International Journal of Environmental Research and Public Health, May 17, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Distributed under a Creative Commons Attribution-NonCommercial| 4.0 International License
Background: This article describes the setting-up process for nurse-led pilot clinics for the man... more Background: This article describes the setting-up process for nurse-led pilot clinics for the management of four chronic diseases: asthma, type 2 diabetes mellitus, epilepsy and hypertension at the primary health care level in urban and rural Cameroon. Methods: The Biyem-Assi urban and the Bafut rural health districts in Cameroon served as settings for this study. International and local guidelines were identified and adapted to the country's circumstances. Training and follow-up tools were developed and nurses trained by experienced physicians in the management of the four conditions. Basic diagnostic and follow-up materials were provided and relevant essential drugs made available. Results: Forty six nurses attended six training courses. By the second year of activity, three and four clinics were operational in the urban and the rural areas respectively. By then, 925 patients had been registered in the clinics. This represented a 68.5% increase from the first year. While the rural clinics relied mainly on essential drugs for their prescriptions, a prescription pattern combining generic and proprietary drugs was observed in the urban clinics. Conclusion: In the quest for cost-effective health care for NCD in sub-Saharan Africa, rethinking health workforce and service delivery has relevance. Nurse-led clinics, algorithm driven service delivery stands as alternatives to overcome the shortage of trained physicians and other issues relating to access to care.
Objective: To evaluate habitual dietary intakes in patients with established hypertension, dyslip... more Objective: To evaluate habitual dietary intakes in patients with established hypertension, dyslipidemia and/or overweight. Methods: A national sample of 6167 French free-living patients, aged 45-65 years, in whom daily food and nutrient intakes (24-h records) and clinical status were regularly monitored between 1994 and 2002. Results: For each disorder, affected patients have reduced fat and energy intakes compared with nonaffected participants after adjustment for confounding factors. In addition, after further adjustment for energy intake, dyslipidemic patients eat less cheeses, sweets, eggs and appetizers, whereas overweight patients eat less bread and sweets, more yoghurts, vegetables, meats and poultries in comparison to their nonaffected counterparts. By contrast, hypertensive patients drink more wines and less milk, eat less yoghurts, fruits and vegetables, more processed meats than participants without hypertension. Nutrient intakes also reflect these distinctive eating patterns as shown by reduced carbohydrate intake and increased protein and mineral intakes in overweight patients and increased alcohol intake and decreased mineral intakes in hypertensives when compared with nonaffected participants. Among affected patients, antihypertensive and hypolipidemic drug treatments are not associated with additional differences in daily food and nutrient intakes except eggs that are consumed in smaller amounts by treated dyslipidemic patients. Conclusion: Hypertensive patients maintain an unhealthy eating pattern that tends to perpetuate their disorder in contrast to dyslipidemic or overweight patients who adopt more protective diets. The origin of this behavioural difference and poor adherence to practice guidelines between hypertensives and other cardiovascular risk patients needs to be investigated.
In the course of our PubMed searches and preprints from MedRxiv, we identified a number of protoc... more In the course of our PubMed searches and preprints from MedRxiv, we identified a number of protocols for RCTs on preventive measures and treatments for Covid-19. This file is updated regularly.
In the course of our PubMed searches and prepreints from MedRxiv, we identified a number of RCTs ... more In the course of our PubMed searches and prepreints from MedRxiv, we identified a number of RCTs and non-randomized studies on preventive measures and treatments for Covid-19 that we have included in our systematic review. This file is updated regularly.
In the course of our PubMed searches we identified and screened the title and abstract of a numbe... more In the course of our PubMed searches we identified and screened the title and abstract of a number of studies on Covid-19 that were finally excluded from our systematic review. This file will be updated regularly.
In the course of our PubMed searches and preprints from MedRxiv, we identified a number of observ... more In the course of our PubMed searches and preprints from MedRxiv, we identified a number of observational studies on preventive measures and treatments for Covid-19 that we have included in our systematic review. This file is updated regularly.
background: Many NSTEACS patients are medically managed without coronary revascularization. The r... more background: Many NSTEACS patients are medically managed without coronary revascularization. The reasons vary and may impact prognosis. methods: EPICOR Asia (NCT01361386) is a prospective study of hospital survivors post ACS enrolled in 219 hospitals from 8 countries/ regions in Asia (06/2011-05/2012). All medically managed NSTEACS patients in EPICOR Asia were classified into 3 groups: 1) no coronary angiography (CAG-); 2) non-significant coronary artery disease (CAD) on angiogram (CAG+ CAD-); and 3) significant CAD (CAG+ CAD+). We compared baseline differences between groups, and report 1-y mortality rates. Results: Of 6,164 NSTEACS patients, 2,272 (37%) were medically managed only, with 1,339 (59%), 254 (11%) and 679 (30%) patients in the CAG-, CAG+ CAD-, and CAG+ CAD+ groups, respectively. There were marked differences in number of NSTEACS patients medically managed among the 8 countries/regions (13-81%). Between-group differences were seen in baseline characteristics (Table). CAG+ CADpatients were younger with fewer CV risk factors than CAG+ CAD+. CAG-patients were older, more likely with known CV disease, more frequently admitted to hospitals with no cath lab, and had the highest 1-y mortality (6.9% versus 3.3% for EPICOR Asia overall). conclusion: NSTEACS patients who are medically managed are a heterogeneous group with different clinical features and outcomes e.g. mortality risk. The factors underlying different management strategies, and to improve prognosis, need to be identified.
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.
Journal of Epidemiology and Community Health, Aug 19, 2009
Background Hypertension is becoming increasingly important in sub-Saharan Africa. However, eviden... more Background Hypertension is becoming increasingly important in sub-Saharan Africa. However, evidences in support of this trend with time are still not available. The aim of this study was to evaluate the 10-year change in blood pressure levels and prevalence of hypertension in rural and urban Cameroon. Methods Two cross sectional population-based surveys in Yaounde (urban area) and Evodoula (rural area) in 1994 (1762 subjects) and 2003 (1398 subjects) used similar methodologies in women and men aged 24 years. Data on systolic and diastolic blood pressures (SBP ≥ and DBP), body mass index, educational level, alcohol consumption and tobacco smoking were collected during the two periods. Results Between 1994 and 2003, blood pressure levels significantly increased in rural women (SBP 18.2 mmHg, DBP 11.9 mmHg) and men + + (SBP 18.8 mmHg, DBP 11.6 mmHg), all p<0.001. In the urban area, SBP increased in women (8.1 mmHg, p<0.001) and men (6.5 + + + + mmHg, p<0.001), and DBP increased only in women (3.3 mmHg, p<0.001). The odds ratio (95 CI) adjusted on confounders + % comparing the prevalence of hypertension (blood pressure 140/90 mmHg and/or treatment) between 2003 and 1994 ranged from 1.5 ≥ (1.1 2.2) in urban men to 5.3 (3.2 8.9) in rural men.-Discussion Blood pressure levels of this population have deteriorated over time and the prevalence of hypertension has increased by two to five folds. Adverse effects of risk factors could account for some of these changes. Prevention and control programs are needed to reverse these trends and to avoid the looming complications.
Participants with at least two valid dietary records during the first two years of follow-up 107,... more Participants with at least two valid dietary records during the first two years of follow-up 107,996 participants with at least two valid dietary records during the first two years of follow-up not under-reporters 105,551 participants 83,559 (79%) female and 21,992 (21%) male 21,796 Under-energy reporters 274 participants with prevalent type 1 diabetes 1698 participants with prevalent type 2 diabetes 473 participants with missing data for type 2 diabetes
To the Editors: Sub-Saharan Africa (SSA) has an estimated shortfall of health workers equivalent ... more To the Editors: Sub-Saharan Africa (SSA) has an estimated shortfall of health workers equivalent to a need to more than doubling its current workforce. The time required to train new professionals, the inadequate number of training facilities, and the pressing demand emphasize the need for innovative short-term approaches to health care in SSA. Task shifting has been recognized as one of such approaches (World Health Organisation 2007, 2008). Task shifting is a process of delegation whereby tasks are moved, where appropriate, to less specialized health workers (World Health Organisation, 2008). Through this reorganization, available human health resources are used efficiently. Task shifting is already the basis for infectious diseases care in SSA, and has been implemented for chronic diseases. Relevant contributions for epilepsy were published in Epilepsia in 2008 (Kendall-Taylor et al., 2008; Kengne et al., 2008a) together with accompanying commentaries (Birbeck, 2008; Odermatt et al., 2008; Selassie, 2008). Kengne et al. suggested that their nurseled epilepsy care experience was the first documented in Cameroon (Kengne et al., 2008a). Following this, Njamnshi (2009) argued that nurse-led care for epilepsy has been implemented elsewhere in Cameroon. However, he referred to a model of care wherein patients with epilepsy were followed by general practitioners and neurologists (Dongmo et al., 2003). It is important to note that only neurologists were allowed to modify the treatments. The task shifting claimed by Njamnshi does not fit within the model he tends to describe. It is completely out of the scope of task shifting to lower-grade human health resources. His study was based on 44% less participants than that of the study of Kengne et al., and he did not provide clear definitions of processes of care and monitoring. Therefore, further comparison may be misleading. Njamnshi also referred to a model we developed to integrate chronic diseases care with the health system in Cameroon. The diabetes component of the model was published both in ‘‘Diabetes International’’ (Awah et al., 2007) and ‘‘Diabetes Voice’’ (Njamnshi et al., 2006). Building on this diabetes model to develop a national plan for epilepsy in Cameroon is a sound idea, since approaches to chronic diseases are transferable. However, care choices for chronic diseases in SSA must probably favor integrated models over single-disease ones. Single-disease programs are inefficient in a number of respects, given that many such programs involve the same patient populations, settings, or provider. We have demonstrated in Cameroon that integrated chronic diseases care was achievable at the primary level through task shifting. In addition to providing care for epilepsy (Kengne et al., 2008a), within the same package, the same nurses provided acceptable care for asthma (Kengne et al., 2008b), diabetes, and hypertension (Kengne et al., 2009). However, implementing the integrated approach to chronic care in SSA would require collaborative efforts, which would require that specialist physicians see beyond artificial boundaries of specific organ diseases. Therefore, the diabetes model in Cameroon, in addition to informing plans for other chronic diseases, could potentially serve as the foundation and backbone for a comprehensive national chronic diseases program.
Importance Ultraprocessed foods (UPF) are widespread in Western diets. Their consumption has been... more Importance Ultraprocessed foods (UPF) are widespread in Western diets. Their consumption has been associated in recent prospective studies with increased risks of all-cause mortality and chronic diseases such as cancer, cardiovascular diseases, hypertension, and dyslipidemia; however, data regarding diabetes is lacking. Objective To assess the associations between consumption of UPF and risk of type 2 diabetes (T2D). Design, Setting, and Participants In this population-based prospective cohort study, 104 707 participants aged 18 years or older from the French NutriNet-Santé cohort (2009-2019) were included. Dietary intake data were collected using repeated 24-hour dietary records (5.7 per participant on average), designed to register participants' usual consumption for more than 3500 different food items. These were categorized according to their degree of processing by the NOVA classification system. Main Outcomes and Measures Associations between UPF consumption and risk of T2D were assessed using cause-specific multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors). Results A total of 104 707 participants (21 800 [20.8%] men and 82 907 [79.2%] women) were included. Mean (SD) baseline age of participants was 42.7 (14.5) years. Absolute T2D rates in the lowest and highest UPF consumers were 113 and 166 per 100 000 person-years, respectively. Consumption of UPF was associated with a higher risk of T2D (multi-adjusted hazard ratio [HR] for an absolute increment of 10 in the percentage of UPF in the diet, 1.15; 95% CI, 1.06-1.25; median follow-up, 6.0 years; 582 252 person-years; 821 incident cases). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet, for other metabolic comorbidities (HR, 1.13; 95% CI, 1.03-1.23), and for weight change (HR, 1.13; 95% CI, 1.01-1.27). The absolute amount of UPF consumption (grams per day) was consistently associated with T2D risk, even when adjusting for unprocessed or minimally processed food intake (HR for a 100 g/d increase, 1.05; 95% CI, 1.02-1.08). Conclusions and Relevance In this large observational prospective study, a higher proportion of UPF in the diet was associated with a higher risk of T2D. Even though these results need to be confirmed in other populations and settings, they provide evidence to support efforts by public health authorities to recommend limiting UPF consumption. Trial Registration ClinicalTrials.gov Identifier: NCT03335644.
upon Tyne, UK OBJECTIVE: To evaluate and compare physical activity patterns of urban and rural dw... more upon Tyne, UK OBJECTIVE: To evaluate and compare physical activity patterns of urban and rural dwellers in Cameroon, and study their relationship with obesity, diabetes and hypertension. METHODS: We studied 2465 subjects aged ! 15 y, recruited on the basis of a random sampling of households, of whom 1183 were urban dwellers from Yaoundé, the capital city of Cameroon and 1282 rural subjects from Bafut, a village of western Cameroon. They all had an interviewer-administered questionnaire for the assessment of their physical activity and anthropometric measurements, blood pressure and fasting blood glucose determination. The procedure was satisfactorily completed in 2325 (94.3%) subjects. Prevalences were age-adjusted and subjects compared according to their region, sex and age group. RESULTS: Obesity was diagnosed in 17.1 and 3.0% urban and rural women, respectively (P < 0.001), and in 5.4 vs 1.2% urban and rural men, respectively (P < 0.001). The prevalence of hypertension was significantly higher in urban vs rural dwellers (11.4 vs 6.6% and 17.6 vs 9.1% in women and men, respectively; P < 0.001). Diabetes was more prevalent in urban compared to rural women (P < 0.05), but not men. Urban subjects were characterized by lower physical activity (P < 0.001), light occupation, high prevalence of multiple occupations, and reduced walking and cycling time compared to rural subjects. Univariate analysis showed significant associations between both physical inactivity and obesity and high blood pressure. The relationship of physical inactivity with hypertension and obesity were independent in both urban and rural men, but not in women. Body mass index, blood pressure and glycaemia were higher in the first compared with the fourth quartiles of energy expenditure. CONCLUSION: Obesity, diabetes and hypertension prevalence is higher in urban compared to rural dwellers in the populations studied. Physical activity is significantly lower and differs in pattern in urban subjects compared to rural. Physical inactivity is associated with these diseases, although not always significant in women.
International Journal of Environmental Research and Public Health, May 17, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Distributed under a Creative Commons Attribution-NonCommercial| 4.0 International License
Background: This article describes the setting-up process for nurse-led pilot clinics for the man... more Background: This article describes the setting-up process for nurse-led pilot clinics for the management of four chronic diseases: asthma, type 2 diabetes mellitus, epilepsy and hypertension at the primary health care level in urban and rural Cameroon. Methods: The Biyem-Assi urban and the Bafut rural health districts in Cameroon served as settings for this study. International and local guidelines were identified and adapted to the country's circumstances. Training and follow-up tools were developed and nurses trained by experienced physicians in the management of the four conditions. Basic diagnostic and follow-up materials were provided and relevant essential drugs made available. Results: Forty six nurses attended six training courses. By the second year of activity, three and four clinics were operational in the urban and the rural areas respectively. By then, 925 patients had been registered in the clinics. This represented a 68.5% increase from the first year. While the rural clinics relied mainly on essential drugs for their prescriptions, a prescription pattern combining generic and proprietary drugs was observed in the urban clinics. Conclusion: In the quest for cost-effective health care for NCD in sub-Saharan Africa, rethinking health workforce and service delivery has relevance. Nurse-led clinics, algorithm driven service delivery stands as alternatives to overcome the shortage of trained physicians and other issues relating to access to care.
Objective: To evaluate habitual dietary intakes in patients with established hypertension, dyslip... more Objective: To evaluate habitual dietary intakes in patients with established hypertension, dyslipidemia and/or overweight. Methods: A national sample of 6167 French free-living patients, aged 45-65 years, in whom daily food and nutrient intakes (24-h records) and clinical status were regularly monitored between 1994 and 2002. Results: For each disorder, affected patients have reduced fat and energy intakes compared with nonaffected participants after adjustment for confounding factors. In addition, after further adjustment for energy intake, dyslipidemic patients eat less cheeses, sweets, eggs and appetizers, whereas overweight patients eat less bread and sweets, more yoghurts, vegetables, meats and poultries in comparison to their nonaffected counterparts. By contrast, hypertensive patients drink more wines and less milk, eat less yoghurts, fruits and vegetables, more processed meats than participants without hypertension. Nutrient intakes also reflect these distinctive eating patterns as shown by reduced carbohydrate intake and increased protein and mineral intakes in overweight patients and increased alcohol intake and decreased mineral intakes in hypertensives when compared with nonaffected participants. Among affected patients, antihypertensive and hypolipidemic drug treatments are not associated with additional differences in daily food and nutrient intakes except eggs that are consumed in smaller amounts by treated dyslipidemic patients. Conclusion: Hypertensive patients maintain an unhealthy eating pattern that tends to perpetuate their disorder in contrast to dyslipidemic or overweight patients who adopt more protective diets. The origin of this behavioural difference and poor adherence to practice guidelines between hypertensives and other cardiovascular risk patients needs to be investigated.
In the course of our PubMed searches and preprints from MedRxiv, we identified a number of protoc... more In the course of our PubMed searches and preprints from MedRxiv, we identified a number of protocols for RCTs on preventive measures and treatments for Covid-19. This file is updated regularly.
In the course of our PubMed searches and prepreints from MedRxiv, we identified a number of RCTs ... more In the course of our PubMed searches and prepreints from MedRxiv, we identified a number of RCTs and non-randomized studies on preventive measures and treatments for Covid-19 that we have included in our systematic review. This file is updated regularly.
In the course of our PubMed searches we identified and screened the title and abstract of a numbe... more In the course of our PubMed searches we identified and screened the title and abstract of a number of studies on Covid-19 that were finally excluded from our systematic review. This file will be updated regularly.
In the course of our PubMed searches and preprints from MedRxiv, we identified a number of observ... more In the course of our PubMed searches and preprints from MedRxiv, we identified a number of observational studies on preventive measures and treatments for Covid-19 that we have included in our systematic review. This file is updated regularly.
background: Many NSTEACS patients are medically managed without coronary revascularization. The r... more background: Many NSTEACS patients are medically managed without coronary revascularization. The reasons vary and may impact prognosis. methods: EPICOR Asia (NCT01361386) is a prospective study of hospital survivors post ACS enrolled in 219 hospitals from 8 countries/ regions in Asia (06/2011-05/2012). All medically managed NSTEACS patients in EPICOR Asia were classified into 3 groups: 1) no coronary angiography (CAG-); 2) non-significant coronary artery disease (CAD) on angiogram (CAG+ CAD-); and 3) significant CAD (CAG+ CAD+). We compared baseline differences between groups, and report 1-y mortality rates. Results: Of 6,164 NSTEACS patients, 2,272 (37%) were medically managed only, with 1,339 (59%), 254 (11%) and 679 (30%) patients in the CAG-, CAG+ CAD-, and CAG+ CAD+ groups, respectively. There were marked differences in number of NSTEACS patients medically managed among the 8 countries/regions (13-81%). Between-group differences were seen in baseline characteristics (Table). CAG+ CADpatients were younger with fewer CV risk factors than CAG+ CAD+. CAG-patients were older, more likely with known CV disease, more frequently admitted to hospitals with no cath lab, and had the highest 1-y mortality (6.9% versus 3.3% for EPICOR Asia overall). conclusion: NSTEACS patients who are medically managed are a heterogeneous group with different clinical features and outcomes e.g. mortality risk. The factors underlying different management strategies, and to improve prognosis, need to be identified.
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.
Journal of Epidemiology and Community Health, Aug 19, 2009
Background Hypertension is becoming increasingly important in sub-Saharan Africa. However, eviden... more Background Hypertension is becoming increasingly important in sub-Saharan Africa. However, evidences in support of this trend with time are still not available. The aim of this study was to evaluate the 10-year change in blood pressure levels and prevalence of hypertension in rural and urban Cameroon. Methods Two cross sectional population-based surveys in Yaounde (urban area) and Evodoula (rural area) in 1994 (1762 subjects) and 2003 (1398 subjects) used similar methodologies in women and men aged 24 years. Data on systolic and diastolic blood pressures (SBP ≥ and DBP), body mass index, educational level, alcohol consumption and tobacco smoking were collected during the two periods. Results Between 1994 and 2003, blood pressure levels significantly increased in rural women (SBP 18.2 mmHg, DBP 11.9 mmHg) and men + + (SBP 18.8 mmHg, DBP 11.6 mmHg), all p<0.001. In the urban area, SBP increased in women (8.1 mmHg, p<0.001) and men (6.5 + + + + mmHg, p<0.001), and DBP increased only in women (3.3 mmHg, p<0.001). The odds ratio (95 CI) adjusted on confounders + % comparing the prevalence of hypertension (blood pressure 140/90 mmHg and/or treatment) between 2003 and 1994 ranged from 1.5 ≥ (1.1 2.2) in urban men to 5.3 (3.2 8.9) in rural men.-Discussion Blood pressure levels of this population have deteriorated over time and the prevalence of hypertension has increased by two to five folds. Adverse effects of risk factors could account for some of these changes. Prevention and control programs are needed to reverse these trends and to avoid the looming complications.
Participants with at least two valid dietary records during the first two years of follow-up 107,... more Participants with at least two valid dietary records during the first two years of follow-up 107,996 participants with at least two valid dietary records during the first two years of follow-up not under-reporters 105,551 participants 83,559 (79%) female and 21,992 (21%) male 21,796 Under-energy reporters 274 participants with prevalent type 1 diabetes 1698 participants with prevalent type 2 diabetes 473 participants with missing data for type 2 diabetes
To the Editors: Sub-Saharan Africa (SSA) has an estimated shortfall of health workers equivalent ... more To the Editors: Sub-Saharan Africa (SSA) has an estimated shortfall of health workers equivalent to a need to more than doubling its current workforce. The time required to train new professionals, the inadequate number of training facilities, and the pressing demand emphasize the need for innovative short-term approaches to health care in SSA. Task shifting has been recognized as one of such approaches (World Health Organisation 2007, 2008). Task shifting is a process of delegation whereby tasks are moved, where appropriate, to less specialized health workers (World Health Organisation, 2008). Through this reorganization, available human health resources are used efficiently. Task shifting is already the basis for infectious diseases care in SSA, and has been implemented for chronic diseases. Relevant contributions for epilepsy were published in Epilepsia in 2008 (Kendall-Taylor et al., 2008; Kengne et al., 2008a) together with accompanying commentaries (Birbeck, 2008; Odermatt et al., 2008; Selassie, 2008). Kengne et al. suggested that their nurseled epilepsy care experience was the first documented in Cameroon (Kengne et al., 2008a). Following this, Njamnshi (2009) argued that nurse-led care for epilepsy has been implemented elsewhere in Cameroon. However, he referred to a model of care wherein patients with epilepsy were followed by general practitioners and neurologists (Dongmo et al., 2003). It is important to note that only neurologists were allowed to modify the treatments. The task shifting claimed by Njamnshi does not fit within the model he tends to describe. It is completely out of the scope of task shifting to lower-grade human health resources. His study was based on 44% less participants than that of the study of Kengne et al., and he did not provide clear definitions of processes of care and monitoring. Therefore, further comparison may be misleading. Njamnshi also referred to a model we developed to integrate chronic diseases care with the health system in Cameroon. The diabetes component of the model was published both in ‘‘Diabetes International’’ (Awah et al., 2007) and ‘‘Diabetes Voice’’ (Njamnshi et al., 2006). Building on this diabetes model to develop a national plan for epilepsy in Cameroon is a sound idea, since approaches to chronic diseases are transferable. However, care choices for chronic diseases in SSA must probably favor integrated models over single-disease ones. Single-disease programs are inefficient in a number of respects, given that many such programs involve the same patient populations, settings, or provider. We have demonstrated in Cameroon that integrated chronic diseases care was achievable at the primary level through task shifting. In addition to providing care for epilepsy (Kengne et al., 2008a), within the same package, the same nurses provided acceptable care for asthma (Kengne et al., 2008b), diabetes, and hypertension (Kengne et al., 2009). However, implementing the integrated approach to chronic care in SSA would require collaborative efforts, which would require that specialist physicians see beyond artificial boundaries of specific organ diseases. Therefore, the diabetes model in Cameroon, in addition to informing plans for other chronic diseases, could potentially serve as the foundation and backbone for a comprehensive national chronic diseases program.
Importance Ultraprocessed foods (UPF) are widespread in Western diets. Their consumption has been... more Importance Ultraprocessed foods (UPF) are widespread in Western diets. Their consumption has been associated in recent prospective studies with increased risks of all-cause mortality and chronic diseases such as cancer, cardiovascular diseases, hypertension, and dyslipidemia; however, data regarding diabetes is lacking. Objective To assess the associations between consumption of UPF and risk of type 2 diabetes (T2D). Design, Setting, and Participants In this population-based prospective cohort study, 104 707 participants aged 18 years or older from the French NutriNet-Santé cohort (2009-2019) were included. Dietary intake data were collected using repeated 24-hour dietary records (5.7 per participant on average), designed to register participants' usual consumption for more than 3500 different food items. These were categorized according to their degree of processing by the NOVA classification system. Main Outcomes and Measures Associations between UPF consumption and risk of T2D were assessed using cause-specific multivariable Cox proportional hazard models adjusted for known risk factors (sociodemographic, anthropometric, lifestyle, medical history, and nutritional factors). Results A total of 104 707 participants (21 800 [20.8%] men and 82 907 [79.2%] women) were included. Mean (SD) baseline age of participants was 42.7 (14.5) years. Absolute T2D rates in the lowest and highest UPF consumers were 113 and 166 per 100 000 person-years, respectively. Consumption of UPF was associated with a higher risk of T2D (multi-adjusted hazard ratio [HR] for an absolute increment of 10 in the percentage of UPF in the diet, 1.15; 95% CI, 1.06-1.25; median follow-up, 6.0 years; 582 252 person-years; 821 incident cases). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet, for other metabolic comorbidities (HR, 1.13; 95% CI, 1.03-1.23), and for weight change (HR, 1.13; 95% CI, 1.01-1.27). The absolute amount of UPF consumption (grams per day) was consistently associated with T2D risk, even when adjusting for unprocessed or minimally processed food intake (HR for a 100 g/d increase, 1.05; 95% CI, 1.02-1.08). Conclusions and Relevance In this large observational prospective study, a higher proportion of UPF in the diet was associated with a higher risk of T2D. Even though these results need to be confirmed in other populations and settings, they provide evidence to support efforts by public health authorities to recommend limiting UPF consumption. Trial Registration ClinicalTrials.gov Identifier: NCT03335644.
upon Tyne, UK OBJECTIVE: To evaluate and compare physical activity patterns of urban and rural dw... more upon Tyne, UK OBJECTIVE: To evaluate and compare physical activity patterns of urban and rural dwellers in Cameroon, and study their relationship with obesity, diabetes and hypertension. METHODS: We studied 2465 subjects aged ! 15 y, recruited on the basis of a random sampling of households, of whom 1183 were urban dwellers from Yaoundé, the capital city of Cameroon and 1282 rural subjects from Bafut, a village of western Cameroon. They all had an interviewer-administered questionnaire for the assessment of their physical activity and anthropometric measurements, blood pressure and fasting blood glucose determination. The procedure was satisfactorily completed in 2325 (94.3%) subjects. Prevalences were age-adjusted and subjects compared according to their region, sex and age group. RESULTS: Obesity was diagnosed in 17.1 and 3.0% urban and rural women, respectively (P < 0.001), and in 5.4 vs 1.2% urban and rural men, respectively (P < 0.001). The prevalence of hypertension was significantly higher in urban vs rural dwellers (11.4 vs 6.6% and 17.6 vs 9.1% in women and men, respectively; P < 0.001). Diabetes was more prevalent in urban compared to rural women (P < 0.05), but not men. Urban subjects were characterized by lower physical activity (P < 0.001), light occupation, high prevalence of multiple occupations, and reduced walking and cycling time compared to rural subjects. Univariate analysis showed significant associations between both physical inactivity and obesity and high blood pressure. The relationship of physical inactivity with hypertension and obesity were independent in both urban and rural men, but not in women. Body mass index, blood pressure and glycaemia were higher in the first compared with the fourth quartiles of energy expenditure. CONCLUSION: Obesity, diabetes and hypertension prevalence is higher in urban compared to rural dwellers in the populations studied. Physical activity is significantly lower and differs in pattern in urban subjects compared to rural. Physical inactivity is associated with these diseases, although not always significant in women.
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