Estimation of the Economic Burden and Labor Impact of Migraine in Spain: Results from the Spanish Atlas of Migraine Survey 2018

P170 Objectives: To estimate the average annual cost per patient and theimpact on work t of migraine in Spain. Material and Method: This is a prospective, online, anonymous, cross-sectional survey, conducted between June and September2017, promoted by the Spanish Association of Patients with Headache(AEPAC) within the framework of the Spanish Atlas of Migraine2018. People who completed the survey answered questions in relationto their migraine. A distinction was made between chronic migraine(CM) and episodic migraine (EM), considering the monthlyheadache days declared by patients. The economic burden of migrainewas evaluated: direct health costs (including visits to specialists, medical tests, emergency visits, hospital admissions andmedication), indirect costs (lost labor productivity), and those assumedby the migraineur. The labor consequences of migraine overthe last year were analyzed. Chi-square and Mann- Whitney testswere used as contrast tests. Ethics Approval: A central ethics reviewboard approved the study design. Results: 1, 281 people with migraine participated in the survey, 34.2%with CM, 88.2% women, with an average age of 37.3 (SD 11.5). Thedirect health costs for the last year were estimated at €3, 847.29 forCM and €964.19 for EM (p<0, 001). The costs assumed by the patientin the last year were €1, 609.89 for CM and €878.04 for EM (p<0.001).The indirect cost was estimated at €7, 464.83 for CM and €3, 199.15for EM (p <0.001). The total average cost per patient/year rised to€12, 922.01 for CM and €5, 041.41 for EM (p<0.001). Regarding the jobstatus: 62.2% with EM and 49.0% with CM were working, 2.6% withEM and 9.1% with CM were on sick leave and 12.2% with EM and16.8% with CM were unemployed (p <0.05). In the last year, becauseof migraine, 17.8% of patients with EM and 27.2% with CM (p<0.01)requested days of leave or leave of absence, and reduced their workinghours 8.5% with EM and 11.1% CM (p=0.270). Labor efficiencywas reduced in 61.1% of patients with EM and 65.7% with CM(p=0.257). Conclusion: Migraine represents an important economic burden inSpain, particularly in patients with CM. Migraine causes importantproductivity losses resulting from absenteeism, presentism, decreasingthe working hours and the probabilities to keep working, and itsimpact is significantly greater in CM

Low-value care practice in headache: a Spanish mixed methods research study

Background Headache is one of the most prevalent diseases. The Global Burden of Disease Study ranks it as the seventh most common disease overall and the second largest neurological cause of disability in the world. The "Do Not Do" recommendations are a strategy for increasing the quality of care and reducing the cost of care for headache. This study aimed to identify specific low-value practices in headache care, determine their frequency, and estimate the cost overrun that they represent, in order to establish "Do not Do" recommendations specifically for headache by consensus and according to scientific evidence. Methods This was a mixed methods research study that combined qualitative consensus-building techniques, involving a multidisciplinary panel of experts to define the "Do Not Do" recommendations in headache care, and a retrospective observational study with review of a randomized set of patient records from the past 6 months in four hospitals, to quantify the frequency of these "Do Not Do" practices. We calculated the sum of direct costs of medical consultations, medicines, and unnecessary diagnostic tests. Results Seven "Do Not Do" recommendations were established for headache. In total, 3507 medical records were randomly reviewed. Low-value practices had a highly variable occurrence, depending on the hospital and type of headache. Overall, 34.1% of low-value practices were related to treatment, 21% were related to overuse of imaging in consultation, and 19% were related to emergency care. The estimated cost of low-value practices in the four hospitals was 203,520.47 euros per 1000 patients. Conclusions This study identified low-value headache practices that need to be eradicated and provided data on their frequency and cost overruns

Instrument selection for the ASAS core outcome set for axial spondyloarthritis

OBJECTIVES: To define the instruments for the Assessment of SpondyloArthritis international Society-Outcomes Measures in Rheumatology (ASAS-OMERACT) core domain set for axial spondyloarthritis (axSpA). METHODS: An international working group representing key stakeholders selected the core outcome instruments following a predefined process: (1) identifying candidate instruments using a systematic literature review; (2) reducing the list of candidate instruments by the working group, (3) assessing the instruments' psychometric properties following OMERACT filter 2.2, (4) selection of the core instruments by the working group and (5) voting and endorsement by ASAS. RESULTS: The updated core set for axSpA includes seven instruments for the domains that are mandatory for all trials: Ankylosing Spondylitis Disease Activity Score and Numerical Rate Scale (NRS) patient global assessment of disease activity, NRS total back pain, average NRS of duration and severity of morning stiffness, NRS fatigue, Bath Ankylosing Spondylitis Function Index and ASAS Health Index. There are 9 additional instruments considered mandatory for disease-modifying antirheumatic drugs (DMARDs) trials: MRI activity Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joints and SPARCC spine, uveitis, inflammatory bowel disease and psoriasis assessed as recommended by ASAS, 44 swollen joint count, Maastricht Ankylosing Spondylitis Enthesitis Score, dactylitis count and modified Stoke Ankylosing Spondylitis Spinal Score. The imaging outcomes are considered mandatory to be included in at least one trial for a drug tested for properties of DMARD. Furthermore, 11 additional instruments were also endorsed by ASAS, which can be used in axSpA trials on top of the core instruments. CONCLUSIONS: The selection of the instruments for the ASAS-OMERACT core domain set completes the update of the core outcome set for axSpA, which should be used in all trials

Home and nearby nature: Uncovering relational flows between domestic and natural spaces in three countries during COVID-19

This paper addresses the role of living spaces, neighborhood environments, and access to nearby nature in shaping individual experiences of health and well-being during the first wave of the COVID-19 pandemic. Key data is drawn from the GreenCOVID study across Spain, England and Ireland. The survey gathered contextual information about home environments, neighborhood spaces, and access to nature elements, and standardized measures of health and wellbeing between April and July 2020 (n = 3,127). The paper used qualitative data from the survey to document flows between home and nearby nature. These were framed as barriers/mediators with specific focus on differing interpretations of home as both trap and refuge, with additional dimensions of loss, disruption and interruption shaping the broad responses to the pandemic. By contrast nearby nature was an enabler/moderator of health and wellbeing, offering healthy flows between home and nature as well as respite and additional health-enabling factors. Differences were identified between the three countries but important commonalities emerged too, recognising the role nature plays as an asset both within and immediately beyond the home. The use of flow as metaphor also recognises the importance of embodiment and the elastic nature of connections between home and nearby nature for wellbeing. More broadly, flow provides a valuable way to trace affective relational geographers to develop a wider understanding of assemblages of health during pandemics

Impact of monthly headache days on anxiety, depression and disability in migraine patients : results from the Spanish Atlas

Altres ajuts: Novartis SpainIdentifying 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 anxiet

Is a view of green spaces from home associated with 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

Home and nearby nature: uncovering relational flows between domestic and natural spaces in three countries during COVID-19

This paper addresses the role of living spaces, neighborhood environments, and access to nearby nature in shaping individual experiences of health and well-being during the first wave of the COVID-19 pandemic. Key data is drawn from the GreenCOVID study across Spain, England and Ireland. The survey gathered contextual information about home environments, neighborhood spaces, and access to nature elements, and standardized measures of health and wellbeing between April and July 2020 (n = 3,127). The paper used qualitative data from the survey to document flows between home and nearby nature. These were framed as barriers/mediators with specific focus on differing interpretations of home as both trap and refuge, with additional dimensions of loss, disruption and interruption shaping the broad responses to the pandemic. By contrast nearby nature was an enabler/moderator of health and wellbeing, offering healthy flows between home and nature as well as respite and additional health-enabling factors. Differences were identified between the three countries but important commonalities emerged too, recognising the role nature plays as an asset both within and immediately beyond the home. The use of flow as metaphor also recognises the importance of embodiment and the elastic nature of connections between home and nearby nature for wellbeing. More broadly, flow provides a valuable way to trace affective relational geographers to develop a wider understanding of assemblages of health during pandemics. </p

Estimating the savings associated with a migraine-free life: results from the Spanish Atlas

Background and purpose: Migraine is a common and costly neurological disorder. The aims of this study were to quantify the costs of chronic (CM) and episodic migraine (EM) in Spain, evaluating the impact of psychiatric comorbidities and disability, and to estimate the economic savings associated with reducing the number of migraine-days by 50%. Methods: This was an observational, cross-sectional analysis of data from migraine patients who participated in the Spanish Migraine Atlas. The participants were invited to complete a structured questionnaire including the following scales: the Headache Needs Assessment, the Hospital Anxiety and Depression Scale, and the Migraine Disability Assessment Scale (MIDAS). Results: A total of 475 patients were included, of whom 187 had CM (39.4%). Total costs per patient/year were: €16 578.2 ± €34 568.1 for CM and €6227.8 ± €6515.7 for EM. A higher degree of disability, according to MIDAS, significantly increased the total cost of migraine, while the presence of psychiatric comorbidity increased costs for EM patients only. A reduction of 1 migraine-day per month decreased average total costs by €744.14 per patient/year for EM and €663.20 per patient/year for CM, while a reduction in the number of migraine-days by 50% would result in economic savings of €2232.44 per patient/year (R2 = 0.927) for EM and €6631.99 per patient/year (R2 = 0.886) for CM. Conclusions: The costs associated with migraine were driven by migraine frequency and the degree of disability, whereas psychiatric comorbidity only influenced the cost of EM. These results highlight the need to optimize migraine management to reduce the economic migraine burden. Future studies are needed to confirm our results

Mental health systems in countries: where are we now?

More than 85% of the world's population lives in 153 low-income and middle-income countries (LAMICs). Although country-level information on mental health systems has recently become available, it still has substantial gaps and inconsistencies. Most of these countries allocate very scarce financial resources and have grossly inadequate manpower and infrastructure for mental health. Many LAMICs also lack mental health policy and legislation to direct their mental health programmes and services, which is of particular concern in Africa and South East Asia. Different components of mental health systems seem to vary greatly, even in the same-income categories, with some countries having developed their mental health system despite their low-income levels. These examples need careful scrutiny to derive useful lessons. Furthermore, mental health resources in countries seem to be related as much to measures of general health as to economic and developmental indicators, arguing for improved prioritisation for mental health even in low-resource settings. Increased emphasis on mental health, improved resources, and enhanced monitoring of the situation in countries is called for to advance global mental health. © 2007 Elsevier Ltd. All rights reserved.Revie