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1.
J Agric Food Syst Community Dev ; 10(4): 241-265, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34824878

RESUMO

The COVID-19 pandemic is flooding and splitting "efficiency" fault lines in today's industrialized food system. It also exploits centuries of historical traumas, White supremacy, and systemic racism to kill non-White people at triple the rates of Whites. In 1619, an English ship landed on the shores of the Powhatan confederacy, or, as the English called it, Point Comfort, Virginia. The ship delivered stolen people onto stolen land. This was a first step in founding today's U.S. food system. Until that time, the people of North America and West Africa had lived off the land for millennia, foraging, hunting, and cultivating food. But 400 years ago, the twin European colonial influences of invasion and enslavement entwined the lives and, to some extent, the foodways of Native Americans and West Africans in what is now the U.S. Yet, these communities are still resilient. This paper offers re-stories about how African American and Native American communities have adapted and maintained foodways to survive, thrive and renew, from 1619 to COVID-19. Methods include historical and literature reviews, interviews, and brief auto-ethnography. Even in the face of a pandemic, Native American and African American communities still leverage their foodways to survive and thrive. Some of these food system strategies also illustrate shifts that could be made in the United States food system to help everyone thrive.

2.
Prev Chronic Dis ; 16: E113, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31441769

RESUMO

Northern Arapaho and Eastern Shoshone tribes sharing the Wind River Indian Reservation (WRIR) in Wyoming reportedly die 30 years earlier than whites in the state. We analyzed data on the health status of 176 adults from 96 families who participated in a randomized controlled trial to assess health effects of home gardens. Measures of body mass index, waist circumference, blood pressure, hemoglobin A1c, vitamin D, low-density lipoprotein cholesterol, and household food security were collected from participating adults before the intervention. Results indicated that this group has considerably worse health status than average US adults and also fares worse than average American Indians/Alaska Natives. To help improve these disparities, Native Americans need access to appropriate and effective means of health promotion.


Assuntos
Disparidades nos Níveis de Saúde , Hipertensão , Índios Norte-Americanos , Obesidade , Resiliência Psicológica , Adulto , Índice de Massa Corporal , Feminino , Abastecimento de Alimentos/métodos , Abastecimento de Alimentos/estatística & dados numéricos , Jardinagem/métodos , Hemoglobina A Glicada/análise , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Humanos , Hipertensão/sangue , Hipertensão/diagnóstico , Hipertensão/etnologia , Hipertensão/prevenção & controle , Índios Norte-Americanos/psicologia , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Anamnese/estatística & dados numéricos , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/diagnóstico , Obesidade/etnologia , Obesidade/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Estados Unidos/epidemiologia , Circunferência da Cintura/etnologia
3.
BMJ Open ; 9(4): e022731, 2019 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-30948560

RESUMO

INTRODUCTION: This community-based participatory research, Growing Resilience, will be the first full-scale randomised controlled trial we have identified that is designed to evaluate impacts of home gardening on family health. It is based on observational studies suggesting home food gardening has myriad health benefits, Wind River Indian Reservation (WRIR) families' interest in home gardening and the need to end Native American health disparities with empowering, appropriate and effective health interventions. METHODS AND ANALYSIS: A total of 100 Native American families in WRIR who have not gardened recently but want to garden will be randomly allocated (1:1) to intervention (receiving 2 years of support designing, installing and maintaining a home food garden of at least 80 square feet (approximately 7 square meters) or to delayed-intervention control (receiving same gardening support after 2 years of data collection). Willing family members aged 5 and up will participate in data collection each February and August for 2 years, with blood, biometric and survey measures at each. The primary outcome is adult body mass index (BMI). Secondary outcomes include child BMI, and adult hand strength, self-reported physical and mental health, diabetes control and food security. Primary analysis will be intention to treat (ITT), using univariate and bivariate descriptive statistics followed by a mixed model to estimate the ITT effect of the intervention using analysis of covariance (ANCOVA) estimation. We will also examine treatment affects using a gardening fidelity measure, combined adult and child BMI outcomes using a lambda mu and sigma (LMS) Z-score reference data set and possible mechanisms of health impacts. ETHICS AND DISSEMINATION: This protocol was approved by the University of Wyoming Institutional Review Board (IRB) and the project's Community Advisory Board. De-identified data will be shared with each tribe, and results will be published in peer-reviewed journals, summarised for distribution in WRIR, and shared at a national event to be hosted in WRIR in 2020. TRIAL REGISTRATION NUMBER: NCT02672748; Pre-results.


Assuntos
Saúde da Família , Jardinagem/métodos , Promoção da Saúde/métodos , Índios Norte-Americanos , Índice de Massa Corporal , Pesquisa Participativa Baseada na Comunidade , Abastecimento de Alimentos/economia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estações do Ano , Wyoming
4.
J Agric Food Syst Community Dev ; 9(B): 145-165, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-34267984

RESUMO

As a community-based participatory research project designed to promote health and wellbeing, Growing Resilience supports home gardens for 96 primarily Eastern Shoshone and Northern Arapaho families in the Wind River Reservation, located in Wyoming. Through analysis of data from two years of qualitative fieldwork, including stories told by 53 gardeners and members of the project's community advisory board in talking circles and through our novel sovereign storytelling method, we investigated if and how these participants employ relationships, knowledge, and practices across generations through home gardening. We find that participants describe home gardening within present, past, future, and cross-generational frames, rooted in family relationships and knowledge shared across generations. Our analysis of these themes suggests that gardening provides families a means to transmit resilience across generations or, as we call it here, intergenerational resilience. We conclude by discussing intergenerational resilience as a culturally specific mechanism of social-ecological community resilience that may be particularly relevant in Indigenous movements for food sovereignty.

5.
Am J Emerg Med ; 37(2): 294-297, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30442431

RESUMO

OBJECTIVE: The objective of this study was to evaluate a new multidisciplinary process in which intravenous alteplase (tPA) waste, used for acute ischemic stroke (AIS), was salvaged in an attempt to maximize cost effectiveness without impacting door-to-needle (DTN) administration times. DESIGN: This was a retrospective cohort between May 2017 and February 2018. The primary endpoint evaluated for this study was the total tPA salvaged and total cost savings in U.S. dollars. Secondary endpoints evaluated included overall DTN time in minutes. SETTING: Emergency department of a primary stroke center. PATIENTS: A convenience sample of sequential adult (>18 years) patients who received tPA in the ED for AIS were included for analysis. INTERVENTIONS: New stroke process which involved bedside mixing of tPA and salvaging of excess waste in the main central pharmacy. MEASUREMENTS AND MAIN RESULTS: A total of 50 patients were included in the final analysis. There were 25 patients included in the new process and old process groups respectively. A total of 605 mg of alteplase was salvaged from 25 patients in the new process group which was associated with an estimated cost savings of over $120,000 annually. Patients in the new process group had statistically faster average (52 min vs. 60 min; p = 0.01) and median (50 min vs. 58 min; p = 0.03) DTN administration times. CONCLUSION: Preliminary data, in this pilot study, utilizing a multidisciplinary model for tPA administration led to significant cost savings of tPA and decreases in overall DTN administration times.


Assuntos
Isquemia Encefálica/terapia , Acidente Vascular Cerebral/terapia , Terapia Trombolítica , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/uso terapêutico , Fluxo de Trabalho , Administração Intravenosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/economia , Redução de Custos , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Acidente Vascular Cerebral/economia , Ativador de Plasminogênio Tecidual/economia
6.
J Agric Food Syst Community Dev ; 8(Suppl 1): 187-205, 2018 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-30766760

RESUMO

Supporting home and community gardening is a core activity of many community-based organizations (CBOs) that are leading the food justice movement in the U.S. Using mixed methods across multiple action-research studies with five food justice CBOs, this paper documents myriad layers of benefits that gardening yields. Our participatory methods included conducting extensive case studies with five CBOs over five years; quantifying food harvests with 33 gardeners in Laramie, Wyoming, and surveying them about other gardening outcomes (20 responded); and conducting feasibility studies for assessing health impacts of gardening with two of the five CBOs, both in Wyoming. Analyses of these diverse data yielded four categories of gardening benefits: (1) improving health; (2) producing quality food in nutritionally meaningful quantities; (3) providing cultural services; and (4) fostering healing and transformation. Examining these results together illustrates a breadth of health, food, and cultural ecosystem services, and social change yields of home and community food gardening in these communities. It also points to the need to support CBOs in enabling household food production and to future research questions about what CBO strategies most enhance access to and benefits of gardening, especially in communities most hurt by racism and/or insufficient access to fresh food.

7.
BMC Nephrol ; 18(1): 20, 2017 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-28088181

RESUMO

BACKGROUND: Hip fracture is a common injury in older people with a high rate of postoperative morbidity and mortality. This patient group is also at high risk of acute kidney injury (AKI) and chronic kidney disease (CKD), but little is known of the impact of kidney disease on outcome following hip fracture. METHODS: An observational cohort of consecutive patients with hip fracture in a large UK secondary care hospital. Predictive modelling of outcomes using development and validation datasets. Inclusion: all patients admitted with hip fracture with sufficient serum creatinine measurements to define acute kidney injury. Main outcome measures - development of acute kidney injury during admission; mortality (in hospital, 30-365 day and to follow-up); length of hospital stay. RESULTS: Data were available for 2848 / 2959 consecutive admissions from 2007-2011; 776 (27.2%) male. Acute kidney injury occurs in 24%; development of acute kidney injury is independently associated with male sex (OR 1.48 (1.21 to 1.80), premorbid chronic kidney disease stage 3B or worse (OR 1.52 (1.19 to 1.93)), age (OR 3.4 (2.29 to 5.2) for >85 years) and greater than one major co-morbidities (OR 1.61 (1.34 to 1.93)). Acute kidney injury of any stage is associated with an increased hazard of death, and increased length of stay (Acute kidney injury: 19.1 (IQR 13 to 31) days; no acute kidney injury 15 (11 to 23) days). A simplified predictive model containing Age, CKD stage (3B-5), two or more comorbidities, and male sex had an area under the ROC curve of 0.63 (0.60 to 0.67). CONCLUSIONS: Acute kidney injury following hip fracture is common and associated with worse outcome and greater hospital length of stay. With the number of people experiencing hip fracture predicted to rise, recognition of risk factors and optimal perioperative management of acute kidney injury will become even more important.


Assuntos
Injúria Renal Aguda/epidemiologia , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Injúria Renal Aguda/sangue , Idoso , Idoso de 80 Anos ou mais , Creatinina/sangue , Feminino , Fraturas do Quadril/epidemiologia , Mortalidade Hospitalar , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Análise Multivariada , Complicações Pós-Operatórias/sangue , Prevalência , Modelos de Riscos Proporcionais , Recuperação de Função Fisiológica , Insuficiência Renal Crônica/sangue , Medição de Risco , Fatores de Risco , Reino Unido/epidemiologia
8.
Am J Public Health ; 106(5): 854-6, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26985621

RESUMO

OBJECTIVES: We quantified the productivity of food gardens in Laramie, Wyoming, over 3 growing seasons. METHODS: From 2012 to 2014, 33 participating gardening households weighed and recorded each harvest. Academic partners measured plot sizes and converted reported harvest weights to volume in cups. RESULTS: The yield of the average 253-square-foot plot was enough to supply an adult with the daily US Department of Agriculture-recommended amount of vegetables for 9 months. CONCLUSIONS: Gardeners produced nutritionally meaningful quantities of food; thus, food gardening offers promise as an effective public health intervention for improving food security and nutritional health.


Assuntos
Abastecimento de Alimentos/estatística & dados numéricos , Jardinagem/estatística & dados numéricos , Abastecimento de Alimentos/economia , Jardinagem/economia , Humanos , Estações do Ano , Wyoming
9.
J Public Health Manag Pract ; 22(4): 379-86, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26618848

RESUMO

OBJECTIVE: To evaluate the impact of minigrants on home food gardening and review 28 health-related minigrant programs reported in the literature for lessons relevant for using minigrant programs to promote community health. DESIGN: Randomized controlled trial of the impact of minigrants on square footage of food garden area and on garden initiation in 2010 versus 2011. Interviews with participants were also conducted and coded and the literature was reviewed for findings from other community health minigrant programs. SETTING: Laramie, Wyoming. PARTICIPANTS: Sixty adults living in 53 households who attended a gardening training workshop in April 2011. INTERVENTION: A $40 minigrant in the form of a voucher, valid at a local gardening store. RESULTS: Minigrant recipients were more likely to increase their gardening space than the control group. The average increase for the intervention group was 39.2 ft (3.62 m) while the control group average garden plot size decreased slightly, on average, by 1.4 ft (-0.13 m). However, the data were not normally distributed and, therefore, nonparametric statistical tests were used. For the subset of 20 households that did not garden at all in 2010, minigrants also provided motivation to start gardening (8 of 10 minigrant households started a garden vs 2 of 10 control households). Results reported from other health minigrant programs are also positive, though few had quantitative outcomes or control groups for comparison. CONCLUSIONS: Even with very small amounts of money, minigrants show promise as an ethical, inexpensive, empowering, and effective health promotion strategy to enable families and communities to improve their health.


Assuntos
Saúde da Família/normas , Jardinagem/economia , Saúde Pública/economia , Adulto , Saúde da Família/economia , Feminino , Assistência Alimentar , Promoção da Saúde/métodos , Humanos , Masculino , Wyoming
10.
Nephrol Dial Transplant ; 29(10): 1888-93, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24744280

RESUMO

BACKGROUND: Acute kidney injury (AKI) is a common and serious problem in hospitalized patients. Early detection is critical for optimal management but in practice is currently inadequate. To improve outcomes in AKI, development of early detection tools is essential. METHODS: We developed an automated real-time electronic alert system employing algorithms which combined internationally recognized criteria for AKI [Risk, Injury, Failure, Loss, End-stage kidney disease (RIFLE) and Acute Kidney Injury Network (AKIN)]. All adult patients admitted to Nottingham University Hospitals were included. Where a patient's serum creatinine increased sufficiently to define AKI, an electronic alert was issued, with referral to an intranet-based AKI guideline. Incidence of AKI Stages 1-3, in-hospital mortality, length of stay and distribution between specialties is reported. RESULTS: Between May 2011 and April 2013, 59,921 alerts resulted from 22,754 admission episodes, associated with 15,550 different patients. Overall incidence of AKI for inpatients was 10.7%. Highest AKI stage reached was: Stage 1 in 7.2%, Stage 2 in 2.2% and Stage 3 in 1.3%. In-hospital mortality for all AKI stages was 18.5% and increased with AKI stage (12.5, 28.4, 35.7% for Stages 1, 2 and 3 AKI, respectively). Median length of stay was 9 days for all AKI. CONCLUSIONS: This is the first fully automated real time AKI e-alert system, using AKIN and RIFLE criteria, to be introduced to a large National Health Service hospital. It has provided one of the biggest single-centre AKI datasets in the UK revealing mortality rates which increase with AKI stage. It is likely to have improved detection and management of AKI. The methodology is transferable to other acute hospitals.


Assuntos
Injúria Renal Aguda/diagnóstico , Alarmes Clínicos , Diagnóstico Precoce , Injúria Renal Aguda/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Sistemas Computacionais , Progressão da Doença , Feminino , Mortalidade Hospitalar , Hospitalização , Hospitais de Ensino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Índice de Gravidade de Doença
11.
Child Obes ; 9(2): 164-74, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23517281

RESUMO

BACKGROUND: A 2005 Institute of Medicine report argues that "prevention of obesity in children and youth is, ultimately, about community," yet the literature lacks empirical research on what communities are doing to prevent childhood obesity. This research helps fill this gap and highlights promising practices. CASES: This research entailed exploratory analysis of three descriptive case studies of community efforts to prevent childhood obesity in the northeastern United States: Shape Up Somerville in Massachusetts, MA (urban), Whole Community Project in New York, NY (semiurban), and Eat Well Play Hard Chemung in NY (semirural). Data included stakeholder interviews (n=23), participant observation (n ≥ 7 events and meetings/case), and document analysis (n≈100/case) from project inceptions until March, 2010. Meeting participation was tracked. Data were coded for actions and strategies. Actions were mapped to an adapted version of the ANalysis Grid for Environments Linked to Obesity (ANGELO) framework. DISCUSSION: These three projects were successful in changing physical environments for food and activity through program and event offerings. The projects were less active in generating policy and economic change. The scale and scope of actions related to project longevity. Demographics of key project stakeholders may have hinged on individual and institutional identities of project facilitators and on intentionality of inclusion strategies. CONCLUSION: Such projects could likely generate greater scope and scale of environmental changes to prevent childhood obesity if funding agencies provided long-term financial support and technical assistance, even if at lower levels. Diversity of participation would also benefit from stable support and from dispersal of decision-making powers, including through distributed funding.


Assuntos
Participação da Comunidade , Promoção da Saúde , Obesidade/prevenção & controle , Criança , Pré-Escolar , Dieta , Exercício Físico , Feminino , Humanos , Masculino , Massachusetts/epidemiologia , New York/epidemiologia , Obesidade/epidemiologia , Avaliação de Programas e Projetos de Saúde
12.
Adv Nutr ; 4(1): 92-114, 2013 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-23319128

RESUMO

Nutrition research, ranging from molecular to population levels and all points along this spectrum, is exploring new frontiers as new technologies and societal changes create new possibilities and demands. This paper defines a set of frontiers at the population level that are being created by the increased societal recognition of the importance of nutrition; its connection to urgent health, social, and environmental problems; and the need for effective and sustainable solutions at the population level. The frontiers are defined in terms of why, what, who, and how we study at the population level and the disciplinary foundations for that research. The paper provides illustrations of research along some of these frontiers, an overarching framework for population nutrition research, and access to some of the literature from outside of nutrition that can enhance the intellectual coherence, practical utility, and societal benefit of population nutrition research. The frontiers defined in this paper build on earlier forward-looking efforts by the American Society for Nutrition and extend these efforts in significant ways. The American Society for Nutrition and its members can play pivotal roles in advancing these frontiers by addressing a number of well-recognized challenges associated with transdisciplinary and engaged research.


Assuntos
Política Nutricional/tendências , Ciências da Nutrição/tendências , Projetos de Pesquisa , Guias como Assunto , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Política Nutricional/legislação & jurisprudência , Ciências da Nutrição/legislação & jurisprudência , Ciências da Nutrição/normas , Estado Nutricional
13.
Public Health Nutr ; 16(1): 123-9, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22390925

RESUMO

OBJECTIVE: (i) To map how US adults value 'choice' in the context of obesity policy and (ii) to discuss implications for obesity prevention in children. DESIGN: Semi-structured interviews (n =105) were conducted between 2006 and 2009 about causes of and solutions to childhood obesity. Quotes captured in field notes from community meetings (n = 6) on childhood obesity prevention were also analysed. Each use of the word 'choice' and its variants was identified in these texts. Content and discourse were analysed to identify the implied values and meaning in each use. SETTING: North-eastern USA. SUBJECTS: One hundred and five adults, some involved in childhood obesity prevention initiatives. RESULTS: Three distinct frames of 'choice' emerged: (i) having choices (choice as freedom), (ii) making choices (choice as responsibility) and (iii) influencing choices (contextual constraints and impacts on choice). Many speakers used more than one frame over the course of an interview. Most people using the third frame seemed to share the values behind the first two frames, but focused on conditions required to enable people to be accountable for their choices and to make truly free choices. A small subset thought outside the frame of individual choice, valuing, as one person put it, a 'social contract'. CONCLUSIONS: Public debate in the USA about responsibility for and solutions to rising obesity rates often hinges on notions of 'choice'. These frames, and the values underlying them, are not mutually exclusive. Respecting the values behind each 'choice' frame when crafting obesity prevention policy and employing all three in public communications about such policy may facilitate greater consensus on prevention measures.


Assuntos
Comportamento de Escolha , Obesidade , Autonomia Pessoal , Valores Sociais , Adulto , Criança , Política de Saúde , Humanos , Entrevistas como Assunto , New England , Obesidade/prevenção & controle
15.
Health Promot Pract ; 13(6): 826-34, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21525420

RESUMO

To support successful and inclusive community organizing for childhood obesity prevention, this research identified stakeholder perspectives on what communities should do to prevent childhood obesity. It employed factor analysis on statement sorts (Q methodology) conducted by 95 people in an upstate New York community. These participants sorted 36 statements about the issue by how much he or she agreed or disagreed with each. Participants were recruited through strategic snowball sampling to sample a variety of perspectives. The four resulting factors, or perspectives, were interpreted in the context of presort demographic surveys and postsort interviews. This research found one stance that fits the environmental perspective common in public health. The other three factors indicate important variations among perspectives centered on individual responsibility, ranging from libertarian to technocratic views. However, overall, results revealed a substantial degree of agreement among the four perspectives, including on providing access to family activities and on making fruits and vegetables more available and affordable, for example, through subsidies. This article points to common ground for community action on childhood obesity prevention, highlights areas likely to generate considerable contention, and shows whose views are not being accounted for in, at least, this community's childhood obesity prevention project.


Assuntos
Atitude Frente a Saúde , Meio Ambiente , Abastecimento de Alimentos/economia , Atividade Motora , Obesidade/prevenção & controle , Poder Familiar , Políticas de Controle Social/normas , Adolescente , Adulto , Participação da Comunidade/métodos , Feminino , Abastecimento de Alimentos/normas , Humanos , Masculino , Pessoa de Meia-Idade , New York , Política , Pesquisa Qualitativa , Projetos de Pesquisa , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
16.
Nephrol Dial Transplant ; 26(8): 2582-9, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21224493

RESUMO

BACKGROUND: The purpose of this study was to report the evolution of coronary artery calcification (CAC) in subjects with chronic kidney disease Stages 3 and 4 comparing those with and without diabetes. We previously reported prevalence in the same population. METHODS: CAC was measured using multi-slice computer tomography. We prospectively followed up 103 patients for 2 years, 49 with diabetes and 54 without diabetes. Demographic, routine biochemistry, calcification inhibitors and bone mineral density data were collected and analysed. Evolution of CAC was defined as those with a difference of ≥ 2.5 U between baseline and final square root CAC scores. RESULTS: There were more progressors in the group with diabetes, 24 compared to 12 in the group without diabetes (P= 0.004). When diabetes was present, CAC progressed equally in men and women. Risk factors for evolution of CAC included age, baseline CAC score and serum phosphate levels. Baseline CAC score, phosphate and body mass index were independent predictors for the increase of CAC score during the study period. Severity of CAC was greater in the diabetes group (median CAC score at baseline in the group with diabetes 154 increased to 258 2 years later, P < 0.001). CONCLUSIONS: Evolution of CAC is greater in older patients and those with diabetes, where the gender advantage of being female is lost. Serum phosphate level, despite being within the normal range and virtually no use of phosphate binders, was also a risk factor. Further studies are required to determine the levels of serum phosphate required to minimize cardiovascular risk.


Assuntos
Calcinose/etiologia , Doença da Artéria Coronariana/etiologia , Complicações do Diabetes/etiologia , Diabetes Mellitus/fisiopatologia , Falência Renal Crônica/etiologia , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Adulto Jovem
18.
Nephrology (Carlton) ; 13(1): 63-7, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18199106

RESUMO

AIM: Low vitamin D status is associated with secondary hyperparathyroidism and increased bone turnover in the general population and can aggravate the hyperparathyroidism of chronic kidney disease (CKD) patients. It is also correlated to low bone mineral density (BMD), but this correlation is less clear in CKD patients. Aims of our study were to investigate these associations in CKD stages 3 and 4 patients, and to identify significant predictors of BMD in this population. METHODS: Serum 25-hydroxyvitamin D (25OHD) levels, BMD at the femur and radius, and bone mineral metabolism parameters were measured in 89 CKD stages 3 and 4 patients. Vitamin D status was defined according to the NKF/KDOQI guidelines. RESULTS: Mean 25OHD levels were 53.8+/-32.1 nmol/L and correlated to the severity of proteinuria. Thirty-five patients (39%) had vitamin D insufficiency, 29 (33%) had vitamin D deficiency and five (6%) had severe deficiency. Of the 89 patients, two had osteoporosis and 31 had osteopenia either at femur or radius. Independent predictors for the total femur BMD were the intact parathyroid hormone (iPTH) levels and the body mass index (BMI). For the total radius BMD, independent predictor was only the BMI. Serum 25OHD levels were not directly associated with BMD, but they were independent predictors of iPTH. CONCLUSION: Vitamin D insufficiency and deficiency are very common in CKD stages 3 and 4 population and may indirectly affect, via effects on iPTH, the BMD of these patients.


Assuntos
Densidade Óssea/fisiologia , Hipercalcemia/etiologia , Falência Renal Crônica/metabolismo , Osteoporose/etiologia , Hormônio Paratireóideo/sangue , Deficiência de Vitamina D/etiologia , Vitamina D/sangue , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Hipercalcemia/epidemiologia , Hipercalcemia/metabolismo , Incidência , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Medições Luminescentes , Masculino , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Osteoporose/metabolismo , Prognóstico , Índice de Gravidade de Doença , Reino Unido/epidemiologia , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/metabolismo
19.
World J Surg ; 32(1): 26-30, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18026789

RESUMO

BACKGROUND: The objective of the study was to reassess the efficacy of the open onlay technique for repair of major incisional hernias, utilizing the modern adjuncts of components separation and fibrin sealant to reduce the principal complications of seroma and recurrence. Major incisional hernias were defined as >10 cm transverse diameter. METHODS: A prospective audit was applied to 116 patients undergoing open onlay incisional hernia repair during a 2-year period at a single institution. Information was collected concerning operative details, postoperative complications, and recurrence. Clinical review at a median 15.2 months postoperatively was followed by a telephoned structured questionnaire to assess quality of life. All patients with pain or suspected recurrence were recalled for examination. RESULTS: Fascial closure required components separation in 21 (18.1%) patients when tension-free fascia reconstruction was not possible, and fibrin sealant was applied in 22 (18.9%) in whom extensive skin flaps were dissected beyond the semilunar line. Postoperatively, there were 11 (9.5%) seromas and 2 (1.7%) deep wound infections. At 15.2 months' follow-up there were 4 (3.4%) recurrences. CONCLUSIONS: Open onlay mesh repair for major incisional hernias is a versatile operation applicable to all quadrants of the abdominal wall and gives excellent results when used in association with components separation and fibrin sealant.


Assuntos
Parede Abdominal/cirurgia , Adesivo Tecidual de Fibrina/uso terapêutico , Hérnia Abdominal/cirurgia , Telas Cirúrgicas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Complicações Pós-Operatórias , Estudos Prospectivos , Qualidade de Vida , Recidiva , Inquéritos e Questionários , Resultado do Tratamento
20.
Nephrol Dial Transplant ; 22(11): 3208-13, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17617653

RESUMO

BACKGROUND: The purpose of this study was to describe the prevalence and extent of coronary artery calcification (CAC) in subjects with chronic kidney disease (CKD) stages 3 and 4 comparing those with and without diabetes. We also wished to determine if the presence of peripheral artery calcification (PAC) would assist in identifying patients positive for CAC. METHODS: CAC was detected by multi-slice computed tomography and PAC was detected by plain foot radiography. Study population was 112 patients, 54 with diabetes and 58 without, all asymptomatic for heart disease. Demographic and laboratory data were collected and analysed. RESULTS: The prevalence of CAC in CKD patients was 76 and 46.5% with and without diabetes, respectively. Patients with diabetes had higher CAC scores with more vessels affected, and in the presence of diabetes men and women had the same risk for CAC. In patients with diabetes, age was the unique explanatory variable for detecting the presence of CAC, while age and smoking history predicted severity. In patients without diabetes, age, male gender, body mass index, estimated glomerular filtration rate and serum phosphate levels predicted the presence of CAC, while parathyroid hormone predicted severity. Prevalence of PAC was 63 and 12% in subjects with and without diabetes. PAC detected by foot radiography was not an adequate alternative-screening marker for identifying patients with CAC. CONCLUSIONS: CAC is common in CKD stages 3 and 4 patients, especially in men and women with diabetes.


Assuntos
Calcinose/sangue , Doença das Coronárias/sangue , Falência Renal Crônica/complicações , Doenças Vasculares Periféricas/sangue , Adulto , Idoso , Doença das Coronárias/diagnóstico por imagem , Estudos Transversais , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/complicações , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Falência Renal Crônica/sangue , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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