• Widespread differences in cortical thickness (CT) were observed in patients with low back pain. • Changes in CT correlated with self-reported clinical scores of pain and emotion. • Changes in resting state fMRI metrics of functional networks. • Support vector machines separated low back pain patients from controls with a high performance. • Multi-modal biomarkers can be useful when identifying personalized treatments for low back pain.

SARS-CoV-2 (COVID-19) resulted in school closures and contingencies across the U.S. that limited access to school meals for students. While some schools attempted to provide alternative meal access points where students or parents could pick up meals, many students—especially those in low-income households—lacked adequate transportation to these access points. Thus, physical proximity to meal access points was particularly important during the pandemic. In this study, we explore how school meal access changed during the COVID-19 pandemic, especially as it relates to race/ethnicity and socio-economic status. Taking into account both the “supply” (meal access points) and the “demand” (low-income students) for free meals, we employed a two-step floating catchment area analysis to compare meal accessibility in St. Louis, Missouri before and during the pandemic in the spring and summer of 2019 and 2020. Overall, while school meal access decreased during the spring of 2020 during the early months of the pandemic, it increased during the summer of 2020. Moreover, increased access was greatest in low-income areas and areas with a higher proportion of Black residents. Thus, continuing new policies that expanded access to school meals—especially for summer meal programs—could lead to positive long-term impacts on children’s health and well-being.

Background. Previous research has explored the impact of W.I.C. on recipients’ health, but less is known about the connection between barriers to W.I.C. access and health outcomes. We fill in a gap in the literature by studying the relationship between barriers to Special Supplemental Nutrition Program for Women, Infants, and Children (W.I.C.) access and adult and child food insecurity. Methods. After survey administration, we analyzed a cross-sectional sample of 2244 residents in Missouri who have used W.I.C. or lived in a household with a W.I.C. recipient in the past three years. We ran logistic regression models to understand the relationships among barriers to W.I.C. utilization, adult food insecurity, and child food insecurity. Results. Having special dietary needs (for adults), lacking access to technology, encountering inconvenient clinic hours of operation, and experiencing difficulties taking off work were associated with increased adult food insecurity. Difficulties finding WIC-approved items in the store, technological barriers, inconvenient clinic hours, difficulties taking off work, and finding childcare were associated with increased child food insecurity. Conclusion. Barriers to accessing and utilizing W.I.C. are associated with adult and child food insecurity. However, current policies suggest promising approaches to curbing these barriers.

Purpose: Food insecurity has far-reaching consequences for health and well-being, especially during pregnancy and postpartum periods. This study examines a food-is-medicine approach that aimed to reduce food insecurity, maternal stress, depression, anxiety, preterm labor, and low birthweight. Design: Pre-post interventional study of FreshRx: Nourishing Healthy Starts, a pregnancy focused food-is-medicine program led by a local hunger relief organization and obstetrics department. Setting: St. Louis, Missouri, a Midwestern U.S. city with higher-than-average infant mortality, low birthweight, and preterm birth rates. Sample: Participants (N = 125) recruited from a local obstetrics clinic had pregnancies earlier than 24 weeks gestation; spoke English; and were enrolled in Medicaid. At baseline, 67.0% reported very low food security and none reported high food security, while 34.7% indicated depressive symptoms. Intervention: FreshRx included weekly deliveries of fresh food meal kits, nutrition counseling and education, care coordination, and supportive services. Measures: 18-Question U.S. Household Food Security Survey, Edinburgh Postnatal Depression Scale, birthweight, gestational age. Analysis: Single arm pre-post analysis. Results: Average gestational age of 38.2 weeks (n = 84) and birthweight of 6.7 pounds (n = 81) were higher than rates for the general population in the area. For study participants who completed a sixty-day post-partum assessment, 13% (n = 45) indicated maternal depression ( P < .01). Conclusion: Food-is-medicine interventions may be an efficient, effective, and equitable tool for improving birth and maternal health outcomes.

Background: In 2018, the United States Department of Agriculture (USDA) issued flexibilities to the National School Lunch and Breakfast Programs, relaxing the nutrition standards for milk, whole grains, and sodium. This study examines the implementation decision-making among Missouri school food services and the impact of implementing these flexibilities on the meals served. Methods: We developed a survey using the Consolidated Framework of Implementation to determine schools’ implementation of the flexibilities and factors related to implementation. To determine how the implementation of flexibilities affected participation, we merged the survey results with school-level meal county data from the Missouri Department of Elementary and Secondary Education. We used ordinary least squares regression to examine how flexibility adoption related to the number of meals served. Results: Most schools implemented the wheat, milk, and sodium flexibilities. Common reasons for implementation were increasing participation, meeting students’ preferences, expanding menu variety, and saving money. The implementation of flexibilities was associated with more lunches and breakfasts being served per month, particularly among free and reduced-price meals. Conclusions: Continued research is needed to determine how the increased uptake of school meals that do not fully meet dietary guidelines by low-income students results in inequities in health outcomes. The findings can inform the design and implementation of future policies, especially as new rules related to flexibility design are determined.