Improvements in Patient-Reported Outcomes in Relapsed or Refractory Large B-Cell Lymphoma Patients Treated With Epcoritamab.

BACKGROUND: Patient-reported outcomes were evaluated in EPCORE NHL-1 in patients with relapsed or refractory (R/R) large B-cell lymphoma (LBCL) treated with epcoritamab monotherapy (NCT03625037). MATERIALS AND METHODS: Adults with R/R CD20+ LBCL and ≥2 prior systemic antilymphoma therapies, including anti-CD20, completed the Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) and EQ-5D-3L. A subgroup of patients provided additional feedback in one-on-one qualitative interviews. FACT-Lym and EQ-5D-3L score changes from baseline (CFB) to cycle 9 or end of treatment were interpreted using published minimally important differences (MID). RESULTS: In total, 157 patients (88.5% with diffuse LBCL) were treated (median age, 64 years). In total, 70.7% had ≥3 prior treatments, 61.1% had primary refractory disease, and 82.8% were refractory to last systemic therapy. FACT-Lym scores exceeded MID thresholds: mean (SD) CFB were 4.4 (15.2), MID 3.0 to 7.0 (FACT-General); 5.9 (7.6), MID 2.9 to 5.4 (FACT-Lymphoma subscale); 8.4 (15.2), MID 5.5 to 11.0 (FACT-Trial Outcome Index); 10.3 (20.2), MID 6.5 to 11.2 (FACT-Lym total score). EQ-5D-3L index scores, 0.09 (0.20), MID 0.08, and EQ-VAS scores, 16.6 (22.8), MID 7.0, improved. In 20 qualitative interviews, 88.2% reported symptom improvements; 80.0% were "very satisfied" or "satisfied" with epcoritamab. CONCLUSIONS: R/R LBCL patients reported consistent, clinically meaningful improvements in symptoms and HRQoL and satisfaction with epcoritamab.

Understanding Patients' Experiences with Borderline Personality Disorder: Qualitative Interviews.

Background: Patient perspectives of living with borderline personality disorder (BPD) are not traditionally captured in the literature. To overcome this gap, we explored participants' experiences with BPD to gain a better understanding of symptoms and impacts related to the condition. Methods: Two experienced researchers conducted semistructured interviews with a subset of participants from a randomized controlled trial evaluating a BPD treatment. The interview study was independent from the trial. Interviews focused on participants' experiences with BPD prior to the trial, including the symptoms and impacts of BPD. Interview transcripts were analyzed to identify dominant trends and generate patterns in the way participants described their experiences with BPD. Results: A total of 50 adults with BPD participated in the interview study. The mean age of the participants was 28.5 years (range, 18-53 years) and 72.0% were female. All participants described having difficulties with extreme emotional responses and interpersonal relationships, and most participants reported experiencing issues with self-image, impulsivity, suspiciousness/distrust, feelings of emptiness, and anger. The symptoms that were most bothersome to participants were extreme moods or emotional responses and a pattern of unstable personal relationships. All participants remarked that their BPD-related symptoms negatively impacted their interpersonal relationships, and nearly two-thirds of the sample reported that the impact of BPD on their relationships was the most bothersome. Additionally, more than half of the participants discussed impacts on work or school, memory or thinking, self-care, and financial and legal issues. Conclusion: Participants reported that the most bothersome symptoms of BPD were those related to extreme moods or emotional responses and interpersonal relationships. Participants similarly described the impact of BPD on their interpersonal relationships as the most bothersome. Overall, participant perspectives from this study indicate that the burden of BPD is significant and new treatments tailored to patients' real-world needs are warranted.

Development of the Cold Agglutinin Disease Symptoms and Impact Questionnaire (CAD-SIQ).

OBJECTIVES: Cold agglutinin disease (CAD) is a rare autoimmune hemolytic anemia. This study aimed to identify disease-related symptoms and impacts important to patients with CAD, and to develop a novel CAD-specific patient-reported outcome measure. METHODS: Adults with CAD were randomly selected from a United States patient panel to participate in concept elicitation (CE) interviews to identify important symptoms and impacts or cognitive debriefing (CD) interviews to assess the comprehension and relevance of the draft item set. RESULTS: Overall, 37 adults were included (mean [range] age 67.2 [35-87] years). In CE interviews (n = 16), the most frequently reported CAD-related symptoms were reactions to cold environments and fatigue (both 93.8%). CAD had negative impacts on enjoyable activities (81.3%) and daily activities (75.0%). Following CE, standard survey methodological principles were used to develop a draft item pool of 14 concepts. Items were refined through three iterative rounds of CD interviews (n = 21), yielding 11 final items: fatigue; cold sensitivity; dyspnea; wearing extra clothing; limited physical, social, and enjoyable activities; difficulty with usual activities; mood; frustration; and anxiety/stress. CONCLUSIONS: The novel 11-item CAD-Symptoms and Impact Questionnaire provides a measure of the symptoms and impacts of CAD that are important to patients.

Content Validation of Patient-Reported Sleep Measures and Development of a Conceptual Model of Sleep Disturbance in Patients with Moderate-to-Severe, Uncontrolled Asthma.

Purpose: Sleep disturbance is common in patients with asthma and can lead to subsequent impacts on health-related quality of life (HRQOL). Fit-for-purpose patient-reported outcome measures (PROMs) assessing asthma-related sleep disturbance and next-day HRQOL impact (next-day impact) are needed to evaluate disease burden and treatment effects. Patients and Methods: Adults (18-65 years) from three US clinics were recruited for semistructured interviews. Concept elicitation (CE) identified how asthma affects participants' sleep and how asthma-related sleep disturbances impact their daily lives, which informed conceptual model development. Cognitive debriefing (CD) of the Asthma Sleep Disturbance Questionnaire (ASDQ), Sleep Diary, and Patient-Reported Outcomes Measurement Information System Sleep-Related Impairment Short Form 8a (PROMIS SRI SF8a) was completed to assess each measure's content validity. Results: Twelve individuals participated in two interview rounds (6 individuals per round). Participants most frequently reported asthma-related nighttime awakening and decreased sleep quality and duration. Negative impacts of a poor night's sleep due to asthma symptoms included feeling tired/fatigue/lack of energy and subsequent negative impacts on physical functioning, emotions and mood, mental functioning, work or volunteerism, and social functioning. Across both rounds of CD interviews, participants generally found the Sleep Diary and PROMIS SRI SF8a items relevant and easy to complete with no modifications. The ASDQ was modified for clarity and consistency. Conclusion: As described in the conceptual model, asthma affects multiple aspects of sleep that can cause next-day fatigue and other subsequent negative HRQOL impacts. This study demonstrates that the ASDQ, Sleep Diary, and PROMIS SRI SF8a items are comprehensive, relevant, and appropriate for patients with moderate-to-severe, uncontrolled asthma. Evaluation of psychometric properties for the ASDQ, Sleep Diary, and PROMIS SRI SF8a based on clinical trial data in patients with moderate-to-severe, uncontrolled asthma will further support their use.

Preferences of Adult Patients With Inflammatory Bowel Disease for Attributes of Clinical Trials: Evidence From a Choice-Based Conjoint Analysis.

Background: Clinical trial recruitment is the rate-limiting step in developing new treatments. To understand inflammatory bowel disease (IBD) patient recruitment, we investigated two questions: Do changes in clinical trial attributes, like monetary compensation, influence recruitment rates, and does this influence differ across subgroups? Methods: We answered these questions through a conjoint survey of 949 adult IBD patients. Results: Recruitment rates are influenced by trial attributes: small but significant increases are predicted with lower placebo rates, reduced number of endoscopies, less time commitment, open label extension, and increased involvement of participant's primary GI physician. A much stronger effect was found with increased monetary compensation. Latent class analysis indicated three patient subgroups: some patients quite willing to participate in IBD trials, some quite reluctant, and others who can be persuaded. The persuadable group is quite sensitive to monetary compensation, and payments up to US$2,000 for a 1-year study could significantly increase recruitment rates for IBD clinical trials. Conclusions: This innovative study provides researchers with a framework for predicting recruitment rates for different IBD clinical trials.

Older Adults and Parents of Young Children Have Different Handling Practices for Raw Poultry.

Salmonella and Campylobacter are among the most common causes of foodborne disease in the United States. Most illnesses are associated with eating raw or undercooked poultry or cross-contamination. Young children and older adults are more susceptible to contracting foodborne illness and have serious infections compared with other age groups. We conducted a Web-based survey of parents of young children ( n = 1,957) and older adults ( n = 1,980) to estimate adherence to recommended food safety practices for raw poultry and to identify differences in practices between the two groups. The findings present adherence rates for 20 practices. In both groups, less than 50% of respondents reported adherence to seven practices; thus, improvements are needed in these areas. Parent respondents were significantly more likely than older adult respondents to report following eight practices, with most related to avoiding cross-contamination and using a food thermometer. For example, parents (39%) were significantly more likely than older adults (31%) to report not rinsing or washing raw poultry ( P < 0.001). Older adult respondents were significantly more likely than parent respondents to report following seven practices, with most related to chilling to proper temperatures and thawing. For example, older adults (87%) were significantly more likely than parents (69%) to report cooking, freezing, or discarding raw poultry within 1 to 2 days of purchase as recommended ( P < 0.001). For the remaining five practices, no differences were found between groups. To motivate behavior change, food safety messages and materials must target specific at-risk populations as their practices are different. Additional research is needed to better understand how parents of young children and older adults like to receive food safety information and how to tailor the information to different generations.

Making Decisions About Medication Use During Pregnancy: Implications for Communication Strategies.

Objective To explore women's perceptions of the risks and benefits associated with medication use during pregnancy and to better understand how women make decisions related to medication use in pregnancy. Methods We conducted online focus groups with 48 women who used medication during pregnancy or while planning a pregnancy, and 12 in-depth follow-up interviews with a subset of these women. Results We found that women were aware of general risks associated with medication use but were often unable to articulate specific negative outcomes. Women were concerned most about medications' impact on fetal development but were also concerned about how either continuing or discontinuing medication during pregnancy could affect their own health. Women indicated that if the risk of a given medication were unknown, they would not take that medication during pregnancy. Conclusion This formative research found that women face difficult decisions about medication use during pregnancy and need specific information to help them make decisions. Enhanced communication between patients and their providers regarding medication use would help address this need. We suggest that public health practitioners develop messages to (1) encourage, remind, and prompt women to proactively talk with their healthcare providers about the risks of taking, not taking, stopping, or altering the dosage of a medication while trying to become pregnant and/or while pregnant; and (2) encourage all women of childbearing age to ask their healthcare providers about medication use.

Consumers' Perceptions of Edible Marijuana Products for Recreational Use: Likes, Dislikes, and Reasons for Use.

BACKGROUND: Edible marijuana products have become extremely popular in states that have legalized marijuana for recreational use. OBJECTIVES: The goal of this research was to provide a better understanding of consumer perceptions of edible marijuana products, including why they prefer edibles relative to other forms of marijuana (e.g., smoking) and their concerns regarding the consumption of edibles. METHODS: We conducted eight focus groups (four groups in Denver, Colorado, and four groups in Seattle, Washington) in February 2016 with 62 adult consumers of edibles. Focus group transcripts were coded in QSR NVivo 10.0 qualitative analysis software, and coding reports identified trends across participants. RESULTS: Most participants preferred edibles to smoking marijuana because there is no smell from smoke and no secondhand smoke. Other reasons participants like edibles included convenience, discreetness, longer-lasting highs, less intense highs, and edibles' ability to aid in relaxation and reduce anxiety more so than smoking marijuana. Concerns and dislikes about edibles included delayed effects, unexpected highs, the unpredictability of the high, and inconsistency of distribution of marijuana in the product. No participants in either location mentioned harmful health effects from consuming edibles as a concern. Conclusions/Importance: The present study was qualitative in nature and provides a good starting point for further research to quantify through surveys how consumers understand and use edibles. Such information will help guide policy makers and regulators as they establish regulations for edibles. Also, such research can help inform educational campaigns on proper use of edibles for recreational purposes.

How four U.S. states are regulating recreational marijuana edibles.

BACKGROUND: Sales of edible marijuana products have been strong in Colorado and Washington State since the legalization of recreational marijuana. Initially, these states did not have comprehensive labelling or packaging requirements in place. In response to increases in marijuana-related emergency room visits and poison control centre calls, additional regulations were implemented. Currently, Alaska, Colorado, Oregon, and Washington each have passed into law various labelling and packaging requirements for edibles. METHODS: This article presents the primary legal research findings of relevant statutes and regulations for edibles in Alaska, Colorado, Oregon, and Washington. These laws were identified by using Boolean terms and connectors searches in these states' legal databases in LexisNexis. RESULTS: Alaska, Colorado, Oregon, and Washington vary greatly in how they regulate labelling and packaging. Colorado, Oregon and Washington require a Universal Symbol to be affixed to edibles, but only Oregon and Washington require that the use of pesticides be disclosed on the label. Only Colorado and Oregon require that the packaging for edibles bear a Nutrition Facts Panel on the label. Δ9-Tetrahydracannabinol (THC) in a single serving or single edible product as Alaska and Oregon. All four states prohibit the manufacture or packaging of edibles that appeal to youth. CONCLUSION: State laws governing recreational marijuana edibles have evolved since the first recreational edible products were available for sale. Alaska, Colorado, Oregon, and Washington now require edible product labels to disclose a variety of product information, including risk factors associated with consumption. However, there still remain concerns about the regulatory gaps that exist in each of these states, inherent difficulties in enforcing laws around the labelling, packaging, and manufacturing of edibles, and the outstanding question of whether these edible laws are actually informing consumers and keeping the public safe.

Consumer use and understanding of labelling information on edible marijuana products sold for recreational use in the states of Colorado and Washington.

BACKGROUND: In 2014, the states of Colorado and Washington began allowing retail sales of marijuana for recreational use. The regulatory agencies in these states have implemented specific labelling requirements for edible marijuana products sold for recreational use to help address concerns such as delayed activation time, accidental ingestion, and proper dosing. METHODS: We conducted 12 focus groups with 94 adult consumers and nonconsumers of edibles in Denver and Seattle to collect information on their use and understanding of labelling information on edible marijuana products sold for recreational use. Specifically, we asked participants about the usefulness, attractiveness, ease of comprehension, relevancy, and acceptability of the label information. RESULTS: Some focus group participants look for and read specific information, such as the potency profile and serving size statement, but do not read or were unfamiliar with other labelling features. The focus groups revealed that participants have some concerns about the current labelling of edibles. In particular, participants were concerned that there is too much information on the labels so consumers may not read the label, there is no obvious indication that the product contains marijuana (e.g., a Universal Symbol), and the information on consumption advice is not clear. Participants in both locations suggested that education in a variety of formats, such as web- and video-based education, would be useful in informing consumers about the possible risks of edibles. CONCLUSION: The focus group findings suggest that improvements are needed in the labelling of edibles to prevent unintentional ingestion among adult nonusers and help ensure proper dosing and safe consumption among adult users. These findings, along with lessons learned from Colorado and Washington, can help inform the labelling of edibles as additional states allow the sale of edibles for recreational use.

Adding a Social Marketing Campaign to a School-Based Nutrition Education Program Improves Children's Dietary Intake: A Quasi-Experimental Study.

BACKGROUND: Evidence supports the use of social marketing campaigns to improve nutrition knowledge and reinforce the effects of nutrition education programs. However, the additional effects of parent-focused social marketing with nutrition education have received little attention. OBJECTIVE: Our aim was to assess the impact of the Iowa Nutrition Network's school-based nutrition education program (Building and Strengthening Iowa Community Support for Nutrition and Physical Activity [BASICS]) and the benefits of adding a multichannel social marketing intervention (BASICS Plus) to increase parent-directed communication. DESIGN AND INTERVENTION: A quasi-experimental design with three study conditions compared a school-based nutrition education program (BASICS) with a school-based and social marketing intervention (BASICS Plus) and a no-treatment comparison group. PARTICIPANTS/SETTING: The study included 1,037 third-grade students attending 33 elementary schools and their parents. MAIN OUTCOME MEASURES: Measures included parents' reports of their children's in-home consumption of fruits and vegetables (F/V) and use of low-fat/fat-free milk. Data on F/V were collected using a modified version of the University of California Cooperative Extension Food Behavior Checklist; and data on milk use were collected using two questions from the National Health and Nutrition Examination Survey. STATISTICAL ANALYSES: Multilevel, mixed-effect regression models that account for correlation within repeated measures and children within school were used to compare the mean change over time in the outcome variable for one study group with the mean change over time for another study group. RESULTS: Children in BASICS increased mean consumption of fruit by 0.16 cups (P=0.04) compared with children in the comparison group. Children in BASICS Plus increased mean consumption of fruit by 0.17 cups (P=0.03) and mean consumption of vegetables by 0.13 cups (P=0.02). Children in BASICS Plus were 1.3 times (P=0.05) more likely to use low-fat/fat-free milk than children in either the BASICS group or the comparison group. CONCLUSIONS: Gaining parents' attention and engaging them in healthy eating practices for their children can be a useful way to increase the effectiveness of school-based nutrition education programs. This study demonstrates the benefits of incorporating a parent-focused social marketing campaign in nutrition education interventions.

Consumer Shell Egg Consumption and Handling Practices: Results from a National Survey.

Numerous cases and outbreaks of Salmonella infection are attributable to shell eggs each year in the United States. Safe handling and consumption of shell eggs at home can help reduce foodborne illness attributable to shell eggs. A nationally representative Web survey of 1,504 U.S. adult grocery shoppers was conducted to describe consumer handling practices and consumption of shell eggs at home. Based on self-reported survey data, most respondents purchase shell eggs from a grocery store (89.5%), and these eggs were kept refrigerated (not at room temperature; 98.5%). As recommended, most consumers stored shell eggs in the refrigerator (99%) for no more than 3 to 5 weeks (97.6%). After cracking eggs, 48.1% of respondents washed their hands with soap and water. More than half of respondents who fry and/or poach eggs cooked them so that the whites and/or the yolks were still soft or runny, a potentially unsafe practice. Among respondents who owned a food thermometer (62.0%), only 5.2% used it to check the doneness of baked egg dishes when they prepared such a dish. Consumers generally followed two of the four core "Safe Food Families" food safety messages ("separate" and "chill") when handling shell eggs at home. To prevent Salmonella infection associated with shell eggs, consumers should improve their practices related to the messages "clean" (i.e., wash hands after cracking eggs) and "cook" (i.e., cook until yolks and whites are firm and use a food thermometer to check doneness of baked egg dishes) when preparing shell eggs at home. These findings will be used to inform the development of science-based consumer education materials that can help reduce foodborne illness from Salmonella infection.

Eat Smart, Live Strong intervention increases fruit and vegetable consumption among low-income older adults.

This study evaluated the impact of a four-session interactive nutrition education program-Eat Smart, Live Strong (ESLS)-on the consumption of fruit and vegetables by low-income older adults. A pre-post quasi-experimental design study was conducted with a longitudinal sample of 614 low-income Supplemental Nutrition Assistance Program (SNAP) participants and those eligible for SNAP, aged 60 to 80 years, in 17 intervention and 16 comparison senior centers in Michigan. The study compared participants' self-reports of their consumption of fruit and vegetables using a modified version of the University of California Cooperative Extension Food Behavior Checklist. ESLS increased participants' average daily consumption of fruit by 0.2 cups (P < 0.05) and vegetables by 0.31 cups (P < 0.01). ESLS, a four-session, cognitive-behavioral nutrition education program is an effective curriculum for helping low-income older adults eat more fruit and vegetables.

Consumer education needed on norovirus prevention and control: findings from a nationally representative survey of U.S. adults.

Noroviruses (NoVs) are the leading cause of foodborne disease in the United States; however, little is known about consumers' knowledge of NoV infection and their understanding of how to prevent and control associated illness. A nationally representative Web-enabled panel survey of U.S. adults (n = 1,051) was conducted to collect information on consumers' awareness and knowledge of NoVs. Respondents who had heard of NoVs were asked 22 true-and-false questions on the transmission, prevention, and control of NoVs. Forty-seven percent of respondents reported awareness of NoVs, and 85% of respondents had heard of the terms "cruise ship virus," "the stomach bug," or "the stomach flu," which are commonly used to describe NoVs. Of those respondents who had previously heard of NoV or other terms used by consumers to describe NoV (n = 948), 36% correctly answered 11 or more of the 22 true-and-false questions, suggesting that consumers have limited knowledge on how to prevent and control NoV infection. Most consumers do not understand that the primary mode of transmission for NoV infection is fecal to oral, and many have the misperception that meat and poultry are sources of NoV infection. There is the need to educate consumers about how to prevent and control NoV infection. Although there is a proliferation of food safety education materials available, most focus on foodborne bacteria rather than viruses. The survey results will be used to revise existing consumer food safety educational materials to include information on NoV prevention and control.

Consumer-reported handling of raw poultry products at home: results from a national survey.

Salmonella and Campylobacter cause an estimated combined total of 1.8 million foodborne infections each year in the United States. Most cases of salmonellosis and campylobacteriosis are associated with eating raw or undercooked poultry or with cross-contamination. Between 1998 and 2008, 20% of Salmonella and 16% of Campylobacter foodborne disease outbreaks were associated with food prepared inside the home. A nationally representative Web survey of U.S. adult grocery shoppers (n = 1,504) was conducted to estimate the percentage of consumers who follow recommended food safety practices when handling raw poultry at home. The survey results identified areas of low adherence to current recommended food safety practices: not washing raw poultry before cooking, proper refrigerator storage of raw poultry, use of a food thermometer to determine doneness, and proper thawing of raw poultry in cold water. Nearly 70% of consumers reported washing or rinsing raw poultry before cooking it, a potentially unsafe practice because "splashing" of contaminated water may lead to the transfer of pathogens to other foods and other kitchen surfaces. Only 17.5% of consumers reported correctly storing raw poultry in the refrigerator. Sixty-two percent of consumers own a food thermometer, and of these, 26% or fewer reported using one to check the internal temperature of smaller cuts of poultry and ground poultry. Only 11% of consumers who thaw raw poultry in cold water reported doing so correctly. The study results, coupled with other research findings, will inform the development of science-based consumer education materials that can help reduce foodborne illness from Salmonella and Campylobacter.

Evaluating the Impact of Six Supplemental Nutrition Assistance Program Education Interventions on Children's At-Home Diets.

BACKGROUND: Nutrition education in the Supplemental Nutrition Assistance Program Education (SNAP-Ed) is designed to promote healthy eating behaviors in a low-income target population. PURPOSE: To evaluate the effectiveness of six SNAP-Ed interventions delivered in child care centers or elementary school settings in increasing participating children's at-home fruit and vegetable (F/V) consumption by 0.3 cups per day and use of fat-free or low-fat milk instead of whole or reduced-fat milk during the prior week. METHOD: Clustered randomized or quasi-experimental clustered trials took place in child care centers or elementary schools between 2010 and 2012. Parents of children at intervention and control sites completed baseline and follow-up surveys about their child's at home F/V consumption and other dietary behaviors. RESULTS: One of the six interventions was successful in meeting the objective of increasing children's F/V consumption by 0.3 cups per day. For three of the six interventions, there was a small but statistically significant increase in F/V consumption and/or use of low-fat or fat-free milk. CONCLUSION: Although not all interventions were effective, these findings suggest that it is possible for some SNAP-Ed interventions to improve dietary habits among low-income children among some families. The effective interventions appear to have benefited from implementation experience and sustained efforts at intervention refinement and improvement.

Support for a ban on tobacco powerwalls and other point-of-sale displays: findings from focus groups.

This study uses focus group data to document consumer perceptions of powerwall and other point-of-sale (POS) tobacco displays, and support for a ban on tobacco displays. Four focus groups were conducted in 2012 by a trained moderator. The study comprised 34 adult residents of New York State, approximately half with children under age 18 years living at home. Measures used in the study were awareness and perceptions of powerwall and other POS displays, and level of support for a ban on tobacco displays. Analysis focused on perceptions of powerwall and other POS displays, level of support for a ban on tobacco displays and reasons participants oppose a display ban. This study documents a general lack of concern about tobacco use in the community, which does not appear to be associated with support for a ban on POS tobacco displays. Although all participants had seen tobacco powerwalls and most considered them to be a form of advertising, participants were divided as to whether they played a role in youth smoking. Additional research is warranted to determine what factors individuals weigh in assigning value to a ban on POS tobacco displays and other tobacco control policies and how educational efforts can influence those assessments.

Gaps in food safety professionals' knowledge about noroviruses.

Noroviruses (NoVs) are the most common etiologic agents of endemic and epidemic foodborne disease in the United States. Food safety professionals play an important role in protecting the public from foodborne illness. A survey of food safety professionals (n = 314) was conducted to characterize their knowledge of NoVs and to identify gaps in this knowledge. To recruit individuals, 25 professional organizations promoted the survey via their Web sites, newsletters, and/or e-mail distribution lists. The survey used true or false and open-ended questions to assess knowledge about NoVs, including attribution, transmission, and prevention and control strategies, including food handling practices. The online survey was available from mid-October 2012 to mid-January 2013. Of the 314 respondents, 66.2% correctly identified NoVs as one of the three most common causes of foodborne disease in the United States. Only 5.4% of respondents correctly identified the three most common settings for NoV infections, and 65.0% of respondents had the misperception that cruise ships are one of the three most common settings. Seventeen respondents (5.4%) answered all 20 true-or-false questions correctly, 33 respondents (10.5%) answered at least 19 of the 20 questions correctly, and 186 respondents (65.0%) answered at least 15 of the 20 questions correctly (i.e., a score of 75% or higher). The content domain in which respondents had the most incorrect answers was food handling practices. Thirty-eight percent of respondents incorrectly responded that it is safe for restaurant workers infected with NoVs to handle packaged food, food equipment, and utensils. About half of respondents did not know the recommended sanitizing solution for eliminating NoVs from a contaminated surface. The survey findings identified several important gaps in food safety professionals' knowledge of NoVs. The study results will inform the development of a Web-based educational module on NoVs to improve efforts to prevent the spread of NoVs in retail and institutional food establishments.

Knowledge of norovirus prevention and control among infection preventionists.

A Web-based survey was administered to infection preventionists (IPs) (N = 941) to characterize awareness and knowledge of norovirus (NoV). Only 44% of respondents correctly identified NoV as one of the 3 most common foodborne pathogens in the United States, and 5% correctly identified the 3 most common settings for NoV outbreaks. Several gaps in IPs' knowledge of NoV were identified; specifically, IPs could benefit from learning more about the natural history of NoV, modes of transmission, and cleaning and disinfection processes.

Nutrition-education program improves preschoolers' at-home diet: a group randomized trial.

OBJECTIVE: This study evaluated whether a nutrition-education program in child-care centers improved children's at-home daily consumption of fruits and vegetables, at-home use of low-fat/fat-free milk, and other at-home dietary behaviors. MATERIALS AND METHODS: Twenty-four child-care centers serving low-income families were matched by region, type, and size, and then randomly assigned to either an intervention or control condition. In the 12 intervention centers, registered dietitian nutritionists provided nutrition education to children and parents separately during a 6- to 10-week period. They also held two training sessions for center staff, to educate them on healthy eating and physical activity policies at the centers, and distributed weekly parent newsletters that included activities and recipes. Parents (n=1,143) completed a mail or telephone survey at baseline and follow-up to report information on their child's fruit, vegetable, and milk consumption and other dietary behaviors at home. This study used general and generalized linear mixed models to evaluate program impacts, while accounting for the clustering of children within centers. This study included child age, child sex, household size, respondent race/ethnicity, respondent age, and respondent sex as covariates. RESULTS: The program had a substantial impact on children's at-home daily consumption of vegetables and use of low-fat/fat-free milk. This study also found a significant increase in the frequency of child-initiated vegetable snacking, which might have contributed to the significant increase in vegetable consumption. The program did not have a significant impact on fruit consumption or parental offerings of fruits and vegetables, child-initiated fruit snacking, or child fruit consumption. CONCLUSIONS: This intervention in child-care settings that emphasized children, parents, and teachers significantly increased at-home vegetable and low-fat/fat-free milk consumption among low-income preschoolers.