Changes in Adults' Eating Behaviors During the Initial Months of the COVID-19 Pandemic: A Narrative Review

Factors such as regulations and health concerns shifted daily habits, including eating behaviors, during the early months of the coronavirus disease 2019 (COVID-19) pandemic. This comprehensive narrative review synthesizes research on eating behavior changes during the early months of the pandemic (February to June 2020), including changes in amount, rate, and timing of food consumption, types and healthfulness of foods consumed, the occurrence of other specified eating behaviors (eg, restrained eating or binging), and reasons for eating (eg, stress or cravings), among adults. A literature search using three EBSCOhost databases and Google Scholar was conducted to identify relevant articles made available in 2020. A total of 71 articles representing 250,715 individuals from more than 30 countries were reviewed. Findings show eating behaviors changed little during the early COVID-19 pandemic for most participants. Among those whose eating behaviors changed, increases in both intake and frequency of eating meals and snacks were more common than decreases. Findings on timing of eating and healthfulness of food consumed showed mixed results. How-ever, when changes occurred in the type of food consumed, increases were more common for snacks, homemade pastries, white bread/pasta, legumes, and fruits/vege-tables;decreases were more common for meats, seafood/fish, frozen foods, fast food, dark breads/grains, and dark leafy green vegetables. During the pandemic, binging, uncontrolled eating, and overeating increased, meal skipping decreased, and restrictive eating had mixed findings. Changes in factors such as emotions and mood (eg, depression), cravings, and environmental factors (eg, food insecurity) were related to changes in eating behaviors. Findings can inform clinical practitioners in efforts to mitigate disruptions to normal, healthy eating patterns among adults both in and outside of global health catastrophes. J Acad Nutr Diet. 2023;123(1):144-194.

Pro-environmental attitudes, altruism, and COVID-19 risk management behavior. (Special Issue: COVID-19: feeling and confronting pandemic risk challenges.)

Limiting the spread of COVID-19 during the pandemic is a collective action problem that calls on individuals to act, not just for their benefit but also for the benefit of others in their community. Many environmental problems, especially climate change, share this characteristic, which invites inquiry on whether those predisposed to act to solve environmental problems may also be predisposed to act to solve health-focused collective action problems. In this study, we use a survey instrument to examine how pro-environmental attitudes and two types of altruism relate to the tendency to follow social distancing guidelines and limit voluntary social exposure during the pandemic. We find that pro-environmental behaviors predict a feeling of moral obligation to reduce COVID-19 risk and a lower level of voluntary social exposure. Voluntary, individual-level altruism has no relationship with social exposure. These findings point to important insights about the connections between different types of collective action and the nuances in altruistic behavior. These insights may lead to essential guidance for public health and environmental messaging that respects and leverages the differences in voluntary, individual-level altruism and collective altruism.

Perceptions on Susceptibility to Exposure to the COVID-19 Virus: A Qualitative Study on Pregnant and Non-pregnant Adult Women, their Partners, and Healthcare Workers in Metro Manila

Introduction. The World Health Organization (WHO) reported that special populations are more susceptible to the COVID-19 virus. There is little information on whether COVID-19 affects women of reproductive age and their fertility, pregnancy status, and offspring give: We aimed to assess the knowledge, practices, and perceptions (KPP) on the risk and susceptibility to COVID-19 of women of reproductive age. Methods. We conducted a qualitative exploratory descriptive study using the triangulation method. The study consisted of in-depth interviews (IDIs) with women of reproductive age and their spouses, focus group discussions (FGDs), and key informant interviews (KIIs) with health care professionals (HCP) in University of the Philippines-Philippine General Hospital. We assessed KPP using structured, open-ended interview guides. Interview responses were recorded and transcribed verbatim, and thematic analysis was performed using NVivo 12. Results. Eighty participants, 20 women of reproductive age, 20 spouses, 20 non-pregnant women, and 20 HCPs in UP-PGH were included in the study. All participants were knowledgeable about COVID-19. Pregnant women would consult their physicians when they felt symptoms related to COVID-19. Spouses of pregnant women and non-pregnant women observed health measures to prevent the spread of the virus. Both pregnant and non-pregnant patients with COVID-19 felt shamed and stigmatized while the husbands worried that the exposure to the infection will pose a burden to their families. HCWs provided services through teleconsultation and found it challenging to refer patients to other facilities. Conclusion. The study provided insights on KPP of women with reproductive-age to COVID-19 and views of HCWs in providing care to these patients during the pandemic. The effects of COVID-19 are still detrimental and highly evident from the micro to the macro level. © 2022 University of the Philippines Manila. All rights reserved.

Prostheses used in hip, knee, ankle, elbow and shoulder replacement procedures 2020

This document reports the numbers of prostheses recorded and reported to the NJR between 1 January and 31 December 2020. The tables show volumes of components as they have been entered into the registry, regardless of construct. The procedure counts in this document are presented without adjustment and may vary from counts found in the corresponding main NJR Annual Report analysis. If a procedure has been submitted with missing implant information this will also cause numbers to differ. Procedure counts below four have been suppressed. Components are listed and described according to the current classifications used in the registry. It must be noted that due to COVID-19, the ratio of revision to primary procedures increased in 2020 and this may affect the relative changes in the types and brands of implants used in comparison to previous years. As this document was not published for 2019 Annual Report data, comparison has been made with the 2018 Annual Report data.

Telehealth: A new paradigm? Paediatric surgical subspecialty telemedicine survey in the COVID-19 Pandemic at a tertiary care centre

Background:Although the technology has been available and several pilot studies have shown success, use of telemedicine has previously been limited in the United States, especially among surgeons. This study aimed to investigate the benefits and obstacles for successful implementation of telemedicine visits in paediatric surgical subspecialties amid the COVID-19 pandemic.Methods:We analysed survey data from telemedicine visits with paediatric surgical subspecialists from May 1 through June 30, 2020 at our paediatric surgery subspecialty clinics. Univariate logistic regression was used to determine associations in survey responses and various demographic factors.Results:There were 164 respondents to the survey. The most frequently cited barrier to care was ability to get time off work (46.3%). Overall satisfaction with the telemedicine visit was 93.8%, and 55.6% responded that they would choose video telemedicine rather than an in-person or telephone visit. Those living at least 25 miles from the hospital had increased odds of indicating interest in using telemedicine for future visits (OR = 2.56, 95% CI = 1.12?5.86, p = 0.026). The average respondent saved between 30 minutes and 1 hour, and 45 minutes using telemedicine.Conclusions:The implementation of telemedicine at our institution in the paediatric surgical subspecialties has proven to be effective and well-received. Given the benefits of time and money saved for families, paired with high satisfaction rates and continued interest, paediatric surgical subspecialists should work to incorporate virtual visits into regular patient care, even well after the COVID-19 pandemic.Level of Evidence:Level IV

1,5-Anhydroglucitol Is an Independent Predictor of Mortality in Patients with COVID-19

Objective: To assess the relationship between serum 1,5-anhydroglucitol (1,5-AG), a marker of glycemic variability, and mortality in COVID-19 patients. Method: Data from 64 hospitalized COVID-19 patients were collected between June 2020-February 2021 at Sinai Hospital (Baltimore, MD), including 9 patients who died in the hospital. Medical history, demographic variables, and biochemical measurements were taken at time of admission. Baseline means for fasting blood glucose and 1,5-AG were 143.5 mg/dL (SD 68.9) and 14.7 ug/mL (SD 8.8), respectively. HbA1c available in 40 patients-mean value 6.9% (SD 2.3). Result: Multivariate logistic regression analysis showed that only 1,5-AG (n=64) was an independent predictor of mortality (AUC = 0.69, p value 0.017). Fasting glucose (n=64) and HbA1c (n=40) were not statsically significant with AUCs of 0.60 (p value 0.322) and 0.58 (p value 0.464), respectively. In an analysis of clinical variables, a combination of BMI and Age was predictive of mortality (AUC = 0.77, p value 0.004). Interestingly, when 1,5-AG was added to BMI and Age, the AUC increased to 0.94 (p value <0.0001). When fasting glucose was added to BMI and Age the AUC was 0.79 (p value 0.001). A cox regression analysis showed an OR (1,5-AG < 10 ug/mL) for mortality of 0.44 (95% CI 0.11, 1.85). Conclusion: 1,5-AG was an independent predictor of COVID-19 mortality. Fasting glucose and HbA1c showed no statistical significance to outcomes. The HbA1c findings confirm the results from other COVID-19 studies, but the finding that 1,5-AG outperformed fasting glucose in predicting mortality is new. 1,5-AG may provide important and unique information in the COVID-19 clinical setting. An algorithm of BMI, Age, and 1,5-AG may also be clinically useful.

Impact of the COVID-19 Pandemic on Bedside Medical Education: A Mixed-Methods Study

Background. The COVID-19 pandemic obligated academic medical programs to substantially alter the traditional Internal Medicine (IM) rounding model to decrease risk of inpatient nosocomial viral transmission. Our study aimed to describe how IM rounding practices changed during the COVID-19 pandemic and to understand the impacts of these changes on medical education. Methods. We conducted a two-phase, mixed-methods study of inpatient IM rounding team practices at a large academic hospital in Houston, TX. In the first phase (January-February 2021), we organized and audio-recorded 4 virtual (Zoom) focus groups. Each included 5-6 rounding team members, divided by: attendings;senior residents;interns;and medical and physician assistant students. In the second phase (March-May 2021), we performed 6 direct observations of IM teams during rounds. Two observers systematically recorded variables such as time spent on non-bedside versus bedside rounds, number of each team member type entering patient rooms for bedside teaching, and types of personal protective equipment (PPE) worn. Results. Topics discussed during focus groups included comparisons of rounding team size, rounding duration, physical distancing and PPE use, bedside education, communication methods, and patient safety before and after March 2020. Perceptions of changes in each topic were generally consistent across groups (Table 1). Direct observation data showed that team rounding styles remained diverse in the proportion of rounding time spent in an office versus on the wards, and in the number and types of team members entering patient rooms. IM team members uniformly wore respiratory PPE when entering all patient rooms;use of eye protection varied. Teams spent more total time discussing patients with or suspected to have COVID-19 compared to patients without COVID-19 (median 24 min versus 13 min, p< 0.0001). Conclusion. Our results suggest that the COVID-19 pandemic adversely impacted bedside medical education, even into Spring of 2021. Conclusions from this study can be used to 1) address educational gaps related to COVID-19 pandemic-associated rounding changes and 2) create innovative methods of providing high-quality clinical education that will be minimally impacted by future respiratory virus pandemics.

1,5-anhydroglucitol is a novel and independent predictor of mortality in patients with covid-19

Background: Fasting hyperglycemia and diabetes are the independent predictors of morbidity and mortality in patients with COVID-19. Glycemic fluctuations may be independently associated with poor prognosis in adult patients hospitalized for COVID-19. Hypothesis: We hypothesize that 1,5-anhydroglucitol (1,5-AG), a marker of glycemic variability, is strongly associated with in-hospital mortality in patients with COVID-19. Methods: Medical history, demographic variables, and laboratory measurements were collected within 48 hours of hospitalization in COVID-19 patients (n=64), including 9 patients who died in the hospital. Serum 1,5AG was measured by an enzymatic colorimetric assay (GlycoMark, Precision Diabetes, Inc. Raleigh, NC). Multivariate regression analysis was performed to assess the relation between fasting glucose, hemoglobin (Hb)A1c and 1,5-AG and mortality. Results: Baseline mean ± SD for fasting blood glucose,1,5-AG and HbA1c (available in 40 patients) were 143 ± 69 mg/dL and 14.7 ± 8.8 ug/mL and 6.9±2.3%, respectively. Only 1,5-AG was an independent predictor of mortality (n=64, AUC = 0.69, p=0.017), but not fasting glucose (n=64, AUC =0.60, p=0.32) or HbA1c (n=40, AUC=0.58, p =0.46), respectively. With respect to clinical variables, a combination of BMI and Age was predictive of mortality (AUC = 0.77, p=0.004). Interestingly, when 1,5-AG was added to BMI and Age, the AUC increased to 0.94 (p <0.0001). When fasting glucose was added to BMI and Age the AUC was 0.79 (p =0.001). A cox regression analysis demonstrated that 1,5-AG < 10 ug/mL was associated with an odds ratio of 0.44 (95% CI =0.11-1.85) for mortality. Conclusions: This analysis demonstrated that 1,5-AG is a novel and independent predictor of COVID-19 mortality. 1,5-AG may provide important and unique information in the COVID-19 clinical setting. An algorithm of BMI, Age, and 1,5-AG can be used clinically to predict mortality. These findings warrant further investigation in larger studies specific for diabetic and non-diabetic populations.

Equity in designing a summer international research experience: Recruitment and partnerships for a graduate field school in El Salvador

An inclusive international research experience for graduate students is being developed based on equitable, interdisciplinary opportunities in field research and training and proactive efforts in recruiting a diverse cohort. Michigan Technological University, the Consortium of Universities for the Advancement of Hydrologic Science, Inc., and Lutheran World Relief are collaborating to support local development interventions for agricultural and water-access challenges in the "Dry Corridor" of El Salvador. The three-year effort is supported by the National Science Foundation International Research Experiences for Students program. This project, titled "Agricultural Community Adaptations to Extreme Hydrometeorological Events," recruited students for the summer 2020 experience before the COVID-19 interruption. Lessons from this past year pertaining to student recruitment, application selection, and preparatory training will enhance the processes for the coming year. Students were recruited through professional meetings, listservs, social media, and professional contacts. Proactive efforts were implemented to broaden student diversity. The selection process was systematically structured to evaluate applicant experience abroad, language abilities, and academic program relevance to the project goals. Pre-departure training content was developed to provide students with relevant tools and background for the travel, living, and research methods training in El Salvador. The project teams work with universities and governmental agencies in El Salvador. Agronomists, hydrologists, geologists, social scientists, and engineers are collaborating to explore new ways to couple participatory and hydrological research for informing adaptive strategies to water scarcity in agricultural communities. A planning visit in 2019 sought input from local farmers, representatives from governmental and non-governmental institutions, and project partners to help prioritize project research plans. This pre-planning approach fostered greater integration of the interdisciplinary project activities;planning to enhance local engagement in field work and continuous data collection;and development of insightful recruitment and promotional materials. © ASCE.