Although the main goal of asthma management guidelines is to achieve and maintain clinical control, reported levels of not well-controlled asthma remain high. The aim of this analysis was to compare the levels of asthma control and the associated impact on patients' health status in Europe in 2006, 2008 and 2010. An additional outcome was the comparison of the burden of asthma with diabetes. Data were obtained from the cross-sectional, self-reported, European National Health and Wellness Surveys conducted in France, Germany, Italy, Spain and the UK. Asthma control (Asthma Control Test™; QualityMetric, Inc., Lincoln, RI, USA) and health status (Short Form (SF)-12 health survey and the Work Productivity Loss and Activity Impairment questionnaire) were assessed. In 2010, the proportion of treated asthma patients assessed as having not well-controlled asthma was 53.5%, compared with 56.6% and 55.0% in 2008 and 2006, respectively. A significant reduction in not well-controlled asthma was observed in Germany between 2006 (72.3%) and 2010 (62.5%; p=0.005). Fluctuations in control levels were observed in other countries. For all surveys, having at least well-controlled asthma was associated with a significantly lower number of healthcare contacts in the previous 6 months, better mean±(SD) SF-12 scores for the physical (data for 2010: not well controlled 39.9±11.38, at least well-controlled 48.0±9.89; p<0.001) and mental (data for 2010: not well-controlled 40.6±10.95, at least well-controlled 45.0±10.91; p<0.001) components, and significantly less impact on Work Productivity Loss and Activity Impairment. Asthma and diabetes were associated with a similar overall negative impact on health status. A substantial proportion of asthmatics remain not well-controlled across five European countries, resulting in a significant impact on health resources and patients' health status. The overall burden of asthma appears to be similar to that of diabetes.

The 2006 European National Health and Wellness Survey (NHWS) showed that a large proportion of asthmatics had uncontrolled asthma. The current analysis estimated the prevalence of asthma and asthma control (Asthma Control Test TM (ACT); QualityMetric Inc., Lincoln, RI, USA) in five European countries using the 2008 NHWS. Health-related quality of life (HRQoL), using the Short Form-12 (SF-12) health survey, and work productivity/activity impairment were assessed. Of 3,619 respondents aged o18 yrs, the prevalence of self-reported physician diagnosis of asthma was 6.1% (15 million people); 56.6% of treated asthmatics were not well-controlled (NWC; ACT score f19). Individual components of the ACT showed that, compared with at least wellcontrolled patients (ALWC; ACT score o20), NWC patients had activity limitations at least some of the time (40.8% versus 1.5%, p,0.001), were breathless o3 times per week (72.5% versus 5.4%, p,0.001), suffered sleep difficulties due to asthma at least once per week (60.3% versus 4.6%, p,0.001) and required rescue medication o2-3 times per week (77.4% versus 15.9%, p,0.001). NWC patients had also received more healthcare contact in the past 6 months, including hospitalisation (17.4% versus 9.9%, p,0.001). The SF-12 physical and mental summary scores were 7.46 and 4.73 points higher, respectively, for ALWC patients compared with NWC patients (p,0.001). ALWC patients reported less absenteeism (5.5% versus 12.2%) and work impairment (15.4% versus 30.0%) than NWC patients (both p,0.001).The proportion of asthmatics with NWC asthma has not improved since 2006. ALWC asthma is associated with a significant positive impact on healthcare resource use, HRQoL and work productivity.

BackgroundThe purpose of this study was to determine the characteristics of adults with type 2 diabetes mellitus (T2DM) that correlate with greater risk of hypoglycemia and determine the impact of hypoglycemia on health-related quality of life, work productivity, and medication adherence from a patient perspective.MethodsData from a large web-based survey were retrospectively analyzed. Adults with a diagnosis of T2DM taking antihyperglycemic agents were included in the analysis. Participants with knowledge of their hypoglycemic history were divided into three groups: those experiencing recent hypoglycemia (previous 3 months), those experiencing nonrecent hypoglycemia, and those never experiencing hypoglycemia.ResultsOf the participants with T2DM taking antihyperglycemic agents who were knowledgeable of their hypoglycemia history, 55.7% had ever experienced hypoglycemia. Of those, 52.7% had recent hypoglycemia. Compared with those who never experienced hypoglycemia, those who experienced hypoglycemia tended to: be younger; be more aware of their glycated hemoglobin (HbA1c) levels; have higher HbA1c levels; have a higher body mass index; have higher Charlson Comorbidity Index scores; be on insulin, sulfonylureas, and/or glucagon-like peptide-1 agonists; and be less adherent to their antihyperglycemic agents. Hypoglycemia interfered with social activities, caused more missed work (absenteeism), more impairment while at work (presenteeism), and decreased overall work productivity compared with patients who had never experienced hypoglycemia. Overall health-related quality of life, as determined by the Short Form-36 health questionnaire, was negatively impacted by hypoglycemia. Both Physical and Mental Summary scores were significantly lower for the recent hypoglycemia and nonrecent hypoglycemia groups compared with the never hypoglycemia group.ConclusionHypoglycemia can negatively impact many aspects of life. Greater awareness of those who are at risk for developing hypoglycemia can lead to the development of measures (eg, patient and physician education) to prevent future hypoglycemia episodes.

There are many factors that contribute to diabetes burden and the complexity of diabetes management. The results of this study provide insight from a patient perspective regarding how these factors vary across age and race/ethnicity to aid in the individualization of diabetes treatment.

High nicotine dependence is associated with lower quality of life, lower work productivity and higher health-care use. The Heaviness of Smoking Index and the time-to-first-cigarette can provide useful screening measures of nicotine dependence in clinical and research settings.

BackgroundIn order to adequately assess the effectiveness of vaccination in helping to control vaccine-preventable infectious disease, it is important to identify the adherence and uptake of risk-based recommendations.MethodsThe current project includes data from five consecutive datasets of the National Health and Wellness Survey (NHWS): 2007 through 2011. The NHWS is an annual, Internet-based health questionnaire, administered to a nationwide sample of adults (aged 18 or older) which included items on vaccination history as well as high-risk group status. Vaccination rates and characteristics of vaccinees were reported descriptively. Logistic regressions were conducted to predict vaccination behavior from sociodemographics and risk-related variables.ResultsThe influenza vaccination rate for all adults 18 years and older has increased significantly from 28.0% to 36.2% from 2007 to 2011 (ps<.05). Compared with those not at high risk (25.1%), all high-risk groups were vaccinated at a higher rate, from 36.8% (pregnant women) to 69.7% (those with renal/kidney disease); however, considerable variability among high-risk groups was observed. Vaccination rates among high-risk groups for other vaccines varied considerably though all were below 50%, with the exception of immunocompromised respondents (57.5% for the hepatitis B vaccine and 52.5% for the pneumococcal vaccine) and the elderly (50.4% for the pneumococcal). Multiple risk factors were associated with increased rate of vaccination for most vaccines. Significant racial/ethnic differences with influenza, hepatitis, and herpes zoster vaccination rates were also observed (ps<.05).ConclusionsRates of influenza vaccination have increased over time. Rates varied by high-risk status, demographics, and vaccine. There was a pattern of modest vaccination rate increases for individuals with multiple risk factors. However, there were relatively low rates of vaccination for most risk-based recommendations and all fell below national goals.

AimsWith growing recognition of stagnant rates of attempted cigarette smoking cessation, the current study examined demographic and psychometric characteristics associated with successful and attempted smoking cessation in a nationally representative sample. This additional understanding may help target tobacco cessation treatments toward sub-groups of smokers in order to increase attempts to quit smoking.Design, setting, and participantsData were used from the 2011 U.S. National Health and Wellness Survey (n = 50,000).MeasurementsCurrent smoking status and demographics, health characteristics, comorbidities, and health behaviors.FindingsIn 2011, 18%, 29%, and 52% of U.S. adults were current, former, or never smokers, respectively. Over one quarter (27%) of current smokers were attempting to quit. Current smokers (vs. others) were significantly more likely to be poorer, non-Hispanic White, less educated, ages 45–64, and uninsured, and they had fewer health-conscious behaviors (e.g., influenza vaccination, exercise). Attempting quitters vs. current smokers were significantly less likely to be non-Hispanic White and more likely to be younger, educated, insured, non-obese, with family history of chronic obstructive pulmonary disease, and they had more health-conscious behaviors.ConclusionsSmokers, attempting quitters, and successful quitters differ on characteristics that may be useful for targeting and personalizing interventions aiming to increase cessation attempts, likelihood, and sustainability.

These findings suggest that Brazilians may be underdiagnosed and undertreated for MDD. Individuals with MDD reported substantially poorer health outcomes, suggesting the need to increase MDD awareness, especially among males, and provide better access to treatment.