Archive
Sequestering Meals on Wheels Could Cost the Nation $489 Million per Year
Sequestering Meals on Wheels Could Cost the Nation $489 Million per Year
Source: Center for Effective Government
Sequestering Meals on Wheels funds could cost taxpayers far more than it saves. While across-the-board spending cuts that began March 1, called sequestration, are expected to reduce spending on Meals on Wheels programs this year by an estimated $10 million, these savings will be dwarfed by at least $489 million per year in increased spending on Medicaid, both this year and in each subsequent year that sequestration remains in place.
Outside of Washington, waiting lists for Meals on Wheels enrollees have received media attention, but the expected savings have remained largely unquestioned. In reality, cutting Meals on Wheels will very likely increase the federal deficit by increasing the overall cost burden and shifting it to Medicaid, local charities, and other programs.
Overall, Meals on Wheels saves the federal taxpayers money by helping participants live at home instead of living in comparatively expensive nursing homes. The average cost to Medicaid of nursing home care per patient is approximately $57,878 annually.
By contrast, the cost to Medicaid of home care is much lower, approximately $15,371 annually, or $42,507 less than nursing home care. Nationally, according to a survey by the Administration on Aging, as many as "92% [of enrollees] say Meals on Wheels means they can continue to live in their own home."
Based on these estimates, our analysis suggests that sequestering Meals on Wheels funds will actually cost the U.S. taxpayer $479 million dollars over the seven months it will be implemented during this federal fiscal year, which ends September 30 (see the appendix for details of this estimate). Moreover, because sequestration-related cuts are expected to increase in FY 2014 and beyond, if sequestration is not reversed, Medicaid-related costs will increase even more in those years.
The Racial/Ethnic Distribution of Heat Risk-Related Land Cover in Relation to Residential Segregation
Source: Environmental Health Perspectives
Objective: To examine the distribution of heat risk-related land cover (HRRLC) characteristics across racial/ethnic groups and degrees of residential segregation.
Methods: Block group-level tree canopy and impervious surface estimates were derived from the 2001 National Land Cover Dataset for densely populated urban areas of the United States and Puerto Rico, and linked to demographic characteristics from the 2000 Census. Racial/ethnic groups in a given block group were considered to live in HRRLC if at least half their population experienced the absence of tree canopy and at least half of the ground covered by impervious surface (roofs, driveways, sidewalks, roads). Residential segregation was characterized for metropolitan areas in the United States and Puerto Rico using the multigroup dissimilarity index.
Results: After adjusting for ecoregion and precipitation, and holding segregation level constant, non-Hispanic blacks were 52% more likely (95% confidence interval (CI): 37% to 69%), non-Hispanic Asians 32% more likely (95% CI: 18% to 47%), and Hispanics 21% more likely (95% CI: 8% to 35%) to live in HRRLC conditions compared to non-Hispanic whites. Within each racial/ethnic group, HRRLC conditions increased with increasing degrees of metropolitan area-level segregation. Further adjustment for home ownership and poverty did not substantially alter these results, but adjustment for population density and metropolitan area population attenuated the segregation effects, suggesting a mediating or confounding role.
Conclusions: Land cover was associated with segregation within each racial/ethnic group, which may be partially explained by the concentration of racial/ethnic minorities into densely populated neighborhoods within larger, more segregated cities. In anticipation of greater frequency and duration of extreme heat events, climate change adaptation strategies, such as planting trees in urban areas, should explicitly incorporate an environmental justice framework that addresses racial/ethnic disparities in HRRLC.
See: Racial minorities live on the front lines of heat risk, study finds (EurekAlert!)
CDC — Fact Sheets on Insufficient Sleep by State
Fact Sheets on Insufficient Sleep by State
Source: Centers for Disease Control and Prevention
Fact sheets on insufficient sleep are available for all 50 states, the District of Columbia, and three U.S. territories (Puerto Rico, Guam, and the Virgin Islands). Each fact sheet includes a table with the prevalence of insufficient rest or sleep (≥ 14 days in past 30 days) among adults in the state or territory by sex, age, race/ethnicity, education, employment status, marital status, presence of children in the home, and body mass index (a measure of excess weight). The fact sheet also includes a map that presents the prevalence of insufficient sleep among adults of the state or territory by region.
Select a state or territory from the drop-down menu or from the map to open that state’s or territory’s fact sheet (in PDF format).
Sodium Intake in Populations: Assessment of Evidence
Sodium Intake in Populations: Assessment of Evidence
Source: Institute of Medicine
From press release:
Recent studies that examine links between sodium consumption and health outcomes support recommendations to lower sodium intake from the very high levels some Americans consume now, but evidence from these studies does not support reduction in sodium intake to below 2,300 mg per day, says a new report from the Institute of Medicine.
Despite efforts over the past several decades to reduce dietary intake of sodium, a main component of table salt, the average American adult still consumes 3,400 mg or more of sodium a day – equivalent to about 1 ½ teaspoons of salt. The current Dietary Guidelines for Americans urge most people ages 14 to 50 to limit their sodium intake to 2,300 mg daily. People ages 51 or older, African Americans, and people with hypertension, diabetes, or chronic kidney disease – groups that together make up more than 50 percent of the U.S. population – are advised to follow an even stricter limit of 1,500 mg per day. These recommendations are based largely on a body of research that links higher sodium intakes to certain “surrogate markers” such as high blood pressure, an established risk factor for heart disease.
The expert committee that wrote the new report reviewed recent studies that in contrast examined how sodium consumption affects direct health outcomes like heart disease and death. “These new studies support previous findings that reducing sodium from very high intake levels to moderate levels improves health,” said committee chair Brian Strom, George S. Pepper Professor of Public Health and Preventive Medicine at the University of Pennsylvania Perelman School of Medicine. “But they also suggest that lowering sodium intake too much may actually increase a person’s risk of some health problems.”
Self-Reported Increased Confusion or Memory Loss and Associated Functional Difficulties Among Adults Aged ≥60 Years — 21 States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)
Declines in cognitive function vary among persons and can include changes in attention, memory, learning, executive function, and language capabilities that negatively affect quality of life, personal relationships, and the capacity for making informed decisions about health care and other matters (1). Memory problems typically are one of the first warning signs of cognitive decline, and mild cognitive impairment might be present when memory problems are greater than normal for a person’s age but not as severe as problems experienced with Alzheimer’s disease (2,3). Some, but not all, persons with mild cognitive impairment develop Alzheimer’s disease; others can recover from mild cognitive impairment if certain causes (e.g., medication side effects or depression) are detected and treated (3). In 2012, the U.S. Department of Health and Human Services published the National Plan to Address Alzheimer’s Disease, calling for expanding data collection and surveillance efforts to track the prevalence and impact of Alzheimer’s and other types of dementia (4). To estimate the prevalence of self-reported increased confusion or memory loss and associated functional difficulties among adults aged ≥60 years, CDC analyzed data from 21 states that administered an optional module in the 2011 Behavioral Risk Factor Surveillance System (BRFSS) survey. The results indicated that 12.7% of respondents reported increased confusion or memory loss in the preceding 12 months. Among those reporting increased confusion or memory loss, 35.2% reported experiencing functional difficulties. These results provide baseline information about the number of noninstitutionalized older adults with increased confusion or memory loss that is causing functional difficulties and might require services and supports now or in the future.
New From the GAO
New GAO Reports
Source: Government Accountability Office
1. Agricultural Research: Two USDA Agencies Can Enhance Safeguards against Project Duplication and Strengthen Collaborative Planning. GAO-13-255, April 12.
http://www.gao.gov/products/GAO-13-255
Highlights – http://www.gao.gov/assets/660/653753.pdf
2. Management Report: Improvements Are Needed to Enhance the Internal Revenue Service’s Internal Controls. GAO-13-420R, May 13.
http://www.gao.gov/products/GAO-13-420R
3. President’s Emergency Plan for AIDS Relief: Shift toward Partner-Country Treatment Programs Will Require Better Information on Results. GAO-13-460, April 12.
http://www.gao.gov/products/GAO-13-460
Highlights – http://www.gao.gov/assets/660/653767.pdf
4. Defense Logistics: The Department of Defense’s Report on Strategic Seaports Addressed All Congressionally Directed Elements. GAO-13-511R, May 13.
http://www.gao.gov/products/GAO-13-511R
‘Globesization’: ecological evidence on the relationship between fast food outlets and obesity among 26 advanced economies
‘Globesization’: ecological evidence on the relationship between fast food outlets and obesity among 26 advanced economies
Source: Critical Public Health
The aim of this study was to investigate the relationship between the density of fast food restaurants and the prevalence of obesity by gender across affluent nations. Data on Subway’s restaurants per 100,000 people and proportions of men and women aged 15 years or older with a body mass index higher or equal than 30 kg/m2 were obtained for 26 of 34 advanced economies. Countries with the highest density of Subway restaurants such as the USA (7.52 per 100,000) and Canada (7.43 per 100,000) also tend to have a higher prevalence of obesity in both men (31.3% and 23.2%, respectively) and women (33.2% and 22.9%, respectively). On the other hand, countries with a relatively low density of Subway restaurants such as Japan (0.13 per 100,000) and Norway (0.19 per 100,000) had a lower prevalence of obesity in both men (2.9% and 6.4%, respectively) and women (3.3% and 5.9%, respectively). Unadjusted linear regression models showed a significant correlation between the density of Subway’s outlets and the prevalence of adult obesity (β = 0.46; p = 0.02 in men and β = 0.48; p = 0.013 in women). When the data were weighted by population size, the associations became substantially stronger in both men and women (β = 0.85; p = 0.0001 and β = 0.84; p = 0.0001, respectively). Covariate adjustment did not reduce the size of the associations. Our study raises serious concerns about the diffusion of fast food outlets worldwide and calls for coordinated political actions to address what we term ‘globesization’, the ongoing globalization of the obesity epidemic.
The effect of physicians’ body weight on patient attitudes: implications for physician selection, trust and ad herence to medical advice
Source: International Journal of Obesity
Background:
Research has documented negative stigma by health providers toward overweight and obese patients, but it is unknown whether physicians themselves are vulnerable to weight bias from patients.
Purpose:
This study assessed public perceptions of normal weight, overweight or obese physicians to identify how physicians’ body weight affects patients’ selection, trust and willingness to follow the medical advice of providers.
Methods:
An online sample of 358 adults were randomly assigned to one of three survey conditions in which they completed a questionnaire assessing their perceptions of physicians who were described as normal weight, overweight or obese. Participants also completed a measure of explicit weight bias (Fat Phobia Scale) to determine whether antifat attitudes are associated with weight-related perceptions of physicians.
Results:
Respondents reported more mistrust of physicians who are overweight or obese, were less inclined to follow their medical advice, and were more likely to change providers if the physician was perceived to be overweight or obese, compared to normal-weight physicians who elicited significantly more favorable reactions. These weight biases remained present regardless of participants’ own body weight. Inspection of interaction effects revealed opposing effects of weight bias between the obese/overweight and normal-weight physician conditions. Stronger weight bias led to higher trust, more compassion, more inclination to follow advice, and less inclination to change doctors when the physician was presented as normal weight. In contrast, stronger weight bias led to less trust, less compassion, less inclination to follow advice and higher inclination to change doctors when the physician was presented as obese.
Conclusions:
This study suggests that providers perceived to be overweight or obese may be vulnerable to biased attitudes from patients, and that providers’ excess weight may negatively affect patients’ perceptions of their credibility, level of trust and inclination to follow medical advice.
State-Specific Prevalence of Walking Among Adults with Arthritis — United States, 2011
State-Specific Prevalence of Walking Among Adults with Arthritis — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)
Walking contributes to total physical activity and is an appropriate activity to increase overall physical activity levels among adults with arthritis. Walking also is the most preferred exercise among arthritis patients (1,2) and has been shown to improve arthritis symptoms, physical function, gait speed, and quality of life (3–5). To estimate the distribution of average weekly minutes of walking among adults with arthritis by state and map the prevalence of low amounts of walking (<90 minutes per week) among adults with arthritis, CDC analyzed data from the 2011 Behavioral Risk Factor Surveillance System (BRFSS). This report describes the results of that analysis, which indicated that among adults with arthritis in the 50 states and the District of Columbia (DC), the median prevalence of walking was 53% (range: 44.3%–66.2%) for 0 minutes per week, 13.1% (range: 9.3%–16.2%) for 1–89 minutes per week, 5.3% (range: 3.2%–6.8%) for 90–119 minutes per week, 5.6% (range: 2.6%–8.3%) for 120–149 minutes per week, and 23.2% (range: 16.0%–30.6%) for ≥150 minutes per week. A state median of 66% of adults with arthritis walked <90 minutes per week, ranging from a low of 58.0% in California to a high of 76.2% in Tennessee. The large number of persons with arthritis who are not getting the full benefit of regular walking might benefit from community interventions aimed at increasing access to walking as well as specific programs that offer social support.
Seasonal Allergies and Complementary Health Practices
Seasonal Allergies and Complementary Health Practices
Source: National Center for Complementary and Alternative Medicine
Seasonal allergies, also called “hay fever,” are a common chronic medical problem. At least 17.7 million American adults (7.8 percent of the adult population) and 7 million children (about 9 percent of children) have seasonal allergies.
People manage seasonal allergies by taking medication, avoiding exposure to the substances that trigger their allergic reactions, having a series of “allergy shots” (a form of immunotherapy) or using various complementary approaches. According to the 2007 National Health Interview Survey, “respiratory allergy” is among the 15 conditions for which children in the United States use complementary approaches most frequently. This issue of the Digest provides information on what the science says about several complementary health approaches for seasonal allergies, such as saline nasal irrigation, butterbur, honey, acupuncture, and other practices.
Food-Related Parenting Practices and Adolescent Weight Status: A Population-Based Study
Food-Related Parenting Practices and Adolescent Weight Status: A Population-Based Study
Source: Pediatrics
OBJECTIVE: To examine food-related parenting practices (pressure-to-eat and food restriction) among mothers and fathers of adolescents and associations with adolescent weight status within a large population-based sample of racially/ethnically and socioeconomically diverse parent-adolescent pairs.
METHODS: Adolescents (N = 2231; 14.4 years old [SD = 2.0]) and their parents (N = 3431) participated in 2 coordinated population-based studies designed to examine factors associated with weight status and weight-related behaviors in adolescents. Adolescents completed anthropometric measurements and surveys at school. Parents (or other caregivers) completed questionnaires via mail or phone.
RESULTS: Findings suggest that the use of controlling food-related parenting practices, including pressure-to-eat and restriction, is common among parents of adolescents. Mean restriction levels were significantly higher among parents of overweight and obese adolescents compared with nonoverweight adolescents. However, levels of pressure-to-eat were significantly higher among nonoverweight adolescents. Results indicate that fathers are more likely than mothers to engage in pressure-to-eat behaviors and boys are more likely than girls to be on the receiving end of parental pressure-to-eat. Parental report of restriction did not differ significantly by parent or adolescent gender. No significant interactions by race/ethnicity or socioeconomic status were seen in the relationship between restriction or pressure-to-eat and adolescent weight status.
CONCLUSIONS: Given that there is accumulating evidence for the detrimental effects of controlling feeding practices on children’s ability to self-regulate energy intake, these findings suggest that parents should be educated and empowered through anticipatory guidance to encourage moderation rather than overconsumption and emphasize healthful food choices rather than restrictive eating patterns.
Supplemental Nutrition Assistance Program: Examining the Evidence to Define Benefit Adequacy
Supplemental Nutrition Assistance Program: Examining the Evidence to Define Benefit Adequacy
Source: Institute of Medicine
For many Americans who live at or below the poverty threshold, access to healthy foods at a reasonable price is a challenge that often places a strain on already limited resources and may compel them to make food choices that are contrary to current nutritional guidance. To help alleviate this problem, the U.S. Department of Agriculture (USDA) administers a number of nutrition assistance programs designed to improve access to healthy foods for low-income individuals and households. The largest of these programs is the Supplemental Nutrition Assistance Program (SNAP), formerly called the Food Stamp Program, which today serves more than 46 million Americans with a program cost in excess of $75 billion annually. The goals of SNAP include raising the level of nutrition among low-income households and maintaining adequate levels of nutrition by increasing the food purchasing power of low-income families.
In response to questions about whether there are different ways to define the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, USDA’s Food and Nutrition Service (FNS) asked the Institute of Medicine (IOM) to conduct a study to examine the feasibility of defining the adequacy of SNAP allotments, specifically: the feasibility of establishing an objective, evidence-based, science-driven definition of the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, as well as other relevant dimensions of adequacy; and data and analyses needed to support an evidence-based assessment of the adequacy of SNAP allotments.
Supplemental Nutrition Assistance Program: Examining the Evidence to Define Benefit Adequacy reviews the current evidence, including the peer-reviewed published literature and peer-reviewed government reports. Although not given equal weight with peer-reviewed publications, some non-peer-reviewed publications from nongovernmental organizations and stakeholder groups also were considered because they provided additional insight into the behavioral aspects of participation in nutrition assistance programs. In addition to its evidence review, the committee held a data gathering workshop that tapped a range of expertise relevant to its task.
New Report: Famine risk is well understood and badly managed
New Report: Famine risk is well understood and badly managed
Source: Chatham House
Food crises are the deadliest natural disasters, resulting in up to 2 million deaths since 1970, yet responses to them are reactive, slow and fragmented.
A new report, Managing Famine Risk: Linking Early Warning to Early Action argues that whilst famine early warning systems have a good track record of predicting food crises, they have a poor track record of triggering early action to protect lives and livelihoods.
Major improvements in the sophistication and capabilities of famine early warning systems provide the opportunity for decisive early action, but also the opportunity for prevarication, delay and buck-passing among governments and humanitarian agencies.
There is also added political pressure not to report food crises, says Rob Bailey, the report’s author.
‘Governments in at-risk countries may suppress famine early warnings if they are concerned it will challenge their record on hunger reduction,’ he said.
2012 Global Hunger Index
2012 Global Hunger Index
Source: International Food Policy Research Institute
The 2012 Global Hunger Index (GHI) report—the seventh in an annual series—presents a multidimensional measure of global, regional, and national hunger. It shows that progress in reducing the proportion of hungry people in the world has been tragically slow. According to the index, hunger on a global scale remains “serious.” The 2012 GHI report also focuses particularly on how to ensure sustainable food security under conditions of land, water, and energy stress. The stark reality is that the world needs to produce more food with fewer resources, while eliminating wasteful practices and policies.
In the coming decades food security will be increasingly challenged by land, water, and energy scarcity. To improve poor people’s nutrition and food security in this environment, we will need to make a diverse range of foods more available and accessible, identify and address wasteful practices and policies, and ensure that local communities have greater control over and access to productive resources. In other words, we need to build a sustainable world, where the degradation of ecosystems is halted or reversed and all people have access to food, clean water, and modern energy and are empowered to use them for their own well-being.
Assessing the Online Social Environment for Surveillance of Obesity Prevalence
Assessing the Online Social Environment for Surveillance of Obesity Prevalence
Source: PLoS ONE
Background
Understanding the social environmental around obesity has been limited by available data. One promising approach used to bridge similar gaps elsewhere is to use passively generated digital data.
Purpose
This article explores the relationship between online social environment via web-based social networks and population obesity prevalence.
Methods
We performed a cross-sectional study using linear regression and cross validation to measure the relationship and predictive performance of user interests on the online social network Facebook to obesity prevalence in metros across the United States of America (USA) and neighborhoods within New York City (NYC). The outcomes, proportion of obese and/or overweight population in USA metros and NYC neighborhoods, were obtained via the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance and NYC EpiQuery systems. Predictors were geographically specific proportion of users with activity-related and sedentary-related interests on Facebook.
Results
Higher proportion of the population with activity-related interests on Facebook was associated with a significant 12.0% (95% Confidence Interval (CI) 11.9 to 12.1) lower predicted prevalence of obese and/or overweight people across USA metros and 7.2% (95% CI: 6.8 to 7.7) across NYC neighborhoods. Conversely, greater proportion of the population with interest in television was associated with higher prevalence of obese and/or overweight people of 3.9% (95% CI: 3.7 to 4.0) (USA) and 27.5% (95% CI: 27.1 to 27.9, significant) (NYC). For activity-interests and national obesity outcomes, the average root mean square prediction error from 10-fold cross validation was comparable to the average root mean square error of a model developed using the entire data set.
Conclusions
Activity-related interests across the USA and sedentary-related interests across NYC were significantly associated with obesity prevalence. Further research is needed to understand how the online social environment relates to health outcomes and how it can be used to identify or target interventions.
President’s Malaria Initiative — Annual Report 2013
President’s Malaria Initiative — Seventh Annual Report to Congress 2013 (PDF)
Source: USAID/CDC
The past decade has seen unprecedented progress in malaria control efforts in most sub-Saharan African countries. As countries have scaled up insecticide-treated mosquito nets (ITNs), indoor residual spraying (IRS), improved diagnostic tests and highly effective antimalarial drugs, mortality in children under five years of age has fallen dramatically. It is now clear that the cumulative efforts and funding by the President’s Malaria Initiative (PMI), national governments, The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), the World Bank and many other donors are working: The risk of malaria is declining. According to the World Health Organization’s (WHO’s) 2012 World Malaria Report, the estimated annual number of global malaria deaths has fallen by more than one-third – from about 985,000 in 2000 to about 660,000 in 2010.
The U.S. Government’s financial and technical contributions have played a major role in this remarkable progress. However, gaps in resources remain. If progress is to be sustained, committed efforts must continue. The theme for World Malaria Day 2013, and for the years leading up to the 2015 target date for the Millennium Development Goals, is “Invest in the future. Defeat malaria.” To this end, PMI and partners continue to build on investments in malaria control and prevention and respond to challenges, such as antimalarial drug resistance, insecticide resistance and weak malaria case surveillance.
Preliminary Report: Epidemiology of the Avian Influenza A (H7N9) Outbreak in China
Preliminary Report: Epidemiology of the Avian Influenza A (H7N9) Outbreak in China
Source: New England Journal of Medicine
The first identified cases of human infection with a novel influenza A (H7N9) virus occurred in eastern China during February and March 2013 and were characterized by rapidly progressive pneumonia, respiratory failure, acute respiratory distress syndrome (ARDS), and fatal outcomes.1 We analyzed available data from field investigations to characterize the descriptive epidemiology of laboratory-confirmed cases of avian influenza A (H7N9) virus infection in humans reported to the Chinese Center for Disease Control and Prevention (China CDC) as of April 17, 2013. In this report, we summarize the preliminary findings of case investigations and follow-up monitoring of close contacts of persons with confirmed cases of H7N9 virus infection who have been identified to date. This is an ongoing investigation.
Regulating the Way to Obesity: Unintended Consequences of Limiting Sugary Drink Sizes
Regulating the Way to Obesity: Unintended Consequences of Limiting Sugary Drink Sizes
Source: PLoS ONE
Objectives
We examined whether a sugary drink limit would still be effective if larger-sized drinks were converted into bundles of smaller-sized drinks.
Methods
In a behavioral simulation, participants were offered varying food and drink menus. One menu offered 16 oz, 24 oz, or 32 oz drinks for sale. A second menu offered 16 oz drinks, a bundle of two 12 oz drinks, or a bundle of two 16 oz drinks. A third menu offered only 16 oz drinks for sale. The method involved repeated elicitation of choices, and the instructions did not mention a limit on drink size.
Results
Participants bought significantly more ounces of soda with bundles than with varying-sized drinks. Total business revenue was also higher when bundles rather than only small-sized drinks were sold.
Conclusions
Our research suggests that businesses have a strong incentive to offer bundles of soda when drink size is limited. Restricting larger-sized drinks may have the unintended consequence of increasing soda consumption rather than decreasing it.
Incidence and Trends of Infection with Pathogens Transmitted Commonly Through Food — Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 1996–2012
Source: Morbidity and Mortality Weekly Report (CDC)
Foodborne diseases are an important public health problem in the United States. The Foodborne Diseases Active Surveillance Network* (FoodNet) conducts surveillance in 10 U.S. sites for all laboratory-confirmed infections caused by selected pathogens transmitted commonly through food to quantify them and monitor their incidence. This report summarizes 2012 preliminary surveillance data and describes trends since 1996. A total of 19,531 infections, 4,563 hospitalizations, and 68 deaths associated with foodborne diseases were reported in 2012. For most infections, incidence was highest among children aged <5 years; the percentage of persons hospitalized and the percentage who died were highest among persons aged ≥65 years. In 2012, compared with the 2006–2008 period, the overall incidence of infection† was unchanged, and the estimated incidence of infections caused by Campylobacter and Vibrio increased. These findings highlight the need for targeted action to address food safety gaps.
FoodNet conducts active, population-based surveillance for laboratory-confirmed infections caused by Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin–producing Escherichia coli (STEC) O157 and non-O157, Shigella, Vibrio, and Yersinia in 10 sites covering 15% of the U.S. population (48 million persons in 2011).§ FoodNet is a collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA). Hospitalizations occurring within 7 days of specimen collection date are recorded, as is the patient’s vital status at hospital discharge, or at 7 days after the specimen collection date if the patient was not hospitalized. All hospitalizations and deaths that occurred within a 7-day window are attributed to the infection. Surveillance for physician-diagnosed postdiarrheal hemolytic uremic syndrome (HUS), a complication of STEC infection characterized by renal failure, is conducted through a network of nephrologists and infection preventionists and by hospital discharge data review. This report includes 2011 HUS data for persons aged <18 years.
Incidence was calculated by dividing the number of laboratory-confirmed infections in 2012 by U.S. Census estimates of the surveillance population area for 2011.¶ A negative binomial model with 95% confidence intervals (CIs) was used to estimate changes in incidence from 2006–2008 to 2012 and from 1996–1998 to 2012 (1). The overall incidence of infection with six key pathogens for which >50% of illnesses are estimated to be foodborne (Campylobacter, Listeria, Salmonella, STEC O157, Vibrio, and Yersinia) was calculated (2). Trends were not assessed for Cyclospora because data were sparse, or for STEC non-O157 because of changes in diagnostic practices. For HUS, changes in incidence from 2006–2008 to 2011 were estimated.
A Behavioral Weight-Loss Intervention in Persons with Serious Mental Illness
A Behavioral Weight-Loss Intervention in Persons with Serious Mental Illness
Source: New England Journal of Medicine
Background
Overweight and obesity are epidemic among persons with serious mental illness, yet weight-loss trials systematically exclude this vulnerable population. Lifestyle interventions require adaptation in this group because psychiatric symptoms and cognitive impairment are highly prevalent. Our objective was to determine the effectiveness of an 18-month tailored behavioral weight-loss intervention in adults with serious mental illness.Methods
We recruited overweight or obese adults from 10 community psychiatric rehabilitation outpatient programs and randomly assigned them to an intervention or a control group. Participants in the intervention group received tailored group and individual weight-management sessions and group exercise sessions. Weight change was assessed at 6, 12, and 18 months.Results
Of 291 participants who underwent randomization, 58.1% had schizophrenia or a schizoaffective disorder, 22.0% had bipolar disorder, and 12.0% had major depression. At baseline, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 36.3, and the mean weight was 102.7 kg (225.9 lb). Data on weight at 18 months were obtained from 279 participants. Weight loss in the intervention group increased progressively over the 18-month study period and differed significantly from the control group at each follow-up visit. At 18 months, the mean between-group difference in weight (change in intervention group minus change in control group) was −3.2 kg (−7.0 lb, P=0.002); 37.8% of the participants in the intervention group lost 5% or more of their initial weight, as compared with 22.7% of those in the control group (P=0.009). There were no significant between-group differences in adverse events.Conclusions
A behavioral weight-loss intervention significantly reduced weight over a period of 18 months in overweight and obese adults with serious mental illness. Given the epidemic of obesity and weight-related disease among persons with serious mental illness, our findings support implementation of targeted behavioral weight-loss interventions in this high-risk population. (Funded by the National Institute of Mental Health; ACHIEVE ClinicalTrials.gov number, NCT00902694.)
