Understanding Genetic and Environmental Risk Factors in Susceptible Persons

Most major chronic diseases probably result from environmental factors accumulating over time in genetically susceptible persons. A detailed family history assessment can help identify the subset of the general population with a strong predisposition to certain major diseases. An understanding of the environmental factors promoting disease development will facilitate more effective prevention or delay disease in a targeted susceptible population. To effectively use this growing knowledge in genetics and epidemiology, health professionals need to motivate people to follow sound recommendations for preventing and delaying disease.To increase the efficiency and effectiveness of strategies for health promotion and disease prevention, family history data can help determine those diseases for which persons have the greatest risk. They can then concentrate their primary efforts on those preventive measures that will most likely benefit them.     

MEETING COMMUNITY HEALTH NEEDS—The Combined Role of the Physician,Health Department and Hospital

Social and economic changes—the lengthening life span, the shift of population from rural to urban areas, the growth of industry and other factors—have brought about radical changes in the nation''s health needs. Our greatest health problem today is chronic illness. To cope with these problems public health, medical care and hospital services, which are at present geared primarily for acute illness, must be revised.Immediate and specific steps which physicians, health departments and hospitals can take to accomplish this are to define the problem and to initiate studies in several areas: To determine the incidence and prevalence of disease, injuries and impairments; the nature, degree and duration of resulting disability; and the type of care received.The basic approach to chronic illness is prevention. To accomplish this, more emphasis needs to be placed upon health education. Good health cannot be forced upon the public, but educated and enlightened citizens can and do solve their own health problems and those of their families and communities.Due to the complex nature of today''s health problems, they must be approached jointly by physicians, local health services, hospitals and the public. The efforts of those groups must be coordinated and aimed, directly and indirectly, at preventing disease and disability.     

Trialling of an optimal health programme (OHP) across chronic disease

Population ageing is a worldwide phenomenon, most advanced in developed countries and expected to continue over the next few decades. As people are surviving longer with age-associated disease and disability, there is an imperative to identify innovative solutions for an already overburdened health care system. Such innovations need to be focused on disease management, taking into consideration the strong associations that have been established between psychosocial factors and pathophysiological mechanisms associated with chronic disease. Aside from personal and community costs, chronic diseases produce a significant economic burden due to the culmination of health care costs and lost productivity. This commentary reports on a programme of research, Translating Research, Integrated Public Health Outcomes and Delivery, which will evaluate an optimal health programme that adopts a person-centred approach and engages collaborative therapy to educate, support and improve the psychosocial health of those with chronic disease. The effectiveness of the optimal health programme will be evaluated across three of the most significant contributors to disease burden: diabetes mellitus, chronic kidney disease and stroke. Cost-effectiveness will also be evaluated. The findings derived from this series of randomised controlled trials will also provide evidence attesting to the potential applicability of the optimal health programme in other chronic conditions.     

How Can Research on Plants Contribute to Promoting Human Health?

One of the most pressing challenges for the next 50 years is to reduce the impact of chronic disease. Unhealthy eating is an increasing problem and underlies much of the increase in mortality from chronic diseases that is occurring worldwide. Diets rich in plant-based foods are strongly associated with reduced risks of major chronic diseases, but the constituents in plants that promote health have proved difficult to identify with certainty. This, in turn, has confounded the precision of dietary recommendations. Plant biochemistry can make significant contributions to human health through the identification and measurement of the many metabolites in plant-based foods, particularly those known to promote health (phytonutrients). Plant genetics and metabolic engineering can be used to make foods that differ only in their content of specific phytonutrients. Such foods offer research tools that can provide significant insight into which metabolites promote health and how they work. Plant science can reduce some of the complexity of the diet-health relationship, and through building multidisciplinary interactions with researchers in nutrition and the pathology of chronic diseases, plant scientists can contribute novel insight into which foods reduce the risk of chronic disease and how these foods work to impact human health.     

Evolution of virulence,environmental change,and the threat posed by emerging and chronic diseases

Assessments of future threats posed by infection have focused largely on zoonotic, acute disease, under the rubric “emerging diseases.” Evolutionary and epidemiological studies indicate, however, that particular aspects of infrastructure, such as protected water supplies, vector-proof housing, and health care facilities, protect against the emergence of zoonotic, acute infectious diseases. While attention in the global health community has focused on emerging diseases, there has been a concurrent, growing recognition that important chronic diseases, such as cancer, are often caused by infectious agents that are already widespread in human populations. For economically prosperous countries, the immediacy of this threat contrasts with their infrastructural protection from severe acute infectious disease. This reasoning leads to the conclusion that chronic infectious diseases pose a more significant threat to economically prosperous countries than zoonotic, acute infectious diseases. Research efforts directed at threats posed by infection may therefore be more effective overall if increased efforts are directed toward understanding and preventing infectious causes of chronic diseases across the spectrum of economic prosperity, as well as toward specific infrastructural improvements in less prosperous countries to protect against virulent, acute infectious diseases.     

Temporal progress model of metabolic syndrome for clinical decision support system

The development of an integrated and personalized healthcare system is becoming an important issue in the modern healthcare industry. One of main objectives of integrated healthcare system is to effectively manage patients having chronic diseases that require long term care and its temporal information plays an important role to manage the statuses of diseases. Thus, a patient having chronic disease needs to visit the hospital periodically, which generates large volume of medical examination data. Among the various chronic diseases, metabolic syndrome (MS) has become a popular chronic disease in many countries. There have been efforts to develop an MS risk quantification and prediction model and to integrate it into personalized healthcare system, so as to predict the risk of having MS in the future. However, the development of methods for temporal progress management of metabolic syndrome has not been widely investigated. This paper proposes a method for identifying the temporal progress of MS patients' status based on the chronological clustering methodology. To investigate the temporal changes of disease status, we develop a chronological distance variance model that quantifies the difference of areal similarity degree (ASD) values between estimated and examined results of MS risk factors. We evaluate the clinical effectiveness of the temporal progress model by using sample subjects' examination results that have been measured for 10 years. We further elaborate the accuracy of the proposed temporal progress estimation method by using multiple linear regression method. Then, we develop a tier-based patients' MS status classification based on the chronological distance variance. The tier classification is based on the sensitivity for temporal change of MS status according to different values of control range of chronological distance variance. Our proposed temporal change identification method and patients' tier classification are expected to be incorporated with the integrated healthcare systems to help physicians with identifying the temporal progress of MS patients' health status and MS patients with self-management at home environments.     

The Understanding and Interpretation of Innovative Technology-Enabled Multidimensional Physical Activity Feedback in Patients at Risk of Future Chronic Disease

BackgroundInnovative physical activity monitoring technology can be used to depict rich visual feedback that encompasses the various aspects of physical activity known to be important for health. However, it is unknown whether patients who are at risk of chronic disease would understand such sophisticated personalised feedback or whether they would find it useful and motivating. The purpose of the present study was to determine whether technology-enabled multidimensional physical activity graphics and visualisations are comprehensible and usable for patients at risk of chronic disease.MethodWe developed several iterations of graphics depicting minute-by-minute activity patterns and integrated physical activity health targets. Subsequently, patients at moderate/high risk of chronic disease (n=29) and healthcare practitioners (n=15) from South West England underwent full 7-days activity monitoring followed by individual semi-structured interviews in which they were asked to comment on their own personalised visual feedback Framework analysis was used to gauge their interpretation and of personalised feedback, graphics and visualisations.ResultsWe identified two main components focussing on (a) the interpretation of feedback designs and data and (b) the impact of personalised visual physical activity feedback on facilitation of health behaviour change. Participants demonstrated a clear ability to understand the sophisticated personal information plus an enhanced physical activity knowledge. They reported that receiving multidimensional feedback was motivating and could be usefully applied to facilitate their efforts in becoming more physically active.ConclusionMultidimensional physical activity feedback can be made comprehensible, informative and motivational by using appropriate graphics and visualisations. There is an opportunity to exploit the full potential created by technological innovation and provide sophisticated personalised physical activity feedback as an adjunct to support behaviour change.     

Focus: Health Equity: Lung Disease in Central Appalachia: It’s More than Coal Dust that Drives Disparities

The population living in Central Appalachia is disproportionately impacted by lung disease. This is driven, in part, by occupational hazards and environmental exposures. However, it is more than coal dust that is driving the ongoing disparity of lung disease in the region. This review describes how the decline of the coal mine industry and subsequent rise of unemployment, poverty, and educational disparities have increased risk for worse pulmonary health outcomes in the region. Additional challenges related to healthcare access, substance use, cultural characteristics, and social capital are highlighted in their relation to pulmonary health within Central Appalachia. Lastly, the review describes strategies that hold promise to reduce regional health disparities. Several healthcare and community-centered initiatives are highlighted as successful examples of collaborative efforts working towards improving pulmonary health outcomes in the region. However, significant challenges related to social, economic, and environmental factors remain. Addressing these social determinants of health must be a paramount concern for healthcare, community and political leaders seeking to impact change and improve the health and well-being of this vulnerable population.     

Women and AIDS: the ethics of exaggerated harm

This article examines the way in which some biomedical ethicists have constructed sexually transmitted AIDS as a significant threat to women's health. We demonstrate that the familiar claim that'women are the fastest growing group'— whether of HIV-infected or of AIDS patients — is misleading because it obscures the distinction between proportional rate of growth and absolute increase. Feminist ethicists have suggested that misogyny of a male dominated health care system has led to underreporting of women AIDS cases in order to support these feminists'claim of AIDS being a real threat to women's health. Given the apparent rarity of tertiary transmissions of AIDS, the assertion that most or even many women are at significant risk for AIDS seem wrong. Particularly disturbing in this campaign is the fact that the theme of'risky sex'has been extended all the way to lesbians, even though their risk to acquire AIDS sexually is non-existent to minuscule. We argue that actual harm is done to women by this exaggeration of their risk of contracting AIDS sexually. The scare has led to misappropriations of scarce health care funds. AIDS disproportionately affects women who inject drugs, and who suffer other diseases, poverty and malnutrition. It would have been better to concentrate health care efforts in this area instead of'educating'women not at risk for AIDS how to prevent the acquisition of this disease. Unjustifiable AIDS anxiety has been created in women and has resulted in millions of unnecessary HIV-tests, and many broken relationships. This anxiety has inevitably reduced the pleasure of having sex for many women. We reject the kind of'victim ideology'that lies at the heart of this strategy which has, unfortunately, been supported by a number of influential feminist ethicists.     

Meeting community health needs; the combined role of the physician,health department and hospital

Social and economic changes-the lengthening life span, the shift of population from rural to urban areas, the growth of industry and other factors-have brought about radical changes in the nation's health needs. Our greatest health problem today is chronic illness. To cope with these problems public health, medical care and hospital services, which are at present geared primarily for acute illness, must be revised. IMMEDIATE AND SPECIFIC STEPS WHICH PHYSICIANS, HEALTH DEPARTMENTS AND HOSPITALS CAN TAKE TO ACCOMPLISH THIS ARE TO DEFINE THE PROBLEM AND TO INITIATE STUDIES IN SEVERAL AREAS: To determine the incidence and prevalence of disease, injuries and impairments; the nature, degree and duration of resulting disability; and the type of care received. The basic approach to chronic illness is prevention. To accomplish this, more emphasis needs to be placed upon health education. Good health cannot be forced upon the public, but educated and enlightened citizens can and do solve their own health problems and those of their families and communities. Due to the complex nature of today's health problems, they must be approached jointly by physicians, local health services, hospitals and the public. The efforts of those groups must be coordinated and aimed, directly and indirectly, at preventing disease and disability.     

Epidemiology of areca (betel) nut use in the mariana islands: Findings from the University of Guam/University of Hawai`i cancer center partnership program

BackgroundAreca (betel) nut is considered a Group 1 human carcinogen shown to be associated with other chronic diseases in addition to cancer. This paper describes the areca (betel) nut chewing trend in Guam, and health behaviors of chewers in Guam and Saipan.MethodsThe areca (betel) nut module in the Guam Behavioral Risk Factor Surveillance Survey was used to calculate the 5-year (2011–2015) chewing trend. To assess the association between areca (betel) nut chewing and health risks in the Mariana Islands, a cross-section of 300 chewers, ≥18 years old, were recruited from households in Guam and Saipan. Self-reported socio-demographics, oral health behaviors, chronic disease status, diet, and physical activity were collected. Anthropometry was measured. Only areca (betel) nut-specific and demographic information were collected from youth chewers in the household.ResultsThe 5-year areca (betel) nut chewing prevalence in Guam was 11% and increased among Non-Chamorros, primarily other Micronesians, from 2011 (7%) to 2015 (13%). In the household survey, most adult chewers (46%) preferred areca nut with betel leaf, slaked lime, and tobacco. Most youth chewers (48%) preferred areca nut only. Common adult chronic conditions included diabetes (14%), hypertension (26%), and obesity (58%).ConclusionThe 5-year areca (betel) nut chewing prevalence in Guam is comparable to the world estimate (10–20%), though rising among Non-Chamorros. Adult and youth chewers may be at an increased risk for oral cancer. Adult chewers have an increased risk of other chronic health conditions. Cancer prevention and intervention strategies should incorporate all aspects of health.     

Covid-19 & Obesity: Beyond Bmi

The pandemic of novel coronavirus disease 2019 (COVID-19) has triggered an international crisis resulting in excess morbidity and mortality with adverse societal, economic, and geopolitical consequences. Like other disease states, there are patient characteristics that impact clinical risk and determine the spectrum of severity. Obesity, or adiposity-based chronic disease, has emerged as an important risk factor for morbidity and mortality due to COVID-19. It is imperative to further stratify risk in patients with obesity to determine optimal mitigation and perhaps therapeutic preparedness strategies. We suspect that insulin resistance is an important pathophysiologic cause of poor outcomes in patients with obesity and COVID-19 independent of body mass index. This explains the association of type 2 diabetes mellitus (T2DM), hypertension (HTN), and cardiovascular disease with poor outcomes since insulin resistance is the main driver of both dysglycemia-based chronic disease and cardiometabolic-based chronic disease towards end-stage disease manifestations. Staging the severity of adiposity-related disease in a “complication-centric” manner (HTN, dyslipidemia, metabolic syndrome, T2DM, obstructive sleep apnea, etc.) among different ethnic groups in patients with COVID-19 should help predict the adverse risk of adiposity on patient health in a pragmatic and actionable manner during this pandemic.     

New approaches for the treatment of Alzheimer’s disease

Alzheimer’s disease (AD) is the most prevalent chronic neurodegenerative disease. Current approved therapies are symptomatic treatments having some effect on cognitive function. Therapies that target β-amyloid (Aβ) have been the focus of efforts to develop a disease modification treatment for AD but these approaches have failed to show any clinical benefit so far. Beyond the ‘Aβ hypothesis’, there are a number of newer approaches to treat AD with neuroinflammation emerging as a very active area of research based on risk gene analysis. This short review will summarize approved drug therapies, recent clinical trials and new approaches for the treatment of AD.     

Health transition: examples from the western Pacific.

The Industrial Revolution ushered in a rapid transition from agriculture to industrialization. Some biological effects of this transition included increasing life expectancy, reduced infant mortality, and some decline in fertility. Reduced infant mortality first brought about an increase in life expectancy, but as humans were able to control infectious diseases, child and adult mortality also decreased. Now, accidents and chronic diseases are responsible for most mortality in many age groups. This shift from infectious diseases to accidents and chronic diseases is called the health transition. Japan and US are Pacific Basin countries which have relatively high life expectancy and low infant mortality (1988, 75.54 years vs. 71.38 years, and 4.4 vs. 9.9, respectively). These figures suggest that these countries rather advanced in the health transition. Japan may have better life expectancy than the US because of the effect of environmental factors, ethnic diversity, and health care differentials by social class on cardiovascular disease and cancer mortality. China and Thailand hold intermediate positions (67.98 years (1985-1990) vs. 63.82 years (1985-1986), and 32.4 vs. 39, respectively). Some research indicates that urban conditions and factory work increase the cardiovascular disease risk among the Chinese. Recent research suggests that access to immunization and modern medical care for acute disease are the only critical variables of the health transition rather than other variables. Papua New Guinea is not progressing very well (53.18 years and 58). Papua New Guinea has not yet been able to control infectious diseases, especially malaria. This comparison illustrates that populations progress through the health transition at different rates.     

Promoting state health department evidence-based cancer and chronic disease prevention: a multi-phase dissemination study with a cluster randomized trial component

Background

Cancer and other chronic diseases reduce quality and length of life and productivity, and represent a significant financial burden to society. Evidence-based public health approaches to prevent cancer and other chronic diseases have been identified in recent decades and have the potential for high impact. Yet, barriers to implement prevention approaches persist as a result of multiple factors including lack of organizational support, limited resources, competing emerging priorities and crises, and limited skill among the public health workforce. The purpose of this study is to learn how best to promote the adoption of evidence based public health practice related to chronic disease prevention.

Methods/design

This paper describes the methods for a multi-phase dissemination study with a cluster randomized trial component that will evaluate the dissemination of public health knowledge about evidence-based prevention of cancer and other chronic diseases. Phase one involves development of measures of practitioner views on and organizational supports for evidence-based public health and data collection using a national online survey involving state health department chronic disease practitioners. In phase two, a cluster randomized trial design will be conducted to test receptivity and usefulness of dissemination strategies directed toward state health department chronic disease practitioners to enhance capacity and organizational support for evidence-based chronic disease prevention. Twelve state health department chronic disease units will be randomly selected and assigned to intervention or control. State health department staff and the university-based study team will jointly identify, refine, and select dissemination strategies within intervention units. Intervention (dissemination) strategies may include multi-day in-person training workshops, electronic information exchange modalities, and remote technical assistance. Evaluation methods include pre-post surveys, structured qualitative phone interviews, and abstraction of state-level chronic disease prevention program plans and progress reports.

Trial registration

clinicaltrials.gov:NCT01978054.

     

Human rights as a framework for eliminating female genital schistosomiasis

Female genital schistosomiasis (FGS) affects tens of millions of women and girls in sub-Saharan Africa, yet this inequitable threat is often overlooked by advocates in both the neglected tropical disease (NTD) and sexual and reproductive health and rights (SRHR) communities. FGS causes both acute infection and long-term sexual and reproductive health harm to marginalized women and girls, with gender, poverty, and rurality combining to invisibilize the disease. Human rights and gender imperatives can help to galvanize efforts to control and eliminate FGS, as they have for other NTDs. Specifically, international human rights obligations can frame state efforts to address FGS across healthcare settings, upstream social determinants of health, scientific research, and policy implementation. This article analyzes human rights–based approaches to FGS control and elimination efforts, outlining several areas for forward-looking reforms to health policy, programing, and practice. Building from the lessons learned in applying human rights–based approaches to advance progress on other NTDs, this analysis seeks to provide the NTD community with shared understanding around international legal obligations to engage SRHR advocates and draw heightened attention to FGS. Such human rights–based approaches to FGS control and elimination can help to reduce stigma and improve care for the millions of women and girls currently affected by this preventable disease.     

RECENT TRENDS IN PUBLIC HEALTH

Environmental sanitation is experiencing a reawakening with concerted drives at control of water and atmospheric pollution, mosquito and rodent control, and improvement in restaurant sanitation. Communicable disease control efforts are being intensified.With prolongation of life, chronic diseases are assuming increasing importance as public health problems. Maintenance of standards of hospitals and provision for more adequate hospital facilities are also receiving attention. Mental health and chronic alcoholism are being considered as a public health problem.With all these new trends emphasizing prevention of disease, increasing teamwork between physicians in private practice and in public health practice is being manifested. Preventive medicine and public health are now a recognized specialty in medicine.     

Health and the life course: why safety nets matter.

This article argues that a life course approach is necessary to understand social variations in health. This is needed in order to take into account the complex ways in which biological risk interacts with economic, social, and psychological factors in the development of chronic disease. Such an approach reveals biological and social "critical periods" during which social policies that will defend individuals against an accumulation of risk are particularly important. In many ways, the authors of modern welfare states were implicitly addressing these issues, and the contribution of these policies to present day high standards of health in developed countries should not be ignored.     

Causal Inference Regarding Infectious Aetiology of Chronic Conditions: A Systematic Review

Background

The global burden of disease has shifted from communicable diseases in children to chronic diseases in adults. This epidemiologic shift varies greatly by region, but in Europe, chronic conditions account for 86% of all deaths, 77% of the disease burden, and up to 80% of health care expenditures. A number of risk factors have been implicated in chronic diseases, such as exposure to infectious agents. A number of associations have been well established while others remain uncertain.

Methods and Findings

We assessed the body of evidence regarding the infectious aetiology of chronic diseases in the peer-reviewed literature over the last decade. Causality was assessed with three different criteria: First, the total number of associations documented in the literature between each infectious agent and chronic condition; second, the epidemiologic study design (quality of the study); third, evidence for the number of Hill''s criteria and Koch''s postulates that linked the pathogen with the chronic condition.We identified 3136 publications, of which 148 were included in the analysis. There were a total of 75 different infectious agents and 122 chronic conditions. The evidence was strong for five pathogens, based on study type, strength and number of associations; they accounted for 60% of the associations documented in the literature. They were human immunodeficiency virus, hepatitis C virus, Helicobacter pylori, hepatitis B virus, and Chlamydia pneumoniae and were collectively implicated in the aetiology of 37 different chronic conditions. Other pathogens examined were only associated with very few chronic conditions (≤3) and when applying the three different criteria of evidence the strength of the causality was weak.

Conclusions

Prevention and treatment of these five pathogens lend themselves as effective public health intervention entry points. By concentrating research efforts on these promising areas, the human, economic, and societal burden arising from chronic conditions can be reduced.