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Problem behaviours in cats, such as urine marking, scratching, fear, and problems of cohabitation between cats, can present a potential welfare problem for those affected cats and have a negative impact on the human-animal bond. The aim of this study was to develop a Cat Behaviour Issues Assessment Scale (CABIAS) for caregivers to assess these common problem behaviours in cats, and to investigate aspects of the validity and reliability of the CABIAS. The CABIAS uses an index score as a scoring system combining aspects of the frequency and intensity of the problem behaviour. An electronic survey was developed, and 384 households, each with two participants able to observe the cat's behaviour, were recruited for the study. The participants were asked to record their cat's behaviour independently at weekly intervals over a 6-week period. A FELIWAY Optimum diffuser (containing a commercial feline pheromone complex) was provided to half of the participants, to be used during part of the study. The participants were subdivided into four groups according to whether a problem behaviour was present (or not) and whether the pheromone diffuser was provided (or not). The results demonstrated that the index scores for each problem behaviour had very high inter-rater reliability. There was a high correlation between the index scores and the impact the problem behaviours had on the caregivers. In those cats with a declared problem behaviour where the product was used, a reduction in index scores was observed over the duration of the study. The CABIAS was shown to exhibit satisfactory validity, reliability, and sensitivity to change in the current study, suggesting that it may be valuable as a tool for assessing and monitoring scratching, inter-cat cohabitation, urine marking, and fear in cats. The CABIAS could be used by veterinarians and behaviourists to assess these problem behaviours in individual cats and monitor responses to treatment. The CABIAS could also be considered as a research tool to assess the efficacy of interventions aimed at improving these problems.

Objectives: The objective of this study was to collect information from cat owners about the frequency of conflict and affiliative signs in their households in order to: (1) assess correlations with the owners' ratings of household cat-cat harmony; and (2) determine if relationships exist between household variables, cat population variables and behavior frequencies., Methods: Responses to an online survey of adult residents of the USA who were the primary caregiver of 2-4 indoor or indoor-outdoor cats were included in the analysis. Spearman's correlations and χ 2 tests were used to compare behavior frequencies with household and cat population variables., Results: Of 2492 owners of multiple cats, 73.3% noted conflict signs from the very beginning when introducing the cats. The more cats in the house, the more frequent the conflict signs. Staring was the most frequently observed conflict sign, occurring at least daily in 44.9% of households, followed, in order of decreasing frequency, by chasing, stalking, fleeing, tail twitching, hissing and wailing/screaming. Hissing occurred at least daily in 18% of households. Affiliative signs were observed more frequently than conflict signs. Physical contact between cats was observed at least daily in around half of the multi-cat households. Higher harmony scores were correlated with less frequent conflict signs and more frequent affiliative signs. No household or cat population variable, including home size or numerically adequate resources provision, was strongly predictive of the frequency of conflict or affiliative signs., Conclusions and Relevance: This is the first large-scale online survey to obtain frequencies of conflict and affiliative behaviors and compare them with factors linked to the cats or the home settings. The study confirmed that feline relationships are correlated with the owner's perceived impression of the initial introduction, but other household factors and cat population variables included in the study were not strongly predictive of the frequency of conflict or affiliative signs.

Co-infections caused by trypanosomes and gastro-intestinal nematodes (GINs) compromise cattle productivity and their control requires a holistic approach. The effectiveness of trypanocides and anthelmintics is compromised by increasing resistance. Use of combined chemotherapeutic products for synergy, mainly practiced in human medicine, is gaining importance in livestock. A trial to evaluate efficacy of VERYL®, containing diminazene diaceturate (3.5 mg/kg body weight) and levamisole chloride (5 mg/kg body weight) for the control of GINs in cattle, was conducted at KALRO-VSRI Muguga, Kenya, between June and August 2016. Thirty-eight cattle aged between 6 and 12 months, naturally infected with GINs, were randomly allocated into two groups; a treatment group received VERYL® intra-muscularly at 10 mL/100 kg bwt and a control group which received Veriben® (Diminazene aceturate) at 3.5 mg/kg bwt. Faecal egg counts (FECs), coproculture, packed cell volume (PCV) and local tolerance at the injection site were measured during the study. FECs were comparable between the treatment and control groups at day 0. However, treatment of cattle with VERYL significantly (p < 0.001) reduced FECs by day 7 and sustained to day 21 post-treatment. Coproculture results for the treatment and control groups revealed presence of Haemonchus, Cooperia, Ostertagia, Trichostrongylus and Oesophagostomum species. Cattle treated with VERYL® had a significant (p < 0.05) reduction in larval recoveries compared to the control group. VERYL® had minimal adverse effects which cleared after a short while and is thus recommended for controlling GINs in cattle.

This study was designed to evaluate the efficacy of a new florfenicol/meloxicam combination (FMC) in calves with bovine respiratory disease. A total of 90 young calves were challenged via intratracheal deposition of 10 8  colony-forming units of Mannheimia haemolytica Data for 84 calves demonstrating a rectal temperature (RT) above 39.5°C and a combined total clinical score (TCS) greater than or equal to 3 were included. Calves were then randomly allocated to one of the three study groups (FMC; florfenicol/flunixin combination (FFC); or saline) and promptly treated. RT and TCS of calves treated with an FMC or FFC were consistently lower than RT and TCS of calves belonging to the control group (P<0.001). Moreover, at the end of the study, a high clinical cure rate was observed in calves treated with FMC (100 per cent) or FFC (96.6 per cent) whereas cure was limited for calves receiving saline (29.6 per cent). Interestingly, calves treated with FMC were cured without relapse more rapidly compared with calves treated with FFC (HR=1.76, P<0.05) and with a lower percentage of clinical relapse due to fever (P=0.05). These results underline the high efficacy of the FMC and are in line with the pharmacokinetic properties of florfenicol and meloxicam., Competing Interests: Competing interests: DA, ACV and JFC are employees of Ceva Santé Animale., (© British Veterinary Association 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

To increase our knowledge of leukaemia-associated antigens, especially in acute myeloid leukaemia (AML) M4, we prepared a phage display cDNA library using mRNA from the bone marrow cells of a patient with AML M4 at diagnosis. We immunoscreened 10(6) pfu with autologous sera and identified an antigen which we named GKT-AML8. The cDNA showed more than 99% similarity to a sequence on 2q21.2 and 95% sequence similarity to a sequence on 19q13.3. These genes were named ZNF465 and ZNF466, respectively, following HUGO Gene Nomenclature Committee (HGNC) guidelines. Expressed sequence tag data suggests that both genes are transcriptionally active. ZNF465 and ZNF466 encode a 5' krüppel associated box domain typical of negative regulators of gene transcription. We have confirmed the translational start site in the +1 frame in a near-Kozak sequence that produces a 102 amino acid polypeptide from ZNF465. The high level of sequence similarity between ZNF465 and ZNF466 makes their transcripts almost indistinguishable by real-time polymerase chain reaction (RT-PCR). However, GKT-AML8 showed most sequence similarity to ZNF465 and no transcript matching the 3' ZNF466 sequence could be detected in patient samples or healthy volunteers. ZNF465/466 expression was detectable in 12/13 AML and 10/14 chronic myeloid leukaemia patients' samples but not in normal donor peripheral blood (0/8) or 0/3 bone marrow samples which had been separated into CD34(+) and CD34(-) samples. The altered expression of ZNF465/466 in patients' samples and its absence in healthy donor haematopoietic samples indicate that ZNF465 is overexpressed in early myeloid disease and as such may represent a promising target for immunotherapy., (© 2015 Wiley Periodicals, Inc.)

The PRALIMAP (PRomotion de l'ALIMentation et de l'Activité Physique) trial highlights the effectiveness of implementing a screening strategy in high schools to prevent overweight/obesity among adolescents. The strategy comprises three steps: i) body measurements to detect overweight/obese adolescents, ii) a medical interview with each adolescent identified to discuss the findings, and iii) an adapted care management consisting of seven group educational sessions. A process evaluation was conducted in the PRALIMAP trial to assess the effective implementation of the screening strategy activities, and the participation of adolescents and school professionals in them, from a qualitative and a quantitative point of view. The present paper describes the process and the implementation of the screening strategy as performed in the PRALIMAP trial, and discusses the feasibility of such an intervention in high school settings. The ability of nurses to explain the screening results improved with the addition of specialist support. The ability of adolescents to take part in the screening strategy improved when the adapted care management was conducted inside schools and could be increased even further if the waiting time between the three steps could be minimised.

Background: Given the increasing prevalence of obesity among youth over the past decade, prevention has become an international public health priority., Purpose: To evaluate the 2-year effectiveness of three strategies aimed at preventing overweight and obesity among adolescents in a high school setting., Design: PRomotion de l'ALIMentation et de l'Activité Physique (PRALIMAP) is a school-based RCT. Each study high school was assigned to receive or not, over a 2-year period (Grades 10 and 11), each of three prevention strategies according to a 2 × 2 × 2 factorial school randomization. Data were collected in 2006-2009 and analyzed in 2009-2011., Setting/participants: A total of 3538 adolescents (aged 15.6±0.7 years at baseline) in 24 public high schools in Lorraine (northeastern France) completed the PRALIMAP trial., Interventions: The prevention strategies were education (development of nutritional knowledge and skills); environment (creation of a favorable environment by improving availability of "healthy" dietary items and physical activity); and screening and care (detection of overweight/obesity and, if necessary, adapted care management)., Main Outcomes Measures: The main outcome of interest was BMI; BMI z-score and prevalence of overweight/obesity were considered as secondary outcomes., Results: Adolescents who completed the PRALIMAP trial were younger, less often suspected of having eating disorders and depression, and came from a higher socioeconomic class than those who did not. The 2-year change of outcomes was more favorable in the 12 screening and care high schools compared to the no-screening ones: a 0.11 lower increase in BMI (p=0.0303); a 0.04 greater decrease in BMI z-score (p=0.0173); and a 1.71% greater decrease in overweight/obesity prevalence (p=0.0386). Education and environment strategies were not more effective than no strategy intervention., Conclusions: Although the screening and care strategy is an effective way to prevent, at 2 years, overweight and obesity among adolescents in a high school setting, its effects over and above no strategy intervention were small., Trial Registration: This study is registered at www.clinicaltrials.govNCT00814554., (Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Although the outcomes of health promotion and prevention programmes may depend on the level of intervention, studies and trials often fail to take it into account. The objective of this work was to develop a framework within which to consider the implementation of interventions, and to propose a tool with which to measure the quantity and the quality of activities, whether planned or not, relevant to the intervention under investigation. The framework and the tool were applied to data from the diet and physical activity promotion PRALIMAP trial., Methods: A framework allowing for calculation of an intervention dose in any health promotion programme was developed. A literature reviews revealed several relevant concepts that were considered in greater detail by a multidisciplinary working group. A method was devised with which to calculate the dose of intervention planned and that is actually received (programme-driven activities dose), as well as the amount of non-planned intervention (non-programme-driven activities dose)., Results: Indicators cover the roles of all those involved (supervisors, anchor personnel as receivers and providers, targets), in each intervention-related groups (IRG: basic setting in which a given intervention is planned by the programme and may differ in implementation level) and for every intervention period. All indicators are described according to two domains (delivery, participation) in two declensions (quantity and quality). Application to PRALIMAP data revealed important inter- and intra-IRG variability in intervention dose., Conclusions: A literature analysis shows that the terminology in this area is not yet consolidated and that research is ongoing. The present work provides a methodological framework by specifying concepts, by defining new constructs and by developing multiple information synthesis methods which must be introduced from the programme's conception. Application to PRALIMAP underlined the feasibility of measuring the implementation level. The framework and the tool can be used in any complex programme evaluation. The intervention doses obtained could be particularly useful in comparative trials., Trial Registration: PRALIMAP is registered at ClinicalTrials.gov under NCT00814554.

The purpose of this paper is to map out the Therapeutic Patient Education activities of health centers in the Lorraine region of France in the months leading up to the promulgation of the HPST law (reform of the French Public Hospital system) defining and regulating TPE. A self-administered survey and interviews were conducted to identify the educational activities offered by the program (structure, training of professionals, links with general practitioners, etc.) and to quantify them (number of patients, classes, etc.). All health centers in Lorraine were contacted (193 centers in total). 93 centers responded and 48?reported TPE activities, with 131 functional TPE courses (or structured activities) and 40 projects. An analysis based on 8 quality criteria was carried out. The study found that 49 centers met at least 6 quality criteria and were close to the required quality standards. The study also found that the geographical distribution of TPE provision is unbalanced. The number of TPE beneficiaries in a given semester varies between 0 and 24 patients per 1,000 inhabitants (according to the health area), which amounts to 5% of chronically ill people in the Lorraine region.

Background: The continual monitoring of population health-related quality of life (HRQoL) with validated instruments helps public health agencies assess, protect, and promote population health. This study aimed to determine norms for the French adolescent and adult general population for the Duke Health Profile (DUKE) questionnaire in a large representative community sample., Methods: We randomly selected 17,733 French people aged 12 to 75 years old in 2 steps, by households and individuals, from the National Health Barometer 2005, a periodic population study by the French National Institute for Prevention and Health Education. Quality of life and other data were collected by computer-assisted telephone interview., Results: Normative data for the French population were analyzed by age, gender and self-reported chronic disease. Globally, function scores (best HRQoL=100) for physical, mental, social, and general health, as well as perceived health and self-esteem, were 72.3 (SEM 0.2), 74.6 (0.2), 66.8 (0.1), 71.3 (0.1), 71.3 (0.3), 76.5 (0.1), respectively. Dysfunction scores (worst HRQoL=100) for anxiety, depression, pain and disability domains were 30.9 (0.1), 27.6 (0.2), 34.3 (0.3), 3.1 (0.1), respectively., Conclusion: The French norms for adolescents and adults for the DUKE could be used as a reference for other studies assessing HRQoL, for specific illnesses, in France and for international comparisons.

Background: Given the increase in overweight and obesity prevalence in adolescents in the last decade, effective prevention strategies for these conditions in adolescents are urgently needed. The PRALIMAP (Promotion de l'ALImentation et de l'Activité Physique) trial aims to evaluate the effectiveness for these conditions of 3 health promotion strategies--educational, screening and environmental--applied singly or in combination in high schools over a 2-year intervention period., Methods: PRALIMAP is a stratified 2 × 2 × 2 factorial cluster randomised controlled trial including 24 state high schools in Lorraine, northeastern France, in 2 waves: 8 schools in 2006 (wave 1) and 16 in 2007 (wave 2). Students entering the selected high schools in the 4 academic years from 2006 to 2009 are eligible for data collection. Interventional strategies are organized over 2 academic years. The follow-up consists of 3 visits: at the entry of grade 10 (T0), grade 11 (T1) and grade 12 (T2). At T0, 5,458 (85.7%) adolescents participated. The educational strategy consists of nutritional lessons, working groups and a final party. The screening strategy consists in detecting overweight/obesity and eating disorders in adolescents and proposing, if necessary, an adapted care management program of 7 group educational sessions. The environmental strategy consists in improving dietary and physical activity offerings in high schools and facilities, especially catering. The main outcomes are body size evolution over time, nutritional behaviour and knowledge, health and quality of life. An evaluation process documents how each intervention strategy is implemented in the schools and estimates the dose of the intervention, allowing for a per protocol analysis after the main intention-to-treat analysis., Discussion: PRALIMAP aims at improving the prevention and management of overweight and obesity in adolescents by translating current evidence into public health practice. Particular attention is paid to clustering, multiple factorials and long-term duration to address common pitfalls in health promotion trials. The results should inform how best to implement, in a school environment, effective nutrition prevention programs targeting adolescents who are at a point their lives when they develop responsibilities and empowerment for health attitude behaviours., Trial Registration: This trial is registered at ClinicalTrials.gov under NCT00814554.

Background: Medical and scientific committees need validated instruments to assess quality of life, but the lack of general population norms limits their full use in research and clinical practice. This study aimed to determine norms for the French general population for the physical and psychological health and social relationship dimensions of the abbreviated version of WHOQOL-BREF questionnaire in a large representative community sample., Methods: A sample of 16,450 randomly selected subjects 18-75 years old, in two steps: households and individuals, was drawn from the National Health Barometer 2005, a periodic study by the French National Institute for Preventive and Health Education. Quality of life and other characteristics were collected using a computer-assisted telephone interview by use of a booklet., Results: Internal consistency was good. Normative data for the French population are analyzed by age, sex and self-reported chronic disease., Conclusions: Our data provide normative scores for the general French population for three of four dimensions of the WHOQOL-BREF that can be useful to researchers using this measure of health-related quality-of-life assessment and to clinical practitioners.

The serological analysis of antigens by recombinant expression cloning (SEREX) has been used by many laboratories to immunoscreen lambda phage cDNA libraries produced from a range of tumour cell types. We and others have found it difficult to extract an optimal quality and quantity of mRNA for the preparation of cDNA libraries which represent the genes transcribed in haematological samples. The difficulty is believed to be due to residual haem groups in the isolated RNA sample which inhibit the activity of reverse transcriptase used in the later production of cDNA. During our preparation of a cDNA library for SEREX studies, we optimised the isolation of mRNA from samples from patients with haematological malignancies. We compared the efficacy of different methods of mRNA extraction using a range of haematological sample sizes and describe the most efficient techniques to maximise mRNA yield and quality for cDNA library production. The phage library we prepared contained a range of cDNA insert sizes, including high molecular weight sequences which, following immunoscreening with autologous patient sera, led to the isolation of 17 novel antigens. Using the methodology described, we have shown SEREX to be effective for the isolation of leukaemia-associated antigens, which may act as targets for immunotherapy.

From "alcohol primary prevention program in Lorraine", the authors developed a tool for an evaluation of performance: a card index to assess each action of the program. This tool can be applied to various programs, in particular health regional ones. Before presenting the tool, the authors specify conceptual frameworks to which they refer and present the evaluation of performance step which is declined in "evaluation of the results" and "evaluation of the processes". This assessment combine an understanding and a data based approaches. They show how those two kinds of assessment meet different and complementary aims. The tool presented includes 9 cards. The first 8 cards joined together in a booklet make possible a description and evaluation of each contributive action to the program. A ninth card gives a synthesis view to follow and assess the entire program in comparison with the starting reference frame. The publication of this perfectible tool is a call to practices exchanges between professionals in load of health programs.

Objectives: This study assessed the effectiveness of adding spa therapy to usual drug treatment in chronic low back pain patients., Methods: A total of 224 patients were assigned randomly to either a treatment (n=128) or a control (n=96) group. Subjects in both groups received usual drug therapy. Those in the treatment group also underwent spa therapy in Vittel, France, for 6 days a week for 3 consecutive weeks. Effectiveness was assessed using a quality-of-life scale (the Duke Health Profile), clinical measures, and the Roland and Morris disability questionnaire. Groups were compared using an analysis of variance with repeated measures., Results: At both 3 weeks and 3 months, patients in the treatment group exhibited significant improvement in measures of: physical and mental dimensions of quality of life, anxiety, depression, pain duration, pain intensity, and functional disability., Conclusion: This study suggests that spa therapy is an effective treatment for chronic low back pain patients.

The authors, one century later, review the anatomical studies conducted by Launay, a student of Farabeuf, concerning the venous drainage of the face and neck. These studies were based on the analogy between the arterial system and the venous drainage of the external carotid territory. After describing the external carotid vein, the didactic and practical aspects of this study are emphasized.

Drug consumption is sometimes used as a secondary judgment criterion for clinical trials. Many measurement methods are available to quantify drug consumption. Several methods were applied in a rheumatic disease trial involving 121 patients with chronic low back pain who lived around Saint-Nectaire, France, and who participated in the trial from April to November 1993 to determine an easily used and practical measurement method to detect a significant drug consumption change over time. Analgesic and nonsteroidal antiinflammatory drugs (NSAIDs) were classified according to the anatomical therapeutic chemical classification. Consumption was quantified on a weekly basis in number of tablets (method 1), unit of defined daily dose (method 2), milligrams of active principle (method 3), and NSAID equivalence score (method 4). These methods were applied in a randomized clinical trial of spa therapy on sufferers of chronic low back pain. An analysis of variance with repeated measures showed a significant difference in drug consumption between treatment and control groups detected by all methods, except for the NSAID consumption measured with method 3. The comparison of each method by the relative efficiency index indicated that method 1 had a greater sensitivity for detecting changes of drug consumption. Tablet count appears to be a more sensitive and more practical method for detecting a drug consumption change in clinical trials.

Schwannomas are rarely located in the parotid regions. We report a case in a 6-year old child and recall the epidemiology of this type of tumours together with the clinical presentations and therapeutic approaches.

Objective: To assess the overall effectiveness of spa therapy compared with usual routine drug therapy in chronic low back pain (LBP)., Methods: One hundred and twenty-one patients were randomly allocated to treatment (n = 59) and control (n = 62) groups. In the treatment group, patients underwent routine drug therapy and spa therapy 6 days/week for 3 consecutive weeks in Saint-Nectaire, France. In the control group, patients received routine drug therapy. Effectiveness was assessed based on clinical measures, duration and intensity of pain, Roland and Morris' disability questionnaire, the patient's overall evaluation of back health, and drug consumption (analgesic and antiinflammatory). Groups were compared using analysis of covariance with repeated measures., Results: At 3 weeks, patients in the treatment group had significant improvement in all outcome variables (p < 0.0001) except for the Schober index and analgesic and antiinflammatory drug consumption. At 6 months, improvement was still significant for the same outcome variables (p < 0.0001), plus a significant reduction in analgesic consumption., Conclusion: This study suggests both immediate and 6 month effectiveness of spa therapy in chronic LBP. Spa therapy may be beneficial in the management of chronic LBP.

The authors report the use of a vascular island nasolabial flap with facial arterial pedicle and reverse blood flow inspired by the flap described by C. Le Quang in an unpublished indication. This case concerns a 64-year-old patient with a large botryomycoma of the columella. The size of the defect following excision and the length of the columella authorized reconstruction using a split thickness nasolabial reverse flap. At one year post-operatively the result was aesthetic and defatting was unnecessary. This flap is used to repair defects of the nasal lateral wall and ala. In some conditions, it can be used to repair the collumela, providing a safe vascular support in one stage.

Based on a case presented by the patient himself, the authors describe the difficult management of a very large, recurrent epulis arising in a context of flat angioma of one half of the face according to a vascular mode. After a brief review of the clinical and aetiopathogenic aspects, the authors discuss the value of complete surgical treatment and raise the question of the possible relation, in this particular case, between angioma and this recurrent so-called angiomatous epulis.

After a review of the clinical, pathological and aetiological features, the authors describe the various surgical techniques used (conventional surgery or liposuction) to restore a normal social life to these patients, deformed by their disease. They confirm the predominant role of conventional surgery and define the limited indications in which liposuction can be used. Based on a review of 16 cases, the surgeon must make sure that the patient has ceased his or her alcohol abuse before performing this difficult treatment associated with a number of complications.

The effect of spa therapy on chronic low back pain (LBP) was assessed in a randomized trial comparing patients undergoing a 3-week therapy programme in a spa resort in France (n = 50) with patients receiving ambulatory care (n = 52). After 3 weeks, patients in the spa group had significant improvement in their spine mobility and functional score (Waddell index) and a reduction in their daily duration of pain, pain intensity and drug consumption. The long-term effect was assessed after 9 months and showed continued reduction in pain and drug consumption, and improvement in spine mobility but no longer in functional score which returned to baseline level. It is concluded that spa therapy has a positive short-term and a moderate long-term effectiveness on chronic LBP.

The use of an inferiorly based rectus abdominis myocutaneous flap to cover a pelvic pressure sore offers a solution when the possibilities of other local flaps have been exhausted. For sacral pressure sores, the iliac bone is an obstacle for the transposition of this flap. In this case report, we describe how this obstacle can be overcome by creating a trans-osseous tunnel in the ala of the iliac bone through which the flap takes the most direct route to the recepient site.

Nine cases of severe, multioperated clubfeet in children and adolescent have been corrected with Ilizarov apparatus. The two first patients have been treated by midtarsal osteotomy plus progressive correction. One poliomyelitic foot have had a slide lengthening of Achilles tendon and a plantar release. Six did not have any open procedure. One ring and two half circles were linked by five threated rods, in order to allow multi axial correction. Seven wires were introduced in the bones; the correction was obtained in a mean time of two months, the device was maintained one more month, then replaced by a walking cast during one month. The results have been seven times satisfactory, with an average follow up of nineteen months after the end of treatment. We did not note any early complication. One more procedure have been performed for flexum of the toes. The ankle range of motion have always been the same as the preoperative one.

A total of 48 French villages were selected for a survey of water quality from February 1983 to June 1984 as part of an epidemiological study conducted in the rural area of the Rhône-Alpes region. Water samples were collected and analyzed on a weekly basis in each village. Bacteriological analysis of each water sample included enumeration of standard plate count bacteria, total and thermotolerant coliforms, and fecal streptococci. The water quality regulations are examined as to the analysis frequency, the volume of samples, and the relationship between the various bacterial indicators. Analyzing 300-ml, instead of 100-ml, samples tends to generate better information on single water samples. However, if many samples are analyzed over time from the same community, the value of using large volumes of water samples is diminished. The comparisons between bacterial indicators showed that the information obtained from the various indicators was very similar. However, fecal streptococci had a better predictive value of a negative test than coliforms with respect to the French standards.

Screening for colorectal tumours (cancers and polyps) by searching for blood in stools using the gaiac test is a well-known method. We evaluated a new gaiac test, the originality of which from its coupling with an enzyme immuno-assay specifically measuring human hemoglobin (Fecatest). The objectives of this new test were to decrease false positives and thus to improve the positive predictive value of screening. Subjects over 45 years of age attending health examinations at a Center of Preventive Medicine were studied. Of the 5,185 subjects who received the test, 4,376 (84 p. 100) performed it correctly, demonstrating good compliance in this population. For 664 (15 p. 100), the results of the gaiac test were positive. This positivity rate was higher for men than for women (20 p. 100 vs. 10 p. 100) but was not influenced by age. After positive results, 471 (70 p. 100) patients completed investigations decreasing the overall compliance to 80 p. 100. Fifteen cases of cancer and 78 cases of adenomas were found. The positive predictive value of the test was 20 p. 100 for tumours. A benign cause was found in 44 p. 100 of 471 patients, and investigations were negative in 36 p. 100. When the gaiac test was positive, the immunoenzymatic method significantly improved the positive predictive value for cancer (6 p. 100 vs. 3 p. 100) but not for polyps (20 p. 100 vs. 17 p. 100). Three of the 15 cancers and half of the 78 adenomas would not have been discovered with the immunoenzymatic method.(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective follow-up study lasting 18 months in 1983-1984 was conducted in 50 villages in order to assess the risk related to the consumption of drinking water which did not meet the bacteriology standards. 119 physicians, 52 pharmacists and 118 primary-school teachers enumerated the cases of acute gastro-intestinal diseases observed among a population of 29,272 inhabitants. A weekly water sample was analysed in each village as to the presence of four indicator germs of fecal contamination: total plate count, total coliforms, fecal coliforms (thermotolerant) and fecal streptococci. 1,950 cases of acute gastro-intestinal diseases were registered by the physicians and pharmacists during a population experience of 1,873,303 persons-weeks, i.e. an incidence density of 1.06 X 10(-3) cases per person-week. The risk notified by the school teachers among children aged 7 to 11 was higher: 16.3 X 10(-3) cases per child-week. The villages were classified in 3 groups, according to the proportion of substandard samples: "good", "intermediate", and "bad" categories. The relative risk contrasting the "bad" and "good" villages was 3.5 for the cases notified by the physicians and the pharmacists among the general population (95% confidence interval = 2.5-4.8); it was 1.7 for the cases reported by the teachers among the children (95% confidence interval = 1.5-1.9). This concordant difference was very significant but not constant across the 18 months of the survey. The authors conclude that the bacteriology standards are a relevant indicator of a health hazard.

In a prospective follow-up study conducted in 52 French alpine villages, one weekly water sample was taken in each village provided with untreated ground water and analyzed as to the presence of four indicator bacteria: total plate count, total coliforms, thermotolerant (fecal) coliforms, and fecal streptococci. Cases of acute gastro-intestinal disease (AGID) occurring among 29,272 inhabitants were reported through physicians, pharmacists, and primary school teachers. A loglinear model identified fecal streptococcus (FS) as the best predictor; the presence of fecal coliforms enhanced the effect of FS. The total bacteria count and the total coliforms had no independent contributions. A threshold analysis suggested that any level of indicator bacteria above zero was associated with an excess of AGID.

The authors illustrate one facet of field epidemiology. They describe an example: a waterborne disease outbreak. The investigations were undertaken in a town in Moselle (F), on the general population with health professionals, school teachers, counselors and water service workers. They estimate that one thousand people had suffered from gastroenteritis (attack rate greater than 60%). Water was polluted and people became ill at the same time and in the same place. There is a strong statistical association between drinkers of polluted water and gastroenteric illness (relative risk: 10). This study has provided population information and resulted in motivation of the responsible people. In the conclusion of the epidemiological investigation they have carried out coherent measures for the protection of the water distribution system.