Nutrition and development in infants of poor rural areas. Pt. 1. Consumption of mother's milk by infants

This study was designed to examine the pattern of mother's milk consumption of infants from poor Mexican rural areas. A standardized sample of 17 mother-infant units was longitudinally studied in ad-libitum conditions, estimating milk volume by difference in body weights before and after feeding from the breast. Average total milk consumption during the 1st year of life was 183 +or- 23 liters. Daily milk consumption started low (423 +or- 85 ml), increased to a peak at 450 +or- 80 ml, and finally dropped to about 350 +or- 44 ml at 18 months. About 1/2 the cases reached the peak at 8 weeks and the rest at 24 weeks; this difference in presentation of the peak was connected to the mother's parity and nutritional status. Consumption seems to depend on mother's production since the baby keeps a high demand as evidenced by high feeding frequencies and too long sucking times. The gap resulting from decreasing milk production at a time when nutritional needs increase progressively affects the baby's development and nutritional status.

One year of COVID: primary care learning experiences in a health system

Context: Patients and communities consider their primary care clinicians (PCC's) to be their most trusted source of information. During the first 12 months of the COVID pandemic, initially reliable, accurate information was scare, evolving, and at times conflicting. From testing, public health prevention, treatment, and vaccinations clinicians had to learn, apply, and convey this information honestly and openly. Objective: This was a survey of a health system's PCC's after the first year of the pandemic. The objective was to determine the clinical, educational, and advisory roles performed by PCC's and the sources of from which PCC's obtained the information necessary to fulfill these roles. Study Design: An intranet survey was sent to members of the system's primary care learning collaborative. Questions were multiple answer with options for open-ended answers. Setting: Large health system. Population: Learning collaborative membership consisting of physicians, nurse practitioners (NP), and physician assistants (PA). Instrument: Brief intranet survey. Outcome measures: Identify clinical and educational roles for PCC. Results: 192 surveys were sent; 109 responses; 72% physicians, 28% NP/PA. 25 unique clinical roles were identified. Most common: discuss vaccine (94%), work excuse/return to work (88%), outpatient care (87%), virtual assessment for COVID (74%). 14 unique educational or advisory roles were identified; the most common being teaching residents (45%) or students (42%), lecture/discussion on COVID (20%) or vaccines (22%) or advising community groups (18%). Sources of information related to COVID were diverse. When asked to identify the three most relied on sources, system (internal COVID website or disseminated by system) (83%), colleagues (34%), and consultants (33%), were the most common source. CME was the least relied upon (7%). Frequently the system utilized information from CDC, state/local health department information along with national organizations. Conclusions: During the pandemic, primary care clinicians provided a broad array of clinical services, and are a source of information for colleagues, patients, and communities. They rely on a broad array of sources for reliable information, mostly relationship-based, not formal CME. The trusted relationships primary care clinicians have with others throughout their communities was essential in promulgating accurate reliable information during the first year of the pandemic.

Patients' experience with virtual care during COVID-19 pandemic in primary care practice

Context: The advent of COVID-19 pandemic in March of 2020 galvanized primary care practices into adopting telemedicine to be able to continue delivering care to patients safely. As recipients of care delivered virtually, capturing patients' experience is key to evaluating its success and shortcomings. Objective: To describe patients' experience and perceptions with virtual care during COVID-19 pandemic. Study Design/Population: A survey was distributed to 900 adult patients across primacy care practices in MW Minnesota and Arizona from September through October, 2020. Questions asked included: mode of virtual care received (virtual visit, phone visit, secured patient on-line portal or POL), device used, and likelihood of using virtual care for different visit reasons (acute visit, persistent problem, routine/wellness visit or chronic care). Results: Five hundred ninety surveys (65.5%) were returned. Majority (72%) of responders' experience with virtual care was through use of POL to view test results or messages from their care team; 43% of responders also sought clinic advice though this avenue. Thirty percent (n=177) had phone visits compared to 26% video visits. Those over 64 years had more phone than video visits. This age group which comprised 23 % (n=139) of responders, reported more negative experience with video visits compared to other age groups. Only five percent of all responders had negative experience with POL for clinical communications. Across all age groups, responders were "very likely" to engage in virtual visits for routine/wellness care such as medication refills; those in 30-64 age groups were more likely to utilize virtual visits from mental health and chronic disease care than the younger (18-29 years) and older (65 and up) groups. Interestingly, 84% (n=496) of responders had smart phones and only 28% had computers with video cameras. Conclusion: Patients have varying experiences in virtual care which should be taken into consideration as this method of care delivery becomes more integrated into primary care practice. Majority of patients surveyed had access to smartphones than computers with video camera which creates an opportunity for exploring the use of this modality to expand care delivered through telemedicine.

Interprofessional Near-Peer Mentoring Teams Enhance Cancer Research Training: Sustainable Approaches for Biomedical Workforce Development of Historically Underrepresented Students

A cancer research training program explored different approaches for staffing their in-person and virtual programs for high school students. The inclusion of undergraduate near-peer mentors had a universal benefit when implemented across in-person and virtual training programs of one- and ten-week durations. Benefits are described for four stakeholder groups: the high school trainees, program staff, scientist partners, and peer mentors themselves. Peer mentors described that their involvement enhanced their own professional development and, for some, drove a new interest in cancer research. Scientist partners described that peer mentors helped translate their work in the virtual environment for high school students. High school trainees reported their sessions with peer mentors to be one of their favorite parts of the program. Interprofessional peer mentors were highly relatable to students and modeled communication and paths in biomedical research. Staff reported that peer mentors supported student engagement during community shadowing sessions, allowing staff to focus on developing the shadowing experiences with partners. The benefit of including peer mentors was substantial from all viewpoints explored. Their intensive inclusion in cancer research training programs supports sustainability and capacity building in biomedical workforce development.

Experience and Attitudes Toward Telehealth in Student-Run Free Clinics (SRFC)

INTRODUCTION/OBJECTIVES

Telehealth services expanded during the coronavirus disease 2019 (COVID-19) pandemic. Student-run free clinics (SRFC) deliver important health care services to underserved populations, who may face barriers to telehealth use. This study characterizes telehealth usage, experiences, and attitudes among individuals working in SRFCs.

METHODS

In November 2021, a survey adapted from the COVID-19 Healthcare Coalition Telehealth Impact Physician Survey was sent to all registrants who identified themselves as students at the 2020 Society of Student-Run Free Clinics Annual Conference.

RESULTS

Thirty-eight individuals of 576 registrants (7%) representing 21 of 88 (24%) SRFCs completed the survey. Twenty-one (58%) individuals reported using telehealth in their clinic. Those that did not cited lack of infrastructure as a barrier (eg, broadband, Internet challenges, technology investments), were more likely to serve homeless (P = .01), and less likely to serve non-English speaking populations (P = .02). There were increases in telehealth and decreases in in-person visits after March 11, 2020 though changes did not reach statistical significance. At least 15 (68%) wanted to continue chronic disease management, preventative care, and mental/behavioral health via telehealth after COVID-19. Most felt that telehealth was easy to use and improved the health, safety, and timeliness of care of patients, but not work satisfaction or access to care. Difficulty accessing physical devices, Internet, and data was the most-cited barrier to maintaining and accessing telehealth.

CONCLUSIONS

Nearly all participants cited significant benefits and barriers to telehealth that impacted perceived access to care and sustainability. SRFCs' experiences may be modulated by their underserved populations and role in student education. Addressing barriers, particularly patient- and clinic-level technology challenges, could work to improve inequities in telehealth uptake.