Twenty-Four-Hour Urinary Sugars Biomarker in a Vending Machine Intake Paradigm in a Diverse Population

Accurately measuring dietary sugars intake in large-scale epidemiological studies is necessary to understand dietary sugars' true impact on health. Researchers have developed a biomarker that can be used to assess total sugars intake. Our objective is to test this biomarker in diverse populations using an ad libitum intake protocol. Healthy adult participants (n = 63; 58% Indigenous Americans/Alaska Natives; 60% male; BMI (mean ± SD) = 30.6 ± 7.6 kg.m2) were admitted for a 10-day inpatient stay. On day 2, body composition was measured by DXA, and over the last 3 days, ad libitum dietary intake was measured using a validated vending machine paradigm. Over the same days, participants collected daily 24 h urine used to measure sucrose and fructose. The 24 h urinary sucrose and fructose biomarker (24hruSF) (mg/d) represents the sum of 24 h urinary sucrose and fructose excretion levels. The association between the 3-day mean total sugars intake and log 24uSF level was assessed using the Pearson correlation. A linear mixed model regressing log-biomarker on total sugars intake was used to investigate further the association between biomarker, diet, and other covariates. Mean (S.D.) total sugars intake for the group was 197.7 g/d (78.9). Log 24uSF biomarker was moderately correlated with total sugars intake (r = 0.33, p = 0.01). In stratified analyses, the correlation was strongest in females (r = 0.45, p = 0.028), the 18-30 age group (r = 0.44, p = 0.079), Indigenous Americans (r = 0.51, p = 0.0023), and the normal BMI category (r = 0.66, p = 0.027). The model adjusted for sex, age, body fat percent, and race/ethnicity demonstrated a statistically significant association between 24uSF and total sugars intake (β = 0.0027, p < 0.0001) and explained 31% of 24uSF variance (marginal R2 = 0.31). Our results demonstrated a significant relationship between total sugars intake and the 24uSF biomarker in this diverse population. However, the results were not as strong as those of controlled feeding studies that investigated this biomarker.

Gut microbiome diversity, variability, and latent community types compared with shifts in body weight during the freshman year of college in dormitory-housed adolescents

Significant human gut microbiome changes during adolescence suggest that microbial community evolution occurs throughout important developmental periods including the transition to college, a typical life phase of weight gain. In this observational longitudinal study of 139 college freshmen living in on-campus dormitories, we tracked changes in the gut microbiome via 16S amplicon sequencing and body weight across a single academic year. Participants were grouped by weight change categories of gain (WG), loss (WL), and maintenance (WM). Upon assessment of the community structure, unweighted and weighted UniFrac metrics revealed significant shifts with substantial variation explained by individual effects within weight change categories. Genera that positively contributed to these associations with weight change included Bacteroides, Blautia, and Bifidobacterium in WG participants and Prevotella and Faecalibacterium in WL and WM participants. Moreover, the Prevotella/Bacteroides ratio was significantly different by weight change category, with WL participants displaying an increased ratio. Importantly, these genera did not display co-dominance nor ease of transition between Prevotella- and Bacteroides-dominated states. We further assessed the overall taxonomic variation, noting the increased stability of the WL compared to the WG microbiome. Finally, we found 30 latent community structures within the microbiome with significant associations with waist circumference, sleep, and dietary factors, with alcohol consumption chief among them. Our findings highlight the high level of individual variation and the importance of initial gut microbiome community structure in college students during a period of major lifestyle changes. Further work is needed to confirm these findings and explore mechanistic relationships between gut microbes and weight change in free-living individuals.

Prediction of three social cognitive-motivational structure types

Previously, using interviews from Baumrind's longitudinal study, three cognitive-motivational structures (CMSs) were predicted in 68 adolescents from caregiving settings and from the CMS types of their mothers, based on the mothers' interviews elicited six years earlier. CMS theory proposes that during Piaget's Concrete Operational Period care-receiving influences the child's adoption of a social cognitive style, which corresponds to one of Piaget's stages of cognitive development. One who is classified as an Operational experiences the caregiving setting as tuned to the child's long-term interests, becomes focused on function and control of function and grasps the distinctions between and gradations of social attributes. One classified as future Intuitive experiences the caregiving as insufficient or unreliable and becomes focused on getting and having, and assesses social situations based on current striking dimensions. A person classified as being future Symbolic experiences the caregiving as out of tune with the self or the world, becomes focused on identity and emotional closeness, and may define self or object by a single attribute. This previous study did not distinguish between the influence of caregiving (including mothers' CMS) on the formation of adolescent CMS type and the possible constancy of CMS type from ages 9 to 15 years. The current study was designed to distinguish between these two possibilities, using data from 67 of the same mothers. Mothers' interviews were purged of descriptions of her child's behavior. Another interview was composed of the purged descriptions of child behavior. This was also done for interviews held when the child was 4 and 15 as well as at 9. From interviews with descriptions of child behavior purged, mother's CMS type at the child's age of 4 and 9 yr. agreed with her adolescent's previously assigned CMS type (p<.05), and caregiving setting at 9 years predicted the adolescent's CMS type (p<.05). From interviews composed of descriptions of only the child's behavior, adolescent CMS type agreed with previously assigned adolescent CMS type (p<.01). Findings were consonant with the idea that CMS type formation is influenced at about Age 9 and sufficiently established to be recognized at Age 15.

Access to mental health services and health sector social capital

Mental health services are underused relative to mental illness rates. We hypothesized a positive correlation between use of mental health services and community-level health care social capital. Community Tracking Study data from 43 cities (N = 43,278), merged with the National Profile of Local Health Departments and other sources, show that use of mental health services was greater when public health districts collaborated with managed care organizations and other community groups, independent of individual predictors and health care system variables. Use was also positively associated with community levels of public insurance coverage and with direct public health provision of behavioral health care services. Research is needed to understand the mechanisms by which social capital may improve access to mental health services.

Community characteristics as predictors of perceived HMO quality

We model the impact of community characteristics on people's perceptions of the quality of their health care experiences in HMOs. We focus on three community characteristics: sense of community, population density, and population diversity. Sense of community refers to people's perception of interconnection, shared responsibility, and common goals. Population density and population diversity are community characteristics that affect transactions costs in terms of time and energy, and affect people's perceptions of their community. We use data from a 1993 Florida poll to estimate the relationship between HMO members' perceptions of problems with health care experiences (cost, choice, access, satisfaction) and community characteristics. We find that all three community variables are significantly associated with perceptions of health care problems. We also find that effects of community variables operate differently for those in HMOs vs. those under traditional insurance. This study is consistent with research showing that community characteristics impact the health status of community institutions. Results suggest that providers may be able to improve care by being more responsive to individuals' need for community, that providers and communities can mutually gain by collaborating to improve community health, and that it may be cost-beneficial to factor community issues more strongly into health care policy.

The importance of sense of community on people's perceptions of their health-care experiences

OBJECTIVES

The authors study the relationship between people's sense of community and problems they experience with the health-care system, specifically problems related to cost, access, provider choice, and satisfaction.

METHODS

Data from a 1993 Florida poll (n = 1202) was used to conduct a multinomial logit analysis to estimate people's sense of community as a function of 13 characteristics and perceptions of community. Logit analysis was used to estimate the relationship between people's sense of community and their health-care experiences, controlling for other demographic influences, including insurance coverage and self-reported health status.

RESULTS

Lower sense of community was significantly associated with higher levels of choice, cost, and satisfaction problems in people's interactions with the health-care sector.

CONCLUSIONS

Community quality needs to be considered in efforts to improve the functional capabilities of health-care institutions.

Nurses' and other experts' views of health care fraud and abuse

This study examines the perceptions of a Florida panel of experts regarding the effectiveness and cost effectiveness of changes in law related to health care fraud and abuse. The panel was established as a task force under Florida health reform initiatives. The panel first defined fraud and abuse, then studied a variety of proposed initiatives, and finally rated each initiative as to its effectiveness and cost-effectiveness. Findings show significant perceptual differences between the nurses' perceptions and those of other panelists.

Prediction and constancy of cognitive-motivational structures in mothers and their adolescents

Three clinically-derived, cognitive-motivational structures were predicted in 68 adolescents from their caregiving situations as revealed in their mothers' interviews, elicited six years earlier. Basic to each structure is a motivational concern and its related social cognitive style, a style which corresponds to a Piagetian cognitive stage: concrete operational, intuitive or symbolic. Because these structure types parse a non-clinical population, current views of health and accordingly goals of treatment may need modification.

Character structure and performance on the MMPI

In a sample of 74 normal adults, a typology of character structure based on the developmental theory of Piaget was used to predict performance on the MMPI. The typology's validity was assessed by examining its empirical relationship to 11 clinical scales of the MMPI. Significant differences among the character types were noted for 5 of the 11 scales examined (Hypochondriasis, Depression, Masculinity/femininity, Psychasthenia, and Ego strength). There were significant differences on three additional scales (Hysteria, Psychopathic deviate, and Hypomania) between subtypes of the most numerous character type, which included two-thirds of the subjects studied. Differences among the character types and subtypes were generally consistent with expectations.

Piaget's stages of cognitive development and adult character structure

Psychonalytic and Piagetian findings are bridged by understanding character structure. Social cognition of the three character types corresponds to three phase of cognitive development: Symbolic, Intuitive, and (Concrete) Operational. A child constructs his supergo by coordinating his perceptions of his caretaking as he coordinates other perceptions in the Operational Period.