Epidemiology and Public Health
Jordi Alonso Caballero
The Epidemiology and Public Health Program (EPISAP) includes 12 research groups with a total of about 130 professionals from the Hospital del Mar Medical Research Institute (IMIM), the Barcelona Institute for Global Health (ISGlobal), and Pompeu Fabra University (UPF). All EPISAP research groups are recognized by the Catalan Agency for Research (AGAUR) and are members of major Spanish collaborative research networks (CIBERs and RETICs).
EPISAP researchers apply advanced epidemiologic methods and approaches to achieve a better understanding of: a) the frequency and burden of disease; b) major risk factors and underpinning mechanisms; and c) the role of health services and interventions, and their impact on the health outcomes of individuals and populations. Our research focuses on cancer, mental disorders, cardiovascular disease, and environmental and occupational exposures.
We carry out translational research and innovation. EPISAP researchers participate in community activities, as expert members of committees and advisors of health system institutions and organizations. The program’s researchers have longstanding research careers with international recognition and have established solid relationships with many regional, national and international research institutions.
Education and training in epidemiology and public health for graduate, postgraduate and medical specialty students is a key activity of EPISAP. Many of our researchers are faculty members of Pompeu Fabra University (UPF) or the Autonomous University of Barcelona (UAB) and lead a variety of formal courses and programs.
• Quality, effectiveness and costs of breast and colon cancer screening programs.
• Personalization of breast cancer screening program.
• 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.
• Incidence, mortality and case-fatality trends in myocardial infarction (MI) and distribution of cardiovascular (CV) risk factors.
• Predictive capacity of cardiovascular risk functions.
• Common and rare genetic and epigenetic variants associated with CV traits.
• Gene by Environment interaction in CV diseases.
• Health effects of the exposome.
• Environmental, occupational and genetic factors related to cancer, 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.
• Patterns and causes of health inequalities embedded in urbanization processes.
• Urban Planning and the Right to 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.
• Advanced measurement methods for patient-reported outcomes (PROs).
• 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, and low-back pain, MI, among others).
• Comorbidity and health services use among breast cancer survivors.
• Effects of air pollution on fertility and sperm quality.
• Effects of assisted reproduction technologies on perinatal outcomes.
• Frequency and risk factors of common mental disorders and suicide in the 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 chronic physical conditions.
• Prevalence trends of drug use and associated factors.
• Psychiatric comorbidity, interpersonal violence and mortality associated with drug use.
• High density lipoprotein (HDL) functionality and atherogenic lipoprotein-linked
• Nutritional interventions and their value as a cardiovascular predictive factor.
• Nutrigenomics: changes in gene expression attributable to nutrients and foods.
• Interaction between diet and intestinal flora.
• Obesity and diabetes: epidemiology and prevention across the life span.
• Halo effect of a lifestyle intervention on the familiar nucleus.
• Application of evidence based nursing practice.
• Nurse interventions in patients with epilepsy.
• Patient-reported outcomes.
Occupation & Unemployment
• Labor market trajectories and permanent disability and mortality.
• Occupational diseases and injuries, and social protection.
• Working condition surveys in Latin America.
Achieved objectives, 2016
In 2016, researchers of the program have:
• Published 247 papers in scientific journals ranging from Lancet, Nature, JAMA Psychiatry to internationally recognized journals 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 & Genetics group and others have:
• Analyzed the burden of coronary heart disease and cardiovascular risk factors and their trends at the population level.
• Evaluated the relationship between lifestyles (diet, physical activity), environmental exposures (air pollution, noise) and cardiovascular risk factors and subclinical markers of atherosclerosis.
• Analyzed differences in the management and prognosis of myocardial infarction (MI) patients across Europe and developed a valid standardized and adjusted benchmarking monitoring tool.
• Developed and validated new cardiovascular risk functions and analyzed the predictive added value of new biomarkers.
• Contributed to the knowledge of the genetic and epigenetic architecture of several cardiovascular traits such as myocardial infarction, venous thromboembolism, atrial fibrillation, stroke, lipids, smoking and hypertension.
Investigators of the Cardiovascular Risk & Nutrition group and others have:
• Reported that inter-individual differences in cardiovascular risk and dietary response must be taken into account for further applications in personalized nutrition.
• Determined that weight loss and other lifestyle recommendations after bariatric surgery should be encouraged to avoid hypertension relapse and other risk factors.
• Observed that the interventional weight loss program based on a very low-calorie-ketogenic diet is effective in reducing body weight and improvement of glycemic control with safety and good tolerance for T2DM patients.
• Reported that metabolically healthy obese is a target group in whom to implement lifestyle modification initiatives to reduce the likelihood of transition to a metabolically unhealthy phenotype.
• Observed that higher monetary daily diet cost is associated with healthy eating in Spanish youth.
Investigators of the Clinical and Molecular Epidemiology of Cancer group and others have:
• Contributed to identifying three new pancreatic cancer susceptibility signals on chromosomes 1q32.1, 5p15.33 and 8q24.21, which merit functional follow-up to identify target genes and explain the underlying biology.
• Examined the influence of perinatal and childhood-related characteristics, socio-demographic and anthropometric variables on breast cancer risk, and showed the importance of hormones and growth factors in the early stages of life, when the mammary gland is in development.
• Described the accumulation of mixtures of Persistent Toxic Pollutants at high concentrations in significant subgroups of the general population in the USA.
Investigators of the Drug Abuse Epidemiology group and others have:
• Described gender differences in the use of alcohol and prescription drugs in relation to job insecurity.
• Evaluated the impact of smoke-free regulations on smoking prevalence trends in Spain.
• Have assessed gender disparities in excess mortality of heroin or cocaine users.
Investigators of the Epidemiology and Evaluation group and others have:
• Estimated the cumulative risk of breast cancer screening outcomes according to the presence of previous benign breast disease and family history of breast cancer.
• Described the risk of breast cancer according to the radiological characteristics of previous mammograms and biomarker expression of previous benign breast disease.
• Analyzed the colorectal cancer screening process in terms of participants' satisfaction and adherence to follow-up recommendations, and estimated the future demand of colonoscopies generated by the implementation of a population-based colorectal cancer screening program.
• Estimated the average cost weights of APR-DRG for the Spanish NHS based on RECH (Spanish Hospital Cost Network) dataset, and calculated the incremental cost of nosocomial bacteremia caused by the most common organisms, classified by their antimicrobial susceptibility.
• Established the impact of incident disclosure behaviors on medical malpractice claims.
Investigators of the Health Services Research group and others have:
• Meta-analyzed the value of the Center for Epidemiologic Studies Depression (CES-D) as a general population screening tool for major depression.
• Estimated the association of mental disorders with subsequent chronic physical conditions in 17 countries worldwide.
• Estimated the frequency and impact of mental disorders among college students in 21 countries.
• Determined that very limited available evidence supports cost-effectiveness of new treatment modalities for localized prostate cancer over traditional procedures.
• Shown than men who have undergone prior treatment for lower urinary tract symptoms may experience benefit rather than harm from primary localized prostate cancer treatment.
Investigators of the Healthy Cities and Environmental Justice group and others have:
• Started the analysis of the urban greening trajectories of 100 cities in the US, Canada, and Europe and assessed the extent to which they consider issues of health needs/priorities and equity in their plans and interventions.
• Initiated the spatial and quantitative analysis of green gentrification trends in the US, Canada, and Europe through an extensive collection of demographic, real estate, and development data.
• Initiated a study in New York City and Barcelona on the effects of gentrification on health and on the mediating role of gentrification in the relationship between green space and improved health outcomes.
• Worked in collaboration with Barcelona City Council to assess the social impact of healthy cities interventions, such as the Superilles (large city blocks) and others, on local residents.
Investigators of the Infertility/Barcelona group and others have:
• Evaluated the relationship between air pollution and sperm quality.
• Contributed to knowledge of the effects of assisted reproduction technology on the perinatal outcomes (pre-term delivery and birth weight).
Investigators of the Occupational & Environment Epidemiology group and others have:
• Completed studies on the exposome and water contaminants and showed numerous changes in the metabolome and transcriptome, and perturbations in immune response related to uptake of water disinfection byproducts.
• Finalized a large study on night shift workers doing rotating shifts evaluating hormonal levels, genetic variants and gene-expression within the same individual at different shifts.
• Promoted new studies in LMICs on both environmental and infectious agents, and showed a combined effect of Epstein-Barr virus and Plasmodium falciparum infections on endemic Burkitt lymphoma using a multiplex serological approach in a study in Malawi.
Investigators of the Nursing Care Research group and others have:
• Started a quasi-experimental study to determine the effectiveness of a nursing intervention on epileptic patients and their perception of risk.
• Started a qualitative study to assess women’s satisfaction with childbirth in the hospital.
Investigators of the Respiratory Health, Air Pollution &Childhood Development group and others have:
• Described altered brain connectivity in school children exposed to high levels of traffic pollution.
• Completed the field work of the Human Early-Life Exposome study (HELIX project) with more than 1,200 mother-child pairs evaluated.
• Initiated a population based randomized controlled trial to determine the effectiveness of a dietary intervention (four walnuts per day, ~1.5g of n-3 PUFA) in enhancing brain development in teenagers.
Investigators of the Social Epidemiology & Occupational Health group and others have:
• Completed a Basic Occupation and Employment Questionnaire, providing nationally representative, comparable data on work and health status of workers in six Latin America and Caribbean countries.
• Established an association between unstable labor 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.
• Completed the survey on Functional capacity at work and health in a large sample of health care personnel.
Technological & translational objectives
• 3 patents have been transferred to a biotechnology company, related to the prediction of cardiovascular and thromboembolic diseases risk.
• BiblioPRO, the online library of reference for Patient Reported Outcomes (PRO) in Spanish, has reached 5,000 monthly visits and 2,000 new users in 2016 (www.bibliopro.org).
• The CASSANDRA model, an open access web application, is used to assess the impact of preventive interventions at the population level (www.redheracles.net/cassandra/es/).
• A standardized benchmarking tool was developed by EPISAP researchers to monitor hospitals coronary artery disease outcomes (http://www.eurhobop.eu/).
• A platform to study working conditions and workers health risks was developed from databases of the Social Security workforce based on the “Continuous Work History Sample”.
• A basic questionnaire for the future Working Conditions Survey in Latin America.
• A mathematical model developed by EPISAP researchers is being used by theOncology Master Plan to predict future need for colonoscopies in Catalonia.
• EPISAP researchers have continued participating in national and international expert committees, such as: WHO, European Research Council, Expert Boards, European Medicines Agency (EMA), European Monitoring Center for Drugs and Drug Addiction (EMCDDA), Generalitat de Catalunya, and the Spanish Ministry of Health.
In 2016 investigators of EPISAP have:
• Mentored 19 doctoral theses which were successfully defended.
• Led a number of formal educational education activities:
− Postgraduate programs: Master’s in Public Health (120 ECTS) with 2 specialties: research and professional; Master’s Degree in Occupational Health and Safety, in collaboration with Universitat Politècnica de Catalunya (UPC) and Universitat de Barcelona (UB); and the Postgraduate Diploma in Public Health (30 ECTS).
− Graduate courses: The Health System; Epidemiology; Community Health; Health Management; Preventive Medicine and Public Health (Medicine), and many others.
− Other programs: EPISAP researchers have continued actively participating in the Medical Specialties Residency Program, 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, and many others.