Private insurance versus medicaid and adherence to medication in older adults with fibromyalgia

Background: Fibromyalgia, defined as chronic, wide-spread musculoskeletal pain, affects 4 to 10 million Americans and up to 6% of the world population. Medication nonadherence results in $100 to$300 billion in US health expenditures annually. Previous studies have examined medication adherence in commercial health plans or public health plans, but relatively few have compared both populations. The purpose of this study was to estimate the effect of type of insurance on adherence to medication for older adults with fibromyalgia. Methods: The retrospective cohort study analyzed medical claims of fibromyalgia patients collected between January 1, 2005 to June 30, 2011 from the Blue Cross Blue Shield South Carolina State Health Plan (BCBS) and Medicaid data. Older adults age 60 and older were included if they were prescribed duloxetine, milnacipran, or pregabalin (N=3,187). The primary outcome, medication adherence, was defined as having a medication possession ratio (MPR) of ≥ 80%. Independent variables included health insurance, FMS medication, selected comorbidities (FMS-related, musculoskeletal pain, or neuropathic pain), gender, age, and the interaction between health insurance type and treatment. Results: Logistic regression showed older adults with fibromyalgia on Medicaid were over 3 times more likely to be adherent when compared to BCBS in both unadjusted (OR: 3.21, p<0.0001) and adjusted models (OR: 3.74, p<0.0001). Conclusion: Most states do not require a Medicaid prescription co-pay; whereas, private insurers, like Blue Cross Blue Shield, require more out-of-pocket costs. Our study suggests that the co-pays for medications in private plans may present a barrier to patient adherence

Physical, Rheological, Functional, and Film Properties of a Novel Emulsifier: Frost Grape Polysaccharide from \u3ci\u3eVitis riparia Michx\u3c/i\u3e

A novel emulsifier, Frost grape polysaccharide (FGP), isolated from natural exudate of the species Vitis riparia Michx, was physically and rheologically characterized. The determination of the physical, structural, thermodynamic, emulsification, film, and rheological properties of FGP provide essential details for the commercial adoption of this novel plant polysaccharide. FGP is capable of producing exceptionally stable emulsions when compared with the industrially ubiquitous gum arabic (GA). The FGP isolate contained a negligible amount of nitrogen (0.03%), indicating that it does not contain an associated glycoprotein, unlike GA. Solutions of FGP have a high degree of thermostability, displaying no loss in viscosity with temperature cycling and no thermal degradation when held at 90 °C. FGP is an excellent film former, producing high tensile strength films which remain intact at temperatures up to 200 °C. This work identified a number of potential food and pharmaceutical applications where FGP is significantly superior to GA

Validity of the multidimensional fatigue symptom inventory-short form in an African-American community-based sample

OBJECTIVES: This study examined the psychometric properties of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) in a community-based sample of African Americans. Design. A sample of 340 African Americans (116 men, 224 women) ranging in age from 18–81 years were recruited from the community (e.g., churches, health fairs, beauty salons). Participants completed a brief demographic survey, the MFSI-SF and the Positive and Negative Affect Schedule. RESULTS: The structural validity of the MFSI-SF for a community-based sample of African Americans was not supported. The five dimensions of fatigue (General, Emotional, Physical, Mental, Vigor) found for Whites in prior research were not found for African Americans in this study. Instead, fatigue, while multidimensional for African Americans, was best represented by a unique four-four profile in which general and emotional fatigue are collapsed into a single dimension and physical fatigue, mental fatigue, and vigor are relatively distinct. Hence, in the absence of modifications, the MFSI-SF cannot be considered to be structurally invariant across ethnic groups. A modified four-factor version of the MFSI-SF exhibited excellent internal consistency reliability and evidence supports its convergent validity. Using the modified four-factor version, gender and age were not meaningfully associated with MFSI-SF scores. CONCLUSION: Future research should further examine whether modifications to the MFSI-SF would, as the findings suggest, improve its validity as a measure of multidimensional fatigue in African Americans