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BackgroundThe epidemiology of hypertension in the elderly is rarely reported in Africa and little is known about its specificities.ObjectiveTo study the prevalence of hypertension and associated factors in older people in Central Africa.MethodsIndividuals aged 65 years old and over living in two urban and two rural areas of the Republic of Congo (ROC) and the Central African Republic (CAR) were invited to participate into a comprehensive cross-sectional study assessing cognitive impairments and cardiovascular diseases. Demographic, clinical and biological data were collected. Hypertension was defined in case of self-reported on-going treatment and/or when averaged systolic blood pressure at rest was≥140mmHg and/or diastolic blood pressure was≥90mmHg.ResultsAmong 1990 participants (mean age=73 years; 62% females), the overall prevalence of hypertension was 61.1% (95% CI: 58.9-63.2), higher in ROC than in CAR (68.0% vs 53.7%, respectively; p

Introduction Population aging has substantially contributed to the rising number of new cancer cases worldwide. Little has been done to study cancer incidence in older population globally. We thus presented the cancer incidence in people aged 65 years and older along with the projected number of new cancer cases in 2035 by world regions. Methods We extracted incident cancer cases for 184 countries from the GLOBOCAN 2012 database. We presented the number and the proportion of new cases, and the truncated age-standardized incidence rates among 65+ for all-sites combined and the 5 most common cancers by world regions. We also calculated the future incidence in 2035 by applying projected population estimates, assuming no changes in rates. Results In 2012, 6.7 million new cancer cases or (47.5% of all cancers) were diagnosed among older adults worldwide, with 48% occurring in the less developed regions. Over two thirds of all new cases were found in Europe and Asia including China. Lung, colorectal, prostate, stomach and breast cancers represented 55% of the global incidence among the elderly, yet distinct regional pattern was observed e.g. cervix uteri cancer in Sub-Saharan Africa. By 2035, 14 million new cancer cases (68% all cases) are expected in older population. The highest increase is predicted in the Middle East and Northern Africa (+157%), and in China (+155%). Less developed regions will see an increase of 144% of new cancer cases compared to 54% in more developed regions. Conclusion The expected increase of cancer incidence at older ages will have a major impact on the society and challenge oncological practices and health care systems in all global regions in particular those with limited economic resources.

International audience; Introduction et but de l’étudeLa formule de Chumlea, validée pour la prédiction de la taille à partir de la hauteur talon-genou (HTG), peut être utilisée pour les personnes de plus de 60 ans dans l’incapacité de se verticaliser. Aucune formule n’est validée pour la population d’Afrique Centrale. Le but de ce travail était de comparer la taille fournie par des formules prédictives utilisant la HTG à celle mesurée dans une population de personnes âgées (PA) d’Afrique Centrale.Matériel et méthodesL’étude EPIDEMCA, a été réalisée chez des PA de plus de 65 ans au Congo et en République Centrafricaine (RCA). Les PA incluses ont bénéficié d’une évaluation nutrition-nelle avec mesure de la taille (cm) et de la HTG (cm). Une analyse de Bland et Altman et des tests de corrélation ont été réalisés, en fonction du pays, du sexe et de l’âge. Le pourcentage de bonne prédiction, ± 5 cm par rapport à la taille mesurée était calculé. Les formules testées étaient celles de Chumlea pour la population noire américaine (CPNA) [H = 79,69+(1,85*HTG)-(0,14*âge) ; F = 89,58 + (1,61*HTG)-(0,17*âge)] (1), et deux formules pour les caucasiens CPC1 [H = 64,14+(2,02*HTG)-(0,04*âge) ; F = 84,88 + (1,83*HTG) - (0,24*âge)] (2) et CPC2 [H = (2,08*HTG) + 59,01 ; F = 75 + (1,91*HTG)-(0,17*âge)] (3).Résultats et Analyse statistique1754 mesures ont été analysées. L’âge moyen était de 73,3 ± 6,6 et 72,5 ± 6,3 ans (Congo et RCA, p = 0,004). Le sex-ratio H/F était de 0,6 dans les deux pays. Les PA de RCA étaient plus grandes (159,0 ± 9,1 vs 155,9 ± 9,1 cm, p < 0,0001). Les prédictions des trois formules dans la population totale sont présentées dans le tableau 1. La formule CPNA obtenait 91,9 % de bonne prédiction avec cependant un risque d’erreur (± 2 Déviation Standard) de 6,7 % soit 10,5 cm ce qui est difficilement acceptable en pratique clinique. Cependant, il n’existait pas de différence significative entre le pourcentage de dénutrition (Indice de Masse Corporelle < 18,5), en utilisant la taille mesurée ou prédite (34,3 % vs 38,7 %). Avec la formule CPNA, une surestimation de plus de 5 cm existait en moyenne dans 24,2 % des cas, une sous-estimation dans 9,0 % des cas. La formule CPNA permettait d’obtenir dans 66,8 % des cas une prédiction de la taille avec applicabilité correcte (Tableau 1 ci-dessous). n = 1754Moyenne ± écart typeBonne prédiction (%)Surestimation (+5cm) (%)Sous-estimation (−5cm) (%)Biais (%)Coefficient de corrélation Taille mesurée (cm)157,4 ± 9,2––––– Formule CPNA (cm)159,2 ± 7,466,824,29,01,10,81 Formule CPC1 (cm)159,9 ± 7,762,729,67,71,50,81 Formule CPC2 (cm)159,7 ± 8,363,229,07,81,40,81 Table optionsConclusionLa formule de CPNA semble applicable pour l’évaluation de la taille par la HTG chez les personnes âgées d’AC dans environ 66,8 % des cas. Une formule prédictive plus adaptée devra être construite.

A multicenter population-based study was carried out in Central African Republic (CAR) and Republic of Congo between 2011 and 2012 including both urban and rural sites in each country. Participants aged ≥65 years old were interviewed and participants in Congo were followed-up annually between 2012 and 2015 (EPIDEMCA-FU study). Qualitative interviews using an ethno-anthropological approach were also performed with people identified with dementia and their relatives in order to investigate social representations, beliefs and stigma. Results Overall, 2,002 elderly were interviewed in both countries, including 473 in Nola (rural CAR), 500 in Bangui (urban CAR), 529 in Gamboma (rural Congo) and 500 in Brazzaville (urban Congo). The crude prevalence of DSM-IV dementia was estimated at 8.5% (CI95%[6.1-11.3] in Nola, at 6.4% (CI95%[4.4-8.9]) in Bangui, 5.7% (CI95% [3.9-8.0] in Gamboma and at 6.6% (CI95%[4.6-9.1]) in Brazzaville. The crude incidence was estimated at 15.8 (95% CI 10.2 – 23.3) per 1000 PY. Factors associated with either prevalent or incident dementia in these studies, as well as the results of the qualitative interviews, will be detailed during the presentation. Conclusion The need for targeted social and health policies for older people, as well as strategies for dementia care, is evident and growing in sub-Saharan Africa (SSA).

Introduction Aucune etude ne s’est encore interessee aux troubles de la personnalite comme potentiel facteur de troubles cognitifs. Notre objectif etait donc d’etudier l’association entre le trouble de la personnalite dependante (TPD) et les troubles cognitifs (TC), incluant le « Mild Cognitive Impairment » (MCI) et les demences. Methodes Une enquete transversale multicentrique a ete menee en Republique Centrafricaine (RCA) et en Republique du Congo. Apres un depistage des TC en population generale, les sujets âges de 65 ans ou plus identifies comme ayant de faibles performances cognitives etaient invites a un entretien clinique avec un neurologue. Les diagnostics de demences et de MCI etaient poses selon les criteres du DSM-IV et de Petersen, respectivement. Le TPD a ete evalue a l’aide du « Personality Diagnostic Questionnaire – 4+ ». Des modeles de regression logistique multinomiale ont ete utilises pour estimer les associations. Resultats Sur 2001 sujets depistes, 1519 etaient indemnes, 118 MCI, 135 dements et 229 n’avaient pas de diagnostic. Sur 1772 sujets avec un statut cognitif, 255 avait une personnalite dependante. Ajuste sur les facteurs pertinents, le TPD etait significativement associe au MCI en RCA (OR = 2,1 IC95 % : 1,1–4,0) et au Congo (OR = 2,2 IC95 % : 1,0–4,7) alors que le TPD n’etait associe aux demences qu’au Congo (OR = 4,8 IC95 % : 2,0–11,7). Conclusion La personnalite dependante est associee aux troubles cognitifs en Afrique Centrale. Cette association devra etre confirmee dans d’autres contextes. Notre etude ouvre la voie a la recherche sur la relation entre la personnalite et les troubles cognitifs en Afrique.

Introduction Aucune etude ne s’est interessee a la relation entre la consommation alimentaire et les troubles cognitifs (TC) sur le continent africain. Notre etude se propose donc d’analyser l’association entre la consommation alimentaire et les TC en Afrique centrale. Methodes Une enquete transversale multicentrique a ete menee en Republique Centrafricaine (RCA) et en Republique du Congo. Apres un depistage des TC en population generale, les sujets âges ≥ 65 ans avec de faibles performances cognitives etaient invites a un entretien clinique avec un neurologue. Les diagnostics de demences et de MCI etaient poses selon les criteres du DSM-IV et de Petersen, respectivement. La frequence de consommation des principaux groupes d’aliments a ete evaluee au cours des trois derniers jours. En outre, l’information sur la consommation d’alcool etait recueillie. Des modeles de regression logistique multinomiale ont permis d’estimer les associations. Resultats Sur 2001 sujets depistes, 1519 etaient indemnes de TC, 118 MCI, 135 dements et 229 etaient sans diagnostic. En RCA, la consommation d’alcool a ete associee aux demences (OR = 0,3 [0,1–0,8]) et la consommation d’oleagineux au MCI (OR = 3,6 [1,4–9,6]) et aux demences (OR = 2,8 [1,0–7,5]) en zone rurale mais pas en zone urbaine. Au Congo, aucune association n’a ete observee. Conclusion Notre etude apporte de nouvelles donnees sur la relation entre la consommation alimentaire et les troubles cognitifs. Des etudes ulterieures devront etre menees pour analyser non plus l’effet des groupes d’aliments mais l’effet des aliments sur les TC dans cette region peu etudiee.

Background:To date, no studies have examined the relationship between cognitive disorders and personality disorders. Our aim was to investigate the association between dependent personality disorder (DPD) and cognitive disorders in Central Africa.Methods:Between 2011 and 2012, a cross-sectional multicenter population-based study was carried out in rural and urban areas of the Central African Republic (CAR) and the Republic of Congo (ROC). Participants aged ≥65 years were interviewed using the Community Screening Interview for Dementia (CSI-D). Elderly people who performed poorly (CSI-D cognitive tests score or COGSCORE ≤ 24.5/30) were clinically assessed by neurologists and underwent further psychometric testing. The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition and Petersen criteria were required for the diagnosis of dementia and mild cognitive impairment (MCI) respectively. DPD was assessed using the Personality Diagnostic Questionnaire-4+. Socio-demographic, vascular, and psychological factors were also documented. Multivariate multinomial logistic regression models were used to estimate the associations.Results:Of the 2,002 participants screened, 860 and 912 had data for cognitive status and DPD in CAR and ROC respectively. In fully adjusted models, DPD was significantly associated with MCI in ROC (Odds Ratio (OR) = 2.2, 95% CI: 1.0–4.7) and CAR (OR = 2.1, 95% CI: 1.1–4.0) and with dementia only in ROC (OR = 4.8, 95% CI: 2.0–11.7).Conclusions:DPD was associated with cognitive disorders among elderly people in Central Africa. This association should be confirmed in other contexts. This study paves the way for research on the association between personality and cognitive impairment in Africa.

Background: Stressful life events (SLEs) are considered potential risk factors for cognitive disorders. Our objective was to investigate the association between SLEs and cognitive disorders among the elderly people in Central Africa. Method: A population-based study was conducted in the Central African Republic (CAR) and the Republic of Congo (ROC). Participants aged ≥65 were interviewed using the Community Screening Interview for Dementia. Those who performed poorly were clinically assessed by neurologists. DSM-IV and Petersen criteria were required for a diagnosis of dementia or mild cognitive impairment (MCI), respectively. SLEs were assessed through 18 questions about events that occurred during childhood, adulthood and late-life. Sociodemographic, vascular and psychological factors were also documented. Multivariate multinomial logistic regression models were used to estimate the associations. Results: MCI was positively associated with: the total number of SLEs (OR = 1.1, 95% CI: 1.0-1.2), the number of SLEs from the age of 65 (OR = 1.2, 95% CI: 1.0-1.3), the number of SLEs before the age of 16 among non-depressive participants (OR = 1.6, 95% CI: 1.2-2.2) and with a serious illness in a child experienced when the participant was aged 65 or more (OR = 2.8, 95% CI: 1.6-4.6). No association with dementia was observed. Conclusion: SLEs were positively associated with MCI but not dementia. More comprehensive studies are needed to further investigate this relationship.

Introduction.– Les facteurs psychosociaux ont ete associes aux troubles cognitifs de la personne âgee. Dans le programme EPIDEMCA, nous nous sommes interesses a la personnalite dependante (PD) et aux evenements de vie stressants (EVS). Objectifs.–Etudier l’association entre les troubles cognitifs et la personnalite dependante evaluee a l’aide du PDQ-4+, d’une part, et les EVS evalues par le questionnaire de Persson et Skoog, d’autre part, en Afrique Centrale. Methodes.– Une etude transversale multicentrique en deux phases a ete menee en Republique Centrafricaine et au Congo entre 2011 et 2012. Suite au depistage des TC en population generale âge´e de 65 ans et plus, les cas depistes ont ete confirmes au cours d’un examen clinique approfondi avec un neurologue. Le diagnostic de demence etait pose selon les criteres du DSM-IV et celui de MCI selon ceux de Petersen. Des regressions logistiques multinomiales ont ete´ utilisees. Resultats.– Ajustee sur les facteurs pertinents, la PD etait associe avec le MCI (OR Indemne vs MCI : 2,2 IC 95%: 1,0–4,8) et les demences (OR indemne vs demences = 4,4 IC 95 % : 2,0–9,6) au Congo mais pas en RCA (OR indemne vs MCI : 1,9 IC 95 % : 1,0– 3,6 ; OR indemne vs demences = 0,6 IC 95 % : 0,3–1,6). La moyenne du nombre total d’EVS etait significativement plus elevee chez les sujets avec TC (7,1 3,0 chez les MCI et 6,6 3,1 chez les dements) que chez les indemnes (5,9 2,8 ; p < 0,001). Des resultats complementaires seront presentes. Discussion.– C’est la premiere fois que l’association entre des facteurs psychosociaux et les TC est specifiquement etudiee en Afrique. Nos resultats supportent l’idee qu’outre les facteurs bien connus des demences, les facteurs psychosociaux peuvent joueur un role dans la survenue des TC. Ceci est d’autant plus important si la pathologie dementielle est vue comme la resultante d’une accumulation de facteurs sur la vie entiere. Conclusion.– D’autres etudes devront etre conduites dans d’autres contextes avec des outils valides pour confirmer ou infirmer les associations observees dans notre etude. Informations complementaires.– Le programme EPIDEMCA a ete finance par l’Agence nationale de la recherche.

International audience; AIM: To assess the effectiveness of the Diabetes Project in Davao City, Philippines, regarding diabetes care access, diabetes management and cardiovascular risk factors. The project was developed in accordance with the Chronic Care Model (CCM) framework. METHODS: A non-randomized cross-sectional survey was conducted in nine intervention and five control Barangays (villages). People with diabetes aged ≥20 years were interviewed using a structured questionnaire; height, weight, waist circumference, and blood pressure were measured; HbA1c was tested with a NSGP-certified point-of-care device. Logistic regression models were used to compare the two groups. RESULTS: The intervention group (n=503) scored better than the controls (n=136) on the following (OR, 95% CI): percentage of patients taking metformin (1.5, 1.0-2.2); and in the last 12 months: laboratory test for fasting blood sugar (1.6, 1.1-2.3), HbA1c (6.0, 2.4-15.1), lipid profile (1.7, 1.1-2.5), nutritionist visit (1.6, 1.0-2.5) and therapeutic education session (2.7, 1.8-4.0). Glycemic control (HbA1c

International audience

International audience

Background:The worldwide population is ageing and the proportion of elderly aged 60 and over is expected to dramatically rise in Low and Middle Income Countries (LMIC). The epidemic of dementia will not spare those countries, where the largest increases in numbers of people affected are estimated. Besides, dementia is still understudied in sub-Saharan Africa (SSA) compared to other regions. This paper describes the protocol for the 'Epidemiology of Dementia in Central Africa' population-based study, which aims at estimating the prevalence of dementia in two countries of Central Africa and investigating possible risk factors.Methods/Design:A multicenter population-based study was carried out in Central African Republic and Republic of Congo between 2011 and 2012 including both urban and rural sites in each country. Around 2000 participants aged ≥65 years old were interviewed in total using the Community Screening Interview for Dementia (CSI-D), the GMS-AGECAT and the CERAD's 10-word list. Elderly with low performance to the cognitive part of the CSI-D (COGSCORE ≤ 24.5) were then clinically assessed by neurologists and underwent further psychometrical tests. DSM-IV and NINCDS-ADRDA criteria were required for dementia and Alzheimer's disease (AD) diagnoses respectively. The algorithmic 10/66 dementia diagnosis was also determined. Petersen's criteria were required for the diagnosis of Mild Cognitive Impairment. Sociodemographic, and environmental factors including vascular, nutritional, biological, psychosocial and lifestyle factors were collected in each setting in order to investigate factors associated with dementia. Blood sampling was realized to investigate genetic variations that could modify the risk of dementia.Discussion:For now, no large epidemiological study has been undertaken to compare the prevalence of dementia in both rural and urban areas within SSA countries. This programme will provide further evidence regarding the prevalence of dementia in SSA, and also the possible rural/urban disparities existing with associated factors. Furthermore, the genetics of AD in those populations will be addressed.

The aim of this study was to evaluate the working conditions of employees in a local council as well as their possible relationships to health, particularly to psychosocial risks--an emerging occupational risk which causes physical and mental illness. Between November 2004 and October 2005, 919 employees were asked to fill out a self-administered questionnaire about their working conditions, their self-perceived health status, and sociodemographic characteristics. The exposure to psychosocial risk (job strain) was evaluated using the Job Content Questionnaire developed by Karasek. A total of 625 employees responded to the survey (participation rate = 68%). Their self-perceived health status was good overall, but the prevalence of job strain reached 22%, and was associated with an accrued frequency of work dissatisfaction, strong perception of stressful work and the desire and intent to change job positions.

Introduction La denutrition et les evenements de vie stressants (EVS) ont ete associes aux troubles cognitifs chez le sujet âge. Peu de donnees existent en Afrique. Notre objectif etait d’etudier l’association entre les TC (« Mild Cognitive Impairment » (MCI) et demences) et la denutrition, d’une part, et les EVS, d’autre part, en Afrique Centrale. Methodes Une enquete transversale multicentrique a ete menee en Republique Centrafricaine (RCA) et en Republique du Congo. Apres un depistage des TC en population generale, les sujets âges ≥ 65 ans ayant de faibles performances cognitives ont ete examines par un neurologue. Les diagnostics de demences et de MCI etaient poses selon les criteres du DSM-IV et de Petersen, respectivement. La denutrition a ete definie par un perimetre brachial (PB) 2 ou une circonference musculaire brachiale (CMB) e percentile. Les EVS ont ete evalues a l’aide de 18 items interrogeant sur trois periodes de vie (enfance, vie adulte et vieillesse). Des modeles de regression logistique multinomiale ont permis d’estimer les associations. Resultats Sur 2001 sujets depistes, le statut cognitif etait connu pour 1772 d’entre eux. En RCA, aucun marqueur de denutrition n’etait associe au MCI. Tous etaient positivement associes aux demences (PB 2 : OR = 2,7 [1,4–5,0]) ; CMB e percentile : OR = 2,9 [1,3–6,5]). Au Congo, seule la CMB e percentile restait associee au MCI (OR = 3,6 [1,7-7,6]). Aucun marqueur n’etait associe aux demences. Le MCI etait positivement associe au nombre total d’EVS en RCA (OR = 1,2 [1,1–1,3]) mais pas au Congo. Le MCI etait egalement associe au nombre d’EVS survenus a partir de 65 ans (OR = 1,1 [1,0–1,3]) et a la survenue d’une maladie chez un enfant a partir de 65 ans (OR = 2,6 [1,6–4,5]). Aucune association avec les demences n’a ete observee. Conclusion Concernant la denutrition, une difference d’association a ete observee selon le pays. Quant aux EVS, ils etaient associes au MCI mais pas aux demences. De futures etudes longitudinales devront approfondir ces relations.

BackgroundAge is an important prognostic factor for lung cancer. However, no studies have investigated the age difference in lung cancer survival per se. We, therefore, described the role of patient-related and clinical factors on the age pattern in lung cancer excess mortality hazard by stage at diagnosis in New Zealand.MethodsWe extracted 22 487 new lung cancer cases aged 50-99 (median age = 71, 47.1% females) diagnosed between 1 January 2006 and 31 July 2017 from the New Zealand population-based cancer registry and followed up to December 2019. We modelled the effect of age at diagnosis, sex, ethnicity, deprivation, comorbidity, and emergency presentation on the excess mortality hazard by stage at diagnosis, and we derived corresponding lung cancer net survival.ResultsThe age difference in net survival was particularly marked for localised and regional lung cancers, with a sharp decline in survival from the age of 70. No identified factors influenced age disparities in patients with localised cancer. However, for other stages, females had a greater age difference in survival between middle-aged and older patients with lung cancer than males. Comorbidity and emergency presentation played a minor role. Ethnicity and deprivation did not influence age disparities in lung cancer survival.ConclusionSex and stage at diagnosis were the most important factors of age disparities in lung cancer survival in New Zealand.Key messagesWhat is the key question?How do patient-related and clinical factors influence age pattern in lung cancer survival?What is the bottom line?Age disparities in lung cancer survival were strongest for females and non-advanced disease. Deprivation, ethnicity, comorbidity, and emergency presentation did not influence age disparities.Why read on?Our findings reinforce the call for a better representation of older adults in clinical trials and a wider use of geriatric assessment to identify patients who will benefit treatment.