ABSTRACT
Objectives The COVID-19 pandemic created nutritional stressors in indigent patients, especially those with diets prescribed for chronic disease. We studied use of SNAP benefits and how food purchasing behavior was affected in a cohort of inner-city dialysis patients during the past year. Methods 33 dialysis patients were surveyed face to face about use of grocery stores, restaurants, take-out, and use of SNAP or other benefits over 12 months prior to the summer of 2021. The survey also assessed patient attitudes and fears relating to food purchasing due to COVID-19. Results Mean age was 57.1 ± 17.9 yrs, 20 (61%) men, 91% identified as Black. 9/20 pts (27%) reported yearly income under $20,000 with 70% less than $40,000. The number of pts using SNAP, WIC, or Greenmarket Bucks to buy groceries increased from 21% before the pandemic to 33% after (p = 0.019). Age correlated inversely with feeling safe eating at a restaurant indoors (r = −0.47, p = 0.008), or outdoors (r = −0.58, p = < 0.001) and increased use of take-out since the start of the pandemic (r = −0.39, p = 0.032). There was a significant difference in pts who purchased breakfast (45.9 ± 4.0 vs 65.3 ± 3.6, p < .001), lunch (49.7 ± 4.1 vs 65.3 ± 4.0, p = .006) and dinner compared to those who didn't (48.5 ± 4.9 vs 60.9 ± 3.9, p = 0.031). There was a positive correlation between income and the frequency that pts purchased breakfast (r = 0.45, p = 0.048) and lunch (r = 0.45, p = 0.046) and a negative correlation between age and the statement “I wish I could cook more meals at home” (r = −0.497, p = 0.004) and a positive correlation with income (r = 0.60, p = 0.006). There was no association between age and income. Only 6% (2) pts were employed and both were <60 yrs old. Conclusions Use of food assistance programs increased in our dialysis population after the start of the pandemic. Older pts felt less safe eating at restaurants regardless of whether it was indoors or outdoors and more likely to make meals at home. Younger patients were more likely to eat take-out food and reported they wished they could cook more meals at home. Increased use of food programs suggests that more patients may be at risk for food scarcity. In addition to increased use of take out food by younger or lower income patients, this suggests that dietary habits have changed since the pandemic and nutritional counseling for dietary restrictions will be even more important. Funding Sources Unfunded.
ABSTRACT
Increased digitisation of day-to-day activities was occurring prior to the COVID-19 pandemic. The pandemic only accelerated the virtual shift, making web accessibility an urgent issue, especially for marginalised populations. Despite decades of work to develop, refine, and implement web accessibility standards, people with cognitive disabilities regularly experience many barriers to web accessibility. To inform ongoing work to improve web accessibility for people with cognitive disabilities, a systematic review was conducted. The main question guiding this review is: what are the state-of-the-art of interventions that support web accessibility for citizens, 9 years of age and up, living with cognitive impairment? A set of 50 search strings were entered into three academic databases: SCOPUS, ProQuest, and Web of Science. Systematic screening procedures narrowed the search returns to a total of 45 included papers. A data analysis revealed themes associated with the lived experiences of people with cognitive disabilities, tools for improving web accessibility, and methodological best practices for involving people with cognitive disabilities in research. These findings have immediate implications for ongoing research and the development of meaningful solutions to the problem of web accessibility for people with cognitive disabilities.