Epidemiology and Public Health


Research lines 2017


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

• Personalization of breast cancer screening programme.

• 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 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.


• Patterns and causes of health inequalities 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 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.


• 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.


• 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.

Nursing care

• Application of Evidence Based Nursing Practice.

• Nurse interventions on patients with epilepsy.

• Patient-reported outcomes (PROMs) and Patient-reported experiences (PREMs).

Occupation & Unemployment

• Labor market trajectories and permanent disability and mortality.

• Occupational diseases recognition.

• Working condition surveys in Latin America and Caribbean.


Achieved objectives, 2017

Scientific objectives

During 2017, researchers of the programme have published 253 papers in scientific journals ranging from Lancet, JAMA, Nat Genet, World Psychiatry, JAMA Psychiatry 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 and others 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, ankle-brachial index).

• Evaluated the relationship between environmental exposures (air pollution, noise) and hypertension.

• 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.

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

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


Investigators of the Cardiovascular Risk and Nutrition group and others have:

• Reported that a Mediterranean diet pattern improves high-density lipoprotein functionality and LDL atherogenicity, in high cardiovascular risk individuals.

• Observed the atherogenic dyslipidemia remission 1 year after bariatric surgery.

• Surrogate markers of adiposity increased with concurrent obesogenic behaviors in Spanish children and adolescents.

• Studied the paracetamol and caffeine pharmacokinetics after the bariatric surgery.

• Observed that olive oil phenolic compounds have an effect on the expression of blood pressure-related genes.


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

• 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.

• Described the changes in the total effective xenoestrogen burden (TEXB) in breast cancer patients, at surgery and at different time points during an 18-month follow-up, showing that the cancer treatment may be responsible for the increase in the alpha-fraction of TEXB observed in patients with hormone-dependent tumors, which may confer to xenoestrogens a role in the progression of the disease.

• Described factors that influence perceptions and viewpoints of citizens on the responsibility for the presence of toxic substances in food, on enforcement of laws and regulations that control human exposure to toxic substances in food, and on the effectiveness of such regulations.


Investigators of the Drug Abuse Epidemiology group and others have:

• Assessed gender disparities in excess mortality of heroin or cocaine users.

• Examined the prevalence of psychoactive substance use in Spanish drivers.

• Estimated the prevalence and risk factors (especially those related to illegal activities and crime) of suicide ideations and plans, and interpersonal violence among drug users.


Investigators of the Epidemiology and Evaluation group and others have:

• Assessed the clinical and histologic characteristics of breast cancers in women with previous pathologic diagnosis of benign breast disease.

• Determined the cost-effectiveness of double reading versus single reading of digital mammograms in screening programmes.

• Analysed the colorectal cancer screening process in terms of participants' satisfaction and adherence to follow-up recommendations

• Reported socioeconomic inequalities in both uptake of colorectal cancer screening and outcomes.

• Described the variability of surgery treatment in breast cancer patients.

• Described breast cancer survival according to breast density and phenotypes.

• Analysed the incremental cost of nosocomial bacteraemia according to the causative focus and antibiotic sensitivity of the microorganism.

• Estimated the cost and detection rate of glaucoma screening with imaging devices in a primary care centre.


Investigators of the Health Services Research group and others have:

• Described, for the first time, the disability associated with psychotic experiences among individuals without psychotic disorders, based on the World Mental Health surveys.

• 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).

• Obtained competitive funding to study the risk of serious suicidal attempts and re-attempts in Catalonia, based on the innovative prevention programme Suicide Risk Code.

• Identified very limited available evidence supporting cost-effectiveness of new treatment modalities for localized prostate cancer over traditional procedures.

• Shown that men with pretreatment 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 the Ajuntament de Barcelona to assess the social impact of healthy cities interventions, such as the "superilles" and others, on local residents.


Investigators of the Barcelona Research Infertility Group and others have:

• Evaluated the relationship between air pollution and sperm quality.

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


Investigators of the Occupational and Environment Epidemiology group and others have:

• Identified night shift work and circadian disruption as risk factors for breast and prostate cancer.

• Developed bioinformatics tools to characterize the exposome and its interaction with omics and health data.

• Shown new associations between specific antibodies to 'P. falciparum' and Epstein Barr virus in children with Endemic Burkitt Lymphoma, which is the most prevalent paediatric  tumour in Sub-Saharan Africa.

• Associated air pollution with cancer mortality beyond lung cancer. A large scale epidemiological study associates some air pollutants with kidney, bladder and colorectal cancer death.

• Associated swimming in a chlorinated pool with changes in levels of metabolites in blood.


Investigators of the Nursing Care Research group and others have:

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

• Finalized a qualitative study to assess women’s satisfaction with childbirth in the hospital.


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

• Discovered new evidence of air pollution effects on children’s neurodevelopment: exposure to air pollution during pregnancy found to have a negative effect on attentional function in children; decreased short-term and working memory, and motor performance.

• Shown for the first time that lifelong residential exposure to greenness in children is associated with better attention.

• Discovered that physical activity in early childhood favors the development of working memory.

• Completed a study with more than 1,200 pregnant women from the INMA birth cohort finds higher blood levels of PFAS may influence lipid metabolism and glucose tolerance.

• Published the first epidemiological study that evaluates prenatal exposure to different DBPEs and neurodevelopment during the first years of life, showing that child neuropsychological development does not seem to be affected by exposure to water disinfection by-products.


Investigators of the Social Epidemiology & Occupational Health group and others 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 randomised trial to reduce musculoskeletal morbidity and disability among health care workers.

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

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 10,000 monthly visits and 3,000 new users in 2017 (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/).

• Online platform with the trends of the incidence of mortality and permanent disability from 2004 to 2016 of the social security affiliates included in the Muestra Contínua de Vidas Laborales.

• A mathematical model developed by EPISAP researchers is being used by the Director Plan of Oncology to predict future need of 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, among others.

• Elaboration of lifestyle recommendations for the prevention and management of metabolic syndrome (Nutrition ReviewsVR Vol. 75(5):307–326).

Educational objectives

In 2017 investigators of EPISAP have:

• Mentored 11 doctoral theses which were successfully defended.

• Led a number of formal educational education activities:

− Postgraduate programmes: Master’s in Public Health (120 ECTS) with 2 specialties: research and professional; Master’s Degree in Occupational Health and Safety, in collaboration with the Universitat Politècnica de Barcelona (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), among many others.

− Other programmes: EPISAP researchers have continued actively participating in the Medical Specialties Residency Programme, as part of the educational units for the medical specialties of Preventive Medicine & Public Health, and Occupational Medicine. Collaboration with other programmes include: European Educational Programme in Epidemiology (EEPE), Master in Nursing Sciences, Master in Cardiology Nursing, Bachelor’s degree in Biology, Biotechnology and Biochemistry, among many others.

− Other courses: “Nutrition and Cardiovascular Risk”, Institut de Formació Continua IL3, Barcelona University.  Subject: “Life-style effects on health”, Innovation Master of Nutrition, Chronic diseases and healthy ageing. Medicine Faculty, Barcelona University.




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