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Background General practitioners’ perception of the discomfort their patients experience because of corticosteroid-induced adverse events is unknown. Methods An observational epidemiological study was conducted in September 2007. Eight hundred and sixty general practitioners belonging to the reseau Sentinelles® were asked to complete an electronical questionnaire. The questionnaire aimed to assess their perception of discomfort induced by adverse events induced by a long-term (i.e., ≥ 3 months) corticosteroid therapy among their patients. Results were compared with the declaration made by 115 long-term corticosteroid treated patients followed in an internal medicine department. Results Two hundred and ninety-three general practitioners responded to the questionnaire (response rate: 34%). They were predominantly male (87%). Forty-eight percent of them reported 400 to 600 monthly visits. The mean length of corticosteroid therapy for patients was 44 ± 38 months and the mean daily dosage was 15 ± 14 mg. They suffered mainly from lupus erythematosus (33%) or giant cell arteritis (15%). The adverse events considered to be the most disturbing by patients were lipodystrophy (25%), followed by weight gain (18%) and neuropsychiatric complaints (16%). Physicians widely overestimated the discomfort caused by weight gain cited as the most disturbing adverse event by 59% of them and underestimated that induced by mood disorders cited as the most disturbing by only 3% of them. Conclusion The discomfort caused by corticosteroid-induced neuropsychiatric adverse events are underestimated by general practitioners.

Resume Introduction A l’exception des mesures concernant la prevention de l’osteoporose, il n’existe pas de recommandations consensuelles quant aux mesures adjuvantes a prescrire lors d’une corticotherapie systemique prolongee. Nous avons cherche a savoir si les pratiques des internistes concernant ces mesures adjuvantes etaient homogenes ou pas. Methodes L’enquete a ete menee a l’aide d’un questionnaire electronique adresse, en septembre 2007, par courriel aux 813 medecins internistes membres de la Societe nationale francaise de medecine interne disposant d’une adresse electronique. Ce questionnaire concernait la frequence de prescription des mesures associees a une corticotherapie systemique prolongee et pour lesquelles il n’existait pas de recommandations consensuelles (regime alimentaire, mesures d’entretien musculaire, supplementation potassique, protection gastrique, vaccination antigrippale, relais par hydrocortisone). Resultats Trois cents trente-six des 813 medecins sollicites ont repondu au questionnaire (taux de reponse : 41 %). Ces repondeurs etaient majoritairement des hommes (71 %) et travaillaient principalement en centre hospitalo-universitaire (53 %). En ce qui concernait les mesures dietetiques preconisees, seul le regime hyposode etait prescrit de facon relativement homogene par les praticiens (69 % des praticiens le prescrivaient chez plus de 80 % de leurs patients). Un regime hypocalorique, pauvre en glucides et riche en proteines, etait ou non preconise par les praticiens. Une kinesitherapie d’entretien musculaire n’etait pas frequemment proposee (74 % des praticiens la prescrivaient chez moins de 20 % de leurs patients). En revanche, il n’existait aucun consensus concernant la recommandation ou non d’un exercice physique regulier. La supplementation potassique, la protection gastrique, la vaccination antigrippale et le relais hydrocortisone ne faisaient egalement l’objet d’aucun consensus au sein de la communaute interniste. Conclusion Les principales mesures adjuvantes a une corticotherapie systemique prolongee ne font l’objet d’aucun consensus au sein de la communaute interniste francaise.

Inserm has developed, since 1984, an information system based on a computer network of physicians in France. It allows for constitution of large databases on diseases, with individual description of cases, and to explore some aspects of the mathematical theory of communicable diseases. We developed user-friendly interfaces for remote data entry and GIS tools providing real-time atlas of the epidemiologic situation in any location. The continuous and ongoing surveillance network is constituted of about 1200 sentinel voluntary and unpaid investigators. We studied their motivation, reasons for either withdrawal or compliance using survival analyses. We implemented early warning systems for outbreak detection and for time-space forecasting. We conducted epidemiological surveys for investigating outbreaks. Large available time and space series allowed us to calibrate and explore synchronism of influenza epidemics, to test the assumption of panmixing in susceptibles-infectious-removed type models and to study the role of closing school in influenza morbidity and mortality in elderly. More than 250 000 cases of influenza, 150 000 cases of acute diarrheas, 35 000 patients for whom HIV tests have been prescribed by general practitioners and 25 000 cases of chickenpox have been collected. Detection of regional influenza or acute diarrhea outbreaks and forecasting of epidemic trends three weeks ahead are currently broadcasted to the French media and published on Sentiweb© on a weekly basis. Age-cohort-period models assessed field effectiveness of mass immunization strategies against measles and influenza in the country. Case-control studies with more than 1200 sets of cases of acute diarrheas and their matched controls showed the role of calicivirus and rotavirus as probable major causes of gastroenteritis during recurrent widespread outbreaks in winter in France. An age-specific model for chickenpox showed the probable role of children in disease transmission to their susceptible parents or grandparents. High level of synchronism between influenza epidemics has been demonstrated, either at a regional level (in France) or between France and the USA. The designation of our lab as a WHO collaborating center for electronic disease surveillance stimulates the development of global monitoring of diseases. We developed operational systems that are now available for the global monitoring of influenza (FluNet©), and human and animal rabies (RABNET©). Extension of electronic syndromic surveillance is needed in the world for improving surveillance capacities and real-time response against emerging diseases.