[Smoking cessation in smokers with pulmonary Langerhans cell histiocytosis - considerations from the management of ten patients]. / Sevrage tabagique de fumeurs souffrant d'histiocytose pulmonaire langerhansienne. Réflexions issues de la prise en charge de dix patients.

Pulmonary Langerhans cell histiocytosis (PLCH) belongs to the spectrum of diffuse interstitial cystic pneumonias; it affects young people of both sexes and occurs almost exclusively in tobacco smokers or co-users of tobacco and cannabis. The management of this severe chronic disease is undertaken in specialized centers. A better understanding of the pathogenic mechanisms of the disease has opened up prospects for targeted therapies. However, supporting the abstinence from inhaling noxious materials which determine its prognosis remains the cornerstone of treatment. Patients with PLCH who persist in smoking despite the diagnosis may be very dependent on tobacco, experience significant difficulties in stopping smoking, and must have access to specialist smoking cessation clinics.

Factors influencing patient's perception of long-term treatment with low-molecular-weight heparins for cancer-associated thrombosis: an updated analysis of TROPIQUE, a prospective observational study.

PURPOSE: Our objective was to compare patient's expectations to their experience and to identify factors predictive of patient's perception of long-term LMWH for the treatment of cancer-associated thrombosis (CAT). METHODS: Results from the validated Perception Anticoagulant Treatment Questionnaires (PACTQ) completed before inclusion (PACTQ1 for expectations) and at the end (PACTQ2 for convenience and satisfaction) of the 6-month TROPIQUE study were studied with principal component analysis. Possible predictive factors of improved perception of LMWH treatment were analyzed with the Kruskall-Wallis test. RESULTS: Among 409 included patients treated with LMWH, 269 PACT-Q1 and 139 PACT-Q2 were evaluable for treatment perception. Patients had high expectations (A1-A7 score of 26.7 ± 3.5, max = 35). Treatment cost (A7 = 1.90 ± 1.31) and concern about a mistake in anticoagulation (A5 = 1.93 ± 1.12) had little importance while LMWH treatment was considered easy to use (A4 = 4.20 ± 0.93). Six-month treatment with LMWH was associated with a high rate of convenience (B1-B11, C1-C2 = 55.1 ± 8.38, max = 65) and a high satisfaction score (D1-D7 = 25.1 ± 4.32, max = 35). Patients' confidence in treatment and perception of possible LMWH side effects were moderate while perception of autonomy and independence significantly improved at the end of the study compared to inclusion. PACT-Q2 satisfaction score was low in patients who experienced bleeding (PACT-Q2 24.1 ± 3.3 vs. 25.1 ± 4.3). LMWH twice daily tended to be found less convenient compared than once daily (53.3 ± 7.2 vs. 55.0 ± 8.3). CONCLUSION: CAT patients had a good perception of the 6-month LMWH treatment when comparing expectations and experience. Using a quantitative scale validated in the general population for VTE and subcutaneous injection and including a large number of patients, bleeding complications and LMWH twice daily were associated with a nonsignificant trend towards a worsen perception.

[Old and new tobacco products]. / Les anciens et nouveaux produits du tabac.

Tobacco use is not just about manufactured cigarettes. Rolling tobacco, highly prized in the wake of price increases, is estimated to carry more toxic agents than its counterpart. This study shows that the use of cigar, pipe, cigarillos and narghile also leads to a cohort of pathologies similar to or more than what is known for smoking single cigarettes. Exotic, liquid or heated forms do just as much. The non-smoked tobacco, often fallen into disuse in France is very used in the United States and especially in Scandinavia. Denuded of inhaled products, it is often pointed as a form of reduction of smoking risks. Its use by athletes in all countries as a doping attitude, especially in ski disciplines, required a campaign of prevention within the federations concerned.

[Variations of time perspective by social deprivation, what are the effects on smoking cessation?]. / Modification de la perspective temporelle par la précarité: quels effets sur le sevrage tabagique?

Smoking represents a major public health problem because of its high morbidity and mortality rates. Nearly half of the deaths in the lower class are caused by smoking. The socially deprived are physically and psychologically vulnerable. The instability of their situation increases the difficulty to invest in smoking cessation and certain time orientations linked to this social deprivation represent negative factors in the prognosis. Socially deprived populations do not understand the consequences of smoking unless they are in denial of the risks. The motivation to stop is essentially financial. The perception of smoking cessation is taken as a deprivation of pleasure. Independently of the social deprivation factors, taking into account the time perspective conveys necessary information of appropriate care.

Changes in mouse brain metabolism following a convulsive dose of soman: a proton HRMAS NMR study.

Soman, an irreversible organophosphorus cholinesterase inhibitor, induces status epilepticus and, in sensitive brain areas, seizure-related brain damage (e.g. brain edema and neuronal loss). The brain metabolic disturbances associated with these events are ill known. In the present study, we thus evaluated these changes in a murine model of soman-induced status epilepticus up to 7 days after intoxication. Mice, protected by HI-6 and atropine methyl nitrate, were poisoned with soman (172 microg/kg) and then sacrificed at set time points, from 1 h to 7 days. Brain biopsies from the piriform cortex (Pir) and cerebellum (Cer) were analyzed by 1H HRMAS NMR spectroscopy. Spectra were then analyzed using both a supervised multivariate analysis and the QUEST procedure of jMRUI for the quantification of 17 metabolites. The multivariate analysis clearly showed the metabolic differences between a damaged structure (Pir) and a structure with less prominent changes (cerebellum) and helped to globally assess the time course of metabolic changes. Analysis of the individual metabolites showed that the major changes took place in the piriform cortex but that cerebellum was not change-free. The most prominent changes in the former were an early (1-4 h) increase in alanine and acetate, a delayed increase in lactate, glycerophosphocholine and glutamine as well as a delayed decrease in myo-inositol and N-acetylaspartate. A week after poisoning, some metabolic disturbances were still present. Further research will be necessary to clarify what could be the involvement of these metabolites in physiological processes and how they might become useful surrogate markers of brain damage and repair.

Factors predictive of complicated or severe alcohol withdrawal in alcohol dependent inpatients.

OBJECTIVE: In a department of hepatology and gastroenterology, a significant number of patients are hospitalized for alcohol withdrawal. The aim of this retrospective study was to identify factors predictive of severe or complicated alcohol withdrawal in order to improve patient management. METHODS: Between June 2002 and June 2005, 182 patients admitted for alcohol dependence according to the DSM-IV classification were enrolled in this study. A unique management protocol for alcohol withdrawal was applied for all patients. The Cushman score was recorded on day 1, 2 and 3 to assess the severity of alcohol withdrawal. We searched for correlations between epidemiological, clinical and biological data and the Cushman score. RESULT: The study population included 136 (74.7%) men and 46 (25.3%) women, mean age 47.6+/-10.1 years. One hundred and eighteen patients (64.8%) were referred from a specialized outpatient clinic and 64 (35.2%) patients were referred from the emergency unit. The mean and median Cushman scores on day 1, 2 and 3 were: 5.1 and 5; 3.9 and 4; 2.3 and 2, respectively. Twenty patients (11.0%) and five patients (2.7%) had scores greater than or equal to 8 and greater than 12, respectively. The proportion of patients with Cushman score greater than or equal to 8 on day 1 was significantly greater in patients referred from the emergency unit than in those referred from a specialized outpatient clinic (p=0.002). Mean alanine aminotransferase level on day 1 was significantly higher in patients with a score greater than or equal to 8 than in those who had a score less than 8 (112.1+/-44.4 UI/L versus 78.4+/-11.8 UI/L; p=0.046). Referral via an emergency unit as well as an alanine aminotransferase level greater than 1.5fold the upper limit of the normal range were independent predictive factors for a Cushman score greater than or equal to 8. In conclusion, severe alcohol withdrawal (Cushman score>or=8) is significantly associated with initial management in an emergency unit and serum alanine aminotransferase level greater than 1.5 fold the upper limit of the normal range. These predictors should be monitored in order to appropriately adapt the therapeutic schedule.

Alcohol y problemas relacionados con el alcohol en Francia / Alcohol drinking and alcohol-related problems in France

Objetivos: Este artículo describe las pautas de consumo de alcohol, prevalencia de consumo de alcohol, dependencia y mortalidad relacionada con el consumo de alcohol en Francia. Se analiza la evolución del consumo de alcohol en Francia y en los países européos, así como las diferencias entre sexos en relacion con el consumo, dependencia y mortalidad relacionada con el consumo de alcohol. Material y métodos: La Mission interministérielle de lutte contre la drogue et la toxicomanie (Mildt), la Caisse nationale d'assurance maladie des travailleurs salariés (Cnamts) y el Institut national de prévention et d'éducation pour la santé (Inpes [ex CFES], Comité français d'éducation pour la santé), los cuales son los agentes clave en el desarrollo de las políticas públicas dirigidas a la prevención y tratamiento de los problemas relacionados con el consumo de alcohol, han solicitado información al INSERM a través de la consulta colectiva mediante expertos. Este grupo de expertos ha facilitado información científica validada acerca de las pautas de consumo de alchol, los cambios a lo largo del tiempo, las consecuencias sociales asociadas al consumo excesivo de alcohol, los factores de riesgo de abuso y dependencia, y problemas relacionados con el consumo de alcohol. Resultados: El consumo de alcohol en Francia ha descendido un 40% en 40 años, mientras que el consumo de vino ha descendido un 40% en tan sólo 20 años. Sin embargo, el consumo de vino es aún predominante, especialmente en los mayores de 65 años, entre los cuales el 65% consume vino diariamente. Las pautas de consumo de alcohol son muy diferentes entre los jóvenes. Éstos consumen preferentemente cerveza y licores, principalmente los fines de semana, y en un contexto de celebración. Frecuentemente, mezclan bebidas y se emborrachan. Se estima que más de 2 millones de franceses poseen síntomas de dependencia al alcohol, y al menos el 40% de ellos posee otro trastorno mental asociado. La búsqueda de nuevas sensaciones, la edad temprana al inicio del consumo y la falta de reconocimiento de los efectos del alcohol en la persona, son los 3 factores que predicen futuras situaciones de abuso y dependencia al alcohol. El alcohol es el responsable de unas 2.700 muertes y de unos 24.000 accidentados en las carreteras cada año. Conclusiones: Aunque prácticamente toda la población de Francia consume algo de alcohol, las pautas de su consumo difieren marcadamente entre los jóvenes, los cuales consumen cerveza y licores durante los fines de semana, y la población mayor de 65 años, que consumen preferentemente vino y lo hacen todos los días. Estas pautas de consumo de alcohol difieren entre sexos, tanto en los jóvenes como entre los adultos. Por ello, es importante considerar todos estos diversos factores a la hora de diseñar las estrategias preventivas adecuadas

Objective: This paper describes current alcohol drinking patterns, prevalence of alcohol use, dependency and mortality related to alcohol in France. Evolution of alcohol consumption in France and Europe is discussed, as well as differences between males and females about alcohol consumption, morbidity and mortality related to alcohol use. Material and methods: The Mission interministérielle de lutte contre la drogue et la toxicomanie (Mildt), the Caisse nationale d'assurance maladie des travailleurs salariés (Cnamts) and the Institut national de prévention et d'éducation pour la santé (Inpes [ex CFES], Comité français d'éducation pour la santé), who are the key players in public policies for the prevention and management of alcohol-related problems, wanted to question Inserm via the collective expertise procedure. This expertise provided validated scientific information relating to alcohol-related consumption habits and how these had changed over time, the social damages associated with excessive consumption, the risk factors for abuse and dependency and the related management problems. Results: In France, global alcohol consumption has fallen by almost 40% in forty years and the consumption of wine has also decreased by 40%, but over a period of twenty years. Wine consumption is nevertheless largely predominant since 65% of people over the age of 65 drink wine on a daily basis. Consumption habits are very different in young people. They drink beer and spirits more so than wine, and tend to do so at weekends, in a celebratory context. They frequently mix their drinks and become inebriated. Over 2 million people in France are estimated to have symptoms of dependency and almost 40% of these present with another mental disorder. Sensation-seeking, the early onset of consumption and resistance to the subjective effects of alcohol are three factors for predicting abuse and dependency. Alcohol is related with around 2700 deaths and 24 000 injuries on the road each year. Conclusions: Although almost all French people consume alcohol, consumption habits vary considerably between young people who mainly consume alcoholic drinks other than wine at weekends, and people over 65 years of age who drink mostly wine on a daily basis. These consumer habits also differ between girls and boys, and between adult men and women. It is therefore important to consider these various factors in order to define more appropriate prevention strategies

What are the characteristics of adolescent hospitalized suicide attempters?

AIM: To study the specificity of hospitalized adolescent suicide attempters. METHOD: Among a national sample of students (n = 11,718, mean age = 16.6 years) studied in 1999, 9.2% (n = 1078) made at least one suicide attempt during their life (SA); 21.9% (n = 234) of them were hospitalized (HSA). We identified the risk factors (family, school, behavioral and psychological) of SA and HSA by comparing (by gender) a) suicide attempters to non-suicide attempters and b) hospitalized suicide attempters to non-hospitalized suicide attempters. RESULTS: Both for girls and boys, the risk factors for SA varied. However, certain risk factors, particularly depressive mood, low self-esteem and poor parent-child relationships, were not associated with hospitalization. Hospitalized suicide attempters had more personal and social problems. But there is an important difference according to gender: in boys, hospitalization is related to physical fighting (OR = 2.2) and offences (OR = 3.4), in girls to running away (OR = 1.7), consumption of illegal drugs other than cannabis (OR = 2.0), having a living standard outside average (OR = 2.0) and going to a private school (OR = 1.7). CONCLUSION: Suicide attempters with problem behavior are more at risk of being hospitalized than others. However, the difference between hospitalized and non-hospitalized subjects was smaller than expected.

[Physical and sports activities in the history of patients treated for addictions. Report 1999 of the study sponsored by the Ministry of Youth and Sports (France)]. / Activités physiques et sportives dans les antécédents des personnes prises en charge pour addictions. Rapport 1999 de l'étude commanditée par le ministère de la Jeunesse et des Sports (France).

Early February 1999, the French Ministère de la Jeunesse et des Sports (Youth and Sports Ministry) sponsored three different studies, aiming to prevent harmful behavior in the area of sport practices among youth. Two years earlier, our health care team working with drug users published reports on the meaningfulness of intensive sports activities in the history of our patients. The present work was performed to highlight the midterm results of one of these studies, to better understand and quantify the importance of physical training in the history of a group of outpatients seen for addictive disorders and comorbid pathologies. For 20 consecutive weeks, 3,040 self-administered questionnaires were available for persons consulting 20 health centers, 2 self-help groups and a general practitioner network working in the field of alcohol or heroine abuse. One thousand one hundred and eleven questionnaires were filled out (36.1%) and returned by mail for complete analysis: 86% of the answering persons had practiced at least one sports activity or participated in physical training, 10.5% had participated in a national or international level competition, and 10.6% reported stress fractures. In the intensive sports group, 36% had used illicit drugs intravenously and 16.4% said they had already used doping substances. Only 28.4% said they experienced dependence during their period of intensive sports activities compared with 15.2% before this time, and a majority (56.4%) thereafter. Intensive sports or physical training should not be seen as a protective factor nor as a way of improving addictive behaviors. More studies are needed to evaluate individual vulnerability factors and specific harm of overtraining and to determine the exact periods when men and women participating in sports activities are likely to abuse drugs, especially at the end of their career.

Regional variations in alcohol use among young people in France. Epidemiological approach to alcohol use and abuse by adolescents and conscripts.

Over the past decade, we have observed a disparity between alcohol consumption and related mortality, especially in its regional distribution. Two epidemiological surveys carried out by CRSSA and INSERM (unit 472) focused on drinking behaviour patterns among young conscripts and secondary school students. Regular drinkers in particular were studied. Geographical distribution of regular alcohol use differs from that of alcohol-related deaths. Alcohol consumption is higher in the south of France than in the north, while mortality from alcohol abuse remains higher in the north.

[Computer analysis of audiograms in epidemiologic surveillance of cohorts exposed to excessive noise]. / Analyse automatique d'audiogrammes visant à la surveillance épidémiologique de cohortes exposées aux bruits impulsifs.

We have developed a method for the assessment of auditive loss using a sample of 1794 Bekesy audiograms recorded in young military students. A rectangular digital filter was used to smooth rough audiogram signals so as to detect pathological patterns such as scotoms and recruitments. Three factors were extracted from principal component analysis. They were correlated with the usual auditory indices and explained 70% of the total observed variance. The first factor is a general indicator of deafness, while the second and third describe the shapes of the hearing threshold level (asymmetry and convexity). This method can be used for rapid identification of suspect audiograms and is thus of value for epidemiological surveillance of populations exposed to impulsive noise.

[Evaluation of consumptions of alcoholic drinks during the National Service]. / Evaluation des consommations de boissons alcoolisées au cours du Service National.

Using only ingested alcohol quantity, where individual erroneous values are counted and weigh a lot, alcohol consumption evaluation is biased. An original alcohol consumption evaluation is explained: ordinal factor analysis, and evaluation scales are described. This study shows several people groups, whose sensitivity about alcohol consumption safety varies greatly: from people whose alcohol consumption is low and have a bad picture of alcohol, to people whose consumption is high, have a good picture of alcohol, or think that their consumption is low or normal. In fact, for the last ones, alcohol consumption safety will never be effective.