The Global Pediatric Nephrology Workforce: A Survey of the International Pediatric Nephrology Association

Background: The global pediatric nephrology workforce is poorly characterized. The objectives of this paper are to review what is known regarding this workforce, assess pediatric nephrologists’ perceptions of the adequacy of the pediatric nephrology workforce, and understand regional challenges to fellow recruitment and job acquisition. Perceptions regarding optimal length of training and research requirements will also be explored. Methods: A 17-question web-based survey was designed and distributed to members of the International Pediatric Nephrology Association in the Fall of 2015. Quantitative and thematic analyses were performed. Results: We received 341 responses from 2304 valid e-mail invitations. There was a high degree of overall perceived workforce inadequacy with 67% of all respondents reporting some degree of shortage. Perceived workforce shortage ranged from 20% in Australia / New Zealand to 100% in Africa. Respondents from Africa (25%) and North America (22.4%) reported the greatest difficulty recruiting fellows. Respondents from Australia / New Zealand (53.3%) and Latin America (31.3%) reported the greatest perceived difficulty finding jobs as pediatric nephrologists after training. Low trainee interest, low salary, lack of government or institutional support, and few available jobs in pediatric nephrology were the most frequently reported obstacles to fellow recruitment and job availability. Conclusions: Globally, there is a high level of perceived inadequacy in the pediatric nephrology workforce. Regional variability exists in perceived workforce adequacy, ease of recruitment, and job acquisition. Interventions to improve recruitment targeted to specific regional barriers are suggested.Master of Public Healt

Innovative method to produce large-area freestanding functional ceramic foils

Using thick and thin films instead of bulk functional materials presents tremendous advantages in the field of flexible electronics and component miniaturization. Here, a low-cost method to grow and release large-area, microscale thickness, freestanding, functional, ceramic foils is reported. It uses evaporation of sodium chloride to silicon wafer substrates as sacrificial layers, upon which functional lead titanate zirconate ceramic films are grown at 710 °C maximum temperature to validate the method. The freestanding, functional foils are then released by dissolution of the sacrificial sodium chloride in water and have the potential to be integrated into low-thermal stability printed circuits and flexible substrates. The optimization of the sodium chloride layer surface quality and bonding strength with the underlying wafer is achieved thanks to pre-annealing treatment

The global pediatric nephrology workforce: a survey of the International Pediatric Nephrology Association

CHERRIES Checklist. Description of data: Checklist for reporting results of Internet Surveys. (PDF 299 kb

The global pediatric nephrology workforce: a survey of the International Pediatric Nephrology Association

Background: The global pediatric nephrology workforce is poorly characterized. The objectives of our study were to assess pediatric nephrologists\u27 perceptions of the adequacy of the pediatric nephrology workforce, and understand regional challenges to fellow recruitment and job acquisition. Perceptions regarding optimal length of training and research requirements were also queried. Methods: A 17-question web-based survey comprised of 14 close-ended and 3 open-ended questions was e-mailed to members of the International Pediatric Nephrology Association. Quantitative and qualitative analyses were performed. Results: We received 341 responses from members of the International Pediatric Nephrology Association from 71 countries. There was a high degree of overall perceived workforce inadequacy with 67 % of all respondents reporting some degree of shortage. Perceived workforce shortage ranged from 20 % in Australia/New Zealand to 100 % in Africa. Respondents from Africa (25 %) and North America (22.4 %) reported the greatest difficulty recruiting fellows. Respondents from Australia/New Zealand (53.3 %) and Latin America (31.3 %) reported the greatest perceived difficulty finding jobs as pediatric nephrologists after training. Low trainee interest, low salary, lack of government or institutional support, and few available jobs in pediatric nephrology were the most frequently reported obstacles to fellow recruitment and job availability. Conclusions: Globally, there is a high level of perceived inadequacy in the pediatric nephrology workforce. Regional variability exists in perceived workforce adequacy, ease of recruitment, and job acquisition. Interventions to improve recruitment targeted to specific regional barriers are suggested

Systematic Review of Safety and Efficacy of COVID-19 Vaccines in Patients With Kidney Disease

Chronic kidney disease (CKD) affects 37 million or 15% of the U.S. population and 2 in every 1000 Americans are on dialysis or living with a kidney transplant.1 In 2020, coronavirus disease 2019 (COVID-19) infection became the third leading cause of death for persons 45 through 84 years of age, and individuals with kidney disease are recognized as being at higher risk for severe complications from COVID-19 infection.2,S1 While vaccination is a powerful and cost-effective method to reduce infection-related morbidity and mortality, vaccine efficacy has historically not been rigorously studied in individuals with CKD, and COVID-19 vaccine immunogenicity is largely unknown in this high-risk population. Numerous clinical trials of candidate COVID-19 vaccines have been undertaken; however, it is unknown whether results are generalizable to individuals living with kidney disease, in particular those on dialysis or receiving chronic immunosuppression for treatment of glomerulonephritis or kidney transplantation. We sought to systematically review registered COVID-19 vaccine clinical trials for inclusion of criteria relevant to individuals with kidney disease (Supplementary Methods)

Tobacco exposure in adults and children with proteinuric glomerulopathies: a NEPTUNE cohort study.

BACKGROUND: Tobacco exposure has been recognized as a risk factor for cardiovascular disease (CVD) and progression of kidney disease. Patients with proteinuric glomerulopathies are at increased risk for cardiovascular morbidity and mortality. Multiple studies have linked tobacco exposure to CVD and chronic kidney disease, but the relationships between smoking and proteinuric glomerulopathies in adults and children have not been previously explored. METHODS: Data from the Nephrotic Syndrome Study Network (NEPTUNE), a multi-center prospective observational study of participants with proteinuric glomerulopathies, was analyzed. 371 adults and 192 children enrolled in NEPTUNE were included in the analysis. Self-reported tobacco exposure was classified as non-smoker, active smoker, former smoker, or exclusive passive smoker. Baseline serum cotinine levels were measured in a sub-cohort of 178 participants. RESULTS: The prevalence of active smokers, former smokers and exclusive passive smoking among adults at baseline was 14.6%, 29.1% and 4.9%, respectively. Passive smoke exposure was 16.7% among children. Active smoking (reference non-smoking) was significantly associated with greater total cholesterol among adults (β 17.91 95% CI 0.06, 35.76, p = 0.049) while passive smoking (reference non-smoking) was significantly associated with greater proteinuria over time among children (β 1.23 95% CI 0.13, 2.33, p = 0.03). Higher cotinine levels were associated with higher baseline eGFR (r = 0.17, p = 0.03). CONCLUSION: Tobacco exposure is associated with greater risk for CVD and worse kidney disease outcomes in adults and children with proteinuric glomerulopathies. Preventive strategies to reduce tobacco exposure may help protect against future cardiovascular and kidney morbidity and mortality in patients with proteinuric glomerulopathies

Association of Obesity with Cardiovascular Risk Factors and Kidney Disease Outcomes in Primary Proteinuric Glomerulopathies.

BACKGROUND/AIMS: Obesity is a known risk factor for cardiovascular disease and contributes to the development and progression of kidney disease. However, the specific influence of obesity on outcomes in primary glomerular disease has not been well characterized. METHODS: In this prospective cohort study, data were from 541 participants enrolled in the Nephrotic Syndrome Study Network (NEPTUNE), between 2010 and 2019, at 23 sites across North America. Blood pressure, lipids, and kidney disease outcomes including complete proteinuria remission, kidney failure, and chronic kidney disease progression were evaluated. Data were analyzed using linear and logistic regression with generalized estimating equations and time-varying Cox regression with Kaplan-Meier plots. RESULTS: The prevalence of obesity at baseline was 43.3% (N = 156) in adults and 37.6% (N = 68) in children. In adults, obesity was longitudinally associated with higher systolic BP (β = 6.49, 95% CI: 2.41, 10.56, p = 0.002), dyslipidemia (OR = 1.74, 95% CI: 1.30, 2.32, p \u3c 0.001), triglycerides (β = 41.92, 95% CI: 17.12, 66.71, p = 0.001), and lower HDL (β = -6.92, 95% CI: -9.32, -4.51, p \u3c 0.001). In children, obesity over time was associated with higher systolic BP index (β = 0.04, 95% CI: 0.02, 0.06, p \u3c 0.001) and hypertension (OR = 1.43, 95% CI: 1.04, 1.98, p = 0.03). In both adults and children, obesity was associated with a significantly lower hazard of achieving complete remission of proteinuria (adult HR = 0.80, 95% CI: 0.69, 0.88, p \u3c 0.001; pediatric HR = 0.72, 95% CI: 0.61, 0.84, p \u3c 0.001). CONCLUSION: Obesity was associated with higher cardiovascular risk and less proteinuria remission from nephrotic syndrome in adults and children with proteinuric glomerulopathies. Weight-loss strategies may forestall cardiovascular disease and progressive kidney function decline in this high-risk patient group