People across the world have been greatly affected by the ongoing coronavirus disease (COVID-19) pandemic. The high infection risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in hospitals is particularly problematic for recently delivered mothers and currently pregnant women who require professional antenatal care. Online antenatal care would be a preferable alternative for these women since it can provide pregnancy-related information and remote clinic consultations. In addition, online antenatal care may help to provide relatively economical medical services and diminish health care inequality due to its convenience and cost-effectiveness, especially in developing countries or regions. However, some pregnant women will doubt the reliability of such online information. Therefore, it is important to ensure the quality and safety of online services and establish a stable, mutual trust between the pregnant women, the obstetric care providers and the technology vis-a-vis the online programs. Here, we report how the COVID-19 pandemic brings not only opportunities for the development and popularization of online antenatal care programs but also challenges.

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Caffeine consumption among US teenagers (13-17y), young adults (18-24y) and adults (25-29y) for a 10 year period was examined using NHANES 2003-12. Of the 85% who consume caffeine 84% consume caffeinated beverages. This percentage remained constant despite new caffeine sources. Less than 7.1% of the population consume energy drinks. While mean caffeine intake among teenage caffeine consumers decreased from 62 to 55 mg/day (p-value = 0.018) over the 10-year period, no discernable trend was observed for other age groups. Caffeine intake from energy drinks increased, and was only statistically significant for age 18-24y accounting for <9% of total caffeine intake. Mean caffeine intake per consumption occasion was equivalent between coffee and energy drinks for teenagers and young adults. During a 30-min period mean caffeine consumption was similar when an energy drink was the only consumption event or when it occurred with other caffeinated beverage products suggestive of a substitution effect. Linear regression models of caffeine intake from energy drinks against caffeine from coffee, tea and soda among energy drink consumers in the upper 50th percentile shows a statistically significant inverse relationship (R2 = 28%, coffee: β = -0.35, p < 0.001; tea: β = -0.44, p < 0.001; soda: β = -0.22, p = 0.036) and further supports the substitution concept.

Frequent utilization of emergency department (ED) services contributes substantially to the cost of healthcare nationally and is often driven by psychiatric factors. Using national-level data from the Veterans Health Administration (VHA), the present study examined patient-level factors associated with ED use among veteran psychiatric patients. Veterans who had at least one ED visit with a psychiatric diagnosis in fiscal years 2011-2012 (n = 226,122) were identified in VHA administrative records. Andersen's behavioral model of healthcare utilization was used to identify need, enabling, and predisposing factors associated with frequency of ED use (primary outcome) in multivariate regression models. Greater ED use was primarily linked with need (psychotic, anxiety, personality, substance use, and bipolar disorders) and enabling (detoxification-related service utilization and homelessness) factors. Chronic medical conditions, receipt of an opioid prescription, and predisposing factors (e.g., younger age) were also linked to greater ED use; however, the effect sizes for these factors were markedly lower than those of most psychiatric and psychosocial factors. The findings suggest that intensive case management programs aimed reducing frequent ED use among psychiatric patients may require greater emphasis on homelessness and other psychosocial deficits that are common among these patients, and future research should explore cost-effective approaches to implementing these programs.

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