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Item does not contain fulltext BACKGROUND: Change in albuminuria as a surrogate endpoint for progression of chronic kidney disease is strongly supported by biological plausibility, but empirical evidence to support its validity in epidemiological studies is lacking. We aimed to assess the consistency of the association between change in albuminuria and risk of end-stage kidney disease in a large individual participant-level meta-analysis of observational studies. METHODS: In this meta-analysis, we collected individual-level data from eligible cohorts in the Chronic Kidney Disease Prognosis Consortium (CKD-PC) with data on serum creatinine and change in albuminuria and more than 50 events on outcomes of interest. Cohort data were eligible if participants were aged 18 years or older, they had a repeated measure of albuminuria during an elapsed period of 8 months to 4 years, subsequent end-stage kidney disease or mortality follow-up data, and the cohort was active during this consortium phase. We extracted participant-level data and quantified percentage change in albuminuria, measured as change in urine albumin-to-creatinine ratio (ACR) or urine protein-to-creatinine ratio (PCR), during baseline periods of 1, 2, and 3 years. Our primary outcome of interest was development of end-stage kidney disease after a baseline period of 2 years. We defined an end-stage kidney disease event as initiation of kidney replacement therapy. We quantified associations of percentage change in albuminuria with subsequent end-stage kidney disease using Cox regression in each cohort, followed by random-effects meta-analysis. We further adjusted for regression dilution to account for imprecision in the estimation of albuminuria at the participant level. We did multiple subgroup analyses, and also repeated our analyses using participant-level data from 14 clinical trials, including nine clinical trials not in CKD-PC. FINDINGS: Between July, 2015, and June, 2018, we transferred and analysed data from 28 cohorts in the CKD-PC, which included 693 816 individuals (557 583 [80%] with diabetes). Data for 675 904 individuals and 7461 end-stage kidney disease events were available for our primary outcome analysis. Change in ACR was consistently associated with subsequent risk of end-stage kidney disease. The adjusted hazard ratio (HR) for end-stage kidney disease after a 30% decrease in ACR during a baseline period of 2 years was 0.83 (95% CI 0.74-0.94), decreasing to 0.78 (0.66-0.92) after further adjustment for regression dilution. Adjusted HRs were fairly consistent across cohorts and subgroups (ie, estimated glomerular filtration rate, diabetes, and sex), but the association was somewhat stronger among participants with higher baseline ACR than among those with lower baseline ACR (pinteraction

As schools attempt to meet heightened testing requirements, physical, social, and behavioral aspects of child development are often ignored. Physical activity and unstructured play are vital components in children’s health, providing outlets for creativity, socialization, stress reduction, happiness, and active movement (Gray, 2013; Pellegrini & Bohn-Gettler, 2013; Stegelin, Fite, & Wisneski, 2015). Organizations like the American Academy of Pediatrics (AAP) and the National Association for Sport and Physical Education (NASPE) have released position statements on the importance of play breaks, but few schools consistently follow these guidelines (AAP, 2013; NASPE, 2006). The reduction in time offered for play has detrimental effects on school children (Gray, 2011). School leaders need to understand the implications of limiting unstructured play on outcomes, including classroom behavior, academics, attentional focus, social skills, fine and gross motor skills, and emotional development. Preliminary Activities 1 Read “11 Principles of Effective Character Education” and browse the “Character Education Legislation” section of the http://www.Character.org">Character.org website, noting the details pertinent to your state context. Debrief with the whole group. Then divide into teams and engage in a jigsaw activity, with each team reading and reporting on essential ideas/questions from one of the following articles. Teams should comment on how their experiences mirror or contrast those illustrated in the articles. ✓ Ramstetter, C., & Murray, R. (2017). Time to play: Recognizing the benefits of recess. American Educator, 41(1), 17–23. ✓ 250Rhea, D. J., & Rivchun, A. P. (2018). The LiiNK Project®: Effects of multiple recesses and character curriculum on classroom behaviors and listening skills in K-2 Children. Frontiers in Education 3(9). (doi: 10.3389/feduc.2018.00009) ✓ Rhea, D. J. (2016). Recess: The forgotten classroom. Instructional Leader, 29(1), 1-4. ✓ van der Niet, A. G., Smith, J., Scherder, E. J., Oosterlaan, J., Hartman, E., & Visscher, C. (2015). Associations between daily physical activity and executive functioning in primary school-aged children. Journal of Science and Medicine in Sport, 18(6), 673–677. 2 Observe one K–5 classroom; discuss the class and daily schedule with the teacher. Sketch a seating chart. At five-minute intervals, use a coding scheme (e.g., check marks) to document which students are on task and/or appropriately engaged. When a student is off task, briefly note what the student is doing. Write a summary of observed patterns. 3 Take a 15-minute walk outside unplugged—with no cell phone or any other technology. Notice the area around you. Document how you felt before and at the end of the walk, and observations you made.

The purpose of this study was to explore the physical activity patterns and emotional states differences among elementary school students at two private schools with differently structured school days. Students at one school received the LiiNK Project® pilot intervention, which included an additional two 15-minute recess breaks (unstructured outdoor play) throughout the school day and a 15-minute character development lesson three to four times weekly. Students at the comparison school received only one 30-minute recess daily and no additional character development curriculum. Grades K-2 children from two schools (N=262) wore pedometers for one school week and were observed for emotional expressions during recess. A univariate ANOVA revealed that intervention school students took significantly more steps on average than comparison school students, F(1, 260)=0.784, p, {"references":["Centers for Disease Control and Prevention. School health policies and practices study: 2014 Overview. Atlanta, GA: U.S. HHS 2015.","Tremblay MS, LeBlanc AG, Kho ME, Saunders TJ, Larouche R, Colley RC, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act 2011; 8(98): 1-22. https://doi.org/10.1186/1479-5868-8-98","Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Broday J, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005; 352(11): 1138-45."]}

Much of the emphasis for primary care management of chronic kidney disease (CKD) has focused on cardiovascular risk; however, many patients die of other causes. Aim. In order to guide future primary care management of CKD, we report the causes of death from a large U.K. CKD cohort linked to health care administrative data.The Grampian Laboratory Outcomes Mortality and Morbidity Study (GLOMMS-1) is a community cohort of people with established CKD, identified in 2003 and followed up for 6 years. Causes of death were available from death certificates. The relative likelihood of different causes of death was compared to the general population.When standardized for age and sex, mortality was 4.7 (95% confidence interval 4.5-4.9) times higher in GLOMMS-1 than the general population. Non-cardiovascular diseases accounted for 1076 (50.9%) of deaths, 3.7 times more common than in the age- and sex-matched general population. For those with stages 3 and 4 CKD, without cardiovascular disease at baseline, a non-cardiovascular cause accounted for almost two-thirds of deaths. In those 75 years and older, dementia and falls were among the main non-cardiovascular causes of death.Mortality in those with CKD is high, with non-cardiovascular diseases accounting for more than half of all deaths. While there is evidence that intervention may benefit those at risk of cardiovascular death, most of the non-cardiovascular causes of death identified were not readily amenable to prevention. A mechanism to identify which patients may benefit from intervention to prevent cardiovascular disease or renal disease progression is needed.

Background\ud Applying the Kidney Disease Outcomes Quality Initiative definitions of chronic kidney disease (CKD), it appears that CKD is common. The increased recognition of CKD has brought with it the clinical challenge of translating into practice the implications for the patient and for service planning. To understand the clinical relevance and translate that into information to support individual patient care and service planning, we explored clinical outcomes in a large British CKD cohort, identified through routine opportunistic testing, with a 6-year follow-up (∼13 000 patient-years).\ud \ud Methods\ud A cohort had previously been identified with CKD—sustained reduced eGFR over at least 3 months and case note review. Six-year (13 339 patient-years) follow-up for renal replacement therapy (RRT) initiation and death was achieved through data linkage. Age- and sex-specific mortality rates were compared to the general population.\ud \ud Results\ud Of 3414 individuals (most Stage 3b–5), median age 78.6 years, followed for 13 339 patient-years, 170 (5%) initiated RRT and 2024 (59%) died without initiating RRT. RRT initiation rates decreased with age from 14.33 to 0.65 per 100 patient-years among those aged 15–25 and 75–85 years at baseline but the actual numbers initiating RRT increased from 6 to 34, respectively. RRT initiation rates were lower for female sex, absence of macroalbuminuria and less advanced CKD stage. Mortality rates increased with age from 2 to 34 per 100 patient-years for those aged 15–45 and > 85 years at baseline, an excess of 2 and 17 per 100 patient-years over that of the general population, respectively. However, the increase in relative risk was 19-fold for those aged 15–45 years and just 2-fold in those > 85 years. These data have been converted into simple tools for considering individual patients' risk and informing service planning.\ud \ud Conclusions\ud The contrast between relative and absolute risk for both RRT initiation and mortality by age group illustrates the difficulties for planning services. The challenge that now faces clinicians is how to appropriately identify which elderly patients with CKD are at high risk of poor outcome.

Chronic kidney disease (CKD) is a major public health concern. The high prevalence of reduced estimated glomerular filtration (eGFR) in the elderly has led to speculation as to whether it should really be regarded as a disease in all. Patients with CKD exhibit considerable cardiovascular morbidity and mortality but until recently data regarding the natural history of CKD, particularly in the elderly, has been somewhat lacking. As such the clinical significance of K/DOQI’s CKD definition in terms of additional morbidity, mortality and progression to end-stage renal disease (ESRD) remains uncertain. Data have shown that death from cardiovascular disease is far more common than progression to renal replacement therapy in the elderly. Factors which increase the risks of progression to ESRD include younger age, proteinuria and diabetes. Although the elderly have high rates of cardiovascular death, comparatively younger patients with CKD have substantially increased relative risks of death. Specialist renal review should be targeted towards these high-risk patients while the majority of elderly patients can be safely monitored in primary care. It remains doubtful whether labelling all elderly CKD patients with a ‘disease’ confers any additional benefit.