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Implementation of strategies for prevention relevant to national health care systems and specific ce

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2. The InterAcademy Council in its January 2004 Report to the United Nations ... Link the local, regional, national screening program to World Kidney Day ... – PowerPoint PPT presentation

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Title: Implementation of strategies for prevention relevant to national health care systems and specific ce


1
Implementation 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)

2
1. 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
3
NKF 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

4
NKF 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.

5
NKF 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.

6
NKF 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

7
NKF 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

8
NKF and NIDDK practice guidelines for the
USWhat is desirable and feasible globally?
9
Implementation 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.

10
Implementation 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

11
Implementation 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

12
Implementation 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

13
Implementation 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

14
Implementation 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

15
Implementation 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

16
Implementation 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
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