This qualitative study identifies patient, care partner, and clinicians’ perceptions of the patient-centeredness, benefits, and drawbacks of telehealth compared with in-person visits.

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Background and objectivesCoronavirus disease 2019 (COVID-19) disrupted medical care across health care settings for older patients with advanced CKD. Understanding how shared decision making for kidney treatment decisions was influenced by the uncertainty of an evolving pandemic can provide insights for supporting shared decision making through the current and future public health crises.Design, setting, participants, & measurementsWe performed thematic and narrative analyses of semistructured interviews with patients (CKD stages 4 and 5, age 70+), care partners, and clinicians from Boston, Portland (Maine), San Diego, and Chicago from August to December 2020.ResultsWe interviewed 76 participants (39 patients, 17 care partners, and 20 clinicians). Among patient participants, 13 (33%) patients identified as Black, and seven (18%) had initiated dialysis. Four themes with corresponding subthemes emerged related to treatment decision making and the COVID-19 pandemic: (1) adapting to changed educational and patient engagement practices (patient barriers to care and new opportunities for telemedicine); (2) reconceptualizing vulnerability (clinician awareness of illness severity increased and limited discussions of patient COVID-19 vulnerability); (3) embracing home-based dialysis but not conservative management (openness to home-based modalities and limited discussion of conservative management and advanced care planning); and (4) satisfaction and safety with treatment decisions despite conditions of uncertainty.ConclusionsAlthough clinicians perceived greater vulnerability among older patients CKD and more readily encouraged home-based modalities during the COVID-19 pandemic, their discussions of vulnerability, advance care planning, and conservative management remained limited, suggesting areas for improvement. Clinicians reported burnout caused by the pandemic, increased time demands, and workforce limitations, whereas patients remained satisfied with their treatment choices despite uncertainty.Clinical Trial registry name and registration number: Decision Aid for Renal Therapy (DART), NCT03522740

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The Ganges River Dolphin Platanista  gangetica  has been classified as Endangered in the IUCN Red List of Threatened Species.  The IUCN changed its status from ‘Vulnerable’ to ‘Endangered’ in 1996 as the species population was declining in its entire distribution range.  It is, however, classified as ‘Critically Endangered’ in Nepal.  Historically, the freshwater cetacean has been documented in the Karnali, Koshi, Narayani, and Mahakali basins.  With their population and distribution range in decline, the Ganges River Dolphin (GRD) is no longer found in the Mahakali River system, which demarcates and traverses the Western border of India and Nepal.  This study examines the status and distribution of the GRD in the river systems of Nepal during the monsoon of 2016.  The national dolphin population survey was conducted in the three largest river basins in Nepal—Karnali, Narayani, and Koshi.  Each of the three basins represent the extreme upstream limit of the GRD distribution in Ganges River basin.  The national population survey included both a boat-based survey and shore-based synchronized counting in each of the three river systems.  Fifty-two (Best-High-Low: 52-61-50) dolphins were counted during the entire nationwide survey, conducted in July–August, 2016.  Researchers gathered social-data from locals residing alongside the observed basin, giving priority to artisanal fishers and those subsisting to some degree from the rivers known to host the river dolphin.  A questionnaire survey of ninety-two residents from riparian villages adjacent to the GRD hotspots sheds light on the local perspectives towards dolphin conservation coupled with an assessment of their socio-economic status; artisanal fishing practices; and their awareness of dolphin conservation.  According to the survey, notable threats to dolphin conservation are prey depletion; non-availability of suitable habitat; habitat fragmentation and a low level of awareness.  Based on the counting outcomes and social survey, recommendations have been put forward for the conservation of this species.

High stress is a public health issue in the United States (US), that disproportionately affects socially-marginalized group members, including racial and ethnic minorities and those of low socioeconomic status. While city governments have the potential to reduce stress exposure and health disparities through municipal policies, very little is known about factors that are associated with mayor officials' beliefs about stress as a determinant of disparities. This information is important because it can inform the design of interventions to educate city policymakers about evidence related to stress and health disparities. Using data from a 2016 survey of 230 mayor officials (101 mayors, 129 senior staff), multivariable logistic regression was used to determine the extent to which respondents' individual characteristics (e.g., ideology, highest level of education) and the characteristics of their city's population (e.g., percentage of residents non-white) were associated with their identification of stress as a factor that has a "very strong effect" on health disparities. Forty-four percent of respondents identified stress as having a very strong effect on health disparities. In the fully adjusted model, every percentage point increase in the proportion of a respondent's city population that was non-White increased the odds of identifying stress as having a very strong effect on health disparities by 2% [adjusted odds ratio (aOR) = 1.02; 95% CI = 1.00,1.04]. Interventions are needed to increase city policymakers' knowledge about the role of stress in the production of health disparities, which could, in turn, help cultivate political will for city policies that reduce disparities.

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