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Introduction: This study aimed to assess high healthcare utilization over 1 year in patients with axial spondyloarthritis (axSpA)and factors associated with increased healthcare utilization. Methods: A total of 530 unselected patients with axSpA from the Atlas of Axial Spondyloarthritis in Spain—who had used at least one healthcare resource—were included in the present study. Total health care utilization was obtained from the total number of healthcare visits, medical tests, hospital admissions and emergency visits, during the 12 months prior to the survey. Linear regression was used to analyse possible factors associated with higher healthcare utilization. Results: A total of 530 patients with axSpA participated in this study: mean age was 45.3 years and 51.1% were female. In the previous 12 months, 77.9% (n = 530) used at least one healthcare resource, with the median healthcare utilization at 25. In the multiple linear regression, the only categorical factor associated with higher healthcare utilization was female gender (b = 12.854), while the continuous factors associated with higher healthcare utilization were higher disease activity (b = 3.378), longer diagnostic delay (b = 0.959), younger age (b = - 0.737) and greater functional limitation (b = 0.576). Conclusion: Half of patients with axSpA used 25 or more healthcare resources during 1 year. Higher healthcare utilization was associated with younger age, female gender, greater disease activity, higher functional limitation and longer diagnostic delay. Optimal monitoring of patients with axSpA may help to reduce their healthcare utilization.

Background The COVID-19 pandemic and the lockdown measures have had important consequences on the mental health of the population, although little is known about the role played by nature and its benefits. Objectives The present study aims to evaluate the risk of anxiety and depression during the first wave of the COVID-19 pandemic in Spain and to identify the factors most strongly associated with anxiety and depression, including sociodemographic, household characteristics, and access to or contact with natural environment. Methods GreenCOVID is an online cross-sectional study promoted by the Health & Territory Research (HTR) of the University of Seville in Spain, Maynooth University in Ireland, and the University of Winchester in the United Kingdom. This study includes only data from Spain which were collected between April 8, 2020 and April 27, 2020. Binary logistic regression was conducted to identify the factors associated with anxiety and depression through the HADS scale. Results Of the total of 2,464 adults who participated in GreenCOVID Spain, mean age was 38.1 years, 72.6% were female, 58.1% were at risk of anxiety, and 32.3% of depression. In the multivariable logistic regression, the factors associated with risk of anxiety were female: gender, being a student and problems at home. Regarding the risk of depression, the factors most associated were being a student, female gender, problems at home, worse evaluation of views from home and less help from outside views to cope with lockdown. Conclusions Our findings show that during COVID-19 pandemic, in addition to sociodemographic factors female gender and being a student, problems at home, lack of natural elements in the home, and worse appreciation of views from home were associated with mental health problems. Thus, housing conditions and access to the natural environment were important for mental health during COVID-19 lockdown.

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). Associa tions 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.

To identify the parameters associated with self-reported diagnostic delay (DD) in axial spondyloarthritis (axSpA) patients across Europe

To evaluate the overall health and functioning in patients with axial spondyloarthritis (axSpA) and related factors affecting these during the COVID-19 pandemic and lockdown measures

Introduction The COVID-19 pandemic has influenced the daily lives of people and may affect their well-being. The aim of the present study is to assess well-being and associated factors during the first wave of the COVID-19 pandemic in the general population in three European countries. Methods GreenCOVID was an observational cross-sectional study using an online survey (7 April 2020 to 24 July 2020) promoted by the Health & Territory Research (HTR) of the University of Seville in Spain, Maynooth University in Ireland, and the University of Winchester in England, which included a sample of 3109 unselected adults. Well-being was measured using the World Health Organization-Five Well-Being Index (WHO-5) scale. Seven aspects, related to the natural environment of the home, were evaluated (role of outdoor views in coping with lockdown, importance of blue spaces during lockdown, importance of green spaces during lockdown, quality of view from home, use of outdoor spaces or window views, elements of nature in the home, and views of green or blue spaces from home). Binary logistic regression was conducted to identify the parameters associated with poor well-being. Results Mean age was 39.7 years and 79.3% lived in Spain, the majority in urban areas (92.8%). 73.0% were female and 72.0% had undertaken university studies. Poor well-being was reported by 59.0%, while 26.6% indicated the possible presence of clinical depression. The factors most associated with poor well-being were students (OR = 1.541), those who had no engagement in physical activity (OR = 1.389), those who reported ‘living in Spain’ compared to Ireland (OR = 0.724), being female (OR = 1.256), poor quality views from home (OR = 0.887), less benefit from views of the natural environment to cope with lockdown (OR = 0.964), and those younger in age (OR = 0.990). Conclusions More than half of participants reported poor well-being and one in four indicated the possible presence of clinical depression during the fir

Objective To evaluate differences in sociodemographic factors and patient-reported outcomes (PROs) between unemployed and employed patients with axial spondyloarthritis (axSpA), and to explore work-related issues (WRIs). Methods Data from an online survey of 680 unselected patients of the Atlas of Axial Spondyloarthritis in Spain 2017 were analyzed. Active workforce participants were divided into employed and unemployed groups according to International Labour Organization definitions. Sociodemographic characteristics, PROs (Bath Ankylosing Spondylitis Disease Activity Index [0–10], Spinal Stiffness Index [3–12], Functional Limitation Index [0–54], and psychological distress through the 12-item General Health Questionnaire [0–12]) were assessed. Logistic regression analysis was used to evaluate the association with unemployment status. Results Four hundred fifteen (63.6%) patients with axSpA were categorized in the active population, of which 325 (78.3%) were employed and 90 (21.7%) unemployed. Of the unemployed patients, 62.8% (n = 54) declared that their joblessness was due to axSpA. Of the employed patients, 170 (54.3%) reported WRIs in the year prior to the survey, the most frequent being difficulty fulfilling working hours (44.1%), missing work for doctor appointments (42.9%), and taking sick leave (37.1%). Being unemployed was associated with lower educational level (OR = 2.92), disease activity (OR = 1.37), spinal stiffness (OR = 1.21), functional limitation (OR = 1.05), worse mental health (OR = 1.15), anxiety (OR = 2.02), and depression (OR = 2.69) in the univariable models; and with lower educational level (OR = 2.76) and worse mental health (OR = 1.15) in the multivariable analysis. Conclusion Results show significant differences between employed and unemployed patients with axSpA. Employed patients with axSpA endure many problems at work related to their condition, whereas unemployed patients present worse disease outcomes associated with greater psychol

La migraña constituye una de las causas más frecuentes de consulta al neurólogo. En este volumen se analiza la situación concreta de esta cefalea primaria en Andalucía a partir de la información derivada de la encuesta nacional del Atlas de Migraña en España para conocer la realidad de las personas que la padecen desde distintos ámbitos: diagnóstico, atención sanitaria, comorbilidades, tratamientos, salud psicológica, limitaciones y discapacidad, hábitos saludables e impacto laboral. A diferencia de otros estudios, una de las principales aportaciones de esta obra es la incorporación de la perspectiva del paciente y del cuidador en aspectos tales como la eficacia de los tratamientos, las limitaciones en la vida social y laboral, la automedicación o los miedos y esperanzas. El objetivo final de este análisis circunscrito a Andalucía es aportar evidencias científicas para establecer propuestas y recomendaciones destinadas a mejorar la calidad de vida de las personas afectadas.

Aim: To compare the burden of disease in Spanish patients with axial spondyloarthritis (axSpA) vs other European countries (OEC). Methods: Data from 2846 unselected patients from the European Map of Axial Spondyloarthritis (EMAS) and the Atlas of Axial Spondyloarthritis in Spain (Atlas) were collected through online surveys. Comparative analysis was carried out between Spanish patients (2016) and patients from 12 OEC ( 2017-2018). Socio-demographic characteristics, life habits, and patient-reported outcomes (Bath Ankylosing Spondylitis Disease Activity Index 0-10, spinal stiffness 3-12, functional limitation 0-54, the 12-Item General Health Questionnaire [GHQ-12] for psychological distress 0-12) were compared. Chi-square and Mann-Whitney tests were used for qualitative and quantitative variables respectively. Results: 680 (23.9%) Spanish axSpA patients were compared to 2166 axSpA patients (76.1%) from OEC. Compared to Spain, the OEC group had a higher percentage of females (64.1% vs 52.5%; P < .001) and university-educated participants (51.7% vs 36.9%; P < .001). Spanish patients showed a greater diagnostic delay (8.5 ± 7.7 vs 7.2 ± 8.6 years; P < .001), visits to orthopedic specialists before diagnosis (56.9% vs 25.3%; P < .001), human leukocyte antigen-B27 carriership (77.1% vs 70.1%; P = .003), disease activity (5.7 ± 2.0 vs 5.4 ± 2.0; P = .024), and higher unemployment rates (21.7% vs 9.2%; P < .001). Despite lower rates of diagnosed anxiety and depression, Spanish patients were at higher risk of psychological distress according to the GHQ-12 (5.7 ± 4.5 vs 4.8 ± 4.0; P < .001). Conclusion: Compared to European axSpA patients, Spanish patients experience a longer diagnostic delay and greater psychological distress. Being wrongly referred to orthopedic specialists and facing a more precarious labor scenario appear as possible causal factors, highlighting the need to increase the number of rheumatologists, the training of healthcare professionals, and improving axS

Aim To assess the impact of the COVID-19 pandemic on patients with rheumatic and musculoskeletal diseases (RMDs). Methods REUMAVID is a cross-sectional study using an online survey developed by an international multidisciplinary patient-led collaboration across seven European countries targeting unselected patients with RMDs. Healthcare access, daily activities, disease activity and function, well-being (WHO Five Well-Being Index (WHO-5)), health status, anxiety/depression (Hospital Anxiety and Depression Scale (HADS)) and access to information were evaluated. Data were collected in April–July 2020 (first phase). Results Data from the first phase included 1800 patients with 15 different RMDs (37.2% axial spondyloarthritis, 29.2% rheumatoid arthritis, 17.2% osteoarthritis and others). Mean age was 53, 80% female and 49% had undertaken university studies. During the beginning of the pandemic, 58.4% had their rheumatology appointment cancelled and 45.6% reported not having received any information relating to the possible impact of SARS-CoV-2 infection in their RMDs, with the main source being patient organisations (27.6%). Regarding habits, 24.6% increased smoking, 18.2% raised their alcohol consumption, and 45.6% were unable to continue exercising. Self-reported disease activity was high (5.3±2.7) and 75.6% reported elevated pain. Half the patients (49.0%) reported poor well-being (WHO-5) and 46.6% that their health had changed for the worse during lockdown. According to HADS, 57.3% were at risk of anxiety and 45.9% of depression. Conclusion Throughout the first wave of the COVID-19 pandemic, patients with RMDs have experienced disruption in access to healthcare services, poor lifestyle habits and negative effects on their overall health, well-being and mental health. Furthermore, information on COVID-19 has not reached patients appropriately.

Although different studies have evaluated the positive impacts of the COVID-19 pandemic and lockdown measures on reducing noise pollution and traffic levels and improving air quality, how populations have perceived such changes in the natural environment has not been adequately evaluated. The present study provides a more in-depth exploration of human population perception of enhanced natural exposure (to animal life and nature sounds) and reduced harmful exposure (by improved air quality and reduced traffic volume) as a result of the COVID-19 pandemic lockdown. The data is drawn from 3,109 unselected adults who participated in the GreenCOVID survey from April to July 2020 in England, Ireland, and Spain. The findings suggest that the positive impacts to the natural environment as a result of the lockdown have been better received by the population in Spain and Ireland, in comparison to England. Participants who resided in urban areas had better perceived improvements in nature sounds, air quality, and traffic volume compared to those in rural areas. Older populations and those with lower smoking and alcohol consumption were found to perceive this improvement the most. Furthermore, the greater perception of improvements in environmental elements was also associated with better self-perceived health and improved wellbeing. In the binary logistic regression, living in Ireland or Spain, urban areas, female gender, older age, and good overall wellbeing were associated with a greater perception of improvements in the natural environment, while the factors most associated with a greater perception of reduced harmful exposure were living in Spain, had a good self-perceived health status and older age

Background: Commuting to work is an important part of many people's daily life, with travel times increasing steadily and becoming a growing problem. Longer commutes, increased costs, and certain forms of transport can lead to increased stress and poor psychological health. The aim of the present study is to assess the possible associations between commuting patterns and poor mental health in workers. Methods: This is a cross-sectional study analysing information from the representative population survey 2015 ‘Commuting, Daily Habits and Urban Health’ survey in Mairena del Aljarafe (Spain). For the present study, 294 workers aged from 16–64 years old were included. To detect poor mental health, the 12-item General Health Questionnaire (GHQ-12) was administered. The study also included sociodemographic, lifestyle, and commuting patterns. Associations were tested using Mann-Whitney and Chi-square tests. Pearson's correlation was used to evaluate each item of the GHQ-12 scale. Multiple linear regression was applied to explore factors associated with poor mental health. Results: Of the sample of workers, the mean age was 43.1 years old, 46.6% female, 49.0% had undertaken university study, 38.4% smoked, and 44.5% were overweight/obese. For their commute, 77.1% used a private motor vehicle (vs. 6.9% public transport and 16.0% active transport), allocated 51.9 min/day (54.8 min/day private, 44.2 min/day public, and 39.3 min/day active transport, p=0.004), and spent €91.9/month (€99.7/month private, €59.0/month public, and €59.5/month active transport, p<0.001). Workers who used their private motor vehicle to commute to work presented, as driving time increased, poorer mental health and reported worrying levels of sleep loss, being under stress, and feeling unhappy or depressed. However, for public or active commuters, we cannot reach any of these conclusions. The multiple linear regression model shows that workers who use their private motorised transport and those who spe

Although a large body of research supports the theory that exposure to nature results in mental health benefits, research evidence on the e ects of having a view of green space from home is still scarce. The aim of the present study is to assess the impact that access to a green space view from home has on anxiety and depression. This is a cross-sectional study extracting data from the “2018 Green Spaces, Daily Habits and Urban Health Survey” conducted in Carmona (Spain). The study included variables on sociodemographic and lifestyle, view of green spaces from home, self-perceived health status, and risk of anxiety and depression measured using the Hospital Anxiety and Depression Scale (HADS). Chi-square tests were used to assess variable’s associations and a multiple linear regression models used to identify the variables explaining the risk of anxiety and depression, taking into account sociodemographic characteristics, frequency of visits and view of green spaces from home. According to our results, adults who enjoy a view of green spaces from home have a lower risk of anxiety and depression.

Although a large body of research supports the theory that exposure to nature results in mental health benefits, research evidence on the effects of having a view of green space from home is still scarce. The aim of the present study is to assess the impact that access to a green space view from home has on anxiety and depression. This is a cross-sectional study extracting data from the “2018 Green Spaces, Daily Habits and Urban Health Survey” conducted in Carmona (Spain). The study included variables on sociodemographic and lifestyle, view of green spaces from home, self-perceived health status, and risk of anxiety and depression measured using the Hospital Anxiety and Depression Scale (HADS). Chi-square tests were used to assess variable’s associations and a multiple linear regression models used to identify the variables explaining the risk of anxiety and depression, taking into account sociodemographic characteristics, frequency of visits and view of green spaces from home. According to our results, adults who enjoy a view of green spaces from home have a lower risk of anxiety and depression.