An Analysis of the Public Financial Support Eligibility Rule for French Dependent Elders with Alzheimer’s Disease

AbstractBackgroundIt is crucial to define health policies that target patients with the highest needs. In France, public financial support is provided to dependent patients: it can be used to finance informal care time and nonmedical care use. Eligibility for public subsidies and reimbursement of costs is associated with a specific tool: the autonomie gérontologie groupes iso-ressources (AGGIR) scale score.ObjectiveOur objective was to explore whether patients with Alzheimer’s disease who are eligible for public financial support have greater needs than do noneligible patients.MethodsUsing data from the Dépendance des patients atteints de la maladie d’Alzheimer en France study, we calculated nonmedical care expenditures (in €) using microcosting methods and informal care time demand (hours/month) using the Resource Use in Dementia questionnaire. We measured the burden associated with informal care provision with Zarit Burden Interview. We used a modified two-part model to explore the correlation between public financial support eligibility and these three variables.ResultsWe find evidence of higher informal care use, higher informal caregivers’ burden, and higher care expenditures when patients have an AGGIR scale score corresponding to public financial support eligibility.ConclusionsThe AGGIR scale is useful to target patients with the highest costs and needs. Given our results, public subsidies could be used to further sustain informal caregivers networks by financing programs dedicated to lowering informal caregivers’ burden

Epidémiologie de la démence (facteurs de risque vasculaire, accident vasculaire cérébral et risque de démence)

En France depuis quelques années, la mise en place de stratégies de santé publique pour la démence dont la maladie d'Alzheimer (MA), est de plus en plus reconnue comme une nécessité prioritaire. La prévention de la survenue de nouveaux cas de démence et l'accompagnement médico social des sujets déments sont des points forts de ces stratégies. La pathogénie de la MA, qui est la démence la plus fréquente, n'est pas totalement élucidée mais les facteurs de risque vasculaire (FRV) sont de plus en plus incriminés et donc l''espoir de mesures de prévention pour la MA mais une question importante demeure : les FRV ont-ils sur le risque de MA une influence "directe" ou uniquement une influence "indirecte" par l'intermédiaire d'affections vasculaires telles que les accidents vasculaires cérébraux (AVC). Le diagnostic précoce de la MA qui a de potentiels avantages pour le patient et sa famille, repose en partie sur le médecin généraliste. Cette thèse d'épidémiologie évalue en population générale française, (1) l'influence du diabète, de l'hypercholestérolémie, de l'hypertension artérielle, du tabagisme et des AVC sur le risque de survenue d'une démence (2) les capacités d'un test de mémoire qui pourrait êtrte utilisé pour la détection de la MA par le médecin généraliste.In France for some years, public health strategies for dementia namely Alzheimer disease (AD), is more and more recognized as a necessary priority. Prevention of incident cases of dementia and medico social management of demented patients are key points of these strategies. Vascular risk factors (VRF) are more and more evocated for a contribution to AD pathogenesis which to date remains unclear. So VRF are a hope for the prevention of AD which is the most frequent type of dementia. However an important question remains debate : Do VRF have a "direct" influence on AD risk or do they have only an "indirect" influence on this risk with vascular disease as a stroke ? The diagnosis of AD at an early stage which has potential advantage for the patient and his family is mainly based on the generalist practitioner. This thesis of epidemiology assess in a french population, (1) the influence of diabetes mellitus, hypercholesterolemia, hypertension, smoking and stroke on the risk of incident dementia (2) the validity of a neuropsychological memory test for the screening of AD which could be used by the general practitioner.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

CLINICAL EXAMINATION FOR THE DETECTION OF LOWER LIMBS POLYNEUROPATHY AND ARTERIOPATHY AMONG AMBULATORY DIABETICS IN ABIDJAN: WHICH DIAGNOSTIC VALUE?

L\'EXAMEN CLINIQUE POUR LA DETECTION DE LA POLYNEUROPATHIE ET DE L'ARTERIOPATHIE DES MEMBRES INFERIEURS EN CONSULTATION DE DIABETOLOGIE A ABIDJAN: QUELLE VALEUR DIAGNOSTIQUE? RESUME Introduction:La polyneuropathie (P) et l'artériopathie (A) sont les principaux incriminés dans la survenue de lésions du pied diabétique qui mettent en jeu le pronostic fonctionnel de ces sujets. L'objectif: principal de cette étude était d'apprécier la valeur diagnostique de l'examen clinique pour la détection de la P et de l'A des membres inférieurs, en consultation ambulatoire de diabétologie à Abidjan (Côte-d'Ivoire). Méthodes : Cette étude transversale concerne 120 diabétiques randomisés dans le principal centre antidiabétique ambulatoire d'Abidjan. Selon les résultats de l'électromyogramme et du doppler des membres inférieurs, les sujets ont été répartis en 4 populations: P isolée, A isolée, P et A associés (PA), absence de P et de A. Les performances de l'examen clinique ont été appréciées par la sensibilité (Se), la spécificité (Sp), l'indice de Youden (Y) et les rapports de vraisemblance positif et négatif. Résultats: Il s'agissait de 84 hommes et 36 femmes âgés en moyenne de 46 ( ± 8 ans avec des extrêmes de 27 et 65 ans), non insulinodépendants dans 86% des cas. La Se est meilleure pour une P (82%) que pour une A (45%) et pour la PA (50%). La Sp est meilleure pour l'A (82%) que pour la PA (73%) et pour la P (62%). Les erreurs sont moins fréquentes lorsqu'on diagnostique une P (Y à 45%), qu'une A (Y à 28%) ou qu'une PA (Y à 24%). L'apport diagnostique d'un résultat positif et d'un résultat négatif est moins important pour l'association PA que pour une A et une P. Chez les PA, la polyneuropathie est cliniquement surestimée aux détriments de l\'artériopathie: 78% des patients qui ont des signes cliniques de P sont des PA et il n\'est pas retrouvée cliniquement d\'A isolée chez les patients PA. Conclusion : La P, l'A et leur association échappent souvent à l'examen clinique. Le médecin manque ainsi l'opportunité de traiter ces pathologies et de renforcer les mesures de prévention du pied diabétique. Pour la polyneuropathie des scores, exclusivement cliniques pourraient être utilisés. ABSTRACT Background : Lower limbs polyneuropathy (P) and arterial disease (A) are the main causes of diabetic foot lesions which threatens the functional prognosis of these subjects. Objective : The aim of this study was to assess medical examination diagnostic value for lower limbs P and A, in ambulatory diabetic care in Abidjan (Cote-d'Ivoire). Methods : One hundred and twenty diabetics patients randomly selected at the main antidiabetic ambulatory centre of Abidjan, were included in a cross-sectional survey. Our gold standards tests were lower limbs Electromyogramm and Doppler. After their results, subjects were divided up to 4 populations: P isolated, A isolated, P and A associated (PA), lack of P and A. Medical examination diagnostic value were assessed by different index: sensibility (Se), specificity (Sp), Youden indice (Y), positive and negative likelihood ratios. Results : Eigthy-four males and 36 females were included in this study. Eighty-six percents were non insulino-dépendants. The average age for all subjects is 46 years (± 8, ranged from 27 to 65 years). Se is better for screening P (82%) than A (45%) and association PA (50%). Sp is better for screening A (82%) than PA (73%) and P (62%). Diagnosis mistakes are less frequent when medical examination detect P(Y= 45%), than A (Y= 28%) or PA (Y= 24%). Diagnostic contribution of one positive result and one negative result was less important for PA than for A and for P. Among PA subjects, polyneuropathy was overestimate to the detriment of arteriopathy: 78% of patients clinicaly diagnosed as P are PA and it was not founded isolated arteriopathy at the medical examination among PA subjects. Conclusion : P, A or their fearsome association are in many cases misdiagnosed by the medical examination. The consulting physician miss the opportunity to treat these diseases and to reinforce diabetic foot safety measures. Regarding P, scores considered as valid could be used for the medical examination; or as a help to conceive a clinical score adapted to our medical practice. Key Words: Artériopathie, Diabète, Polyneuropathie, Examen clinique, Africa-Arteriopathy, Diabetes, Polyneuropathy, Medical examination African Journal of Neurological Sciences Vol.23(2) 200

Survie des personnes atteintes de cancers solides en France métropolitaine, 1989-2013

International audienc

Prévalence et facteurs de risque des démences au Bénin (Afrique de l'Ouest).

International audienc

EPIDEMIOLOGY OF HOSPITALIZED PATIENTS IN NEUROLOGY: EXPERIENCE OF COCODY TEACHING HOSPITAL AT ABIDJAN (CÔTE-D\'IVOIRE)

EPIDEMIOLOGIE DES PATIENTS HOSPITALISES EN NEUROLOGIE: EXPERIENCE DU CENTRE HOSPITALIER UNIVERSITAIRE DE COCODY A ABIDJAN (COTE-D'IVOIRE) RESUME Objectif: Identifier les principales étiologies et diagnostics des affections neurologiques et décrire leur évolution, en hospitalisation de neurologie. Méthodes: Analyse rétrospective des dossiers médicaux des patients admis dans le service de Neurologie du CHU de Cocody (Abidjan) entre le 1er décembre 1998 au 31 Décembre 2000. Résultats: Mille dix huit sujets âgés en moyenne de 45 ± 17,7 ans (extrêmes de 1 et 93 ans) avec un sexe ratio de 1,7 en faveur des hommes. Ces patients provenant en majorité du service des urgences (65,2%) ont été hospitalisés en moyenne pendant 12,5± 9,6 jours. Les principaux diagnostics étaient: un Accident vasculaire cérébral (42,1%), un abcès cérébral (17,9%) et une méningo-encéphalite (ME) dans 11,9%. La létalité globale en cours d'hospitalisation était de 23,5% avec un décès plus fréquent lors des infections neurologiques (30,5%) que des affections vasculaires (20,6%). Le risque de décès était d'une part plus élevé en cas d'infection neurologique qu'en cas d'accident vasculaire cérébral et d'autre part plus élevé en cas d'infection par rapport à toutes les autres affections. Les létalités les plus élevées étaient observées pour les ME (52,1%), les polyradiculoneuropathies (50%) et les encéphalites (34,2%). Conclusion: Dans notre étude les affections infectieuses et vasculaires sont prédominantes. Des études ultérieures seront utiles pour conforter la fréquence de ces affections et analyser la prise en charge de celles qui sont les plus létales. ABSTRACT Objective: To identify aetiologies and diagnosis of neurological diseases and describe their progress at neurology hospitalization. Methods: A retrospective analysis of medical back-rest of subjects admitted at the inpatients unit of Cocody neurological service between the 1st December 1998 and the 31th December 2000. Results: One thousand and eighteen patients with an average age of 45 ±17,7 years (ranged from 1 to 93 years) and a sex ratio of 1,7 were included in this study. These patients mostly transfered from the casualty department (65,2%) had a mean length hospital stay 12,5± 9,6 days (ranged from 1 to 68). The main diagnosis where: a stroke (42,1%), a cerebral abscess (17,9%) and a meningoencephalitis (ME) for 11,9%. Global letality during hospital stay was about 23,5% with a death more frequent for infectious (30,5%) than for vascular diseases (20,6%). Death risk was in the one hand higher for neurological infectious than for stroke and in the second hand higher for neurological infectious than for all other diseases. Highest letality were observed for ME (52,1%), polyradiculoneuropathies (50%) and encephalitis (34,2%). Conclusion: In our study infectious and vascular diseases were predominant. Studies are necessary to strengthen the frequency of these diseases and to analyse the management of the most lethal of them. Key Words: Afrique, Epid้miologie, Neurologie, Africa, Epidemiology, Neurology African Journal of Neurological Sciences Vol.23(2) 200

Prevalence des troubles cognitifs et démences chez les personnes âgées à Bangui en République Centrafricaine.

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Prevalence of dementia among elderly people living in Cotonou, an urban area of Benin (West Africa)

International audienceBackground/Aims: The population of Benin is, like those of most developing countries, aging; dementia is therefore a major concern. Our goal was to estimate the prevalence of dementia in an elderly population living in urban Benin. Methods: In a cross-sectional community-based study, people aged 65 years and above were screened using the Community Screening Interview for Dementia and the Five-Word Test. Results: The prevalence of dementia was 3.7% (95% CI 2.6-4.8) overall. The figure increased with age and was higher among women than men. Conclusion: Dementia was slightly more prevalent than previously reported in a rural area of Benin, but the rate was similar to that recorded in other cities in developing countries

Using ecological socioeconomic position (SEP) measures to deal with sample bias introduced by incomplete individual-level measures: inequalities in breast cancer stage at diagnosis as an example

International audienceBACKGROUND:When studying the influence of socioeconomic position (SEP) on health from data where individual-level SEP measures may be missing, ecological measures of SEP may prove helpful. In this paper, we illustrate the best use of ecological-level measures of SEP to deal with incomplete individual level data. To do this we have taken the example of a study examining the relationship between SEP and breast cancer (BC) stage at diagnosis.METHODS:Using population based-registry data, all women over 18 years newly diagnosed with a primary BC in 2007 were included. We compared the association between advanced stage at diagnosis and individual SEP containing missing data with an ecological level SEP measure without missing data. We used three modelling strategies, 1/ based on patients with complete data for individual-SEP (n = 1218), or 2/ on all patients (n = 1644) using an ecological-level SEP as proxy for individual SEP and 3/ individual-SEP after imputation of missing data using an ecological-level SEP.RESULTS:The results obtained from these models demonstrate that selection bias was introduced in the sample where only patients with complete individual SEP were included. This bias is redressed by using ecological-level SEP to impute missing data for individual SEP on all patients. Such a strategy helps to avoid an ecological bias due to the use of aggregated data to infer to individual level.CONCLUSION:When individual data are incomplete, we demonstrate the usefulness of an ecological index to assess and redress potential selection bias by using it to impute missing individual SEP