Number Of At-risk Individuals Research Articles

Disparities in Lung Cancer Screening Availability: Lessons From Southwest Virginia

Little is known about health disparities in access to low-dose computed tomography (LDCT) screening. This study hypothesized that the current capacity for LDCT screening would be exceeded by the number of at-risk individuals in Virginia. Cancer incidence data and adult smoking rates for Virginia were obtained from public sources between 2006 and 2012. The American College of Radiology website was queried in 2015 to identify lung cancer screening facilities in Virginia, which were surveyed. Spatial exploratory data analysis was used to examine secondary data, and descriptive analysis was used to examine primary survey data. Rural counties have higher lung cancer death rates and smoking rates than metropolitan counties. Despite a tremendous burden for LDCT screening in rural counties, particularly in southwest Virginia, there were only two LDCT facilities. In total,37 accredited LDCT facilities were identified in Virginia. On average, facilities had been screening for 14.6 months and screened an average of 76 patients. At-risk smokers in Virginia, particularly those living in rural areas with high smoking rates, do not have adequate recommended LDCT coverage. More screening centers are needed to care for the high number of rural smokers at risk for lung cancer.

Epidemiology and Ecology of Opportunistic Premise Plumbing Pathogens: Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa.

BackgroundLegionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa are opportunistic premise plumbing pathogens (OPPPs) that persist and grow in household plumbing, habitats they share with humans. Infections caused by these OPPPs involve individuals with preexisting risk factors and frequently require hospitalization.ObjectivesThe objectives of this report are to alert professionals of the impact of OPPPs, the fact that 30% of the population may be exposed to OPPPs, and the need to develop means to reduce OPPP exposure. We herein present a review of the epidemiology and ecology of these three bacterial OPPPs, specifically to identify common and unique features.MethodsA Water Research Foundation–sponsored workshop gathered experts from across the United States to review the characteristics of OPPPs, identify problems, and develop a list of research priorities to address critical knowledge gaps with respect to increasing OPPP-associated disease.DiscussionOPPPs share the common characteristics of disinfectant resistance and growth in biofilms in water distribution systems or premise plumbing. Thus, they share a number of habitats with humans (e.g., showers) that can lead to exposure and infection. The frequency of OPPP-infected individuals is rising and will likely continue to rise as the number of at-risk individuals is increasing. Improved reporting of OPPP disease and increased understanding of the genetic, physiologic, and structural characteristics governing the persistence and growth of OPPPs in drinking water distribution systems and premise plumbing is needed.ConclusionsBecause broadly effective community-level engineering interventions for the control of OPPPs have yet to be identified, and because the number of at-risk individuals will continue to rise, it is likely that OPPP-related infections will continue to increase. However, it is possible that individuals can take measures (e.g., raise hot water heater temperatures and filter water) to reduce home exposures.CitationFalkinham JO III, Hilborn ED, Arduino MJ, Pruden A, Edwards MA. 2015. Epidemiology and ecology of opportunistic premise plumbing pathogens: Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa. Environ Health Perspect 123:749–758; http://dx.doi.org/10.1289/ehp.1408692

Systemic Hypertension: An Endemic, Epidemic, and a Pandemic

Disease epidemics have influenced world history throughout time. Although disease patterns such as the plague and smallpox historically have been infectious in nature, chronic diseases such as cardiovascular disease, stroke, congestive heart failure, and end-stage renal disease have become the new global epidemics. The effects of these conditions affect nearly all populations of the world. Although high blood pressure has been implicated as the common link of these pandemic patterns only for less than half a century, the impact of hypertension treatment and control has become a documented population-based response with the greatest potential for global impact. For example, an estimated 45% of the deaths among African-American men could be prevented with treatment of high blood pressure to goal level. However, population demographics and risk factors predict a worsening effect as the populations of the world increase in age, racial disparities in access to medical care widen, and comorbid conditions such as obesity and metabolic syndrome continue to increase at epidemic rates. The economic impact of hypertension-related conditions, end-stage renal disease, and congestive heart failure is staggering, such that health care delivery systems will fail if the current trends are not changed. Hospitalization rates of hypertension-related conditions are increasing along with an aging population. The number of at-risk individuals in the population also is increasing. As the definition of hypertension changes with lower levels of blood pressure, the proportion of the population considered to have hypertension increases substantially. These trends and disease patterns clearly identify the essential need to implement population and clinical strategies for high blood pressure prevention, treatment, and control.

Cost-Effectiveness of Community-Level Approaches to HIV Prevention: A Review

Effective community-level HIV prevention strategies have the potential to reach large numbers of at-risk individuals at relatively small per-capita costs, and therefore to be highly cost-effective. We review the published literature on the cost-effectiveness of community-level HIV prevention interventions, including five studies of sexual behavior change interventions and seven risk reduction programs for injection drug users. Overall, these studies indicate that community-level strategies can be very cost-effective, and in many cases, actually save society money by averting the need for costly HIV/AIDS medical care.

Decreased DNA repair in familial Alzheimer's disease.

Alterations in the capacity of a cell to repair DNA lesions play an important role in a number of human diseases. We and others have demonstrated defective DNA repair of alkylation damage in cells from patients with Alzheimer's disease. It has been hypothesized that this defect is related to the cause of Alzheimer's disease and results in the accumulation of lesions in the central nervous system neurons. One prediction of this hypothesis is that in dominantly inherited Alzheimer's disease, the repair defect will be present in half of the offspring of affected patients long before they develop symptoms of the disease. In order to test the hypothesis that decreased DNA repair is responsible for familial Alzheimer's disease and their at-risk offspring we have studied DNA repair in these individuals after exposure of lymphoblasts to alkylating agents. Our results indicate that cell lines from affected patients repair significantly less damage in 3 h than cell lines from healthy controls. A small number of at-risk individuals were also studied and some of these had lower levels of repair, although more cell lines from individuals in this group must be studied. These findings provide further support for defective DNA repair playing a role in the pathogenesis of Alzheimer's disease.