RESUMEN
The Zuni Indians of New Mexico are experiencing an epidemic of chronic kidney disease (CKD). The Zuni Pueblo created the Zuni Kidney Project (ZKP) to decrease the burden of CKD in the community. The aim of this study was to estimate the prevalence of CKD among Zuni Indians using National Kidney Foundation Kidney Disease Outcomes Quality Initiative criteria. The ZKP conducted a population-based, cross-sectional survey to estimate the prevalence of CKD and related risk factors among Zuni Indians aged > or =20 yr (n = 1113). GFR was estimated using equations based on serum creatinine, and urine albumin:creatinine ratio was calculated in a single spot urine sample. ESRD counts were obtained from health care providers. The age- and sex-adjusted prevalence of CKD among the Zuni Indians was >2.5-fold higher than that among the US composite population. The estimated prevalence of CKD stages 1 and 2 combined was three- to four-fold higher than that of CKD stages 3 and 4 combined. This ratio was significantly higher than that in the US composite population (1.4-fold). The prevalence of CKD stage 5 was eight-fold higher among the Zuni Indians than among the composite US population. The Zuni Indians have an expanded pool of CKD that contributes to the high burden of ESRD. The high prevalence of CKD stages 1 and 2 provides a unique opportunity to develop innovative treatment programs to reduce the burden of CKD in Zuni Pueblo.
Asunto(s)
Indígenas Norteamericanos/estadística & datos numéricos , Enfermedades Renales/etnología , Adulto , Enfermedad Crónica , Creatinina/sangre , Estudios Transversales , Femenino , Tasa de Filtración Glomerular , Humanos , Enfermedades Renales/sangre , Enfermedades Renales/etiología , Enfermedades Renales/fisiopatología , Fallo Renal Crónico/epidemiología , Masculino , México/epidemiología , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: To describe the clinical features and hospitalization rates of American Indian children with full or incomplete fetal alcohol syndrome (FAS). STUDY DESIGN: Two retrospective case-control studies were conducted of Northern Plains American Indian children with presumed FAS identified from 1981 to 1993 by using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 760.71. Children who had full or incomplete FAS were compared with each other and with children who did not have FAS. RESULTS: Compared with the control children, the 43 children with FAS and the 35 children with incomplete FAS had more facial dysmorphology, growth deficiency, central nervous system dysfunction, and muscular problems and were hospitalized more frequently with otitis media, pneumonia, FAS, dehydration, and anemia. Case children were hospitalized more days than were control children. Case children were removed from their homes and placed in foster care more often than were control children. CONCLUSIONS: Children with full or incomplete FAS had many health, learning, and social needs. Health care providers and community programs should identify the needs of these children and offer optimal services to meet those needs.
Asunto(s)
Trastornos del Espectro Alcohólico Fetal/diagnóstico , Trastornos del Espectro Alcohólico Fetal/etnología , Indígenas Norteamericanos , Orden de Nacimiento , Estudios de Casos y Controles , Enfermedades del Sistema Nervioso Central/etiología , Femenino , Trastornos del Espectro Alcohólico Fetal/patología , Estudios de Seguimiento , Cuidados en el Hogar de Adopción , Trastornos del Crecimiento/etiología , Cardiopatías/etiología , Hospitalización , Humanos , Recién Nacido , Masculino , Enfermedades Musculoesqueléticas/etiología , EmbarazoRESUMEN
OBJECTIVE: To determine the effect of maternal antibody on hepatitis A vaccine immunogenicity in infants. Study design Infants of mothers negative for antibody to hepatitis A virus (anti-HAV; group 1) were administered hepatitis A vaccine at 2, 4, and 6 months of age, and infants of anti-HAV-positive mothers were randomized to receive either hepatitis A vaccine (group 2) or hepatitis B vaccine (group 3) on the same schedule. Group 3 infants subsequently received hepatitis A vaccine at 8 and 10 months of age. RESULTS: At 15 months of age, 100% of infants in group 1, 93% in group 2, and 92% in group 3 had protective levels of antibody. However, there were significant differences in the geometric mean concentration (GMC) of anti-HAV between groups. Group 1 GMC was 231 mIU/mL, compared with 85 mIU/mL for group 2 and 84 mIU/mL for group 3 (P<.001, group 1 vs group 3). CONCLUSIONS: Passively acquired maternal anti-HAV resulted in a significantly lower final antibody response when infants were administered hepatitis A vaccine at 2, 4, and 6 months of age or at 8 and 10 months of age.