Chronic Kidney Disease Patients Struggle to Make Meaning of Their Illness

MedicalResearch.com Interview with:

Dr. Ann M. O’Hare, MD Professor,Division of Nephrology University of Washington Investigator, VA HSR&D Center of Excellence Affiliate Investigator, Group Health Research Institute Seattle, WA 

Prof. O’Hare

Dr. Ann M. O’Hare, MD
Professor,Division of Nephrology
University of Washington
Investigator, VA HSR&D Center of Excellence
Affiliate Investigator, Group Health Research Institute
Seattle, WA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We set out to conduct a qualitative study among patients with advanced kidney disease to learn about their thoughts and experience with advance care planning.

Our questions, especially at the beginning of the interview were quite broad and asked patients more generally about their experiences of illness and care. Although we did not ask patients about the emotional impact of illness and care, this came across as a strong theme when we analyzed the interviews, and that is what we describe here.

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Chronic Disease Linked To Increased Risk of Cancer and Cancer Death

MedicalResearch.com Interview with:

Dr. Xifeng Wu, MD PhD Department Chair, Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences Director, Center for Translational and Public Health Genomics Professor, Department of Epidemiology Division of Cancer Prevention and Population Sciences The University of Texas MD Anderson Cancer Center, Houston, Texas

Dr. Xifeng Wu

Xifeng Wu MD PhD
Prevention and Population Sciences
MD Anderson Center

MedicalResearch.com: What is the background for this study?

Response: Previous studies have shown that certain chronic diseases may predispose to cancer. These studies generally assessed chronic diseases or disease markers individually. As chronic diseases are typically clustered, it is necessary to study them simultaneously to elucidate their independent and joint impact on cancer risk. Therefore, we investigated the independent and joint effect of several common chronic diseases or disease markers on cancer and life span in a large prospective cohort. Also, we compared the contribution of chronic diseases or disease markers to cancer risk with that of lifestyle factors. We further assessed whether physical activity could attenuate the cancer risk associated with chronic diseases or disease markers. We hope the results of this study can contribute to evidence-based recommendations for future cancer prevention strategies.

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Handful of Nuts a Day Can Reduce Chronic Diseases

MedicalResearch.com Interview with:

Dr. Dagfinn Aune Department of Epidemiology and Biostatistics School of Public Health Imperial College London St. Mary's Campus London  UK

Dr. Dagfinn Aune

Dr. Dagfinn Aune
Department of Epidemiology and Biostatistics
School of Public Health
Imperial College London
St. Mary’s Campus London  UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There is a growing body of evidence suggesting that intake of nuts may reduce the risk of coronary heart disease, but the relation between nut intake and other diseases like cancer and stroke, and the relation with mortality and less common causes of death is not clear. Also it is not clear how much nuts are needed to reduce the risk.

So our current meta-analysis reviewed the data from 20 studies (29 publications) on nut intake and different health outcomes. We found that a nut intake of approximately one serving per day (28 g/d or a handful) was associated with a reduced risk of coronary heart disease (by 30%), total cancer (15%), all-cause mortality (22%) and mortality from respiratory disease (50%), diabetes (40%), and infections (75%), although there were few studies in the latter three analyses. We found that most of the benefit was observed up to an intake of around 20 grams per day. Similar results were found for total nuts, tree nuts and peanuts (which are botanically defined as legumes), but peanuts were also associated with reduced risk of stroke, while only tree nuts were associated with reduced cancer risk. We also calculated the number of deaths that potentially could be avoided, under the assumption that the observed associations are causal, and arrived at 4.4 million deaths in North and South America, Europe, Southeast Asia and the Western Pacific (unfortunately we did not have data on nut intake from West Asia and Africa so we were not able to include those areas).

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Declining Death Rates Largely Due To Decreased Tobacco Exposure

Mohammed K. Ali, MBChB, MSc, MBA Associate Professor of Global Health and Epidemiology Rollins School of Public Health Emory University

MedicalResearch.com Interview with:
Mohammed K. Ali, MBChB, MSc, MBA
Associate Professor of Global Health and Epidemiology
Rollins School of Public Health
Emory University

Medical Research: What is the background for this study? What are the main findings?

Dr. Ali: The background of this study is that we attempted to provide a comprehensive overview so that readers could see what has been happening for the 4 most common sets of chronic non-communicable diseases (cardiovascular diseases, diabetes, common cancers, and chronic respiratory diseases) over the past 30 years (1980-2012). We looked at one measure: death due to these conditions as that is the longest-standing way to understand what diseases are most common in society and warrant efforts to address them. And, we picked these 4 groups of conditions because together, they account for one out of every two deaths worldwide. We compiled data for 49 countries where over 70% of deaths in the country are documented and reported to the World Health Organization’s Mortality Database. What we found is that:

  • Between 1980 and 2012, death rates for many conditions (heart disease and stroke; cervical and stomach cancers) declined worldwide.
  • Second, deaths due to diabetes, liver cancers, and female lung cancer and female respiratory diseases increased worldwide.
  • And third, there were disparities between high-income countries (like the US, Australia, European countries) and low- and middle-income countries (like Mexico or Eastern European countries) in that these latter countries experienced less impressive declines in deaths due to heart disease, stroke, stomach, and cervical cancers, and actual increases in deaths due to breast cancers and colon cancers.This suggests that we have made important strides in high-income countries, largely due to efforts to lower tobacco exposure, and that awareness, access to healthcare, screening, and earlier treatments seem to be having an effect on prolonging survival from many cancers. Similarly, greater attention to and treatment of cardiovascular risk factors may be yielding benefits. However, more efforts are needed in low- and middle-income countries, and these disparities should not be overlooked.

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Telemedicine May Help Patients Adopt Healthy Lifestyle and Manage Chronic Diseases

Dr. Rashid Bashshur PhD Director of Telemedicine University of Michigan Health System Emeritus Professor of Health Management and Policy University of Michigan, School of Public HealthMedicalResearch.com Interview with:
Dr. Rashid Bashshur PhD

Director of Telemedicine
University of Michigan Health System
Emeritus Professor of Health Management and Policy
University of Michigan, School of Public Health 

Medical Research: What is the background for this study? What are the main findings?

Dr. Bashshur: The impetus for this research derives from the confluence of several factors, including the increasing incidence and prevalence of chronic diseases, their associated morbidity and  mortality and their high cost. The search for solutions has taken center stage in health policy.  Patients must be engaged in  in managing their health and health care, and they must assume greater responsibility for adopting and maintaining a healthy life style to reduce their dependence on the health system and to help themselves in maintaining an optimal level of health.  The  telemedicine intervention promises to  address all these issues and concerns, while also providing ongoing monitoring and guidance for patients who suffer from serious chronic illness.

The preponderance of the evidence from robust scientific studies points to the beneficial effects of the telemedicine intervention (through telemonitoring and patient engagement) in terms of reduction in use of service (including hospital admissions/readmissions, length of hospital stay, and emergency department visits) as well as improved health outcomes.  The single exception was reported in a study among frail  elderly patients with co-morbidities who did not benefit from the telemedicine intervention.

There is an ever-growing and complex body of empirical evidence that attests to the potential of telemedicine for addressing the triad problems of limited access to care, uneven distribution of quality across communities, and cost inflation.  Research demonstrates the effectiveness of the telemedicine intervention in addressing all three problems, especially when patients are engaged in managing their personal health and healthcare.  The enabling technology can be used to promote healthy life styles, informed decision making, and prudent use of health resources.

Unintended consequences of delaying mortality for older adults may also increase the use of resources, especially in the long run, and society must decide on the ultimate values it chooses to promote.
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Mobile Health Technologies Will Change Chronic Disease Management

Ryan Jeffrey Shaw, PhD, MS, RN Assistant Professor School of Nursing Center for Health Informatics Center for Precision Medicine Duke University MedicalResearch.com Interview with:
Ryan Jeffrey Shaw, PhD, MS, RN

Assistant Professor School of Nursing
Center for Health Informatics
Center for Precision Medicine
Duke University

Medical Research: What is the background for this study? What are the main findings?

Dr. Shaw: Primary care delivery revolves around a series of episodes, rather than functioning as a continuum. When patients come to a clinic data on their health is collected as a single data point. This model neglects potentially meaningful data from patients’ daily lives and results in less informed treatment and scheduling of follow-up visits. Lack of meaningful data further blinds clinicians to patients’ health outside of the clinic and can contribute to unnecessary emergency department visits and hospitalizations.

Personalized care through mobile health technologies inspires the transition from isolated snapshots based on serial visits to real time and trended data. By using technologies from cell phones to wearable sensors, providers have the ability to monitor patients and families outside of the traditional office visit.

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