Childhood Obesity Literature Review Capstone

Construct the first draft of your 4- to 5-page Mini Literature Review. It should include the following:

• A brief introduction that provides information about the scope and nature of the issue, at least 5–6 body paragraphs that provide sufficient detail, and a conclusion. Your paper should evidence the 6–8 resources from your Annotated Bibliography. You should include both parenthetical (in-text citations) as well as your references at the end of the document (i.e., your Annotated Bibliography sources that apply) in proper APA format.
• Use the remaining instructions in this Project Template to develop the subtopics of this Mini Literature Review, which form the body paragraphs of your Mini Literature Review. For example, in the Introduction, you can provide epidemiological and statistical data about your issue. You can also discuss how this issue transcends borders, etc.
• Summarize and analyze these resources. Paraphrase them in your own words. List the key arguments and findings, describing how you think they apply to your topic, and what the implications of the findings may be for your Capstone Project.

Running head: CHRONIC KIDNEY DISEASE Chronic Kidney Disease: Problems, Perceptions, and Strategies for Intervention David Brown Walden University HLTH 4900, Section 2, Capstone November 16, 2013 Instructor: Dr. Jody Early 1 CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 2 Abstract Chronic kidney disease is considered one of the most significant health issues affecting morbidity and mortality and contributes heavily to the state of global health. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are chronic illnesses that have a dramatic impact on the cost of health care delivery in the United States. Early detection and intervention are critical to the long-term prognosis of this patient population; however, a health disparity exists because not everyone who is at risk for CKD has access to resources for screening and treatment. One of the goals of community-level and national programs is to create parity of care by focusing attention on marginalized communities that are at a statistically higher risk for CKD. The global impact of CKD and ESRD is significant because long-term survival depends on expensive technology and many regions of the world lack the resources needed to treat this disease. Health behavior and culture are known contributors to the long-term survivability of the disease. Since early detection is the key, creating screening programs that target populations at greatest risk will have the highest impact, and be the most cost-effective solution to combating this chronic illness. CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 3 Chronic Kidney Disease: Problems, Perceptions, and Strategies for Intervention Chronic kidney disease (CKD) is considered one of the primary global health issues and contributes significantly to the social burden of care. CKD, along with cardiovascular disease, diabetes, chronic respiratory disease, and cancer, is a chronic illness that is classified as a noncommunicable disease (Healthy People 2020, 2013). Non-communicable diseases have a significant societal impact to domestic growth, productivity, and health care costs and are the most common cause of morbidity and premature death in the United States (Couser, Remuzzi, Mendis, & Tonelli, 2011). Chronic illnesses are also characterized by physical and emotional stressors that can become overwhelming when simultaneously coping with multiple comorbidities (Moulton, 2008). Although the World Health Assembly has determined that noncommunicable diseases contribute heavily to the state of global health, they concede that public health policy can dramatically affect patient morbidity and mortality (Couser et al., 2011). CKD is a public health threat that is on the rise and will likely not slow without deliberate intervention. This literature review will describe the impact that chronic kidney disease and end-stage renal disease have on the global burden of care, as well as detail the issues that contribute to health care disparities affecting this patient population. Factors that affect morbidity and mortality will also be discussed and a solution will be presented that has the potential to reduce the health system burden and improve the prognosis of many who suffer from this chronic disease. Chronic Kidney Disease Statistics and Epidemiological Data The impact of chronic kidney disease and end-stage renal disease (ESRD) on the federal Medicare budget is staggering. In 2008, CKD cost $60 billion and ESRD totaled $39.5 billion, which was 27% of the annual Medicare budget (Rettig, 2011). Recently, studies have reported that approximately 26 million Americans have some degree of CKD (Navaneethan, Aloudat, & CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION Singh, 2008). Only 5% of the people in the most treatable early stages of CKD are aware they have the disease, and almost 50% of those in stage 4 remain unaware unless diagnosed with a comorbid condition such as hypertension or diabetes (Couser et al., 2011). As with many illnesses, prevention and wellness programs that offer CKD screening can improve long-term outcomes. Prevention and Wellness Strategies for At-Risk Populations Prevention and wellness strategies do much for mitigating the physiologic damage from CKD, and can extend the productivity and mortality within this patient population. The greatest benefits are realized when detection and intervention occur early in the disease cycle; however, limiting factors such as genetic, environmental, and social barriers interfere with efforts to deploy prevention and wellness strategies that can also screen for health issues (Pearson, 2008). Although CKD is an illness that affects all cultural, geopolitical, and socioeconomic classes, not all groups have the same clinical outcomes. Native Americans, Asian and Pacific Islanders, and Hispanics have a greater likelihood of progressing to ESRD, and African Americans are four times more likely than Caucasians to suffer renal failure requiring a kidney transplant (National Medical Association, n.d.). The data indicates that a significant disparity exists between Caucasians and other ethnic groups in the diagnosis and treatment of CKD. Evaluative and preventative strategies are a part of high quality health care delivery, and involve interventions that incorporate a diet plan, exercise routine, and medication protocol. Intervention strategies should be tailored to the particular community since each of the disparate groups has ethnic and cultural differences that must be factored to ensure interventional plan compliance. The Impact of Quality Health Care Delivery on CKD 4 CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 5 High quality health care delivery can have a dramatic impact on the morbidity and mortality of people suffering from CKD. A study conducted by the National Kidney FoundationKidney Disease Outcomes Quality Initiatives has proven that hospitalizations are reduced, and mortality is improved if patients are referred to a nephrologist within one month of new onset CKD (Navaneethan et al., 2008). This study also discovered that individuals were more likely to be delayed in getting a referral if they were part of a minority, uninsured, less educated, or elderly. Access to service, proper screening, and appropriate follow-through are challenges that must be addressed if this disparity is to be eliminated. Evaluation and comprehensive counseling on social and environmental factors that negatively impact health are important acute interventions, and long-term health benefits are seen when early referral to a nephrologist and access to follow-up care are provided (Collins, Gilbertson, Snyder, Chen, & Foley, 2010). Currently, numerous programs exist that focus on high-risk populations and are designed to provide access to screening and follow-up care. The National Kidney Foundation (2013) sponsors KEEP Healthy, which is an extension of their Kidney Early Evaluation Program (KEEP) and brings a nationally sponsored, community-based initiative designed to screen and educate in regions that have statistically higher CKD populations. The Kidney Care Prevention Program (KCPP) is a regional community-based program in North Carolina that staff trained kidney care coordinators and educators who can intervene early in the disease process, and can offer support through early-stage CKD intervention and management (Harward & Falk, 2008). These are only two examples of community-based programs designed to provide individuals with the best chance at early detection and intervention. Many such programs exist, and more are being offered as federal funding becomes available. The Global Impact of CKD CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 6 Although the impact of CKD on the United States and most developed countries is significant, it is much worse in less developed countries. Screening programs are essential for early detection, but many areas of the world lack the infrastructure to be able to offer these services. Limited access to care and technology, poor living conditions and diet, and an inadequate supply of pharmaceuticals results in rapid conversion from CKD to ESRD, which is quickly followed by death (Couser et al., 2011). When CKD progresses to ESRD, the only cure is a kidney transplant. Renal replacement therapy, which is also known as hemodialysis, can be used as a bridge to transplant. There are 2 million people currently on hemodialysis worldwide, which constitutes only 12% of the global CKD population, and nearly all of them are treated in just five countries, including the United States, Japan, Germany, Brazil, and Italy (Couser et al., 2011). This means that 88% of the world population does not have a bridge to transplant, nor do they have access to renal transplantation surgery. When viewed from this perspective, it becomes clear just how devastating a diagnosis of CKD can be to most of the world’s population. Health Behavior and CKD Health behavior plays a significant role in an individual’s ability to cope with and manage chronic illness. Health behavior is so important in disease management that many health behavior models have been created in an effort to understand the link. One of the oldest health behavior theories is the Health Belief Model (HBM). The HBM asserts that people have an inherent readiness to act, which is built from life experiences, self efficacy, the perception of vulnerability to a given health problem, the severity of the issue, and the barriers and benefits to taking positive action (Williams, Manias, Liew, Gock, & Gorelik, 2012). Life experiences fall in the category of mediating factors, which also includes demographics, level of education, structural, and social variables. It is theorized that mediating factors that greatly impact CKD are CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 7 primary causes of the current health disparity (Williams et al., 2012). Recognizing these variables and creating practices that mitigate them are the keys to creating health parity across the different CKD population groups. Culture can also affect health behavior and should be considered when creating screening and intervention programs. Culture and CKD An individual’s culture influences their perspectives on health and wellness, which can subsequently affect how well they manage their disease. One of the challenges with managing patient populations that have a high incidence of undiagnosed and undertreated CKD is that they tend to be culturally and linguistically diverse (CALD) groups (Williams et al., 2012). Chronic disorders such as CKD, diabetes, and cardiovascular disease require a strict adherence to lifestyle modification instructions and medication protocols. Limited health literacy, poor cognition, or a language barrier inhibits effective communication and has been shown to result in poor health outcomes (Norris & Nissenson, 2008). These communities are also at risk because they cannot afford health care, have decreased access the health system, and have little or no access to screening and testing facilities (Rettig, Norris, & Nissenson, 2008). These communities often shun modern health services because historically conditioned biases have created in an inability to trust or feel safe in contemporary health care delivery centers (Rettig et al., 2008). Establishing community-based health clinics that are staffed and managed by lay health advisors, especially in regions that have heavy racial and ethnic populations, will not only create community buy-in, but also create agents of change. Lay health advisors are community members who have a natural tendency to help, and are provided training and support so they can assist and advise others in their community on various health issues (Pullen-Smith & Plescia, 2008). Overcoming health care disparities will require lay health advisors to be recruited from CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION within the affected patient population. Recruiting members from within the community has resulted in improved attitudes as community members gain control over their own health issues. The Role of Technology in Treating CKD Patients with CKD and ESRD rely heavily on technology to manage their disease process. Point-of-care testing that can measure creatinine, glucose, albumin, and other critical blood values allows clinics to mobilize and bring much needed health care into the community instead of waiting for members of at-risk groups to be proactive and seek screening centers (Harward & Falk, 2008). The mobile centers have been instrumental in finding individuals who are in the early stages of CKD and respond best to early intervention. When CKD progresses to ESRD, the person must learn to embrace the technology that will sustain his or her life until renal transplantation can be offered. Being tethered to a dialysis machine several days a week for six hours at a time, constant testing, and living with a dialysis catheter or fistula create a technological burden that can be overwhelming. Embracing technology is not easy for patients to do because machine dependency runs contrary to the freedom and autonomy that the individual previously enjoyed. Acculturation occurs when the patient conforms to behavior patterns and routines that are needed in order to exist indefinitely on machine dependency (Harward & Falk, 2008). At the point of acculturation, the patient fully embraces the new technology and accepts it as an integral part of life. Legal and Ethical Issues Impacting CKD Besides technology concerns, there are many legal and ethical issues surrounding the condition of CKD that can impact an individual’s ability to obtain the necessary treatment. In October 1972, the federal government passed the Social Security Amendments, which extended Medicare coverage to the disabled, and officially recognized ESRD as a disability (Vassalotti, 8 CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 9 Gracz-Weinstein, Gannon, & Brown, 2006). In 2009, the American Recovery and Reinvestment Act (ARRA) shifted the focus from reactive and therapeutic intervention, to a proactive and preventative model (Menzin et al., 2011). Currently, instead of waiting and treating the terminal disease of ESRD, which is ineffective, inefficient, and costly, clinicians are screening for CKD in at-risk populations so that appropriate intervention can occur at a stage where the disease process can be halted or even reversed. There are other federal programs that help those suffering from CKD. A second example of a public policy that focuses on active intervention is the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which provides funding to education programs for individuals with stage 4 CKD (Menzin et al., 2011). The MIPPA has proven successful at providing funding that creates highly effective targeted education. The Interdisciplinary Team’s Approach to Treating CKD The process of screening, treatment, and education need the involvement from many disciplines within health care. An interdisciplinary team approach can be the best way to manage complex illnesses such as CKD. Working within culturally and linguistically diverse communities require teams that can provide a range of health care needs, facilitate communication, and serve as patient advocates and representatives. Interdisciplinary teams typically include physicians, technicians, linguists, social workers and case managers, and community advocates, among others (Sinasac, 2012). These teams must also collaborate with community agencies, which can enhance the effectiveness of health promotion efforts (Sinasac, 2012). Public health strategies can also include non-traditional groups such as community service organizations, American Indian tribes, boys and girls clubs, and faith-based organizations, which can penetrate deeper into the communities and reach individuals where they CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 10 live, work, play, eat, and pray (Pullen-Smith & Plescia, 2008). Interdisciplinary teams allow for the breadth of services needed to make a significant impact on CKD screening and intervention. The Scholar-Practitioner’s Role in Treating CKD My role as a scholar-practitioner is to be aware of social disparities and endeavor to correct observed societal imbalances. CKD is considered one of the most significant health care disparities that exist in America today. As a scholar-practitioner, I must be a leader and advocate for positive social change within my community. Becoming involved with organizations such as the National Kidney Foundation’s KEEP Healthy program, the Minority Intervention and Kidney Education (MIKE) program, or local organizations like the Kidney Care Prevention Program (KCPP) are ways that I can influence social change as it relates to CKD and ESRD. Opportunities exist for me to become a trained kidney care coordinator/educator and lead efforts to promote health and wellness activities (Harward & Falk, 2008). Being a scholar-practitioner, I can be involved with identifying a need and targeting the appropriate patient populations by researching health status statistics and epidemiology studies, developing focus groups, assessing social marketing strategies, and analyzing current evidence-based practices to be used in creating new public health policies (Sinasac, 2012). As a scholar-practitioner, a worthy goal would be to spearhead the formation of a new organization that brings health care services to minority communities, socioeconomically depressed people, and the uninsured and underinsured. Another way I can have an impact in my community and make a positive social change is to involve myself with an existing organization whose goal is to eliminate racial and ethnic health disparities for chronic illnesses such as CKD. Through these types of actions, I can fully embrace the role of scholar-practitioner and become an agent of positive social change. CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 11 References Collins, A. J., Gilbertson, D. T., Snyder, J. J., Chen, S. C., & Foley, R. N. (2010). Chronic kidney disease awareness, screening and prevention: Rationale for the design of a public education program. Nephrology (Carlton), 15 Suppl 2, 37–42. doi:10.1111/j.14401797.2010.01312.x Couser, W. G., Remuzzi, G., Mendis, S., & Tonelli, M. (2011). The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney International, 80(12), 1258–1270. doi:10.1038/ki.2011.368 Harward, D. H., & Falk, R. J. (2008). The Kidney Care Prevention Program: An innovative approach to chronic kidney disease prevention. North Carolina Medical Journal, 69(3), 233–236. Healthy People 2020. (2013, April 10). Chronic kidney disease. HealthyPeople.gov. Retrieved November 8, 2013, from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=6 Menzin, J., Lines, L. M., Weiner, D. E., Neumann, P. J., Nichols, C., Rodriguez, L., … Mayne, T. (2011). A review of the costs and cost effectiveness of interventions in chronic kidney disease: Implications for policy. Pharmacoeconomics, 29(10), 839–861. doi:10.2165/11588390-000000000-00000 Moulton, A. (2008). Chronic kidney disease: The diagnosis of a “unique” chronic disease. CANNT Journal, 18(1), 34–38. National Kidney Foundation. (2013). Kidney early evaluation program publications. Retrieved November 8, 2013, from http://www.kidney.org/news/keep/index.cfm CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 12 National Medical Association. (n.d.). Chronic kidney disease in the African American community. Consensus Report of the NMA. Navaneethan, S. D., Aloudat, S., & Singh, S. (2008). A systematic review of patient and health system characteristics associated with late referral in chronic kidney disease. BMC Nephrology, 9(1), 3. doi:10.1186/1471-2369-9-3 Norris, K., & Nissenson, A. R. (2008). Race, gender, and socioeconomic disparities in CKD in the United States. Journal of the American Society of Nephrology : JASN, 19, 1261–70. doi:10.1681/ASN.2008030276 Pearson, M. (2008). Racial disparities in chronic kidney disease: Current data and nursing roles. Nephrology Nursing Journal, 35(5), 485–489. Pullen-Smith, B., & Plescia, M. (2008). Public health initiatives to prevent and detect chronic kidney disease in North Carolina. North Carolina Medical Journal, 69(3), 224–226. Rettig, R. A. (2011). Special treatment–the story of Medicare’s ESRD entitlement. The New England Journal of Medicine, 364, 596–8. doi:10.1056/NEJMp1014193 Rettig, R. A., Norris, K., & Nissenson, A. R. (2008). Chronic kidney disease in the United States: a public policy imperative. Clinical journal of the American Society of Nephrology, 3, 1902–10. doi:10.2215/CJN.02330508 Sinasac, L. (2012). The community health promotion plan: A CKD prevention and management strategy. CANNT Journal, 22(3), 25–28. Vassalotti, J., Gracz-Weinstein, L., Gannon, M., & Brown, W. (2006). Targeted screening and treatment of chronic kidney disease: Lessons learned from the Kidney Early Evaluation Program. Disease Management & Health Outcomes, 14(6), 341–352. CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION Williams, A., Manias, E., Liew, D., Gock, H., & Gorelik, A. (2012). Working with CALD groups: Testing the feasibility of an intervention to improve medication selfmanagement in people with kidney disease, diabetes, and cardiovascular disease. Renal Society of Australasia Journal, 8(2), 62–69. 13 CAPSTONE PROJECT HLTH/PUBH 4900 B.S. IN HEALTHCARE MANAGEMENT TITLE OF PROJECT NAME; DATE; TERM LEARNING OUTCOMES 1 AND 2 • Explain your topic and the rationale for your project. • Provide a few researched facts about your chosen healthcare issue. • Specifically discuss how it impacts the context and quality of healthcare delivery inside and outside of the United States. • How does this health issue transcend borders? In other words, explain how this issue impacts the global society—not just your local community, state, or country. • Make sure that all data and research are properly cited within your PowerPoint slides. LEARNING OUTCOMES 1 AND 2 CONTINUED • Explain your topic and the rationale for your project. • Provide a few researched facts about your chosen healthcare issue. • Specifically discuss how it impacts the context and quality of healthcare delivery inside and outside of the United States. • How does this health issue transcend borders? In other words, explain how this issue impacts the global society—not just your local community, state, or country. • Make sure that all data and research are properly cited within your PowerPoint slides. LEARNING OUTCOME 3 • Explain how behavioral, demographic, and cultural factors impact your selected healthcare issue. • Which groups are most impacted? • What are some of the cultural biases of this healthcare issue? • Give at least 2 examples of culturally and linguistically appropriate health services to avoid unequal treatment when delivering healthcare to your chosen group. LEARNING OUTCOME 3 CONTINUED • Explain how behavioral, demographic, and cultural factors impact your selected healthcare issue. • Which groups are most impacted? • What are some of the cultural biases of this healthcare issue? • Give at least 2 examples of culturally and linguistically appropriate health services to avoid unequal treatment when delivering healthcare to your chosen group. LEARNING OUTCOMES 5 AND 6 • Describe the critical issues in acute and long-term care from patient and provider perspectives in order to reduce this problem, and give an example of how an interprofessional “team” approach can be used to address this problem. LEARNING OUTCOMES 5 AND 6 CONTINUED • Describe the critical issues in acute and long-term care from patient and provider perspectives in order to reduce this problem, and give an example how an interprofessional “team” approach can be used to address this problem. LEARNING OUTCOMES 4 AND 7 • Describe one technological, one legal, and one ethical issue related to your chosen healthcare issue. • Give an evidence-based example of how a healthcare organization’s performance, quality, and safety can be improved to overcome the technological/legal/ethical issue. LEARNING OUTCOMES 4 AND 7 CONTINUED • Describe one technological, one legal, and one ethical issue related to your chosen healthcare issue. • Give an evidence-based example of how a healthcare organization’s performance, quality, and safety can be improved to overcome the technological/legal/ethical issue. LEARNING OUTCOMES 8 AND 10 • What are some of the healthcare costs, specific to economic evaluation and financial management associated with this issue, and how do they impact the quality of health service delivery? • Give an example of how human resource methods of managing healthcare employees could lead to cost-effective care and improved outcomes for patients. LEARNING OUTCOMES 8 AND 10 CONTINUED • What are some of the healthcare costs, specific to economic evaluation and financial management associated with this issue, and how do they impact the quality of health service delivery? • Give an example of how human resource methods of managing healthcare employees could lead to cost-effective care and improved outcomes for patients. LEARNING OUTCOMES 8 AND 11 • Explain how your healthcare issue impacts, or is impacted by, insurance, reimbursement, prospective payment, and value-based purchasing. • Give evidence-based examples of how fraud and abuse impact delivery and access to care. LEARNING OUTCOMES 8 AND 11 CONTINUED • Explain how your healthcare issue impacts, or is impacted by, insurance, reimbursement, prospective payment, and value-based purchasing. • Give evidence-based examples of how fraud and abuse impact delivery and access to care. LEARNING OUTCOMES 2 AND 9 • Research and list one healthcare organization addressing your health issue. • Apply strategic planning methods by describing the organization’s mission, vision, and values, and analyze the strengths, weaknesses, opportunities, and threats of the healthcare organization. LEARNING OUTCOMES 2 AND 9 CONTINUED • Research and list one healthcare organization addressing your health issue. • Apply strategic planning methods by describing the organization’s mission, vision, and values, and analyze the strengths, weaknesses, opportunities, and threats of the healthcare organization. LEARNING OUTCOMES AND WALDEN’S MISSION • Provide 2–3 examples of what you’ve learned in your program to advance social change by addressing this healthcare issue as an effective healthcare administrator as it relates to the areas of strategic planning, budgeting and fiscal evaluation, management, human resources, or leadership. LEARNING OUTCOMES AND WALDEN’S MISSION CONTINUED • Provide 2–3 examples of what you’ve learned in your program to advance social change by addressing this healthcare issue as an effective healthcare administrator as it relates to the areas of strategic planning, budgeting and fiscal evaluation, management, human resources, or leadership. REFERENCES • Make sure all of your references follow APA formatting. • You may use additional slides for references as needed. Running head: OBESITY 1 Childhood Obesity Childhood obesity continues to present itself as a significant public health challenge. With various elements and dimensions available to study, evaluate, and tackle the problem, extensive literature provides research into various aspects of childhood obesity. Also, being a global problem, it is crucial to approach the issue from an ideologically diversified perspective. It is critical to understand and acknowledge that various environmental disparities ranging from culture, media influence, to socio-cultural status impose influence on the prevalence and control of the issue. With the presence of magnified risks such as later-life health problems, there exists a gap in addressing childhood obesity. The gap requires a multifaceted approach that covers broad influential elements such as physiological and psychological factors – also, the comprehensive study and evaluation of approaches such as prevention and management are critical. Annotated Bibliography Anderson, K. (2018). A Review of the Prevention and Medical Management of Childhood Obesity. Child and Adolescent Psychiatric Clinics of North America, 27(1), 63-76. doi: 10.1016/j.chc.2017.08.003 A Review of the Prevention and Medical Management of Childhood Obesity by Anderson (2018) is an article that addresses the management and prevention of childhood obesity. It observes that childhood obesity is a pressing healthcare issue that remains a public health priority. The article reveals the need for an integrated chronic care approach. With this in mind, the article stresses the need for prevention efforts. It further proposes that these efforts must be directed and focused on healthy modifications of the family-based lifestyle. Anderson OBESITY 2 highlights some of the recommendations outlined by the United States Prevention Services Task Force, such as obesity screening for children above the age of six. The article is recent as it was published two years ago. It, therefore, indicates that the research and data are relatively up-to-date, therefore providing a fresh approach to the issue of childhood obesity. Anderson analyzes various elements of childhood obesity and its comorbidities and how they influence and affect various medical specialties. The article provides a critical review of childhood obesity, and it presents a critical and informative input to the project. Anderson presents the ideas solidly and systematically, that creates ease of evaluation. Greydanus, D., Agana, M., Kamboj, M., Shebrain, S., Soares, N., Eke, R., & Patel, D. (2018). Pediatric obesity: Current concepts. Disease-A-Month, 64(4), 98-156. doi: 10.1016/j.disamonth.2017.12.001 Greydanus et al., in the article Pediatric obesity: Current concepts present a refreshing approach to childhood obesity. It concentrates on concepts of the early twenty-first-century timeline. The article delves into a broad discussion of the various critical elements of childhood obesity. It reflects on the definition, history, and principles of management, among others. For example, it creates an increased emphasis on exercise and diet – which is primarily inclined on the clinical application and research approach. Bariatric surgery and pharmacotherapy are other primary issues that Greydanus et al. address within the article with observations of their increased applications – although with adult and adolescent populations combating obesity and overweight related problems. The broad OBESITY 3 analysis that touches on the issue of obesity, along with age progression, presents a base for juxtaposing and critically analyzing the issue of childhood obesity. The article was also published two years ago, which makes it clear that the arguments and ideas presented within are recent. The ideas and arguments are adequately presented and analyzed. With a broad scope of elements relating to childhood obesity being analyzed, the article is a vital resource in the research process. It recognizes the need to address this issue. Various elements and concepts, such as diagnostic perspectives and psychosocial considerations, among others, are analyzed through an in-depth approach. These create a robust and informative data source for the project. Jones, A. (2018). Parental Socioeconomic Instability and Child Obesity. Biodemography and Social Biology, 64(1), 15-29. doi: 10.1080/19485565.2018.1449630 Jones discusses an essential aspect of childhood obesity. In Parental Socioeconomic Instability and Child Obesity, Jones uses extensive data that ranges from 1986 to 2010 as per the National Longitudinal Study of Youth (NLSY) and NLSY Child and Young Adult Supplement. Socioeconomic status is a dimension that is often overlooked but which has a significant influence on childhood obesity. The article reviews this data and establishes a vital relationship between childhood obesity and the socioeconomic status of parents over time. The research and analysis presented in the article point at various findings. For example, a comparison of the maternal and paternal educational progressions and employment transitions has been presented and analyzed concerning childhood obesity – which is a critical and differentiated approach to the issue of childhood OBESITY 4 obesity. The issue of social class and the implications of policy related to childhood obesity have been discussed in the article. The article is two years since publication, which reflects that it is recent research. An observation of the data applied and analyzed reveals that extensive data is evaluated and analyzed to support the ideas within the article. Jones goes as far back as 1986. The ideas are systematically laid out with comprehensive idea-related analyses of the primary research data. It is vital for the project in that it presents a different but critically informative aspect of external elements influencing and affecting childhood obesity. Kumar, S., & Kelly, A. (2017). Review of Childhood Obesity. Mayo Clinic Proceedings, 92(2), 251-265. doi: 10.1016/j.mayocp.2016.09.017 Kumar and Kelly recognize that childhood obesity is a pressing public health problem. Interestingly, their approach identifies that this is an issue that cuts across globally. A major issue they identify in this article is the comorbidity of childhood obesity with other conditions and diseases that were previously considered to be exclusive to the adult demographic. These include hypertension and type 2 diabetes mellitus. The analytical and conservative nature that this article takes is vital as it presents another critical issue, which is the disease comorbidity element. The article delves into various other aspects of childhood obesity, such as the causal aspect. The article reviews various fundamental ideas such as endocrine and genetic causal factors and the part they play in childhood obesity. Literature has been reviewed, ranging from the year 1994 to 2016 from OBESITY 5 the PubMed database. The extensive research data is critical to the projects as it ensures robust and well-founded findings and inferences. The article was published three years ago and therefore offers relatively recent data on the subject issue. As a review of the etiology, epidemiology, and comorbidities relating to childhood obesity, the article plays an essential role in the project review. It provides an in-depth review and analysis of vital elements. The data and ideas are well elaborated and can be effectively evaluated. Kumar and Kelly present a very informative perspective that is key to childhood obesity study and analysis. Lee, E., & Yoon, K. (2018). Epidemic obesity in children and adolescents: risk factors and prevention. Frontiers of Medicine, 12(6), 658-666. doi: 10.1007/s11684-018-0640-1 Epidemic obesity in children and adolescents: risk factors and prevention by Lee and Yoon are densely informative on various aspects of childhood obesity. It analyzes the prevalence of childhood obesity while also including adolescents. The approach is a fine element that offers a basis for comparative analysis. Lee and Yoon identify the issue of childhood and adolescent obesity as an epidemic. Rightly so, they offer various critical issues such as the influence on adult prevalence and comorbidities. Further, risks such as premature death and adulthood mortality as related to childhood mortality are addressed. Some vital causal factors are analyzed and evaluated. Elements ranging from environmental factors to socio-environmental and biological factors are addressed. The complexities involved in the issue of addressing risk factors are identified and OBESITY 6 dwelled on in terms of treatment strategies and options for this vulnerable demographic. The article is a two-year-old publication and is therefore relatively recent. Lee and Yoon present vital ideas and concepts that provide fundamental ideas and arguments for the project. A critical analysis of the work identifies the fact that information and ideas are well presented within the paper. The article is significant to the projects in that it analyzes, from a different perspective, the ideas that are fundamental to the project. Styne, D., Arslanian, S., Connor, E., Farooqi, I., Murad, H., Silverstein, J., & Yanovski, J. (2017). Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism. doi: 10.1210/jc.2016-2573 The objective, as presented by Styne et al. in this article, is the formulation of clinical guidelines for practice in assessing, treating, and preventing childhood obesity. The article acknowledges that pediatric obesity is a great health concern internationally – a threat to adult health. The article identifies various critical elements that include the mental health aspect of the disease, which is an important observation. It is a critical perspective of addressing the issue of childhood obesity. The idea of prevention, where possible, is, therefore, highlighted as vital. Styne et al. address the issue of genetics as a culprit. They further acknowledge the limited research in aspects of pharmacotherapy and behavioral studies and present a recommendation towards enhanced research in these elements. The article identifies various aspects that need further research, OBESITY 7 including biological and genetic factors. The article urges further investigations and research to be directed towards the identification of more effective strategies and processes of treating preventing childhood obesity. The article is three years old from publication and, being relatively recent, contains viable guidelines towards handling and evaluating childhood obesity. The research is co-sponsored by primary stakeholders in the related healthcare field. The data is well presented with effective and informative points of view, as evidenced by the guidelines presented. The article is important to the project as these recommendations are robust results of in-depth research in childhood obesity. It offers an invaluable perspective on the project. Small, L., & Aplasca, A. (2016). Child Obesity and Mental Health. Child and Adolescent Psychiatric Clinics of North America, 25(2), 269-282. doi: 10.1016/j.chc.2015.11.008 Child Obesity and Mental Health is critical to the project research. The article is a critical analysis of the mental health aspect of childhood obesity. Rates of child obesity increased massively in the last 3 decades according to Small and Aplasca. The article identifies the frequency of childhood obesity, the heightened focus on the national level, and, most critically, the various mental health elements that are comorbid with it. As a result, Small and Aplasca highlight the need to consider this as a public health concern – which it is. The article analyzes and evaluates the obesity and mental health relationship, though complex, to try and identify and remedy their interdependencies and severity. The article evaluates the connection between the two conditions through the evaluation of OBESITY 8 research literature. It further works towards identifying various treatment options that may influence and affect both health issues. The article is four years old since publication and is also relatively recent. The approach it offers is important for the project. The non-direct influences on childhood obesity, such as mental health that are easy to miss and overlook – they are some of the critical dimensions of research that offer informative perspectives in combating the problem effectively. The article is critical to the research in that it presents a basis for a multifaceted approach and analysis of childhood obesity. Stanford, F., Tauqeer, Z., & Kyle, T. (2018). Media and Its Influence on Obesity. Current Obesity Reports, 7(2), 186-192. doi: 10.1007/s13679-018-0304-0 The external environment and its effect on childhood obesity are critical to understanding the problem. These extra-clinical approaches to childhood obesity are critical in identifying trends and patterns that influence factors such as prevention and prevalence, among others. The article reviews the media’s role in shaping and influencing the public’s perception concerning childhood obesity. The element of information diffusion and its influence on the understanding of obesity as an issue in society. The article delves into the areas of harm that arise from the lack of sufficient awareness, such as fat-shaming and weight bias. The issues of health science reporting concerning issues of physical activity to obesity tend to fuel inappropriate misunderstandings and myths. The article is two years old since publication and is also relatively recent. The issue of information presents another critical dimension to combating childhood and other types of obesity. The article addresses the issue of OBESITY 9 information accuracy in creating awareness. It stresses the fundamental impact of accurate information on public health and combating this chronic issue of obesity and its related bias and stigma. The information and evaluation of ideas are effectively and efficiently presented. The ideas handled by this article are important as they add a unique perspective to the project. Tucker, S., & Lanningham-Foster, L. (2015). Nurse-Led School-Based Child Obesity Prevention. The Journal of School Nursing, 31(6), 450-466. doi: 10.1177/1059840515574002 Sharon and Lanningham-Foster present a model of school-based obesity prevention programs. They identify various elements that range from reduced child physical activity (PA) to skyrocketing obesity rates in children. Quantitative research evaluating these programs has indicated that these school-based programs are efficient and effective in obesity prevention, intervention, and treatment. The article quantitatively offers a systematic review of the effect of school nurses participating in these programs, which presented positive results. It further encourages research in the line of a school nurse, or other health professionals led intervention programs targeting obesity. The article is five years old from publication, and although the most dated among the articles outlined in this bibliography, it presents a functional and practical method of combating childhood obesity. The approach is critical and presents various elements that are useful to the project. The article presents ideas that are informative towards the development of preventive and intervention oriented practical programs. OBESITY 10 Running head: CHRONIC KIDNEY DISEASE Chronic Kidney Disease: Problems, Perceptions, and Strategies for Intervention David Brown Walden University HLTH 4900, Section 2, Capstone November 16, 2013 Instructor: Dr. Jody Early 1 CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 2 Abstract Chronic kidney disease is considered one of the most significant health issues affecting morbidity and mortality and contributes heavily to the state of global health. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are chronic illnesses that have a dramatic impact on the cost of health care delivery in the United States. Early detection and intervention are critical to the long-term prognosis of this patient population; however, a health disparity exists because not everyone who is at risk for CKD has access to resources for screening and treatment. One of the goals of community-level and national programs is to create parity of care by focusing attention on marginalized communities that are at a statistically higher risk for CKD. The global impact of CKD and ESRD is significant because long-term survival depends on expensive technology and many regions of the world lack the resources needed to treat this disease. Health behavior and culture are known contributors to the long-term survivability of the disease. Since early detection is the key, creating screening programs that target populations at greatest risk will have the highest impact, and be the most cost-effective solution to combating this chronic illness. CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 3 Chronic Kidney Disease: Problems, Perceptions, and Strategies for Intervention Chronic kidney disease (CKD) is considered one of the primary global health issues and contributes significantly to the social burden of care. CKD, along with cardiovascular disease, diabetes, chronic respiratory disease, and cancer, is a chronic illness that is classified as a noncommunicable disease (Healthy People 2020, 2013). Non-communicable diseases have a significant societal impact to domestic growth, productivity, and health care costs and are the most common cause of morbidity and premature death in the United States (Couser, Remuzzi, Mendis, & Tonelli, 2011). Chronic illnesses are also characterized by physical and emotional stressors that can become overwhelming when simultaneously coping with multiple comorbidities (Moulton, 2008). Although the World Health Assembly has determined that noncommunicable diseases contribute heavily to the state of global health, they concede that public health policy can dramatically affect patient morbidity and mortality (Couser et al., 2011). CKD is a public health threat that is on the rise and will likely not slow without deliberate intervention. This literature review will describe the impact that chronic kidney disease and end-stage renal disease have on the global burden of care, as well as detail the issues that contribute to health care disparities affecting this patient population. Factors that affect morbidity and mortality will also be discussed and a solution will be presented that has the potential to reduce the health system burden and improve the prognosis of many who suffer from this chronic disease. Chronic Kidney Disease Statistics and Epidemiological Data The impact of chronic kidney disease and end-stage renal disease (ESRD) on the federal Medicare budget is staggering. In 2008, CKD cost $60 billion and ESRD totaled $39.5 billion, which was 27% of the annual Medicare budget (Rettig, 2011). Recently, studies have reported that approximately 26 million Americans have some degree of CKD (Navaneethan, Aloudat, & CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION Singh, 2008). Only 5% of the people in the most treatable early stages of CKD are aware they have the disease, and almost 50% of those in stage 4 remain unaware unless diagnosed with a comorbid condition such as hypertension or diabetes (Couser et al., 2011). As with many illnesses, prevention and wellness programs that offer CKD screening can improve long-term outcomes. Prevention and Wellness Strategies for At-Risk Populations Prevention and wellness strategies do much for mitigating the physiologic damage from CKD, and can extend the productivity and mortality within this patient population. The greatest benefits are realized when detection and intervention occur early in the disease cycle; however, limiting factors such as genetic, environmental, and social barriers interfere with efforts to deploy prevention and wellness strategies that can also screen for health issues (Pearson, 2008). Although CKD is an illness that affects all cultural, geopolitical, and socioeconomic classes, not all groups have the same clinical outcomes. Native Americans, Asian and Pacific Islanders, and Hispanics have a greater likelihood of progressing to ESRD, and African Americans are four times more likely than Caucasians to suffer renal failure requiring a kidney transplant (National Medical Association, n.d.). The data indicates that a significant disparity exists between Caucasians and other ethnic groups in the diagnosis and treatment of CKD. Evaluative and preventative strategies are a part of high quality health care delivery, and involve interventions that incorporate a diet plan, exercise routine, and medication protocol. Intervention strategies should be tailored to the particular community since each of the disparate groups has ethnic and cultural differences that must be factored to ensure interventional plan compliance. The Impact of Quality Health Care Delivery on CKD 4 CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 5 High quality health care delivery can have a dramatic impact on the morbidity and mortality of people suffering from CKD. A study conducted by the National Kidney FoundationKidney Disease Outcomes Quality Initiatives has proven that hospitalizations are reduced, and mortality is improved if patients are referred to a nephrologist within one month of new onset CKD (Navaneethan et al., 2008). This study also discovered that individuals were more likely to be delayed in getting a referral if they were part of a minority, uninsured, less educated, or elderly. Access to service, proper screening, and appropriate follow-through are challenges that must be addressed if this disparity is to be eliminated. Evaluation and comprehensive counseling on social and environmental factors that negatively impact health are important acute interventions, and long-term health benefits are seen when early referral to a nephrologist and access to follow-up care are provided (Collins, Gilbertson, Snyder, Chen, & Foley, 2010). Currently, numerous programs exist that focus on high-risk populations and are designed to provide access to screening and follow-up care. The National Kidney Foundation (2013) sponsors KEEP Healthy, which is an extension of their Kidney Early Evaluation Program (KEEP) and brings a nationally sponsored, community-based initiative designed to screen and educate in regions that have statistically higher CKD populations. The Kidney Care Prevention Program (KCPP) is a regional community-based program in North Carolina that staff trained kidney care coordinators and educators who can intervene early in the disease process, and can offer support through early-stage CKD intervention and management (Harward & Falk, 2008). These are only two examples of community-based programs designed to provide individuals with the best chance at early detection and intervention. Many such programs exist, and more are being offered as federal funding becomes available. The Global Impact of CKD CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 6 Although the impact of CKD on the United States and most developed countries is significant, it is much worse in less developed countries. Screening programs are essential for early detection, but many areas of the world lack the infrastructure to be able to offer these services. Limited access to care and technology, poor living conditions and diet, and an inadequate supply of pharmaceuticals results in rapid conversion from CKD to ESRD, which is quickly followed by death (Couser et al., 2011). When CKD progresses to ESRD, the only cure is a kidney transplant. Renal replacement therapy, which is also known as hemodialysis, can be used as a bridge to transplant. There are 2 million people currently on hemodialysis worldwide, which constitutes only 12% of the global CKD population, and nearly all of them are treated in just five countries, including the United States, Japan, Germany, Brazil, and Italy (Couser et al., 2011). This means that 88% of the world population does not have a bridge to transplant, nor do they have access to renal transplantation surgery. When viewed from this perspective, it becomes clear just how devastating a diagnosis of CKD can be to most of the world’s population. Health Behavior and CKD Health behavior plays a significant role in an individual’s ability to cope with and manage chronic illness. Health behavior is so important in disease management that many health behavior models have been created in an effort to understand the link. One of the oldest health behavior theories is the Health Belief Model (HBM). The HBM asserts that people have an inherent readiness to act, which is built from life experiences, self efficacy, the perception of vulnerability to a given health problem, the severity of the issue, and the barriers and benefits to taking positive action (Williams, Manias, Liew, Gock, & Gorelik, 2012). Life experiences fall in the category of mediating factors, which also includes demographics, level of education, structural, and social variables. It is theorized that mediating factors that greatly impact CKD are CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 7 primary causes of the current health disparity (Williams et al., 2012). Recognizing these variables and creating practices that mitigate them are the keys to creating health parity across the different CKD population groups. Culture can also affect health behavior and should be considered when creating screening and intervention programs. Culture and CKD An individual’s culture influences their perspectives on health and wellness, which can subsequently affect how well they manage their disease. One of the challenges with managing patient populations that have a high incidence of undiagnosed and undertreated CKD is that they tend to be culturally and linguistically diverse (CALD) groups (Williams et al., 2012). Chronic disorders such as CKD, diabetes, and cardiovascular disease require a strict adherence to lifestyle modification instructions and medication protocols. Limited health literacy, poor cognition, or a language barrier inhibits effective communication and has been shown to result in poor health outcomes (Norris & Nissenson, 2008). These communities are also at risk because they cannot afford health care, have decreased access the health system, and have little or no access to screening and testing facilities (Rettig, Norris, & Nissenson, 2008). These communities often shun modern health services because historically conditioned biases have created in an inability to trust or feel safe in contemporary health care delivery centers (Rettig et al., 2008). Establishing community-based health clinics that are staffed and managed by lay health advisors, especially in regions that have heavy racial and ethnic populations, will not only create community buy-in, but also create agents of change. Lay health advisors are community members who have a natural tendency to help, and are provided training and support so they can assist and advise others in their community on various health issues (Pullen-Smith & Plescia, 2008). Overcoming health care disparities will require lay health advisors to be recruited from CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION within the affected patient population. Recruiting members from within the community has resulted in improved attitudes as community members gain control over their own health issues. The Role of Technology in Treating CKD Patients with CKD and ESRD rely heavily on technology to manage their disease process. Point-of-care testing that can measure creatinine, glucose, albumin, and other critical blood values allows clinics to mobilize and bring much needed health care into the community instead of waiting for members of at-risk groups to be proactive and seek screening centers (Harward & Falk, 2008). The mobile centers have been instrumental in finding individuals who are in the early stages of CKD and respond best to early intervention. When CKD progresses to ESRD, the person must learn to embrace the technology that will sustain his or her life until renal transplantation can be offered. Being tethered to a dialysis machine several days a week for six hours at a time, constant testing, and living with a dialysis catheter or fistula create a technological burden that can be overwhelming. Embracing technology is not easy for patients to do because machine dependency runs contrary to the freedom and autonomy that the individual previously enjoyed. Acculturation occurs when the patient conforms to behavior patterns and routines that are needed in order to exist indefinitely on machine dependency (Harward & Falk, 2008). At the point of acculturation, the patient fully embraces the new technology and accepts it as an integral part of life. Legal and Ethical Issues Impacting CKD Besides technology concerns, there are many legal and ethical issues surrounding the condition of CKD that can impact an individual’s ability to obtain the necessary treatment. In October 1972, the federal government passed the Social Security Amendments, which extended Medicare coverage to the disabled, and officially recognized ESRD as a disability (Vassalotti, 8 CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 9 Gracz-Weinstein, Gannon, & Brown, 2006). In 2009, the American Recovery and Reinvestment Act (ARRA) shifted the focus from reactive and therapeutic intervention, to a proactive and preventative model (Menzin et al., 2011). Currently, instead of waiting and treating the terminal disease of ESRD, which is ineffective, inefficient, and costly, clinicians are screening for CKD in at-risk populations so that appropriate intervention can occur at a stage where the disease process can be halted or even reversed. There are other federal programs that help those suffering from CKD. A second example of a public policy that focuses on active intervention is the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which provides funding to education programs for individuals with stage 4 CKD (Menzin et al., 2011). The MIPPA has proven successful at providing funding that creates highly effective targeted education. The Interdisciplinary Team’s Approach to Treating CKD The process of screening, treatment, and education need the involvement from many disciplines within health care. An interdisciplinary team approach can be the best way to manage complex illnesses such as CKD. Working within culturally and linguistically diverse communities require teams that can provide a range of health care needs, facilitate communication, and serve as patient advocates and representatives. Interdisciplinary teams typically include physicians, technicians, linguists, social workers and case managers, and community advocates, among others (Sinasac, 2012). These teams must also collaborate with community agencies, which can enhance the effectiveness of health promotion efforts (Sinasac, 2012). Public health strategies can also include non-traditional groups such as community service organizations, American Indian tribes, boys and girls clubs, and faith-based organizations, which can penetrate deeper into the communities and reach individuals where they CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 10 live, work, play, eat, and pray (Pullen-Smith & Plescia, 2008). Interdisciplinary teams allow for the breadth of services needed to make a significant impact on CKD screening and intervention. The Scholar-Practitioner’s Role in Treating CKD My role as a scholar-practitioner is to be aware of social disparities and endeavor to correct observed societal imbalances. CKD is considered one of the most significant health care disparities that exist in America today. As a scholar-practitioner, I must be a leader and advocate for positive social change within my community. Becoming involved with organizations such as the National Kidney Foundation’s KEEP Healthy program, the Minority Intervention and Kidney Education (MIKE) program, or local organizations like the Kidney Care Prevention Program (KCPP) are ways that I can influence social change as it relates to CKD and ESRD. Opportunities exist for me to become a trained kidney care coordinator/educator and lead efforts to promote health and wellness activities (Harward & Falk, 2008). Being a scholar-practitioner, I can be involved with identifying a need and targeting the appropriate patient populations by researching health status statistics and epidemiology studies, developing focus groups, assessing social marketing strategies, and analyzing current evidence-based practices to be used in creating new public health policies (Sinasac, 2012). As a scholar-practitioner, a worthy goal would be to spearhead the formation of a new organization that brings health care services to minority communities, socioeconomically depressed people, and the uninsured and underinsured. Another way I can have an impact in my community and make a positive social change is to involve myself with an existing organization whose goal is to eliminate racial and ethnic health disparities for chronic illnesses such as CKD. Through these types of actions, I can fully embrace the role of scholar-practitioner and become an agent of positive social change. CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION 11 References Collins, A. J., Gilbertson, D. T., Snyder, J. J., Chen, S. C., & Foley, R. N. (2010). Chronic kidney disease awareness, screening and prevention: Rationale for the design of a public education program. Nephrology (Carlton), 15 Suppl 2, 37–42. doi:10.1111/j.14401797.2010.01312.x Couser, W. 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CHRONIC KIDNEY DISEASE: PROBLEMS, PERCEPTIONS, AND STRATEGIES FOR INTERVENTION Williams, A., Manias, E., Liew, D., Gock, H., & Gorelik, A. (2012). Working with CALD groups: Testing the feasibility of an intervention to improve medication selfmanagement in people with kidney disease, diabetes, and cardiovascular disease. Renal Society of Australasia Journal, 8(2), 62–69. 13