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Objective: To explore what is currently known about women's breastfeeding experiences associated with maternity care in facilities that implement policies supported by the Baby-Friendly Hospital Initiative (BFHI)., Data Sources: We used the scoping review methodology of JBI. We searched the Scopus, CINAHL, Embase, MEDLINE (Ovid), and PsycINFO databases and gray literature., Study Selection: We considered articles published during or after 1991 in English. Inclusion criteria were based on the participant, concept, and context framework and included women who gave birth and initiated breastfeeding during or after maternity care in facilities that were certified through the BFHI, were working toward certification, or were implementing BFHI-aligned policies., Data Extraction: We extracted the following data from each report: author(s), year/country of publication, study design, research aim, patient population/sample size, clinical setting, BFHI status, and outcomes. We further extracted relevant outcomes by using concepts from the interactive theory of breastfeeding., Data Synthesis: We included 44 reports of studies conducted in 19 countries in the review: 27 quantitative, 9 qualitative, and 8 mixed-methods studies. We mapped the extracted data to 10 concepts from the interactive theory of breastfeeding to classify patient experiences, including dynamic interaction between mother and child; stress; time; woman's and child's biological conditions; woman's and child's perception; woman's decision-making; family and social authority; woman's body image; space; and organizational systems for the protection, promotion, and support of breastfeeding., Conclusion: We found that various interrelated factors in addition to BFHI-specific policies influenced women's experiences. Based on these results, we suggest that awareness of women's personal breastfeeding experiences is crucial to delivering optimal care and developing evidence-based policies. Breastfeeding practice guidelines and policies should be developed to encompass women's experiences to enhance future inpatient breastfeeding support., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2024 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Introduction: The increase in nicotine vaping among youth has emerged as a critical public health concern. Vaping among youth is linked to adverse health outcomes, including nicotine addiction, cardiovascular and pulmonary diseases and mental health challenges. Recently, there has been a growing demand for research to expand on treatments to enhance the recovery process from vaping nicotine in youth. To this date, no comprehensive review identifies all interventions available for vaping recovery and compares their effectiveness in youth. This proposed systematic review seeks to identify all recovery-oriented interventions for youth aged 10-24 that facilitate vaping recovery and evaluate the measured effectiveness. This review will serve to support healthcare practitioners, nurses and policymakers to further understand recovery interventions and aid in improving vaping recovery among youth., Method and Analysis: This protocol, registered with PROSPERO, adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) framework, and the final review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to ensure quality and replicability. The review will comprise studies including youth aged 10-24 engaging in nicotine vaping. A comprehensive search will be conducted across MEDLINE, Embase, PsycINFO, Scopus and CINAHL, with no restrictions on the date range due to the recency of the topic. Two independent reviewers will screen the identified research for eligibility at the title and abstract levels, with any disagreements resolved by a third reviewer. The review will include randomised control trials and quasi-experimental studies. Full-text review and data extraction will be standardised and completed by the primary researcher. Additionally, studies will be assessed for quality and potential biases., Ethics and Dissemination: Given that this is a review of existing literature, no ethics approval is required. The focus on youth necessitates careful consideration of ethical standards. This review is committed to contributing responsibly to public health knowledge regarding youth vaping recovery. The results from this review will be disseminated through publication in an open-access, peer-reviewed journal and likely through posters and presentations at scientific conferences., Prospero Registration Number: CRD42024543994., Competing Interests: Competing interests: All authors have completed the International Committee of Medical Journal Editors (ICMJE) uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ http://www.icmje.org/disclosure-of-interest/ and declare no organizational support for this work, no financial relationships with interested entities within the past three years, and no other potential conflicts of interest., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Intimate partner violence (IPV) is a wicked social problem affecting women of all social strata and geographical location, globally. Pregnancy may be a time of heightened risk of IPV and more deleterious outcomes. Breastfeeding - a protective factor for maternal and child well-being - may be jeopardized or more challenging for women experiencing IPV. This study explored the experiences of postpartum women with histories of IPV who sought trauma- and violence-informed breastfeeding support from primary care providers., Methods: Using interpretive description and philosophically underpinned by intersectionality, in-depth semi-structured interviews were completed at 12-weeks postpartum with five breastfeeding mothers with a history of IPV who sought breastfeeding support from a family physician clinic employing a trauma- and violence-informed (TVIC) model of care., Findings: Four themes and two sub-themes shed light onto the experience of accessing breastfeeding support for women with a history of IPV and the perceived barriers that they faced when attempting to accesses this support, including: 1) The (demoralizing) navigation of the perinatal system ; 2) Fostering trust : i) " It's support, but it's also knowledge" ; and ii) TVIC: feeling safe and feeling "I mattered" ; 3) Informal support: partners, family, and friends ; and 4) Baby in focus: overcoming challenges and building confidence ., Conclusions: TVIC may aid in the development of trusting therapeutic relationships, in turn improving access to breastfeeding support, breastfeeding self-efficacy, and breastfeeding success for women who experience violence. Further research on the implementation and evaluation of TVIC for perinatal breastfeeding education and care among women is required., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: This study explores the lived experiences of women living with multiple sclerosis (MS) and identifies barriers to their optimal health and well-being., Methodology: Using van Manen's interpretative phenomenologic analysis, the researchers conducted semistructured interviews with 23 women diagnosed with MS in Southwestern Ontario, Canada. Data were analyzed using NVivo 12 software, and themes were validated through member checking., Results: The study revealed a key theme of "obstacles for women with MS" and subthemes related to barriers to physical, mental, and social well-being. Participants reported experiencing feelings of health despite their MS diagnosis but identified various constraints on their optimal health and well-being, including challenges with employment, financial support, and housing security., Conclusion: The findings highlight the need for healthcare professionals to advocate for equitable treatments, medication, and accessibility supports for women with MS, as well as for policies that address disability income support and affordable housing. Further research is recommended to explore power imbalances experienced by women with MS in precarious employment situations or living with episodic disabilities., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Human breastmilk is the optimal nutrition for infants; however, preliminary research suggests that women who experience intimate partner violence (IPV) are less likely to initiate and continue breastfeeding. Self-efficacy is a known facilitator to achieve positive breastfeeding outcomes. This study aimed to explore the relationship between experiencing IPV and breastfeeding duration, exclusivity, and self-efficacy for Canadian mothers, and to identify potential variables that influence breastfeeding decision-making among women with experiences of IPV., Method: This was a cross-sectional secondary analysis of surveys completed by 129 mothers with children under the age of 2 years from Ontario, Canada. Data were stratified according to those who had experienced IPV and those who had not. Breastfeeding outcomes assessed included breastfeeding self-efficacy and breastfeeding duration and exclusivity. Non-parametric tests and correlations were used to determine if relationships existed between IPV and breastfeeding outcomes., Results: 72.3% (n = 94) of women in this sample breastfed their child(ren). Experiencing IPV was associated with lower breastfeeding self-efficacy scores (W = 768, p = 0.055) with a moderate effect size (r = 0.32 [95% 0.06,0.55]). This relationship was significant in the context of psychological abuse (W = 816.5, p = 0.015) with a small effect size (r = 0.22 [95% 0.03,0.41])., Conclusions: This study provides novel preliminary evidence suggesting that experiencing IPV of any type can negatively impact breastfeeding self-efficacy, with psychological abuse potentially being the most detrimental. Future research is required to build upon these findings., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Adolescent mothers require trauma- and violence-informed care during the perinatal period due to trauma histories and ongoing violence as a result of pregnancy. Nurses and midwives play a critical role in caring for adolescent mothers in primary healthcare settings in Rwanda in the perinatal period., Purpose: To explore the experiences of nurses and midwives working with adolescent mothers in selected primary healthcare settings in Rwanda to inform the delivery of trauma- and violence- informed care., Methods: This study utilized an interpretive description qualitative approach and was conducted in eight primary healthcare settings in Rwanda. Twelve nurses and midwives working in perinatal services and four heads of health centers participated in in-depth individual interviews. Data were analyzed thematically., Results: The analysis revealed four main themes and 11 (sub-themes): (a) relational practice (being creative and flexible, "lending them our ears"); (b) individual challenges of providing care to adolescent mothers (lack of knowledge to provide care related to gender-based violence, and gendered experience); (c) factors contributing to workarounds (inflexible guidelines, lack of protocol and procedures, lack of nurses' and midwives' in service training, and the physical structure of the perinatal environment); and (d) vicarious trauma (living the feelings, "I carry their stories home," and hypervigilance in parenting)., Conclusion: Nurses and midwives find caring for adolescent mothers challenging due to their unique needs. These needs require them to be creative, adaptable, and attentive listeners to better understand their challenges. These practitioners face difficulties such as insufficient specific knowledge related to, for example, gender-based violence, inflexible guidelines, and a lack of protocols and training. Additionally, in the perinatal environment attention to the needs of practitioners in those settings is often lacking, and many nurses and midwives report experiencing vicarious trauma. Consequently, there is a pressing need for guidelines and protocols specifically tailored for the care of adolescent mothers. Ongoing trauma- and violence- informed care training and professional education should be provided to enhance the ability of nurses and midwives to care for adolescent mothers and prevent re-traumatization and mitigate vicarious trauma effectively., (© 2024. The Author(s).)

Background: The integration of patient portals into health systems has the potential to increase access for women. For example, within a mental health context, women are at a higher risk of developing anxiety and depression but may experience barriers in accessing care. Therefore, the aim of this rapid review was to understand what is currently known about patient portal use among women. The objectives were (1) To discover pertinent facilitators for women when using patient portals; (2) To discern if women face individual barriers to accessing patient portals; and (3) To explore the potential role of patient portals for women's mental health care., Methods: A rapid review methodology was implemented using the Cochrane Rapid Reviews Methods Group, as well as a grey literature scan. Inclusion criteria included articles that focused on women's use of patient portals within healthcare settings. Four databases were searched, including Embase, MEDLINE (Ovid), CINAHL and PsycINFO in September 2023. Two independent reviewers performed screening, data extraction, and analysis., Results: This search resulted in screening 1385 titles and abstracts, and 82 articles for full-text eligibility. 15 articles were included in the review. Data were extracted and analyzed, guided by the research objectives. Facilitators to patient portal use included processes that enhanced user engagement, the provision of portal tools, and management of health care features. Barriers included health equity factors and use of medical jargon. Applications to mental health care included how use of portals eased women's anxiety and increased their sense of internal control., Conclusions: The results of this review indicate that interrelated factors influence women's experiences with using patient portals. By understanding facilitators and barriers to portal use, and applications for mental health care, we can understand how to improve women's use of portals in the future., (© 2024. The Author(s).)

Intimate partner violence (IPV) is a pervasive, worldwide public health concern. Risk of IPV may elevate during the perinatal period, increasing maternal and fetal health risks. Trauma- and violence-informed care shows promise among interventions addressing associated mental health sequelae. As a secondary analysis, the purpose of this study was to employ a qualitative arts-based exploration to better understand pregnant women's experiences of trauma and violence-informed perinatal care in the context of IPV. Using an arts-based qualitative methodology, different art forms were used to analyze, interpret, and report data, resulting in a layered exploration to represent phenomena. From this, four themes were reflected in four poetic pieces: Black Deep Corners, Triggering my Thoughts, Breaking through the Brokenness, and Now Perfectly Imperfect. Nine pieces of visual art were created reflecting these themes, creating a layered, embodied, artistic way to empathically explore and translate phenomena.

Introduction: In Rwanda, maternal community health workers play a critical role to improving maternal, newborn and child health, but little is known about their specific experiences with adolescent mothers, who face unique challenges, including trauma, ongoing violence, stigma, ostracism, mental health issues, barriers within the healthcare system, and lack of access to the social determinants of health. This study explored the experiences of maternal community health workers when caring for adolescent mothers in Rwanda to inform the delivery of trauma- and violence-informed care in community maternal services., Methods: Interpretive Description methodology was used to understand the experiences of 12 community health workers purposively recruited for interviews due to their management roles. To gain additional insights about the context, seven key informants were also interviewed., Findings: Maternal community health workers provided personalized support to adolescent mothers through the provision of continuity of care, acting as a liaison, engaging relationally and tailoring home visits. They reported feeling passionate about their work, supporting each other, and receiving support from their leaders as facilitators in caring for adolescent mothers. Challenges in their work included handling disclosures of violence, dealing with adolescent mothers' financial constraints, difficulties accessing these young mothers, and transportation issues. Adolescent mothers' circumstances are generally difficult, leading to self-reports of vicarious trauma among this sample of workers., Conclusion: Maternal community health workers play a key role in addressing the complex needs of adolescent mothers in Rwanda. However, they face individual and structural challenges highlighting the complexities of their work. To sustain and enhance their roles, it is imperative for government and other stakeholders to invest in resources, mentorship, and support. Additionally, training in equity-oriented approaches, particularly trauma- and violence-informed care, is essential to ensure safe and effective care for adolescent mothers and to mitigate vicarious trauma among maternal community health workers., (© 2024. The Author(s).)

Globally, it is estimated that 245 million women and girls aged 15 and over have experienced intimate partner violence (IPV) in the past 12 months. Moreover, research has highlighted the disproportionately high prevalence of IPV victimization among pregnant women. IPV can have serious health implications for women and their infants, yet little is known about maternal health-related decision-making by mothers exposed to IPV. To this end, the purpose of this scoping review was to examine what is known regarding health-related maternal decision-making among perinatal women in the context of IPV. Using Arksey and O'Malley's framework, five electronic databases were searched, resulting in 630 articles. Eligible articles were primary studies written in English, included participants who experienced IPV at any time in their life, and reported results focused on maternal health-related decision-making in the context of IPV. Thirty-six articles were screened by the review team, resulting in seven included articles. Three main themes emerged regarding health-related maternal decision-making by mothers experiencing IPV, including suboptimal breastfeeding practices, under-utilization of maternal and child health services, and poor adherence to medical recommendations/regimens that impact health-related outcomes for mother and child. The well-established risk of poorer health outcomes among women experiencing IPV, alongside the findings of this scoping review, calls for further research specifically addressing health-related decision-making among perinatal women who experience IPV., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Intimate partner violence (IPV) includes multiple forms of harm inflicted on an intimate partner. Experiences of IPV impact mental and physical health, social relationships, and parenting and resilience may play an important role in how women overcome these detrimental effects. There is little research on how resilience relates to mothers' experience of IPV. We explored the role of resilience in the context of mothers who have experienced IPV in rural settings via semi-structured interviews with six women and 12 service providers. The relationship between resilience and motherhood was a common theme across all narratives. From this theme emerged three subthemes: 1) breaking the cycle of abuse; 2) giving children the "best life"; and 3) to stay or to leave: deciding "for the kids". Findings underscore the importance of supporting rural women who experience violence in cultivating their resilience and consideration of policy changes which support trauma- and violence-informed care., (© 2024 Kimberley T. Jackson et al., published by Sciendo.)

Background: Social support is essential to promoting optimal health outcomes for women with breast cancer. However, an estimated 12% of women with breast cancer simultaneously experience intimate partner violence (IPV; physical, psychological, or sexual abuse by an intimate partner). Women who experience IPV during breast cancer may lack traditional social support, and thus seek out alternative sources of support. Online community forums, such as Reddit, can provide accessible social connections within breast cancer-specific communities. However, it is largely unknown how women with breast cancer use Reddit to describe and seek support for experiences of IPV., Objective: This study aims to explore how patients with breast cancer describe toxic relationships with their partners and immediate family members on Reddit., Methods: This exploratory, cross-sectional, topic-modeling study analyzed textual data from 96 users in the r/breastcancer subreddit in February 2023. The meaning extraction method, inclusive of principal component analysis, was used to identify underlying components. Components were subjected to sentiment analysis and summative content analysis with emergent categorical development to articulate themes., Results: Seven themes emerged related to toxic relationships: (1) contextualizing storytelling with lymph nodes, (2) toxic behavior and venting emotions, (3) abandonment and abuse following diagnosis, (4) toxic relationships and social-related fears, (5) inner strength and navigating breast cancer over time, (6) assessing social relationships and interactions, and (7) community advice and support. Toxic relationships were commonly characterized by isolation, abandonment, and emotional abuse, which had profound emotional consequences for patients. Reddit facilitated anonymous venting about toxic relationships that helped patients cope with intense feelings and stress. Exchanging advice and support about navigating toxic relationships during breast cancer were core functions of the r/breastcancer community., Conclusions: Findings emphasized the value of Reddit as a source of social support for patients with breast cancer experiencing toxic relationships. Clinicians who understand that many patients with breast cancer experience toxic relationships and considerable psychological sequelae are better prepared to support their patients' holistic well-being. Further investigation of Reddit as a possible resource for advice, information, and support has the potential to help inform clinical practice and subsequently, patient health outcomes., (©Cara Anne Davidson, Richard Booth, Kimberley Teresa Jackson, Tara Mantler. Originally published in JMIR Cancer (https://cancer.jmir.org), 23.02.2024.)

Bolstering women's resilience in the context of gender-based violence (GBV) requires attention to structural conditions needed to support women to thrive, particularly in rural communities. This cross-sectional study explored how resilience was influenced by structural violence in rural Ontario among women experiencing GBV (n = 14) and service providers in the GBV sector (n = 12). Interviews were conducted and revealed forms of structural violence that undermine resilience for women experiencing GBV in rural communities, including 1) housing- gentrification, short-term rentals of residential properties, and long waitlists, 2) income- fighting for enough money to survive, 3) safety- abusers gaming the system, and 4) access- successes and new barriers. Structural conditions must be attended to as they are prerequisites required to build resilience., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mantler et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Cancer is predominantly understood as a physical condition, but the experience of cancer is often psychologically challenging and has potential to be traumatic. Some people also experience re-traumatization during cancer because of previous, non-cancer-related trauma, such as intimate partner violence or adverse childhood experiences. A trauma-informed approach to care (TIC) has potential to enhance care and outcomes; however, literature regarding cancer-related TIC is limited. Accordingly, the objective of this scoping review was to identify what is known from existing literature about trauma-informed approaches to cancer care in Canada and the United States. A scoping review (using Arksey and O'Malley's (2005) framework) was conducted. The PsycINFO, CINAHL, MEDLINE (Ovid), Embase (Ovid), and Scopus databases, key journals, organizations, and reference lists were searched in February 2022. In total, 124 sources met the review criteria and 13 were included in the final review. Analysis included a basic descriptive summary and deductive thematic analysis using conceptual categories. Theorizations, applications, effectiveness, and feasibility of TIC were compiled, and gaps in TIC and recommendations for TIC were identified. TIC appeared to be growing in popularity and promising for improving cancer outcomes; however, gaps in the theorization, effectiveness, and feasibility of TIC persisted. Many recommendations for the application of TIC were not issued based on a strong body of evidence due to a lack of available literature. Further research is required to develop evidence-based recommendations regarding TIC related to cancer. A systematic review and meta-analysis would be warranted upon literature proliferation., Competing Interests: Declaration of Conflicting InterestsThe author declared no potential conflicts of interest with respect to the authorship and/or publication of this article.

Introduction: The Baby-friendly Hospital Initiative is a global programme that is meant to support breastfeeding within organisations. Most of the current literature is focused on implementation and uptake of the programme; however, little is known about the patient experience of breastfeeding within these settings. By exploring this current gap in the literature, we may discover important contextual elements of the breastfeeding experience. The objective of this protocol is to provide a framework for a scoping review where we aim to understand the extent and type of evidence in relation to the patient experience of breastfeeding in Baby-friendly Hospital Initiative (BFHI)-certified settings., Methods and Analysis: The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The databases to be searched for relevant literature include MEDLINE, Embase, PsycINFO, CINAHL and Scopus in April 2023. A grey literature scan will include reviewing documents from professional organisations/associations. For all sources of evidence that meet the inclusion criteria, data will be extracted and presented in a table format. The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Participants in this review will include any individual who delivered their baby in a BFHI-certified setting. Exploring the patient experience will involve reviewing their subjective perceptions of events related to breastfeeding. These events must occur in a BFHI-certified hospital, and therefore, home births and other outpatient settings will be excluded., Ethics and Dissemination: Ethical approval is not required for this scoping review protocol or the final review. Knowledge gained from this research will be disseminated through the primary author's PhD dissertation work, as well as manuscript publications and conference presentations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This interpretive description study explored coping among older women in Ontario experiencing intimate partner violence (IPV) during COVID-19. Twelve in-depth interviews with older women found age-related normative beliefs played a role in how older women viewed their lives and how they looked beyond their experiences of IPV. Their roles as caretakers and homemakers influenced their response to IPV, and COVID-19 exacerbated feelings of lost time and loneliness. Coping strategies consisted of social support, including telephone formal services and physical activities. Women expressed a lack of appropriate services and financial limitations as barriers. They identified the need for age-appropriate services that acknowledge their unique experiences.

Abstract: BACKGROUND: Multiple sclerosis (MS) is an immune-mediated disease that affects the central nervous system, and is potentially disabling. Women experience MS more frequently than men at a 3:1 ratio. Current literature suggests that women may experience health, social determinants of health, and disability differentially, and there is a gap in the research examining how gender intersects with MS. METHODS: Interviews were conducted with 23 women with MS. van Manen's hermeneutic phenomenology was used to inform and analyze the data to understand the nature and meaning of health and well-being for participants. RESULTS: A key theme of "enhancing wholeness for women with MS" emerged from the data, which suggests that women with MS view themselves as healthy and "whole" despite living with MS. Supporting factors for physical, mental, and social well-being include the ability to enact human agency within social structures such as with employment or seeking care with MS clinics. The findings informed the development of a figure that depicts the supporting factors of health and well-being for women living with MS. CONCLUSION: The health and well-being of women with MS may be optimally supported by nurses and interdisciplinary healthcare teams through careful consideration as to how agency is enacted within social structures, for example, MS clinics, employment, and social support systems, as well as considerations for social determinants of health., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 American Association of Neuroscience Nurses.)

Objectives: Vaccine hesitancy (VH) in maternal decision-making is important to understand to achieve community immunity targets and optimize pediatric COVID-19 vaccine adoption. COVID-19 is exacerbating the risk of intimate partner violence (IPV) for women in abusive relationships, a known risk factor for maternal VH. This project aimed to: (1) determine if IPV impacts maternal VH in Canada; and (2) understand maternal attitudes towards routine childhood vaccines and a pediatric COVID-19 vaccine in Canada., Methods: As part of a cross-sectional, quantitative study, 129 women completed an online survey. IPV was assessed using the Abuse Assessment Screen and the revised, short-form Composite Abuse Scale. The Parent Attitudes about Childhood Vaccines scale evaluated maternal attitudes towards routine vaccinations and a COVID-19 vaccine. Questions informed by the World Health Organization's Increasing Vaccination Model (IVM) evaluated perceived barriers and facilitators to COVID-19 vaccination., Results: In total, 14.5% of mothers were hesitant towards routine childhood vaccines, while 97.0% were hesitant towards a COVID-19 vaccine. Experiencing IPV was significantly associated with maternal COVID-19 VH (W = 683, p < 0.05). Social processes were identified as instrumental barriers and facilitators to COVID-19 vaccination, meaning that social norms and information sharing among social networks are critical in maternal vaccination decision-making., Conclusions for Practice: This study provides novel evidence of maternal IPV significantly impacting VH and the presence of strong maternal VH specific to a COVID-19 vaccine in the Canadian context. Further research is required to fully understand the factors that build confidence and mitigate hesitancy in mothers, especially mothers who have experienced IPV., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Intimate partner violence (IPV) is a significant public health concern exacerbated by the pandemic. Experiences of violence vary based on geographic location and living in rural communities has been found, in some contexts, to amplify consequences of IPV. Resilience, the ability to survive and thrive despite facing adversity, has long been a dominant narrative within IPV literature, yet little is known about how resilience is cultivated among rural women experiencing violence. The purpose of this study was to explore how rural women experiencing IPV cultivate resilience., Methods: Using Interpretive Description, in-depth qualitative interviews were conducted with 14 women who experienced IPV and 12 staff from women's shelters across rural communities in Ontario, Canada to elicit perspectives about women's resilience and environmental conditions that may shape resilience in the context of IPV., Results: Women's resilience was cultivated by personal changes aimed at surviving or thriving, and aspects of their environment that enabled or created barriers for resilience. Women adopted a positive, hopeful mindset and bolstered their inner strength through living from a place of integrity, being resolute in decisions, and using mental resistance when faced with doubt. Women faced barriers to resilience in the form of unhelpful help and COVID-19 public health guidelines. Paradoxically, living in a rural community both cultivated and undermined resilience., Conclusions: Supporting women to cultivate resilience through modifying environmental factors to enable personal strengths to flourish is paramount in supporting women who have experienced IPV, particularly in rural contexts., Competing Interests: Conflict of InterestThe authors have no conflicts of interest to declare., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

This article explores leadership education, leadership scholarship, and leadership practices with a focus on the continued growth in thought, paradigm development, research and practices that address societal problems in relation to human existence. We respond to the question "how can the integration of counter narratives into leadership education - all while integrating diverse perspectives into our leadership education conversation so the complexity we now understand to be true can be revealed?" The exploration creates opportunities to deepen the diversity, equity, and inclusion discourse incorporated into graduate leadership education programs., (© 2022 Wiley Periodicals, LLC.)

Transitional-aged youth (TAY) between the ages of 16 and 24 experience higher rates of mental distress than any other age group. It has long been recognized that stability, consistency, and continuity in mental health care delivery are of paramount importance; however, the disjointed progression from paediatric to adult psychiatric services leaves many TAY vulnerable to deleterious health outcomes. In Spring 2019, eight TAY living with mental health challenges participated in a Photovoice study designed to: (1) illuminate their individual transition experiences; and, (2) support a collective vision for optimal mental health care at this nexus. Participants took photographs that reflected three weekly topics- the good, the bad , and the vision -and engaged in a series of three corresponding photo-elicitation focus group sessions. Twenty-four images with accompanying titles and captions were sorted into nine participant-selected themes. Findings contribute to an enhanced awareness of psychiatric service delivery gaps experienced by TAY, and advocate for seamless and supportive transitions that more effectively meet the mental health care needs of this population.

Background: With strict public health measures implemented in March 2020 due to the COVID-19 pandemic, many breastfeeding parents, who are within an at-risk population, have experienced limited formal and/or informal breastfeeding social support. In the Canadian context, the experiences of these women is unknown., Research Aim: To explore the experiences of at-risk postpartum breastfeeding women in accessing formal and informal breastfeeding social support during the COVID-19 pandemic., Methods: This was a prospective, longitudinal interpretive description study using mixed methods. Data were gathered using an online survey and one 52-112-min semi-structured interview at 12-weeks postpartum. At-risk breastfeeding participants were those who lack social support and had at least one of the following: age < 25 years; experiencing or had experienced intimate partner violence; or of low income. We sought participants' experiences of accessing breastfeeding social support during the first few months of the COVID-19 pandemic/lockdown. Seven participants completed the survey and the interview., Results: Participants identified that the COVID-19 pandemic created barriers to accessing formal and informal breastfeeding social support, which stemmed from public health restrictions and difficulties communicating online with families and healthcare providers. Additionally, participants identified that the COVID-19 pandemic/lockdowns facilitated feelings of connectedness, protection, and resiliency., Conclusion: We provide preliminary insight into the experiences of trying to access breastfeeding social support during the COVID-19 pandemic. Future researchers should seek to prioritize improved communication and resources in supporting breastfeeding during COVID-19 and future pandemics/lockdowns.

The transition from adolescence to adulthood is a tumultuous time riddled with stress, confusion, and uncertainty. An abrupt shift in biobehavioural development between the ages of 16 and 24 corresponds with an increase in mental health challenges; thereby necessitating comprehensive and coordinated psychiatric services that bridge pediatric and adult care realms. Unfortunately, this transition is often unsupportive and disjointed, leaving many transitional-aged youth (TAY) overwhelmed and ill-equipped to cope with the increased demands of adulthood independently. Eight TAY with mental health challenges were invited to participate in a PhotoVoice study that explored the strengths and shortcomings of this transition process, through a combination of photography and photo-elicitation focus group discussions. A descriptive qualitative approach was used to analyze all participant dialogue. Four themes emerged from the data: accessibility, coordination, independence, and support. Participant insights illuminated critical gaps in mental health care delivery, but also revealed novel solutions and opportunities for transformational change.

Aim: To evaluate the impact of a trauma and violence-informed cognitive behavioural therapy (TVICBT) intervention, compared with standard care on mental health, coping, bonding and maternal-infant attachment among pregnant women with a history of intimate partner violence and who displayed symptomatology consistent with anxiety, depression or post-traumatic stress disorder (PTSD)., Design: A mixed-methods case study design was employed, where women either received standard perinatal care or were referred to a specialized TVICBT program., Methods: Data were collected through a retrospective obstetric medical chart audit in 2017 at an Ontario hospital in a large urban centre. Multiple choice and 'yes/no' questions were analysed using measures of central tendency and dispersion, in addition to frequency counts. Qualitative data from clinical notes were subjected to an inductive content analysis approach to identify key concepts., Results: In total, 69 women participated (intervention group = 37, standard care group = 32). Prevalence of mental illness between groups was consistent, apart from the TVICBT group having a significant increase in PTSD. In the TVICBT group, 83.8% of women (n = 31) expressed perinatal concerns, compared with only 37.5% (n = 12) of the standard care group. More women in the intervention group (94.6%, n = 35) coped successfully in the intrapartum period than the standard care group (78.1%, n = 25). However, more women in the standard care group (97.0%, n = 31) exhibited appropriate bonding behaviours than the TVICBT group (88.6%, n = 31)., Conclusion: The TVICBT intervention was effective in assisting women to identify triggers during their pregnancy journey, develop appropriate coping strategies and advocate for their needs to best cope., Impact: TVICBT offers an effective, individualized, trauma and violence-informed approach to optimize the health outcomes of perinatal women and their infants by promoting positive coping and maternal-infant bonding, thus filling an existing practice gap of a lack of individualized, trauma-informed care., (© 2021 John Wiley & Sons Ltd.)

In North America, the most common societal response to intimate partner violence (IPV) has been the establishment of women's shelters for temporary housing and security. Rurality further compounds the challenges women experiencing IPV face, with unique barriers from their urban counterparts. This study sought to explore the intersection of rural women's health care experiences within the context of IPV. Eight rural women living in Southwestern Ontario, who had experienced IPV, had used women's shelter services, and who had accessed health care services in the preceding 6 months were interviewed. Using a feminist, intersectional lens, we collected and analyzed qualitative data using an interpretive description approach. Findings demonstrated that women were able to identify strengths and opportunities from their experiences, but significant challenges also exist for rural women seeking health care who experience IPV. Our findings underscore the need for filling of policy gaps between health care and the services women use. We propose that further research is needed on alternative, integrated models of shelter services that address health care needs for women experiencing IPV.

The COVID-19 pandemic and resultant public health measures, although helpful in reducing the spread of the disease, have disproportionately impacted women experiencing intimate partner violence (IPV). Despite these adverse circumstances, women continue to show resilience. Although difficult to define, resilience can be conceptualized as a dynamic process in which psychosocial and environmental factors interact to enable an individual to survive, grow, and thrive despite exposure to adversity. This research identifies facilitators and gaps in supports to promoting resilience among urban and rural women experiencing intimate partner violence (IPV) during the COVID-19 pandemic, via an online survey ( n  = 95) and interviews ( n  = 19). T-tests, Wilcoxon rank sum tests, and interpretive description were utilized for analyses. Almost 41% of participants experienced an increase in abuse during COVID-19, and resilience significantly decreased during COVID-19 ( t (44) = 2.91, p  = 0.006). Qualitatively, four parent themes (coercive control, social services, resilience, and future) and seven sub-themes emerged. Changes are needed in accessibility and delivery of support services for women experiencing IPV during COVID-19, and future pandemics., Competing Interests: Conflict of interestThe authors have no conflicts of interest to declare that are relevant to the content of this article., (© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022.)

Background: Strict public health measures central to slowing the spread of COVID-19 have, unintentionally, exacerbated risks for women experiencing intimate partner violence (IPV) while impeding their usual coping strategies. The goal of this study was to understand how coping was influenced by COVID-19 for women who have experienced IPV and identify changes in coping strategies and gaps that need to be addressed to support coping., Methods: A qualitatively driven, sequential, cross-sectional design, where quantitative data informed and was embedded within qualitative data collection, was used to explore the experiences of IPV (CAS-R-SF scale) and coping (Brief-COPE scale) specific to IPV of 95 Canadian women. A subset of 19 women was invited to complete an interview exploring coping strategies identified within the survey to contextualize and validate these findings., Results: Survey data subjected to quantitative content analysis identified ten themes, all of which were explored in semi-structured interviews. Thematic interview findings included (1) influence of COVID-19 on coping, (2) coping during COVID-19, and (3) needed coping strategies., Conclusion: COVID-19 had important impacts on the experiences and coping strategies of women who experience IPV. To better support this population in pandemic circumstances, in-person services should be prioritized with an emphasis on accessible and empathetic care. Public health measures in response to COVID-19, and the eventuality of future pandemics, should aim to be gender- and violence-informed., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022.)

Aim: This article provides a concept analysis of anticipatory guidance regarding breastfeeding-related pain and establishes a definition to inform the concept's practical use., Background: Breastfeeding-related pain is a barrier to achieving optimal breastfeeding outcomes, which can impede maternal and infant health. Education through anticipatory guidance that addresses breastfeeding-related pain can improve breastfeeding outcomes, but no formal definition is currently available for practitioner use., Design: Walker and Avant's protocol for concept analyses was employed., Data Source: A comprehensive literature review was conducted using CINAHL, PubMed, Scopus, and OMNI. Search terms included anticipatory guidance, breastfeeding, pediatrics, nursing, and lactating. This identified 379 articles, of which six addressed anticipatory guidance for breastfeeding-related pain., Review Methods: Inclusion criteria asked that literature be available in English and published between 2000 and 2020., Results: Three key characteristics of anticipatory guidance regarding breastfeeding-related pain were identified: timing, content, and intention. Antecedents included maternal intention to breastfeed and interaction with a healthcare provider. Consequences included improved breastfeeding outcomes, enhanced maternal understanding of challenges, and maternal empowerment in relation to pain management., Conclusions: Anticipatory guidance about breastfeeding-related pain can empower women to sustain breastfeeding in spite of challenges, thus prolonging the breastfeeding period, and subsequently improving infant nutrition and health outcomes., (© 2021 Wiley Periodicals LLC.)

To increase our understanding of chronic pain in clinical and research contexts, an assessment of its dimensions using reliable and valid self-reported pain measures is imperative. However, well-validated Arabic chronic pain assessment scales are lacking. The Chronic Pain Grade (CPG) scale has been used worldwide, yet an Arabic version of the CPG scale has not yet been validated. Thus, we conducted this study to demonstrate the psychometric properties, including reliability, convergent validity, and construct validity of the Arabic CPG scale. A cross-sectional study was conducted in two hospitals in Saudi Arabia. Data were collected from a convenience sample of 233 chronic pain patients. The confirmatory factor analysis showed an excellent fit with the factor structure of the CPG scale and, thus, supported construct validity. The two identified subscales were pain intensity and pain disability. Convergent validity was supported by having significant correlations between the short-form McGill Pain Questionnaire and CPG subscales. Internal consistency reliability was demonstrated, as Cronbach's α was 0.916 for pain intensity and 0.815 for pain disability. This study provides evidence that the Arabic CPG scale is a reliable and valid measure of chronic pain dimensions, including pain intensity, and pain-related disability. This Arabic version of the CPG scale has the potential to expand research and clinical assessment in the Arab world. Future studies are required for further validation., (© 2021 Wiley Periodicals LLC.)

Individuals having in-center hemodialysis treatment re quire transportation services on average six trips a week (three roundtrips for three treatment days), making access to transportation an important component for sustaining the health and well-being of these individuals. This qualitative study aimed to explore how persons receiving in-center hemodialysis treatment explain ways in which access to transportation for such treatment influences their overall health using the World Health Organization's definition of health. Purposive sampling was used to recruit eight participants from a community hemodialysis center in a suburban region of Southwestern Ontario, Canada. Data were obtained using semi-structured individual interviews and analyzed using inductive analysis. Three interrelated themes revealed each patient's experience: reliability, choice, and personal safety., Competing Interests: The authors reported no actual or potential conflict of interest in relation to this nursing continuing professional development (NCPD) activity., (Copyright© by the American Nephrology Nurses Association.)

Purpose: Intimate partner violence (IPV) is a pervasive public health issue impacting one in three women, worldwide. Broadly defined as any act of coercive control within the context of an intimate relationship, IPV often results in significant negative health outcomes. Cognitive Behavioral Therapy (CBT), a mainstay treatment for relational trauma, has particular relevance for women undergoing the many transformations associated with the perinatal period. The findings of this case analysis build upon existing literature supporting the positive impact of Trauma and Violence- Informed CBT (TVICBT) for women who have experienced IPV and are living with mental health challenges., Methods: As part of a larger mixed-methods study, three women who experienced IPV and received TVICBT during pregnancy participated in in-depth, semi-structured interviews to determine the perceived value and acceptability of this intervention., Findings: Insights gained herein, serve to enrich current evidence, suggesting that TVICBT provided during pregnancy may hold promise for the treatment of IPV-related mood and anxiety disorders., Conclusions: Given that improved perinatal mental health has been linked to enhanced maternal resiliency and quality of life, greater maternal-infant attachment, and positive child health outcomes, this research has the potential to bridge the critical knowledge gap at the intersection of motherhood, trauma, and mental health.

Women who have experienced intimate partner violence (IPV) have significant detrimental physical and mental health consequences associated with the violence as well as numerous barriers to health-care and social service utilization. Service integration offers a solution to help support women who have experienced violence overcome negative health consequences as well as barriers to system navigation and use. The purpose of this scoping review was to examine research activity pertaining to IPV and primary health-care and women's shelters integration. Namely, the aim was to determine the extent, range, and nature of research related to the effects of integrating primary health-care services and women's shelters. Nineteen sources were identified as potentially relevant from four electronic databases, with four articles meeting the inclusion criteria of integration of primary health-care and women's shelter services where outcomes were presented related to the efficacy of primary health-care received and integration. Numerical analysis revealed considerable homogeneity among articles in terms of methodological approaches, patient populations, and type of integration. Inductive thematic content analysis revealed three themes that resulted from integration: (1) increased access to and acceptability of services, (2) bridge back to health-care, and (3) decreasing future health-care burden. The findings from this scoping review represent a first attempt to summarize the literature, indicate a need for additional research, and suggest implications for practice.

Background: Children with medical complexity (CMC) and their parents are affected physically and mentally during transitions in care. Coordinated models of care show promise in improving health outcomes., Objective: The purpose of this scoping review was to examine research related to CMC and their parents and transitions in care. The aim was 3-fold: (1) to examine the extent, range, and nature of research activity related to the impact of transitions on physical and mental health for CMC and their parents; (2) to summarize and disseminate research findings for key knowledge users; and (3) to identify research gaps in the existing literature to inform future studies., Methods: Twenty-three sources were identified through database searches and five articles met the inclusion criteria of CMC (multi-organ involvement or technology-dependent) (or parents of CMC) transitioning from hospital to alternate levels of care where outcome measures were physical or mental health-related., Results: Numerical analysis revealed substantial variation in methodological approaches and outcome measures. Content analysis revealed two themes for parents of CMC during this transition: (1) emotional distress, and (2) high expectations; and three themes for CMC: (1) improved health, (2) changes in emotion, and (3) disrupted relationships., Conclusion: The findings from this scoping review reveal for parents, transitions in care are fraught with emotional distress and high expectations; and for CMC there are improvements in quality of life and emotional health post- hospital to home transitions when collaborative models of care are available. This review serves as an early attempt to summarize the literature and demonstrate a need for further research., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Introduction: Intimate partner violence (IPV) impacts approximately one quarter of Canadian women, and services provided to support women are heavily influenced by policy. Policy sets the stage and tone for action in all sectors. To date, there have been no critical discourse analyses examining how provincial, hospital, and women's shelter policies intersect and impact women in rural communities., Methods: A critical discourse analysis using a case study of one rural community in south-western Ontario was undertaken by a multisectoral team of researchers using a critical, feminist, intersectional lens. The selected policies were (1) Domestic Violence Action Plan for Ontario (ODVAP), (2) the rural women's shelter policy, and (3) the hospital policy., Results: The internal analysis of the policies revealed that ODVAP focused on societal solutions to violence requiring cross-sectoral cooperation with a focus on marginalized populations, whereas the rural shelter policy focused on creating a philosophical orientation to underpin their work with clients. There was no formal hospital policy related to the provision of services for women who have experienced violence. The policies revealed a disconnect between the stated goals and the specifics concerning how the policies would come together to achieve these goals. Obstacles such as having no clear link for how ODVAP and the shelter policy would work together, idealization of training but a lack of specificity on what training would be useful, and the requirement of affirmative action on the part of women to engage with services functioned as a means to maintain the status quo, that is, working in a siloed approach to care., Conclusions: Integrative systems are important for women who have experienced IPV given the wide range of health, social, and economic consequences of violence. Policy alignment is important for women who have experienced or are experiencing IPV, particularly in rural contexts where services are fraught with additional barriers.

Purpose: Despite how commonly breastfeeding-related pain is experienced in the postpartum period, and its frequent implication in breastfeeding cessation, this unique type of pain is not well evaluated nor assessed. The purpose of this study was to gain a comprehensive description and understanding of breastfeeding-related pain among postpartum breastfeeding women. Methods: This study employed a mixed methods approach using a descriptive-interpretive qualitative approach, in addition to administering the Short-Form McGill Pain Questionnaire, second version, to comprehensively gain both quantitative and qualitative descriptors of breastfeeding-related pain. Fourteen partnered and educated women living in Southern Ontario with experience of breastfeeding-related pain took part in this study. Results: The results from this study suggest that breastfeeding-related pain is often experienced as severe and distressing, and comprises various elements of pain including continuous, intermittent, neuropathic, and affective components. Conclusion: Breastfeeding-related pain is multidimensional and can be severe and distressing for women. Current measurement tools may not adequately reflect the multidimensional components of this unique type of pain, which may limit the effectiveness of health care providers to help with its identification and management.

Objective: Support from fathers is consistently associated with improved breastfeeding duration and exclusivity rates. Additionally, there is growing evidence that fathers want to be included in breastfeeding interventions provided by health care professionals. The objective of this review was to determine the effect of partner-inclusive educational and psychosocial interventions on breastfeeding initiation, duration, and exclusivity., Design: A systematic review was conducted using a search strategy developed with an expert health sciences librarian. Electronic databases MEDLINE, EMBASE, CINAHL, and PsycINFO were systematically searched for randomized controlled trials and quasi-experimental studies from inception to August 4, 2018. Independent data extraction and quality assessments were conducted by authors using Cochrane Collaboration tools. Due to significant heterogeneity in intervention content, outcome measures, and follow-up time points, data were synthesized qualitatively., Findings: 3982 articles were identified, of which 12 studies in 15 publications met the inclusion criteria and were included. All of the studies improved at least one breastfeeding outcome, including duration (n = 5/9) and exclusivity (n = 8/10) up to 24 weeks postpartum. Six studies examined increasing paternal breastfeeding support and all found beneficial effects. Biases were identified in the studies with the most common bias relating to the randomization process and the blinding of outcome assessors., Implications for Practice: The inclusion of fathers/partners in breastfeeding interventions improves breastfeeding initiation, duration, and exclusivity rates. Interventions that include face-to-face information delivery, are designed in a culturally appropriate manner, and provide information on how partners can support breastfeeding are more likely to have a beneficial effect. Research is warranted to examine the underlying intervention mechanisms., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose: Breastfeeding-related pain is commonly experienced early in the postpartum period and is an important contributor to breastfeeding cessation, yet little is known about what this pain means to women and how it is experienced. The purpose of this study was to gain a better understanding of the phenomenon of breastfeeding-related pain, how women experience this pain, and the meaning it holds for them., Study Design and Methods: Interpretive descriptive methods and inductive content analysis were used. Women were recruited using purposive sampling with a snowball approach. Data were collected via one-to-one interviews using a semistructured interview guide with postpartum women having experienced breastfeeding-related pain in the past 2 months., Results: Fourteen postpartum women who met inclusion criteria were interviewed. They were predominantly Caucasian, well educated, and had greater than average Canadian annual household incomes. The dominant emerging discourse revealed three key themes: (a) interplay between breastfeeding pain and context, (b) action enablers and/or barriers, and (c) breastfeeding outcomes., Clinical Implications: Breastfeeding-related pain is an unpleasant sensory and affective experience for women during the postpartum period. Availability and accessibility of breastfeeding supports are essential to enable women to achieve their breastfeeding goals. Providing anticipatory guidance may help women to cope more effectively with their breastfeeding-related pain.

Background: Intimate partner violence (IPV) is a pervasive public health problem, impacting the health and quality of life of survivors worldwide. The trauma of IPV is associated with a high incidence of mental illness, namely depressive and anxiety disorders, and posttraumatic stress disorder (PTSD). Moreover, literature endorses cognitive behavioral therapy (CBT) interventions as a gold standard for those with symptomatology consistent with anxiety disorders, mood disorders, and PTSD. However, efficacy has not been evaluated among a population of pregnant survivors of IPV., Objective: We present the protocol that will be used to explore the efficacy of trauma-informed cognitive behavioral therapy on maternal and child health outcomes for pregnant women with PTSD, depression, or anxiety symptomatology resulting from IPV. A secondary aim will be to test the validity and feasibility of study methodology to support the successful implementation of a full-scale randomized controlled trial., Methods: The Promoting Attachment Through Healing (PATH) study will use a mixed-methods approach grounded in an intersectional feminist framework to explore the effectiveness of trauma-informed CBT for pregnant survivors of IPV. Study participants will be recruited through the hospital-based Perinatal Mental Health Clinic (London, Ontario, Canada). A feasibility sample of 20 pregnant women (cohort 1) will be selected to engage in an eight-session antenatal CBT intervention facilitated by the program's perinatal clinical nurse specialist, with evaluation at baseline, at two months postpartum (intervention and online questionnaire), and at six and twelve months postpartum (online questionnaire only). Concurrently, we will conduct a retrospective audit of 100 medical charts (cohort 2; 50 charts of perinatal women who received CBT and 50 charts of women who did not receive perinatal CBT) from the past five years. The efficacy of the intervention will be based on a reduction of mental illness symptomatology, improved maternal-infant attachment, maternal coping, and maternal quality of life. Additionally, the feasibility of the protocol and acceptability of the intervention from the women's perspective will be examined. Inductive content analysis of all qualitative data will be used to determine common themes. Additionally, descriptive statistics, including measures of central tendency and dispersion, will be computed for all continuous variables. Alternatively, frequency tables will be constructed for all categorical variables., Results: The work reported here is in the proposal phase. Once the protocol is implemented, we will report the results in a follow-up paper. Participant recruitment for cohort 1 has started and we have finished data collection for cohort 2. It is anticipated that the results will be available by the end of 2018., Conclusions: Findings will assess the acceptability of the study methodology and protocol for a full-scale randomized controlled trial. Furthermore, if CBT is proven effective for pregnant survivors of IPV, this intervention could be readily adopted by health care and social support services, thereby contributing to an improved standard of care for this unique population., Trial Registration: ClinicalTrials.gov NCT03536442; https://www.clinicaltrials.gov/ct2/show/NCT03536442 (Archived by WebCite at http://www.webcitation.org/6zeurv1ay)., Registered Report Identifier: RR1-10.2196/9820., (©Kimberley T Jackson, Sarah Parkinson, Brianna Jackson, Tara Mantler. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 25.05.2018.)

Nipple pain and damage are commonly experienced by breastfeeding women and are associated with negative breastfeeding outcomes. Health care providers often recommend the application of lanolin to treat painful/damaged nipples, yet no randomized controlled trial has evaluated the effectiveness of lanolin on nipple pain and breastfeeding outcomes. The purpose of this study was to evaluate the effect of lanolin on nipple pain among breastfeeding women with damaged nipples. A randomized, single-blind, controlled trial was conducted at a tertiary care hospital in Hamilton, Ontario, Canada. Breastfeeding women (N = 186) identified as having nipple pain/damage were randomized to apply lanolin (intervention group; n = 93) or to receive usual postpartum care (control group; n = 93). The primary outcome was nipple pain at 4 days post-randomization measured by the Numeric Rating Scale. Additional outcomes included nipple pain measured by the Short Form McGill Pain Questionnaire, breastfeeding duration/exclusivity, breastfeeding self-efficacy, and maternal satisfaction with lanolin treatment versus usual care. The results revealed no significant group differences in mean pain scores at 4 days post-randomization. Women in both groups experienced clinically relevant decreases in nipple pain by 7 days post-randomization. Significantly, more women in the lanolin group reported that they were satisfied with treatment compared with those receiving usual care. No significant group differences were found for other secondary outcomes. While more women were satisfied using lanolin, its application to sore/damaged nipples was ineffective for reducing nipple pain or improving breastfeeding outcomes., (© 2016 John Wiley & Sons Ltd.)

The first microcrystalline borazine-linked polymer, BLP-2(H), has been synthesized. BLP-2(H) crystallizes into 2D sheets that stack in an eclipsed AA fashion, has high thermal stability (∼420 °C) and high porosity (SA(BET) = 1178 m(2) g(-1)) and it can store up to 2.4 wt% of hydrogen at 77 K and 15 bar with isosteric heat of adsorption of 6.8 kJ mol(-1).

Successful incorporation of triptycene into benzimidazole-linked polymers leads to the highest CO(2) uptake (5.12 mmol g(-1), 273 K and 1 bar) by porous organic polymers and results in high CO(2)/N(2) (63) and CO(2)/CH(4) (8.4) selectivities.

Social learning from peers can trigger herd-wide intoxication with white locoweed (Oxytropis sericea), an alkaloid-synthesizing herbaceous legume that grows on rangelands of western North America. We conducted an experiment to test the hypothesis that restriction of the area allocated to animals to feed in would inhibit social facilitation of locoweed ingestion in yearling heifers. Eight heifers that avoided white locoweed (LA) and eight heifers that readily consumed it (LE) were selected from a pool of 40 cross-bred heifers and were randomly assigned to the social facilitation or social interference treatment groups. We conducted 200 10-min feeding trials in three 5-day phases (pre-treatment, treatment, post-treatment) during which animals were presented with a set of bowls arrayed in a test arena, some of which contained ground wheat straw and others contained air-dried ground white locoweed. During the pre-treatment (days 1 to 5) and the post-treatment phases (days 11 to 15) non-social trials were conducted in which the feeding behavior of individual animals was investigated in an 80 m2 arena containing 12 feeding bowls. During the treatment phase (days 6 to 10) social learning trials were conducted in which LA + LE pairs from the social interference group were exposed to 12 bowls of food distributed in an 80 m2 arena intended to induce social interference, and LA + LE pairs from the social facilitation group were exposed to 36 bowls of food distributed in a 240 m2 arena intended to permit social facilitation. During pre-treatment phase, LA heifers consumed detectably less locoweed and wheat straw and exhibited lower preference for locoweed than LE (P ⩽ 0.05) although wheat straw preference of LA and LE was similar. During social learning trials (treatment phase), LA in the social interference group visited similar number of locoweed bowls (mean ± s.e.m.: 0.2 ± 0.12) as they had during non-social learning (0.2 ± 0.20). Conversely, LA heifers in the social facilitation group visited detectably more locoweed bowls during social learning trials (1.6 ± 0.46) compared with the pre-treatment phase (0.2 ± 0.16). Correlation between daily number of locoweed bowls visited by LA and LE during social learning trials was detected in the social facilitation (r = 0.70; P < 0.01), but not in the social interference group (r = 0.15; P = 0.52). During testing trials (post-treatment phase), locoweed and wheat straw intake and preference of LA and LE in both treatment groups was similar. Manipulation of the feeding environment delayed, but did not inhibit social learning of toxic weed ingestion in this study.

Rolipram-sensitive, low-K(m)80% loss of norepinephrine in cerebral cortex) without affecting dopaminergic systems. The lesions resulted in temporary reduction of PDE4 activity in cerebral cortex, cerebellum and brainstem. Lesions in the adult rats, on the other hand, did not alter PDE4 activity. Decreased PDE4 activity by neonatal noradrenergic lesions was due to a decrease in the V(max) of cAMP hydrolysis by PDE4, and not a change in the K(m) values. Immunoblot analysis showed that decreased PDE4 activity in cerebellum was associated with reduced expression of PDE4A5, PDE4A1, and several PDE4B variants. No change in the expression of any PDE4 subtype in cerebral cortex was detected with the antibodies used in this study. Neither the permanent loss of noradrenergic innervation in cerebral cortex, nor the permanent noradrenergic hyperinnervation in brainstem was accompanied by any permanent change in PDE4 activity. Decreasing PDE4 activity early after neonatal noradrenergic lesions might be important in maintaining constant concentrations of cAMP, which is critical for the cellular proliferation and differentiation that is active during this period.

The addition of xylazine to ketamine hydrochloride was found to enhance analgesia, anesthesia, and muscle relaxation in rhesus monkeys. At 0.10 ml/kg body weight, this combination provided adequate anesthesia for such procedures as cisternal puncture, lumbar spinal puncture, insertion of urinary catheters, finger amputations, and tattooing. The combination of ketamine and xylazine did depress the heart rate, respiration rate, and body temperature more than the administration of ketamine alone. The period of anesthesia also was prolonged, but the monkeys regained consciousness more rapidly at the end of the anesthetic period.