Impairment in Activities of Daily Living and Unmet Need for Care Among Older Adults: A Population-Based Study From Burkina Faso.

OBJECTIVES: The importance of impairment in performing activities of daily living (ADL) is likely to increase in sub-Saharan Africa because few care options for affected people exist. This study investigated the prevalence of ADL impairment, the extent to which care need was met, and described characteristics of people with ADL impairment and unmet need in Burkina Faso. METHODS: This study used data from the Centre de Recherche en Santé de Nouna Heidelberg Aging Study, a population-based study among 3,026 adults aged older than 40 years conducted in rural Burkina Faso. Information on 6 basic ADL items was sought, with a follow-up question asking whether care need was not met, partially met, or met. Bivariable correlations and multivariable logistic regression were used to determine sociodemographic and health characteristics associated with ADL impairment and unmet need. RESULTS: ADL impairment of any kind was reported by 1,202 (39.7%) respondents and was associated with older age (adjusted odds ratio: 1.05 [95% CI: 1.04-1.06]), being a woman (1.33 [1.06-1.60]), and reporting depressive symptoms (1.90 [1.65-2.18]). Among those with ADL impairment, 67.8% had at least one unmet need. Severe ADL impairment was found in 202 (6.7%) respondents, who reported a lower prevalence of unmet need (43.1%). Severe ADL impairment was associated with depressive symptoms (2.55 [2.11-3.07]) to a stronger degree than any ADL impairment. DISCUSSION: Prevalence of ADL impairment and unmet need was high in this setting. Variation in impairment across the population highlighted key groups for future interventions. Unmet need for care was highest in middle-aged adults, indicating a gap in care provision.

Depressive symptoms and cardiovascular disease: a population-based study of older adults in rural Burkina Faso.

OBJECTIVES: To contribute to the current understanding of depressive disorders in sub-Saharan African (SSA) countries by examining the association of depressive symptoms with cardiovascular and cardiometabolic conditions in a population-based study of middle-aged and older adults in rural Burkina Faso. SETTING: This study was conducted in the Nouna Health and Demographic Surveillance System in north-western Burkina Faso, in a mixed rural and small-town environment. The data were obtained between May and July 2018. PARTICIPANTS: Consenting adults over 40 years of age (n=3026). PRIMARY AND SECONDARY OUTCOME MEASURES: Depressive symptoms were assessed using the Patient Health Questionnaire depression module (PHQ-9). Chronic cardiometabolic conditions were assessed via a lipid panel and glycated haemoglobin measures from serum, alongside anthropometry and blood pressure measurements and a self-reported questionnaire. Multivariable linear regression was used to test the relationship between depressive symptoms and cardiovascular/cardiometabolic conditions after controlling for sociodemographic factors. RESULTS: Depressive symptoms were not associated with the metabolic syndrome (standardised beta coefficient=0.00 (95% CI -0.04 to 0.03)), hypertension (beta=0.01 (95% CI -0.02 to 0.05)), diabetes mellitus (beta=0.00 (95% CI -0.04 to 0.04)) and past diagnosis of elevated blood pressure or blood sugar. Prior stroke diagnosis (beta=0.04 (95% CI 0.01 to 0.07)) or heart disease (beta=0.08 (95% CI 0.05 to 0.11)) was positively associated with the standardised PHQ-9 score as were self-reported stroke symptoms. CONCLUSION: Objectively measured cardiometabolic conditions had no significant association with depressive symptoms in an older, poor, rural SSA population, in contrast to observations in high income countries. However, consequences of cardiovascular disease such as stroke and heart attack were associated with depressive symptoms in older adults in Burkina Faso.

The functional organization of human epileptic hippocampus.

The function and connectivity of human brain is disrupted in epilepsy. We previously reported that the region of epileptic brain generating focal seizures, i.e., the seizure onset zone (SOZ), is functionally isolated from surrounding brain regions in focal neocortical epilepsy. The modulatory effect of behavioral state on the spatial and spectral scales over which the reduced functional connectivity occurs, however, is unclear. Here we use simultaneous sleep staging from scalp EEG with intracranial EEG recordings from medial temporal lobe to investigate how behavioral state modulates the spatial and spectral scales of local field potential synchrony in focal epileptic hippocampus. The local field spectral power and linear correlation between adjacent electrodes provide measures of neuronal population synchrony at different spatial scales, ∼1 and 10 mm, respectively. Our results show increased connectivity inside the SOZ and low connectivity between electrodes in SOZ and outside the SOZ. During slow-wave sleep, we observed decreased connectivity for ripple and fast ripple frequency bands within the SOZ at the 10 mm spatial scale, while the local synchrony remained high at the 1 mm spatial scale. Further study of these phenomena may prove useful for SOZ localization and help understand seizure generation, and the functional deficits seen in epileptic eloquent cortex.

Forecasting seizures in dogs with naturally occurring epilepsy.

Seizure forecasting has the potential to create new therapeutic strategies for epilepsy, such as providing patient warnings and delivering preemptive therapy. Progress on seizure forecasting, however, has been hindered by lack of sufficient data to rigorously evaluate the hypothesis that seizures are preceded by physiological changes, and are not simply random events. We investigated seizure forecasting in three dogs with naturally occurring focal epilepsy implanted with a device recording continuous intracranial EEG (iEEG). The iEEG spectral power in six frequency bands: delta (0.1-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), beta (12-30 Hz), low-gamma (30-70 Hz), and high-gamma (70-180 Hz), were used as features. Logistic regression classifiers were trained to discriminate labeled pre-ictal and inter-ictal data segments using combinations of the band spectral power features. Performance was assessed on separate test data sets via 10-fold cross-validation. A total of 125 spontaneous seizures were detected in continuous iEEG recordings spanning 6.5 to 15 months from 3 dogs. When considering all seizures, the seizure forecasting algorithm performed significantly better than a Poisson-model chance predictor constrained to have the same time in warning for all 3 dogs over a range of total warning times. Seizure clusters were observed in all 3 dogs, and when the effect of seizure clusters was decreased by considering the subset of seizures separated by at least 4 hours, the forecasting performance remained better than chance for a subset of algorithm parameters. These results demonstrate that seizures in canine epilepsy are not randomly occurring events, and highlight the feasibility of long-term seizure forecasting using iEEG monitoring.

Hypertelorism: the importance of three-dimensional imaging and trends in the surgical correction by facial bipartition.

BACKGROUND: The technique of facial bipartition has been considered a great advance in achieving a more natural appearance in hypertelorism correction. METHODS: Fourteen patients who had undergone hypertelorism correction by facial bipartition were retrospectively studied to analyze the role of three-dimensional computed tomographic reconstruction in the evaluation of the deformity and preoperative planning. The procedure and surgical details that can improve the outcome were described. A reproducible set of three-dimensional measurements that can help in preoperative patient evaluation was determined based on information obtained using the Analyze/AVW 3.1 system (Biomedical Imaging Resource, Mayo Foundation, Rochester, Minn.). RESULTS: In this series, the most common diagnosis was frontonasal dysplasia (64.3 percent). Five patients had second-degree (35.7 percent) and nine had third-degree hypertelorism (64.3 percent). The three-dimensional scans were shown to be highly accurate in predicting the degree of deformity. There was a significant difference in the preoperative and postoperative interdacryon distance and midface height (p < 0.05) but not in the bitemporal distance (p = 0.08). The simulation correlated significantly with the postoperative result when interdacryon distance and midface height were analyzed (0.736 and 0.999). CONCLUSIONS: Facial bipartition provided a three-dimensional correction of hypertelorism. Three-dimensional imaging can definitely be considered an extra tool for accurate surgical planning and helping the family understand the surgical procedure and the end result.