Epidemiological reflections of the contribution of anthropology to public health policy and practice

Academic disciplines like anthropology and epidemiology provide a niche for researchers to speak the same language, and to interrogate the assumptions that they use to investigate problems. How anthropological and epidemiological methods communicate and relate to each other affects the way public health policy is created but the philosophical underpinnings of each discipline makes this difficult. Anthropology is reflective, subjective and investigates complexity and the individual; epidemiology, in contrast, is objective and studies populations. Within epidemiological methods there is the utilitarian concept of potentially sacrificing the interests of the individual for the benefits of maximizing population welfare, whereas in anthropology the individual is always included. Other strengths of anthropology in the creation of public health policy include: its attention to complexity, questioning the familiar; helping with language and translation; reconfiguring boundaries to create novel frameworks; and being reflective. Public health requires research that is multi-, inter- and trans-disciplinary. To do this, there is a need for each discipline to respect the 'dignity of difference' between disciplines in order to help create appropriate and effective public health policy.     

Molecular epidemiology: a multidisciplinary approach to understanding parasitic zoonoses

Sound application of molecular epidemiological principles requires working knowledge of both molecular biological and epidemiological methods. Molecular tools have become an increasingly important part of studying the epidemiology of infectious agents. Molecular tools have allowed the aetiological agent within a population to be diagnosed with a greater degree of efficiency and accuracy than conventional diagnostic tools. They have increased the understanding of the pathogenicity, virulence, and host-parasite relationships of the aetiological agent, provided information on the genetic structure and taxonomy of the parasite and allowed the zoonotic potential of previously unidentified agents to be determined. This review describes the concept of epidemiology and proper study design, describes the array of currently available molecular biological tools and provides examples of studies that have integrated both disciplines to successfully unravel zoonotic relationships that would otherwise be impossible utilising conventional diagnostic tools. The current limitations of applying these tools, including cautions that need to be addressed during their application are also discussed.     

Ionizing radiation biomarkers for potential use in epidemiological studies

Ionizing radiation is a known human carcinogen that can induce a variety of biological effects depending on the physical nature, duration, doses and dose-rates of exposure. However, the magnitude of health risks at low doses and dose-rates (below 100mSv and/or 0.1mSvmin(-1)) remains controversial due to a lack of direct human evidence. It is anticipated that significant insights will emerge from the integration of epidemiological and biological research, made possible by molecular epidemiology studies incorporating biomarkers and bioassays. A number of these have been used to investigate exposure, effects and susceptibility to ionizing radiation, albeit often at higher doses and dose rates, with each reflecting time-limited cellular or physiological alterations. This review summarises the multidisciplinary work undertaken in the framework of the European project DoReMi (Low Dose Research towards Multidisciplinary Integration) to identify the most appropriate biomarkers for use in population studies. In addition to logistical and ethical considerations for conducting large-scale epidemiological studies, we discuss the relevance of their use for assessing the effects of low dose ionizing radiation exposure at the cellular and physiological level. We also propose a temporal classification of biomarkers that may be relevant for molecular epidemiology studies which need to take into account the time elapsed since exposure. Finally, the integration of biology with epidemiology requires careful planning and enhanced discussions between the epidemiology, biology and dosimetry communities in order to determine the most important questions to be addressed in light of pragmatic considerations including the appropriate population to be investigated (occupationally, environmentally or medically exposed), and study design. The consideration of the logistics of biological sample collection, processing and storing and the choice of biomarker or bioassay, as well as awareness of potential confounding factors, are also essential.     

Fungal diversity from communities to genes

Fungi are hyperdiverse organisms and assemble in complex communities, characterized by high levels of species richness, turnover, and endemism. However, the origins and maintenance of such high diversity and the role environments play in fungal adaptation are still elusive. Traditionally, efforts to understand fungal diversity in their environment have been divided between studies at the species level and below species level, with separate disciplines such as community ecology and population genetics working independently and with little communication. Here I argue that linking these different approaches is required to fully document the diversity of fungi in nature. Understanding the patterns and mechanisms of fungal diversity and composition requires not only the study of species assemblies and ranges, but also relies on comprehending fungal intra-specific variation, dispersal and establishment, including identifying key traits influencing fitness. This implies better integration and cross-fertilization between disciplines addressing fungi at a multitude of biological levels, ranging from genes to whole communities. Such approach will yield direct links between variation, adaptation and environments and provide a much more comprehensive understanding of fungal diversity.     

Studying fungal pathogens of humans and fungal infections: fungal diversity and diversity of approaches

Seminal work by Louis Pasteur revealed the contribution of fungi – yeasts and microsporidia to agroindustry and disease in animals, respectively. More than 150 years later, the impact of fungi on human health and beyond is an ever-increasing issue, although often underestimated. Recent studies estimate that fungal infections, especially those caused by Candida, Cryptococcus and Aspergillus species, kill more than one million people annually. Indeed, these neglected infections are in general very difficult to cure and the associated mortality remains very high even when antifungal treatments exist. The development of new antifungals and diagnostic tools that are both necessary to fight fungal diseases efficiently, requires greater insights in the biology of the fungal pathogens of humans in the context of the infection, on their epidemiology, and on their role in the human mycobiota. We also need a better understanding of the host immune responses to fungal pathogens as well as the genetic basis for the increased sensitivity of some individuals to fungal infections. Here, we highlight some recent progress made in these different areas of research, in particular based on work conducted in our own laboratories. These progresses should lay the ground for better management of fungal infections, as they provide opportunities for better diagnostic, vaccination, the development of classical antifungals but also strategies for targeting virulence factors or the host.     

Are Statistical Contributions to Medicine Undervalued?

Econometricians Daniel McFadden and James Heckman won the 2000 Nobel Prize in economics for their work on discrete choice models and selection bias. Statisticians and epidemiologists have made similar contributions to medicine with their work on case-control studies, analysis of incomplete data, and causal inference. In spite of repeated nominations of such eminent figures as Bradford Hill and Richard Doll, however, the Nobel Prize in physiology and medicine has never been awarded for work in biostatistics or epidemiology. (The "exception who proves the rule" is Ronald Ross, who, in 1902, won the second medical Nobel for his discovery that the mosquito was the vector for malaria. Ross then went on to develop the mathematics of epidemic theory--which he considered his most important scientific contribution-and applied his insights to malaria control programs.) The low esteem accorded epidemiology and biostatistics in some medical circles, and increasingly among the public, correlates highly with the contradictory results from observational studies that are displayed so prominently in the lay press. In spite of its demonstrated efficacy in saving lives, the "black box" approach of risk factor epidemiology is not well respected. To correct these unfortunate perceptions, statisticians would do well to follow more closely their own teachings: conduct larger, fewer studies designed to test specific hypotheses, follow strict protocols for study design and analysis, better integrate statistical findings with those from the laboratory, and exercise greater caution in promoting apparently positive results.     

Climate Change,Vector-borne Disease and Interdisciplinary Research: Social Science Perspectives on an Environment and Health Controversy

Over the last two decades, the science of climate change’s theoretical impacts on vector-borne disease has generated controversy related to its methodological validity and relevance to disease control policy. Critical social science analysis, drawing on science and technology studies and the sociology of social movements, demonstrates consistency between this controversy and the theory that climate change is serving as a collective action frame for some health researchers. Within this frame, vector-borne disease data are interpreted as a symptom of climate change, with the need for further interdisiplinary research put forth as the logical and necessary next step. Reaction to this tendency on the part of a handful of vector-borne disease specialists exhibits characteristics of academic boundary work aimed at preserving the integrity of existing disciplinary boundaries. Possible reasons for this conflict include the leadership role for health professionals and disciplines in the envisioned interdiscipline, and disagreements over the appropriate scale of interventions to control vector-borne diseases. Analysis of the competing frames in this controversy also allows identification of excluded voices and themes, such as international political economic explanations for the health problems in question. A logical conclusion of this analysis, therefore, is the need for critical reflection on environment and health research and policy to achieve integration with considerations of global health equity.     

Looking Ahead in Rice Disease Research and Management

Rice production is subject to increasing environmental and social constraints. Agricultural labor and water, which are key resources for rice production, illustrate this point. Nearly all rice-producing countries face reduced availability of agricultural water and shortage of farm labor. Plant pathologists should be concerned with such large-scale evolutions because these global drivers have an impact on not only the rice production system but also on the individual field and single-rice-plant levels. These concerns are closely associated with the long-term sustainability and environmental consequences of the intensification of agricultural systems brought about by problems of feeding a rapidly growing human population. Furthermore, genetic diversity in rice production has been reduced, thus inducing frequent disease epidemics and pest outbreaks. Looking ahead, we need to realize the need to maintain the diversity and yet retain the high productivity of the system. Natural resources, including genetic resources, are not infinitely abundant. We have to be efficient in utilizing genetic resources to develop durable resistance to rice diseases. Developing resistance is an important first step in tackling the disease problem, but it is not the only step available to achieve durability. Deployment of resistance must be considered in conjunction with development of host plant resistance. To attain durability, we need a better understanding of the coevolution process between the pathogen and the host resistance gene. Our target is an integrated gene management approach for better disease control and more effective utilization of genetic resources. Plant pathology, as an applied science, derives its strengths from various disciplines. To do the job right, we need a better understanding of the pathosystems, the epidemiology, and the coevolution process between the pathogen and the host resistance gene. The challenge, as pointed out by pioneers in our profession, is to prove the usefulness and the relevance of our research. Thus, we need to strike a balance between mission-oriented and fundamental research and make sure that our profession is (still) useful in the information technology and genomic era. We believe that a gene-based and a resource-based disease management approach should allow us to incorporate these new scientific developments. However, we do need to incorporate the new science for fundamental research to solve practical problems of rice production.     

The Exploration-Exploitation Dilemma: A Multidisciplinary Framework

The trade-off between the need to obtain new knowledge and the need to use that knowledge to improve performance is one of the most basic trade-offs in nature, and optimal performance usually requires some balance between exploratory and exploitative behaviors. Researchers in many disciplines have been searching for the optimal solution to this dilemma. Here we present a novel model in which the exploration strategy itself is dynamic and varies with time in order to optimize a definite goal, such as the acquisition of energy, money, or prestige. Our model produced four very distinct phases: Knowledge establishment, Knowledge accumulation, Knowledge maintenance, and Knowledge exploitation, giving rise to a multidisciplinary framework that applies equally to humans, animals, and organizations. The framework can be used to explain a multitude of phenomena in various disciplines, such as the movement of animals in novel landscapes, the most efficient resource allocation for a start-up company, or the effects of old age on knowledge acquisition in humans.     

Cloning Should Be Simple: Escherichia coli DH5α-Mediated Assembly of Multiple DNA Fragments with Short End Homologies

Numerous DNA assembly technologies exist for generating plasmids for biological studies. Many procedures require complex in vitro or in vivo assembly reactions followed by plasmid propagation in recombination-impaired Escherichia coli strains such as DH5α, which are optimal for stable amplification of the DNA materials. Here we show that despite its utility as a cloning strain, DH5α retains sufficient recombinase activity to assemble up to six double-stranded DNA fragments ranging in size from 150 bp to at least 7 kb into plasmids in vivo. This process also requires surprisingly small amounts of DNA, potentially obviating the need for upstream assembly processes associated with most common applications of DNA assembly. We demonstrate the application of this process in cloning of various DNA fragments including synthetic genes, preparation of knockout constructs, and incorporation of guide RNA sequences in constructs for clustered regularly interspaced short palindromic repeats (CRISPR) genome editing. This consolidated process for assembly and amplification in a widely available strain of E. coli may enable productivity gain across disciplines involving recombinant DNA work.     

Macromolecular Drug Delivery: Basic Principles and Therapeutic Applications

Macromolecular drugs hold great promise as novel therapeutics of several major disorders, such as cancer and cardiovascular disease. However, their use is limited by lack of efficient, safe, and specific delivery strategies. Successful development of such strategies requires interdisciplinary collaborations involving researchers with expertise on e.g., polymer chemistry, cell biology, nano technology, systems biology, advanced imaging methods, and clinical medicine. This poses obvious challenges to the scientific community, but also provides opportunities for the unexpected at the interface between different disciplines. This review summarizes recent studies of macromolecular delivery that should be of interest to researchers involved in macromolecular drug synthesis as well as in vitro and in vivo drug delivery studies.     

Has anthropology any future?

Anthropology has a future and a very pertinent role to play, if we are sensitive to and aware of the new developments in the fields of medicine, biology and ecology which are undergoing dramatic changes. Most definitely these fields will need an anthropological dimension to be added. The natural history and diversity of Man remains the basis of anthropology, but it is time to reassess the training available to students today, in order to keep the discipline alive, growing and significant. Undoubtedly we must offer our students a broad, general basis of knowledge in the first years. Thereafter we must include biomedical disciplines such as anatomy, molecular biology, genetics, epidemiology, and other pertinent subjects, such as statistics, ecology, prehistory, etc. With these “tools” the future student would be well equipped to introduce anthropological aspects into many fields. As European universities cannot provide all these disciplines at a single institution at a level equivalent to PhD studies, we must work towards a tradition of exchange, co-operation and joint projects and universally acknowledged academic degrees such as a Masters and Ph.D. The Erasmus Biology Programme has already achieved some results in this respect and is ready with a proposal of a European Masters Degree in anthropology. The “tools” of modern science together with the more traditional training will enrich the discipline, but more importantly enable the anthropologist to address controversial and often frightening prospects left in the wake of for example gene technology and gene manipulation, in a competent and scientific manner. Many societies have allowed anthropologists to study their populations in detail. We, on the other hand, have an obligation to ensure that the data we have acquired and accumulated are not misused by those who practise racist, eugenic or nationalistic ideals. The ability to carry out these obligations lies to a great extent in a strong, dynamic and diverse organisation, such as an EAA which is open to renewal and willing to address future social and political issues. A fragmented EAA cannot cope with these. There must be room for all in our organisation, ranging from the traditional to the very specialised anthropologist. If we achieve the necessary unity, we will be able to participate in the challenges that the technology of the 20th and 21st centuries imposes on the daily lives of all of us. To err is characteristic of everyone but only idiots persevere in it (Cicero).     

The interface between epidemiology and population genetics

Modern biology increasingly integrates disparate disciplines. Here, Steve Paterson and Mark Viney examine the interface between epidemiology and population genetics. They argue that infection and inheritance can be considered as analogous processes, and that epidemiology and population genetics share many common features. They consider the potential for existing population genetic theory to dissect epidemiological patterns in field studies and they consider other relationships between genetics and epidemiology that provide a research challenge for the future.     

Virus evolution and transmission in an ever more connected world

The frequency and global impact of infectious disease outbreaks, particularly those caused by emerging viruses, demonstrate the need for a better understanding of how spatial ecology and pathogen evolution jointly shape epidemic dynamics. Advances in computational techniques and the increasing availability of genetic and geospatial data are helping to address this problem, particularly when both information sources are combined. Here, we review research at the intersection of evolutionary biology, human geography and epidemiology that is working towards an integrated view of spatial incidence, host mobility and viral genetic diversity. We first discuss how empirical studies have combined viral spatial and genetic data, focusing particularly on the contribution of evolutionary analyses to epidemiology and disease control. Second, we explore the interplay between virus evolution and global dispersal in more depth for two pathogens: human influenza A virus and chikungunya virus. We discuss the opportunities for future research arising from new analyses of human transportation and trade networks, as well as the associated challenges in accessing and sharing relevant spatial and genetic data.     

Characterizing the effect of endocrine disruptors on human health: The role of epidemiological cohorts

Research on endocrine disruptors (EDs) developed from numerous disciplines. In this concert of disciplines, epidemiology is central to inform on the relevance for humans of mechanisms and dose-response functions identified in animals, to characterize the health impact (number of attributable disease cases), the cost associated with ED exposure, and the efficiency of the measures taken to limit exposure. Here, we present epidemiological tools to draw valid inference regarding effects of potential EDs. Epidemiology is generally observational, requiring care to control confounding bias. Many potential EDs have a short biological half-life; approaches relying on repeated biospecimens sampling allow limiting exposure misclassification and the resulting bias. For non-persistent compounds, couple–child cohorts are a central study design. Cohorts can now rely on molecular biology approaches to characterize exposures and intermediate pathways, which corresponds to the advent of molecular epidemiology and allows stronger interactions between epidemiology, toxicology, and molecular epidemiology to characterize the health effects of EDs.     

Molecular ecology and biological control: the mating system of a marsupial pest

Many studies in molecular ecology have focused on the use of repeat DNA markers to determine the nature of mating systems in a wide variety of animal species. Whilst these studies typically have focused on important issues such as the evolutionary consequences of fitness variation among males, genetic studies of mating systems are potentially also important because they can generate information of significance to wider issues in wildlife management. For example, genetically modified, sexually transmitted viral diseases have been suggested as potential agents for the control of vertebrate pest species. An understanding of the epidemiology of such agents requires an intimate knowledge of the sexual contact rates between individuals of the target species. Here, we report the use of minisatellite DNA profiling to reveal the mating system in two New Zealand populations of the introduced Australian brushtail possum. The brushtail possum is New Zealand's most important mammalian pest and a species for which control by a sexually transmitted immunocontraceptive has been proposed. Encouragingly, we report considerable variation in the reproductive success of males at both study sites, with one male siring offspring from four females in one year (mean no. of offspring/reproductively successful male/year at the two sites is 1.95-2.15), while many sired none. This bias in the pattern of reproductive success among males will probably facilitate the spread of an immunocontraceptive agent and thereby increase the power of this approach to biological control.     

What is Cryptosporidium? Reappraising its biology and phylogenetic affinities

In raising the question "What is Cryptosporidium?", we aim to emphasize a growing need to re-evaluate the affinities of Cryptosporidium species within the phylum Apicomplexa so as to better understand the biology and ecology of these parasites. Here, we have compiled evidence from a variety of molecular and biological studies to build a convincing case for distancing Cryptosporidium species from the coccidia conceptually, biologically and taxonomically. We suggest that Cryptosporidium species must no longer be considered unusual or unique coccidia but rather seen for what they are--a distantly related lineage of apicomplexan parasites that are not in fact coccidia but that do occupy many of the same ecological niches. Looking at Cryptosporidium species without traditional coccidian blinders is likely to reveal new avenues of investigation into pathogenesis, epidemiology, treatment and control of these ubiquitous pathogens.     

Evaluation of a Phylogenetic Marker Based on Genomic Segment B of Infectious Bursal Disease Virus: Facilitating a Feasible Incorporation of this Segment to the Molecular Epidemiology Studies for this Viral Agent

BackgroundInfectious bursal disease (IBD) is a highly contagious and acute viral disease, which has caused high mortality rates in birds and considerable economic losses in different parts of the world for more than two decades and it still represents a considerable threat to poultry. The current study was designed to rigorously measure the reliability of a phylogenetic marker included into segment B. This marker can facilitate molecular epidemiology studies, incorporating this segment of the viral genome, to better explain the links between emergence, spreading and maintenance of the very virulent IBD virus (vvIBDV) strains worldwide.Conclusions/SignificanceThis study contributes to a better understanding of the emergence of vvIBDV strains, describing molecular epidemiology of IBDV using the state-of-the-art methodology concerning phylogenetic reconstruction. This study also revealed the presence of a novel natural reassorted strain as possible manifest of change in the genetic structure and stability of the vvIBDV strains. Therefore, it highlights the need to obtain information about both genome segments of IBDV for molecular epidemiology studies.     

EPIDEMIOLOGY AND SOCIAL JUSTICE IN LIGHT OF SOCIAL DETERMINANTS OF HEALTH RESEARCH

The present article identifies how social determinants of health raise two categories of philosophical problems that also fall within the smaller domain of ethics; one set pertains to the philosophy of epidemiology, and the second set pertains to the philosophy of health and social justice. After reviewing these two categories of ethical concerns, the limited conclusion made is that identifying and responding to social determinants of health requires inter-disciplinary reasoning across epidemiology and philosophy. For the reasoning used in epidemiology to be sound, for its scope and (moral) purpose as a science to be clarified as well as for social justice theory to be relevant and coherent, epidemiology and philosophy need to forge a meaningful exchange of ideas that happens in both directions.