The PEERCARE peer led programme for college students: A qualitative evaluation of a "chill-out" harm reduction space.

Aims: Harmful patterns of alcohol consumption, such as binge drinking, are prevalent among the student population at universities. Despite the risks of this behaviour, few secondary prevention programmes have been created to meet the specific needs of this population. The PEERCARE programme is a peer-based prevention programme that seeks harm reduction for alcohol overuse in party environments, among other goals. To do so, a "chill-out" space is created by peer educators in party environments to limit the risks associated with alcohol overuse. This study sought to examine peer educators' experience with a chill-out space to identify their specific actions, difficulties and needs, and to consider possibilities for improvement. Methods: Nine engineering students from one French grandes écoles campus trained as peer educators (six men and three women; mean age 21 years) participated. Semi-structured interviews were used for data collection. Results: The thematic analysis showed that the peer educators were highly engaged with this programme in response to alcohol overuse on their campus. The chill-out space was lauded for its non-judgemental and non-moralising nature. In addition, the numerous risk reduction activities that were enacted confirmed the benefits of these spaces during parties. The peer educators' experience was positive, and acting as managers of the chill-out space seemed to answer to a sense of competence recognitiontion. Conclusion: This study confirms the relevance of utilising chill-out spaces during parties and provides preliminary data on the deployment and management of peer-led chill-out space approaches. Expanding the implementation of such spaces to more educational institutions is recommended.

[Addictive behavior among teenagers: new trends]. / Conduites addictives chez les adolescents, les nouvelles tendances.

The majority of teenagers benefit from scientific advances, whether pharmacological or technological, but the most vulnerable use them to their detriment. While only certain substances or activities are potentially "addictive", the psyche, personality and environment play a major role in the onset of an addiction. Pleasure-seeking motivates gambling and drug use. Suffering will drive the adolescent to pursue this practice, which provides pleasure and relief, to the detriment of any other activity. It becomes exclusive, toxic and alienating. The therapist must rise to the challenge.

Screening for adverse childhood experiences among young people using drugs in Vietnam: related factors and clinical implications.

BACKGROUND: Research evidence shows a strong association between adverse childhood experiences (ACEs) and later-life substance use. But little is known about the prevalence and impact of ACEs among young people using drugs (YPUD) in Vietnam. METHOD: A cross-sectional study using respondent-driven sampling and peer recruitment methods was conducted among YPUD aged 16-24 in three cities in Vietnam. Eligible participants were screened for ACEs using the ACE-IQ, tested for HIV and hepatitis C, and assessed for sociodemographic and behavioral characteristics. RESULTS: Data were collected on 553 individuals whose median age was 20: 79% were male, 18.3% women and 2.7% transgender. Methamphetamine use was reported by 75.8% of participants. 85.5% reported at least one ACE and 27.5% had four ACEs or more. An ACE score of 4 or higher was associated with female and transgender, lower educational level, methamphetamine use, buying sex, depression, psychotic symptoms and expressed need for mental health support. CONCLUSIONS: ACEs were found to be very common among YPUD in Vietnam. It is therefore strongly recommended that these young people should be provided with a comprehensive and secure assessment and care that includes not only essential harm reduction and addiction treatment needs but also addresses their mental health needs.

Alcohol Use, Anxiety and Depression among French Grandes Écoles Engineering Students during the COVID-19 Pandemic.

In French Grandes Écoles, heavy alcohol consumption seems to be generalized and largely tolerated, leading to particular concerns about Alcohol Use Disorder and harmful alcohol practices among students. The COVID-19 pandemic led to increased psychological difficulties, and two coexisting scenarios seemed to emerge regarding alcohol consumption: A decrease in alcohol consumption linked to the absence of festive events, and an increase in solitary alcohol consumption to cope with lockdowns. The aim of this exploratory study is to investigate the evolution of alcohol consumption, consumption motives and the relationship of these factors to the anxiety and the depression of French Grandes Écoles students during the COVID-19 pandemic, depending on their residential status. After the last lockdown, 353 students completed a questionnaire measuring alcohol consumption, motivation to drink, anxiety and depression during and after the COVID-19 period. Although students confined to campus were more likely to increase their alcohol use, they also presented higher well-being scores than those who lived off campus. A significant proportion of students were aware of their increased alcohol use due to the COVID-19 pandemic, and the motives attributed to their increased consumption highlight the need for vigilance and specialized support facilities.

[Pregnancy and chronic renal failure: what is new in 2023?] / Grossesse et insuffisance rénale chronique : quelle prise en charge en 2023 ?

Chronic renal failure (CRF) during pregnancy increases the risk of fetomaternal complications such as preeclampsia, premature delivery and, above all, a deterioration of renal function. A multidisciplinary preconceptional assessment is necessary in this complex clinical situation. Progress in neonatal resuscitation and a better understanding of the pathophysiological mechanisms of autoimmune nephropathy have improved the prognosis of these high-risk pregnancies. This article provides an overview of the issues related to the follow-up of pregnant women with renal disease. It summarizes the glomerular and hemodynamic physiological changes during pregnancy, the fetal and maternal risk, and the adaptation of antihypertensive and immunosuppressive drug treatments.

La présence d'une insuffisance rénale chronique (IRC) lors d'une grossesse augmente le risque de complications fœto-maternelles, comme une prééclampsie, un accouchement prématuré et surtout une péjoration de la fonction rénale. Un bilan préconceptionnel multidisciplinaire permet d'optimiser une situation clinique complexe. Les progrès de la réanimation néonatale et une meilleure compréhension des mécanismes physiopathologiques des néphropathies auto-immunes permettent une amélioration du pronostic de ces grossesses à risque. Cet article donne une vue d'ensemble des problématiques liées au suivi des femmes enceintes souffrant d'une maladie rénale. Il résume les modifications physiologiques glomérulaires et hémodynamiques durant la grossesse, le risque fœto-maternel ainsi que l'adaptation des traitements médicamenteux antihypertenseurs et immunosuppresseurs.

Metformin versus SGLT-2 inhibitors: how low can we go?

The progression of chronic kidney disease is difficult to stop once established. Metformin and sodium-glucose cotransporter 2 inhibitors show promise, but clinical trials with a head-to-head comparison in patients with more advanced (stage 3b-4) chronic kidney disease are largely lacking, partly for safety reasons. In this issue, Corremans et al. compare the effects of metformin and canagliflozin in rats with adenine-induced moderate (stage 2-4) chronic kidney disease. Metformin halted progression, whereas canagliflozin did not. This commentary puts the results in a wider clinical context.

Exposure to HIV risks among young people who use drugs (YPUD) in three cities in Vietnam: time to develop targeted interventions.

INTRODUCTION: The aim of this study is to identify the profiles of young people who use drugs (YPUD) and their exposure to HIV risks in the 3 main cities of Vietnam, Haiphong, Hanoi, and Ho Chi Minh City (HCMC), in order to design a community-based intervention to prevent HIV. METHODS: A survey using respondent-driven sampling (RDS) was conducted among YPUD aged 16-24. Participants were eligible if they reported drug use, confirmed by a urine test. After obtaining informed consent, they were screened for HIV/HCV and assessed using face-to-face questionnaires and self-report. A cluster analysis was conducted, taking into account risk behaviors and confirmed HIV-positive status. RESULTS: Seven hundred and three YPUD aged 16-24 were recruited between October 2016 and February 2017, 584 of whom were included in the final analysis. Median age was 21 (17.7, 23.0); 79% were male, 18% female, and 2% transgender. Methamphetamines use was reported by 77%, followed by cannabis (51%) and heroin (17%); polydrug use was common; 15% had "ever" injected drugs. HIV prevalence was 7%. Among all participants, 48% reported non-consistent condom use and 1% reported needle/syringe sharing during the previous month. Four distinct profiles of HIV risk behaviors were identified: The high multiple-risk group mixed unsafe drug use with unsafe sexual practices and had higher prevalence of HIV; the second group practiced high-risk sex with non-consistent condom combined with methamphetamine use; the third group was a moderate-risk group with limited unsafe sexual practices; and the fourth was considered at "low-risk" as reportedly, most never had sex and never injected. The highest risk group included more female YPUD, living in HCMC, who used heroin and had unsafe sex with their regular partners. The second high-risk group included most of the MSM and all transgender people and frequently reported mental health disorders. CONCLUSIONS: The profiles of YPUD who are at risk of HIV vary according to age, location, and population group. Injecting YPUD are the most exposed to risk and need immediate attention. Sexual exposure to HIV is very common. Mental health is a major concern. Interventions need to be integrated in a differentiated but holistic approach.

Inhibition of vascular calcification by inositol phosphates derivatized with ethylene glycol oligomers.

Myo-inositol hexakisphosphate (IP6) is a natural product known to inhibit vascular calcification (VC), but with limited potency and low plasma exposure following bolus administration. Here we report the design of a series of inositol phosphate analogs as crystallization inhibitors, among which 4,6-di-O-(methoxy-diethyleneglycol)-myo-inositol-1,2,3,5-tetrakis(phosphate), (OEG2)2-IP4, displays increased in vitro activity, as well as more favorable pharmacokinetic and safety profiles than IP6 after subcutaneous injection. (OEG2)2-IP4 potently stabilizes calciprotein particle (CPP) growth, consistently demonstrates low micromolar activity in different in vitro models of VC (i.e., human serum, primary cell cultures, and tissue explants), and largely abolishes the development of VC in rodent models, while not causing toxicity related to serum calcium chelation. The data suggest a mechanism of action independent of the etiology of VC, whereby (OEG2)2-IP4 disrupts the nucleation and growth of pathological calcification.

Internet Gaming Disorder: Exploring Its Impact on Satisfaction in Life in PELLEAS Adolescent Sample.

Among adolescents, heavy video game use and socializing online may be valued socially by peers, depending on gender and age, which can increase life satisfaction. However, heavy video gaming may also be linked to symptoms of Internet Gaming Disorder, which can decrease life satisfaction. Overall, when symptoms of Internet Gaming Disorder are present, do subjects experience decreased or increased life satisfaction, all other things being equal? The aim of this study was to explore the association between Internet Gaming Disorder symptoms and life satisfaction, while controlling for gender, age, and other conditions that may impact life satisfaction. More than 2000 adolescents filled out an anonymous questionnaire at school, and 43 patients in a care center filled out the same questionnaire. Sociodemographic characteristics, family life conditions, use of screens (videos, video games, and social networks), mental health screenings, and a life satisfaction measure were collected. Distribution of participants' characteristics was provided, and stratified multivariate analyses by young male, older male, young female, and older female school populations were carried out. Results suggested that Internet Gaming Disorder symptoms had similar prevalence before and after the age of 15 in males (21% vs. 19%) and in females (6% vs. 7%) respectively and was significantly associated with decreased life satisfaction in older males, even after adjusting for parental support, depression, and economic conditions. Associations between symptoms of Internet Gaming Disorder and life satisfaction may be different depending on adolescent gender and age group.

Effects of a prevention intervention concerning screens, and video games in middle-school students: Influences on beliefs and use.

BACKGROUND AND AIMS: The aim of this study was to evaluate the effects of a prevention intervention on French adolescents' Internet and video games use and on their beliefs concerning gaming and Internet Gaming Disorder (IGD), in order to adjust prevention programs further. METHODS: The study comprised a prevention intervention group (PIG) and a control group assessed at three times - baseline, post-test, and 4-month follow-up. At baseline, a total of 434 junior high adolescents from five secondary schools were assessed (Mage = 13.2 years; SD = 0.5). The main outcome measures were adolescents' gaming and Internet use (amount of time spent during the week and the weekend), the number of adolescents with IGD, and beliefs about gaming and IGD. RESULTS: The results showed significant effects of the prevention intervention on Internet and gaming use (at T2, time spent was significantly lower in the PIG), an important increase of IGD prevalence between baseline and follow-up in the control group, and decreased rates of IGD among adolescents in the PIG between post-intervention and follow-up. Between baseline and follow-up, the control group showed a more significant increase of minutes per day during the week and the weekend on Internet versus during the week on video games. The impact of the prevention intervention on adolescents' beliefs varied according to gender. Girls had a better understanding generally of the potential dangers of and reasons for IGD. DISCUSSION: Implications for future research and prevention approaches are discussed in this study.

[Challenges in managing diabetes in chronic hemodialysis]. / Défis dans la prise en charge du diabète en hémodialyse chronique.

Hemodialysis (HD) centers are facing an increasing number of patients with diabetes. These cases require an intensive multidisciplinary approach of the consequences of renal failure, glycemic control and nutrition and the management of frequent co-morbidities, in particular the diabetic foot. A major challenge is to decrease glycemic variability and the risk of hypoglycemia. Because of increased risk of hypoglycemia-associated mortality, the HbA1C target is loosened in the majority of HD patients. Continuous glucose monitoring technology has identified important glycemic fluctuations during and after dialysis. However, their reliability in HD needs to be improved. New therapeutic pathways that decrease glucose excursions and hypoglycemia, such as GLP1 receptor agonists and sensor-coupled insulin pumps, have yet to be validated in HD.

Les centres d'hémodialyse (HD) sont confrontés à un nombre croissant de patients diabétiques. Leur prise en charge multidisciplinaire tient compte de l'insuffisance rénale, du contrôle glycémique, de la nutrition et des comorbidités fréquentes, en particulier le pied diabétique. La réduction de la variabilité glycémique et des hypoglycémies qui sont associées à une mortalité accrue reste un défi. La cible de l'HbA1C est assouplie chez la majorité des patients. L'usage du contrôle en continu de la glycémie permet d'identifier les fluctuations glycémiques per et interdialytiques importantes. Sa fiabilité doit cependant être améliorée en HD. Les nouvelles voies thérapeutiques qui diminuent les excursions glycémiques et le risque d'hypoglycémie comme les GLP1 agonistes et les pompes à insuline couplées aux sensors restent à valider en HD.

Why and how to include parents in the treatment of adolescents presenting Internet gaming disorder?

BACKGROUND AND AIMS: Clinicians and researchers are increasingly interested in investigating excessive use of video gaming recently named Internet gaming disorder (IGD). As is the case with extensively researched adolescent problem behaviors such as substance use disorder, several studies associate IGD with the young person's family environment and the parent-adolescent relationship in particular. Evidence-based treatments for a range of adolescent clinical problems including behavioral addictions demonstrate efficacy, the capacity for transdiagnostic adaptation, and lasting impact. However, less attention has been paid to developing and testing science-based interventions for IGD, and at present most tested interventions for IGD have been individual treatments (cognitive behavioral therapy). METHODS: This article presents the rationale for a systemic conceptualization of IGD and a therapeutic approach that targets multiple units or subsystems. The IGD treatment program is based on the science-supported multidimensional family therapy approach (MDFT). Following treatment development work, the MDFT approach has been adapted for IGD. RESULTS: The article discusses recurring individual and family-based clinical themes and therapeutic responses in the MDFT-IGD clinical model, which tailors interventions for individuals and subsystems within the young person's family. DISCUSSION AND CONCLUSIONS: Basic science developmental research can inform conceptualization of IGD and a systemic logic model of intervention and change. This paper aims to expand treatment theorizing and intervention approaches for practitioners working with frequently life-altering behaviors of excessive Internet gaming. We operationalize this aim by addressing the question of why and how parents should be involved in youth IGD treatment.

Changing trends in end-stage renal disease patients with diabetes.

BACKGROUND: Worldwide, diabetes has become the most common cause of end-stage renal disease (ESRD), yet Swiss data are largely lacking. METHODS: This observational study examined ESRD patients with diabetes mellitus (ESRD-DM) at end of 2009 and 2014. The prevalence and characteristics of ESRD-DM patients were collected in all dialysis facilities in the Canton of Vaud of Switzerland in 2009 and in 2014, and the 5-year mortality rate was assessed. RESULTS: A total of 107 and 140 ESRD-DM patients underwent dialysis at end of 2009 and 2014, respectively. Within the 5-year period a total of 167 incidental ESRD-DM patients required dialysis, corresponding to an estimated incidental rate of 0.84/1000 person-years in the diabetic population. In 2009, all patients with ESRD-DM underwent haemodialysis, decreasing to 96.2% in 2014, with 3.8% on peritoneal dialysis. Age, sex, body mass index, type of diabetes, duration of diabetes, cause of ESRD, dialysis duration, dialysis frequency, vascular access, and glycosylated haemoglobin levels did not differ between 2009 and 2014. In 2014, macrovascular comorbidity was reported more often than in 2009, but not amputations. Haemoglobin level decreased significantly from 117.9 g/l to 112.3 g/l. Calcium-containing phosphate binder and angiotensin-converting enzyme inhibitor use significantly decreased, whereas iron therapy significantly increased with time. The 5-year mortality rate was 61.7%. Five-year survivors were significantly younger and had a higher body mass index. CONCLUSIONS: The growing prevalence of ESRD-DM emphasises that prevention of chronic kidney disease and its progression should be a public health priority in Switzerland.

[Extra-renal manifestations of the autosomal dominant polycystic kidney disease]. / Atteintes extrarénales de la polykystose rénale: signes cliniques,dépistage et prise en charge.

Extra-renal complications of autosomal dominant polycystic kidney disease (ADPKD) are often unrecognized. Liver cysts are usually benign, but may cause chronic pain, may interfere with nutrition and may necessitate partial liver resection or even liver transplant. Somatostatin analogs may be an alternative therapy. Cerebral aneurisms are rare, but devastating. They must be investigated in case of positive familial history. Cardiac valvulopathies will be searched for by echocardiography. Abdominal wall herniae are often identified during the physical exam in ADPKD patients. ADPKD patients may present with higher incidence of diverticulitis. Cysts of the seminal vesicle are frequent but are usually asymptomatic. Recognizing extra-renal complications helps improving the overall survival of ADPKD patients.

Cet article porte sur les atteintes extrarénales de la maladie polykystique autosomique dominante et leur prise en charge. Les kystes hépatiques sont souvent bénins, mais peuvent devenir invalidants, mener à une dénutrition et nécessiter des mesures chirurgicales allant jusqu'à la transplantation hépatique. Les analogues de la somatostatine sont une alternative thérapeutique. Les anévrismes cérébraux, plus rares, nécessitent un dépistage systématique par l'anamnèse familiale. Les valvulopathies cardiaques seront recherchées par échographie. Les hernies de la paroi abdominale sont souvent associées à la polykystose. Les patients atteints de polykystose peuvent présenter une incidence accrue de diverticulite. Les kystes des vésicules séminales sont fréquents, mais en général asymptomatiques.

Relationships between parental attitudes, family functioning and Internet gaming disorder in adolescents attending school.

While recent data suggest a high prevalence of adolescent with Internet gaming disorder, little is known about interpersonal factors that contributes or protect to this disorder. Thus, the aim of this study was to examine the relationships between parental attitudes, adolescent perception of family functioning and Internet gaming disorder (IGD) and explore gender differences. From a sample of 434 adolescents attending school (n =434; age 13.2 years), 383 non-problematic gamers (NPG, 196 males; 187 females) were compared with 37 problematic gamers (PG, 29 males; 8 females). Family functioning was assessed with the Family Relationship Index and parental attitudes with a questionnaire measuring rules, access to video games, monitoring and banning of video games. NPG have a better family cohesion while PG have more family conflict and a poorer family relationship. While rules about gaming use are important in males, for females, banning is associated with IGD. For both sex, parental monitoring, conflicts and family relationship are associated with IGD. These findings highlight the strong influence of parental attitudes and family functioning on the occurrence of IGD in adolescents and their gender specificities. Thus, prevention programs need to take into account the importance of parents, parenting and gender specificities.

Is alexithymia related to cannabis use disorder? Results from a case-control study in outpatient adolescent cannabis abusers.

OBJECTIVE: In recent decades, alexithymia has been considered a risk factor for multiple somatic and psychiatric conditions. Yet, whereas alexithymia has been extensively studied in adults with a substance misuse, only one study has reported data on cannabis abusers from the general population. Hence, our main objective was to explore alexithymia in a clinical sample of treatment-seeking young outpatients with a DSM-IV cannabis dependence or abuse diagnosis compared to controls. METHODS: 120 young patients (95 males - mean age 17.9years (SD=2.8; 14 to 25)) with a cannabis dependence or abuse (DSM-IV-TR criteria evaluated with the MINI), seeking treatment in an addiction unit, and 110 healthy control subjects (77 males - mean age 18.2years (SD=3.4; 14 to 25)) participated in the study. They completed a battery of self-reports measuring alexithymia (TAS-20; BVAQ-B), depression (BDI-13) and state and trait anxiety (STAI). RESULTS: 35.3% of cannabis users were alexithymic, and logistic regression analysis showed that the alexithymic components of difficulties identifying and describing feelings combined with trait anxiety predicted group membership. CONCLUSION: This first study on young cannabis abusers and dependent subjects further emphasizes the importance of considering the affective style, and particularly the anxious temperament and alexithymia features, as factors associated with substance misuse during late adolescence.

Prevalence and Diagnostic Approach to Sleep Apnea in Hemodialysis Patients: A Population Study.

BACKGROUND: Previous observations found a high prevalence of obstructive sleep apnea (OSA) in the hemodialysis population, but the best diagnostic approach remains undefined. We assessed OSA prevalence and performance of available screening tools to propose a specific diagnostic algorithm. METHODS: 104 patients from 6 Swiss hemodialysis centers underwent polygraphy and completed 3 OSA screening scores: STOP-BANG, Berlin's Questionnaire, and Adjusted Neck Circumference. The OSA predictors were identified on a derivation population and used to develop the diagnostic algorithm, which was validated on an independent population. RESULTS: We found 56% OSA prevalence (AHI ≥ 15/h), which was largely underdiagnosed. Screening scores showed poor performance for OSA screening (ROC areas 0.538 [SE 0.093] to 0.655 [SE 0.083]). Age, neck circumference, and time on renal replacement therapy were the best predictors of OSA and were used to develop a screening algorithm, with higher discriminatory performance than classical screening tools (ROC area 0.831 [0.066]). CONCLUSIONS: Our study confirms the high OSA prevalence and highlights the low diagnosis rate of this treatable cardiovascular risk factor in the hemodialysis population. Considering the poor performance of OSA screening tools, we propose and validate a specific algorithm to identify hemodialysis patients at risk for OSA for whom further sleep investigations should be considered.

Effects of Sucroferric Oxyhydroxide Compared to Lanthanum Carbonate and Sevelamer Carbonate on Phosphate Homeostasis and Vascular Calcifications in a Rat Model of Chronic Kidney Failure.

Elevated serum phosphorus, calcium, and fibroblast growth factor 23 (FGF23) levels are associated with cardiovascular disease in chronic renal disease. This study evaluated the effects of sucroferric oxyhydroxide (PA21), a new iron-based phosphate binder, versus lanthanum carbonate (La) and sevelamer carbonate (Se), on serum FGF23, phosphorus, calcium, and intact parathyroid hormone (iPTH) concentrations, and the development of vascular calcification in adenine-induced chronic renal failure (CRF) rats. After induction of CRF, renal function was significantly impaired in all groups: uremic rats developed severe hyperphosphatemia, and serum iPTH increased significantly. All uremic rats (except controls) then received phosphate binders for 4 weeks. Hyperphosphatemia and increased serum iPTH were controlled to a similar extent in all phosphate binder-treatment groups. Only sucroferric oxyhydroxide was associated with significantly decreased FGF23. Vascular calcifications of the thoracic aorta were decreased by all three phosphate binders. Calcifications were better prevented at the superior part of the thoracic and abdominal aorta in the PA21 treated rats. In adenine-induced CRF rats, sucroferric oxyhydroxide was as effective as La and Se in controlling hyperphosphatemia, secondary hyperparathyroidism, and vascular calcifications. The role of FGF23 in calcification remains to be confirmed.

Vitamin D: a review on its effects on muscle strength, the risk of fall, and frailty.

Vitamin D is the main hormone of bone metabolism. However, the ubiquitary nature of vitamin D receptor (VDR) suggests potential for widespread effects, which has led to new research exploring the effects of vitamin D on a variety of tissues, especially in the skeletal muscle. In vitro studies have shown that the active form of vitamin D, calcitriol, acts in myocytes through genomic effects involving VDR activation in the cell nucleus to drive cellular differentiation and proliferation. A putative transmembrane receptor may be responsible for nongenomic effects leading to rapid influx of calcium within muscle cells. Hypovitaminosis D is consistently associated with decrease in muscle function and performance and increase in disability. On the contrary, vitamin D supplementation has been shown to improve muscle strength and gait in different settings, especially in elderly patients. Despite some controversies in the interpretation of meta-analysis, a reduced risk of falls has been attributed to vitamin D supplementation due to direct effects on muscle cells. Finally, a low vitamin D status is consistently associated with the frail phenotype. This is why many authorities recommend vitamin D supplementation in the frail patient.