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Clinical and radiographic characteristics associated with AHT and nAHT were identified, despite limitations in the literature. This systematic review also highlights the need for consistent criteria in identifying and reporting clinical and radiographic characteristics associated with AHT and nAHT.

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Background Little is known about diet quality with a reduced-energy, low-fat, partial meal replacement (PMR) plan, especially in individuals with type 2 diabetes. The Action for Health in Diabetes (Look AHEAD) trial implemented a PMR plan in the intensive lifestyle intervention (ILI). Objective Compare dietary intake and percent meeting fat-related and food group dietary recommendations in ILI and diabetes support and education (DSE) groups at 12 months. Design Randomized controlled trial, comparing ILI to DSE, at 0- and 12-months. Participants/setting From 16 United States sites, the first 50% of participants (aged 45 to 76 years, overweight or obese, with type 2 diabetes) were invited to complete dietary assessments. Complete 0- and 12-month dietary assessments (collected between 2001 and 2004) were available on 2,397 participants (46.6% of total participants), with 1,186 randomized to DSE and 1,211 randomized to ILI. Main outcome measures A food frequency questionnaire assessed intake: energy; percent energy from protein, fat, carbohydrate, polyunsaturated fatty acids (PUFA), and saturated fats; trans fatty acids; cholesterol; fiber; weekly meal replacements (MRs); and daily servings from food groups from the Food Guide Pyramid. Statistical analyses performed Mixed-factor analyses of covariance (ANCOVA), using Proc MIXED with a repeated statement, with age, sex, race/ethnicity, education, and income controlled. Unadjusted chi-square tests compared percent meeting fat-related and food group recommendations at 12 months. Results At 12 months, ILI had a significantly lower fat and cholesterol intake and greater fiber intake than DSE. ILI consumed more servings/day of fruits; vegetables; and milk, yogurt & cheese; and fewer servings/day of fats, oils & sweets than DSE. A greater percentage of ILI than DSE participants met fat-related and most food group recommendations. Within ILI, a greater percentage of participants consuming ≥ 2 MRs/day than < 1 MR/day met most fat-related and food group recommendations. Conclusions The PMR plan consumed by ILI was related to superior diet quality.

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All children have a basic right to health care. When a child’s health care needs are not met, for any reason, health care providers (HCPs) must consider the barriers involved and the processes required to resolve the situation. Social, economic, or other barriers can prevent parents from accessing care for their child. Sometimes differing opinions, priorities, or values, between a child’s HCPs and parents come to impede the child receiving needed medical care. In some cases, caregiver failure to ensure needed care may be considered medical neglect. Specific skills and knowledge can help HCPs to prevent such situations from arising, and to work effectively with the family if they do. This statement offers an approach that HCPs can use to promote the best interests, well-being, and safety of children or youth at risk for medical neglect.

Background Brucella infections associated with travel to endemic countries or imported unpasteurized dairy products continue to present public health challenges in the United States. Although less than 6 brucellosis cases are typically reported annually in Dallas County, a record of 25 brucellosis cases were diagnosed in 2016, primarily due to large outbreaks from imported unpasteurized cheese.MethodsIn 2016, all Brucella clinical isolates one isolate from cheese were confirmed as B. melitensis by PCR and biochemical testing in the Dallas County laboratory. Case interviews and medical chart reviews were conducted to determine exposures and illness characteristics. Supplemental questionnaires were administered to assess knowledge and practices relevant to brucellosis and pasteurization.ResultsIn 2016, 20 confirmed and 5 probable brucellosis cases were reported in Dallas County. Twenty cases, including 2 residents in an adjacent county, were associated with one of 3 separate epidemiologic clusters linked to unpasteurized goat cheese purchased in Mexico, legally imported for personal use, and distributed domestically to friends and relatives. Of the 27 cases, all were Hispanic, 22% were less than 18 years of age (median age 39 years), 67% were male, and only 59% had recent international travel. Although 50% of interviewed adults demonstrated an understanding of pasteurization, 67% were unaware that the consumed cheese was unpasteurized, and 92% were unaware of any health risks associated with consuming unpasteurized cheese. All adults cited economic consequences of their illness, such as missing work (median 31 days) or significant medical costs (median $4,000).ConclusionThese findings highlight the need to improve awareness about the health risks associated with consuming unpasteurized dairy products. Public health and healthcare providers should consider that brucellosis can occur in persons without travel history or who are unaware that they consumed unpasteurized food. Active public health follow-up conducted for these brucellosis clusters ensured: education of exposed persons with low English literacy rates, prompt referral of symptomatic patients to clinical care, and notification of evaluating clinicians and laboratories of a suspected diagnosis.Disclosures All authors: No reported disclosures.

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