Last issues of ISGlobal Updates

• December 2023
• November 2023
• October 2023
• September 2023
• July-August 2023
• June 2023
• May 2023
• April 2023
• March 2023
• February 2023
• January 2023
• December 2022
• November 2022
• October 2022
• September 2022
• July-August 2022
• June 2022
• May 2022
• April 2022
• March 2022
• February 2022
• January 2022
• December 2021
• November 2021
• October 2021
• September 2021
• July-August 2021
• June 2021
• May 2021
• April 2021
• March 2021
• February 2021

Would you like to receive our newsletter?

A study by scientists from the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa” Foundation, INRAE, Inserm, and the Université Sorbonne Paris Nord, has revealed that the time at which we eat could influence our risk of developing cardiovascular disease. This study, carried out on a sample of over 100,000 people from the NutriNet-Santé cohort, followed between 2009 and 2022, suggests that eating a late first or last mealis associated with a higher risk of cardiovascular disease. It also appears that a longer night-time fasting duration is associated with a reduced risk of cerebrovascular disease such as stroke. The findings, published in Nature Communications, suggest the importance of daily meal timing and rhythm in reducing cardiovascular disease risk.

Cardiovascular diseases are the leading cause of death in the world according to the Global Burden of Disease study, with 18.6 million annual deaths in 2019, of which around 7.9 are attributable to diet . This means that diet plays a major role in the development and progression of these diseases. The modern lifestyle of Western societies has led to specific eating habits such as eating dinner late or skipping breakfast. In addition to light, the daily cycle of food intake (meals, snacks, etc.) alternating with periods of fasting synchronizes the peripheral clocks, or circadian rhythms, of the body’s various organs, thus influencing cardiometabolic functions such as blood pressure regulation. Chrononutrition is emerging as an important new field for understanding the relationship between the timing of food intake, circadian rhythms and health.

Scientists used data from 103,389 participants in the French NutriNet-Santé cohort (79% of whom were women, with an average age of 42) to study the associations between food intake patterns and cardiovascular disease. To reduce the risk of possible bias, the researchers accounted for a large number of confounding factors, especially sociodemographic factors (age, sex, family situation, etc.), diet nutritional quality, lifestyle and sleep cycle.

The results show that having a first meal later in the day (such as when skipping breakfast), is associated with a higher risk of cardiovascular disease, with a 6% increase in risk per hour delay. For example, a person who eats for the first time at 9 a.m. is 6% more likely to develop cardiovascular disease than someone who eats at 8 a.m. When it comes to the last meal of the day, eating late (after 9 p.m.) is associated with a 28% increase in the risk of cerebrovascular disease such as stroke compared with eating before 8 p.m., particularly in women. Finally, a longer duration of night-time fasting – the time between the last meal of the day and the first meal of the following day – is associated with a reduced risk of cerebrovascular disease, supporting the idea of eating one’s first and last meals earlier in the day.

First and last meals early and long night-time fasting

These findings, which need to be replicated in other cohorts and through additional scientific studies with different designs, highlight a potential role for meal timing in preventing cardiovascular disease. They suggest that adopting the habit of eating earlier first and last meals with a longer period of night-time fasting could help to prevent the risk of cardiovascular disease.

The NutriNet-Santé study

The NutriNet-Santé study is a public health study coordinated by the Nutritional Epidemiology Research Team (EREN-CRESS, Inserm/INRAE/Cnam/Université Sorbonne Paris Nord/Université Paris Cité), which, thanks to the commitment and support of over 175,000 study participants, is advancing research into the links between nutrition (diet, physical activity, nutritional status) and health. The study was launched in 2009 and has already resulted in over 270 international scientific publications. There is still a call for new study participants living in France to continue advancing research into the relationship between nutrition and health.

By spending a few minutes a month responding via the etude-nutrinet-sante.fr secure online platform, participants help to advance knowledge of the relationship between diet and health.

Reference

A Palomar-Cros et al. (2023) Dietary circadian rhythms and cardiovascular disease risk in the prospective NutriNet-Santé cohort. Nature Communications DOI: 10.1038/s41467-023-43444-3

A lack of funding, of capacity building and of political focus are some of the barriers to the effective implementation of antimicrobial resistance strategies, according to a detailed analysis in which ISGlobal researchers participated. The report, prepared for the European Commission under the EU4Health programme, also identifies actions and best practices to overcome these barriers, many of which are common to all countries.

Antibiotic-resistant bacteria are responsible for around 670,000 infections and 35,000 deaths each year in the European Union. Worldwide, antimicrobial resistance causes 1.27 million deaths each year, and this figure could rise to 10 million by 2050 if no action is taken.

The report recently published on the European Commission's website will be of great use in guiding policies and initiatives to combat this problem. The study was coordinated by a panel of experts, including Jordi Vila, Director of the Antimicrobial Resistance Initiative, and carried out by a working group where Sara Soto, Director of the Bacterial and Viral Infections Programme, participated as thematic lead.

The team carried out literature reviews, interviews, surveys and workshops involving nearly 500 stakeholders from the 29 countries of the European Union plus Norway and Iceland to provide a detailed analysis of the barriers to the effective implementation of national action plans on antimicrobial resistance and infection prevention and control in hospitals, long-term care facilities, primary care, and pharmacies.

Common barriers at the policy, clinical and behavioural level

The analysis revealed common issues across countries, regardless of size or socio-economic status, at all levels: policy and institutional (including funding), clinical (including use of guidelines and practices) and behavioural (of healthcare professionals and patients). The main barriers identified include: insufficient funding to implement the measures foreseen in the national action plans, lack of trained staff, lack of specific measures for long-term care facilities and limited involvement of pharmacies in antibiotic stewardship. They also highlight a lack of political focus, a lack of harmonised indicators to monitor the implementation of the plans, and a lack of education and awareness on the issue.

"Almost all countries have action plans, most of them with a One Health approach, but their implementation varies widely and the environmental dimension is not sufficiently covered," says Sara Soto.

At the clinical level, there is great heterogeneity in the quantity and quality of data collected and in how antimicrobial resistance is monitored and reported. Shortcomings are even more pronounced in long-term care facilities, where there is a severe shortage of trained staff.

Primary care and pharmacies play a key role in ensuring appropriate antibiotic use and changing people's behaviour, but are rarely included in national plans. A major behavioural barrier is pressure from patients for doctors to prescribe antibiotics.

Recommendations and good practice

But the report not only points out problems. It also suggests a number of actions to overcome them and identifies examples of good practice in different countries. For example, a high-level position in the ministry of health to coordinate the fight against antimicrobial resistance, a national surveillance system to collect data from all clinical microbiology laboratories, the establishment of local groups for health workers to share best practices in antibiotic prescribing, and the use of tools (tests or apps) in primary care to facilitate diagnosis.

"This study aims to support the preparation of future EU initiatives and policies against antimicrobial resistance, including the implementation of the One Health Action Plan," says Jordi Vila.

Referencia:

Study on the barriers to effective development and implementation of national policies on antimicrobial resistance. Final report. June 2023. Publications Office of the European Union. doi:10.2925/826400.

The Barcelona Institute for Global Health (ISGlobal), its international community of researchers and all its staff are distraught to see the war in Gaza intensify and the number of casualties and victims, many of them children, rise by the day. The atrocious events that sparked the current situation, and the brutal response that has followed, highlight the complexity of a deep-rooted conflict and the chronic fragility of a situation that has now blown out of control, resulting in thousands of deaths, and the massive displacement of civilians. As a global health player, ISGlobal remains appalled by the unacceptable loss of human lives, the attacks on hospitals and other traditionally considered safe spaces, and the immense suffering and destruction caused so far. 

We join the World Health Organization and other international humanitarian actors, research institutions and universities in urgently calling for an immediate and lasting ceasefire, putting an end to the violence and ensuring the protection and care of the local population. We urge political leaders to continue conversations to find concerted and lasting solutions that respect human rights and the principles of sovereignty under international law, and that promote the restoration of peaceful relations and coexistence. We express our solidarity and support for these and all other victims of confrontations and senseless violence worldwide.

Forging global partnerships, promoting innovative approaches and putting equity at the centre are some of the key elements to address the global health challenges we face today. This was one of the main conclusions of the "International Global Health Partnership Forum", the meeting organised by ISGlobal on 28 November at the CosmoCaixa in Barcelona. The event, which served to present the institution's new strategy until 2027, also offered different perspectives on the main health challenges identified by ISGlobal today.

A strategy adapted to today's health challenges

After the opening address by the President of the Board of Trustees and Director of the International Area of the ”la Caixa” Foundation, HRH the Infanta Cristina of Spain, and the speeches by Carmen Cabezas, Secretary for Public Health of the Government of Catalonia, and Antón Leis, Director of the Spanish Agency for International Development Cooperation (AECID), ISGlobal's new strategic orientations for the period up to 2027 were presented. Antoni Plasència, Director General of ISGlobal, highlighted the organisation's unique and solid position to address current and future global health challenges, while Denise Naniche, scientific director, emphasised the need to adjust the new strategy taking into account the setbacks in achieving the Sustainable Development Goals (SDGs).

Samba Sow, Director General of the National Institute of Public Health of Mali and President of the PANTHER platform, then stressed that "the principle of equity is the basis for forging partnerships" and emphasised the need to decolonise science and global health and to strengthen community involvement. In this context, he underlined African countries' aspirations for self-reliance and the need for the continent to move from being a passive recipient of aid to an active partner in the search for sustainable solutions.

An effective and equitable preparedness and response model

"After COVID-19, there will be more crises, pandemics and disasters. We need sustainable preparedness and response plans and common protocols that can be adapted to each crisis," said Elisabeth Cardis, Head of ISGlobal's Radiation Group, at the start of the first panel. Katherine Ginsbach of the O'Neill Institute stressed the importance of regulation, while Helena Legido-Quigley of Imperial College London urged assessing countries' preparedness beyond infrastructure, with leadership as a key element. Olivier Morgan of the World Health Organization (WHO) highlighted the complexity of risk assessment and called for an interdisciplinary and multi-sectoral approach.

Access to innovation in the Global South

The second panel focused on innovation priorities in the Global South. Martinho Dgedge, President of the Manhiça Foundation, highlighted Africa's progress against malaria, AIDS and tuberculosis, the challenges of diagnosing and treating chronic diseases such as cancer, and the need for capacity building in the region. For his part, Unitaid's Executive Director, Phillipe Duneton, pointed out that the business models of the global North, based on low volumes and high prices, are not adaptable to the global South, which needs high volumes at low prices. Finally, there was consensus on the need for technology to be accessible to all communities.

An integrated approach to the global health crisis

The final panel of the day explored the intersection of climate and health. After Ivana Cvijanovic of ISGlobal reviewed the evidence that climate change is man-made and we are at a critical point, Maria Neira, WHO's Director for Public Health and the Environment, sought to send a positive message by pointing to the enormous health benefits of addressing the causes of climate change. But to do so, "we need real cooperation between public and private entities, coordinated action," urged Benoit Miribel of the One Sustainable Health for All Foundation. The One Health approach was also echoed by Carla de Freitas Campos of Fiocruz, in the previous panel.

Strong partnerships for better global health

In the closing session, Annette Petters, Chair of ISGlobal's External Advisory Board, summed up the day's proceedings and spoke about the organisation's new strategic plan, designed to address all the challenges raised throughout the day. Finally, Quique Bassat, who has been appointed as ISGlobal's Incoming Director General, closed the event by reinforcing the message that it is essential to build bridges and solid alliances with our partners if we are to advance ISGlobal's mission in such a complex context. This event, focusing on issues of particular relevance to ISGlobal and global health, is planned to be held every two years and will involve partners and collaborators from all over the world.

Recognising commitment to ISGlobal

On the eve of the event, a dinner attended by all the speakers, as well as other ISGlobal partners and staff, paid tribute to the outgoing chairs of the External Advisory Committee, David Savitz and Marcel Tanner. Both were named ISGlobal Honorary Professors in recognition of their dedication and commitment to the institution and were presented with a diploma and a commemorative illustration.

Air conditioning and heating systems have contributed considerably to reducing mortality linked to extreme temperatures in Spain, according to a study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa” Foundation. The findings, published in Environment International, provide valuable insights for designing policies to adapt to climate change.

Rising temperatures but lower mortality

Spain, like many parts of the world, has experienced rising temperatures in recent decades, with the average annual mean temperature increasing at an average rate of 0.36°C per decade. The warming trend is even more pronounced in the summer months (0.40°C per decade). Surprisingly, this increase in temperature has coincided with a progressive reduction in mortality associated with heat. In addition, cold-related mortality has also decreased.

“Understanding the factors that reduce susceptibility to extreme temperatures is crucial to inform health adaptation policies and to combat the negative effects of climate change,” says first author of the study, Hicham Achebak, researcher at ISGlobal and Inserm (France) and holder of a Marie Sklodowska-Curie Postdoctoral Fellowship from the European Commission.

Effective societal adaptations

In this study, Achebak and colleagues analysed the demographic and socioeconomic factors behind the observed reduction in heat and cold-related mortality, despite rising temperatures. They found that the increase in air conditioning (AC) prevalence in Spain was associated with a reduction in heat-related mortality, while the rise in heating prevalence was associated with a decrease in cold-related mortality. Specifically, AC was found to be responsible for about 28.6% of the decline in deaths due to heat and 31.5% of the decrease in deaths due to extreme heat between the late 1980s and the early 2010s. Heating systems contributed significantly, accounting for about 38.3% of the reduction in cold-related deaths and a substantial 50.8% decrease in extreme cold-related fatalities during the same period. The decrease in mortality due to cold would have been larger had there not been a demographic shift towards a higher proportion of people aged over 65, who are more susceptible to cold temperatures. 

The authors conclude that the reduction in heat-related mortality is largely the result of the country’s socioeconomic development over the study period, rather than specific interventions such as heat-wave warning systems.

Four decades of data

For the statistical analysis, the research team collected data on daily mortality (all causes) and weather (temperature and relative humidity) for 48 provinces in mainland Spain and the Balearic Islands, between January 1980 and December 2018. These data were then linked to 14 indicators of context (demographic and socioeconomic variables such as housing, income and education) for these populations over the same period.

Implications for climate adaptation

The results of the study extend previous findings on heat-related mortality in Spain and underscore the importance of air conditioning and heating as effective adaptation measures to mitigate the effects of heat and cold. “However, we observed large disparities in the presence of AC across provinces. AC is still unaffordable for many Spanish households,” says Achebak.

The authors also point out that the widespread use of AC could further contribute to global warming depending on the source of electricity generation, which is why other cooling strategies, such as expanding green and blue spaces in cities, are also needed.

“Our findings have important implications for the development of adaptation strategies to climate change. They also inform future projections of the impact of climate change on human health,” concludes Joan Ballester, ISGlobal researcher and study coordinator.

Reference

 Achebak H, Quijal-Zamorano M, Lloyd SJ, Méndez-Turrubiates RF, Rey G and Ballester J. Drivers of the time-varying heat-cold-mortality association in Spain: a longitudinal observational study. Environment International. 2023. Doi: 10.1016/j.envint.2023.108284.

ISGlobal's Annual Scientific Meeting took place on Monday 11 December at the CosmoCaixa in Barcelona, with almost 200 attendees. The event, organised by ISGlobal researchers Sara Soto and Xavier Rodó, highlighted the potential of the research carried out at the institution and its impact on global health.

"In this year's edition, we wanted to encourage the participation of young people from our institution and promote debate on high-impact topics such as the exposome, artificial intelligence, the link between climate change and infectious diseases, and the relationship between antibiotic resistance and the microbiome," said the organisers.

The first debate focused on the future of malaria and arboviral diseases such as dengue and chikungunya in the context of the climate crisis. ISGlobal researchers Mikel Martínez and Quique Bassat noted that climate change may contribute to the worsening of the malaria situation in the world and that it is therefore necessary to include the climate factor in malaria control models. They also highlighted that some estimates suggest that there is already a high burden of arboviral diseases in Africa and that a better understanding of the situation is needed to know whether climate change will affect these diseases.

Jordi Vila and Mireia Gascón then discussed the gut microbiota and its links to the exposome, highlighting the need for more studies in humans, especially at younger ages, to better understand how factors such as diet, lifestyle, pollution, and medications affect the microbiota. They also stressed the importance of reducing the unnecessary use of antibiotics, which alter the gut microbiota.

The third session, led by Manolis Kogenivas, researcher at ISGlobal, and Jaume Mora, Scientific Director of Oncology at the Hospital Sant Joan de Déu in Barcelona, explored the importance of prevention in adult cancers and how external and environmental factors influence their development, while in the case of childhood cancers, genetics plays a central role.

The final debate focused on the advances and functionalities of artificial intelligence. Alfonso Valencia, from the Barcelona Supercomputing Centre, and Josep M. Ganyet, from the University of Pompeu Fabra, showed examples of creations using artificial intelligence and debated the ethical controversies surrounding its use. Both defended the importance of the human presence in validating and guiding AI and ensuring the quality of its response.

During the scientific meeting, Principal Investigators, Predoctoral Fellows and Postdoctoral Fellows presented ISGlobal's new projects in infectious diseases, environment and urban health. The meeting also highlighted the most important scientific results recently published by the different ISGlobal programmes, ranging from the impact of climate on zoonotic diseases to the prevention of malaria and the study of the exposome in the early years of life.

Driving social change through science

The afternoon session focused on the impact of research. Julie Bayley, from the University of Lincoln in the UK, debunked some of the myths surrounding the concept, such as that it only happens after scientific publication or that it cannot be planned. "Impact is a team sport within an organisation. We can do a lot by explaining our research and building trust in society," said Bayley.

ISGlobal's Director General, Antoni Plasència, closed the day with an emotional speech in which he defended and celebrated the "science with heart" that ISGlobal does and thanked all the members of the institution for their commitment and their "infinite curiosity to discover and understand, to take risks and to innovate". After nine years as Director General of ISGlobal, Antoni Plasència will be replaced by Quique Bassat next January.

ISGlobal is launching a new series of analytical documents aimed at contributing to the fight against COVID-19 and orienting the strategy for lifting mitigation and confinement measures. The collection will, initially, comprise 17 documents in which 23 experts will endeavour, from the standpoint of research, to identify and respond to some of the major challenges posed by the current crisis. The aim of this collection, coordinated by ISGlobal’s Policy team, is to contribute evidence-based information and the answers to questions about the main topics involved in the management of the COVID-19 crisis. It is possible that further documents will be added depending on the issues and questions that arise as the pandemic continues.

The main focus of the analysis will be on the scientific and epidemiological aspects of the crisis, but considerations related to economic, social, public health and communication aspects will also be included. The final output will make up a guide to the concept of what the authors are calling ‘precision public health’. “To date, the mitigation measures have succeeded in slowing down transmission of the virus and preventing the collapse of our health care system,” says Antoni Plasència, Director of ISGlobal. “As an institute committed to working for the health of all people, ISGlobal’s current mission must be to contribute to ensuring a controlled exit from the containment phase”.

This project is being coordinated by the ISGlobal Policy team. At this time, the authors on the team are as follows: Josep M. Antó, Joan Ballester, Quique Bassat, Elisabeth Cardis, Carlos Chaccour, Carolyn Daher, Carlota Dobaño, Gonzalo Fanjul, Alberto García-Basteiro, Raquel González, Caterina Guinovart, Manolis Kogevinas, Jeffrey Lazarus, Jill Litt, Anna Llupiá, Denise Naniche, Mark Nieuwenhuijsen, Cristina O’Callaghan, Antoni Plasència, Adelaida Sarukhan, Elisa Sicuri, Jordi Sunyer and Rafa Vilasanjuan.

Read the published documents here:

55. How Can We Prepare for and Respond to Radiological Incidents During Armed Conflicts?

54. Health and Climate: Briefing Notes Ahead of COP28

53. Towards Clean Air in the EU: the Need for a Bold Step Forward

52. How Can We Address the Effects of Economic Downturns on Systemic Health Crises?

51. What Opportunities and Challenges Does the EU Global Health Strategy Present?

50. The All-Hazards Preparedness Approach: How Can We Be Better Prepared for the Next Public Health Crisis?

49. Childhood Pneumonia: The Impact of the Pandemic and What Needs to Be Done Now

48. The International Pandemic Treaty: What is at Stake?

47. What impact has the COVID-19 pandemic had on the fight against malaria?

46. What Impact has COVID-19 had on Childhood Immunization Programs?

45. Could COVID-19 Present an Opportunity in the Fight Against HIV?

44. How Has COVID-19 Affected the Global Fight Against Tuberculosis?

43. COVID-19 and Other Pandemics: Indirect Effects in Low- and Middle-Income Countries

41. COVID-19: When and How Will the Pandemic End?

39. COVID-19 Vaccines: What Are the Global Health Consequences of a Third Dose?

38. How to Respond to COVID-19 in a Small Island State. The Experience of the English-Speaking Caribbean and the Importance of International Cooperation

37. The Chilean Paradox: Why Are Cases Rising Despite High Levels of Vaccination?

36. What Is Long COVID and What Can We Do to Address the Problem?

35. Will We Be Able to Achieve Herd Immunity Against COVID-19?

34. What Can We Expect From the G20 and EU Global Health Summit?

33. COVID-19, Global Cooperation and Reigniting the Economy: Do we Need Vaccine Certificates?

32. Will We See a Wave of Mental Health Problems After the COVID-19 Pandemic?

31. Ivermectin and COVID: What's Going On?

30. Biomedical R&D and Innovation: How Can We Protect the Public Interest After COVID-19?

29. How Is COVID-19 Affecting Pregnant Women?

28. What Are the Main Challenges That Global COVID-19 Immunisation Efforts Must Now Overcome?

27. Who Should Receive the First Doses of COVID-19 Vaccine?

26. What Is a Zero-COVID Strategy and How Can It Help Us Minimise the Impact of the Pandemic?

25. The G20, Vaccines and COVID-19: Why is the Success of the COVAX Iniciative Vital?

24. COVID-19: What Can Past Nuclear Accidents Teach Us?

23. Is COVID-19 Threatening the Success of the Sustainable Development Goals in Spain?

22. Should We Be Concerned About SARS-CoV-2 Reinfections?

21. How Should We Handle the Influenza Epidemic During the Coronavirus Pandemic?

20. Infodemic: How Has the Epidemic of Misinformation Affected the Response to COVID-19?

19. What Are the Health Priorities of Older Adults During a Pandemic?

18. COVID-19 in Latin America: What does it take to go from a highly-vulnerable region to a pandemic-ready region?

17. How Should We Deal With New Outbreaks of COVID-19?

16. What Do We Know About the Impact of Gender on the COVID-19 Pandemic?

15. How Can We Prevent COVID-19 from Exacerbating Other Epidemics in Low- and Middle-Income Countries?

14. What Role Can Spanish Cooperation Play in the Response to COVID-19 and the Prevention of Future Crises?

13. How Can We Resume International Travel During the COVID-19 Pandemic?

12. What Are the Barriers to Achieving Universal Immunisation Against COVID-19?

11. Improving Case and Contacts Tracing During the COVID-19 Pandemic

10. How Should Work Environments Adapt During the COVID-19 Epidemic?

9. Is an Immunity Passport an Option as Part of a Deconfinement Strategy?

8. How Can we Ensure a Socially Equitable Approach to Deconfinement during the COVID-19 Pandemic?

7. COVID-19: How to Manage the Reopening of Schools?

6. Mobility & COVID-19: How Should We Redesign Transport for a New Future?

5. Should We Go Outside During the COVID-19 Confinement and Beyond?

4. Should We Allow Physical Activity During The Coronavirus Disease Pandemic?

3. What Are the Main Research Gaps for Lifting Confinement Measures? 

2. Can We Meet Children’s Needs During Home Confinement and Relaxation of Restrictions?

1. Components of a Safe and Phased Reopening of Society

The burden of heat-related mortality during the summer of 2022 in Europe may have exceeded 70,000 deaths according to a study led by the Barcelona Institute for Global Health (ISGlobal), a research centre supported by the “la Caixa” Foundation, in collaboration with the Barcelona Supercomputing Center (BSC). The authors of the study, published in The Lancet Regional Health – Europe, revised upwards initial estimates of the mortality associated with record temperatures in 2022 on the European continent.

In an earlier study, published in Nature Medicine, the same team used epidemiological models applied to weekly temperature and mortality data in 823 regions in 35 European countries and estimated the number of heat-related premature deaths in 2022 to be 62,862. In that study, the authors acknowledged that the use of weekly data would be expected to underestimate heat-related mortality, and pointed out that daily time-series data are required to accurately estimate the impact of high temperatures on mortality.

The objective of the new study was to develop a theoretical framework capable of quantifying the errors arising from the use of aggregated data, such as weekly and monthly temperature and mortality time-series. Models based on temporally aggregated data are useful because aggregated data are available in real-time from institutions such as Eurostat, facilitating quantification of the health hazard within a few days of its emergence. To develop a theoretical framework, the research team aggregated daily temperatures and mortality records from 147 regions in 16 European countries. They then analysed and compared the estimates of heat- and cold-related mortality by different levels of aggregation: daily, weekly, 2-weekly and monthly. 

Analysis revealed differences in epidemiological estimates according to the time scale of aggregation. In particular, it was found that weekly, 2-weekly and monthly models underestimated the effects of heat and cold as compared to the daily model, and that the degree of underestimation increased with the length of the aggregation period. Specifically, for the period 1998-2004, the daily model estimated an annual cold and heat-related mortality of 290,104 and 39,434 premature deaths, respectively, while the weekly model underestimated these numbers by 8.56% and 21.56%, respectively.

“It is important to note that the differences were very small during periods of extreme cold and heat, such as the summer of 2003, when the underestimation by the weekly data model was only 4.62%,” explains Joan Ballester Claramunt, the ISGlobal researcher who leads the European Research Council’s EARLY-ADAPT project.

The team used this theoretical framework to revise the mortality burden attributed to the record temperatures experienced in 2022 in their earlier study. According to the calculations made using the new methodological approach, that study underestimated the heat-related mortality by 10.28%, which would mean that the actual heat-related mortality burden in 2022, estimated using the daily data model, was 70,066 deaths, and not 62,862 deaths as originally estimated.

Using weekly data to analyse the effects of temperatures in the short term

“In general, we do not find models based on monthly aggregated data useful for estimating the short-term effects of ambient temperatures,” explains Ballester. “However, models based on weekly data do offer sufficient precision in mortality estimates to be useful in real-time practice in epidemiological surveillance and to inform public policies such as, for example, the activation of emergency plans for reducing the impact of heat waves and cold spells.”

It is an advantage in this area of research to be able to use weekly data since investigators often encounter bureaucratic obstacles that make it difficult or impossible to design large-scale epidemiological studies based on daily data. According to Ballester, when daily data is not available, the use of weekly data, which are easily accessible for Europe in real time, is a solution that can offer “a good approximation of the estimates obtained using the daily data model”.

"Aggregation of mortality data at the weekly level has important implications for designing sustainable climate-driven health early warning systems using publicly available data." says Prof Rachel Lowe, ICREA Research Professor, BSC Global Health Resilience Group Leader and Director of the Lancet Countdown in Europe.

Reference

Ballester J, van Daalen KR, Chen Z, Achebak H, Antó JM, Basagaña X, Robine JM, Herrmann FR, Tonne C, Semenza JC, Lowe R. The effect of temporal data aggregation to assess the impact of changing temperatures in Europe: an epidemiological modelling study. The Lancet Regional Health – Europe. Nov 2023. doi: 10.1016/j.lanepe.2023.100779

Having an early supper or leaving an interval of at least two hours before going to bed are both associated with a lower risk of breast and prostate cancer. Specifically, people who take their evening meal before 9 pm or wait at least two hours before going to sleep have an approximate 20% lower risk of those types of cancer compared to people who have supper after 10pm or those who eat and go to bed very close afterwards, respectively. These were the main conclusions of a new study by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa” Banking Foundation. The study is the first to analyse the association between cancer risk and the timing of meals and sleep.

Previous studies of the link between food and cancer have focused on dietary patterns—for example, the effects of eating red meat, fruit and vegetables and the associations between food intake and obesity. However, little attention has been paid to other factors surrounding the everyday act of eating: the timing of food intake and the activities people do before and after meals. Recent experimental studies have shown the importance of meal timing and demonstrated the health effects of eating late at night.

The aim of the new study, published in the International Journal of Cancer, was to assess whether meal timing could be associated with risk of breast and prostate cancer, two of the most common cancers worldwide. Breast and prostate cancers are also among those most strongly associated with night-shift work, circadian disruption and alteration of biological rhythms. The study assessed each participant’s lifestyle and chronotype (an individual attribute correlating with preference for morning or evening activity).

The study, which formed part of the MCC-Spain project, co-financed by the CIBER of Epidemiology and Public Health (CIBERESP), included data from 621 cases of prostate cancer and 1,205 cases of breast cancer, as well as 872 male and 1,321 female controls selected randomly from primary health centres. The participants, who represented various parts of Spain, were interviewed about their meal timing, sleep habits and chronotype and completed a questionnaire on their eating habits and adherence to cancer prevention recommendations.

“Our study concludes that adherence to diurnal eating patterns is associated with a lower risk of cancer,” explained ISGlobal researcher Manolis Kogevinas, lead author of the study. The findings “highlight the importance of assessing circadian rhythms in studies on diet and cancer”, he added.

If the findings are confirmed, Kogevinas noted, “they will have implications for cancer prevention recommendations, which currently do not take meal timing into account”. He added: “The impact could be especially important in cultures such as those of southern Europe, where people have supper late.”

ISGlobal researcher Dora Romaguera, the last author of the study, commented: “Further research in humans is needed in order to understand the reasons behind these findings, but everything seems to indicate that the timing of sleep affects our capacity to metabolise food.”

Animal experimental evidence has shown that the timing of food intake has “profound implications for food metabolism and health”, commented Romaguera.

Referència

Manolis Kogevinas, Ana Espinosa, Adela Castelló, Inés Gómez-Acebo, Marcela Guevara, Vicente Martin, Pilar Amiano, Juan Alguacil, Rosana Peiro, Victor Moreno, Laura Costas, Guillermo Fernández-Tardón, Jose Juan Jimenez, Rafael Marcos-Gragera, Beatriz Perez-Gomez, Javier Llorca, Conchi Moreno-Iribas, Tania Fernández-Villa, Madalen Oribe, Nuria Aragones, Kyriaki Papantoniou, Marina Pollán, Gemma Castano-Vinyals, Dora Romaguera. Effect of mistimed eating patterns on breast and prostate cancer risk (MCC-Spain study). Int J Cancer. 17 July 2018. https://doi.org/10.1002/ijc.31649

Four years after the outbreak of the COVID-19 pandemic awakened us to the dangers of a global health crisis, the world is still not adequately prepared for a new pandemic, natural disaster or nuclear accident. The opportunity to build on the lessons learned is still open and progress has been made, but it is fragile and time may be running out, according to Elisabeth Cardis, Head of the Radiation Group and Chair of the Preparedness Hub at ISGlobal's.

For this reason, on 27 November, the Gaspar Casal Foundation and ISGlobal organised the conference PR³ after the COVID-19 pandemic, referring to the PR³ concept coined by ISGlobal (Preparedness, Response, Recovery and Resilience). Experts from different fields gathered at the Barcelona Biomedical Research Park (PRBB) to share the initiatives that have been developed since the A PR³ Challenge meeting held in May 2022. The meeting also addressed future challenges and included a closing session to establish collaborations and networks and plan future activities.

Antoni Plasència, Director General of ISGlobal and President of the European Global Health Research Institutes Network (EGHRIN), opened the event by stressing that "we need to invest in surveillance, promote the One Health approach, use antibiotics responsibly, strengthen health systems, collaborate globally and develop preparedness plans”.

Preparing for pandemics and disasters: working in silos doesn't work

Roberto Lucchini from Florida International University (USA) pointed to the increasing trend of chemical accidents (about 30 per year in Europe, and the number is rising). Oliver Razum from the University of Bielefeld (Germany) discussed how many European health systems are still ill-prepared to deal with war refugees. And lawyer Alicia del Llano, from the Gaspar Casal Foundation, highlighted the urgent need for legal preparation: "The challenges require concrete action and there is still a lack of concrete legislation". Health impact assessment (HIA), which is still in its infancy in Spain, can be a useful tool for implementing and evaluating PR³ plans, programmes and strategies with a particular focus on equity.

All speakers agreed that working in silos does not work and that multidisciplinary approaches are needed to address complex realities.

Tools and protocols for preparedness and response

The second part of the day reviewed the tools, knowledge and best practices available for different types of crises and in different countries and regions, such as the US NIEHS’s Rapid Acquisition Protocol Designer for Pre- and Post-Disaster Incident Data (RAPIDD) , launched in 2023 and used in the Arizona fires last June; the World Health Organization’s (WHO) Global Clinical Platform, a secure database of anonymised clinical data from patients in healthcare facilities around the world; or the protocols developed by the International Volcanic Health Hazard Network (IVHHN).

AI: the new revolution in weather forecasting

ISGlobal researcher Joan Ballester, who leads the European Research Council's EARLY-ADAPT project, spoke of heat and health early warning systems that are now beginning to benefit from artificial intelligence and its extraordinary ability to predict weather: "This is a real revolution," he said.

At the end of the day, the question of how to know if a preparedness plan really works hung in the air. Elke Wynberg, from the Erasmus MC in the Netherlands, summed it up humorously: “The plan will have worked if people think we have overreacted”.

Air pollution is the largest environmental cause of death. Now, a study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, has estimated which sources contribute most to the mortality associated with two air pollutants - PM_2.5 and NO₂ - in 857 European cities.

The results of this research, which have been published in The Lancet Public Health, show great variability between the different cities studied, suggesting that, given that each one has its own particularities and its own sources of air pollution, strategies to improve air quality should be adapted to each local context.

Contributors to PM_2.5 mortality

Pooling the data for the 857 cities, the figures show that the largest contributor to PM_2.5 mortality is emissions from residential sources, with an average contribution across all cities of 22.7%. In second place is the agricultural sector, which accounts on average for 18% of PM_2.5 mortality, followed by industry (13.8%), transport (13.5%), the energy sector (10%), natural sources (8.8%) and shipping (5.5%).
 

"If we look at NO₂ and PM_2.5 combined, traffic remains the largest contributor to both poor air quality and associated mortality. However, if we look exclusively at the PM_2.5-related mortality, we see a significant contribution from the residential sector and agriculture," notes Sasha Khomenko, ISGlobal researcher and first author of the study.

"Although we have not broken down the specific sources of emissions for each sector in our study, we do know from the scientific literature that most of the particulate matter generated at the household level is mainly due to biomass and coal burning for heating and, to a lesser extent, fossil fuel-based systems for heat and hot water generation and gas cookers," Khomenko explains. "We know that rising fossil fuel prices and climate change mitigation policies have led to an increase in biofuel use. However, the fact that they are products of natural origin does not mean that they are not harmful to health," she adds.

"As far as agriculture is concerned, intensive livestock farming is known to be a major source of particulate matter, which is generated mainly from ammonia in animal slurry and also through the use of certain fertilisers. It is a source of pollution that spreads from its place of origin and moves to nearby cities", she says.

PM_2.5 particles are the air pollutant with the greatest negative impact on mortality in European cities. The team stresses that more research is needed to determine which components of PM_2.5 particles are most harmful to health, so that more precise mitigation measures can be designed.

Contributors to NO₂ mortality

In terms of NO₂ mortality, there is one very prominent contributor, which is the transport sector, with an average contribution across all cities of 48.5%. Other sectors with a considerable contribution are industry with an average of 15%, the energy sector with 14.7%, housing (10.3%) and shipping (9.7%).
 

NO₂ is a gas that is generated in combustion processes, mainly from motor vehicles, but also in industrial or power generation facilities.

"Bolder measures are required to drastically reduce pollution and deaths associated with traffic, which remains the main source of emissions. And, at the same time, implement policies to mitigate the other sources of both NO₂ and PM_2.5 emissions, such as regulating emissions from industry and shipping, and limiting biomass burning in households and emissions from agriculture and livestock", says Mark Nieuwenhuijsen, director of ISGlobal's Urban Planning, Environment and Health Initiative.

“To reduce air pollution we need multisectoral holistic action and solutions, for example with task forces across the current silos (e.g. urban planning, transport engineering, housing, environment, health, education, agriculture, business) at city, national and EU levels”, Nieuwenhuijsen adds.

Methodology

The study focused on 857 European cities that appear in the Urban Audit 2018 dataset. Baseline NO₂ and PM_2.5 emissions data, relating to 2015, were obtained from the regional Copernicus Atmosphere Monitoring Service inventory and classified into 12 sectors using a standard nomenclature system (GNFR). In addition, population and mortality figures for the 857 cities were obtained from public databases, also for the year 2015.

To estimate the contribution of each emission source to the concentration of pollutants in the atmosphere, the researchers used the Screening for High Emission Reduction Potentials for Air quality (SHERPA) tool developed by the European Comission’s Joint Research Centre (JRC). This tool applies the principles of chemical transport models in a simplified way. These models take into account factors such as meteorology or chemical transformations to simulate the concentration of pollutants in the atmosphere. The research team divided the surface area of the European cities studied into 36 km² grids. Using SHERPA, they estimated the changes in atmospheric concentrations of PM_2.5 and NO₂ that would occur if emissions were reduced in each of the grids on the map and calculated the relative contribution of each of the pollution sources.

Finally, a comparative risk assessment was carried out to estimate the mortality that could be prevented under different scenarios of reduced pollutant concentrations associated with each of the emission sources.

It should be noted that, due to the spatial resolution of the study, estimates made for smaller cities may be less precise than those for larger cities.

Data of the 857 cities

The different source contribution to  PM2.5 and NO2 associated mortality are available on the ISGlobal Ranking website.

Examples of European cities

Reference

Sasha Khomenko, Enrico Pisoni, Philippe Thunis, Bertrand Bessagnet, Marta Cirach, Tamara Iungman, Evelise Pereira Barboza, Haneen Khreis, Natalie Mueller, Cathryn Tonne, Kees de Hoogh, Gerard Hoek, Sourangsu Chowdhury, Jos Lelieveld, Mark Nieuwenhuijsen. Spatial and sector-specific contributions of emissions to ambient air pollution and mortality in European cities: a health impact assessment. The Lancet Public Health, 2023. doi:10.1016/S2468-2667(23)00106-8 

A proportion of patients with drug-resistant tuberculosis (TB) receive ineffective treatment due to misdiagnosis by rapid molecular tests, according to a genomic analysis carried out in southern Mozambique and co-led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by "la Caixa" Foundation, and the Institute of Biomedicine in Valencia (IBV), from the Spanish National Research Council (CSIC). The results indicate that new molecular tests need to be developed to detect a wider range of mutations that confer resistance to first-line TB drugs.

Mozambique is one of the countries with the highest burden of drug-resistant TB. The World Health Organisation (WHO) recommends use of the Xpert/Ultra molecular test to identify mutations that confer resistance to the first-line drug rifampicin. However, the test does not detect another mutation that also confers resistance to the drug, which was recently identified in Eswatini and South Africa, two countries that share a border with southern Mozambique. In addition, the test does not detect resistance to another first-line drug, isonoazid.

In this study, the teams of Alberto García-Basteiro, researcher at ISGlobal and CISM, and Iñaki Comas, from the IBV, joined forces to evaluate the presence of this and other mutations that confer resistance to anti-TB drugs in the region. To do so, they sequenced the entire genome of the bacterium (M. tuberculosis) from more than 600 patient samples collected during two studies (one in 2018 and the other in 2014) in southern Mozambique. Both resesarchers belong to the CIBER networks of the Health Institute Carlos III.

Resistance to first-line anti-TB drugs but not to newer drugs

12.7% of samples (78 out of 612) had one or more mutations conferring resistance to first-line and/or second-line drugs. Ten percent of the strains were resistant to isoniazid and four percent were resistant to rifampicin, the main first-line drugs. The mutation reported in Eswatini and South Africa was found in one strain, but is likely to have arisen locally. The analysis found two additional mutations conferring rifampicin resistance, which also escape the Xpert/Ultra test. In addition, a high number of isoniazid-resistant cases were detected, which are also missed by the test.

The good news is that no mutations associated with resistance to two new MDR-TB drugs were found in the region, although a recently published study by another group did find increased resistance to bedaquiline.

Increased surveillance needed

"The strain circulating in Eswatini and South Africa does not appear to have spread significantly to the Manhiça region, but we found evidence that strains with other mutations are being transmitted between Mozambique and other countries in the region," says Comas. "We observed the circulation of strains resistant to isoniazid but not to rifampicin, and which Xpert/Ultra does not detect," he adds. The authors therefore stress the need to increase surveillance and broaden the target mutations beyond those detected by the Xpert/Ultra test.

"Our results provide the most recent figures on the prevalence of antimicrobial resistance by Mycobacterium tuberculosis in this region," says García-Basteiro.

Tuberculosis is the infectious disease that causes the most deaths in the world. In 2022, it was responsible for about 10 million cases and 1.3 million deaths, and about 400,000 people developed TB resistant to one or both first-line drugs. Ending TB is possible, but a collective effort is required.

Reference:

Mariner-Llicer C, Saavedra B, Mambuque E, et al. Monitoring of first-line drug resistance mutations outside the scope of Xpert MTB/RIF Ultra is needed for successful control of DR-TB in Southern Mozambique. Clinical Infectious Diseases, Dec, 2023. doi:10.1093/cid/ciad684.

A multinational study of almost one million individuals confirms a strong and clear association between exposure to radiation from CT scans in young people and an increased risk of blood cancers. This is the main conclusion of the analyses led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa” Foundation, in the European-funded EPI-CT study. These results, published in Nature Medicine, highlight the importance of continuing to apply strict radiological protection measures, particularly in paediatric populations.

The benefits of computed tomography (CT) for imaging in patient management (including diagnostic efficacy, treatment planning and disease follow-up) are undisputed. However, the extensive use of this procedure in recent decades has raised concerns in the medical and scientific community about the potential cancer risks associated with exposure to ionising radiation, particularly in young patients. “The exposure associated with CT scans is considered low (less than 100 mGy), but it is still higher than for other diagnostic procedures,” says Elisabeth Cardis, Head of the Radiation Group at ISGlobal and senior author of the study. Previous studies have suggested an increased risk of cancer in in children exposed to CT scans, but they had several methodological limitations.

To address these limitations, clinicians, epidemiologists and dosimetrists from nine European countries (Belgium, Denmark, France, Germany, Netherlands, Norway, Spain, Sweden, and UK) came together to conduct a multinational, European-funded study, EPI-CT, coordinated by the International Agency for Research on Cancer (IARC).

“Implementing this large, multinational study was challenging – it involved extracting data from radiology records of 276 hospitals and linking them to population-based registries in nine countries, all while maintaining the confidentiality of the individuals’ data,” says Cardis.

A dose-dependent association

The study analysed data from almost one million people, who underwent at least one CT scan before the age of 22. The dose of radiation delivered to the bone marrow, where blood cells are produced, was estimated for each person. By linking this information to national cancer registries, EPI-CT researchers were able to identify those who developed a blood cancer over time. Individuals were followed for an average of 7.8 years, although for those who had CT scans in the early years of the technology, researchers were able to monitor cancer incidence for more than 20 years after the first scan.

The results show a clear association between the total radiation doses to the bone marrow from CT scans and the risk of developing both myeloid and lymphoid malignancies. A dose of 100 mGy multiplied the risk of developing a blood cancer by a factor of about 3. Thus, a typical scan today (with an average dose of about 8 mGy) increases the risk of developing these malignancies by about 16%. “In terms of absolute risk, this means that, for every 10,000 children who have a CT scan, we can expect to see about 1-2 cases of cancer in the 12 years following the examination,” says first author Magda Bosch de Basea, ISGlobal researcher at the time of the study.

The authors point out that more work is needed to ensure that doses and technical parameters are systematically and adequately collected in the clinics in real time to further improve risk estimates in the future.

Public health implications

Today, more than one million children in Europe undergo CT scans every year. Although radiation doses from CT scans have decreased substantially in recent years, the findings of this study underline the need to raise awareness among the medical community and to continue to apply strict radiation protection measures, especially in the youngest patients. “The procedure must be properly justified – taking into account possible alternatives - and optimised to ensure that doses are kept as low as possible while maintaining good image quality for the diagnosis,” Cardis explains. 

Do you want to know more? You can read here the Q&A on the study.

Reference

Bosch de Basea M, Thierry-Chef I, Harbron R et al. Risk of haematological malignancies from CT radiation exposure in children, adolescents and young adults. Nat Med. DOI: 10.1038/s41591-023-02620-0

Josep Maria Antó, senior researcher and former scientific director of ISGlobal, has been appointed by the Government of Catalonia as a member of its Advisory Council for Sustainable Development (CADS).

The CADS, created in December 1998, is a collegiate body whose main function is to advise the Government of Catalonia in the field of sustainable development and, especially, in the integration of sustainability in policies, territorial and sectoral planning instruments, in legislative and regulatory projects and in strategic projects or initiatives promoted by Catalonia. Since 2017, the CADS has been supporting the Government of Catalonia in the actions promoted to contribute to the achievement of the 17 Sustainable Development Goals of the 2030 Agenda.

Josep Maria Antó is one of the founders of the Centre for Research in Environmental Epidemiology (CREAL), which in 2016 merged with ISGlobal . Antó directed ISGlobal's research area until 2019, when he started working on Planetary Health , an approach that proposes to jointly address the health of people and the planet. He is currently Emeritus Professor of Medicine at Pompeu Fabra University (UPF) and co-chair of The Lancet Countdown Europe initiative.

The CADS is composed of a minimum of 10 and a maximum of 15 members. Along with Josep Maria Antó, four other members have been appointed for a period of two years: Amaranta Herrero, postdoctoral researcher at the University of Barcelona and strategic coordinator of the project "Barcelona, World Capital of Sustainable Food 2021" between 2019 i 2022; Anna Ayuso Pozo, senior researcher at CIDOB in the research line on Sustainable Development; Xavier Duran, scientific journalist; and Marta Torres, senior researcher on energy and climate at IDRRI (Institut du Développement Durable et des Relations Internationales).

Since 2004, CADS has been a member of the EEAC network, which brings together 19 environmental, sustainability and climate change advisory councils of governments and parliaments from 14 European states and regions, and is one of the driving forces behind MedECC, the Mediterranean expert group on climate and environmental change.