The COVID-19 Pandemic, Rising Inflation, and Their Influence on Dining Out Frequency and Spending.

BACKGROUND: High intake of food away from home is associated with poor diet quality. This study examines how the COVID-19 pandemic period and Food Away from Home (FAFH) inflation rate fluctuations influenced dining out behaviors. METHODS: Approximately 2800 individuals in Texas reported household weekly dining out frequency and spending. Responses completed prior to the COVID-19 pandemic (2019 to early 2020) were compared to the post-COVID-19 period (2021 through mid-2022). Multivariate analysis with interaction terms was used to test study hypotheses. RESULTS AND CONCLUSION: From the COVID-19 period (before vs. after), the unadjusted frequency of dining out increased from 3.4 times per week to 3.5 times per week, while the amount spent on dining out increased from $63.90 to $82.20. Once the relationship between dining out (frequency and spending) was adjusted for FAFH interest rate and sociodemographic factors, an increase in dining out frequency post-COVID-19 remained significant. However, the unadjusted increase in dining out spending did not remain significant. Further research to understand the demand for dining out post-pandemic is warranted.

Climbing Mount Everest: Tips for C-L Psychiatrists Managing Patients with Anorexia Nervosa on The Medical Unit

Background/Significance: The prevalence of anorexia nervosa (AN) has drastically increased in the face of the COVID-19 pandemic (Schwartz et al 2021, Goldberg et al. 2022), resulting in increased number of presentations of malnourished AN patient on general medical units. The AN population is one of the most difficult to manage in a medical setting, due to both patient factors, such as ambivalence towards recovery and behaviors that interfere with weight gain, as well as systemic barriers, such as the lack of structured containment and consistent staffing for patient supervision. There is a significant need for increased eating disorders expertise in CL psychiatry as we continue to support our medical colleagues in the treatment of these patients. Method(s): The Toronto General Hospital (TGH) at the University of Toronto has been creating a pathway where CL psychiatrists closely consult with colleagues working in the TGH eating disorders program for challenging cases, with the goal of developing a consistent future treatment approach for individuals presenting with anorexia nervosa on a medical unit. Key challenges from clinical cases were identified and targeted as areas for education and improvement. Result(s): Major challenges from past clinical cases of AN requiring consultation are described. Themes include difficulty with finding of incapacity for these patients, ongoing eating disorders symptoms during the process of refeeding, inconsistent staff approaches, and poor weight gain and prolonged hospitalizations. Important lessons learned and recommendations for future practice are discussed. Promotion of rapid weight gain via multiple measures, consistent limit setting and a united approach to patient care by all members of the multidisciplinary team were identified as key elements to the successful treatment of anorexia patients. Features that would support a clinical finding of incapacity are also discussed. Conclusion/Implications: Barriers to successful treatment of AN patients on inpatient medical settings are highlighted, and effective treatment approaches to these patients are discussed by sharing insights from the collaborative pathway between CL psychiatry and the eating disorder program created at the Toronto General Hospital. References: 1. Schwartz MD., Costello KL. Eating disorder in teens during the COVID-19 pandemic. Journal of adolescent health. 2021 (68): 1020-1023. 2. Goldberg L., Ziv A., Vardi Y., Hadas S., Zuobi T., Yeshareem L., Gur T., Steinling S., Scheuerman O., Levinsky Y. The effect of COVID-19 pandemic on hospitalization and disease characteristics of adolescents with anorexia nervosa. European journal of pediatrics 2022 Jan (3): 1-5. Copyright © 2022

Prevalence of maternal obesity at delivery and association with maternal and neonatal outcomes.

INTRODUCTION: Maternal obesity has been linked to adverse outcomes for mothers and their offspring, including, but not limited to gestational hypertension (gHTN), gestational diabetes (GDM), pre-eclampsia, fetal macrosomia, and emergency cesarean section. Recent investigations have also shown that obesity, as defined by a body mass index (BMI) ≥ 30, especially severe obesity (BMI ≥ 40), is a risk factor for both hospitalization and death from COVID-19. OBJECTIVES: The objective of this study is to determine the prevalence and association of maternal obesity at delivery with adverse antenatal, intrapartum, and neonatal outcomes in a cohort of consecutive delivering patients at a tertiary care center in Iowa from May to September 2020. A secondary objective is to determine if maternal obesity has any relationship to past or current COVID-19 infection status at the time of delivery. This is a secondary analysis of a prospective cohort study to analyze obstetric outcomes among COVID-19 infected and uninfected patients. METHODS: We conducted a prospective cohort study using demographic and clinical data obtained from the electronic medical record. Excess plasma was collected from routine blood samples obtained at delivery admission to determine the seroprevalence of COVID-19 antibody using the DiaSorin and Roche antibody assays. Frequency variables were each calculated separately, and a comparison of maternal and neonatal outcomes was conducted using the generalized linear mixed modeling (GLMM) framework to account for varying distributions (normal and binary). RESULTS: 1001 women delivered during the study period and 89.7% met criteria for being overweight or obese; 17.9% met criteria for severe obesity. Women with obesity had 49.8% lower odds of possessing private insurance, and women with severe obesity were less than half as likely to plan to breastfeed at the time of discharge. Women with obesity of any kind had a significantly increased odds of GDM and gHTN, and an increased risk of an infant with macrosomia, hypoglycemia, and NICU admission. No significant association was found between BMI and COVID-19 infection or disease severity. CONCLUSION: This study provides insight into obstetric complications facing women with obesity, especially those with severe obesity. This report serves to highlight potential challenges, such as insurance status and labor complications, that impact women of high BMI to a greater degree when compared to their normal-weight counterparts.

SARS-CoV-2 Infection during Pregnancy in a Rural Midwest All-delivery Cohort and Associated Maternal and Neonatal Outcomes.

OBJECTIVE: This study aimed to estimate the prevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) among pregnant patients at the time of delivery in a rural Midwest tertiary care hospital and to examine demographics, clinical factors, and maternal and neonatal outcomes associated with SARS-CoV-2 infection during pregnancy. STUDY DESIGN: This prospective cohort study included all delivering patients between May 1 and September 22, 2020 at the University of Iowa Hospitals and Clinics. Plasma SARS-CoV-2 antibody testing was performed. SARS-CoV-2 viral reverse-transcription polymerase chain reaction (RT-PCR) results and maternal and neonatal outcomes were collected from the electronic medical record. Data were analyzed using univariate statistical methods with clustering for multiple births. RESULTS: In total, 1,000 patients delivered between May 1 and September 22, 2020. Fifty-eight (5.8%) were SARS-CoV-2 antibody positive. Twenty-three also tested viral positive during pregnancy. Three of 1,000 (0.3%) were viral positive on admission but antibody negative. The median age was 30 years (interquartile range [IQR]: 26-33 years) and body mass index was 31.75 kg/m2 (IQR 27.7-37.5 kg/m2). The cesarean delivery rate was 34.0%. The study population was primarily white (71.6%); however, 41.0% of SARS-CoV-2 infected patients identified as Black, 18.0% as Hispanic/Latino, 3.3% as Native Hawaiian/Pacific Islander, and only 27.9% as White (p < 0.0001). SARS-CoV-2 infection was more likely in patients without private insurance (p = 0.0243). Adverse maternal and/or neonatal outcomes were not more likely in patients with evidence of infection during pregnancy. Two SARS-CoV-2 infected patients were admitted to the intensive care unit. There were no maternal deaths during the study period. CONCLUSION: In this largely rural Midwest population, 6.1% of delivering patients had evidence of past or current SARS-CoV-2 infection. Rates of SARS-CoV-2 during pregnancy were higher among racial and ethnic minorities and patients without private insurance. The SARS-CoV-2 infected patients and their neonates were not found to be at increased risk for adverse outcomes. KEY POINTS: · SARS-CoV-2 seroprevalence rate in pregnant population in Iowa is 5.8%.. · Infections are higher among minorities, non-English speakers, and patients without private insurance.. · No increased adverse maternal/neonatal outcomes observed for SARS-CoV-2 infected mothers..