Prenatal Telemedicine During COVID-19: Patterns of Use and Barriers to Access

Lay Summary To protect pregnant patients from infection during the COVID pandemic, maternity care providers turned to video and phone visits (“telemedicine”) to provide as much prenatal care as possible. To evaluate this change in our prenatal care program, we surveyed 164 pregnant people who had participated in a virtual prenatal visit about their care. Participants reported both positive and negative experiences, ranging from appreciation for having a safer option than in-person visits during the pandemic, to problems due to poor internet connection, lack of privacy, and lack of access to necessary equipment. Although 77.4% of respondents indicated they would recommend telemedicine to a friend, our program evaluation highlights the fact that the ability to participate in virtual care is not equally distributed. Unless steps are taken to address this problem, relying on telemedicine for a significant portion of prenatal care could result in widening disparities in prenatal care and outcomes. Policymakers and healthcare systems which provide telemedicine must address issues of access to technology and connectivity to avoid adding to maternal health disparities. Objective To evaluate patient experience with a prenatal telemedicine visit and identify barriers to accessing telemedicine among rural pregnant people in northern New England during the beginning of the COVID-19 pandemic. Materials and Methods We conducted a post-visit electronic survey of pregnant people who successfully participated in a prenatal telemedicine visit at a rural academic medical center in Northern New England. Nineteen questions were included in five domains; 1) engagement with prenatal care; 2) barriers to telemedicine and in person healthcare; 3) experience of prenatal care; 4) remote pregnancy surveillance tools; 5) sources of COVID-19 information. Results Responses were obtained from 164 pregnant people. Forty percent of participants had participated in an audio-only telemedicine visit, and 60% in a video telemedicine visit. The visit was easy or somewhat easy for 79% of respondents and somewhat difficult or difficult for 6.8%. The most common barrier to accessing telemedicine was poor internet or phone connectivity, followed by childcare responsibilities, lack of equipment and lack of privacy. Participants also engaged in additional remote prenatal care including phone calls with registered nurses (7.6%), communication with the obstetrics team through a secure health messaging portal (21.1%) and home health monitoring (76.3%). Discussion and Conclusions In this survey evaluating the experience of pregnant people participating in a prenatal telemedicine visit during the COVID-19 pandemic, respondents had a positive experience with telemedicine overall, but also identified significant barriers to participation including issues with connectivity and lack of equipment for the visit. Most participants used telemedicine in combination with other tools for remote self-care.

Use of Cervid Serosurveys to Monitor Eastern Equine Encephalitis Virus Activity in Northern New England, United States, 2009–2017

Vertebrate surveillance for eastern equine encephalitis virus (EEEV) activity usually focuses on three types of vertebrates: horses, passerine birds, and sentinel chicken flocks. However, there is a variety of wild vertebrates that are exposed to EEEV infections and can be used to track EEEV activity. In 2009, we initiated a pilot study in northern New England, United States, to evaluate the effectiveness of using wild cervids (free-ranging white-tailed deer and moose) as spatial sentinels for EEEV activity. In Maine, New Hampshire, and Vermont during 2009–2017, we collected blood samples from hunter-harvested cervids at tagging stations and obtained harvest location information from hunters. U.S. Centers for Disease Control and Prevention processed the samples for EEEV antibodies using plaque reduction neutralization tests (PRNTs). We detected EEEV antibodies in 6 to 17% of cervid samples in the different states and mapped cervid EEEV seropositivity in northern New England. EEEV antibody-positive cervids were the first detections of EEEV activity in the state of Vermont, in northern Maine, and northern New Hampshire. Our key result was the detection of the antibodies in areas far outside the extent of documented wild bird, mosquito, human case, or veterinary case reports of EEEV activity in Maine, New Hampshire, and Vermont. These findings showed that cervid (deer and moose) serosurveys can be used to characterize the geographic extent of EEEV activity, especially in areas with low EEEV activity or with little or no EEEV surveillance. Cervid EEEV serosurveys can be a useful tool for mapping EEEV activity in areas of North America in addition to northern New England.

A Life in History: Making the Team

This article traces the author’s path from early life in the United Kingdom to graduate school in Newfoundland and New Brunswick and then to a series of faculty positions – ultimately, at Saint Mary’s University. Early work in the seventeenth-century history of northern New England gave way to a more broadly comparative approach to this era and, eventually, to an effort to coordinate imperial, colonial, and Indigenous history in northeastern North America. A variety of career uncertainties and evolutions also led to involvement in the history of higher education, the history of Atlantic Canada, and the history of sport. Through it all, collaborative work developed as a recurrent approach, with Atlantic Canada themes frequently underpinning responses to a variety of historiographies.

Personalizing Moral Reframing in Interpersonal Conversation: A Field Experiment

Organizations in the contemporary United States face substantial challenges with persuading citizens and moving them to take action. Prior research finds that citizens’ views can be changed and strengthened using frames consistent with their moral values. However, it can be difficult for organizations to tailor their appeals to individuals’ moral values given the difficulty in predicting which moral values matter to which citizens. We present a pre-registered field experiment in which canvassers for Planned Parenthood of Northern New England (n = 52) sought to overcome this challenge by listening for individual voters’ (n = 1, 034) moral values and then tailoring their appeals to those moral values. In contrast to an earlier study finding no impact of long-form canvassing on abortion attitudes, we find these conversations had large effects on interest in taking action and some evidence of changes in policy attitudes. This experiment provides a template for practitioners and researchers to build on.

Tracking Recent DDT Contamination in a Northern New England Watershed

Ecological research since 2005 into potential causes of declines in loon population at Squam Lake, New Hampshire, U.S.A., revealed multiple potential causes, but no particular source of contaminants. In 2017, tributary sediment analyses revealed specific sub-watersheds transporting contaminants to the lake (Vogel, 2019). For this study, from 2018 to 2020, we used an approach to this problem that allowed for rapid source area determination of DDT using soil and sediment analyses. We find modern presence of p,p’ isomers of DDT and DDE within the Bennett Brook sub-watershed, arising from 60-year-old orchard applications and a former barn. Highest concentrations, 723 μg/kg p,p’ DDT and 721 μg/kg p,p’ DDE, occur near the barn’s foundation rubble. DDT exceeds that of the daughter product, DDE, in some of the sub-watershed’s soils, including but not limited to the barn site. In the soils where DDT>DDE, we infer delayed breakdown of DDT. DDT<DDE occurs in the streambed and lake deposits, as well as some soils. A Pb-210 dated sediment core, collected near the outlet of Bennet Brook, shows continuous accumulation of the daughter products, DDE and DDD, from 1951 to the present. Residuals are derived from multiple sources within the sub-watershed, including orchard soils, the barn site, and sediment accumulations in the stream. These DDT residues fall below mandatory soil remediation levels for the State of New Hampshire, but exceed some sediment quality guidelines for protection of aquatic life. Bioaccumulation of p,p’ DDE is evident in crayfish that reside in Bennett Brook.

Climate change in the context of whole-farming systems: opportunities for improved outreach

Climate change poses a challenge to farming systems worldwide. However, existing research suggests that farmers and those providing outreach may have different climate change perspectives, and there is little understanding of how farmers prioritize climate change compared with other aspects of their farming system. To compare how farmers and outreach professionals in northern New England consider climate change within the context of whole-farming systems, we conducted mental modeling interviews with 33 farmers and 16 outreach professionals. Despite being primed to consider climate during the interviews, only 24% of farmers and 25% of outreach professionals included climate in their mental models. Key differences arose in both group’s perceptions of weather: outreach professionals focused on connections between good weather and biophysical factors, while farmers drew additional connections to factors like quality of life and overall farm success. Social factors including community well-being, public education, and farm success were significantly more likely to be included (P < 0.05), and in some cases were more influential, in farmer models compared to outreach professional models. We conclude that farmer participants did not perceive climate to be a central factor of their farming systems, and valued human and social dimensions more highly than outreach professionals perceived. These factors may warrant special consideration in efforts to make outreach meaningful to local contexts, along with framing climate change within its broader relationship to other farming system aspects. Interdisciplinary teams may be helpful in developing outreach approaches that fully contextualize climate change within farmers’ complex whole-farm management perspectives.