Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-27 (of 27 Records) |
Query Trace: Foltz V[original query] |
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Draft Genome Sequence of Clostridium botulinum Subtype bont/A5(B2').
Kruemmel AR , Halpin JL , Foltz V , Dykes J , Lquez C . Microbiol Resour Announc 2022 11 (7) e0034822 Here, we report the draft genome sequence of Clostridium botulinum strain CDC76130, which harbors a rare botulinum toxin gene (bont) complex arrangement of bont/A5 and truncated bont/B2 within the same ha toxin gene cluster. |
Clostridium botulinum Type B Isolated From a Wound Botulism Case Due to Injection Drug Use Resembles Other Local Strains Originating From Hawaii.
Halpin JL , Foltz V , Dykes JK , Chatham-Stephens K , Lúquez C . Front Microbiol 2021 12 678473 Clostridium botulinum produces botulinum neurotoxin (BoNT), which can lead to death if untreated. In the United States, over 90% of wound botulism cases are associated with injection drug use of black tar heroin. We sought to determine the phylogenetic relatedness of C. botulinum isolated from an injection drug use wound botulism case and isolates from endogenous infant botulism cases in Hawaii. Nineteen C. botulinum type B isolates from Hawaii and one type B isolate from California were analyzed by whole-genome sequencing. The botulinum toxin gene (bont) subtype was determined using CLC Genomics Workbench, and the seven-gene multi-locus sequence type (MLST) was identified by querying PubMLST. Mashtree and pairwise average nucleotide identity were used to find nearest neighbors, and Lyve-SET approximated a phylogeny. Eighteen of the isolates harbored the bont/B5 gene: of those, 17 were classified as sequence type ST36 and one was classified as ST104. A single isolate from Hawaii harbored bont/B1 and was determined to belong to ST110, and the isolate from California harbored bont/B1 and belonged to ST30. A tree constructed with Lyve-SET showed a high degree of homology among all the Hawaiian C. botulinum isolates that harbor the bont/B5 gene. Our results indicate that the bont/B-expressing isolates recovered from Hawaii are closely related to each other, suggesting local contamination of the drug paraphernalia or the wound itself with spores rather than contamination of the drug at manufacture or during transport. These findings may assist in identifying interventions to decrease wound botulism among persons who inject drugs. |
Notes from the field: Botulism type B after intravenous methamphetamine use - New Jersey, 2020
Waltenburg MA , Larson VA , Naor EH , Webster TG , Dykes J , Foltz V , Edmunds S , Thomas D , Kim J , Edwards L . MMWR Morb Mortal Wkly Rep 2020 69 (39) 1425-1426 On May 15, 2020, a White man aged 41 years arrived at an emergency department in New Jersey with a 2-day history of new onset blurred vision, double vision, ptosis, and difficulty swallowing. He was evaluated for cerebrovascular accident (CVA [stroke]), was found to have unremarkable computed tomography and magnetic resonance imaging brain scans, and was discharged with a diagnosis of diplopia (double vision). The following day, his symptoms worsened, and he visited a second emergency department with slurred speech, oral thrush, and facial weakness. Thorough skin and scalp examinations revealed peripheral phlebitis and sites of induration, but no abscesses or open wounds. He was admitted to the hospital with a diagnosis of CVA and treated with antifungal medications for oral and laryngeal candidiasis. |
Improving access and systems of care for evidence-based childhood obesity treatment: Conference key findings and next steps
Wilfley DE , Staiano AE , Altman M , Lindros J , Lima A , Hassink SG , Dietz WH , Cook S , The Improving Access and Systems of Care for Evidence-Based Childhood Obesity Treatment Conference Workgroup , Foltz J . Obesity (Silver Spring) 2017 25 (1) 16-29 OBJECTIVE: To improve systems of care to advance implementation of the U.S. Preventive Services Task Force recommendations for childhood obesity treatment (i.e., clinicians offer/refer children with obesity to intensive, multicomponent behavioral interventions of >25 h over 6 to 12 months to improve weight status) and to expand payment for these services. METHODS: In July 2015, 43 cross-sector stakeholders attended a conference supported by the Agency for Healthcare Research and Quality, American Academy of Pediatrics Institute for Healthy Childhood Weight, and The Obesity Society. Plenary sessions presenting scientific evidence and clinical and payment practices were interspersed with breakout sessions to identify consensus recommendations. RESULTS: Consensus recommendations for childhood obesity treatment included: family-based multicomponent behavioral therapy; integrated care model; and multidisciplinary care team. The use of evidence-based protocols, a well-trained healthcare team, medical oversight, and treatment at or above the minimum dose (e.g., >25 h) are critical components to ensure effective delivery of high-quality care and to achieve clinically meaningful weight loss. Approaches to secure reimbursement for evidence-based obesity treatment within payment models were recommended. CONCLUSIONS: Continued cross-sector collaboration is crucial to ensure a unified approach to increase payment and access for childhood obesity treatment and to scale up training to ensure quality of care. |
Support for food and beverage worksite wellness strategies and sugar-sweetened beverage intake among employed U.S. adults
Lee-Kwan SH , Pan L , Kimmons J , Foltz J , Park S . Am J Health Promot 2017 31 (2) 128-135 PURPOSE: Sugar-sweetened beverage (SSB) consumption is high among U.S. adults and is associated with obesity. Given that more than 100 million Americans consume food or beverages at work daily, the worksite may be a venue for interventions to reduce SSB consumption. However, the level of support for these interventions is unknown. We examined associations between workday SSB intake and employees' support for worksite wellness strategies (WWSs). DESIGN: We conducted a cross-sectional study using data from Web-based annual surveys that gather information on health-related attitudes and behaviors. SETTING: Study setting was the United States. SUBJECTS: A total of 1924 employed adults (≥18 years) selected using probability-based sampling. MEASURES: The self-reported independent variable was workday SSB intake (0, <1 or ≥1 times per day), and dependent variables were employees' support (yes/no) for the following WWSs: (1) accessible free water, (2) affordable healthy food/drink, (3) available healthy options, and (4) less available SSB. ANALYSIS: Multivariable logistic regression was used to control for sociodemographic variables, employee size, and availability of cafeteria/vending machine. RESULTS: About half of employees supported accessible free water (54%), affordable healthy food/drink (49%), and available healthy options (46%), but only 28% supported less available SSB. Compared with non-SSB consumers, daily SSB consumers were significantly less supportive of accessible free water (adjusted odds ratio, .67; p < .05) or less available SSB (odds ratio, .49; p < .05). CONCLUSION: Almost half of employees supported increasing healthy options within worksites, although daily workday SSB consumers were less supportive of certain strategies. Lack of support could be a potential barrier to the successful implementation of certain worksite interventions. |
CDC Grand Rounds: Public health strategies to prevent and treat strokes
George MG , Fischer L , Koroshetz W , Bushnell C , Frankel M , Foltz J , Thorpe PG . MMWR Morb Mortal Wkly Rep 2017 66 (18) 479-481 Worldwide, stroke is the second leading cause of death and a leading cause of serious long-term disability. In the United States, nearly 800,000 strokes occur each year; thus stroke is the fifth leading cause of death overall and the fourth leading cause of death among women. Major advances in stroke prevention through treatment of known risk factors has led to stroke being considered largely preventable. For example, in the United States, stroke mortality rates have declined 70% over the past 50 years, in large part because of important reductions in hypertension, tobacco smoking, and more recently, increased use of anticoagulation for atrial fibrillation. Although the reduction in stroke mortality is recognized as one of the 10 great public health achievements of the 20th century, gains can still be made. Approximately 80% of strokes could be prevented by screening for and addressing known risks with measures such as improving hypertension control, smoking cessation, diabetes prevention, cholesterol management, increasing use of anticoagulation for atrial fibrillation, and eliminating excessive alcohol consumption. |
Physician characteristics associated with sugar-sweetened beverage counseling practices
VanFrank BK , Park S , Foltz JL , McGuire LC , Harris DM . Am J Health Promot 2016 32 (6) 1365-1374 PURPOSE: Frequent sugar-sweetened beverage (SSB) consumption is associated with chronic disease. Although physician counseling can positively affect patient behavior, physicians' personal characteristics may influence counseling practices. We explored SSB-related topics physicians discuss when counseling overweight/obese patients and examined associations between physicians' SSB-related counseling practices and their personal and medical practice characteristics. DESIGN: Cross-sectional survey. SETTING: DocStyles survey, 2014. PARTICIPANTS: A total of 1510 practicing US physicians. MEASURES: Physician's SSB counseling on calories, added sugars, obesity/weight gain, health effects, consumption frequency, water substitution, and referral. ANALYSIS: Adjusted odds ratios (aORs) were calculated with multivariable logistic regression, adjusting for physician's personal and medical practice characteristics. RESULTS: Most physicians (98.5%) reported SSB-related counseling. The most reported topic was obesity/weight gain (81.4%); the least reported were added sugars (53.1%) and referral (35.0%). Physicians in adult-focused specialties had lower odds than pediatricians of counseling on several topics (aOR range: 0.26-0.64). Outpatient physicians had higher odds than inpatient physicians of counseling on consumption frequency and water substitution (aOR range: 1.60-2.01). Physicians consuming SSBs ≥1 time/day (15.7%) had lower odds than nonconsumers of counseling on most topics (aOR range: 0.58-0.68). CONCLUSION: Most physicians reported SSB-related counseling; obesity/weight gain was discussed most frequently. Counseling opportunities remain in other topic areas. Opportunities also exist to strengthen SSB counseling practices in adult-focused specialties, inpatient settings, and among physicians who consume SSBs daily. |
Prevalence and correlates of missing meals among high school students - United States, 2010
Demissie Z , Eaton DK , Lowry R , Nihiser AJ , Foltz JL . Am J Health Promot 2016 32 (1) 89-95 PURPOSE: To determine the prevalence and correlates of missing meals among adolescents. DESIGN: The 2010 National Youth Physical Activity and Nutrition Study, a cross-sectional study. SETTING: School based. PARTICIPANTS: A nationally representative sample of 11 429 high school students. MEASURES: Breakfast, lunch, and dinner consumption; demographics; measured and perceived weight status; physical activity and sedentary behaviors; and fruit, vegetable, milk, sugar-sweetened beverage, and fast-food intake. ANALYSIS: Prevalence estimates for missing breakfast, lunch, or dinner on ≥1 day during the past 7 days were calculated. Associations between demographics and missing meals were tested. Associations of lifestyle and dietary behaviors with missing meals were examined using logistic regression controlling for sex, race/ethnicity, and grade. RESULTS: In 2010, 63.1% of students missed breakfast, 38.2% missed lunch, and 23.3% missed dinner; the prevalence was highest among female and non-Hispanic black students. Being overweight/obese, perceiving oneself to be overweight, and video game/computer use were associated with increased risk of missing meals. Physical activity behaviors were associated with reduced risk of missing meals. Students who missed breakfast were less likely to eat fruits and vegetables and more likely to consume sugar-sweetened beverages and fast food. CONCLUSION: Breakfast was the most frequently missed meal, and missing breakfast was associated with the greatest number of less healthy dietary practices. Intervention and education efforts might prioritize breakfast consumption. |
Prevention of stroke: a strategic global imperative
Feigin VL , Norrving B , George MG , Foltz JL , Roth GA , Mensah GA . Nat Rev Neurol 2016 12 (9) 501-12 The increasing global stroke burden strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new primary prevention strategies with larger effect sizes are needed. Here, we review the latest stroke epidemiology literature, with an emphasis on the recently published Global Burden of Disease 2013 Study estimates; highlight the problems with current primary stroke and cardiovascular disease (CVD) prevention strategies; and outline new developments in primary stroke and CVD prevention. We also suggest key priorities for the future, including comprehensive prevention strategies that target people at all levels of CVD risk; implementation of an integrated approach to promote healthy behaviours and reduce health disparities; capitalizing on information technology to advance prevention approaches and techniques; and incorporation of culturally appropriate education about healthy lifestyles into standard education curricula early in life. Given the already immense and fast-increasing burden of stroke and other major noncommunicable diseases (NCDs), which threatens worldwide sustainability, governments of all countries should develop and implement an emergency action plan addressing the primary prevention of NCDs, possibly including taxation strategies to tackle unhealthy behaviours that increase the risk of stroke and other NCDs. |
Overview of the obesity intervention taxonomy and pooled analysis working group
Belle SH , Stevens J , Cella D , Foltz JL , Loria CM , Murray DM , Czajkowski SM , Arteaga SS , Thom E , Pratt CA . Transl Behav Med 2016 6 (2) 244-59 The National Heart, Lung, and Blood Institute and the National Institutes of Health Office of Disease Prevention convened a meeting on August 29-30, 2013 entitled "Obesity Intervention Taxonomy and Pooled Analysis." The overarching goals of the meeting were to understand how to decompose interventions targeting behavior change, and in particular, those that focus on obesity and to combine data from groups of related intervention studies to supplement what can be learned from the individual studies. This paper summarizes the workshop recommendations and provides an overview of the two other papers that originated from the workshop and that address decomposition of behavioral change interventions and pooling of data across diverse studies within a consortium. |
Taking an Antibiotic Time-out: Utilization and Usability of a Self-Stewardship Time-out Program for Renewal of Vancomycin and Piperacillin-Tazobactam
Graber CJ , Jones MM , Glassman PA , Weir C , Butler J , Nechodom K , Kay CL , Furman AE , Tran TT , Foltz C , Pollack LA , Samore MH , Goetz MB . Hosp Pharm 2015 50 (11) 1011-24 BACKGROUND: Antibiotic time-outs can promote critical thinking and greater attention to reviewing indications for continuation. OBJECTIVE: We pilot tested an antibiotic time-out program at a tertiary care teaching hospital where vancomycin and piperacillin-tazobactam continuation past day 3 had previously required infectious diseases service approval. METHODS: The time-out program consisted of 3 components: (1) an electronic antimicrobial dashboard that aggregated infection-relevant clinical data; (2) a templated note in the electronic medical record that included a structured review of antibiotic indications and that provided automatic approval of continuation of therapy when indicated; and (3) an educational and social marketing campaign. RESULTS: In the first 6 months of program implementation, vancomycin was discontinued by day 5 in 93/145 (64%) courses where a time-out was performed on day 4 versus in 96/199 (48%) 1 year prior (P = .04). Seven vancomycin continuations via template (5% of time-outs) were guideline-discordant by retrospective chart review versus none 1 year prior (P = .002). Piperacillin-tazobactam was discontinued by day 5 in 70/105 (67%) courses versus 58/93 (62%) 1 year prior (P = .55); 9 continuations (9% of time-outs) were guideline-discordant versus two 1 year prior (P = .06). A usability survey completed by 32 physicians demonstrated modest satisfaction with the overall program, antimicrobial dashboard, and renewal templates. CONCLUSIONS: By providing practitioners with clinical informatics support and guidance, the intervention increased provider confidence in making decisions to de-escalate antimicrobial therapy in ambiguous circumstances wherein they previously sought authorization for continuation from an antimicrobial steward. |
Adults eligible for cardiovascular disease prevention counseling and participation in aerobic physical activity - United States, 2013
Omura JD , Carlson SA , Paul P , Watson KB , Loustalot F , Foltz JL , Fulton JE . MMWR Morb Mortal Wkly Rep 2015 64 (37) 1047-1051 Cardiovascular disease (CVD) is the leading cause of death in the United States, and physical inactivity is a major risk factor (1). Health care professionals have a role in counseling patients about physical activity for CVD prevention. In August 2014, the U.S. Preventive Services Task Force (USPSTF) recommended that adults who are overweight or obese and have additional CVD risk factors be offered or referred to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. Although the USPSTF recommendation does not specify an amount of physical activity, the 2008 Physical Activity Guidelines for Americans state that for substantial health benefits adults should achieve >/=150 minutes per week of moderate-intensity aerobic physical activity or >/=75 minutes per week of vigorous-intensity aerobic activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity. To assess the proportion of adults eligible for intensive behavioral counseling and not meeting the aerobic physical activity guideline, CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS). This analysis indicated that 36.8% of adults were eligible for intensive behavioral counseling for CVD prevention. Among U.S. states and the District of Columbia (DC), the prevalence of eligible adults ranged from 29.0% to 44.6%. Nationwide, 19.9% of all adults were eligible and did not meet the aerobic physical activity guideline. These data can inform the planning and implementation of health care interventions for CVD prevention that are based on physical activity. |
Electronic health records to support obesity-related patient care: results from a survey of United States physicians
Bronder KL , Dooyema CA , Onufrak SJ , Foltz JL . Prev Med 2015 77 41-7 OBJECTIVE: Obesity-related electronic health record (EHR) functions increase the rates of measuring BMI, diagnosing obesity, and providing obesity services. This study describes the prevalence of obesity-related EHR functions in clinical practice and analyzes characteristics associated with increased obesity-related EHR sophistication. MATERIALS AND METHODS: Data were analyzed from DocStyles, a web-based panel survey administered to 1507 primary care providers practicing in the United States in June, 2013. Physicians were asked if their EHR has specific obesity-related functions. Logistical regression analyses identified characteristics associated with improved obesity-related EHR sophistication. RESULTS: Of the 88% of providers with an EHR, 83% of EHRs calculate BMI, 52% calculate pediatric BMI percentile, and 32% flag patients with abnormal BMI values. Only 36% provide obesity-related decision support and 17% suggest additional resources for obesity-related care. Characteristics associated with having a more sophisticated EHR include age ≤45years old, being a pediatrician or family practitioner, and practicing in a larger, outpatient practice. DISCUSSION: Few EHRs optimally supported physician's obesity-related clinical care. The low rates of obesity-related EHR functions currently in practice highlight areas to improve the clinical health information technology in primary care practice. CONCLUSIONS: More work can be done to develop, implement, and promote the effective utilization of obesity-related EHR functions to improve obesity treatment and prevention efforts. |
Childhood Obesity Research Demonstration (CORD): the cross-site overview and opportunities for interventions addressing obesity community-wide
Foltz JL , Belay B , Dooyema CA , Williams N , Blanck HM . Child Obes 2015 11 (1) 4-10 BACKGROUND: This is the first of a set of articles in this issue on the Childhood Obesity Research Demonstration (CORD) project and provides an overview of the multisite approach and community-wide interventions. Innovative multisetting, multilevel approaches that integrate primary healthcare and public health interventions to improve outcomes for children with obesity need to be evaluated. The CORD project aims to improve BMI and obesity-related behaviors among underserved 2- to 12-year-old children by utilizing these approaches. METHODS: The CORD consortium, structure, model terminology and key components, and common measures were solidified in year 1 of the CORD project. Demonstration sites applied the CORD model across communities in years 2 and 3. Evaluation plans for year 4 include site-specific analyses as well as cross-site impact, process, and sustainability evaluations. RESULTS: The CORD approach resulted in commonalities and differences in participant, intervention, comparison, and outcome elements across sites. Products are to include analytic results as well as cost assessment, lessons learned, tools, and materials. DISCUSSION: Foreseen opportunities and challenges arise from the similarities and unique aspects across sites. Communities adapted interventions to fit their local context and build on strengths, but, in turn, this flexibility makes cross-site evaluation challenging. CONCLUSION: The CORD project represents an evidence-based approach that integrates primary care and public health strategies and evaluates multisetting multilevel interventions, thus adding to the limited research in this field. CORD products will be disseminated to a variety of stakeholders to aid the understanding, prevention, and management of childhood obesity. |
The Childhood Obesity Research Demonstration Project: a team approach for supporting a multisite, multisector intervention
Williams N , Dooyema CA , Foltz JL , Belay B , Blanck HM . Child Obes 2014 11 (1) 104-8 BACKGROUND: Comprehensive multisector, multilevel approaches are needed to address childhood obesity. This article introduces the structure of a multidisciplinary team approach used to support and guide the multisite, multisector interventions implemented as part of the Childhood Obesity Research Demonstration (CORD) project. This article will describe the function, roles, and lessons learned from the CDC-CORD approach to project management. METHODS: The CORD project works across multisectors and multilevels in three demonstration communities. Working with principal investigators and their research teams who are engaging multiple stakeholder groups, including community organizations, schools and child care centers, health departments, and healthcare providers, can be a complex endeavor. To best support the community-based research project, scientific and programmatic expertise in a wide range of areas was required. The team was configured based on the skill sets needed to interact with the various levels of staff working with the project. CONCLUSIONS: By thoughtful development of the team and processes, an efficient system for supporting the multisite, multisector intervention project sites was developed. The team approach will be formally evaluated at the end of the project period. |
The impact of recent CHIP eligibility expansions on children's insurance coverage, 2008-12
Goldstein IM , Kostova D , Foltz JL , Kenney GM . Health Aff (Millwood) 2014 33 (10) 1861-7 Following the reauthorization of the Children's Health Insurance Program (CHIP) in 2009, fifteen states raised their CHIP income eligibility thresholds to further reduce uninsurance among children. We examined the impact of these expansions on uninsurance, public insurance, and private insurance among children who became newly eligible for CHIP after the expansions. Using a difference-in-differences approach, we estimated that the expansions reduced uninsurance by 1.1 percentage points among the newly eligible, cutting their uninsurance rate by nearly 15 percent. Public coverage increased by 2.9 percentage points, with variations in take-up among the states. A better understanding of these state-level differences in take-up could inform efforts to enroll children who remain uninsured but are eligible for CHIP. CHIP is up for reauthorization in 2015, and further funding will be needed to maintain the program, which provides insurance to children who might not have access to affordable private coverage. |
Health-promoting environments in U.S. medical facilities: physician perceptions, DocStyles 2012
Goldstein IM , Foltz JL , Onufrak S , Belay B . Prev Med 2014 67 65-70 OBJECTIVE: Medical facilities are natural leaders for health promotion because of their mission, influence, and reach. We sought to determine the frequency of physicians reporting supportive, health-promoting environments in their facility and identify characteristics of physicians and medical practices associated with support. METHODS: We analyzed a sample of 1,485 U.S. primary care physicians in DocStyles 2012 survey. Physicians rated their facility's support for healthy nutrition, physical activity, and lactation environments. Frequencies and adjusted odds ratios for supportive environments (rated "Good" or "Very Good") were assessed by select characteristics. RESULTS: The frequency of physicians reporting supportive environments was 70.0% for nutrition, 60.0% for physical activity, 76.0% for lactation, and 40.4% for all 3 environments combined. Supportive nutrition [odds ratio: 2.91 (1.49-5.66)] and physical activity [2.13 (1.19-3.83)] environments were associated with physicians seeing upper middle class to affluent patients versus poor patients. Supportive lactation environments were associated with pediatricians [3.35 (2.14-5.25)] and obstetricians/gynecologists [3.39 (2.15-5.33)] versus internists. CONCLUSIONS: Less than half of physicians reported their facility supportive of all these environments, suggesting there are many missed opportunities for U.S. medical facilities to promote wellness. Facilities serving poor patients and those staffed by internists and family/general practitioners may represent one area of need. |
Differences between the fourth and fifth Korotkoff phases among children and adolescents
Freedman DS , Foltz JL , Berenson GS . Am J Hypertens 2014 27 (12) 1495-502 BACKGROUND: The relative importance of the fourth (K4) and fifth (K5) Korotkoff phases as the indicator of diastolic blood pressure (DBP) levels among children remains uncertain. METHODS: In a sample of 11,525 youth aged 5-17, we examined interexaminer differences in these 2 phases and the relation of theses 2 phases to adult blood pressure levels and hypertension. The longitudinal analyses were conducted among 2,156 children who were re-examined after age 25 years. RESULTS: Mean (+/-SD) levels of DBP were 62 (+/-9) mm Hg (K4) and 49 (+/-13) mm Hg (K5). K4 showed less interobserver variability than did K5, and 7% of the children had at least 1 (of 6) K5 value of 0mm Hg. Longitudinal analyses indicated that K4 was more strongly associated with adult blood pressure levels and hypertension. In correlational analyses of subjects who were not using antihypertensive medications in adulthood (n = 1,848), K4 was more strongly associated with the adult DBP level than was K5 (r = 0.22 vs. 0.17; P < 0.01). Analyses of adult hypertension (based on high blood pressure levels or use of antihypertensive medications) indicated that the screening performance of childhood levels of K4 was similar to that of systolic blood pressure and was higher than that of K5, with areas under the receiver operator characteristic curves of 0.63 (systolic blood pressure), 0.63 (K4), and 0.57 (K5). CONCLUSIONS: As compared with K5 levels among children, K4 shows less interobserver variability and is more strongly associated with adult hypertension. |
Improving the weight of the nation by engaging the medical setting in obesity prevention and control
Foltz JL , Belay B , Blackburn GL . J Law Med Ethics 2013 41 Suppl 2 19-26 This manuscript highlights examples of strategies that have made strides in improving the quality of health care environments, systems-level improvements to support self-management, and collaborations between primary care and public health to support effective approaches to prevent obesity among children and adults in the U.S. |
Legionnaires' disease case-finding algorithm, attack rates, and risk factors during a residential outbreak among older adults: an environmental and cohort study
Silk BJ , Foltz JL , Ngamsnga K , Brown E , Munoz MG , Hampton L , Jacobs-Slifka K , Kozak NA , Underwood JM , Krick J , Travis T , Farrow O , Fields BS , Blythe D , Hicks LA . BMC Infect Dis 2013 13 (1) 291 BACKGROUND: During a Legionnaires' disease (LD) outbreak, combined epidemiological and environmental investigations were conducted to identify prevention recommendations for facilities where elderly residents live independently but have an increased risk of legionellosis. METHODS: Survey responses (n = 143) were used to calculate attack rates and describe transmission routes by estimating relative risk (RR) and 95% confidence intervals (95% CI). Potable water collected from five apartments of LD patients and three randomly-selected apartments of residents without LD (n = 103 samples) was cultured for Legionella. RESULTS: Eight confirmed LD cases occurred among 171 residents (attack rate = 4.7%); two visitors also developed LD. One case was fatal. The average age of patients was 70 years (range: 62--77). LD risk was lower among residents who reported tub bathing instead of showering (RR = 0.13, 95% CI: 0.02--1.09, P = 0.03). Two respiratory cultures were characterized as L. pneumophila serogroup 1, monoclonal antibody type Knoxville (1,2,3), sequence type 222. An indistinguishable strain was detected in 31 (74%) of 42 potable water samples. CONCLUSIONS: Managers of elderly-housing facilities and local public health officials should consider developing a Legionella prevention plan. When Legionella colonization of potable water is detected in these facilities, remediation is indicated to protect residents at higher risk. If LD occurs among residents, exposure reduction, heightened awareness, and clinical surveillance activities should be coordinated among stakeholders. For prompt diagnosis and effective treatment, clinicians should recognize the increased risk and atypical presentation of LD in older adults. |
An epidemiologic investigation of potential risk factors for Nodding Syndrome in Kitgum District, Uganda
Foltz JL , Makumbi I , Sejvar JJ , Malimbo M , Ndyomugyenyi R , Atai-Omoruto AD , Alexander LN , Abang B , Melstrom P , Kakooza AM , Olara D , Downing RG , Nutman TB , Dowell SF , Lwamafa DK . PLoS One 2013 8 (6) e66419 INTRODUCTION: Nodding Syndrome (NS), an unexplained illness characterized by spells of head bobbing, has been reported in Sudan and Tanzania, perhaps as early as 1962. Hypothesized causes include sorghum consumption, measles, and onchocerciasis infection. In 2009, a couple thousand cases were reportedly in Northern Uganda. METHODS: In December 2009, we identified cases in Kitgum District. The case definition included persons who were previously developmentally normal who had nodding. Cases, further defined as 5- to 15-years-old with an additional neurological deficit, were matched to village controls to assess risk factors and test biological specimens. Logistic regression models were used to evaluate associations. RESULTS: Surveillance identified 224 cases; most (95%) were 5-15-years-old (range = 2-27). Cases were reported in Uganda since 1997. The overall prevalence was 12 cases per 1,000 (range by parish = 0.6-46). The case-control investigation (n = 49 case/village control pairs) showed no association between NS and previously reported measles; sorghum was consumed by most subjects. Positive onchocerciasis serology [age-adjusted odds ratio (AOR1) = 14.4 (2.7, 78.3)], exposure to munitions [AOR1 = 13.9 (1.4, 135.3)], and consumption of crushed roots [AOR1 = 5.4 (1.3, 22.1)] were more likely in cases. Vitamin B6 deficiency was present in the majority of cases (84%) and controls (75%). CONCLUSION: NS appears to be increasing in Uganda since 2000 with 2009 parish prevalence as high as 46 cases per 1,000 5- to 15-year old children. Our results found no supporting evidence for many proposed NS risk factors, revealed association with onchocerciasis, which for the first time was examined with serologic testing, and raised nutritional deficiencies and toxic exposures as possible etiologies. |
Clinical, neurological, and electrophysiological features of nodding syndrome in Kitgum, Uganda: an observational case series
Sejvar JJ , Kakooza AM , Foltz JL , Makumbi I , Atai-Omoruto AD , Malimbo M , Ndyomugyenyi R , Alexander LN , Abang B , Downing RG , Ehrenberg A , Guilliams K , Helmers S , Melstrom P , Olara D , Perlman S , Ratto J , Trevathan E , Winkler AS , Dowell SF , Lwamafa D . Lancet Neurol 2013 12 (2) 166-74 BACKGROUND: Nodding syndrome is an unexplained illness characterised by head-bobbing spells. The clinical and epidemiological features are incompletely described, and the explanation for the nodding and the underlying cause of nodding syndrome are unknown. We aimed to describe the clinical and neurological diagnostic features of this illness. METHODS: In December, 2009, we did a multifaceted investigation to assess epidemiological and clinical illness features in 13 parishes in Kitgum District, Uganda. We defined a case as a previously healthy child aged 5-15 years with reported nodding and at least one other neurological deficit. Children from a systematic sample of a case-control investigation were enrolled in a clinical case series which included history, physical assessment, and neurological examinations; a subset had electroencephalography (EEG), electromyography, brain MRI, CSF analysis, or a combination of these analyses. We reassessed the available children 8 months later. FINDINGS: We enrolled 23 children (median age 12 years, range 7-15 years) in the case-series investigation, all of whom reported at least daily head nodding. 14 children had reported seizures. Seven (30%) children had gross cognitive impairment, and children with nodding did worse on cognitive tasks than did age-matched controls, with significantly lower scores on tests of short-term recall and attention, semantic fluency and fund of knowledge, and motor praxis. We obtained CSF samples from 16 children, all of which had normal glucose and protein concentrations. EEG of 12 children with nodding syndrome showed disorganised, slow background (n=10), and interictal generalised 2.5-3.0 Hz spike and slow waves (n=10). Two children had nodding episodes during EEG, which showed generalised electrodecrement and paraspinal electromyography dropout consistent with atonic seizures. MRI in four of five children showed generalised cerebral and cerebellar atrophy. Reassessment of 12 children found that six worsened in their clinical condition between the first evaluation and the follow-up evaluation interval, as indicated by more frequent head nodding or seizure episodes, and none had cessation or decrease in frequency of these episodes. INTERPRETATION: Nodding syndrome is an epidemic epilepsy associated with encephalopathy, with head nodding caused by atonic seizures. The natural history, cause, and management of the disorder remain to be determined. FUNDING: Division of Global Disease Detection and Emergency Response, US Centers for Disease Control and Prevention. |
Household income disparities in fruit and vegetable consumption by state and territory: results of the 2009 Behavioral Risk Factor Surveillance System
Grimm KA , Foltz JL , Blanck HM , Scanlon KS . J Acad Nutr Diet 2012 112 (12) 2014-21 Few studies take into account the influence of family size on household resources when assessing income disparities in fruit and vegetable (F/V) consumption. Poverty income ratio (PIR) is a measure that utilizes both reported income and household size. We sought to examine state-specific disparities in meeting Healthy People 2010 objectives for F/V consumption by percent PIR. This analysis included 353,005 adults in 54 states and territories reporting data to the 2009 Behavioral Risk Factor Surveillance System in the United States. Percent PIR was calculated using the midpoint of self-reported income range and family size. The prevalences consuming at least two fruits and at least three vegetables per day were examined by percent PIR (<130% [greatest poverty], 130% to <200%, 200% to <400%, and ≥ 400% [least poverty]). The percent of adults consuming vegetables at least three times daily was significantly lower (21.3%) among those living at greatest poverty (<130% PIR) compared with 30.7% among those with least poverty (≥ 400% PIR). Daily consumption of vegetables at least three times was significantly lower among those with greatest poverty in a majority of states and territories surveyed (43 of 54). The overall percent of adults consuming fruits at least 2 times daily was also lower among those living at greatest vs least poverty, but the difference was smaller (32.0% vs 34.2%), with 14 states reporting a difference that was significantly lower among those with greatest poverty. Our study revealed that in 2009 a significantly lower proportion of US adults living at greatest poverty consumed fruits at least two times daily or vegetables at least three times daily compared with those with the least poverty, with greater disparity in vegetable intake. Policy and environmental strategies for increased affordability, access, availability, and point-of-decision information are approaches that may help disparate households purchase and consume F/V. |
Promoting women's health in hospitals: a focus on breastfeeding and lactation support for employees and patients
Belay B , Allen J , Williams N , Dooyema C , Foltz J . J Womens Health (Larchmt) 2012 22 (1) 1-4 Hospitals often are one of the largest employers in communities, and nationwide, they employ more than 6.3 million employees. Hospitals also serve tens of millions of inpatients annually. Hospitals, therefore, can be leaders in worksite wellness and promoting breastfeeding and lactation support for new mothers. By adopting model standards and practices that promote breastfeeding, hospitals can influence women's health. This article focuses on the efforts of the Centers for Disease Control and Prevention's Division of Nutrition, Physical Activity, and Obesity to promote breastfeeding and lactation support for hospital employees and patients. |
Support among U.S. adults for local and state policies to increase fruit and vegetable access
Foltz JL , Harris DM , Blanck HM . Am J Prev Med 2012 43 S102-8 BACKGROUND: Few American children or adults meet national objectives for consumption of both fruits and vegetables (FV). State and local policies that support community access to FV can help support individuals and families in having easier access to FV for purchase and ultimately consumption. PURPOSE: To assess U.S. adult support for state and local policies designed to increase community-level access to FV. METHODS: Data were analyzed from the 2008 HealthStyles survey of U.S. adults (N=5181), in which participants were asked how likely they would be to support four types of changes to local or state policies: those that would create farmers' markets and community gardens, or increase FV offerings in small stores and public sector venues. Respondents' answers were collapsed into three categories ("supportive," "neutral," and "unsupportive"); the prevalence of support for each type of policy was determined, and logistic regression was used to calculate ORs for support of each by selected demographic variables. RESULTS: Overall, 62.1% supported farmers' markets, 57.7% supported the public sector, 54.3% supported small stores, and 47.2% supported community garden policies. Support for policy changes was relatively high among women, Hispanics, and non-Hispanic blacks. CONCLUSIONS: Although some variation in support exists, the majority of Americans support state or local policy changes designed to increase community access to FV. Future research should augment this work by including questions on willingness to pay, trade-off methods, or referendum-style questions to inform priorities among FV policy initiatives. |
Population-level intervention strategies and examples for obesity prevention in children
Foltz JL , May AL , Belay B , Nihiser AJ , Dooyema CA , Blanck HM . Annu Rev Nutr 2012 32 391-415 With obesity affecting approximately 12.5 million American youth, population-level interventions are indicated to help support healthy behaviors. The purpose of this review is to provide a summary of population-level intervention strategies and specific intervention examples that illustrate ways to help prevent and control obesity in children through improving nutrition and physical activity behaviors. Information is summarized within the settings where children live, learn, and play (early care and education, school, community, health care, home). Intervention strategies are activities or changes intended to promote healthful behaviors in children. They were identified from (a) systematic reviews; (b) evidence- and expert consensus-based recommendations, guidelines, or standards from nongovernmental or federal agencies; and finally (c) peer-reviewed synthesis reviews. Intervention examples illustrate how at least one of the strategies was used in a particular setting. To identify interventions examples, we considered (a) peer-reviewed literature as well as (b) additional sources with research-tested and practice-based initiatives. Researchers and practitioners may use this review as they set priorities and promote integration across settings and to find research- and practice-tested intervention examples that can be replicated in their communities for childhood obesity prevention. (Expected final online publication date for the Annual Review of Nutrition Volume 32 is July 17, 2012. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.) |
Strategies for pediatric practitioners to increase fruit and vegetable consumption in children
Kim SA , Grimm KA , May AL , Harris DM , Kimmons J , Foltz JL . Pediatr Clin North Am 2011 58 (6) 1439-53 High intake of fruits and vegetables (FV) is associated with a decreased risk for many chronic diseases and may assist in weight management, but few children and adolescents consume the recommended amounts of FV. The pediatric practitioner can positively influence FV consumption of children through patient-level interventions (eg, counseling, connecting families to community resources), community-level interventions (eg, advocacy, community involvement), and health care facility-level interventions (eg, creating a healthy food environment in the clinical setting). This article reviews the importance of FV consumption, recommended intakes for children, and strategies by which pediatric practitioners can influence FV consumption of children. |
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