Background Cost-related non-adherence (CRN) is prevalent among individuals with diabetes and can have significant negative health consequences. We examined health and non-health-related pressures and the use of cost-reducing strategies among the U.S. adult population with and without diabetes that may impact CRN. Methods Data from the 2013 wave of National Health Interview Survey (n=34,557) were used to identify the independent impact of perceived financial stress, financial insecurity with healthcare, food insecurity, and cost-reducing strategies on CRN. Results 11% (n=4,158) of adults reported diabetes. 14% with diabetes reported CRN, compared to 7% without. Greater perceived financial stress (Prevalence Ratio (PR)=1.07 [95% CI: 1.05 to 1.09]), financial insecurity with healthcare (PR=1.6 [95% CI: 1.5 to 1.67]), and food insecurity (PR=1.30 [95% CI: 1.2 to 1.4]) were all associated with a greater likelihood of CRN. Asking the doctor for a lower cost medication was associated with a lower likelihood of CRN (PR=0.2 [95% CI: 0.2 to 0.3]), and 27% with CRN reported this. Other cost-reducing behavioral strategies (using alternative therapies, buying prescriptions overseas) were associated with a greater likelihood of CRN. Conclusions Half of adults with diabetes perceived financial stress, and one-fifth reported financial insecurity with healthcare and food insecurity. Talking to a health care provider about low-cost options may be protective against CRN in some situations. Improving screening and communication to identify CRN and increase transparency of low-cost options patients are pursuing may help safeguard from the health consequences of cutting back on treatment.

Obesity correlates with SDB severity. Waist circumference is a better measure than BMI or neck circumference to predict SDB. Men and women are anthropometrically different. Even with an AHI of 5 or more, only half of SDB patients in this study were clinically obese. An abnormal waist circumference for men and women is 102 cm (40 inches) or more.

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In heart failure patients the consumption of (-)-epicatechin ((-)-Epi)-rich cocoa can restore skeletal muscle (SkM) mitochondrial structure and decrease biomarkers of oxidative stress. However, nothing is known about its effects on exercise capacity and underlying mechanisms in normal, sedentary subjects. Twenty normal, sedentary subjects (∼50 years old) were randomized to placebo or dark chocolate (DC) groups and consumed 20 g of the products for 3 months. Subjects underwent before and after treatment, bicycle ergometry to assess VO2 max and work, SkM biopsy to assess changes in mitochondrial density, function and oxidative stress and blood sampling to assess metabolic endpoints. Seventeen subjects completed the trial. In the DC group (n=9), VO2 max increased (17% increase, p=0.056) as well as maximum work (watts) achieved (p=0.026) with no changes with placebo (n=8). The DC group evidenced increases in HDL levels (p=0.005) and decreased triglycerides (p=0.07). With DC, SkM evidenced significant increases in protein levels for LKB1, AMPK and PGC1α and in their active forms (phosphorylated AMPK and LKB1) as well as in citrate synthase activity while no changes were observed in mitochondrial density. With DC, significant increases in SkM reduced glutathione levels and decreases in protein carbonylation were observed. Improvements in maximum work achieved and VO2 max may be due to DC activation of upstream control systems and enhancement of SkM mitochondria efficiency. Larger clinical studies are warranted to confirm these observations.

We compared data from 243 patients with episodic migraine (EM) and 132 patients with chronic daily headache (CDH). We divided the latter group into those with tension-type headache only (CDH Type 1) and those with headaches having migrainous features (CDH Types 2 + 3) and compared each with the EM group and all three groups with one another. CDH Type 1 patients differed from those in the other groups by virtue of gender (more often male) and mean age at headache onset (older). The CDH Types 2 + 3 and EM groups differed only in that the former were more likely to have undergone a brain-imaging study. These data suggest that CDH Type 1 may represent a distinct headache syndrome, while CDH Types 2 + 3 closely resemble episodic migraine.

This study describes anatomic findings of the retrolingual airway in patients that correlate with OSA and can be measured on an upper airway CT. Patients with severe OSA (AHI > or = 40) tend to have retrolingual airways less than 4% of the cross-sectional area of the cervicomandibular ring. The retrolingual airspace is the major site of obstruction in severe OSA and should be carefully evaluated before surgical treatment is considered.

We developed an evidence base of best practices for clinicians to maintain patient-centered communications in the presence of computerized systems in the exam room. Further work includes development and empirical evaluation of evidence-based guidelines to better integrate computerized systems into clinical care.

Rationale: Patient perceptions of financial burden and rates of cost-related nonadherence are high among individuals with asthma across the socioeconomic spectrum. Little is known about preferences and frequency of physician-patient discussions about cost/ affordability among individuals managing respiratory conditions. Objectives:To examine who has a preference to discuss the cost of their asthma care with their physician, how often physicianpatient communication about cost/affordability actually is occurring, and what clinical and demographic characteristics of patients are predictive of communication.Methods: Data came from 422 African American adult women with asthma who were asked about communication preferences and practices around cost and affordability with their physician. Data were analyzed using descriptive statistics and multiple variable logistic regression models.Measurements and Main Results: Fifty-two percent (n = 219) of this sample perceived financial burden. Seventy-two percent (n = 300) reported a preference to discuss cost with their healthcare provider. Thirty-nine percent (n = 163) reported actually having a conversation with their physician about cost. Among the 61% who reported no discussion, 40% (n = 103) reported financial burden, and 55% (n = 140) reported a preference for discussion.Lower household income (P , 0.001), perception of financial burden (P , 0.001), and higher out-of-pocket expenses for medicines (P , 0.05) were significantly predictive of greater preference to communicate about cost/affordability with the doctor when adjusted for clinical and demographic characteristics. Perception of financial burden (P , 0.001), preference to discuss affordability (P , 0.001), and greater number of chronic conditions (P , 0.001) were significantly predictive of greater likelihood of communication about cost/affordability with the doctor when adjusted for clinical and demographic characteristics. Bivariate analyses revealed that patients who reported a discussion of cost were more likely to report worse asthma control and lower asthma-related quality of life.Conclusions: An imbalance is evident between patients who would like to discuss cost with their doctor and those who actually do. Patients are interested in low-cost options and a venue for addressing their concerns with a care provider; therefore, a greater understanding is needed in how to effectively and efficiently integrate these conversations and viable solutions into the delivery of health care. Additional research is necessary to determine whether communication about the cost of therapy is associated with health outcomes.