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PurposeIn an effort to address persistent inequities in maternal and infant health, policymakers and advocates have pushed to expand access to doula care. Several states, including California, now cover doula services through Medicaid. As coverage expands, research on the impact of doula care will likely increase. To develop best practices for research, it is critical to engage community doulas, clients, and other key stakeholders.DescriptionOur overarching goal was to build capacity for future doula- and client-centered research on community doula care. First, we established a Steering Committee with members from seven relevant stakeholder groups: community doulas, former or potential doula clients, clinicians, payers, advocates, researchers, and public health professionals. Second, we conducted a needs assessment to identify and understand stakeholders' needs and values for research on community doula care. Findings from the needs assessment informed our third step, conducting a research prioritization to develop a shared research agenda related to community doula care with the Steering Committee. We adapted the Research Prioritization by Affected Communities protocol to guide this process, which resulted in a final list of 21 priority research questions. Lastly, we offered a training to increase capacity among community doulas to engage in research on community doula care.AssessmentOur findings provide direction for those interested in conducting research on doula care, as well as policymakers and funders.ConclusionThe findings of our stakeholder-engaged process provide a roadmap that will lead to equity-oriented research centering clients, doulas, and their communities.

Despite the importance of respectful pregnancy care, birthing people experience high rates of mistreatment in clinical settings in the United States. In light of persistent racialized maternal and infant health inequities, doula care is increasingly promoted as an intervention. Limited research has examined healthcare providers’ experiences with doulas. As part of an evaluation of community doula programs in San Francisco, California, we interviewed physicians (n ​= ​11), certified nurse-midwives (n ​= ​7), and nurses (n ​= ​10) who worked in hospitals and clinics where doula clients receive care. Using reflexive thematic analysis, we identified two themes around how providers perceive doulas to affect pregnancy-related care. First, providers described doulas fostering accountability at multiple levels. Providers described how their personal sense of accountability to patients increased in the presence of doulas; at times, this mitigated racism and implicit bias in clinical settings. Additionally, through the partnership between the community doula organization and local hospitals, doulas engaged in bidirectional feedback with providers, creating opportunities for institutional-level accountability. Second, providers perceived doulas to bridge gaps in care for pregnant and birthing people by providing services, such as continuous labor support, that are not realistic for clinicians to provide. This analysis contributes to the broader literature on doula care by describing mechanisms through which doulas improve pregnancy-related care. Doulas may be critical for birthing people who are most likely to experience mistreatment due to racism and other dimensions of oppression. Future research should explore facilitators and barriers to developing partnerships between clinical sites and doula organizations and the long-term effects of these partnerships on health equity.

BackgroundBeginning in March 2020, health care systems in the United States restricted the number of support people who could be present during pregnancy-related care to reduce the spread of COVID-19. We aimed to describe how SisterWeb, a community-based doula organization that employs Black, Pacific Islander, and Latinx doulas in San Francisco, California, adapted to the COVID-19 pandemic.MethodsAs part of process and outcome evaluations conducted through an academic-community partnership, we interviewed SisterWeb doulas, mentors, and leaders in 2020, 2021, and 2022 (n=26 interviews). We identified preliminary themes using the Rapid Assessment Process and then conducted thematic analysis of data related to COVID-19.ResultsSisterWeb leadership remained committed to safeguarding doulas by shifting to virtual support until doulas were onboarded as benefitted employees. Doulas reported hospital policies impacted clients' pregnancy-related care. Initially, doulas adapted to virtual support by connecting with clients more frequently through phone and text. When permitted to meet in person, doulas adjusted to client preference. Finally, as the pandemic impacted doulas' well-being, they turned to mentors for emotional support.Discussion and health equity implicationsThis analysis contributes to a growing body of literature describing doulas' experiences during the pandemic. By shifting to virtual support, SisterWeb leaders prioritized the health, safety, and financial stability of doulas, who were members of communities disproportionately impacted by COVID-19. Our findings suggest that public health guidance, organizational COVID-19 precautions, and hospital policies hindered SisterWeb's goal of ensuring clients receive equitable medical care. In addition, we found that emotional support for doulas is vital to their work.

Primary antibody deficiencies are characterized by tile inability to effectively produce antibodies and inay invol-ue defects iii B-cell development or maturation. Prililary alltibody deficieiicies can occur at mly age, depending on the disease pathology. Certaiti primary antibody deficiencies affect males mid females equally, whereas others affect mates more often. Patients typically present with recurrent sinopulmonary and gastrointestinal infections, and some patients can experience an increased risk of opportunistic infections. Multidisciplinary collaboration is important iii the management of patients with primary antibody deficiencies because these patients require heightened monitoring for atopic, autoimmune, and nialignant comorbidities and complications. The underlying genetic defects associated luith many primary antibody deflciencies have been discovered, but, in some diseases, the underlying genetic defect and inheritance are still unkiiozon. The diagnosis of primary antibody deficiencies is often macie through the evaluation of immunoglobillin levels, lynipliocyte levels, and antibody responses. A definitive diagnosis is obtained through genetic testing, which offers specific ilianageinent options and may inform future family planning. Treatment varies but generally inchides antibiotic prophylaxis, vaccination, and intmunoglobitlin replacement. Hematopoietic stem cell transplantation is also an option for certain primary antibody deficiencies. [ABSTRACT FROM AUTHOR]

Among numerous challenges encountered at the beginning of extrauterine life, the most celebrated is the first breath that initiates a life-sustaining motor activity.sup.1. The neural systems that regulate breathing are fragile early in development, and it is not clear how they adjust to support breathing at birth. Here we identify a neuropeptide system that becomes activated immediately after birth and supports breathing. Mice that lack PACAP selectively in neurons of the retrotrapezoid nucleus (RTN) displayed increased apnoeas and blunted CO.sub.2-stimulated breathing; re-expression of PACAP in RTN neurons corrected these breathing deficits. Deletion of the PACAP receptor PAC1 from the pre-Bötzinger complex--an RTN target region responsible for generating the respiratory rhythm--phenocopied the breathing deficits observed after RTN deletion of PACAP, and suppressed PACAP-evoked respiratory stimulation in the pre-Bötzinger complex. Notably, a postnatal burst of PACAP expression occurred in RTN neurons precisely at the time of birth, coinciding with exposure to the external environment. Neonatal mice with deletion of PACAP in RTN neurons displayed increased apnoeas that were further exacerbated by changes in ambient temperature. Our findings demonstrate that well-timed PACAP expression by RTN neurons provides an important supplementary respiratory drive immediately after birth and reveal key molecular components of a peptidergic neural circuit that supports breathing at a particularly vulnerable period in life. A peptidergic brainstem circuit is identified that supports the initiation and establishment of breathing by providing a supplementary respiratory drive immediately after birth., Author(s): Yingtang Shi [sup.1] , Daniel S. Stornetta [sup.1] , Robert J. Reklow [sup.2] , Alisha Sahu [sup.1] , Yvonne Wabara [sup.1] , Ashley Nguyen [sup.1] , Keyong Li [sup.1] [...]

Purpose: This study was intended to characterize the impact of meibomian gland dysfunction (MGD) on patients' quality of life. Methods: In this prospective, multicenter, noninterventional clinical study (NCT01979887), eligible individuals (age ≥40 years; absence of uncontrolled ocular/systemic disease) were categorized, based on composite grading of ocular symptoms, Schirmer score, and meibum quality, into (1) non-MGD, (2) mild/moderate MGD, or (3) severe MGD cohorts. The MGD Impact Questionnaire (MGD IQ), a 10-item patient-reported outcome measure, was self-administered at clinic visit on day 1, and readministered on day 22 to assess intervisit agreement regarding MGD IQ responses. Results: In total, 75 subjects were assigned to the study cohorts (25 per cohort). Across cohorts, MGD IQ item scores rose incrementally with increasing MGD severity. The severe MGD cohort experienced greater difficulty with reading and performance of leisure activities, greater time on eye care, and greater bother with eye care and eye appearance than the mild/moderate MGD cohort (all P < 0.05). Compared with the non-MGD cohort, the mild/moderate MGD cohort had greater difficulty working on computer, whereas the severe MGD cohort had greater difficulty reading, driving, and performing leisure activities, more frequent difficulty with outdoor activities, more time on eye care, and greater bother with eye care (all P < 0.05). Intervisit agreement between MGD IQ responses was fair to moderate (weighted kappa statistic 0.33‒0.58). Conclusions: Vision-related activities are negatively impacted by increasing severity of MGD. The MGD IQ instrument can help characterize disease severity and amplify the patient's voice in patient-centric clinical research. ClinicalTrials.gov NCT01979887. [ABSTRACT FROM AUTHOR]