Carme Borrell

IR-Sant Pau - Sant Pau Institute of Biomedical Research, Barcino, Catalonia, Spain

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Publications (437)994.47 Total impact

  • Gaceta Sanitaria 06/2015; 29(3). DOI:10.1016/j.gaceta.2015.03.005 · 1.25 Impact Factor
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    ABSTRACT: Socioeconomic inequalities affecting health are of major importance in Europe. The literature enhances the role of social determinants of health, such as socioeconomic characteristics and urbanization, to achieve health equity. Yet, there is still much to know, mainly concerning the association between cause-specific mortality and several social determinants, especially in metropolitan areas. This study aims to describe the geographical pattern of cause-specific mortality in the Lisbon Metropolitan Area (LMA), at small area level (parishes), and analyses the statistical association between mortality risk and health determinants (material deprivation and urbanization level). Fourteen causes have been selected, representing almost 60 % of total mortality between 1995 and 2008, particularly those associated with urbanization and material deprivation. A cross-sectional ecological study was carried out. Using a hierarchical Bayesian spatial model, we estimated sex-specific smoothed Standardized Mortality Ratios (sSMR) and measured the relative risks (RR), and 95 % credible intervals, for cause-specific mortality relative to 1. urbanization level, 2. material deprivation and 3. material deprivation adjusted by urbanization. The statistical association between mortality and material deprivation and between mortality and urbanization changes by cause of death and sex. Dementia and MN larynx, trachea, bronchus and lung are the causes of death showing higher relative risk associated with urbanization. Infectious and parasitic diseases, Chronic liver disease and Diabetes are the causes of death presenting higher relative risk associated with material deprivation. Ischemic heart disease was the only cause with a statistical association with both determinants, and MN female breast was the only without any statistical association. Urbanization level reduces the impact of material deprivation for most of the causes of death. Men face a higher impact of material deprivation and urbanization level, than women, in most cause-specific mortality, even when considering the adjusted model. Our findings explore the specific pattern of fourteen causes of death in LMA and reveals small areas with an excess risk of mortality associated with material deprivation, thereby identifying problematic areas that could potentially benefit from public policies effecting social inequalities.
    International Journal for Equity in Health 06/2015; 14(1):55. DOI:10.1186/s12939-015-0182-y · 1.71 Impact Factor
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    ABSTRACT: Background Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.
    International Journal for Equity in Health 04/2015; 14(1). DOI:10.1186/s12939-015-0164-0 · 1.71 Impact Factor
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    ABSTRACT: The relation between “neo-Marxian” social class (NMSC) and health in the working population has received considerable attention in public health research. However, less is known about the distribution of mental well-being according to NMSC in a European context. The objectives of this study are (i) to analyse the association of mental well-being and NMSC among employees in Europe (using a welfare regime typology), (ii) to investigate whether the relation between NMSC and mental well-being is the same in women compared to men within each welfare regime, and (iii) to examine within each welfare regime the role of the gender division of labour and job quality as potential mediating factors in explaining this association.
    Social Science & Medicine 03/2015; 128. DOI:10.1016/j.socscimed.2015.01.027 · 2.56 Impact Factor
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    International Journal of Public Health 03/2015; · 1.97 Impact Factor
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    ABSTRACT: To evaluate theses of a Masters program in Public Health (MPH), in terms of the students' and theses' characteristics that influence publication of the thesis as a scientific article. Longitudinal study of students who successfully completed the MPH at Universitat Pompeu Fabra and Universitat Autònoma de Barcelona (Spain) from 2006 to 2010. Participants completed an electronic survey and additional data were gathered from university files. 162 students participated in the study (83 % response rate). 60.5 % had already published an article derived from their thesis at the time of the study or were in process of publishing it. The likelihood of publishing in a peer-reviewed journal was greater among women (aRR = 1.41), among those who had a bachelor's degree in sciences other than health (aRR = 1.40), had completed the MPH on time (aRR = 2.10), had enrolled in a doctoral program after the MPH (aRR = 1.44) or had a masters thesis score of ≥7 (aRR = 1.61). The majority of MPH students published their thesis in a peer-reviewed journal. The strongest predictors of successful publication were related to academic performance.
    International Journal of Public Health 03/2015; 60(4). DOI:10.1007/s00038-015-0664-0 · 1.97 Impact Factor
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    ABSTRACT: The study examines changes in the distribution and socioeconomic inequalities of dental care utilization among adults after the major healthcare reform in Chile, 2004–2009. We evaluated the proportion of people who visited the dentist at least once in the previous two years, and the mean number of visits. These outcome variables were stratified by sex, age (20–39, 40–59, 60–63; ≥64 years), educational level (primary, secondary, higher), type of health insurance (public, private, uninsured), and socioeconomic status (quintiles of an asset-index). We also used the concentration index (CIndex) to assess the extent of socioeconomic inequalities in the use of dental care, stratified by age and sex as a proxy for OPEN ACCESS Int. J. Environ. Res. Public Health 2015, 12 2824 dental care needs. The use of dental care significantly increased between 2004 and 2009, especially in those with public health insurance, with lower educational level and lower socioeconomic status. The CIndex for the total population significantly decreased both for the proportion who used dental care, and also the mean number of visits. Findings suggest that the use of dental care increased and socioeconomic-related inequalities in the utilization of dental care declined after a Major Health Reform, which included universal coverage for some dental cares in Chile. However, efforts to ameliorate these inequalities require an approach that moves beyond a sole focus on rectifying health coverage.
    International Journal of Environmental Research and Public Health 03/2015; 12(3):2823-2836. DOI:10.3390/ijerph120302823 · 1.99 Impact Factor
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    ABSTRACT: Introduction Socio-economic inequalities in health are large in urban areas; however, local municipal governments may plan, manage and provide services and policies which can reduce these. The objective of this study was to describe the beliefs and perceptions of public policymakers in a European city, Barcelona. They are the key actors in designing and implementing urban public policies. Methods A qualitative research study describing policymakers’ beliefs on health inequalities. The study population were twelve policymakers. These were politicians or officers from the city council. Informant profiles were selected using a theoretical sample. Semi-structured individual interviews were performed to collect the data and a thematic content analysis was carried out. Results Politicians were aware of health inequalities in their city and identified diverse social causes. They viewed reducing inequalities as a priority for the city’s government. Officers were less knowledgeable and described less efforts in addressing health inequalities. It was stated by some that reducing inequalities in non-health sectors helped to reduce health inequalities indirectly and there was some collaboration between two sectors. The most frequent barriers encountered when implementing policies were funding and the cities’ limited authority. Conclusions Officers and policymakers had different levels of awareness and access to information on health and its socials determinants. Officers referred to specific causes of health inequalities and policies which related to their sectors and politicians were more familiar with upstream determinants and policies. Some participants explained that policies and programmes needed to be evaluated and very little intersectoral action was said to be carried out. More efforts should be made to provide all policymakers with information on the social determinants of health inequalities. Research on health inequalities and policy should engage with policymakers and promote health as a cross cutting issue in the city council in liaison with the third sector.
    International Journal for Equity in Health 02/2015; 14(1). DOI:10.1186/s12939-015-0143-5 · 1.71 Impact Factor
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    ABSTRACT: Socioeconomic inequalities are increasingly recognised as an important public health issue, although their role in the leading causes of mortality in urban areas in Europe has not been fully evaluated. In this study, we used data from the INEQ-CITIES study to analyse inequalities in cause-specific mortality in 15 European cities at the beginning of the 21st century. A cross-sectional ecological study was carried out to analyse 9 of the leading specific causes of death in small areas from 15 European cities. Using a hierarchical Bayesian spatial model, we estimated smoothed Standardized Mortality Ratios, relative risks and 95% credible intervals for cause-specific mortality in relation to a socioeconomic deprivation index, separately for men and women. We detected spatial socioeconomic inequalities for most causes of mortality studied, although these inequalities differed markedly between cities, being more pronounced in Northern and Central-Eastern Europe. In the majority of cities, most of these causes of death were positively associated with deprivation among men, with the exception of prostatic cancer. Among women, diabetes, ischaemic heart disease, chronic liver diseases and respiratory diseases were also positively associated with deprivation in most cities. Lung cancer mortality was positively associated with deprivation in Northern European cities and in Kosice, but this association was non-existent or even negative in Southern European cities. Finally, breast cancer risk was inversely associated with deprivation in three Southern European cities. The results confirm the existence of socioeconomic inequalities in many of the main causes of mortality, and reveal variations in their magnitude between different European cities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Journal of Epidemiology &amp Community Health 01/2015; 69(5). DOI:10.1136/jech-2014-204312 · 3.29 Impact Factor
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    ABSTRACT: The aim of this study was to estimate the magnitude of gender differences in hazardous drinking among middle-aged people and to analyse whether these differences are associated with contextual factors, such as public policies or socioeconomic factors. Cross-sectional design. The study population included 50- to 64-year-old residents of 16 European countries who participated in the Survey of Health, Ageing and Retirement in Europe project conducted in 2010-12 (n = 26 017). We estimated gender differences in hazardous drinking in each country. To determine whether different social context or women's empowerment variables were associated with gender differences in hazardous drinking, we fitted multilevel Poisson regression models adjusted for various individual and country-level variables, which yielded prevalence ratios and their 95% confidence intervals (95% CI). Prevalence of hazardous drinking was significantly higher in men than women [30.2% (95% CI: 29.1-31.4%) and 18.6% (95% CI: 17.7-19.4%), respectively] in most countries, although the extent of these differences varied between countries. Among individuals aged 50-64 years in Europe, risk of becoming a hazardous drinker was 1.69 times higher (95% CI: 1.45-1.97) in men, after controlling for individual and country-level variables. We also found that lower values of the gender empowerment measure and higher unemployment rates were associated with higher gender differences in hazardous drinking. Countries with the greatest gender differences in hazardous drinking were those with the most restrictions on women's behaviour, and the greatest gender inequalities in daily life. Lower gender differences in hazardous drinking seem to be related to higher consumption among women. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
    The European Journal of Public Health 01/2015; DOI:10.1093/eurpub/cku234 · 2.46 Impact Factor
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    ABSTRACT: The aim of this study was to analyze inequalities in the prevalence of poor mental health and their association with socioeconomic variables and with the care network in the Autonomous Communities in Spain. A cross-sectional multilevel study was performed, which analyzed individual data from the National Health Survey in Spain (ENS), in 2006 (n = 29,476 people over the age of 16). The prevalence of poor mental health was the dependent variable, measured by the General Health Questionnaire (GHQ-12 > = 3). Individual and contextual socioeconomic variables, along with mental health services in the Autonomous Communities, were included as independent variables. Models of multilevel logistic regression were used, and odds ratios (OR) were obtained, with confidence intervals (CI) of 95%. The results showed that there are inequalities in the prevalence of poor mental health in Spain, associated to contextual variables, such as unemployment rate (men OR 1.04 CI 1.01-1.07; women OR 1.02 CI 1.00-1.05). On the other hand, it was observed that inequalities in the mental health care resources in the Autonomous Communities also have an impact on poor mental health.
    01/2015; 18:E27. DOI:10.1017/sjp.2015.28
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    ABSTRACT: Introduction: Urban populations are growing and to accommodate these numbers, cities are becoming more involved in urban renewal programs to improve the physical, social and economic conditions in different areas. This paper explores some of the complexities surrounding the link between urban renewal, health and health inequalities using a theory-driven approach. Methods: We focus on an urban renewal initiative implemented in Barcelona, the Neighbourhoods Law, targeting Barcelona's (Spain) most deprived neighbourhoods. We present evidence from two studies on the health evaluation of the Neighbourhoods Law, while drawing from recent urban renewal literature, to follow a four-step process to develop a program theory. We then use two specific urban renewal interventions, the construction of a large central plaza and the repair of streets and sidewalks, to further examine this link. Discussion: In order for urban renewal programs to affect health and health inequality, neighbours must use and adapt to the changes produced by the intervention. However, there exist barriers that can result in negative outcomes including factors such as accessibility, safety and security. Conclusion: This paper provides a different perspective to the field that is largely dominated by traditional quantitative studies that are not always able to address the complexities such interventions provide. Furthermore, the framework and discussions serve as a guide for future research, policy development and evaluation.
    Social Science & Medicine 01/2015; 124:266-274. DOI:10.1016/j.socscimed.2014.11.050 · 2.56 Impact Factor
  • Carme Borrell
    12/2014; 2(2). DOI:10.1016/j.jth.2014.10.007
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    ABSTRACT: Cause-of-death data linked to information on socioeconomic position form one of the most important sources of information about health inequalities in many countries. The proportion of deaths from ill-defined conditions is one of the indicators of the quality of cause-of-death data. We investigated educational differences in the use of ill-defined causes of death in official mortality statistics. Using age-standardized mortality rates from 16 European countries, we calculated the proportion of all deaths in each educational group that were classified as due to "Symptoms, signs and ill-defined conditions". We tested if this proportion differed across educational groups using Chi-square tests. The proportion of ill-defined causes of death was lower than 6.5% among men and 4.5% among women in all European countries, without any clear geographical pattern. This proportion statistically significantly differed by educational groups in several countries with in most cases a higher proportion among less than secondary educated people compared with tertiary educated people. We found evidence for educational differences in the distribution of ill-defined causes of death. However, the differences between educational groups were small suggesting that socioeconomic inequalities in cause-specific mortality in Europe are not likely to be biased.
    BMC Public Health 12/2014; 14(1):1295. DOI:10.1186/1471-2458-14-1295 · 2.32 Impact Factor
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    ABSTRACT: The objective of this study was to analyze the association between social class and psychosocial occupational risk factors and self-rated health and mental health in a Chilean population. A cross-sectional study analyzed data from the First National Survey on Employment, Work, Quality of Life, and Male and Female Workers in Chile (N = 9,503). The dependent variables were self-rated health status and mental health. The independent variables were social class (neo-Marxist), psychosocial occupational risk factors, and material deprivation. Descriptive and logistic regression analyses were performed. There were inequalities in the distribution of psychosocial occupational risk factors by social class and sex. Furthermore, social class and psychosocial occupational risk factors were associated with unequal distribution of self-rated health and mental health among the working population in Chile. Occupational health interventions should consider workers' exposure to socioeconomic and psychosocial risk factors.
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    ABSTRACT: to Describe perceived health, mental health and certain health-related behaviors according to sexual attraction and behavior in the population residing in Barcelona in 2011.
    Gaceta Sanitaria 09/2014; DOI:10.1016/j.gaceta.2014.07.013 · 1.25 Impact Factor
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    ABSTRACT: Introduction: In Czechia, immigrants without permanent residence are not entitled to public health insurance and should purchase a commercial insurance. Methods: Using data from a survey of Ukrainian immigrants and a country-wide Health Interview Survey for Czechs, we analyse inequalities in access to different healthcare services. Results: Ukrainians with a permanent visa have lower access than Czechs to specialist and dental care. Ukrainians with a long-term visa have a lower access than Czechs to all types of care, and than compatriots with a permanent visa to primary care (adjusted Prevalence Ratio 0.45, 95%CI 0.34-0.61), hospitalization (0.29, 0.12-0.71) and emergency room (0.60, 0.37-1.00). Conclusions: The exclusion of long-term immigrants from the public healthcare system should be revised on grounds of equity and public health protection.
    International Journal of Public Health 07/2014; 59(5). DOI:10.1007/s00038-014-0592-4 · 1.97 Impact Factor
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    ABSTRACT: a b s t r a c t Few studies have addressed the effect of gender policies on women's health and gender inequalities in health. This study aims to analyse the relationship between the orientation of public gender equality policies and gender inequalities in health in European countries, and whether this relationship is mediated by gender equality at country level or by other individual social determinants of health. A multilevel cross-sectional study was performed using individual-level data extracted from the Eu-ropean Social Survey 2010. The study sample consisted of 23,782 men and 28,655 women from 26 European countries. The dependent variable was self-perceived health. Individual independent variables were gender, age, immigrant status, educational level, partner status and employment status. The main contextual independent variable was a modification of Korpi's typology of family policy models (Dual-earner, Traditional-Central, Traditional-Southern, Market-oriented and Contradictory). Other contextual variables were the Gender Empowerment Measure (GEM), to measure country-level gender equality, and the Gross Domestic Product (GDP). For each country and country typology the prevalence of fair/poor health by gender was calculated and prevalence ratios (PR, women compared to men) and 95% confi-dence intervals (CI) were computed. Multilevel robust Poisson regression models were fitted. Women had poorer self-perceived health than men in countries with traditional family policies (PR ¼ 1.13, 95%CI: 1.07e1.21 in Traditional-Central and PR ¼ 1.27, 95%CI: 1.19e1.35 in Traditional-Southern) and in Contradictory countries (PR ¼ 1.08, 95%CI: 1.05e1.11). In multilevel models, only gender inequalities in Traditional-Southern countries were significantly higher than those in Dual-earner countries. Gender inequalities in self-perceived health were higher, women reporting worse self-perceived health than men, in countries with family policies that were less oriented to gender equality (espe-cially in the Traditional-Southern country-group). This was partially explained by gender inequalities in the individual social determinants of health but not by GEM or GDP.
    Social Science & Medicine 07/2014; 117. DOI:10.1016/j.socscimed.2014.07.018 · 2.56 Impact Factor
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    ABSTRACT: The economic crisis has adverse effects on determinants of health and health inequalities. The aim of this article was to present a set of indicators of health and its determinants to monitor the effects of the crisis in Spain. On the basis of the conceptual framework proposed by the Commission for the Reduction of Social Health Inequalities in Spain, we searched for indicators of social, economic, and political (structural and intermediate) determinants of health, as well as for health indicators, bearing in mind the axes of social inequality (gender, age, socioeconomic status, and country of origin). The indicators were mainly obtained from official data sources published on the internet. The selected indicators are periodically updated and are comparable over time and among territories (among autonomous communities and in some cases among European Union countries), and are available for age groups, gender, socio-economic status, and country of origin. However, many of these indicators are not sufficiently reactive to rapid change, which occurs in the economic crisis, and consequently require monitoring over time. Another limitation is the lack of availability of indicators for the various axes of social inequality. In conclusion, the proposed indicators allow for progress in monitoring the effects of the economic crisis on health and health inequalities in Spain.
    Gaceta Sanitaria 06/2014; 28:124–131. DOI:10.1016/j.gaceta.2014.03.009 · 1.25 Impact Factor
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    ABSTRACT: In the last decade, the Neighbourhoods Law in Catalonia (Spain) funded municipalities that presented urban renewal projects within disadvantaged neighbourhoods focusing on physical, social and economic improvements. The objective of the study was to evaluate the effects of this law on the health and health inequalities of residents in the intervened neighbourhoods in the city of Barcelona. A quasi-experimental predesign and postdesign was used to compare adult residents in five intervened neighbourhoods with eight non-intervened comparison neighbourhoods with similar socioeconomic characteristics. The Barcelona Health Survey was used for studying self-rated and mental health in pre (2001, 2006) and post (2011) years. Poisson regression models stratified by sex were used to compute prevalence ratios comparing 2011 with 2006, and later stratified by social class, to study health inequalities. The intervened neighbourhoods had a significant decrease in poor self-rated health in both sexes while no significant changes occurred in the comparison group. When stratified by social class, a significant improvement was observed in poor self-rated health in the manual group of the intervened neighbourhoods in both sexes, resulting in a decrease in self-rated health inequalities. Similar results were observed in poor mental health of women, while in men, poor mental health worsens in both neighbourhood groups but mostly in the comparison group. The Neighbourhoods Law had a positive effect on self-rated health and seems to prevent poor mental health increases in both sexes and especially among manual social classes.
    Journal of epidemiology and community health 05/2014; 68(9). DOI:10.1136/jech-2013-203434 · 3.29 Impact Factor

Publication Stats

7k Citations
994.47 Total Impact Points


  • 2013–2015
    • IR-Sant Pau - Sant Pau Institute of Biomedical Research
      Barcino, Catalonia, Spain
    • Madrid Salud
      Madrid, Madrid, Spain
  • 1997–2015
    • Agència de Salut Pública de Barcelona
      Barcino, Catalonia, Spain
    • University Pompeu Fabra
      • Department of Experimental and Health Sciences
      Barcino, Catalonia, Spain
  • 2014
    • Erasmus MC
      • Department of Public Health
      Rotterdam, South Holland, Netherlands
  • 2012–2013
    • University of Alicante
      • Community Nursing, Preventive Medicine and Public Health and History of Science
      Alicante, Valencia, Spain
    • IMIM Hospital del Mar Medical Research Institute
      Barcino, Catalonia, Spain
  • 2001–2013
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 2004–2012
    • Instituto de Salud Carlos III
      Madrid, Madrid, Spain
    • Instituto Nacional de Salud Pública
      Cuernavaca, Morelos, Mexico
  • 2011
    • Institut Medicina Legal De Catalunya
      Barcino, Catalonia, Spain
  • 2010
    • Center for Innovative Public Health Research
      سان کلمنت، کالیفرنیا, California, United States
  • 2006–2009
    • Erasmus Universiteit Rotterdam
      • Department of Public Health (MGZ)
      Rotterdam, South Holland, Netherlands
    • Universidad Autónoma de Madrid
      Madrid, Madrid, Spain
  • 2008
    • Universitat de Girona
      • Department of Nursing
      Girona, Catalonia, Spain
  • 2007
    • Queensland University of Technology
      • Institute of Health and Biomedical Innovation
      Brisbane, Queensland, Australia
  • 2000–2006
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 2005
    • University of São Paulo
      • School of Public Health (FSP)
      San Paulo, São Paulo, Brazil
  • 2004–2005
    • University of Helsinki
      Helsinki, Uusimaa, Finland
  • 1997–2005
    • Catalan Institute of Oncology
      Badalona, Catalonia, Spain
  • 2000–2003
    • Instituto de Salud Global de Barcelona
      Barcino, Catalonia, Spain
  • 1999–2003
    • Complutense University of Madrid
      Madrid, Madrid, Spain
  • 2002
    • University of Maryland, Baltimore
      • School of Nursing
      Baltimore, MD, United States
  • 1993–1998
    • Institut Català de la Salut
      Cerdanyola del Vallès, Catalonia, Spain
  • 1996
    • Harvard University
      Cambridge, Massachusetts, United States