Background Gender differences in dyslipidemia are widely documented, but the contributors to these differences are not well understood. This study examines whether differences in quality of care, intensity of lipid- lowering medication regimen and medication adherence can explain this disparity. Methods Secondary analysis of medical records data and questionnaires collected from adult patients with type 2 diabetes (n=1,369) from seven outpatient clinics affiliated with an academic medical center as part of the Reducing Racial Disparities in Diabetes: Coached Care (R2D2C2) study. Primary outcome was LDL cholesterol. Findings Women had higher LDL cholesterol levels than men (mean[SD]: 101.2[35.2] mg/dl vs. 92.3[33.0] mg/dl, p<0.001), but were no less likely to receive recommended processes of diabetes care, to attain targets for glycemic control and blood pressure, or to be on intensive medication regimens. More women than men reported medication nonadherence due to cost (32.7% vs. 24.2%, p=0.040) and due to side effects (47.2% vs. 36.8%, p=0.024). For all patients, regimen intensity (p<0.05) and nonadherence due to side effects (p<0.01) were each associated with higher LDL cholesterol levels. The addition of a new lipid lowering agent was associated with subsequent nonadherence related to side effects for women (p<0.001), but not for men (p=0.45, test for interaction p=0.048). Conclusions Despite comparable quality of diabetes care and regimen intensity for lipid management, women with diabetes experienced poorer lipid control than men. Medication nonadherence appeared to be a major contributor to dyslipidemia, particularly for women, because of side effects associated with intensifying the lipid lowering regimen.

Consistent with findings of previous studies, our data indicate that there was no observed benefit of using POCUS to identify pre-procedure landmarks when performing an LP.

Introduction Effective approaches to promote adolescent physical activity are needed. Moreover, a one-size-fits-all approach has been minimally successful to date. This randomized controlled trial evaluates a theory-based personalized exercise prescription to enhance motivation for being active and physical activity participation among adolescent reluctant exercisers. Study Design Adolescents were characterized by affective style as reluctant (predisposed to negative affect during exercise) or latent (predisposed to positive affect during exercise) exercisers based on their affective response to an acute exercise task, and then randomly assigned to an exercise prescription of either a personalized or a moderate intensity. Assignment was double-blind. Assessments were pre- and post- the 8-week intervention. Setting/participants Participants were an ethnically diverse group of adolescents (19% non-Latino White) in a public middle-school. The exercise intensity manipulation and assessments took place at the school site during regular Physical Education. Intervention Participants were assigned to either a moderate-intensity exercise prescription [target heart rate (HR) range 60%-80% of HR max] or a personalized exercise prescription corresponding to an intensity that “feels good” to the individual for 8 weeks during daily Physical Education. Main outcome measures Outcome measures included exercise-related intrinsic motivation (via questionnaire), and daily moderate-to-vigorous physical activity (MVPA; via accelerometer). Results The exercise intensity manipulation did not yield actual differences in exercise intensity during PE, and had no effect on either Intrinsic Motivation or MVPA. There was no significant interaction between affective style and group assignment in predicting Intrinsic Motivation or MVPA. Conclusion This study did not find support for a link between affective experiences during exercise and physical activity participation. Providing adolescents with a personalized exercise intensity prescription and asking them to follow the prescription during PE was not an effective strategy to manipulate their affective experience of exercise. A more rigorous test of affective manipulation may require supervised exercise sessions during which exercise intensity can be directly observed and controlled.

Background Little information exists as to the exercise intensity that adolescents enjoy and whether identifiable subgroups of adolescents will choose higher-intensity exercise. Methods Healthy adolescents (N = 74; mean age = 11.09) completed a cardiorespiratory fitness test, a moderate-intensity exercise task, and an exercise task at an intensity that felt “good”. Heart rate (HR), work rate (WR) and ratings of perceived exertion (RPE) were assessed every 3 minutes. Results During the “feels good” task, adolescents exercised at a HR recognized as beneficial for cardiovascular health (Mean HR = 66-72% of HR at VO2peak). Adolescents who experienced a positive affective shift during the moderate-intensity task engaged in higher-intensity exercise during the “feels-good” task as compared to those whose affective response to moderate-intensity exercise was neutral or negative (76% of peak HR vs. 70% of peak HR, p < .01).There was no difference between groups in RPE. Conclusions Adolescents tend to select an exercise intensity associated with fitness benefits when afforded the opportunity to choose an intensity that feels good. An identified subgroup engaged in higher-intensity exercise without a commensurate perception of working harder. Encouraging adolescents to exercise at an intensity that feels “good” may increase future exercise without sacrificing fitness.

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