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To evaluate the effectiveness of Shop Smart Tennessee (SSTN) in engaging small food retailers in promoting healthy food items and impacting consumer purchasing Research has shown the food retail environment, including accessibility and affordability of foods, is an important component of dietary choices. As a strategy to increase consumers' ability and motivation to purchase healthier foods, food retail work is a critical component of a multipronged approach to address chronic disease prevention (CDC, 2014). Using the Theory of Planned Behavior and reciprocal determinism, SSTN works with small food retailers - mostly rural - to implement strategies to encourage healthy food choices. Additionally, by engaging consumers, SSTN seeks to increase demand of healthier foods such as low-calorie beverages, whole grains, lean proteins, and fruit. Target audiences included small food retailers and shoppers of SNAP/EBT accepting stores in low-income census tracts from 2021-2023. SSTN is an eight-week SNAP-Ed food retail program designed to encourage consumers to make healthy food selections. SSTN uses weekly taste testing, educational materials, behavioral economics approaches, and social media to achieve program goals. Additionally, SSTN educators work with retailers to implement store environmental changes and stocking enhancements designed to promote healthy choices. Evaluation data were collected through a standardized store assessment conducted at the start of the intervention, post-intervention retailer interviews, and paper surveys distributed to consumers during final sessions. Since 2021, SSTN has been implemented in 31 stores reaching over 9,100 consumers. 370 adults completed surveys. Fifty-six percent (n=209) of respondents reported they purchased promoted foods as a result of the in-store taste testings. Twenty store managers completed surveys. During program delivery, 40% (n=8) managers started stocking new healthy items and 42% (n=9) increased their stock of current healthy items. SSTN effectively engaged food retailers and positively impacted consumer demand for healthier foods demonstrating the ability of small food retail interventions to benefit both customers and store owners. Supplemental Nutrition Assistance Program - Education [ABSTRACT FROM AUTHOR]

Background: We investigated an outbreak of fungal infections of the central nervous system that occurred among patients who received epidural or paraspinal glucocorticoid injections of preservative-free methylprednisolone acetate prepared by a single compounding pharmacy. Methods: Case patients were defined as patients with fungal meningitis, posterior circulation stroke, spinal osteomyelitis, or epidural abscess that developed after epidural or paraspinal glucocorticoid injections. Clinical and procedure data were abstracted. A cohort analysis was performed. Results: The median age of the 66 case patients was 69 years (range, 23 to 91). The median time from the last epidural glucocorticoid injection to symptom onset was 18 days (range, 0 to 56). Patients presented with meningitis alone (73%), the cauda equina syndrome or focal infection (15%), or posterior circulation stroke with or without meningitis (12%). Symptoms and signs included headache (in 73% of the patients), new or worsening back pain (in 50%), neurologic symptoms (in 48%), nausea (in 39%), and stiff neck (in 29%). The median cerebrospinal fluid white-cell count on the first lumbar puncture among patients who presented with meningitis, with or without stroke or focal infection, was 648 per cubic millimeter (range, 6 to 10,140), with 78% granulocytes (range, 0 to 97); the protein level was 114 mg per deciliter (range, 29 to 440); and the glucose concentration was 44 mg per deciliter (range, 12 to 121) (2.5 mmol per liter [range, 0.7 to 6.7]). A total of 22 patients had laboratory confirmation of Exserohilum rostratum infection (21 patients) or Aspergillus fumigatus infection (1 patient). The risk of infection increased with exposure to lot 06292012@26, older vials, higher doses, multiple procedures, and translaminar approach to epidural glucocorticoid injection. Voriconazole was used to treat 61 patients (92%); 35 patients (53%) were also treated with liposomal amphotericin B. Eight patients (12%) died, seven of whom had stroke. Conclusions: We describe an outbreak of fungal meningitis after epidural or paraspinal glucocorticoid injection with methylprednisolone from a single compounding pharmacy. Rapid recognition of illness and prompt initiation of therapy are important to prevent complications. (Funded by the Tennessee Department of Health and the Centers for Disease Control and Prevention.) [ABSTRACT FROM PUBLISHER]

Outbreaks of hepatitis C virus (HCV) infections can occur among hemodialysis patients when recommended infection control practices are not followed (1). On January 30, 2014, a dialysis clinic in Tennessee identified acute HCV in a patient (patient A) during routine screening and reported it to the Tennessee Department of Health. Patient A had enrolled in the dialysis clinic in March 2010 and had annually tested negative for HCV (including a last HCV test on December 19, 2012), until testing positive for HCV antibodies (anti-HCV) on December 18, 2013 (confirmed by a positive HCV nucleic acid amplification test). Patient A reported no behavioral risk factors, but did have multiple health care exposures.

Purpose: Enterotoxigenic Escherichia coli (ETEC) is traditionally recognized as a common cause of traveler's diarrhea, but is becoming a more frequent cause of foodborne disease outbreaks in the United States. It is important for public health practitioners and clinicians to be aware of ETEC as a domestic cause of gastroenteritis. We investigated a foodborne disease outbreak to understand the epidemiology of ETEC in this setting., Methods: We conducted a cohort study of 63 employees of Company A. A case was defined as an employee who experienced diarrhea or vomiting or fever and cramps after eating a catered meal at Company A from August 14th-15th. A standardized questionnaire was administered to cases and controls., Results: Of 63 employees, 36 met the case definition (Attack Rate = 57.1%). Diarrhea (94%) and cramps (74%) were common, whereas vomiting was not (3%). Mean duration of illness was 2.7 days. Coleslaw at the August 15th lunch was significantly associated with illness (Odds ratio = 4.4, 95% CI = 1.1-17). Stool specimens were positive for heat-stable enterotoxin-producing E. coli O169:H41. Contamination likely occurred at the point of service., Conclusions: This outbreak illustrates the changing epidemiology of enterotoxigenic E. coli and the importance for healthcare practitioners to consider ETEC as a potential cause of domestically acquired gastroenteritis.