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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 substantial proportion of the world’s population remains willing to get vaccinated against diseases including COVID-19, according to a new survey across 23 countries that represent more than 60% of the world’s population. The study, published in Nature Medicine, was co-led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by “la Caixa” Foundation, and the Graduate School of Public Health and Health Policy of the City University of New York (CUNY SPH). 

The severe human impact of the COVID-19 pandemic led to the rapid research and development of safe and effective vaccines based on existing models, and resulted in the largest vaccination campaign in history. Just one year after COVID-19 was declared a pandemic, more than 250 million people worldwide had been vaccinated against SARS-CoV-2, the virus that causes it. 

Although no longer considered a significant public health threat, the virus continues to circulate and mutate. This means that variant-adapted boosters are still needed, especially for the many people at higher risk of severe disease and death.

“Today, vaccine hesitancy, pandemic fatigue and vaccine fatigue are major challenges to ensuring that people stay up to date with their vaccinations, including COVID-19 boosters” says Jeffrey V. Lazarus, head of the Health Systems Research Group at ISGlobal, Professor of Global Health at CUNY SPH, and coordinator of the study. 

Vaccine confidence remains high

Through a series of annual surveys across 23 countries over the course of the pandemic, Lazarus and his colleagues have been assessing global trust in information sources and vaccines. In this fourth survey of 23,000 adults, conducted in October 2023, the research team found that the intent to get a COVID-19 booster was slightly lower (71.6% of respondents) compared to 2022 (87.9%). However, the global population’s overall trust in vaccination did not diminish. More than 3 in 5 participants (60.8%) said they were more willing to get vaccinated for diseases other than COVID-19 as a result of their experience during the pandemic, while only 23.1% were less willing. 

“This finding suggests there is a general openness to vaccination that can be used to boost confidence in new generations of COVID-19 vaccines and boosters,” says Ayman El-Mohandes, study co-author and Dean of the City University of New York School for Public Health & Health Policy. “We must design targeted messages for trusted communicators to encourage vaccine uptake.” 

The new survey also evaluated public trust in information sources used during the pandemic. Overall, the most trusted sources were healthcare providers (with a score of 6.9 out of 10) and the World Health Organization (6.5 out of 10), highlighting the importance of continuing to rely on these sources in future communication campaigns. There was, however, some variability between countries. For example, religious leaders ranked 3.16 in Sweden but 6.72 in India. 

Public trust in the ability of authorities, scientists, and health organisations to manage future pandemics presented a mixed picture. “The great variability of trust observed across countries makes it clear that improving vaccine confidence globally will require more culturally appropriate local communication strategies,” says Lazarus. “There is an urgent need to catch up on routine immunisations and prepare for potential new pandemic threats, so we must continue to monitor vaccine confidence,” he adds. 

The survey data are highly representative for different geographic regions in the world and different demographic groups (age, gender, education level) within each country.

Reference

Lazarus, J.V., White, T.M., Wyka, K. et al. Influence of COVID-19 on trust in routine immunization, health information sources and pandemic preparedness in 23 countries in 2023. Nat Med (2024). https://doi.org/10.1038/s41591-024-02939-2

Young men working in agricultural or livestock settings are the most affected by snakebites, according to research in Paraguay based on data from the last six years. The study, led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, highlights the importance of collecting more and better data to estimate the true burden of this neglected disease.

Every year, between 80,000 and 140,000 people die from the bite of a venomous snake. In 2017, the WHO added poisoning by snakebite to the list of neglected tropical diseases, to give greater visibility to a public health problem for which there is not only a problem of access to anti-venom treatments, but also a lack of reliable data at global and national levels.

In the Americas, the vast majority of snakebite cases occur in eastern Paraguay and southeastern Brazil. In Paraguay, nearly 300,000 people live in areas where at least one species of venomous snake is present and more than three hours away from a medical centre.

"The problem is that there is a great lack of updated information on the burden of snakebites in the country," says Sofia Ardiles, ISGlobal researcher and first author of the study.

The research team analysed bite cases reported in Paraguay between 2015 and 2021, as well as socio-demographic, clinical and treatment information for each case. A total of 1651 bites were reported between 2015 and 2021 (an average of 235 cases per year). These figures are similar to those reported between 2004 and 2015, indicating that the incidence has remained stable. The regions with the highest number of cases are those that form part of the Gran Chaco, a geographical region that includes territories in Argentina, Bolivia, Brazil and Paraguay, where ISGlobal is working with local partners to improve care for neglected diseases.

Men of productive age: most affected

Men of productive age (around 25 years old) account for almost 70% of cases, many of whom work in the agricultural or livestock sector. "This reinforces the notion that snakebite is an occupational disease," says Irene Losada, ISGlobal researcher and co-author of the study. Many of the bites occurred during the day, on farms or in homes, and during the rainy season. "Having a better idea of the context in which most bites occur can help us implement protective measures in the workplace," she adds.

In more than half of the cases, the snake responsible was not identified or documented, which can complicate choosing the most appropriate anti-venom. Fifteen percent of patients were treated more than six hours after the bite.

"We found that there is a lack of information on mortality, sequelae, adverse effects of treatment and patient management," says Ardiles. This underlines the importance of improving data collection to estimate the true human and social burden of this neglected disease.

The study was a joint effort with Paraguay’s Zoonosis and Rabies Control Centre, headed by Edgar Sanabria.

Reference

Ardiles-Ruesjas S, Sanabria E, Segovia Portillo VH, Jara Oroa L, de Egea V, Sequera G, Alonso-Padilla J, Losada I and Pinazo, MJ. Epidemiological and sociodemographic description of snakebite envenoming cases in Paraguay reported between 2015 and 2021. BMJ Public Health. 2024;2:e000359. doi:10.1136/bmjph-2023-000359

Date

07/05/2024

Hour

18.30 - 20.00 h

Place

CaixaForum Macaya
(Paseo de Sant Joan, 108) Barcelona

Speakers

Nerea Morán (UPM), Pilar Sampietro y Raül Torán (ISGlobal).

¿Desde las ciudades podemos ser autosuficientes desde un punto de vista energético? ¿De qué manera podemos cultivar nuestros propios alimentos en las ciudades? ¿Es un sistema viable? ¿Tendría consecuencias en la economía de mercado y el sector de la alimentación?

El 7 de mayo trataremos de responder a estas y muchas otras preguntas relacionadas con la sostenibilidad y la autosuficiencia de nuestras urbes en un contexto social en que nuestra alimentación está muy vinculada al consumo, la inmediatez y los gustos gastronómicos nuevos y elaborados.

El evento tiene una duración aproximada de 90 minutos y es gratuito. Aún así, el aforo es limitado, por lo que recomendamos que llegar puntual y reservar las entradas con antelación.

Con la participación de:

• Nerea Morán, doctora arquitecta por la Universidad Politécnica de Madrid.
• Pilar Sampietro, periodista radiofónica especializada en ecología y cultura, y coautora del libro 'La ciudad comestible' (Morsa, 2018).
• Raül Torán, divulgador científico de ISGlobal. Moderador.

Date

21/05/2024

Hour

18.30 - 20.00 h

Place

CaixaForum Macaya
(Paseo de Sant Joan, 108) Barcelona

Speakers

Carolyn Daher, Mònica Ubalde y Raül Torán, de ISGlobal.

¿Qué consecuencias comporta tanto a nivel social como para nuestra salud el hecho de crecer en una ciudad donde predomina el tráfico y el ruido? ¿Cómo afectan estos determinantes a la población más joven?

Este debate abierto, de 90 minutos de duración, abordará cómo hacer compatible el crecimiento de la ciudad con el fomento de una buena salud de la ciudadanía, y cómo repensar las urbes para disponer de más espacios públicos donde los más pequeños puedan jugar y las personas mayores recrearse.

La entrada es gratuita aunque el aforo limitado por lo que se recomienda llegar puntuales y reservar la entrada.

Con la participación de:

• Carolyn Daher, coordinadora de la Iniciativa de Planificación Urbana, Medio Ambiente y Salud de ISGlobal.
• Mònica Ubalde, investigadora postdoctoral de ISGlobal.
• Raül Torán, divulgador científico de ISGlobal. Moderador.

Campus Clínic Solidari (Solidarity Campus Clínic) aims to optimise the synergies and commitment to international and local collaboration of all the entities that make up Campus Clínic: the Hospital Clínic Barcelona, the Faculty of Medicine and Health Sciences, CAPSBE, IDIBAPS, ISGlobal and the Món Clínic Barcelona Private Foundation.
Their experience, knowledge, people, resources and partnerships are all focused on contributing to the global challenges of global health.

The aim is for all Campus professionals and students to know and learn about the global needs and challenges of health cooperation; to participate in local and international health cooperation projects; to care for people in vulnerable situations; to encourage and promote teaching, training and research in health cooperation; and to establish Campus Clínic's cooperation and commitment as a value recognised by society.

In recent conflicts and emergencies, Campus Clínic Solidari has collaborated by sending medical equipment and materials from the Hospital Clinic that had been withdrawn for renewal, but which could have a second useful life by being used to create a field hospital in Ukraine, and also to help those affected by the earthquake in Morocco.

What does Campus Clínic Solidari do?

Campus Clínic Solidari works in different strategic lines:

• Twinning with health centres in Mozambique and other regions that have the potential to host healthcare, teaching and/or research projects
• Intervention in health emergencies by providing medical material for remote support, as in the case of the Field Hospital in Ukraine or the intervention in the Moroccan earthquake.
• Call for grants to fund projects proposed by Campus Clínic professionals to develop their own or third-party initiatives. To date, over 150 international projects have been funded.
• Collaboration with NGOs and the Third Sector through stable agreements and one-off actions to ensure help gets to where it is needed; such as for example Open Arms, Bombers Solidaris, Fundació Exit, Fundació Vicente Ferrer or the Fundació Convent de Santa Clara, promoted by Sister Lucia Caram.
• Training through courses and conferences to share knowledge with the twinned centres and others where cooperation projects can be developed.

Healthcare and non-healthcare professionals, teachers and students and research personnel from all the institutions in the Campus can all participate in Campus Clínic Solidari.

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

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.

A new study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, has investigated the relationship between exposure to ambient air temperature and foetal size and growth during pregnancy. The results, published in Environment International, show that cumulative exposure to heat and cold is associated with changes in foetal head circumference, a measure linked to brain development.

The study used data from 23,408 pregnant women from three European birth cohorts: the English Born in Bradford cohort, the Dutch Generation R study, and the Spanish INMA - Environment and Childhood project. The UrbClim™ model was used to calculate weekly exposure to ambient temperature at the mothers' homes during pregnancy. Foetal measures from ultrasound examinations at mid and late pregnancy, including estimated foetal weight, head circumference, and femur length, were analysed. Foetal growth from mid to late pregnancy was calculated and weight, head circumference, and length at birth were also analysed.

The results showed an association between exposure to hotter temperatures and larger head circumference at late pregnancy. Colder temperatures were associated with smaller head circumference at late pregnancy and a slower growth in head circumference from mid to late pregnancy.

The team observed specific periods of vulnerability to cold during the first trimester of pregnancy, when several foetal brain development processes take place. Specifically, susceptibility periods for exposure to cold were identified during pregnancy weeks 1 to 7 for a smaller head circumference at late pregnancy and weeks 4 to 12 for a slower head circumference growth.

Long-term implications

The team found no associations between ambient air temperature and birth outcomes, suggesting that the effects observed during pregnancy may recover at birth. "However, the identified effects of temperature on foetal development may become more prominent in magnitude and duration, especially in the context of worsening climate change" says Esmée Essers, ISGlobal researcher and first author of the study.

The results of this study highlight the importance of further research into the link between temperature exposure and foetal size and growth by replicating this study in different climatic regions.

"This work is important because we need to better understand how and when temperature can affect the foetus, to identify the underlying biological mechanisms and to provide a basis for climate change mitigation strategies for pregnant women and their future children," says Mònica Guxens, ISGlobal researcher and last author of the study.

Reference

Essers, E., Granés, L., Delaney, S., Ballester, J., Santos, S., Petricola, S., C Yang, T., Fernández-Somoano, A., Bereziartua, A., Ballester, F., Tardón, A., Vrijheid, M., Lertxundi, A., McEachan RC, R., El Marroun, H., Tiemeier, H., Iñiguez C., Guxens, M. Ambient air temperature exposure and foetal size and growth in three European birth cohorts. Environment International, Volume 186, April 2024. Doi: 10.1016/j.envint.2024.108619

Clínica Universidad de Navarra and the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa” Foundation, have launched a clinical trial to investigate the efficacy of ivermectin against COVID-19. The aim of the study, carried out in collaboration with Idifarma, is to determine whether administration of ivermectin is associated with a shorter viral clearance time .

“Ivermectin has been shown to have an antiviral effect against other single-chain RNA viruses, including dengue and yellow fever, and it has successfully inhibited the replication of those viruses in vitro,” explained Carlos Chaccour, a specialist affiliated with Clínica Universidad de Navarra and ISGlobal and principal investigator for the new study. “We are also interested in assessing the drug’s immunomodulatory role because one of the major problems with the SARS CoV-2 virus is the disordered immune response it causes.”

Ivermectin was recently shown to inhibit the replication of SARS-CoV-2 in vitro at very high doses , but this effect has not yet been studied in vivo. The new study will investigate this question in a randomised trial. Twenty-four patients with mild disease and no risk factors will be given a single oral dose of ivermectin or placebo less than 48 hours after the onset of symptoms.

These newly diagnosed patients will not require hospitalisation, so follow-up will be carried out in their homes during their period of self-isolation. “We will give patients a single dose when they come to the clinic for a diagnostic test,” explained Chaccour. “This will be followed by a month-long period of home-based follow-up, during which we will take five nasal swabs and monitor their symptoms. This will allow us to see whether ivermectin helps to clear the infection more quickly.”

The SARS-CoV‑2 Ivermectin Navarra ISGlobal Trial (SAINT) is being funded by Clínica Universidad de Navarra and ISGlobal.

All participants will be recruited from Clínica Universidad de Navarra in Pamplona and their immune response will be jointly analysed by the Clínica and ISGlobal.

Primary health care, conditional cash transfers and social pensions have prevented 1.4 million deaths of all ages in Brazil over the past two decades, according to a study coordinated by the Barcelona Institute for Global Health (ISGlobal), a centre supported by “la Caixa” Foundation. If expanded, these programmes could avert an additional 1.3 million deaths and 6.6 million hospitalisations by 2030.

The COVID-19 pandemic has exacerbated poverty and social inequalities worldwide, particularly in low- and middle-income countries (LMICs). In addition, the economic consequences of the ongoing war in Ukraine and soaring inflation are expected to push even more people into poverty in the coming years. This is what we call a polycrisis: multiple crises interacting in such a way that their combined impact is greater than the sum of the parts.

In terms of public health, worsening socioeconomic conditions mean higher rates of disease and death, especially among the most vulnerable people in LMICs. But social programmes can mitigate the health consequences of economic crises. Brazil has led one of the largest welfare state expansions over the past two decades, implementing a public universal healthcare system along with conditional cash transfer programmes (Programa Bolsa Familia) for the poorest families and social pensions (Beneficio de Prestacao Continuada) for the elderly and disabled.

Reductions in hospitalisations and deaths

In this study, ISGlobal researcher Davide Rasella and his team evaluated the combined effect of these three programmes (conditional cash transfers, social pensions and primary health care) on hospitalisations and deaths over almost two decades (from 2004 to 2019). “This is the first study to conduct a nationwide combined evaluation of cash transfers, social pensions, and primary health care for a such long period in a LMIC,” says Rasella, who coordinated the study. 

Using data from 2,548 Brazilian municipalities, they show that high coverage of the three programmes led to reductions in overall hospitalisation and mortality rates, particularly among children under five years of age and adults over 70. A total of 1.46 million deaths were averted between 2004 and 2019. The research team then used forecasting methods to show that extending the programmes to the newly poor and vulnerable could avert up to 1.3 million additional deaths by 2030.

“We clearly show that expanding these three programmes is a viable strategy to mitigate the health impact of the current global polycrisis,” says Daniella Cavalcanti, co-first author of the study. “On the contrary, fiscal austerity measures would only result in a large number of preventable deaths.”

Reference

Aransiola TJ, Ordoñez JA, Cavalcanti D et al. Current and Projected Mortality and Hospitalization Rates Associated with Conditional Cash Transfer, Social Pension, and Primary Health Care Programs in Brazil, 2000-2030. JAMA Network Open. 2024; 7(4):e247519. doi: 10.1001/jamanetworkopen.2024.7519

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.

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.