Comparison of Nutritional Risk Scores for Predicting Mortality in Japanese Chronic Hemodialysis Patients.

OBJECTIVE: Protein energy wasting (PEW) is consistently associated with poor prognosis in hemodialysis (HD) patients. We compared the predictability of PEW as diagnosed by The International Society of Renal Nutrition and Metabolism criteria (PEWISRNM) and geriatric nutritional risk index (GNRI) for all-cause mortality in Japanese HD patients. As cut-off values for body mass index (BMI) for PEW have not been established in PEWISRNM for Asian populations, these were also investigated. DESIGN AND SUBJECTS: The nutritional status from 409 HD patients was evaluated according to ISRNM and GNRI criteria. To compare the predictability of mortality, C-index, net reclassification improvement (NRI) and integrated discrimination improvement were evaluated. RESULTS: During follow-up (median, 52 months; range, 7 months), 70 patients (17.1%) presented PEW according to ISRNM and 131 patients (32.1%) according to GNRI; in addition, 101 patients (24.7%) died. PEWISRNM and GNRI were identified as independent predictors of death. Addition of PEWISRNM and GNRI to a predictive model based on established risk factors improved NRI and integrated discrimination improvement. However, no differences were found between models including PEWISRNM and GNRI. When lowering the criterion level of BMI per 1 kg/m2 sequentially, PEWISRNM at BMI <20 kg/m2 maximized the hazard ratio for mortality. The model including PEWISRNM at BMI <20 kg/m2 improved NRI compared with the model including GNRI. CONCLUSION: PEWISRNM and GNRI represent independent predictors of mortality, with comparable predictability. The diagnostic criterion of BMI in the ISRNM for Japanese population might be better at <20 kg/m2 than at <23 kg/m2.

Exploration of appropriate media to influence sustainable on-site sanitation choices in Sri Lanka- visualization with still images or a video.

Pit latrines are the most common form of improved sanitation in many rapidly developing countries. However, they cause the highest amount of groundwater pollution among on-site sanitation (OSS) facilities. Many households in developing countries use groundwater as their main or sub-source, and pit latrines are not a sustainable solution. Thus, the conversion from pit latrines to septic tanks is required. We created two types of media, still images and a video, to illustrate the differences in functions and hygiene risks between pit latrines and septic tanks. Moreover, a survey was conducted in Sri Lanka to determine the media choice that would increase the people's preference for septic tanks as their next OSS, even weeks after the information is presented. The choice of the next OSS participants selected before they were presented with the images was the same as that currently in use, reflecting the belief that the problem of pit latrines was not currently apparent and need not be changed. However, a video presentation of the information made it possible for a larger group of people to choose the usage of septic tanks in the future, especially in suburban areas where the problems were likely to occur.