A growing body of research shows that exposure to air pollution, especially during pregnancy and childhood, may have a negative impact on brain development. Now a study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, has found that exposure to nitrogen dioxide (NO2) during the first two years of life is associated with poorer attention capacity in children aged 4 to 8, especially in boys. NO₂ is a pollutant that comes mainly from traffic emissions.

The study, published in Environment International, shows that higher exposure to NO2 was associated with poorer attentional function in 4- to 6-year-olds, with increased susceptibility to this pollutant observed in the second year of life. This association persisted at an age of 6 to 8 years of age only in boys, with a slightly greater susceptibility period from birth to 2 years of age.

The researchers used data from 1,703 women and their children from the INMA Project birth cohorts in four Spanish regions. Using the home address, the researchers estimated daily residential exposure to NO2 during pregnancy and the first 6 years of childhood. In parallel, they assessed the attentional function (the ability to choose what to pay attention to and what to ignore) at 4-6 years and 6-8 years, and working memory (the ability to temporarily hold information) at 6-8 years, using validated computerised tests.

Periods of higher susceptibility to air pollution

A previous INMA study reported that exposure to NO2 during pregnancy and childhood was associated with impaired attentional function in children at 4-5 years of age. The present study found that:

• Higher exposure to NO2 between 1.3 and 1.6 years of age was associated with higher hit reaction time standard error, an indicator of speed consistency, in the attentional function test at 4–6 years of age.
• Higher exposure to NO2 between 1.5 and 2.2 years of age was associated with more omission errors.
• Higher exposure to NO2 between 0.3 and 2.2 years was associated with higher hit reaction time standard error at 6–8 years only in boys.
• No associations were found between higher exposure to NO2 and working memory in children aged 6 to 8 years.

“These findings underline the potential impact of increased traffic-related air pollution on delayed development of attentional capacity and highlight the importance of further research into the long-term effects of air pollution in older age groups”, explains Anne-Claire Binter, last author of the study and postdoctoral researcher at ISGlobal.

As the brain matures

Attentional function is crucial for the development of the brain’s executive functions, which manage and control actions, thoughts and emotions to achieve a goal or purpose. “The prefrontal cortex, a part of the brain responsible for executive functions, develops slowly and it is still maturing during pregnancy and childhood,” adds Binter. This makes it vulnerable to exposure to air pollution, which has been linked in animal studies to inflammation, oxidative stress, and impaired energy metabolism in the brain.

“In boys, the association between exposure to N0₂ and attentional function may last longer because their brains mature more slowly, which could make them more vulnerable”, she points out. To understand this better, future studies should follow people over time to see how age and gender affect the relationship between air pollution and attention span, especially in older age groups.

In conclusion, “this study suggests that early childhood, up to the age of 2, seems to be a relevant period for implementing preventive measures,” says Binter. “Even a small effect at the individual level from relatively low levels of exposure, as in this study, can have large consequences at the population level. Exposure to traffic-related air pollution is therefore a determinant of the health of future generations.”

Reference

Crooijmans, K.L.H.A., Iñiguez, C., Withworth, K.W., Estarlich, M., Lertxundi, A., Fernández-Somoano, A., Tardón, A., Ibarluzea, J., Sunyer, J., Guxens M., Binter, A.C. 2024, Nitrogen dioxide exposure, attentional function, and working memory in children from 4 to 8 years: Periods of susceptibility from pregnancy to childhood, Environment International. Volume 186, 2024, 108604, ISSN 0160-4120, https://doi.org/10.1016/j.envint.2024.108604

Stressful experiences in midlife or during childhood may be associated with a higher risk of developing Alzheimer's disease and neuroinflammation, respectively. This is one of the conclusions of a study published in Annals of Neurology and led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, in collaboration with the Barcelonaβeta Brain Research Center (BBRC), research centre of the Pasqual Maragall Foundation.

Stressful Life Events are those in which objective external threats activate behavioural and psychological responses on us, for example, death of a loved one, unemployment or illness. Mounting evidence suggests that stress could be associated with an increased risk of dementia and cognitive decline .

The purpose of this research was to assess whether the accumulation of stressful life events throughout life could influence the development of Alzheimer’s-related pathologies in older ages. To do so, the research team counted on 1,290 volunteers from the ALFA cohort in Barcelona , also supported by the ”la Caixa” Foundation, all of them cognitively unimpaired at the time of the study, but with a direct family history of Alzheimer's disease.

Participants went through interviews to assess the number of Stressful Life Events. Lumbar punctures and magnetic resonance imaging (MRI) were performed to test different biomarkers related to Alzheimer’s disease.

Midlife as a vulnerable period

The statistical analyses revealed that the accumulation of stressful events during midlife was associated with higher levels of β-amyloid (Aβ) protein , a key player in the development of Alzheimer’s disease.

“We know midlife is a period when Alzheimer’s disease pathologies start to build up. It is possible that these years represent a vulnerable period where experiencing psychological stress may have a long-lasting impact on brain health”, says Eleni Palpatzis, ISGlobal researcher and first author of the study.

Childhood stress and neuroinflammation

The research team also found that higher levels of stressful experiences in childhood were associated with higher risk of developing neuroinflammation in older ages. Inflammation has been recognized as a key molecular response in neurodegenerative diseases and these results are in line with emerging evidence suggesting childhood trauma to be linked with increased adulthood inflammation.

Sex differences on the impact of stressors

Accumulation of stressful life events over the course of life was associated with higher levels of β-amyloid (Aβ) protein only in men . In women, however, the researchers observed that more stressful experiences over the course of life were associated with lower volumes of grey matter, implying that stress may have sex-specific effects.

“Our results suggest that the mechanisms through which life stressors affect brain health in men and women are different: amyloid protein accumulation in men and brain atrophy in women”, says Eider Arenaza-Urquijo , ISGlobal researcher and last author of the study.

Stronger effects in people with psychiatric history

Lastly, the authors found that stressful life events in people with a history of psychiatric disease were associated with higher levels of Aβ and tau proteins, neuroinflammation and with lower grey matter volume , suggesting that this population could be more susceptible to the effects of stressful life events, for example, due to impaired stress-coping abilities which could make them more vulnerable.

“Our study reinforces the idea that stress could play a significant role in the development of Alzheimer’s disease and provides initial evidence regarding the mechanisms behind this effect, but additional research is needed to replicate and validate our initial findings”, says Eider Arenaza-Urquijo .

Reference

Palpatzis E, Akinci M, Aguilar-Dominguez P, Garcia-Prat M, Blennow K, Zetterberg H, Carboni M, Kollmorgen G, Wild N, Fauria K, Falcon C, Gispert JD, Suárez-Calvet M, Grau-Rivera O, Sánchez-Benavides G, Arenaza-Urquijo EM; ALFA study. Lifetime Stressful Events Associated with Alzheimer's Pathologies, Neuroinflammation and Brain Structure in a Risk Enriched Cohort. Ann Neurol. 2024 Mar 11. doi: 10.1002/ana.26881 . Epub ahead of print. PMID: 38466157.

Genetic diversity of the malaria parasite in pregnant women and children declined in an area targeted for malaria elimination in Mozambique, according to a study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by “la Caixa” Foundation and the Manhiça Health Research Centre (CISM). The findings, published in Nature Communications, highlight the added value of routine sampling of pregnant women as a cost-effective strategy to enhance genomic surveillance of the parasite and detect changes in transmission within the community.

Genomic surveillance of the malaria parasite P. falciparum is essential to monitor the emergence and spread of drug-resistant parasites. But it can provide much more information. “We believe that the genomic diversity of the parasite population can also help us evaluate the effectiveness of interventions aimed at eliminating the disease: we expect lower genetic diversity of the parasite in areas with less transmission,” says ISGlobal researcher Alfredo Mayor. 

Regular collection of samples for genomic surveillance is challenging and costly, particularly in low-resource settings; but Mayor and his team have a solution: pregnant women attending their first antenatal care visit as an easy-to-reach sentinel population. The team previously showed that the malaria burden in pregnant women mirrors that of the community. In this study, they evaluated whether the genetic diversity of the parasite in pregnant women is also representative, and whether it can inform about changes in transmission levels.

Genomic surveillance of malaria in antenatal care

The research team sequenced P. falciparum sampled from 289 women attending their first antenatal visit and 93 children from the community, aged 2-10 years old. The samples were collected between 2015 and 2018 in three areas of southern Mozambique: one with high-transmission of the disease (Ilha Josina) and two with low-transmission (Magude, where elimination interventions were implemented, and Manhiça).

The analysis confirmed that genetic diversity and the prevalence of drug resistance markers were consistent between women attending antenatal care and children from the community. The parasite population in Ilha Josina had the highest genetic diversity, while Magude had the lowest. Furthermore, in Magude there was a clear decline in the diversity of parasites infecting a single individual (intra-host diversity), indicating a reduction in the size of the parasite population following the elimination interventions. No decrease in intra-host diversity was observed in Manhiça.

 “Our findings reveal the impact of interventions on the structure of the parasite population, which is not as apparent when looking only at the number of cases during the same time period”, says Nanna Brokhattingen, first co-author of the study. “Parasite surveillance in pregnant women can complement clinical and epidemiological data when evaluating the impact of malaria control and elimination interventions,” adds Mayor. The authors conclude that routine genomic surveillance at antenatal care clinics represents a cost-effective and convenient approach to inform about changes in disease transmission.

Reference

Nanna Brokhattingen, Glória Matambisso, Clemente da Silva et al. Genomic malaria surveillance of antenatal care users detects reduced transmission following elimination interventions in Mozambique. Nat Commun. https://doi.org/10.1038/s41467-024-46535-x.

Sulfadoxine-pyrimethamine (SP) retains parasitological activity and remains effective for preventing P. falciparum infection in pregnant women and low birth weight in babies, even in areas with a high prevalence of mutations associated with SP resistance. This is the main conclusion of a study conducted in southern Mozambique and led by the Manhiça Health Research Institute (CISM) and the Barcelona Institute for Global Health (ISGlobal), a centre supported by "la Caixa" Foundation.

Providing preventive antimalarial treatment to pregnant women and children under five, regardless of whether they are infected, is an effective strategy for reducing the burden of malaria in these two highly vulnerable populations. In pregnant women, monthly doses of sulfadoxine-pyrimethamine (SP) after the first trimester have been shown to be safe and effective in reducing the severe consequences of malaria in mothers and their babies, including low birth weight. However, there is concern about the growing prevalence of malaria parasites that carry a series of mutations that decrease the efficacy of SP. Specifically, five mutations in two genes (quintuple mutants) are associated with SP resistance.

“Curiously, even in areas where the prevalence of quintuple mutants is high, chemoprevention with SP still seems to provide a benefit to pregnant women,” says ISGlobal researcher Alfredo Mayor. “Whether this sustained benefit is due to other non-malaria effects of sulfadoxine (which also acts as an antibiotic), or whether there is still a direct effect on malaria infections, is not clear,” he adds.

To answer this question, a team led by Mayor and CISM researcher Glòria Matambisso investigated malaria infections, antibodies, clinical outcomes and parasite resistance markers over three years in a total of 4,016 pregnant women in Southern Mozambique.

SP retains anti-parasite activity

Despite the fact that 94% of infected women at the first antenatal visit carried quintuple mutants, preventive treatment with SP (IPTp-SP) remained effective in those who took three or more doses of SP during pregnancy (84% of the participants). Specifically, they showed increased clearance of P. falciparum infections (the prevalence of infected women fell from 7.7% at the first visit to 1.9% at delivery); had a lower prevalence of antibodies resulting from parasite colonisation of the placenta; and their babies had a higher birth weight, compared to women who took less than three doses of SP.

“Our results suggest that SP retains activity against parasites carrying these five mutations, and that the observed benefit is not only due to sulfadoxine’s antibiotic properties,” says Glória Matambisso, first author of the study. In other words, the sustained parasitological effect of SP in clearing malaria infections, combined with the antibiotic properties of sulfadoxine, may explain why IPTp-SP remains beneficial even in areas where the quintuple mutation is dominant. The authors conclude that, until more effective alternatives are found, SP should continue to be used for malaria chemoprevention in pregnant women, despite the high prevalence of molecular markers of drug resistance.

“This is good news,” says Mayor. But the fact that many of the participants went to their first antenatal visit at week 21 (instead of during the first trimester, as recommended) and that 16% of them failed to receive three or more SP doses, means that there are still major barriers to the successful implementation of IPTp. “We need to strengthen our operational capacities to provide timely chemoprevention to pregnant women,” he adds.

Reference

Matambisso G, Brokhattingen N, Maculuve S et al. Parasitological and clinical effects of malaria chemoprevention with sulfadoxine-pyrimethamine in pregnant women from southern Mozambique. J Infection. 2024. Doi: 10.1016/j.jinf.2024.106144

A new study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, sheds light on the growth of lung function in children. The results show that increased levels of physical activity and a higher body mass index (BMI) play a key role in the recovery of early deficits. These findings, published in the journal Thorax, have important implications for clinical practice, research and public health policy, providing new insights into how to improve respiratory health from childhood to adulthood.

The study analysed data from the Spanish birth cohort of the INMA - Environment and Childhood project, which included a total of 1,151 children and adolescents aged 4-18 years. The researchers measured lung function using spirometry, a technique that assesses lung function through the amount of exhaled air. More specifically, the researchers measured forced expiratory volume in one second (FEV1), which is the volume of air exhaled in the first second during forced exhalation after a deep inhalation, and forced vital capacity (FVC), which is the maximum amount of air a person can exhale after a deep inhalation without a time limit. While FEV1 is an indicator of how open the airways are, FVC gives an indication of the size of the lungs.

Four trajectories of lung function growth were identified from the spirometries: a low trajectory (19% of the sample for both FEV1 and FVC), a normal trajectory (62% and 63%), a high trajectory (16% and 13%) and a final trajectory called "catch-up" (2% and 5% of the sample). The “catch-up” group started with lung function values below the low trajectory and showed accelerated growth between 4 and 10 years of age, reaching normal lung function values in adolescence.

"The key finding of our study is that low lung function in early childhood does not automatically translate into poor lung function in early adulthood, but that accelerated growth can recover early-life lung function deficits and result in normal values in adolescence," says Sarah Koch, ISGlobal researcher and first author of the study.

High levels of physical activity and body mass improve lung function

Using clinical records, questionnaires and results from face-to-face visits with participants and their families, the team gathered information on possible predictors of lung function growth. These were grouped into four categories: demographic and birth characteristics, allergic diseases, smoking and other environmental exposures, and physical activity and body mass.

The study results show that accelerated lung function growth is mainly associated with higher levels of physical activity in early childhood (between the ages of 4 and 7) and higher body mass index at the age of 4.

"Our study confirms and goes beyond previous research on known predictors of lung function. Children with less allergic disease were more likely to have normal or high FEV1 trajectories. This supports previous evidence on how children's allergic conditions affect lung function growth," says Judith Garcia-Aymerich, ISGlobal researcher and senior author of the study.

Clinical and public health implications

A clear risk factor for chronic respiratory disease is the early onset or accelerated lung function decline beyond that expected with normal ageing. . Therefore, understanding the determinants that predict lung function growth during childhood and adolescence is as important for preventing these diseases as understanding the determinants of lung function decline in later adulthood.

The results of this study have important implications for clinical practice and public health policy. "Both clinical management and public health policies should support and promote a healthy diet and high levels of physical activity in children with low baseline lung function, suboptimal environmental conditions or early-life allergies. This can help overcome growth limitations in lung function and improve respiratory health in childhood and adulthood," says Sarah Koch.

Reference
Koch, S., Prado Peralta, G., Carsin, AE., Abellan, A., Roda, C., Torrent, M., Iñiguez, C., Ballester, F., Ferrero, A., Zabaleta, C., Lertxundi, A., Guxens, M., Vrijheid, M., Sunyer, J., Casas, M., Garcia-Aymerich, J. Physical activity and body mass related to catch-up lung function growth in childhood: a population-based accelerated cohort study. Thorax, 2024. Doi: 10.1136/thorax-2022-219666

Date

11/05/2024

Hour

9.30 - 15.00 h

Place

C/ de Casanova, 143

El próximo sábado 11 de mayo las diversas entidades del Campus Clínic celebrarán la primera edición del Clínic Obert. Un evento que ocupará más de 15.000 metros cuadrados en la calle y en el que se desarrollarán más de 100 actividades que se distribuirán en 4 escenarios, 5 salas de conferencias con 18 charlas, 15 visitas en espacios interiores y más de 60 carpas con talleres y puntos informativos. El objetivo es conectar con la ciudadanía, haciendo prevención de la salud y fomentando hábitos de vida saludable.

Entre otros, habrá un espacio dedicado a la investigación, la tecnología y la innovación. Se podrá visitar el primer quirófano del mundo con tecnología 5G. También se realizarán talleres familiares de ciencia, una visita al 'Biobanc', el taller 'El café de la inmunoterapia' o una visita al laboratorio de diabetes del IDIBAPS.

Más información aquí.

Actividades de ISGlobal

Malaria Escape 

Sábado, 11 de mayo de 2024. De 9:30h a 15:00h

Público: Todas las edades
Tipo de actividad: Taller

Juego de pistas para tomar conciencia de esta enfermedad y el parásito que la causa. Resolviendo varias pruebas se podrá aprender más sobre la transmisión, las zonas del mundo más afectadas y qué se puede hacer para evitar el contagio. ¡Ven a hacer de detective!

Juego de Genes: descifrando genes para combatir la malaria

Sábado, 11 de mayo de 2024. De 9:30h a 15:00h

Público: Infantil / Juvenil
Tipo de actividad: Taller

¿Te gustaría sentirte como un científico investigando la malaria? En este taller utilizaremos fresas como sustitutos del parásito causante de esta enfermedad y extraeremos el ADN con utensilios de cocina, haciendo una analogía con el proceso que se realiza en el laboratorio.

Viaja con salud

Sábado, 11 de mayo de 2024. De 9:30h a 15:00h

Público: Todas las edades
Tipo de actividad: Mesa informativa

Planifica tu viaje, emprende la aventura y vuelve a casa sin olvidar la salud. ¿Sabes qué debe tener un botiquín de viaje como es debido? ¿Sabrías decir qué riesgos corres allá donde viajas? ¿Conoces algunos de los falsos mitos que corren sobre enfermedades tropicales? El equipo del Servicio de Atención al Viajero Internacional del hospital Clínic Barcelona (@saviclinicbcn) te invitamos a jugar, pintar y participar en nuestras actividades para que cuando viajes lo hagas siempre con la mejor salud.

Salud Global: Postgrados de la Universidad de Barcelona e ISGlobal

Sábado, 11 de mayo de 2024. De 9:30h a 15:00h

Público: Adultos
Tipo de actividad: Mesa informativa

¿Quieres contribuir a hacer realidad la equidad en salud? Ven a hablar con el equipo de formación de ISGlobal sobre los programas de postgrado en salud global/internacional de la Universidad de Barcelona e ISGlobal.

Virus emergentes y reemergentes: ¿qué nos espera?

Sábado, 11 de mayo de 2024. De 13:15h a 13:45h

Público: Adultos
Tipo de actividad: Charla
Lugar: Aula Magna.
Punto de encuentro: Vestíbulo de la Facultad de Medicina (C/ de Casanova, 143), llegar 10 minutos antes 

Charla informativa sobre las emergencias de especies virales y los mecanismos por los que los virus pueden emerger. Hablaremos de algunos virus que circulan en la actualidad y que pueden ser relevantes en nuestro medio por las condiciones climáticas, ecológicas o sociales.

A study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, and the Barcelona Supercomputing Center - Centro Nacional de Supercomputación (BSC-CNS), has consistently estimated daily ambient concentrations of PM_2.5, PM₁₀, NO₂ and O₃ across a large ensemble of European regions between 2003 and 2019 based on machine learning techniques. The aim was to assess the occurrence of days exceeding the 2021 guidelines of the World Health Organization (WHO) for one or multiple pollutants, referred to as “unclean air days”.

The research team analysed pollution levels in more than 1,400 regions in 35 European countries, representing 543 million people. The results, published in Nature Communications, show that overall suspended particulate matter (PM_2.5 and PM₁₀) and nitrogen dioxide (NO₂) levels have decreased in most parts of Europe. In particular, PM₁₀ levels decreased the most over the study period, followed by NO₂ and PM_2.5, with annual decreases of 2.72%, 2.45% and 1.72% respectively. In contrast, O₃ levels increased annually by 0.58% in southern Europe, leading to a nearly fourfold rise in unclean air days.

The study also looked at the number of days on which the limits for two or more pollutants were exceeded simultaneously, a confluence known as a “compound unclean air day”. Despite the overall improvements, 86.3% of the European population still experienced at least one compound unclean day per year during the study period, with PM_2.5-NO₂ and PM_2.5-O₃ emerging as the most common compound combinations.

The results highlight the significant improvements in air quality in Europe followed by the decline of PM₁₀ and NO₂, while PM_2.5 and O₃ levels have not followed a similar positive trend, resulting in a higher number of people exposed to unclean air levels. "Targeted efforts are needed to address PM_2.5 and O₃ levels and associated compound unclean days, especially in the context of rapidly increasing threats from climate change in Europe," says Zhao-Yue Chen, ISGlobal researcher and lead author of the study.

"Our consistent estimation of population exposure to compound air pollution events provides a solid basis for future research and policy development to address air quality management and public health concerns across Europe," points out Carlos Pérez García-Pando, ICREA and AXA Research Professor at the BSC-CNS.

Heterogeneous geographical distribution

The research team has developed machine learning models to estimate high-resolution daily concentrations of major air pollutants like PM_2.5, PM₁₀, NO₂ and O₃. This data-driven approach creates a comprehensive daily air quality picture for the European continent, going beyond sparsely distributed monitoring stations. The models gather data from multiple sources, including satellite-based aerosol estimates, existing atmospheric and climate data, and land use information. By analysing these air pollution estimates, the team calculated the annual average number of days in which the WHO daily limit for one or more air pollutants is exceeded.

Despite air quality improvements, 98.10%, 80.15% and 86.34% of the European population lives in areas exceeding the WHO recommended annual levels for PM_2.5, PM₁₀ and NO₂, respectively. These results closely match the European Environment Agency (EEA)'s estimates for 27 EU countries using data from urban stations only. Additionally, no country met the ozone (O₃) annual standard during the peak season from 2003 to 2019. Looking at short-term exposure, over 90.16% and 82.55% of the European population lived in areas with at least 4 days exceeding WHO daily guidelines for PM_2.5 and O₃ in 2019, while the numbers for NO₂ and PM₁₀ were 55.05% and 26.25%.

During the study period, PM_2.5 and PM₁₀ levels were highest in northern Italy and eastern Europe, while PM₁₀ levels were highest in southern Europe. High NO₂ levels were mainly observed in northern Italy and in some areas of western Europe, such as in the south of the United Kingdom, Belgium and the Netherlands. Similarly, O₃ increased by 0.58% in southern Europe, while it decreased or showed a non-significant trend in the rest of the continent. On the other hand, the most significant reductions in PM_2.5 and PM₁₀ were observed in central Europe, while for NO₂ they were found in mostly urban areas of western Europe.

The complex management of ozone

The average exposure time and population exposed to unclean air concentrations of PM_2.5 and O₃ is much higher than for the other two pollutants. According to the research team, this highlights the urgency of greater control for these pollutants and the importance of addressing the increasing trend and impact of O₃ exposure.

Ground-level or tropospheric O₃ is found in the lower layers of the atmosphere and is considered a secondary pollutant because it is not emitted directly into the atmosphere, but is formed from certain precursors - such as volatile organic compounds (VOCs), carbon monoxide (CO) and nitrogen oxides (NOx) - that are produced in combustion processes, mainly in transport and industry. In high concentrations, ozone can damage human health, vegetation and ecosystems.

"Ozone management presents a complex challenge due to its secondary formation pathway. Conventional air pollution control strategies, which focus on reducing primary pollutant emissions, may not be sufficient to effectively mitigate O₃ exceedances and associated compound unclean days," says Joan Ballester Claramunt, ISGlobal researcher and senior author of the study. However, addressing climate change, which influences ozone formation through increased sunlight and rising temperatures, is crucial for long-term ozone management and protection of public health," he adds.

The challenge of compound episodes

Despite improvements in air pollution, the research team reported that over 86% of Europeans experienced at least one day with compound air pollution events each year between 2012 and 2019, where multiple pollutants exceeded WHO limits simultaneously. Among those compound days, the contribution of PM_2.5-O₃ compound days increased from 4.43% in 2004 to 35.23% in 2019, becoming the second most common type in Europe, indicating a worrying trend. They mainly occur in lower latitudes during warm seasons and are likely linked to climate change and the complex interplay between PM_2.5 and O₃.

Warmer temperatures and stronger sunlight in summer boost O₃ formation through chemical reactions. Subsequently, higher levels of O₃ will accelerate the oxidation of organic compounds in the air. This oxidation process leads to the condensation of certain oxidized compounds, forming new PM_2.5 particles. Additionally, climate change increases the likelihood of wildfires, which further elevate both O₃ and PM_2.5 levels. “This complex interplay creates a harmful loop, highlighting the urgent need to address climate change and air pollution simultaneously,” explains Ballester Claramunt.

Reference

Main study: Chen, Z.Y., Petetin, H., Turrubiates, R.F.M., Achebak, H., García-Pando, C.P. and Ballester, J., 2024. Population exposure to multiple air pollutants and its compound episodes in Europe, Nature Communications. Doi: 10.1038/s41467-024-46103-3

Related study: Chen, Z.Y., Turrubiates, R.F.M., Petetin, H., Lacima, A., García-Pando, C.P. and Ballester, J., 2024. Estimation of pan-European, daily total, fine-mode and coarse-mode Aerosol Optical Depth at 0.1° resolution to facilitate air quality assessments. Science of The Total Environment, p.170593. Doi: 10.1016/j.scitotenv.2024.170593

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Date

09/04/2024

Hour

14.00h - 15.30 h CET

Place

Virtual

Speakers

Chairs: Abigail Pratt – Senior Program Officer, Bill & Melinda Gates Foundation and Nana Aba Williams – MESA Coordinator, Barcelona Institute for Global Health Margaret Odera, Community Health Impact Coalition Evelyn Korkor Ansah, University of Health and Allied Sciences Maureen Momanyi, UNICEF Harriet Napier, Clinton Health Access Initiative, Inc.

MESA, the malaria knowledge hub, hosted by ISGlobal, would like to invite you to participate in the upcoming forum, “Opportunities for implementing and sustaining Community Health Workers in malaria control and prevention.”

Community health workers (CHWs) are increasingly central to the delivery of community interventions in low-and middle-income countries, and have been pivotal to progress in malaria control, from supporting case management of fever, treatment access, and delivery of mass drug administration in campaigns for interventions such as seasonal malaria chemoprevention in the Sahel region. Some countries with a high burden of malaria have adopted a model whereby CHWs are trained to timely test, treat, monitor and/refer malaria cases. These models have contributed to a substantial reduction in malaria cases in some of these countries; however, their implementation presents a number of challenges mainly related to the supervision, supply and support of CHWs.

CHWs, majority of whom are women, are a critical workforce that, if treated as professionals and well-integrated in national health systems, has an enormous potential to extend health care services to those who need them most. There is intense advocacy on the need for CHWs to be professionalized and salaried not only for equity, but also for program sustainability. 

The MESA forum seeks to support CHWs in effectively combating malaria by advocating for necessary resources. It aims to address challenges faced by current CHW models in alleviating the burden of malaria within communities. Additionally, the forum endeavors to explore strategies for creating equitable and sustainable CHW models. Lastly, it advocates for the professionalization of CHWs, recognizing their vital role in healthcare provision.

Register for the event

The Barcelona Institute for Global Health (ISGlobal) has obtained, for the second consecutive time, accreditation as a Severo Ochoa Centre of Excellence. This distinction is awarded by the Ministry of Science, Innovation and Universities with the aim of "promoting the quality of Spanish scientific research by recognising the best centres and units that stand out for their international relevance and impact".

On Friday 22 March 2024, the State Research Agency published a provisional resolution proposal announcing the ten centres recognised with this prestigious accreditation in the 2023 call for applications. The distinction has a duration of four years and is accompanied by financial support of €4.5 million for institutional strengthening, plus €1.16 million for research staff training. 

The evaluation committee highlighted the "unique focus" of ISGlobal's proposal, whose strategic plan “targets the intersection of infectious diseases, non-communicable diseases, climate, and the environment". "The strategic plan, underpinned by basic science with a focus on strengthening multi-omics methodologies, emphasises translational and integrative multidisciplinary activities, reflecting the ethics and values of the centre," they added.

For his part, director general of ISGlobal, Quique Bassat, expressed his joy at the news, saying that "the Severo Ochoa is not only a hallmark that certifies us as one of the centres of excellence in research in Spain, but it will also help us to shape the ISGlobal of the coming years, in which we intend to break down silos and holistically address health challenges that go beyond disciplines and borders".

Bassat also wished to thank Mark Nieuwenhuijsen, who, as scientific director of ISGlobal's Severo Ochoa Programme, led the preparation of the proposal that was recognised by the evaluation committee.

In the ongoing fight against tuberculosis (TB), a newly launched Global TB Dictionary aims to provide a common language for researchers, policymakers, funders and affected communities. Developed through a systematic approach and guided by evidence and expert review, the dictionary aims to unify TB-related terminology and promote clearer communication in the field.

Tuberculosis remains a major global challenge, causing an estimated number of 10.6 million new disease episodes and 1.3 million TB-related deaths in 2022 alone. Scientific output on TB has grown exponentially since the 1990s. Advances in research and treatment have broadened the understanding of the TB spectrum from exposure to infection to disease, challenging long-held concepts and introducing new terminology for use in research and control efforts.

The need for a standardised TB lexicon is evident in the evolving landscape of TB research, where new discoveries and evolving concepts are constantly reshaping our understanding of the disease. Terms such as “subclinical TB”, “incipient TB”, and even “tuberculosis” itself have been used ambiguously, prompting some professionals to advocate for clearer terminology. Similarly, case definitions for paediatric TB have undergone several revisions, contributing to inconsistencies in reporting and analysis.

Unifying terms and definitions through a consensus process

To address these challenges, a diverse group of researchers, public health officials and TB survivors worked together to create the first edition of the Global TB Dictionary. The development process, led by ISGlobal, involved a comprehensive review of TB-related literature, including publications from the Global TB Programme (WHO), the International Union Against Tuberculosis and Lung Disease (The Union), and the Centers for Disease Control and Prevention (CDC) in the United States. In addition, a systematic search of PubMed was conducted to identify articles discussing TB terms and concepts or containing glossaries. Expert input from a panel of TB experts ensured the inclusion of relevant terms and definitions.

The glossary underwent multiple review iterations, with terms and definitions assessed by multiple reviewers to ensure accuracy and coherence. Extensive discussion within the editorial team resolved discrepancies and ensured alignment with current scientific knowledge and non-stigmatising language. 

Furthermore, individuals affected by tuberculosis have also been included in developing the dictionary, "ensuring that the language used in the dictionary is widely accepted and appropriate for all individuals in the TB community. The participation of patients not only ensured the inclusivity of the language used in the dictionary but also provided valuable insight into how the disease affects their lives," emphasized Joanna Ehrlich, project manager at ISGlobal and coordinator of the dictionary.

The dictionary aims to include regular updates to reflect advances in TB research and the inclusion of new terms suggested by the TB community. Users can access the document online and contribute suggestions for future editions, ensuring that it remains a dynamic and evolving resource.

"We hope that this open-access glossary will be a useful resource that allows the community of TB researchers, policymakers, funders and people affected by TB to unite around a common understanding of TB-related vocabulary," said Alberto García-Basteiro, ISGlobal researcher and co-editor of the TB dictionary's together with Prof Marcel Behr from Mcgill University, in Canada.

The development of the Global TB Dictionary is a step towards improving communication and collaboration in TB research and control efforts. By providing a common reference point, the dictionary facilitates clearer communication among stakeholders and improves the overall coherence of TB-related discourse.

Access the dictionary: www.tbdictionary.org

Read the commentary in The Lancet Global Health here.

The Museo Nacional de Ciencias Naturales (MNCN) in Madrid opened today the temporary exhibition "Misión Malaria: una mirada histórica". The exhibition brings together more than 150 objects from the collection of epidemiologist Quique Bassat, ISGlobal director general, which, together with pieces from the MNCN itself, the Royal Botanical Garden and the Faculty of Pharmacy of the Complutense University of Madrid, open a window on the unexpected relationships between the history of medicine, research, politics and public health. From the efforts to bring to Europe a 'miracle bark' from the Peruvian Andes that cured fever, to the discovery of the parasitic origin of malaria and the role of the mosquito as a vector, to the major public health campaigns to combat it, the exhibition also looks at the relevance of a disease that will kill 608,000 people in 2022 alone, mainly children in African countries.

"Malaria has been a major concern for health professionals from ancient times to the present day. It is crucial that we do not forget that malaria remains a public health emergency in the 21st century, especially in Africa. It is both preventable and curable, so each of the thousands of deaths that occur every year from malaria is truly unacceptable," Bassat stresses.

A journey through the history of malaria

Curated by Matiana González Silva, coordinator of ISGlobal's Malaria Elimination Initiative, and Alain Paul Mallard, the exhibition offers a journey through how malaria has been understood, prevented and cured over the centuries, and how this has changed as the great paradigms of medical history have shifted.

Through old books, medicine bottles, hygiene propaganda, audio-visual elements and extensive iconography, “Misión Malaria” illustrates the strategic role of antimalarials in contexts as diverse as 19th-century European colonial expansion and the Second World War, scientific research on parasites and mosquitoes in Algeria and India, and public health campaigns in Italy, Spain and Panama. Taken together, the exhibition offers a glimpse of the path that has led to today's dramatic malaria situation in Africa, as well as the hope for innovative tools such as vaccines.  

"For years, the museum has been conducting research and workshops on malaria, so it seems very timely to have this exhibition that shows the centuries-long struggle against the disease from a social and cultural point of view," says Borja Milá, deputy director of exhibitions at the MNCN.

The inauguration of the exhibition, which can be visited until 22 September in the MNCN's Biodiversity Building, was attended by Rafael Zardoya, director of the MNCN, Matiana González, co-curator, Quique Bassat, director of ISGlobal, Carlos Juan Closa, vice president of Organisation and Institutional Relations of the CSIC, Javier Padilla, Secretary of State for Health, and Javier Gamo, director of the Global Health Medicines Unit of the biopharmaceutical company GSK Spain, the main sponsor of the exhibition.

The Brazilian cash transfer programme has reduced by more than half the number of new cases and deaths from HIV/AIDS among the very poor, according to a large cohort study coordinated by the Barcelona Institute for Global Health (ISGlobal), a centre supported by “la Caixa” Foundation, in collaboration with the Institute of Collective Health of the Federal University of Bahia, Brazil. The results, published in Nature Communications, show that these programmes are essential for reaching the AIDS-related targets by 2030.

Living with very little money puts people at greater risk of contracting many different diseases, including HIV/AIDS, a pandemic that has caused more than 30 million deaths worldwide. Poverty not only increases the risk of contracting HIV, it also makes it harder to get appropriate and timely care.

But fighting diseases like HIV/AIDS is not just about health care. It’s also about improving the conditions in which people live (the social determinants of health). One way to help families with low incomes is through programmes that give them money if they meet certain conditions, such as making sure their children go to school and get medical check-ups. These programmes have been used in many low- and middle-income countries (LMICs) and have helped improve health in many ways. One of the world’s largest such programmes is the Programa Bolsa Família (PBF), which was launched in Brazil two decades ago.

 “Conditional cash transfer (CCT) programmes are among the most effective and widely used interventions to address the social determinants of health, but the magnitude of its impact on HIV/AIDS was not clear,” says Davide Rasella, ISGlobal researcher and study coordinator.

In this study, Rasella and colleagues looked at data from more than 22 million PBF beneficiaries over 9 years (between 2007 and 2015) to find out.

Effect according to income, sex and age

The results of the analysis show a strong effect of the PBF on all disease-related outcomes. But this effect depended on the baseline income of the beneficiaries. Among people with extremely low income, the number of new AIDS cases and deaths was reduced by more than half (55% and 54% respectively), and the case-fatality rate of the disease was also reduced (by 37%). The programme had almost no effect on people with higher incomes.

The impact was also stronger in women and adolescents, showing that this programme helps to reduce inequalities based not only on income but also on sex and age.

Conditional cash transfers can help prevent HIV/AIDS through several mechanisms. For example, by reducing the likelihood that women will resort to sex to meet basic needs, or by providing access to health education and information, or by reducing malnutrition and other co-morbidities that exacerbate the disease.

“This is the largest evaluation of the impact of CCTs on an infectious disease, in particular on HIV/AIDS,” says Andréa F. da Silva, researcher at the Institute of Collective Health of the Federal University of Bahia, and first author of the study.

As Rasella points out, these are “very strong results.” They show that CCTs significantly reduce AIDS cases and deaths in extremely vulnerable populations and should be considered an essential intervention to achieve the AIDS-related Sustainable Development Goals by 2030.

Reference

Silva, A.F., Dourado, I., Lua, I. et al. Los ingresos determinan el impacto de las transferencias de efectivo sobre el VIH/SIDA: estudio de cohortes de 22,7 millones de brasileños. Nat Commun 15, 1307 (2024). https://doi.org/10.1038/s41467-024-44975-z

ISGlobal's commitment to improving the quality of life of Bolivia's most vulnerable populations is being strengthened with two new collaboration agreements aimed at addressing the region's major health challenges.

Research on Chagas and other neglected diseases

In late 2023, ISGlobal's Chagas Initiative and the Integral Nature Health Foundation (SANIT) in Cochabamba, Bolivia, signed a collaboration agreement consolidating their joint work on strengthening, researching, and implementing strategies for Chagas disease and other prevalent neglected diseases in Bolivia.

Currently, joint efforts are focused on 1) innovations in detection, surveillance and monitoring of mother-to-child transmission of Chagas disease, 2) comprehensive management of Chagas disease and its cardiac impact in the Bolivian Chaco region, and 3) perspectives on climate research and social engagement for comprehensive management of vector-borne zoonotic diseases in the Bolivian Chaco.

With this new five-year strategic agreement, ISGlobal and the SANIT Foundation aim to expand their activities to other areas of the region, leveraging their expertise and capacity with local partners to improve the health of vulnerable populations.

Cardiovascular care and strengthening health network

Cardiovascular disease is the leading cause of death in Bolivia, a country which also has the highest prevalence of Chagas disease in the world. To strengthen the response to this problem, ISGlobal and Novartis will establish a reference centre for cardiovascular care in the municipality of Yacuiba, strengthening the health network in the Bolivian Gran Chaco, an area with a population vulnerable to these diseases and where cardiovascular complications are the main cause of mortality and morbidity among people affected by Chagas.

This project, in collaboration with the SANIT Foundation and the Bolivian National Health System, aims to be sustainable through 1) the implementation of a protocolized model of comprehensive care for people affected by cardiovascular diseases, including Chagas, 2) capacity building according to an integrated management model, 3) support for health programme management focused on improving referral pathways between different levels of the health network, and 4) promotion of research capacity.

Antibodies produced in response to COVID-19 vaccines targeting the original variant, as well as those generated through a combination of vaccination and infection, are valid correlates of protection against Omicron, despite its ability to better evade immunity. This is the main conclusion of a cohort study led by the Barcelona Institute for Global Health (ISGlobal) with the collaboration of the Daniel Bravo Andreu Private Foundation (FPDBA). The findings, published in BMC Medicine, also support the need to prioritise booster vaccinations in people without recent infections.

The protection provided by COVID-19 vaccines depends not only on the duration of vaccine-induced immunity, but also on the emergence of new viral variants. Before Omicron, it became clear that the level of vaccine-induced antibodies correlated well with protection against infection. “However, it was not clear whether this would hold true with Omicron, which is very different from the earlier variants,” explains Carlota Dobaño, Head of the Immunology Group at ISGlobal and co-senior author of the study together with colleague Gemma Moncunill. It also wasn’t clear whether hybrid immunity, resulting from previous infection plus vaccination, would provide additional protection against the new variant - an important element for informing public health strategies and for optimising individual protection. This work is part of END-VOC, a European project to monitor the impact of emerging COVID-19 variants by using data from well-established cohorts across the world.

In this study, Dobaño and her team assessed the antibody response to the Spike (S) and Nucleocapsid (N) proteins of Omicron BA.1 in a cohort of healthcare workers from the Hospital Clinic (SEROCOV) that they have been following since the early days of the pandemic. They looked at IgG and IgA antibody levels in these workers, their “immune history” (whether they had been previously infected or had received a booster dose), and correlated this with protection against Omicron infections. The study involved 393 participants, of whom 287 had received a booster (or third dose) one year before, and 243 had been previously infected with SARS-CoV-2.

Protection associated with higher antibody levels

The results show that higher levels of anti-Spike IgG and IgA to the original (Wuhan), Delta and Omicron BA.1 variants were associated with protection against infection by Omicron. “Despite the higher ability of Omicron variants to evade antibody immunity, we show that antibodies elicited by vaccines against the original variant and prior infections are still a good predictor of protection, even against infections by BA.2 and BA4.5, which were the subvariants circulating at the time,” says Moncunill.

And with recent infection

Previous SARS-CoV-2 infection was also associated with greater protection against infection by Omicron, although this effect diminished over time. Recent infections provided the strongest protection, regardless of antibody levels. The authors point out that this may be due not only be a matter of time, but also of the infecting variant, as the most recent infections were with Omicron, while older infections were with pre-Omicron variants.

Those who received a different mRNA vaccine as booster were better protected against infection than those who received the same vaccine as the first two doses. “These data confirm that heterologous vaccination works better, even within mRNA vaccines,” adds Carla Martin Perez, first author of the study. However, the protective effect of the third dose against infection was not evident beyond three months.

“Recent infection was the strongest factor associated with protection against Omicron in our cohort,” concludes Dobaño. A protection where antibody levels play an important but partial role.

This information may help to optimise vaccination strategies and to prioritise booster doses for those who have not been recently infected.

Reference

Martin Perez C, Aguilar R, Jiménez A et al. Correlates of protection and determinants of SARS-CoV-2 breakthrough infections one year after third dose vaccination. BMC Med. 2024. doi:10.1186/s12916-024-03304-3.