Sociodemographic Disparities in Ambulatory Pediatric Telemedicine Utilization During COVID-19.

Objective: Few studies have examined sociodemographic disparities in ambulatory pediatric telemedicine utilization during the coronavirus disease 2019 pandemic. We aimed to (1) assess disparities in telemedicine visit completion during the first 6 weeks of the pandemic in 2020 and (2) determine if these disparities were significantly different from those present in 2019, when all visits occurred in person. Methods: We compared sociodemographic characteristics of patients with successful versus unsuccessful telemedicine visits from March 10, 2020 to April 18, 2020, using generalized linear mixed models. We performed the same analysis for in-person visits from the same period in 2019. We tested for differences across years using interaction terms in a combined 2019-2020 model. Results: Of 3,639 telemedicine visits scheduled, 3,033 (83.3%) were successful. In 2020, Black/African American race was significantly associated with lower odds of telemedicine visit success (odds ratio 0.65 [95% confidence interval 0.49-0.87]) compared with White race, after adjusting for age, gender, ethnicity, insurance type, visit timing, visit specialty, social vulnerability index, and internet access. In 2019, racial identity other than White was significantly associated with lower odds of in-person visit success than White, as was public insurance compared with private. In the full 2019-2020 model, in-person visits (2019) had lower odds of success than telemedicine visits (2020), and neither race, insurance type, nor any other sociodemographic characteristic had significant interactions with year. Conclusions: Racial disparities were evident in telemedicine utilization early in the pandemic; however, these disparities were not significantly different from those seen in 2019, when all visits were in person. Furthermore, telemedicine may improve access to care overall, despite having no significant impact on inequity. Efforts to eliminate racial disparities in ambulatory pediatric health care utilization are necessary across visit modalities.

Reducing Oil Separation in Ready-to-Use Therapeutic Food.

Ready-to-use therapeutic food (RUTF) is a shelf-stable, low moisture, energy dense medicinal food composed of peanut butter, vegetable oils, milk powder, a multiple micronutrient premix and sugar. RUTF is used by millions of children annually to treat malnutrition. After mixing, RUTF is a semisolid covered with oil. To produce a homogenous RUTF, hydrogenated vegetable oils are incorporated in small quantities. This study utilized a benchtop methodology to test the effect of RUTF ingredients on oil separation. An acceptable oil separation was <4%. This method compared 15 different vegetable oil stabilizers with respect to oil separation. The dynamic progression of oil separation followed a Michaelis-Menten pattern, reaching a maximum after 60 days when stored at 30 °C. Hydrogenated vegetable oils with triglyceride or 50% monoglycerides reduced the oil separation to acceptable levels. The additive showing the largest reduction in oil separation was used in an industrial trial, where it also performed acceptably. In conclusion, fully hydrogenated soybean and rapeseed oil added as 1.5% controlled oil separation in RUTF.