Food Insecurity in Kalamazoo

Introduction: Food insecurity is both an inconvenience and problem. As of 2013, over 16 million children in the USA were food insecure. The consequences of food insecurity include health issues from nutritional deficits, developmental difficulties, and behavioral problems that manifest in educational, personal and professional challenges. Overall, food insecurity and its impact on individuals and families is under-recognized. Additionally, the extent to which physicians play a role in helping patients secure access to food assistance programs remains unclear. Objective: The objective of this study was to assess the efficacy and methodologies of current healthcare practices based in Kalamazoo County, MI, in identifying pediatric patients who are food insecure. Results will help local assistance resources, such as Kalamazoo Loaves and Fishes, improve outreach efforts and re-focus their programs. Furthermore, results could impact physician practices regarding identifying those who are food insecure. Methods: The American Academy of Pediatrics (AAP) developed a 2-question survey with 97% sensitivity for identifying food insecurity. The questions are: Within the past 12 months, we worried whether our food would run out before we got money to buy more and Within the past 12 months, the food we bought just didn\u27t last and we didn\u27t have money to buy more. Using these questions as a foundation, we developed an electronically distributed 20-question survey that assessed awareness of food insecurity among Kalamazoo pediatric and family medicine physicians. Survey questions covered years of practice, usage of the AAP questions, level of formal training on food insecurity, mid-level and support staff, and resources recommended to patients. Results and Discussion: The 25 responses were analyzed for differences between groups. Although no significant relationships were found, 76% of respondents believed food insecurity directly related to their patient\u27s illness, though only 52% ask direct questions about food insecurity. Women, Infants and Children (WIC) program referrals were common and almost all respondents were willing to include the two AAP-validated food insecurity screening questions in their practice. A consensus emerged that a list of local resources would be helpful in addressing food insecurity. Conclusion: Kalamazoo pediatricians and family medicine physicians believe food insecurity directly relates to the problems affecting their patients. However, only half of physicians ask patients about food insecurity. Future work should focus on expanding physician-patient conversations about food insecurity, addition of validated food insecurity questions to patient questionnaires, and compiling a list of local resources for distribution to local providers

A Year in Review: Clarifying the State of Chronic Traumatic Encephalopathy Research in 2016

Introduction: Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease associated with repeated mild traumatic brain injury. In the past decade, CTE has raised concern regarding safety in athletics and has been subject to intense media coverage. The medical and lay community continue to debate its impact as it pertains to athletics, military trauma, and domestic abuse. Despite newfound focus in recent years, fundamental knowledge gaps persist in understanding CTE. Purpose: To better understand the state of current CTE research, we performed a systematized review of publications from 2016. The study clarifies the manner in which CTE research has evolved over time, distinguishes the various areas of research as of 2016, and identifies knowledge gaps requiring further investigation. Methods: We completed a PubMed search with MeSH terms Chronic Traumatic Encephalopathy and CTE on publications released after January 1st, 2016. The search places priority on articles considered to have had the most impact in the past year based on their number of times cited and impact factor. The various papers are organized into categories based on their primary focus: Cellular and Molecular Mechanisms, Pathology and Pathophysiology, Antemortem Diagnosis, Suicide, Risk and Protective Factors, Review articles, and Controversy and Challenges in the diagnosis of CTE. Results: After applying inclusion criteria, 136 articles were identified and categorized. Efforts to identify impact articles from the overall search cohort are ongoing as of abstract submission in order to avoid study exclusion. Search results demonstrate the breadth of ongoing research and the areas in which researchers made particularly notable achievements in 2016. Of greatest note, a NINDS/NIBIB consensus panel (McKee et al. 2016) published a series of studies to standardize neuropathological criteria for post-mortem diagnosis of CTE and to distinguish CTE from other neurodegenerative tauopathies. Furthermore, significant research was published in the above categories including the development of biomarkers for antemortem diagnosis of CTE and the impact of cognitive reserve on the progression of symptomatic disease. Discussion: Despite increased awareness of CTE in the medical community, debate continues over the underlying pathogenic mechanism and its status as its own entity rather than as a subset of another neurodegenerative disease. A knowledge gap exists in the ability to make a definitive antemortem diagnosis of CTE and requires further research. Overall, this review accomplishes its primary aims of clarifying the state of current CTE research and identifying areas for future direction