North Carolina's Plan to Address Obesity: Healthy Weight and Healthy Communities

The plan itself is available at www.eatsmartmovemorenc.comThis presentation describes the 2013-2020 NC Obesity Plan. Evidence based core behaviors are described as well as strategies for encouraging the adoption of those behaviors in worksites, health care and colleges and universities Efforts such as medical nutrition therapy in the Family Medicine clinic; weight and diabetes education classes for those without insurance coverage; the local baby friendly hospital--initiated in response to the plan are describedThere were no sponsors for this talk. The Eat Smart Move More Leadership Team is responsible for the Plan described

Eating to Reduce NAFLD the Mediterranean Way

This 2-sided handout describes the Mediterranean Diet as an evidence-based eating approach demonstrated to be associated with benefits in the management and prevention of non-alcoholic fatty liver disease (NAFLD). This handout can be used by providers or educators to explain the Mediterranean approach to eating and assist their clients/patients in making realistic behavior changes to follow a Mediterranean style diet. The frontside of this handout uses the plate method to help users visualize the correct type, frequency, and proportion of foods that are included in a Mediterranean style of eating. The backside of this handout offers 6 tips to help users make their own eating pattern more like a Mediterranean approach to eating, like increasing intake of fruits and vegetables, choosing more whole grains, and changing the type of fat and protein in their diet

Emergency Food Bag and Patient Education for the MOTHeRS' Project

The authors are pleased to share these materials with others at no expense, please credit The MOTHeRS’ Project, Brody School of Medicine at East Carolina University. We would appreciate your telling us if/how you used these materials.The MOTHeRS’ Project was developed in 2020 with funding from the United Healthcare Foundation (UHF), ECU Physicians, and the Departments of OB-GYN, Psychiatry and Family Medicine, to utilize NC-STeP—a statewide telepsychiatry program to bring multidisciplinary care to three community-based primary care obstetric clinics in Carteret, Duplin, and Chowan counties. Through this collaborative care model that includes the patient, nurse navigator, diabetes educator, behavioral health manager, primary obstetrician, MFM specialist, and a psychiatrist consultant, the MOTHeRS’ Project brings support and insights of specialty physicians to the identified practices. An additional component of this program will be the Medical Food Pantry to include healthy food bags and tailored patient education to women with high risk pregnancies and food insecurity, living in rural areas. This entry includes the presentation that was developed and presented at ECU Family Medicine's annual Scholarship/Research Day. It describes the process used to develop the medically-tailored emergency food bag and complementary nutrition educational materials which will be provided to pregnant women who screen positive for food insecurity in the clinical setting. This presentation also discusses implementation of the MOTHeRS' project, how the process is being evaluated, and shares preliminary results obtained from follow-up surveys with food-bag recipients.United Health Foundation; Brody School of Medicine, Department of Family Medicine; ECU Physician

MOTHeRS' Project: Acceptability of a Medically Tailored Food Bag Treating Food Insecurity in High-Risk Pregnant Patients

The authors are pleased to share these materials with others at no expense, please credit The MOTHeRS’ Project, Brody School of Medicine at East Carolina University. We would appreciate your telling us if/how you used these materials.The MOTHeRS’ Project was developed in 2020 with funding from the United Healthcare Foundation (UHF), ECU Physicians, and the Departments of OB-GYN, Psychiatry and Family Medicine, to utilize NC-STeP—a statewide telepsychiatry program to bring multidisciplinary care to three community-based primary care obstetric clinics in Carteret, Duplin, and Chowan counties. Through this collaborative care model that includes the patient, nurse navigator, diabetes educator, behavioral health manager, primary obstetrician, MFM specialist, and a psychiatrist consultant, the MOTHeRS’ Project brings support and insights of specialty physicians to the identified practices. An additional component of this program will be the Medical Food Pantry to include healthy food bags and tailored patient education to women with high risk pregnancies and food insecurity, living in rural areas. This entry includes the poster that was developed for presentation at the 2021 Annual SNEB Conference. It describes the process used to develop the medically-tailored emergency food bag and complementary nutrition educational materials which will be provided to pregnant women who screen positive for food insecurity in the clinical setting. This presentation also discusses implementation of the MOTHeRS' project, how the process is being evaluated, and shares preliminary results obtained from follow-up surveys with food-bag recipients.United Health Foundation; Brody School of Medicine, Department of Family Medicine; ECU Physician

Meeting the Challenge of Providing Nutrition Services During the COVID-19 Pandemic.

Contributions came from Lindsay Drier MS, RDN, LDN; Kathleen Ascanio MS, RDN, LDN; Robin Tant MPA, RDN, LDN; Ashley Strickland RDN, LDN, CNSC; Laura Matarese PhD, RDN, LDN, CNSC, FADA, FASPEN, FAND; Jill Jennings MS, RDN, LDN and Julia Johnstone MS, RDN, LDNExamples of Registered Dietitian Nutritionists (RDNs) who used their abilities to innovate and adapt to ensure the public, their patients and clients received continuous nutrition services, weight management services, diabetes prevention programs and Medical Nutrition Therapy during the lock-down of many "non essential" medical services during COVID 19. Strategies used in outpatient practices, Cooperative Extension Service and public health agencies are described.non

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Genomic reconstruction of the SARS-CoV-2 epidemic in England.

The evolution of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus leads to new variants that warrant timely epidemiological characterization. Here we use the dense genomic surveillance data generated by the COVID-19 Genomics UK Consortium to reconstruct the dynamics of 71 different lineages in each of 315 English local authorities between September 2020 and June 2021. This analysis reveals a series of subepidemics that peaked in early autumn 2020, followed by a jump in transmissibility of the B.1.1.7/Alpha lineage. The Alpha variant grew when other lineages declined during the second national lockdown and regionally tiered restrictions between November and December 2020. A third more stringent national lockdown suppressed the Alpha variant and eliminated nearly all other lineages in early 2021. Yet a series of variants (most of which contained the spike E484K mutation) defied these trends and persisted at moderately increasing proportions. However, by accounting for sustained introductions, we found that the transmissibility of these variants is unlikely to have exceeded the transmissibility of the Alpha variant. Finally, B.1.617.2/Delta was repeatedly introduced in England and grew rapidly in early summer 2021, constituting approximately 98% of sampled SARS-CoV-2 genomes on 26 June 2021

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570