In response to overlooked oral health needs among hospitalised children in Alder Hey Children's Hospital (AHCH), an initiative known as 'Mini Mouth Care Matters' (MMCM), was implemented to improve children's mouthcare by appropriately training healthcare professionals (HCPs) to be confident and knowledgeable in assessing, providing and promoting oral health among hospitalised children. Commissioned by Liverpool City Council, the launch of MMCM in AHCH commenced in February 2024. Previous surveys in the hospital indicated a need for oral care training. Implementation of MMCM involved streaming an e-learning course and videos for HCPs and children on the hospital website, drop-in sessions in the wards, study day training sessions, allocation and training of champions and provision of mouth care packs. Several challenges were encountered during the preparation of the resources and the implementation of the intervention. One key lesson learned is that it is preferable for the manager or team responsible for implementation to come from within the organisation. This allows them to leverage their connections and navigate the hospital's workload dynamics. Theory-based process and outcomes evaluation is planned to understand the effect of MMCM implementation on its effectiveness and to study MMCM normalisation within routine clinical practice. The evaluation of MMCM will contribute to understanding the impact of oral health interventions in hospital settings and will inform future strategies to improve oral care practices and outcomes for hospitalised children.

ObjectiveThis study aimed to describe the experiences of chemotherapy-induced oral mucositis among patients with breast cancer. Its primary focus is on how chemotherapy-induced oral mucositis affects day-to-day functioning, psychological wellness and overall quality of life.Methods12 Jordanian women who had been diagnosed with breast cancer and had presented with chemotherapy-induced oral mucositis were the purposive sample for this qualitative study, which employed in-depth, semistructured interviews. The verbatim transcriptions of the interviews were subjected to thematic analysis.ResultsThe thematic analysis of the 12 participants’ reviews revealed five main themes: distressing physical manifestations, eating and nutritional struggles, mouth care difficulties, psychological strain, social and emotional consequences, and coping and adaptation strategies.ConclusionsBreast cancer patients’ daily routines, mental health and quality of life are all significantly impacted by chemotherapy-induced oral mucositis. According to the study, individuals with breast cancer who experience chemotherapy-induced oral mucositis should get patient-centred care and address their emotional, psychological, social and physical discomfort to maximise their outcomes.

In Alberta, a provincial daily oral hygiene policy (OHP) for Long-Term Care Facilities (LTCF) was approved in 2018, and a mouth care training program (MCTP) was implemented in 2015. These initiatives require LTCFs to provide residents with twice-daily oral hygiene assistance and staff training. This study aimed to evaluate the provincial implementation scope, compliance rates, perceived impact on residents, and areas for improvement. A web-based survey was distributed to LTCF managers across Alberta, with 77 responses representing 11,653 residents. Overall, 66.2% of LTCF managers had implemented the OHP, and 50.6% implemented the MCTP. Managers implementing these policies showed a 14.3% increase in twice-daily oral hygiene provision, with 46% reporting improved oral cleanliness. Notably, 33.9% indicated improved resident quality of life, and 55.2% observed increased staff oral health knowledge. However, reliance on family/caregivers for oral hygiene products (79.2%) and poor attendance at external dental appointments (67.6%) were significant barriers reported by managers. Thus, while policy implementation has positively impacted residents and staff, gaps remain in resource availability and professional support. Future policies should focus on enhancing access to oral health professionals and providing in-house dental resources.

Background/Objectives: Missed nursing care (MNC), defined as any omitted or delayed aspect of required patient care, is a global concern affecting both patient outcomes and nurse well-being. In Saudi Arabia, few studies have examined its relationship with job satisfaction. This study assessed the prevalence of MNC, job satisfaction, and their association among nurses in government hospitals. Methods: A correlational, cross-sectional study was conducted between February and May 2025 in government hospitals across Albahah, Hail, and Almadina. A total of 366 registered nurses participated. Data were collected via a structured online questionnaire including demographic information, the Missed Nursing Care Scale, and the Minnesota Satisfaction Questionnaire (MSQ). Data were analyzed using descriptive statistics, Spearman's correlation, and regression analysis. Results: Basic care activities such as mouth care, bathing, and meal assistance were the most frequently missed tasks, mainly due to staffing shortages and high patient loads. The median MSQ score was 60 (44-71 Interquartile Range), reflecting moderate job satisfaction. A significant negative correlation was observed between MNC and job satisfaction (r = -0.267, p < 0.001), indicating that increased missed care was associated with lower satisfaction levels. Conclusions: The findings highlight the urgent need for healthcare administrators and policymakers to implement strategies to improve staffing levels and work environments. Addressing these organizational factors is essential to reducing missed nursing care, enhancing nurse job satisfaction, and ultimately improving patient safety and care quality in Saudi government hospitals.

BackgroundIn the UK older adults in care homes have exhibited poorer oral health than age-equivalent persons in the community. In response the National Institute for Health and Care Excellence issued guidance (NG48) on the maintenance and improvement of oral health in this group. Currently, there is little evidence on the cost-effectiveness of such interventions. The aim of this study was to examine the feasibility of evaluating an intervention framed around NICE guidance.MethodsThe study was undertaken in 22 care homes across 2 sites with eligibility criteria used to ensure access to residents for whom the oral health care intervention was relevant and who could consent to participation. The intervention followed the guidance issued by NICE in respect of care staff knowledge; oral health assessment and development of care plans, and provision of daily mouth care to residents. Quantitative and qualitative data were collected from residents and care home managers and interviews undertaken with a range of stakeholders. Quantitative data from residents comprised EQ5D5L at baseline, 6 and 12 months, qualitiative data was taken from interviews. Descriptive statistics and a discussion of themes raised in surveys and interviews was undertaken. The trial was registered with the UK’s Clinical Study Registry (ISRCTN10276613) on 17/04/2020.ResultsOf 119 residents recruited, 115 provided usable EQ5D5L data at baseline. The data had good face validity. Managers from 7 of 22 homes provided responses to the care home survey. All responding care homes routinely recorded information on care provided to residents and 5 of the 7 recorded information on the funding source for that care. Care assistant time was a key consideration among managers in terms of resource use. Residents overall quality of life was a key consideration among managers in terms of outcomes. Among key stakeholders, there was a universal appreciation of the need to improve the evidence base on the value for money of interventions framed around NG48.ConclusionThe study supports the case for the conduct of an economic evaluation in a definitive trial to address a manifest gap in the evidence base on oral hygiene interventions in this context.

BackgroundThe aging population and increasing prevalence of natural teeth among older adults have escalated the demand for oral health care, especially in nursing settings. Impaired oral health in older individuals is closely linked to systemic conditions such as diabetes and cardiovascular diseases. The expert standard “promoting oral health in nursing” was developed in Germany to enhance the quality of oral care and address future challenges in geriatric nursing. It comprises a series of recommended interventions targeting oral health promotion in nursing care. However, significant barriers, including high patient-to-nurse ratios and staff shortages, often result in missed or rationed nursing care, limiting the feasibility and implementation of such interventions. Evaluating the acceptability of this standard is critical to its successful integration into routine nursing practice.ObjectiveWe aim to assess the acceptability of the expert standard among nursing staff providing care for older individuals, identify factors influencing its adoption, and examine the relationship between nursing competence, care rationed or missed (CROM), and the standard’s acceptability.MethodsThis quantitative cross-sectional study will collect data from nursing staff in 25 hospitals and long-term care facilities in North Rhine-Westphalia, Germany, using standardized survey instruments. Based on the template of the generic theoretical framework of acceptability, a questionnaire to measure the acceptability of interventions across 7 domains was created. Oral health knowledge will be assessed using the Oral Health Literacy Profile and competence in mouth care using the questionnaire developed by the DNQP (Deutsches Netzwerk für Qualitätsentwicklung in der Pflege [German network for Quality Development in Nursing]). Barriers to implementation will be evaluated according to the acute care nurses’ questionnaire on oral hygiene and CROM using the oral care–related question from the Basel Extent of Rationing of Nursing Care instrument. Statistical analyses consist of first calculating the mean acceptability with a 95% CI for each recommended intervention of the expert standard. Second, repeated measures ANOVA is used to examine mean differences in acceptability between these interventions. Third, linear regression analyses are used to test the impact of nursing competence on acceptability and lastly chi-square tests of independence are used to compare CROM with already published rates in German-speaking countries.ResultsThe results are anticipated to provide insights into the acceptability of the expert standard and its determinants, including nursing competence and perceived barriers. Data collection will commence in June 2025 and is expected to be completed by October 2025.ConclusionsThis study evaluates the acceptability of the expert standard for oral health in nursing. The findings will support evidence-based strategies to enhance feasibility, reduce CROM prevalence, and improve oral health in older adults. By focusing on acceptability as a prerequisite for implementation, this study emphasizes the need to align interventions with the realities of nursing care to achieve effective outcomes.International Registered Report Identifier (IRRID)PRR1-10.2196/72528

ObjectivesThe purposes of this study are to (1)assess the levels of care-related pain prior to and during routine nursing procedures among mechanically ventilated patients, (2) identify care-related procedures that are likely to induce or increase pain in mechanically ventilated patients, and (3) investigate the relationship between care related pain levels and patient gender, age, and analgesia and/or sedatives prior to or during procedures.Materials and methodsA prospective observational study conducted between January 2023-August 2024, patients were assessed twice during either nociceptive and non-nociceptive care-related procedures, immediately prior to one of the selected routine procedures being conducted and then during the procedure using the Behavioural Pain Scale (BPS), Ramsay scale (RS), and two haemodynamic parameters (blood pressure [BP] and heart rate [HR]. Nociceptive care-related procedures include repositioning (i.e. patients rolled to one side from their initial position), endotracheal suctioning, and vascular punctures (i.e. cannulation). Non-nociceptive care-related procedures include eye care (simple eye washes with normal saline and cotton wool ball), mouth care (brush teeth and tongue with a mouth swab soaked in normal saline as a cleansing agent), and central venous catheter dressing changes.ResultsThis study found that 33.3% of patients experience pain at rest (BPS score >3).1–7 The current study findings verify that repositioning is the most painful routine nursing procedure. The second most painful procedure is endotracheal suctioning. The study also suggests that other hygiene interventions used on critically ill mechanically ventilated patients (such as mouth care), exacerbate pain in patients to a similar degree to other routine nursing procedures such as dressing change and invasive procedures.ConclusionCare-related pain is a real problem in critically ill patients, particularly in those patients who are unable to self-report pain. The intensity of care-related pain varies noticeably, depending on the type of procedure. In the absence of self-report of pain, clinicians must rely on other alternatives to assess pain. Performing systematic initial and ongoing assessment of pain, administering supplementary pre-emptive analgesia, and considering factors that exacerbate pain are crucial steps in improving pain management in critically ill mechanically ventilated patients.

ABSTRACTBackgroundMissed Nursing Care is a global health problem with adverse consequences for patients, nurses and healthcare systems. It occurs when the necessary nursing care is not provided, is only partially provided or is delayed. This study aimed to investigate the prevalence, types and reasons for Missed Nursing Care in Danish hospitals on a national scale.MethodsIn a cross‐sectional study, the Danish version of the MISSCARE survey was used to collect data from nursing staff.ResultsA total of 3507 nursing staff from 35 regional and university hospitals participated. Nursing staff reported that 44% of nursing care elements were always, frequently or occasionally missed, ranging between 32% and 53% across hospitals. The most frequent missed nursing care elements included ambulation, turning patients, documentation, mouth care, participation in interdisciplinary care meetings, emotional support and patient teaching. The main reasons for Missed Nursing Care were inadequate staffing, unexpected increases in patient volume and acuity, urgent patient situations and high admission and discharge activity.ConclusionMissed Nursing Care is a prevalent problem in Danish hospitals, with nearly half of the necessary nursing care elements being missed. However, variations between hospitals exist. Fundamental physical and emotional nursing care elements were often missed, while nursing care to prevent critical situations was prioritised. The main reason for Missed Nursing Care was an imbalance between nursing resources, patient volume and acuity. Targeted interventions are needed to address Missed Nursing Care to improve the quality of nursing care and ultimately achieve better outcomes for patients and nursing staff.

Optimal oral health is essential at all stages of life, to enable individuals to eat and speak without discomfort, and to socialise, thereby contributing to their general health, well-being and quality of life. Effective daily mouth care for people who require support is essential to prevent deterioration in oral health and general health and should be part of their overall care. This How to article details the preparation, equipment and procedure involved in undertaking mouth care in adults. The article also provides an overview of mouth care in patients who are intubated, neurodivergent people and/or those with cognitive impairment or learning disabilities, and those receiving end of life care. Nurses undertaking mouth care must have the knowledge and skills needed to do so safely and effectively, and work within their competence level. • Inadequate mouth care can lead to dehydration and malnutrition, while a dry mouth creates an ideal environment for fungus or bacteria to become dominant pathogens within the oral cavity, adversely affecting the person's appetite, creating soreness within the oral cavity and leading to a general decline in health. • Maintaining a healthy, functioning mouth and routinely removing food debris can reduce the risk of choking and/or aspiration pneumonia, particularly in people with dementia and/or dysphagia. • All healthcare professionals should seek to promote oral health and have an understanding of the link between optimal oral health and general health, and be able to explain this to patients; it is also vital that nurses are aware of current evidence and best practice in oral hygiene. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when providing mouth care. • How you could use this information to educate nursing students or colleagues about appropriate methods for providing effective, person-centred mouth care.

Radiation-induced oral mucositis (RIOM) is a major side-effect of (chemo)radiation (CRT) of patients with head and neck cancer (HNC). This study tries to establish a novel cryotherapy (CyT) method using a mouth care device (MCD; Cooral®, BrainCool AB, Lund, Sweden) to prevent RIOM. Patients were non-randomly assigned to use the MCD after every radiotherapy session for 30-60 minutes. Subjects were asked to answer daily questionnaires assessing tolerability of the intervention. Mucositis was assessed at baseline, once weekly and at weeks 1/3/6 after CRT. The primary endpoint was patient tolerance, defined by the time the MCD was used and the patients' perception. Secondary outcomes were the degree (CTCAE v5.0) and duration of RIOM. Ten patients were eligible with a mean age of 62 years. Four patients received concurrent platinum-based CRT, whereas the others received radiotherapy alone. Overall, 214 CyT sessions were performed (73% of planned CyT sessions). The mean daily CyT duration was 48 minutes (range, 30-60 minutes). All patients reported cooling as comfortable. Nine completed the intervention, one terminated it early due to hypersalivation. No Grade 4 RIOM was observed. Grade 3 mucositis was observed in 4 and Grade 2 in 3 cases. The Cooral System was well tolerated, with a duration of application that was acceptable for most patients. We concluded that the MCD can be safely used in patients undergoing CRT. A prospective phase II trial, assessing the efficacy in preventing RIOM, is planned.

Objective: Pineapple peel is a byproduct of pineapple commonly found in Indonesia. Its abundant metabolites are promising as a natural antibacterial agent and developed as a mouth care product. This research aimed to formulate a mouthwash product using pineapple peel extract, evaluate the formula according to internationally accepted regulation standards, and investigate its antibacterial activity. Methods: The pineapple peel extract is obtained by ethanol maceration process and then went through filtration and evaporation. The extract was incorporated into mouthwash using co-solvation techniques and evaluated for its physicochemical properties and antibacterial activity towards Streptococcus mutans, Porphyromonas gingivalis, and Lactobacillus acidophilus. Results: The formulation met the regulation standard criteria according to these parameters: microbial test, metal impurities, and alcohol content. The formulation also shows antibacterial properties towards S. mutans, P. gingivalis, and L. acidophilus with zones of inhibition were 10.17± 1.25 mm, 11.75±0.54 mm, and 7.25±0.54 mm, respectively. Conclusion: The physicochemical and microbiological evaluation confirmed the formula's compliance with the Indonesian Food and Drug Regulatory Body and antibacterial properties toward S. aureus, P. gingivalis, and L. acidophilus.

To identify types of patient-reported missed nursing care and adverse events and identify the factor associated with missed care in a Western Australian tertiary hospital. Research in the domain of missed nursing care has established the association between missed nursing care and unsafe patient outcomes. However, there is a paucity of evidence on patient perception of missed nursing care and associated factors. Cross-sectional study. A study of inpatients in a tertiary teaching hospital in Western Australia was carried out. Ninety-eight patients admitted in 16 medical and surgical wards were sampled. The patient MISSCARE survey was used to capture patient-reported types of missed care, prevalence of adverse events and the association between missed care, unit type, demographic characteristics and patient health problems. Descriptive and logistic analysis were performed using SPSS. The most frequently reported missed nursing care activities included mouth care (63%), ambulation (35%), helping patient out of bed into a chair (31%), informing patient about tests or procedures (29%) and considering patient opinion (27%). The majority of reported missed care activities were from basic care domain followed by communication. The most common adverse events reported were intravenous infusion leaking into skin, intravenous fluid running dry, falls and development of pressure ulcer. Significant association was observed between missed nursing care and patient age. The findings of this study showed significant level of patient-reported missed nursing care particularly in the domain of basic care. Although this study's limitations, including its small sample size and potential response bias, warrant caution in generalising the findings, the insights gained provide a valuable foundation for future research aimed at improving patient care. Findings provide valuable insight about patient's perception of missed care and inform the need for effective interventions to reduce unsafe outcomes related to missed nursing care. Healthcare systems need to make necessary efforts to ensure that patients receive the right amount of care needed to maintain and promote safe hospitalisation outcomes. The study was reported according to the STROBE guidelines. The development of this study protocol, data collection, analysis and interpretation of results were carried out through a collaborative effort between patients, families and the research team.

As an important agricultural product, cigar tobacco lacks reports on chemical compositions. The investigation on characteristic components of Yunnan local cigar tobacco revealed 15 Cembrane-type diterpenes including nine undescribed ones (1-9). Their structures were elucidated on the basis of extensive spectroscopic analysis, computational calculations, and X-ray diffraction. The skeleton of Cigarcembrane (1) with a new 6/12-ring system was previously undescribed. This is the first time to report eunicellane (2-7) and gersemiane (8-9) skeletons from plant resources. The transformation mechanism of cigarcembrane, eunicellane, and gersemiane from Cembrane during cigar fermentation was postulated. Chromatographic analysis revealed 10 as a marker for cigars. All the isolated compounds showed the promotion of hOMF cell proliferation, enlightening us to seek lead compounds in mouth care.

High nurse turnover during nursing shortages can contribute to missed nursing care. This study investigated the prevalence of missed nursing care and how nurse turnover affects missed nursing care. A cross-sectional design was adopted to collect data from a convenience sample of nurses working in general hospitals in South Korea. Six-month turnover rates (0%, 1-14%, 15-22%, and 23-50%) and 24 missed nursing care activities were measured. A multivariate regression analysis was performed to examine the relationship between nurse turnover and missed nursing care, after controlling for nurse and work-related characteristics. The final sample was 264 nurses. The mean six-month turnover rate was 15.49%. Seven activities (turning patient every 2 h, attending interdisciplinary care conference, ambulation, patient bathing/skin care, emotional support, mouth care, full documentation) had a missed care prevalence of 30% or higher. Nurses in units with moderate turnover rates (15 and 22%) reported more missed nursing care than those in units with zero turnover. Nurse turnover increases missed nursing care, highlighting the adverse effects of nurse turnover on care processes. Consequently, hospitals and governments should implement policy changes and strategies to prevent nurse turnover.

ABSTRACT This study was conducted to determine the missed nursing care and to compare missed nursing care with descriptive characteristics of nurses during the COVID-19 period. The study was conducted with 182 nurses as a descriptive design working in seven public hospitals with a level III neonatal intensive care unit in Istanbul between April and July 2021. The study used an introductory information form for nurses and the Misscare survey-Pediatric version. Missed nursing care included “mouth care,” “full documentation of all necessary data,” and “communication of all relevant information during shift change or handover” in the first three ranks (n = 179, 98.35%). It was found that the highest score among reasons for missed nursing care was in the communication sub-dimension (2.50 ± 0.74). It was found that the reasons for missing care for nurses between the ages of 26–30 and with 6–10 years of professional experience (p < .05) were material resources-related, while the reasons for missing care for nurses with 11 years or more of professional experience (p < .05) and caring for 4 sick newborns in a shift (p < .01) were communication problems. It was concluded that nurses were unable to provide at least one nursing care in the last shift, and this was primarily due to communication-related problems. Training and policies for the development of communication skills can be suggested to reduce missed nursing care.

Aim: The research was descriptive in order to examination of missed nursing care requirements and reasons. Method: A descriptive, cross-sectional, and comparative research design was used in this study. The research was conducted with 400 nurses working in the emergency, intensive care and clinics of a hospital in Turkey. Research data were collected the Introductory Information Form and the Missed Nursing Care Scale. The descriptive number of the study was represented by the percentage mean ± standard deviation. Results: According to the results of our study, most frequently the nurses found that missed nursing care requirements were ambulation three times daily, turning the patient every 2 h, patient bathing/skin care, mouth care, feeding patients while food is still warm, and to provide emotional support to the patient and / or patient relatives. The most highly ranked reasons for missed nursing care were the inadequate number of staff members, unexpected increase in patient volume and/or acuity on the unit, inadequate number of assistive and/or clerical personnel, urgent patient situations. Conclusion: According to the results of our study, it was determined that the nurses missed the care needs of the patients. Labor resources are among the most important reasons for unmet nursing care needs.

Poor oral health can influence an individual's dietary intake, which may result in malnutrition. Both problems in oral health and function and malnutrition are common in older people. The aim of the present study was to explore the associations between oral health and oral function and malnutrition in community-dwelling older people within three different databases. Data analyses were performed on three existing Dutch databases (Interrai: n = 3876, LPZ: n = 966, PRIMa mouth CARE: n = 975). Logistic regressions (adjusted for age and gender) tested the relation between oral health and oral function (independent variable) and malnutrition (dependent variable). Problems in oral health and oral function such as broken teeth (OR: 1.43 [95%CI: 1.12-1.81]), oral pain and discomfort (OR: 2.58 [95%CI: 1.52-4.39]), chewing difficulties (OR: 1.99 [95%CI: 1.54-2.57]), swallowing problems (OR: 6.63 [95%CI: 2.85-15.42]), coughing (OR: 6.05 [95%CI: 2.08-17.61]) and food adaptations (OR: 5.46 [95%CI: 2.60-11.4]) were found to be significantly associated with malnutrition in older people. This study demonstrated a significant link between oral health problems and oral function with malnutrition in community-dwelling older people. Oral health care and healthcare professionals need to consider oral health and oral function in relation to nutritional status and vice versa in community-dwelling older people.

Missed nursing care (MNC) refers to the partial, delayed, or omitted delivery of essential patient care. It is a critical issue in healthcare systems worldwide, directly impacting patient safety, satisfaction, and outcomes. While extensively studied in developed nations, evidence from low- and middle-income countries, particularly Pakistan, remains limited. Objective: To evaluate the prevalence of MNC among senior nursing staff and identify contributing factors in a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted among 245 registered nurses working in the ICU, ER, and other departments of Sir Ganga Ram Hospital, Lahore. Data were collected using an adapted questionnaire assessing MNC frequency and analyzed using SPSS. Descriptive statistics were calculated, and the reliability and validity of the tool were confirmed through Cronbach’s Alpha and Kaiser-Meyer-Olkin (KMO) measures. Results: The study found a high prevalence of MNC, with discharge planning (Mean = 2.77, SD = 1.14), patient ambulation (Mean = 1.79, SD = 0.99), and mouth care (Mean = 2.26, SD = 1.23) identified as the most frequently missed tasks. Contributing factors included excessive workload, resource shortages, and insufficient staffing. Nurses with less experience were more likely to report missed tasks, highlighting the importance of clinical exposure and training in reducing care omissions. Conclusion: Missed nursing care poses a significant challenge to healthcare quality and patient safety in Pakistan. Addressing these issues requires systemic reforms, including improved staffing ratios, resource allocation, and professional development programs. These findings provide valuable insights for policymakers and healthcare administrators to implement effective interventions aimed at mitigating MNC and enhancing nursing care quality.

BackgroundThe World Health Organisation states that newborns should receive colostrum as soon as possible after birth. However, among newborns needing neonatal intensive care, initiation of lactation and access to colostrum might be delayed. At the centre of this study, a tertiary care hospital in Sweden (10,000 deliveries/year), few admitted infants received colostrum within the day of birth, warranting a quality improvement. In order to reduce the time from birth to first colostrum received by infants admitted to the Neonatal Intensive Care Unit (NICU), a new clinical routine including a colostrum-kit, was implemented as standard care in June 2018. The colostrum-kit contained information about hand expression of breastmilk as well as material for collecting, labelling and transporting the colostrum. The kit should be handed to all birthing parents with infants admitted to the NICU.MethodsData on time in minutes from birth to first colostrum administered to the infant (oral mouth care, oral feeding or gavage feeding) was retrieved for all infants born between 1 September 2016 and 31 October 2023, admitted to the NICU within 1h from birth. Infants were divided into four time-cohorts, compared with nonparametric ANOVA.ResultsThe study included 3618 infants born at 22 + 0 – 43 + 0 weeks gestational age, of whom 2814 (78%) had available data on time to colostrum. Median (IQR) time in hours was 35 (20–36) pre-implementations, followed by 18 (7–38), 11 (4–26) and 8 (3–22) in the subsequent follow-up cohorts, p < 0.001. Subgroups of mode of delivery had median (IQR) pre-implementation of 30 (19–54) for vaginal and 47 (23–72) for caesarean section that reached 7 (2–18) and 9 (3–26) in the last follow-up. Subgroups of gestational age (< 28, 28–31, 32–36, > 36 weeks) had a pre-implementation time of 48 (26–80), 46 (23–73), 33 (20–60) and 32 (19–57), that in the last follow-up was reduced to 4 (2–20), 7 (2–29), 9 (2–33) and 9 (4–19).ConclusionsImplementing a colostrum-kit for infants admitted to the NICU significantly reduced the time to first colostrum administered to the infant in all gestational ages. The difference between subgroups of gestational age or mode of delivery was reduced. The effect persisted over time.

The research aims to test and analyze the influence of environmental knowledge, word of mouth (WOM), green marketing, and environmental care attitude on the intention to purchase green products. The population in this study is Generation Z in Yogyakarta. The sample size is 150 people, with the criteria of respondents being at least 18 years old, born between 1997 and 2012, residing in Yogyakarta, and having purchased and consumed green products. This study uses a quantitative method, with purposive sampling technique, and data analysis technique using Partial Least Squares Structural Equation Modeling (PLS-SEM) which is processed using SmartPLS 4.0 software. The results of the study indicate that environmental knowledge has a positive effect on the intention to purchase green products, word of mouth (WOM) has a positive effect on the intention to purchase green products, green marketing has a positive effect on the intention to purchase green products, and environmental care attitude has a positive effect on the intention to purchase green products.