Background: The COVID-19 pandemic is an unprecedented public health crisis affecting people worldwide, including those with rheumatic and musculoskeletal diseases (RMDs). Objectives: REUMAVID aims to assess the impact of the COVID-19 pandemic and lockdown on the wellbeing, mental health, disease activity and function, access to health care and treatment, support services, and hopes and fears of people RMDs. Methods: REUMAVID is an international collaboration led by the Health & Territory Research group at University of Seville, Spain, together with a multidisciplinary team including patient organization and rheumatologists. This cross-sectional study consisting of an online survey gathering data from patients with a diagnosis of 15 RMDs in Cyprus, France, Greece, Italy, Portugal, Spain and the United Kingdom. Participants are recruited by patient organizations. Data is collected in two phases: 1) during the first peak of the COVID-19 pandemic (Spring 2020), and 2) as a follow-up to the pandemic (Winter 2020). This analysis presents descriptive results of the aggregated data, summarizing continuous and categorical variables. Results: A total of 1,800 RMD patients have participated in the first wave of the COVID-19 pandemic (from early April to mid-June 2020). The most frequent reported diagnosis were axial spondyloarthritis (37.2%), rheumatoid arthritis (29.2%) and osteoarthritis (17.2%). Mean age was 52.6±13.2, 80.1% were female, 69.6% were in a relationship or married and 48.6% had university studies. In total, 1.1% had tested positive for COVID-19, 10.8 % reported symptoms but were not tested, while 88.1% did not experience any symptoms. 46.6% reported worsening health during the pandemic. 63.9% perceived their health status to be “fair to very bad”. Access to care was limited with 58.4% being unable to keep the rheumatologist appointment, of which, 35.2% were cancelled by the provider and 54.4% was attended by phone or online. 15.8% changed their medication, for which 65.5% were changed by the provider and 24.6% by own decision. Reported wellbeing and psychological health during the pandemic was poor, with 49.0% reporting poor wellbeing according to the WHO-5 scale, 57.3% marking as anxiety and 45.8% as depression in the HADS scale. During the pandemic, 24.6% smoked and 18.2% drank more than before and 54.5% were unable to exercise at home. Conclusion: Results from the first phase of REUMAVID show disturbance of the healthcare quality, substantial changes in harmful health behaviors and an unprecedented impairment of mental health in REUMAVID participants. REUMAVID will continue to collect information in order to assess the impact of the COVID-19 pandemic in people affected by RMDs across Europe. Acknowledgements: This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations, the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom. Disclosure of Interests: Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Laura Christen Employee of: Novartis Pharma AG, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.
For decades, coastal destinations have been facing the need to renew their traditional tourism models, marked by high seasonality and territorial exploitation, the latter justified by the development of accommodation for second homes. The current tourism scenario offers different challenges and opportunities, which can help to modify these tourism models. In this context, the increase in life expectancy and the generalization of the development of healthy lifestyles makes it possible for new tourism models, such as health and wellness tourism, to develop as potential drivers of change. The main objective of this paper is to understand the potential of health and wellness tourism to qualify and diversify coastal tourist destinations, as well as to analyse the recent evolution of coastal tourism and its current problems. Qualitative methods based on the review of related literature, analysis of the content of the plans and the SWOT matrix, as well as the case study of a specific destination are used for this purpose. Los destinos litorales se enfrentan desde hace décadas a la necesidad de renovar sus modelos turísticos tradicionales, marcados por una elevada estacionalidad y la depredación territorial, esta última causada por la construcción de alojamiento destinado a segundas residencias. El escenario turístico actual ofrece distintos retos y oportunidades, que pueden ayudar a complementar estos modelos turísticos. En este contexto, el aumento de la esperanza de vida y la generalización de desarrollo de estilos de vida saludables posibilita que nuevos modelos turísticos, como el turismo de salud y bienestar, puedan desarrollarse como potenciales palancas de cambio. El principal objetivo de esta investigación es comprender la potencialidad del turismo de salud y bienestar para cualificar y diversificar los destinos turísticos litorales, así como analizar la reciente evolución del turismo litoral y su actual problemática. Para ello, se utilizan métodos cualitativos sustentados en la revisión bibliográfica relacionada, análisis de contenidos de planes y matriz DAFO, así como el caso de estudio de un destino concreto.
The term axial spondyloarthritis covers both patients with non-radiographic (nr-axSpA) and ankylosing spondylitis (AS). Axial spondyloarthritis (axSpA) is a chronic disease that typically affects the axial skeleton, and produces varying degrees of pain, stiffness, and fatigue [1-2].
Objectives
The aim of this study is to describe the burden of disease from the patient´s perspective who participated in the International Map of Axial Spondyloarthritis in Argentina.
Methods
IMAS is a cross-sectional online survey including axSpA patients from around the globe. In this study, Argentinian axSpA patients ≥ 18 years old with AS or nr-axSpA, who provided informed consent and participated in the IMAS survey, were included. To determine disease burden from patient´s perspective BASDAI and GHQ-12 scale were performed. In addition, data on demographic, clinical and treatment characteristics were included to describe the daily life of these patients. Numerical variables are expressed as mean (standard deviation) or median (interquartile range), while categorical variables are expressed as count and percentage.
Results
115 individuals (67 men) were included. Mean ± SD age of surveyed participants was 46.9 ± 12.3 years. 76.5% reported being diagnosed with ankylosing spondylitis. Most of them (n: 98) live in Buenos Aires and surroundings. The median BASDAI score was 5.1 (IQR: 3.5), 66.1% had a BASDAI score > 4. The mental state (psychological distress) was affected in less than half, 41.7% of the participants showed a GHQ-12 >3. The delay in diagnosis was 4 years (SD 8). Biologics were prescribed in 88 out of 115 (76.5%) patients and 92% were on them at the time of the survey. The most frequently reported associated health conditions were anxiety and sleep disorders. The main hopes revealed by the respondents were to stop the disease (87%), recover quality of life (72%), and improve mobility (56%).
Conclusion
This is the first study of the International Map of Axial Spondyloarthritis in Argentina. In this sample of patients with axSpA, a substantial proportion were active in their disease, although most of them were under biological treatment. The delay in diagnosis was less than that reported in other series, and we should not underestimate the anxiety and sleep disorders suffered by these patients.
Reference
[1]Poddubnny Denis, Sieper Joachim.The Lancet 2017 Jul 1;390(10089):73-84.2. Garrido-Cumbrera M, Poddubnyy D, Gossec L, et al. The European Map of Axial Spondyloarthritis: Capturing the patient perspective—an analysis of 2846 patients across 13 countries. Curr Rheumatol Rep 2019; 21:19.
Acknowledgements:
NIL.
Disclosure of Interests
Fernando Sommerfleck Grant/research support from: Novartis Argentina, Marco Garrido-Cumbrera Grant/research support from: Novartis, Natalia Zamora Grant/research support from: Novartis Argentina, Mariana Benegas Grant/research support from: Novartis Argentina, LEANDRO FERREYRA Grant/research support from: Novartis Argentina, Maria Laura Acosta Felquer: None declared, Alejandro Benitez: None declared, Emilio Buschiazzo: None declared, María Soledad Gálvez Elkin: None declared, Rodrigo Garcia Salinas: None declared, Pamela Giorgis: None declared, Gisela Paola Pendon: None declared, Diego Vila: None declared, Paula Aliberti Employee of: Novartis Argentina, Vanesa Duarte Employee of: Novartis Argentina, Victoria Martire Grant/research support from: Novartis Argentin.a.
Background: Sleep is an essential health aspect that is often impacted in patients with axial spondyloarthritis (axSpA). Objectives: This analysis aims to assess the prevalence and associated factors of sleep disorders in a large sample of European axSpA patients. Methods: Data were analyzed from 2,846 unselected patients with self-reported clinician-given diagnosis of axSpA of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries. Socio-demographic data; BASDAI [0-10] scores; engagement in physical activity; axSpA influence on work choice (assessed with yes/no question “Was your current or past work choice in any way determined by axSpA?”); risk of psychological distress (12-item General Health Questionnaire [GHQ-12; 0-12]); functional limitation [0-54] and self-reported anxiety and depression were evaluated. Presence of sleep disorders was assessed by the question: “Please indicate whether you have been diagnosed with any of the following: sleep disorders”. A Mann-Whitney test was used to compare the means of numerical variables between dichotomous variables, the Chi-Square test was used to compare the distribution between the categorical variables. Simple and multivariable logistic regression models were used to identify associations between sleep disorders and disease characteristics, mental health and work-related variables. Results: Age of respondents was 43.9 years; 61.3% were female; 48.1% had a university degree; 67.9% were married and 71.3% were HLA-B27 positive. The prevalence of sleep disorders was 39.0%. In the bivariate analysis, presence of sleep disorders was associated with female gender (68.3% vs. 31.7%; p<0.001); overweight/obese (56.5% vs. 49.8%; p<0.001); increased BASDAI scores (6.1±1.8 vs. 5.0±2.1; p<0.001); fatigue (7.0±2.0 vs. 5.8±2.4; p<0.001); morning stiffness (5.8±2.4 vs. 4.8±2.4; p<0.001), work impact (56.5% vs. 38.2%; p< 0.001); anxiety (56.8% vs. 12.5%; p<0.001); depression (51.8% vs. 10.1%; p<0.001) and higher GHQ-12 scores (6.4±4.0 vs. 3.9±3.9; p<0.001). However, factors that remained independently associated with sleep disorders in the multivariable analysis were anxiety (OR=3.8 p<0.001) and depression (OR=3.1 p<0.001) and female gender (OR=1.4; p=0.002) [Table 1]. Table 1. Regression analysis to predict presence of sleep disorders (N=2191) Simple logistic regression Multivariable logistic regression OR 95% CI p-value OR 95% CI p-value Gender (female) 1.59 1.36-1.87 <0.001 1.40 1.13-1.73 0.002 Marital status (married) 1.13 0.99-1.28 0.074 NA NA NA Overweight/Obesity 1.31 1.12-1.53 0.001 1.39 1.14-1.71 0.001 BASDAI (0-10) 1.33 1.27-1.39 <0.001 1.07 0.95-1.21 0.246 Fatigue/Tiredness (0-10)* 1.28 1.23-1.33 <0.001 1.04 0.97-1.12 0.271 Morning Stiffness intensity (0-10)* 1.19 1.15-1.23 <0.001 1.05 0.98-1.13 0.188 Reported Work impact (yes) 2.10 1.78-2.48 <0.001 1.29 1.05-1.58 0.015 Anxiety (yes) 9.18 7.58-11.11 <0.001 3.84 2.99-4.94 <0.001 Depression (yes) 9.53 7.78-11.66 <0.001 3.09 2.37-4.02 <0.001 GHQ-12 (0-12)** 1.16 1.14-1.19 <0.001 1.03 1.00-1.06 0.029 *As measured by the respective item of the BASDAI scale. **12-item General Health Questionnaire. A value of 3 or above indicates a risk of poor mental health. Conclusion: Sleep disorders were highly prevalent among axSpA European patients and strongly associated with female gender and reporting worse mental health, and spinal stiffness. Patients on permanent and temporary sick leave were more likely to report sleep disorders. The strong association between sleep disorders with both anxiety and depression should encourage rheumatologists to screen their patients with sleep disturbance in case they require additional specialist support. Acknowledgements: This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study. Disclosure of Interests: Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.
Abstract Identifying highly disabled patients or at high risk of psychiatric comorbidity is crucial for migraine management. The burden of migraine increases with headache frequency, but the number of headache days (HDs) per month after which disability becomes severe or the risk of anxiety and depression is higher has not been established. Here, we estimate the number of HDs per month after which migraine is associated with higher risk of anxiety and depression, severe disability and lower quality of life. We analysed 468 migraine patients (mean age 36.8 ± 10.7; 90.2% female), of whom 38.5% had ≥ 15 HDs per month. Our results show a positive linear correlation between the number of HDs per month and the risk of anxiety (r = 0.273; p < 0.001), depression (r = 0.337; p < 0.001) and severe disability (r = 0.519; p < 0.001). The risk of anxiety is higher in patients having ≥ 3HDs per month, and those with ≥ 19HDs per month are at risk of depression. Moreover, patients suffering ≥ 10HDs per month have very severe disability. Our results suggest that migraine patients with ≥ 10HDs per month are very disabled and also that those with ≥ 3HDs per month should be screened for anxiety.
The International Map of Axial Spondyloarthritis (IMAS) is a global assessment of the impact and burden of axial spondyloarthritis (axSpA) from the patient perspective, and identifying the unmet needs of axSpA patients through a survey. This research started in 2016 with the Atlas of Axial Spondyloarthritis in Spain, expanded in 2017-2018 to 13 European countries giving rise to the European Map of Axial Spondyloarthritis (EMAS) and further expanding worldwide across 27 countries to become the International Map of Axial Spondyloarthritis (IMAS).
Objectives
Here we present the scope of the study, distribution and main characteristics of patients included and instruments to collect data, as well as highlighting the impact of the disease.
Methods
This research is a collaboration between the Axial Spondyloarthritis International Federation (ASIF), the University of Seville and Novartis Pharma AG together with a scientific committee composed of axSpA patient representatives, rheumatologists, psychologists, and researchers. IMAS collected information through an online cross-sectional survey (2017-2022) from unselected axSpA patients from Europe, Asia, North America, Latin America and Africa. The inclusion criteria were: age ≥ 18 years, residents in the specified country, a diagnosis of axSpA (self-reported AS/nr-axSpA) and under the care of an health care professional. Patients completed a comprehensive questionnaire containing over 120 items on socio-demographics, health behaviours, diagnosis and disease characteristics, comorbidities, mental health (General Health Questionnaire- GHQ-12), healthcare resource utilization, pharmacological treatments, disease activity (BASDAI), physical activity and functioning, employment, and disease related fears and hopes.
Results
5,557 axSpA patients participated in IMAS. The mean age was 43.9±12.8 years, 55.4% were women, 46.2% had university education and 48.5% were employed. 20.6% were on sick leave (temporary or permanent), 71.4% had difficulty finding job due to axSpA and 71.0% reported work-related issues. Patients' diagnostic delay was a mean of 7.4±9.0 years (median: 4.0), and the mean disease duration was 17.1±13.3 years. 75.0% of patients had active disease and 59.4% were at risk of poor mental health. In addition, patients had a mean of 2 physical comorbidities. On average, patients had visited primary care physicians 4.6 times and the rheumatologist 3.6 times in the year prior to the survey. 78.6% had ever taken NSAIDs, 43.6% csDMARDs and 48.8% bDMARDs. The greatest fear of these patients was disease progression (55.9%), while the greatest hope was to be able to relief pain (54.2%).
Conclusion
IMAS is the largest survey in geographical reach and this is the first-time global results are presented. IMAS has shown the global profile of axSpA patients, highlighting unmet needs, including unacceptable delays in diagnosis, and high burden of the disease in axSpA patients worldwide. This global dataset will enable more detailed investigations to obtain evidence on the critical issues that matter to patients around the world in order to improve their care and quality of life.
Acknowledgements
This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.
Disclosure of Interests
Marco Garrido-Cumbrera Grant/research support from: Novartis, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Fernando Sommerfleck Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Consultant of: Abbvie, Novartis, Janssen, Christine Bundy Speakers bureau: AbbVie, Celgene, Janssen, Lilly, Novartis and Pfizer, Souzi Makri Consultant of: Novartis, GSK and Bayer, José Correa-Fernández: None declared, SHASHANK MURLIDHAR AKERKAR Speakers bureau: Pfizer, Novartis, Eli Lilly, Jansen, Jo Lowe Grant/research support from: No personal funding, but ASIF has received funding from Novartis, UCB, Lilly, Abbvie, Boehringer Ingleheim, Pfizer, Janssen, Elie Karam: None declared, Laura Christen Employee of: Novartis employment and stock ownership, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Galapagos, MoonLake, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Novartis.
Commuting to work is an important part of many people's daily life, with travel times increasing constantly and becoming a growing problem. The aim of the present study is to assess the associations between commuting and poor mental health in workers. This is a cross-sectional study extracting information from the 'Commuting, Daily Habits and Urban Health Survey' in Mairena del Aljarafe (Spain), including a representative sample of 294 workers. Poor mental health was accessed using the 12-item General Health Questionnaire (GHQ-12). Associations were tested using Mann-Whitney and Chi-square tests, while Pearson's correlation was used for each item of the GHQ-12, and multiple linear regression was applied to explore factors associated with poor mental health. Of the 294 workers, the mean age was 43.1 years old, 46.6% female, 49% had a university education, 38.4% smoked, and 44.5% were overweight/obese. For their commute, 77.1% used a private motor vehicle (vs. 6.9% public and 16.0% active), spent 51.9 min/day (54.8 min/day private, 44.2 min/day public, and 39.3 min/day active), and expended €91.9/month (€99.7/month private, €59.0/month public and €59.5/month active). The multiple linear regression model shows that people who used their private motorised transport and those who spent more time on their commute to work are associated with poorer mental health. The results of this study show that both driving a motor vehicle and commuting time are associated with poorer mental health. Therefore, the use of public and/or active travel should be encouraged, as well as better management to improve traffic congestion and thus reduce travel times.
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