Invisible Connections: health beyond medical care

We live in an interconnected world, transcending geographical and disciplinary barriers. We’ve witnessed the exponential growth of social networks, we live in smart homes – where electronic devices and appliances are controlled via smartphone -, we’ve adopted teleworking, we often do our shopping online. But what about health? How many of us use wearables to monitor the number of daily steps or the quality of our sleep? But more than meeting a goal, constantly reminded by our smartwatches – “there are only 3000 steps left to reach your daily goal” – are we focused on health as a whole? Do we realise that everything around us influences our state? Are we looking for unified solutions in preventing, detecting, and addressing global health threats?

1998, Malaysia. The Nipah virus caused hundreds of cases of acute encephalitis, and just as many deaths. The origin? A group of bats (natural hosts) passed the virus to pigs that enhanced it and transmitted it to humans. The outbreak started on a farm and quickly spread, with a significant impact on public health. Many pointed out deforestation is the issue, forcing bats to forage for food in inhabited areas. More than 20 years later, similar events are multiplying; these underpin the “One Health” concept : human activities, animal health and environmental conditions are interconnected, and it is urgent to adopt integrated approaches.

Shall we get to know some starting points for said approaches?

 

Human, animal and environmental health: the triad that brings us balance

Over the last four years, INESC TEC has been involved in close to 70 projects in human health, with funding around €12M. In research, as in health, it’s possible to cross several domains and knowledge, in favour of solutions that promote people’s well-being.

Carlos Ferreira, researcher and Business Development Manager of INESC TEC TEC4Health, recognises that symbiosis between humans, animals and nature is vital – in response to pandemic outbreaks, or the control of antimicrobial resistance, for example. A triad that is based on relationships of dependence and collaboration for the balance of the ecosystem.

The caduceus of Hermes, symbol of the One Health concept, is an invitation to the union and balance between opposing forces.

“We are very dependent on the environment and animals for our survival, and there is a lot of evidence of the impact they could have on our health. This is clear in food: it is true that the prevalence of food intolerances, e.g., gluten and lactose intolerance, has been observed in some populations. The cause of said issues is multifactorial and may include genetic, immunological, but also environmental factors. For example, with the application of pesticides to control pests on crops, we are influencing and modifying foods – to which we are not tolerant”.

But the examples don’t end here. Let’s talk about figures: 60% of pathogens that cause human diseases originate in domestic animals or wildlife; 75% of emerging infectious human diseases originate in animals; 80% of pathogens that cause concern in terms of bioterrorism originate in animals.

When we talk about zoonoses [1], the key seems to lie in prevention. Hence, it’s crucial to monitor the animals as far as possible. Something that is already done concerning plants: the team of the METBOTS project developed a solution that integrates advanced sensors, using light to measure the organic transformations that occur in the plant to obtain higher quality results in the crop. Imagine being able to do the same for animals… and people!

 

Spock’s Tricorder comes to life

In Star Trek, Spock wore a device capable of diagnosing any disease by bringing it closer to the patient. An amazing technology that would save doctors a lot of time and work. We do not have a Tricorder yet; but we are getting closer, with the possibility of making diagnosis on the spot. Rui Martins, researcher at INESC TEC, leads research in point-of-care tests [2], which combines UV-visible spectroscopy and Artificial Intelligence, enabling the identification and quantification of constituent elements of blood samples. The same technique used in plants and animals, now explored with humans.

It’s not fiction! The “Tricorder” created at INESC TEC is very similar to the one in Star Trek: small, portable, and capable of analysing and interpreting data.

“Blood is a ‘vehicle’ for everything that happens in our body and is paramount in clinical analysis. By using a single drop of blood – and without the use of reagents – we can get immediate results. This is extremely beneficial, as in addition to the convenience of being portable and fast, it is also inexpensive. Moreover, the non-use of reagents will solve inventory and storage problems”, explained Rui Martins, who envisions a future in which each person can have their own portable analyser, and the ability to send immediate results to physicians. The next step is the commercialisation of this equipment.

Currently, the National Health Service is equipped with cutting-edge technology and multi-million-euro infrastructures. Efficient systems already exist (it is possible to process 1000 samples collected between morning and lunchtime), but it’s possible to achieve higher levels of optimisation. “Point-of-Care isn’t going to close labs. But in certain situations, this system can really make a difference. It is very useful for chronic patients who need to be tested regularly, or to help babies or patients in intensive care; even in emergency medicine, because it only requires a drop of blood for immediate results”, said the researcher.

The application of this methodology to the veterinary area is revolutionary, mainly because it is not possible to carry out an exhaustive monitoring. Rui Martins mentioned tuberculosis: “the number of wild animals in the interior regions of the county are increasing due to depopulation; we are unable to continuously monitor animals like boars, which are a vector of human tuberculosis. When a case is detected, the infection may already be present amidst the animal population”.

This real-time, on-site analysis system is also the basis of the Multiscope project; in this case, it combines multimodal stethoscopes (which perform auscultation and electrocardiograms) and deep learning techniques to track cardiovascular diseases resulting from rheumatic fever.

 

Measuring what surrounds us to take action

The environment, and especially climate change, are also decisive factors in the spread of diseases. INESC TEC is already working on solutions capable of studying the environment and understanding the influence on human health.

Gaia, goddess of the Earth in Greek mythology, teaches us the importance of harmony among humans, animals, and nature.

“INESC TEC created a wearable – explored by our spin-off  WeSenss – equipped with sensors to monitor vital and environmental data. In a firefighting scenario, for example, it is possible to measure the physiological parameters of firefighters and study the impact that the environment (temperature or toxic gases) has on their well-being, through a professional management app. More recently, the same wearable was used to monitor the team that participated in the first analog mission in Portugal – CAMões -, inside the Gruta do Natal (Azores)”, mentioned Carlos Ferreira.

But there are more examples. The Health From Portugal project is the health PRR that brings together the largest number of entities (about 90) with the objective of developing new health products, based on innovation and technology. Let’s just talk about one of the potential results: the development of devices capable of monitoring the environment and understanding its impact on people’s health. Artur Rocha, coordinator of INESC TEC’s Centre for Human-Centered Computing and Information Science (Humanise), is the lead researcher in the project, and this research area in specific.

“Doing a little futurology, the main is goal, on the one hand, to assess people’s health, and, on the other, to evaluate the environment at home and abroad. We will use cohort studies [3] that may help us understand, for example, the influence of pollution or air quality on respiratory infections. Measurement is something very important in health, and we look beyond people’s physiological parameters”, he explained.

 

And will the environment have an impact on mental health?

Artur Rocha and Gonçalo Gonçalves have been working, for many years, with projects related to mental health. For example, the creation of the Moodbuster platform, an ecosystem of online and mobile applications for patients and therapists that allows you to assess various types of aspects, e.g., mood or daily activities, and design new therapies that can improve people’s mental health.

“This platform includes an Ecological Momentary Assessments module, which aims to understand how the environment affects us at any given moment. It is very different to report how we feel when things happen, or when we talk about them in the context of a medical appointment. The perception and memory we retain of the facts is different. Also in this area, but now focusing on specific treatments, we are building a catalogue of micro-interventions that work as responses to situations and living conditions that cause ill-being, anxiety, or often more serious pathologies”, explained the researcher.

Health, being a multidisciplinary area, requires support via partnerships and cooperation with other national and international entities. Artur Rocha added that “in terms of public policies and funding mechanisms, there is this concern”, including different vectors of research, “beyond actual health”. “As scientists, we seek to promote a comprehensive understanding of the complex interactions between different areas. And, above all, to allow people to manage their own health, perceiving it as a whole”, he stated.

We work every day on the adoption of the One Health concept, through innovative tools and multidisciplinary projects, like the development of on-site diagnostic technologies, real-time analysis, and wearables for environmental monitoring. And there is also a growing concern in public policies to leverage holistic approaches to promoting global health. Deep down, what we seek is the same as the Vulcans: Live long and prosper.

We finish this text going back a few decades, and listening to U2 (it’s not our favourite band, but to some of our readers, it actually is) and the song One: “One love, one blood, one life… We get to carry each other”.

 

[1] Diseases that are transmitted from animals to humans, or from humans to animals.
[2] Point of Care Testing (POCT) can be defined as any rapid diagnostic test performed at the point of care — doctor’s offices, emergency room, home care, pharmacies, hospitals, laboratories.
[3] The cohort study follows a large group of people and evaluates, for example, the effects of exposed risk factors on health.

 

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