[Preventive practice in general medicine in the Rhone-Alps region]. / Pratiques préventives en médecine générale en région Rhône-Alpes.

The Fifth Health Conference in the Rhone-Alps which took place in early 2001 provided the ideal opportunity and forum for holding a debate about prevention in ambulatory care. In order to provide arguments supporting a wider basis for reflection, the Regional Department of Social and Health Affairs in the Rhone-Alps initiated a study focusing on preventive practices of general practitioners in various areas such as vaccination follow-up procedures; care provided to the elderly; gynaecology, life styles and additions (alcohol, tobacco, and drugs). Utilising the network of the Association for the Development of Medical Information (A.D.I.M.), a representative sample of 80 general practitioners working in the Rhone-Alps region was constituted, which allowed for the inclusion of 3,658 patients from July to December 2000. Results show a distortion between objective preventive practices measured with different physicians' activity scores in the aforementioned areas and the estimated level of effectiveness determined from individual physician's statements. The subsequent calculation of these scores, based on a large sample of patients with similar characteristics to the general population, provide an objective reality from the care consumer's perspective: there is an overall lack of prevention on the part of physicians. The physicians themselves cite the lack of time; an inadequate system of payment and insufficient training as causes for this situation. The implementation of an economic incentive system could facilitate the development preventive practice in general medicine and ambulatory care.

Good immunogenicity of GBM strain inactivated hepatitis A vaccine in healthy male adults.

A formalin-inactivated aluminium hydroxide adsorbed hepatitis A vaccine was evaluated in a dose-response study on 195 healthy male adults (age range: 18-31 years) in two French hospitals (Lyon, Rouen). Four doses (20, 40, 80, 160 RIA antigen units) were administered intramuscularly (i.m.) in two injections over a 6-month period. At the time of the first vaccine injection, 32 subjects (16.4%) were found positive (> 20 mIU ml-1) for HAV antibody (total Ig RIA HAVAB assay, Abbott Laboratories) and were excluded from the analysis of immunogenicity criteria. Fourteen days after the first vaccine injection, 78.1% (95% confidence interval (CI): 62-90) of seronegative subjects who received the 160 RIA antigen unit dose seroconverted with a geometric mean titre (GMT) of 43 mIU ml-1 (95% CI: 33-56). Seroconversion was 100% (95% CI: 91-100) at 1 month with a GMT of 95 mIU ml-1 (95% CI: 79-112). Statistical analysis revealed a significant dose-related effect (p < 0.0001) on GMT by multivariate regression analysis of the results after the first injection. Biological safety was evaluated and alanine aminotransferase and aspartate aminotransferase levels were similar prior to and 14 days after the first injection in the four groups. Reactions after injection were similar in the four dosage groups: 6.2% of subjects reported immediate reactions after first vaccination (feeling sick, spontaneous pain, headache), 8.9% reported local reactions at the site of injection (spontaneous pain, haematoma, local adenopathy) and 13.5% reported general reactions ('flu-like' syndrome, gastrointestinal tract disorders, fatigue, headache).(ABSTRACT TRUNCATED AT 250 WORDS)

[Malaria in the republic of São Tomé and Principe. Epidemiologic evaluation and chemoresistance of P. falciparum]. / Le paludisme en république de São Tomé et Principe. Evaluation épidémiologique et chimiorésistance de P. falciparum.

The authors report the results of a valuation of paludometric indices during mai 1990 in Democratic São Tomé e Príncipe Republic (RDSTP). These investigations (parasitic index and spleen index) suggest that malaria is mesoendemic in these area. Plasmodium susceptibility to chloroquine at posology of 25 mg/kg per os was evaluated (WHO standard 7 days field test). Among 58 children, ranging from 5 to 11 years old, resistance at level R I was observed in 9% of cases, at level R II in 14%. Among 10 strains of P. falciparum, 9 were chloroquine resistant in vitro. 2 strains were also less sensible to quinine.

[Chemoprophylaxis of Plasmodium falciparum malaria by a combination of 100 mg of chloroquine and 200 mg of proguanil per day in a zone III of chloroquine resistance (Gabon). Study of 431 French soldiers]. / Chimioprophylaxie du paludisme à Plasmodium falciparum par une association de 100 mg de chloroquine et de 200 mg de proguanil par jour dans une zone III de chloroquino-résistance (Gabon). Etude chez 431 militaires français.

Incidence of P. falciparum malaria in french non-immune soldiers serving in Gabon for four months has increased from 21% in 1987 to 37% in 1988. Since 1989, in a first step, the personal protection measures were reinforced. Thereafter, the usual chemoprophylaxis (chloroquine 100 mg daily) was replaced by a daily association of chloroquine 100 mg and proguanil 200 mg. A 85% decrease of malaria incidence was observed in 431 soldiers. The effects of the personal protection strengthening and of the new chemoprophylaxis can be evaluated to be respectively responsible for 50% and 71% decrease. Among the secondary effects, gastric pain was the most frequent, but it was never a cause of chemoprophylaxis stopping. The mouth ulcer frequency was far lower than that elsewhere reported. No significant biological abnormalities could be related to the chloroquine-proguanil association.

[Pruritus after taking chloroquine and filariasis]. / Prurit après prise de chloroquine et filarioses.

A study of relations between pruritus after doses of chloroquine and on the one hand the infection by Mansonella perstans (filariasis frequent in some areas but pathogenic) and on the other hand the infection by Onchocerca volvulus (filariasis frequent in some other areas but not very pathogenic) was carried out in two villages in Ivory Coast. It is not possible to show an obvious relation between the presence of pruritus and the two filariasis.

Evaluation of the protective effect of BCG vaccination by a case-control study in Yaounde, Cameroon.

A case-control study carried out in Yaounde (Cameroon) shows that the protective effect of BCG against pulmonary tuberculosis in the young adult was 66% (relative risk 0.34). This result is not affected by taking into account various factors such as sex, age, socio-economic class and geographical origin.

[Evaluation and epidemiologic surveillance of nutritional deficiencies. Principles and application to elementary health units]. / Evaluation et surveillance épidémiologique des déficits nutritionnels. Principes et application aux formations sanitaires élémentaires.

The authors briefly describe some anthropometric, biologic and clinical nutrition indicators used to assess the severity of malnutrition. Problems related to selection of population samples and framework for possible action against malnutrition are also indicated. For transverse evaluation, they suggest to utilize the cluster sampling method recommended by W.H.O. for studying vaccine coverage. The main indicator of nutritional status is then the brachial perimeter qualitatively evaluated with Shakir's strip. To monitor epidemiological importance of malnutrition, they suggest to take into account: the figures indicated by the maternities (birth weight), the figures indicated by M.C.H. and school health (ratio of malnourished children--weight average by age and sex), the figures indicated by specialized hospital departments such as pediatrics, nurseries... They insist upon seasonal factors and evaluation of the rate of coverage of the target population by maternities, M.C.H. and school health, in order to correctly read the declared figures.

[Epidemiologic aspects of tuberculosis in Yaounde (Republic of Cameroon)]. / Aspects épidémiologiques de la tuberculose à Yaoundé (République du Cameroun).

A retrospective investigation was carried out in March 1984 on files of 447 tubercular patients traced in 1982 in the Unit of Pneumophthisiology of the Jamot Hospital in Yaounde. It demonstrates that: 80% of the patients have a pulmonary localization, 95% of the pulmonary tuberculosis are diagnosed by bacilloscopy often after a long latency, 60% of two-sided forms and 64% of forms with excavation, by radiological examination, 65% of the recorded patients live outside Yaounde, a one year standard treatment follow-up leads to 50% cures, 50% of the patients do not come back before six months and 50% after six months. The epidemiological findings done from this investigation lead to suggest adaptations of the fight-programme relevant to the bacilloscopic tracing, the curative protocols and the BCG vaccination.

[Mass treatment of Schistomsoma haematobium bilharziasis in the member states of the Organization for Coordination of the Campaign against Endemic Diseases in Central Africa]. / Réflexions sur le traitement de masse des bilharzioses à Schistosoma haematobium dans les états membres de l'Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC).

The authors analysed the results of the control of Schistosoma haematobium bilharziasis in two central African countries, the Congo and the Cameroun . These results demonstrated: --The feasibility of mass screening by filtering urine; --The acceptability and efficacy of new antibilharzian drugs, praziquantel and oltipraz . With the aim of improving the cost/effectiveness ratio of these campagnes and taking into account the health requirements which exist and/or are desired by the population, the authors propose four modifications of the strategy of mass control: --The integration of Schistosoma haematobium bilharziasis control with the other regional health priorities; --Screening target groups;