Regional variations in the incidence of end-stage renal failure in Japan

CONTEXT: Despite recent medical advances, the number of patients beginning dialysis annually is increasing in both the United States and Japan. The ethnically homogeneous population of Japan presents an opportunity to study the presence of factors other than race/ethnicity that might contribute to incidence of end-stage renal disease (ESRD). OBJECTIVE: To determine if and where regional differences exist in ESRD in Japan. DESIGN, SETTING, AND SUBJECTS: Analysis of data reported by the Japanese Society for Dialysis Therapy based on the annual number of patients with ESRD beginning maintenance dialysis therapy in all 47 prefectures of Japan from 1982 to 1998. MAIN OUTCOME MEASURES: Mean annual ESRD incidence and increasing rate of ESRD in each of 11 predefined areas making up the entire country. RESULTS: Incidence of ESRD increased approximately 3-fold in Japan during the study years, from 81.3 per 1 million in 1982 to 237.6 per 1 million in 1998. Significant regional differences were found in both measures. The mean (SEM) annual ESRD incidence (P<.01) and increasing rate of ESRD (P<.01), respectively, were significantly different across Japan. Koshinetsu (140 [11] per 1 million and 9.1 [0.6] per 1 million/y) and Hokuriku (141 [12] per 1 million and 9.7 [0.5] per 1 million/y) were the areas with the lowest incidence and increasing rate of incidence, while Okinawa (188 [17] per 1 million and 13.4 [0.6] per 1 million/y) and Kyushu (179 [15] per 1 million and 12.0 [0.6] per 1 million/y) were the areas with the highest incidence and increasing rate of incidence. CONCLUSIONS: We found definite and significant regional differences in incidence and increasing rate of incidence of ESRD in Japan. Further analyses are needed to identify factors that contribute to these regional differences and thereby improve strategies for treatment of renal disease. JAMA. 2000;284:2622-2624.     

Controlling HIV in Indigenous Australians

We know what to do, but doing it is the challenge.     

EBM and the health of Indigenous Australians

Implementing evidence-based medicine (EBM) in primary healthcare for Indigenous people will usually involve increasing services, particularly those for chronic conditions. As shown by the example of diabetes care, there are significant organisational, educational, economic, cultural and structural barriers to implementing EBM in many Indigenous communities. Many of these barriers could be reduced by better-organised service delivery systems at the community level, greater numbers of Indigenous health professionals and greater advocacy for healthy public policy by health services. There is evidence that delivering evidence-based primary healthcare, particularly for chronic diseases, can improve health outcomes in Indigenous communities. There is a need for more investment in strategies to implement EBM and evidence-based public health in Indigenous settings.     

Social determinants and the health of Indigenous Australians

Health is dependent on conditions that enable people to live lives they would choose to live.     

The epidemiology of end-stage renal disease in Georgia

We have examined the incidence of end-stage renal disease (ESRD) in Georgia in 1986 and 1987. We found high age-sex-race specific and total incidence rates compared to rates reported for other U.S. populations. Cause-specific and total ESRD incidence rates were significantly higher among blacks as compared to whites. In both races, the majority of new cases of ESRD occurring in Georgia during 1986 and 1987 can be attributed to diabetes or hypertension. Total ESRD rates were not uniform throughout the state; counties of the Coastal Plain (South) were significantly more likely to have higher rates than counties in the Piedmont Region (North). These patterns of ESRD in Georgia have implications for possible prevention efforts.     

尿毒症患者致瘤因素探讨

目的：探讨终末期肾脏疾病（ESDR）肿瘤发生率增高的潜在因素。方法：阅读国外文献,对尿毒症患者潜在的肿瘤易患因素进行分析、总结。结果：在尿毒症患者中存在某些直接或间接致瘤因素,这些因素可以促进肿瘤形成。结论：尿毒症患者比一般人群患恶性肿瘤的危险性明显增高。     

Diabetes in Indigenous Australians: possible ways forward

Reducing the burden of diabetes will require action well beyond the health service sphere.     

Regional variation in out-of-hospital cardiac arrest incidence and outcome

Graham Nichol, MD, MPH; Elizabeth Thomas, MSc; Clifton W. Callaway, MD, PhD; Jerris Hedges, MD, MS; Judy L. Powell, BSN; Tom P. Aufderheide, MD; Tom Rea, MD; Robert Lowe, MD, MPH; Todd Brown, MD; John Dreyer, MD; Dan Davis, MD; Ahamed Idris, MD; Ian Stiell, MD, MSc

JAMA. 2008;300(12):1423-1431.

Context  The health and policy implications of regional variation in incidence and outcome of out-of-hospital cardiac arrest remain to be determined.

Objective  To evaluate whether cardiac arrest incidence and outcome differ across geographic regions.

Design, Setting, and Patients  Prospective observational study (the Resuscitation Outcomes Consortium) of all out-of-hospital cardiac arrests in 10 North American sites (8 US and 2 Canadian) from May 1, 2006, to April 30, 2007, followed up to hospital discharge, and including data available as of June 28, 2008. Cases (aged 0-108 years) were assessed by organized emergency medical services (EMS) personnel, did not have traumatic injury, and received attempts at external defibrillation or chest compressions or resuscitation was not attempted. Census data were used to determine rates adjusted for age and sex.

Main Outcome Measures  Incidence rate, mortality rate, case-fatality rate, and survival to discharge for patients assessed or treated by EMS personnel or with an initial rhythm of ventricular fibrillation.

Results  Among the 10 sites, the total catchment population was 21.4million, and there were 20 520 cardiac arrests. A total of 11 898(58.0%) had resuscitation attempted; 2729 (22.9% of treated) had initial rhythm of ventricular fibrillation or ventricular tachycardia or rhythms that were shockable by an automated external defibrillator; and 954(4.6% of total) were discharged alive. The median incidence of EMS-treated cardiac arrest across sites was 52.1 (interquartile range [IQR], 48.0-70.1)per 100 000 population; survival ranged from 3.0% to 16.3%, with a median of 8.4% (IQR, 5.4%-10.4%). Median ventricular fibrillation incidence was 12.6 (IQR, 10.6-5.2) per 100 000 population; survival ranged from 7.7% to 39.9%, with a median of 22.0% (IQR, 15.0%-24.4%),with significant differences across sites for incidence and survival (P<.001).

Conclusion  In this study involving 10 geographic regions in North America,there were significant and important regional differences in out-of-hospital cardiac arrest incidence and outcome.

     

磷结合剂在终末期肾病中的应用

终末期肾病患者普遍存在高磷血症,而高磷血症是终末期肾病患者死亡率和心血管疾病发生率增高的重要因素。另外高磷血症还可引起甲状旁腺功能亢进、骨营养不良、转移性钙化等,因此有效控制血清磷水平是终末期肾病一体化治疗的重要措施。目前高磷血症的治疗主要包括饮食限磷、透析治疗、磷结合剂的应用及必要时甲状旁腺的切除。本文将具体介绍各种磷结合剂用于治疗高磷血症的研究进展。     

终末期肾脏疾病患者生活质量研究近况

随着生物—心理—社会健康观的确立，终末期肾脏疾病(ESRD)的治疗目的不再局限于生命的维持和症状的缓解，生活质量逐渐成为新的临床评价终点。ESRD患者生活质量测评需普适性量表和疾病特异性量表联合使用。