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The French Pandemic Influenza Plan ("Plan National de Prévention et de Lutte Pandémie Grippale") places general practitioners at the heart of the provision of care to patients through consultations and house calls. The purpose of this study was to determine whether GP practices are able to provide treatment to flu patients within their premises in the event of a highly pathogenic influenza pandemic. A simulation exercise conducted in a GP practice (SIMUGRIP-MG2) was carried out in the autumn of 2009. 3 general practitioners, the practice secretary, 33 patients and care staff took part in the exercise during a half day of practice. The study found that the quality of some hygiene practices and procedures was inadequate: the duration of handwashing was too short (mean: 11.8 seconds), gloves were not worn, and FFP2 masks were often handled. The study found that the implementation of these procedures required increased effort and attention from GPs. It was also found that this type of consultation requires additional preparation time (refitting, supply of materials) and generates additional costs (linked, for example, to storage issues). In seeking to improve the quality of care provided to infected patients in the event of an influenza pandemic, several factors must be considered, including recent data on the effectiveness of countermeasures, additional training to improve hygiene practices, and infrastructure modernization to improve ergonomics in GP practices.

A simulation exercise aimed at assessing the management and provision of ambulatory care in the context of a highly pathogenic influenza pandemic was conducted in a specifically dedicated consultation center (Centre de Consultation Dédié (CCD) à la grippe) based on official French guidelines. The exercise was carried out in a school in Paris equipped to simulate a "flu clinic". 3 practitioners provided treatment lasting 2 hours to nursing students acting as patients. The exercise highlighted a number of major organizational issues. Staff were found to be unable to manage the center and to perform patient transfers; face masks were not routinely and consistently worn by doctors and patients; and communication between professionals within the clinic was limited. The exercise showed that much remains to be done to ensure that "flu clinics" are effective and functional. The results suggest that the exercise will need to be repeated on a larger scale and over a longer period.

Context: In 2004, 22% of French citizen were vaccinated against Hepatitis B Virus (HBV), 7.3% had previously been protected by a contact with HBV, and 0.65% were carriers of HBV Those rates are not known among migrant people, especially if they have no health insurance. It is not known whether those people have adequate personal strategies of prevention., Aims and Method: Prospective study to assess the effectiveness of an internet-accessible expert system in helping the GP to determine the most accurate strategy of prevention, related to the serologic HBV profile of each patient, and to apply this strategy, among migrant people coming from subsaharian Africa and Asia, attending their GP. The prevalence of each serologic profile was measured., Results: From 11.5.2007 to 12.31.2008, 28 GPs included 547 migrant people. 8% are HBV carriers, 33% have been protected by a contact with HBV, 16% are vaccinated, and 23% have had no contact with virus nor vaccination. A full accurate preventive information strategy could be carried out with help of the expert system, respectively among 100% of HBV carriers, 100% of vaccinated people, 98% of people protected by HBV contact, and 40% of people who had no marker A vaccination has been done among 64% of people who required it. For people whose only marker of HBV infection was anti HBc, 41% was considered protected by HBV contact, 48% was vaccinated, this result can be related to a lack of accuracy in international guidelines in this situation., Conclusion: Prevalence of contact with HBV is much higher in migrant people coming from subsaharian Africa and Asia, than in the average French population. An internet-accessible expert system is a useful tool for GPs in order to enhance strategies of prevention in HBV infection.

Context: In France, 43% to 63% of diabetics have an annual fundoscopy. Do the new screening tools, coupled with teletransmission of the images, allow for satisfying ophthalmological screening? It is an important matter given the foreseeable reduction in the number of French ophthalmologists in the forthcoming years., Objectives: To measure the quality of screening for diabetic retinopathy (DR), in the framework of a network, by the provision of a retinograph by numeric camera (with teletransmission of the images and centralised interpretation), in a screening centre located in town., Method: The study evaluated the quality of screening obtained in two comparable groups of general practitioners, one using the retinograph and the other using the classical method of screening by ophthalmologist. The screening was targeted at diabetics who had not had a fundoscopy in the preceding year, nor had known DR or a treating ophthalmologist (for the retinography group only)., Results: 667 patients were sampled in the retinography group (456 included) and 707 in the control group (426 included) between 1/04/02 and 1/11/02; 417 patients were followed until the end of the study in the 2 groups. A screening examination was considered effective if it was performed within the six months following its request, and by the presence of a report in the file of the general practitioner. The percentage of patients thus screened was 74% in the retinography group and 71,5% in the other group (not significant). 16% of diabetics in the retinography group had DR compared with 10% of patients in the control group. The analysis of the level of satisfaction of patients tended to show a preference for the system of screening by fundal photography., Conclusion: In the framework of a healthcare network, the availability of a retinograph by numeric camera, with the interpretation of photos by teletransmission of the images, obtained a high level of quality of screening for diabetic retinopathy that was at least as good as that obtained by a healthcare network using the classical ophthalmological screening method.

Mucins are macromolecules lying the cells in contact with external environment and protect the epithelium against constant attacks such as digestive fluids, microorganisms, pollutants, and toxins. Mucins are the main components of mucus and are synthesized and secreted by specialized cells of the epithelium (goblet cells, cells of mucous glands) or non mucin-secreting cells. Human mucin genes show common features: large size of their mRNAs, large nucleotide tandem repeat domains, complex expression both at tissular and cellular level. Since 1987, 21 MUC symbols have been used to designate genes encoding O-glycoproteins containing tandem repeat domains rich in serine, threonine and proline. Some of these genes encode true mucins while others encode non mucin adhesion O-glycoproteins. In this paper, we propose a classification based on sequence similarities and expression areas. Two main families can be distinguished: secreted mucins or gel-forming mucins (MUC2, MUC5AC, MUC5B, MUC6), and membrane-bound mucins (MUC1, MUC3, MUC4, MUC12, MUC17). Muc-deficient mice will provide important models in the study of functional relationships between these two mucin families.