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Popp J, Waters DL, Leekity K, Ghahate D, Bobelu J, Tsikewa R, Herman CJ, Shah V. Using the Centers for Disease Control and Prevention's Stay Independent Checklist to Engage a Community of American Indians and Raise Awareness About Risk of Falls, 2016. Prev Chronic Dis 2017; 14:E05. [PMID: 28103184 PMCID: PMC5268745 DOI: 10.5888/pcd14.160395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The unintentional death rate from falls is higher among American Indians from the US Southwest than from other regions in the country. The Zuni Pueblo is a geographically isolated, rural American Indian community located in western New Mexico. Education and screening for falls risk is lacking in this community and may be needed to reduce falls and falls-related illness and death. Community Context Building on a 17-year relationship with the Zuni Health Initiative, meetings were held with Zuni tribal leadership, staff from the Zuni Senior Center and Zuni Home Health Services, members of the Zuni Comprehensive Community Health Center, Indian Health Service, and Zuni community health representatives (CHRs) to discuss elder falls in the community. Existing infrastructure, including CHRs who were already trained and certified in diabetes education and prevention, provided support for the study. Methods Tribal leadership agreed that CHRs would be trained to administer the Centers for Disease Control and Prevention’s (CDC’s) Stay Independent checklist to assess falls risk. They administered the checklist during one-on-one interviews in Shiwi (Zuni native language), English, or both to a convenience sample of 50 Zuni elders. Outcomes Mean age of participants was 72 (standard deviation, 7.4) years, and 78% were women. Fifty-two percent reported at least 1 fall during the past year; 66% scored 4 or more on the CDC Stay Independent checklist, indicating elevated risk for falls. CHRs reported that the checklist was easy to administer and culturally accepted by the elder participants. Interpretation This study broadened the Zuni Health Initiative to include falls risk screening. Self-reported falls were common in this small sample, and the incidence was significantly higher than the national rate. These results highlight the need for community engagement, using culturally acceptable falls screening, to promote falls education and implement falls prevention programs.
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Affiliation(s)
- Janet Popp
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Debra L Waters
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.,Dunedin School of Medicine and School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | | | - Donica Ghahate
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Jeanette Bobelu
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Ross Tsikewa
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Carla J Herman
- School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Vallabh Shah
- New Mexico Health Disparity Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM 87131-0001.
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Garcia-Garcia G, Jha V. Chronic kidney disease in disadvantaged populations. Intern Med J 2015; 45:123-7. [PMID: 25650533 DOI: 10.1111/imj.12663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/12/2014] [Indexed: 12/21/2022]
Affiliation(s)
- G Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
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Garcia-Garcia G, Jha V. CKD in disadvantaged populations. Can J Kidney Health Dis 2015; 2:18. [PMID: 26029381 PMCID: PMC4449556 DOI: 10.1186/s40697-015-0050-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 03/04/2015] [Indexed: 01/13/2023] Open
Affiliation(s)
- Guillermo Garcia-Garcia
- />Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Jal Mexico
| | - Vivekanand Jha
- />Postgraduate Institute of Medical Education and Research, Chandigarh, India
- />George Institute for Global Health, New Delhi, India
- />University of Oxford, Oxford, UK
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García-García G, Jha V. World Kidney Day 2015: CKD in disadvantaged populations. Am J Kidney Dis 2015; 65:349-53. [PMID: 25704039 DOI: 10.1053/j.ajkd.2014.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Guillermo García-García
- Hospital Civil de Guadalajara and University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India
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Chronic kidney disease in disadvantaged populations. Curr Opin Organ Transplant 2015; 20:229-33. [PMID: 25856185 DOI: 10.1097/mot.0000000000000171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- G Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico, USA
| | - V Jha
- Postgraduate Institute of Medical Education and Research, Chandigarh, India ; George Institute for Global Health, New Delhi, India ; University of Oxford, Oxford, UK
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Affiliation(s)
- Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Mexico
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Garcia-Garcia G, Jha V. Chronic kidney disease in disadvantaged populations. ACTA ACUST UNITED AC 2015; 48:377-81. [PMID: 25760025 PMCID: PMC4445659 DOI: 10.1590/1414-431x20144519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 01/13/2023]
Abstract
The increased burden of chronic kidney disease (CKD) in disadvantaged populations is due to both global factors and population-specific issues. Low socioeconomic status and poor access to care contribute to health care disparities and exacerbate the negative effects of genetic or biological predisposition. Provision of appropriate renal care to these populations requires a two-pronged approach: expanding the reach of dialysis through development of low-cost alternatives that can be practiced in remote locations, and implementation and evaluation of cost-effective prevention strategies. Kidney transplantation should be promoted by expansion of deceased donor transplant programs and use of inexpensive, generic immunosuppressive drugs. The message of World Kidney Day 2015 is that a concerted attack against the diseases that lead to end-stage renal disease, by increasing community outreach, better education, improved economic opportunity, and access to preventive medicine for those at highest risk, could end the unacceptable relationship between CKD and disadvantage in these communities.
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Affiliation(s)
- G Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - V Jha
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Garcia-Garcia G, Jha V. Chronic kidney disease in disadvantaged populations. Nephrology (Carlton) 2015; 20:113-6. [PMID: 25712555 DOI: 10.1111/nep.12367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Mexico
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Garcia-Garcia G, Jha V. CKD in disadvantaged populations. Nephrol Ther 2015; 11:1-4. [PMID: 25650172 DOI: 10.1016/j.nephro.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil of Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico.
| | - Vivekanand Jha
- Postgraduate Institute of Medical Education and Research, Chandigarh, India; George Institute for Global Health, New Delhi, India; University of Oxford, Oxford, UK
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Garcia-Garcia G, Jha V. Chronic kidney disease in disadvantaged populations. Pediatr Nephrol 2015; 30:183-7. [PMID: 25395360 DOI: 10.1007/s00467-014-2996-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 10/16/2014] [Accepted: 10/21/2014] [Indexed: 12/31/2022]
Abstract
The increased burden of CKD in disadvantaged populations is due to both global factors and population-specific issues. Low socioeconomic status and poor access to care contribute to healthcare disparities and exacerbate the negative effects of genetic or biologic predisposition. Provision of appropriate renal care to these populations requires a two-pronged approach: expanding the reach of dialysis through development of low-cost alternatives that can be practiced in remote locations, and implementation and evaluation of cost-effective prevention strategies. Kidney transplantation should be promoted by expanding both deceased donor transplant programs and the use of inexpensive, generic immunosuppressive drugs. The message of WKD 2015 is that a concerted attack against the diseases that lead to ESRD, by increasing community outreach, better education, improved economic opportunity, and access to preventive medicine for those at highest risk, could end the unacceptable relationship between CKD and disadvantage in these communities.
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Affiliation(s)
- Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
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Garcia-Garcia G, Jha V. Chronic kidney disease (CKD) in disadvantaged populations. Clin Kidney J 2015; 8:3-6. [PMID: 25713703 PMCID: PMC4310427 DOI: 10.1093/ckj/sfu124] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 10/24/2014] [Indexed: 01/13/2023] Open
Abstract
Twelve March 2015 will mark the 10th anniversary of World Kidney Day (WKD), an initiative of the International Society of Nephrology and the International Federation of Kidney Foundations. Since its inception in 2006, WKD has become the most successful effort ever mounted to raise awareness among decision-makers and the general public about the importance of kidney disease. Each year WKD reminds us that kidney disease is common, harmful and treatable. The focus of WKD 2015 is on chronic kidney disease (CKD) in disadvantaged populations. This article reviews the key links between poverty and CKD and the consequent implications for the prevention of kidney disease and the care of kidney patients in these populations.
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Affiliation(s)
- Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
| | - Vivekanand Jha
- Institute of Medical Education and Research, Chandigarh, India
- George Institute for Global Health, New Delhi, India
- University of Oxford, Oxford, UK
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Garcia-Garcia G, Jha V. Chronic kidney disease in disadvantaged populations. Nephron Clin Pract 2015; 128:292-6. [PMID: 25614182 DOI: 10.1159/000369148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Mexico
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Filippi MK, Young KL, Nazir N, Williams C, Brown T, Choi WS, Greiner KA, Daley CM. American Indian/Alaska Native willingness to provide biological samples for research purposes. J Community Health 2012; 37:701-5. [PMID: 22057422 DOI: 10.1007/s10900-011-9502-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article examines the willingness of American Indian/Alaska Natives (AI/AN) to provide biological samples for research purposes. Prior cases of abuse and misuse of individuals, materials, and data highlight ethical research concerns. Investigators may be hesitant to engage AI/ANs in research projects. We conducted a survey of AI/ANs in the central plains region of the US over 1 year. This convenience sample completed a series of questions on biological samples and research. Survey results (N=998) indicate that 70.15% of AI/ANs would be willing to provide saliva/spit for a specific study with the proper consent and control of samples. In conclusion, researchers should find ways to work with and for AI/ANs, assuring participant input in the research process.
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Affiliation(s)
- Melissa K Filippi
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Abstract
The rising global burden of chronic renal disease, the high cost of providing renal replacement therapies, and renal disease also being a risk factor for cardiovascular disease is increasing focus on renal disease prevention. This article focuses on the aspects of renal disease (specifically poststreptococcal glomerulonephritis [PSGN] and chronic kidney disease [CKD]) in Indigenous populations in Australia, New Zealand, Canada, and the United States that diverge from those typically seen in the general population of those countries. The spectrum of renal and many other diseases seen in Indigenous people in developed countries is similar to that seen in developing countries. Diseases like PSGN that have largely disappeared in developed countries still occur frequently in Indigenous people. CKD during the childhood years is due to congenital anomalies of the kidney and urinary tract in up to 70% of cases and occurs later in polycystic kidney disease and childhood-onset diabetes. Several risk factors for CKD in adulthood are already present in childhood.
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Affiliation(s)
- Gurmeet R Singh
- Child Health Division, Menzies School of Health Research, Charles Darwin University Darwin, PO Box 41096, Casuarina, NT 0810, Australia.
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Abstract
The world's almost 400 million Indigenous people have low standards of health. This poor health is associated with poverty, malnutrition, overcrowding, poor hygiene, environmental contamination, and prevalent infections. Inadequate clinical care and health promotion, and poor disease prevention services aggravate this situation. Some Indigenous groups, as they move from traditional to transitional and modern lifestyles, are rapidly acquiring lifestyle diseases, such as obesity, cardiovascular disease, and type 2 diabetes, and physical, social, and mental disorders linked to misuse of alcohol and of other drugs. Correction of these inequities needs increased awareness, political commitment, and recognition rather than governmental denial and neglect of these serious and complex problems. Indigenous people should be encouraged, trained, and enabled to become increasingly involved in overcoming these challenges.
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Affiliation(s)
- Michael Gracey
- Unity of First People of Australia, Perth, WA, Australia.
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Mottl AK, Vupputuri S, Cole SA, Almasy L, Göring HHH, Diego VP, Laston S, Shara N, Lee ET, Best LG, Fabsitz RR, MacCluer JW, Umans JG, North KE. Linkage analysis of albuminuria. J Am Soc Nephrol 2009; 20:1597-606. [PMID: 19369405 PMCID: PMC2709673 DOI: 10.1681/asn.2008080895] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 01/13/2009] [Indexed: 02/02/2023] Open
Abstract
American Indians have a higher prevalence of albuminuria than the general population, likely resulting from a combination of environmental and genetic risk factors. To localize gene regions influencing variation in urinary albumin-to-creatinine ratio, we performed a linkage analysis and explored gene-by-diabetes, -hypertension, and -obesity interactions in a large cohort of American Indian families. We recruited >3600 individuals from 13 American Indian tribes from three centers (Arizona, North and South Dakota, and Oklahoma). We performed multipoint variance component linkage analysis in each center as well as in the entire cohort after controlling for center effects. We used two modeling strategies: Model 1 incorporated age, gender, and interaction terms; model 2 also controlled for diabetes, BP, body mass index, HDL, LDL, triglycerides, and smoking status. We evaluated interactions with diabetes, hypertension, and obesity using additive, interaction-specific linkage and stratified analyses. Loci suggestive for linkage to urinary albumin-to-creatinine ratio included 1q, 6p, 9q, 18q, and 20p. Gene-by-diabetes interaction was present with a quantitative trait locus specific to the diabetic stratum in the Dakotas isolated on 18q21.2 to 21.3 using model 1 (logarithm of odds = 3.3). Gene-by-hypertension interaction was present with quantitative trait loci specific to the hypertensive stratum in the Dakotas on 7q21.11 using model 1 (logarithm of odds = 3.4) and 10q25.1 using model 2 (logarithm of odds = 3.3). These loci replicate findings from multiple other genome scans of kidney disease phenotypes with distinct populations and are worthy of further study.
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Affiliation(s)
- Amy K Mottl
- UNC Kidney Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7155, USA.
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Haysom L, Williams RE, Hodson EM, Lopez-Vargas P, Roy LP, Lyle DM, Craig JC. Cardiovascular risk factors in Australian indigenous and non-indigenous children: a population-based study. J Paediatr Child Health 2009; 45:20-7. [PMID: 19208061 DOI: 10.1111/j.1440-1754.2008.01426.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Indigenous people have a two- to tenfold increased risk of premature death from cardiovascular disease. We aimed to determine whether some key risk factors for cardiovascular disease occur more commonly in Aboriginal than non-Aboriginal Australian children. METHODS Children were enrolled from primary schools throughout New South Wales, the state with the highest number of Aboriginal people. Associations between ethnicity, gender, birthweight, socio-demographic status and hypertension, obesity, baseline and persistent albuminuria were determined. RESULTS A total of 2266 children (55% Aboriginal) were enrolled. Mean age was 8.9 years (+/-3.8 years). Obesity (body mass index >or=2 standard deviations) was detected in 7.1%, systolic hypertension (blood pressure >90th percentile) in 7.2%, diastolic hypertension in 5.9%, baseline albuminuria (albumin : creatinine >or=3.4 mg/mmol) in 7.3% and persistent albuminuria in 1.5% with no differences between Aboriginal and non-Aboriginal children. Hypertension was less common with increasing social disadvantage (trend P < 0.02). Increasing body mass index standard deviation was strongly associated with systolic and diastolic hypertension (both P < 0.0001). CONCLUSIONS Many risk factors for cardiovascular disease are already common in young children but not more prevalent in Aboriginal than in non-Aboriginal children. In all children, overweight and obesity have the strongest association with hypertension, but social disadvantage appears protective for hypertension. Our findings suggest that risk for cardiovascular health disparities seen in indigenous adults manifests beyond childhood and that a window of opportunity exists to prevent some of these outcomes.
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Affiliation(s)
- Leigh Haysom
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead NSW, Australia.
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Pavkov ME, Knowler WC, Hanson RL, Nelson RG. Diabetic nephropathy in American Indians, with a special emphasis on the Pima Indians. Curr Diab Rep 2008; 8:486-93. [PMID: 18990306 PMCID: PMC3480511 DOI: 10.1007/s11892-008-0083-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Diabetes affects American Indians disproportionately compared with other racial/ethnic groups in the United States and is almost exclusively type 2 diabetes. Much of our knowledge about diabetes in American Indians comes from studies in a few tribes. The most extensively studied American Indians are the Pima Indians from the Gila River Indian Community in Arizona, who participated in a longitudinal study of diabetes and its complications between 1965 and 2007. They have one of the highest reported incidence and prevalence of type 2 diabetes in the world, and kidney disease attributable to diabetes is a major cause of morbidity and mortality. In this article, we examine the course, determinants, and trends of diabetic kidney disease in American Indians, with special emphasis on studies conducted in the Pima Indians. We also review therapeutic strategies for managing diabetic kidney disease.
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Affiliation(s)
- Meda E Pavkov
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ 85014-4972, USA
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Codreanu I, Perico N, Sharma SK, Schieppati A, Remuzzi G. Prevention programmes of progressive renal disease in developing nations (Review Article). Nephrology (Carlton) 2006; 11:321-8. [PMID: 16889572 DOI: 10.1111/j.1440-1797.2006.00587.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Development of strategies for the early detection and prevention of non-communicable diseases, including kidney disease, is the only realistic strategy to avert an imminent global health and economic crisis and enhance equity in health care worldwide. In this article, we briefly examine the burden of non-communicable diseases, including diabetes, hypertension, cardiovascular disease and how chronic kidney disease (CKD) represents a key integrated element in the setting, even in developing countries. A possible explanation of the increasing number of people who have or are at risk to develop CKD in poor countries is also given. A survey of major screening and intervention programmes performed or ongoing globally is then presented, highlighting differences and hurdles of projects planned in developed or developing nations as well as in unprivileged communities in developed countries. Finally, some recommendations on future steps to implement prevention programmes in emerging worlds are provided.
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Affiliation(s)
- Igor Codreanu
- Department of Medicine and Transplantation, Ospedali Riuniti di Bergamo, Mario Negri Institute for Pharmacological Research, Bergamo, Italy
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