FibroScan used in street-based outreach for drug users is useful for hepatitis C virus screening and management: a prospective study.

Although hepatitis C virus (HCV) infection prevalence is high among drug users, they do not commonly receive regular care in academic centres. The aim of this prospective study was to assess the influence of FibroScan use on HCV screening and management in street-based outreach. From January 2006 to January 2007, all consecutive drug users were offered noninvasive evaluation of liver fibrosis with FibroScan. After FibroScan, parameters were recorded with a structured, face-to-face questionnaire by outreach workers. All 298 subjects accepted FibroScan evaluation drug use was--ever injected heroin (69%), ever snorted or injected cocaine (89%), current chronic alcohol abuse (44%). The median FibroScan score was 5.3 kPa. Before blood sampling, 34% of subjects reported HCV positivity. HCV positivity was found in 83 cases. All these subjects had positive HCV-RNA. Forty-five subjects agreed to meet a hepatologist. By multivariate analysis, never snorted cocaine, consumed alcohol < 21 drinks per week, duration of injected heroin > 7 years, and FibroScan > 7.1 kPa were significantly associated with HCV positivity. Thus in a street-based outreach service for drug users, the acceptance of FibroScan is excellent. FibroScan with a hospital-based physician may facilitate screening and management of drug users for HCV infection.

[How should research protocols be implemented in the field?]. / Comment mettre en oeuvre des protocoles de recherche sur le terrain?

The hepatitis issue is a major public health concern, especially the widespread expansion of HCV infection among drug users. Prevention is focused on the prevention of risky behaviors (injection, needle and material sharing). Research is needed to improve our comprehension of the relatively low efficiency of actions taken in this field. We need better knowledge of the users' present practices, patterns of use and contexts of consumption but also about their own knowledge or beliefs about this infection. These qualitative studies should be conducted with a direct contact with users in the field: streets, drug scenes, low threshold structures, addiction therapy centres, physicians networks... These are not easy fields for study because of different reasons linked with the structures per se but also with the particular public involved. Some specific difficulties are presented as well as some means of coping with them. Experience has shown that it is possible to handle these issues and to conduct such studies.

Hypnotic overdoses and fairy tales: Snow White and the uses of disenchantment.

In most Western countries, more than two-thirds of attempted suicides are among women suffering from drug overdoses. Explanations for women's use of less violent methods include the wish to avoid disfiguration, the influence of upbringing, and sex differences in cultural expectations. Many women under stress have a weaker intention to die, and their suicidal act is generally less a deliberate search for death than a desire to live another life, indicating a need to escape from a difficult situation. In this respect, the suicidal woman's desire to sleep through an overdose coma is very significant. We call to mind the strength of the kinship between death and sleep. Reinterpreting the fairy tale "Snow White" and making a parallel with some contemporary clinical cases, we show that the illusion of a nondefinitive death is often assimilated, in Western culture, with a step toward rebirth.