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C. Narkam, M.B. B.A.O., M.B.B.Ch., Ph.D.
Co-Director, David Geffen School of Medicine at UCLA
Renal impairment and outcomes in heart failure: systematic review and meta-analysis. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Renal function, digoxin therapy, and heart failure outcomes: evidence from the digoxin intervention group trial. Proteinuria, chronic kidney disease, and the effect of an angiotensin receptor blocker in addition to an angiotensin-converting enzyme inhibitor in patients with moderate to severe heart failure. The association among renal insufficiency, pharmacotherapy, and outcomes in 6,427 patients with heart failure and coronary artery disease. The prognostic importance of different definitions of worsening renal function in congestive heart failure. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Prevalence and patterns of left ventricular hypertrophy in patients with predialysis chronic renal failure. Epidemiology and pathophysiology of left ventricular abnormalities in chronic kidney disease: a review. Chronic kidney disease associated mortality in diastolic versus systolic heart failure: a propensity matched study. Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Clinical and subclinical cardiovascular disease and kidney function decline in the elderly. Renin angiotensin system blockade and cardiovascular outcomes in patients with chronic kidney disease and proteinuria: a meta-analysis. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. Efficacy and safety of carvedilol in treatment of heart failure with chronic kidney disease: a meta-analysis of randomized trials. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. Improving prognosis estimation in patients with heart failure and the cardiorenal syndrome. Association of B-type natriuretic Peptide levels with estimated glomerular filtration rate and congestive heart failure. N-terminal pro brain natriuretic peptide predicts mortality in patients with end-stage renal disease in hemodialysis. Understanding B-type natriuretic peptide and its role in diagnosing and monitoring congestive heart failure. Plasma amino-terminal pro-brain natriuretic peptide and accuracy of heart-failure diagnosis in primary care: a randomized, controlled trial. Superiority of brain natriuretic peptide as a hormonal marker of ventricular systolic and diastolic dysfunction and ventricular hypertrophy. B-type natriuretic peptide for acute dyspnea in patients with kidney disease: insights from a randomized comparison. Methods of assessment of volume status and intercompartmental fluid shifts in hemodialysis patients: implications in clinical practice. Cardiac natriuretic peptides are related to left ventricular mass and function and predict mortality in dialysis patients. N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients.
Sexual activity prior to coitus initiation: A comparison between males and females. The Science is clear: Separating families has long-term damaging psychological and health consequences for children, families, and communities. Improving executive function in childhood: Evaluation of a training intervention for 5-year-old children. The relationship between screen time, nighttime sleep duration, and behavioural problems in preschool children in China. Children gain greater control over the movement of their bodies, mastering many gross and fine motor skills that eluded the younger child. Changes in the brain during this age enable not only physical development but contributes to greater reasoning and flexibility of thought. School becomes a big part of middle and late childhood, and it expands their world beyond the boundaries of their own family. Peers start to take center-stage, often prompting changes in the parent-child relationship. Learning Objectives: Physical Development in Middle and Late Childhood · · · · · Summarize the overall physical growth Describe the changes in brain maturation Describe the positive effects of sports Describe reasons for a lack of participation in youth sports Explain current trends regarding being overweight in childhood, the negative consequences of excess weight, the lack of recognition of being overweight, and interventions to normalize weight Physical Development Overall Physical Growth: Rates of growth generally slow during these years. They also tend to slim down and gain muscle strength and lung capacity making it possible to engage in strenuous physical activity for long periods of time. The beginning of the growth spurt, which occurs prior to puberty, begins two years earlier for females than males. The mean age for the beginning of the growth spurt for girls is nine, while for boys it is eleven. Children of this age tend to sharpen their abilities to perform both gross motor skills, such as riding a bike, and fine motor skills, such as cutting their fingernails. In gross motor skills (involving large muscles) boys typically outperform girls, while with fine motor skills (small muscles) girls outperform the boys. These improvements in motor skills are related to brain growth and experience during this developmental period. Brain Growth: Two major brain growth spurts occur during middle/late childhood (Spreen, Riser, & Edgell, 1995). Between ages 6 and 8, significant improvements in fine motor skills and eye-hand coordination are noted. Then between 10 and 12 years of age, the frontal lobes become more developed and improvements in logic, planning, and memory are evident (van der Molen & Molenaar, 1994). From age 6 to 12, the nerve cells in the association areas of the brain, that is those areas where sensory, motor, and intellectual functioning connect, become almost completely myelinated (Johnson, 2005). The hippocampus, responsible for transferring information from the short-term to longterm memory, also show increases in myelination resulting in improvements in memory functioning (Rolls, 2000). Children in middle to late childhood are also better able to plan, coordinate activity using both left and right hemispheres of the brain, and to control emotional outbursts. Paying attention is also improved as the prefrontal cortex matures (Markant & Thomas, 2013). Sports Middle childhood seems to be a great time to introduce children to organized sports, and in fact, many parents do. Nearly 3 million children play soccer in the United States (United States Youth Soccer, 2012). This activity promises to help children build social skills, improve athletically and learn a sense of competition. However, it has been suggested that the emphasis on competition and athletic skill can be counterproductive and lead children to grow tired of the game and want to quit. Soccer Federation recently advised coaches to reduce the amount of drilling engaged in during practice and to allow children to play more freely and to choose their own positions. The hope is that this will build on their love of the game and foster their natural talents. Girls were more likely to have never participated in any type of sport (see Figure 5. They also found that fathers may not be providing their daughters as much support as they do their sons. While boys rated their fathers as their biggest mentor who taught them the most about sports, girls rated coaches and physical education teachers as their key mentors.
But communities need to lead the development of wellness models that will work for them. We should redistribute resources from our expensive medical and social services systems and truly be flexible enough to support community-led capacity building efforts to meet the wellbeing needs of all residents. This will require us to invest in multi-sector, asset-based approaches much more seriously, and to Models to Prevent Chronic Disease and Create Health in Communities 99 connect these efforts in more robust ways. The formation of a nationwide wellness network participating in a community of practice may result in surprising breakthroughs in truly constructing health and wellbeing. And it will require foundations and governments to braid resources so implementation teams have sufficient resources to be successful. Finally, we should provide robust support to those implementing health interventions to incorporate systems thinking in as many efforts as possible so that the nation can learn from the outcomes of these experiments. National organizations can work together on a broad capacity building effort so that more sectors are applying systems approaches that support all aspects of our human needs. We believe that health is the basis and, therefore, an essential ingredient of all human life. An emerging public health strategic agenda challenges us to create wellness for all. Let us apply what science tells us and embark on this journey together and inspire a new generation of people who intrinsically seek solutions to address human needs and produce healthier generations. As Executive Director of Wildflower Consulting, she has focused on organizational and community capacity-building; resource development; program development and oversight; community-driven strategic planning; evidence-based public-health practice; policy advocacy; community engagement; cross-sector collaboration; facilitation; and evaluation. The prospective impact of food pricing on improving dietary consumption: A systematic review and meta-analysis. Research on neighborhood effects on health in the United States: A systematic review of study characteristics. Posttraumatic stress disorder and symptoms among American Indians and Alaska Natives: A review of the literature. What can be learned from the types of community benefit programs that hospitals already have in place? Built environment and health behaviors among African Americans: A systematic review. Retrieved May 13, 2018, from Centers for Disease Control and Prevention: Invest in your community: 4 considerations to improve health & well-being for all [Infographic]. Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations. The association between income and life expectancy in the United States, 2001-2014. Moving toward paradigm-shifting research in health disparities through translational, transformational, and transdisciplinary approaches. Cancer statistics for African Americans, 2016: Progress and opportunities in reducing racial disparities. Emerging Opportunities for Collaboration Between the Health and Community Development Sectors. Finding synergy: Reducing disparities in health by modifying multiple determinants. Using systems science to understand the determinants of inequities in healthy eating. Inequality in the built environment underlies key health disparities in physical activity and obesity. Final Rule: Additional Requirements for Charitable Hospitals; Community Health Needs Assessments for Charitable Hospitals; Requirement of a Section 4959 Excise Tax Return and Time for Filing the Return. A longitudinal study of Medicaid coverage for tobacco dependence treatments in Massachusetts and associated decreases in hospitalizations for cardiovascular disease. Improving public health system performance through multiorganizational partnerships. Improving access to smoking cessation services for disadvantaged groups: A systematic review. Community Violence as a Population Health Issue: Proceedings of a Workshop - in Brief. Health, United States, 2015: With Special Feature on Racial and Ethnic Disparties.
All such teams should at the least provide written or online information to their patients and families directing them to seek advice in situations where they may be prescribed medications from other providers or may be seeking over-the-counter drugs or supplements. Recommendations are partly based upon knowledge of pharmacology rather than controlled trials in carefully defined populations. The main international implication is centered on costs of some newer therapies compared to the older ones. Somewhat paradoxically, as the weight of evidence resides mainly with agents that have been available for longer, they have the advantage of being less costly, and have the side effects that are well documented; thus many of these older agents are preferred. Current guidance suggests either infusion of 1 ml/kg body weight/ hour for 3-12 hours before and after the procedure or 100 ml/hr, beginning 6 to 12 hours before and continuing 4 to 12 hours after intravascular iodinated contrast medium administration. Definitive studies of N-acetylcysteine and other antioxidants would help determine their usefulness or otherwise. Gadolinium-containing contrast media Gadolinium is a rare earth element that is naturally highly toxic. These Kidney International Supplements (2013) 3, 91111 chapter 4 chelates are excreted unchanged by the kidneys by glomerular filtration and have much lower direct nephrotoxicity than conventional radioiodine contrast media. Prevention is therefore the best approach with avoidance of gadolinium exposure unless clinically indicated and to use the lowest risk agent at the lowest dose. Kidney International Supplements (2013) 3, 91111 Regarding both Recommendations 4. Bowel preparation the increasing use of colonoscopy as a screening tool for bowel cancer has resulted in many people undergoing bowel 105 chapter 4 preparation with oral sodium phosphate-containing preparations. Case reports of acute and late irreversible renal failure with biopsy-proven phosphate deposition have led to a new disease entity termed acute phosphate nephropathy. Evidence Base There is some debate as to whether the cause of the kidney injury is entirely due to dehydration rather than phosphate use per se. As there are non-phosphate-containing bowel preparations available, these should be used in all the above groups (and arguably in all people given the biochemical abnormalities observed in normal volunteers). As for radiocontrast media, rehydration with saline may be required in the frail and ill irrespective of the bowel preparation that is used. International Relevance Electrolyte disturbances that are sometimes severe and include hyperphosphatemia, hypocalcemia, hypo- and hypernatremia, and hypokalemia have been reported in normal volunteers undergoing oral phosphate bowel preparation. A recent study from Iceland estimated the incidence to be around 1 per thousand doses621 but others would suggest incidence rates of between 1% and 4%. An early symptomatic response associated with severe hyperphosphatemia and hypocalcemia and a later (days to months) irreversible kidney injury associated with a specific tubulointerstitial calcium phosphate deposition. Appreciating that increased risk and implementing some of the recommendations below may result in improved outcomes for people. It will be important to develop policies and robust research agendas to address areas which do not have a substantial evidentiary base. Both should be avoided in people at risk and this is the current recommendation of the American Society for Gastrointestinal Endoscopy. There is a growing body of evidence in the general population for reduction in infections, hospitalizations, and mortality as a result of immunizations. No unique adverse events related to influenza vaccine have been identified in people on dialysis. People with kidney disease vaccinated with the pneumococcal vaccine seem to develop different serotype-specific titers, develop lower levels of antibody titers, and have a more rapid loss of antibody titers as compared with healthy control subjects. Frequency and type of vaccination will vary according to local circumstances and prevalence of disease. As protective antibody levels may fall, this should be checked (possibly annually) with booster doses given if appropriate. Pediatric Considerations the availability of different vaccinations may vary worldwide, as does the prevalence of specific bacterial, viral, and other infections. It is reasonable to offer individuals appropriate immunization according to local practices. K Provide pneumococcal vaccine with a single booster dose 5 years after the initial dose.