Parenting styles are associated with overall child dietary quality within low-income and food-insecure households.

OBJECTIVE: To examine the association between parenting styles and overall child dietary quality within households that are low-income and food-insecure. DESIGN: Child dietary intake was measured via a 24 h dietary recall. Dietary quality was assessed using the Healthy Eating Index-2005 (HEI-2005). Parenting styles were measured and scored using the Parenting Styles and Dimensions Questionnaire. Linear regressions were used to test main and interaction associations between HEI-2005 scores and parenting styles. SETTING: Non-probability sample of low-income and food-insecure households in South Carolina, USA. PARTICIPANTS: Parent-child dyads (n 171). Parents were ≥18 years old and children were 9-15 years old. RESULTS: We found a significant interaction between authoritative and authoritarian parenting style scores. For those with a mean authoritarian score, each unit increase in authoritative score was associated with a higher HEI-2005 score (b = 3·36, P < 0.05). For those with an authoritarian score that was 1 sd above the mean authoritarian score, each unit increase in authoritative score was associated with a higher HEI-2005 score (b = 8.42, P < 0.01). For those with an authoritarian score that was -1 sd below the mean authoritarian score, each unit increase in authoritative score was associated with a lower HEI-2005 score; however, this was not significant (b = -1·69, P > 0·05). Permissive parenting style scores were negatively associated with child dietary quality (b = -2·79, P < 0·05). CONCLUSIONS: Parenting styles should be considered an important variable that is associated with overall dietary quality in children living within low-income and food-insecure households.

Food insecurity, childhood hunger and caregiver life experiences among households with children in South Carolina, USA.

OBJECTIVE: We explored how positive and negative life experiences of caregivers are associated with household food insecurity. DESIGN: The Midlands Family Study (MFS) was a cross-sectional study with three levels of household food security: food secure, food insecure without child hunger and food insecure with child hunger. Ordinal logistic regression analysis was used for analyses of negative and positive life experiences (number, impact, type) associated with food insecurity. SETTING: An eight-county region in South Carolina, USA, in 2012-2013. PARTICIPANTS: Caregivers (n 511) in households with children. RESULTS: Caregivers who reported greater numbers of negative life experiences and greater perceived impact had increased odds of household food insecurity and reporting their children experienced hunger. Each additional negative life experience count of the caregiver was associated with a 16 % greater odds of food insecurity without child hunger and a 28 % greater odds of child hunger. Each one-unit increase in the negative impact score (e.g. a worsening) was associated with 8 % higher odds of food insecurity without child hunger and 12 % higher odds of child hunger. Negative work experiences or financial instability had the strongest association (OR = 1·8; 95 % CI 1·5, 2·2) with child hunger. Positive life experiences were generally not associated with food security status, with one exception: for each unit increase in the number of positive experiences involving family and other relationships, the odds of child hunger decreased by 22 %. CONCLUSIONS: More research is needed to understand approaches to build resilience against negative life experiences and strengthen positive familial, community and social relationships.

Neisseria zalophi sp. nov., isolated from oral cavity of California sea lions (Zalophus californianus).

Three independent strains of Neisseria sp. were isolated from the oral cavity of California sea lions (Zalophus californianus) that were admitted to The Marine Mammal Center facilities in California, USA. The strains were isolated from oral swabs by cultivation on Trypticase Soy agar with 5% sheep blood under aerobic conditions. The 16S rRNA gene sequence of these three strains shared 99% similarity, but demonstrated only 97-98% nucleotide similarity to the phylogenetically closest relatives such as N. canis, N. zoodegmatis, N. animaloris, and N. dumasiana. These three strains also shared 99% sequence similarity of their rplF, rpoB, and gyrB gene sequences. Based on the biochemical tests alone (i.e., without genetic analysis of housekeeping genes), it is difficult to discriminate this novel species from N. canis; however, it can be easily discriminated from all phylogenetically closely related species using the sequencing analysis of its housekeeping genes (e.g., rplF, rpoB, or gyrB genes). Thus, genetic testing is indispensable for accurate identification of this species in a routine laboratory practice. The species is an obligate aerobe and able to grow in Mueller-Hinton broth supplemented with 6% NaCl, but the phylogenetically closely related species (N. canis, N. zoodegmatis, N. animaloris, and N. dumasiana) were not. Based on these phenotypic and genotypic characteristics and phylogenetic data, we conclude that these new strains represent a novel species of the genus Neisseria, for which the name Neisseria zalophi sp. nov. is proposed. The type strain is CSL 7565T (= ATCC BAA2455T = DSM 102031T).

Severity of household food insecurity and lifetime racial discrimination among African-American households in South Carolina.

OBJECTIVES: In 2014, 30% of African-American households with children had low or very low food security, a rate double that of white households with children. A household has low food security if its members experience food shortages and reductions in food quality attributable to a lack of household resources or access and very low food security if its members also experience reductions in food intake and disrupted eating patterns. Households that are either low or very low food secure are known collectively as food insecure. We examined the association between the severity of household food insecurity and reports of lifetime racial discrimination among a sample of food-insecure African-American households in South Carolina. DESIGN: Data were collected from 154 African-American respondents. Food insecurity was measured using the US Department of Agriculture's Household Food Security Survey Module. Lifetime racial discrimination was measured using the Perceived Ethnic Discrimination Questionnaire-Community Version (PEDQ-CV). We used logistic regression to test the association between severity of food insecurity (low vs. very low food secure), PEDQ-CV score and PEDQ-CV subscales. All models were adjusted for demographic and socioeconomic variables. RESULTS: A one-unit increase in the frequency of lifetime racial discrimination was associated with a 5% increase in the odds of being very low food secure (odds ratio (OR) 1.05, P < .05). More reports of discrimination that were stigmatizing or devaluing (OR 1.16, P < .05), took place at a workplace or school (OR 1.15, P < .05) or were threatening or aggressive (OR 1.39, P < .05) increased the odds of being very low food secure. More reports of racial discrimination that were excluding or rejecting did not significantly increase the odds of being very low food secure (OR 1.07, P > .05). CONCLUSIONS: Severity of household food insecurity is associated with lifetime racial discrimination among African-American households in South Carolina.

Proposed Epidemiological Cutoff Values for Ceftriaxone, Cefepime, and Colistin in Salmonella.

We tested a diverse set of 500 isolates of nontyphoidal Salmonella enterica subsp. enterica from various animal, food, and human clinical sources for susceptibility to antimicrobials currently lacking epidemiological cutoff values (ECOFFs) set by the European Committee on Antimicrobial Susceptibility Testing. A consortium of five different laboratories each tested 100 isolates, using broth microdilution panels containing twofold dilutions of ceftriaxone, cefepime, and colistin to determine the minimum inhibitory concentrations of each drug when tested against the Salmonella isolates. Based on the resulting data, new ECOFFs of 0.25 µg/mL for ceftriaxone, 0.12 µg/mL for cefepime, and 2 µg/mL for colistin have been proposed. These thresholds will aid in the identification of Salmonella that have phenotypically detectable resistance mechanisms to these important antimicrobials.

Household food insecurity and medication "scrimping" among US adults with diabetes.

OBJECTIVE: Our research examined the prevalence of food insecurity among adults with self-reported diabetes and whether food insecurity was associated with cutting back ("scrimping") on prescribed medications because of financial constraints. METHODS: We conducted a cross-sectional analysis of data from the 2011 National Health Interview Survey (NHIS). Adults completing this survey were considered to have diabetes if they reported current use of insulin or "diabetic pills" (n=3,242). Food insecurity was determined with a 10-item scale; respondents were categorized as food secure (FS), marginally food secure (MFS) or food insecure (FI). RESULTS: Approximately one in six adults in NHIS with diabetes reported food insecurity (17.0%), and an additional 8.8% were marginally FS. An individual was considered to be scrimping on medications if he/she gave a "yes" response to at least one of four questions pertaining to reduced, delayed or avoided medication use. Overall, 18.9% of respondents with diabetes reported one or more type of medication scrimping: 11.7% of FS individuals, 27.7% of MFS individuals and 45.6% of FI individuals. In adjusted analyses, marginal food security and food insecurity remained strongly associated with scrimping. CONCLUSIONS: One-quarter of adults with diabetes may have difficulty obtaining foods appropriate for a diabetic diet; a substantial number of these individuals also fail to obtain or take medications. Practitioners may miss either problem unless targeted questions are included in clinical encounters. Clinicians should consider referring FI and MFS diabetic patients to community food resources.

Perceived and geographic food access and food security status among households with children.

OBJECTIVE: To examine the association of both perceived and geographic neighbourhood food access with food security status among households with children. DESIGN: This was a cross-sectional study in which participants' perceptions of neighbourhood food access were assessed by a standard survey instrument, and geographic food access was evaluated by distance to the nearest supermarket. Multinomial logistic regression models were used to examine the associations. SUBJECTS: The Midlands Family Study included 544 households with children in eight counties in South Carolina, USA. Food security status among participants was classified into three categories: food secure (FS), food insecure (FI) and very low food security among children (VLFS-C). RESULTS: Compared with FS households, VLFS-C households had lower odds of reporting easy access to adequate food shopping. VLFS-C households also had lower odds of reporting neighbourhood access to affordable fruits and vegetables compared with FS households and reported worse selection of fruits and vegetables, quality of fruits and vegetables, and selection of low-fat products. FI households had lower odds of reporting fewer opportunities to purchase fast food. None of the geographic access measures was significantly associated with food security status. CONCLUSIONS: Caregivers with children who experienced hunger perceived that they had less access to healthy affordable food in their community, even though grocery stores were present. Approaches to improve perceived access to healthy affordable food should be considered as part of the overall approach to improving food security and eliminating child hunger.

Development of a structured observational method for the systematic assessment of school food-choice architecture.

The objective of this study is to develop a structured observational method for the systematic assessment of the food-choice architecture that can be used to identify key points for behavioral economic intervention intended to improve the health quality of children's diets. We use an ethnographic approach with observations at twelve elementary schools to construct our survey instrument. Elements of the structured observational method include decision environment, salience, accessibility/convenience, defaults/verbal prompts, number of choices, serving ware/method/packaging, and social/physical eating environment. Our survey reveals important "nudgeable" components of the elementary school food-choice architecture, including precommitment and default options on the lunch line.

WGS accurately predicts antimicrobial resistance in Escherichia coli.

OBJECTIVES: The objective of this study was to determine the effectiveness of WGS in identifying resistance genotypes of MDR Escherichia coli and whether these correlate with observed phenotypes. METHODS: Seventy-six E. coli strains were isolated from farm cattle and measured for phenotypic resistance to 15 antimicrobials with the Sensititre(®) system. Isolates with resistance to at least four antimicrobials in three classes were selected for WGS using an Illumina MiSeq. Genotypic analysis was conducted with in-house Perl scripts using BLAST analysis to identify known genes and mutations associated with clinical resistance. RESULTS: Over 30 resistance genes and a number of resistance mutations were identified among the E. coli isolates. Resistance genotypes correlated with 97.8% specificity and 99.6% sensitivity to the identified phenotypes. The majority of discordant results were attributable to the aminoglycoside streptomycin, whereas there was a perfect genotype-phenotype correlation for most antibiotic classes such as tetracyclines, quinolones and phenicols. WGS also revealed information about rare resistance mechanisms, such as structural mutations in chromosomal copies of ampC conferring third-generation cephalosporin resistance. CONCLUSIONS: WGS can provide comprehensive resistance genotypes and is capable of accurately predicting resistance phenotypes, making it a valuable tool for surveillance. Moreover, the data presented here showing the ability to accurately predict resistance suggest that WGS may be used as a screening tool in selecting anti-infective therapy, especially as costs drop and methods improve.

Evaluation of compliance to national nutrition policies in summer day camps.

OBJECTIVE: The National Afterschool Association (NAA) standards specify the role of summer day camps (SDC) in promoting healthy nutrition habits of the children attending, identifying foods and beverages to be provided to children and staff roles in promoting good nutrition habits. However, many SDC do not provide meals. Currently, national guidelines specifying what children are allowed to bring to such settings do not exist, nor is there a solid understanding of the current landscape surrounding healthy eating within SDC. DESIGN: A cross-sectional study design using validated measures with multiple observations was used to determine the types of foods and beverages brought to SDC programmes. SETTING: Four large-scale, community-based SDC participated in the study during summer 2011. SUBJECTS: The types of foods and beverages brought by children (n 766) and staff (n 87), as well as any instances of staff promoting healthy eating behaviours, were examined via direct observation over 27 d. Additionally, the extent to which current foods and beverages at SDC complied with NAA standards was evaluated. RESULTS: Less than half of the children brought water, 47% brought non-100% juices, 4% brought soda, 4% brought a vegetable and 20% brought fruit. Staff foods and beverages modelled similar patterns. Promotion of healthy eating by staff was observed <1% of the time. CONCLUSIONS: Findings suggest that foods and beverages brought to SDC by children and staff do not support nutrition standards and staff do not regularly promote healthy eating habits. To assist, professional development, parent education and organizational policies are needed.

Higher food prices may threaten food security status among American low-income households with children.

Children in food-insecure households are more likely to experience poorer health function and worse academic achievement. To investigate the relation between economic environmental factors and food insecurity among children, we examined the relation between general and specific food prices (fast food, fruits and vegetables, beverages) and risk of low (LFS) and very low food security (VLFS) status among low-income American households with children. Using information for 27,900 child-year observations from the Early Childhood Longitudinal Study-Kindergarten Class of 1998-1999 linked with food prices obtained from the Cost of Living Data of the Council for Community and Economic Research, formerly known as the American Chamber of Commerce Researchers' Association, fixed effects models were estimated within stratified income groups. Higher overall food prices were associated with increased risk of LFS and VLFS (coefficient = 0.617; P < 0.05). Higher fast food and fruit and vegetable prices also contributed to higher risk of food insecurity (coefficient = 0.632, P < 0.01 for fast food; coefficient = 0.879, P < 0.01 for fruits and vegetables). However, increasing beverage prices, including the prices of soft drinks, orange juice, and coffee, had a protective effect on food security status, even when controlling for general food prices. Thus, although food price changes were strongly related to food security status among low-income American households with children, the effects were not uniform across types of food. These relations should be accounted for when implementing policies that change specific food prices.

Genetic characterization of Escherichia coli O104 isolates from different sources in the United States.

Escherichia coli O104 isolates collected from different sources in the United States were examined for virulence genes typical of enterohemorrhagic E. coli and those identified in the O104:H4 isolate associated with the 2011 German outbreak. The unexpected presence of virulence markers in these isolates highlights the importance of screening unusual and potentially pathogenic Shiga toxin-producing E. coli serotypes.

Policy instruments used by States seeking to improve school food environments.

US legislatures and program administrators have sought to control the sale of foods offered outside of federally funded meal programs in schools, but little is known about which policies, if any, will prevent obesity in children. We used a theoretical policy science typology to understand the types of policy instruments used by US state governments from 2001 to 2006. We coded 126 enacted bills and observed several types of instruments prescribed by state legislatures to influence the foods sold in schools and improve the school food environment. Our study helps to better understand the various instruments used by policymakers and sets the stage to examine the effectiveness of the policy instruments used to prevent obesity.

Prevalence of Antimicrobial Resistance in Select Bacteria From Retail Seafood-United States, 2019.

In 2019, the United States National Antimicrobial Resistance Monitoring System (NARMS) surveyed raw salmon, shrimp, and tilapia from retail grocery outlets in eight states to assess the prevalence of bacterial contamination and antimicrobial resistance (AMR) in the isolates. Prevalence of the targeted bacterial genera ranged among the commodities: Salmonella (0%-0.4%), Aeromonas (19%-26%), Vibrio (7%-43%), Pseudomonas aeruginosa (0.8%-2.3%), Staphylococcus (23%-30%), and Enterococcus (39%-66%). Shrimp had the highest odds (OR: 2.8, CI: 2.0-3.9) of being contaminated with at least one species of these bacteria, as were seafood sourced from Asia vs. North America (OR: 2.7; CI: 1.8-4.7) and Latin America and the Caribbean vs. North America (OR: 1.6; CI: 1.1-2.3) and seafood sold at the counter vs. sold frozen (OR: 2.1; CI: 1.6-2.9). Isolates exhibited pan-susceptibility (Salmonella and P. aeruginosa) or low prevalence of resistance (<10%) to most antimicrobials tested, with few exceptions. Seafood marketed as farm-raised had lower odds of contamination with antimicrobial resistant bacteria compared to wild-caught seafood (OR: 0.4, CI: 0.2-0.7). Antimicrobial resistance genes (ARGs) were detected for various classes of medically important antimicrobials. Clinically relevant ARGs included carbapenemases (bla IMI-2, bla NDM-1) and extended spectrum ß-lactamases (ESBLs; bla CTX-M-55). This population-scale study of AMR in seafood sold in the United States provided the basis for NARMS seafood monitoring, which began in 2020.

Children are aware of food insecurity and take responsibility for managing food resources.

Child food insecurity is measured using parental reports of children's experiences based on an adult-generated conceptualization. Research on other child experiences (e.g. pain, exposure to domestic violence) cautions that children generally best report their own experiences, and parents' reports of children's experiences may lack adequate validity and impede effective intervention. Because this may be true of child food insecurity, we conducted semistructured interviews with mothers, children (age 9-16 y), and other household adults in 26 South Carolina families at risk for food insecurity. Interview transcripts were analyzed using a constant comparative process combining a priori with inductive coding. Child interviews revealed experiences of food insecurity distinct from parent experiences and from parent reports of children's experiences. Children experienced cognitive, emotional, and physical awareness of food insecurity. Children took responsibility for managing food resources through participation in parental strategies, initiation of their own strategies, and generation of resources to provide food for the family. Adults were not always aware of children's experiences. Where adult experiences of food insecurity are conditioned on inadequate money for food, child experiences were grounded in the immediate household social and food environment: quality of child/parent interactions, parent affect and behavior, and types and quantities of foods made available for children to eat. The new, child-derived understanding of what children experience that results from this study provides a critical basis from which to build effective approaches to identify, assess, and respond to children suffering from food insecurity.

Positive parenting practices associated with subsequent childhood weight change.

We aimed to identify positive parenting practices that set children on differential weight-trajectories. Parenting practices studied were cognitively stimulating activities, limit-setting, disciplinary practices, and parent warmth. Data from two U.S. national longitudinal data sets and linear and logistic regression were used to examine association of initial parenting practices with subsequent change in body mass index (BMI) Z-score and being overweight, stratified by income and gender. Lower change in BMI Z-score and lower likelihood of being or becoming overweight occurred among girls if parents engaged in cognitively stimulating activities or set bedtime; among low-income girls if parents helped with art and set bedtime; among high-income girls if they participated in dance or music, parents talked about nature or visited a museum or library, or parents had rules about number of hours for watching television; among low-income boys if they participated in dance or parents built something with them or set bedtime; and among high-income boys if they participated in dance or music. Greater expression of warmth was associated with lower change in BMI Z-score. Parenting practices facilitating cognitive stimulation, setting limits, and expressing warmth are associated with lower likelihood of being or becoming overweight and can be promoted by healthcare professionals.

Antimicrobial susceptibility testing and successful treatment of hospitalised patients with extensively drug-resistant Campylobacter jejuni infections linked to a pet store puppy outbreak.

OBJECTIVES: Most patients with Campylobacter infection do not require antibiotics; however, they are indicated in severe cases. Clinical breakpoints for many antibiotics are not yet established by the CLSI, making antibiotic selection for resistant infections challenging. During an outbreak of pet store puppy-associated XDR Campylobacter jejuni infections resistant to seven antibiotic classes, several patients required antibiotics. This study aimed to determine MICs of the outbreak strain for various antibiotics and describes the successful treatment of two patients using imipenem/cilastatin, a drug not traditionally used for Campylobacter infections. METHODS: We used whole-genome multilocus sequence typing (wgMLST) to determine the genetic relatedness of Campylobacter isolates collected from two human patients' stool samples with the outbreak strain. We performed extended antimicrobial susceptibility testing on 14 outbreak isolates and 6 control strains to determine MICs for 30 antibiotics (14 classes). RESULTS: Isolates from both patients were highly related to the outbreak strain by wgMLST. MICs indicated resistance of the outbreak strain to most antibiotic classes, except phenicols, glycylcyclines and carbapenems. Due to potential side effects of phenicols and safety issues precluding use of glycylcyclines such as tigecycline when alternatives agents are available, we used carbapenems to treat patients who were severely ill from the outbreak strain infections. CONCLUSION: Stewardship and clinical vigilance are warranted when deciding whether and how to treat patients with suspected C. jejuni diarrhoea with antibiotics. Clinicians should maintain a high index of suspicion for XDR Campylobacter when patients fail to improve and consider the use of carbapenems in such settings.

A National Antimicrobial Resistance Monitoring System Survey of Antimicrobial-Resistant Foodborne Bacteria Isolated from Retail Veal in the United States.

ABSTRACT: Little is known about the prevalence of antimicrobial-resistant (AMR) bacteria in veal meat in the United States. We estimated the prevalence of bacterial contamination and AMR in various veal meats collected during the 2018 U.S. National Antimicrobial Resistance Monitoring System (NARMS) survey of retail outlets in nine states and compared the prevalence with the frequency of AMR bacteria from other cattle sources sampled for NARMS. In addition, we identified genes associated with resistance to medically important antimicrobials and gleaned other genetic details about the resistant organisms. The prevalence of Campylobacter, Salmonella, Escherichia coli, and Enterococcus in veal meats collected from grocery stores in nine states was 0% (0 of 358), 0.6% (2 of 358), 21.1% (49 of 232), and 53.5% (121 of 226), respectively, with ground veal posing the highest risk for contamination. Both Salmonella isolates were resistant to at least one antimicrobial agent as were 65.3% (32 of 49) of E. coli and 73.6% (89 of 121) of Enterococcus isolates. Individual drug and multiple drug resistance levels were significantly higher (P < 0.05) in E. coli and Enterococcus from retail veal than in dairy cattle ceca and retail ground beef samples from 2018 NARMS data. Whole genome sequencing was conducted on select E. coli and Salmonella from veal. Cephalosporin resistance (blaCMY and blaCTX-M), macrolide resistance (mph), and plasmid-mediated quinolone resistance (qnr) genes and gyrA mutations were found. We also identified heavy metal resistance genes ter, ars, mer, fieF, and gol and disinfectant resistance genes qac and emrE. An stx1a-containing E. coli was also found. Sequence types were highly varied among the nine E. coli isolates that were sequenced. Several plasmid types were identified in E. coli and Salmonella, with the majority (9 of 11) of isolates containing IncF. This study illustrates that veal meat is a carrier of AMR bacteria.

Policies that restrict sweetened beverage availability may reduce consumption in elementary-school children.

OBJECTIVE: We investigated whether having a policy regarding the availability of sweetened beverages in school was associated with children's purchase and total weekly and daily consumption of sweetened beverages. DESIGN: Data were obtained from 10 719 children aged 9-13 years and 2065 elementary schools in the Early Childhood Longitudinal Study-Kindergarten cohort. Multilevel logistic regression was used to determine the magnitude and significance of relationships between the availability of different beverages and purchase of sweetened beverages at school and overall consumption of beverages. RESULTS: The purchase of sweetened beverages by children in school was strongly associated with the administrative policy of sweetened beverage availability. Compared with children in schools without an administrative policy that allowed sweetened beverages, children in schools with the policy were three times more likely to be either occasional or frequent consumers of sweetened beverages. CONCLUSIONS: A policy of availability of sweetened beverages makes an independent contribution to children's purchase and consumption of sweetened beverages in the 5th grade year.