Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-15 (of 15 Records) |
Query Trace: Whitehill F [original query] |
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Epidemiologic and genomic evidence for zoonotic transmission of SARS-CoV-2 among people and animals on a Michigan mink farm, United States, 2020
Ghai RR , Straily A , Wineland N , Calogero J , Stobierski MG , Signs K , Blievernicht M , Torres-Mendoza Y , Waltenburg MA , Condrey JA , Blankenship HM , Riner D , Barr N , Schalow M , Goodrich J , Collins C , Ahmad A , Metz JM , Herzegh O , Straka K , Arsnoe DM , Duffiney AG , Shriner SA , Kainulainen MH , Carpenter A , Whitehill F , Wendling NM , Stoddard RA , Retchless AC , Uehara A , Tao Y , Li Y , Zhang J , Tong S , Barton Behravesh C . Viruses 2023 15 (12) Farmed mink are one of few animals in which infection with SARS-CoV-2 has resulted in sustained transmission among a population and spillback from mink to people. In September 2020, mink on a Michigan farm exhibited increased morbidity and mortality rates due to confirmed SARS-CoV-2 infection. We conducted an epidemiologic investigation to identify the source of initial mink exposure, assess the degree of spread within the facility's overall mink population, and evaluate the risk of further viral spread on the farm and in surrounding wildlife habitats. Three farm employees reported symptoms consistent with COVID-19 the same day that increased mortality rates were observed among the mink herd. One of these individuals, and another asymptomatic employee, tested positive for SARS-CoV-2 by real-time reverse transcription PCR (RT-qPCR) 9 days later. All but one mink sampled on the farm were positive for SARS-CoV-2 based on nucleic acid detection from at least one oral, nasal, or rectal swab tested by RT-qPCR (99%). Sequence analysis showed high degrees of similarity between sequences from mink and the two positive farm employees. Epidemiologic and genomic data, including the presence of F486L and N501T mutations believed to arise through mink adaptation, support the hypothesis that the two employees with SARS-CoV-2 nucleic acid detection contracted COVID-19 from mink. However, the specific source of virus introduction onto the farm was not identified. Three companion animals living with mink farm employees and 31 wild animals of six species sampled in the surrounding area were negative for SARS-CoV-2 by RT-qPCR. Results from this investigation support the necessity of a One Health approach to manage the zoonotic spread of SARS-CoV-2 and underscores the critical need for multifaceted public health approaches to prevent the introduction and spread of respiratory viruses on mink farms. |
Mpox respiratory transmission: the state of the evidence.
Beeson A , Styczynski A , Hutson CL , Whitehill F , Angelo KM , Minhaj FS , Morgan C , Ciampaglio K , Reynolds MG , McCollum AM , Guagliardo SAJ . Lancet Microbe 2023 4 (4) e277-e283 The relative contribution of the respiratory route to transmission of mpox (formerly known as monkeypox) is unclear. We review the evidence for respiratory transmission of monkeypox virus (MPXV), examining key works from animal models, human outbreaks and case reports, and environmental studies. Laboratory experiments have initiated MPXV infection in animals via respiratory routes. Some animal-to-animal respiratory transmission has been shown in controlled studies, and environmental sampling studies have detected airborne MPXV. Reports from real-life outbreaks demonstrate that transmission is associated with close contact, and although it is difficult to infer the route of MPXV acquisition in individual case reports, so far respiratory transmission has not been specifically implicated. Based on the available evidence, the likelihood of human-to-human MPXV respiratory transmission appears to be low; however, studies should continue to assess this possibility. |
Environmental persistence of monkeypox virus on surfaces in household of person with travel-associated infection, Dallas, Texas, USA, 2021
Morgan CN , Whitehill F , Doty JB , Schulte J , Matheny A , Stringer J , Delaney LJ , Esparza R , Rao AK , McCollum AM . Emerg Infect Dis 2022 28 (10) 1982-1989 In July 2021, we conducted environmental sampling at the residence of a person in Dallas, Texas, USA, who had travel-associated human West African monkeypox virus (MPXV-WA). Targeted environmental swab sampling was conducted 15 days after the person who had monkeypox left the household. Results indicate extensive MPXV-WA DNA contamination, and viable virus from 7 samples was successfully isolated in cell culture. There was no statistical difference (p = 0.94) between MPXV-WA PCR positivity of porous (9/10, 90%) vs. nonporous (19/21, 90.5%) surfaces, but there was a significant difference (p<0.01) between viable virus detected in cultures of porous (6/10, 60%) vs. nonporous (1/21, 5%) surfaces. These findings indicate that porous surfaces (e.g., bedding, clothing) may pose more of a MPXV exposure risk than nonporous surfaces (e.g., metal, plastic). Viable MPXV was detected on household surfaces after at least 15 days. However, low titers (<10(2) PFU) indicate a limited potential for indirect transmission. |
Epidemiological and clinical characteristics of patients with monkeypox in the GeoSentinel Network: a cross-sectional study
Angelo KM , Smith T , Camprubí-Ferrer D , Balerdi-Sarasola L , Díaz Menéndez M , Servera-Negre G , Barkati S , Duvignaud A , Huber KLB , Chakravarti A , Bottieau E , Greenaway C , Grobusch MP , Mendes Pedro D , Asgeirsson H , Popescu CP , Martin C , Licitra C , de Frey A , Schwartz E , Beadsworth M , Lloveras S , Larsen CS , Guagliardo SAJ , Whitehill F , Huits R , Hamer DH , Kozarsky P , Libman M . Lancet Infect Dis 2022 23 (2) 196-206 BACKGROUND: The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously reported from endemic countries. We aimed to describe the epidemiological and clinical characteristics among individuals with confirmed cases of monkeypox infection. METHODS: We descriptively analysed data for patients with confirmed monkeypox who were included in the GeoSentinel global clinical-care-based surveillance system between May 1 and July 1 2022, across 71 clinical sites in 29 countries. Data collected included demographics, travel history including mass gathering attendance, smallpox vaccination history, social history, sexual history, monkeypox exposure history, medical history, clinical presentation, physical examination, testing results, treatment, and outcomes. We did descriptive analyses of epidemiology and subanalyses of patients with and without HIV, patients with CD4 counts of less than 500 cells per mm(3) or 500 cells per mm(3) and higher, patients with one sexual partner or ten or more sexual partners, and patients with or without a previous smallpox vaccination. FINDINGS: 226 cases were reported at 18 sites in 15 countries. Of 211 men for whom data were available, 208 (99%) were gay, bisexual, or men who have sex with men (MSM) with a median age of 37 years (range 18-68; IQR 32-43). Of 209 patients for whom HIV status was known, 92 (44%) men had HIV infection with a median CD4 count of 713 cells per mm(3) (range 36-1659; IQR 500-885). Of 219 patients for whom data were available, 216 (99%) reported sexual or close intimate contact in the 21 days before symptom onset; MSM reported a median of three partners (IQR 1-8). Of 195 patients for whom data were available, 78 (40%) reported close contact with someone who had confirmed monkeypox. Overall, 30 (13%) of 226 patients were admitted to hospital; 16 (53%) of whom had severe illness, defined as hospital admission for clinical care rather than infection control. No deaths were reported. Compared with patients without HIV, patients with HIV were more likely to have diarrhoea (p=0·002), perianal rash or lesions (p=0·03), and a higher rash burden (median rash burden score 9 [IQR 6-21] for patients with HIV vs median rash burden score 6 [IQR 3-14] for patients without HIV; p<0·0001), but no differences were identified in the proportion of men who had severe illness by HIV status. INTERPRETATION: Clinical manifestations of monkeypox infection differed by HIV status. Recommendations should be expanded to include pre-exposure monkeypox vaccination of groups at high risk of infection who plan to engage in sexual or close intimate contact. FUNDING: US Centers for Disease Control and Prevention, International Society of Travel Medicine. |
Monkeypox outbreak - nine states, May 2022
Minhaj FS , Ogale YP , Whitehill F , Schultz J , Foote M , Davidson W , Hughes CM , Wilkins K , Bachmann L , Chatelain R , Donnelly MAP , Mendoza R , Downes BL , Roskosky M , Barnes M , Gallagher GR , Basgoz N , Ruiz V , Kyaw NTT , Feldpausch A , Valderrama A , Alvarado-Ramy F , Dowell CH , Chow CC , Li Y , Quilter L , Brooks J , Daskalakis DC , McClung RP , Petersen BW , Damon I , Hutson C , McQuiston J , Rao AK , Belay E , McCollum AM . MMWR Morb Mortal Wkly Rep 2022 71 (23) 764-769 On May 17, 2022, the Massachusetts Department of Public Health (MDPH) Laboratory Response Network (LRN) laboratory confirmed the presence of orthopoxvirus DNA via real-time polymerase chain reaction (PCR) from lesion swabs obtained from a Massachusetts resident. Orthopoxviruses include Monkeypox virus, the causative agent of monkeypox. Subsequent real-time PCR testing at CDC on May 18 confirmed that the patient was infected with the West African clade of Monkeypox virus. Since then, confirmed cases* have been reported by nine states. In addition, 28 countries and territories,(†) none of which has endemic monkeypox, have reported laboratory-confirmed cases. On May 17, CDC, in coordination with state and local jurisdictions, initiated an emergency response to identify, monitor, and investigate additional monkeypox cases in the United States. This response has included releasing a Health Alert Network (HAN) Health Advisory, developing interim public health and clinical recommendations, releasing guidance for LRN testing, hosting clinician and public health partner outreach calls, disseminating health communication messages to the public, developing protocols for use and release of medical countermeasures, and facilitating delivery of vaccine postexposure prophylaxis (PEP) and antivirals that have been stockpiled by the U.S. government for preparedness and response purposes. On May 19, a call center was established to provide guidance to states for the evaluation of possible cases of monkeypox, including recommendations for clinical diagnosis and orthopoxvirus testing. The call center also gathers information about possible cases to identify interjurisdictional linkages. As of May 31, this investigation has identified 17(§) cases in the United States; most cases (16) were diagnosed in persons who identify as gay, bisexual, or men who have sex with men (MSM). Ongoing investigation suggests person-to-person community transmission, and CDC urges health departments, clinicians, and the public to remain vigilant, institute appropriate infection prevention and control measures, and notify public health authorities of suspected cases to reduce disease spread. Public health authorities are identifying cases and conducting investigations to determine possible sources and prevent further spread. This activity was reviewed by CDC and conducted consistent with applicable federal law and CDC policy.(¶). |
Use of JYNNEOS (smallpox and monkeypox vaccine, live, nonreplicating) for preexposure vaccination of persons at risk for occupational exposure to orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022
Rao AK , Petersen BW , Whitehill F , Razeq JH , Isaacs SN , Merchlinsky MJ , Campos-Outcalt D , Morgan RL , Damon I , Sánchez PJ , Bell BP . MMWR Morb Mortal Wkly Rep 2022 71 (22) 734-742 Certain laboratorians and health care personnel can be exposed to orthopoxviruses through occupational activities. Because orthopoxvirus infections resulting from occupational exposures can be serious, the Advisory Committee on Immunization Practices (ACIP) has continued to recommend preexposure vaccination for these persons since 1980 (1), when smallpox was eradicated (2). In 2015, ACIP made recommendations for the use of ACAM2000, the only orthopoxvirus vaccine available in the United States at that time (3). During 2020-2021, ACIP considered evidence for use of JYNNEOS, a replication-deficient Vaccinia virus vaccine, as an alternative to ACAM2000. In November 2021, ACIP unanimously voted in favor of JYNNEOS as an alternative to ACAM2000 for primary vaccination and booster doses. With these recommendations for use of JYNNEOS, two vaccines (ACAM2000 and JYNNEOS) are now available and recommended for preexposure prophylaxis against orthopoxvirus infection among persons at risk for such exposures. |
Rabies in a dog imported from Azerbaijan - Pennsylvania, 2021
Whitehill F , Bonaparte S , Hartloge C , Greenberg L , Satheshkumar PS , Orciari L , Niezgoda M , Yager PA , Pieracci EG , McCullough J , Evenson A , Brown CM , Schnitzler H , Lipton B , Signs K , Stobierski MG , Austin C , Slager S , Ernst M , Kerins J , Simeone A , Singh A , Hale S , Stanek D , Shehee P , Slavinski S , McDermott D , Zinna PA , Campagna R , Wallace RM . MMWR Morb Mortal Wkly Rep 2022 71 (20) 686-689 On June 16, 2021, rabies virus infection was confirmed in a dog included in a shipment of rescue animals imported into the United States from Azerbaijan. A multistate investigation was conducted to prevent secondary rabies cases, avoid reintroduction of a dog-maintained rabies virus variant (DMRVV), identify persons who might have been exposed and would be recommended to receive rabies postexposure prophylaxis, and investigate the cause of importation control failures. Results of a prospective serologic monitoring (PSM) protocol suggested that seven of 32 (22%) animals from the same shipment as the dog with confirmed rabies virus infection and who had available titer results after rabies vaccine booster had not been adequately vaccinated against rabies before importation. A requirement for rabies vaccination certificates alone will not adequately identify improper vaccination practices or fraudulent paperwork and are insufficient as a stand-alone rabies importation prevention measure. Serologic titers before importation would mitigate the risk for importing DMRVV. |
Use of a modified preexposure prophylaxis vaccination schedule to prevent human rabies: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022
Rao AK , Briggs D , Moore SM , Whitehill F , Campos-Outcalt D , Morgan RL , Wallace RM , Romero JR , Bahta L , Frey SE , Blanton JD . MMWR Morb Mortal Wkly Rep 2022 71 (18) 619-627 Human rabies is an acute, progressive encephalomyelitis that is nearly always fatal once symptoms begin. Several measures have been implemented to prevent human rabies in the United States, including vaccination of targeted domesticated and wild animals, avoidance of behaviors that might precipitate an exposure (e.g., provoking high-risk animals), awareness of the types of animal contact that require postexposure prophylaxis (PEP), and use of proper personal protective equipment when handling animals or laboratory specimens. PEP is widely available in the United States and highly effective if administered after an exposure occurs. A small subset of persons has a higher level of risk for being exposed to rabies virus than does the general U.S. population; these persons are recommended to receive preexposure prophylaxis (PrEP), a series of human rabies vaccine doses administered before an exposure occurs, in addition to PEP after an exposure. PrEP does not eliminate the need for PEP; however, it does simplify the rabies PEP schedule (i.e., eliminates the need for rabies immunoglobulin and decreases the number of vaccine doses required for PEP). As rabies epidemiology has evolved and vaccine safety and efficacy have improved, Advisory Committee on Immunization Practices (ACIP) recommendations to prevent human rabies have changed. During September 2019-November 2021, the ACIP Rabies Work Group considered updates to the 2008 ACIP recommendations by evaluating newly published data, reviewing frequently asked questions, and identifying barriers to adherence to previous ACIP rabies vaccination recommendations. Topics were presented and discussed during six ACIP meetings. The following modifications to PrEP are summarized in this report: 1) redefined risk categories; 2) fewer vaccine doses in the primary vaccination schedule; 3) flexible options for ensuring long-term protection, or immunogenicity; 4) less frequent or no antibody titer checks for some risk groups; 5) a new minimum rabies antibody titer (0.5 international units [IUs]) per mL); and 6) clinical guidance, including for ensuring effective vaccination of certain special populations. |
Risk factors for hospitalization among adults aged 65years with non-typhoidal Salmonella infection linked to backyard poultry contact
Whitehill FM , Stapleton GS , Koski L , Sievert D , Nichols M . Zoonoses Public Health 2022 69 (3) 215-223 OBJECTIVE: We describe the epidemiology of live poultry-associated salmonellosis (LPAS) and investigate potential risk factors associated with hospitalization among adults aged ≥65 years in the United States during 2008-2017. LPAS is a public health concern in the United States, especially among people with increased risk for hospitalization, such as older adults. SAMPLE: We analysed data from people aged ≥65 years with non-typhoidal salmonellosis who reported live poultry contact within seven days prior to illness onset. PROCEDURE: We used logistic regression to estimate the odds of hospitalization associated with several risk factors including types of live poultry contact exposures. RESULTS: LPAS among older adults in this analysis resulted in high hospitalization rates. Salmonella Hadar infection was associated with increased hospitalization. Among older adults with LPAS, 109 individuals of 127 (86%) reported contact with live poultry at their or someone else's residence, and 85 of 105 with available information (81%) reported owning poultry. CONCLUSIONS AND CLINICAL RELEVANCE: Additional infection prevention information and education targeted at poultry-owning older adults are needed to prevent illness and hospitalization. |
Notes from the Field: Three Human Rabies Deaths Attributed to Bat Exposures - United States, August 2021
Kunkel A , Minhaj FS , Whitehill F , Austin C , Hahn C , Kieffer AJ , Mendez L , Miller J , Tengelsen LA , Gigante CM , Orciari LA , Rao AK , Wallace RM . MMWR Morb Mortal Wkly Rep 2022 71 (1) 31-32 During September 28–November 10, 2021, CDC confirmed three human rabies deaths in the United States, all in persons who did not seek postexposure prophylaxis (PEP) after bat exposures that occurred during August 2021. This increase in bat-associated human rabies deaths in the United States followed only three deaths during the previous 48 months. The cases during fall 2021 occurred in two adults and one child, all male, from Idaho, Illinois, and Texas. Initial symptoms included pain and paresthesia near the site of exposure progressing to dysphagia, altered mental status, paralysis, seizure-like activity, and autonomic instability. All three patients had recognized direct contact (e.g., bite or collision) with a bat approximately 3–7 weeks before symptom onset and died approximately 2–3 weeks after symptom onset. The deaths were associated with three bat species: Lasionycteris noctivagans (silver-haired bat), Tadarida brasiliensis (Mexican free-tailed bat), and Eptesicus fuscus (big brown bat) (Figure). All three species are common in the United States and have been implicated in previous rabies cases. One patient submitted the bat responsible for exposure for testing but refused PEP, despite the bat testing positive for rabies virus, due to a long-standing fear of vaccines. The other two patients did not realize the risk for rabies from their exposures, either because they did not notice a bite or scratch or did not recognize bats as a potential source of rabies. Case and contact investigations were led by the appropriate state and local health departments, and all human laboratory testing occurred at CDC. This activity was reviewed by CDC and conducted consistent with applicable federal law and CDC policy.* |
Approaches for Implementing Healthy Food Interventions in Settings With Limited Resources: A Case Study of Sodium Reduction Interventions in Emergency Food Programs Addressing Food Insecurity
Strazza K , Jordan J , Ferriola-Bruckenstein K , Kane H , Whitehill J , Teachout E , Yarnoff B . Am J Health Promot 2021 36 (3) 8901171211056121 PURPOSE: This study describes how recipients of the Centers for Disease Control and Prevention funded Sodium Reduction in Communities Program (SRCP) worked with emergency food programs to improve access to healthy food to address chronic conditions. DESIGN: SRCP recipients partnered with emergency food programs to implement sodium reduction strategies including nutrition standards, procurement practices, environmental strategies, and behavioral economics approaches. SETTING: SRCP recipients and emergency food programs in Washington County and Benton County, Arkansas and King County, Washington. SUBJECTS: SRCP recipient staff, emergency food program staff, and key stakeholders. MEASURES: We conducted semi-structured interviews with key stakeholders and systematic review of program documents. ANALYSIS: Data were analyzed using effects matrices for each recipient. Matrices were organized using select implementation science constructs and compared in a cross-case analysis. RESULTS: Despite limited resources, emergency food programs can implement sodium reduction interventions which may provide greater access to healthy foods and lead to reductions in health disparities. Emergency food programs successfully implemented sodium reduction interventions by building on the external and internal settings; selecting strategies that align with existing processes; implementing change incrementally and engaging staff, volunteers, and clients; and sustaining changes. CONCLUSION: Findings contribute to understanding the ways in which emergency food programs and other organizations with limited resources have implemented public health nutrition interventions addressing food insecurity and improving access to healthy foods. These strategies may be transferable to other settings with limited resources. |
Estimating the Cost-Effectiveness of the Sodium Reduction in Communities Program
Yarnoff B , Teachout E , MacLeod KE , Whitehill J , Jordan J , Tayebali Z , Bates L . Public Health Nutr 2021 25 (4) 1-29 OBJECTIVE: This study assessed the cost-effectiveness of the Centers for Disease Control and Prevention's (CDC's) Sodium Reduction in Communities Program (SRCP). DESIGN: We collected implementation costs and performance measure indicators from SRCP recipients and their partner food service organizations. We estimated the cost per person and per food service organization reached and the cost per menu item impacted. We estimated the short-term effectiveness of SRCP in reducing sodium consumption and used it as an input in the Prevention Impact Simulation Model to project the long-term impact on medical cost savings and quality adjusted life years gained due to a reduction in cardiovascular disease and estimate the cost-effectiveness of SRCP if sustained through 2025 and 2040. SETTING: CDC funded eight recipients as part of the 2016-2021 round of the Sodium Reduction in Communities Program (SRCP) to work with food service organizations in eight settings to increase the availability and purchase of lower-sodium food options. PARTICIPANTS: Eight SRCP recipients and 20 of their partners. RESULTS: At the recipient level, average cost per person reached was $10, and average cost per food service organization reached was $42,917. At the food service organization level, median monthly cost per food item impacted by recipe modification or product substitution was $684. Cost-effectiveness analyses showed that, if sustained, the program is cost saving (i.e. the reduction in medical costs is greater than the implementation costs) in the target population by $1.82 through 2025 and $2.09 through 2040. CONCLUSIONS: By providing evidence of the cost-effectiveness of a real-world sodium reduction initiative, this study can help inform decisions by public health organizations about related cardiovascular disease prevention interventions. |
A Preparedness Model for Mother-Baby Linked Longitudinal Surveillance for Emerging Threats.
Woodworth KR , Reynolds MR , Burkel V , Gates C , Eckert V , McDermott C , Barton J , Wilburn A , Halai UA , Brown CM , Bocour A , Longcore N , Orkis L , Lopez CD , Sizemore L , Ellis EM , Schillie S , Gupta N , Bowen VB , Torrone E , Ellington SR , Delaney A , Olson SM , Roth NM , Whitehill F , Zambrano LD , Meaney-Delman D , Fehrenbach SN , Honein MA , Tong VT , Gilboa SM . Matern Child Health J 2021 25 (2) 1-9 INTRODUCTION: Public health responses often lack the infrastructure to capture the impact of public health emergencies on pregnant women and infants, with limited mechanisms for linking pregnant women with their infants nationally to monitor long-term effects. In 2019, the Centers for Disease Control and Prevention (CDC), in close collaboration with state, local, and territorial health departments, began a 5-year initiative to establish population-based mother-baby linked longitudinal surveillance, the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). OBJECTIVES: The objective of this report is to describe an expanded surveillance approach that leverages and modernizes existing surveillance systems to address the impact of emerging health threats during pregnancy on pregnant women and their infants. METHODS: Mother-baby pairs are identified through prospective identification during pregnancy and/or identification of an infant with retrospective linking to maternal information. All data are obtained from existing data sources (e.g., electronic medical records, vital statistics, laboratory reports, and health department investigations and case reporting). RESULTS: Variables were selected for inclusion to address key surveillance questions proposed by CDC and health department subject matter experts. General variables include maternal demographics and health history, pregnancy and infant outcomes, maternal and infant laboratory results, and child health outcomes up to the second birthday. Exposure-specific modular variables are included for hepatitis C, syphilis, and Coronavirus Disease 2019 (COVID-19). The system is structured into four relational datasets (maternal, pregnancy outcomes and birth, infant/child follow-up, and laboratory testing). DISCUSSION: SET-NET provides a population-based mother-baby linked longitudinal surveillance approach and has already demonstrated rapid adaptation to COVID-19. This innovative approach leverages existing data sources and rapidly collects data and informs clinical guidance and practice. These data can help to reduce exposure risk and adverse outcomes among pregnant women and their infants, direct public health action, and strengthen public health systems. |
CDC's Sodium Reduction in Communities Program: Evaluating differential effects in food service settings, 2013-2016
Jordan J , Hickner H , Whitehill J , Yarnoff B . Prev Chronic Dis 2020 17 E72 High sodium intake can lead to hypertension and increase the risk for heart disease and stroke; however, research is lacking on the effectiveness of community-based sodium reduction programs. From 2013 through 2016, the Centers for Disease Control and Prevention (CDC) funded 10 state and local health departments to implement sodium reduction strategies across diverse institutional food settings. Strategies of the Sodium Reduction in Communities Program (SRCP) are implementing food service guidelines, making menu modifications, enabling purchase of reuced-sodium foods, and providing consumer information. CDC aggregated awardee-reported performance measures to evaluate progress in increasing the access, availability, and purchase of reduced sodium foods. Evaluation results of the SRCP show the potential differential effects of sodium reduction strategies in a community setting and support the need for additional community-level efforts in this emerging area of public health. |
Value of a facilitated quality improvement initiative on cardiovascular disease risk: findings from an evaluation of the Aggressively Treating Global Cardiometabolic Risk Factors to Reduce Cardiovascular Events (AT GOAL)
Losby JL , Osuji TA , House MJ , Davis R , Boyce SP , Greenberg MC , Whitehill JM Jr . J Eval Clin Pract 2015 21 (5) 963-70 RATIONALE, AIMS AND OBJECTIVES: In the United States, cardiovascular disease (CVD) is the leading cause of death. The US Centers for Disease Control and Prevention contracted an evaluation of the Aggressively Treating Global Cardiometabolic Risk Factors to Reduce Cardiovascular Events (AT GOAL) programme as part of its effort to identify strategies to address CVD risk factors. METHODS: This study analysed patient-level data from 7527 patients in 43 primary care practices. The researchers assessed average change in control rates for CVD-related measures across practices, and then across patients between baseline and a patient's last visit during the practice's tenure in the programme (referred to as 'end line') using repeated measures analysis of variance and random effects generalized least squares, respectively. RESULTS: Among non-diabetic patients, there were significant increases in control rates for overall blood pressure (74.3% to 78.0%, P = 0.0002), systolic blood pressure (70.3% to 80.6%, P = 0.0099), diastolic blood pressure (90.1% to 92.7%, P = 0.0001) and low-density lipoprotein (LDL; 48.6% to 53.1%, P = 0.0001) between baseline and end line. Among diabetic patients, there was a significant increase in diastolic blood pressure control (59.8% to 61.9%, P = 0.0141). While continuous CVD-related outcomes show an overall trend between baseline and end line, patients with uncontrolled measures at baseline showed a decrease between baseline and end line relative to their counterparts who were controlled at baseline. CONCLUSIONS: Findings from the AT GOAL evaluation support the value of a facilitated quality improvement (QI) initiative on managing CVD risk. |
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