How can we identify the environmental population

Research concept

Use of synergies and creation of added value through joint research in the field of "Environment - Population - Patients"

The overarching goal of the work on the UNIKA ‐ T is the sustainable improvement of the health situation of the population. The chronic, often multi-causal diseases focused on develop in the interaction of environmental factors on the basis of the individual genetic and metabolic makeup. In summary, chronic (environmental) diseases are referred to as so-called "noncommunicable diseases" (NCDs, non-communicable diseases). NCDs such as cancer, cardiovascular diseases, diabetes and chronic respiratory diseases are the most important global cause of lost quality of life and premature death. They place a high personal burden on patients and their relatives and enormous costs on national economies. Primary prevention and reducing the burden of disease can take place where modifiable (environmental) risk factors play a role. These factors must be comprehensively identified and their molecular mechanisms in humans clarified. This opens up the possibility of developing targeted preventive measures early on and using them effectively. By knowing the molecular mechanisms of NCDs, new target structures for innovative therapies can be developed. NCD patients require long-term support from various institutions in the health system. The planning and analysis of strategic and operational service processes in the health sector, especially in hospitals, is of crucial importance. Medical care and the quality of life of patients after discharge from the hospital are also analyzed to identify opportunities for improvement. With epidemiological registers, the disease occurrence for selected NCDs is completely recorded, so that changes in the area of ​​disease prevention (prevention) and therapy improvements in the population can be checked. The research focus of the three chairs of the UNIKA-T start here in order to create added value for prevention, sustainable health and optimization of patient care, which would not be possible without the UNIKA-T.

The Interlocking of the expertise and research approaches of the three chairs is visualized in Figure 1. Due to the common focus on NCDs, accompanied by a different but synchronized way of working, the overall result of the UNIKA-T research goes well beyond the sum of the department-specific research efforts. The Chair of Environmental Medicine analyzes the molecular mechanisms of human-environment interaction. Complex analyzes will record for the Augsburg region, but also for each individual patient, which environmental factors are decisive for health and illness. We focus on real-time analyzes of environmental factors that trigger allergies, such as pollen and mold spores. In this way we can better understand (allergic) chronic inflammatory diseases such as hay fever, asthma or neurodermatitis and find solutions for patients. The effect of environmental factors (exposome) on humans (e.g. symptoms, immunological changes) is analyzed in panel studies or in complex cell models. The Chair of Epidemiology deals, among other things, with lifestyle factors (e.g. diet, physical activity), medication intake and quality of life (psychosocial factors), which play a role in both primary prevention and patient care. In particular, the most exact possible characterization of metabolic properties should lay the foundation for precise prevention, therapy and long-term care. The Chair for Health Care Operations / Health Information Management primarily addresses patient care and the optimized provision and use of scarce resources in the supply chain of the health system, primarily using the methods of Operations Research / Management Science.

Figure 1: Schematic representation of the primary starting points for the joint research of the three UNIKA ‐ T chairs.

To achieve the In order to achieve a healthier population in the long term, the phases of preventive care (prevention), acute medical care (therapy, outpatient and inpatient) and aftercare (long-term care) must be taken into account and dovetailed (Figure 2). Prevention benefits from knowledge of the triggers for various clinical pictures and quantifies the contribution of individual risk factors and protective factors. The precision of the statements increases with the exact description (endo- and phenotyping) of the individuals, so that ultimately a good risk prediction with the determination of high-risk groups in the population and personalized prevention can take place. For sustainable health as the central target dimension, operational excellence in care through the optimal provision of scarce resources and new, more effective forms of therapy is indispensable. The aftercare phase, including a cross-sectoral approach, represents the final step and, when the patient has recovered completely, returns to the area of ​​prevention. However, this is usually not the case with NCDs. Rather, the acute patients become lifelong patients, or at least high-risk groups, who often constantly inquire about the services of the health system (e.g. continuous drug therapy).

Figure 2: From prevention to health services research: interlinking the research of the three UNIKA-T chairs.

In summary, the special constellation at the UNIKA-T enables one transdisciplinary approachwhich is unique in this form. The interlinking of the chairs and the associated benefits can be illustrated by four exemplary joint projects ("Pollen monitoring - exposure recording and provision of information", "Care of stroke patients", "Consideration of health aspects in town planning" and "Psychosocial factors and chronic inflammatory skin diseases") will be demonstrated, which are presented in more detail here.