Healthcare-based interventions to address food insecurity during pregnancy: a systematic review.

OBJECTIVE: This study was a systematic review aimed to assess published literature regarding healthcare-based interventions addressing food insecurity during pregnancy and their effects on patient-reported, pregnancy, or nutritional outcomes. DATA SOURCES: A systematic search was performed in February 2022 (subsequently updated in August 2022) using Embase, Medline, Cochrane Library, and Scopus using terms related to food insecurity interventions during pregnancy. STUDY ELIGIBILITY CRITERIA: Studies examining healthcare-based interventions addressing food insecurity during pregnancy with patient-reported outcomes (eg, program satisfaction), adverse pregnancy outcomes (eg, preterm birth), or nutritional outcomes (eg, dietary intake) were included. Studies using data before 1995, conducted outside the United States, or focused solely on dietary content or the Special Supplemental Nutrition Program for Women, Infants, and Children or Supplemental Nutrition Assistance Program as the intervention of interest were excluded. METHODS: Of note, 3 authors screened the abstracts and full articles for inclusion. The final cohort included 5 studies. Moreover, 3 authors independently extracted data from each article and assessed the study quality using the Grading of Recommendations, Assessment, Development, and Evaluations and the risk of bias using the National Institutes of Health Study Quality Assessment tools. RESULTS: Overall, 5 studies describing the interventions addressing food insecurity during pregnancy were included. Study designs included prospective cohort (n=1) and retrospective cohort (n=4) studies. There was heterogeneity in the type of intervention, with 3 using food vouchers, 1 focusing on a group prenatal service with nutrition and food management education, and 1 using a food connection program. Most studies (4 [80%]) shared patient-reported outcomes (eg, food security levels and program utilization rates), with 2 studies examining pregnancy-related outcomes (ie, glucose level, blood pressure, and preterm birth) and 2 studies examining nutritional outcomes. The interventions were associated with improved levels of food insecurity, reduced odds of preterm birth, and improved blood pressure trends; the findings demonstrated a 56% to 81% program utilization rate. All studies exhibited moderate to low study quality, with fair to good internal validity. CONCLUSION: Although data on healthcare-based interventions targeted at food insecurity during pregnancy are limited, the few studies identified suggest that such interventions may affect pregnancy outcomes. A better understanding of the local scope and context of food insecurity and community-based organizations' efforts not captured by the literature in this area can help inform the development of interventions targeting food access during pregnancy.

Ethical Principles in Personal Protective Equipment Inventory Management Decisions and Partnerships Across State Lines During the COVID-19 Pandemic.

The COVID-19 pandemic created unprecedented strain on the personal protective equipment (PPE) supply chain. Given the dearth of PPE and consequences for transmission, GetMePPE Chicago (GMPC) developed a PPE allocation framework and system, distributing 886 900 units to 274 institutions from March 2020 to July 2021 to address PPE needs. As the pandemic evolved, GMPC made difficult decisions about (1) building reserve inventory (to balance present and future, potentially higher clinical acuity, needs), (2) donating to other states/out-of-state organizations, and (3) receiving donations from other states. In this case study, we detail both GMPC's experience in making these decisions and the ethical frameworks that guided these decisions. We also reflect on lessons learned and suggest which values may have been in conflict (eg, maximizing benefits vs duty to mission, defined in the context of PPE allocation) in each circumstance, which values were prioritized, and when that prioritization would change. Such guidance can promote a values-based approach to key issues concerning distribution of PPE and other scarce medical resources in response to the COVID-19 pandemic and related future pandemics.

Reducing Social Isolation of Seniors during COVID-19 through Medical Student Telephone Contact.

Social isolation has been associated with many adverse health outcomes in older adults. We describe a phone call outreach program in which health care professional student volunteers phoned older adults, living in long-term care facilities and the community, at risk of social isolation during the COVID-19 pandemic. Conversation topics were related to coping, including fears or insecurities, isolation, and sources of support; health; and personal topics such as family and friends, hobbies, and life experiences. Student volunteers felt the calls were impactful both for the students and for the seniors, and call recipients expressed appreciation for receiving the calls and for the physicians who referred them for a call. This phone outreach strategy is easily generalizable and can be adopted by medical schools to leverage students to connect to socially isolated seniors in numerous settings.