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Vallabhan MK, Foos K, Roldan P, Negrete S, Page-Reeves JM, Jimenez EY, Kong AS. Telemedicine Quality Improvement during the Corona Virus 2019 Pandemic Increases Pediatric Weight Management Access. Pediatr Qual Saf 2024; 9:e731. [PMID: 38751895 PMCID: PMC11093564 DOI: 10.1097/pq9.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/27/2024] [Indexed: 05/18/2024] Open
Abstract
Background The corona virus 2019 pandemic disrupted care for pediatric patients with chronic conditions, including those with childhood obesity. Lockdowns forced providers to create new ways of caring for this population. Telemedicine was a promising but previously unavailable solution. This quality improvement report details how the Healthy and Fit Children's Clinic transitioned and improved care via telemedicine. Methods Between March 2020 and April 2021, the quality improvement project team incorporated the Model for Improvement to transition the clinic to telemedicine. The team tracked Healthy and Fit Children's Clinic appointments, no-shows, billing and reimbursement data, and noted unintended consequences or unanticipated barriers. Patients and their families were given a satisfaction survey at the end of each telemedicine encounter. Results Compared with pre-telemedicine implementation, there was a 120% increase in completed patient clinic visits per week and a sustained positive shift above the established baseline. Telemedicine no-show rates achieved <10%, with an average sustained rate of <20%, compared with unchanged in-person no-show rates of >50% pre- and post-telemedicine implementation. There was a 74% increase in monthly billing and a sustained positive shift above the pre-telemedicine baseline. On average, patients rated all six satisfaction questions ≥92 on the 100-point scale (compared with 83 pre-telemedicine). Conclusions This transition to telemedicine was successful and could be translatable to other clinic sites. Patients attended their clinic visits more consistently and were highly satisfied with their care. In a population where continuity of care is paramount, telemedicine shows promise as a tool to treat childhood obesity.
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Affiliation(s)
- Monique K. Vallabhan
- From the Division of Adolescent Medicine, Department of Pediatrics, School of Medicine, University of New Mexico
| | | | - Patricia Roldan
- From the Division of Adolescent Medicine, Department of Pediatrics, School of Medicine, University of New Mexico
| | - Sylvia Negrete
- Division of General Pediatrics, Department of Pediatrics, School of Medicine, University of New Mexico
| | | | - Elizabeth Y. Jimenez
- From the Division of Adolescent Medicine, Department of Pediatrics, School of Medicine, University of New Mexico
| | - Alberta S. Kong
- From the Division of Adolescent Medicine, Department of Pediatrics, School of Medicine, University of New Mexico
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Duncan MJ, Belita E, Amores A, Riazi NA, Carsley S, Vanderloo LM, Carson V, Chaput JP, Faulkner G, Leatherdale ST, Patte KA. Changes in breakfast and water consumption among adolescents in Canada: examining the impact of COVID-19 in worsening inequity. BMC Nutr 2024; 10:27. [PMID: 38317176 PMCID: PMC10840267 DOI: 10.1186/s40795-024-00831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND To assess whether changes in breakfast and water consumption during the first full school year after the emergence of the COVID-19 pandemic varied based on sex/gender, race/ethnicity, and socioeconomic status among Canadian adolescents. METHODS Prospective annual survey data collected pre- (October 2019-March 2020) and post-COVID-19 onset (November 2020-June 2021) the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study. The sample consisted of 8,128 students; mean (SD) age = 14.2 (1.3) years from a convenience sample of 41 Canadian secondary schools. At both timepoints self-reported breakfast and water consumption were dichotomized as daily or not. Multivariable logistic generalized estimating equations with school clustering were used to estimate differences in maintenance/adoption of daily consumption post-COVID-19 based on demographic factors, while controlling for pre-COVID-19 behaviour. RESULTS Adjusted odds ratios (AOR) with 95% confidence intervals are reported. Females (AOR = 0.71 [0.63, 0.79]) and lower socioeconomic status individuals (AORLowest:Highest=0.41 [0.16, 1.00]) were less likely to maintain/adopt daily breakfast consumption than male and higher socioeconomic status peers in the 2020-2021 school year. Black identifying individuals were less likely than all other racial/ethnic identities to maintain/adopt plain water consumption every day of the week (AOR = 0.33 [0.15, 0.75], p < 0.001). No significant interaction effects were detected. CONCLUSIONS Results support the hypothesis that changes in nutritional behaviours were not equal across demographic groups. Female, lower socioeconomic status, and Black adolescents reported greater declines in healthy nutritional behaviours. Public health interventions to improve adherence to daily breakfast and water consumption should target these segments of the population. TRIAL REGISTRATION Not a trial.
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Affiliation(s)
- Markus J Duncan
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada.
| | - Emily Belita
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Angelica Amores
- School of Public Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
| | - Negin A Riazi
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Sarah Carsley
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Room 500, Toronto, ON, M5T 3M7, Canada
| | - Leigh M Vanderloo
- ParticipACTION, 77 Bloor St. W., Suite 1205, Toronto, ON, M5S 1M2, Canada
- School of Occupational Therapy, Western University, 1201 Western Rd., London, ON, N6G 1H1, Canada
| | - Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 8840 114 St., Edmonton, AB, T6G 2H9, Canada
| | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children?s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Department of Pediatrics, University of Ottawa, 75 Laurier Ave. East, Ottawa, ON, K1N 6N5, Canada
| | - Guy Faulkner
- School of Kinesiology, University of British Columbia, Lower Mall Research Station, 2259 Lower Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Scott T Leatherdale
- School of Public Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
| | - Karen A Patte
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
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Sharma R, Lahariya C, Hossain MM. Impact of Climate Change, Food Insecurity, and COVID-19 on the Health of Neonates and Children: A Narrative Review. Indian J Pediatr 2023; 90:104-115. [PMID: 37505407 DOI: 10.1007/s12098-023-04757-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023]
Abstract
Climate change, food insecurity, and epidemics affect all population sub-groups. This article reviews the current evidence on the relationships between climate change, food insecurity, and the COVID-19 pandemic in the context of newborn and child health. The authors searched Medline, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases using a structured approach. Food insecurity, particularly from the lack of food access and affordability, increased amidst the COVID-19 pandemic. Factors such as nationwide lockdowns, increased unemployment and financial instability, and school closures precipitated food insecurity. Children born to immigrant parents, belonging to racial and ethnic minority groupsor low-income families, and those who were Autistic were highly vulnerable. Climate change also contributes to food insecurity, with increased susceptibility among neonates and children compared to adults. There is a need for further research on the relationships between climate-linked exposures and COVID-19 transmission. Multisectoral collaborations and multilevel interventions are necessary to mobilize local and national resources for mitigating and preventing the synergistic effects of the three concurrent crises. The evidence-informed discourse on this topic can help in improved preparedness and response for future outbreaks and epidemics. The policy interventions for newborn and child survival need to factor in climate change, food insecurity, and emerging diseases.
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Affiliation(s)
- Rachit Sharma
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA.
| | - Chandrakant Lahariya
- Integrated Department of Health Policy, Epidemiology, Preventive Medicine and Pediatrics, Foundation for People-centric Health Systems, New Delhi, India
- S.D. Gupta School of Public Health, The IIHMR University, Jaipur, India
| | - M Mahbub Hossain
- Department of Decision and Information Sciences, C.T. Bauer College of Business, University of Houston, Houston, TX, 77204, USA
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX, 77204, USA
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Pemjean I, Mediano F, Ferrer P, Garmendia ML, Corvalán C. Food access, domestic environments, and dietary quality of low-middle income Chilean children during the COVID-19 pandemic. Front Public Health 2023; 11:1164357. [PMID: 37408742 PMCID: PMC10319070 DOI: 10.3389/fpubh.2023.1164357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/25/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Food access is associated with dietary quality; however, people living in similar physical environments can have different food access profiles. Domestic environments may also influence how food access relates to dietary quality. We studied food access profiles of 999 low-middle income Chilean families with children during the COVID-19 lockdown and how these profiles relate to dietary quality; secondarily, we also explore the role of the domestic environment in this relationship. Materials and methods Participants of two longitudinal studies conducted in the southeast of Santiago, Chile, answered online surveys at the beginning and end of the COVID-19 pandemic lockdown. Food access profiles were developed by a latent class analysis considering food outlets and government food transfers. Children's dietary quality was estimated by self-reported compliance with the Chilean Dietary Guidelines of Americans (DGA) and daily ultra-processed food (UPF) consumption. Logistic and linear regressions were used to assess the association between food access profiles and dietary quality. Domestic environment data (i.e., the sex of the person who buys food and cooks, meal frequency, cooking skills, etc.) were incorporated in the models to assess their influence on the relationship between food access and dietary quality. Results We have categorized three food access profiles: Classic (70.2%), Multiple (17.9%), and Supermarket-Restaurant (11.9%). Households led by women are concentrated in the Multiple profile, while families from higher income or education levels are focused on the Supermarket-Restaurant profile. On average, children presented poor dietary quality, with a high daily UPF consumption (median = 4.4; IQR: 3) and low compliance with national DGA recommendations (median = 1.2; IQR: 2). Except for the fish recommendation (OR = 1.77, 95% CI:1.00-3.12; p: 0.048 for the Supermarket-Restaurant profile), the food access profiles were poorly associated with children's dietary quality. However, further analyses showed that domestic environment variables related to routine and time use influenced the association between food access profiles and dietary quality. Conclusion In a sample of low-middle income Chilean families, we identified three different food access profiles that presented a socioeconomic gradient; however, these profiles did not significantly explain children's dietary quality. Studies diving deeper into household dynamics might give us some clues on intra-household behaviors and roles that could be influencing how food access relates to dietary quality.
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Affiliation(s)
- Isabel Pemjean
- Doctoral Program in Public Health, School of Public Health, University of Chile, Santiago, Chile
| | - Fernanda Mediano
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, United States
| | - Pedro Ferrer
- Center for Research in Food Environments and Prevention of Nutrition-Related Diseases (CIAPEC), Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - María Luisa Garmendia
- Center for Research in Food Environments and Prevention of Nutrition-Related Diseases (CIAPEC), Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Camila Corvalán
- Center for Research in Food Environments and Prevention of Nutrition-Related Diseases (CIAPEC), Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
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