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Research on the social determinants of health has demonstrated robust correlations between several social factors, health status, and life expectancy. Some of these factors could be modified through policy intervention. National-level public policies explicitly based on population health research are in various stages of development in many Western countries, but in spite of evident need, seemingly not at all in the United States. Because research shows such a strong association between education and good health, we offer evidence to show that at least two pressing problems in American society, namely the uneven distribution of educational attainment and health disparities linked to socioeconomic position, may be ameliorated through policy initiatives that link quality early childhood care, child development programs, and parental training in a seamless continuum with strengthened K-12 education. [ABSTRACT FROM AUTHOR]

In 2022, the U.S. Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), U.S. state and local partners, the Public Health Agency of Canada (PHAC), and the Canadian Food Inspection Agency (CFIA) conducted a binational sample-initiated retrospective outbreak investigation (SIROI) of Listeria monocytogenes illnesses linked to enoki mushrooms. The FDA and CDC investigated the first known L. monocytogenes outbreak linked to enoki mushrooms from 2016 to 2020, making the 2022 outbreak the second time this pathogen-commodity pair was investigated by FDA and CDC. The 2022 outbreak included six ill people, all of whom were hospitalized. Epidemiologic, laboratory, and traceback evidence led to multiple public health actions, including voluntary recalls by firms, public communications about the outbreak, and FDA's country-wide Import Alert for enoki mushrooms from China. This SIROI illustrates the importance of surveillance sampling, national and international coordination of efforts, and rapid information sharing to identify and stop foodborne outbreaks on a global scale. To reduce the risk of listeriosis illnesses linked to contaminated enoki mushrooms, public health and regulatory agencies in the United States and Canada remain committed to conducting comprehensive surveillance for Listeria in foods and in people, efficiently investigating identified outbreaks, and implementing control measures to potentially minimize the impact of future outbreaks., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Inc.)

Keeping the global food supply safe necessitates international collaborations between countries. Health and regulatory agencies routinely communicate during foodborne illness outbreaks, allowing partners to share investigational evidence. A 2016-2020 outbreak of Listeria monocytogenes infections linked to imported enoki mushrooms required a multinational collaborative investigation among the United States, Canada, Australia, and France. Ultimately, this outbreak included 48 ill people, 36 in the United States and 12 in Canada, and was linked to enoki mushrooms sourced from one manufacturer located in the Republic of Korea. Epidemiologic, laboratory, and traceback evidence led to multiple regulatory actions, including extensive voluntary recalls by three firms in the United States and one firm in Canada. In the United States and Canada, the Korean manufacturer was placed on import alert while other international partners provided information about their respective investigations and advised the public not to eat the recalled enoki mushrooms. The breadth of the geographic distribution of this outbreak emphasizes the global reach of the food industry. This investigation provides a powerful example of the impact of national and international coordination of efforts to respond to foodborne illness outbreaks and protect consumers. It also demonstrates the importance of fast international data sharing and collaboration in identifying and stopping foodborne outbreaks in the global community. Additionally, it is a meaningful example of the importance of food sampling, testing, and integration of sequencing results into surveillance databases., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Inc.)

Abstract: Fruit drying has traditionally received little food safety attention in spite of Salmonella outbreaks and recalls involving low-moisture foods. This study was conducted to assess the food safety implications during the home drying process, with dried apples as an example. A cohort of home apple dryers (n = 979) participated in an online survey through Qualtrics XM in May 2021. The results showed that participants' knowledge of safe food handling practices regarding dried fruit was low. On average, participants used only 8 of 18 identified food safety practices during apple drying. The survey revealed inadequate frequency of hand washing during apple preparation, potential points of cross-contamination from kitchen tools, lack of hurdle technology without a pretreatment step, failure to incorporate a thermal kill step during drying, and a lack of objective measurements to ensure that target parameters are attained. Participants mainly pretreated apples for sensory improvement instead of microbial reduction. When presented with some benefits of pretreatment, participants who did not pretreat their apples considered doing so to kill bacteria. The use of safe food handling practices differed within demographic groups. Participants 18 to 39 years old (mean = 7.47; 95% confidence interval [CI] = 7.26, 7.67) and 40 to 59 years old (mean = 7.43; 95% CI = 7.16, 7.70) reported using fewer safe practices than did those >60 years old (mean = 8.49; 95% CI = 8.22, 8.75), and participants who identified as male (mean = 7.38; 95% CI = 7.16, 7.60) reported using fewer safe practices than did those identifying as female (mean = 7.92; 95% CI = 7.74, 8.11). The findings of this study provide food handling data to support the development of more accurate food safety risk assessment models and to guide the development of food safety education for consumers who dehydrate produce in the home., (Published 2022 by the International Association for Food Protection. Not subject to U.S. Copyright.)

Listeriosis is a serious infection usually caused by eating food contaminated with the bacterium Listeria monocytogenes. An estimated 1,600 persons become ill with listeriosis each year, among whom approximately 260 die. Persons at higher risk for listeriosis include pregnant persons and their newborns, adults aged ≥65 years, and persons with weakened immune systems. Persons with invasive listeriosis usually report symptoms starting 1-4 weeks after eating food contaminated with L. monocytogenes; however, some persons who become infected have reported symptoms starting as late as 70 days after exposure or as early as the same day of exposure (1). On January 29, 2021, PulseNet, the national molecular subtyping surveillance network coordinated by CDC, identified a multistate cluster of three L. monocytogenes infections: two from Maryland and one from Connecticut (2). CDC, the Food and Drug Administration (FDA), and state and local partners began an investigation on February 1, 2021. A total of 13 outbreak-related cases were eventually identified from four states. All patients reported Hispanic ethnicity; 12 patients were hospitalized, and one died. Rapid food testing and record collection by regulatory agencies enabled investigators to identify a brand of queso fresco made with pasteurized milk as the likely source of the outbreak, leading to an initial product recall on February 19, 2021. Fresh, soft Hispanic-style cheeses made with pasteurized milk are a well-documented source of listeriosis outbreaks. These cheeses can be contaminated with L. monocytogenes unless stringent hygienic controls are implemented, and the processing environment is monitored for contamination (3). U.S. public health agencies should establish or improve communications, including new methods of disseminating information that also effectively reach Hispanic populations, to emphasize the risk from eating fresh, soft Hispanic-style cheeses, even those made with pasteurized milk., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

A racially and ethnically diverse physician workforce is critical to meeting the needs of the United States' increasingly diverse patient population. Unfortunately, Black, Latinx, American Indian, and Alaska Native communities remain underrepresented in medicine. The disproportionate impact of the COVID-19 pandemic by race/ethnicity and increased public attention to anti-Black and anti-Asian racism have inspired a growing national discourse on addressing systemic racism. Within academic medicine, there has been a call for the fundamental incorporation of antiracism into medical training and professional competency. From the perspective of a group primarily led by residents who are women of color, we describe our 6 years of experience leading a Diversity Committee that catalyzed sustained and systemic efforts to advance diversity, equity, inclusion (DEI), and antiracism at a large urban pediatrics residency program. We outline the implementation and key outcomes of the Diversity Committee's ongoing initiatives to increase resident diversity, foster an inclusive learning environment, develop a resident curriculum on DEI and antiracism, and center the needs and wisdom of the communities that our institution serves. Finally, we highlight challenges and lessons learned to inform other institutions striving to advance DEI and antiracism in academic medicine., (Published by Elsevier Inc.)

Poultry contact is a risk factor for zoonotic transmission of non-typhoidal Salmonella spp. Salmonella illness outbreaks in the United States are identified by PulseNet, the national laboratory network for enteric disease surveillance. During 2020, PulseNet observed a 25% decline in the number of Salmonella clinical isolates uploaded by state and local health departments. However, 1722 outbreak-associated Salmonella illnesses resulting from 12 Salmonella serotypes were linked to contact with privately owned poultry, an increase from all previous years. This report highlights the need for continued efforts to prevent backyard poultry-associated outbreaks of Salmonella as ownership increases in the United States.

This study reports on the stability of United States Pharmacopeia-grade metronidazole powder and commercially available metronidazole tablets in two dye-free oral suspending vehicles, namely Oral Mix and Oral Mix Sugar-Free. Metronidazole at 50 mg/mL was prepared individually in Oral Mix and Oral Mix Sugar-Free suspension vehicles and placed in 50-mL amber polyethyleneterephthalate bottles and 3-mL amber plastic syringes and stored at 4°C or 25°C/60% relative humidity for 90 days. The solutions were analyzed at the time of preparation and at 7 days, 14 days, 30 days, 45 days, 60 days, 75 days, and 90 days, with the concentration of metronidazole measured by high-performance liquid chromatography with photodiode array detection. The oral solutions were also monitored for pH, homogeneity, color, and odor. Except for the Oral Mix suspension of metronidazole prepared from the United States Pharmacopeia-grade powder and from the commercial tablet, when stored in pre-filled syringes, all the other preparations were stable at 4°C or 25°C/60% relative humidity for 90 days, with the metronidazole remaining within ± 10% of the initial concentration. The pH, color, odor, and resuspendability remained essentially unchanged. Metronidazole in Oral Mix and Oral Mix Sugar-Free oral suspensions, compounded from United States Pharmacopeia-grade powder or commercially available tablets, are a suitable alternative as an extemporaneously prepared medication., (Copyright© by International Journal of Pharmaceutical Compounding, Inc.)

Purpose: The aim of this study was to validate the English version of the HeartQoL health-related quality of life questionnaire for use in patients with angina or myocardial infarction., Methods: Patients living in the United States and referred, either for percutaneous coronary intervention or to cardiac rehabilitation, completed the HeartQoL, the Short Form-36 Health Survey, and the Hospital Anxiety and Depression Scale at baseline and 3-months later. The data were analyzed for validity, reliability, and responsiveness., Results: Patients (n = 313 with angina and n = 97 with myocardial infarction) who were referred either for percutaneous coronary intervention (n = 164) or to cardiac rehabilitation (n = 246) completed baseline questionnaires. Patients with angina had significantly lower HeartQoL scores (poorer health-related quality of life) compared with patients with myocardial infarction. Exploratory factor analysis largely supported the 2-factor structure of the HeartQoL in both diagnoses, but further investigation is warranted. Internal consistency reliability was adequate, convergent validity correlations were significant, and discriminative validity was fully confirmed in patients with angina and largely confirmed in patients with myocardial infarction. Responsiveness was largely confirmed in patients who underwent percutaneous coronary intervention (n = 67) and those referred to cardiac rehabilitation (n = 167) with conventional statistical tests and clinically with the effect size, a standardized measure of change., Conclusions: The English HeartQoL health-related quality of life questionnaire is valid, reliable, and responsive in patients with angina and myocardial infarction allowing (1) assessment of baseline, (2) between-diagnosis comparisons, and (3) evaluation of change over time.

The history of human experimentation in the twelve years between Hitler's rise to power and the end of the Second World War is notorious in the annals of the twentieth century. The horrific experiments conducted at Dachau, Auschwitz, Ravensbrueck, Birkenau, and other National Socialist concentration camps reflected an extreme indifference to human life and human suffering. Unfortunately, they do not reflect the extent and complexity of the human experiments undertaken in the years between 1933 and 1945. Following the prosecution of twenty-three high-ranking National Socialist physicians and medical administrators for war crimes and crimes against humanity in the Nuremberg Medical Trial (United States v. Karl Brandt et al.), scholars have rightly focused attention on the nightmarish researches conducted by a small group of investigators on concentration camp inmates. Less well known are alternative pathways that brought investigators to undertake human experimentation in other laboratories, settings, and nations.

To review the scientific evidence behind the traditional view that prenatal care improves pregnancy outcomes. The literature published in English between 1965 and 2002 was searched for relevant studies and opinions on prenatal care outcomes. As search engine we used the MEDLINE bibliographic database, employing a combination of keywords, including pregnancy, prenatal care and outcomes. Editorials, proceedings of meetings and reviews, were included in the analysis. This review was not intended to be a systematic or exhaustive review of the literature on prenatal care. The significant heterogeneity of the retrieved papers made any aggregation impossible. In each of the reviewed studies we assessed the methodologic aspects and validity of conclusions, using established criteria for the evaluation of prenatal interventions. Our processing of editorials and other personal opinions was conducted with the intention to draw the line between statements based on scientific evidence and speculative, emotional or traditional concepts. Outcomes research related to prenatal care is marred by methodologic flaws and conceptual problems. While traditional prenatal protocols are based on an individual-centered medical care system, the outcomes are measured using population-based parameters. Interventions capable of improving maternal and neonatal outcomes at the population level are more likely to be social and economic rather than health interventions case by case.