Diabetes Burden in Urban and Rural Senegalese Populations: A Cross-Sectional Study in 2012

Diabetes represents a challenging global health issue in the 21st century. Data from sub-Saharan African populations are scarce and are usually restricted to urban settings. The objective of this study was to compare prevalence and risk factors of diabetes in rural and urban areas in Senegal. Methods. In a community-based survey between January and May 2012, we included 1027 adults aged ≥18 years living in northern Senegal. Sociodemographic, clinical, and biological data were collected during household visits. Multivariate logistic regression was performed to identify factors associated with diabetes. Results. Mean age of participants was 48.0 ± 16.9 years and 65.7% were female. Participants from urban area represented 55.7%. The age-standardized prevalence of diabetes was 7.6% (6.0% in men versus 9.0% in women). Prevalence of diabetes was higher in urban areas (8.1%) compared to rural areas (4.6%). Disease awareness rate was 43%. After multivariate analysis, age (OR = 1.63, p = 0.001), familial history of diabetes (OR = 1.42, p = 0.001), and abdominal obesity (OR = 1.17, p = 0.05) were associated with diabetes. Conclusion. Diabetes is frequent in urban and rural areas in Senegal. Awareness rate is very low among populations. Age, family history of diabetes, and abdominal obesity are the main risk factors identified.

[Arterial hypertension in Dakar: Prevalence, awareness, treatment, and control]

The aim of this study was to determine prevalence, awareness, treatment, and control of hypertension, and its risk factors in Dakar. Six hundred people aged 20 and older, living in the city of Dakar were interviewed. This sample was constructed using the combined quota method in order to strive to representativeness of the target population. Prevalence of hypertension was 27.50%. Quarter of those suffering from high blood pressure were aware of their problem, and among the latter, 61% said they were on treatment. However, of these, only 32% had controlled arterial blood pressure, that is less than 6% of those suffering from hypertension. Two factors were associated with hypertension, awareness, and treatment: age and the frequency of doctor visits. These results indicate that hypertension already constitutes a major health concern in the Senegalese capital. Detection can be considerably improved given that only a quarter of the hypertensives are aware of this problem. Compliance with treatments also appears particularly problematic. Public health policies should be quickly set up to minimize the consequences of this emerging burden.

Hypertension prevalence, awareness, treatment and control in Dakar (Senegal)

The prediction of risk profile trends associated with non-communicable diseases in developing countries is among the greatest global health challenges. The aim of this study is to estimate prevalence, awareness, treatment and control of hypertension in Dakar (Senegal). This study was carried out between January and June 2009 on a population sample of 600 individuals living in the department of Dakar. This sample was constructed using the quota method in order to strive for representativeness. Sociodemographic characteristics, hypertension, hypertension awareness, treatment and control, and body mass index of individuals were collected during face-to-face interviews. Statistical analyses used were χ2-tests and binary logistic regressions. Prevalence of hypertension was 27.50%. Prevalence of awareness, treatment and control among hypertensives were 27.88%, 16.97% and 5.45%, respectively. Logistic regression showed that the prevalence, awareness and treatment of hypertension increased with increasing age. Overweight and obese subjects were more often hypertensive but did not differ from others in awareness and treatment. This could be linked to the social valorization of stoutness in West Africa, which explains that excess weight is not perceived as a risk factor for hypertension. In conclusion, given the very low rates of awareness, treatment and control in our sample, developing strategies for averting a hypertension epidemic must be a priority objective.

Prevalence of diabetes and associated risk factors in a Senegalese urban (Dakar) population

AIM

The aim of this study was to estimate the prevalence of diabetes in the urban population living in Dakar, Senegal, and to investigate the factors associated with diabetes.

METHODS

Data from a 2009 survey of 600 individuals, aged 20 years or above and considered representative of the population of the city of Dakar, were evaluated. Socioeconomic characteristics, hypertension, capillary whole blood glucose, and weight and height measurements of these subjects were collected during face-to-face interviews. The statistical analyses used chi-square (chi2) tests and binary logistic regressions.

RESULTS

The percentage of participants with fasting blood glucose levels greater than or equal to 1.10 g/L and/or currently being treated for diabetes was 17.9% (n=107, 95% CI: 14.7-20.8). Observed rates of diabetes were significantly higher among women (chi2 = 6.3; P < 0.05), in subjects aged > 40 years (chi2=33.6; P < 0.001), in those with low educational levels (chi2=11.9; P < 0.05) and in those with hypertension (chi2 = 13.9; P < 0.001), and in those who were overweight (BMI ≥ 25 kg/m2 and < 30 kg/m2) or obese (BMI ≥ 30 kg/m2; chi2=40.3; P < 0.001). After adjusting for gender, age, educational level, BMI and blood pressure, the results showed that gender, age and BMI were associated with diabetes: women, older people and those with a higher BMI had significantly greater chances of being diabetic than the rest of the population, whatever their blood pressure and educational level.

CONCLUSION

Diabetes is becoming a pressing public-health problem in Senegal, and the major risk factors for the increasing diabetes prevalence in the city of Dakar are gender, age and body mass index.

Prevalence, awareness, treatment and control of hypertension among adults 50 years and older in Dakar, Senegal

Background

Older adults are disproportionately affected by hypertension, which is an established risk factor for cardiovascular disease. Despite these facts, no study on the prevalence, awareness, treatment and control on arterial hypertension in Senegal has been conducted, specifically among elderly people.

Methods

Five hundred people aged 50 years and older, living in the city of Dakar were interviewed. This sample was constructed using the combined quota method in order to strive for representativeness of the target population.

Results

Prevalence of hypertension was 65.4% in our sample. Half of those suffering from high blood pressure were aware of their problem and among the latter, 70% said they were on treatment. However, of these, only 17% had controlled arterial blood pressure. The only factor associated with awareness, treatment and control of hypertension was the frequency of doctor visits.

Conclusion

Improving follow-up health checks of older adults are necessary to limit the consequences of hypertension in Dakar.

The vascular endothelium masks the persistent inhibition of rat thoracic arterial tone induced by S-nitrosoglutathione

AIM

In endothelium-denuded arteries, the nitric oxide (NO) donor S-nitrosoglutathione (GSNO) induced a persistent hypo-reactivity to vasoconstrictors, and low-molecular weight thiols such as N-acetyl cysteine (NAC) produced a relaxant effect. These effects were attributed to the formation of vascular NO stores. In arteries with a functional endothelium, such long-lasting effects on arterial tone have not been well characterised. In this study, we proposed to examine the possibility of storing exogenous NO when the vascular endothelium is still able to produce its own NO.

METHODS

For this purpose, changes in isometric tension of isolated arteries were assessed in organ chambers, and nitrosothiol formation was characterised by confocal microscopy.

RESULTS

In rat aortic rings with endothelium pre-exposed to GSNO, the contractile response to norepinephrine (NE) was not attenuated in comparison with control rings, but NAC induced a relaxant effect. However, an attenuation of the response to NE was observed in GSNO-exposed, intact aortic rings after inhibition of NO synthase by N(ω)-nitro-L-arginine methylester (L-AME) or in GSNO-denuded rings. The relaxing effects of NAC were due to the mobilisation of NO from nitrosothiols after nitrosylation of protein SH residues. Moreover, the hypo-reactivity to NE and the relaxant effect of NAC were abolished by 1H-[1,2,4] oxadiazolo(4,3-a)quinoxalin-1-one (ODQ), an inhibitor of soluble guanylyl cyclase, and partially by the K+-sensitive channel inhibitor tetra-ethyl-ammonium (TEA).

CONCLUSION

These data show that endothelium-derived NO masked the persistent effect of GSNO in rat thoracic aorta. However, the ability of GSNO to form releasable NO stores without altering the vascular tone can be particularly useful in preventing endothelial dysfunction in which NO formation decreases.

Prevalence of obesity in Dakar

The present study is to our knowledge the first to evaluate the prevalence of obesity among both men and women in Dakar. It was carried out on a sample of 600 dwellers of the Senegalese capital. The prevalence of general obesity is 8.3%, and that of overweight is 22.3%. The underweight rate remains high, given that 12.3% of the adults in this sample show a body mass index (BMI) of <18.5 kg/m(2) . The prevalence of central obesity is 41.2% according to waist to hip ratio (WHR), and 21.2% according to waist circumference (WC). These figures mask considerable differences between men and women and between generations. For instance, women are often more obese than men, whether it is a question of general obesity (13% and 3.9% respectively) or central obesity (37.5% and 5.5% by WC respectively). Moreover, prevalence of general and central obesity rise drastically with age, irrespective of gender. Thus, in addition to combating infectious disease and undernutrition, Senegal must now face problems associated with overweight and obesity.

[Supervision of body composition and cardiovascular parameters in long sprint running athletes (400 m)]

INTRODUCTION

The follow-up of performances and the prevention about possible incidents at the athletes make necessary the medical supervision in physical training. The aims of this study are to estimate the effect of a precompetition training program in athletes' body composition, and cardiovascular modifications (in clinical examination and electrocardiogram)

MATERIALS AND METHODS

Ten athletes (3 men and 7 women; mean age of 23.6 +/- 3.16 years) of Dakar international Athletics' Center are subjected to a training on a period of 2 months in aerobic dominant followed by a period of 3 months in anaerobic dominant. At the beginning and the end of training program, an electrocardiogram is recorded after blood pressure (BP) measure in lying and standing posture and heart rate (HR) take. The weight, height and cutaneous folds are measured to calculate the body fat percentage, fat body mass, fat-free mass and body mass index. Every athlete has performed the Ruffier test Comparisons are realized by the paired t-test, statistically significant for a p value < 0,05 RESULTS: Significant declines after training interest HR (79.2 +/- 14.7 vs 63.2 +/- 10.25 beat min(-1); p< 0.001), systolic BP in standing posture (11.8 +/- 0.44 vs 10.6 +/- 0.96 mmHg; p= 0.02), and Ruffier index (4.4 +/- 3.28 vs 2.23 +/- 1.62; p= 0.048) whereas the fat-free mass increased (53.14 +/- 8.41 vs 54.16 +/- 9.67 kg; p= 0.046). At the electrocardiogram, the number of athletes having sinusal bradycardia is crossed from 1 to 4; there is no modification as for the two cases of uncomplete right bundle-branch block and the pre-existent left ventricular hypertrophy. Negative T waves in V1 and V2 leads are present in one athlete before training and in two others after.

CONCLUSION

The impact of the specific training on body is real, interesting more the cardiovascular system.

[Comparative study of the effect of fasting during Ramadan on the glycaemia at rest in sportsmen and sedentaries]

The fast of Ramadan submits body to transient metabolic modifications; and decrease of glycaemia can be one of results. Physical exercise modifies rate of plasmatic hormones responsible for its regulation. The purpose of this study is to appreciate the influence of the fast on this biologic parameter in sportsmen and sedentaries. Thirty (30) healthy subjects (15 sportsmen of stamina and 15 sedentaries), with 25 years of average age were recruited. They have all a comparable diet. We excluded subjects having practised a physical exercise the day of the test. Capillary glycaemia was measured after weighed and physical exam, in 2 periods: in second Ramadan's fortnight, 15 minutes before food intake, two (2) months after Ramadan at least 4 hours at distance of the last meal. Comparisons were remitted in the test of Student, significant for p value lower than 0.05. During Ramadan, the glycaemia of the sportsmen at rest, is at one exception always superior or equal to that of the sedentaries. However, there is non significant difference as much during the fast as in normal food intake. Respective averages are 4.6 mmol/l, 0.15 and 4.5 mmol/l, 0.01 during Ramadan. They cross then in 4.8 mmol/l, 0.2 and 4.8 mmol/l, 0.4 in normal food intake. Landmark, the comparison of the averages from period to the other one in every group shows a significant difference only for the sedentaries. The return to normal food intake was expressed by an important gain in weight for all subjects. The fast of Ramadan has no notorious influence on sportsman's glycaemia contrary to that of sedentary. In other words, the sportsman administers better his stocks of glucose. Previous works however strongly advised against sports practice during Ramadan and more particularly the competitions, because, exercises of strong intensity can induce dehydration.

[Physical performance and thermoregulatory study of subjects with sickle cell trait during a sub-maximal exercise]

The sickle cell trait is a genetic abnormality of red blood cells. It is due to the mutation of a parental gene, which rest Its to the substitution of glutamic acid by valin on beta globin chain of haemoglobin. The possibility for sickle cell trait carriers (SCT) to present any disturbance during predominantly anaerobic and aerobic exercises is unclear. Ten (10) subjects with sickle cell trait and 10 subjects control were studied during exercise test on cycloergometer. They were all students of the National Institute of Popular Education and Sport of Dakar. The mean of environmental temperature was 26 degrees C and humidity was 60 to 80%. After haematological analysis, a submaximal muscular exercise for one hour with 75% of maximal heart rate was done. We have determined heart rate, blood pressure, rectal and skin temperature during exercise. Haematological parameters shown any significant difference between the two groups. No significant difference was found in cardiocirculatory variables during maximal exercise in cycloergometer between control group and sickle cell trait group. The two groups have done submaximal exercise during 1 hour without particular difficulty. We have not observed a significant difference between the two groups in cardiovascular variables, rectal and skin temperature during exercise, and after 3 minutes of rest. These results show that subjects with SCT have physical capacity comparable with control subjects during a sub maximal exercise for 1 hour. We can assure that subjects with SCT in our country may participate in sports competition, as well as normal subjects (HbAA).

[The therapeutic itinerapy of epileptics admitted by the Electoencephalographic Laboratory at CHU Dakar]

In Senegal, as in other under developed countries, the delays before seeking medical treatment are long varying from 2 to 12 according to studies. This is related to the fact that in traditional African communities, prejudices and believes delayed medical management which is seeked after failure of traditionnal treatments. The objectives of this study concerning therapeutic itinerary of epileptics in the EEG laboratory at the Neurology Department at CHU in Dakar were to evaluate the average latency of medical consultation and to identify the recourse path by patients receiving antiepileptic treatment. We conducted from March to may 2001, a cross disciplinary study, with a sample size of 212 patients. 79.2% of patients were less than 30 years old. They first seek treatment in hospitals in 36.8%, traditional practionners in 35.8%, health centers in 23%, and private clinics in 4%. The average delay of treatment in modern structures was by 13.4 +/- 4.7 months. The towards the healers was linked to faulty beliefs in 61.8% of the cases, lack of information (22.4%), or a lack of financial means (2.6%). The patients were refeared to traditional healers in 6.7% of the cases for reasons of confidence in traditional medecine. The orientation to neurology clinic was recommended by health personal in 83% of the cases, family (14.6%), or the healer (1.4%). The long and difficult journey of epileptics in Senegal remains marked by exclusion, absence or delay of medical attention.

[Spatial orienting of attention: a study of reaction time during pointing movement]

AIM

The aim of this study was to investigate how advance information both explicit and implicit provided prior to movement may affect the spatial orientation and the internal attention control processes in normal adult subjects. The originality of this work compared to the test of Posner, lies essentially in the methodology used to study the attentional systems. The use of three procedures of reaction time (RT) allowed us to study the setting concerned of the specific and non-specific components of the attention in the motor preparation. By associating of these three procedures of RT, we have evaluated the effects of the explicit and implicit components of advance information on motor preparation. The use of advance information to the movement requires the implication of the attentional systems.

MATERIAL AND METHODS

Experiments were carried out using a simple reaction time (RT) procedure involving the use of an orientation cue and two choice reaction time situations: one with a neutral preparatory cue and one with a priming cue giving the likelihood of the preparatory stimulus (S1) being compatible with the imperative stimulus (S2). The mechanisms underlying the subjects' vigilance and the orientation of their attention were studied by assessing the effects on their reaction times of the preparatory signal and those of the cue giving the likelihood of S1 and S2 being compatible. The preparatory signal was designed to explicitly attract the subjects' attention towards the position of the forthcoming pointing target, whereas the cue giving the compatibility between S1 and S2 was intended to mobilize the subject's attention more implicitly. Prior to performing the pointing movement towards a visual target, the subjects' attention was therefore mobilized by the advance information containing two components: the explicit information about the position of S1 and the implicit information about the probability of S1 and S2 being compatible.

RESULTS AND CONCLUSION

The results obtained here on 17 normal adult subjects show that the subjects significantly improved their RTs by using the explicit component of the information provided. The implicit information available was also used in the choice reaction situations: a priming effect was found to occur, which resulted in the shortening of the primed "compatible cue" reaction times in comparison with the "neutral cue" reaction times, and in the correlation which was found to exist between the reaction time performances and the degree of compatibility between the preparatory signal and the imperative signal. These results suggest that various components of the attentional system may participate in processing the advance information provided prior to the movement in reaction time tasks of the kind used here. The explicit information provided prior to the movement may mobilize the subject's vigilance and spatially orients his attention; whereas the implicit information available may rather subserve the internal control of the subject's attention.

[Anatomophysiologic and clinical study of the association of epilepsy and Parkinson's disease: apropos of 2 cases]

The authors described the first cases in Senegal (West Africa) of the association Parkinson's disease and epilepsy. Almost studies on this feature, stressed on their different pathophysiology basis epilepsy is related on excess of neuronal excitation, and Parkinson disease is an expression of lack of motor neuromodulation. The diagnosis has been done because of the coming out two seizures in the year on two patients one 59 years old and the other 70 years old experiencing Parkinson disease well documented before and treated. Biological study, ultrasonography and Doppler, CT Scan lead to rule out a vasculopathy. Good outcome with antiparkinsonian and anticonvulsant medications confirm the diagnosis.

[Transplantation of cryopreserved carotids in the rabbit: effect of cryoprotective agents]

The cryopreservation of blood vessels has been carried out for some decades with variable results. In order to study the behaviour of cryopreserved allografts by using new technique of cryopreservation a study on the ultrastructure arterial tissue consequences by microscopic techniques has been carried. The graft has been harvested from carotid artery of donor rabbit, implanted to a carotid artery of a recipient rabbit and extracted at 1, 3 and 5 months after the operation. An intimal thickening and a cellular loss in the media have been observed. However, good patency has been observed in all cryopreserved allografts. Manifestations of rejection are delayed in groups with polyethylene glycol.

[Ammonia-gas poisoning: respiratory troubles evaluated by functional exploration]

The objective of our research is first to evaluate the defects in the respiratory function which have been noticed among patients suffering from ammonia poisoning during the accident at the SONACOS factory of Dakar in 1992. Secondly it is to set precisely the seriousness of the problem. This retrospective study is carried out on 50 patients examined at the Physiology and Functional Exploration Laboratory of the faculty of Medicine of Dakar University from March 1993 to October 1995. These patients have been submitted to at least two respiratory functional explorations. Ten of them have been treated for two years, thus benefiting from a spirographic control of these respiratory troubles already noticed. 58 % of the patients have developed an obstruction syndrome with the following specifities : fourteen patients out of 29 revealed a serious stoppage of the bronchi, twelve had a moderate bronchial obstruction, and three showed a minor bronchial obstruction. Besides, 34 % of the patients have developed a mixed syndrome with a minor restrictive component and a severe obstructive component. 8 % of the poisoned have presented a normal lung function testing. About the localisation of the respiration disorders at the level of the bronchial system, 61 % of the patients have shown an obstruction of the proximal, medial and distal bronchi. 26 % have presented obstruction of the distal bronchi, 13 % have shown an attack at their medial and distal bronchi. 5 patients out of 10 have shown any modification in their respiratory troubles while 3 of 10 have shown significant improvement. Then 2 out of 10 have shown degradation in their respiratory problems with an extension of bronchial obstruction. The ammonia poisoning has caused serious respiratory disorders related to the general and local toxic action of ammonia on the respiratory tract, its retention at their level and its effects on the respiratory function. The severity of the patent injuries incites to issue recommendations concerning the prevention of ammonia poisoning and the quick and efficient taking charge of the casualties in case of any accidental intoxication.

[Effects of spatial orientation on attention reaction time during pointing movement towards visual direction]

In the present study, it was consequently proposed to investigate how the spatial orientation of attention made by the explicit and implicit components of advance information, affected the reaction time (RT) performances. Subjects performed a simple RT task with an orientation cue and two choice RT situations, the one with a neutral cue and the other with a primed cue. The motor task to be performed consisted of pointing towards a visual target. The mechanisms involved in the orientation of attention were studied on the one hand by analysing the effects of the preparatory signal, which explicitly oriented the subjects' attention towards the forthcoming target position, and on the other hand, by examining whether the reinforced probability of warning stimulus(WS) and imperative stimulus (IS) being compatible affected the subjects' performances, i.e., whether they detected and made use of the information implicitly conveyed that there existed a bias in favour of the probability that IS would appear in the direction predicted by WS. The results of this study show that the subjects shortened their RTs by using both the explicit(auditory) and the implicit(probability-related) information with which they were provided prior to performing the movement. These data on the effects of the oriented auditory signal on the reaction times indicate that in our experiments, by orienting their attention depending on the position of the stimuli, the subjects were able to reduce their reaction times. The significant correlation found to exist here between the level of probability associated with the position of the WS and the choice RT values indicates that also the implicit information as to the WS-IS compatibility was taken into account by the subjects in all the situations.

[Drug resistant epilepsy in Senegal: therapeutic, clinical and socioeconomic factors]

The aim of our study was to emphasize factors which support pharmaco-resistance in Senegal. For this purpose, 23 patients with partial or generalized epilepsy were studied, after determining the plasmatic concentration of the antiepileptic drugs. The aetiologies were numerous: encephalitis, injuries, neonatal encephalitis. All patients were under traditional treatment before coming to the hospital. So antiepileptic drugs were taken a long time after the beginning of epilepsy later, they were Phenobarbital, Carbamazepine, Phenytoin, and Valproic acid. Only seven patients had sufficient plasmatic level of the antiepileptic drug. The low socio-economic conditions of patients which limit the choice of the most adapted drug in each case, is one of the most important reason of the pharmaco-resistance. Another factor of the pharmaco-resistance is cultural and is linked with the absence of notion of chronic disease necessitating long and regular treatment in senegalese traditional society.

[Rectal temperature trends during 24 hours in a hot climate with and without nutritional support]

A group of 22 young subjects staying in rest was studied in the aim to follow the nycthemeral evolution of the rectal temperature, according to two situations: 1) normal feeding, 2) absence of feeding. The use of drinking water was not limited. The experimentation was carried out in tropical area, Kédougou (Eastern Senegal), during a high period of temperature. The mean of day temperature was 38 degrees C and the night temperature, 22 degrees C. The skin and rectal temperature, the arterial pressure and the cardiac frequency were measured every three hours. The results showed a significant difference in the nycthemeral rythm of the rectal temperatures. The nocturnal temperatures were not different in the two conditions. We observed a significant elevation (delta = 0.31 +/- 0.18 degree C) of the diurne post prandial temperature. The results supported that the thermic modification observed during the experience were linked to the feed.

The use of advance information for motor preparation in Parkinson's disease: effects of cueing and compatibility between warning and imperative stimuli

The ability of 13 Parkinsonian patients and 11 age-matched control subjects to process and use two components of the information given prior to a voluntary movement was studied using reaction time (RT) tasks. This advance information about the direction of a pointing movement was given using a double stimulation paradigm with an auditory warning signal (WS) which occurred prior to a visual imperative signal (IS). The first component of the information was given by the WS at the beginning of each trial, and the second component was the WS-IS compatibility during series of trials. The subjects were tested with three RT paradigms: a cued simple (CS) task, a cued choice (NC) task, and a priming choice (P) task. The results show that the normal subjects used both the lateral cue and the WS-IS compatibility to shorten their RTs, whereas the Parkinsonian patients were able to use the lateral warning signal, but their ability to use the degree of compatibility stimuli was impaired. These data suggest that when dealing with lateral cues in a RT task, Parkinsonian patients have no difficulty in identifying a stimulus and selecting the appropriate response, but that this is no longer so in the case of stimulus compatibility. This impairment may be due to attentional disorders involving a dysfunction affecting the medial premotor system, which includes the basal ganglia and may be responsible for the feedforward movement control deficits associated with Parkinson's disease.

[Effects of advance information given by sensory cues on the duration and precision of a pointing movement in Parkinson's disease]

The aim of the present study was to investigate Parkinsonians' ability to process and use the explicit and implicit advance information available about a motor task they are preparing to perform. For this purpose, the performances of 13 Parkinsonians were compared with those of 11 control subjects in a double stimulus reaction time task. The explicit information was provided by a preparatory auditory signal (S1), and the implicit information was conveyed by the probability that the imperative signal (S2) would be consistent with S1 in a given series of trials. Each subject performed 3 successive RT tasks under the following conditions: an oriented cue condition, a neutral cue condition and a primed condition. The results show that the movement times of the Parkinsonians were longer than those of the control subjects, and that they lengthened with the clinical evolution of the disease. Neither the explicit nor the implicit advance information had any effect on the control subjects' performance variables; nor did they affect the Parkinsonians' movement times or pointing areas. The Parkinsonians' systematic errors increased however in the case of primed responses. The fact that the patients' bradykinesia was associated with fairly accurate pointing performances suggests that in Parkinson's disease, a change of voluntary movement performance strategy may occur, involving greater reliance on visual cues.

[EEG spike focus topography: study of potential fields]

Mapping study of EEG spike focus was performed on 122 topographic maps, from 88 records of 72 subjects, classified in: F for "functional" (no epileptic seizure); EGI, EGS and EGC: respectively generalized idiopathic, symptomatic and cryptogenic epilepsies; EPI, EPS and EPC: respectively partial idiopathic, symptomatic and cryptogenic epilepsies--epilepsies with centro-temporal spikes (EPR) are predominant in this group--; EI: indeterminate epilepsies. The graphoelements study: morphology, localization, amplitude, time course (sites of appearance, culmination and disappearance) and of electrical fields: distribution, monopolar, bipolar or intermediary aspect was performed. In order to quantify the brain mapping data we established series of numeric parameters: maximal negative and positive values; sum of the negative and positive values; ratio of these values. EGS and EPS groups have very variable map imaging for a patient or from a patient to another, r1 ratio is lower to 0.33. Idiopathic epilepsies are characterised by the stability of imaging, in the EGI group aspect is frequently monopolar with a central negativity, r1 and r2 ratios are high (0.9 and 1.2); in the EPI group the aspect can be monopolar or bipolar, in the EPR the aspect is stable, longitudinal bipolar, r1 and r2 ratios are between 0.33 and 0.99. In the EGC, EPC and EI groups there is no typical imaging, the mapping aspect can be monopolar or bipolar, in EGC and EPC r1 ratio is between 0 and 0.99, in EI r1 and r2 ratios are low (r1 = r2 = 0.2). In the F group the monopolar aspect is frequent. We can note the stability of the electrical fields apportionment in idiopathic epilepsies which is explainable by the integrity of the cerebral potential propagation pathways in spite of a dysfunction responsible of the epileptic seizures, the presence of a lesion is one of the responsible factors of the instability of the brain mapping.

Vanguard family planning acceptors in Senegal

This study examines contraceptive use among clients at the three clinics providing family planning services in Dakar, Senegal in early 1983. Most clients first became interested in family planning following the birth of a child, and most are interested in spacing future pregnancies, although one-third state that they want no more children. The clinic itself was found to be an important determinant of the type of contraceptive used, with only the government-operated clinic providing a balance between IUDs, oral contraceptives, and barrier methods. Nearly half of the clients interviewed said that a lack of knowledge about contraception is the reason for the low contraceptive prevalence rates among Senegalese women; another frequently cited reason was the opposition of the husband. Most clients reported the broadcast media to be the best means of providing family planning information to potential acceptors.

Facteurs predictifs de mortalite par accident vasculaire cerebral (AVC) a la Clinique Neurologique du chu de Fann, Dakar - Senegal

Description Les AVC constituent un problème de santé publique avec une mortalité élevée. Objectif Identifier les facteurs prédictifs de mortalité par accidents vasculaires cérébraux à la Clinique Neurologique du CHU de Fann, Dakar. Méthodes Il s’agit d’une étude rétrospective du 1er Janvier 2001 au 01 Novembre 2003 portant sur des patients avec AVC et ayant eu un examen tomodensitométrique cérébral. Les données sociodémographiques, les antécédents médicaux et chirurgicaux, les signes de gravité associés au tableau neurologique et le pronostic vital ont été collectés. Des analyses uni, bi et multivariées par la régression logistique multiple ont été effectuées. Résultats La population de patients (314) était composée de 56,1% de femmes avec une moyenne d’âge de 61,3 ans (±13,8), un délai moyen d’admission de 8,4 jours (±23,5). Les facteurs de risque d’AVC étaient dominés par l’HTA, l’antécédent d’AVC et le diabète. Les AVCI représentaient 60,2%. Un coma et une HTA étaient associés au tableau neurologique. Soixante dix huit (78) patients sont décédés soit un taux de létalité de 24,8%. Lors de l’analyse de régression logistique multivariée, seuls les antécédents d’AVC et l’existence de coma étaient associés de manière indépendante à la mortalité par AVC. Conclusion Ces résultats démontrent la nécessité d’une amélioration de la prise en charge des patients en unité de soins intensifs et la prévention des récidives d’AVC par une éducation sanitaire des malades.Mots-clés: accident vasculaire cérébral, mortalité, pronostic, Sénégal.