BackgroundOur objective was to characterize the relationship of anemia and hemoglobin concentrations with cross-sectional cognitive functions and changes in cognitive functions over 2 years in a large sample of Chinese middle aged and elderly.MethodsTen thousand nine hundred eighteen adults aged 45 years or older participating in the China Health and Retirement Longitudinal Study (CHARLS) were used for cross-sectional analyses and 9324 were used for longitudinal analysis. Cognitive functions were assessed by memory recall (episodic memory), mental status (TICS), and global cognitive function at baseline survey (Visit 1) and first follow-up survey (Visit 2). The lower the cognitive test score, the worse the cognitive function. Anemia was defined as hemoglobin concentrations lower than 13 g/dl for men and lower than 12 g/dl for women. Adjusted multivariate regression analyses were used to explore the relationships of different cognitive domains with anemia and hemoglobin concentration.ResultsOverall, the prevalence of anemia was 12.86% and the mean hemoglobin concentration was 14.37 ± 2.20 g/dl. After adjusting for socio-demographic and health-related covariates, the cross-sectional association between anemia and global cognitive function [β (95%CI) = − 0.49(− 0.69~ − 0.29)], episodic memory [β (95%CI) = − 0.14(− 0.23~ − 0.05)], and TICS [β (95%CI) = − 0.23(− 0.38~ − 0.08)] were significant and did not differ by gender. The hemoglobin concentration was also associated with global cognitive function among the whole sample (P < 0.05 for all). The longitudinal analyses showed global cognitive function and episodic memory were associated with anemia independent of covariates (P < 0.05 for all). Sensitivity analyses further provided significant results showing the association between anemia and cognition decline (P < 0.05).ConclusionThere was a cross-sectional and longitudinal association between anemia and accelerated decline in cognitive functions in Chinese middle-aged and elderly. This suggests that anemia and low hemoglobin concentrations are independent risk factors of cognitive decline.

BackgroundBreast cancer (breast Ca) is recognised as a major public health problem in the world. Data on reproductive factors associated with breast Ca in the Central African Republic (CAR) is very limited. This study aimed to identify reproductive variables as risk factors for breast Ca in CAR women.MethodsA case–control study was conducted among 174 cases of breast Ca confirmed at the Pathology Unit of the National Laboratory in Bangui between 2003 and 2015 and 348 age-matched controls. Data collection tools included a questionnaire, interviews and a review of medical records of patients. Data were analysed using SPSS software version 20. Odd ratios and 95% confidence intervals (CI) for the likelihood of developing breast Ca were obtained using unconditional logistic regression.ResultsIn total, 522 women with a mean age of 45.8 (SD = 13.4) years were enrolled. Women with breast Ca were more likely to have attained little or no education (AOR = 11.23, CI: 4.65–27.14 and AOR = 2.40, CI: 1.15–4.99), to be married (AOR = 2.09, CI: 1.18–3.71), to have had an abortion (AOR = 5.41, CI: 3.47–8.44), and to be nulliparous (AOR = 1.98, CI: 1.12–3.49). Decreased odds of breast Ca were associated with being employed (AOR = 0.32, CI: 0.19–0.56), living in urban areas (AOR = 0.16, CI: 0.07–0.37), late menarche (AOR = 0.18, CI: 0.07–0.44), regular menstrual cycles (AOR = 0.44, CI: 0.23–0.81), term pregnancy (AOR = 0.26, CI: 0.13–0.50) and hormonal contraceptive use (AOR = 0.62, CI: 0.41–0.93).ConclusionBreast Ca risk factors in CAR did not appear to be significantly different from that observed in other populations. This study highlighted the risk factors of breast Ca in women living in Bangui to inform appropriate control measures.

BackgroundBreast cancer is recognised as a major public health problem in developing countries; however, there is very limited evidence about its epidemiology in the Central African Republic. The aim of this study was to investigate the epidemiological and histopathological characteristics of breast cancer in Bangui.MethodsThis is a retrospective study based on the data collected from pathological anatomy records from 2003 to 2015 in Bangui. A questionnaire was designed to collect information and data was analysed using descriptive and inferential statistical methods.ResultsThe mean age was 45.83 (SD = 13.5) years. The age group of 45–54 years represented the majority of the study population (29.3%). Over 69.5% of the women were housewives with a moderate economic status (56.9%). Less than 14% of the study population had a level of academic degree and 85.6% lived in cities. The breast cancer prevalence was 15.27%. The age-standardized incidence and death by world population (ASW) were 11.19/100,000 and 9.97/100,000 respectively. 50–54 years were most affected. Left breast cancer is mainly common and the time between first symptoms and consultation is more than 48 months. Most (69%) of the samples analysed were lumpectomy. The most common morphology of breast cancer was invasive ductal carcinoma (64.9%). Scarff Bloom Richardson III was the main grade in both common pathological types, but their proportion showed no significant increase along with time (χ2 = 7.06, p = 0.54). Invasion of regional lymph node differed significantly among the pathological type of breast cancer (χ2 = 24.6, p = 0.02). Surgery and chemotherapy were appropriate treatment yet 84.5% of the cases died.ConclusionThe findings of this study showed that breast cancer is common and mostly affected women. Epidemiological trends are more or less common to those of developing countries with a predominance of invasive ductal carcinoma. However, most of the women studied live in an urban area and developed the disease in advanced stage. The establishment of an appropriate framework will effectively contribute to promoting the early detection and reducing the incidence of this disease in the population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3863-6) contains supplementary material, which is available to authorized users.

Hypertension is of public health importance in China, but information on geographic distribution on hypertension by map visualization is limited for middle-aged and older adults. Regional geographic variations remain unexplained. Our study is to present geographic distributions at the provincial level and identify provinces and municipalities with high hypertension diagnosis, measurement and prevalence rates and/or low awareness, treatment, control rates among aged 45+ adults in China. We used data collected from the China Health and Retirement Longitudinal Study (n = 13,583) of Chinese people aged 45 years or older. We used weighted rates for our analysis. The rates by provinces and municipalities were compared using map visualization, and explore the main factors of the disparity using ordinal logistic regression. Higher hypertension prevalence rates (56.3%) but lower hypertension awareness, treatment and control rates (37.3%, 21.1% and 14.9%, respectively) were observed in Guizhou. Shanghai and Beijing had the highest hypertension prevalence, awareness and treatment rates (65.0%, 87.8% and 80.0% for Shanghai, 57.5%, 88.6% and 77.5% for Beijing, respectively). Remarkable variations were observed among surveyed provinces and municipalities. Several Chinese regions show particularly higher prevalence rates and/or lack of hypertension awareness and poor control.

ObjectivesThe relationship between cadmium exposure and cognition has been well studied in children. However, the association between environmental cadmium exposure and cognitive function has not been researched extensively in older adults. Our goal was to evaluate the association between cognitive function and blood cadmium levels in US adults aged 60 years or older.DesignA cross-sectional study.SettingThe US National Health and Nutrition Examination Survey (NHANES).ParticipantsA total of 2068 adults aged 60 years or older who completed four cognitive assessment tests and blood cadmium detection in two waves of NHANES (2011–2014).Main outcome measuresCognitive assessment was conducted by household interview or at a Mobile Examination Center (MEC) using the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Word List Learning Test, the CERAD Word List Recall Test, the Animal Fluency Test and the Digit Symbol Substitution Test (DSST). We created a composite cognitive z-score to represent global cognitive function.ResultsThe median blood cadmium concentration in the study participants was 0.35 µg/L, and the IQR was 0.24–0.56 µg/L. In linear regression analyses, adjusting for demographics, behaviour and medical history, blood cadmium as a continuous variable was inversely associated with the composite z-score (μg/L, β=−0.11, 95% CI −0.20 to −0.03). Similarly, there was a significant association between quartiles of blood cadmium and composite z-score, with somewhat lower scores in the upper quartile of exposure (blood cadmium ≥0.63 µg/L) compared with those in the lower quartile of exposure (blood cadmium <0.25 µg/L) (μg/L, β=−0.14, 95% CI −0.25 to –0.03), and there was a trend by quartiles of blood cadmium (P<0.0001).ConclusionsOur findings suggest that increased blood cadmium is associated with worse cognitive function in adults aged 60 years or older in the USA.