Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review

Background The burden of end-stage kidney disease (ESKD) in sub-Saharan Africa is unknown but is probably high. Access to dialysis for ESKD is limited by insufficient infrastructure and catastrophic out-of-pocket costs. Most patients remain undiagnosed, untreated, and die. We did a systematic literature review to assess outcomes of patients who reach dialysis and the quality of dialysis received. Methods We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles in English or French from sub-Saharan Africa reporting dialysis outcomes in patients with ESKD published between Jan 1, 1990, and Dec 22, 2015. No studies were excluded to best represent the current situation in sub-Saharan Africa. Outcomes of interest included access to dialysis, mortality, duration of dialysis, and markers of dialysis quality in patients with ESKD. Data were analysed descriptively and reported using narrative synthesis. Findings Studies were all of medium to low quality. We identified 4339 studies, 68 of which met inclusion criteria, comprising 24 456 adults and 809 children. In the pooled analysis, 390 (96%) of 406 adults and 133 (95%) of 140 children who could not access dialysis died or were presumed to have died. Among those dialysed, 2747 (88%) of 3122 adults in incident ESKD cohorts, 496 (16%) of 3197 adults in prevalent ESKD cohorts, and 107 (36%) of 294 children with ESKD died or were presumed to have died. 2508 (84%) of 2990 adults in incident ESKD cohorts discontinued dialysis compared with 64 (5%) of 1364 adults in prevalent ESKD cohorts. 41 (1%) of 4483 adults in incident ESKD cohorts, 2280 (19%) of 12 125 adults in prevalent ESKD cohorts, and 71 (19%) of 381 children with ESKD received transplants. 16 studies reported on management of anaemia, 17 on dialysis frequency, eight on dialysis accuracy, and 22 on vascular access for dialysis Interpretation Most patients with ESKD starting dialysis in sub-Saharan Africa discontinue treatment and die. Further work is needed to develop equitable and sustainable strategies to manage individuals with ESKD in sub-Saharan Africa

Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review

Background Access to diagnosis and dialysis for acute kidney injury can be life-saving, but can be prohibitively expensive in low-income settings. The burden of acute kidney injury in sub-Saharan Africa is presumably high but remains unknown. We did a systematic review to assess outcomes of acute kidney injury in sub-Saharan Africa and identify barriers to care. Methods We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles published between Jan 1, 1990, and Nov 30, 2014. We scored studies, and all were of medium-to-low quality. We made a pragmatic decision to include all studies to best refl ect reality, and did a descriptive analysis of extracted data. This study is registered with PROSPERO, number CRD42015015690. Findings We identifi ed 3881 records, of which 41 met inclusion criteria, including 1403 adult patients and 1937 paediatric patients. Acute kidney injury in sub-Saharan Africa is severe, with 1042 (66%) of 1572 children and 178 (70%) 253 of adults needing dialysis in studies reporting dialysis need. Only 666 (64%) of 1042 children (across 11 studies) and 58 (33%) of 178 adults (across four studies) received dialysis when needed. Overall mortality was 34% in children and 32% in adults, but rose to 73% in children and 86% in adults when dialysis was needed but not received. Major barriers to access to care were out-of-pocket costs, erratic hospital resources, late presentation, and female sex. Interpretation Patients in these studies are those with resources to access care. In view of overall study quality, data interpretation should be cautious, but high mortality and poor access to dialysis are concerning. The global scarcity of resources among patients and health centres highlights the need for a health-system-wide approach to prevention and management of acute kidney injury in sub-Saharan Africa

Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review.

BACKGROUND: Access to diagnosis and dialysis for acute kidney injury can be life-saving, but can be prohibitively expensive in low-income settings. The burden of acute kidney injury in sub-Saharan Africa is presumably high but remains unknown. We did a systematic review to assess outcomes of acute kidney injury in sub-Saharan Africa and identify barriers to care. METHODS: We searched PubMed, African Journals Online, WHO Global Health Library, and Web of Science for articles published between Jan 1, 1990, and Nov 30, 2014. We scored studies, and all were of medium-to-low quality. We made a pragmatic decision to include all studies to best reflect reality, and did a descriptive analysis of extracted data. This study is registered with PROSPERO, number CRD42015015690. FINDINGS: We identified 3881 records, of which 41 met inclusion criteria, including 1403 adult patients and 1937 paediatric patients. Acute kidney injury in sub-Saharan Africa is severe, with 1042 (66%) of 1572 children and 178 (70%) 253 of adults needing dialysis in studies reporting dialysis need. Only 666 (64%) of 1042 children (across 11 studies) and 58 (33%) of 178 adults (across four studies) received dialysis when needed. Overall mortality was 34% in children and 32% in adults, but rose to 73% in children and 86% in adults when dialysis was needed but not received. Major barriers to access to care were out-of-pocket costs, erratic hospital resources, late presentation, and female sex. INTERPRETATION: Patients in these studies are those with resources to access care. In view of overall study quality, data interpretation should be cautious, but high mortality and poor access to dialysis are concerning. The global scarcity of resources among patients and health centres highlights the need for a health-system-wide approach to prevention and management of acute kidney injury in sub-Saharan Africa. FUNDING: None

Liberté humaine et appartenance naturelle : contribution d'une herméneutique critique pour penser le lien éthique et ontologique de l'humain à la nautre

Our research lies at a crossroads of different issues associated around a reflection upon the current ecological crisis. Without denying the related technical and institutional aspects, we have chosen to view this problematic as a crisis in the representation of the human relationship to nature. The reading of Charles Taylor's works has inspired us to connect contemporary ecological debates with elements of the debate that opposed the philosophy of Enlightenment and the Naturphilosophie in the 18th century. This debate shows two different views of human realization: 1) as torn away from a nature that has been objectified, or 2) as a symbolic and existential immersion within a nature that has intrinsic value. This analysis has encouraged us to defend the idea of a necessary modification of the binary ontological ground from which most of today's environmental ethics have emerged. Two alternative ontological paths have been analyzed : the phenomenological path, as developed by Merleau-Ponty and Augustin Berque, and the objective idealism of intersubjectivity developed by Vittorio Hösle. On the ontological level, the convergences between these two approaches nevertheless, results in diverging and even contradictory epistemological options. The phenomenologico-hermeneutic framework developed by Taylor has allowed us to go beyond these oppositions, and to draw the outline of an integrative ontology which could serve as a basis for the development of an ethical ecology which recognizes nature’s intrinsic value but which does not deny the moral specificity of human beings. Finally we have tried to clarify the status of such an ethico-ontological reflection inside the public sphere and to think of conditions for a possibility of a paradigm shift in ethics under the conditions of ecological crisis.Notre recherche se situe à la croisée de différentes problématiques articulées autour d’une réflexion sur la situation actuelle de crise écologique. Sans nier les aspects techniques et institutionnels qui lui sont corrélés, nous avons choisi de l’interpréter comme une crise de la représentation du rapport de l’humain à la nature. La lecture de Charles Taylor nous a inspiré une mise en relation des débats écologiques contemporains avec des éléments du débat qui opposait, au 18e siècle, la philosophie des Lumières à la Naturphilosophie allemande. Ce débat met en scène deux visions de l’accomplissement humain : comme l’arrachement à une nature objectivée et comme l’immersion symbolique et existentielle au sein d’une nature valorisée en elle-même. L’analyse réalisée nous a encouragée à défendre l’idée d’une nécessaire modification du sol ontologique binaire à partir duquel se développe la plupart des éthiques environnementales. Deux voies ontologiques alternatives ont été analysées : la voie phénoménologique telle que développée par Merleau-Ponty et Augustin Berque, et la voie de l’idéalisme objectif de l’intersubjectivité développée par Vittorio Hösle. Les convergences sur le plan ontologique entre ces deux approches se traduisent néanmoins par des options épistémologiques divergentes voire contradictoires. Le cadre phénoménologico-herméneutique développé par Taylor nous a permis de surmonter ces antagonismes, et d’esquisser les traits d’une ontologie intégrative susceptible de servir d’assise à l’élaboration d’une éthique écologique qui, bien qu’intrinséquiste, ne nie pas la spécificité morale de l’humain. Nous avons enfin cherché à clarifier le statut d’une telle réflexion éthico-ontologique dans l’espace public et à penser les conditions de possibilité d’un changement de paradigme en éthique au regard de la crise écologique.(FILO - Philosophie) -- UCL, 201

Evaluation de l’augmentation de la radicalité chirurgicale sur la survie sans récidive dans le cadre des néoplasie ovariennes avancées

No abstract availabl

Écosystème de la transition : la diversité des engagements pour répondre à l’urgence écologique

Les constats effrayants sur l’état du monde sont nombreux d’où l’usage de plus en plus fréquent de « gros mots » comme urgence, désastre, crise, fin du monde, catastrophe, et effondrement pour décrire l’énormité de ce que nous vivons. Même si nous pensons qu’il est indispensable de regarder en face la dégradation de nos écosystèmes et d’exiger une réaction à la hauteur des défis, nous voudrions insister sur l’importance de ne pas confondre urgence et recette unique. Lorsque les enjeux sont importants, la tentation peut être grande de sacrifier la pluralité des actions mises en œuvre au nom d’impératifs liés à l’urgence qui ne s’embarrassent pas d’une analyse complexe ou nuancée. Et pourtant, penser une sortie de la crise écologique demande de prendre en compte la complexité de ses causes et donc la pluralité des modes d’engagements « valables » pour y répondre

Energy poverty: A conceptual analysis

This Chapter briefly summarises the article written by Frogneux et al. (2014) during the 2GENDERS research project

Liberté individuelle et contraintes matérielles: une approche conceptuelle de la pauvreté énergétique en Belgique

La pauvreté énergétique a été conceptualisée comme une injustice environnementale par Walker et Day (2012). Notre papier se situe dans le prolongement de cette approche, et l’inscrit de façon critique à l’intérieur de la réflexion menée par Amartya Sen sur les capabilités (1999, 2009). Nous montrons combien, d’une part, l’idée de justice de Sen qui repose sur la notion de capabilité peut être pertinente pour penser la justice énergétique et environnementale, mais combien, d’autre part, cette approche demeure insuffisante pour penser la transition écologique. Nous proposons un cadre conceptuel dans lequel une voie démocratique de transition serait possible. Pour cela, nous proposons de penser la liberté et l’imagination sociale dans un cadre non libéral avec le concept d’autonomie de C. Castoriadis