EU-CaRE study: Could exercise-based cardiac telerehabilitation also be cost-effective in elderly?

BACKGROUND: The role of cardiac rehabilitation (CR) is well established in the secondary prevention of ischemic heart disease. Unfortunately, the participation rates across Europe remain low, especially in elderly. The EU-CaRE RCT investigated the effectiveness of a home-based mobile CR programme in elderly patients that were not willing to participate in centre-based CR. The initial study concluded that a 6-month home-based mobile CR programme was safe and beneficial in improving VO2peak when compared with no CR. OBJECTIVE: To assess whether a 6-month guided mobile CR programme is a cost-effective therapy for elderly patients who decline participation in CR. METHODS: Patients were enrolled in a multicentre randomised clinical trial from November 11, 2015, to January 3, 2018, and follow-up was completed on January 17, 2019, in a secondary care system with 6 cardiac institutions across 5 European countries. A total of 179 patients who declined participation in centre-based CR and met the inclusion criteria consented to participate in the European Study on Effectiveness and Sustainability of Current Cardiac Rehabilitation Programs in the Elderly trial. The data of patients (n = 17) that were lost in follow-up were excluded from this analysis. The intervention (n = 79) consisted of 6 months of mobile CR programme with telemonitoring, and coaching based on motivational interviewing to stimulate patients to reach exercise goals. Control patients did not receive any form of CR throughout the study period. The costs considered for the cost-effectiveness analysis of the RCT are direct costs 1) of the mobile CR programme, and 2) of the care utilisation recorded during the observation time from randomisation to the end of the study. Costs and outcomes (utilities) were compared by calculation of the incremental cost-effectiveness ratio. RESULTS: The healthcare utilisation costs (P = 0.802) were not significantly different between the two groups. However, the total costs were significantly higher in the intervention group (P = 0.040). The incremental cost-effectiveness ratio for the primary endpoint VO2peak at 6 months was €1085 per 1-unit [ml/kg/min] improvement in change VO2peak and at 12 months it was €1103 per 1 unit [ml/kg/min] improvement in change VO2peak. Big differences in the incremental cost-effectiveness ratios for the primary endpoint VO2peak at 6 months and 12 months were present between the adherent participants and the non-adherent participants. CONCLUSION: From a health-economic point of view the home-based mobile CR programme is an effective and cost-effective alternative for elderly cardiac patients who are not willing to participate in a regular rehabilitation programme to improve cardiorespiratory fitness. The change of QoL between the mobile CR was similar for both groups. Adherence to the mobile CR programme plays a significant role in the cost-effectiveness of the intervention. Future research should focus on the determinants of adherence, on increasing the adherence of patients and the implementation of comprehensive home-based mobile CR programmes in standard care.

Patients Unmet Needs in Chronic Rhinosinusitis With Nasal Polyps Care: A Patient Advisory Board Statement of EUFOREA.

Background: European patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have had only limited occasions to unite to have their voices heard, hence missing the opportunity to contribute to the improvement of CRSwNP care. Aims: To identify unmet needs in CRSwNP from the perspective of CRSwNP patients from the Patient Advisory Board (PAB) of the European Forum for Research and Education in Allergy and Airways diseases (EUFOREA). Methodology: Semi-structured interviews were conducted individually with 15 European patients with CRSwNP and with a disease history of more than 2 years. Patients shared their burden of the disease and frustrations related to CRSwNP care, experiences with key pillars of current treatment options, shortcomings of the current care pathways and recommendations for improvement of care. A panel of 30 members of the Patient Advisory Board reviewed the interview report and provided further input during 2 virtual meetings. Results: CRSwNP patients indicated the need for greater awareness from society and physicians of the disease burden with impact on social function and well-being. Along with a loss of ability to smell and the continuous presence of secretions in the nose, most patients reported poor sleep quality and psychological impact as the most bothersome symptoms. Patients' frustrations relate primarily to the underestimation of the disease burden, the lack of coordination of care and the limited treatment options available to them. Treatment options with oral corticosteroids and/or sinus surgery both have positive and negative aspects, including the lack of long-lasting efficacy. Better coordination of care, more patient-centered care, greater public awareness, increases in research on the disease mechanisms and better therapeutic options would be warmly welcomed by CRSwNP patients. Conclusions: This statement of the EUFOREA Patient Advisory Board on CRSwNP provides novel insights on the underestimation of the burden of CRSwNP and shortcomings of current care. Multiple recommendations made by the patients can underpin action plans for implementation of better care for CRSwNP among all physicians treating patients with this disabling disease.

Corrigendum: Patients Unmet Needs in Chronic Rhinosinusitis With Nasal Polyps Care: A Patient Advisory Board Statement of EUFOREA.

[This corrects the article DOI: 10.3389/falgy.2021.761388.].

Factors influencing consent rates of deceased organ donation in Western Cape Province, South Africa.

BACKGROUND: South Africa (SA) has very low and unchanging organ donation rates. A key point in the pathway of organ donation is obtaining informed consent from the family, which is necessary before organ donation can proceed. There is no published SA research on the consent rate and factors that influence this. OBJECTIVES: To describe the number of requests for consent and factors influencing this process in the SA context. METHODS: A prospective descriptive study was performed of all requests to families for organ donation in Western Cape Province, SA, by Groote Schuur Hospital (state sector), Red Cross War Memorial Children's Hospital (state sector) and Netcare (private sector) transplant co-ordinators from 1 May 2017 to 1 May 2018 to describe factors influencing consent rates. RESULTS: The 6 co-ordinators (3 state sector and 3 private sector) recorded data of 83 consecutive families approached in 16 hospitals over the 1-year period. Consent to organ donation was granted for 23 family requests (n=18 (state sector); n=5 (private sector)). The number of families approached was greater in the state sector (n=74) than in the private sector (n=9). The overall consent rate was 27.7% (24.3% (state sector); 55.5% (private sector)). The majority of referrals came from trauma and emergency units (n=55; 66.3%) and very few from intensive care units (n=25; 30.1%). Immediate fluid resuscitation was required in 56 (67.5%) potential donors. The majority of families (n=74; 89.2%) were receptive to the organ donation request, independent of their ultimate decision regarding donation. The main reason given for refusing to consent was that it was against their religion (n=21) or culture (n=18). CONCLUSIONS: This study showed that the number of families approached for consent to organ donation were low in the Western Cape (lower in the private sector), with a low consent rate (lower in the state sector). Donor management by clinical teams needs to be ongoing and active during the consent process. Consent discussions (and public awareness initiatives) need to be sensitive to and deal with religious and cultural reservations about organ donation.

Early identification and referral of organ donors in five private hospitals: A survey to determine the knowledge and views of critical care professional nurses pre and post a PowerPoint training intervention.

Background: Internationally, the declining number of organ donors does not meet the rising demand for life-saving solid organ transplant operations. Critical care professional nurses play an important role in the identification of organ donors. A deeper understanding is needed of the missed opportunities of identification and referral of potential organ donors to organ transplant co-ordinators in the critical care environment. Objectives: To describe the knowledge and views of critical care professional nurses (CCPNs) in South Africa concerning the early identification and referral of organ donors, and to describe the short-term effect of implementing a PowerPoint training intervention on nurses' knowledge in this domain. Methods: A mixed method, experimental, exploratory, descriptive study design was followed. Critical care professional nurses in seven intensive care units at five private hospitals completed a data collection instrument comprising 11 quantitative and three qualitative questions, before and after completing a PowerPoint training intervention. The post test was done directly after the training intervention due to the environment of nursing shift work. Results: A total of 173 (79%) CCPNs participated, from a population of 218. The median (interquartile range) score for all participants increased from 60% (48 - 76) prior to the PowerPoint training intervention, to 96% (88 - 96) after the intervention (p<0.0001). Three main themes emerged from the qualitative questions: stress experienced by the CCPNs during the organ donor process (62%); inadequate collaboration between doctors and nurses (34%); and the need for a policy (9%) to guide the donor referral process. Conclusion: CCPNs' knowledge regarding the early identification and referral of potential organ donors increased significantly following a targeted PowerPoint training intervention. The identified themes suggest that CCPNs require support in order to effectively communicate with the donor's family and medical staff. Contributions of the study: The findings of this study will contribute to the increase in organ donor referrals. Increased education of critical care professional nurses and doctors on effective communication, and the early identification and referral of organ donors, will expectedly help to resolve the critical barriers in the organ donor process.

Monolayer protected gold nanoparticles with metal-ion binding sites: functional systems for chemosensing applications.

In this review we describe the use of monolayer protected gold nanoparticles (Au NPs) for chemosensing applications. The attention is focused on a special subclass of Au NPs, namely those that contain binding sites for metal ions in the monolayer. It will be shown that these systems are very well-equipped for metal ion sensing as the complexation of the metal ions can affect the properties of the system in many ways leading to detectable output signals even at very low analyte concentrations. In addition, the presence of metal ions in the monolayer themselves can serve as recognition units for the highly selective interaction with small organic molecules or biomacromolecules. Key examples will be discussed that underscore the attractive properties and potential of this class of Au NPs as components of chemosensing assays.

Amplification of chirality: the "sergeants and soldiers" principle applied to dynamic hydrogen-bonded assemblies.

The amplification of supramolecular chirality has been studied in dynamic chiral hydrogen-bonded assemblies 1(3).(CA)(6) using "Sergeants and Soldiers" experiments. Previously, we have shown that chiral centers present in either the dimelamine component 1 or the cyanurate component CA quantitatively induce one handedness (M or P) in the assembly. This offers the possibility to study the amplification of chirality under two different kinetic regimes. When chiral dimelamines 1 are used, the exchange of chiral components and (M/P)-interconversion, i.e., interconversion between the (M)- and (P)-isomers of assembly 1(3).(CA)(6), take place via identical pathways (condition A). When chiral cyanurates CA are used, the exchange of chiral components occurs much faster than (M/P)-interconversion (condition B). Experimentally, a much stronger chiral amplification is observed under condition B. For example, the observed chiral amplification for a mixture of chiral and achiral components (40:60) is 46% under condition B and 32% under condition A. Kinetic models were developed to fit the experimental data and to simulate chiral amplification in dynamic systems in general. These simulations show that it is theoretically possible that the diastereomeric excess in a dynamic system is more than 99% with less than 1% chiral component present!

Chiral exciton coupling of merocyanine dyes within a well defined hydrogen-bonded assembly.

Multichromophoric hydrogen-bonded assemblies 1(3) small middle dot(BAR)(6) are studied that bear a remarkably close resemblance to commelinin, a naturally occurring assembly responsible for an intense blue color of flowers. The incorporated chromophores exhibit a hypsochromic shift in the UV/visible (Vis) absorption maximum (Delta lambda(max) = 14 nm) compared with the free chromophores. In addition, the chiroptical properties of incorporated chromophores can be rationally controlled by changing the supramolecular chirality of the assembly. These properties have been used to study the stability of this type of assembly with UV and CD spectroscopy at concentrations far below the NMR sensitivity threshold (10(-4) M). The determined C(50%) values of 2-3 microM in benzene show the extremely high stability of these hydrogen-bonded assemblies.

Thermodynamic stabilities of linear and crinkled tapes and cyclic rosettes in melamine--cyanurate assemblies: a model description.

In this paper we describe model calculations for the self-assembly of N,N-disubstituted melamines 1 and N-substituted cyanuric acid or 5,5-disubstituted barbituric acid derivatives 2 into linear or crinkled tapes and cyclic rosettes via cooperative hydrogen bond formation. The model description considers all possible stereoisomeric tape structures consisting of two to eight different components (270 different species in total) and one cyclic hexameric rosette structure. Furthermore, eight steric parameters (R(12)-R(28)) are included that represent the different types of steric interactions within the assemblies. Most importantly, the model calculations clearly show that the tape/rosette ratio is very sensitive to changes in parameters that directly affect the internal energy of the rosette structure. In this respect, three parameters have been characterized, i.e., the basic equilibrium constant K(0) for the bimolecular association of a melamine and cyanurate, the equilibrium constant K(r)/K(0) for the cyclization of a linear hexamer, and the parameter R(12)-a(Z)b, representing attractive or repulsive interactions between adjacent melamine and cyanurate moieties. For example, an increase in K(0) from 100 to 10,000 M(-1) ([A](0) = [B](0) = 10 mM, K(r) = 0.01 M) or in K(r) from 0.001 to 0.1 M ([A](0) = [B](0) = 10 mM, K(0) = 1000 M(-1)) raises the concentration of the rosette from <5 to approximately 90% or from approximately 10 to approximately 85%, respectively. Similarly, a change in R(12)-a(Z)b from 1.0 (no repulsive or attractive interactions) to 1.5 (slight attractive interaction) raises the rosette fraction of the mixture from 25% to 45%. In sharp contrast to this, the model calculations show that parameters that only affect the internal energy of the tapes (R(13)--R(28)) hardly change the tape/rosette ratio. For example, by changing R(13)-a(EE)a from 1.0 (no repulsive or attractive interactions) to 0.001 (maximum repulsion), the rosette fraction in the mixture changes by no more than 8%. Including all possible sterics that occur only in tapes (i.e., R(13)--R(28)), the maximum change in rosette fraction is no more than 16%. These predictions can be rationalized by considering that any change in the stability of the tapes only affects the rosette concentration by means of shifting the equilibrium between free 1 and 2 and the rosette. Since there are 270 different tapelike structures in equilibrium, this mixture represents the best buffer solution in the world. These model calculations seem to conflict with the concept of peripheral crowding as put forward by Whitesides et al., which states that bulky substituents on the periphery of the melamine (and cyanurate) components can be used to shift the tape/rosette equilibrium completely toward the rosette structure. Computer simulations (CHARMm 24.0) show that linear tapes with bulky substituents are severely distorted from planarity, while the corresponding rosette remains planar. Therefore, tapelike structures with bulky substituents are expected to have a much higher solubility than the corresponding rosettes, which can explain the observed crystal data.

Intensive and prolonged health promotion strategy may increase awareness of osteoporosis among postmenopausal women.

The aim of the study was to measure the results of a 15-year health promotion strategy towards osteoporosis, in an urban community of subjects over 45 years old, in terms of osteoporosis awareness and handling. To this end an ancillary study to a large survey of the Belgian population's self-perceived health status was carried out. A rectangular sample of 4800 individuals over 45 years old was randomly selected in two Belgian cities, among the affiliates of the two main health insurance providers. One of the cities (Liège) had been, since the early 1980s, the target of a constant health promotion strategy, directed to both the medical community and the general population, aimed at increasing osteoporosis awareness in women after the menopause. During the same period, no particular steps were taken in the other city (Aalst) to increase osteoporosis awareness in the community. In our study, the participants were asked to spontaneously report any chronic, serious and/or severe disorders that they had been suffering from, for at least 6 months, during the previous 12 months. They also provided a list of drugs they were taking at the time of the survey. Osteoporosis was reported to be a disease affecting 1.5% of men in Aalst and 1.3% of men in Liege (p = 0.61). For women, osteoporosis was reported to be present in 4.8% in Aalst and 10.8% in Liege (p<0.001). Self-reporting of osteoporosis prevalence in Liege was statistically significantly higher in women aged 45-64 years, 65-74 years or over 75 years (p<0.001). Obesity, alcohol consumption or physical activity were equally distributed between women from Liège and Aalst. Prescription drugs used for osteoporosis had been delivered to a similar proportion of men in Aalst and Liège. In women, a statistically significant difference in these prescription drugs was observed between Liège and Aalst, both for the overall population (p<0.001) and in each of the age classes (p<0.001 for 45-64 years and 65-74 years; p<0.009 for over 75 years). A continuous long-term health promotion strategy, directed toward both physicians and the general population, thus appears to increase awareness about osteoporosis in women over 45 years and/or in the medical community. This is reflected by an increase in self-reported prevalence of osteoporosis and in the prescription of drugs aimed at prevention and treatment of this disorder. Whether these observations reflect an appropriate diagnosis and a proper handling of the disease remains to be evaluated by objective diagnostic tools such as bone densitometry and by an evaluation of the effectiveness of prescription practices in postmenopausal women.

An enantiomerically pure hydrogen-bonded assembly.

Chiral molecules have asymmetric arrangements of atoms, forming structures that are non-superposable mirror images of each other. Specific mirror images ('enantiomers') may be obtained either from enantiomerically pure precursor compounds, through enantioselective synthesis, or by resolution of so-called racemic mixtures of opposite enantiomers, provided that racemization (the spontaneous interconversion of enantiomers) is sufficiently slow. Non-covalent assemblies can similarly adopt chiral supramolecular structures, and if they are held together by relatively strong interactions, such as metal coordination, methods analogous to those used to obtain chiral molecules yield enantiomerically pure non-covalent products. But the resolution of assemblies formed through weak interactions, such as hydrogen-bonding, remains challenging, reflecting their lower stability and significantly higher susceptibility to racemization. Here we report the design of supramolecular structures from achiral calix[4]arene dimelamines and cyanurates, which form multiple cooperative hydrogen bonds that together provide sufficient stability to allow the isolation of enantiomerically pure assemblies. Our design strategy is based on a non-covalent 'chiral memory' concept, whereby we first use chiral barbiturates to induce the supramolecular chirality in a hydrogen-bonded assembly, and then substitute them by achiral cyanurates. The stability of the resultant chiral assemblies in benzene, a non-polar solvent not competing for hydrogen bonds, is manifested by a half-life to racemization of more than four days at room temperature.

Ag+ labeling: a convenient new tool for the characterization of hydrogen-bonded supramolecular assemblies by MALDI-TOF mass spectrometry.

Herein we describe our results on the characterization of a wide variety of different hydrogen-bonded assemblies by means of a novel matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) technique with Ag+ labeling. The labeling technique with Ag+ ions is extremely mild and provides a nondestructive way to generate charged assemblies that can be detected by mass spectrometry. Up to now more than 25 different single (1(3).2(3)), double (3(3).2(6)), and tetrarosettes (4(3).2(12)) have been successfully characterized by the use of this method. The success of the method entirely depends on the presence of a suitable binding site for the Ag+ ion. A variety of functionalities has been identified that provide strong binding sites for Ag+, either acting in a cooperative way (pi-arene and pi-alkene donor functionalities) or individually (cyano and crown ether functionalities). The method works well for assemblies with molecular weights between 2,000 and 8,000 Da, and most likely far beyond this limit.

Efficacy of sinus irrigation versus sinus irrigation followed by functional endoscopic sinus surgery.

Sinus irrigation is the traditional treatment for chronic maxillary sinusitis. Functional endoscopic sinus surgery (FESS) restores aeration and allows secretions to be removed from an infected sinus. This study compares the efficacy of sinus irrigation with that of sinus irrigation followed by FESS in 89 patients. We measured the effects by way of sinus radiographs, nasendoscopic findings, and patient complaints. When we analyzed the data in terms of intent to treat, we found significantly favorable results for sinus irrigation followed by FESS at the end point, though only for loss of smell and purulent rhinitis. Treatment consisting of sinus irrigation alone prevented surgery in 58% of all patients for 1 year. Both treatment methods were combined with a 10-day course of loracarbef, which might have contributed to the outcome. We conclude that a good option for treatment of chronic maxillary sinusitis seems to be sinus irrigation in combination with a broad-spectrum antibiotic followed by FESS.

[The loyalty of Belgian patients to their family practitioner]. / De trouw van Belgische patiënten aan hun huisarts.

OBJECTIVE: To determine the effect of a non-committal registration specifying the intention of patients to contact a particular general practitioner, on patient loyalty in Belgium. SETTING: Antwerp and Liège DESIGN: Case control study. METHOD: Medical consumption was registered during one year by two health insurance companies for a group of 4000 participating patients (experimental group) and 4000 non-participants (control group) within two selected areas (Antwerp and Liège). Patient loyalty was measured by means of the normalised usual provider continuity index. RESULTS: No relevant differences were found between the experimental group and the control group. Even when taking into account that a general practitioner is not available 20% of the time, the proportion of loyal patients hardly reached 70%. CONCLUSION: A non-committal registration had no influence on patient loyalty. There is a clear difference between intention and actual behaviour. More coercive measures are needed to reach a more loyal behaviour.

Life-style: marital status, education, living situation, social contacts, personal habits (smoking, drinking). Euronut SENECA investigators.

Data on marital status, living conditions and social contacts of 2586 elderly persons living in 19 towns from 12 European countries, who were born between 1913 and 1918, and who participated in the Euronut SENECA study on Nutrition of the Elderly in Europe, reflect on the whole a high quality of life in the elderly population of these small traditional European towns. Housing offers adequate comfort in general and many elderly people have access to gardens. In most survey towns the majority of men and women of this age group have at least one child within the town or nearer. In some of the southern and eastern towns 40% or more live with their children. In most survey towns 30-50% of the women live alone (more than 50% in the Danish and Norwegian towns Roskilde and Elverum) but in general social nets are strong enough to prevent the danger of acute isolation. But in four towns (Roskilde/Denmark, Chateau Renault-Amboise/France, Elverum/Norway and Padua/Italy) 10-13% of all women lived alone and did not know a neighbour well enough to call on for help. In three towns (Monor/Hungary, Vila Franca de Xira/Portugal and Marki/Poland) social contacts were distinctly less frequent than in all other towns and participation in community activities virtually non-existent. These were the same towns in which substantial groups reported food budgeting problems. Danger of isolation, however, seemed to be rather low. A high intensity of social contacts and no danger of acute isolation in spite of relatively few available children was noted in the German-speaking town of Switzerland (Burgdorf). Further analyses will have to test whether food consumption or nutritional status is related to any of the studied life-style factors.

The entire nucleotide sequence of foxtail mosaic virus RNA.

The nucleotide sequence of the RNA genome of foxtail mosaic virus (FMV), a member of the potexvirus family, is 6151 nucleotides long, exclusive of a poly(A) tail. The RNA contains five principal open reading frames (ORFs), designated from the 5' terminus as encoding proteins with Mr values of 152.3K (ORF1), 26.4K (ORF2) which overlaps an 11.3K (ORF3) product, 5.8K (ORF4) which overlaps a 28.8K readthrough protein (ORF5A) which leads into the coat protein cistron of 23.7K (ORF5). The sizes and composition of the proteins encoded by the ORFs are generally similar to those found in other potexviruses; the least similar is the coat protein which nonetheless retains apparently critical consensus regions. The 5' terminus of the previously reported 0.9 kb subgenomic (sg) RNA was determined by S1 nuclease mapping and shown to begin with the sequence GAAGA, 43 nucleotides upstream from the first nucleotide of the coat protein initiation codon. The positions of the 5' end of this sgRNA and of that deduced from the nucleotide sequence for a 1.9 kb sgRNA are entirely consistent with the previously published sizes of these sgRNAs.

Occupational conditions of ward staff and quality of residential care for individuals with mental retardation.

Effects of occupational conditions of ward staff on the quality of residential care for individuals with mental retardation was assessed. Three questions were asked: (a) Does type of contract under which staff members are employed differentially affect their distribution of activities? (b) Does length of duty have an effect on their distribution of activities? (c) Does the number of staff members present on the living group influence quality of care? Over a 40-week period, data were collected on 30 ward staff members who were responsible for 39 residents with severe and profound mental retardation. Results show that staff differentially distributed their activities, especially with respect to organizational activities and the amount of custodial care, depending on the type of contract they were employed under and the number of consecutive days they worked. Number of staff present on the living group appeared to be a major factor in terms of distribution of activities. Implications for staff managers and administrators of residential facilities were discussed.

Disposition and metabolic profiling of the penetration enhancer Azone. I. In vitro studies: urinary profiles of hamster, rat, monkey, and man.

Chain-labeled 14C-Azone was intravenously administered to hamster, monkey, and rat, to compare its metabolic profile with that obtained previously in humans after dermal application. Azone-derived radioactivity was excreted predominantly in the urine for both hamster and monkey, which is similar to the disposition in humans. Metabolic profiling in urine revealed extensive systemic metabolism to occur in all species studied. The main fraction of the metabolites was most polar in man, followed by rat, monkey, and hamster. Traces of the parent compound were detectable only in hamster urine. Although some of the polar major human metabolites were also present in rat urine, the animals were unsuitable for collecting metabolites of Azone observed in humans. In rats, complete cleavage of the dodecyl side chain was ruled out by administering Azone that had been labeled at two distinct positions of the molecule. Additionally, oral administration of Azone to rats resulted in the same metabolic profile as intravenous administration, indicating that gastrointestinal metabolism does not occur or is similar to systemic metabolism.

Rabies in Western Canada 1978-1984.

The results of laboratory examination of 22,503 specimens for the diagnosis of rabies by the standard fluorescent antibody and mouse inoculation tests over a seven year period are presented. Specimens were received from British Columbia, Alberta, Saskatchewan, the Yukon and Northwest Territories. Of the 1,445 positive cases, 10.50% involved human contact. The main reservoirs of rabies were skunks, bats and foxes. The reliability of the fluorescent antibody test for the diagnosis of rabies was reaffirmed by agreement with the mouse inoculation test in over 99% of cases.