Direct-to-patient telehealth equity: Reaching diverse pediatric populations in primary care.

INTRODUCTION: Telehealth is the use of electronic information and technology for long-distance clinical care. In direct-to-patient (DTP) telehealth, the patient initiates care from a personal computer or mobile device to a medical provider. While information on standard clinic-to-clinic telehealth exists, less is known about DTP telehealth in pediatric populations. Using quantitative and qualitative data, we examined DTP telehealth for low-income pediatric patient-families and compared the experience of English and non-English speakers. METHOD: Telehealth visits for acute and preventive care took place from April 2020 to May 2020 at a pediatric primary care clinic (80% Medicaid-insured, 40% non-English-speaking). Patients and primary care providers conducted the visit through the clinic's portal or other platforms (WhatsApp, FaceTime, Zoom). Providers completed an electronic survey with patient feedback about the telehealth experience and their own observations. An iterative inductive/deductive approach informed a coding scheme for free-text survey responses consisting of five domains. RESULTS: REDCap surveys were completed for 258 (52%) of telehealth visits. There was an overrepresentation of English visits compared to the overall clinic population and the majority of visits were via mobile phone. Visits with English speakers utilized the patient portal and had positive process ease ratings more often than those with non-English speakers. Providers rated most telehealth visits as satisfactory, with contributing elements including family call environment, technology process and experience, value added, and barriers. DISCUSSION: Expanding telehealth in pediatrics without worsening health disparities requires building digital health that is user-friendly on mobile technology, facilitating patient preferred language, and simplifying logistical processes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Clinical aspects of hypertension in children.

The importance of measuring blood pressure routinely in children over 3 years, and in specific circumstances in younger children, is increasingly recognized. The incidence of pediatric hypertension is relatively high, its prevalence increasing, and high blood pressure tends to track into adulthood. Interpretation of a blood pressure measurement requires knowledge of sex-, age-, and height-specific normative values. Blood pressure is classified as normal if < 90th percentile, and high if > 95th percentile, and as prehypertension if 90-95th percentile. The methods available to measure blood pressure together with their advantages and disadvantages, as well as pitfalls in measurement, are discussed. Also discussed is Ambulatory Blood Pressure Monitoring which may define if there is "dipping", i.e. a decrease in blood pressure by > 10% during sleep, a novel parameter that may help identify children at risk of sustained hypertension or its complications. Signs, symptoms and physical findings of the child with hypertension are reviewed.

Eating and digesting "Lestrygonians": a physiological model of reading.

In this article, I propose that, beneath a deceptively simple story-line, "Lestrygonians" functions like a living entity, one through which Bloom unknowingly traverses. First, there is Joyce's familiar Dublin, on a macroscopic level, and, second, there is the episode's narrative, personified by a gigantic female organism, in whose digestive tract Bloom has been reduced to Lilliputian size. Some critics have noted the importance of the physiological details of digestion here; no one, however, has noted to what extent the structure of the episode is represented by the digestive model. My final claim about the episode's digestive proclivities concerns its effects on the reader. If "Lestrygonians" replicates alimentary functions by propelling both its characters and the reading process along, it also elicits, in the reader, the synesthesia of reading with autonomic sensations.