A growing demand for alternative sources of texturized vegetable protein (TVP) has resulted from various factors including plant allergies, perceived health risks associated with genetically modified organisms (GMO), animal welfare beliefs, and lifestyle choices. Soy and wheat have been the primary ingredients in TVP over the past few decades, but desires for clean label ingredients (especially non-GMO and nonallergenic) have led to demand for alternative plant protein ingredients such as pea protein. To understand the capabilities of pea protein to create meat-like texture with additions of another protein source that also contributes starch, this study focused on extruding pea protein with increasing amounts of chickpea flour (CPF). Six treatments, with inclusions of CPF ranging from 0 to 50%, were processed on a twinscrew extruder to determine the optimal ratio of pea protein isolate to CPF. Bulk density was the greatest with 20% CPF (272 g/L) and resulted in the lowest water holding capacity (55.5%). Texture profile analysis (TPA) hardness, springiness, and chewiness showed optimum results for the 10 and 20% CPF (674 to 1024 g, 72.1 to 80.7%, 400 to 439, respectively). With no CPF addition, protein interactions created a strong network exhibiting extreme springiness (91.3%). Addition of CPF greater than 20% resulted in a detrimental decrease in hardness by 38 to 84% and chewiness by 73 to 92%. Phase transition analysis and specific mechanical energy data provided a greater understanding of the degree of texturization during extrusion. Inclusion of CPF between 10 and 20% led to the optimum protein to starch ratio, allowing adequate protein texturization and creating product characteristics that could potentially mimic meat.

Objectives. To assess the performance of US health centers during the first year of required sexual orientation and gender identity (SOGI) data reporting and to estimate the baseline proportion of lesbian, gay, bisexual, and transgender patients accessing health centers. Methods. We conducted a secondary analysis of SOGI data from 2016. These data were reported by 1367 US health centers caring for 25 860 296 patients in the United States and territories. Results. SOGI data were missing for 77.1% and 62.8% of patients, respectively. Among patients with data, 3.7% identified as lesbian, gay, bisexual, or something else; 0.4% identified as transgender male or female; 27.5% did not disclose their sexual orientation; and 9.3% did not disclose their gender identity. Conclusions. Although health centers had a high percentage of missing SOGI data in the first year of reporting, among those with data, the percentages of lesbian, gay, bisexual, and transgender people were similar to national estimates, and disclosure was more than 70%. Future data collection efforts would benefit from increased training for health centers and improved messaging on the clinical benefits of SOGI data collection and reporting.

Among a high-risk adolescent sample, primarily health-seeking behaviors increased the odds of HPV vaccination, reinforcing the importance of providers using various routine preventative visits as opportunities/cues to vaccine.

Syndemic theory posits that epidemics of multiple physical and psychosocial problems co-occur among disadvantaged groups due to adverse social conditions. Although sexual minority populations are often stigmatized and vulnerable to multiple health problems, the syndemic perspective has been underutilized in understanding chronic disease. To assess the potential utility of this perspective in understanding the management of co-occurring HIV and Type 2 diabetes, we used linear regression to examine glycemic control (A1c) among men who have sex with men (MSM) with both HIV and Type 2 diabetes (n = 88). Bivariable linear regression explored potential syndemic correlates of inadequate glycemic control. Compared to those with adequate glycemic control (A1c ≤ 7.5 %), more men with inadequate glycemic control (A1c > 7.5 %) had hypertension (70 vs. 46 %, p = 0.034), high triglycerides (93 vs. 61 %, p = 0.002), depression (67 vs. 39 %, p = 0.018), current substance abuse (15 vs. 2 %, p = 0.014), and detectable levels of HIV (i.e., viral load ≥75 copies per ml blood; 30 vs. 10 %, p = 0.019). In multivariable regression controlling for age, the factors that were independently associated with higher A1c were high triglycerides, substance use, and detectable HIV viral load, suggesting that chronic disease management among MSM is complex and challenging for patients and providers. Findings also suggest that syndemic theory can be a clarifying lens for understanding chronic disease management among sexual minority stigmatized populations. Interventions targeting single conditions may be inadequate when multiple conditions co-occur; thus, research using a syndemic framework may be helpful in identifying intervention strategies that target multiple co-occurring conditions.