SUM701S Environmental impacts on Health and Disease 2024
Topic outline
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The summer school assessment consists of 2 parts.
Part 1 includes the exam, with 50 MCQs (1 mark each) for the 50% of the total mark.
Part 2 includes in-class presentation for the 50% of the total mark. In-class presentations will be double-marked.
Presentations marking rubric uploaded below.
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SUM701S Assessment
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In this session we will welcome you to the summer school. Dr Stavroula Kanoni will give you an overview of the Summer school, the different sessions, the learning outcomes and the assessment.
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The relationship between the natural environment and human health has gained significant attention in recent years. The natural environment influences various aspects of human health. This lecture explores the diverse ways in which exposure to natural environments can impact physical, mental, and social well-being. By understanding these connections, we can recognize the importance of preserving and integrating nature into our daily lives to promote a healthier society.
Further reading:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041730/ Barbier EB. Habitat loss and the risk of disease outbreak. J Environ Econ Manage. 2021 Jul;108:102451. doi: 10.1016/j.jeem.2021.102451. Epub 2021 Apr 13. PMID: 33867599; PMCID: PMC8041730.
https://www.sciencedirect.com/science/article/pii/S2212420922005696 Willis Gwenzi, Emilia C. Skirmuntt, Tendai Musvuugwa, Charles Teta, Dariusz Halabowski, Piotr Rzymski, Grappling with (re)-emerging infectious zoonoses: Risk assessment, mitigation framework, and future directions, International Journal of Disaster Risk Reduction, Volume 82, 2022, 103350, ISSN 2212-4209, https://doi.org/10.1016/j.ijdrr.2022.103350.
https://link.springer.com/article/10.1007/s11154-019-09521-z Yilmaz, B., Terekeci, H., Sandal, S. et al. Endocrine disrupting chemicals: exposure, effects on human health, mechanism of action, models for testing and strategies for prevention. Rev Endocr Metab Disord 21, 127–147 (2020). https://doi.org/10.1007/s11154-019-09521-z
https://www.science.org/doi/full/10.1126/sciadv.aax0903 Gregory N. Bratman et al, Nature and mental health: An ecosystem service perspective.Sci. Adv.5,eaax0903(2019).
Original slides presented in powerpoint can be downloaded from here: https://docs.google.com/presentation/d/11bQsRyuYM60bhhOyZtjl1j56ynyZDDQs/edit?usp=sharing&ouid=104117054285749695337&rtpof=true&sd=true (file too big for QMplus; link will expire at the end of August 2023)-
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In this journal club we will discuss two recent publications from the same research group, evaluating the impact of air pollution, road traffic noise and lack of greenness on the risk of type 2 diabetes and stroke.
https://www.sciencedirect.com/science/article/pii/S0160412022004974?via%3Dihub
https://www.sciencedirect.com/science/article/pii/S2666776223000741?via%3Dihub
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What do you think might be the potential biological/physiological mechanisms that could explain the findings of these two papers?
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This lecture explores the intersection of climate change and health, framed in a multi-tiered-approach. Here we explore issues such as heatwaves, food security, vector-borne disease and mental health issues as a result of climate change, their implications to health. This lecture also explores the benefits of adopting a public health approach in addressing the reality of climate change, with a possible win-win approach in policy making and strategic implementation.
Further reading:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01787-6/fulltextRomanello, M., McGushin, A., Di Napoli, C., Drummond, P., Hughes, N., Jamart, L., Kennard, H., Lampard, P., Rodriguez, B.S., Arnell, N. and Ayeb-Karlsson, S., 2021. The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. The Lancet, 398(10311), pp.1619-1662.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8835258/Orsetti, E., Tollin, N., Lehmann, M., Valderrama, V. A., & Morató, J. (2022). Building resilient cities: climate change and health interlinkages in the planning of public spaces. International journal of environmental research and public health, 19(3), 1355.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32822-8/fulltextSwinburn, B. A., Kraak, V. I., Allender, S., Atkins, V. J., Baker, P. I., Bogard, J. R., ... & Dietz, W. H. (2019). The global syndemic of obesity, undernutrition, and climate change: the Lancet Commission report. The Lancet, 393(10173), 791-846.
The original slides presented in powerpoint can be downloaded from here: https://docs.google.com/presentation/d/17IX2yVsI_w5yHfA9L-zvDR-KEeVxBPxE/edit?usp=sharing&ouid=104117054285749695337&rtpof=true&sd=true (file too big for QMplus; link will expire at the end of August 2023)-
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This talk reviews the effects of air pollution on children’s lungs. It first describes the pollutant mix in urban areas, then reviews in vitro data on how fossil fuel particles increase susceptibility to infection. The epidemiological evidence for adverse health effects is then examined, and how the risks of air pollution can be communicated to patients, the public and policy makers described.
The original slides presented in powerpoint can be downloaded from here: https://docs.google.com/presentation/d/1pd5cY_mSupokWtQvr_zJmcy_7GR2C52K/edit?usp=sharing&ouid=104117054285749695337&rtpof=true&sd=true (file too big for QMplus; link will expire at the end of August 2023)Further reading below as pdfs.
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It is well established that bacteria are the main cause of infectious disease. However, evidence is now emerging that these microorganisms may be indirectly responsible for diseases where the aetiology remains unclear, including cancer and rheumatoid arthritis. The mouth contains a range of sites with different environmental characteristics which enables a diverse normal microflora to exist with a total population in the region of 1010 bacteria. Some members of the normal microflora can act as opportunistic pathogens under certain circumstances and cause the major diseases of the oral cavity, namely periodontitis (gum disease) and dental caries. The relationship between the periodontal pathogens and systemic diseases has been explored for the past 30 years. This lecture will cover the possible connection between oral bacteria and cardiovascular disease, pneumonia, preterm / low birth weight and diabetes.
Further reading:
https://www.sciencedirect.com/science/article/abs/pii/S1075996413001625?via%3Dihub
https://www.frontiersin.org/articles/10.3389/fphys.2021.709438/full-
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Further reading as pdf files.
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In this lecture, we explore the links between climate change and pandemics throughout history, including the Plague of Justinian, the Black Death, and look forward to the present and the future. We will examine how environmental conditions catalyze the emergence and spread of communicable and vector-borne diseases, propagated by habitat loss and environmental change. This lecture will also offers insights into the significance of proactive global climate policies in mitigating health risks, thus highlighting the need for a multi-sectoral approach in addressing these global challenges.
Further reading:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812531/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720230/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513891/
Friel, S., Schram, A., & Townsend, B. (2020). The nexus between international trade, food systems, malnutrition and climate change. Nature Food, 1(1), 51-58 (bellow as pdf)-
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Rapid advances in DNA sequencing technologies in the past 20 years have revolutionized our understanding of the diversity of microbial life living within us and around us. This has allowed researchers to discover the influence of these communities on human health. The communities of microbes (microbiota/microbiome) living within the human body are essential for nutrient digestion, hormone production, gene regulation and interaction with our peripheral and central nervous systems. However, the communities of microbes living within the body differ depending on our environments and are changing significantly with industrialization. This session will introduce the human microbiome at different stages throughout life, how it has changed with industrialization and the impact this has on non-communicable diseases.
Further reading: Uploaded as files-
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The emergence of COVID-19 led to a number of works which integrate epidemiological with economic models to study the feedback effects between the economy on one hand and the pandemic and Non Pharmaceutical Interventions (NPIs) on the other. Even though the links between epidemiology and social sciences are well known and define fields of study such as Social Epidemiology and Sociology of Health, the insights of these fields have to a great extent not been incorporated to economic epidemiological models.
This lecture will discuss how epidemiological models can and should be extended to include ideas from not only from economics but also from behavioural and social sciences such as the rich literature on Social Determinants of Health. The lecture will cover the following key topics:
- Infection dynamics: The SIR model and some key variations
- A Behavioural SIR model: Theory and Empirics
- A Socioeconomic compartmental model: Why socioeconomic conditions matter
Proposed readings
Di Guilmi, Galanis, Baskozos (2021)
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Further reading:
Stress and heart disease. https://www.nature.com/articles/nrcardio.2012.45
Chronic inflammation in the etiology of disease across the life span. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7147972/
Inflammation and Treatment Resistance in Major Depression: The Perfect Storm https://www.psychiatrictimes.com/view/inflammation-and-treatment-resistance-major-depression-perfect-storm
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This session will focus on exploring and discussing links between the built environment and mental health. Students will learn about the direct and indirect effects of the built environment on mental health. They will also become familiar with the concept of a therapeutic environment. We will discuss built environment in healthcare facilities, but also, more broadly, in residential and work places. The session will include presentation of key concepts and interactive discussions in small groups.
Further reading:
- Evans GW. The built environment and mental health. J Urban Health. 2003 Dec;80(4):536-55. doi: 10.1093/jurban/jtg063. PMID: 14709704; PMCID: PMC3456225. https://link.springer.com/article/10.1093/jurban/jtg063
- Jovanović N, Campbell J, Priebe S. How to design psychiatric facilities to foster positive social interaction - A systematic review. Eur Psychiatry. 2019 Aug;60:49-62. doi: 10.1016/j.eurpsy.2019.04.005. Epub 2019 May 18. PMID: 31112827. https://www.sciencedirect.com/science/article/abs/pii/S0924933819300744?via%3Dihub
- Gesler W, Bell M, Curtis S, Hubbard P, Francis S. Therapy by design: evaluating the UK hospital building program. Health Place. 2004 Jun;10(2):117-28. doi: 10.1016/S1353-8292(03)00052-2. PMID: 15019906. https://www.sciencedirect.com/science/article/pii/S1353829203000522
- Oeljeklaus L, Schmid HL, Kornfeld Z, Hornberg C, Norra C, Zerbe S, McCall T. Therapeutic Landscapes and Psychiatric Care Facilities: A Qualitative Meta-Analysis. Int J Environ Res Public Health. 2022 Jan 28;19(3):1490. doi: 10.3390/ijerph19031490. PMID: 35162518; PMCID: PMC8835684. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8835684/
- Jovanović N, Miglietta E, Podlesek A, Malekzadeh A, Lasalvia A, Campbell J, Priebe S. Impact of the hospital built environment on treatment satisfaction of psychiatric in-patients. Psychol Med. 2022 Jul;52(10):1969-1980. doi: 10.1017/S0033291720003815. https://www.cambridge.org/core/journals/psychological-medicine/article/impact-of-the-hospital-built-environment-on-treatment-satisfaction-of-psychiatric-inpatients/12FFA1081149FD0593212CB2F8C4E483
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This session will cover monogenic and complex genetic diseases. We will be discussing how to ascertain if a condition has a genetic component, and then what laboratory and analytical methods to use for gene discovery. The lecture will then cover hypertension as an exemplar.
Hypertension affects over 1 billion people worldwide, and for a small percentage of individuals their high blood pressure is due to rare inherited mutations, however the majority (95%) have what is called essential hypertension. This is regarded a complex genetic condition, where both genes and environment are important. There has been much progress over the past decade in understanding the genetic component of essential hypertension using genome-wide association studies. We will cover the major advances in this area, key results and briefly the approaches to understand gene-environment interactions for blood pressure traits.
Further reading:
1. Horton et al. Recent developments in genetics/genomic medicine (Review). Clinical Science 2019
2. Li et al. Whole -exome sequencing identifies a de novo PDE3A variant causing autosomal dominant hypertension with brachydactyly type E syndrome: a case report. BMC Medical Genetics, 2020.
3. Evangelou et al. Genetic analysis in over one million people identifies 535 new loci associated with blood pressure traits. Nature Genetics, 2018.
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The Epigenome – the packaging and chemical modifications of the genome – gives an insight to cell-specific activity. This session will focus on the utility of one of these epigenetic marks, DNA methylation, to reveal molecular changes in disease pathology, but also its potential to act as an epidemiological biomarker of long-term environmental exposure.
Quantitative DNA methylation signatures from blood can readily be determined for health-related factors, such as tobacco smoking. Additionally, estimates of age, or DNA methylation ‘clocks’, capture the multisystemic and phenotypic changes occurring with age. These ‘biological’ DNA methylation age measures are associated with both morbidity and mortality.
Thus, the integration of epigenomic data, capturing non-genetic or environmental risk factors, with identified genetic risk, has the potential to be highly informative and bring a deeper understanding of disease susceptibility.
Further reading:
1. Wu H, Eckhardt C & Baccarelli A. (2023) Molecular mechanisms of environmental exposures and human disease. Nature Reviews Genetics 24, 332–344
https://www.nature.com/articles/s41576-022-00569-3
2. Feil R & Fraga M. (2012) Epigenetics and the environment: emerging patterns and implications Nature Reviews Genetics 13(2):97-109.
https://www.nature.com/articles/nrg3142
3. Horvath S & Raj K. (2018) DNA methylation-based biomarkers and the epigenetic clock theory of ageing. Nature Reviews Genetics 19: 371–384
https://www.nature.com/articles/s41576-018-0004-3
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In this session we will discuss nutritional factors that modulate health and disease, different dietary patterns and what is a food pyramid. We will discuss the planetary diet and which are the functional foods and the nutraceuticals. We will discuss the field of nutrigenetics and how might gene-by-environment interactions modulate disease risk.
Further reading:
•Ramos-Lopez O, et al: Guide for Current Nutrigenetic, Nutrigenomic, and Nutriepigenetic Approaches for Precision Nutrition Involving the Prevention and Management of Chronic Diseases Associated with Obesity. J Nutrigenet Nutrigenomics 2017;10:43-62. doi: 10.1159/000477729 https://karger.com/jnn/article/10/1-2/43/181355/Guide-for-Current-Nutrigenetic-Nutrigenomic-and•Marcum, J.A. Nutrigenetics/Nutrigenomics, Personalized Nutrition, and Precision Healthcare. Curr Nutr Rep 9, 338–345 (2020). doi: 10.1007/s13668-020-00327-z https://link.springer.com/article/10.1007/s13668-020-00327-z•Gul K, Singh AK, Jabeen R. Nutraceuticals and Functional Foods: The Foods for the Future World. Crit Rev Food Sci Nutr. 2016 Dec 9;56(16):2617-27. doi: 10.1080/10408398.2014.903384. PMID: 25629711 https://www.tandfonline.com/doi/abs/10.1080/10408398.2014.903384?journalCode=bfsn20•Ojo O, Jiang Y, Ojo OO, Wang X. The Association of Planetary Health Diet with the Risk of Type 2 Diabetes and Related Complications: A Systematic Review. Healthcare (Basel). 2023 Apr 13;11(8):1120. doi: 10.3390/healthcare11081120. PMID: 37107955; PMCID: PMC10138355 https://www.mdpi.com/2227-9032/11/8/1120-
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This session will look at some key health behaviours with a focus on diet and nutrition. We will examine how the environment effects what we eat and consider how we can change the environment to improve population health.
Further reading:Explore the Global Burden of Disease risk-factor summaries on this page: Global Burden of Disease: GBD cause and risk summaries (thelancet.com)
You might particularly be interested in the dietary risks and other risks linked to dietary risk (for example high body-mass index).
Coleman et al, 2022. A rapid review of the evidence for children’s TV and online advertisement restrictions to fight obesity. Preventive Medicine Reports.
If feeling hardcore, you might like to read: Westbury S, Ghosh I, Jones HM, Mensah D, Samuel F, Irache A, Azhar N, Al-Khudairy L, Iqbal R, Oyebode O. The influence of the urban food environment on diet, nutrition and health outcomes in low-income and middle-income countries: a systematic review. BMJ Glob Health. 2021 Oct;6(10):e006358. doi: 10.1136/bmjgh-2021-006358 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8506857/-
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In this seminar we will explore biodiversity monitoring from an ecological perspective. We will examine the needs for monitoring, relevant national and international legislation which enforce the requirement for monitoring, and data types which are returned to these agreements. We will explore modern methods for gathering data and the emerging technological innovations which allow us to gather new data types.
Further reading
https://www.sciencedirect.com/science/article/pii/S0006320716303652 Neil Brummitt, Eugenie C. Regan, Lauren V. Weatherdon, Corinne S. Martin, Ilse R. Geijzendorffer, Duccio Rocchini, Yoni Gavish, Peter Haase, Charles J. Marsh, Dirk S. Schmeller, Taking stock of nature: Essential biodiversity variables explained, Biological Conservation, Volume 213, Pages 252-255, 2017
Browse the WWF Living Planet report and monitoring resources from the Zoological Society of London, selecting areas you are interested in:
https://www.zsl.org/what-we-do/science-research/global-biodiversity-monitoring
https://www.frontiersin.org/articles/10.3389/fenvs.2019.00197/full Makiola A, Compson ZG, Baird DJ, Barnes MA, Boerlijst SP, Bouchez A, Brennan G, Bush A, Canard E, Cordier T, Creer S, Curry RA, David P, Dumbrell AJ, Gravel D, Hajibabaei M, Hayden B, van der Hoorn B, Jarne P, Jones JI, Karimi B, Keck F, Kelly M, Knot IE, Krol L, Massol F, Monk WA, Murphy J, Pawlowski J, Poisot T, Porter TM, Randall KC, Ransome E, Ravigné V, Raybould A, Robin S, Schrama M, Schatz B, Tamaddoni-Nezhad A, Trimbos KB, Vacher C, Vasselon V, Wood S, Woodward G and Bohan DA (2020) Key Questions for Next-Generation Biomonitoring. Front. Environ. Sci. 7:197. doi: 10.3389/fenvs.2019.00197
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In this session we will discuss how all environmental exposures could be integrated in the concept of the "exposome". We will discuss ways they we can model and measure the exposome, how we can design exposome-wide association studies, the use of biosensors and wearables and the significance of the ditigal twins.
Further reading:
•Ding, E., Wang, Y., Liu, J. et al. A review on the application of the exposome paradigm to unveil the environmental determinants of age-related diseases. Hum Genomics 16, 54 (2022). https://doi.org/10.1186/s40246-022-00428-6•Münzel, T., Sørensen, M., Hahad, O. et al. The contribution of the exposome to the burden of cardiovascular disease. Nat Rev Cardiol (2023). https://doi.org/10.1038/s41569-023-00873-3•Armeni P, Polat I, De Rossi LM, Diaferia L, Meregalli S, Gatti A. Digital Twins in Healthcare: Is It the Beginning of a New Era of Evidence-Based Medicine? A Critical Review. J Pers Med. 2022 Jul 30;12(8):1255. https://doi.org/10.3390/jpm12081255•Ates, H.C., Nguyen, P.Q., Gonzalez-Macia, L. et al. End-to-end design of wearable sensors. Nat Rev Mater 7, 887–907 (2022). https://doi.org/10.1038/s41578-022-00460-x-
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In this journal club we will discuss this paper: The ethical aspects of exposome research: a systematic review https://academic.oup.com/exposome/article/3/1/osad004/7115840. We will look into different ethical aspects that might arise when we analyse the totality of environmental exposures and their corresponding biological responses within the human body. We will also discuss aspects of leveraging results of the exposome research to inform public guidelines and what is the best way to safeguard individuals' personal data.
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This section includes important publications for further reading from all sessions
