Providing Emotional Support and Physical Comfort During a Time of Social Distancing: A Thematic Analysis of Doulas' Experiences During the Coronavirus Pandemic.

Doulas are trained, non-clinical professionals that provide a continuum of support for mothers. An interpretive phenomenological approach was used to explore the professional experiences of doulas (n = 17) during the COVID-19 pandemic in the US. Data were collected using brief intake surveys, in-depth semi-structured interviews, and an online discussion group. After a list of significant statements was created and grouped during emergent themes analysis, the reflections were summarized into three themes, (1) Doula Resilience, (2) Experiencing Vulnerability, and (3) Concern for Client Vulnerability that encapsulate the experiences of doulas during the COVID-19 pandemic. We conclude that as part of the COVID-19 recovery process, policy makers should look to non-clinical interventions for improving maternal health, such as promoting and supporting synergy between doulas and other maternal health service providers.

Simpler is better: Predicting consumer vehicle purchases in the short run.

When agencies such as the US Environmental Protection Agency (EPA) establish future greenhouse gas emissions standards for new vehicles, forecasting future vehicle purchases due to changes in fuel economy and prices provides insight into regulatory impacts. We compare predictions from a nested logit model independently developed for US EPA to a simple model where past market share predicts future market share using data from model years 2008, 2010, and 2016. The simple model outperforms the nested logit model for all goodness-of-prediction measures for both prediction years. Including changes in vehicle price and fuel economy increases bias in forecasted market shares. This bias suggests price increases are correlated with unobserved increases in vehicle quality, changes in preferences, or brand-specific changes in market size but not cost pass-through. For 2010, past shares predict better than a nested logit model despite a major shock, the economic disruption caused by the Great Recession. Observed share changes during this turbulent period may offer upper bounds for policy changes in other contexts: the largest observed change in market share across the two horizons is 6.6% for manufacturers in 2016 and 3.4% for an individual vehicle in 2010.

Economic performance and cost-effectiveness of using a DEC-salt social enterprise for eliminating the major neglected tropical disease, lymphatic filariasis.

BACKGROUND: Salt fortified with the drug, diethylcarbamazine (DEC), and introduced into a competitive market has the potential to overcome the obstacles associated with tablet-based Lymphatic Filariasis (LF) elimination programs. Questions remain, however, regarding the economic viability, production capacity, and effectiveness of this strategy as a sustainable means to bring about LF elimination in resource poor settings. METHODOLOGY AND PRINCIPAL FINDINGS: We evaluated the performance and effectiveness of a novel social enterprise-based approach developed and tested in Léogâne, Haiti, as a strategy to sustainably and cost-efficiently distribute DEC-medicated salt into a competitive market at quantities sufficient to bring about the elimination of LF. We undertook a cost-revenue analysis to evaluate the production capability and financial feasibility of the developed DEC salt social enterprise, and a modeling study centered on applying a dynamic mathematical model localized to reflect local LF transmission dynamics to evaluate the cost-effectiveness of using this intervention versus standard annual Mass Drug Administration (MDA) for eliminating LF in Léogâne. We show that the salt enterprise because of its mixed product business strategy may have already reached the production capacity for delivering sufficient quantities of edible DEC-medicated salt to bring about LF transmission in the Léogâne study setting. Due to increasing revenues obtained from the sale of DEC salt over time, expansion of its delivery in the population, and greater cumulative impact on the survival of worms leading to shorter timelines to extinction, this strategy could also represent a significantly more cost-effective option than annual DEC tablet-based MDA for accomplishing LF elimination. SIGNIFICANCE: A social enterprise approach can offer an innovative market-based strategy by which edible salt fortified with DEC could be distributed to communities both on a financially sustainable basis and at sufficient quantity to eliminate LF. Deployment of similarly fashioned intervention strategies would improve current efforts to successfully accomplish the goal of LF elimination, particularly in difficult-to-control settings.

Characterizing Nature and Participant Experience in Studies of Nature Exposure for Positive Mental Health: An Integrative Review.

A growing number of studies demonstrate significant associations between nature experiences and positive mental health outcomes (e.g., improved mood, decreased stress). However, implementation of this research by practitioners in fields such as urban design or public health has been limited. One reason for this is that it remains unclear what elements of nature and types of participant experience are consistently associated with mental health benefits. As a result, decision-makers who aim to enhance mental health in cities have little guidance about which elements of nature and types of experiences in natural areas may lead to positive mental health outcomes. We reviewed 30 studies with 41 distinct exposures in nature that elicited positive mental health benefits and characterized the elements of nature found at these sites, as well as aspects of participants' experience. Elements of natural areas considered include: forest, managed grass, and water as dominant land cover types, specific water features (e.g., small ponds, fountains) and built features (e.g., trails, paths). The majority of the studies we reviewed assessed the experiences of individuals (vs. in groups) participating in walks during warmer seasons. Most studies did not describe the "nature of the nature" associated with positive mental health outcomes. We contacted authors and used Google Earth imagery to reconstruct the specific natural elements, landscape typology, and site adjacencies present in past studies. We recommend specific ways researchers could better and more transparently document important elements of nature and participant experience in study design and reporting that will enhance the planning and design relevance of their work.

"They have already thrown away their chicken": barriers affecting participation by HIV-infected women in care and treatment programs for their infants in Blantyre, Malawi.

HIV-infected infants and young children are at high risk of serious illness and death. Morbidity and mortality can be greatly reduced through early infant diagnosis (EID) of HIV and timely initiation of antiretroviral therapy (ART). Despite global efforts to scale-up of EID and infant ART, uptake of these services in resource poor, high HIV burden countries remain low. We conducted a qualitative study of 59 HIV-infected women to identify and explore barriers women face in accessing HIV testing and care for their infants. To capture different perspectives, we included mothers whose infants were known positive (n=9) or known negative (n=14), mothers of infants with unknown HIV status (n=13), and pregnant HIV-infected women (n=20). Five important themes emerged: lack of knowledge regarding EID and infant ART, the perception of health care workers as authority figures, fear of disclosure of own and/or child's HIV status, lack of psychosocial support, and intent to shorten the life of the child. A complex array of cultural, economic, and psychosocial factors creates barriers for HIV-infected women to participate in early infant HIV testing and care programs. For optimal impact of EID and infant ART, reasons for poor uptake should be better understood and addressed in a culturally sensitive manner.

Achieving adherence with antiretroviral medications for pediatric HIV disease.

Factors influencing antiretroviral adherence for 42 HIV-positive children were elicited from primary caregivers, and the perspectives of families and clinicians regarding success with adherence were compared. Interviews in preferred language (Spanish or English), chart reviews, and visual analogue scales (VAS) were used. Adherence was high by traditional markers of prescriptions filled (100%), doses reported taken (97%), and appointments kept (88%). Clinicians estimated slightly but not significantly lower adherence than did families using the VAS. Sixty-four percent of families reported barriers to adherence, and 30% reported strategies that differ from those in the general adherence literature. Adherence strategies devised by families depended heavily on family support and resolution of disclosure issues in the household.