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Objective: To evaluate the impact of type and timing of antiretroviral therapy (ART) on the risk of preterm delivery (PTD) and small‐for‐gestational age (SGA) birth among pregnant women and people living with HIV in Canada. Methods: Data for this retrospective cohort study were analyzed from the Canadian Perinatal HIV Surveillance Program from 1990 to 2020. The association between ART and risk of PTD (<37 weeks) and SGA birth (<10th percentile) was explored using mixed effects logistic regression and time‐dependent Cox proportional hazards models. Results: Overall, there were 14.9% (654 of 4379) PTD and 18.5% (732 of 3947) SGA cases. A higher risk of PTD was observed with nonnucleoside reverse transcriptase inhibitor–(adjusted hazard ratio [aHR], 1.73; P = 0.019) and boosted protease inhibitor– (aHR, 186; P = 0.007) based regimens compared with integrase strand transfer inhibitor (INSTI)–based regimens. ART initiation prior to conception was associated with a lower risk of SGA birth compared with ART initiation after conception at 1 to 14 weeks (adjusted odds ratio [aOR], 0.69; P = 0.024) and > 14 weeks (aOR, 0.70; P = 0.005). Conclusion: INSTI‐based ART regimens were associated with lower risk of PTD compared with other regimens, and ART initiation before conception was associated with a lower risk of SGA birth. These findings, with overall safety data, should be considered when providing pregnancy counseling to people living with HIV. Synopsis: The type and timing of antiretroviral therapy during pregnancy influence perinatal complications, including preterm delivery and small for gestational age birth, in Canada. [ABSTRACT FROM AUTHOR]

Objective: This study surveys child psychiatry residency program directors in order to 1) characterize child welfare training experiences for child psychiatry residents; 2) evaluate factors associated with the likelihood of program directors' endorsing the adequacy of their child welfare training; and 3) assess program directors' familiarity with some existing child welfare training and information resources. Method: Program directors of American College of Graduate Medical Education (ACGME)-accredited child psychiatry residency programs were surveyed anonymously. Participants characterized their program's child welfare training curriculum and indicated their awareness of selected child welfare information and training resources. Results: In all, 68% of program directors responded; 90% of respondents indicated that their residents encounter child welfare-involved youth very frequently or frequently. Just over half of the respondents reported inadequate training materials, and half were aware of at least one of the three queried child welfare information resources. However, nearly 40% of respondents who were familiar with the queried child welfare resources still reported having inadequate training materials. Respondents with adequate training materials were more likely to classify their program as devoting enough time to child welfare training. Respondents at sites that spent less than 5 hours on non-didactic child welfare training during residency were more likely to indicate that not enough time was spent on training. Conclusions: The findings of this study suggest that increasing child psychiatry program director awareness of existing child welfare information resources and providing 6-or-more hours of non-didactic child welfare training, two feasible and relatively low resource actions, may improve child welfare training in child psychiatry residencies.

The article theorizes that augmenting traditional humanities course work with documentary video-making can enhance and motivate learning. The English class profiled focused on aging and the lives of elders in an adult daycare center and a retirement community. Students documented elders' stories in video over 15 weeks. The instructor's goal was to use the immediacy of video to challenge and dismantle ageist stereotypes. Documentary video-making is a simple, and enticing, technology that gives students a powerful tool for getting to know elders. Scholarship on classroom uses of digital video-making is discussed, and critical comments from the five reflective essays students wrote during the semester are used to track changes in student perceptions of elders. (Contains 9 notes.)

Washington State Medicaid mandates a second opinion when threshold safety parameters for attention deficit hyperactivity disorder (ADHD) medications are exceeded. This is found to save $1.2 million and saves 538 fewer patients from exceeding safety thresholds.

Examined 6-month post-recruitment clinical and placement outcomes for 31 youths with serious emotional disturbance (SED) at imminent risk of out-of-home placement in the Hawaii Continuum of Care (COC). Youths were randomly assigned to multisystemic therapy (MST) adapted for SED populations or to Hawaii's existing COC services. Assessments were conducted at intake and 6 months after referral. In comparison with counterparts in the comparison condition, youths in the MST condition reported significant reductions in externalizing symptoms, internalizing symptoms, and minor criminal activity; their caregivers reported near significant increases in social support; and archival records showed that MST youths experienced significantly fewer days in out-of-home placement. The findings generally replicate the favorable short-term outcomes observed previously for MST with youths experiencing SED.

Background: While treatment guidelines for HIV in adults have evolved rapidly with the advent of new antiretroviral (ARV) treatment, those for the prevention of vertical HIV transmission in pregnancy have evolved more slowly due to safety and efficacy concerns. Here we describe Canadian prescribing patterns for ARV treatments during pregnancy and compare them to perinatal HIV prescribing guidelines of the United States Department of Health and Human Services (HHS), that are commonly used in Canada and include recommendations for newly commercialized therapies. Methods: The Canadian Perinatal HIV Surveillance Program (CPHSP) captures annual medical data on mothers living with HIV and their infants from 23 sites across Canada. Women from this cohort who received an ARV treatment during pregnancy and who gave birth between 2004 and 2020 were included in the study. ARV treatments were designated as 'preferred/alternative' as per HHS HIV perinatal guidelines, or 'other than preferred/alternative'. Results: We identified 3673 pregnancies from 2720 women. The proportion of women that conceived while on ARV treatment increased from 29% in 2003 to 90% in 2020. Other than preferred/alternative ARV treatments were received in 1112 (30%) of pregnancies and this was significantly associated with having initiated ARV treatment before conception. Conclusion: In Canada during the study period, a high number of women were prescribed an other than preferred/alternative ARV treatment during pregnancy. Further optimization of ARV treatment in women of childbearing age living with HIV is warranted. [ABSTRACT FROM AUTHOR]