Author Correction: The impact of poor asthma control among asthma patients treated with inhaled corticosteroids plus long-acting ß2-agonists in the United Kingdom: a cross-sectional analysis.

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The impact of poor asthma control among asthma patients treated with inhaled corticosteroids plus long-acting ß2-agonists in the United Kingdom: a cross-sectional analysis.

There are several new treatment options for patients whose asthma remains uncontrolled on free-dose and fixed-dose combinations of inhaled corticosteroids plus long-acting ß2-agonists (ICS+LABA). In order to evaluate the likely impact of these treatments, we assessed the effect of uncontrolled asthma on healthcare and patient burden within the UK among adult patients treated with ICS+LABA. Data obtained from 2010-2011 UK National Health and Wellness Surveys identified 701 patients treated with ICS+LABA. Patients with not well-controlled asthma (Asthma Control Test™ score <20) were compared with well-controlled asthma (score ≥ 20) patients on multiple measures. Cost burden was calculated using healthcare resource utilisation models and work productivity and impairment questionnaire. Overall, 452 and 249 patients reported not well-controlled and well-controlled asthma, respectively. A greater proportion of not well-controlled patients visited the accident & emergency department (21 vs. 14%, P = 0.016), were hospitalised (13 vs. 8%, P = 0.022) and had lower mental and physical health-related quality of life (P < 0.001) and impaired work productivity and activity scores: presenteeism (23 vs. 11%, P < 0.001), work impairment (29 vs. 17%, P < 0.001) and activity impairment (46 vs. 24%, P < 0.001). Calculated direct and indirect yearly costs/person doubled among not well-controlled compared to well-controlled asthma patients (£6592 vs. £3220). Total cost to society was estimated at £6172 million/year (direct costs, £1307 million; indirect costs, £4865 million). In conclusion, not well-controlled asthma is common among UK adults treated with ICS+LABA, resulting in impairments across a number of important health outcomes and represents a significant unmet need and resource burden. ASTHMA: DRUG COMBO LEAVES MANY WITH UNCONTROLLED DISEASE: Many people who take inhaled steroids combined with long-acting ß2-agonist drugs still have poorly controlled asthma. A team led by Ian Pavord from the University of Oxford, UK, identified 701 people from the 2010-2011 UK National Health and Wellness Surveys who were taking this drug combination for their asthma. The researchers found that nearly two-thirds of these individuals had poorly controlled asthma associated with more visits to the emergency room, worse quality of life (both mentally and physically), impaired productivity and other health problems. The calculated direct and indirect costs per person with poorly controlled asthma were about double that for someone whose asthma was under control. The authors conclude that better treatment and management is needed to reduce costs and address the unmet medical need for people with persistent uncontrolled asthma.

Behaviours, thoughts and perceptions around mealtime insulin usage and wastage among people with type 1 and type 2 diabetes mellitus: A cross-sectional survey study.

AIMS: People with diabetes who use mealtime insulin (MTI) were surveyed about insulin wastage and injection habits when insufficient insulin remains in a disposable prefilled pen/cartridge to administer a full dose in a single injection. METHODS: Cross-sectional, online, self-reported survey of MTI usage/wastage behaviour in 400 adults with type 1 (n=120) or type 2 (n=280) diabetes mellitus administering >20units/day of MTI via 100units/ml prefilled pens/cartridges for ⩾1month, conducted in France, Germany, Italy and UK. RESULTS: Participants' mean±standard deviation age was 54.5±12.2years, body mass index was 29.9±7.2kg/m2 and duration of MTI therapy was 8.6±7.8years. They administered 3.7±5.9 injections/day with meals, using 11.3±18.0 prefilled pens/cartridges per month. Overall, 63.5% split the dose across two prefilled pens/cartridges (i.e. administered two injections to obtain a full dose), 15.0% used just what remained in their current pen (i.e. took a lower-than-prescribed dose) and 36.3% discarded prefilled pens/cartridges still containing insulin (i.e. took full dose with new pen). The latter participants discarded a mean 5.5±8.2 prefilled pens/cartridges monthly still containing insulin, each containing 8.6±8.7 units of insulin. Participants who wasted insulin considered it frustrating, time-consuming and painful to inject twice. CONCLUSIONS: Patients taking >20units/day MTI can find transitions between insulin pens challenging. This study highlights the need to identify ways of improving transitions between pens to make transitions easier for insulin users, which could potentially improve adherence to prescribed doses and reduce waste.

The Burden of Bladder Pain in Five European Countries: A Cross-sectional Study.

OBJECTIVE: To estimate the burden of illness associated with bladder pain in 5 European countries: France, Germany, Italy, Spain, and the United Kingdom. PATIENTS AND METHODS: Patients with a diagnosis of bladder pain (ie, unpleasant sensation, pain, pressure, or discomfort related to the urinary bladder) were identified from data collected by the cross-sectional National Health and Wellness Survey performed in 2013. Propensity score matching was used to construct a comparator group without bladder pain (1 case: 2 controls). Assessments were performed for several outcomes including health-related quality of life (HRQoL; 36-item Short-Form, version 2), work-related function (Work Productivity and Activity Impairment questionnaire), employment status, and all-cause healthcare resource use. RESULTS: We identified 275 patients with a physician diagnosis of bladder pain, 274 of whom were successfully matched to 548 controls without bladder pain. Compared with matched controls, patients with bladder pain had significantly impaired HRQoL (mental component summary: 38.5 vs 44.5; physical component summary: 38.9 vs 47.8; P <.001). Overall work productivity loss was significantly greater in patients with bladder pain compared with matched controls (41.7% vs 21.5%; P <.001). Patients with bladder pain were also significantly more likely to use all-cause healthcare resources and make more visits to healthcare providers in the previous 6 months than matched controls (P <.001 for all outcomes). CONCLUSION: Bladder pain is associated with a considerable burden in Europe in terms of impaired HRQoL and work productivity, and increased healthcare resource use.

Lanthanum carbonate oral powder: satisfaction, preference and adherence in French and Spanish patients with end-stage renal disease.

BACKGROUND: Phosphate binders, such as lanthanum carbonate, control elevated serum-phosphate levels in patients with end-stage renal disease (ESRD). Lanthanum carbonate is available in oral powder and tablet form. The aim of this survey was to investigate satisfaction with, preference for, and adherence to lanthanum carbonate oral powder in patients with ESRD. SCOPE: Patients from France and Spain who had been taking lanthanum carbonate powder for at least 4 weeks, and who had experience of other phosphate binders of any formulation, were asked to complete an online or telephone survey. Treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication-9; preference was measured using 5-point Likert scale agreement ratings; and adherence was measured using the Morisky Medication Adherence Scale-4. Data were evaluated using bivariate analyses. FINDINGS: Overall, 160 patients participated (80 per country). Lanthanum carbonate powder was reported to have a higher effectiveness rating (p<0.05), be more convenient (p<0.05), and provide a higher level of satisfaction (p<0.01) than previous binders. There was an overall preference for lanthanum carbonate powder over previous binders of any formulation (p<0.001). Adherence to medication was similar for all binders analysed: 66.3% of French patients adhered to lanthanum carbonate powder, and 65.0% adhered to previous binder treatment (p=not significant); 52.5% of Spanish patients adhered to lanthanum carbonate powder, and 56.3% adhered to previous binder treatment (p=not significant). LIMITATIONS: The survey enrolled patients who had already experienced phosphate binders before the study began. Information on patient preferences for and adherence to previous phosphate binders was therefore based on the patients' memories of these experiences, which may have been subject to change over time. Although most participants completed the online survey in this study, a telephone survey was used for individuals who could not access the online version; if only one method of data recording had been used, there may have been reduced variation in responses. CONCLUSION: Patients with ESRD report increased satisfaction with and preference for lanthanum carbonate powder over other formulations, suggesting that lanthanum carbonate powder is more convenient and easier to use than other formulations.

Asthma control in patients treated with inhaled corticosteroids and long-acting beta agonists: A population-based analysis in Germany.

BACKGROUND: The prevalence and the characteristics of poor asthma control among adults treated with combinations of inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA) are not completely understood. METHODS: Data from adult patients in Germany with self-reported asthma treated with an ICS-LABA combination in the National Health and Wellness Survey (NHWS) were analysed. Patients with well-controlled and not well-controlled asthma according to the Asthma Control Test (ACT) score were compared, with respect to socio-demographic characteristics, attitudes, adherence and outcomes. RESULTS: Among the German patients with self-reported asthma (5.2% of the respondents), 16.2% (382 patients) were treated with an ICS-LABA combination and did not report concomitant chronic obstructive pulmonary disease, chronic bronchitis or emphysema. In this subgroup, 55.8% had not well-controlled asthma (ACT < 20). ICS-LABA treated patients with not well-controlled asthma were more likely to report emergency visits (16.4% vs. 8.9%), missed more time from work (absenteeism: 12.9% vs. 4.3%), were more impaired while at work (presenteeism: 29.0% vs. 14.9%) and were more likely to be women (69.0% vs. 57.4%), compared with well-controlled patients. There were no significant differences in age, body mass index, smoking, income, education or self-reported adherence between the two groups, but different attitudes regarding the patient-physician relationship. CONCLUSIONS: A substantial proportion of patients treated with ICS and LABA had not well-controlled asthma. These patients did not differ from well-controlled patients in terms of education or self-reported adherence, but in terms of their attitudes regarding the patient-physician relationship.

HAV & HBV vaccination among travellers participating in the National Health and Wellness Survey in five European countries.

BACKGROUND: A main cause of hepatitis A and B infections in European countries is travel to endemic countries. Most research on hepatitis vaccination among travellers from Europe has been conducted in airports or travel clinics, samples which potentially overrepresented frequent travellers. METHODS: 2102 respondents across France, Germany, Italy, Spain, and UK completed an internet-based questionnaire. Vaccination status, travel to endemic countries, and other characteristics were compared across frequent, occasional, and non-travellers. Logistic regressions tested association between vaccination and travel adjusting for potential confounders. RESULTS: Most respondents were occasional travellers (61%) and 24% were frequent travellers. Frequent travellers had 2.3-2.4 times the odds of being vaccinated relative to non-travellers, and odds of vaccination were 2.5-3.1 times higher among travellers to endemic areas relative to others (all p < .05). Frequent travellers were more aware of their vaccination status (HAV: 80% vs. 72%; HBV: 82% vs. 74%), though many who were vaccinated could not identify the number of injections to complete the series (47% vs. 29%) (all p < .05). CONCLUSION: Travel frequency and destination endemicity are associated with increased hepatitis A and B vaccination. The number of unvaccinated travellers and the lack of recall for the dosing schedule suggest the need to improve travellers' awareness and adherence to recommendations.

How does our search engine "see" the world? The case of amodal completion.

This article illustrates a dissociation between the perceived attributes of an object and the ability of those attributes to guide the deployment of attention in visual search. Orientation is an attribute that guides search. Thus, a vertical line will "pop out" amid horizontal distractors. Amodal completion can create perceptually convincing oriented stimuli when two elements appear to form a complete object partially hidden behind an occluder. Previous work (e.g., Rensink & Enns, Vision Research, 38, 2489-2505, 1998) has shown a preattentive role for amodal completion in search tasks. Here, we show that orientation based on perceptually compelling amodal completion may fail to guide attention. The broader conclusion is that introspection is a poor guide to the capabilities of our internal search engine.

Perceptual multistability in figure-ground segregation using motion stimuli.

In a series of experiments using ambiguous stimuli, we investigate the effects of displaying ordered, discrete series of images on the dynamics of figure-ground segregation. For low frame presentation speeds, the series were perceived as a sequence of discontinuous, static images, while for high speeds they were perceived as continuous. We conclude that using stimuli varying continuously along one parameter results in stronger hysteresis and reduces spontaneous switching compared to matched static stimuli with discontinuous parameter changes. The additional evidence that the size of the hysteresis effects depended on trial duration is consistent with the stochastic nature of the dynamics governing figure-ground segregation. The results showed that for continuously changing stimuli, alternative figure-ground organizations are resolved via low-level, dynamical competition. A second series of experiments confirmed these results with an ambiguous stimulus based on Petter's effect.

How do painters represent motion in garments? Graphic invariants across centuries.

Western visual art has radically changed throughout the centuries: different techniques, interest in the representation of reality, and use of graphic signs. Indeed, only a few pictorial cues have retained the same meaning and use. These kinds of graphic invariants may play a key role not only in a comparative study of art history, but also for discovering underlying common perceptual mechanisms. Here the aim is to show that western painters use the same graphic solutions to represent motion in garments, across countries and centuries. A pilot experiment, using 160 paintings representative of all main western European art movements from the thirteenth to the twentieth century, shows that different artists represented the motion of garments with the same orientation, curvature and convergence of lines. Experiment 1 demonstrates, with a smaller sample of paintings (16, i.e. two per century) that the relationship between orientation, curvature and convergence of lines is a good predictor of perceived motion. Experiment 2 shows how the same garments, isolated from the context of the paintings, still give different dynamic impressions according to the same rules. Finally, Experiment 3 confirmed the same results, whilst patterns previously used are simplified to their geometrical structure. These results call for an underlying perceptual mechanism that specifically recognizes orientation, curvature and parallelism levels as cues of motion in a static pattern.