< Epidemiology and Public Health Programme

Research lines 2018

Cancer

• Quality, effectiveness and costs of breast and colon cancer screening programs.

• Personalization of breast cancer screening program. To develop new predictive models of individual risk of breast cancer in women participating in mammographic breast cancer screening based on individual risk factors to estimate the impact of the polygenic risk score as a risk factor for breast cancer

• To estimate health care needs and resources for long term breast cancer survivors surveillance

• Clinical and molecular epidemiology of exocrine pancreatic cancer.

• Causes and consequences of diagnostic and therapeutic delays in cancer.

• Comparative effectiveness and cost-utility of localized prostate cancer therapies.

• Methodological issues in longitudinal studies on body burden of environmental pollutants and pancreatic cancer risk.

• Toenail concentrations of trace elements and occupational history in pancreatic cancer.

Cardiovascular

• Determination of incidence, mortality and case-fatality trends in myocardial infarction (MI) and distribution of cardiovascular (CV) risk factors.

• Development of new systems to establish myocardial infarction and acute coronary syndrome population incidence with administrative data (CMBD and mortality data) in Girona and Catalonia.

• Improvement of predictive capacity of cardiovascular risk functions for primary prevention of cardiovascular diseases.

• Physical activity measurement and its relationship with cardiovascular health and mechanisms.

• Analysis of common and rare genetic and epigenetic variants (focused on microRNA and gene methylation) associated with cardiovascular traits; Gene by Environment interaction in CV diseases.

• New biomarkers of prognosis and prediction of cardiovascular diseases, with particular emphasis in epigenetics (DNA methylation and microRNAs) and in the analysis of their causal or mediating role.

• Apply the benchmarking function developed in the EURHOBOP and EUROTRACS EC projects led by EPISAP groups, to Catalan hospitals in agreement with AQUAS.

• Development and evaluation of new methods to prevent cardiovascular diseases by using information technologies

• Effectiveness of drugs and intervention in the prevention and treatment of cardiovascular diseases.

Environment

• Health effects of Exposome.

• Birth cohorts in Europe.

• Environmental, occupational and genetic factors related to cancer, immune, respiratory disease and child health.

• Exposure assessment using new biomedical technologies and implementing complex statistics and bioinformatics methods.

• Environmental exposures in early life and neurodevelopment, obesity and metabolic syndrome, and allergy and asthma.

• NCDs and Environment to low and middle income countries.

• Assessing the population distribution and impact on human health of Persistent Organic Pollutants (POPs) and other environmental chemical agents.

• Global urban environments. Built environment and health.

• Body concentrations of persistent pollutants and unhealthy metabolic phenotypes in normal-weight, overweight and obese individuals.

Equity

• Patterns and causes of health inequities embedded in urbanization processes.

• Urban Planning and the Right to the Healthy Cities.

• In-depth spatial and quantitative analysis of the scope and magnitude of green gentrification trends in 40 cities in the US, Canada, and Europe.

• Health and wellbeing effects of green rooftops for people with disabilities: effects and potential mechanisms.

• Advanced theoretical and measurement methods of objective and perceived gentrification for public health research.

• Health effects of gentrification and displacement, pathways, and mechanisms

Health care

• Advanced measurement methods for patient-reported outcomes (PROMs).

• Information systems for assessment of costs per patient and risk adjustment.

• New strategies for improving quality and patient safety.

• Tools and methods for improving health services research, including discrete event simulation models.

• Comparative effectiveness and cost-utility of therapies for most burdensome conditions (asthma, cancer, depression, low-back pain, and MI, among others).

• Comorbidity and health services use among breast cancer survivors.

• Access to care and changes in urban healthcare delivery systems (healthcare gentrification) (cross with equity).

Infertility

• Effects of air pollution on fertility and sperm quality.

• Effects of air pollution and ovarian reserve.

• Effects of assisted reproduction technologies on perinatal outcomes.

Mental health

• Frequency and risk factors of common mental disorders and suicide in general population and among university students.

• Distribution and correlates of perceived health and psychological well-being in the general population.

• Association of mental disorders and physical chronic conditions.

• Prevalence trends of drug use and associated factors.

• Psychiatric comorbidity, interpersonal violence and mortality associated to drug use.

• Incidence of suicide attempt and reattempt and evaluation of interventions in high risk of suicide individuals.

• Impacts of gentrification and displacement on mental health and wellbeing (Cross with equity).

Nutrition

• Obesity and diabetes: epidemiology and prevention across the life span.

• High density lipoproteins (HDL) functionality and atherogenic lipoproteins linked to nutrition. Predictive value of HDL functions for chronic degenerative diseases, such as cardiovascular, cancer, and neurodegenerative ones.

• Nutrigenomics: changes in gene expression attributable to nutrients and foods.

• Interaction between diet and intestinal flora.

• Halo effect of a life-style intervention on the familiar nucleus.

• Nutrition intervention studies.

• Nutritional epidemiology and childhood obesity.

Nursing care

• Nurse empowerment: impact of BPSO program on nurse’s work environment and nurse evidence based practice.

• PROMs -Patient-Reported Outcomes and PREMs -Patient-reported experiences (PREMs).

• Impact nursing care on patient and caregivers and health systems: impact of specific nursing care programs on: QOL in dialysis patients; patients with epilepsy.

• Development of a decision algorithm of the PICC

• Analysis of the PSMAR Electronic Nursing records

Occupation & Employment

• Labor market trajectories and permanent disability and mortality.

• Occupational diseases recognition.

• Working condition surveys in Latin America and Caribbean.

• Cluster-randomized controlled trial of a multicomponent workplace intervention to improve musculoskeletal health in hospital workers (INTEVAL_plus).

Achieved objectives 2018

Scientific objectives

During 2018, researchers of the programme have published 273 papers in scientific journals ranging from New England Journal of Medicine, Lancet, Nature Genetics, BMJ-British Medical Journal, Lancet Respiratory Medicine, Circulation, Diabetes Care, Journal of Allergy and Clinical Immunology, Nature Communications to journals internationally recognized in the fields of molecular, clinical, and environmental epidemiology. Such a broad integration of basic, clinical and epidemiologic knowledge is one of our signs of identity worldwide.

 

Investigators of the Cardiovascular Epidemiology and Genetics group have:

• Analyzed the relationship between chronic immune-mediated inflammatory diseases and cardiovascular risk.

• Developed and validated a method for self-screening of cardiovascular risk.

• Evaluated the effectiveness of cardiovascular primary prevention strategies (such as the use of statins), and therapeutic interventions (such as revascularization) in patients with an acute coronary syndrome and peripheral artery disease.

• Contributed to the knowledge of the genetic and epigenetic architecture of several cardiovascular traits such as myocardial infarction, stroke, lipid profile, diabetes, hypertension and obesity.

• Initiated the follow-up of the 11,000 participants of the REGICOR cohort.

 

Investigators of the Cardiovascular Risk and Nutrition group have:

• Reported that an intervention with virgin olive oils enriched in phenolic compounds improves HDL antioxidant content in hypercholesterolemic subjects.

• Observed that pre-operative Helicobacter pylori eradication improves the body weight and triglycerides at a short-term period after the bariatric surgery.

• Reported that the incidence of the type II diabetes in the working population is within the range established in the general population.

• Observed that the laparoscopic Roux-en-Y gastric bypass is associated with greater reduction in total cholesterol and low-density lipoprotein cholesterol in comparison to sleeve gastrectomy, after a 5 year-follow up.

• Established the effectiveness of an implementation of a daily physical activity intervention program, in which the goal-setting for aerobic activity was mainly based on briskly walking, in elderly subjects after one year of follow-up.

• Leisure time physical activity is inversely associated with body mass index, waist circumference and incidence of general and abdominal obesity, in elderly individuals.

• Established that higher levels of leisure time physical activity and adherence to the Mediterranean diet are associated separately and jointly with lower all-cause mortality. The finding that light of leisure time physical activity is inversely associated with mortality is relevant, given that it is a feasible option for older adults.

• Reported that the screen time, physical activity, meal frequency, and external eating predict adherence to the Mediterranean diet independently of baseline diet quality, in Spanish children.

• Reported a community-based childhood obesity intervention program on anthropometric measures and lifestyle, in Spanish children aged 8 to 10 years.

• Reviewed the association between the microbiota diversity and the obesity and changes in weight.

• Reviewed the mid-term results of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy

 

Investigators of the Girona Heart Registry-REGICOR group have:

• Analyzed the burden of coronary heart disease and cardiovascular risk factors and their trends at the population level across all ages.

• Analyzed the validity of cardiovascular risk functions and analyzed the predictive added value of new biomarkers (glomerular filtration rate, albumin, vitamin D, Apo A and Apo B, inflammatory biomarkers).

• Evaluated the effectiveness of cardiovascular primary prevention strategies (such as the use of statins), and therapeutic interventions (such as invasive vs conservative strategy) in patients with an acute coronary syndrome.

• Identified several predictors of in-hospital mortality and analyzed the interhospital variability in patients with acute coronary syndrome.

• Contributed to the knowledge of the genetic hypertension.

• Initiated the follow-up of the 11,000 participants of the REGICOR cohort.

• Analyzed the role of miRNAs in the development of atherosclerosis and their role as predictors of future coronary heart disease events.

• Assessed the trends, projections and consequences of overweight and diabetes in Spanish population.

 

Investigators of the Clinical and Molecular Epidemiology of Cancer group have:

• Explained the relative influence of trace element concentrations on the mutational status of the oncogene KRAS in pancreatic cancer patients.

• Described occupational factors that influence trace element concentrations in pancreatic cancer cases.

• Shown that higher blood concentrations of Persistent Toxic Pollutants are associated with unhealthy metabolic phenotypes, not only in obese and overweight individuals, but also in normal-weight individuals.

 

Investigators of the Epidemiology and Evaluation group have:

• Described treatment and long term complications of Ductal Carcinoma in Situ in breast cancer screening participants.

• Described long term complications and readmissions of breast cancer patients (invasive and DCIS) according to treatment and mode of diagnosis

• Systematically reviewed and critically appraised the use of health care services among long-term breast cancer survivors.

• Systematically reviewed and critically appraised the individualized breast cancer risk prediction models and personalized breast cancer screening strategies.

• Deepen the knowledge of the relationship between clinical and histologic characteristics of breast cancers in women with previous pathologic diagnosis of benign breast disease in Spain and the determined the long-term risk of screen-detected and interval breast cancer after false-positive results at mammography screening in a Joint analysis of an  international  cohort.

• Described the relationship between values of FIT (faecal immunichemical test) under the threshold of positivity and the diagnosis of interval cancers and future risk of advanced colorectal neoplasia in a colorectal cancer screening programme and describe the factors influencing a colorectal cancer diagnosis in the emergency department.

• Initiated an international collaboration to take part of a large European Randomized Controlled Trial (MyPEBS) to assess personalized breast cancer screening strategies based on women’s individual risk.

 

Investigators of the Health Services Research group have:

• Described the treatment gap of anxiety disorders, uncovering a very low level of use of health services and that less than a 10% of cases receiving adequate treatment worldwide.

• Described the prevalence and risk factors of mental conditions among university students, including suicidal thoughts and behaviours, common mental disorders and the associated disability in 8 countries.

• Systematically reviewed the risk factors of suicidal thoughts and behaviors in adolescents and young adults, and quantitatively estimated the risk associated to early exposure to interpersonal violence (abuse, maltreatment, neglect, bullying and community violence), and sexual orientation (LGBT).

• Launched a collaborative research project to study the risk of serious suicidal attempts and re-attempts in Catalonia, based on the innovative prevention programme Suicide Risk Code.

• Collaborated with the most recent publication of results of the Global Burden of Disease with 2017 estimates worldwide, as well as produced detailed analyses for Spain.

• Systematically reviewed longitudinal studies to assess the impact of primary treatments for localized prostate cancer, measured with Patient-Reported Outcomes (PROs), and to examine differences among modalities within treatments.

• Described, for the first time, the impact of asthma on patients' Health-Related Quality of Life by comparing it with general population reference norms, stratifying by gender.

 

Investigators of the Healthy Cities and Environmental Justice group have:

• Initiated comparative studies and analyses (completed/published for New York City) on the relationship between green space exposure and health, with gentrification as mediating factor.

• Initiated a study about perceived health and wellbeing of families (including parents and children) of urban greening interventions in Barcelona

Initiated studies of the relationship between gentrification and health impacts

• Initiated a study on the restructuring of the American healthcare delivery system and access to care and quality jobs (healthcare gentrification) in Dallas, Seattle, Philadelphia and Atlanta

• Assessed the impacts of urban rooftop gardening on health for participants with mental disabilities and mental health problems.

 

Investigators of the Barcelona Research Infertility Group have:

• Evaluated the relationship between air pollution and Assisted Reproduction.

• Contributed to the knowledge of the effects of assisted reproduction technology on the perinatal outcomes (pre-term delivery and birth weight).

 

Investigators of the Nursing Care Research group have:

• Continued the quasi-experimental study to determine the effectiveness of a nurse intervention on epileptic patients and their perception of risk.

• Started a multicentric quasi-experimental study to determine the impact of “Centros comprometidos con la excelencia en cuidados” program on the nurses work environment and their Evidence based practice attitudes.

• Iniciated the validation of the ICU nursing workload scale (NAS) based on electronic records.

 

Investigators of the Social Epidemiology & Occupational Health group have:

• Completed a Basic Working and Employment Questionnaire, providing nationally representative, comparable data on work and health status of workers in eight Latin America and Caribbean countries.

• Established an association between unstable labour market trajectories and early retirement due to permanent disability and mortality, based on analyses of the Spanish Continuous Working Life Sample.

• Initiated a cluster randomized trial to reduce musculoskeletal morbidity and disability among health care workers.

• Identified cases series of patients admitted in the PSMar with suspected occupational disease.

 

Investigators of the Occupational and Environment Epidemiology group have:

• Been leaders of OMEGA-NET, a network to integrate and optimize occupational cohorts in Europe and to help foster healthy work environments.

• Shown that early supper is associated with lower risk of breast and prostate cancer. People who have their evening meal before 9 pm or wait two hours before going to sleep have lower risk of breast and prostate.

• Contributed to a new study that analyzed 2,000 women—half of whom had breast cancer—from several parts of Spain and conclude that exposure to common THM levels in drinking water not associated with breast cancer.

• Discovered that night exposure to blue light is linked with breast and prostate cancer. The study is based on images taken by astronauts to evaluate outdoor lighting in Madrid and Barcelona.

 

Investigators of the Respiratory Health, Air Pollution and Childhood Development group have:

• Contributed to make possible that 1,200 pregnant women in Barcelona will participate in one of the largest studies on air pollution and pregnancy. The BISC project will assess the role of the placenta regarding air pollutants and brain development in children, before and after birth. The cohort is funded through and ERC Advanced Grand and a grant from the US Health Effects Institute.

• Discovered that Mediterranean diet during pregnancy is associated with lower risk of accelerated growth for the child.

• Discovered that risk gene for Alzheimer’s Disease may aggravate the health effects of air pollution on neurodevelopment in children. Children carrying the ε4 variant of the APOE gene may be particularly vulnerable to the detrimental effects of air pollutants on brain.

• Contributed to the POLAR project, funded by the European Institute of Innovation and Technology project, that uses innovative tools (mobile application) for monitoring allergic rhinitis and its relationship with health and environmental factors.

 

Technological & translational objectives

The EPISAP Groups have contributed to the following translational and innovation achievements:

• Consolidating and expanding technological platforms and services:

- BiblioPRO, the online library of reference for Patient Reported Outcomes (PRO) in Spanish (www.bibliopro.org).

- CASSANDRA model, an open access web application that is used to assess the impact of preventive interventions at the population level (www.redheracles.net/cassandra/es/).

- EURHOBOP benchmarking tool, that was developed by EPISAP researchers to monitor hospitals coronary artery disease outcomes.

- GRANMO online software for sample size estimation in Biomedical Research (https://www.imim.es/ofertadeserveis/software-public/granmo/index.html).

- REGICOR cardiovascular risk function for primary prevention, that is setup on the electronic medical records of Madrid, Catalonia, Basc Country, Valencia, Balearic Islands, Extremadura, and is in use among most primary care practitioners (https://www.imim.es/ofertadeserveis/software-public/regicor/).

- WORKss for data from 1,5 million of the Spanish Social Security affiliated with information on mortality and permanent disability since 2004 and data linkage capabilities with health records.

- Data sharing platform (DataShield) for EU birth cohorts.

- Teleform data collection platforms for cancer data abstraction software workflow solutions, and several projects in Hospital del Mar.

- National data sharing platform (SURBCAN project) from Real World Data for the study of effectiveness and efficiency of chronic care of breast cancer patients in the SNS, using the actual pathways of care endured by those patients.

• To assess the impact on workflow and user acceptance of The NAVIFY Tumor Board solution (NTBS) to prepare for multidisciplinary Tumor Boards, an oncology informatics platform (Roche Diagnostics Information Solutions; Belmont, CA). It facilitates extraction of key data from clinical source data systems and presents holistic, relevant and intuitive information to clinicians during case preparation.

• To participate in the Barcelona City Scientific Council as core invited/founding member (Isabelle Anguelovski).

• To develop a database based on survey data on health impacts of gentrification in Barcelona.

• To develop a database based on survey data on green space perceptions and wellbeing in Barcelona.

• To participate in the Mental Health Plan of the city of Barcelona (Jordi Alonso).

 

Patents under exploitation:

• Title: Risk markers for cardiovascular diseases (I). Authors: Jaume Marrugat; Roberto Elosua; Eduardo Salas; Sergio Castillo; Joan Salgado; José M. Ordovás. Country: National. Under Explotation: Yes, by Gendiag Exe, S.L. Application # / Patent No: WO 2010/142713. Year 2010.

• Title: Risk markers for cardiovascular diseases (II). Authors: Jaume Marrugat; Roberto Elosua; Eduardo Salas; Sergio Castillo; Joan Salgado; José M. Ordovás. Country: International. Under exploitation: Yes, by Gendiag Exe, S.L. Application No / Patent #: EP/09.06.09/EPA 09162329. Year 2010.

• Title: Risk markers for cardiovascular diseases (III). Authors: Jaume Marrugat; Roberto Elosua; Eduardo Salas; Sergio Castillo; Joan Salgado; José M. Ordovás. Country: International; Under exploitation: Yes, by Gendiag Exe, S.L. Application No / Patent #: 10725412.0 – 122 PCT/ep2010058064. Year 2012.

• Title: Method and kit for detecting the risk of developing hypertension. Authors: José Manuel Fernández, Marta Tomás, Esther Vázquez, Mariano Sentí, Jaume Marrugat, Miguel Ángel Valverde. Country: International; Under exploitation: Yes, by Universidad Pompeu Fabra. Number: WO/2005/093096 -P200400883; Year: 24 March 2004.

Educational objectives

In 2018 investigators of EPISAP have:

• Mentored 10 doctoral theses which were successfully defended.

• Led a number of formal educational education activities:

- Continue and expand our active collaboration in graduate education (Medicine, Biology, Other Health Sciences) Pompeu Fabra University (UPF)-Autonomous University of Barcelona (UAB), and University of Vic -Central of Catalonia (UVic-UCC).

- Consolidate leadership in postgraduate education in Public health: Master’s in Public Health program (120 ECTS UPF-UAB), Master’s Degree in Occupational Health and Safety (UPC-UB-UPF), and Postgraduate Diploma in Public Health (30 ECTS).

- Continue and expand participation in the Medical Specialties Residency Programs, as part of the educational units for the medical specialties of Preventive Medicine & Public Health, and Occupational Medicine. Collaboration with other programs include: European Educational Program in Epidemiology (EEPE), Master in Nursing Sciences, Master in Cardiology Nursing, Bachelor’s degree in Biology, Biotechnology and Biochemistry, among many others.

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