Advances in the Care of Infants With Prenatal Opioid Exposure and Neonatal Opioid Withdrawal Syndrome.

A significant number of advances have been made in the last 5 years with respect to the identification, diagnosis, assessment, and management of infants with prenatal opioid exposure and neonatal opioid withdrawal syndrome (NOWS) from birth to early childhood. The primary objective of this review is to summarize major advances that will inform the clinical management of opioid-exposed newborns and provide an overview of NOWS care to promote the implementation of best practices. First, advances with respect to standardizing the clinical diagnosis of NOWS will be reviewed. Second, the most commonly used assessment strategies are discussed, with a focus on presenting new quality improvement and clinical trial data surrounding the use of the new function-based assessment Eat, Sleep, and Console approach. Third, both nonpharmacologic and pharmacologic treatment modalities are reviewed, highlighting clinical trials that have compared the use of higher calorie and low lactose formula, vibrating crib mattresses, morphine compared with methadone, buprenorphine compared with morphine or methadone, the use of ondansetron as a medication to prevent the need for NOWS opioid pharmacologic treatment, and the introduction of symptom-triggered dosing compared with scheduled dosing. Fourth, maternal, infant, environmental, and genetic factors that have been found to be associated with NOWS severity are highlighted. Finally, emerging recommendations on postdelivery hospitalization follow-up and developmental surveillance are presented, along with highlighting ongoing and needed areas of research to promote infant and family well-being for families impacted by opioid use.

Portugal nautical stations: Strategic alliances for sport tourism and environmental sustainability.

Nautical tourism is a tourist product with great development in the European space and a lot of potential to promote and develop tourist destinations. Considering the dynamics of nautical tourism management and the importance of meeting the specificities of this market niche, the objective of this study was to analyse the strategic alliances for the development of the offer of nautical tourism products, namely the strategic goals and sustainable environmental practices adopted by their actors which integrated the strategic alliances in order to certificate a plethora of nautical stations in Portugal. Between September and December 2021, 17 Portuguese nautical stations' application forms were collected. Content analysis using Nvivo software was the technique used for data analysis. The results showed a multiplicity of strategic objectives associated with the strategic alliance established between the nautical stations. The strategic vision of nautical stations for the development of strategic alliances is built, firstly, on the objective of structuring the tourism offer, followed by increasing governance and promoting and marketing nautical tourism using the image of the destination. Based on these results, it is possible to infer the importance of nautical stations in destination competitiveness and the role of strategic alliances in facilitating penetration in the nautical tourism market. The managers of nautical stations should consider the use of strategic alliances to make a cooperative marketing in order to improve the experience of the clients. Regarding environmental sustainability practices, the results exposed the prominence of environmental education actions in contrast to the reduced number of nautical stations developing actions for the adoption of sustainable transport. This study contributes to a better understanding of nautical tourism and Portuguese nautical stations, a project of strategic investment in sport and tourism, inferring on the objectives underlying the formation of strategic alliances and on the adopted environmental sustainability practices. The conclusions of this study point to the need for future scientific research on the actual operationalization of the objectives underlying the formation of strategic alliances, as well as the environmental practices developed by nautical stations.