Showing 5 ideas for tag "co-morbidities"

Goal 1: Promote Human Health

ESTABLISH NORMATIVE AGE- AND GENDER-SPECIFIC DATA FOR SLEEP DISRUPTION, SLEEP QUALITY AND CIRCADIAN TIMING

There is growing evidence that sleep durations are progressively declining in the United States. Moreover, sleep durations are different at different ages and in different ethnic groups. Currently definitions of normal are based on consensus since there is a lack of key data. Defining normal as with FEV1 is a critical step.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

There is a developing evidence from both basic research and clinical research on the role of insufficient sleep in different co-morbidities. These include cardiovascular disease, hypertension and metabolic disorders. The Centers for Disease Control (CDC) has appreciated the importance of this that adequate sleep is one of the pillars of health. As part of the CDC-supported program on sleep health, a consensus statement has been issued on normal sleep duration. The group doing this on behalf of the American Academic of Sleep Medicine and Sleep Research Society realized that our evidence base is inadequate at this time. Thus, there is a need to focus on this critical challenge. Sleep duration varies across the lifespan and there is some evidence that it is different in different ethnic groups. Thus, there is a need for comprehensive efforts to address this question and to obtain normative data for sleep duration that is age-, gender-specific and with respect to different ethnic groups.

Feasibility and challenges of addressing this CQ or CC

There are now recent cohorts at NIH assessing sleep duration using not only self-report but also actigraphy. These could be used as an initial approach to address this question. This will require some degree of coordination between NIH Institutes. In the future a cohort that is specific to addressing questions about sleep duration and other sleep problems would be optimal. There are major prevalent public health issues. This would be facilitated by development of new mobile approaches to assessing these behaviors in an objective way.

Name of idea submitter and other team members who worked on this idea Sleep Research Society

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Goal 2: Reduce Human Disease

COPD and co-morbidities

Society is ageing and chronic degenerative diseases including COPD are increasingly occurring together.
The critical question is whether certain diseases occur together by chance or are they occurring together because they share pathobiological commonalities and mechanisms? This leads to a series of practical consequences and questions
1. Which diseases are occurring concurrent with COPD more than chance alone would... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

It is entirely possible and actually likely that several diseases manifesting in different organ systems may have shared pathobiological mechanisms. This could be the case of systemic inflammation or abnormal repair, precipitated by interaction with external agents such as pollution or smoking. This would manifest as different diseases affecting different organ systems (as could be the case of COPD and Lung Cancer) using today's taxonomy.
As it stands (taking the COPD Lung Cancer example) each is treated differently and actually strategically and clinically, they are handled as separate entitites. In all reality, if we can identify the diseases that share common pathogenetic mechanism, it is likely that we can develop common biomarker profiles that will detect disease predisposition so that early intervention can be planned.
In addition and equally important, once common co-morbidities can be grouped by pathobiology, plans can be developed by the medical establishment including health authorities to develop common approaches rather than the disjointed separate specialties that today handle each of the different organ systems.
Finally, the potential of aggregation of diseases into common pathobiological fields can reduce health care cost by integrating fields and voiding dispersion of resources.

Feasibility and challenges of addressing this CQ or CC

It is entirely possible to use large throughput data analysis such as system network analysis to determine in a hypothesis free environment, what is the relationship amongst diseases. This analysis, that can be facilitated by the availability of electronic medical records can provide a first glance evidence of commonality amongst certain diseases.
This can be validated in other cohorts and a plan for profiling a representative sample of those cohorts in order to determine their proteomic and metabolomics profile. This will provide insight into the mechanisms responsible for the expression of the diseases and can lead to translational research aimed at identifying the mechanisms for the generation of the syndrome and potential therapeutic targets.
Once proven correct, it will be possible to identify and treat several diseases simultaneously with targeted therapy once appropriate trials have been completed.
The project here presented is already feasible and likely to offer new roads leading to a better taxonomy, identification and treatment of what now represents a puzzle of different pieces poorly interlocked.
Given the magnitude of the population that is and will be even more affected by multiple chronic diseases, this is a field that is ready for prime research efforts.

Name of idea submitter and other team members who worked on this idea COPD and co-morbidities: Chance or Fate?

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Goal 1: Promote Human Health

Investigating Co-Morbidities in Women's Cardiovascular Health

There are important questions related to the cardiovascular health of women, and particularly to diagnostic and therapeutic challenges arising from the common existence of co-morbid conditions. The latter consideration, as well as the limitations of the budgets of individual institutes and centers at the NIH, suggest that it may be reasonable for the NHLBI to consider cross-NIH collaborations with I/Cs that have related... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Collaboration across I/Cs could encourage investigators or teams to explore new concepts underlying the etiology of common or rare cardiovascular diseases (CVD), including stroke, particularly those with gender-related differences. In addition, clinical research on these disorders would benefit from active consideration of the common co-morbidities seen in patients with CVD, especially as patients with these co-morbidities are often specifically excluded from clinical trials. Since the patients who will ultimately benefit from treatments developed will often suffer from multiple other disorders, the societal benefit would be substantial. While any single I/C could support such studies, collaborative funding would be likely to bring together new teams of investigators with novel ideas.

Feasibility and challenges of addressing this CQ or CC

We believe that there is likely to be a good response from investigators, both basic and clinical, to collaborative, multi-I/C RFAs. It might be of additional benefit to provide some funds specifically for teams that are newly collaborative in response to the RFAs, to encourage increased cross-field collaboration.

Name of idea submitter and other team members who worked on this idea Rose Marie Robertson for American Heart Association

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Goal 3: Advance Translational Research

Generalizing patient education to address co-morbidities

How do we generalize our educational efforts such that multiple co-morbidities and their self-care can be addressed?

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

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Patients with with many co-morbidities, many times have to weigh the benefits of a particular medication for one issue, with the downside of what it may do to another issue. There needs to be much more education in this area.

Name of idea submitter and other team members who worked on this idea Karen Deitemeyer, COPD Foundation State Captain Program

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Goal 2: Reduce Human Disease

Molecular mechanism for hypertension and the diverse co-morbidities

What molecular mechanism causes hypertension as well as the diverse co-morbidities in hypertension?

We discovered a fundamental mechanism that causes chronic and acute tissue injury due to the action of the powerful digestive enzymes, the same used for daily digestion. In various acute and chronic cardiovascular conditions the compartmentalization of these enzymes fails and they escape into the intestine and systemic... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

- There is a need to identify with genomic, proteomic and zymographic tools the full extend of unchecked digestive and proteolytic enzyme activities in hypertensives. Since unchecked protease activity is transient and depends on daily and monthly cycles, continuous in-vivo measurement techniques need to be developed with next generation sensitivity and specificity. The enzymatic profile of individuals needs to be determined.
- Knowledge of specific enzyme activities in patients will open the opportunity for individualized pharmacological treatment of the fundamental cause of hypertension and its co-morbidities as compared to treatment of multiple symptoms, a strategy, which leads to a significant reduction of costs.
- Identification of the unchecked degrading enzyme activity opens the door to determine the root cause of its activity in the cardiovascular systems, especially its connection to the digestive system. It will be possible to link digestion (including specific digestive enzymes and the protection mechanisms against their escape into the cardiovascular system, the macronutrients and specific food contents) with cell and organ dysfunctions on an omic scale.
- The role of digestive enzymes provides a rational opportunity to establish a link to the protective effect of “calorie restriction” identified in aging research. It will be possible to determine the relationship between aging in hypertension and autodigestion as basis for new interventions.

Feasibility and challenges of addressing this CQ or CC

The investigation of "autodigestion" as a fundamental mechanisms of various diseases requires the development of new techniques and will profoundly guide thinking about inflammatory diseases (e.g. non-infectious) and their treatment.

Study of autodigestion will shed light on cell/tissue molecular degrading mechanisms and in particular on proteolytic destruction of membrane receptors and their impact on loss of cell functions and associated co-morbidities.

There is a need to develop omic approaches that identify the degrading process and the breakdown products generated and the role of digestive and other degrading enzymes in the context of specific food consumption.

The work fits into all three strategic goals:

Promote health, reduce disease and provide translational approaches.

Name of idea submitter and other team members who worked on this idea Geert Schmid-Schoenbein

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