Public Health Genomics: future paradigm shift for YHC?

1. Public Health Genomics: future paradigm shift for YHC? Prof. dr. Frans J.M. Feron Department of Social Medicine Faculty of Health Medicine and Life Sciences Maastricht University f.feron@maastrichtuniversity.nl

2. Public Health Genomics: …the use of genomics information to benefit Public Health …an emerging field of study that assesses the impact of genes and their interaction with behavior, diet and the environment on the population’s health …18.800.000 hits on ‘Genomics’ by Google …1.320.000 hits on ‘Public Health Genomics’ by Google …798.385 ‘genomic’ hits by PubMed 2

3. The main focus of Child & Youth Health Care: …health - growth – development …the interaction between the genetically biological vulnerable child and the environment where relevant to health – growth - development 3

4. The Health Field ConceptMarc Lalonde, 1974

5. The Health Field ConceptMarc Lalonde, 1974

6. Bio-ecological transactional model

7. Bio-ecological transactional model

8. Biopsychosocial model Ref: Brunner & Marmot, 2006

9. Biopsychosocial model Ref: Brunner & Marmot, 2006

10. Genomics  prospective health care: Ref: Snyderman R. The role of genomics in enabling prospective health care. In: Willard H, Ginsburg GS, eds. Genomic and personalized medicine. Durham, NC: Elsevier, 2009:378–85.

11. Vanderbiltdoinglong-termstudy of child health Dec. 3, 2010, 3:03 a.m. CST AssociatedPress NASHVILLE, Tenn. (AP) — VanderbiltUniversityMedical Center in Nashville and others have begun a major long-termstudy of child health in the United States. The National Children'sStudywillexaminehow environment, behavior and genetics impact children's health, development and growth. Itwill track 100,000 childrenfrombeforebirth to age 21.

12. Vanderbilt doing long-term study of child health Dec. 3, 2010, 3:03 a.m. CST Associated Press NASHVILLE, Tenn. (AP) — Vanderbilt University Medical Center in Nashville and others have begun a major long-term study of child health in the United States. The National Children's Study will examine how environment, behavior and genetics impact children's health, development and growth. It will track 100,000 children from before birth to age 21.

13. “Classic” example: newborn screening

14. “Classic” example: newborn screening

15. Example: ADHD Russell A. Barkley, 2006 The totality of evidence indicates that neurological and genetic factors play a substantial role in the origins and the expression of this disorder

16. ADHD: genetic contribution is a “fact in the bag” • Evidence-based genetic association with ADHD: • DRD4 - dopamine D4 receptor • DRD5 - dopamine D5 receptor • DAT - dopamine transporter gen • DBH - dopamine β-hydroxylase • 5-HTT - serotonin transporter gen • HTR1B - serotonin receptor gen • SNAP-25 - synaptosomal-associated protein 25 Faraone et al, Biol Psychiatry, 2005;57:1313

17. Example: schisis

18. Example: early life stress

19. Example: Child maltreatment Ref: Nature Neuroscience 2009, vol. 12 no. 8

20. Paradigm shift:

22. Challenges and benefits PH-Genomics for child and youth health care… • To develop and make family history tools available for prevention • To understand health effects of gene-environment interaction via public health investigations • To improve quality of life for our children & families • To reduce health costs through early detection and intervention • To improve long-term health outcomes in a life course perspective, with children transitioning to healthy and productive adults Child Health Genomics Working Group, Canada 2008

23. On behalf of all children… …I wish you lots of (genomics-)inspiration for the future!

24. Thank you for your attention Maastricht, 2011 - Prof. dr. Frans J.M. Feron