The Influence of Early-Life Health Conditions on Life Course Health.

We expand on previous studies investigating the links between early health and later health by examining four distinct dimensions of early-life health and multiple life course outcomes, including the age of onset of serious cardiovascular diseases (CVDs) and several job-related health outcomes. The four dimensions of childhood health are mental, physical, self-reported general health, and severe headaches or migraines. The data set we use includes men and women in 21 countries from the Survey of Health, Ageing and Retirement in Europe. We find that the different dimensions of childhood health have unique ties to later outcomes. For men, early mental health problems play a stronger role for life course job-related health outcomes, but early poor/fair general health is more strongly linked to the spike in onset of CVDs in their late 40s. For women, these links between childhood health dimensions and life course outcomes are similar but are less clear-cut than for men. The spike in onset of CVDs in women's late 40s is driven by those with severe headaches or migraines, while those with early poor/fair general health or mental health problems do worse as captured by job-related outcomes. We also delve into and control for possible mediating factors. Exploring the links between several dimensions of childhood health and multiple health-related life course outcomes will enable a better understanding of how health inequalities originate and are shaped over the course of people's lives.

Characterizing Loss of Control Associated With Binge Eating in College-Age Men.

BACKGROUND: The Diagnostic and Statistical Manual of Mental Disorders (5th ed.) identifies key features of binge eating (BE) to include the consumption of a large amount of food and the perception of loss of control (LOC) over eating during a distinct episode. While earlier research has focused on food consumption, findings are now emerging on the role of LOC associated with the BE episodes, particularly in women. However, it is unclear that these findings are applicable to men without knowing how men experience LOC associated with BE. AIMS: This study examined how college-age men describe LOC associated with BE. METHOD: Previously collected qualitative data from a study examining BE in college age-students were used to examine responses from 53 men (mean age 19.9 ± 1.1 [SD] years). Respondents were asked about their individual experiences of LOC associated with BE episodes. Data were analyzed using content analysis. RESULTS: Four categories emerged from the data: (1) keep eating, (2) can't stop, (3) without thinking, and (4) food so good. CONCLUSIONS: Findings extend the current understanding of LOC associated with BE in men and point to potential gender differences, and/or weight influences, based on previous reports. Identified categories may be potentially targeted areas for tailored therapy to enhance awareness and self-regulation of BE behavior.

Retrospective Analysis of Cataract Formation and Nutritional Etiology in a Managed Collection of Parakeet Auklets (Aethia psittacula).

The parakeet auklet (Aethia psittacula) is a piscivorous seabird with a natural diet of various invertebrate and teleost species, which is challenging to replicate in a managed collection. A high prevalence of early onset cataracts was observed in a managed collection of parakeet auklets at the North Carolina Zoo (Asheboro, NC, USA), which was hypothesized to be related to inappropriate vitamin A and E levels. From 1994 to 2002, these parakeet auklets were offered dietary supplementation comprising Vita-Zu small bird tablets. In June 2002, the birds were transitioned to only Thiamin-E paste (vitamin E and thiamin only). Plasma samples were collected from birds with and without cataracts from 1998 to 2005 and submitted for vitamin A (retinol) and vitamin E (α-tocopherol) analysis. Food items comprising the birds' diet were also evaluated for vitamin content. This information was combined with clinical and necropsy data from medical records from 1994 to 2015. A total of 78% of birds (39/50) developed cataracts, with a median age of onset of 7 years (range, 2-12 years). Cataracts ranged from incipient to hypermature during both routine ophthalmic examinations and postmortem evaluations. The median (range) of plasma retinol and α-tocopherol values were 1.99 µg/mL (0.20-6.68 µg/mL) and 15.39 µg/mL (3.40-96.27 µg/mL), respectively. There were no significant differences in plasma concentrations of vitamins based on the animals' sex, origin, presence of cataracts, or administered vitamin supplementation product. No other etiologies for cataract development were identified in the population. Further research in free-ranging parakeet auklet nutrition and cataract occurrence is warranted for continued species collection management.

Testing a method to improve predictions of disease and mortality risk in western lowland gorillas (gorilla gorilla gorilla) using allostatic load.

Allostatic load is the wear-and-tear organisms accumulate due to senescence and stress; it is measured by combining biomarkers from multiple somatic systems into allostatic load indices (ALIs). Frequently used in human research, ALIs have shown consistent results across samples despite different biomarkers and methods. However, determining optimal models likely is necessary if ALIs are to be feasible research tools in other species. Herein, we build on prior research in western lowland gorillas to explore one potential method for determining which biomarkers may be best for estimating allostatic load. After narrowing down which biomarkers to include using a combination of forward stepwise regression and independent biomarker associations with project variables, we estimated allostatic load using both the traditional one-tailed quartile method as well as a multi-method approach. There was a significant positive association between allostatic load and triglycerides, but not cholesterol, both of which are commonly used as diagnostic markers of poor health. Using binomial generalized linear models, a one-unit increase in allostatic load was associated with increased risk of all-cause morbidity and mortality, but reduced risk of cardiac disease. Although conclusions were similar, compared to our original ALIs, these new ALIs had weaker effect sizes and poorer relative goodness of fit, suggesting this method for identifying the best possible list of biomarkers to include in an index was not effective. This report continues the development of ALIs as a clinical tool in wildlife while systematically testing one possible method for determining an optimal ALI for a particular species.

Dynamic and heterogeneous effects of sibling death on children's outcomes.

This paper explores the effects of experiencing the death of a sibling on children's developmental outcomes. Recent work has shown that experiencing a sibling death is common and long-term effects are large. We extend understanding of these effects by estimating dynamic effects on surviving siblings' cognitive and socioemotional outcomes, as well as emotional and cognitive support by parents. Using the Children of the National Longitudinal Survey of Youth 1979 (CNLSY79), we find large initial effects on cognitive and noncognitive outcomes that decline over time. We also provide evidence that the effects are larger if the surviving child is older and less prominent if the deceased child was either disabled or an infant, suggesting sensitive periods of exposure. Auxiliary results show that parental investments in the emotional support of surviving children decline following the death of their child.

Mindfulness in persons with anorexia nervosa and the relationships between eating disorder symptomology, anxiety and pain.

Mindfulness is useful for some psychiatric illnesses, but limited research exists among persons with anorexia nervosa (AN). This study aimed to determine the relationship between mindfulness, eating disorder symptomology and indicators of health in women with AN (n = 59) entering residential treatment. Participants completed a self-administered survey, including the Cognitive Affective Mindfulness Scale and other measures. Additional data from medical records were collected. Greater mindfulness was associated with less eating disorder symptoms (p = .049). This relationship was most profound in individuals with AN, including restrictive and binge-purge subtypes compared to individuals with atypical AN (interaction p-value = 0.044). Greater mindfulness was significantly associated with less shape (p = .023) and weight concern (p = .047). Expectedly, anxiety was inversely associated with eating disorder symptoms (p = .001). Greater pain was associated with less eating disorder symptoms (p = .024). Overall, mindfulness may be a protective factor against some eating disorder symptomology.

Maximizing research on the adverse effects of child poverty through consensus measures.

A variety of new research approaches are providing new ways to better understand the developmental mechanisms through which poverty affects children's development. However, studies of child poverty often characterize samples using different markers of poverty, making it difficult to contrast and reconcile findings across studies. Ideally, scientists can maximize the benefits of multiple disciplinary approaches if data from different kinds of studies can be directly compared and linked. Here, we suggest that individual studies can increase their potential usefulness by including a small set of common key variables to assess socioeconomic status and family income. These common variables can be used to (a) make direct comparisons between studies and (b) better enable diversity of subjects and aggregation of data regarding many facets of poverty that would be difficult within any single study. If kept brief, these items can be easily balanced with the need for investigators to creatively address the research questions in their specific study designs. To advance this goal, we identify a small set of brief, low-burden consensus measures that researchers could include in their studies to increase cross-study data compatibility. These US based measures can be adopted for global contexts.

How developmental neuroscience can help address the problem of child poverty.

Nearly 1 in 5 children in the United States lives in a household whose income is below the official federal poverty line, and more than 40% of children live in poor or near-poor households. Research on the effects of poverty on children's development has been a focus of study for many decades and is now increasing as we accumulate more evidence about the implications of poverty. The American Academy of Pediatrics recently added "Poverty and Child Health" to its Agenda for Children to recognize what has now been established as broad and enduring effects of poverty on child development. A recent addition to the field has been the application of neuroscience-based methods. Various techniques including neuroimaging, neuroendocrinology, cognitive psychophysiology, and epigenetics are beginning to document ways in which early experiences of living in poverty affect infant brain development. We discuss whether there are truly worthwhile reasons for adding neuroscience and related biological methods to study child poverty, and how might these perspectives help guide developmentally based and targeted interventions and policies for these children and their families.

Binge Eating and Loss of Control in College-Age Women.

BACKGROUND: Loss of control (LOC) over eating is a cardinal feature of the DSM-5 definition of binge eating (BE). While this behavior is frequently reported in college-age women, there is limited research on descriptions of loss of control from first-person accounts from individuals reporting LOC associated with BE. OBJECTIVE: The objective of this study was to investigate descriptions of LOC associated with BE episodes in college-age women who reported recent BE behavior. STUDY DESIGN: A secondary analysis of previously collected qualitative data on BE behaviors in college students was conducted. Two hundred and twenty-one college-age women's (age = 19.77 ± 1.03) comments regarding the experiences of LOC associated with BE episodes were analyzed using conventional content analysis. Codes were inductively generated allowing categories to emerge from the data codes. RESULTS: Three major overarching descriptive categories were identified: (1) LOC over eating, (2) feelings associated with the LOC, and (3) cognitive dispositions (thoughts) associated with LOC during a BE episode. DISCUSSION: The findings of this study expand the current literature on LOC over eating and provide a number of potential targets for intervention with college-age women who report BE behaviors.

The first multi-zoo application of an allostatic load index to western lowland gorillas (Gorilla gorilla gorilla).

Vertebrate stress responses are highly adaptive biological functions, maximizing survival probability in life-threatening situations. However, experiencing repeated and/or chronic stressors can generate physiological dysregulation and lead to disease. Because stress responses are multi-systemic and involve a wide range of physiological functions, identifying responses to stressors is best accomplished using integrated biomarker models. Allostatic load, defined as the physiological dysregulation that accumulates over the lifespan due to stressful experiences, is one such model. Allostatic load is measured using allostatic load indices, which are composites of biomarkers from multiple somatic systems. Previously, we reported the use of a 7-biomarker allostatic load index (albumin, CRH, cortisol, DHEA-S, glucose, IL-6, TNF-α) in western lowland gorillas housed at a single zoo. Herein, this index is expanded to examine allostatic load responses to lifetime stressors in gorillas from two additional zoos (n = 63) as well as two pooled samples. The index was created using quartile cut-points for each biomarker. Significant associations were observed between multiple predictor variables and allostatic load, including sex, age, number of stressful events (anesthetic events, zoo transfers, agonistic interactions with wounding, pregnancies), and rearing history (mother-reared, nursery-reared, wild-caught). Additionally, allostatic load was associated with indicators of morbidity (creatinine, cholesterol, triglycerides), age at death, and mortality risk. These results are consistent with those reported in human allostatic load research, suggesting allostatic load indices have potential as an investigative and clinical tool for gorillas and other great apes.

Satiation deficits and binge eating: Probing differences between bulimia nervosa and purging disorder using an ad lib test meal.

Purging disorder (PD) has been included as a named condition within the DSM-5 category of Other Specified Feeding or Eating Disorder and differs from bulimia nervosa (BN) in the absence of binge-eating episodes. The current study evaluated satiation through behavioral and self-report measures to understand how this construct may explain distinct symptom presentations for bulimia nervosa (BN) and purging disorder (PD). Women (N = 119) were recruited from the community if they met DSM-5 criteria for BN (n = 57), PD (n = 31), or were free of eating pathology (n = 31 controls). Participants completed structured clinical interviews and questionnaires and an ad lib test meal during which they provided reports of subjective states. Significant group differences were found on self-reported symptoms, ad lib test meal intake, and subjective responses to food intake between individuals with eating disorders and controls and between BN and PD. Further, ad lib intake was associated with self-reported frequency and size of binge episodes. In a multivariable model, the amount of food consumed during binges as reported during clinical interviews predicted amount of food consumed during the ad lib test meal, controlling for other binge-related variables. Satiation deficits distinguish BN from PD and appear to be specifically linked to the size of binge episodes. Future work should expand exploration of physiological bases of these differences to contribute to novel interventions.

EVALUATING ALLOSTATIC LOAD: A NEW APPROACH TO MEASURING LONG-TERM STRESS IN WILDLIFE.

Animal welfare, conservation, and stress assessment are all critical components of species survival. As organisms experience stressors, they accumulate physiologic dysregulation, leading to multiple negative health outcomes. This brief review suggests measuring the degree of stress-induced damage, known as allostatic load, and then using allostatic load to evaluate changes implemented to improve animal welfare and conservation efforts. Over the past two decades, human clinical research has developed multiple allostatic load indices constructed from composites of neuroendocrine, cardiovascular, metabolic, and immune biomarkers. These indices are designed to estimate allostatic load in hopes of ameliorating or even negating damaging effects of stress. Among humans, allostatic load is associated with a variety of factors such as age, sex, stressful experiences, personality, social position, and early life history. Despite conservation of stress responses throughout mammalian species, reported allostatic load indices for animals are rare. Because many zoo researchers and field scientists already collect data on multiple biomarkers, constructing allostatic load indices may be a relatively affordable, easily implemented, and powerful tool for assessing relative risks of morbidity and mortality within wildlife. As an example, in a study among zoo-housed gorillas, an allostatic load index constructed using seven biomarkers was associated significantly with age, sex, stressful experiences, rearing history, markers of poor health, and mortality risk. Such results evidence that allostatic load is as applicable to animal populations as it is to humans. By using allostatic load as a predictive tool, human caretakers will be better informed of individuals at greatest risk for health declines. Most importantly, allostatic load may provide earlier opportunity for preemptive care while contributing a transformational tool to animal welfare research. Additionally, allostatic load may be compared between individuals and groups within the same population and allow comparisons of health between and across populations, consequently informing habitat and population protection efforts.

Trajectories of Change in Body Weight During Inpatient Treatment for Anorexia Nervosa.

BACKGROUND: Identifying distinct trajectories of change in body weight during inpatient treatment for anorexia nervosa (AN) may provide knowledge about the process of weight restoration and may help detect optimal body weight response patterns among individuals who are at risk for not achieving weight restoration or leaving treatment prematurely. OBJECTIVE: This study explored the extent to which distinct trajectories of change in body weight existed among individuals during inpatient treatment for AN. DESIGN: Group-based trajectory modeling was used to identify distinct trajectories of change in body weight among 500 individuals receiving inpatient treatment for AN. RESULTS: Four distinct trajectories were identified: weight gain ( n = 197), treatment resistant ( n = 177), weight plateau ( n = 82), and weight fluctuate ( n = 44). CONCLUSION: Clinically, it is important to consider the heterogeneity of changes in body weight during inpatient treatment to help guide interventions and outcomes.

Procedures and Protocols for Weight Assessment During Acute Illness in Individuals With Anorexia Nervosa: A National Survey.

BACKGROUND: Weight assessment is a key component of nursing care for individuals with the acute illness of anorexia nervosa (AN). However, there is little data to guide protocols and procedures regarding weight assessment. OBJECTIVE: To describe institutional practices regarding weight assessment of individuals during acute illness of AN. DESIGN: Treatment facilities ( N = 24) completed a survey about written protocols and procedures regarding weight assessment and disclosure of weight to patients. RESULTS: The majority of facilities ( n = 22; 92%) have written protocols for weight assessment. Weight assessments occurred mostly in the morning ( n = 23; 95.8%), in hospital gowns ( n = 21; 87.5%), and after voiding ( n = 14; 58.3%). Respondents described mixed practices for disclosing weight to patients. CONCLUSION: Results indicate widespread variability in weight assessment and disclosure of weight. Further research is necessary to help develop evidence-based guidelines about weighing practices during acute illness for individuals with AN.

Effect of the Affordable Care Act on Racial and Ethnic Disparities in Health Insurance Coverage.

OBJECTIVES: To document how health insurance coverage changed for White, Black, and Hispanic adults after the Affordable Care Act (ACA) went into effect. METHODS: We used data from the American Community Survey from 2008 to 2014 to examine changes in the percentage of nonelderly adults who were uninsured, covered by Medicaid, or covered by private health insurance. In addition to presenting overall trends by race/ethnicity, we stratified the analysis by income group and state Medicaid expansion status. RESULTS: In 2013, 40.5% of Hispanics and 25.8% of Blacks were uninsured, compared with 14.8% of Whites. We found a larger gap in private insurance, which was partially offset by higher rates of public coverage among Blacks and Hispanics. After the main ACA provisions went into effect in 2014, coverage disparities declined slightly as the percentage of adults who were uninsured decreased by 7.1 percentage points for Hispanics, 5.1 percentage points for Blacks, and 3 percentage points for Whites. Coverage gains were greater in states that expanded Medicaid programs. CONCLUSIONS: The ACA has reduced racial/ethnic disparities in coverage, although substantial disparities remain. Further increases in coverage will require Medicaid expansion by more states and improved program take-up in states that have already done so.

The Effects of the Affordable Care Act Adult Dependent Coverage Expansion on Mental Health.

BACKGROUND: In September 2010, the Affordable Care Act increased the availability of private health insurance for young adult dependents in the United States and prohibited coverage exclusions for their pre-existing conditions. The coverage expansion improved young adults' financial protection from medical expenses and increased their mental health care use. These short-term effects signal the possibility of accompanying changes in mental health through one or more mechanisms: treatment-induced symptom relief or improved function; improved well-being and/or reduced anxiety as financial security increases; or declines in self-reported mental health if treatment results in the discovery of illnesses. AIMS: In this study, we estimate the effects of this insurance coverage expansion on young adults' mental health outcomes one year after its implementation. METHODS: We use a difference-in-differences (DD) framework to estimate the effects of the ACA young adult dependent coverage on mental health outcomes for adults ages 23-25 relative to adults ages 27-29 from 2007-2011. Outcome measures include a global measure of self-rated mental health, the SF-12 mental component summary (MCS), the PHQ-2 screen for depression, and the Kessler index for non-specific psychological distress. RESULTS: The overall pattern of findings suggests that both age groups experienced modest improvements in a range of outcomes that captured both positive and negative mental health following the 2010 implementation of the coverage expansion. The notable exception to this pattern is a 1.4 point relative increase in the SF-12 MCS score among young adults alone, a measure that captures emotional well-being, mental health symptoms (positive and negative), and social role functioning. DISCUSSION: This study provides the first estimates of a broad range of mental health outcomes that may be responsive to changes in mental health care use and/or the increased financial security that insurance confers. For the population as a whole, there were few short-term changes in young adults' mental health outcome relative to older adults. However, the relative increase in the SF-12 score among young adults, while small, is likely meaningful at a population level given the observed effect sizes for this measure obtained in clinical trials. IMPLICATIONS: The vast majority of mental illnesses emerge before individuals reach age 24. Public policy designed to expand health insurance coverage to this population has the potential to influence mental health in a relatively short time frame.

Rearing history and allostatic load in adult western lowland gorillas (Gorilla gorilla gorilla) in human care.

Disrupted rearing history is a psychological and physical stressor for nonhuman primates, potentially resulting in multiple behavioral and physiological changes. As a chronic, soma-wide stressor, altered rearing may be best assessed using a holistic tool such as allostatic load (AL). In humans, AL estimates outcomes of lifetime stress-induced damage. We predicted mother-reared gorillas would have lower AL than nursery-reared and wild-caught conspecifics. We estimated AL for 27 gorillas housed at the Columbus Zoo and Aquarium between 1956 and 2014. AL estimates were calculated using biomarkers obtained during previous anesthetic events. Biomarkers in the high-risk quartile were counted toward a gorilla's AL. Rearing history was categorized as mother-reared, nursery-reared, and wild-caught. Using ANCOVA, rearing history and AL are significantly associated when age and sex are entered as covariates. Wild-caught gorillas have significantly higher AL than mother-reared gorillas. Neither wild-caught nor mother-reared gorillas are significantly different from nursery-reared gorillas. When examined by sex, males of all rearing histories have significantly lower AL than females. We suggest males face few stressors in human care and ill effects of rearing history do not follow. Wild-caught females have significantly higher AL than mother-reared females, but neither is significantly different from nursery-reared females. Combined with our previous work on AL in this group, wherein females had twofold higher AL than males, we suggest females in human care face more stressors than males. Disrupted rearing history may exacerbate effects of these stressors. Providing opportunities for females to choose their distance from males may help reduce their AL.

The importance of family income in the formation and evolution of non-cognitive skills in childhood.

Little is known about the relationship between family income and children's non-cognitive (or socio-emotional) skill formation. This is an important gap, as these skills have been hypothesized to be a critical link between early outcomes and adult socioeconomic status. This paper presents new evidence of the importance of family income in the formation and evolution of children's non-cognitive skills using a recent US panel dataset that tracks children between grades K-5. Findings suggest an important divergence in non-cognitive skills based on family income that accumulates over time and does not seem to be explained by children's health status differences.

Increased inflammation and decreased insulin sensitivity indicate metabolic disturbances in zoo-managed compared to free-ranging black rhinoceros (Diceros bicornis).

Black rhinoceros (rhinos) living in zoos express a host of unusual disease syndromes that are associated with increased morbidity and mortality, including hemolytic anemia, rhabdomyolysis, hepatopathy and ulcerative skin disease, hypophosphatemia and iron overload. We hypothesized that iron overload is a consequence and indicator of disturbances related to inflammation and insulin/glucose metabolism. The objectives of this study were to: (1) generate the first baseline information on biomarkers of inflammation (tumor necrosis factor alpha [TNFα], serum amyloid A [SAA]), insulin sensitivity (insulin, glucose and proxy calculations of insulin sensitivity), phosphate and iron stores (ferritin) using banked serum from free-ranging black rhinos; and (2) then compare serum biomarkers between zoo-managed (n=86 individuals) and free-ranging (n=120) animals. Enzyme immunoassays were validated for serum and then biomarker levels analyzed using mixed models while controlling for sex, age and year of sample collection. Concentrations of TNFα, SAA, insulin and insulin-to glucose ratio were higher (P<0.05) in black rhinos managed in ex situ conditions compared to free-living counterparts. Findings indicate that the captive environment is contributing to increased inflammation and decreased insulin sensitivity in this endangered species.

The effect of fluphenazine decanoate on glucocorticoid production, reproductive cyclicity, and the behavioral stress response in the Persian onager (Equus hemionus onager).

Artificial insemination, performed to maximize genetic diversity in populations of zoo-housed animals, requires intensive management and has been associated with low success rates in fractious species. In these species, stressors, such as frequent handling, may impact fertility. Long-acting neuroleptic pharmaceuticals (LANs) can attenuate the stress response to handling, but may also disrupt ovulation in some species, compromising their use for artificial insemination. Therefore, the goal of this study was to determine whether LANs may be used to mitigate stress during reproductive management in wild equids without inhibiting ovulation. Six female Persian onagers (Equus hemionus onager) were treated with fluphenazine decanoate (FD; 0.1 mg/kg IM) or saline control in a random crossover design study. Urinary cortisol, progesterone, estrogen metabolites and behavior were monitored, and follicular dynamics were examined using ultrasonography until ovulation. Onagers demonstrated significantly lower cortisol concentrations (P = 0.03) when treated with FD (6.61 ± 3.26 ng/mg creatinine) compared to saline (9.73 ± 3.19 ng/mg creatinine). Overall, there were no differences in peak estrogen (P = 0.51) or progesterone (P = 0.38) concentrations between the two groups, and all animals ovulated within the expected time frame following FD treatment. However, some onagers exhibited only minor reductions in cortisol secretion and one treated female demonstrated a suppressed luteal progesterone peak, indicating a possible reproductive cost to FD administration. While FD may be useful for highly fractious equids for which the stress of handling delays or inhibits ovulation, these results warrant further investigation of dosing.