Aims To explore how people who use fentanyl and health‐care providers engaged in and responded to overdose risk communication interactions, and how these engagements and responses might vary by age. Design A single‐site qualitative in‐depth interview study. Setting Boston, MA, United States. Participants The sample included 21 people (10 women, 11 men) who were either 18–25 or 35+, English‐speaking, and reported illicit fentanyl use in the last year and 10 health‐care providers who worked directly with people who use fentanyl (PWUF) in clinical and community settings. Measurements Open‐ended, flexible interview questions guided by a risk communication framework were used in all interviews. Codes used for thematic analysis included deductive codes related to the risk communication framework and inductive, emergent codes from interview content. Findings We identified potential age‐based differences in perceptions of fentanyl overdose, including that younger participants appeared to display more perceptions of an immunity to fentanyl's lethality, while older people seemed to express a stronger aversion to fentanyl due to its heightened risk of fatal overdose, shorter effects and potential for long‐term health consequences. Providers perceived greater challenges relaying risk information to young PWUF and believed them to be less open to risk communication. Compassionate harm reduction communication was preferred by all participants and perceived to be delivered most effectively by community health workers and peers. PWUF and providers identified structural barriers that limited compassionate harm reduction, including misalignment of available treatment with preferred options and clinical structures that impeded the delivery of risk communication messages. Conclusions Among people who engage in illicit fentanyl use, fentanyl‐related risk communication experiences and preferences may vary by age, but some foundational elements including compassionate, trust‐building approaches seem to be preferred across the age spectrum. Structural barriers in the clinical setting such as provider‐prescribing power and infrequent encounters may impede the providers’ ability to provide compassionate harm reduction communication.

Background Nearly a year after COVID‐19 was initially detected, guidance for pregnant and new mothers remains varied. Objective The goal of this systematic review is to summarize recommendations for three areas of maternal and fetal care—breastfeeding, post‐partum social distancing, and decontamination. Search strategy We searched PubMed, Embase and Web of Science spanning from inception to November 9, 2020. Selection criteria Articles were included if they focused on COVID‐positive mothers, commented on at least one of the three areas of interest, and were published in English. Data collection and analysis Our combined database search yielded 385 articles. After removing duplicates and articles that did not cover the correct populations or subject matter, a total of 74 articles remained in our analysis. Main results Most articles recommended direct breastfeeding with enhanced precaution measures. Recommendations regarding post‐partum social distancing varied, although articles published more recently often recommended keeping the mother and newborn in the same room when possible. Decontamination recommendations emphasized mask wearing, good hand hygiene, and proper cleaning of surfaces. Conclusion In general, there was a focus on shared decision making when approaching topics such as breastfeeding and post‐partum social distancing. Guidelines for decontamination were fairly uniform.

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Importance: Caregivers of children with cerebral palsy can best help their child if they understand the disorder and the correct terminology. Objective: To assess caregiver understanding of cerebral palsy. Design: This was a cross-sectional study from a large tertiary medical center in Boston, to assess understanding of the term cerebral palsy by primary caregivers of children and adolescents with cerebral palsy. All cases were obtained from hospital electronic medical records. Telephone surveys were conducted. Caregiver understanding of cerebral palsy was assessed by open-ended responses (50%) and success in answering true/false questions about cerebral palsy (50%). Participants: Primary caregivers of children 18 years and younger with cerebral palsy. Results: Thirty-three percent of caregivers denied ever being told that their child had cerebral palsy. Most caregivers identified cerebral palsy as a brain problem (79%), lifelong condition (73%), often caused by a perinatal (60%) or gestational (40%) insult. Fifty-two percent knew that cerebral palsy was nonprogressive. Sixty-two percent of caregivers believed they had a good, very good, or excellent understanding of cerebral palsy, whereas the investigators found 69% of caregivers had a good, very good, or excellent understanding of cerebral palsy (P = .006). Most caregivers rated very good or excellent the setting where cerebral palsy was discussed (58%), the explanations provided (55%), and the amount of time spent (45%), yet using a Pearson correlation coefficient, most important was the time spent ( r = 0.53). Conclusions: Following discussion with their child’s physician, most primary caregivers of children with cerebral palsy have a good, very good, or excellent understanding of cerebral palsy. Most critical to a good understanding of cerebral palsy was the time spent in explaining the diagnosis.