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Swanson MB, Weidemann DK, Harshman LA. The impact of rural status on pediatric chronic kidney disease. Pediatr Nephrol 2024; 39:435-446. [PMID: 37178207 PMCID: PMC10182542 DOI: 10.1007/s00467-023-06001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
Children and adolescents in rural areas with chronic kidney disease (CKD) face unique challenges related to accessing pediatric nephrology care. Challenges to obtaining care begin with living increased distances from pediatric health care centers. Recent trends of increasing centralization of pediatric care mean fewer locations have pediatric nephrology, inpatient, and intensive care services. In addition, access to care for rural populations expands beyond distance and encompasses domains of approachability, acceptability, availability and accommodation, affordability, and appropriateness. Furthermore, the current literature identifies additional barriers to care for rural patients that include limited resources, including finances, education, and community/neighborhood social resources. Rural pediatric kidney failure patients have barriers to kidney replacement therapy options that may be even more limited for rural pediatric kidney failure patients when compared to rural adults with kidney failure. This educational review identifies possible strategies to improve health systems for rural CKD patients and their families: (1) increasing rural patient and hospital/clinic representation and focus in research, (2) understanding and mediating gaps in the geographic distribution of the pediatric nephrology workforce, (3) introducing regionalization models for delivering pediatric nephrology care to geographic areas, and (4) employing telehealth to expand the geographic reach of services and reduce family time and travel burden.
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Affiliation(s)
- Morgan Bobb Swanson
- Department of Epidemiology, College of Medicine and College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Darcy K Weidemann
- Department of Pediatrics, Section of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Lyndsay A Harshman
- Department of Pediatrics, Division of Nephrology, Dialysis and Transplantation, University of Iowa, 425 General Hospital, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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Bjornstad P, Chao LC, Cree-Green M, Dart AB, King M, Looker HC, Magliano DJ, Nadeau KJ, Pinhas-Hamiel O, Shah AS, van Raalte DH, Pavkov ME, Nelson RG. Youth-onset type 2 diabetes mellitus: an urgent challenge. Nat Rev Nephrol 2023; 19:168-184. [PMID: 36316388 PMCID: PMC10182876 DOI: 10.1038/s41581-022-00645-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
The incidence and prevalence of youth-onset type 2 diabetes mellitus (T2DM) and its complications are increasing worldwide. Youth-onset T2DM has been reported in all racial and ethnic groups, but Indigenous peoples and people of colour are disproportionately affected. People with youth-onset T2DM often have a more aggressive clinical course than those with adult-onset T2DM or those with type 1 diabetes mellitus. Moreover, the available treatment options for children and adolescents with T2DM are more limited than for adult patients. Intermediate complications of youth-onset T2DM, such as increased albuminuria, often develop in late childhood or early adulthood, and end-stage complications, including kidney failure, develop in mid-life. The increasing frequency, earlier onset and greater severity of childhood obesity in the past 50 years together with increasingly sedentary lifestyles and an increasing frequency of intrauterine exposure to diabetes are important drivers of the epidemic of youth-onset T2DM. The particularly high risk of the disease in historically disadvantaged populations suggests an important contribution of social and environmental factors, including limited access to high-quality health care, healthy food choices and opportunities for physical activity as well as exposure to stressors including systemic racism and environmental pollutants. Understanding the mechanisms that underlie the development and aggressive clinical course of youth-onset T2DM is key to identifying successful prevention and management strategies.
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Affiliation(s)
| | - Lily C Chao
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | | | - Allison B Dart
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Malcolm King
- University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Helen C Looker
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia
| | | | - Orit Pinhas-Hamiel
- Paediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amy S Shah
- Cincinnati Children's Hospital and The University of Cincinnati, Cincinnati, OH, USA
| | | | - Meda E Pavkov
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA.
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Kidney Health of Indigenous Children: Insights from Australia, Aotearoa New Zealand, and Canada. CURRENT PEDIATRICS REPORTS 2022. [DOI: 10.1007/s40124-022-00274-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Purpose of Review
This review seeks to highlight the common and unique factors that impact the kidney health of Indigenous children in Australia, Aotearoa New Zealand, and Canada with a particular interest on efforts to improve their kidney health outcomes and the framework to pursue future efforts.
Recent Findings
In the period since the adoption of the United Nations (UN) Declaration on the Rights of Indigenous People (UNDRIP) there has been a number of studies documenting poorer renal health outcomes and potential causes amongst Indigenous paediatric populations in Australia, Aotearoa New Zealand, and Canada. There is a shortage of studies that look at interventions to improve these outcomes.
Summary
Poorer kidney health outcomes amongst Indigenous children are rarely genetic and appear to be more related to societal inequities. Reported efforts to improve outcomes are few but have demonstrated the ability to make change and with sustained focus on reducing inequities there is hope to improve the renal health of Indigenous children.
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Dart A. Sociodemographic determinants of chronic kidney disease in Indigenous children. Pediatr Nephrol 2022; 37:547-553. [PMID: 34032921 DOI: 10.1007/s00467-021-05110-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/07/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022]
Abstract
Rates of chronic kidney disease (CKD) are disproportionately increased in Indigenous peoples. The focus has traditionally been on adults, as they experience the highest rates of kidney failure requiring kidney replacement therapy. The impacts of colonization, systemic racism, and sociodemographic marginalization however impact the health of Indigenous peoples across the lifespan. This review presents the social context within which Indigenous children develop and the impact relevant to kidney health across the developmental stages. In utero exposures impact nephron endowment which can manifest in glomerular hyperfiltration and sclerosis as well as an increased risk of congenital anomalies of the kidney and urinary tract. Young children are at increased risk of autoimmune conditions, secondary to infectious and environmental exposures, and are also exposed to the impacts of a Western lifestyle manifesting early onset overweight/obesity. Adolescents begin to manifest more severe metabolic complications such as type 2 diabetes. The impacts of early onset diabetes are associated with aggressive kidney complications and high rates of kidney failure in young adulthood. Finally, the key elements of successful prevention and treatment strategies are discussed including the importance of screening for asymptomatic, modifiable early disease, linked with clinical primary and tertiary care follow-up, and culturally relevant and safe care.
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Affiliation(s)
- Allison Dart
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, Health Sciences Centre, University of Manitoba, CE-208 Children's Hospital, 840 Sherbrook St, Winnipeg, MV, R3A 1S1, Canada. .,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
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Frejuk KL, Harasemiw O, Komenda P, Lavallee B, McLeod L, Chartrand C, Di Nella M, Ferguson TW, Martin H, Wicklow B, Dart AB. Impact of a screen, triage and treat program for identifying chronic disease risk in Indigenous children. CMAJ 2021; 193:E1415-E1422. [PMID: 34518342 PMCID: PMC8443280 DOI: 10.1503/cmaj.210507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis project was a point-of-care screening program in rural and remote First Nations communities in Manitoba that aimed to identify and treat hypertension, diabetes and chronic kidney disease. The program identified chronic disease in 20% of children screened. We aimed to characterize clinical screening practices before and after intervention in children aged 10-17 years old and compare outcomes with those who did not receive the intervention. METHODS This observational, prospective cohort study started with community engagement and followed the principles of ownership, control, access and possession (OCAP). We linked participant data to administrative data at the Manitoba Centre for Health Policy to assess rates of primary care and nephrology visits, disease-modifying medication prescriptions and laboratory testing (i.e., glycosylated hemoglobin [HbA1c], estimated glomerural filtration rate [eGFR] and urine albumin- or protein-to-creatinine ratio). We analyzed the differences in proportions in the 18 months before and after the intervention. We also conducted a 1:2 propensity score matching analysis to compare outcomes of children who were screened with those who were not. RESULTS We included 324 of 353 children from the screening program (43.8% male; median age 12.3 yr) in this study. After the intervention, laboratory testing increased by 5.8% (95% confidence interval [CI] 1.1% to 10.1%) for HbA1c, by 9.9% (95% CI 4.2% to 15.5%) for eGFR and by 6.2% (95% CI 2.3% to 10.0%) for the urine albumin- or protein-to-creatinine ratio. We observed significant improvements in laboratory testing in screened patients in the group who were part of the program, compared with matched controls. INTERPRETATION Chronic disease surveillance and care increased significantly in children after the implementation of a point-of-care screening program in rural and remote First Nation communities. Interventions such as active surveillance programs have the potential to improve the chronic disease care being provided to First Nations children.
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Affiliation(s)
- Kara L Frejuk
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Oksana Harasemiw
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Paul Komenda
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Barry Lavallee
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Lorraine McLeod
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Caroline Chartrand
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Michelle Di Nella
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Thomas W Ferguson
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Heather Martin
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Brandy Wicklow
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Allison B Dart
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man.
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6
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Guillemette L, Wicklow B, Sellers EAC, Dart A, Shen GX, Dolinsky VW, Gordon JW, Jassal DS, Nickel N, Duhamel TA, Chateau D, Prior HJ, McGavock J. Intrauterine exposure to diabetes and risk of cardiovascular disease in adolescence and early adulthood: a population-based birth cohort study. CMAJ 2021; 192:E1104-E1113. [PMID: 32989023 DOI: 10.1503/cmaj.190797] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND It is unclear whether intrauterine exposure to maternal diabetes is associated with risk factors for cardiovascular disease and related end points in adulthood. We examined this potential association in a population-based birth cohort followed up to age 35 years. METHODS We performed a cohort study of offspring born between 1979 and 2005 (n = 293 546) and followed until March 2015 in Manitoba, Canada, using registry-based administrative data. The primary exposures were intrauterine exposure to gestational diabetes and type 2 diabetes mellitus. The primary outcome was a composite measure of incident cardiovascular disease events, and the secondary outcome was a composite of risk factors for cardiovascular disease in offspring followed up to age 35 years. RESULTS The cohort provided 3 628 576 person-years of data (mean age at latest follow-up 20.5 [standard deviation 6.4] years, 49.3% female); 2765 (0.9%) of the offspring experienced a cardiovascular disease end point, and 12 673 (4.3%) experienced a cardiovascular disease risk factor. After propensity score matching, the hazard for cardiovascular disease end points was elevated in offspring exposed to gestational diabetes (adjusted hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.12-1.79) but not type 2 diabetes (adjusted HR 1.40, 95% CI 0.98-2.01). A similar association was observed for cardiovascular disease risk factors (gestational diabetes: adjusted HR 1.92, 95% CI 1.75-2.11; type 2 diabetes: adjusted HR 3.40, 95% CI 3.00-3.85). INTERPRETATION Intrauterine exposure to maternal diabetes was associated with higher morbidity and risk related to cardiovascular disease among offspring up to 35 years of age.
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Affiliation(s)
- Laetitia Guillemette
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Brandy Wicklow
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Elizabeth A C Sellers
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Allison Dart
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Garry X Shen
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Vernon W Dolinsky
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Joseph W Gordon
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Davinder S Jassal
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Nathan Nickel
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Todd A Duhamel
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Dan Chateau
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Heather J Prior
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man
| | - Jonathan McGavock
- Children's Hospital Research Institute of Manitoba (Guillemette, Wicklow, Sellers, Dart, Shen, Dolinsky, Gordon, McGavock); Developmental Origins of Health and Disease Research Network (DEVOTION) (Guillemette, Nickel, McGavock) and Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme (Wicklow, Sellers, Dart, Dolinsky, Gordon, McGavock), Children's Hospital Research Institute of Manitoba; Rady Faculty of Health Sciences (Shen), Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences (Jassal), Department of Community Health Sciences (Chateau), Health, Leisure and Human Performance Research Institute, Faculty of Kinesiology and Recreation Management (Duhamel), University of Manitoba; Manitoba Centre for Health Policy (Nickel, Chateau, Prior), Winnipeg, Man.
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Curtis S, Martin H, DiNella M, Lavallee B, Chartrand C, McLeod L, Woods C, Dart A, Tangri N, Rigatto C, Komenda P. Kidney Check Point-of-Care Testing-Furthering Patient Engagement and Patient-Centered Care in Canada's Rural and Remote Indigenous Communities: Program Report. Can J Kidney Health Dis 2021; 8:20543581211003744. [PMID: 33868690 PMCID: PMC8020215 DOI: 10.1177/20543581211003744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/15/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose of program Access to health care services remains a significant barrier for many Indigenous people's living in rural and remote regions of Canada. Driven by geographical isolation and compounded by socioeconomic and environmental disparities, individuals living under these circumstances face disproportionately poor health outcomes. Kidney Check is a comprehensive screening, triage, and treatment initiative working to bring culturally safe preventive care to rural and remote Indigenous communities across Manitoba, Ontario, BC, Alberta, and Saskatchewan. The project's patient-oriented approach addresses concerns raised by kidney patients and their caregivers using culturally safe practices. Using the various expertise of their multidisciplinary team, Kidney Check seeks to further collaborative efforts to improve access to preventive health care for these groups. Meaningful engagement with patients, communities, and local health care stakeholders ensures Indigenous voices are heard and incorporated into the project in a way that promotes shared decision-making and sustainability. Sources of information As an affiliate program of the Can-SOLVE CKD Network, Kidney Check's guiding priorities were developed over 3 years of patient consultation and finalized during 2 workshops held with more than 30 patients, caregivers, Indigenous peoples, researchers, and policy makers using a modified Delphi process. Today, patients continue to participate in project development via 2 governing bodies: The Patient Governance Circle and the Indigenous Peoples Engagement and Research Council (IPERC). Methods Modeled after the Indigenous-led 2015 FINISHED project in Manitoba, Kidney Check employs point-of-care testing to identify diabetes, hypertension, and chronic kidney disease (CKD) in individuals, ages 10 and above, regardless of pre-existing risk factors. The Kidney Check team consists of 4 working groups: project leadership, provincial management, local community partners, and patient partners. By using and building on existing relationships between local and provincial health care stakeholders and various Indigenous communities, the program furthers collaborative efforts to bridge gaps in health equity. Key findings The Kidney Check program has established an infrastructure that integrates patient engagement at all stages of the program from priority setting to deployment and dissemination strategies. Limitations While we encourage and offer screening services to all, many still choose not to attend for a variety of reasons which may introduce selection bias. Kidney Check uses patient engagement as a foundational component of the program; however, there is currently a limited amount of research documenting the benefits of patient engagement in health care settings. More formal qualitative evaluations of these activities are needed. In addition, as the COVID-19 pandemic has halted screening procedures in most communities, we currently do not have quantitative data to support the efficacy of the Kidney Check program. Implications For many Indigenous people, lack of accessibility to health care services is compounded by sociopolitical barriers that disrupt relationships between patients and providers. Meaningful engagement presents one opportunity to ensure the voices and perspectives of Indigenous patients and communities are incorporated into health services. In addition, this screening paradigm has shown to be cost effective as shown by analyses done on the FINISHED screening program.
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Affiliation(s)
- Sarah Curtis
- Chronic Disease Innovation Center, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Heather Martin
- Chronic Disease Innovation Center, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Michelle DiNella
- Chronic Disease Innovation Center, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | | | | | - Lorraine McLeod
- Diabetes Integration Project, Winnipeg, MB, Canada.,First Nations Health and Social Secretariat of Manitoba, MB, Canada
| | | | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Center, Seven Oaks General Hospital, Winnipeg, MB, Canada.,Max Rady Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Claudio Rigatto
- Chronic Disease Innovation Center, Seven Oaks General Hospital, Winnipeg, MB, Canada.,Max Rady Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Paul Komenda
- Chronic Disease Innovation Center, Seven Oaks General Hospital, Winnipeg, MB, Canada.,Can-SOLVE CKD Network, Winnipeg, MB, Canada.,Max Rady Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Curtis S, Collister D, Martin H, Sokoro AR, McLeod L, Chartrand C, Lavallee B, Woods C, Levin A, Komenda P. The Kidney Check program - championing patient-centered, culturally safe, preventive kidney care in Canada's rural and remote Indigenous communities. EJIFCC 2021; 32:61-68. [PMID: 33753975 PMCID: PMC7941067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sarah Curtis
- Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
| | - David Collister
- Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Heather Martin
- Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
| | - Abdul Razaq Sokoro
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
- Department of Pathology, University of Manitoba, Winnipeg, Canada
- Shared health, Diagnostic Services, Winnipeg, Manitoba, Canada
| | - Lorraine McLeod
- First Nations Health and Social Secretariat of Manitoba, Canada
- Diabetes Integration Project, Winnipeg, Manitoba, Canada
| | | | - Barry Lavallee
- Diabetes Integration Project, Winnipeg, Manitoba, Canada
| | | | - Adeera Levin
- CanSOLVE CKD Network, Canada
- The University of British Columbia, Vancouver, Canada
| | - Paul Komenda
- Chronic Disease Innovation Centre, Seven Oaks Hospital, Winnipeg, Manitoba, Canada
- Max Rady Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Canada
- CanSOLVE CKD Network, Canada
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Carino M, Elia Y, Sellers E, Curtis J, McGavock J, Scholey J, Hamilton J, Clarson C, Pinto T, Hadjiyannakis S, Mertens L, Samaan MC, Ho J, Nour M, Panagiotopoulos C, Jetha M, Gabbs M, Mahmud FH, Wicklow B, Dart A. Comparison of Clinical and Social Characteristics of Canadian Youth Living With Type 1 and Type 2 Diabetes. Can J Diabetes 2021; 45:428-435. [PMID: 33714663 DOI: 10.1016/j.jcjd.2021.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Our aim in this study was to describe the clinical and social characteristics of 2 Canadian cohorts of adolescents with diabetes. METHODS Participants from the Improving renal Complications in Adolescents with type 2 diabetes through REsearch (iCARE) study (n=322) and the Early Determinants of Cardio-Renal Disease in Youth With Type 1 Diabetes (n=199) study were compared. RESULTS Adolescents were 10 to 18 years of age (mean ± standard deviation: 14.8±2.4 years). The T2DM cohort had a shorter duration of diabetes. Both groups had glycated hemoglobin levels above target. The type 2 diabetes (T2D) cohort was comprised of predominantly Indigenous youth. The type 1 diabetes (T1D) cohort was 58.3% European/Caucasian, with a high proportion (41.7%) of visible minority groups (Afro-Caribbean, Asian/Pacific Islander, Hispanic). The prevalence of obesity, hypertension, left ventricular hypertrophy, albuminuria and hyperfiltration was higher in the T2D cohort. The T1D cohort was more socially and economically advantaged in all 4 dimensions of health inequality. CONCLUSIONS There are significant differences in clinical and social characteristics of adolescents with T2D and T1D in Canada. Both have inadequate glycemic control with evidence of onset and progression of diabetes-related complications.
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Affiliation(s)
- Marylin Carino
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Yesmino Elia
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Can-SOLVE CKD SPOR Network, Canada
| | - Elizabeth Sellers
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jacqueline Curtis
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jon McGavock
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Scholey
- Can-SOLVE CKD SPOR Network, Canada; Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jill Hamilton
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cheril Clarson
- Department of Pediatrics, University of Western Ontario, Western University, London, Ontario, Canada
| | - Teresa Pinto
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stasia Hadjiyannakis
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Mertens
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - M Constantine Samaan
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Josephine Ho
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Munier Nour
- Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Constadina Panagiotopoulos
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary Jetha
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Melissa Gabbs
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Farid H Mahmud
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Can-SOLVE CKD SPOR Network, Canada
| | - Brandy Wicklow
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Can-SOLVE CKD SPOR Network, Canada
| | - Allison Dart
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Can-SOLVE CKD SPOR Network, Canada.
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