The prevalence of mild cognitive impairment in diverse geographical and ethnocultural regions: The COSMIC Collaboration

Background Changes in criteria and differences in populations studied and methodology have produced a wide range of prevalence estimates for mild cognitive impairment (MCI). Methods Uniform criteria were applied to harmonized data from 11 studies from USA, Europe, Asia and Australia, and MCI prevalence estimates determined using three separate definitions of cognitive impairment. Results The published range of MCI prevalence estimates was 5.0%-36.7%. This was reduced with all cognitive impairment definitions: performance in the bottom 6.681% (3.2%-10.8%); Clinical Dementia Rating of 0.5 (1.8%-14.9%); Mini-Mental State Examination score of 24-27 (2.1%-20.7%). Prevalences using the first definition were 5.9% overall, and increased with age (P < .001) but were unaffected by sex or the main races/ethnicities investigated (Whites and Chinese). Not completing high school increased the likelihood of MCI (P = .01). Conclusion Applying uniform criteria to harmonized data greatly reduced the variation in MCI prevalence internationally

Paludisme : vers le développement d'un nouveau modèle pharmacologique

Le paludisme constitue la première maladie parasitaire, concerne 40% de la population mondiale, et 90% des cas cliniques de paludisme se situent dans l'Afrique sub-saharienne. L'émergence des souches de #Plasmodium falciparum chimiorésistantes et l'expansion générale de ces pharmacorésistances limitent considérablement l'efficacité des traitements et constituent une préoccupation majeure de santé publique. Sur des bases quantitatives et qualitatives, la demande pour de nouveaux antipaludiques est supérieure à celle de toutes les autres médications et le paludisme est l'une des principales préoccupations de nombre d'organisations internationales en terme de maladie infectieuse. Depuis une quinzaine d'année, nous avons initié un programme de recherche sur le métabolisme phospholipidique de #Plasmodium, l'agent de la maladie, au cours de son cycle érythrocytaire. Ces recherches ont permis de définir l'ensemble des voies métaboliques et de la machinerie enzymatique utilisée par le parasite pour assurer ses besoins en phospholipides, nécessaires pour la biogenèse de ses membranes ; d'autre part, nous avons montré que le parasite ne peut plus se multiplier quand il ne peut plus confectionner de membranes. Des groupes de chimistes ont synthétisé des molécules qui interfèrent avec le métabolisme de ces phospholiplides. L'approche la plus avancée fait intervenir comme cible le transporteur de choline de l'érythrocyte impaludé qui fournit au parasite intraérythrocytaire un substrat indispensable pour la biosynthèse de phposphatidylcholine, phospholiplide majeur du parasite. Les chefs de file montrent une forte efficacité sur des singes #Aotus infectés par le parasite humain, #Plasmodium falciparum, y compris à parasitémie élevée, et des tests effectués au Cameroun montrent une activité similaire contre les isolats de #Plasmodium falciparum$ polychimiorésistants... (D'après résumé d'auteur

Frequent attendance and the concordance between PHQ screening and GP assessment in the detection of common mental disorders

International audienceOBJECTIVE:Frequent Attenders (FAs) have high rates of both common mental disorders (CMD) and physical disorders, partly justifying this service use behaviour. This study examines both case and non-case concordance between CMDs as estimated by a self-report screening questionnaire and as rated by the general practitioner (GP), in FAs compared to Other Attenders (OAs).METHODS:2275 patients of an overlapping sample of 55 GPs from 2 surveys performed 10 years apart, completed in the waiting room the Patient Health Questionnaire (PHQ) and Client Service Receipt Inventory on 6-month service use. For each patient, the GP rated mental health on a 0-4 scale, with a clear indication that scores of 2 and above referred to caseness. PHQ-CMDs included major and other depressive, anxiety, panic, and somatoform disorders, identified using the original PHQ DSM-IV criteria-based algorithms. FA was defined as the top 10% of attenders in age, sex and survey-year stratified subgroups.RESULTS:FAs had higher rates of PHQ-CMDs (42% versus 23% for OAs, p < .0001). They reported more personal and social problems, disability and had higher GP-rated physical illness. Survey-day antidepressant/anxiolytic medication prescription was higher for FAs (p < .0001), with (p = .02) but also without a CMD (p < .0001). Both GP/PHQ case and non-case concordance differed between FAs and OAs, with a non-case concordance odds ratio of 0.5 (95% CI: 0.3-0.7, p = .001) for FAs compared to OAs.CONCLUSION:Despite a greater likelihood of GPs detecting CMDs in FAs, our findings suggest a potential risk of 'over-detection' of patients not reaching CMD threshold criteria among FAs

Malaria contract holders' meeting

A programme for developing new drugs for the treatment of #Plasmodium falciparum malaria is targeted against the essential phospholipid metabolism of the intra-erythrocytic stages of the parasite. Blockage of the choline transporter that provides the intracellular parasite with choline, a precursor required for synthesis of phosphatidylcholine, the major phospholipid of the parasite, seems to hold the most promise. Molecules with the ability to interfere with this step, whose structures have been optimised using structure-activity criteria, have been synthesised. The antimalarial activity of the compounds produced so far, which have in vitro-activities in the ng/ml or nanomolar ranges, appears satisfactory. The present compounds are also active, in vitro, against parasites resistant to the antimalarial drugs already in clinical use. In vivo, one of the compounds, G25, successfully cleared high parasitaemias of murine parasites in mice and of #P. falciparum in #Aotus$ monkeys. There were no recrudescences in the treated monkeys and the therapeutic index of the drug in monkeys is probably > 50. Targeting of phospholipid metabolism therefore appears to be a rational and promising approach to the development of new antimalarial drugs. (Résumé d'auteur