Maternal and co-parental experiences and satisfaction with a co-parenting breastfeeding eHealth intervention in Canada.

BACKGROUND: Suboptimal breastfeeding rates are a public health priority. Interventions that include both breastfeeding women and their co-parents can increase breastfeeding initiation, duration, and exclusivity. eHealth can be an effective means of designing such interventions, as parents increasingly use the internet to access health information. The objective of this study was to determine maternal and co-parent satisfaction with an eHealth intervention. METHODS: The study was part of a larger randomized controlled trial that took place in Canada between March 2018 and April 2020. Data was collected from mothers (n = 56) and co-parents (n = 47). INTERVENTION: The eHealth intervention group received: 1) continued access to an eHealth breastfeeding co-parenting resource from the prenatal period to 52 weeks postpartum; 2) a virtual meeting with a research assistant; and 3) 6 weekly emails reminders. Follow-up data were collected via online questionnaires completed at 2 weeks post enrollment and 4, 12, 26, and 52 weeks postpartum to determine use and satisfaction with the intervention components. FINDINGS: The majority of mothers and co-parents independently reviewed the eHealth resource (95% and 91%, respectively), with higher use in the prenatal period. Participants found the resource to be useful (92%), informative (93%), targeted both parents (90%), and easy to understand (97%). Participants indicated the resource was comprehensive, easily navigated, convenient, and engaging. APPLICATION TO PRACTICE: Providing mothers and their co-parents with breastfeeding co-parenting support via an eHealth intervention delivers accessible, comprehensive information which may assist them in meeting their breastfeeding goals.

The value of discharged case fatality rate in estimating the severity and epidemic trend of COVID-19 in China: a novel epidemiological study.

Aim: The main objective of this study was to explore the value of the discharged case fatality rate (DCFR) in estimating the severity and epidemic trend of COVID-19 in China. Subjects and methods: Epidemiological data on COVID-19 in China and Hubei Province were obtained from the National Health Commission of the People's Republic of China from January 20, 2020, to March 31, 2020. The number of daily new confirmed cases, daily confirmed deaths, daily recovered cases, the proportion of daily deaths and total deaths of discharged cases were collected, and the total discharge case fatality rate (tDCFR), daily discharge case fatality rate (dDCFR), and stage-discharge case fatality rate (sDCFR) were calculated. We used the R software (version 3.6.3, R core team) to apply a trimmed exact linear time method to search for changes in the mean and variance of dDCFR in order to estimate the pandemic phase from dDCFR. Results: The tDCFR of COVID-19 in China was 4.16% until March 31, 2020. According to the pattern of dDCFR, the pandemic was divided into four phases: the transmission phase (from January 20 to February 2), the epidemic phase (from February 3 to February 14), the decline phase (from February 15 to February 22), and the sporadic phase (from February 23 to March 31). The sDCFR for these four phases was 43.18% (CI 39.82-46.54%), 13.23% (CI 12.52-13.94%), 5.86% (CI 5.49-6.22%), and 1.61% (CI 1.50-1.72%), respectively. Conclusion: DCFR has great value in assessing the severity and epidemic trend of COVID-19. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-023-01895-4.

Modelling COVID-19 transmission using IDSIM, an epidemiological-modelling desktop app with multi-level immunization capabilities.

Background: : The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented demands on local public health units in Ontario, Canada, one of which was the need for in-house epidemiological modelling capabilities. The objective of this study is to develop a native Windows desktop app for epidemiological modelling, to be used by public health unit epidemiologists to predict COVID-19 transmission in Durham Region. Methods: : The developed app is an implementation of a multi-stratified compartmental epidemiological model that can accommodate multiple virus variants and levels of vaccination, as well as public health measures such as physical distancing, contact tracing followed by quarantine and testing followed by isolation. It was used to investigate the effects of different factors on COVID-19 transmission, including vaccination coverage, vaccine effectiveness, waning of vaccine-induced immunity and the advent of the Omicron variant. The simulation start date was November 22, 2021. Results: : For the Delta variant, at least 90% of the population would need to be vaccinated to achieve herd immunity. A Delta-variant-only epidemiological curve would be flattened from the start in the absence of immunity waning and within six months in the presence of immunity waning. The percentage of infections caused by the Omicron variant was forecast to increase from 1% to 97% in the first month of the simulation. Total Omicron infections were forecasted to be reduced, respectively, by 26% or 41% if 3,000 or 5,000 booster doses were administered per day. Conclusion: : For the Delta variant, both natural and vaccination-induced immunity are necessary to achieve herd immunity, and waning of vaccine-induced immunity lengthens the time necessary to reach herd immunity. In the absence of additional public health measures, a wave driven by the Omicron variant was predicted to pose significant public health challenges with infections predicted to peak in 2-3 months from the start of the simulation, depending on the rate of administration of booster doses.

Designing an eHealth Breastfeeding Resource With Young Mothers Using a Participatory Design.

INTRODUCTION: Breastfeeding rates among young mothers are low and do not meet recommendations from health authorities, putting the health of young mothers and their infants at risk. Young mothers require breastfeeding support that meets their learning needs and preferred mode for accessing information. The objective of this study was to work collaboratively with young mothers in order to cocreate an eHealth breastfeeding resource. METHODOLOGY: A three-phase exploratory study was conducted in Ontario, Canada. In Phases I and II, young mothers and health care providers (HCPs) were recruited and preferences for an eHealth breastfeeding resource were explored. In Phase III, feedback from young mothers and HCPs about the new resource was collected. RESULTS: Participants found the breastfeeding eHealth resource visually appealing, engaging, and informative. DISCUSSION: Cocreating a tailored breastfeeding eHealth resource with young mothers and HCPs using a participatory approach ensured that the resource design and content met the learning needs of young mothers.

The comparison of access to an eHealth resource to current practice on mother and co-parent teamwork and breastfeeding rates: A randomized controlled trial.

BACKGROUND: Breastfeeding rates are suboptimal, putting mothers and their infants' health at risk. One modifiable risk factor amenable to intervention is partner support. Having women work as a team with their co-parents to meet their breastfeeding goals has been found to improve breastfeeding outcomes. eHealth resources have been found to be accessible and feasible ways to provide breastfeeding education yet, the best way to design breastfeeding interventions for mothers and their co-parents is not known. OBJECTIVES: To compare two study conditions to determine: (1) which way is more effective to provide breastfeeding education to women and their co-parents on increasing breastfeeding rates and associated secondary outcomes, such as breastfeeding knowledge, attitude, self-efficacy and overcoming challenges; (2) the difference in co-parenting and partner support between the study groups; (3) how parents in both groups preferred to access breastfeeding information; and (4) the groups' satisfaction with the eHealth resource that was provided. DESIGN: This study used a randomized controlled trial design (Clinicaltrials.org #NCT03492411). Participants were randomly allocated to study groups with concealed opaque envelopes by a blinded research assistant. Participants in Study Condition #1 (SC1) accessed a previously created, online e-Health resource, in addition to other generally available resources they could access in the community; participants in Study Condition #2 (SC2) accessed only the generally available resources. SETTING: Participants were recruited in health care providers' offices and services for expectant parents in Ontario and via social media throughout Canada. PARTICIPANTS: Expectant women (n = 113) and their co-parents (n = 104) were enrolled. METHODS: After eligibility was determined, consents obtained and baseline surveys completed, group allocation was conducted. SC1 had a virtual meeting with a research assistant to review the eHealth resource. Weekly emails were sent to all participants for 6 weeks as reminders. Follow-up data were electronically collected from mothers and co-parents at 2 weeks post enrollment and 4, 12, 26 and 52-weeks postpartum. RESULTS: Breastfeeding rates were high in both groups (SC1 63% and SC2 57% 'exclusive' 6 months) and (SC1 71% and SC2 78% 'any' 12 months) and not statistically significantly different. High scores were found in both groups in secondary outcome measures. Generally available breastfeeding resources were used in both groups with websites being used often and rated as most helpful. SC1 rated the eHealth resource provided to them highly. CONCLUSION: The findings suggest both mothers and their co-parents should be targeted in breastfeeding education and web-based resources designed to meet their needs.

High level of dietary soybean oil depresses the growth and anti-oxidative capacity and induces inflammatory response in large yellow croaker Larimichthys crocea.

Increasing demand, uncertain availability and high price of fish oil with the expansion of aquaculture made it essential to search alternative lipid sources. Vegetable oil has been proved to be the best candidate for the replacement of fish oil in aquafeeds. However, this replacement especially in high level potentially has some negative effects on fish. The present study was conducted to investigate the growth performance, anti-oxidative and inflammatory responses of large yellow croaker to replacement of dietary fish oil by soybean oil. Three isonitrogenous (46% crude protein) and isolipidic (13% crude lipids) diets were formulated to feed fish (initial body weight: 36.80 ±â€¯0.39 g) for 12 weeks. The control diet was designed to contain 6.5% of fish oil, and named as FO. On the basis of the control diet, the fish oil was 50% and 100% replaced by soybean oil, and these two diets were named as FS and SO, respectively. Results showed that the specific growth rate significantly decreased in the SO group. Crude lipid contents in muscle and liver of fish fed SO diet were significantly higher than those in the FO group. The ratio of n-3 poly-unsaturated fatty acids (PUFAs) to identified fatty acids in liver decreased significantly, while n-6 PUFAs increased significantly with increasing dietary soybean oil inclusion. The levels of triacylglycerol, non-esterified fatty acid and tumour necrosis factor α, and the activity of aspartate aminotransferase in serum significantly increased in SO group. The total anti-oxidative capacity and expressions of the anti-oxidation-related genes (superoxide dismutase 1 and 2, catalase, glutathion peroxidase and nuclear factor erythroid 2-related factor 2) were significantly decreased by dietary soybean inclusion. Dietary soybean oil significantly decreased the gene expressions of the anti-inflammatory cytokines (arginase I and interleukin 10), and increased the pro-inflammatory cytokines (tumour necrosis factor α and interleukin 1ß). The replacement of dietary fish oil by soybean oil also induced an over-expression of toll-like receptor 22 and myeloid differentiation factor 88 in liver. In conclusion, dietary soybean oil could suppress growth performance and liver anti-oxidative capacity, and induce inflammatory responses of large yellow croaker.

Designing an eHealth Breastfeeding Resource With Indigenous Families Using a Participatory Design.

INTRODUCTION: The traditional practice of breastfeeding has been negatively affected by the historical trauma experienced by the Canadian Indigenous community. Culturally relevant information and support should be created to enable the communities to reclaim this traditionally revered infant feeding method. The objective of this participatory design study was to work in partnership with Indigenous communities to create an eHealth breastfeeding resource for Indigenous families. METHODOLOGY: In partnership with Indigenous mothers and care providers in Ontario, Canada, an eHealth breastfeeding resource was designed based on their recommendations. Once the new resource was created, it was evaluated by additional Indigenous mothers. RESULTS: The participants indicated the resource was culturally relevant and that they liked the content and design. DISCUSSION: Using a participatory design when creating services and programs in partnership with Indigenous communities ensures the creation of resources that meet their needs, are culturally relevant, and align with cultural beliefs.

The Development and piloting of an eHealth breastfeeding resource targeting fathers and partners as co-parents.

OBJECTIVE: Traditionally breastfeeding education programs target mothers solely. The objective of this study was to design and pilot test an interactive eHealth breastfeeding co-parenting resource developed to target both mothers and fathers. eHealth resources provide an accessible and engaging format on which to educate parents and assist them in meeting their breastfeeding goals. Best practices to design such resources are not currently known. DESIGN: A three phase pilot study was conducted. The three phases included conducting a needs assessment, creating the resource and pilot testing the resource with mother, father and health care professionals to determine their perspectives regarding the usability and design of the prototype resource. The interactive prototype resource was designed to provide information to parents on breastfeeding and co-parenting, which included suggestions on how fathers can be involved and support breastfeeding and how the couples can work as a team to meet their breastfeeding goals. Setting: Recruitment took place in a health region in Southern Ontario, Canada between June 2014 and March 2015. Online questionnaires were completed by participants in all phases of the study. PARTICIPANTS: Participants (n=149) were pregnant or new mothers and their partners in the health region who read and speak English and had access to the internet and health care professionals who work with breastfeeding families in Ontario, Canada. INTERVENTION: A prototype eHealth breastfeeding co-parenting resource was developed based on maternal and paternal feedback from Phase I and utilized an interactive interface which included games and multimodal information delivery. The prototype eHealth resource was provided to the parents in Phase II and health care professionals in Phase III. The final resource was created based on feedback from these participants. MEASUREMENTS AND FINDINGS: The resource was pilot tested with new and expectant parents using pre- and post-test questionnaires which included measures for breastfeeding self-efficacy (Breastfeeding Self-Efficacy Short Form), infant feeding attitude (Iowa Infant Feeding Attitude Scale), breastfeeding knowledge (Breastfeeding Knowledge Questionnaire) and co-parenting relationship (Co-parenting Relationship Scale). Maternal and paternal breastfeeding self-efficacy and knowledge and infant feeding attitude scores all increased from pre-test to post-test. However, there was no difference in the co-parenting relationship scores from pretest to post-test. KEY CONCLUSIONS: This study has used feedback from parents and health professionals to develop a prototype resource which appears to be effective in increasing parents' breastfeeding knowledge, attitude and self-efficacy. The prototype resource was rated positively by parents and health care providers. IMPLICATIONS FOR PRACTICE: An eHealth breastfeeding co-parenting resource designed with input from the target population is an effective way of providing information to mothers and fathers. Further research with a randomized controlled design and more diverse populations is needed to determine effectiveness of the resource on breastfeeding duration and exclusivity.

Assessment of the toxicity of mixtures of nickel or cadmium with 9,10-phenanthrenequinone to Daphnia magna: impact of a reactive oxygen-mediated mechanism with different redox-active metals.

Recently, we showed that reactive oxygen species (ROS) formation was involved in the toxicity of the redox-active metal Cu and mixtures of Cu plus a photomodified polycyclic aromatic hydrocarbon (PAH), phenanthrenequinone (PHQ), to Daphnia magna. It is unknown, however, if similar results can be observed for metals with lower or no redox activity and their mixtures with PHQ. In the present study using D. magna, the toxicity of Ni, a weakly redox-active metal, and of Cd, a non-redox active metal, was examined with or without PHQ. The abilities of Ni, Cd, PHQ, and binary mixtures of metal plus PHQ to generate ROS were measured using a 2',7'-dichlorofluorescein fluorescence assay. The results were compared with the results of Cu and mixtures of Cu plus PHQ from a recent study by our group. The order of metal toxicity to D. magna was found to be Cd > or = Cu > Ni. As with Cu/PHQ mixtures, synergistic toxicity was observed for mixtures of Ni and PHQ, whereas additive toxicity was observed for mixtures of Cd and PHQ. Alone, PHQ had no impact on ROS levels in D. magna. Nickel alone caused elevated ROS, which was further enhanced in the presence of PHQ. Neither Cd nor Cd/PHQ mixtures increased ROS production. Attenuation of toxicity and ROS production was observed in response to treatment with low concentrations of L-ascorbic acid. These results indicate potential toxic interactions between metals and modified PAHs. With redox-active metals, such as Cu and Ni, and modified PAHs, such as PHQ, these interactions can involve ROS formation.

Photoinduced toxicity of polycyclic aromatic hydrocarbons to Daphnia magna: ultraviolet-mediated effects and the toxicity of polycyclic aromatic hydrocarbon photoproducts.

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental contaminants known for their photoinduced toxicity. This toxicity may occur through two mechanisms: Photosensitization, and photomodification. Photosensitization generally leads to the production of singlet oxygen, a reactive oxygen species that is highly damaging to biological molecules. Photomodification of PAHs, usually via oxidation, results in the formation of new compounds and can occur under environmentally relevant levels of actinic radiation. The toxicities of 16 intact PAHs to Daphnia magna were assessed under two ultraviolet radiation conditions. The toxicity of intact PAHs generally increased in the presence of full-spectrum simulated solar radiation relative to that in the presence of visible light plus ultraviolet A only. Despite the knowledge of a bipartite mechanism of phototoxicity that includes photosensitization and photomodification, few studies have examined the effects of PAH photoproducts on animals. To expand the existing data, 14 PAH photoproducts (oxy-PAHs) also were assayed, most of which were highly toxic without further photomodification. Two photoproducts of benzo[a]pyrene, 1,6- and 3,6-benzo[a]pyrenequinone, were the most toxic compounds tested, followed closely by benz[a]anthraquinone. Each of these three compounds had a median effective concentration in the low nanomolar range. The data presented highlight the effects of ultraviolet radiation on mediating PAH toxicity and the need to analyze absorption spectra of contaminants in the prediction of photoinduced toxicity. The importance of the role of photomodification also is stressed, because several oxy-PAHs, an unregulated group of contaminants, were highly toxic to D. magna, a key bioindicator species in aquatic ecosystems.

Assessment of the toxicity of mixtures of copper, 9,10-phenanthrenequinone, and phenanthrene to Daphnia magna: evidence for a reactive oxygen mechanism.

Polycyclic aromatic hydrocarbons and their derivatives are ubiquitous environmental contaminants. They are commonly present in complex mixtures with other contaminants, such as metals. The toxicities of phenanthrene (PHE) and 9,10-phenanthrenequinone (PHQ) with or without Cu were determined using Daphnia magna. Copper was the most toxic among the three chemicals tested, followed by PHQ and then PHE, with 48-h median effective concentrations (EC50s) of 0.96, 1.72, and 5.33 microM, respectively. Copper at 0.31 microM, or approximately the 5% effective concentration, decreased the EC50 of PHQ from 1.72 to 0.28 microM. Likewise, PHQ at 1.2 microM, or approximately the 10% effective concentration, significantly lowered the EC50 of Cu from 0.96 to 0.30 microM. This synergistic effect was not observed, however, in mixtures of Cu and PHE based on the response addition model. Assimilation of Cu wasfound to be similar with or without PHQ at increasing external concentrations of Cu, indicating that the increased toxicity of their mixtures is physiologically based. The ability of Cu plus PHQ to generate reactive oxygen species (ROS) was measured as well. Copper alone caused elevated ROS levels at a low concentration (0.63 microM). With PHQ present, however, this elevation in ROS occurred at an even lower Cu level (0.31 microM). Possible attenuation effects of ascorbic acid (vitamin C) on toxicity and ROS production induced by Cu, PHQ, and their mixtures were then examined. Ascorbic acid protected against Cu and Cu-plus-PHQ mixture-mediated toxicity but did not affect PHQ toxicity. Ascorbic acid also lowered ROS levels in the presence of Cu and Cu plus PHQ. We conclude that there exist potential toxic interactions between metals and modified PAHs and that these interactions can involve ROS formation.