IntroductionChronic kidney disease (CKD), diabetes, and hypertension play a disproportionate role in the growing public health challenge posed by noncommunicable diseases (NCDs) in East Africa. The impact of these NCDs may pose the greatest challenge in rural areas with limited screening and treatment facilities, although precise prevalence estimates of these conditions in rural Tanzania are lacking.MethodsThe prevalence of CKD, diabetes, and hypertension, were estimated from a probability sample of adults (n = 739) residing in 2 communities within Kisarawe, a rural district of Tanzania. Following consent, participants were studied in their homes. Random point-of-care (POC) measures of glycosylated hemoglobin and blood pressure, were obtained. Serum creatinine, drawn at the POC and measured at Muhimbili National University, was used to calculate estimated glomerular filtration rate with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.ResultsThe median age was 35 years (interquartile range 25−45 years). Overall the pooled prevalence for CKD stages III, IV, and V was 12.4% (95% confidence interval [CI] = 10.2−14.8). Surprisingly, the prevalence of CKD stage V (3.0%; 95% CI = 2.1−4.4) was high among the youngest age group (18−36 years). The prevalence estimates for prehypertension and hypertension were 38.0% (95% CI = 34.6−41.5) and 19.9% (95% CI = 17.1−22.9), respectively. The prevalence estimates for prediabetes and diabetes were 25.7% (95% CI = 22.6−29.1) and 14.8% (95% CI = 12.4−17.6), respectively.ConclusionAlthough this pilot study had a relatively small sample size, the prevalence estimates for CKD, diabetes, and hypertension were higher than we expected based on previous estimates from Tanzania. CKD was not significantly associated with diabetes or hypertension, suggesting the possibility of an alternative causality.

Telemedicine is well established as a means of providing high-quality healthcare at a distance, particularly to patients in underserved populations. Technologies in teledermatology can be used to complement traditional methodologies of clinical trials, expanding accessibility of trials to people typically unable to participate in research. Tools of communication technology may enhance many aspects of clinical trials in dermatology, from recruitment and retention of participants to collection of real-time data. Clinical trials can be made completely virtual or incorporate aspects of virtual technologies at any stage of research. Virtual clinical trials are considered highly patient-centered, as the ability of participants to engage with research staff from their own home often supplants the need for many or all on-site clinic visits. As technological advances influence every aspect of modern life, clinical trials will also evolve to incorporate these tools, meeting participant expectations and overcoming traditional challenges of conducting research. Virtual clinical trials come with specific issues pertaining to analysis of data, technology, and oversight. As more virtual trials are conducted, advantages and limitations of using such technology in research will become clearer and regulatory guidelines will be more firmly established.

No abstract

No abstract

In utero smoke exposure appears to be associated with an increased likelihood of high waist circumference and body mass index percentiles, especially among female adolescents. Our study demonstrates the long-term cardiometabolic impact in offspring, highlighting the importance of prepregnancy smoking cessation.