Where ecosystems, people and health meet: academic traditons and emerging fields for research and practice

Human-driven environmental change has brought attention to the importance of ecosystems in sustaining human health and well-being. There are various schools of thought and fields of inquiry and action that seek to understand health in relation to linked social and ecological phenomena. We describe 18 such fields and outline common elements and incongruities among them. They converge around the application of systems thinking and crossing disciplinary boundaries, while differences are found in methodologies, research foci and problem framing. Although fields encourage sustainable and equitable pathways for health promotion, depoliticized and ahistorical approaches continue to be standard practice. Future research calls for a deeper commitment to examining ourselves as political actors, making space for conversations around power dynamics, and (re)centering participants in research methodologies.As mudanças ambientais antrópicas despertaram a atenção para a importância dos ecossistemas como fundamentais para sustentar a saúde e o bem-estar humanos. Várias escolas de pensamento e campos de atuação em pesquisa e ação buscam compreender a saúde e os fenômenos sociais e ecológicos associados. Apresentamos 18 desses campos de atuação destacando seus elementos comuns e divergências. Eles convergem em torno do cruzamento de fronteiras disciplinares e na aplicação do pensamento sistêmico, enquanto as principais diferenças são encontradas nas metodologias, nos enfoques de pesquisa e no enquadramento dos problemas. Embora os campos busquem promover a saúde pelos caminhos sustentáveis e equitativos, as abordagens despolitizadas e a-históricas continuam sendo parte da prática padrão. Pesquisas futuras requerem um compromisso maior na avaliação das nossas próprias condutas como atores políticos e na promoção de novos espaços de discussões sobre a dinâmica de poder, a fim de (re)centralizar os participantes nas metodologias de pesquisa

Background risk of breast cancer and the association between physical activity and mammographic density

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Simulation modeling for stratified breast cancer screening : a systematic review of cost and quality of life assumptions

BACKGROUND: The economic evaluation of stratified breast cancer screening gains momentum, but produces also very diverse results. Systematic reviews so far focused on modeling techniques and epidemiologic assumptions. However, cost and utility parameters received only little attention. This systematic review assesses simulation models for stratified breast cancer screening based on their cost and utility parameters in each phase of breast cancer screening and care. METHODS: A literature review was conducted to compare economic evaluations with simulation models of personalized breast cancer screening. Study quality was assessed using reporting guidelines. Cost and utility inputs were extracted, standardized and structured using a care delivery framework. Studies were then clustered according to their study aim and parameters were compared within the clusters. RESULTS: Eighteen studies were identified within three study clusters. Reporting quality was very diverse in all three clusters. Only two studies in cluster 1, four studies in cluster 2 and one study in cluster 3 scored high in the quality appraisal. In addition to the quality appraisal, this review assessed if the simulation models were consistent in integrating all relevant phases of care, if utility parameters were consistent and methodological sound and if cost were compatible and consistent in the actual parameters used for screening, diagnostic work up and treatment. Of 18 studies, only three studies did not show signs of potential bias. CONCLUSION: This systematic review shows that a closer look into the cost and utility parameter can help to identify potential bias. Future simulation models should focus on integrating all relevant phases of care, using methodologically sound utility parameters and avoiding inconsistent cost parameters

Inhibition of TGF-β Signaling and Decreased Apoptosis in IUGR-Associated Lung Disease in Rats

Intrauterine growth restriction is associated with impaired lung function in adulthood. It is unknown whether such impairment of lung function is linked to the transforming growth factor (TGF)-β system in the lung. Therefore, we investigated the effects of IUGR on lung function, expression of extracellular matrix (ECM) components and TGF-β signaling in rats. IUGR was induced in rats by isocaloric protein restriction during gestation. Lung function was assessed with direct plethysmography at postnatal day (P) 70. Pulmonary activity of the TGF-β system was determined at P1 and P70. TGF-β signaling was blocked in vitro using adenovirus-delivered Smad7. At P70, respiratory airway compliance was significantly impaired after IUGR. These changes were accompanied by decreased expression of TGF-β1 at P1 and P70 and a consistently dampened phosphorylation of Smad2 and Smad3. Furthermore, the mRNA expression levels of inhibitors of TGF-β signaling (Smad7 and Smurf2) were reduced, and the expression of TGF-β-regulated ECM components (e.g. collagen I) was decreased in the lungs of IUGR animals at P1; whereas elastin and tenascin N expression was significantly upregulated. In vitro inhibition of TGF-β signaling in NIH/3T3, MLE 12 and endothelial cells by adenovirus-delivered Smad7 demonstrated a direct effect on the expression of ECM components. Taken together, these data demonstrate a significant impact of IUGR on lung development and function and suggest that attenuated TGF-β signaling may contribute to the pathological processes of IUGR-associated lung disease

Deterministic Chaos and Fractal Complexity in the Dynamics of Cardiovascular Behavior: Perspectives on a New Frontier

Physiological systems such as the cardiovascular system are capable of five kinds of behavior: equilibrium, periodicity, quasi-periodicity, deterministic chaos and random behavior. Systems adopt one or more these behaviors depending on the function they have evolved to perform. The emerging mathematical concepts of fractal mathematics and chaos theory are extending our ability to study physiological behavior. Fractal geometry is observed in the physical structure of pathways, networks and macroscopic structures such the vasculature and the His-Purkinje network of the heart. Fractal structure is also observed in processes in time, such as heart rate variability. Chaos theory describes the underlying dynamics of the system, and chaotic behavior is also observed at many levels, from effector molecules in the cell to heart function and blood pressure. This review discusses the role of fractal structure and chaos in the cardiovascular system at the level of the heart and blood vessels, and at the cellular level. Key functional consequences of these phenomena are highlighted, and a perspective provided on the possible evolutionary origins of chaotic behavior and fractal structure. The discussion is non-mathematical with an emphasis on the key underlying concepts