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The article assesses the outcome of the Exclusive Breastfeeding program in the U.S. from 2000 to 2004. The National Immunization Survey (NIS) monitors the progress of Healthy People 2010 (HP2010) in its objectives on exclusive breastfeeding. The program is intended to add the proportion of mothers who exclusively breastfeed their infants through age 3 months to 60% and through 6 months to 25%. Rates of exclusive breastfeeding through infants aging 3 months and 6 months and the factors that contribute to these low rates are presented.

The article presents an overview of statistics which were released by the U.S. Centers for Disease Control and Prevention (CDC), and which were concerned with breast feeding and related maternity practices at hospitals and birthing centers in the United States. The CDC looked at whether hospitals and birthing centers were in compliance with the Healthy People 2010 targets for breast feeding. It found that only four U.S. states, Alaska, Montana, Oregon and Washington, have met all five of the targets.

Purpose: The purpose of this study was to identify the barriers, facilitators, and priority needs related to cancer prevention, control, and research in persistent poverty areas., Methods: We conducted three focus groups with 17 providers and staff of primary care clinics serving persistent poverty areas throughout the state of Arkansas., Results: We identified multiple barriers, facilitators, and priority needs related to cancer prevention and control at primary care clinics serving persistent poverty areas. Barriers included transportation, medical costs, limited providers and service availability, and patient fear/discomfort with cancer topics. Facilitators identified were cancer navigators and community health events/services, and priority needs included patient education, comprehensive workflows, improved communication, and integration of cancer navigators into healthcare teams. Barriers to cancer-related research were lack of provider/staff time, patient uncertainty/skepticism, patient health literacy, and provider skepticism/concerns regarding patient burden. Research facilitators included better informing providers/staff about research studies and leveraging navigators as a bridge between clinic and patients., Conclusion: Our results inform opportunities to adapt and implement evidence-based interventions to improve cancer prevention, control, and research in persistent poverty areas. To improve cancer prevention and control, we recommend locally-informed strategies to mitigate patient barriers, improved patient education efforts, standardized patient navigation workflows, improved integration of cancer navigators into care teams, and leveraging community health events. Dedicated staff time for research, coordination of research and clinical activities, and educating providers/staff about research studies could improve cancer-related research activities in persistent poverty areas., (© 2023. The Author(s).)

Background: The American Diabetes Association (ADA) Diabetes Risk Test (DRT) is a screening tool to identify people at risk for developing diabetes. Individuals with a DRT score of 5 or higher may have prediabetes or diabetes and should see a healthcare provider., Objective: To determine how many additional employees are identified as being at risk for developing diabetes during an employee wellness screening by using a more stringent DRT cutoff score of 4 instead of 5., Methods: During an annual employee wellness screening event, a hemoglobin A1C (A1c) was drawn for participants with a DRT score of > 4 or by request regardless of risk score. A1C values were classified as normal (<5.7%), prediabetes (>5.7 and <6.5%) or diabetes (>6.5%). Risk scores and A1C values were analyzed using descriptive statistics. Cost of additional laboratory testing was also reviewed., Results: An A1C was collected for 158 participants. Fourteen of 50 (28%) participants with a DRT of 4 had A1c values in the prediabetes range and no history of diabetes or prediabetes. Using the lower DRT score of 4 resulted in an additional expenditure of $305 with $85.40 resulting in the identification of an otherwise unaware person at risk for developing diabetes., Conclusion: Using a DRT cutoff score of 4 as part of an employee wellness screening program resulted in additional laboratory costs to identify persons at risk for developing diabetes but also allowed for earlier education to slow or stop the progression to diabetes which may reduce healthcare costs over time.

Background: Antibiotics are commonly prescribed for uncomplicated urinary tract infection (UTI) and acute otitis media (AOM) and may be unnecessary at times. The aim of this study was to evaluate prescribing practices for UTIs and AOM in a rural ambulatory care setting and to identify areas for improvement., Methods: In a single-center, retrospective review conducted at a rural clinic, patients diagnosed with uncomplicated UTI and AOM were included. Patients were identified by International Classification of Diseases, Tenth (ICD-10) codes, and data were collected for visits between January 1, 2017, and December 31, 2017. The primary outcome was to assess adherence of antimicrobial prescribing to current treatment guidelines., Results: Of the 76 patients identified, 28 met inclusion criteria. Of the 28 patients, 75% received an agent recommended first line in the treatment guidelines, and 18 of the 21 received a recommended dose. Only 17% of patients were prescribed an appropriate duration of treatment., Conclusion: Opportunities exist for antimicrobial stewardship interventions for uncomplicated UTIs and AOM. Prescribers are not consistently adhering to guidelines in regard to antibiotic choice, dose, or duration. Additional education and stewardship interventions are crucial considering the increased prevalence of antimicrobial resistance.

Context: In response to the COVID-19 pandemic, the Centers for Disease Prevention and Control (CDC) clinicians provided real-time telephone consultation to healthcare providers, public health practitioners, and health department personnel., Objective: To describe the demographic and public health characteristics of inquiries, trends, and correlation of inquiries with national COVID-19 case reports. We summarize the results of real-time CDC clinician consultation service provided during 11 March to 31 July 2020 to understand the impact and utility of this service by CDC for the COVID-19 pandemic emergency response and for future outbreak responses., Design: Clinicians documented inquiries received including information about the call source, population for which guidance was sought, and a detailed description of the inquiry and resolution. Descriptive analyses were conducted, with a focus on characteristics of callers as well as public health and clinical content of inquiries., Setting: Real-time telephone consultations with CDC Clinicians in Atlanta, GA., Participants: Health care providers and public health professionals who called CDC with COVID-19 related inquiries from throughout the United States., Main Outcome Measures: Characteristics of inquiries including topic of inquiry, inquiry population, resolution, and demographic information., Results: A total of 3154 COVID-19 related telephone inquiries were answered in real-time. More than half (62.0%) of inquiries came from frontline healthcare providers and clinical sites, followed by 14.1% from state and local health departments. The majority of inquiries focused on issues involving healthcare workers (27.7%) and interpretation or application of CDC's COVID-19 guidance (44%)., Conclusion: The COVID-19 pandemic resulted in a substantial number of inquiries to CDC, with the large majority originating from the frontline clinical and public health workforce. Analysis of inquiries suggests that the ongoing focus on refining COVID-19 guidance documents is warranted, which facilitates bidirectional feedback between the public, medical professionals, and public health authorities.

Introduction: Pharmacist prescribing of contraception is becoming increasingly available in selected states. The objective of this study was to assess US community pharmacists' perspectives on expanding access, barriers, and facilitators since states have begun pharmacist scope of practice expansions for prescribing contraception., Methods: A survey study of US community pharmacists' support for expanded access models, pharmacist prescribing practices and interest, and importance of safety, cost, and professional practice issues for prescribing was conducted., Results: Pharmacists are generally supportive of pharmacist prescribing and behind-the-counter models for hormonal contraception and generally opposed to over-the-counter access. A majority (65%) are interested in prescribing hormonal contraception. The top motivation for prescribing contraception is enjoying individual patient contact (94%). Safety concerns (eg, patients not obtaining health screenings) remained most important for pharmacist implementation, followed by cost (eg, lack of payment or reimbursement for pharmacists' services), and professional practice (eg, pharmacist time constraints and liability) issues., Conclusion: This study provides an updated understanding of attitudes toward models of expanded access to hormonal contraception, interest in prescribing, and barriers and facilitators to this service among community pharmacists. Many barriers such as time and reimbursement remain unchanged. This information can inform policy and implementation efforts.

Introduction: Our objectives were to describe pharmacist perceptions of training and preparation to prescribe hormonal contraception (HC), identify training gaps, and elicit preferred training methods., Methods: In this cross-sectional survey, pharmacists in the United States (US) completed an online 29-item survey. Descriptive statistics were used to analyze responses., Results: Of 823 participating pharmacists, 58% felt they received adequate training to prescribe HC. Prescribing any medications within the last five years or completion of residency training were significantly associated with more participants feeling adequately trained. Of those who indicated HC was not covered in their pharmacy school curriculum, most (78%) felt they were either not adequately trained or unsure. Only 36% were aware of the Centers for Disease Control and Prevention US Medical Eligibility Criteria for Contraceptive Use (CDC MEC). Residency-trained pharmacists were statistically more likely to have used the CDC MEC and feel comfortable prescribing for adolescents. Most participants desired more training about switching between products (80%) and patient specific product selection (72%). Preferred methods for additional training were basic (

CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders are investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). CDC has published recommendations for health care providers regarding EVALI (2-4). Recently, researchers from Utah and New York published proposed diagnosis and treatment algorithms for EVALI (5,6). EVALI remains a diagnosis of exclusion because, at present, no specific test or marker exists for its diagnosis, and evaluation should be guided by clinical judgment. Because patients with EVALI can experience symptoms similar to those associated with influenza or other respiratory infections (e.g., fever, cough, headache, myalgias, or fatigue), it might be difficult to differentiate EVALI from influenza or community-acquired pneumonia on initial assessment; EVALI might also co-occur with respiratory infections. This report summarizes recommendations for health care providers managing patients with suspected or known EVALI when respiratory infections such as influenza are more prevalent in the community than they have been in recent months (7). Recommendations include 1) asking patients with respiratory, gastrointestinal, or constitutional symptoms about the use of e-cigarette, or vaping, products; 2) evaluating those suspected to have EVALI with pulse oximetry and obtaining chest imaging, as clinically indicated; 3) considering outpatient management for clinically stable EVALI patients who meet certain criteria; 4) testing patients for influenza, particularly during influenza season, and administering antimicrobials, including antivirals, in accordance with established guidelines; 5) using caution when considering prescribing corticosteroids for outpatients, because this treatment modality has not been well studied among outpatients, and corticosteroids could worsen respiratory infections; 6) recommending evidence-based treatment strategies, including behavioral counseling, to help patients discontinue using e-cigarette, or vaping, products; and 7) emphasizing the importance of annual influenza vaccination for all persons aged ≥6 months, including patients who use e-cigarette, or vaping products., 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.

Objective: To provide guidance for clinicians on risk assessment of medication use during pregnancy and lactation., Data Sources: Authors completed PubMed searches to identify articles focused on the use of medications in pregnancy, including fetal development, drug transfer across the placenta, trimester exposure, chronic conditions in pregnancy, medications in lactation, and lactation and chronic disease., Study Selection and Data Extraction: Articles were reviewed to provide overall guidance to medication selection during pregnancy. The following information was reviewed: medication use in pregnancy, including fetal development, drug transfer across the placenta, trimester exposure, chronic conditions in pregnancy, medications in lactation, and lactation and chronic disease., Data Synthesis: This article will provide an overview of medication safety considerations during pregnancy and lactation. Information was interpreted to help clinicians predict the potential risk and benefit in each patient to make an evidence-based decision. The article concludes with guidance on risk assessment and how pharmacists may support fellow health care providers and their patients when considering medication use., Conclusions: Information about the effects of medication use during reproductive periods is limited. With the removal of the Food and Drug Administration pregnancy categories, clinicians will be relying on pharmacists to aid in the appropriate selection of therapies for patients. It is critical that pharmacists keep abreast of resources available and be able to assess data to help prescribers and their patients.

Purpose: This article describes the health testing training process used at Presbyterian College School of Pharmacy and evaluates perceptions of the sequential training model among students in their first, second, and third professional years., Educational Activity and Setting: After observing student deficiencies in the knowledge and skills necessary for performing health tests, despite receiving didactic training within the core curriculum, faculty members searched for supplemental training programs used by other schools of pharmacy. No literature regarding structured programs was found. Consequently, faculty developed test-specific training modules for a variety of health screenings. Students who participated in the sequential self-learning followed by a live skills assessment were surveyed to determine their perceptions of the training., Findings: During the 2014-2015 academic year, 78 students successfully completed health testing training modules. Of these students, 56 (72%) completed an attitudinal survey designed to assess their perceptions. Nearly 93% of respondents perceived improved confidence after completing the training. Regardless of the year in pharmacy school, 88% of respondents believe they would not have been adequately prepared to conduct the health test(s) without this training., Summary: Student perception and acceptance of health testing training were positive. Using sequential training modules to teach and reinforce the skills necessary for performing health tests can improve student ability and confidence. Consequently, students have the opportunity to impact the health of the community while becoming practice ready in the area of health testing., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Since 1990, the prevalence of obesity has been steadily increasing in the United States. Over the past four years, new medications have become approved and available, allowing for more options in the management of chronic weight loss among overweight or obese patients. This review article summarizes the efficacy, safety, and clinical attributes of liraglutide among overweight or obese patients with or without comorbidities. Areas covered: A MEDLINE search, from 1970 to June 2016, was conducted using key terms-glucagon-like peptide-1 receptor agonist, liraglutide, overweight, and obesity. Published clinical trials, in the English-language and with primary endpoints related to weight loss, were reviewed and critiqued in this article. Expert commentary: Available as a subcutaneous daily injection, liraglutide is the first glucagon-like peptide-1 (GLP-1) receptor agonist indicated for obesity management, as adjunct therapy with lifestyle and behavioral modifications. Liraglutide 3 mg daily has been associated with greater weight loss than placebo or orlistat in patients without type 2 diabetes. Additionally, liraglutide has resulted in reductions in waist circumference, systolic and diastolic blood pressure, and improvements in lipid panel among overweight and obese patients with and without type 2 diabetes.

The Advisory Committee on Immunization Practices recently updated its guidelines on pneumococcal pneumonia vaccines for older adults. The new guidelines recommend that patients age 65 years and older receive the PCV13 vaccine in a series along with the PPSV23 vaccine. This article summarizes these changes along with a review of when to vaccinate other key adult populations.

The prevalence of diabetes continues to rise worldwide. Over the past five years, available treatment options have expanded to allow individualized management of patients with diabetes. The glucagon-like peptide-1 (GLP-1) receptor agonists have become an essential tool in the management of type 2 diabetes mellitus (T2DM). This class provides several advantages for glycemic control with minimal risk of hypoglycemia. Based on the most recent guidelines for T2DM, GLP-1 receptor agonists can be prescribed as monotherapy or in combination with oral antidiabetic agents or insulin for the management of T2DM. Dulaglutide has become the most recent and available GLP-1 receptor agonist on the market. Dulaglutide is a once-weekly GLP-1 receptor agonist that can be used as monotherapy or as a second-line agent for T2DM. This review article summarizes the efficacy, safety, and clinical attributes of dulaglutide among patients with T2DM.

Maternal and child health (MCH) surveillance data are important for understanding gaps in services and disparities in burden of disease, access to care, risk behaviors, and health outcomes. However, national and state surveillance systems are not always designed to gather sufficient data for calculating reliable estimates of the health conditions among high-risk or underrepresented population subgroups living in smaller geographic areas. The Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System (PRAMS) has conducted surveillance for over 25 years in collaboration with state and city health departments. In 2012, PRAMS embarked on a multiyear collaboration with the W.K. Kellogg Foundation (WKKF) to include oversampling of minority and low-income women in selected geographic areas in four states (Louisiana, Michigan, Mississippi, and New Mexico) where the WKKF funded extensive place-based initiatives are located. The PRAMS-WKKF collaboration has broad implications for promoting meaningful collaboration between public, private, local, state, and federal organizations to address MCH data gaps on disparities, and for improving the availability of information needed for MCH programs, policy makers, and women.

Type 2 diabetes mellitus (T2DM) carries a high prevalence in the United States and worldwide. Therefore, the number of medication classes being developed and studied has grown. The individualized management of diabetes is accomplished by evaluating a medication's efficacy, safety, and cost, along with the patient's preference and tolerance to the medication. Sodium glucose co-transporter 2 inhibitors are a new therapeutic class indicated for the treatment of diabetes and have a unique mechanism of action, independent of beta-cell function. The first agent approved by the Food and Drug Administration (FDA) was canagliflozin in March 2013. Two agents - dapagliflozin and empagliflozin - were FDA-approved in January and July 2014, respectively. A clear understanding of the new class is needed to identify its appropriate use in clinical practice. Members of the American College of Clinical Pharmacy Endocrine and Metabolism Practice and Research Network reviewed available literature regarding this therapeutic class. The article addresses the advantages, disadvantages, emerging role, and patient education for sodium glucose co-transporter 2 inhibitors. Key limitations for this article include limited access to clinical trial data not published by the pharmaceutical company and limited data on products produced outside the United States.

During the 2009 influenza A (H1N1) pandemic, many pregnant women experienced severe illness and some gave birth while ill with suspected or confirmed pandemic (H1N1) 2009 influenza. Because of concerns about possible transmission of this novel virus to immunologically naïve newborns, and the absence of definitive studies regarding this risk, the Centers for Disease Control and Prevention (CDC) reviewed relevant literature to understand the potential burden of disease and routes of transmission affecting newborns. This report describes the issues considered during the 2009 H1N1 pandemic as CDC developed guidance to protect newborns in hospital settings. Also presented is a framework of protection efforts to prevent novel influenza infection in fetuses/newborns before birth and in hospital settings. Although developed specifically for the pandemic, the framework may be useful during future novel influenza outbreaks.