Title: Implementation of strategies for prevention relevant to national health care systems and specific ce
1Implementation of strategies for prevention
relevant to national health care systems and
specific centres in the emerging world
- Introduction (Jan J. Weening)
- Public health in the emerging world (Dan Kaseje)
- Strengthening health research capacity in
developing countries a critical element for
achieving health equity (Chitr Shitthi-amorn) - International aid and medical practice in the
less-developed world doing it right (Ivor Katz)
21. NKF and NIDDK practice guidelines for the US
- 2. The InterAcademy Council in its January 2004
Report to the United Nations
3. Implementation of strategies for prevention
relevant to national health care systems and
specific centres in the emerging world
3NKF and NIDDK practice guidelines for the US-1.
Clinical Guidelines-
- Define chronic kidney disease (CKD), classify
stages - Evaluate kidney function
- Association level of kidney function with
systemic complications - Stratify the risk for loss of kidney function and
development of cardiovascular disease
4NKF and NIDDK practice guidelines for the US-2.
Clinical Guidelines-
- Assess those who have increased risk on CKD based
on sociodemographic factors - Test in these individuals markers of kidney
damage, specifically proteinuria - Estimate in these individuals the level of GFR
from prediction equations that take into account
serum creatinine, and some or all of the
following factors age, gender, race and body
size.
5NKF and NIDDK practice guidelines for the US-3.
GFR estimates-
- Standardization of GFR estimates (creatinine
calibration reporting MDRD equation serum
creat, age, sex, Afr-Am or not) - Instruction of physicians
- Education of care providers to undergraduate,
graduate and postgraduate levels - Education of public
- Research recommendations improve and develop new
prediction equations using better filtration
markers continue to evaluate the burden of CKD
evaluate alternative definitions of CKD.
6NKF and NIDDK practice guidelines for the US-4.
Albuminuria measurement-
- Albumin is preferred over total protein in
agegtpuberty - Ratio of albumin over urine creatinin on a spot
untimed urine specimen should be determined and
reported - Use PARADE recommendations repeat assays no
vigorous exercise refrigerate samples one
freeze is acceptable no need to acidify need
for standardization adjust creatinine for gender - Definitions
- normal lt30 mg albumin/g creatinine
- Microalbuminuria gt30 to 300 mg alb/g creatinine
- Macroalbuminuria gt300 mg alb/g creatinine
7NKF and NIDDK practice guidelines for the US-5.
Albuminuria as a clinical marker of kidney
damage-
- Populations at increased risk for CKD (DM, HT,
family) should be screened annually for
microalbuminuria - Test for therapy effect within 6 months
- Children should be screened with standard
dipstick twice prior to starting school and in
early adolescence - Research recommendations value of testing for
albuminuria value of titration of anti-HT based
on changes in albuminuria guidelines for
expected reductions in albuminuria new markers
(urinary cells and mediators of injury) - Albuminuria as a surrogate marker for clinical
trials
8NKF and NIDDK practice guidelines for the
USWhat is desirable and feasible globally?
9Implementation of strategies for prevention
relevant to national health care systems and
specific centres in the emerging world Jan J.
Weening
- The InterAcademy Council in its January 2004
Report to the United Nations states that - inadequate attention has been given by the
international community to the needs of capacity
building in science and technology (ST) as the
engine that drives knowledge-based development. - local ST capacity is essential for using and
contributing to the worlds valuable store of
knowledge. - current structures of higher-education systems
in many countries are inadequate to meet the
challenges of the 21st century. - the culture and values of science are critical
for building a global community. - building capacity in agriculture, engineering,
health, and the social sciences is essential for
national development.
10Implementation of strategies for prevention
relevant to national health care systems and
specific centres in the emerging world Jan J.
Weening
- The InterAcademy Council in its January 2004
Report to the United Nations states - In addition to national and regional funding
programs for the support of ST through networks
and centers of excellence, two global funds
should be established - A Global Institutional Fund for 10 to 20 centers
of excellence over a period of 5 to 10 years - A Global Program Fund to support research
proposals
11Implementation of strategies for prevention
relevant to national health care systems and
specific centres in the emerging world Jan J.
Weening
- The InterAcademy Council in its January 2004
Report to the United Nations states - Human resources should be expanded by a number of
actions including the support of
industrialized-country governments for ST
professionals and doctoral programs in developing
nations best universities by offering long-term
fellowships to deserving young people from
industrialized countries who wish to do their
training in world-class research programs in
developing nations - Visiting professors from foreign countries should
participate - Industrialized nations should provide incentives
for outstanding young researchers from developing
countries to apply their skills in the service of
their native lands thus enhancing future
leadership - Digital libraries of science have to be
established
12Implementation of strategies for prevention
relevant to national health care systems and
specific centres in the emerging world Jan J.
Weening
- The InterAcademy Council in its January 2004
Report to the United Nations states - Strengthen national societies of science,
engineering and medicine - Mobilize the international ST community
- Raise the level of public awareness
- Protect public goods and define the boundaries of
the public/private interface - SEE ADDENDUM
- Report p. 1-15
13Implementation of strategies for prevention
relevant to national health care systems and
specific centres in the emerging world Jan J.
Weening
- Establish epidemiology and biostatistics of renal
disease, its associated risk factors, preclinical
signs - Perform exemplary screening and intervention
programs in confined groups (e.g. taxi drivers
school teachers) - Link the local, regional, national screening
program to World Kidney Day - Develop a network of participating health care
centers of primary, secondary and tertiary level - Place the program under auspices of National
Government - Raise Public and Press Awareness
14Implementation of strategies for prevention
relevant to national health care systems and
specific centres in the emerging world Jan J.
Weening
- Implementation requires
- Increased Public Health capacity
- Establishment of centres of excellence for public
health research - Enhancement of information infrastructure
- Establishment of awareness-raising programs
15Implementation of strategies for prevention
relevant to national health care systems and
specific centres in the emerging world Jan J.
Weening
- Centers of excellence for public health to be
established as an integral part of medical
research centers - Can such centers be at the interphase of
public/private? - ISN can provide sister center relations with
exchange of senior staff, health care workers,
nurses, students from high-income countries - ISN organizes regional and local conferences
where the outcome of local experience is
disseminated
16Implementation of strategies for prevention
relevant to national health care systems and
specific centres in the emerging world Jan J.
Weening
- ISN provides a
- Fellowship Program
- Senior Scholar Program
- Library Enhancement Program
- Local Visit and Update Program
- Science Journal
- Clinical Therapeutic and Management Journal?
- International Guidelines (in collaboration with
NKF-US) - Prevention Programs
- Epidemiology and biostatistics
- Intervention strategies