Participant experiences in a breastmilk biomonitoring study: A qualitative assessment.

BACKGROUND: Biomonitoring studies can provide information about individual and population-wide exposure. However they must be designed in a way that protects the rights and welfare of participants. This descriptive qualitative study was conducted as a follow-up to a breastmilk biomonitoring study. The primary objectives were to assess participants' experiences in the study, including the report-back of individual body burden results, and to determine if participation in the study negatively affected breastfeeding rates or duration. METHODS: Participants of the Greater Boston PBDE Breastmilk Biomonitoring Study were contacted and asked about their experiences in the study: the impact of study recruitment materials on attitudes towards breastfeeding; if participants had wanted individual biomonitoring results; if the protocol by which individual results were distributed met participants' needs; and the impact of individual results on attitudes towards breastfeeding. RESULTS: No participants reported reducing the duration of breastfeeding because of the biomonitoring study, but some responses suggested that breastmilk biomonitoring studies have the potential to raise anxieties about breastfeeding. Almost all participants wished to obtain individual results. Although several reported some concern about individual body burden, none reported reducing the duration of breastfeeding because of biomonitoring results. The study literature and report-back method were found to mitigate potential negative impacts. CONCLUSION: Biomonitoring study design, including clear communication about the benefits of breastfeeding and the manner in which individual results are distributed, can prevent negative impacts of biomonitoring on breastfeeding. Adoption of more specific standards for biomonitoring studies and continued study of risk communication issues related to biomonitoring will help protect participants from harm.

Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic Review

Paper published in PLoS Medicine in 2007.

How Much Does It Cost to Provide Antiretroviral Therapy for HIV/AIDS in Africa?

Background: Many African countries are rapidly expanding HIV/AIDS treatment programs. Empirical information on the cost of delivering antiretroviral therapy (ART) for HIV/AIDS is needed for program planning and budgeting. Methods: We searched published and gray sources for estimates of the cost of providing ART in service delivery (non-research) settings in sub-Saharan Africa. Estimates were included if they were based on primary local data for input prices. Results: 17 eligible cost estimates were found. Of these, 10 were from South Africa. The cost per patient per year ranged from $396 to $2,761. It averaged approximately $850/patient/year in countries outside South Africa and $1,700/patient/year in South Africa. The most recent estimates for South Africa averaged $1,200/patient/year. Specific cost items included in the average cost per patient per year varied, making comparison across studies problematic. All estimates included the cost of antiretroviral drugs and laboratory tests, but many excluded the cost of inpatient care, treatment of opportunistic infections, and/or clinic infrastructure. Antiretroviral drugs comprised an average of one third of the cost of treatment in South Africa and one half to three quarters of the cost in other countries. Conclusions: There is very little empirical information available about the cost of providing antiretroviral therapy in non-research settings in Africa. Methods for estimating costs are inconsistent, and many estimates combine data drawn from disparate sources. Cost analysis should become a routine part of operational research on the treatment rollout in Africa.

Practices of Ministerial Leadership of Korean-American United Methodist Clergywomen; Toward a Wesleyan Ecclesiology in a Global Context

This study documents, analyzes, and interprets Korean American United Methodist (KAUM) clergywomen‘s experiences in and understandings of the church. It examines contributions these (and potentially, other) clergywomen might make to Wesleyan ecclesiology generally, and particular ways United Methodists live out their faith in transitional, diverse, and global contexts. The project attempts to re-vision existing Wesleyan ecclesial discourse in the United Methodist Church (UMC) by recognizing and incorporating the contributions of racial-ethnic clergy as expressed through their leadership and practices of faith. A "practice-theory-practice" model of practical theology was used to pay systematic attention to the practical locus of the inquiries. Twenty Korean American United Methodist clergywomen were interviewed by telephone, using a voluntary sampling technique to ascertain how they both experienced the church and understood and lived out various practices of faith, including preaching, participation in and administration of the sacraments, preparation for ordained ministry, and other spiritual practices such as prayer, worship, retreats, and journaling. The dissertation summarizes those findings, provides contextual and historical interpretation, and then analyzes their responses in relation to Wesleyan theology, MinJung (mass of people) theology, and the theology of YeoSung (women who display dignity and honor as human beings). This study identifies the extraordinary call of the KAUM clergywomen interviewees to be bridge builders, strong nurturers, wounded healers, committed educators, breakers of old stereotypes, persistent seekers to fulfill God‘s call, and ecclesial leaders with ―tragic consciousness‖ who can disrupt marginality and facilitate the creative transformation of Han (a deep experience of suffering and oppression) into a constructive energy capable of shaping a new reality. According to this study, KAUM clergywomen‘s experiences and practices of faith as ecclesial leaders strengthen Wesleyan ecclesiology in terms of the UMC‘s efforts to be an inclusive church through connectionalism, and its commitment to social justice. MinJung theology and the theology of YeoSung, in their respective understandings of the church, broaden Wesleyan ecclesiology and enable the Church to be more relevant in a global context by embracing those who have not been normative theological subjects.