Use of two methods of analysis to estimate the annual rate of tuberculosis infection in Southern Algeria.

SETTING: Analysis of tuberculin skin test surveys. OBJECTIVE: To estimate the annual tuberculous infection rate in Tamanrasset (southern Algeria) by applying on the one hand the classical method of the Tuberculosis Surveillance Research Unit (TSRU) of the International Union Against Tuberculosis, and on the other the study of variations of allergy published by Raj Narain et al. METHODS: 3675 pupils aged 5-18 years were tested in October 1982 or November 1983; 1240 of them were tested on both occasions. The technique of the World Health Organization, with 2 TU PPD RT23 tuberculin was used by trained testers. The TSRU method was applied to the 863 children aged 5-15 years without bacille Calmette-Guerin (BCG) scar, according to three estimates of the prevalence of infection (cut-off points of the distribution of reactions of 10 mm, of 14 mm corrected by dividing by 0.82, and mirror technique with a mode of 17 mm), and to three hypotheses of the decrease in infection risk (1%, 3% and 5%). The study of variations of allergy was used in the 1240 pupils tested twice (BCG-vaccinated or not). RESULTS: The average annual risk of tuberculous infection estimated by the TSRU method was lower than 1% (0.5%-0.6% according to the most stringent criteria). By the method of variations of allergy, the estimated annual infection rate was 0.9%. For the latter, our results are consistent with those obtained by other researchers. CONCLUSIONS: These findings suggest that the study of variations of allergy might be a good alternative approach to estimate the annual infection rate in countries where children are BCG-vaccinated at birth, which is the case for most developing countries.

Respiratory history during infancy and childhood, and respiratory conditions in adulthood.

The aim of this paper was to study respiratory disorders in infancy and childhood as a risk factor for respiratory conditions in adulthood. During the first part of the survey 15,247 adolescents in the Bordeaux area (average age: 16.5 years, boys = 46.6%) filled in a self-administered questionnaire concerning their respiratory history during infancy and childhood, their present symptoms and their smoking habits. Each subject with chronic cough (n = 538) was then matched with two controls (n = 1094) and the parents of these subjects and of their controls were sent a complementary questionnaire. During the second part, 1807 adults (average age: 39.3 years; men = 49.7%) working at Bordeaux University filled in a self-administered questionnaire about their present respiratory symptoms, smoking habits and respiratory symptoms during adolescence. Spirometry was performed in 172 adolescents and 1665 adults. The results of the first part showed a very significant relationship in adolescents between respiratory history during infancy and childhood and current chronic cough even in non-smokers, non-wheezers and non-asthmatics. The second part showed a very significant relationship in adults between respiratory symptoms during adolescence and present respiratory symptoms on the one hand, and a lower pulmonary function on the other, taking wheezing, smoking and asthma into account. In common with many similar studies, we conclude that respiratory disorders in young children may predispose to later disease, and that consequently it might be important to determine appropriate measures to prevent respiratory illness in childhood.

[Respiratory history in children and asthma]. / Antécédents respiratoires de l'enfant et maladie asthmatique.

The purpose of this study was to examine the relationship between asthma, the respiratory history and possible disturbances of pulmonary function in teenage asthmatics. This aetiological study was carried out in 103 asthmatics and 1094 controls who were teenagers attending schools in Bordeaux. In addition to the data collected by the teenagers using a self administered questionnaire, parents also filled out a complementary questionnaire. Spirometry was performed in a sample of 112 subjects. The result showed a significant relationship between asthma and respiratory history in childhood and infancy. Moreover there was a significant decrease of FEV1, (in girls only) and FEF 25-75 (boys and girls) amongst the asthmatic pupils.

Validity and repeatability of the IUATLD (1984) Bronchial Symptoms Questionnaire: an international comparison.

The International Union against Tuberculosis and Lung Disease (IUATLD) Bronchial Symptoms Questionnaire (1984) was developed for use in studies of asthma and its reliability measured in an earlier survey in England. The association of the symptoms elicited by this questionnaire to bronchial response to histamine has also been described. This paper presents the results of studies of the questionnaire in four clinical centres in Europe. The reliability of the questionnaire and its ability to predict the bronchial response to histamine were compared for English, Finnish, French and German translations of the questionnaire in samples of diagnosed asthmatics and controls in Nottingham, Berlin, Helsinki and Paris. The answers to questions showed good repeatability, especially in Finland and Germany, particularly those questions on asthma and wheeze. The most sensitive symptom for predicting hyperresponsiveness was the question on wheeze, the most specific questions were those on waking at night with shortness of breath (Paris and Nottingham) and morning tightness (Helsinki and Berlin). This study shows that the IUATLD (1984) questionnaire may provide useful, valid and comparable data even in translation but these studies will need to be repeated in representative samples before such a possibility is accepted as fully demonstrated.

Treatment compliance and self-medication in asthma in France.

A study was carried out among asthmatic patients in order to determine their compliance to treatment and self-medication. Data collection used a self-administered postal questionnaire as tested in a previous study. The population under study included 450 asthmatic patients; 370 answered; their mean age was 47 +/- 16 yrs and 44% were men. An aerosol was the preferred route of administration (41%). Eighty two percent of the patients tended to reduce the doses following improvement; 80% claimed to know treatment for attacks; 90% had already been using an inhaler, although only 62% had been shown how to use one. Forty eight percent had already bought drugs without prescription, especially patients within the 25-34 yrs age group. This study is consistent with similar surveys performed in other populations. Improved quality of information about treatments and how to use drugs is higher in patients with chronic forms of asthma involving unpredictable acute attacks.

[Chronic cough in adolescents and respiratory symptoms in adults]. / Toux chronique de l'adolescent et symptômes respiratoires de l'adulte.

The object of this work was to study the relationship between chronic cough in adolescence, and chronic symptoms and airflow obstruction in adults. The data were collected between 1982 and 1984 from 1807 men and women living in Bordeaux (France) and its surrounds. A self administered questionnaire was used which focused on current respiratory symptoms and respiratory symptoms during adolescence. Spirometric curves (FVC, FEV1 and FEF 25-75) were measured. The population was evenly split between men (mean age 40.1) and women (mean age 38.6). Most subjects were French; more than half were non smokers; all socioprofessional categories were represented except farmers, craftsmen and merchants. The proportion of subjects with current respiratory symptoms was 2 to 10 times higher amongst subjects with respiratory symptoms during their adolescence than in those who had none. The relationships were highly significant and remained so after adjustments for the confounding factors following: sex, age, nationality, socio-economic status, smoking habits, occupational exposure and previous occupational disease. Mean spirometric values were higher amongst subjects without chronic cough during their adolescence than those who had cough. Differences were significant for FVC, FEV1, FEF 25-75 in women and were on the borderline for FEF 25-75 in men. This study showed that respiratory conditions in adolescence represent an important risk factor for chronic symptoms and airflow obstruction in adult life.

[Smoking in adolescents in Guadeloupe]. / Tabagisme chez les adolescents en Guadeloupe.

A study was made of the smoking habits of 10,349 teenagers attending secondary school in Grande-Terre, Lamentin and Marie-Galante in Guadeloupe (41.4% were male; mean age 16.4 +/- 1.8). The study was made using a self administered questionnaire which also included questions on respiratory symptoms in teenagers and the smoking habits of their parents. The proportion of regular smokers (greater than one cigarette per day) was 9.2% in boys and 5.6% in girls: the boys were smoking on average 7.3 cigarettes a day, the girls 5.9. The proportion of smokers increased with age, being the highest in the children of managerial and commercial classes or skilled artisans, and was strongly linked to the smoking habits of the parents. Respiratory symptoms were more common in teenagers who smoked.

[Chronic bronchitis. Development, prevention]. / La bronchite chronique. Evolution, prévention.

The adoption of an arbitrary epidemiological definition for chronic bronchitis has enabled some progress to be made in the understanding of the frequency and natural course of this disease. It is important to distinguish between chronic airflow obstruction and chronic hypersecretion of bronchial mucus. The prevalence of the disease can only be assessed in selective groups of the population and varies according to the characteristics of these groups, but is approximately 15% of men and 8% of women. There is relatively low mortality in France: 6/100,000 in 1985 and varies according to the departments, up to 38/100,000 inhabitants. These data ought to be interpreted with care and it is also important to take account of factors linked to their evolution. Longitudinal studies undertaken 20 years ago have allowed two hypotheses to be formulated to aid in a more precise understanding of the natural history of the disease: the first of these was the Dutch hypothesis which is currently undergoing a renewal of interest linked to epidemiological studies on HRB, and the English hypothesis which has the merit of emphasizing the principal risk factor in chronic bronchitis. Certain smokers are sensitive to tobacco, even though some others are not. Does the explanation of this lie in the relationship between obstructive ventilatory problems and bronchial hyper-reactivity? This association is discussed in the light of recent work as well as the relationship between bronchial hyperactivity, smoking and chronic bronchitis. Other risk factors have been studied: occupational hazards, air pollution and acute respiratory infections in childhood. But, in spite of all the work carried out to better define the risk factors and prognosis of the disease, this makes up a complex overall picture which is poorly understood and which should stimulate us to further research. The prevention of the disorder should be aimed at three levels; at the primary level (to prevent the appearance of the disorder) the only objective which may lead to a satisfactory solution in public health terms, a secondary level would be to identify those people or groups at special risk, but it is not recommended to undertake systematic examination of large populations in view of the fact that the early diagnosis of non-specific chronic pulmonary disease as well as special studies have not been shown to demonstrate the value of these procedures. The objective of prevention is to eliminate or neutralise factors linked to the disease.(ABSTRACT TRUNCATED AT 400 WORDS)

[Smoking among nursing students]. / Le tabagisme chez les élèves infirmières.

The aim of this work is to study smoking habits in young adults in a particularly sensitive environment. The data were collected in 28 nursing schools of the Public Hospital System in Paris by means of anonymous self-administered questionnaire. The questions focused on smoking habits, knowledge of risks and student attitudes. The 5,598 respondents (mean age of 22.6 years) were 89 per cent female. The results showed a high prevalence of current smoking (44%) especially amongst the younger students. Students preferred brands with a medium range tar level. Most of the students knew the smoking risk, agreed with the policy of prohibiting smoking in the hospital and thought that it is the role of nurses to counsel patients to stop smoking, but only one third hold a positive view of this role.

Prevalence of asthma in adolescents in various parts of France and its relationship to respiratory allergic manifestations.

Six studies have been carried out in France and French Polynesia to investigate the prevalence of asthma in adolescents attending secondary school and in Paris university students (68,179 subjects overall). All the studies used the same questionnaire, self-administered in the classroom, and interviews administered to students during the university's preventive medicine examination. An epidemiologic definition of asthma was considered an affirmative answer to the question, "Have you ever had attacks of asthma?" The prevalence of asthma ranged from 4 to 12 percent, most often higher in boys with a tendency to increase with age. The relationship between asthma and other allergic respiratory conditions was studied. Some recommendations are made here to improve the validity of data and to increase knowledge about the etiology of asthma.

Variation of lung function during the workshift among cotton and jute workers.

Cotton and jute dust exposure is known to induce reversible airway obstruction. We compared 50 exposed workers to 99 non exposed workers for the prevalence of respiratory symptoms and ventilatory impairment, and for variations in pulmonary function after five working days and after inhalation of salbutamol. The prevalence of respiratory symptoms was not significantly different between the two groups. Pulmonary function was not different on Monday morning, however, significant differences were observed on Friday afternoon. The exposed workers had a lower flow rate at 75% of exhaled forced vital capacity than controls (P less than 0.01). Salbutamol induced greater bronchodilatation in the exposed group. Comparison with a control group is necessary to take into account the change in pulmonary function. Repeated tests, combined with pharmacological tests, are able to differentiate the lung function pattern of exposed and non exposed workers.

[Respiratory history of children and chronic cough in adolescents]. / Antécédents respiratoires de l'enfant et toux chronique de l'adolescent.

The purpose of this work was to study the relation between respiratory history during childhood and teenagers' chronic cough and possible abnormalities of pulmonary function. This etiological survey was carried out among 538 pupils with a chronic cough and 1,094 controls (boys and girls), teenagers attending school in Bordeaux and its surroundings (average age, 16.7 years). The data were collected by means of self-administered questionnaires among the teenagers and their parents. Spirometry was performed in a randomised sample of 172 pupils. A significant relation was found between chronic cough and both respiratory history and a decrease of F.E.V.1 (in boys and girls) and F.E.F. 25-75 (in girls only). Moreover this relation was present also among the subjects with incomplete answers and in the group of non-asthmatics.

[Antitubercular therapeutic regimens routinely prescribed in Bas-Rhin and results of treatment]. / Régimes thérapeutiques antituberculeux prescrits en routine dans le Bas-Rhin et résultats du traitement.

The overall plans and therapeutic regimens prescribed for new cases of pulmonary tuberculosis notified in the Bas-Rhin in 1979 to 1980 (372 Subjects) were studied, as were relapses occurring over a three year period from the date of notification. As in the preceding analysis of cases between 1970/78, the proportion of patients treated exclusively at home was low (22.8%) and the duration of stay in a Sanatorium was lengthy (mean 86.6 days for cases without bacteriological confirmation and 142.3 days for bacteriologically positive cases). The mean duration of chemotherapy was 12.5 months (+/- 3.7). The therapeutic regimens prescribed showed a significant variability: if 80.6% of patients received, at one time or another, the combination of Isoniazid (H), Rifampicin (R) and Ethambutol (E), only 33.9% of the adults treated received the HRE/HR regimen, for periods of variable duration. Four relapses were seen during the fixed follow-up period.

[Long-term radiology and respiratory function study following exposure to asbestos]. / Etude radiologique et fonctionnelle respiratoire au long cours après exposition à l'amiante.

During the supervision of 93 workers in an asbestos factory pulmonary function tests and radiographs were performed using the same equipment and by the same team, at 5 yearly intervals. The assessment of radiographic changes was judged by following both the reader of the films and the technique used (either un-named films or simultaneous films at 5 yearly intervals). On reading un-named films the appraisal of parenchymal abnormalities was variable from one reader to another; on the other hand they were less marked for simultaneous readings made by the same observer. Progressive pulmonary function tests showed that the fall in vital capacity and of VEMS in 5 year intervals was more rapid when there was a parenchymal abnormality, when the duration of exposure was long or the subject was older when first exposed. The results showed that in spite of ceasing to be exposed the parenchymal abnormalities progressed.

[Lessons from a long-term survey on the effects of massive occupational exposure to asbestos. The AMISOL affair 10 years later]. / Enseignements d'une enquête au long cours sur les effets d'une exposition professionnelle massive à l'amiante. L'affaire AMISOL 10 ans plus tard.

For the past 10 years the authors have followed up a cohort of workers who had been massively exposed to dust in an asbestos textile factory which closed down in 1974. They report on the difficulties of all kinds they encountered during this epidemiological survey. The most original result is that they were able to establish that the radiological and functional manifestations of asbestosis pursue their course after the subjects have ceased to be exposed. Another important point is the early development of lesions in peripheral bronchioles, detected by volume-flow loops. The authors insist on the psycho-social problems at the site of work or in daily life which arise from the use of asbestos or of fibres with similar properties. Social protection, at present well organized, should suppress the risk of asbestosis in Western countries. However, a number of problems remain to be solved, notably those concerning the long-term risk of pleural mesothelioma, the mode of action of the fibers and the immune reactions they induce, and the economic and social consequences of a hypothetical ban on asbestos--a material very difficult to replace. This study embodies, in miniature, all the problems of society associated with asbestos during this second half of the XX th century.