Martina Recalde Marcuard

Background: The global burden of mental and behavioral health disorders has been increasing in the last 30 years. These disorders cause premature mortality and pose an important public health burden. As the world population becomes more urbanized, the metropolitan environment continues to result in negative physical and mental health effects; however, green spaces have been shown to act as a buffer to these negative health effects. Although the relationship between mental health and green spaces has been investigated in previous studies, there are still gaps, especially with regards to the relationship between green spaces and specific mental and behavioral disorders.
Objective: To determine the association between green space (NDVI, percentage of green spaces) and the risk of developing depression, anxiety, stress, OCD and eating disorders in adults in Catalonia.
Methods: We will conduct a cohort study using data from the Information System for Research in Primary Care (SIDIAP). We will include all persons registered in the SIDIAP who are aged ?18 years between January 1, 2009 and December 31, 2018. The exposure of interest will be the availability of green spaces (measured using NDVI and the percentage of green space at the census tract level). Outcomes will be captured through diagnostic codes (ICD-10) of each mental and behavioral disorder. To evaluate the association between green spaces and the risk of each specific mental and behavioral disorder, cox proportional hazard models will be fitted to estimate cause specific hazard ratios (HR) and 95% confidence intervals (CIs).

Background: Nowadays, two thirds of the world’s population lives in urban areas. Air pollution and green spaces are two of the most-used indicators to measure the impact of urban environment on health. These indicators have been associated with different health outcomes such as lung cancer or premature mortality. A recent case-control publication has suggested that an increase in green spaces may decrease the incidence of breast cancer. Although this study is extremely relevant to the field, these results need to be replicated in longitudinal studies. Therefore, our objective is to determine whether air pollution and green spaces are associated with the risk of developing breast cancer in women living in Catalonia.
Methods: With data from the Information System on the Development of Research in Primary Care (SIDIAP), a cohort study will be carried out in women over 18 years of age between 2006 and 2018. At the census tract level, they will be assigned a level of air pollution and green spaces at the time of entry into the database until they have a diagnosis of breast cancer, die, emigrate or the study ends. We will use Cox models to investigate the association between the exposures and breast cancer, adjusting for possible confounding factors.

El projecte inclou dos estudis:
El primer estudi, ja fet fa una setmana durant 4 dies amb diverses bases de dades internacionals online, ha estudiat el comportament d’infeccions víriques similars que hi ha hagut en el passat: s’han descrit les característiques de les persones amb complicacions d’infeccions víriques com la grip, s’han valorat els predictors de resultats adversos entre els pacients hospitalitzats amb pneumònies virals, s’han generat algoritmes per identificar els pacients amb més risc de complicacions i/o morbimortalitat, i s’ha avaluat la seguretat dels tractaments utilitzats per a un ús potencial en Covid-19.
El segon estudi vol descriure les característiques de les persones amb Covid-19 a Catalunya, així com desenvolupar models predictius de les complicacions de la Covid-19 fent servir els mètodes i resultats obtinguts en el primer estudi. Per això, es farà la integració de la informació dels pacients infectats amb Covid-19 a Catalunya, la transformació de la nova informació a un model de dades internacional, i després de contrastar les dades amb altres bases de dades d’altres països, s’elaboraran uns criteris pronòstic aplicables a les polítiques de control de pandèmia de Covid-19 al nostre país.
Els models predictius de casos greus d’infecció vírica permetran classificar els pacients amb Covid-19 per gestionar-los adequadament, avaluant la necessitat de que el malalt vagi a l’hospital o es quedi a casa, i les condicions necessàries per al seu tractament.

A goal of Discovery and Translational Sciences is to implement new technology platforms to accelerate research. This grant allows the rapid acquisition and analysis of emerging data from the ongoing global outbreak of Covid-19. The clinical and epidemiological data will inform the foundation’s response to the outbreak including expanding our understanding of risk factors for disease progression and the design of efficient clinical trials.

Objectives: To investigate the association between bariatric surgery (BS) and the risk of obesity-related cancers (esophagus, liver, pancreas, colorectal, breast (postmenopausal), endometrium, kidney, stomach, gallbladder, ovary, thyroid, meningioma, and multiple myeloma) and to examine the association between BS with all-cause mortality.

Design: This study will be a matched cohort using SIDIAP and CMBD-PADRIS source data and data been mapped to the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM).

Setting: Population-based, electronic health records from primary and secondary care in Catalonia.

Participants: Individuals aged ?18 years, with a record of BMI ?35 kg/m2 or an Obesity diagnosis, without history of bariatric surgery nor cancer, who have been on the database for 1 year before study entry and have at least 1 year of follow-up.

Exposure: Bariatric surgery procedure.

Outcomes: Incident diagnoses of obesity-related cancers and date of death.

Expected Results: Participants who undergo BS have a decreased risk of obesity-related cancers and improved survival compared to morbidly obese participants who do not undergo bariatric surgery.

Applicability: The results of this study will be valuable for policymakers (decision-making about financing this procedure), for surgeons (surgery recommendation), for patients (knowing the risks and benefits of this procedure) and for general practitioners (advising patients to consult a surgeon).

Limitations: Insufficient statistical power to study less frequent cancer types or to find suitable matches of cases and possible unmeasured confounding due to variables that might be lacking in the SIDIAP database.

Background
Clinical trials have shown an association between aromatase inhibitor (AI) use for the treatment of breast cancer and adverse musculoskeletal disease when compared with tamoxifen. This has not been investigated in routine clinical practice.

Hypothesis
In comparison to tamoxifen, AI use is associated with an increased incidence of carpal tunnel syndrome (CTS), tendinopathy, osteoarthritis and related procedures/surgery in post menopausal women with hormone receptor positive breast cancer.

Methodology
Cohort study design, using non identifiable SIDIAP OHDSI CDM mapped data in order to enable replication of the study internationally within the OHDSI network. All post-menopausal (defined >55 years) women with an incident diagnosis of breast cancer, with 6 months continous enrolment prior to diagnosis, and incident use of AI, tamoxifen, or both within 1 year of diagnosis. Those with a prevalent cancer, or outcome prior to breast cancer diagnosis are excluded. Incidence of fracture (vertebral and appendicular fractures) to be used as a positive control outcome.

Variables & Measurements
The date of exposure will be identified from the first drug exposure; outcomes defined as the first incident record of an outcome, each outcome assessed independently, identified using OMOP CDM ATLAS generated definitions.

Statistical Analysis
Propensity score adjustment to minimise confounding. Cumulative Incidence of outcome; cox proportional hazards modelling to estimate hazard ratios for each of the outcomes.

Expected results
Incidence of adverse musculoskeletal outcomes at a population level in Catalonia, with replication worldwide to enable international comparison.

Applicability
To counsel women at the beginning of treatment; consider earlier identification and surveillance during treatment.

Strengths & Limitations
The study is based upon drug dispensation rather than adherence, and only contains information from clinical services, leading to the potential to underreport an association. The study aims to increase generalisability through using OMOP CDM mapped data, to ensure the study can be replicated within the international OHDSI community.

Investigar si la enfermedad cardiovascular incidente (ECV) modifica la asociación entre la obesidad y el riesgo de desarrollar cánceres «»relacionados con la obesidad»» utilizando modelos de supervivencia (Cox o modelos paramétricos flexibles). Para tal fin, replicaremos los análisis estadísticos en el Enlace de datos de investigación de práctica clínica (CPRD) realizado previamente en el SIDIAP.

Background:
Increased body mass index (BMI), indicating general adiposity, is an established risk factor for several cancers. There is convincing evidence for associations between BMI and cancers of the oesophagus (adenocarcinoma), pancreas, colon, rectum, breast (postmenopausal), endometrium, liver, kidney and probable evidence for gallbladder, ovary, and prostate. However, data are currently limited for many other cancer sites. Recently, a population-based cohort study of 5.24 million UK adults reported associations between BMI and 17 cancers, suggesting wider-ranging associations. These observations are important and need replication in other populations. Furthermore, BMI alone may not fully capture the complex biology underlying associations between adiposity and cancer risk, and individuals with similar BMI may have distinct disease risks depending on their body fat distribution. Waist circumference (WC) is often used as an indicator of central adiposity and have even been suggested to be a superior predictor of cancer risk. Furthermore, there is still a crucial need for better characterisation of existing obesity-cancer links to determine dose-response relationships and effect modification by important individual level factors across a wide range of cancer sites.
Hypothesis and Objectives:
The main objective of this project is to investigate the relationships between adiposity and 22 major cancers using measured BMI and outcome data from prospectively collected primary care records in 6 million individuals from a Mediterranean population.
Specific objectives are to investigate (1) non-linear dose-response associations and effect modification by individual level factors (e.g., age group, smoking, hormone use); (2) relations of duration of overweight/obesity to site-specific cancer using repeated measures of BMI; and (3) to derive standardized risk estimates for general (BMI) and central (WC) adiposity in relation to site-specific cancers.
Setting and Methods:
The proposed study will use comprehensive data from a prospective population-based database from the Information System for the Development of Research in Primary Care (SIDIAP). SIDIAP includes data of anonymized patient records for nearly six million people throughout Catalonia since 2006. SIDIAP includes all data collected by health professionals during routine visits, including anthropometric measurements, clinical diagnoses, as well as demographic and lifestyle information. The quality of these data has been previously documented.
All people in SIDIAP aged 15 years or older with BMI data and subsequent follow-up will be included. Baseline measured BMI will be calculated and assigned as the earliest BMI recorded. Repeated weight measurements will be used to predict individual BMI trajectories for each study participant. Approximately 260,900 first primary cancers have been recorded from 2006-2014. Hazard ratios will be calculated using Cox models, and spline models will be fitted to investigate the dose-response nature of the observed associations. Overweight/obesity duration will be estimated using quadratic growth models.
Impact:
This project will represent one of the largest studies in this area of research to date and will substantially advance our understanding of the impact of obesity on cancer risk, including rarer cancers and cancer at younger age. It will strengthen the rationale to implement strategies of obesity prevention and mitigating the public health effects of cancer due to obesity.