The prevalence of chronic pain in children and adolescents: a systematic review update and meta-analysis.

ABSTRACT: Chronic pain, defined as persistent or recurring pain or pain lasting longer than 3 months, is a common childhood problem. The objective of this study was to conduct an updated systematic review and meta-analysis on the prevalence of chronic pain (ie, overall, headache, abdominal pain, back pain, musculoskeletal pain, multisite/general pain, and other) in children and adolescents. EMBASE, PubMed, CINAHL, and PsycINFO were searched for publications between January 1, 2009, and June 30, 2023. Studies reporting population-based estimates of chronic nondisease related pain prevalence in children or adolescents (age ≤ 19 years) were included. Two independent reviewers screened articles based on a priori protocol. One hundred nineteen studies with a total of 1,043,878 children (52.0% female, mean age 13.4 years [SD 2.4]) were included. Seventy different countries were represented, with the highest number of data points of prevalence estimates coming from Finland and Germany (n = 19 each, 4.3%). The overall prevalence of chronic pain in children and adolescents was 20.8%, with the highest prevalence for headache and musculoskeletal pain (25.7%). Overall, and for all types of pain except for back pain and musculoskeletal pain, there were significant differences in the prevalence between boys and girls, with girls having a higher prevalence of pain. There was high heterogeneity (I 2 99.9%). Overall risk of bias was low to moderate. In summary, approximately 1 in 5 children and adolescents experience chronic pain and prevalence varies by pain type; for most types, there is higher pain prevalence among girls than among boys. Findings echo and expand upon the systematic review conducted in 2011.

Influence of paternal preconception health on pregnancy, intrapartum, postpartum and early childhood outcomes: protocol for a parallel scoping review.

INTRODUCTION: Preconception care is the provision of behavioural, social or biomedical interventions to women and couples prior to conception. To date, preconception research has primarily focused on maternal health, despite the male partner's contribution before birth to both short-term and long-term child outcomes. The objectives of the reviews are: (1) to identify, consolidate and analyse the literature on paternal preconception health on pregnancy and intrapartum outcomes, and (2) to identify, consolidate and analyse the literature on paternal preconception health on postpartum and early childhood outcomes. METHODS AND ANALYSIS: A scoping review will be conducted following the Joanna Briggs Institute methodology. MEDLINE, PsycINFO, Embase, Scopus and CINAHL databases will be searched for articles published in English. Two independent reviewers will screen titles and abstracts and then full text using Covidence, with conflicts resolved by a third reviewer. Data extraction will be performed using Covidence. ETHICS AND DISSEMINATION: Ethics approval is not required for this scoping review. Results will be published in peer-reviewed journals as well as presented at relevant national and international conferences and meetings.

Psychometrics of the breastfeeding self-efficacy scale and short form: a systematic review.

BACKGROUND: The Breastfeeding Self-Efficacy Scale and its short-form were developed in Canada and have been used internationally among numerous maternal populations. However, the psychometric properties of the scales have not been reviewed to confirm their appropriateness in measuring breastfeeding self-efficacy in culturally diverse populations. The purpose of this research was to critically appraise and synthesize the psychometric properties of the scales via systematic review. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Three databases (EMBASE, MEDLINE, and PsycINFO) were searched from 1999 (original publication of the Scale) until April 27, 2022. The search was updated on April 1, 2023. Studies that assessed the psychometric properties of the BSES or BSES-SF were included. Two researchers independently extracted data and completed the quality appraisals. RESULTS: Forty-one studies evaluated the psychometrics of the BSES (n = 5 studies) or BSES-SF (n = 36 studies) among demographically or culturally diverse populations. All versions of the instrument demonstrated good reliability, with Cronbach's alphas ranging from .72 to .97. Construct validity was supported by statistically significant differences in mean scores among women with and without previous breastfeeding experience and by correlations between the scales and theoretically related constructs. Predictive validity was demonstrated by statistically significant lower scores among women who ultimately discontinued breastfeeding compared to those who did not. CONCLUSION: The BSES and BSES-SF appear to be valid and reliable measures of breastfeeding self-efficacy that may be used globally to (1) assess women who may be at risk of negative breastfeeding outcomes (e.g., initiation, duration and exclusivity), (2) individualize breastfeeding support, and (3) evaluate the effectiveness of breastfeeding interventions.

Bibliometric analysis of published articles on perinatal anxiety from 1920 to 2020.

INTRODUCTION: Trends and gaps in perinatal anxiety research remain unknown. The objective of this bibliometric review was to analyze the characteristics and trends in published research on perinatal anxiety to inform future research. METHODS: All published literature in Web of Science on perinatal anxiety from January 1, 1920 to December 31, 2020 were screened by two reviewers. VOSViewer was utilized to visualize linkages between publications. Bibliometric data were extracted from abstracts. RESULTS: The search strategy identified 4561 publications. After screening, 2203 publications related to perinatal anxiety were used for the visualization analysis. For the bibliometric data, 1534 publications had perinatal anxiety as a primary focus. There were 7910 different authors, over half named only once (55.5 %), from 63 countries. 495 journals were identified, with over half (56.0 %) publishing only one article. Most articles were published between 2011 and 2020 (75.9 %). In terms of perinatal timing, over half (54.2 %) published on antenatal anxiety. Only 6.0 % of studies reported on perinatal anxiety in fathers and 56.5 % also reported on perinatal depression. LIMITATIONS: Web of Science was solely used, and manual screening of each publication was required. CONCLUSION: This bibliometric analysis found: (1) perinatal anxiety is a growing field of research, with publications increasing over time; (2) there is variation in authors and journals; (3) over half of the publications focus on antenatal anxiety; (4) paternal anxiety is understudied; and (5) only 6 % of publications came from low and lower-middle income countries. Gaps related to maternal postnatal anxiety and paternal perinatal anxiety exist.

Bibliometric analysis of published articles on perinatal depression from 1920 to 2020.

AIM: To analyze the characteristics and trends in published research on perinatal depression between 1920 and 2020. METHODS: A search strategy in Web of Science identified all published literature on perinatal depression between January 1, 1920, and December 31, 2020. Output from Web of Science was used to analyze bibliometric information, and VOSViewer was used to visualize the networks of linkages between identified publications. RESULTS: There were 16,961 publications identified. Among these publications, there were 82,726 unique authors and 140 countries represented. The United States had the highest frequency of publications (44.6%). Most publications (69.8%) occurred between 2011 and 2020, with the first publication identified in 1928. There were 2197 unique journals identified, with over half publishing only one (n = 948, 43.2%) or two relevant publications (n = 314, 14.3%). Authors with the largest number of publications were Wisner (n = 115), Dennis (n = 95), and Murray (n = 92), while authors with the largest number of citations were Cox (n = 7225), Murray (n = 2755), and O'Hara (n = 2069). LIMITATIONS: While the Web of Science is a representative database identifying the greatest number of relevant articles, it may be unrepresentative of all published literature. CONCLUSION: This is the first study mapping publications on perinatal depression between 1920 and 2020. The rate of publication on perinatal depression has been steadily increasing in recent years with a wide variety of authors, countries, and journals represented. As the field continues to grow, trends may shift as early career researchers emerge and the importance of mental health in low-income countries is prioritized.

Postpartum Mental Health and Perceptions of Discrimination Among Asian Fathers During the COVID-19 Pandemic.

PURPOSE: The purpose of this study was twofold: (1) to examine the prevalence of postpartum depression and anxiety symptomatology among fathers of Asian descent living in North America during the COVID-19 pandemic, and (2) to identify the occurrences of online racial discrimination. STUDY DESIGN AND METHODS: Using a cross-sectional design and convenience sampling methods, we recruited fathers online via social media sites (Facebook, Instagram) between March 12 and July 31, 2022. The Edinburgh Postnatal Depression Scale, General Anxiety Scale, and the Online Victimization Scale assessed mental health well-being and discrimination outcomes. Data were analyzed using descriptive statistics, two sample t-test, chi-square test of independence, and Pearson's correlation analysis. RESULTS: Our sample included 61 fathers within 6 months postpartum living in the United States and Canada. Participants were on average 34 years old, married, and represented 17 Asian ethnic groups, including Asian Indian (41%), Filipino (11.3%), and Korean (8.1%). One-third of our participants (31.1%, n = 19) were at high risk of developing postpartum depression and scores of three (4.9%) fathers indicated they had clinically significant anxiety. Overall, 26.3% reported experiencing direct online racial discrimination and 65% reported occurrences of indirect online racial discrimination. CLINICAL IMPLICATIONS: There was a high rate of depressive symptoms and occurrences of online racial discrimination among fathers of Asian descent living in North America. These rates are higher than the general perinatal population and further research is warranted to examine risk factors and preventive strategies among this unique paternal ethnic group.

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

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

Procedural pain assessment in neonates at risk of neonatal opioid withdrawal syndrome: a scoping review protocol.

OBJECTIVE: The objective of this review is to identify evidence on pain assessment during acute procedures in hospitalized neonates at risk of neonatal opioid withdrawal syndrome (NOWS). INTRODUCTION: While all neonates are routinely exposed to various painful procedures, neonates at risk of NOWS have longer hospital stays and are exposed to multiple painful procedures. NOWS occurs when a neonate is born to a birth parent who identifies as having sustained opioid use (such as morphine or methadone) during pregnancy. Accurate pain assessment and management during painful procedures is critical for minimizing the well-documented adverse effects of unmanaged pain in neonates. While pain indicators and composite pain scores are valid and reliable for healthy neonates, there is no review of evidence regarding procedural pain assessment in neonates at risk of NOWS. INCLUSION CRITERIA: Eligible studies will include those reporting on hospitalized pre-term and full-term neonates at risk of NOWS having pain assessments (ie, behavioral indicators, physiological indicators, validated composite pain scores) during and/or after exposure to an acute painful procedure. METHODS: This review will follow the JBI scoping review methodology. Databases to be searched will include MEDLINE (Ovid), CINAHL (EBSCO), Embase, PsyclNFO (EBSCO), and Scopus. The relevant data will be extracted by 2 reviewers using a modified JBI extraction tool. The results will be summarized in narrative and tabular format, including the components of participants, concept, and context (PCC). REVIEW REGISTRATION: Open Science Framework https://osf.io/fka8s .

The Canadian Healthy Life Trajectories Initiative (HeLTI) Trial: a study protocol for monitoring fidelity of a preconception-lifestyle behaviour intervention.

BACKGROUND: In evaluating technology-based behaviour change interventions, it is increasingly important to have a monitoring plan for intervention fidelity. It is important to maintain intervention fidelity to ensure that the theory-based intervention that is being tested is what causes the observed changes, particularly for eHealth behaviour change interventions. In this protocol, we outline the intervention fidelity and monitoring protocol for Healthy Life Trajectory Initiative (HeLTI) Canada, a randomized controlled trial evaluating the effect of a preconception-early childhood technology-based intervention delivered by public health nurses among pregnancy-planning women and their partners to optimize child growth and development. METHODS: The HeLTI Canada fidelity protocol is based on the National Institutes of Health Behaviour Change Consortium (NIH BCC) Treatment Fidelity Framework, outlining the following components of intervention fidelity: study design, provider training, intervention delivery, intervention receipt, and intervention enactment. The intervention fidelity components and associated monitoring strategies were developed to align with the HeLTI Canada approach. Strategies for intervention fidelity monitoring include a pre-post written evaluation of training, standardization of provider training, use and monitoring of activity logs, and intervention session checklists. Possible challenges to intervention fidelity include provider turnover due to the length of the trial and lack of ability to directly monitor participant behaviour change in real-life settings. Details about intervention fidelity monitoring are provided in detail. The study launched in January 2021 and is currently recruiting. DISCUSSION: Using the NIH BCC Treatment Fidelity Framework, HeLTI Canada has a robust framework for monitoring and reporting intervention fidelity to improve intervention validity, ability to assess intervention effectiveness, and transparency. TRIAL REGISTRATION: ISRCN ISRCTN13308752 . Registered on February 29, 2019.

Cohort profile: Impact of Maternal and Paternal Mental Health - Assessing Concurrent Depression, Anxiety and Comorbidity in the Canadian Family (IMPACT study).

PURPOSE: This paper describes a prospective cohort, Impact of Maternal and Paternal Mental Health: Assessing Concurrent Depression, Anxiety and Comorbidity in The Canadian Family (IMPACT) study, which followed maternal-paternal dyads and their children across the first 2 years post partum. PARTICIPANTS: A total of 3217 cohabitating maternal-paternal dyads were recruited into the study from 2014 to 2018. Each dyad member separately completed online questionnaires at baseline (<3 weeks post partum) and again at 3, 6, 9, 12, 18 and 24 months on a variety of measures, including mental health, parenting environment, family functioning and child health and development. FINDINGS TO DATE: At baseline, the mean maternal age was 31.9±4.2 years and 33.8±5.0 years for fathers. Overall, 12.8% of families had a household income below the poverty line of $C50 000, and 1 in 5 mothers and 1 in 4 fathers were not born in Canada. One in 10 women experienced depressive symptoms during pregnancy (9.7%) and 1 in 6 had markedly anxious symptoms (15.4%) while 1 in 20 men reported feeling depression during their partner's pregnancy and 1 in 10 had marked anxiety (10.1%). Approximately 91% of mothers and 82% of fathers completed the 12-month questionnaire as did 88% of mothers and 78% of fathers at 24 months postpartum. FUTURE PLANS: The IMPACT study will examine the influence of parental mental illness in the first 2 years of a child's life with a focus on understanding the mechanisms by which single (maternal or paternal) versus dual (maternal and paternal) parental depression, anxiety and comorbidity symptoms affect family and infant outcomes. Future analyses planned to address the research objectives of IMPACT will consider the longitudinal design and dyadic interparental relationship.

Impact of parent-targeted eHealth educational interventions on infant procedural pain management: a systematic review.

OBJECTIVE: The objective of this review was to determine whether electronic health (eHealth) educational interventions about infant procedural pain and pain management impact parental outcomes (eg, mental health, knowledge uptake), eHealth outcomes (eg, acceptance, use), and pain management outcomes (eg, parental involvement, infant pain response). INTRODUCTION: Pain in infants is a common concern for parents. Routine postpartum care for infants in early life requires them to endure painful procedures, such as immunizations, yet infants often receive little to no pain management. Parents are an essential component of effective pain management, although they may not be aware of the roles they play. Despite the increased number of eHealth resources available to educate parents about infant pain management, their impact has yet to be synthesized. INCLUSION CRITERIA: This review considered studies that evaluated eHealth educational interventions targeted at parents during pregnancy and up to 1 year postpartum. Interventions included, but were not limited to, mobile applications, web-based applications, websites, videos, interactive training, hands-on direct simulation, short message service (SMS), and desktop applications. Primary outcomes included parental outcomes (eg, stress or anxiety, self-efficacy, knowledge, attitudes), eHealth outcomes (eg, acceptance, use), and pain management outcomes (eg, parental involvement, infant pain response). Experimental, quasi-experimental, and observational study designs were included. METHODS: MEDLINE, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and SciELO were searched for studies published in English up to June 14, 2021. Citation lists of relevant reviews and included studies were also searched for additional peer-reviewed articles. Two independent reviewers conducted critical appraisal using standardized tools from JBI, and data extraction, using a data extraction form designed by the authors. Statistical pooling of quantitative data was not possible due to heterogeneity; thus, the findings were reported narratively. RESULTS: A total of 4163 unique studies were screened, with 11 studies ultimately included for synthesis. Five articles were randomized controlled trials, 5 articles were analytical cross-sectional studies, and 1 article was quasi-experimental. Studies reported on 4 unique eHealth educational interventions, all of which used video format and primarily targeted the postnatal period. The findings for all primary outcomes were mixed but suggested either improvements in outcomes or no impact. The certainty of evidence was determined as low or very low across primary outcomes for reasons related to imprecision, risk of bias, and indirectness. CONCLUSIONS: Although heterogeneity of findings limited quantitative synthesis of data, this review suggests that short and engaging educational videos have the potential to positively impact parents' knowledge, confidence, and desire to be involved in procedural pain management for their children. Most of the interventions presented in this review describe evidence-based information about procedural pain management strategies that are known to be effective for infant populations. Thus, it is reasonable to assume that infant pain response should be lower when parents appropriately apply the strategies. However, the findings of this review were not able to confirm this assumption. More research is needed to evaluate the impact of parent-targeted pain management education on infant pain response. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020151569.

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

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

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

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

Scoping Review of Racial and Ethnic Representation of Participants in Mental Health Research Conducted in the Perinatal Period During the COVID-19 Pandemic.

OBJECTIVE: To identify the racial and ethnic representation of participants in mental health research conducted in the perinatal period during the COVID-19 pandemic. DATA SOURCES: MEDLINE, CINAHL, Cochrane Library, PsycINFO, Scopus, Web of Science. STUDY SELECTION: We included peer-reviewed research articles in which researchers reported mental health outcomes of women during the perinatal period who were living in the United States or Canada during the COVID-19 pandemic. We included 25 articles in the final review. DATA EXTRACTION: We extracted the citation, publication date, design, aim, country of origin, participant characteristics, sampling method, method of measurement of race and ethnicity, and mental health outcome(s). DATA SYNTHESIS: The combined racial and ethnic representation of the 16,841 participants in the included studies was White (76.5%), Black (9.8%), other/multiracial (6.2%), Asian (3.9%), Hispanic/Latina (2.6%), Indigenous or Ethnic Minority Canadian (0.9%), and Native American or Alaska Native (0.1%). Most studies were conducted in the United States, used a cross-sectional design, and incorporated social media platforms to recruit participants. Depression, anxiety, and stress were the most frequently assessed mental health outcomes. CONCLUSION: Relatively few women of color who were pregnant or in the postpartum period during the pandemic participated in mental health research studies. Future studies should develop intentional recruitment strategies to increase participation of women of color. Researchers should use updated guidance on reporting race and ethnicity to accurately represent every participant, minimize misclassification of women of color, and report meaningful results.

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

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

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

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

Experiences of nurses and midwives in policy development in low- and middle-income countries: Qualitative systematic review.

Background: Nurses provide 90% of health care worldwide, yet little is known of the experiences of nurses and midwives in policy development in low- and middle-income countries (LMICs). Objective: To identify, appraise and synthesize the qualitative evidence on the experiences of nurses' and midwives' involvement in policy development LMICs. Design: A qualitative systematic review using modified Joanna Briggs Institute (JBI) methodology. Setting: Low and middle-income countries. Participants: Nurses' and midwives' involved in policy development, implementation, and/or evaluation. Methods: A systematic search was undertaken across nine databases to retrieve published studies in English between inception and April of 2021. Screening, critical appraisal, and data extraction was undertaken by two independent reviewers. Results: Ten articles met inclusion criteria. All studies were published between 2000 to 2021 from a variety of LMICs. The studies were medium to high quality (70-100% critical appraisal scores). Four major themes were identified related to policy development: 1) Marginal representation of nurses; 2) Determinants of nurses' involvement (including at the individual, organization, and systematic level); 3) Leadership as a pathway to involvement; 4) Promoting nurses' involvement. Conclusion: All studies demonstrated that nurses and nurse midwives continue to be minimally involved in policy development. Findings reveal reasons for nurses' limited involvement and strategies to foster sustained engagement of nurses in policy development in LMICs. To enhance their involvement in policy development in LMICs, change is needed at multiple levels. Systemic power relations need to be reconstructed to facilitate more collaborative interdisciplinary practices with nurses co-leading and co-developing health care policies.

The experience of remote recruitment for Essential Coaching for Every Mother during the coronavirus disease 2019 pandemic.

INTRODUCTION AND AIMS: Due to physical distancing recommendations because of the COVID-19 pandemic, recruitment approaches for perinatal research needed to shift from in-person to remote. The purpose of this study is to describe the recruitment and retention of women for an mHealth intervention study for Essential Coaching for Every Mother. METHODS: Three methods were used for recruitment: social media, posters in hospital, and media outreach. First time mothers were eligible for enrollment antenatally (37+ weeks) and postnatally (<3 weeks). Eligibility screening occurred remotely via text message. Outcomes were days to recruit 75 participants, eligibility vs. ineligibility rates, dropout and exclusion reasons, survey completion rates, perinatal timing of enrollment, and recruitment sources. RESULTS: Recruitment ran from 15 July to 19 September 2020 (67 days) with 200 potential participants screened and 88 enrolled. It took 50 days to enroll 75 participants. Women recruited antenatally were more likely to receive all intervention messages (68 vs. 19%) and miss fewer messages (6.4 vs. 13.8) than women enrolled postnatally. Participants heard about the study through family/friends (31%), news (20%), Facebook groups/ads (30%), posters (12%), or other (7%). CONCLUSION: Antenatal recruitment resulted in participants enrolling earlier and receiving more messages. Remote recruitment was a feasible way to recruit, with word of mouth and media outreach being most successful, followed by Facebook.

Incidence, prevalence, and timing of postpartum complications and mortality in Canada and the United States: a systematic review and meta-analysis protocol.

OBJECTIVE: The goal of this systematic review is to assess the incidence, prevalence, and timing of common postpartum (up to 1 year after delivery) medical, surgical/procedural, and psychosocial complications and mortality. INTRODUCTION: Childbirth is the most common cause for hospitalization, and cesarean delivery is the most commonly performed inpatient surgery. After delivery, mothers are at risk of short- and long-term complications that can impact their well-being. The results of this review will inform evidence-based recommendations for patient education, monitoring, and follow-up. INCLUSION CRITERIA: We will include studies performed in Canada and/or the United States that report the incidence or prevalence of medical, procedural/surgical, and psychosocial complications within 1 year postpartum. Observational studies (analytical cross-sectional studies, retrospective and prospective cohorts), randomized or non-randomized controlled trials with a control or standard of care group, systematic reviews, and meta-analyses will be included. Studies with fewer than 100 patients, participants younger than 18 years, no reporting of duration, or focus on patients with a specific condition rather than a general postpartum population will be excluded. METHODS: The search strategy was codeveloped with a medical librarian and included full-text English-language articles published within the past 10 years (2011-2021) in PubMed, CINHAL, Web of Science, and Cochrane Database of Systematic Reviews. Screening, critical appraisal, and data extraction will be performed by two independent reviewers using Covidence, standardized JBI tools, and a standardized form, respectively. For each complication, the incidence or prevalence, timing of the frequency measurement, and duration of follow-up from individual studies will be determined. Meta-analysis will be performed if feasible. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42022303047.