Lessons in ethnonephrology

Only recently has the nephrology community moved beyond a fairly singular focus on terminal kidney failure to embrace population-based studies of earlier stages of disease, its markers and risk factors, and of interventions. Observations in developing countries, and in minority, migrant, and disadvantaged groups in westernized countries, have promoted these developments. We are only beginning to interpret renal disease in the context of public health history, social and health transitions, changing population demography, and competing mortality. Its intimate relationships to other health issues are being progressively exposed. Perspectives on the multideterminant etiology of most disease and the pedestrian nature of most risk factors are maturing. We are challenged to reconcile epidemiologic patterns with morphology in diseased renal tissue, and to consider structural markers, such as nephron number and glomerular size, as determinants of disease susceptibility. New work force models are mandated for population-based studies and intervention programs. Intervention programs need to be integrated with other chronic disease initiatives and nested in a matrix of systematic primary care, and although flexible to changing needs, must be sustained over the long term. Cross-disciplinary collaboration is essential in designing those programs, and in promoting them to health-care funders. Substantial expansion and restructuring of the discipline is needed for the nephrology community to participate effectively in those processes.

Organ trafficking and transplant tourism: the role of global professional ethical standards - the 2008 declaration of Istanbul

By 2005, human organ trafficking, commercialization, and transplant tourism had become a prominent and pervasiveinfluence on transplantation therapy. The most common source of organs was impoverished people in India,Pakistan, Egypt, and the Philippines, deceased organ donors in Colombia, and executed prisoners in China. Inresponse, in May 2008, The Transplantation Society and the International Society of Nephrology developed theDeclaration of Istanbul on Organ Trafficking and Transplant Tourism consisting of a preamble, a set of principles, anda series of proposals. Promulgation of the Declaration of Istanbul and the formation of the Declaration of IstanbulCustodian Group to promote and uphold its principles have demonstrated that concerted, strategic, collaborative,and persistent actions by professionals can deliver tangible changes. Over the past 5 years, the Declaration of IstanbulCustodian Group organized and encouraged cooperation among professional bodies and relevant international, regional,and national governmental organizations, which has produced significant progress in combating organ traffickingand transplant tourism around the world. At a fifth anniversary meeting in Qatar in April 2013, the DICGtook note of this progress and set forth in a Communique´ a number of specific activities and resolved to furtherengage groups from many sectors in working toward the Declaration’s objectives.

The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and its Association with Quality of Life in Ambulatory Patients Receiving Radiotherapy

OBJECTIVE: To evaluate the scored Patient-generated Subjective Global Assessment (PG-SGA) tool as an outcome measure in clinical nutrition practice and determine its association with quality of life (QoL). DESIGN: A prospective 4 week study assessing the nutritional status and QoL of ambulatory patients receiving radiation therapy to the head, neck, rectal or abdominal area. SETTING: Australian radiation oncology facilities. SUBJECTS: Sixty cancer patients aged 24-85 y. INTERVENTION: Scored PG-SGA questionnaire, subjective global assessment (SGA), QoL (EORTC QLQ-C30 version 3). RESULTS: According to SGA, 65.0% (39) of subjects were well-nourished, 28.3% (17) moderately or suspected of being malnourished and 6.7% (4) severely malnourished. PG-SGA score and global QoL were correlated (r=-0.66, P<0.001) at baseline. There was a decrease in nutritional status according to PG-SGA score (P<0.001) and SGA (P<0.001); and a decrease in global QoL (P<0.001) after 4 weeks of radiotherapy. There was a linear trend for change in PG-SGA score (P<0.001) and change in global QoL (P=0.003) between those patients who improved (5%) maintained (56.7%) or deteriorated (33.3%) in nutritional status according to SGA. There was a correlation between change in PG-SGA score and change in QoL after 4 weeks of radiotherapy (r=-0.55, P<0.001). Regression analysis determined that 26% of the variation of change in QoL was explained by change in PG-SGA (P=0.001). CONCLUSION: The scored PG-SGA is a nutrition assessment tool that identifies malnutrition in ambulatory oncology patients receiving radiotherapy and can be used to predict the magnitude of change in QoL.

Reducing the global burden of depression : population level analysis of intervention cost-effectiveness in 14 world regions

International evidence on the cost and effects of interventions for reducing the global burden of depression remain scarce. Aims: To estimate the population-level cost-effectiveness of evidence-based depression interventions and their contribution towards reducing current burden. Method: Primary-care-based depression interventions were modelled at the level of whole populations in 14 epidemiological subregions of the world. Total population-level costs (in international dollars or I$) and effectiveness (disability adjusted life years (DALYs) averted) were combined to form average and incremental cost-effectiveness ratios. Results: Evaluated interventions have the potential to reduce the current burden of depression by 10–30%. Pharmacotherapy with older antidepressant drugs, with or without proactive collaborative care, are currently more cost-effective strategies than those using newer antidepressants, particularly in lower-income subregions. Conclusions: Even in resource-poor regions, each DALYaverted by efficient depression treatments in primary care costs less than 1 year of average per capita income, making such interventions a cost-effective use of health resources. However, current levels of burden can only be reduced significantlyif there is a substantialincrease substantial increase intreatment coverage.

Implication of global warming on air-conditioned office buildings in Australia

With the accelerated trend of global warming, the thermal behavior of existing buildings, which were typically designed based on current weather data, may not be able to cope with the future climate. This paper quantifies, through computer simulations, the increased cooling loads imposed by potential global warming and probable indoor temperature increases due to possible undersized air-conditioning system. It is found from the sample office building examined that the existing buildings would generally be able to adapt to the increasing warmth of 2030 year Low and High scenarios projections and 2070 year Low scenario projection. However, for the 2070 year High scenario, the study indicates that the existing office buildings, in all capital cities except for Hobart, will suffer from overheating problems. When the annual average temperature increase exceeds 2°C, the risk of current office buildings subjected to overheating will be significantly increased. For existing buildings which are designed with current climate condition, it is shown that there is a nearly linear correlation between the increase of average external air temperature and the increase of building cooling load. For the new buildings, in which the possible global warming has been taken into account in the design, a 28-59% increase of cooling capacity under 2070 High scenario would be required to improve the building thermal comfort level to an acceptable standard.