Biomedical subjects

C Helmer

Publications and source records attributed to C Helmer.

At least 19 recordsLinked to original sources

PubMed2006

Characteristics of undiagnosed diabetes in community-dwelling French elderly: the 3C study.

We aimed to assess clinical and socio-demographic characteristics of undiagnosed diabetes, including glucose control, in French community-living elderly people. Diagnosed and undiagnosed diabetes, impaired fasting glucose (IFG) and characteristics of subjects were assessed by interview, clinical examination and fasting blood glucose measures at the baseline visit of the Three-City (3C) study including 9294 people over 65 in three urban areas in France. In the Bordeaux sample, HbA1c was measured in diabetic and IFG subjects and in a sub-sample of non-diabetic subjects. The proportion of diagnosed diabetes, undiagnosed diabetes and IFG was, respectively, 8.2%, 1.4% and 3.6%. Diabetic and IFG subjects were more likely to be men, to suffer from hypertension and to be overweight. They were less likely to have a high income and more likely to have a lower educational level. These factors were unrelated to knowledge of diabetic status. In the Bordeaux sub-sample, 19.6% of the diagnosed diabetic subjects and 16.1% of those undiagnosed had an HbA1c greater than 8%. Prevalence of ischemic heart disease was more common in diagnosed than in undiagnosed diabetic subjects (P=.021). A significant number of undiagnosed elderly had poor glucose control suggesting a potential benefit for diabetes screening in the elderly.

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PubMed2006

[Quasi-experimental evaluation of a nutritional educational intervention among home support assistants for the elderly].

BACKGROUND: The French National Program on Nutrition and Health has defined two specific objectives targeting older persons: (i) to improve their status in calcium and vitamin D and (ii) to prevent undernutrition. Home help provides support in activities of daily living, including meals, to dependent persons. The objective of our study was to evaluate the impact of a nutritional education intervention on knowledge and practices among home support assistants for the elderly. METHODS: Three facilities providing home support in Gironde (France) selected 132 home support assistants to follow an education program and 134 controls. Nutrition training was conducted in the intervention group by a dietician during two half-day sessions in May-June 2004. A non randomized controlled trial design was used for evaluation. Nutritional knowledge (20 questions) and practice (5 questions) of home support assistants were assessed by questionnaire before (April 2004) and after (September 2004) the training period in each group. Satisfaction of the intervention group was also assessed. RESULTS: The intervention group included 101 participants and the control group 106 persons who answered both questionnaires before and after the education program. The intervention group was significantly younger (p < 0.05), less educated (p = 0.01) and had less often participated to previous nutrition training (p < 0.001) than the control group. There was no significant difference between the two groups before intervention for their mean scores of knowledge or practices. The intervention group significantly improved its knowledge score (mean gain 2.5 points, p < 0.001) after the training period, whereas the score remained unchanged in the control group (mean gain 0.5 points, p = 0.06). The impact of the nutritional education was very significant (p < 0.0001) after adjustment for the characteristics which differed between the two groups. The practice scores did not differ significantly after intervention in multivariate analyses. Satisfaction of trained home support assistants was very high. CONCLUSION: An education program of home support assistants for elderly persons can improve their nutritional knowledge, but this study cannot conclude that the intervention was efficient to improve the nutritional status of older persons.

Adult↗

PubMed2004

Nutritional factors and risk of incident dementia in the PAQUID longitudinal cohort.

PURPOSE: The aim of this study was to present a summary of the results obtained in the PAQUID study regarding wine consumption, fish and seafood consumption and vitamin A and E plasma concentrations. METHODS: This study was carried out from the PAQUID (Personnes Agees QUID) cohort, an epidemiological study on cognitive and functional aging after 65 years in Southwestern France. The relationship between nutritional factors and risk of incident dementia was measured using logistic regression or Cox proportional hazards models on different subsamples of the cohort. RESULTS: Among 2950 initially non-demented subjects, moderate drinkers had a decreased relative risk of developing a dementia in the subsequent 8 years (RR=0.56) compared to non-drinkers. In a sub-sample of 1416 subjects, those who ate fish or seafood at least once a week had a significant reduced risk of incident dementia adjusted for age and sex (RR=0.66). Lastly, a nested casecontrol study was performed among 182 subjects. Adjusted for confounders, the risk of dementia was significantly increased for the lowest vitamin E concentration compared to the highest one (OR=2.54). DISCUSSION: These results are in agreement with a possible protective role of a diet rich in poly-unsaturated fats and antioxidant components. However, confounding factors such as education and lifestyle may be involved and should be further explored.

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PubMed2004

Nutritional status of older Tibetans in rural Sichuan China.

OBJECTIVE: To examine the nutritional status of older Tibetans in rural China. DESIGN: Cross sectional study. SETTING: Remote mountainous region of Sichuan province of Western China. SUBJECTS AND METHOD: Forty four male and forty six female Tibetans, over 60 years old were recruited. Body weight, standing height, triceps and bicep skinfold thicknesses (TSF, BSF), mid arm circumference (MAC) and waist circumference (WC) were measured. Dietary intakes were assessed by a twenty-four hour dietary recall. Based on skinfold thicknesses and MAC, total body fat and corrected arm muscle area (CAMA) were calculated by published equations. Their nutritional status and dietary intakes were compared with those of normal older people in Hong Kong and a rural area near Tianjin in the east coast of China. RESULTS: Compared with Hong Kong older women, the Tibetan older women had similar BMI and total body fat, but their CAMA was significantly greater (p<0.01). The Tibetan older men had lower BMI, total body fat (p<0.05), and higher CAMA than the Hong Kong older men (p<0.05). The average calorie intake in the Tibetans was lower than that of older people in Hong Kong and rural Tianjin. Intakes of protein, vitamins and minerals were the lowest in Tibetans and the highest in older people in Hong Kong. CONCLUSIONS: Older Tibetans had more lean mass than Hong Kong older Chinese despite having lower caloric and protein intakes. Older Tibetan women were fatter than their male counterparts, and they were as fat as the older people in Hong Kong, despite having low caloric intakes.

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PubMed2003

Association between antioxidant nutritional indicators and the incidence of dementia: results from the PAQUID prospective cohort study.

OBJECTIVE: To analyse the relation between antioxidant vitamins A, E, and malondialdehyde (MDA) lipoperoxidation product plasma concentrations with incident dementia. DESIGN: : A nested case-control within the PAQUID (Personnes Agées QUID) cohort. SETTING: The PAQUID population-based prospective cohort in southwestern France. SUBJECTS: Among 626 subjects with blood collection at baseline, 46 developed a dementia during the follow-up and were considered to be cases. Each case was matched (on age and sex) to three controls. RESULTS: Plasma vitamin E concentrations were lower among cases (mean value at 22.62 micromol/l (s.d.: 7.38) vs 24.99 (s.d.: 6.73 among controls). The same trend was observed for vitamin A concentrations, but the difference was not significant. On the contrary, MDA concentrations tended to be higher (mean value 1.35 micromol/l (s.d.: 0.53) vs 1.23 (s.d.: 0.44)) among cases. In logistic regression models, plasma values were split into tertiles. Adjusted for confounders, the risk of dementia was significantly increased in the lowest vitamin E tertile (< or =21.0 micromol/l) (OR=3.12, P=0.033) compared to the highest one (> or =25.5 micromol/l). The risk of Alzheimer's disease was also increased, with borderline significance (OR=3.06, P=0.053). Risks associated with vitamin A were nonsignificant. Similarly, there was a trend to an increased risk of dementia in the highest tertile of MDA (OR=1.67, P=0.31). CONCLUSIONS: These results suggest that subjects with low plasma vitamin E concentrations are at a higher risk of developing a dementia in subsequent years.

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PubMed2003

[Prevalence of dementia and Alzheimer's disease among subjects aged 75 years or over: updated results of the PAQUID cohort].

The progression of the prevalence of dementia in developed countries will increase the difficulties of medical and psycho-social management of demented patients and their family. The aim of this study was to estimate the prevalence of dementia among subjects aged 75 years and over. These subjects have been followed-up ten years after the baseline examination of the PAQUID study, a prospective population-based cohort study on normal and pathological aging after 65 years. A total of 1,461 subjects, aged 75 years and over, have been visited. The prevalence of dementia was estimated to be at 17.8 p.cent. About 38.5 p.cent of these demented subjects ware living in an institution, which leads to the fact that more than the two thirds of the subjects living in an institution were demented persons. Alzheimer's disease was the main etiology of dementia (79.6 p.cent). Based on the French population census, currently there would be about 769,000 demented people aged 75 years or over in France. Dementia accounts for 72 p.cent of the potential need for the French subvention for dependent persons, called Allocation Personnalisee d'Autonomie P. These results point out the importance of regarding dementia as a Public Health priority and of developing necessary measures for caring for these subjects, whether residing in their home or an institution.

Activities of Daily Living↗

PubMed2002

The disablement process: a conceptual framework for dementia-associated disability.

Most of the social and economic burden of dementia is attributable to its consequences in terms of disability. In this review, we describe the concepts defined in the disablement process model of Verbrugge and Jette [Soc Sci Med 1994;38:1-14] and show how they apply to dementia. The main pathway leads from pathology to impairments, functional limitations and disability. Pathologies (any cause of dementia) are expressed by impairments in specific cognitive processes. Functional limitations are limitations in generic cognitive tasks such as remembering a list of words or orientating oneself in time and space. They are responsible for disability in activities of daily living. Predisposing risk factors as well as introduced intraindividual and extraindividual factors speed up or slow down the main pathway. We show how the model can help in understanding the functional consequences of dementia, for better assessment and management of demented subjects.

Activities of Daily Living↗

PubMed2002

[Alzheimer's disease: a public health problem: yes, but a priority?].

Alzheimer's Disease is a major Public Health problem for many reasons. First, it is a frequent disease since, in France, the prevalence was estimated at about 400.000 cases, and the annual incidence at 100.000 cases. The frequency of the disease increases, in particular due to the ageing of the population. This disease has major consequences on the life of the patient and his/her caretaker. The cost of the disease is important, estimated at about 50 milliards of French francs. Pharmaceutical treatment and other interventions are possible in particular to delay the nursing home placement. On the other hand, this disease is often ignored, under-diagnosed, underestimated and exposed to inequality in resorting to care. In summary, Alzheimer's Disease (AD) has all the criteria required for a major public health problem. In spite of this observation, AD is not yet considered as a priority for health authorities, although attitudes are changing.

Accidents, Traffic↗

PubMed2001

Mortality with dementia: results from a French prospective community-based cohort.

Despite the magnitude of the problem, little is known about the duration of dementia. Survival and risk factors of mortality with dementia and the impact of dementia on the risk of death were investigated using the Personnes Agées Quid (PAQUID) prospective population-based cohort study between 1988 and 1998. Statistical models dealing with interval censoring were performed. Among 3,675 participants aged 65 years or older and initially nondemented, 2,923 have been followed up for 8 years. Of these, 281 persons with incident dementia were actively diagnosed. The mean age of onset of dementia was 82.3 years. In the total population, the relative risk of dying after developing dementia was estimated to be 1.82 (95% confidence interval (CI): 1.77, 2.68) when adjusted for sociodemographic variables and comorbidity. Deaths from cerebrovascular diseases and respiratory diseases were particularly increased among persons with dementia, compared with those without. The median survival time of the persons with dementia was estimated to be 4.5 years. Women with dementia had a longer survival than did men with dementia, particularly for Alzheimer-type dementia (relative risk = 0.47, 95% CI: 0.27, 0.83). Educational level was not significantly associated with survival in persons with dementia. These results provide further evidence of the malignancy of dementia, which will be a challenge for the 21st century.

Age of Onset↗

PubMed2001

Occupation during life and risk of dementia in French elderly community residents.

OBJECTIVE: To determine whether principal occupation during life is a risk factor for incident Alzheimer's disease, vascular dementia, or dementia with parkinsonism. METHODS: This study was carried out from the PAQUID (Personnes Agées QUID) cohort, an epidemiological study on normal and pathological aging after 65 years in the south west of France. At baseline, 2950 non-demented people living at home were identified and re-examined 1, 3, 5, 8, and 10 years later with identical standardised neurological and neuropsychological measures. Cox proportional hazards models with delayed entry were used, taking age as the time scale and adjusting for sex, education, tobacco, and wine consumption to estimate the risk ratio (RR) of incident dementia, Alzheimer's disease, vascular dementia, and dementia with parkinsonism associated with occupational category. RESULTS: Of the 2950 subjects, 393 became demented, of whom 251 had Alzheimer's disease, 112 had vascular dementia, and 27 had dementia with parkinsonism. The risk of Alzheimer's disease was not related to a given occupation. However the risk of dementia with parkinsonism seemed to be increased in farmers in comparison with professionals and managerials, particularly among women (RR 7.47; 95%CI, 1.80-31.07). CONCLUSION: The data suggest that occupation does not change the risk of Alzheimer's disease, which seems to be more influenced by cognitive abilities in childhood and adolescence than by occupation in adult life. However, being a farmer may increase the risk of dementia with parkinsonism among women; occupation could act by the way of differences in health behaviour or in exposure to environmental factors.

Age Distribution↗

PubMed2001

Single stage biological nitrogen removal by nitritation and anaerobic ammonium oxidation in biofilm systems.

In full scale wastewater treatment plants with at times considerable deficits in the nitrogen balances, it could hitherto not be sufficiently explained which reactions are the cause of the nitrogen losses and which micro-organisms participate in the process. The single stage conversion of ammonium into gaseous end-products--which is henceforth referred to as deammonification--occurs particularly frequently in biofilm systems. In the meantime, one has succeeded to establish the deammonification processes in a continuous flow moving-bed pilot plant. In batch tests with the biofilm covered carriers, it was possible for the first time to examine the nitrogen conversion at the intact biofilm. Depending on the dissolved oxygen (DO) concentration, two autotrophic nitrogen converting reactions in the biofilm could be proven: one nitritation process under aerobic conditions and one anaerobic ammonium oxidation. With the anaerobic ammonium oxidation, ammonium as electron donor was converted with nitrite as electron acceptor. The end-product of this reaction was N2. Ammonium and nitrite did react in a stoichiometrical ratio of 1:1.37, a ratio which has in the very same dimension been described for the ANAMMOX-process (1:1.31 +/- 0.06). Via the oxygen concentration in the surrounding medium, it was possible to control the ratio of nitritation and anaerobic ammonium oxidation in the nitrogen conversion of the biofilm. Both processes were evenly balanced at a DO concentration of 0.7 mg/l, so that it was possible to achieve a direct, almost complete elimination of ammonium without addition of nitrite. One part of the provided ammonium did participate in the nitritation, the other in the anaerobic ammonium oxidation. Through the aerobic ammonium oxidation into nitrite within the outer oxygen supplied layers of the biofilm, the reaction partner was produced for the anaerobic ammonium oxidation within the inner layers of the biofilm.

Bacteria, Anaerobic↗

PubMed2001

Six years' practical experience with aerobic/anoxic deammonification in biofilm systems.

Nitrogen elimination through autotrophic micro-organisms is currently in the focus of research projects on the treatment of wastewater with high nitrogen contents, for instance to be able to develop and fix dimensioning parameters for purposeful application. In fact, several industrial plants have already shown for some years that the steady operation of nitrogen elimination without carbon demand is possible. Due to the low growth rates of the participating micro-organisms, these processes can be found in particular in biofilm systems, which also allow for the simultaneous running of the two basic processes. In the following, we will discuss on the basis of the operation results of industrial and pilot-scale plants the operation stability of the aerobic/anoxic deammonification, and explain which experiences are available in particular for conversion in biofilm systems.

Bacteria, Aerobic↗

PubMed2001

[Radiation-induced stricture of the papilla and the common bile duct: successful treatment with balloon dilation].

Radiation-induced lesions of the bile ducts rarely occur and may be difficult to manage. We report the case of a 59-year old woman who developed radiation-induced stenosis of the papilla and the common bile duct 25 years after abdominal radiation therapy for abdominal non-Hodgkin's lymphoma. She presented with recurrent cholangitis and chronic cholestasis. Endoscopic results showed dilation of the intrahepatic bile ducts, radiation-induced inflammation and narrowing of the antrum and the duodenum, and stricture of the papilla and the last few millimeters of the common bile duct. The patient was treated with endoscopic balloon dilation. Forty-two months after endoscopic dilation, the patient remained asymptomatic with normal liver tests and no biliary dilation at ultrasound.

Bile Duct Diseases↗

PubMed2000

Refractory sprue, coeliac disease, and enteropathy-associated T-cell lymphoma. French Coeliac Disease Study Group.

BACKGROUND: Adult refractory sprue is a poorly defined disorder. We did a multicentre national study of patients with refractory sprue to characterise their clinical and pathological profile and outcome, and to assess the frequency and prognostic significance of phenotypic and molecular abnormalities in the intraepithelial T-cell population. METHODS: Patients with severe symptomatic villous atrophy mimicking coeliac disease but refractory to a strict gluten-free diet, and with no initial evidence of overt lymphoma, were diagnosed at gastrointestinal referral centres between 1974 and 1998. Fixed and/or frozen duodenojejunal biopsy samples were reanalysed and immunostained with CD3 and CD8 monoclonal antibodies to find out the phenotype of intraepithelial lymphocytes (IEL). TCRgamma gene rearrangements were assessed on frozen biopsy samples by multiplex fluorescent PCR. FINDINGS: There were 21 patients with refractory sprue and 20 controls with coeliacs disease. 16 (84%) of 19 assessed patients had an aberrant intraepithelial lymphoid intestinal population expressing intracytoplasmic CD3 but not surface CD8. Clonal intestinal TCRgamma gene rearrangements were found in 13 (76%) of 17 patients assessed; four (out of 12 assessed) had clonal dissemination to the blood. The 16 patients with an aberrant phenotype all had uncontrolled malabsorption; three subsequently developed overt T-cell lymphoma, and eight died. The three (16%) patients without aberrant clonal IEL made a complete clinical and histological recovery with steroid therapy plus a gluten-free diet. INTERPRETATION: An immunophenotypically aberrant clonal intraepithelial T-cell population (similar to that of most cases of enteropathy-associated T-cell lymphoma) can be found in up to 75% of patients with refractory coeliac sprue; its identification by simple diagnostic techniques represents a marker of poor outcome (including occurrence of overt T-cell lymphoma). We suggest that refractory sprue associated with an aberrant clonal IEL may be the missing link between coeliac disease and T-cell lymphoma and may be classified as cryptic enteropathy-associated T-cell lymphoma.

Adult↗

PubMed2000

Biliary varices on endoscopic ultrasonography: clinical presentation and outcome.

BACKGROUND AND STUDY AIMS: Bile duct varices are not a well-recognized feature of portal venous obstruction. The aim of the present study was to describe the clinical and endosonographic features of biliary involvement in patients with extrahepatic portal venous obstruction (EPVO). PATIENTS AND METHODS: A retrospective study was conducted of the clinical features, outcome, and endosonographic findings (using Olympus EUM-3 or EUM-20 probes) in 21 patients with EPVO and endosonographic features of biliary varices. Biliary varices were defined as multiple, large, serpiginous, anechoic vascular channels in and/or surrounding the extrahepatic biliary tracts. RESULTS: Biliary varices have not previously been visible using conventional imaging methods (computed tomography and ultrasonography). They were identified using EUS in the wall of the common bile duct in 16 patients (76%), surrounding the common bile duct (CBD) in 11 patients (52%), and in the gallbladder in nine (43%). The varices were the cause of obstructive jaundice in three of the 21 patients (14%), but only when they were in the wall of the CBD. Two of these patients were treated using portosystemic shunting, and the other received a biliary endoprosthesis. The EUS examination also provided evidence of unrecognized pancreatic or biliary tumors in three other patients with EPVO of undetermined origin. CONCLUSIONS: EUS can serve to diagnose biliary varices in patients with EPVO and jaundice. Although biliary varices are mainly asymptomatic, they may cause obstructive jaundice when they are located in the wall of the CBD. EUS can also detect unrecognized malignant tumors in patients with EPVO of undetermined origin.

Adult↗

PubMed2000

Prognosis with dementia in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group.

The effect of dementia on time to death and institutionalization in elderly populations is of importance to resource planning, as well as to patients and their carers. The authors report a collaborative reanalysis of nine population-based studies conducted in Europe to compare dementia cases and noncases in risk of and time to death and to institutionalization. Prevalent and incident cases were more likely than noncases to reside in an institution at baseline and were more likely to enter institutional care. Prevalent cases also had over twice the risk of death compared to noncases and survival for men with dementia was consistently lower than that for women with dementia of the same age group.

Age Factors↗

PubMed2000

Prognosis with Parkinson's disease in europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group.

Data are lacking on the prognosis (institutionalization and death) of PD cases identified in population-based studies. Data from five population-based European studies were compared and pooled. Each study used comparable two-step screening methods to identify cases and performed one or more follow-up examinations of their respective participants after defined periods of time. PD was classified on the basis of questionnaire and clinical data. The studies include 16,143 participants (252 with PD). The relative risk (RR) (95% CI) of death associated with PD was 2.3 (1.8 to 3.0). The risk for death in men with PD (RR 3.1 [2.1 to 4.4]) was higher than in women with PD (RR 1. 8 [1.2 to 5.1]). The rate of institutionalization varied across studies, increased with age, and was considerably higher in PD cases compared to noncases. Women with PD had a fivefold higher risk to live in a care facility than did men with PD. These data on mortality and rate of institutionalization reflect the high burden of PD in the population.

Age Factors↗

PubMed1999

Marital status and risk of Alzheimer's disease: a French population-based cohort study.

OBJECTIVE: To analyze the relationship between marital status and risk of AD or dementia. METHODS: This study was carried out from the Personnes Agées QUID (PAQUID) cohort, an epidemiologic study on normal and pathologic aging after age 65 years. The PAQUID cohort began in 1988. Individuals were followed up at 1, 3, and 5 years, with an active detection of dementia. Marital status was divided into four categories: widowed, never married, divorced or separated, and the reference category, married or cohabitant. The longitudinal relationship between marital status and risk of incident AD or dementia was analyzed by a Cox model with delayed entry. RESULTS: Among the 3,675 individuals initially not demented, 2,106 were married or cohabitants, 1,287 were widowers, 179 were never married, and 103 were divorced or separated. Among the 2,881 individuals reevaluated at least once for the risk of dementia during the 5-year follow-up, 190 incident cases of dementia were identified, including 140 with AD. The relative risks (RRs) of dementia (RR = 1.91, p = 0.018) and of AD (RR = 2.68, p<0.001) were increased for the never-married individuals compared with those who were married or cohabitants. This excess of risk was specifically associated with AD. Adjustment for other risk factors of dementia (education, wine consumption), or for factors reflecting social environment, leisure activities, and depression, did not modify the risk of AD for never-married individuals (RR = 2.31, p = 0.02). CONCLUSIONS: We confirmed an association between marital status and AD, with an excess risk observed among never-married individuals. This association may provide clues about the pathogenesis of AD.

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