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The U.S. Department of Agriculture (USDA) Food Security Survey Module (FSSM) is a valuable tool for measuring food insecurity, but it has limitations for capturing experiences of less severe food insecurity. To develop and test the Four Domain Food Insecurity Scale (4D-FIS), a complementary measure designed to assess all four domains of the food access dimension of food insecurity (quantitative, qualitative, psychological, and social).Low-income Black, Latina, and White women (n = 109) completed semi-structured (qualitative) and structured (quantitative) interviews. Interviewers separately administered two food insecurity scales, including the 4D-FIS and the USDA FSSM adult scale. A scoring protocol was developed to determine food insecurity status with the 4D-FIS. Analyses included a confirmatory factor analysis to examine the hypothesized structure of the 4D-FIS and an initial evaluation of reliability and validity. A four-factor model fit the data reasonably well as judged with fit indices. Results showed relatively high factor loadings and inter-factor correlations indicated that factors were distinct. Cronbach's alpha (ɑ) for the overall scale was 0.90 (subscale ɑ ranged from 0.69 to 0.91) and provided support for the scale's internal consistency reliability. There was fair overall agreement between the 4D-FIS and USDA FSSM adult scale, but agreement varied by category. Findings provide preliminary support for the 4D-FIS as a complementary measure of food insecurity, with implications for researchers, practitioners, and policymakers working in U.S. communities.

Studies in rodents with reduced nephron mass have suggested a strong positive correlation between dietary phosphate consumption and CKD progression. Prior work by our group demonstrated that dietary phosphate restriction can prevent tubular injury and microcyst formation in rodents with glomerulonephritis. Tubular injury and cystic dilation of tubules are key contributors to kidney function decline in polycystic kidney disease (PKD). Here, we determined whether dietary phosphate restriction slows renal cyst growth and fibrosis in a mouse model of PKD. Pcy/pcymice received a normal phosphate (0.54%) or a phosphate-restricted (0.02%) diet (n= 10/group) from 7 to 20 wk of age. All of the other major dietary constituents, including protein source and content, were comparable between the two diets. At 20 wk, body weight, kidney weight-to-body weight ratio (KW/BW), cystic area, cyst number, and kidney fibrosis were quantified. Pcy/pcymice fed a phosphate-restricted diet had lower serum phosphate, fibroblast growth factor 23, and parathyroid hormone levels, along with elevated serum calcium levels and increased kidney Klothogene expression compared with mice that consumed the control diet. Dietary phosphate restriction resulted in a 25% lower KW/BW ratio and reduced the cyst number, cystic index, and gene expression for the tubular injury markers neutrophil gelatinase-associated lipocalin and interleukin-18. Mice fed the phosphate-restricted diet exhibited lower kidney expression for pathways involved in collagen deposition and myofibroblast activation (collagen type I-α1, phosphorylated SMAD3, and α-smooth muscle actin); however, histological differences in kidney fibrosis were not appreciated. Dietary phosphate restriction slows cystogenesis and inhibits the activation of key pathways in the generation of kidney fibrosis in PKD mice.

Introduction

A drug, by definition, is a medicine or substance that has a physiological effect when ingested or introduced into the body. Medications are utilized daily in the field of dermatology to treat a variety of skin conditions, such as eczema, psoriasis, and warts. The purpose of this column is to highlight common medicines used in dermatology, focusing on their mechanisms of action, usage and function, and available alternatives. This article describes the features of podophyllotoxin, utilized in diluted solution as podofilox, a topical treatment for external genital warts, such as condylomata acuminata.

American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) created the Surgical Risk Calculator, to allow physicians to offer patients a risk-adjusted 30-day surgical outcome prediction. This tool has not yet been validated in plastic surgery. A retrospective analysis of all plastic surgery-specific complications from a quality assurance database from September 2013 through July 2015 was performed. Patient preoperative risk factors were entered into the ACS Surgical Risk Calculator, and predicted outcomes were compared with actual morbidities. The difference in average predicted complication rate versus the actual rate of complication within this population was examined. Within the study population of patients with complications (n=104), the calculator accurately predicted an above average risk for 20.90% of serious complications. For surgical site infections, the average predicted risk for the study population was 3.30%; this prediction was proven only 24.39% accurate. The actual incidence of any complication within the 4924 patients treated in our plastic surgery practice from September 2013 through June 2015 was 1.89%. The most common plastic surgery complications include seroma, hematoma, dehiscence and flap-related complications. The ACS Risk Calculator does not present rates for these risks. While most frequent outcomes fall into general risk calculator categories, the difference in predicted versus actual complication rates indicates that this tool does not accurately predict outcomes in plastic surgery. The ACS Surgical Risk Calculator is not a valid tool for the field of plastic surgery without further research to develop accurate risk stratification tools.

American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) created the Surgical Risk Calculator, to allow physicians to offer patients a risk-adjusted 30-day surgical outcome prediction. This tool has not yet been validated in plastic surgery. A retrospective analysis of all plastic surgery-specific complications from a quality assurance database from September 2013 through July 2015 was performed. Patient preoperative risk factors were entered into the ACS Surgical Risk Calculator, and predicted outcomes were compared with actual morbidities. The difference in average predicted complication rate versus the actual rate of complication within this population was examined. Within the study population of patients with complications (n=104), the calculator accurately predicted an above average risk for 20.90% of serious complications. For surgical site infections, the average predicted risk for the study population was 3.30%; this prediction was proven only 24.39% accurate. The actual incidence of any complication within the 4924 patients treated in our plastic surgery practice from September 2013 through June 2015 was 1.89%. The most common plastic surgery complications include seroma, hematoma, dehiscence and flap-related complications. The ACS Risk Calculator does not present rates for these risks. While most frequent outcomes fall into general risk calculator categories, the difference in predicted versus actual complication rates indicates that this tool does not accurately predict outcomes in plastic surgery. The ACS Surgical Risk Calculator is not a valid tool for the field of plastic surgery without further research to develop accurate risk stratification tools.

Obesity continues to be a public health concern across the globe. Obesity has a demonstrated association with health behaviors and health outcomes, such as diabetes, hypertension, and cancer. Over the past 2 decades, obesity has increased worldwide and remains highest in the United States. It is critical to understand the definition of obesity, using body mass index appropriately, recent estimates, and risk factors as a framework within which clinicians should work to help reduce the burden of obesity. This framework, including the Healthy People 2020 place-based approach to social determinants of health, is described in this article.

Dermatology is a complex area of medicine that requires knowledge of skin biology, pathophysiology, chemistry, diagnostic tests, and physical examination. Although the skin may be the primary focus of a disease process, systemic disease processes may present with manifestation in the skin. This nurse perspective focuses on delusions of parasitosis or Ekbom’s syndrome. Ekbom’s syndrome is a psychocutaneous disorder in which patients believe they are infested with bugs, in the absence of actual infestation. This disorder needs multidisciplinary collaboration to aid treatment.

The availability of an adequate household food supply is critical for the older population. There is little work that has examined food security and the influence of nativity on food security among older Mexican Americans living along the Texas-Mexico border. Using data from 140 older women (age ≥ 50 y) who participated in the 2009 Colonia Household and Community Food Resource Assessment (C-HCFRA), we examined demographic characteristics, health characteristics, food access and mobility, federal and community food and nutrition assistance programs, quality of food environment, food security, eating behaviors, and alternative food sources. 77% of participants experienced food insecurity, with 68% experiencing very low food security. Very low food security was associated with being born in Mexico, adjusting for household income and food assistance program participation. This article provides compelling evidence for enhanced research efforts that will better understand coping strategies and the use of food and nutrition assistance programs for reducing hardship associated with very low food security among older U.S.- and Mexico-born Mexican American women.

This study examined the association of compositional measures of collective social functioning, composed of community and familial social capital and perceived personal disparity, with food security among older (aged 50-59 y) and senior (aged ≥ 60 y) adult residents of the largely rural Brazos Valley in Central Texas using data from the 2006 Brazos Valley Community Health Assessment (analytic N = 1059, 74% response rate). Among older adults and seniors, 18.6% reported food insecurity (5.5% often and 13.1% sometimes), defined as running out of food and not having money to buy more. Low community social capital was reported by 22.4% of participants, and 30.8% indicated they were single, widowed, or divorced, an indicator of limited familial social capital. A robust multinomial regression model found the odds of reporting greater food insecurity increased for individuals who were women, African American, residents of a household with a low or poverty-level income, individuals who perceived themselves to be worse off than others within their community, and those who had low social capital. The odds of being food insecure decreased for older respondents, partnered respondents and persons with more education (pseudo r2 = 0.27, p < 0.0000). Compositional level measures of collective social functioning are important associates of food insecurity among older adults and seniors, regardless of severity.

This study used the concept of material hardship to understand how unmet needs related to food, housing, and health influence depressive symptoms among homebound older adults (N = 345) in North Carolina. Using data from the Nutrition and Function Study, 37% reported high levels of depressive symptoms and 17.4% indicated not receiving needed health care. Approximately 10% of respondents were food insecure; 30.7% were at risk for food insecurity; and 39.7% reported having to choose between either food and medication or food and paying bills. Adjusted logistic regression model revealed that food insecurity status (OR = 4.9) and age 60-74 y (OR = 2.4) were significantly associated with a greater number of depressive symptoms. Other indicators of material hardship, such as having a major financial difficulty, unmet health need, and inadequate housing, were not significant. By far, food insecurity was the most salient influence on depressive symptoms. These findings have important implications for service providers, researchers, and policymakers.

We surveyed nonindustrial private (family) forestland owners in five states in the southern United States to identify their perception, awareness, and adoption of wildfire prevention and mitigation programs. Wildfire is perceived as an imminent threat by the majority of the survey respondents, and over two-thirds of them have taken some preventive measure. Program awareness, wildfire experience and risk perception, information sources, wildfire preventive activities, and preferences for government interventions differ across racial groups; experience with wildfire, knowledge and activities of fire protection, information sources, and desire for government intervention and technical assistance are also significantly different between male and female landowners. Additionally, program awareness by landowners does not necessarily translate into action in preventing and mitigating wildfire, suggesting that additional assistance and stimuli would be needed to encourage private landowners to be more proactive against wildfire.

We used a national household survey to examine knowledge, attitudes, and preferences pertaining to wildland fire. First, we present nationwide results and trends. Then, we examine opinions across region and race. Despite some regional variation, respondents are fairly consistent in their beliefs about assuming personal responsibility for living in fire-prone areas and believing that residents of such areas should follow government guidelines for managing fire risk. However, we find divergence of opinion on “trusting forest professionals” between African-American and Caucasian people. Across all survey questions related to fire management and public confidence, African-Americans appear to be relatively more concerned than Caucasian or Hispanic people.

Recent data from the US Forest Service's onsite National Visitor Use Monitoring Survey (National Visitor Use Monitoring Survey, 2004. Unpublished demographic results for 2002–2003. Data on file with Donald English, Program Manager, Visitor Use Monitoring Project, Washington,DC) shows that visits made by African Americans account for very low percentages of visits to national forests across the country. This is true even in the South, a region where African Americans are highly concentrated. In contrast, Hispanic visits to national forests in the Southwest arehigh, relative to their population proportion. We examine additional national level household data on awareness of federal lands and management to help understand the discrepancy between Hispanic and African American recreational use of federal lands. We hypothesized that awareness, knowledgeof management objectives, and attitudes about fees would reduce African American/Hispanic visitation differences; but strong differences remained after accounting for these factors. Results suggest other factors such as private landownership, and social definitions of place may be useful inconsidering African American use of wildland public recreation areas in the South.

The ethnicity and marginality explanations of minority recreation participation provide the conceptual basis for our inquiry. These theories are examined for a sample of rural African Americans and whites. Using logistic regression, we test for black and white differences in: 1) visitation to wildland areas in general; 2) visitation to National Forest wildland areas; and 3) household visitation to the Apalachicola National Forest. Next, we test the marginality/ethnicity paradigm by examining reasons for non-visitation and latent demand for visitation. Our findings show that race, sex, and age as well as a race/poor (poor black) interaction term are strong predictors of visitation. However, race appears to be less effective in predicting reasons for non-visitation and latent demand for wildland visitation. Overall, results do not provide strong support for either ethnicity or marginality as a sole explicator of racial differences in wildland recreation. Rather, results indicate that the two probably work in combination to explain racial differences. The poor black interaction also suggests that rural black visitation to wildlands varies depending upon income, with less affluent blacks actually participating more than those with higher incomes. This contradicts the marginality assertion that recreation participation varies positively with income and suggests that marginality theory may need to be qualified depending upon residence (rural versus urban) and type of activity.

A personal narrative is presented which explores the author's routine and chores at their farm during a Saturday morning.