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Zinc oxide (ZnO) and aluminum doped zinc oxide (AZO) nanoparticles were synthesized by a typical sol-gel method. The effect of the doping and the annealing temperatures were studied. The dopant percentage of 4% was fixed. XRD patterns showed that ZnO and Al doped ZnO nanoparticles exhibit good crystallization. The crystallite size was shown to decrease by doping and increase by increasing the annealing temperature in the range 350–650 °C. The incorporation of aluminum atoms in the ZnO lattice was confirmed by performing the FTIR spectra. However, the EDX analysis shows that only some aluminum atoms were incorporated. Keywords: Aluminum doped Zinc oxide, Annealing, Crystallite size, Sol-gel

Ferroelectric ceramic samples of lithium-niobate ( LiNbO 3 ) material synthesized by solid-state reaction were investigated. Raman spectra analysis confirmed that the structure of these ceramics became more rigid with the rise of L i composition. Frequency and temperature dependencies of dielectric permittivity and electric modulus of these ceramics were studied in the ranges of frequency 1 Hz - 10 MHz and temperature 300–1000 °C, respectively. We found that both dielectric constant e′ and loss e′′ are high at lower frequencies and decrease with increasing of frequency. Furthermore, the electric modulus analyses reveal a non-Debye relaxation behavior and the shift in relaxation peak towards higher frequency range indicates a specific conduction process in the material and favoring of long-range motion of mobile charge carriers. Relaxation frequency extracted using imaginary part M″ and d c conductivity measurements were found to follow the Arrhenius law, which indicate that the conduction process is thermally activated.

Asthma affects millions worldwide resulting in a significant disease burden. However, data on asthma burden from the Middle East is limited. This analysis describes the asthma burden in Egypt, Turkey and a Gulf cluster (Kuwait, Saudi Arabia and United Arab Emirates) as part of the SNAPSHOT program.SNAPSHOT was an observational, cross-sectional program carried out by telephone in a random sample of the adult general population of the five above mentioned countries. Quotas were defined per country demographics. Subjects were considered to have asthma if they fulfilled the screening criteria, based on the global Asthma Insights and Reality studies. Data collected included demographics, physician consultations, and asthma control (measured by the Asthma Control Test; ACT). Quality of life was assessed using the EuroQol Five-Dimension questionnaire (EQ-5D); and limitations to daily activities using the modified Sheehan Disability Scale (SDS).939 subjects answered questions related to asthma burden. Overall, 367 (44.2%) reported uncontrolled asthma (ACT≤19), and reported significantly lower EQ-5D-3L utility values (0.6 ± 0.4) and EQ-VAS scores (60.7 ± 24.2) compared to controlled subjects (0.8 ± 0.3 and 75.3 ± 19.8 respectively) (p 0.0001). A significantly higher proportion with uncontrolled asthma also reported experiencing impact on activities of daily living compared to subjects with controlled asthma (p 0.0001). Overall, 355 (37.8%) asthma subjects were followed by a physician. However, most visits were unscheduled (695;78.0%).Uncontrolled asthma imposes a significant burden in these Middle Eastern countries resulting in increased frequency of healthcare use, lower quality of life, and a higher impact on daily life compared to controlled asthma.

Copper sulfide nano-particles were prepared by the sol-gel method followed by a thermal treatment at 200 °C. Structural and optical properties were analyzed using X-Ray Diffraction, Scanning Electron Microscopy, Fourier Transform Infrared and Ultraviolet–Visible spectroscopies. It was found that the obtained compound is a mixed phase and contains randomly distributed lamellas. The optical band gap was found to be direct with a gap width of 2.1 eV. Thermoelectric analysis revealed that this semiconductor shows a p-type conduction and has a power factor of 4.5 μWm−1K−2. These results may be beneficial for future investigations and future uses in optical and thermoelectric devices.

Composites of an epoxy-resin matrix with randomly dispersed carbon black nanoparticles in various amounts and below the percolation threshold were prepared and their dielectric spectra were measured in the frequency range from 100 Hz to 20 MHz and temperature range from 20 °C to 95 °C. The obtained data were analyzed by means of electric permittivity formalism. Two dielectric relaxation processes were revealed in the frequency range and temperature interval of the measurements. One of these relaxations appearing near the glass transition temperature was associated with the interfacial polarization effect. Whereas the other appearing at lower temperature is consistent with the Havriliak–Negami model. Furthermore, the analysis of the temperature dependence of their relaxation time using the Vogel–Tammam–Fulcher (VTF) model shows the existence of carbon black/matrix interaction.

The involvement of erythropoietin in cardiac adaptation to acute and chronic (CHx) hypoxia was investigated in erythropoietin deficient transgenic (Epo-TAg(h)) and wild-type (WT) mice. Left (LV) and right ventricular functions were assessed by echocardiography and hemodynamics. HIF-1α, VEGF and Epo pathways were explored through RT-PCR, ELISA, Western blot and immunocytochemistry. Epo gene and protein were expressed in cardiomyocytes of WT mice in normoxia and hypoxia. Increase in blood hemoglobin, angiogenesis and functional cardiac adaptation occurred in CHx in WT mice, allowing a normal oxygen delivery (O2T). Epo deficiency induced LV hypertrophy, increased cardiac output (CO) and angiogenesis, but O2T remained lower than in WT mice. In CHx Epo-TAg(h) mice, LV hypertrophy, CO and O2T decreased. HIF-1α and Epo receptor pathways were depressed, suggesting that Epo-TAg(h) mice could not adapt to CHx despite activation of cardioprotective pathways (increased P-STAT-5/STAT-5). HIF/Epo pathway is activated in the heart of WT mice in hypoxia. Chronic hypoxia induced cardiac adaptive responses that were altered with Epo deficiency, failing to maintain oxygen delivery to tissues.

SummaryChronic obstructive pulmonary disease (COPD) is a potentially severe chronic progressive respiratory condition requiring long-term treatment and frequently involving episodic hospitalisations to manage exacerbations. The objective of this analysis was to document diagnosis, evaluation, treatment and management of COPD-related respiratory symptoms in 1,392 subjects fulfilling an epidemiological definition of COPD identified in a general population sample of 62,086 individuals aged ⩾ 40 years in ten countries in the Middle East and North Africa region (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), together with Pakistan. 442 subjects (31.8%) claimed to have received a diagnosis of COPD from a physician and 287 (20.6%) had undergone spirometry in the previous year. Use of specific treatments for respiratory symptoms was reported by 218 subjects (15.7%). Use of inhaled long-acting bronchodilators together with corticosteroids (53 subjects; 3.8%) and use of oxygen therapy (31 subjects; 2.3%) was very low. 852 subjects (61.2%) had consulted a physician about their respiratory condition at least once in the previous year, with a mean number of consultations of 3.4±3.6. Moreover, 284 subjects (20.4%) had been hospitalised overnight for their COPD, with a mean of 2.3±3.7 hospitalisations per year. Use of all healthcare resources was significantly higher (p < 0.001) in subjects with CAT scores ⩾10 than in those with scores < 10, and greater in those with exacerbations than in those without. In conclusion, COPD in the region is under-diagnosed, inadequately evaluated and inadequately treated. Nonetheless, COPD symptoms are responsible for considerable healthcare consumption, with high levels of physician consultation and hospitalisation.

SummaryData on COPD-related healthcare resources use are rarely documented in developing countries. This article presents data on COPD-related healthcare resource consumption in the Middle East, North Africa and Pakistan and addresses the association of this variable with illness severity. A large survey of COPD was conducted in eleven countries of the region, namely Algeria, Egypt, Jordan, Lebanon, Morocco, Pakistan, Saudi-Arabia, Syria, Tunisia, Turkey and United Arab Emirates, using a standardised methodology. A total of 62,086 subjects were screened. This identified 2,187 subjects fulfilling the “epidemiological” definition of COPD. A detailed questionnaire was administered to document data on COPD-related healthcare consumption. Symptom severity was assessed using the COPD Assessment Test (CAT). 1,392 subjects were analysable. Physician consultations were the most frequently used healthcare resource, ranging from 43,118 [95% CI: 755–85,548] consultations in UAE to 4,276,800 [95% CI: 2,320,164–6,230,763] in Pakistan, followed by emergency room visits, ranging from 15,917 [95% CI: 0–34,807] visits in UAE to 683,697 [95% CI: 496,993–869,737] in Turkey and hospitalisations, ranging from 15,563 [95% CI: 7,911–23,215] in UAE to 476,674 [95% CI: 301,258–652,090] in Turkey. The use of each resource increased proportionally with the GOLD 2011 severity groups and was significantly (p < 0.0001) higher in subjects with more symptoms compared to those with lower symptoms and in subjects with exacerbations to those without exacerbations. The occurrence of exacerbations and the CAT score were independently associated with use of each healthcare resource. In conclusion, the BREATHE study revealed that physician consultation is the most frequently COPD-related healthcare resource used in the region. It showed that the deterioration of COPD symptoms and the frequency of exacerbations raised healthcare resource consumption.

SummaryFew recent comparative data exist on smoking habits in the Middle East and North Africa (MENA) region. The objective of this analysis was to evaluate smoking patterns in a large general population sample of individuals aged ⩾40 years in ten countries in the region (Algeria, Egypt, Jordan, Lebanon, Morocco, Saudi Arabia, Syria, Tunisia, Turkey and United Arab Emirates), together with Pakistan, using a standardised methodology. A random sample of 457,258 telephone numbers was generated and called. This identified 65,154 eligible subjects, of whom 62,086 agreed to participate. A screening questionnaire was administered to each participant, which included six questions relating to cigarette consumption and waterpipe use. The age- and gender-adjusted proportion of respondents reporting current or past smoking of cigarettes or waterpipes was 31.2% [95% CI: 30.9–31.6%]. This proportion was significantly higher (p < 0.001) in men (48.0%) than in women (13.8%), but no relevant differences were observed between age groups. Smoking rates were in general lowest in the Maghreb countries and Pakistan and highest in the Eastern Mediterranean countries, ranging from 15.3% in Morocco to 53.9% in Lebanon. Consumption rates were 28.8% [28.4–29.2%] for cigarette smoking and 3.5% [3.4–3.6%] for waterpipe use. Use of waterpipes was most frequent in Saudi Arabia (8.5% of respondents) but remained low in the Maghreb countries (< 1.5%). Cumulative cigarette exposure was high, with a mean number of pack·years smoked of 18.5±20.5 for women and 29.1±26.2 for men. In conclusion, smoking is a major health issue in the MENA region.

In this work we studied the electrical properties of carbon black mixed into ethylene butylacrylate copolymer, using impedance spectroscopy, in the frequency range from 100 Hz to 100 kHz and over the temperature range from 150 to 360 K. A series of samples was prepared with several filler contents, below and above the percolation threshold, which was calculated using direct current conductivity measurements. For concentrations below the critical concentration the negative temperature coefficient in resistivity effect is observed, and for concentrations above that threshold the positive temperature coefficient in resistivity effect is present. The dielectric response was analyzed using complex permittivity or modulus formalisms, depending on the concentration of filler in the polymer matrix. Havriliak–Negami model was used to fit the experimental results.

This work presents a study of the electrical conductivity of mixtures of carbon black particles in the ethylene butylacrylate copolymer matrix over the temperature range − 120 to 80 °C. The DC conductivity of these mixtures is examined and a positive temperature coefficient in resistivity effect is found for the carbon black concentration above the percolation threshold ϕ C ( ϕ C ≈ 11%). AC electrical measurements in the frequency range 100 Hz to 0.2 MHz have allowed us to identify different mechanisms of the conduction in these composites. The temperature dependence of the dielectric response has been analyzed below the epoxy glass transition temperature, for various carbon concentrations. Jonscher's phenomenological model has been used for modelling the dielectric response of our composite materials. We find that the activation energy is insensitive to the presence of the carbon particles and we conclude that means that the carbon black particles do not interact or only weakly interact with the chain segments of the macromolecules in the copolymer.

In this paper we report the d.c. electrical conductivity measurements between 80 and 350 K, and the dielectric properties at low frequencies (10 Hz

Summary Background Bronchial asthma is the most frequent chronic childhood disease and can have a marked impact on educational development, activities and quality of life. The AIRMAG survey provides an opportunity to assess asthma and its impact in children in North Africa. Objective To describe the prevalence, burden and management of asthma in children in the Maghreb. Methods A general population sample was generated using a stratified sampling method based on randomly-generated lists of telephone numbers. The target sample consisted of 10 000 households in each country, which were contacted by telephone. A structured interview was proposed. Two screening questions were asked to identify subjects with asthma. Children who met these criteria were then questioned in more detail about their asthma. Results Of 30 350 households contacted, 1090 subjects with asthma were identified, of whom 248 were aged under sixteen and interviewed by proxy. The prevalence of paediatric asthma ranged from 3.5% in Tunisia to 4.4% in Morocco. 22.8% of children were rated as severe persistent and 30.9% as intermittent. Asthma control was adequate in 7.6% of children and unacceptable in 46.2%. Control was best in Tunisia and worst in Morocco. 12.2% had been hospitalised for their asthma in the previous year and 32.9% had needed to attend an emergency department. Short-acting β-agonists were used by 52.8% of children and prophylactic inhaled corticosteroids (alone or in association with long-acting β-agonists) by 27.0%. Conclusions Asthma has a major impact on the lives of children with asthma in the Maghreb. This could be improved by offering more appropriate care as recommended in the GINA guidelines.

Summary Background The goal of asthma management is to achieve disease control, defined. as the ability to lead a normal life with normal pulmonary function. However, many epidemiological surveys have demonstrated that asthma control is unacceptable in the majority of patients. Objective To evaluate asthma control in 624 adults with asthma in the Maghreb, participating in the AIRMAG survey. Methods As part of a general population survey of asthma in the Maghreb conducted by structured telephone interview, information was obtained on asthma control and treatment. Control was determined with the Asthma Control Test (ACT) and using an algorithm based on the GINA control guidelines. Results The mean ACT score was 16.6 ± 4.6, corresponding to uncontrolled asthma. Asthma was uncontrolled (ACT score ⩽19) in 71.3% of subjects and optimally controlled (ACT score = 25) in 3.7%. Using the GINA-based algorithm, asthma was uncontrolled in 50.9% and controlled in 7.6%. Asthma control differed between countries, being best in Tunisia and worst in Morocco (p = 0.004). Only 163 subjects (26.1%) were receiving a recommended prophylactic treatment (inhaled corticosteroids alone or in association with long-acting β-agonists). Other factors associated with asthma control were educational level, asthma perceptions and frequency of physician consultations. Conclusions Asthma control is unacceptably poor in the Maghreb. This could be changed by improved access to appropriate treatments, more proactive patient follow-up and better patient education.

Summary Background: Bronchial asthma is the most frequent chronic respiratory disease in both adults and children. The prevalence and burden of asthma vary considerably between different regions of the world. Information on asthma in Africa is fragmentary and relatively old. Objective: The objective of this cross-sectional epidemiological survey was to determine the prevalence and burden of asthma in the North African countries of Algeria, Morocco and Tunisia using the methodology developed in the Asthma Insights and Reality (AIR) programme. Methods: A general population sample was generated using a stratified sampling method based on randomly-generated lists of telephone numbers. The target sample consisted of 10 000 households in each country, which were contacted by telephone. A structured interview was proposed. Two screening questions were asked to identify subjects with asthma. Subjects who met these criteria were then questioned in more detail about their asthma. Results: Of 30 350 households contacted, 1 090 subjects with asthma were identified of whom 872 provided complete data. The age- and gender-adjusted prevalence of asthma was 3.45% [95% CI: 3.09 3.80%] in Algeria, 3.89% [95% CI: 3.52 4.27%] in Morocco and 3.53% [95% CI: 3.18 3.89%] in Tunisia. Prevalence was highest in children and older adults, and in urban areas. Annual incidence rates ranged between 28/10 000 in Tunisia and 46/10 000 in Algeria. 74.3% of adults reported being handicapped by their asthma all or most of the time, 26.4% reported a visit to a hospital emergency department in the previous year and 23.9% absence from work or school due to asthma. 48.0% reported that their sleep was very or quite disturbed by asthma. Conclusions: The prevalence of asthma in the Maghreb countries is moderate, but its impact is high. © 2009 Published by Elsevier Ltd.

Summary Background Patient adherence to recommended use of ICS is questionable in asthma, with irregular use or interruptions occurring frequently. Factors explaining discontinuation of controller therapy could orientate interventions. The characteristics of patients with interruptions of inhaled corticosteroids (ICSs), intentional or accidental, were investigated. Methods Asthma patients regularly prescribed ICS by GPs (Cegedim network) were included. Patients' characteristics and behaviours toward ICS (accidental/intentional interruptions, less frequent use of ICS and change in dosing) were identified from self-report questionnaires, and linked to data prescription database. Interrelations between declared behaviours toward ICS were studied with a Multiple Component Analysis (MCA) and the correlates of ICS interruptions were identified. Results During the past 3 months, 31.6% of 204 patients (mean age: 53.8 years, females: 59.3%) intentionally interrupted ICS when feeling better, 25.4% forgot ICS and 18.3% deliberately changed the doses. A quarter of patients considered constant use of respiratory medicines as unhealthy. MCA revealed that intentional, accidental interruptions and less frequent use of ICS were closely correlated. Risk of intentional interruption was increased when patients considered constant use of respiratory therapy to be unhealthy (OR = 3.36, 95%CI = [1.47–7.66]). Conversely, risk was significantly lower when ICS was associated or combined with another controller (OR = 0.24, 95%CI = [0.08–0.73]), compared to ICS in monotherapy. Less frequent interruptions were observed in patients older than 65 (OR = 0.35, 95%CI = [0.13–0.89]). Conclusions Our study suggests that discontinuation of use of controllers is associated with other inadequate behaviours or beliefs about inhaled controllers. Efforts should be targeted at patients' perceptions and behaviours toward controller therapy.

Background Patients' perception of their ability to influence their asthma symptoms has not been sufficiently addressed. Objective To study the relationship between patients' perceived ability to self-care, as approached by internal locus of control (LOC) orientation, and concomitant level of asthma control. Methods A cross-sectional study was conducted from May 19, 2004, through July 7, 2005. Asthma patients receiving inhaled corticosteroids and supervised in primary care were identified. Asthma control was measured with the Asthma Control Test. Patients reported their LOC orientation on a 100-mm visual analog scale (0%, "I have absolutely no influence on asthma change," to 100%, "this change only depends on me"). Asthma therapy was obtained from a prescription database. The risk of an internal LOC of less than 50% was studied. Results Among the 163 patients with documented LOC (mean age, 52 years; 58% female), 72 (44.2%) had an internal LOC of less than 50%. Asthma control was inadequate for 65 of the 157 patients with available data on the global score of the Asthma Control Test (41.4%). Patients with inadequately controlled asthma had a higher risk of a LOC of less than 50% (odds ratio, 2.68; 95% confidence interval, 1.23-5.81). A 3-fold increased risk also appeared for patients older than 65 years compared with those younger than 45 years. Conversely, no association was identified with sex, asthma severity markers, or therapy. Conclusions Asthma control was related to internal LOC orientation (ie, perceived ability to self-care). Improved self-care efficiency is a target for adequate disease management.

Resume Le traitement de l’osteoporose par les bisphosphonates peut conduire a une reduction importante des taux de fractures. Toutefois, l’efficacite des bisphosphonates est limitee par la mauvaise persistance des patientes a poursuivre leur traitement. L’introduction de formes a administration hebdomadaire a ete associee a une meilleure observance du traitement. Objectifs Cette etude de modelisation a ete concue pour estimer le gain en matiere de persistance associe a un traitement mensuel et son impact sur les taux de fractures. Methodes Les taux de traitement de l’osteoporose et les taux de persistance a ces traitements ont ete obtenus a partir de donnees sur les prises hebdomadaires et quotidiennes de bisphosphonates extraites d’un panel de medecins generalistes francais et pour la prise mensuelle de bisphosphonates a partir d’une base de donnees des filieres de soins integres aux Etats-Unis (managed care). Les analyses de survie ont ete utilisees pour evaluer la persistance. Les taux de fractures, d’hospitalisations et de surmortalite ont ete appliques en se basant sur des donnees issues d’essais cliniques et de donnees epidemiologiques. Resultats En utilisant un schema therapeutique a prise mensuelle, la reduction du risque de fractures vertebrales et non vertebrales, comparee a des sujets non traites, a ete estimee a 21,2 et 9,5 % respectivement. La reduction du risque d’hospitalisation a ete estimee a 17 % et la reduction de la mortalite a 18,1 %. Ces reductions sont environ 60 % plus importantes que les estimations faites avec une prise quotidienne de bisphosphonates et 25 % plus elevees qu’avec un traitement hebdomadaire. Conclusion Ce modele soutient la notion qu’une meilleure persistance au traitement notamment associee a une prise mensuelle des bisphosphonates pourrait avoir un impact significatif sur le taux des fractures osteoporotiques, ainsi que sur les hospitalisations et la surmortalite qui en decoulent.

Resume Introduction L’infection sexuellement transmissible (IST) a papillomavirus humains (HPV) est l’IST la plus frequente dans le monde, avec une incidence tres elevee dans la classe d’âge 17–25 ans. C’est le principal facteur du cancer du col de l’uterus. Une vaccination systematique des jeunes filles permettrait de reduire significativement l’incidence de cette maladie et la mortalite qui y est liee. Objectif L’un des objectifs de l’etude Enjeux, enquete conduite en population generale feminine, etait d’identifier la place des jeunes filles dans le circuit de soins francais afin de mieux apprecier les conditions dans lesquelles une vaccination anti-HPV efficace pourrait etre implementee. Methodes Le recueil des donnees etait realise en face a face au moyen d’un questionnaire puis d’un autoquestionnaire ; 5 354 entretiens ont ete realises aupres de femmes âgees de 18 a 70 ans. Trois cent vingt d’entre elles ont repondu a des questions concernant leur fille âgee de 11 a 14 ans, et 406 ont repondu a des questions concernant leur fille de 15 a 17 ans ; parmi ces dernieres, 318 ont repondu a leur tour au questionnaire face a face et 294 ont complete l’autoquestionnaire. Resultats Environ un tiers des jeunes filles de 15–17 ans avaient une activite sexuelle. Au sein de ce groupe, il a ete constate des conduites a risque concernant la contraception, en particulier une utilisation insuffisante des moyens de prevention (51 % seulement utilisaient le preservatif). Les donnees concernant le suivi medical des jeunes filles de 11 a 17 ans montraient que celles-ci etaient bien integrees dans le circuit de soins et consultaient regulierement. Le medecin generaliste etait le plus consulte, suivi par le medecin scolaire. Les frequences de consultation du medecin generaliste au cours des 12 derniers mois etaient similaires d’une tranche d’âge a l’autre, et dans plus de 50 % des cas il etait consulte plus de 2 fois par an. Une raison de consultation frequente chez le medecin generaliste etait la vaccination ; les raisons gynecologiques etaient moins frequentes. Conclusion Les resultats de cette enquete ont montre le role pivot du medecin generaliste dans la prise en charge des jeunes filles de 11 a 17 ans.

Summary Introduction Migraine is a prevalent neurological disorder that can be alleviated by specific treatment for acute headaches, in particular, the triptans, including naratriptan. France has developed official guidelines for the use of triptans as part of migraine management. This pharmacoepidemiological study sought to evaluate how naratriptan is prescribed and used in community medicine in France. Methods The protocol called for general practitioners to be randomly selected from a list of all physicians in France and for each to include two patients with migraine. Data came from questionnaires completed by the physician and by the patient (including HIT-6 and QVM to assess headache impact and quality of life) as well as a patient diary. Results In all, 2530 physicians included 3863 patients: 54.3% were treated with naratriptan, 22.4% with another triptan and 23.3% with a non-triptan medication. Of the patients receiving naratriptran, 82.3% were women. Migraine impact was greater and quality of life worse in the patients receiving triptans than those treated with other medications (p Discussion Data from this cross-sectional study indicate that triptans in general and naratriptan in particular are most often prescribed for patients with the most severe migraines. Consistent with official French guidelines, physicians often recommend taking naratriptan after and only if a NSAID fails to provide relief. Nonetheless, one patient in three starts treatment late, which may significantly reduce the efficacy rate, increase the risk of recurrence and side effects, and prolong the headache. Conclusion Naratriptan is generally prescribed in accordance with official guidelines. Delay in taking medication by around one third of patients probably reduces its efficacy.

Resume Objectif Caracteriser la periode de sevrage de la population des femmes fumeuses au cours de la grossesse. Patientes et methodes Il s'agit d'une enquete descriptive par questionnaire sur un echantillon de femmes accouchant dans quatre regions francaises incluant 979 sujets. Les variables analysees concernent les caracteristiques maternelles de l'accouchement et du nouveau-ne, les habitudes tabagiques avant et pendant la grossesse de la patiente, la notion de risque lie au tabagisme, ainsi que les motivations au sevrage tabagique. Resultats Dans notre population, le taux de femmes fumeuses en debut de grossesse est de 30,9 %, et de 18,1 % au jour de l'accouchement. De plus, environ une fumeuse sur 50 realise son sevrage en vue de la grossesse. Ainsi, 45 % des femmes sont sevrees, essentiellement au premier trimestre : parmi les femmes fumeuses a la date de debut de grossesse et sevrees au jour de l'accouchement, 84 % le sont au premier trimestre, 8,8 % au deuxieme et 7,1 % et troisieme. Discussion et conclusion La plupart des arrets a lieu avant toute intervention specifique de tabacologie. En effet, la premiere consultation de grossesse se produit alors meme que, le plus souvent, la patiente est deja sevree.

More and more frequently, the health authorities and the French assessment agencies are led to issue Marketing Authorizations (MAs), give opinions on the eligibility for reimbursement of drugs or to draft recommendations for clinical practice based on the results of foreign studies. The results of these studies are more or less difficult to transpose to French practice. These difficulties generate varying degrees of uncertainty concerning the effect to be expected of a drug. A more or less extensive loss of effect is sometimes even predictable. Some of the difficulties in transposition are discussed in this article and proposals for action are made in order to allow one, in the long term, to predict in the most precise manner possible the effects to be expected from a drug in the French population and be able to verify this prediction at an interval from its eligibility for reimbursement.

De plus en plus souvent, les autorites de sante et les agences d'evaluation francaises sont conduites a delivrer des AMM (Autorisation de Mise sur le Marche), a rendre des avis sur l'admission au remboursement de medicaments ou a elaborer des recommandations pour la pratique clinique a partir de resultats d'etudes etrangeres. Les resultats de ces etudes sont plus ou moins difficiles a transposer a la pratique francaise. Ces difficultes generent une incertitude de degre variable sur l'effet a attendre d'un medicament. Une perte d'effet plus ou moins importante est quelquefois meme previsible. Quelques unes des difficultes de transposition sont discutees dans cet article et des propositions d'actions sont formulees pour permettre, a terme, de predire de la facon la plus precise possible les effets a attendre d'un medicament en population francaise et de pouvoir verifier cette prediction a distance de son admission au remboursement.

Summary Background Imported malaria remains an important, but often unrecognised, health problem in Europe. Little information exists on the incidence of imported malaria with respect to exposure. This study aimed to estimate the incidence of malaria in a cohort of travellers with respect to protection measures. Method In all 13,017 participants enrolled in a French general population cohort (SU.VI.MAX cohort) and followed-up over 8 years were investigated. All participants received a retrospective questionnaire about travel to malaria-endemic countries relating to countries visited, duration of stay, use of protection measures and chemoprophylaxis. Malaria cases was confirmed from medical records. Results Data were obtained for 752 individuals who made 1393 trips to malaria-endemic areas. This sample was predominantly middle-class and high-risk groups such as migrants were not represented. Mechanical protection was used in 589 trips (42.3%) and chemoprophylaxis in 1017 trips (73.0%). This was appropriate for the zone in 615 trips (44.0%) and adequate compliance was reported in the case of 497 trips (35.6%). Appropriate chemoprophylaxis and physical protection measures were used in 21.7% of the trips. Six laboratory-confirmed cases of imported malaria yielded an estimated incidence density of 148 cases/month of exposure/10,000 travellers. In five cases, appropriate protection measures had not been taken. Conclusion Appropriate chemoprophylaxis and physical protection measures against malaria infection are used by less than one-quarter of a sample of predominantly middle-class travellers from France to endemic areas. More intense education measures need to be implemented to reduce the risk of imported malaria.

Resume Introduction Un observatoire national d’etude de la prise en charge des migraines en medecine generale a ete mene aupres de 349 medecins generalistes. Cet observatoire a permis de recueillir des donnees concernant 2 537 patients cephalalgiques. Methodes Les principales donnees recueillies ont ete le diagnostic IHS, la severite des cephalees a partir de l’echelle MIGSEV, la prise en charge, et l’impact sur la vie quotidienne (echelles QVM et HIT-6). Resultats Parmi les 2 537 patients inclus, 52 p. 100 d’entre eux etaient des patients migraineux au sens strict des criteres IHS (code 1.1/1.2), 34 p. 100 presentaient un desordre migraineux (IHS code 1.7) et 14 p. 100 etaient des cephalalgiques non migraineux. L’etude de la prise en charge des patients montre que 71 p. 100 d’entres eux prennent un traitement de crise non specifique, 46 p. 100 un traitement de crise specifique et 27 p. 100 un traitement de fond. L’analyse de l’impact des cephalees a partir de differents outils tels que le QVM ou le HIT-6 a permis de mettre en evidence le lien existant entre, d’une part le diagnostic et d’autre part la severite de la migraine et son impact sur la vie des patients migraineux. L’etude de la correlation entre la douleur de la derniere crise evaluee par le patient et par le medecin montre que ce dernier tend a sous-estimer la douleur du patient. Conclusion Ces resultats soulignent l’importance du dialogue entre le patient migraineux et le medecin. Une formation des medecins a l’utilisation d’outils simples de mesure de l’impact des migraines sur la vie quotidienne comme l’echelle HIT-6, pourrait les aider a mieux evaluer cette maladie afin d’optimiser la prise en charge des patients migraineux.

The respective roles of controlled clinical trials and observational studies (cohort or case-control studies) in evaluating the efficacy, safety and usefulness of a drug were analysed. A randomised, controlled, double-blind study is the best method of estimating the efficacy of a treatment. It provides the least biased and most robust estimate of the causal relationship. In certain situations and on the basis of certain criteria, observational studies can have a proof-of-efficacy value. Randomised, controlled, pre- and postmarketing authorisation (MA) clinical studies identify the rarer adverse effects and compare them with those resulting from the reference treatment. Before the MA, the pooled safety data from different controlled trials can provide an estimation of relatively frequent adverse events and subjects at risk. However, an observational study is the most appropriate method of evaluating the safety of a drug in the currently used conditions. By definition, a drug influences the health of a population if it directly or indirectly improves its health. A drug would have a major role in public health if it reduced mortality or morbidity related to a particular disease or if it improved the quality of life of patients with this disease. Prior to marketing a product, modelling is the approach of choice to quantify the expected effect. Pragmatic, postmarketing trials and observational studies are the reference methods used to define the population affected, the efficacy and safety of the drug in a real situation and its usefulness for public health. In conclusion, randomised clinical trials remain the reference approach for evaluating efficacy, while observational studies have a confirmatory value. Observational studies are the most appropriate way of evaluating safety in the currently used conditions, as the clinical trial has limited indications. In the interests of public health, modelling is the pre-marketing approach of choice, while pragmatic trials and observational studies are the postmarketing reference approaches.

Resume La place relative des essais cliniques comparatifs et des etudes observationnelles (cohortes ou etudes castemoins) a ete etudiee dans l’objectif d’evaluer l’efficacite, la tolerance et l’interet de sante publique d’un medicament. L’essai randomise, comparatif, realise en double insu est la meilleure methode pour estimer l’efficacite d’un traitement. Il permet l’estimation la moins biaisee et la plus robuste de la relation causale. Dans certaines situations et sous certains criteres, des etudes observationnelles peuvent avoir valeur de preuve d’efficacite. Les etudes cliniques randomisees comparatives en pre- et post-AMM (autorisation de mise sur le marche) permettent d’identifier les effets indesirables plus rares et de les comparer au traitement de reference. Avant l’AMM, les donnees de securite regroupees des differents essais comparatifs peuvent permettre d’estimer des evenements indesirables relativement frequents et les sujets a risque. Cependant, l’etude observationnelle est plus adaptee pour evaluer la securite d’emploi dans les conditions reelles d’utilisation. Par definition, un medicament a un impact sur la sante des populations s’il permet d’ameliorer directement ou indirectement son etat de sante. Un medicament aura un interet majeur en termes de sante publique s’il reduit la mortalite ou la morbidite liee a cette maladie ou s’il ameliore la qualite de vie des patients qui en sont atteints. Avant la commercialisation d’un produit, la modelisation est l’approche de choix pour quantifier l’impact attendu. En post-AMM, les essais pragmatiques et les etudes observationnelles sont les methodes de reference pour definir la population rejointe, l’efficacite et la tolerance en situation reelle et l’interet en sante publique d’un medicament. En conclusion, l’essai clinique randomise reste la reference pour l’evaluation de l’efficacite, l’etude observationnelle ayant une valeur confirmatoire. L’etude observationnelle est plus adaptee pour evaluer la securite d’emploi dans les conditions reelles d’utilisation, l’essai clinique ayant des indications limitees. Pour l’interet de sante publique, la modelisation est l’approche de choix en pre-AMM. En post-AMM, les essais pragmatiques et les etudes observationnelles sont les references.

Resume Introduction L’usage de psychotropes est important en France et augmente depuis deux decennies. A ce jour, aucune etude nationale confrontant cet usage au diagnostic des troubles psychiatriques n’a ete realisee. L’etude ESEMeD/MHEDEA 2000 permet d’avoir une idee precise des conditions d’usage des psychotropes et de mettre en perspective la France par rapport a cinq autres pays europeens (Allemagne, Belgique, Espagne, Hollande et Italie). Les objectifs etaient (1) decrire l’usage des psychotropes declares (globalement et par classe therapeutique) afin d’en evaluer la prevalence annuelle, les durees de traitement et les facteurs demographiques associes a leur utilisation. (2) estimer la proportion des sujets presentant un trouble anxieux, depressif ou lie a l’alcool (abus ou dependance) qui sont effectivement traites par un antidepresseur (AD) ou un anxiolytique-hypnotique (AX-HY). (3) evaluer la proportion des usagers de psychotropes repondant aux criteres diagnostiques de troubles depressif, anxieux, ou lie a l’alcool. Methode Il s’agit d’une enquete transversale realisee en 2001-2003, en population generale, chez des sujets âges de plus de 18 ans et non institutionnalises, vivant en Allemagne (n = 3 555), en Belgique (n = 2 419), en Espagne (n = 5 473), en France (n = 2 894), aux Pays-Bas (n = 2 372) et en Italie (n = 4 712). En France, la base de sondage utilisee etait une liste de numeros de telephone generes aleatoirement. Les sujets ont ete interroges a leur domicile par des enqueteurs professionnels. Le questionnaire WMH-CIDI a ete utilise. Resultats En France, 21 % des sujets interroges (n = 590) avait pris au moins une fois un psychotrope dans l’annee. Il s’agissait d’un anxiolytique-hypnotique (AX-HY) pour 19 %, d’un antidepresseur (AD) pour 6,0 %, d’un antipsychotique (AP) pour 0,8 % et d’un thymoregulateur (TY) pour 0,4 %.La repartition des usagers d’AX-HY selon le nombre de jours de traitement etait la suivante : 44 % (1-15 jours), 13 % (16-30 jours), 14 % (1-3 mois), 6,7 % (3-6 mois) et 23 % (> 6 mois). Pour les AD, la repartition etait : 21 % (1-15 jours), 7,8 % (16-30 jours), 18 % (1-3 mois), 12 % (3-6 mois) et 42 % (> 6 mois). Parmi les personnes qui repondaient aux criteres de trouble depressif dans l’annee ou au cours de la vie, 43 % et 29 % respectivement avaient pris un AX-HY dans les douze derniers mois, 29 % et 16 % un AD. Pour ceux qui repondaient au diagnostic de trouble anxieux dans l’annee ou au cours de la vie, l’usage d’AX-HY, dans les douze derniers mois, a concerne 43 % et 30 % des sujets tandis que celui des AD concernait 16 % et 14 %. En cas de trouble lie a l’alcool dans l’annee ou sur la vie, l’usage d’AX-HY, dans les douze derniers mois, a concerne respectivement 63 % et 22 % de ces sujets et l’usage des AD, 9,3 % et 7,2 %.Chez les usagers d’AX-HY au cours des douze derniers mois, un diagnostic de trouble depressif a ete retrouve parmi 16 % sur l’annee et 39 % au cours de la vie. Chez les usagers d’AD, les prevalences respectives etaient de 31 % et 64 %. Un diagnostic de trouble anxieux sur l’annee et au cours de la vie a ete retrouve parmi 22 % et 37 % des usagers d’AX-HY et parmi 27 % et 50 % des usagers d’AD respectivement. Un diagnostic de trouble lie a l’alcool sur l’annee et au cours de la vie a ete retrouve parmi 2,5 % et 6,6 % des usagers d’AX-HY et parmi 1,1 % et 7,8 % des usagers d’AD respectivement.Le taux d’usagers d’AX-HY ne repondant a aucun des diagnostics precedents etait de 68 % sur l’annee et de 46 % au cours de la vie. En ce qui concerne les usagers d’AD ne repondant a aucun des diagnostics precedents, ce taux s’etablissait a 56 % sur l’annee et a 20 % au cours de la vie.La comparaison des donnees francaises a celles de l’echantillon europeen montre que la prevalence annuelle de l’usage des AX-HY et des AD est plus elevee en France avec des durees moyennes d’usage plus courtes. Pour les AP et les TY, il n’existe pas de difference nette entre la France et l’ensemble des six pays de l’etude. Discussion Depuis deux decennies, l’usage des AX-HY semble avoir diminue en France, meme s’il reste plus eleve que celui observe dans les autres pays de l’etude. Cet usage plus important peut, en partie, s’expliquer par le fait qu’il correspond, dans la moitie des cas, a un usage ponctuel. En revanche, l’usage des AD a augmente. Chez les sujets presentant des troubles depressifs ou anxieux recents, l’usage des AX-HY reste plus important que celui des AD. Enfin, parmi les usagers des AX-HY, seulement la moitie a presente un episode anxieux, depressif ou lie a l’alcool au cours de leur vie, alors que cette proportion s’eleve a 80 % chez les usagers des AD. Remerciements Ce projet a ete soutenu financierement par la Commission Europeenne (Contrat QLG5-1999-01042) et a ete developpe grâce au soutien humain et financier du Laboratoire GlaxoSmithKline que nous remercions chaleureusement. L’etude ESEMeD/ MHEDEA 2000 (The European Study of Epidemiology of Mental Disorders/Mental Health Disability : a European Assessment in the year 2000) a ete menee conjointement avec l’Organisation Mondiale de la Sante : World Mental Health Survey Initiative ( http://www.hcp.med.harvard.edu/wmh/ ). Nous remercions l’equipe coordinatrice World Mental Health (WMH) pour leur aide concernant les outils de mesure et pour leur conseil en matiere de procedures operationnelles.

Resume Introduction NOEMIE (Nouvel Observatoire Epidemiologique de la Migraine en Entreprise) est un observatoire visant a evaluer l’action d’un depistage et d’une orientation du migraineux vers les filieres de soins, a partir du service de Medecine du travail de l’entreprise. Methodes et patients Il s’agit d’une etude epidemiologique observationnelle, comparative, longitudinale, multicentrique, d’une duree de 18 mois (12 mois d’inclusion et 6 mois de suivi) menee aupres de 17 centres de Medecine du travail en France. Deux groupes de migraineux (selon les criteres IHS) ont ete inclus : le groupe A constitue de migraineux deja pris en charge, le groupe B de sujets n’ayant pas consulte depuis plus de 12 mois et orientes vers les filieres de soins. Le critere principal d’evaluation etait l’evolution du score a 6 mois de l’echelle de Qualite de Vie Migraine (QVM). Resultats L’analyse des 2 groupes de patients a l’inclusion montre qu’ils sont comparables en termes de caracteristiques socio-demographiques, anciennete et severite de la maladie. En revanche, il existe une difference statistiquement significative en ce qui concerne la frequence des crises, la prise en charge, le jugement de l’efficacite des traitements et la qualite de vie. Apres 6 mois de suivi, les scores de QVM ont ete significativement ameliores dans les deux groupes de sujets. L’analyse des 4 753 crises rapportees revele que le travail en cours, en cas de crise, a du s’interrompre dans 12,4 p. 100 des cas dans le groupe A contre 10,9 p. 100 dans le groupe B. Les arrets de travail, par rapport aux donnees de l’inclusion, ont regresse considerablement dans les deux groupes. Conclusion La detection de migraineux non pris en charge et leur orientation vers une filiere de soins ameliorent leur qualite de vie, permettent une prise en charge adequate de la migraine et diminuent ses consequences professionnelles.

Resume Cette etude pharmacoepidemiologique decrit l’utilisation des triptans en medecine generale, aupres de migraineux « naifs » (n’ayant jamais utilise un triptan) et « non naifs » de triptans (experience anterieure d’un traitement par cette classe therapeutique). Elle montre que 95 % des patients inclus sont migraineux selon les criteres de l’International Headache Society (IHS), ce qui confirme le bon usage des triptans en medecine generale. Les patients beneficiant de triptans sont des migraineux ayant un profil de severite superieur a celui des migraineux en population generale. Les patients « naifs » et « non naifs » ont un profil comparable en termes de diagnostic IHS et de severite de la maladie mais les patients « non naifs » ont une histoire de la maladie plus ancienne et un impact plus marque sur la qualite de vie. Les raisons des modifications de traitements avancees le plus frequemment sont la recherche d’une meilleure efficacite de leur nouveau traitement, une action plus rapide, une moindre recurrence et une meilleure tolerance.

Migraine remains an under-diagnosed disease. Many migraine sufferers are not currently treated within the healthcare system and most of them take self-medication. A prospective national study was conducted in France with 770 pharmacies. Data on symptoms, drug dispensing, patient management, and satisfaction of 7 264 subjects complaining of headache at the pharmacy were collected. Two-third of the subjects were migraine sufferers according to the IHS criteria. 32 p. cent of them came to the pharmacy during a pain attack. 63 p. cent had a medical prescription (46 p. cent in the non-migraine group) with triptans being most often prescribed drug (in almost half of the cases). Nearly one-third of the migraine sufferers without medical prescription were referred to a doctor by the pharmacist. This first study on migraine and headaches and pharmacies highlights the important role that pharmacists can play in improving the management of migraine and headache through advice and proper orientation towards medical practitioners.

Resume Objectifs Cette etude a ete realisee dans le but de determiner l’evolution du nombre de cas d’herpes genital et d’evaluer l’impact de differentes strategies de traitements en France. Methode Un modele d’histoire naturelle de l’infection genitale par le virus Herpes simplex est presente et applique a la population francaise. Le modele prend en compte les infections par le virus Herpes simplex type 1 (HSV-1) ou 2 (HSV-2), les premiers episodes, les recurrences, l’excretion virale et l’effet du traitement sur les individus infectes. Resultats Nous avons estime pour l’annee 2000 que 270 000 individus auraient souffert d’herpes genital en France. Le nombre annuel total cumule d’episodes de recurrence serait de 1,5 millions avec 23 millions de journees avec excretion virale. Nous avons estime que 70 p. 100 de ces dernieres concerneraient des sujets seropositifs sans signes cliniques. Le nombre attendu de deces neonatals attribuables resterait tres faible. Un traitement systematique des episodes cliniques pourrait reduire le nombre de jours avec lesions (– 27 p. 100) et etre egalement efficace sur l’excretion virale chez les malades symptomatiques (– 50 p. 100). Un traitement continu des malades les plus severes (≥ 6 recurrences par an) reduirait l’excretion virale (– 85 p. 100). Les traitements antiviraux pourraient avoir un impact majeur sur la qualite de vie des malades, mais ne devraient inflechir que modestement l’incidence des nouvelles infections. Discussion Le modele realise s’appuie sur l’ensemble des resultats partiels publies sur l’epidemiologie de l’herpes genital au niveau international. Toutefois, de nombreux aspects de cette maladie sont encore mal documentes et differentes hypotheses doivent etre retenues pour simuler l’histoire naturelle de l’herpes genital au niveau d’une population. L’absence de donnees francaises, notamment sur les profils de seroprevalence HSV-1 et HSV-2 par âge, constitue une source supplementaire d’incertitude. Les resultats obtenus presentent donc un caractere largement exploratoire. Ce type d’approche constitue toutefois le seul moyen possible pour integrer les multiples elements de connaissance de la maladie afin de predire l’impact de differentes strategies d’intervention de sante publique. Le modele presente doit donc etre concu comme un outil general qui pourra integrer dans l’avenir les nouvelles donnees qui seront produites.

Round table no. 2 was devoted to the postmarketing evaluation of drugs. The debates involved both the questions posed by postmarketing evaluation and the methods for responding to them. The major categories of questions likely to be posed are as follows: efficacy in actual situations; safety in actual situations; prognostic factors and patients responding; place in the therapeutic strategy; impact on the healthcare care system; the ‘joined’ population (those who actually obtain benefit); and drug utilisation review. In addition, the methodological approaches have been divided into three categories: the experimental approach, the observational approach and the modelling approach. Each of these methodological approaches has been qualified with respect to each of the questions. The objective was neither to establish a classification of the methods according to the level of proof, nor to propose methodological formulae. Instead, the participants applied themselves to describe the strengths and the limits of the different methods for each of the questions in turn. The debates then focused on the process of identification of pertinent questions and appropriate methods. In this context, the round-table participants applied an analysis of the current system of postmarketing study projects and formulated some propositions for their improvement. Finally, the place of existing databases in the postmarketing evaluation was discussed and the participants emphasised the importance of initiating a very detailed assessment of the information that could be provided by such databases before instituting ad hoc studies.

Round table no. 2 was devoted to the postmarketing evaluation of drugs. The debates involved both the questions posed by postmarketing evaluation and the methods for responding to them. The major categories of questions likely to be posed are as follows: efficacy in actual situations; safety in actual situations; prognostic factors and patients responding; place in the therapeutic strategy; impact on the healthcare care system; the 'joined' population (those who actually obtain benefit); and drug utilisation review. In addition, the methodological approaches have been divided into three categories: the experimental approach, the observational approach and the modelling approach. Each of these methodological approaches has been qualified with respect to each of the questions. The objective was neither to establish a classification of the methods according to the level of proof, nor to propose methodological formulae. Instead, the participants applied themselves to describe the strengths and the limits of the different methods for each of the questions in turn. The debates then focused on the process of identification of pertinent questions and appropriate methods. In this context, the round-table participants applied an analysis of the current system of postmarketing study projects and formulated some propositions for their improvement. Finally, the place of existing databases in the postmarketing evaluation was discussed and the participants emphasised the importance of initiating a very detailed assessment of the information that could be provided by such databases before instituting ad hoc studies.

The public health educational impact of community-based ultrasound (US) surveys for cystic echinococcosis (CE) can form an important part of the development about the awareness of the importance of the disease in an endemic area. In addition to identifying asymptomatic carriers and thereby facilitating early diagnosis and treatment, such surveys can be used to impart important educational messages at the individual, household, community, regional and national levels. US surveys are usually appealing to rural communities where such services are not available but where the technique is generally appreciated by its application in a wide field of medical applications. The qualities of the test (painless, non-invasive and gives instant recordable results) are also attractive to participants during such surveys and the majority of the population in a selected study area choose to be screened. Two such surveys were carried out amongst the Berber people of the mid-Atlas mountains in central Morocco in May 2000 and 2001. Over 11,000 people were screened in the two 10-day surveys. Informed consent had been obtained through community meetings and with the chiefs of villages prior to the surveys being conducted. Individuals who volunteered to be screened entered the study and as far as is known there were no refusals. The concept of voluntary participation, the explanation of the life cycle and clinical manifestations of the disease and its prevention are all-important educational messages. The occurrence of CE is almost always known in an endemic community but is usually very poorly understood leading in many cases to a fear of the disease, especially amongst families with an infected individual who has previously undergone surgery. During the US survey considerable attention was paid to provide educational input before, during and after the survey. Information was provided at the start of the survey to local leaders, doctors, veterinarians and school teachers on the aims of the study and to obtain informed consent. At the start of the study everyone was individually schooled about the route of transmission of the parasite and how this may be best prevented. The knowledge level of those screened was assessed by showing hydatid cysts, either freshly obtained from the abattoir of from photographs. Animal cysts were recognised by almost everyone but its transmission and link to human disease was invariably unknown. Patients found to be infected with CE were always confidentially counselled and followed up for treatment, if required. Treatment options were explained to the individual or to parents in the case of a child. Local physicians participated in discussions on the WHO guidelines for the treatment of CE and all cases were fully discussed providing an educational element for the local doctors. The 1% US prevalence found sent an important message to the local politicians and the perceived importance of the disease had an impact at the leadership level. Local leaders made calls for a control programme. The long term educational impact remains to be evaluated as does the role such surveys play in the future collaboration of communities with the implementation of a control programme.

Background: The actual impact of influenza epidemics cannot be accurately estimated from medical practice-based surveillance data. A prospective household contact study was performed in order to quantify the burden of influenza. Methods: The study took place in France between January and March 2000. A total of 947 households were recruited by 161 general practitioners (GP), from an “index-case” who consulted the GP for influenza-like illness. Virological specimens were collected for diagnosis of influenza and other respiratory pathogen infections. All household members were asked to complete a questionnaire, which included a 15-day follow-up, with details of clinical events, healthcare resources and work–sick leave. Results: Identified among household contacts were 395 influenza type A-positive index cases and 313 secondary cases. The median time to alleviation of major influenza symptoms was 8 days in index cases and 6 days in secondary cases. Forty-two percent of secondary cases did not consult while 15% consulted more than once. The mean number of treatments taken was respectively 3.7 and 2.2 in index and secondary cases. Work–sick leave was mainly associated with the severity of the illness. Conclusion: These results could help for quantifying the burden of influenza epidemics.

Large scale thermal energy storage for solar heating applications can be accomplished in the ground through the installation of an array of vertical heat exchange boreholes or U-tubes. Simulation modeling of the storage subsystem and its integration with the total system is essential for design and performance evaluation. Although U-tube storage design is especially attractive in clay soils and preferable to boreholes in many geological conditions, only a borehole simulation model is currently available, validated, and integrated into a system simulation model. This article presents a comparative analysis of the heat transfer from boreholes and U-tubes using analytical solutions, finite element modeling, and the available simulation model. The analysis is used to support the development of a methodology by which the heat transfer of any U-tube configuration can be modeled by appropriately specifying parameters in the borehole storage simulation model. The borehole model can then be used to model the storage subsystem integrated within a total system simulation model.

An enzyme-linked immunosorbent assay (ELISA) using sonicated purified Theileria annulata piroplasms was compared with an indirect immunofluorescent antibody test (IFAT) during a vaccination trial in cattle to test different doses and passage numbers of an attenuated T. annulata-infected lymphoblastoid cell-line, and also with Giemsa-stained blood smears during an epidemiological field study of tropical theileriosis in Morocco. The sensitivities of both the ELISA (0.56) and the IFAT using T. annulata piroplasm antigen (0.56) were lower than the IFAT using schizont antigen (0.94) for detecting serum antibodies from 18 cattle immunised 38 days previously with cell-line. The ELISA was, however, the most sensitive test after 180 days (0.50 compared with 0.06 for the piroplasm IFAT and 0.39 for the schizont IFAT), and each test detected antibodies in all sera after challenge with live T. annulata sporozoites. There were minor differences in the ability of blood smear examinations and the ELISA to detect infected and uninfected cattle in the field study at the start and end of the disease season. Initially, the sensitivity and specificity of blood smears were both 0.96 and for the ELISA were 0.83 and 0.86, whereas at the end of the season sensitivity and specificity of blood smears were 0.96 and 0.86 and for the ELISA were 0.95 and 0.94. The specificity of the ELISA was affected by the presence of calves with colostral antibodies, and if these were disregarded the specificities before and after the season were 0.94 and 1.00.

The effects of long-term chronic stress (induced by repeated restraint, overcrowding or both), short-term chronic stress (induced by a triad of stressors over a short period of time early in life) and adrenalectomy were investigated on the prevalence, on the degree of insulitis and various physiological and immunological parameters in the NOD mouse, a spontaneous model of type I-insulin-dependent diabetes mellitus (IDDM). Long-term chronic stress, obtained by restraint once a week or overcrowding, significantly protected NOD females, while both applied concomitantly had only a tendency to protect against diabetes. In contrast, short-term chronic stress had no significant effect on diabetes expression, whereas adrenalectomy resulted in a trend toward accelerated diabetes onset. The various long-term chronic stress paradigms exerted different effects on the progression of insulitis: repeated restraint tended to protect against insulitis, overcrowding had no effect but, when associated with restraint, significantly counteracted the beneficial effect of restraint alone. Adrenalectomy and short-term chronic stress had no significant effect on the development of insulitis. Various parameters, such as body, thymus and spleen weights, thymus and spleen cellularities, mitogen-induced spleen cell proliferation and serum corticosterone levels were also studied under the various experimental conditions. Taken together, the observations suggest that stressors modulate the expression of spontaneous autoimmune diabetes by exerting pleiotropic effects on immune and/or inflammatory components at the pancreas level and on peripheral glucose metabolism.