Nourishing Humanity without Destroying the Planet

As part of the roundtable, “Ethics and the Future of the Global Food System,” this essay discusses some of the major challenges we will face in feeding the world in 2050. A first challenge is nutritional: 690 million people (9 percent of the world's population) are currently undernourished, while 2.1 billion adults (28 percent of the population) are overweight or obese. The current global food system is insufficient in ensuring that the nutritious foods that make up healthy diets are available and accessible for the world's population. Moreover, by 2050, as the global population increases, food demand will increase by 50–60 percent. A fundamental challenge is meeting this demand while not wreaking irreversible havoc on natural resources, the environment, and planetary systems. A body of scientific research has coalesced around the need to reduce food loss and waste, adopt environmentally sustainable production practices, and shift toward plant-dominant diets. Other long-standing food system problems include deficits in providing fair wages and decent working conditions for food system workers, threats to smallholder farmer livelihoods, and tens of billions of animals kept in welfare-deficit confinement conditions. These food system challenges are bad states of affairs that matter from a variety of moral perspectives. In other words, there is a robust moral case for addressing these challenges. Yet concerted policy action in this area is insufficient and largely absent, pointing to the underlying challenge and complexity of political inertia

Different but the Same: Common Themes in Illness Experience Among People With Diverse Long COVID Symptoms and the Potential Benefits of Virtual Group Medical Visits

Long coronavirus disease 2019 (COVID-19) is poorly understood, widespread and debilitating. Integrative medical group visits (IMGVs) provide group medical care virtually or in person and are reimbursed by insurance payors. IMGV introduces integrative modalities such as mindfulness, nutrition, and acupressure in a person-centered, supportive, and educational environment. To evaluate a telehealth IMGV program called Nourish to Flourish (N2F) for patients with long COVID, three researchers conducted a qualitative analysis of pre- and post-group individual interviews. Twenty-five patients provided interviews, of which fifteen included pre- and post-group individual interviews. Main themes were unpredictable symptom patterns, a common range of emotions associated with long COVID experience, reconceptualizing self-identity, multiple barriers to care in conventional settings, and connections formed in N2F. Although symptoms varied, N2F participants found commonalities in their experiences of living with long COVID. They empathized with one another regarding changing symptoms, inconsistent social support, shifting identities, and barriers to effective medical care

Cultural Transformation in Healthcare: How Well Does the Veterans Health Administration Vision for Whole Person Care Fit the Needs of Patients at an Academic Rehabilitation Center?

Background The Veterans Health Administration is undergoing a cultural transformation toward person-driven care referred to as the Whole Health System of Care. Objective This pilot study evaluated whether the Whole Health model resonates with patients of a large public university rehabilitation clinic. Methods Thirty participants completed the Veterans Health Administration's Personal Health Inventory (PHI), and six attended the course "Taking Charge of My Life and Health." Researchers analyzed PHI responses and post-course focus group transcripts. A short post-PHI survey and post-course evaluation were collected. Results Participants agreed the PHI is a simple, useful tool. The course, while well attended, did not meet participants' expectations. Participants wanted access to integrative therapies and opportunities to contribute to healthcare transformation. Conclusion Rehabilitation patients resonated with the Whole Health vision. They expressed enthusiasm for the cultural transformation represented by the model along with frustration that standard healthcare experiences fall short of this vision

Integrative medical group visits for patients with chronic pain: results of a pilot single-site hybrid implementation-effectiveness feasibility study

Background Approximately 20% of adults in the United States experience chronic pain. Integrative Medical Group Visit (IMGV) offers an innovative approach to chronic pain management through training in mindfulness, nutrition, and other mind-body techniques combined with peer support. To date, there are no studies on IMGV implementation, despite its promise as a feasible non-pharmacological intervention for chronic pain management. In this study, we assessed the feasibility of implementing IMGV and assessing its effectiveness for chronic pain. Methods Implementation Mapping was used to develop and evaluate implementation strategies for IMGV. Strategies included disseminating educational materials, conducting ongoing training, and conducting educational meetings. IMGV was delivered by three healthcare providers: an allopathic physician, registered yoga teacher, and naturopathic physician. The effectiveness of IMGV on patient health outcomes was assessed through qualitative interviews and a Patient-Reported Outcomes Scale (PROMIS-29). Provider perspectives of acceptability, appropriateness, and feasibility were assessed through periodic reflections (group interviews reflecting on the process of implementation) and field notes. Paired t-tests were used to assess changes between scores at baseline and post intervention. Qualitative data were coded by three experienced qualitative researchers using thematic content analysis.ResultsOf the initial 16 patients enrolled in research, 12 completed at least two sessions of the IMGV. Other than fatigue, there was no statistically significant difference between the pre- and post-scores. Patients reported high satisfaction with IMGV, noting the development of new skills for self-care and the supportive community of peers. Themes from patient interviews and periodic reflections included the feasibility of virtual delivery, patient perspectives on acceptability, provider perspectives of feasibility and acceptability, ease of recruitment, complexity of referral and scheduling process, balancing medical check-in with group engagement, and nursing staff availability. Conclusions IMGV was feasible, acceptable, and effective from the perspectives of patients and providers. Although statistically significant differences were not observed for most PROMIS measures, qualitative results suggested that participants experienced increased social support and increased pain coping skills. Providers found implementation strategies effective, except for engaging nurses, due to staff being overwhelmed from the pandemic. Lessons learned from this pilot study can inform future research on implementation of IMGV

How animal agriculture stakeholders define, perceive, and are impacted by antimicrobial resistance: challenging the Wellcome Trust’s Reframing Resistance principles

Humans, animals, and the environment face a universal crisis: antimicrobial resistance (AR). Addressing AR and its multidisciplinary causes across many sectors including in human and veterinary medicine remains underdeveloped. One barrier to AR efforts is an inconsistent process to incorporate the plenitude of stakeholders about what AR is and how to stifle its development and spread—especially stakeholders from the animal agriculture sector, one of the largest purchasers of antimicrobial drugs. In 2019, The Wellcome Trust released Reframing Resistance: How to communicate about antimicrobial resistance effectively (Reframing Resistance), which proposed the need to establish a consistent and harmonized messaging effort that describes the AR crisis and its global implications for health and wellbeing across all stakeholders. Yet, Reframing Resistance does not specifically engage the animal agriculture community. This study investigates the gap between two principles recommended by Reframing Resistance and animal agriculture stakeholders. For this analysis, the research group conducted 31 semi-structured interviews with a diverse group of United States animal agriculture stakeholders. Participants reported attitudes, beliefs, and practices about a variety of issues, including how they defined AR and what entities the AR crisis impacts most. Exploration of Reframing Resistance’s Principle 2, “explain the fundamentals succinctly” and Principle 3, “emphasis that this is universal issue; it can affect anyone, including you” reveals disagreement in both the fundamentals of AR and consensus of “who” the AR crisis impacts. Principle 2 may do better to acknowledge that animal agriculture stakeholders espouse a complex array of perspectives that cannot be summed up in a single perspective or principle. As a primary tool to combat AR, behavior change must be accomplished first through outreach to stakeholder groups and understanding their perspectives

Concert recording 2017-05-04b

[Track 1]. Fanfare for the common man / Aaron Copland -- [Track 2]. Bach Buch / J.S. Bach translated by Pann -- [Track 3]. Highway musings / Ryan Key -- [Track 4]. Serenade in D minor / Antonín Dvorák

IMGV for Long COVID

Pilot data supports virtual Integrative Medical Group Visits for people with Long COVID Abstract Background Long COVID is a common, debilitating post-infectious illness following mild to severe COVID infections. Effective management of Long COVID is currently unknown. Shared Medical Appointments or Integrative Medical Group Visits (IMGV) are effective interventions for chronic conditions. Virtual IMGVs may improve management of Long COVID. Objective This single arm non-randomized study assessed the feasibility of patient-reported outcome measures to study a virtual IMGV for Long COVID. Data from IMGV for Long COVID participants will guide program development and contribute to the evidence base for management of Long COVID. Methods Surveys administered before and after the group intervention measured anxiety, perceived stress, fatigue, sleep quality, and patient-specific symptomatology among patients from a tertiary care COVID recovery clinic. Paired t-tests quantified change in self-reported measures. Results Fourteen patients with Long COVID completed the intervention and pre and post measures (78.6% female, 71.4% non-Hispanic White, mean age 48.9 years). Chief symptomatology was fatigue, shortness of breath and “brain fog.” Symptoms decreased in interference when compared to pre-intervention levels (mean difference -1.3 [95% CI-2.2, -0.5]). There was no change in self-reported unrefreshing sleep or overall wellness. Perceived stress scores decreased after the intervention compared to baseline (mean difference -3.4 [95% CI -5.8, -1.1]). Conclusion Patient-reported outcome measures of perceived stress and symptom interference improved post-intervention. Few effective interventions are currently available for this large and growing population facing debilitating symptoms. Larger studies are needed to explore the potential of Integrative Medical Group Visits to improve quality of life among people with Long COVID

Cultural Transformation in Healthcare: How well does the Veterans Administration vision for whole person care fit the needs of patients at an academic rehabilitation center?

Introduction/Rationale: The Veterans Administration (VA) has developed an innovative integrative health model called “Whole Health for Life”. The cornerstone of the model is the Personal Health Inventory (PHI), which introduces patients to a holistic framework of health and wellness while encouraging them to identify personal health goals. The goal of this study is to understand whether the VA’s model is a good fit for patients at the Center for Rehabilitation Care (CRC). Participant feedback will inform the development of integrative health services at the CRC. Methods: This mixed methods study recruited thirty participants to complete and evaluate the VA’s Personal Health Inventory (PHI). Thirty adults were recruited from an academic outpatient rehabilitation clinic. The heterogeneous patient population included patients seeking treatment for a variety of concerns, including obesity, chronic pain, and discrete injuries. Six participants completed the course “Taking Charge of My Life and Health”. Outcomes measured included personal responses to PHI, survey responses measuring clarity and feasibility of the PHI and participant feedback based on focus group data at the conclusion of the course. Results: Participants found the Personal Health Inventory easy to understand and they think it has potential to improve their health. The course, “Taking Charge of My Life and Health”, was well attended, but participants' expectations were not met. They expressed both enthusiasm with the model and frustration that standard health care experiences fall short of this vision. Conclusion: Participants valued the opportunity to express their opinions and their aspirations for health care transformation. While the course, Taking Charge of My Life and Health did not meet their expectations, they welcome the opportunity to engage further with whole person care. Master of Public Healt

Understanding the Baby-Friendly Hospital Initiative: A Multidisciplinary Analysis

In the United States, roughly 1 out of 4 births takes place at a hospital certified as Baby-Friendly. This paper offers a multi-disciplinary perspective on the Baby-Friendly Hospital Initiative (BFHI), including empirical, normative, and historical perspectives. Our analysis is novel in that we trace how medical practices of “quality improvement,” which initially appear to have little to do with breastfeeding, may have shaped the BFHI. Ultimately, we demonstrate that a rich understanding of the BFHI can be obtained by tracing how norms of gender/motherhood interact with, and are supplemented by, other normative, historical, and institutional realities. We conclude with suggestions for practical revisions to the BFHI

A descriptive exploration of younger and older adults’ experiences of Integrative Medical Group Visits for Long COVID

Introduction: Long COVID disproportionately affects older adults. Individuals with Long COVID (LC) often experience symptoms that severely impact quality of life, and treatment approaches are still evolving. The Integrative Medical Group Visit (IMGV) model is an evidence-based approach that may be useful to treat patients with LC; however, there is limited evidence describing the experience and/or feasibility of using IMGV for LC treatment, especially among the older adult population. The purpose of this study is to describe older and younger adults’ experiences of both having LC and participating in a virtually delivered IMGV for LC. Methods: This is a secondary analysis of qualitative data from a parent study examining the experiences of participants in a virtually delivered IMGV for patients with LC. Patients participated in semi-structured interviews before and after 8 weekly IMGV sessions. Thematic analysis was used to analyze interview data. Results: Overall, 21 pre-interviews and 17 post-interviews were collected. Thematic analysis of patient interviews by age group resulted in three themes that each contained similarities and differences between the younger and older adult participants. These themes included: (1) experiences of LC (2) feelings about the future (3) experiences of the pilot IMGV on LC. Conclusion: This study provides critical context for clinicians who treat older adults with LC. Results support virtually delivered IMGVs as a potentially feasible option for both older and younger adults who want to apply an integrative approach to their LC treatment. Findings from this study will inform future research on IMGV for LC treatment