attention should be paid to mothers with moderately preterm infants, caesarean delivery, poor psychological well-being and financial woes., (© 2017 John Wiley & Sons Ltd.)

Purpose: To describe mothers' experiences with expressing breast milk for preterm or SGA infants., Study Design and Methods: This is a descriptive qualitative study involving 130 mothers of preterm or SGA infants admitted to a neonatal intensive care unit. Data were collected in collaboration with two Finnish peer support associations. An Internet-based questionnaire with open-ended questions was administered to respondents. Responses were analyzed with inductive content analysis., Results: Mothers had to try to manage daily life and breast pumping. The combination of preterm birth and separation from the hospitalized infants served simultaneously as motivating factors and obstacles. Mothers tried to look beyond the unnatural and difficult process of milk expression, looking forward to eventual breastfeeding. Concerns about time and scheduling, equipment, environment, and sufficient milk supply were prevalent, as well as feelings of unfamiliarity, difficulty, frustration, and loneliness., Clinical Implications: Expressing breast milk should be considered as a helpful factor for preterm or SGA infants' mothers. Separation between mother and infant should be avoided. Mothers need adequate equipment and a private space for expressing milk, in addition to assistance with their daily routines. For mothers to successfully manage expression, they also require an environment that fosters a sense of caring, normality, and hope, as well as frequent care for their emotional needs.

Background: Preterm infants' mothers face several challenges when providing critical breast milk for their infants; therefore, sensitive and evidence-based counseling and support are needed. However, a general view of the experiences preterm infants' mothers can face during their infants' hospitalization and after discharge is lacking., Purpose: The aim of this integrative review was to explore practical and emotional experiences of preterm infants' mothers with respect to breast milk expression and breastfeeding, from the birth of the preterm infant, during the neonatal intensive care unit (NICU) stay, and postdischarge until the cessation of breastfeeding., Methods/search Strategy: A systematic literature search from MEDLINE, CINAHL, PsycInfo, and Cochrane databases were performed. The search resulted in 20 qualitative and 3 quantitative studies. The data were analyzed by thematic analysis., Findings: Coping was the central theme in mothers' experiences. The benefits of breast milk served both as a supportive factor and an obstructive factor for the mothers, and breastfeeding was used to rebuild connection and motherhood. Simultaneously, the mothers needed to cope with new demands, interfering NICU environment, demanding expressing, and difficulties with breastfeeding., Implications for Practice: Expressing and breastfeeding are important for the mothers to contribute to their infants' care and to rebuild the interrupted connection. Evidence-based and sensitive informational and practical counseling are vital for the mothers. Intensive emotional support is important during encountered problems and during cessation., Implications for Research: Future research is needed about mothers' experiences using supplementation methods, test-weighing, exploring experiences of mothers of late-preterm infants, and the validity of the concept of coping with this phenomenon.

Purpose: To pilot two instruments: Breastfeeding Advice and Coping with Breastfeeding in NICU settings., Design: Psychometric testing of the Breastfeeding Advice and Coping with Breastfeeding instruments., Sample: Mothers (N = 47) with singleton or twin preterm (≤36 + 6 gestation weeks) infant(s) (N = 55) at discharge collected from seven NICUs in Finland., Main Outcome Variables: The validity and reliability of two instruments: Breastfeeding Advice measuring the quality of breastfeeding counseling and Coping with Breastfeeding measuring the mothers' experienced ability to cope with breastfeeding issues., Results: Infants' mean gestation age was 32.5 weeks at birth. The items of the instruments were supported by previous studies, demonstrating content validity. There was a significant correlation (r = .72, p < .001) between Breastfeeding Advice and Coping with Breastfeeding, indicating constructor validity. Evidence for predictive validity was not found. Good reliability for internal consistency of the Breastfeeding Advice (Cronbach's α = .86) and Coping with Breastfeeding (Cronbach's α = .85) was found.

Unlabelled: We wanted to improve detection of low bone mineral density in preterm infants by combining serum measurements of total alkaline phosphatase, its bone-type isoenzyme and serum inorganic phosphate in a prospective design. The subjects were 43 preterm infants. Total and bone isoenzyme activity of alkaline phosphatase was determined at 3 wk chronological age and at 3 and 6 mo corrected age. The main outcome measure, apparent bone mineral density (BMAD) at the distal forearm and forearm shaft, was assessed by dual energy X-ray absorptiometry at 3 and 6 mo corrected age. An apparent density below 95 mg/cm3 at 3 mo corrected age was considered to indicate bone disease, based on the distribution of BMAD values of children with non-complicated courses of prematurity. At 3 mo corrected age, total alkaline phosphatase activities exceeding 900 IU/l revealed low bone mineral density with 88% sensitivity and 71% specificity. Measurements of bone isoenzyme activity did not improve diagnostic performance. Serum inorganic phosphate levels below 1.8 mmol/l reflected low bone density with high specificity (96%), but the sensitivity was only 50%., Conclusion: A combination of the criteria "serum total alkaline phosphatase activity above 900 IU/l" and "serum inorganic phosphate concentrations below 1.8 mmol/l" yielded a sensitivity of 100% at a specificity of 70%. This was the best available screening method for low bone mineral density in preterms.