|Volume 58 Number 2
Locating Quality Health Information on the Top Six Diseases in Tennessee
UT Preston Medical Library
Program Abstract: Learn how to find the highest quality information on heart disease, cancer, stroke, chronic lung disease, Alzheimer's, and diabetes. The speaker includes tips for finding background, screening, and treatment information, plus statistical, health provider, and local agency and support goup print and electronic sources.
Although there exist a myriad number of human illnesses, the majority of chronic disease states and deaths relate to a few major diseases. In Tennessee the top causes of death include heart disease, cancer, stroke, accidents, chronic obstructive pulmonary disease, Alzheimer’s disease, and diabetes (Tennessee Department of Health, 2006). Nationwide, these causes remain constant but percentages differ by state (Centers for Disease Control).
Health information continues to be one of the top reasons that people search the Internet, according to Pew (Fox, 2006). Public library users also seek book on consumer health. Naturally, health professions students seek statistics, curriculum support materials, patient education tools, and research.
In Tennessee, the two best general sites include the National Library of Medicine’s MedlinePlus and the Tennessee Electronic Library. MedlinePlus.gov includes National Institute of Health (NIH) Senior Health, a site where one can change the font to a larger one, increase the background contrast, and even have the topic read to the end user. MedlinePlus also links to ClinicalTrials.gov, the database listing all clinical trials funded by the NIH. The Tennessee Electronic Library includes two health databases. Health Reference Center Academic includes full-text medical, nursing, business, and consumer journals and encyclopedias. Health and Wellness Resource Center has similar content but features short consumer health videos.
To find statistical sources, some sites remain key repositories of information. Health Information Tennessee provides county by county health reports and statistics, plus the annual report on Tennessee deaths. Nationally, the Centers for Disease Control (CDC) maintains statistics as part of their directive through the National Center for Health Statistics (NCHS). The NCHS offers both detailed reports and Fast Facts. Cancer statistics can be found in more detail at the National Cancer Institute and on the American Cancer Society site. For more health statistics, try the University of Michigan Library’s Government Documents page .
Some information seekers look for health policy and health history. The Agency for Healthcare Research and Quality focuses on best practice. Here one can link to Guidelines.gov to find nationally approved practice guidelines on various ailments. Also at the AHRQ site, one may find the Guide to Clinical Preventive Services with recommendations for health screenings at different ages of life. Specific to cancer, one can visit the NCCN for current cancer guidelines. Although there are lots of sites that deal with the history of medicine, the National Library of Medicine can get the researcher started.
Drug information on the Internet presents challenges. The Food and Drug Administration (FDA) offers the most current facts on drugs approved by the federal government and consumer warnings. DailyMed from the National Library of Medicine provides drug information in less technical language. The Drug Information on MedlinePlus also includes a section on vitamins and herbal supplements. Harvard Medical School’s Intelihealth is another trustworthy consumer site. Commercial sites worth knowing include Rxlist and Drugs.com. They include pill identifier tools. Lastly, the Memphis Public Library’s drug information page links consumers to some of the aforementioned, to Medicare Part D assistance, new medicines in development, and pharmaceutical company grant application information.
In the United States, herbal supplements and vitamins are classes as dietary supplements. The Office of Dietary Supplements offers the IBIDS database where researchers can find bibliographic information on vitamins and herbal medicines. The National Library of Medicine provides consumer information. HerbMed offers more data.
For further information on alternative medicine, Lana Dixon’s University of Tennessee Knoxville Subject Guide provides a starting point . No search on alternative medicine would be complete without checking Quackwatch for review of scientific effectiveness of a treatment.
Since the major disease states are just so, several general sites can provide sound data. Among these are Mayo Clinic, KidsHealth, Hardin MetaDirectory, Yahoo Health, WebMD, and the Merck Manuals. Consumers should keep in mind that commercial sites do promote products or organizations, however subtly. WebMD and Yahoo do receive funding from drug companies. Merck is a drug company. Mayo Clinic is a health system. The .org and .edu are the most free from commercial influence, but valid and current health information can be found on commercial sites.
To find treatment for the major disease states, consumers often seek to find the best doctors or hospitals. The best sources for hospital rankings are the annual evaluation by U.S. News and Medicare.
To locate information on physicians or other health care providers, one may use a variety of sources. MedlinePlus includes, within its directories, lists provided by health professional associations on how to find a rheumatologist, psychologist, etc. The American Board of Medical Specialties ABMS also has guides. Board certified physicians have additional training and pass advanced tests or board examinations to become certified. In Tennessee one can check the Tennessee Department of Health Licensure to find out whether a health professional holds a current license in Tennessee. Some records have practitioner profiles that detail where the physician or other health professional went to school and completed his internship and residency, his or her hospital affiliations, which TennCare plans that he or she takes, and whether he or she has ever lost a lawsuit for more than $75,000. In addition, in some locations, local polls are taken of best physicians, such as the City View annual issue in Knoxville ("Top Doctors, 2008"). Books on best physicians are generally opinion polls and usually contain the names of physicians in the cities surveyed (America's Top Doctors, 2006).
For people with a disease state or their caregivers, support group information can be helpful. Online discussion groups can be found on Yahoo, Google, Bloglines, major organizational sites, and social networking sites. The National Library of Medicine maintains a Directory of Health Associations. For state and local information, some states have MedlinePlus GoLocal, a service that directs people to local resources and support groups. In Tennessee, one can call the statewide 2-1-1 number or go to their site to find social service agency assistance. Local directories, such as those maintained by Memphis Public Library and Knox County Public Library can provide names of local contact people for support groups.
Sometimes libraries, health agencies, health professionals, educators, or consumers want to know where to order free publications. Government agencies and national associations will often provide these in limited quantities. Some examples are the FDA, NIH Health Information, and the NCI.
While many people go online for information, others prefer books or seek books to complement online sources or vice versa. In order to purchase health books, librarians can turn to a variety of professional resources. The gold standard in consumer health information is the 2003 Consumer Health Information Source Book by Alan Rees (2003).
Other recommended sources for health sciences collection development can be located at the Medical Library Association website. Particularly useful are the Consumer and Patient Health Information Section and the Collection Development Section.
In addition, the Brandon-Hill lists for the Small Medical Library, for Nursing, and for Allied Health remain useful, even though they are no longer updated. Doody’s is a subscription service with recommended lists by topic and reviews. Some consumer health is included but primarily the focus is on the professional health sciences book titles. Most consumer health titles can be selected by the librarian using reviews. A list of recommended consumer health titles on the major disease states can be found in the Appendix.
The number one disease in the United States and in Tennessee is heart disease. Heart disease is any disorder that affects the heart’s ability to function normally. Some examples include coronary artery narrowing, heart attacks, heart failure, valvular disorders, arrhythmias, and acute coronary syndrome. According to the Centers for Disease Control (CDC) , 12% of American adults have been diagnosed with heart disease. Heart disease accounts for 21.7% of deaths. The average hospital length of stay is 4.5 days. In Tennessee, the Tennessee Department of Health reports that diseases of the heart caused 24.3% of deaths in the state in 2006 (Tennessee Department of Health).
Recommended websites for heart disease information include the American Heart Association; the CDC Heart Diseases section ; MedlinePlus: Heart Diseases; Mended Hearts; the National Coalition for Women with Heart Disease (NCWHD); and the National Heart, Lung, and Blood Institute. The American Heart Association provides information on specific heart-related conditions for both children and adults, heart healthy living, warning signs and symptoms, an encyclopedia, etc. Besides national statistics, the CDC includes general information and occupational heart disease information. MedlinePlus from the National Library of Medicine adds specific links to other association and government sites, treatments and alternative therapies, coping and recovery, and news and research. Mended Hearts partners with hospitals and rehabilitation clinics to provide support group meetings and educational forums, plus tools for caregivers and survivors. The NCWHD focuses on women’s special needs regarding heart disease. The NHLBI provides fact sheets.
Cancer is the uncontrolled growth of abnormal cells in the body. Cancerous cells are also called malignant cells. The CDC reports that 7.4% of Americans have been diagnosed with cancer, cancer causes 18.6% of deaths, and the average hospital length of stay is 6.8 days. Among men, the top three are prostate, lung, and colon. Among women, the top three are breast, lung, and colon. Early screening can catch prostate, breast, and colon cancer in the earlier, more curable stages. In 2006, the CDC declared cancer, the number two killer, a chronic disease, meaning that 60% of those diagnosed will survive five years. In Tennessee, cancer caused 21.7% of deaths in 2006 (Tennessee Department of Health).
Recommended sites include the American Cancer Society (ACS), the American Society of Cancer Organizations (ASCO), Cancer News on the Net, the CDC, MedlinePlus: Cancer, the National Cancer Institute (NCI), which includes Physicians Data Query (PDQ), Oncolink, Cancer Resources at the Preston Medical Library, the University of Tennessee Medical Center Cancer Institute links, the Wellness Community of East Tennessee, and the Women’s Cancer Network.
Newly diagnosed patients or their family members should start with the ACS and NCI sites. ACS includes treatments, coping skills, prevention, research, clinical trials, news, community activities and resources, political advocacy, and volunteer opportunities. NCI provides similar information, more in depth statistics, health disparities, and additional scientific sources for the health professional. The NCI PDQ section provides treatment protocols in both consumer and health professional levels for the majority of common cancer types. Even so, information is often overwhelming for the newly diagnosed who may not realize that survival statistics are at least two years old at the most current due to the time needed for statistical analysis.
Survivors can link to other organizations for support. ASCO provides links to specific cancer type organizations. The Wellness Community, a national support organization, has an office in Knoxville offering support groups and programs, plus an online community. The UT Medical Center links include a list of support groups and financial aid sources for cancer patients in east Tennessee. Oncolink is patient friendly and developed by a physician whose child had cancer. The Preston Medical Library provides further links not listed.
Stroke is the interruption of the blood supply to any part of the brain and can be called a “brain attack.” Ischemic strokes are caused by blood clots or other blockage of blood vessels leading to the brain. Hemorrhagic strokes are caused by blood vessels bleeding into the brain or aneurysms. Cerebrovascular diseases are those that affect the blood supply to the brain.
According to the CDC, 2.6% of Americans have had a stroke, strokes cause 5.1% of deaths, and the average hospital length of stay is 5.2 days. In Tennessee, stroke is likewise the third leading cause of death with the rate of deaths at 5.7% in 2006 (Tennessee Department of Health).
Recommended sites for stroke include the American Stroke Association (ASA), a division of the American Heart Association, CDC: Stroke, Internet Stroke Center, MedlinePlus: Stroke, MedlinePlus: Aneurysm, the National Institute of Neurological Disorders and Stroke (NINDS), and the Patricia Neal Rehabilitation Center. Most of these sites provide information on risk factors, statistics, treatments, symptoms, prevention, recovery, rehabilitation, and news. The Internet Stroke Center provides support for caregivers. The Pat Neal site focuses on the details of rehabilitation with links to other resources. The NINDS links as well to clinical trials.
Chronic obstructive pulmonary disease (COPD) is lung disease that makes it difficult to breathe. Most people with COPD have both bronchitis and emphysema. According to the CDC, COPD causes 4.4% of deaths nationally. 4.3% of American adults have been diagnosed with chronic bronchitis, 1.8% with emphysema, and 7.3% with asthma, a related condition. In Tennessee, COPD, defined as chronic lower respiratory diseases, caused 5% of deaths in 2006 and is the fifth leading cause of death (Tennessee Department of Health).
Recommended sites for COPD include American Lung Association, the American Association of Respiratory Care, COPD-Alert, MedlinePlus: COPD, and the National Heart, Lung, and Blood Institute (NHLBI). The American Lung Association focuses on the prevention of lung disease and includes air quality and smoking cessation information. The AARC site is created by respiratory therapists with clear and detailed patient information. COPD-Alert is a support and advocacy group. NHLBI includes clinical trials along with fact sheets and research data.
Alzheimer’s disease, one form of dementia, is a progressive, degenerative brain disease affecting memory, thinking and behavior. The CDC related that 14% of nursing home patients have Alzheimer’s and it causes 2.3% of deaths. Length of stay before discharge from a nursing home is 620 days and from a hospital 6.8 days. In Tennessee, Alzheimer’s took sixth place as cause of death, responsible for 3.5% of deaths (Tennessee Department of Health).
Recommended sites include the Administration on Aging Alzheimer’s Resource Room, the Alzheimer’s Association, Family Caregiver Alliance, Fisher Center , MedlinePlus: Alzheimer’s Disease, MedlinePlus: Alzheimer’s Caregivers, National Institute on Aging Alzheimer’s Disease Education for Referral Center (NIH-ADEAR), and the National Institute of Neurological Disorders and Stroke. Most of these sites provide treatment and basic facts. The Fisher Center focuses on research, the Family Caregiver Alliance provides support for Alzheimer's family and caregivers.
Diabetes is a disease in which blood glucose, or sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With Type 1 diabetes, the body does not make insulin. With Type 2 diabetes, the more common type, the body does not make or use insulin well. Without enough insulin glucose stays in the blood and damages other organ systems. According to the CDC, 7.2% of American adults are diagnosed with diabetes. 2.8% remain undiagnosed. Diabetes causes 2.5% of deaths. The average length of stay in a hospital is 4.7 days. Diabetes accounts for 2.5 million physician office visits. In Tennessee diabetes caused 2.9% of deaths in 2006 (Tennessee Department of Health).
Recommended sites include the American Diabetes Association, CDC Diabetes, the Juvenile Diabetes Research Foundation International (JDRF), MedlinePlus: Diabetes, and the National Diabetes Information Clearinghouse. A newly diagnosed person will want to start with the American Diabetes Association. Besides diagnosis and treatment, this site covers nutrition, recipes, weight loss, exercise, prevention, a diabetes risk test, and community events. The JDRF provides information on living with diabetes at different stages in a child’s life.
To close on a positive note, there are two sites recommended for information on how to assess one’s risk of any of these diseases and more and how to improve one’s health. Washington University at St. Louis offers a “What is Your Risk?” calculator. Drs. Roizen and Oz, authors of several books, including You: the Owner’s Manual, host a site where one can calculate his or her real age, the physiological versus the chronological age of your body (Roizen and Oz, 2008). A thirty minute test is free, but one does have to register. One can also sign up for weekly RealAge tips to be sent via email. Other tests and tools are also available to keep one avoiding the major disease states, or managing them effectively, for as long as possible.
America’s Top Doctors. Castle Connolly, 2006.
Centers for Disease Control, National Center for Health Statistics. http://www.cdc.gov/nchs/fastats/deaths.htm
Fox, Susannah. Online Health Search 2006. Pew Internet and American Life http://www.pewinternet.org/PPF/r/190/report_display.asp
Rees, Alan. The Consumer Health Information Source Book. New York: Bowker, 2003.
Roizen, Michael F. and Oz, Mehmet C. YOU: the Owner’s Manual, Updated and Expanded Edition: An Insider’s Guide to the Body That Will Make You Healthier and Younger. Collins, 2008.
Tennessee Department of Health. Tennessee Deaths 2006. http://health.state.tn.us/Statistics/PdfFiles/TnDeaths06.pdf
“Top Doctors,” City View, March 2008, vol. 24, issue 3, pp. 35-42.
- Mayo Clinic Heart Book by Gersh, et al. HarperCollins, 2000
- Heart Disease for Dummies by Rippe. Wiley, 2004
- Everyone’s Guide to Cancer Therapy by Ko, et al. McMeel, 2008
- Everyone’s Guide to Cancer Survivorship by Rosenbaum, et al. McMeel, 2007
- Stroke for Dummies by Marler. Wiley, 2005
- 36 Hour Day by Mace and Rabins. Johns Hopkins Press, 2006
- Learning to Speak Alzheimer’s by Coste and Butler. Houghton Mifflin, 2004
- Joslin Guide to Diabetes by Beaser and Campbell. Fireside, 2005
- ADA Complete Guide to Diabetes, 2006
- AMA Family Medical Guide, 2004
- How Doctors Think by Groopman. Mariner, 2008
- Merck Manual of Health and Aging, 2005
- Merck Manual of Medical Information Home Edition by Beers, 2004
- How We Die by Nuland. Demco, 2004
- You: Staying Young by Roizen and Oz. Free Press, 2008