Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-14 (of 14 Records) |
Query Trace: Ely E[original query] |
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Delivering the National Diabetes Prevention Program: Assessment of Outcomes in In-Person and Virtual Organizations
Ely EK , Ng BP , Cannon MJ . J Diabetes Res 2023 2023 8894593 The Centers for Disease Control and Prevention's Diabetes Prevention Recognition Program (DPRP) has helped organizations deliver the National Diabetes Prevention Program (National DPP) lifestyle change program for over 10 years. Four delivery modes are now approved: in person, online (self-paced, asynchronous delivery), distance learning (remote, synchronous delivery), and combination (hybrid delivery using more than one delivery mode). We assessed outcomes using data from 333,715 participants who started the 12-month program between January 1, 2012, and December 31, 2018. The average number of sessions attended was highest for in-person participants (15.0), followed by online (12.9), distance learning (12.2), and combination (10.7). The average number of weeks in the program was highest for in-person participants (28.1), followed by distance learning (20.1), online (18.7), and combination (18.6). The average difference between the first and last reported weekly physical activity minutes reflected an increase for in person (42.0), distance learning (27.1), and combination (15.0), but a decrease for online (-19.8). Among participants retained through session 6 or longer, average weekly physical activity minutes exceeded the program goal of 150 for all delivery modes. Average weight loss (percent of body weight) was greater for in person (4.4%) and distance learning (4.7%) than for online (2.6%) or combination (2.9%). Average participant weight loss increased gradually by session for all delivery modes; among participants who remained in the program for 22 sessions, average weight loss exceeded the program goal of 5% for all delivery modes. In summary, if participants stay in the program, most have positive program outcomes regardless of delivery mode; they have some outcome improvement even if they leave early; and their outcomes improve more the longer they stay. This highlights the benefits of better retention and increased enrollment in the National DPP lifestyle change programs, as well as enhancements to online delivery. |
Vital signs for pediatric health: Infant mortality
Kelleher KJ , Hoagwood K , Walker DK , Kaminski JW , Gardner W , Fox EG . NAM Perspect 2023 2023 In 2015, the Institute of Medicine (now the National Academy of Medicine) released the report Vital Signs: Core Metrics for Health and Health Care Progress as a “basic, minimum slate of core metrics for use as sentinel indices of performance at various levels with respect to the key elements of health and health care progress” (IOM, 2015). Although indicators of pediatric health were included in that report as key elements of healthy behaviors, healthy communities, and preventive services, the core measures in the report emphasized indicators of adult health. This series of papers, “Vital Signs for Pediatric Health”, describes four metrics across the pediatric life course, each measuring how well the health care system is building the physical, cognitive, and socio-emotional health of the pediatric population, thereby laying the foundation for life-long health and well-being. The metrics—infant mortality, school readiness, chronic absenteeism, and high school graduation—were selected to focus on four different developmental stages of growth. A standardized set of core metrics to assess pediatric health could provide data to support health systems in identifying important areas for attention among their pediatric population and enable them to respond in a timely way. This rapid response is especially important in pediatric health systems as children undergo rapid development within a short time span. | | This paper discusses one of those four measures—infant mortality rate (IMR)—as a measure of the early period of life. IMR is used globally as a key indicator of child survival. As a measure, it is sensitive to improvements in care for both women and children, is associated with other well-being indicators in communities, and reflects health inequities in the community (ChildStats, 2021; Ely et al., 2017). | | This paper defines IMR and describes why it is a critical pediatric vital sign, then articulates the value of reducing disparities in IMR. Finally, the paper lays out the challenges to using IMR as an indicator for health system accountability. |
Disparities in infant mortality by maternal race and Hispanic origin, 2017-2018
Driscoll AK , Ely DM . Semin Perinatol 2022 46 (8) 151656 Disparities in infant mortality by race and Hispanic origin groups continue to persist in the United States. Maternal and infant characteristics known to be associated with infant mortality vary by race and ethnicity. This report describes racial and ethnic disparities in infant mortality in the United States using the 2017-2018 cohort linked birth/infant death files from the National Vital Statistics System. Distributions of births and infant mortality rates are described by selected maternal and infant characteristics. Adjusted rates and rate ratios from logistic regression models, compared to unadjusted rates and ratios, show the extent to which race and Hispanic origin disparities would be attenuated if all groups had the same distributions of select maternal and infant factors. Results support the premise that the different distributions of several variables across racial/ethnic groups, most notably gestational age, account for a significant portion of the disparities in infant mortality between racial/ethnic groups. |
Associations between persistent symptoms after mild COVID-19 and long-term health status, quality of life, and psychological distress.
Han JH , Womack KN , Tenforde MW , Files DC , Gibbs KW , Shapiro NI , Prekker ME , Erickson HL , Steingrub JS , Qadir N , Khan A , Hough CL , Johnson NJ , Ely EW , Rice TW , Casey JD , Lindsell CJ , Gong MN , Srinivasan V , Lewis NM , Patel MM , Self WH . Influenza Other Respir Viruses 2022 16 (4) 680-689 BACKGROUND: We sought to assess whether persistent COVID-19 symptoms beyond 6months (Long-COVID) among patients with mild COVID-19 is associated with poorer health status, quality of life, and psychological distress. METHODS: This was a multicenter prospective cohort study that included adult outpatients with acute COVID-19 from eight sites during 2-week sampling periods from April 1 and July 28, 2020. Participants were contacted 6-11months after their first positive SARS-CoV-2 to complete a survey, which collected information on the severity of eight COVID-19 symptoms using a 4-point scale ranging from 0 (not present) to 3 (severe) at 1month before COVID-19 (pre-illness) and at follow-up; the difference for each was calculated as an attributable persistent symptom severity score. A total attributable persistent COVID-19 symptom burden score was calculated by summing the attributable persistent severity scores for all eight symptoms. Outcomes measured at long-term follow-up comprised overall health status (EuroQol visual analogue scale), quality of life (EQ-5D-5L), and psychological distress (Patient Health Questionnaire-4). The association between the total attributable persistent COVID-19 burden score and each outcome was analyzed using multivariable proportional odds regression. RESULTS: Of the 2092 outpatients with COVID-19, 436 (21%) responded to the survey. The median (IQR) attributable persistent COVID-19 symptom burden score was 2 (0, 4); higher scores were associated with lower overall health status (aOR 0.63; 95% CI: 0.57-0.69), lower quality of life (aOR: 0.65; 95%CI: 0.59-0.72), and higher psychological distress (aOR: 1.40; 95%CI, 1.28-1.54) after adjusting for age, race, ethnicity, education, and income. CONCLUSIONS: In participants with mild acute COVID-19, the burden of persistent symptoms was significantly associated with poorer long-term health status, poorer quality of life, and psychological distress. |
Delivering the national diabetes prevention program: Assessment of enrollment in in-person and virtual organizations
Cannon MJ , Ng BP , Lloyd K , Reynolds J , Ely EK . J Diabetes Res 2022 2022 2942918 The aim of the US Centers for Disease Control and Prevention's (CDC) National Diabetes Prevention Program (National DPP) is to make an evidence-based lifestyle change program widely available to the more than 88 million American adults at risk for developing type 2 diabetes. The National DPP allows for program delivery using four delivery modes: in person, online, distance learning, and combination. The objective of this study was to analyze cumulative enrollment in the National DPP by delivery mode. We included all participants who enrolled in CDC-recognized organizations delivering the lifestyle change program between January 1, 2012, and December 31, 2019, and whose data were submitted to CDC's Diabetes Prevention Recognition Program. During this time, the number of participants who enrolled was 455,954. Enrollment, by delivery mode, was 166,691 for in-person; 269,004 for online; 4,786 for distance-learning; and 15,473 for combination. In-person organizations enrolled the lowest proportion of men (19.4%) and the highest proportions of non-Hispanic Black/African American (16.1%) and older (65+ years) participants (28.2%). Online organizations enrolled the highest proportions of men (27.1%), younger (18-44 years) participants (41.5%), and non-Hispanic White participants (70.3%). Distance-learning organizations enrolled the lowest proportion of Hispanic/Latino participants (9.0%). Combination organizations enrolled the highest proportions of Hispanic/Latino participants (37.3%) and participants who had obesity (84.1%). Most in-person participants enrolled in organizations classified as community-centered entities (41.4%) or medical providers (31.2%). Online and distance-learning participants were primarily enrolled (93.3% and 70.2%, respectively) in organizations classified as for-profit businesses or insurers. Participants in combination programs were enrolled almost exclusively in organizations classified as medical providers (89%). The National DPP has reached nearly half a million participants since its inception in 2012, but continued expansion is critical to stem the tide of type 2 diabetes among the many Americans at high risk. |
Genomic investigation of a household SARS-CoV-2 disease cluster in Arizona involving a cat, dog, and pet owner.
Yaglom HD , Hecht G , Goedderz A , Jasso-Selles D , Ely JL , Ruberto I , Bowers JR , Engelthaler DM , Venkat H . One Health 2021 13 100333 Arizona's COVID-19 and Pets Program is a prospective surveillance study being conducted to characterize how SARS-CoV-2 impacts companion animals living in households with SARS-CoV-2-positive individuals. Among the enrolled pets, we identified a SARS-CoV-2-infected cat and dog from the same household; both animals were asymptomatic but had close contact with the symptomatic and SARS-CoV-2-positive owner. Whole genome sequencing of animal and owner specimens revealed identical viral genomes of the B.1.575 lineage, suggesting zoonotic transmission of SARS-CoV-2 from human to at least one pet. This is the first report of the B.1.575 lineage in companion animals. Genetically linking SARS-CoV-2 between people and animals, and tracking changes in SARS-CoV-2 genomes is essential to detect any cross-species SARS-CoV-2 transmission that may lead to more transmissible or severe variants that can affect humans. Surveillance studies, including genomic analyses of owner and pet specimens, are needed to further our understanding of how SARS-CoV-2 impacts companion animals. |
Retention among participants in the National Diabetes Prevention Program Lifestyle Change Program, 2012-2017
Cannon MJ , Masalovich S , Ng BP , Soler RE , Jabrah R , Ely EK , Smith BD . Diabetes Care 2020 43 (9) 2042-2049 OBJECTIVE: To assess retention in the National Diabetes Prevention Program (DPP) lifestyle change program, which seeks to prevent type 2 diabetes in adults at high risk. RESEARCH DESIGN AND METHODS: We analyzed retention among 41,203 individuals who enrolled in Centers for Disease Control and Prevention (CDC)-recognized in-person lifestyle change programs at organizations that submitted data to CDC's Diabetes Prevention Recognition Program during January 2012-February 2017. RESULTS: Weekly attrition rates were typically <1-2% but were between 3.5% and 5% at week 2 and at weeks 17 and 18, where session frequency typically transitions from weekly to monthly. The percent of participants retained through 18 weeks varied by age (45.9% for 18-29 year olds, 53.4% for 30-44 year olds, 60.2% for 45-54 year olds, 66.7% for 55-64 year olds, and 67.6% for >/=65 year olds), race/ethnicity (70.5% for non-Hispanic whites, 60.5% for non-Hispanic blacks, 52.6% for Hispanics, and 50.6% for other), mean weekly percentage of body weight lost (41.0% for </=0% lost, 66.2% for >0 to <0.25% lost, 72.9% for 0.25 to <0.5% lost, and 73.9% for >/=0.5% lost), and mean weekly physical activity minutes (12.8% for 0 min, 56.1% for >0 to <60 min, 74.8% for 60 to <150 min, and 82.8% for >/=150 min) but not by sex (63.0% for men and 63.1% for women). CONCLUSIONS: Our results demonstrate the need to identify strategies to improve retention, especially among individuals who are younger or are members of racial/ethnic minority populations and among those who report less physical activity or less early weight loss. Strategies that address retention after the first session and during the transition from weekly to monthly sessions offer the greatest opportunity for impact. |
Infant mortality attributable to birth defects - United States, 2003-2017
Almli LM , Ely DM , Ailes EC , Abouk R , Grosse SD , Isenburg JL , Waldron DB , Reefhuis J . MMWR Morb Mortal Wkly Rep 2020 69 (2) 25-29 Birth defects are a leading cause of infant mortality in the United States, accounting for 20.6% of infant deaths in 2017 (1). Rates of infant mortality attributable to birth defects (IMBD) have generally declined since the 1970s (1-3). U.S. linked birth/infant death data from 2003-2017 were used to assess trends in IMBD. Overall, rates declined 10% during 2003-2017, but decreases varied by maternal and infant characteristics. During 2003-2017, IMBD rates decreased 4% for infants of Hispanic mothers, 11% for infants of non-Hispanic black (black) mothers, and 12% for infants of non-Hispanic white (white) mothers. In 2017, these rates were highest among infants of black mothers (13.3 per 10,000 live births) and were lowest among infants of white mothers (9.9). During 2003-2017, IMBD rates for infants who were born extremely preterm (20-27 completed gestational weeks), full term (39-40 weeks), and late term/postterm (41-44 weeks) declined 20%-29%; rates for moderate (32-33 weeks) and late preterm (34-36 weeks) infants increased 17%. Continued tracking of IMBD rates can help identify areas where efforts to reduce IMBD are needed, such as among infants born to black and Hispanic mothers and those born moderate and late preterm (32-36 weeks). |
A national effort to prevent type 2 diabetes: Participant-level evaluation of CDC's National Diabetes Prevention Program
Ely EK , Gruss SM , Luman ET , Gregg EW , Ali MK , Nhim K , Rolka DB , Albright AL . Diabetes Care 2017 40 (10) 1331-1341 OBJECTIVE: To assess participant-level results from the first 4 years of implementation of the National Diabetes Prevention Program (National DPP), a national effort to prevent type 2 diabetes in those at risk through structured lifestyle change programs. RESEARCH DESIGN AND METHODS: Descriptive analysis was performed on data from 14,747 adults enrolled in year-long type 2 diabetes prevention programs during the period February 2012 through January 2016. Data on attendance, weight, and physical activity minutes were summarized and predictors of weight loss were examined using a mixed linear model. All analyses were performed using SAS 9.3. RESULTS: Participants attended a median of 14 sessions over an average of 172 days in the program (median 134 days). Overall, 35.5% achieved the 5% weight loss goal (average weight loss 4.2%, median 3.1%). Participants reported a weekly average of 152 min of physical activity (median 128 min), with 41.8% meeting the physical activity goal of 150 min per week. For every additional session attended and every 30 min of activity reported, participants lost 0.3% of body weight (P < 0.0001). CONCLUSIONS: During the first 4 years, the National DPP has achieved widespread implementation of the lifestyle change program to prevent type 2 diabetes, with promising early results. Greater duration and intensity of session attendance resulted in a higher percent of body weight loss overall and for subgroups. Focusing on retention may reduce disparities and improve overall program results. Further program expansion and investigation is needed to continue lowering the burden of type 2 diabetes nationally. |
Characterization of the Proteins Associated with Caulobacter crescentus Bacteriophage CbK Particles.
Callahan CT , Wilson KM , Ely B . Curr Microbiol 2015 72 (1) 75-80 Bacteriophage genomes contain an abundance of genes that code for hypothetical proteins with either a conserved domain or no predicted function. The Caulobacter phage CbK has an unusual shape, designated morphotype B3 that consists of an elongated cylindrical head and a long flexible tail. To identify CbK proteins associated with the phage particle, intact phage particles were subjected to SDS-PAGE, and the resulting protein bands were digested with trypsin and analyzed using MALDI mass spectroscopy to provide peptide molecular weights. These peptide molecular weights were then compared with the peptides that would be generated from the predicted amino acid sequences that are coded by the CbK genome, and the comparison of the actual and predicted peptide masses resulted in the identification of single genes that could code for the set of peptides derived from each of the 20 phage proteins. We also found that CsCl density gradient centrifugation resulted in the separation of empty phage heads, phage heads containing material organized in a spiral, isolated phage tails, and other particulate material from the intact phage particles. This additional material proved to be a good source of additional phage proteins, and preliminary results suggest that it may include a CbK DNA replication complex. |
The preventability of ventilator-associated events: the CDC Prevention Epicenters' Wake Up and Breathe Collaborative
Klompas M , Anderson D , Trick W , Babcock H , Kerlin MP , Li L , Sinkowitz-Cochran R , Ely EW , Jernigan J , Magill S , Lyles R , O'Neil C , Kitch BT , Arrington E , Balas MC , Kleinman K , Bruce C , Lankiewicz J , Murphy MV , ECox C , Lautenbach E , Sexton D , Fraser V , Weinstein RA , Platt R . Am J Respir Crit Care Med 2014 191 (3) 292-301 RATIONALE: The Centers for Disease Control and Prevention (CDC) introduced ventilator-associated event (VAE) definitions in January 2013. Little is known about VAE prevention. We hypothesized that daily, coordinated spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) might prevent VAEs. OBJECTIVES: To assess the preventability of VAEs. METHODS: We nested a multicenter quality improvement collaborative within a prospective study of VAE surveillance amongst 20 intensive care units between November 2011 and May 2013. Twelve units joined the collaborative and implemented an opt-out protocol for nurses and respiratory therapists to perform paired daily SATs and SBTs. The remaining 8 units conducted surveillance alone. We measured temporal trends in VAEs using generalized mixed effects regression models adjusted for patient-level unit, age, sex, reason for intubation, SOFA score, and comorbidity index. MEASUREMENTS AND MAIN RESULTS: We tracked 5,164 consecutive episodes of mechanical ventilation: 3,425 in collaborative units and 1,739 in surveillance-only units. Within collaborative units, significant increases in SATs, SBTs, and percentage of SBTs performed without sedation were mirrored by significant decreases in duration of mechanical ventilation and hospital length-of-stay. There was no change in VAE risk per ventilator-day but significant decreases in VAE risk per episode of mechanical ventilation (OR 0.63, 95% CI 0.42-0.97) and infection-related ventilator-associated complications (OR 0.35, 95% CI 0.17-0.71) but not pneumonias (OR 0.51, 95% CI 0.19-1.3). Within surveillance-only units, there were no significant changes in SAT, SBT, or VAE rates. CONCLUSIONS: Enhanced performance of paired, daily SATs and SBTs is associated with lower VAE rates. Clinical trial registration available at www.clinicaltrials.gov, ID NCT01583413. |
Results of medical countermeasure drills among 72 Cities Readiness Initiative metropolitan statistical areas, 2008-2009
Jones JR , Neff LJ , Ely EK , Parker AM . Disaster Med Public Health Prep 2012 6 (4) 357-362 OBJECTIVE: The Cities Readiness Initiative is a federally funded program designed to assist 72 metropolitan statistical areas (MSAs) in preparing to dispense life-saving medical countermeasures within 48 hours of a public health emergency. Beginning in 2008, the 72 MSAs were required to conduct 3 drills related to the distribution and dispensing of emergency medical countermeasures. The report describes the results of the first year of pilot data for medical countermeasure drills conducted by the MSAs. METHODS: The MSAs were provided templates with key metrics for 5 functional elements critical for a successful dispensing campaign: personnel call down, site activation, facility setup, pick-list generation, and dispensing throughput. Drill submissions were compiled into single data sets for each of the 5 drills. Analyses were conducted to determine whether the measures were comparable across business and non-business hours. Descriptive statistics were computed for each of the key metrics identified in the 5 drills. RESULTS: Most drills were conducted on Mondays and Wednesdays during business hours (8:00 am-5:00 pm). The median completion time for the personnel call-down drill was 1 hour during business hours (n = 287) and 55 minutes during non-business hours (n = 136). Site-activation drills were completed in a median of 30 minutes during business hours and 5 minutes during non-business hours. Facility setup drills were completed more rapidly during business hours (75 minutes) compared with non-business hours (96 minutes). During business hours, pick lists were generated in a median of 3 minutes compared with 5 minutes during non-business hours. Aggregate results from the dispensing throughput drills demonstrated that the median observed throughput during business hours (60 people/h) was higher than that during non-business hours (43 people/h). CONCLUSION: The results of the analyses from this pilot sample of drill submissions provide a baseline for the determination of a national standard in operational capabilities for local jurisdictions to achieve in their planning efforts for a mass dispensing campaign during an emergency. |
Sufficient sleep, physical activity, and sedentary behaviors
Foti KE , Eaton DK , Lowry R , McKnight-Ely LR . Am J Prev Med 2011 41 (6) 596-602 BACKGROUND: Insufficient sleep among adolescents is common and has adverse health and behavior consequences. Understanding associations of physical activity and sedentary behaviors with sleep duration could shed light on ways to promote sufficient sleep. PURPOSE: The purpose of this study is to determine whether physical activity and sedentary behaviors are associated with sufficient sleep (8 or more hours of sleep on an average school night) among U.S. high school students. METHODS: Data were from the 2009 national Youth Risk Behavior Survey and are representative of 9th-12th-grade students nationally (n=14,782). Associations of physical activity and sedentary behaviors with sufficient sleep were determined using logistic regression models controlling for confounders. Data were analyzed in October 2010. RESULTS: Students who engaged in ≥60 minutes of physical activity daily during the 7 days before the survey had higher odds of sufficient sleep than those who did not engage in ≥60 minutes on any day. There was no association between the number of days students were vigorously active ≥20 minutes and sufficient sleep. Compared to their respective referent groups of 0 hours on an average school day, students who watched TV ≥4 hours/day had higher odds of sufficient sleep and students who played video or computer games or used a computer for something that was not school work ≥2 hours/day had lower odds of sufficient sleep. CONCLUSIONS: Daily physical activity for ≥60 minutes and limited computer use are associated with sufficient sleep among adolescents. |
Iodine status of the U.S. population, National Health and Nutrition Examination Survey, 2005-2006 and 2007-2008
Caldwell KL , Makhmudov A , Ely E , Jones RL , Wang RY . Thyroid 2011 21 (4) 419-27 BACKGROUND: This report presents urinary iodine (UI) concentrations for the general U.S. population during 2005-2006 and 2007-2008. These findings are the fourth and fifth assessments of the population since National Health and Nutrition Examination Survey (NHANES) III (1988-1994), when the median UI concentration for the population decreased from NHANES I (1971-1974). METHODS: During 2005-2006 and 2007-2008, approximately 5000 participants per year were selected to participate in NHANES. The participants were interviewed and examined. UI concentration was measured on a random one third subsample of 2649 participants, aged 6 years and older in 2005-2006, and in all participants in 2007-2008. These urine iodine concentrations are representative of the general U.S. population by age, sex, and race/ethnicity. RESULTS: (i) The median UI concentrations for the general U.S. population in 2005-2006 and 2007-2008 were 164 mug/L (95% confidence interval [CI] 154-174) and 164 mug/L (95% CI 154-173), respectively. Also, the proportions of the population with a UI concentration of <50 mug/L during these survey periods were 9.8% +/- 1.3% and 8.8% +/- 0.4%, respectively. The median UI concentration and prevalence of ≥200 mug/L appeared to be higher in children and persons ≥70 years than in other age groups. (ii) In both surveys, children aged 6-11 years had median UI concentrations of ≥200 mug/L, and about 5% of them had a UI concentration of <50 mug/L. (iii) All pregnant women (sample size 184) surveyed during 2005-2008 had a median UI concentration of 125 mug/L (95% CI 86-198), and 56.9% +/- 7.9% of this group had a UI concentration of <150 mug/L. UI concentrations were lower among non-Hispanic black survey participants than non-Hispanic white and Mexican-American participants. CONCLUSIONS: These findings affirm the stabilization of UI concentration and adequate iodine nutrition in the general U.S. population since 2000. However, certain groups likely do not achieve a sufficient dietary iodine intake according to the World Health Organization. The needs of these vulnerable groups and the inadequacy of their dietary iodine intake should be addressed in future efforts. |
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