Chronic kidney disease mortality trends in selected Central America countries, 1997-2013: clues to an epidemic of chronic interstitial nephritis of agricultural communities.

BACKGROUND: In Central America, chronic interstitial nephritis of agricultural communities (CINAC) has reached epidemic proportions. Clusters of cases have been described in several farming communities. Its aetiology remains uncertain and a controversy exists on its key triggers, among them the heat stress-dehydration mechanism and the toxic exposure to agrochemicals. METHODS: This study analysed the mortality pattern and trend of chronic kidney disease code N18 (CKD-N18) according to the International Statistical Classification of Diseases and Related Health Problems-10th Revision, the proxy and the underlying cause of death, in four selected Central American countries from 1997 to 2013. In addition, we used exponential regression to retrospectively model the likely onset and prior trajectory of the epidemic. RESULTS: Between 1997 and 2013, CKD-N18 mortality accounting 47 885 deaths (31% were female), 19 533 of which occurred below 60 years of age (26% female). The excess of mortality starts as early as 10-14 years of age for both boys and girls. El Salvador and Nicaragua, with mortality rates between 9-fold and 12-fold higher than reference countries, were the most affected. Statistical modelling suggests that the epidemic commenced around the mid-1970s, coinciding with important changes in modes of agricultural production. CONCLUSIONS: This study provides the most comprehensive mortality analysis of this epidemic published to date and confirms an excess of CKD-N18 mortality and its relation with the epidemic of CINAC. The overall trends and the mortality pattern among women, children and adolescents suggest that the heat stress-dehydration hypothesis cannot fully explain this epidemic and that other environmental factors, more likely agricultural practices and agrochemicals, may be causally involved.

Primary care practitioners survey of non-alcoholic fatty liver disease.

BACKGROUND: The rising incidence of non alcoholic fatty liver disease (NAFLD) mirrors the epidemics of obesity and metabolic syndrome. Primary care practitioners (PCPs) are central to management of patients with NAFLD, but data on knowledge and attitudes of PCPs towards NAFLD are lacking. MATERIAL AND METHODS: We conducted a statewide, stratified survey of 250 PCPs to examine knowledge, practices and attitudes regarding NAFLD and the barriers to providing care for this condition. RESULTS: NAFLD was perceived as an important health problem by 83% of PCPs. Eighty five percent of PCPs underestimated the population prevalence of NAFLD. Although the association of NAFLD with metabolic syndrome was identified by 91% of PCPs, only 46% screened diabetic obese patients for NAFLD. Only 27% of PCPs referred NAFLD patients to a hepatologist for evaluation. PCPs who reported seeing more than 5 NAFLD patients annually, referred to hepatology less frequently (P = 0.01). The majority of PCPs (58%) recommended weight loss and a calorie restriction. Only 8% of PCPs would recommend Vitamin E. The major perceived barrier in managing NAFLD was lack of confidence in understanding of the disease (58% of PCPs). DISCUSSION: An overwhelming majority of PCPs perceived NAFLD as an important health issue in their practice. However, screening rates for NAFLD among obese diabetics were low. A major barrier to managing these patients was self-reported lack of knowledge about NAFLD. Development of guidelines should emphasize strategies for screening vulnerable populations (obese, diabetics), evidence based management and barriers to providing care.

Comunicación biomédica: GLOEPI; glosario inglés-español de términos de epidemiología y estadística sanitaria / Biomedical communication: GLOEPI; english-spanish glosary of epidemiology terms and sanitary statistics

Este glosario llamado GLOEPI pretende ayudar a los profesionales de lengua hispana que trabajan en epidemiología y estadística sanitaria a contar con equivalentes fiables de términos que se usan en las publicaciones en este campo. Las equivalentes que se proponen son frutos del contacto con publicaciones epidemiológicas en español y en inglés y a menudo de la necesidad (con fines de publicación) de traducir textos de carácter epidemiológico