Transforming Public Health Practice With Generative Artificial Intelligence.

Public health practice appears poised to undergo a transformative shift as a result of the latest advancements in artificial intelligence (AI). These changes will usher in a new era of public health, charged with responding to deficiencies identified during the COVID-19 pandemic and managing investments required to meet the health needs of the twenty-first century. In this Commentary, we explore how AI is being used in public health, and we describe the advanced capabilities of generative AI models capable of producing synthetic content such as images, videos, audio, text, and other digital content. Viewing the use of AI from the perspective of health departments in the United States, we examine how this new technology can support core public health functions with a focus on near-term opportunities to improve communication, optimize organizational performance, and generate novel insights to drive decision making. Finally, we review the challenges and risks associated with these technologies, offering suggestions for health officials to harness the new tools to accomplish public health goals.

Estimating the Incubation Period of Salmonella Urinary Tract Infections Using Foodborne Outbreak Data.

Urinary tract infections (UTIs) are common and may occur in foodborne Salmonella outbreaks. Using data from PulseNet, the U.S. national molecular subtyping network for foodborne disease surveillance, we analyzed the 9781 Salmonella isolates associated with the 110 outbreaks from 2004 to 2013 that included at least one urine isolate. Within each outbreak, we calculated standardized isolation dates, using these dates in a linear mixed model to estimate the difference in incubation period for infections yielding stool versus urine isolates. We estimate that the incubation period for Salmonella UTIs is on average 10.6 (95% confidence interval 6.0-15.2) days longer than for gastrointestinal illness, suggesting that outbreak investigators should interview UTI patients about a longer time period before illness onset to identify sources of infection.

Exploration of risk factors for ceftriaxone resistance in invasive non-typhoidal Salmonella infections in western Kenya.

Multidrug-resistant non-typhoidal Salmonella (NTS) infection has emerged as a prominent cause of invasive infections in Africa. We investigated the prevalence of ceftriaxone-resistant invasive NTS infections, conducted exploratory analysis of risk factors for resistance, and described antimicrobial use in western Kenya. We conducted a secondary analysis of existing laboratory, epidemiology, and clinical data from three independent projects, a malaria vaccine trial, a central nervous system (CNS) study, and the International Emerging Infections Program morbidity surveillance (surveillance program) during 2009-2014. We calculated odds ratios (OR) with 95% confidence intervals (CI) for ceftriaxone-resistant NTS infections compared with ceftriaxone-susceptible infections. We surveyed hospitals, pharmacies, and animal drug retailers about the availability and use of antimicrobials. In total, 286 invasive NTS infections were identified in the three projects; 43 NTS isolates were ceftriaxone-resistant. The absolute prevalence of ceftriaxone resistance varied among these methodologically diverse projects, with 18% (16/90) of isolates resistant to ceftriaxone in the vaccine trial, 89% (16/18) in the CNS study, and 6% (11/178) in the surveillance program. Invasive ceftriaxone-resistant infections increased over time. Most ceftriaxone-resistant isolates were co-resistant to multiple other antimicrobials. Having an HIV-positive mother (OR = 3.7; CI = 1.2-11.4) and taking trimethoprim-sulfamethoxazole for the current illness (OR = 9.6, CI = 1.2-78.9) were significantly associated with acquiring ceftriaxone-resistant invasive NTS infection. Ceftriaxone and other antibiotics were widely prescribed; multiple issues related to prescription practices and misuse were identified. In summary, ceftriaxone-resistant invasive NTS infection is increasing and limiting treatment options for serious infections. Efforts are ongoing to address the urgent need for improved microbiologic diagnostic capacity and an antimicrobial surveillance system in Kenya.

A Case of Localized, Unilateral (Cephalic) Wound Botulism.

We describe a rare presentation of botulism originally presenting with exclusively unilateral cranial nerve deficits following a puncture wound to the face. Cephalic tetanus was initially suspected but laboratory testing confirmed botulism. Botulism caused by local diffusion of toxin from a contaminated head wound can be confused with cephalic tetanus.

Two Listeria monocytogenes Pseudo-outbreaks Caused by Contaminated Laboratory Culture Media.

Listeriosis is a serious foodborne infection that disproportionately affects elderly adults, pregnant women, newborns, and immunocompromised individuals. Diagnosis is made by culturing Listeria monocytogenes from sterile body fluids or from products of conception. This report describes the investigations of two listeriosis pseudo-outbreaks caused by contaminated laboratory media made from sheep blood.

Increase in Multistate Foodborne Disease Outbreaks-United States, 1973-2010.

INTRODUCTION: Changes in food production and distribution have increased opportunities for foods contaminated early in the supply chain to be distributed widely, increasing the possibility of multistate outbreaks. In recent decades, surveillance systems for foodborne disease have been improved, allowing officials to more effectively identify related cases and to trace and identify an outbreak's source. MATERIALS AND METHODS: We reviewed multistate foodborne disease outbreaks reported to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System during 1973-2010. We calculated the percentage of multistate foodborne disease outbreaks relative to all foodborne disease outbreaks and described characteristics of multistate outbreaks, including the etiologic agents and implicated foods. RESULTS: Multistate outbreaks accounted for 234 (0.8%) of 27,755 foodborne disease outbreaks, 24,003 (3%) of 700,600 outbreak-associated illnesses, 2839 (10%) of 29,756 outbreak-associated hospitalizations, and 99 (16%) of 628 outbreak-associated deaths. The median annual number of multistate outbreaks increased from 2.5 during 1973-1980 to 13.5 during 2001-2010; the number of multistate outbreak-associated illnesses, hospitalizations, and deaths also increased. Most multistate outbreaks were caused by Salmonella (47%) and Shiga toxin-producing Escherichia coli (26%). Foods most commonly implicated were beef (22%), fruits (13%), and leafy vegetables (13%). CONCLUSIONS: The number of identified and reported multistate foodborne disease outbreaks has increased. Improvements in detection, investigation, and reporting of foodborne disease outbreaks help explain the increasing number of reported multistate outbreaks and the increasing percentage of outbreaks that were multistate. Knowing the etiologic agents and foods responsible for multistate outbreaks can help to identify sources of food contamination so that the safety of the food supply can be improved.

The effect of normally consumed amounts of sucrose or high fructose corn syrup on lipid profiles, body composition and related parameters in overweight/obese subjects.

The American Heart Association (AHA) has advocated that women and men not consume more than 100 and 150 kcal/day, respectively, from added sugars. These levels are currently exceeded by over 90% of the adult population in the United States. Few data exist on longer-term metabolic effects when sucrose and High Fructose Corn Syrup (HFCS), the principal sources of added dietary sugars, are consumed at levels typical of the general population. Sixty five overweight and obese individuals were placed on a eucaloric (weight stable) diet for 10-weeks, which incorporated sucrose- or HFCS-sweetened, low-fat milk at 10% or 20% of calories in a randomized, double-blinded study. All groups responded similarly (interaction p > 0.05). There was no change in body weight in any of the groups over the 10-week study, or in systolic or diastolic blood pressure. Likewise, there were no changes in total cholesterol, triglycerides, low-density lipoprotein (LDL), or apolipoprotein B (Apo B). We conclude that (1) when consumed as part of a eucaloric diet fructose--when given with glucose (as normally consumed) does not promote weight gain or an atherogenic lipid profile even when consumed at two to four times the level recently recommended by the AHA. (2) There were no differences between HFCS and sucrose on these parameters.

Cholera epidemic associated with consumption of unsafe drinking water and street-vended water--Eastern Freetown, Sierra Leone, 2012.

During 2012, Sierra Leone experienced a cholera epidemic with 22,815 reported cases and 296 deaths. We conducted a matched case-control study to assess risk factors, enrolling 49 cases and 98 controls. Stool specimens were analyzed by culture, polymerase chain reaction (PCR), and pulsed-field gel electrophoresis (PFGE). Conditional logistic regression found that consuming unsafe water (matched odds ratio [mOR]: 3.4; 95% confidence interval [CI]: 1.1, 11.0), street-vended water (mOR: 9.4; 95% CI: 2.0, 43.7), and crab (mOR: 3.3; 95% CI: 1.03, 10.6) were significant risk factors for cholera infection. Of 30 stool specimens, 13 (43%) showed PCR evidence of toxigenic Vibrio cholerae O1. Six specimens yielded isolates of V. cholerae O1, El Tor; PFGE identified a pattern previously observed in seven countries. We recommended ensuring the quality of improved water sources, promoting household chlorination, and educating street vendors on water handling practices.

Popcorn is more satiating than potato chips in normal-weight adults.

BACKGROUND: Strategies that may increase compliance to reduced energy intakes are needed to reduce the health burden of obesity. Conflicting evidence exists regarding the effects of snacking on satiety and energy intake. METHODS: This study compared short-term satiety from two common snack foods, low fat popcorn or potato chips. Using a counterbalanced within-subject design, 35 normal weight non-smoking participants (17 men, 18 women) ages 20-50 years (mean age 33 ± 11, BMI 23 ± 2 kg/m²) consumed four conditions each: 200 mL of water (control), one cup (4 g, 15 kcal) popcorn, 6 cups (27 g, 100 kcal) popcorn, and one cup (28 g, 150 kcal) potato chips, each with 200 mL water. Participants rated their hunger, satisfaction, prospective consumption, and thirst on 100 mm visual analogue scales 30 minutes after commencement of snack consumption. In addition, post-snack energy intake from an ad libitum meal (amount served less amount remaining) was measured, and the test food and meal combined energy intake and energy compensation were calculated. RESULTS: Participants expressed less hunger, more satisfaction, and lower estimates of prospective food consumption after six cups of popcorn compared to all other treatments (P < 0.05). Energy compensation was 220% ± 967%, 76% ± 143% and 42% ± 75% after one cup popcorn, six cups popcorn and one cup potato chips, respectively. Combined energy intake was significantly greater (P < 0.01) during the potato chips condition (803 ± 277 kcal) compared to control (716 ± 279 kcal) or popcorn conditions (698 ± 286 kcal for one cup and 739 ± 294 kcal for six cups). Combined energy intakes from both popcorn conditions were not significantly different than control (p > 0.05). CONCLUSION: Popcorn exerted a stronger effect on short-term satiety than did potato chips as measured by subjective ratings and energy intake at a subsequent meal. This, combined with its relatively low calorie load, suggests that whole grain popcorn is a prudent choice for those wanting to reduce feelings of hunger while managing energy intake and ultimately, body weight.

The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on weight loss and related parameters.

BACKGROUND: The replacement of sucrose with HFCS in food products has been suggested as playing a role in the development of obesity as a public health issue. The objective of this study was to examine the effects of four equally hypocaloric diets containing different levels of sucrose or high fructose corn syrup (HFCS). METHODS: This was a randomized, prospective, double blind trial, with overweight/obese participants measured for body composition and blood chemistry before and after the completion of 12 weeks following a hypocaloric diet. The average caloric deficit achieved on the hypocaloric diets was 309 kcal. RESULTS: Reductions were observed in all measures of adiposity including body mass, BMI,% body fat, waist circumference and fat mass for all four hypocaloric groups, as well as reductions in the exercise only group for body mass, BMI and waist circumference. CONCLUSIONS: Similar decreases in weight and indices of adiposity are observed when overweight or obese individuals are fed hypocaloric diets containing levels of sucrose or high fructose corn syrup typically consumed by adults in the United States.

Body composition, dietary composition, and components of metabolic syndrome in overweight and obese adults after a 12-week trial on dietary treatments focused on portion control, energy density, or glycemic index.

BACKGROUND: Given the rise in obesity and associated chronic diseases, it is critical to determine optimal weight management approaches that will also improve dietary composition and chronic disease risk factors. Few studies have examined all these weight, diet, and disease risk variables in subjects participating in recommended multi-disciplinary weight loss programs using different dietary strategies. METHODS: This study compared effects of three dietary approaches to weight loss on body composition, dietary composition and risk factors for metabolic syndrome (MetS). In a 12-week trial, sedentary but otherwise healthy overweight and obese adults (19 M & 138 F; 38.7±6.7 y; BMI 31.8±2.2) who were attending weekly group sessions for weight loss followed either portion control, low energy density, or low glycemic index diet plans. At baseline and 12 weeks, measures included anthropometrics, body composition, 3-day food diaries, blood pressure, total lipid profile, HOMA, C-reactive protein, and fasting blood glucose and insulin. Data were analyzed by repeated measures analysis of variance. RESULTS: All groups significantly reduced body weight and showed significant improvements in body composition (p<0.001), and components of metabolic syndrome (p<0.027 to 0.002), although HDL decreased (p<0.001). Dietary energy, %fat and %saturated fat decreased while protein intake increased significantly (p<0.001). There were no significant differences among the three groups in any variable related to body composition, dietary composition, or MetS components. CONCLUSION: Different dietary approaches based on portion control, low energy density, or low glycemic index produced similar, significant short-term improvements in body composition, diet compositin, and MetS components in overweight and obese adults undergoing weekly weight loss meetings. This may allow for flexibility in options for dietary counseling based on patient preference.

The effect of high-fructose corn syrup consumption on triglycerides and uric acid.

Rates of overweight and obesity have been on a steady rise for decades, and the problems society faces from this and associated metabolic diseases are many. As a result, the need to understand the contributing factors is great. A very compelling case can be made that excess sugar consumption has played a significant role. In addition, fructose, as a component of the vast majority of caloric sweeteners, is seen to be particularly insidious. Evidence shows that fructose bypasses many of the body's satiating signals, thus potentially promoting overconsumption of energy, weight gain, and the development on insulin resistance. It has also been shown to increase uric acid levels, which in turn promotes many of the abnormalities seen in the metabolic syndrome including hypertriglyceridemia. However, the main source of fructose in the diet is high-fructose corn syrup (HFCS), an artificially manufactured disaccharide that is only 55% fructose. This review highlights the fact that limited data are available about the metabolic effects of HFCS compared with other caloric sweeteners. The data suggest that HFCS yields similar metabolic responses to other caloric sweeteners such as sucrose.

High-fructose corn syrup, energy intake, and appetite regulation.

High-fructose corn syrup (HFCS) has been implicated in excess weight gain through mechanisms seen in some acute feeding studies and by virtue of its abundance in the food supply during years of increasing obesity. Compared with pure glucose, fructose is thought to be associated with insufficient secretion of insulin and leptin and suppression of ghrelin. However, when HFCS is compared with sucrose, the more commonly consumed sweetener, such differences are not apparent, and appetite and energy intake do not differ in the short-term. Longer-term studies on connections between HFCS, potential mechanisms, and body weight have not been conducted. The main objective of this review was to examine collective data on associations between consumption of HFCS and energy balance, with particular focus on energy intake and its regulation.

Effects of high-fructose corn syrup and sucrose consumption on circulating glucose, insulin, leptin, and ghrelin and on appetite in normal-weight women.

OBJECTIVE: Fructose has been implicated in obesity, partly due to lack of insulin-mediated leptin stimulation and ghrelin suppression. Most work has examined effects of pure fructose, rather than high-fructose corn syrup (HFCS), the most commonly consumed form of fructose. This study examined effects of beverages sweetened with HFCS or sucrose (Suc), when consumed with mixed meals, on blood glucose, insulin, leptin, ghrelin, and appetite. METHODS: Thirty lean women were studied on two randomized 2-d visits during which HFCS- and Suc-sweetened beverages were consumed as 30% of energy on isocaloric diets during day 1 while blood was sampled. On day 2, food was eaten ad libitum. Subjects rated appetite at designated times throughout visits. RESULTS: No significant differences between the two sweeteners were seen in fasting plasma glucose, insulin, leptin, and ghrelin (P > 0.05). The within-day variation in all four items was not different between the two visits (P > 0.05). Net areas under the curve were similar for glucose, insulin, and leptin (P > 0.05). There were no differences in energy or macronutrient intake on day 2. The only appetite variable that differed between sweeteners was desire to eat, which had a higher area under the curve the day after Suc compared with HFCS. CONCLUSION: These short-term results suggest that, when fructose is consumed in the form of HFCS, the measured metabolic responses do not differ from Suc in lean women. Further research is required to examine appetite responses and to determine if these findings hold true for obese individuals, males, or longer periods.

Consumption of whole-grain cereals during weight loss: effects on dietary quality, dietary fiber, magnesium, vitamin B-6, and obesity.

OBJECTIVE: While various weight-management approaches produce weight loss, they may differ in dietary quality. We monitored changes in nutrient intakes in overweight and obese subjects on three different weight-management programs. DESIGN: Randomized clinical trial (pilot study) with two 12-week phases: phase 1, weekly counseling; phase 2, monitoring only. SUBJECTS/SETTING: One hundred eighty nonsmoking, sedentary overweight and obese adults began this outpatient study; 134 (body mass index [calculated as kg/m(2)]=30.9+/-2.4; age=42.3+/-1.2 years) were used in analyses. INTERVENTION: Twenty-four weeks of exercise only (control group), hypocaloric diet plus exercise, or hypocaloric diet with fiber-rich whole-grain cereals plus exercise. MAIN OUTCOME MEASURES: At weeks 0, 12, and 24, diet quality was assessed by 3-day food records and body weight was measured. STATISTICAL ANALYSES PERFORMED: Three-way analysis of variance with repeated measures. RESULTS: The hypocaloric diet with fiber-rich whole-grain cereals plus exercise decreased energy intake more than exercise only (P=0.032). By week 12, the hypocaloric diet with fiber-rich whole-grain cereals plus exercise and the hypocaloric diet plus exercise decreased total fat more than exercise only, which was sustained in the hypocaloric diet with fiber-rich whole-grain cereals plus exercise at 24 weeks (P<0.001). At weeks 12 and 24, the hypocaloric diet with fiber-rich whole-grain cereals plus exercise reduced saturated fat intake more than exercise only. The hypocaloric diet with fiber-rich whole-grain cereals plus exercise increased total fiber, insoluble fiber (both P<0.001), magnesium (P=0.004), and vitamin B-6 (P=0.002) intakes more than the hypocaloric diet plus exercise and exercise only. Calcium and vitamin E intakes were inadequate in all groups. Weight loss was similar in the hypocaloric diet with fiber-rich whole-grain cereals plus exercise and the hypocaloric diet plus exercise. CONCLUSIONS: Weight-reduction strategies may be associated with reduced intake of micronutrients, such as calcium and vitamin E. However, a hypocaloric diet with fiber-rich whole-grain cereal is effective for improving or maintaining other aspects of dietary quality during weight loss.