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Anchor lead: A worldwide survey indicates health problems that are increasing, Elizabeth Tracey reports

Taking a look at death and disease around the world reveals trends that are important from a public health perspective. The recent Global Burden of Disease study published in the Lancet reveals several such areas. That’s according to Mike Klag, dean of the Johns Hopkins Bloomberg School of Public Health.

Klag: These data also emphasize the increasing importance of depression and mental illness in terms of quality of life in terms of disability adjusted life years. These are conditions that are growing around the world and we need cost-effective interventions to help stem that burden of disease.  :17

Klag notes that we can all learn from this study.

Klag: There are countries that are doing well, where their life expectancy is improving at a much higher level than you would expect from their level of development. We can learn from those countries what it is that helps prevent noncommunicable diseases, and I think that’s the next step of these analyses.  :16

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What do death data worldwide tell us? Elizabeth Tracey reports

What do people worldwide die of? That’s the substance of the Global Burden of Disease study published recently in the Lancet. Mike Klag, dean of the Bloomberg School of Public Health at Johns Hopkins, describes the data.

Klag: Now over 70% of people around the world are estimated to die from causes that are not infectious. Noncommunicable diseases. So these are diseases like cardiovascular disease, lung disease, Alzheimer’s, obesity related diseases and risk factors that come from obesity. That’s not to say that there isn’t a big burden of infectious diseases. There are, and we can’t take our eye off that, but increasingly the drivers of why people get sick and why they die are noncommunicable diseases.  :28

Klag notes that the majority of noncommunicable diseases are under the control of the individual, and that prudent choices regarding diet, exercise, and smoking can dramatically impact the chance of developing one of these conditions and experiencing early death. At Johns Hopkins, I’m Elizabeth Tracey.

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Senior man communicating with a male doctor in the office.

This week’s topics include physician assisted suicide, preventing infection post-C-section in obese women, 12 year outcomes of bariatric surgery, and death among triathletes.

Program notes:

0:46 Triathlon events and death
1:43 Half with previously unknown cardiac problems
2:43 Trouble in water harder to resuscitate
3:36 Physician assisted suicide
4:36 In Oregon data gathered
5:36 Should be able to provide
6:40 No cancer excision if futile
7:15 12 year outcomes from bariatric surgery
8:15 3/4ths of diabetes remitted
9:07 Preventing infections in obese women with C-sections
10:45 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/09/23/should-doctors-assist-in-death/

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Anchor lead: Just how much abuse do nurses endure? Elizabeth Tracey reports

Occupational Safety and Health Administration data tell us that healthcare workers are four times more likely than others to experience workplace violence, a statistic that may not be surprising in light of the recent handcuffing of a Utah emergency department nurse by a policeman. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says the problem is escalating.

Davidson: There is a torrent of inappropriate behaviors from patients when they’re attributable to a medical condition. We are seeing an increasing intensity and really frequency of these events. We have to have better interventions for managing delirium, for managing challenging behaviors, particularly in people who are mentally incapacitated. How do we use conversational skills or conversational skills to cool conversations down, rather than heating them up?  :32

Davidson affirms that developing new protocols and communications channels is also key to de-escalating violence against nurses. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What are the implications of the recent viral story on police handcuffing a nurse? Elizabeth Tracey reports

A policeman handcuffing an emergency department nurse for 20 minutes in late July went viral, and has precipitated a lot of responses. Patricia Davidson, dean of the Johns Hopkins School of Nursing, describes her reactions.

Davidson: Firstly, the importance of policies, procedures, and contact. The other amazing thing was the courage and tenacity of nurse Wubbels under these extenuating circumstances to maintain advocacy and protection of the patient. Really I’ve never been prouder to be a nurse, to see her actions. And the other thing that is really important, particularly in this increasingly complex times that we are all trained in situations of escalation.   :32

Davidson says she’s advocating for training that’s similar to negotiators for hostage release or those intervening in a threatened suicide as critical for nurses in potentially or frankly hostile situations, noting that such skills are an important part of a nurse’s toolkit. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How can people with heart failure be safely managed outside of the hospital? Elizabeth Tracey reports

Heart failure rates domestically and internationally are soaring, with a recent study pointing to dietary salt consumption as one contributory factor. Nisha Gilotra, a cardiologist at Johns Hopkins, says a novel approach called a ‘bridge clinic’ can help people who’ve been hospitalized with heart failure avoid repeated hospitalizations.

Gilotra: In that clinic they’re able to have very close monitoring of whether the treatments that were initiated in the hospital are still working, if they need to be adjusted, they can even avoid coming back into the hospital by calling the clinic and saying I feel more short of breath, my weight is going up, my legs are swelling. And come in and get their pills adjusted, or even through an IV get medication that helps get the fluid off.  :25

Enrollment in the bridge clinic starts while people with heart failure are in the hospital and relies on abundant education to help them recognize when their condition is worsening and reach out for help. Giotra says people are really happy to be participants in their own care and avoid coming back to the hospital. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Should everyone be screened for type 1 diabetes? Elizabeth Tracey reports

Type 1 diabetes, where the body attacks its own insulin producing cells, seems to be increasing in incidence worldwide, pointing to the need to screen children for the condition. Now a need blood test developed by Dax Fu, a physiology expert at Johns Hopkins, and colleagues, may help.

Fu: If we could detect the disease earlier then we have a long time to find out ways to prevent or delay the occurrence of the type 1 diabetes.   :10

Fu says the test relies on the presence of proteins in the blood that point to type 1 diabetes, and that these may be present 10 years before the condition is actually manifest.

Fu: Right now the current screenings can only be used in the hospital for people who have a high risk of type 1 however in the past few years the percentage has increased by 1 or 2% every year.  :11

Fu hopes that combining existing technology with that developed for this test will enable screening to be 99 percent accurate in identifying type 1 diabetes. At Johns Hopkins, I’m Elizabeth Tracey.

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