Instituto de Investigación Biosanitaria de Granada (ibsGRANADA)
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Publication Socioeconomic inequalities in adherence to clinical practice guidelines and breast cancer survival: a multicentre population-based study in Spain(BMJ Group, 2024-12) Petrova, Dafina; Redondo-Sanchez, Daniel; Rodriguez-Barranco, Miguel; Marcos-Gragera, Rafael; Guevara, Marcela; Carulla, Maria; Lopez-de-Munain, Arantza; Vizcaino, Ana; Del-Barco, Sonia; Gonzalez-Flores, Encarnacion; Pollan, Marina; Sanchez, Maria-Jose; [Petrova, D] Instituto de Investigación Biosanitaria ibs.GRANADA, Escuela Andaluza de Salud Pública, Hospital Universitario Virgen de las Nieves, Granada, Spain; [Rodriguez-Barranco, M] Instituto de Investigación Biosanitaria ibs.GRANADA, Escuela Andaluza de Salud Pública, Granada, Spain; [Gonzalez-Flores, E] Instituto de Investigación Biosanitaria ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain; [Sanchez, M.J] Instituto de Investigación Biosanitaria ibs.GRANADA, Escuela Andaluza de Salud Pública, Granada, Spain; [Redondo-Sanchez, D] Instituto de Investigación Biosanitaria ibs.GRANADA, Escuela Andaluza de Salud Pública, Granada, Spain; Cancer Epidemiological Surveillance Subprogram of CIBERESP and the Health Institute Carlos III (VICA); Fundación Científica Asociación Española Contra el Cáncer; Health Institute Carlos III; EU/FEDER; FECYTWomen residing in lower socioeconomic status (SES) areas have lower breast cancer survival but it is not clear how differences in the quality of care received contribute to these disparities. We compared adherence to clinical practice guidelines (CPG) for the diagnosis and treatment of breast cancer and subsequent breast cancer survival between women residing in lower versus higher SES areas. We conducted a multicentre population-based study of all new cases of invasive breast cancer in women diagnosed 2010-2014 in six Spanish provinces with population-based cancer registries (n=3206). Clinical data were extracted in the framework of the European Cancer High Resolution studies and vital status follow-up covered a minimum of 5 years. SES of the patient's residence was measured with the 2011 Spanish Deprivation Index. Adherence to CPG was measured with 16 indicators based on European and Spanish guidelines. Relative survival was modelled using flexible parametric models. There were no differences in the type of treatment received but women living in the lowest SES areas were less likely to undergo a sentinel lymph node biopsy, reconstruction after mastectomy, surgery within 30 days after pathological diagnosis and adjuvant treatment within 6 weeks after surgery. After accounting for demographic and clinical factors, women residing in lower SES areas had higher risk of death, HR=1.57 (95% CI 1.04, 2.36). Further accounting for adherence to CPG in the model, in particular having undergone a sentinel lymph node biopsy, eliminated the significant effect of SES. Despite the overall coverage of the Spanish health system, women living in more deprived areas were less likely to receive care in line with CPG and had shorter survival.Publication Update of European Society of Clinical Microbiology and Infectious Diseases coronavirus disease 2019 guidelines: diagnostic testing for severe acute respiratory syndrome coronavirus 2(Elsevier, 2023-04-21) Fragkou, Paraskevi C; De Angelis, Giulia; Menchinelli, Giulia; Can, Fusun; Garcia, Federico; Morfin-Sherpa, Florence; Dimopoulou, Dimitra; Dimopoulou, Konstantina; Zelli, Silvia; de Salazar, Adolfo; Reiter, Rieke; Janocha, Hannah; Grossi, Adriano; Omony, Jimmy; Skevaki, Chrysanthi; [Garcia, F] Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria, Ibs. Granada, Granada, Spain; [de Salazar, A] Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria, Ibs. Granada, Granada, Spain; Deutsche Forschungsgemeinschaft; Fundacion Progreso y Salud, Consejería de Salud, Junta de AndalucíaSince the onset of COVID-19, several assays have been deployed for the diagnosis of SARS-CoV-2. The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) published the first set of guidelines on SARS-CoV-2 in vitro diagnosis in February 2022. Because the COVID-19 landscape is rapidly evolving, the relevant ESCMID guidelines panel releases an update of the previously published recommendations on diagnostic testing for SARS-CoV-2. This update aims to delineate the best diagnostic approach for SARS-CoV-2 in different populations based on current evidence. An ESCMID COVID-19 guidelines task force was established by the ESCMID Executive Committee. A small group was established, half appointed by the chair, and the remaining selected with an open call. The panel met virtually once a week. For all decisions, a simple majority vote was used. A list of clinical questions using the population, intervention, comparison, and outcome (PICO) format was developed at the beginning of the process. For each PICO, 2 panel members performed a literature search focusing on systematic reviews with a third panellist involved in case of inconsistent results. The panel reassessed the PICOs previously defined as priority in the first set of guidelines and decided to address 49 PICO questions, because 6 of them were discarded as outdated/non-clinically relevant. The 'Grading of Recommendations Assessment, Development and Evaluation (GRADE)-adoption, adaptation, and de novo development of recommendations (ADOLOPMENT)' evidence-to-decision framework was used to produce the guidelines. After literature search, we updated 16 PICO questions; these PICOs address the use of antigen-based assays among symptomatic and asymptomatic patients with different ages, COVID-19 severity status or risk for severe COVID-19, time since the onset of symptoms/contact with an infectious case, and finally, types of biomaterials used.Publication Mechanisms Considering Public Investment in Pricing and Reimbursement Decisions of Medicines and Other Health Technologies: A Scoping Review.(Open Mind Journals Ltd., 2025-08-27) García-Díaz, Mario; Špacírová, Zuzana; García-Mochón, Leticia; Espín, Jaime; [García-Diaz,M; Špacírová, Z; García-Mochón,L; Espín,J] Andalusian School of Public Health/Escuela Andaluza de Salud Pública (EASP), Cuesta del Observatorio 4, Beiro, 18011, Granada, Spain.; [Špacírová, Z; García-Mochón,L; Espín,J] Instituto de Investigación Biosanitaria ibs, Granada, Spain Instituto de Investigación Biosanitaria ibs, Granada, Spain.; [García-Mochón,L; Espín,J] CIBER en Epidemiología y Salud Pública (CIBERESP)/CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.Background: Pricing and reimbursement (P&R) systems do not normally use public investments in research and development (R&D) as criteria when negotiating the prices and reimbursement of health technologies. Objective: The objective was to find mechanisms that consider public investment in R&D when negotiating P&R or obtaining a fair return on this public investment METHODS: We conducted a scoping review. A total of four databases (PubMed, Embase, Scopus and Web of Science) and a grey literature information source (Google Scholar) were searched. Eligible articles were published before 2024 and described how public sector investment in R&D is considered in price negotiations or how the public sector can obtain a return on R&D investment. Results: The review found 28 papers referring to mechanisms that take into account public investment in R&D to reduce prices in the P&R negotiation (e.g. delinkage R&D model, advance purchase agreement and government patent use), to obtain a fair return on investment (e.g. royalties and venture philanthropy) or to save costs or share risks (e.g. social impact bonds and prize fund). Examples are provided of health technologies that used these mechanisms. Conclusions: Policymakers have several resources they can draw from to ensure a fair and efficient use of public R&D funds. However, there is little evidence that these instruments are widely used in practice, and there is no political consensus on what mechanism is the most appropriate and why. In view of the above, it is essential to create a common framework that will ensure a fairer and more affordable system for public health budgets.Publication A Framework for Considering the Role of the Public Sector in R&D of Health Technology(Springer Nature, 2025-08-08) Rejón-Parrilla, Juan Carlos; Epstein, David; Mestre-Ferrandiz, Jorge; Espin, Jaime; [Rejón-Parrilla, JC] Health Technology Assessment Area (AETSA), Andalusian Public Foundation Progress and Health (FPS), Seville, Spain; [Epstein, D] Department of Applied Economics, University of Granada, Granada, Spain; [Mestre-Ferrandiz, J] Department of Economics, University Carlos III, Madrid, Spain; [Espin, J] Andalusian School of Public Health, Granada, Spain; [Espin, J] Instituto de Investigación Biosanitaria ibs., Granada, Spain; [Espin, J] CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; Universidad de Granada; European Union’s Horizon Europe researchThe development of health technologies involves complex, costly, and risky investments, with significant contributions from both public and private sectors. Recent EU pharmaceutical directives propose transparency on public funding to aid pricing negotiations and affordability. However, questions remain regarding how public investments should be measured and their influence on pricing and reimbursement (P&R) decisions. In this paper, we characterise public sector institutions as "payers," "R&D investors," and "regulators". Through a myriad of agencies and decisions, these institutions directly, indirectly or sometime unexpectedly influence risk and return on private research and development (R&D) through P&R, direct investments, and regulatory policy. P&R decisions by payers for innovative therapies influence risk and expected return of future R&D. Value-based pricing offers a more reliable signal of payers' priorities than cost-plus or (international) reference pricing. For greatest impact, public R&D investment should be directed to areas where markets are deficient, such as basic science, translational research, real-world studies, and towards emerging fields like AI and gene editing that will play an increasing role in healthcare and drug development. Applied R&D should be conducted on a financially sustainable basis. Licensing arrangements can be used to recover those investments, while promoting spillover benefits to wider society. Market access regulators are aware of the need for scrupulous transparency and neutrality, but other public sector actors (payers and R&D investors) also must recognise their policies affect the level playing field.Publication Revisión sistemática sobre el uso de peces para el control vectorial de las enfermedades transmitidas por mosquitos(Ministerio de Sanidad y Consumo, 2025-06-05) Tortosa-La Osa, Silvia; Esteo Alcalá, María Victoria; Martín-Ruiz, Eva; Olry de Labry-Lima, Antonio; [Martín-Ruiz,E] Departamento de Enfermería; Facultad de Enfermería, Fisioterapia y Podología; Universidad de Sevilla. Sevilla. España.; [Martín-Ruiz,E] Escuela Andaluza de Salud Pública. Granada. España.; [Olry de Labry-Lima,A] Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública; Instituto de Salud Carlos III. Madrid. España.; [Olry de Labry-Lima,A] Centro Andaluz de Documentación e Información de Medicamentos (CADIME). Granada. España.FUNDAMENTOS // Se estima que un 80% de la población mundial está en riesgo de contraer una enfermedad de transmisión vectorial, siendo los mosquitos los responsables de una mayor carga de enfermedad. Dado que el control biológico es una opción más natural que otras intervenciones disponibles y que el uso de peces está muy extendido, el objetivo de esta revisión fue analizar la eficacia de las intervenciones con peces para el control de las enfermedades transmitidas por mosquitos. MÉTODOS // Se llevó a cabo una búsqueda bibliográfica a través de PubMed, Embase, Cochrane, LILACS, WOS-Core Collection y CAB Abstracts de estudios observacionales o experimentales publicados en inglés, español o portugués hasta diciembre de 2023. Las variables de resultados de interés eran indicadores entomológicos y epidemiológicos. RESULTADOS // De las 2.227 referencias identificadas, siete artículos fueron finalmente incluidos. Todos los estudios midieron el impacto usando indicadores entomológicos, mientras que solo dos usaron, además, epidemiológicos. Las intervenciones se basaron en la liberación de peces en recipientes de agua domésticos, en campos de arroz y en excavaciones y pozos vinculados a la construcción de un canal. En todos los estudios se observó una reducción significativa de los indicadores entomológicos y epidemiológicos. La reducción larvaria osciló entre el 80% y el 100%, mientras que la reducción de casos clínicos llegó a un 99,87%. CONCLUSIONES // La liberación de peces conlleva una reducción relevante tanto de los indicadores larvarios como de los casos clínicos. No obstante, es necesario analizar si la liberación de peces a mayor escala es factible, sostenible, coste-efectiva y suficiente para lograr el control vectorial, además de considerar el potencial impacto negativo de su introducción en un determinado ecosistema.Publication Trends in the incidence of brain cancer and the use of mobile phones: analysis of the Spanish Network of Cancer Registries (REDECAN).(Doyma, 2025-05-14) Galceran, Jaume; Ameijide, Alberto; Cañete, Adela; Peris-Bonet, Rafael; López de Munain, Arantza; Aizpurúa, Amaia; de la Cruz, Marta; Sanvisens, Arantza; Sánchez, María José; Palacios, Isabel; Franch, Paula; Sánchez, Antonia; Guevara, Marcela; Carulla, Marià; Gutiérrez, Pilar; Sáez, Isabel; Rodríguez, Marta; Alemán, Araceli; Sabater, Consol; [Sanchez-Perez,MJ] Granada Cancer Registry, Andalusian School of Public Health (EASP), Granada, Spain.; [Sanchez-Perez,MJ] Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain.; [Sanchez-Perez,MJ] Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.; [Sanchez-Perez,MJ] Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.; REDECANPurpose: The association between the use of mobile phones use and the risk of brain cancer remains controversial. The aim of this study is to describe trends in the incidence of central nervous system (CNS) cancers in Spain and its possible relationship with mobile phone use. Methods: Trends and trend changes from 1985 to 2015 in adjusted incidence rates of CNS cancers by sex, age (adults and children), site, and histological type were assessed using data from 14 general and paediatric cancer registries. Results: The study included 20,325 CNS malignancies in adults and 2,372 in children. For adults, the overall rate of malignant brain tumours showed a slight increase of 0.2% (95% CI: 0.1 - 0.4) per year. This increase was concentrated in the early years up to 1996 (1.7% per year, 95% CI: 0.9 - 2.6) followed by 20 years of a non-significant slight decline of -0.1% (95% CI: -0.4 - 0.1) per year until 2015. In children, an increase of 7.6% (95% CI: 2.4 - 13.1) per year until 1991 followed by a decrease of -1.0% (95%CI: -1.7 - -0.3) per year until 2015 was observed. This increase in the incidence in 1980s and early 1990s could be explained by diagnostic improvements especially in imaging techniques implemented during these years. Conclusion: The present findings do not support a possible relationship between the use of mobile phones and the incidence of malignant brain tumours. However, the possibility of the presence of a weak correlation or that a longer latency period would be needed to observe a possible ecological correlation cannot be discarded.Publication Inflammation and gut barrier function-related genes and colorectal cancer risk in western European populations.(Oxford University Press, 2025-03-15) Mandle, Hannah B; Jenab, Mazda; Gunter, Marc J; Tjønneland, Anne; Olsen, Anja; Dahm, Christina C; Zhang, Jie; Sugier, Pierre-Emmanuel; Rothwell, Joseph; Severi, Gianluca; Kaaks, Rudolf; Katzke, Verena A; Schulze, Matthias B; Masala, Giovanna; Sieri, Sabina; Panico, Salvatore; Sacerdote, Carlotta; Bonet, Catalina; Sánchez, María José; Amiano, Pilar; Huerta, José María; Guevara, Marcela; Palmqvist, Richard; Löwenmark, Thyra; Perez-Cornago, Aurora; Weiderpass, Elisabete; Heath, Alicia K; Cross, Amanda J; Vineis, Paolo; Hughes, David J; Fedirko, Veronika; [Sanchez-Perez,MJ] Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain.; [Sanchez-Perez,MJ] Instituto de Investigación Biosanitaria ibs. 18011 Granada, Spain.; [Sanchez-Perez,MJ] Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.; Cancer Prevention and Research Institute of Texas (CPRIT) Rising Stars Award; Health Research Board (HRB) of Ireland; World Cancer Research Fund (WCRF); EU Marie Curie Doctoral Training Network “Colomark”; Agency for Research on Cancer (IARC); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College LondonGut barrier dysfunction and related inflammation are known to be associated with the development and progression of colorectal cancer (CRC). We investigated associations of 292 single-nucleotide polymorphisms (SNPs) from 27 genes related to endotoxins/lipopolysaccharide (LPS) sensing and tolerance, mucin synthesis, inflammation, and Crohn's disease with colon and rectal cancer risks. Incident CRC cases (N = 1374; colon = 871, rectum = 503) were matched 1:1 to controls nested within the European Prospective Investigation into Cancer and Nutrition cohort. Previously measured serum concentrations of gut barrier function and inflammation biomarkers (flagellin/LPS-specific immunoglobulins and C-reactive protein [CRP]) were available for a sub-set of participants (Ncases = 1001; Ncontrols = 667). Forty-two unique SNPs from 19 different genes were associated with serum biomarkers at Punadjusted ≤ 0.05 among controls. Among SNPs associated with a gut permeability score, 24 SNPs were in genes related to LPS sensing and mucin synthesis. Nine out of 12 SNPs associated with CRP were in genes related to inflammation or Crohn's disease. TLR4 was associated with colon cancer at the SNP level (nine SNPs, all Punadjusted ≤ 0.04) and at the gene level (Punadjusted ≤ 0.01). TLR4 rs10759934 was associated with rectal cancer but not colon cancer. Similarly, IL10 was associated with rectal cancer risk at an SNP and gene level (both Punadjusted ≤ 0.01), but not colon cancer. Genes and SNPs were selected a priori; therefore, we present unadjusted P-values. However, no association was statistically significant after multiple testing correction. This large and comprehensive study has identified gut barrier function and inflammation-related genes possibly contributing to CRC risk in European populations and is consistent with potential etiological links between host genetic background, gut barrier permeability, microbial endotoxemia, and CRC development.Publication The still incomplete pursuit of universal access to medicines.(Cambridge University Press, 2025-05-22) Fernández, Paloma; Del Llano, Alicia; Vidal, Jaume; Espin, Jaime; Del Llano, Juan E; [Espin,J] Andalusian School of Public Health (EASP), Granada, Spain.; [Espin,J] CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; [Espin,J] Instituto de Investigación Biosanitaria IBS, Granada, SpainA substantial share of the global population continues to face barriers to accessing essential medicines. While the pharmaceutical industry's business model has successfully facilitated the development of innovative medications, efforts to promote universal access to medicines (UAM) remain ineffective. This paper critically assesses the existing barriers to global access to medicines, including the role of unsuitable governance, the protection of intellectual property rights, and other market barriers such as shortages, quality shortcomings, and high prices. Furthermore, we explore a number of promising potential strategies that can help towards achieving the UAM. Specifically, we evaluate the evidence from various initiatives, including alternative models of innovation, manufacturing, procurement, intellectual property management, and structural/organisational operations. We argue that the effective realisation of UAM requires a robust framework to implement these initiatives. This framework must strike a delicate balance between addressing public health needs, incentivising research and development, and ensuring affordability. Achieving such a balance encompasses a careful oversight and collaboration between national and international regulatory bodies.Publication Cohort profile: the CORDELIA study (Collaborative cOhorts Reassembled Data to study mEchanisms and Longterm Incidence of chronic diseAses).(Kluwer Academic Publishers, 2025-05-12) Hernáez, Álvaro; Camps-Vilaró, Anna; Polo-Alonso, Sara; Subirana, Isaac; Ramos, Rafel; de Cid, Rafael; Rodríguez-Artalejo, Fernando; Elosua, Roberto; Chirlaque, M Dolores; Amiano, Pilar; Bermúdez-López, Marcelino; Guevara, Marcela; Cinza-Sanjurjo, Sergio; Sánchez, María José; de León, Antonio Cabrera; Laclaustra, Martín; Rojo-Martínez, Gemma; Guembe-Suescun, María J; Pérez-Gómez, Beatriz; Vega-Alonso, Tomás; Torán-Monserrat, Pere; Lora-Pablos, David; Huerta, José María; Valdivielso, José M; Dégano, Irene R; Félix-Redondo, Francisco J; Gandarillas, Ana María; Valdés, Sergio; Mundet-Tuduri, Xavier; Sánchez, Pedro L; Martín-Sánchez, Vicente; Rigo, Fernando; Alonso-Sampedro, Manuela; Moreno-Iribas, Conchi; Martín-Escudero, Juan Carlos; Delgado, Elías; Grau, Maria; Urrutia, Inés; Ovejero, Diana; Quintela, Inés; Martí-Lluch, Ruth; Blay, Natalia; Banegas, José R; Tizón-Marcos, Helena; Gómez, Jesús Humberto; Aizpurua, Amaia; Castro-Boqué, Eva; Delfrade, Josu; Prieto-Díaz, Miguel Ángel; Rodríguez-Barranco, Miguel; Almeida-González, Delia; Moreno-Franco, Belén; Oualla-Bachiri, Wasima; Sayón-Orea, Carmen; Plans-Beriso, Elena; Lozano, José Eugenio; López-Lifante, Víctor M; Cancelas-Navia, Pilar; Cabrera-Castro, Natalia; Cambray, Serafí; Zacarías-Pons, Lluís; Fernández-Bergés, Daniel; Donoso-Navarro, Encarnación; Maldonado-Araque, Cristina; Franch-Nadal, Josep; Dorado-Díaz, Pedro Ignacio; Villarín-Castro, Alejandro; Frontera-Juan, Guillem; Gude, Francisco; Andueza, Naroa; Téllez-Plaza, María; Ares-Blanco, Jessica; Cruz, Raquel; Ribas-Aulinas, Marc; Barretina, Jordi; Guallar-Castillón, Pilar; Caínzos-Achirica, Miguel; Colorado-Yohar, Sandra Milena; Llorente, Adrián; Diaz-Tocados, Juan Miguel; Ardanaz, Eva; Micó-Pérez, Rafael Manuel; Fernández-Martínez, Nicolás Francisco; Del Cristo Rodríguez-Pérez, María; Cenarro, Ana; Calle-Pascual, Alfonso L; Marrugat, Jaume; [Sanchez-Perez,MJ; Rodriguez-Barranco,M; Fernandez-Martinez,NF] CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.; [Sanchez-Perez,MJ; Rodriguez-Barranco,M; Fernandez-Martinez,NF] Escuela Andaluza de Salud Pública, Granada, Spain.; [Sanchez-Perez,MJ; Rodriguez-Barranco,M; Fernandez-Martinez,NF] Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain.; Instituto de Salud Carlos III; European UnionThe CORDELIA Study (Collaborative Cohorts Reassembled Data to Study Mechanisms and Long-term Incidence of Chronic Diseases) combines 35 Spanish population cohorts to investigate the clinical, environmental, genetic, and omics determinants of cardiovascular disease in the Southern European population. It aims to conduct the largest genome-wide association study to date on cardiovascular disease in this population, improve predictions of cardiovascular incidence using genomic and clinical data, and identify subgroups that would benefit most from targeted pharmacological and lifestyle interventions. CORDELIA includes 196,632 individuals (ages 18-84, 54% female, 96% born in Spain, 20% with higher education, recruited from 1989 to 2020, with follow-up periods ranging from 5 to 30 years), with DNA samples available for 117,342 participants (60%). Of the participants, 24% were current smokers, 43% hypertensive, 11% diabetic, 15% medicated with lipid-lowering drugs, 44% overweight, and 27% obese. If not already available, genotyping is being performed using the Axiom™ Spain Biobank array (~ 750,000 variants, including 115,000 specific and 50,000 rare functional variants from the Spanish population). The cohort also includes incident events (coronary heart disease, stroke, heart failure, peripheral artery disease, hypertension, diabetes); date and cause of death; and harmonized data on risk factors (body mass index, waist circumference, lipid profile, blood pressure, glucose, creatinine), lifestyle (smoking, physical activity, diet, alcohol), and socioeconomic status. 99,019 participants (50%) also provide plasma samples. CORDELIA will significantly contribute to understanding the complex interplay of risk factors contributing to cardiovascular disease and advance the fields of precision medicine and public health in Southern European individuals.Publication How should medicines reimbursement work? The views of Spanish experts.(Cambridge University Press, 2025-01-30) Rejon-Parrilla, Juan Carlos; Epstein, David; Pérez-Troncoso, Daniel; Espin, Jaime; [Rejon-Parrilla,JC] Health Technology Assessment Area (AETSA), Andalusian Public Foundation Progress and Health (FPS), Seville, Spain.; [Espín,J] Andalusian School of Public Health, Granada, Spain.; [Espín,J] Instituto de Investigación Biosanitaria ibs., Granada, Spain.; [Espín,J] CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.; Spanish Ministry of Science and Innovation/National Research Agency MCIN/AEI/10.13039/501100011033Although the criteria that support reimbursement decisions for medicines are often set by legislation, as is the case in Spain, in many cases neither the definition nor the measurement methods for these criteria are provided. Our goal was to elicit the views of a large sample of Spanish technical specialists on how to evaluate each one of the criteria that inform pricing and reimbursement decisions in Spain. Professionals from various stakeholder groups involved in health economics, health technology assessment, and industry participated in a survey. Participants recommended that reimbursement decisions should take specific account of unmet medical need and rare diseases. Health benefit should be measured using quality-adjusted life-years. There should be an explicit cost-effectiveness threshold, and this threshold should take account of population groups and special situations.Publication Nutritional profile of the diet according to circadian clock genes in the European Prospective Investigation into Cancer and Nutrition (EPIC) chronodiet study.(Elsevier, 2025-06) Molina-Montes, Esther; Rodríguez-Barranco, Miguel; Alcalá-Santiago, Ángela; Gálvez-Navas, José María; Huerta, José María; Amiano, Pilar; Lasheras, Cristina; Moreno-Iribas, Conchi; Jimenez-Zabala, Ana; Chirlaque, María-Dolores; Gasque, Alba; Luján-Barroso, Leila; Agudo, Antonio; Jakszyn, Paula; Quirós, José Ramón; Sánchez, María José; [Rodríguez-Barranco,M; Garcia-Navas,JM; Sanchez-Perez,MJ] Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; [Rodríguez-Barranco,M; Garcia-Navas,JM; Sanchez-Perez,MJ] CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain; [Rodríguez-Barranco,M; Garcia-Navas,JM; Sanchez-Perez,MJ] Andalusian School of Public Health (EASP), Granada, Spain.; Instituto de Salud Carlos IIIBackground & aims: Circadian rhythms seem to impact both dietary intake and metabolism, depending on the individual's chronotype. We aimed to explore whether the nutritional composition of meals throughout the day is influenced by genetics linked to the circadian clock and chronotype within the "European Prospective Investigation into Cancer and Nutrition (EPIC) chronodiet" study. Methods: The study population comprised 3,183 subjects with information on diet and twelve genetic variants of six genes (PER1, PER2, PER3, CRY1, NR1D1, CLOCK). The associations between the variants with chrononutrition variables (macronutrients and serving sizes of each meal) were evaluated using linear regression, considering an additive genetic model, and adjusting for sex, age and center, among others. The β coefficients, 95 % confidence intervals (CI), and p-values corrected for multiple comparisons were estimated. A genetic risk score (GRS) that was associated to the evening/late chronotype as well as overweight/obesity in a previous study, the chronotype-GRS, was tested for its association with chrononutrition variables. Results: The nutritional profile of the diet differed according to the individual's chronotype, with evening/late chronotypes exhibiting an unbalanced intake during breakfast and dinner compared to the intermediate and early chronotypes (e.g., percentage of fats consumed at breakfast relative to the total fat intake: 13 % and 9 %, respectively). However, significant differences were not encountered by the chronotype-GRS. In multivariate analyses, individual associations between the genetic variants and the nutrients revealed some nominal associations (e.g., rs1801260 and rs2070062 with carbohydrates at breakfast: β = -0.06 to 0.08). Higher scorings of the chronotype-GRS were inversely associated with the intake of proteins and carbohydrates (β = -0.46 and -0.41; nominal p-value<0.006; corrected = 0.25) during breakfast. Also, there was an inverse association between the chronotype-GRS and the breakfast's portion size (β = -0.3; nominal p-value = 0.03; corrected = 0.1). Conclusions: Genetic susceptibility to an evening-like chronotype prone to overweight/obesity seems to be associated with a smaller serving size during breakfast, with lower protein and carbohydrate content.Publication Comprehensive analysis of West Nile Virus transmission: Environmental, ecological, and individual factors. An umbrella review.(Elsevier, 2025-06) Vargas Campos, Carlos Adrián; García-Pérez, Selene; Figuerola, Jordi; Martínez-de la Puente, Josué; Polo, Irene; Rodríguez-de-Fonseca, Belén; Fernández-Álvarez, Sofía; Galván Fraile, Víctor; Martín-Rey, Marta; Lacasaña, Marina; Bermúdez-Tamayo, Clara; [Lacasaña,M; Bermudez-Tamayo;C] Andalusian School of Public Health EASP, Granada, Spain.; [Lacasaña,M; Bermudez-Tamayo;C] Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.; [Lacasaña,M; Bermudez-Tamayo;C] Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.; Ministry of Ecological Transition and Demographic Challenge (Spain)Background: West Nile Virus (WNV) exemplifies the complexities of managing vector-borne diseases, expanding globally due to human activities and ecological changes. Originating from Africa and transmitted by Culex mosquitoes, WNV is now reported across multiple continents. The aim of this study was to identify the environmental, ecological, and individual factors influencing WNV transmission. Methods: An umbrella review was conducted. Comprehensive searches were performed in PubMed, Scopus, Web of Science, Embase, and LILACS. Inclusion criteria were reviews involving WNV transmission agents (reservoirs, vectors, hosts) and associative analyses between environmental, ecological, or individual factors and WNV transmission. Data extraction and quality appraisal were performed using templates and the AMSTAR 2 tool. Results: From 404 retrieved studies, 23 systematic reviews and meta-analyses were included. Almost 70 % were low or critically low quality. The co-occurrence network highlighted emerging research on climate change and environmental factors. Temperature, precipitation, and land use significantly influence WNV transmission. Warmer temperatures enhance mosquito populations and viral replication, while extreme weather events like droughts increase mosquito-human contact. Climate change significantly contributes to WNV dynamics by altering temperature and precipitation patterns, enhancing vector proliferation, and extending transmission seasons. Ecological factors such as higher avian diversity, vegetation indexes, and distribution of mosquito species can impact WNV transmission significantly. Education and income levels influence preventive behaviors and infection risk, with lower socioeconomic status linked to higher WNV risk. Certain occupational groups are also at elevated risk of WNV infection. Conclusion: Environmental factors like temperature and precipitation critically affect WNV transmission by influencing mosquito behavior and avian reservoir dynamics. Socio-economic status and education levels significantly impact individual preventive behaviors and infection risk. Multifactorial influences on infection risk make necessary integrated surveillance systems and public health strategies. Longitudinal studies with One Health approaches are necessary to better understand WNV dynamics and reduce WNV transmission.Publication Associations of milk, dairy products, calcium and vitamin D intake with risk of developing Parkinson´s disease within the EPIC4ND cohort.(Kluwer Academic Publishers, 2024-11) Gröninger, Mareike; Sabin, Jara; Kaaks, Rudolf; Amiano, Pilar; Aune, Dagfinn; Castro, Natalia Cabrera; Guevara, Marcela; Hansen, Johnni; Homann, Jan; Masala, Giovanna; Nicolas, Geneviève; Peters, Susan; Sacerdote, Carlotta; Sánchez, María José; De Magistris, Maria Santucci; Sieri, Sabina; Vermeulen, Roel; Zhao, Yujia; Lill, Christina M; Katzke, Verena A; [Sanchez-Perez,MJ] Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, 28029, Spain.; [Sanchez-Perez,MJ] Escuela Andaluza de Salud Pública (EASP), Granada, 18011, Spain.; [Sanchez-Perez,MJ] Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain.; International Agency for Research on Cancer (IARC); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London; NIHR Imperial Biomedical Research Centre (BRC)Literature indicates a potential association between dairy consumption and risk of Parkinson´s disease (PD), especially among men, yet the results remain inconclusive. We investigated this association in a large prospective European cohort. Dietary and non-dietary data was collected from 183,225 participants of the EPIC-for-Neurodegenerative-Diseases (EPIC4ND) cohort, a sub-cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Crude and multivariable-adjusted Cox proportional hazards models were employed to examine potential associations between baseline dietary intake of dairy, calcium and vitamin D with incident PD risk. No relationship was observed between dairy consumption (HR 1.07, 95% CI 0.82-1.39), individual dairy products (milk: HR 0.95, 95% CI 0.73-1.23; yogurt: HR 1.03, 95% CI 0.82-1.29; cheese: HR 1.13, 95% CI 0.85-1.51), or vitamin D (HR 1.08, 95% CI 0.80-1.45) with PD risk. However, we observed a risk-increasing association with higher calcium intakes (HR 1.33, 95% CI 1.00-1.78, p for trend = 0.031), which was more pronounced in men (HR 1.50, 95% CI 1.00-2.25, p for trend = 0.044) and in ever smokers (HR 1.64, 95% CI 1.06-2.53, p for trend = 0.014). No compelling evidence was found for an association between dairy products or vitamin D intake and PD risk indicating a potentially limited relevance of dairy intake in PD risk than previously described. Our observations of a positive association between dietary calcium intake and PD risk in men and in ever smokers require further validation.Publication Associations between degree of food processing and all-cause and cause-specific mortality: a multicentre prospective cohort analysis in 9 European countries.(Elsevier, 2025-01-08) González-Gil, Esther M; Matta, Michèle; Morales Berstein, Fernanda; Cairat, Manon; Nicolas, Geneviève; Blanco, Jessica; Kliemann, Nathalie; Bertazzi Levy, Renata; Rauber, Fernanda; Jacobs, Inarie; Al Nahas, Aline; Cakmak, Emine Koc; Vamos, Eszter P; Chang, Kiara; Yammine, Sahar G; Millett, Christopher; Touvier, Mathilde; Matias Pinho, Maria Gabriela; Tsilidis, Konstantinos K; Heath, Alicia K; Lill, Christina M; Pala, Valeria; Moreno-Iribas, Conchi; De Magistris, Maria Santucci; Dahm, Christina C; Bock, Niels; Olsen, Anja; Tjønneland, Anne; van der Schouw, Yvonne T; Amiano, Pilar; Jannasch, Franziska; Schulze, Matthias B; Romana Mancini, Francesca; Marques, Chloé; Cadeau, Claire; Bonet, Catalina; Redondo-Sánchez, Daniel; Borch, Kristin Benjaminsen; Brustad, Magritt; Skeie, Guri; Humberto-Gómez, Jesús; Macciotta, Alessandra; Ferrari, Pietro; Dossus, Laure; Gunter, Marc J; Huybrechts, Inge; [Redondo-Sanchez,D] Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain; [Redondo-Sanchez,D] Escuela Andaluza de Salud Pública (EASP), Granada 18011, Spain.; [Redondo-Sanchez,D] Instituto de Investigación Biosanitaria ibs.GRANADA, Granada 18012, Spain.; World Cancer Research Fund International (IIG_FULL_2020_033); Institut National Du Cancer (INCa number 2021-138); Agency for Research on Cancer (IARC)Background: Ultra-processed food (UPF) consumption has been linked with higher risk of mortality. This multi-centre study investigated associations between food intake by degree of processing, using the Nova classification, and all-cause and cause-specific mortality. Methods: This study analyzed data from the European Prospective Investigation into Cancer and Nutrition. All-cause mortality and cause-specific mortality due to cancer, circulatory diseases, digestive diseases, Parkinson's disease, and Alzheimer's disease served as endpoints. Hazard ratios (HRs) and 95% CIs were estimated using multivariable Cox proportional hazards regression models. Substitution analyses were also performed. Findings: Overall, 428,728 (71.7% female) participants were included in the analysis and 40,016 deaths were documented after 15.9 years of follow-up. UPFs (in percentage grams per day [g/d]) were positively associated with all-cause mortality (HRs per 1-SD: 1.04; 95% CI: 1.02,1.05), as well as mortality from circulatory diseases (1.09; 95% CI: 1.07,1.12), cerebrovascular disease (1.11; 95% CI: 1.05,1.17), ischemic heart disease (1.10; 95% CI: 1.06,1.15), digestive diseases (1.12; 95% CI: 1.05,1.20), and Parkinson's disease (1.23; 95% CI: 1.06,1.42). No associations were found between UPFs and mortality from cancer or Alzheimer's disease. Replacing processed and UPFs with unprocessed/minimally processed foods was associated with lower mortality risk. Interpretation: In this pan-European analysis, higher UPF consumption was associated with greater mortality from circulatory diseases, digestive diseases, and Parkinson's disease. The results support growing evidence that higher consumption of UPFs and lower consumption of unprocessed foods may have a negative impact on health.Publication A new environmental public health practice to manage current and future global health challenges through education, training, and capacity building.(Frontiers Media, 2024-11-18) Leonardi, Giovanni S; Zeka, Ariana; Ashworth, Matthew; Bouland, Catherine; Crabbe, Helen; Duarte-Davidson, Raquel; Etzel, Ruth Ann; Giuashvili, Nia; Gökdemir, Özden; Hanke, Wojciech; van den Hazel, Peter; Jagals, Paul; Khan, Ejaz Ahmad; Martin-Olmedo, Piedad; Pett, Joseph; Ruadze, Ekaterine; Santamaria, Maria Grazia; Semenza, Jan C; Sorensen, Cecilia; Vardoulakis, Sotiris; Yip, Fuyuen; Lauriola, Paolo; [Martin-Olmedo,P] Andalusian School of Public Health, Granada, Spain.; [Martin-Olmedo,P] Ibs. GRANADA, Granada, Spain.; National Institute for Health and Care Research (NIHR); Health Protection Research Unit in Environmental Change and Health (NIHR 200909); UK Health Security Agency (UKHSA); London School of Hygiene and Tropical Medicine (LSHTM); University College London; The Met OfficeUnsustainable globalisation of economic activities, lifestyles and social structures has contributed to environmental degradation, posing major threats to human health at the local and global levels. All these problems including climate change, pollution, and biodiversity loss represent challenges that are unlikely to be met with existing approaches, capabilities and tools. This article acknowledges the need for well-prepared practitioners from many walks of life to contribute to environmental public health (EPH) functions thus strengthening society's capacity and capability to respond effectively and in a timely manner to such complex situations and multiple challenges. It envisions a new EPH practice addressing questions on: Why do this? What needs to be addressed? Who will do it? How can it be implemented? This article focuses on the main challenging EPH issues worldwide and how they could be addressed using a conceptual framework for training. A companion article shows how they have been tackled in practice, providing ideas and experiences.Publication Evolution of the risk of death and hospitalisation in drivers involved in road crashes in spain, 1993-2020: an age-period-cohort analysis.(BioMed Central, 2024-12-18) Martín-delosReyes, Luis Miguel; Martínez-Ruiz, Virginia; Rivera-Izquierdo, Mario; Jiménez-Mejías, Eladio; Fernández-Martínez, Nicolás Francisco; Lardelli-Claret, Pablo; [Martin-delosReyes,LM; Fernández-Martínez,NF] Centros de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.; [Martin-delosReyes,LM; Fernández-Martínez,NF] Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.; [Martin-delosReyes,LM; Fernández-Martínez,NF] Andalusian School of Public Health (EASP), Granada, Spain.; Instituto de Salud Carlos III (Ministry of Science and Innovation, Government of Spain); European Funds (FEDER and FSE+)Background: A prerequisite for understanding temporal changes in road crash severity is an unbiased description of this phenomenon. The aim of this study was to estimate the independent association trends of age, period and cohort with severity, encompassing the risk of death (RD) and the risk of death or hospitalisation (RDH) within 24 h, for drivers of passenger cars involved in road crashes with casualties in Spain from 1993 to 2020. Methods: The study population comprised 2,453,911 drivers of passenger cars aged 18 to 98 years involved in road crashes included in the registers of the General Directorate of Traffic. Crash- and driver-related variables with sufficient continuity over time were included, establishing RD and RDH as study outcomes. Temporal trends of both outcomes were analysed using multivariable Poisson regression and multivariable age-period-cohort intrinsic estimator models. An additional sensitivity analysis was performed for the subset of single crashes. Results: Severity estimates showed some variation across strategies. The APC model identified: (1) a J-shaped pattern for the effect of age on severity, (2) a decline in severity between 2001 and 2004 and 2013-2016, and (3) a birth cohort effect for both RD and RDH. In particular, the 1952-1958 cohort had the highest risk (RD = 1.17; 95%CI = 1.11-1.24 and RDH = 1.16; 95%CI = 1.13-1.19), followed by a decreasing trend in subsequent cohorts. Restricting the analysis to single crashes yielded similar results, with the exception of the age effect (severity increased with age). Furthermore, sex differences were observed-female sex was inversely associated with severity, especially for RD. Conclusions: RD and RDH decreased during the first decade of the 21st century, but seemed to stabilise from 2013 onwards. Evidence from this study support that birth cohort is associated with road crash severity, independent of age and period. This cohort effect might be due, at least partially, to improvements in general and road safety education. Further studies are needed to elucidate the causes of our findings and to identify factors accounting for sex differences.Publication Building competency to deal with environmental health challenges: experiences and a proposal.(Frontiers Editorial Office, 2024-11-28) Leonardi, Giovanni S; Zeka, Ariana; Ashworth, Matthew; Bouland, Catherine; Crabbe, Helen; Duarte-Davidson, Raquel; Etzel, Ruth A; Giuashvili, Nia; Gökdemir, Özden; Hanke, Wojciech; van den Hazel, Peter; Jagals, Paul; Khan, Ejaz Ahmad; Martin-Olmedo, Piedad; Pett, Joseph; Ruadze, Ekaterine; Santamaria, Maria Grazia; Semenza, Jan C; Sorensen, Cecilia; Vardoulakis, Sotiris; Yip, Fuyuen; Lauriola, Paolo; [Martin-Olmedo,P] Andalusian School of Public Health, Granada, Spain.; [Martin-Olmedo,P] Ibs. GRANADA, Granada, Spain.; Health Protection Research Unit in Environmental Change and Health; UK Health Security Agency; London School of Hygiene and Tropical Medicine; University College London; Met OfficeThe global landscape of professional training in environmental health, encompassing ecological public health or environmental public health, lacks consistent global implementation for training programs for public health practitioners, clinical professionals, and individuals across various disciplines, as well as standardized curricula for undergraduates. This training gap is related to the overall lack of capacity in addressing the population impacts of the triple challenge of pollution, biodiversity loss, and climate change, impeding the worldwide transition to and development of ecological sustainability. This paper reviews existing approaches and their potential to address implementation challenges within the necessarily tight timescale. Spreading of best practice appears feasible even without substantial additional resources, through the reorientation of current practices via comprehensive multi-disciplinary training programs. By adopting international best practices of training in environmental health, the focus in training and education can shift from future decision-makers to enhancing the competencies of current professionals and their institutions.Publication Programa y Libro de Abstracts del V Simposio de Terapias Avanzadas y Tecnologías Biomédicas del ibs.GRANADA(Insituto de Investigación Biosanitaria de Granada (ibsGRANADA), 2024-12-20) Chato-Astrain, Jesus; Martínez-Ruiz, Laura; Campos-Sanchez, FernandoPrograma y Libro de Abstracts del V Simposio de Terapias Avanzadas y Tecnologías Biomédicas del ibs.GRANADA celebrado el 20 de diciembre de 2024 en la Facultad de Medicina de la Universidad de Granada.Item Differences in Dietary Habits, Physical Exercise, and Quality of Life between Patients with Obesity and Overweight.(2021-07-20) Herrera-Espiñeira, Carmen; de Pascual Y Medina, Ana María; López-Morales, Manuel; Díaz Jiménez, Paloma; Rodríguez Ruiz, Antonia; Expósito-Ruiz, ManuelaOverweight and obesity differ in their repercussions on the health and health-related quality of life (HRQoL) of patients. The objective of this study was to compare physical activity levels and dietary habits before admission and HRQoL at discharge between patients with obesity and overweight. A cross-sectional study was undertaken among participants in a clinical trial on education for healthy eating and physical activity, enrolling non-diabetic patients admitted to Internal Medicine Departments. These were classified by body mass index (BMI) as having overweight (25-29.9 Kg/m2) or obesity (≥30 kg/m2). Data were gathered on sociodemographic characteristics, clinical variables (medication for anxiety/depression, Charlson Comorbidity Index, length of hospital stay), physical exercise and diet (International Physical Activity and Pardo Questionnaires), and HRQoL (EQ-5D-5L). The study included 98 patients with overweight (58.2% males) and 177 with obesity (52% males). In comparison to patients with obesity, those with overweight obtained better results for regular physical exercise (p = 0.007), healthy diet (p = 0.004), and "emotional eating" (p = 0.017). No between-group difference was found in HqoL scores. Patients with overweight and obesity differ in healthy dietary and physical exercise behaviors. Greater efforts are warranted to prevent an increase in the BMI of patients, paying special attention to their state of mind.Item Proteome Comparison Between Natural Desiccation-Tolerant Plants and Drought-Protected Caspicum annuum Plants by Microbacterium sp. 3J1.(2020-07-10) García-Fontana, Cristina; Vilchez, Juan Ignacio; Manzanera, MaximinoDesiccation-tolerant plants are able to survive for extended periods of time in the absence of water. The molecular understanding of the mechanisms used by these plants to resist droughts can be of great value for improving drought tolerance in crops. This understanding is especially relevant in an environment that tends to increase the number and intensity of droughts. The combination of certain microorganisms with drought-sensitive plants can improve their tolerance to water scarcity. One of these bacteria is Microbacterium sp. 3J1, an actinobacteria able to protect pepper plants from drought. In this study, we supplemented drought-tolerant and drought-sensitive plant rhizospheres with Microbacterium sp. 3J1 and analyzed their proteomes under drought to investigate the plant-microbe interaction. We also compare this root proteome with the proteome found in desiccation-tolerant plants. In addition, we studied the proteome of Microbacterium sp. 3J1 subjected to drought to analyze its contribution to the plant-microbe interaction. We describe those mechanisms shared by desiccation-tolerant plants and sensitive plants protected by microorganisms focusing on protection against oxidative stress, and production of compatible solutes, plant hormones, and other more specific proteins.