Search

Introduction: Immigrants are among the most vulnerable population groups in North America; they face multidimensional hurdles to obtain proper healthcare. Such barriers result in increased risk of developing acute and chronic conditions. Subsequently a great deal of burden is placed on the healthcare system. Community navigator programs are designed to provide culturally sensitive guidance to vulnerable populations in order to overcome barriers to accessing healthcare. Navigators are healthcare workers who support patients to obtain appropriate healthcare. This scoping review systematically searches and summarizes the literature on community navigators to help immigrant and ethnic minority groups in Canada and the United States overcome barriers to healthcare. Methods: We systematically searched electronic databases for primary articles and grey literature. Study selection was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Articles were selected based on four criteria: (1) the study population was comprised of immigrants or ethnic minorities living in Canada or the United States ; (2) study outcomes were related to chronic disease management or primary care access; (3) the study reported effects of community navigator intervention; (4) the study was published in English. Relevant information from the articles was extracted and reported in the review. Result: Only one study was found in the literature that focused on navigators for immigrants in Canada. In contrast, 29 articles were found that reported navigator intervention programs for immigrant minorities in the United States. In these studies navigators trained and guided members of several ethnic communities for chronic disease prevention and management, to undertake cancer screening as well as accessing primary healthcare. The studies reported substantial improvement in the immigrant and ethnic minority health outcomes in the United States. The single Canadian study also reported positive outcome of navigators among immigrant women. Conclusion: Navigator interventions have not been fully explored in Canada, where as, there have been many studies in the United States and these demonstrated significant improvements in immigrant health outcomes. With many immigrants arriving in Canada each year, community navigators may provide a solution to reduce the existing healthcare barriers and support better health outcomes for new comers. [ABSTRACT FROM AUTHOR]

IMPORTANCE The established chronic kidney disease (CKD) progression end point of end-stage renal disease (ESRD) or a doubling of serum creatinine concentration (corresponding to a change in estimated glomerular filtration rate [GFR] of-57% or greater) is a late event. OBJECTIVE To characterize the association of decline in estimated GFR with subsequent progression to ESRD with implications for using lesser declines in estimated GFR as potential alternative end points for CKD progression. Because most people with CKD die before reaching ESRD, mortality risk also was investigated. DATA SOURCES AND STUDY SELECTION Individual meta-analysis of 1.7 million participants with 12 344 ESRD events and 223 944 deaths from 35 cohorts in the CKD Prognosis Consortium with a repeated measure of serum creatinine concentration over 1 to 3 years and outcome data. DATA EXTRACTION AND SYNTHESIS Transfer of individual participant data or standardized analysis of outputs for random-effects meta-analysis conducted between July 2012 and September 2013, with baseline estimated GFR values collected from 1975 through 2012. MAIN OUTCOMES AND MEASURES End-Stage renal disease (initiation of dialysis or transplantation) or all-cause mortality risk related to percentage change in estimated GFR over 2 years, adjusted for potential confounders and first estimated GFR. RESULTS The adjusted hazard ratios (HRs) of ESRD and mortality were higher with larger estimated GFR decline. Among participants with baseline estimated GFR of less than 60 mL/min/1.73 m², the adjusted HRs for ESRD were 32.1 (95% Cl, 22.3-46.3) for changes of -57% in estimated GFR and 5.4 (95% Cl, 4.5-6.4) for changes of -30%. However, changes of -30% or greater (6.9% [95% Cl, 6.4%-7.4%] of the entire consortium) were more common than changes of -57% (0.79% [95% Cl, 0.52%-1.06%]). This association was strong and consistent across the length of the baseline period (1 to 3 years), baseline estimated GFR, age, diabetes status, or albuminuria. Average adjusted 10-year risk of ESRD (in patients with a baseline estimated GFR of 35 mL/min/1.73 m²) was 99% (95% Cl, 95%-100%) for estimated GFR change of -57%, was 83% (95% Cl, 71%-93%) for estimated GFR change of -40%, and was 64% (95% Cl, 52%-77%) for estimated GFR change of -30% vs 18% (95% Cl, 15%-22%) for estimated GFR change of 0%. Corresponding mortality risks were 77% (95% Cl, 71%-82%), 60% (95% Cl, 56%-63%), and 50% (95% Cl, 47%-52%) vs 32% (95% Cl, 31%-33%), showing a similar but weaker pattern. CONCLUSIONS AND RELEVANCE Declines in estimated GFR smaller than a doubling of serum creatinine concentration occurred more commonly and were strongly and consistently associated with the risk of ESRD and mortality, supporting consideration of lesser declines in estimated GFR (such as a 30% reduction over 2 years) as an alternative end point for CKD progression. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to explore the associations between the prevalence of chronic kidney disease (CKD) and polymorphisms in the genes encoding matrix metalloproteinases (MMPs) and tissue inhibitor of matrix metalloproteinases (TIMPs). MMPs degrade extracellular matrix proteins in the glomerulus, and play important roles in kidney disease progression. Methods: DNA samples from 3,309 subjects aged 35-69 years were genotyped for 10 potentially functional polymorphisms in MMP and TIMP genes. The prevalence of CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2) was compared among the genotypes. Results: The prevalence of CKD decreased significantly with the number of minor alleles in MMP9 C-1562T (odds ratios (ORs) 0.77 for CT and 0.65 for TT compared with CC; p for trend = 0.023) and MMP9 R668Q (ORs, 0.79 for RQ and 0.64 for QQ compared with RR; p for trend = 0.024). The haplotype MMP9 -1562T/279R/668Q showed a reduced risk for CKD compared with the most common -1562C/279R/668R (OR 0.77, p = 0.008), and the genotype combination -1562TT/ 279RR/668QQ showed a halved risk for CKD compared with major allele homozygous -1562CC/279RR/668RR (OR 0.53, p = 0.091). Conclusion: The potentially functional polymorphisms of MMP9 were associated with the prevalence of CKD in a large Japanese population. These genotypes have been reported to increase MMP9 expression, supporting the hypothesis that MMP-9 has a protective role in the progression of kidney diseases. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article focuses on a study to determine the association of age with the likelihood of treatment of kidney failure. A community-based cohort study of adults in Alberta, Canada, who had outpatient estimated glomerular filtration rate measured between May 1, 2002 and March 31, 2008 and who did not require renal replacement therapy at baseline, was conducted. Main outcomes included adjusted rates of treated kidney failure, untreated kidney failure and death. The study concluded that in Alberta, Canada, rates of untreated kidney failure are significantly higher in older compared with younger individuals.

Japanese serial television dramas are becoming very popular overseas, particularly in other Asian countries. Exposure to smoking scenes in movies and television dramas has been known to trigger initiation of habitual smoking in young people. Smoking scenes in Japanese dramas may affect the smoking behavior of many young Asians. We examined smoking scenes and smoking-related items in serial television dramas targeting young audiences in Japan during the same season in two consecutive years. Fourteen television dramas targeting the young audience broadcast between July and September in 2001 and 2002 were analyzed. A total of 136 h 42 mm of television programs were divided into unit scenes of 3 mm (a total of 2734 unit scenes). All the unit scenes were reviewed for smoking scenes and smoking-related items. Of the 2734 3-mm unit scenes, 205 (7.5%) were actual smoking scenes and 387 (14.2%) depicted smoking environments with the presence of smoking-related items, such as ashtrays. In 185 Unit scenes (90.2% of total smoking scenes), actors were shown smoking. Actresses were less frequently shown smoking (9.8% of total smoking scenes). Smoking characters in dramas were in the 20-49 age group in 193 Unit scenes (94.1% of total smoking scenes). In 96 unit scenes (46.8% of total smoking scenes), at least one non-smoker was present in the smoking scenes. The smoking locations were mainly indoors, including offices, restaurants and homes (122 unit scenes, 59.6%). The most common smoking-related items shown were ashtrays (in 45.5% of smoking-item-related scenes) and cigarettes (in 30.2% of smoking-item-related scenes). Only 3 unit scenes (0.1 % of all scenes) promoted smoking prohibition. This was a descriptive study to examine the nature of smoking scenes observed in Japanese television dramas from a public health perspective. [ABSTRACT FROM AUTHOR]