2018, Number 3
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MEDICC Review 2018; 20 (3)
Researchers’ perceived challenges in studying chronic kidney disease of nontraditional etiology in Mesoamerica
Wright EM
Language: English
References: 46
Page: 45-51
PDF size: 166.53 Kb.
ABSTRACT
INTRODUCTION Despite growing research interest in the epidemic
of chronic kidney disease of nontraditional etiology (a distinct form of
chronic kidney disease disproportionately affecting agricultural populations
across Mesoamerica—Central America and southern Mexico),
its etiology remains poorly understood.
OBJECTIVE Elucidate factors that impact researchers’ efforts to
understand the epidemic of chronic kidney disease of nontraditional
etiology.
METHODS Semistructured interviews were conducted with 39 international
researchers, selected based on their publications and participation
in conferences about chronic kidney disease of nontraditional
etiology. Interviews were conducted from May through September
of 2015 in English or Spanish by video conference, telephone or in
person. Interviews were audio recorded, transcribed, and analyzed
iteratively using content analysis.
RESULTS Of 39 researchers interviewed, 30.8% were women, 84.6%
had a medical and/or doctoral degree and 74.3% had ≥6 years’ experience
carrying out research on chronic kidney disease of nontraditional
etiology. Three major themes were identified related to factors affecting
research progress. The fi rst, infl uence of state and private interests,
concerned perceptions that sugar industry and some governments in
Mesoamerica dismissed, hindered, intimidated and inaccurately represented
research on chronic kidney disease of nontraditional etiology.
The second, limited material and human resources, had to do with
scarcity of stable, impartial funding and adequate in-country research
infrastructure. Researchers were largely funded by nontraditional
sources (charitable organizations, private donations, sugar industry in
Mesoamerica, personal funds) or not funded at all. The third, logistical
challenges across study lifetimes, referred to barriers such as unwieldy
approval mechanisms, gang interference and publication hurdles.
CONCLUSIONS Producing high quality and clinically relevant studies
to address chronic kidney disease of nontraditional etiology in the
resource-scarce Mesoamerican research climate has been fraught with
challenges. These fi ndings contextualize the progress that has been
made in understanding chronic kidney disease of nontraditional etiology
to date and highlight the need for public health and biomedical organizations
to support researchers’ ongoing efforts to engage all stakeholders
in addressing the epidemic, disseminate their research fi ndings and
identify feasible strategies for addressing the community-wide suffering
caused by chronic kidney disease of nontraditional etiology.
REFERENCES
Ramírez-Rubio O, McClean MD, Amador JJ, Brooks DR. An epidemic of chronic kidney disease in Central America: an overview. J Epidemiol Community Health. 2013 Jan;67(1):1–3.
Jayasumana C, Orantes C, Herrera R, Almaguer M, López L, Silva LC, et al. Chronic interstitial nephritis in agricultural communities: a worldwide epidemic with social, occupational and environmental determinants. Nephrol Dial Transplant. 2017 Feb;32(2):234–41.
Correa-Rotter R, Wesseling C, Johnson RJ. CKD of unknown origin in Central America: the case for a Mesoamerican nephropathy. Am J Kidney Dis. 2014 Mar;63(3):506–20.
Brooks DR, Ramírez-Rubio O, Amador JJ. CKD in Central America: a hot issue. Am J Kidney Dis. 2012 Apr;59(4):481–4.
Nanayakkara S, Komiya T, Ratnatunga N, Senevirathna ST, Harada KH, Hitomi T, et al. Tubulointerstitial damage as the major pathological lesion in endemic chronic kidney disease among farm-ers in North Central Province of Sri Lanka. Environ Health Prev Med. 2012 May;17(3):213–21.
Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, Almeida AF, et al. What do we know about chronic kidney disease in India: fi rst report of the Indian CKD registry. BMC Nephrol. 2012 Mar 6;13:10.
Trabanino RG, Aguilar R, Silva CR, Mercado MO, Merino RL. Nefropatía terminal en pacientes de un hospital de referencia en El Salvador. Rev Panam Salud Pública. 2002 Sep;12(3):202– 6. Spanish.
Wesseling C, Crowe J, Hogstedt C, Jakobsson K, Lucas R, Wegman D, editors. Mesoamerican Nephropathy: Report from the First International Research Workshop on MeN. First International Research Workshop on Mesoamerican Nephropathy; 2012 Nov 28–30; San Jose, Costa Rica. Heredia (CR): Program on Work, Environment, and Health in Central America; 2013. 240 p.
Pan American Health Organization. Chronic Kidney Disease in Agricultural Communities in Central America. 152nd Session of the Executive Committee. Washington, D.C.: Pan American Health Organization; World Health Organization; 2013 Jun. 12 p.
Bodin T, García-Trabanino R, Weiss I, Jarquín E, Glaser J, Jakobsson K, et al. Intervention to reduce heat stress and improve effi ciency among sugarcane workers in El Salvador: Phase 1. Occup Environ Med. 2016 Jun;73(6):409–16.
Bolaños J. Nicaragua. Sugar Annual. Nicaragua: Sugar production down 4 percent [Internet]. Washington, D.C.: United States Department of Agriculture Foreign Agricultural Service; 2016 Apr 20 [cited 2017 Jul 15]. 5 p. Available from: https://gain.fas.usda.gov/Recent%20GAIN%20 Publications/Sugar%20Annual_Managua_Nica ragua_4-20-2016.pdf
Hutchinson Y. Sickly Sweet: Human Rights Conditions for Sugarcane Workers in Western Nicaragua [Internet]. León (NI): La Isla Foundation; 2014 Aug [cited 2017 Apr 30]. 73 p. Available from: http://laislanetwork.org/wp-content/ uploads/2014/08/Sickly-Sweet-InDesign .pdf?7a2409
Rodríguez MI. Chronic Kidney Disease in Our Farming Communities: Implications of an Epidemic. MEDICC Rev. 2014 Apr;16(2):77–8.
Wesseling C, Aragón A, González M, Weiss I, Glaser J, Bobadilla NA, et al. Kidney function in sugarcane cutters in Nicaragua – A longitudinal study of workers at risk of Mesoamerican nephropathy. Environ Res. 2016 May;147:125– 32.
Roncal Jiménez CA, Ishimoto T, Lanaspa MA, Rivard CJ, Nakagawa T, Ejaz AA, et al. Fructokinase activity mediates dehydration-induced renal injury. Kidney Int. 2014 Aug;86(2):294–302.
Orantes CM, Herrera R, Almaguer M, Brizuela EG, Núñez L, Alvarado NP, et al. Epidemiology of Chronic Kidney Disease in Adults of Salvadoran Agricultural Communities. MEDICC Rev. 2014 Apr;16(2):23–30.
Raines N, González M, Wyatt C, Kurzrok M, Pool C, Lemma T, et al. Risk Factors for Reduced Glomerular Filtration Rate in a Nicaraguan Community Affected by Mesoamerican Nephropathy. MEDICC Rev. 2014 Apr;16(2):16–22.
Murray KO, Fischer RS, Chavarria D, Duttmann C, García MN, Gorchakov R, et al. Mesoamerican nephropathy: a neglected tropical disease with an infectious etiology? Microbes Infect. 2015 Oct;17(10):671–5.
McClean M, Amador JJ, Laws R, Kaufman JS, Weiner DE, Sánchez Rodríguez JM, et al. Investigating biomarkers of kidney injury and chronic kidney disease among workers in Western Nicaragua [Internet]. Massachusetts: Boston School of Public Health; 2012 Apr 26 [cited 2017 Apr 30]. 52 p. Available from: http://www.cao-ombuds man.org/documents/Biological_Sampling_Re port_April_2012.pdf
Obrador GT, Rubilar X, Agazzi E, Estefan J. The Challenge of Providing Renal Replacement Therapy in Developing Countries: The Latin American Perspective. Am J Kidney Dis. 2016 Mar;67(3):499–506.
Silva LC, Ordúñez P. Chronic Kidney Disease in Central American Agricultural Communities: Challenges for Epidemiology and Public Health. MEDICC Rev. 2014 Apr;16(2):66–71.
Glaser J, Weiss I; La Isla Foundation. CKDu: strategies for saving lives now. MEDICC Rev. 2014 Apr;16(2):81–2.
Murphy H. Deadly Illness in Nicaragua Baffl es Experts. New York Times [Internet]. 2014 May 8 [cited 2017 Nov 13]; [about 6 screens]. Available from: https://www.nytimes.com/2014/05/09/ world/americas/deadly-illness-in-nicaragua-baf fl es-experts.html
Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nursing. 2008 Apr;62(1):107–15.
Brown P, Morello-Frosch R, Zavestoski S; Contested Illness Research Group. Contested Illnesses: Citizens, Science, and Health Social Movements. Los Angeles: University of California Press; 2012. 324 p.
Livingston J. Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic. Durham (NC): Duke University Press; 2012. 228 p.
Brandt AM. Inventing confl icts of interest: a history of tobacco industry tactics. Am J Public Health. 2012 Jan;102(1):63–71.
Ramírez-Rubio O, Brooks DR, Amador JJ, Kaufman JS, Weiner DE, Scammell MK. Chronic kidney disease in Nicaragua: a qualitative analysis of semi-structured interviews with physicians and pharmacists. BMC Public Health. 2013 Apr 16;13:350.
Kirsch S. Mining capitalism: The relationship between corporations and their critics. Oakland: University of California Press; 2014. 314 p.
Kearns CE, Glantz SA, Schmidt LA. Sugar Industry Infl uence on the Scientifi c Agenda of the National Institute of Dental Research’s 1971 National Caries Program: a historical analysis of internal documents. PLoS Med. 2015 Mar;12(3):e1001798.
About the WE Program [Internet]. León (NI): La Isla Network; c2017 [cited 2017 Apr 30]. Available from: http://weprogram.org/about/
Wegman D, Crowe J, Hogstedt C, Jakobsson K, Wesseling C, editors. Mesoamerican Nephropathy: Report from the Second International Research Workshop on MeN. Second International Research Workshop on Mesoamerican Nephropathy; 2015 Nov 18–20; San Jose, Costa Rica. Heredia (CR): Program on Work, Environment, and Health in Central America; 2016. 200 p.
Wesseling C, Aragón A, Elgstrand K, Flores R, Hogstedt C, Partanen T. SALTRA: a regional program for workers’ health and sustainable development in Central America. Int J Occup Environ Health. 2011 Jul–Sep;17(3):223–9.
Ordúñez P, Nieto FJ, Martínez R, Soliz P, Giraldo GP, Mott SA, et al. Chronic kidney disease mortality trends in selected Central America countries, 1997–2013: clues to an epidemic of chronic interstitial nephritis of agricultural communities. J Epidemiol Community Health. 2018 Apr;72(4):280–6.
Lozier M, Turcios-Ruiz RM, Noonan G, Ordúñez P. Chronic kidney disease of nontraditional etiology in Central America: a provisional epidemiologic case defi nition for surveillance and epidemiologic studies. Rev Panam Salud Pública. 2016 Nov;40(5):294–300.
Consejo de Ministros de Salud de Centroamérica y República Dominicana. Resolución de la XXXC Reunión del Consejo de Ministros de Salud de Centroamérica y República Dominicana (COMISCA); 2011 1–2 Dec; San Salvador, El Salvador [Internet]. San Salvador (SV): Ministry of Health of El Salvador; 2011 Dec 2 [cited 2018 Mar 5]. 13 p. Available from: http://www.sica.int/ busqueda/busqueda_basica.aspx?IdCat=26&Id Mod=3&IdEnt=143. Spanish.
Chavkin S. Reform in Costa Rica signals new strategy against lethal epidemic [Internet]. Washington, D.C.: The Center for Public Integrity; 2015 Jul 29 [cited 2018 Mar 5]; [about 4 screens]. Available from: https://www.publicintegrity.org/ 2015/07/29/17716/reform-costa-rica-signals -new-strategy-against-lethal-epidemic
Ministerio de Medio Ambiente y Recursos Naturales (MARN) [Internet]. San Salvador (SV): MARN; c2018. Noticias. Diputados aprobaron dictamen que prohíbe el uso de 53 agroquímicos; 2013 Sep 6 [cited 2018 Mar 5]; [about 1 screen]. Available from: http://www.marn.gob.sv/ diputados-aprobaron-dictamen-que-prohibe-el -uso-de-53-agroquimicos/. Spanish.
Dirks JH, Robinson SW. The global perspective of the International Society of Nephrology: A decade of experience with COMGAN. Kidney Int. 2005 Oct;68(4):1395–410.
Caplin B, Jakobsson K, Glaser J, Nitsch D, Jha V, Singh A, et al. Epidemiology of eGFR in Low and Middle Income Populations – Rationale and core protocol for the Disadvantaged Populations eGFR Epidemiology Study (DEGREE). BMC Nephrol. 2017 Jan 3;18(1):1.
Wesseling C, Crowe J, Hogstedt C, Jakobsson K, Lucas R, Wegman DH. The Epidemic of Chronic Kidney Disease of Unknown Etiology in Mesoamerica: A Call for Interdisciplinary Research and Action. Am J Public Health. 2013 Nov;103(11):1927–30.
Crane JT. Scrambling for Africa: AIDS, Expertise, and the Rise of American Global Health Science. New York: Cornell University Press; 2013 Sep 24. 224 p.
Weisinger JR, Bellorin-Font E. Latin American nephrology: Scientifi c production and impact of the publications. Kidney Int.1999 Oct;56(4):1584–90.
Balster RL. Expanding the role of scientists from low and middle income countries in the journal publication process. Drug Alcohol Depend. 2006 May;82(3):185–6.
Northridge ME, Holtzman D, Bergeron CD, Zambrana RE, Greenberg MR. Mentoring for publication in the American Journal of Public Health. Am J Public Health. 2015 Mar;105(Suppl 1):S14–6.
Harris M, Macinko J, Jiménez G, Mahfoud M, Anderson C. Does a research article’s country of origin affect perception of its quality and relevance? A national trial of US public health researchers. BMJ Open. 2015 Dec 30;5(12):e008993.