Gambling disorder-related illegal acts: Regression model of associated factors

Gambling disorder-related illegal acts (GDRIA) are often crucial events for gamblers and/or their entourage. This study was designed to determine the predictive factors of GDRIA. Methods Participants were 372 gamblers reporting at least three DSM-IV-TR (American Psychiatric Association, 2000) criteria. They were assessed on the basis of sociodemographic characteristics, gambling-related characteristics, their personality profile, and psychiatric comorbidities. A multiple logistic regression was performed to identify the relevant predictors of GDRIA and their relative contribution to the prediction of the presence of GDRIA. Results Multivariate analysis revealed a higher South Oaks Gambling Scale score, comorbid addictive disorders, and a lower level of income as GDRIA predictors. Discussion and conclusion An original finding of this study was that the comorbid addictive disorder effect might be mediated by a disinhibiting effect of stimulant substances on GDRIA. Further studies are necessary to replicate these results, especially in a longitudinal design, and to explore specific therapeutic interventions

Both active and sham low-frequency rTMS single sessions over the right DLPFC decrease cue-induced cravings among pathological gamblers seeking treatment: A randomized, double-blind, sham-controlled crossover trial

Background: Craving is a core symptom of addictive disorders, such as pathological gambling for example. Over the last decade, several studies have assessed the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the addiction field, which triggers the dorsolateral prefrontal cortex (DLPFC) to decrease craving. The STIMJEU study investigated whether a single session of low-frequency (LF, i.e., 1 Hz) rTMS applied to the right DLPFC reduced cueinduced gambling craving in a sample of treatment-seeking pathological gamblers. Methods: Thirty patients received both active and sham rTMS in random order and were blinded to the condition in a within-subject crossover design. Outcome measures included self-reported gambling craving (Visual Analog Scale and Gambling Craving Scale) and physiological measures (heart rate and blood pressure). Results: The rTMS sessions were associated with a significant decrease in the gambling urge, regardless of whether the session was active or sham. When controlling cue-induced craving levels, no effects were observed on craving for active rTMS. Overall, rTMS was well-tolerated, and the credibility of the sham procedure was assessed and appeared to be appropriate. Conclusions: We failed to demonstrate the specific efficacy of one session of LF rTMS to decrease cue-induced craving in pathological gamblers. A strong placebo-effect and rTMS parameters may partly explain these results. Yet, we are convinced that rTMS remains a promising therapeutic method. Further studies are required to examine its potential effect

Cognitive distortions and ADHD in pathological gambling: A national longitudinal case-control cohort study

Introduction The primary outcome of our study was to assess the links between the level of cognitive distortions and the severity of gambling disorder. We also aimed at assessing the links between patient gambling trajectories and attention deficit and hyperactivity disorder (ADHD). Materials and methods The study population (n = 628) was comprised of problem and non-problem gamblers of both sexes between 18 and 65 years of age, who reported gambling on at least one occasion during the previous year. Data encompassed socio-demographic characteristics, gambling habits, the South Oaks Gambling Screen, the Gambling Attitudes and Beliefs Survey – 23, the Wender Utah Rating Scale – Child, and the Adult ADHD Self-report Scale. Results The cognitive distortions with the greatest correlation to the severity of gambling disorder were the “Chasing” and “Emotions.” These two dimensions were able to distinguish between problem gamblers seeking treatment or not. While age of onset of gambling and length of gambling practice were not associated with the level of distorted cognitions, a period of abstinence of at least 1 month was associated with a lower level of distorted cognitions. The presence of ADHD resulted in a higher level of distorted cognitions. Conclusion Cognitive work is essential to the prevention, and the treatment, of pathological gambling, especially with respect to emotional biases and chasing behavior. The instauration of an abstinence period of at least 1 month under medical supervision could be a promising therapeutic lead for reducing gambling-related erroneous thoughts and for improving care strategies of pathological gamblers

Response shift detection in patient-reported outcomes : methods for identification and assessment of response shift at item-level in longitudinal studies

En santé, le besoin de quantifier des phénomènes subjectifs a émergé au cours du dernier siècle avec par exemple, l'évaluation de la qualité de vie (QdV), de la fatigue ou de l'anxiété. L'intérêt croissant face à ces mesures de santé perçue appelées "Patient-Reported Outcomes" (PRO) apparaît notamment dans les maladies chroniques. Afin de pouvoir analyser l'évolution de la QdV des patients ou d'autres types de PRO au fil du temps, des données longitudinales sont collectées.Ces données issues de PRO sont difficiles à appréhender car les patients peuvent percevoir et interpréter différemment les questions qui leur sont posées au cours du temps selon l’évolution de leur maladie, en termes de signification, priorités et retentissement sur leur vie personnelle. Ce phénomène, appelé « response shift » (RS), est souvent lié à la façon dont les patients s’adaptent à leur maladie. En présence de RS, les évolutions observées des patients peuvent ne pas refléter correctement les véritables changements ressentis par ceux-ci. L’objectif de ce travail porte sur le développement et l’évaluation de deux approches l’une, basée sur les modèles à équations structurelles (SEM) et l’autre, sur la théorie de réponse à l’item (IRT), avec l’originalité de travailler au niveau de l’item. Ces méthodes permettent la détection et l'estimation du RS ainsi que sa prise en compte lors d’analyses.Les performances des approches ont été évaluées en les appliquant sur des données réelles mais également au moyen d'études de simulations. Les résultats obtenus grâce aux simulations permettent de mieux identifier quelle approche méthodologique adopter selon les contextes. Les avantages et inconvénients de l'utilisation de chacune des méthodes, sont soulignés et des recommandations ont été proposées.During the last century, many studies in health attempt to measure important characteristics, such as Health Related Quality of Life (QoL) using Patient-reported outcomes (PRO). QoL and other perceived health measures (pain, fatigue, etc.) are increasingly used in chronic diseases. In order to analyse the evolution of patients’ QoL or other types of PRO over time, longitudinal data are collected.These PRO data are difficult to interpret due to the patients’ changing in the standards, values, or conceptualization of what the PRO is intended to measure (eg: QoL). This phenomenon is referred to as “response shift” (RS) and is often linked to the way the patients might adapt or cope with their disease experience. As a consequence of RS, observed patient’s evolutions may thus not properly reflect true perceived health changes.The objective of this work is to develop and assess two approaches at item level, one, based on structural equation modelling (SEM) and other, on item response theory (IRT). These statistical approaches are currently used for RS analysis on PRO data. Both the identification of RS occurrence and its appropriate adjustment in the analyses of longitudinal PRO data are studied.The performance of IRT and SEM were assessed by applying them on real data and through simulations studies. The results obtained in the simulation allow choosing which methodological approach should be applied according to the context.The pros and cons of using one method or another as well as the potential of using both of them as complementary analyses providing different insights into the field of response shift are be underlined

Impact of new oral disease-modifying therapies on the prescription of injectable and off-label drugs in multiple sclerosis in France over 2011-2015 using national administrative databases

International audienc

Use of healthcare services by patients with multiple sclerosis in France over 2010-2015: a nationwide population-based study using health administrative data

International audienceBackgroundMost of the knowledge about people with multiple sclerosis (PwMS) in France comes from cohorts, which may suffer from recruitment bias or from the unique registry located in Lorraine, East France.ObjectiveTo describe use of care in the French population of PwMS, over 2010–2015.MethodsAll PwMS in the French national health data system (97% of the general population covered) were included. Demographics, and use of care were described (visits with general practitioners (GPs), neurologists, nurses, physiotherapists and hospitalisations). A focus on the neurological follow-up was also conducted.ResultsA total of 112,415 PwMS were identified (sex ratio F:M = 2.4, median age 46), of whom 5005 died during follow-up. The median numbers of visits with GPs and neurologists were 6.6 and 1.3 respectively per patient-year. Moreover, 53,457 (47.6%) received multiple sclerosis (MS) treatments; about 13% of patients had no neurological follow-up, and 81.8% had at least one hospitalisation.ConclusionsFor the first time in France, this exhaustive dataset offered the opportunity to provide objective figures regarding care practices for MS at the national level, without any selection bias. It also allowed description of patients with MS according to their neurological follow-up, especially those who were absent from cohorts led by neurologists

Prevalence of mental disorders is higher in patients with multiple sclerosis than in the general population or in patients with rheumatoid arthritis in France

International audienceBackground: Mental disorders (MDs) in multiple sclerosis (MS) patients decreases treatment adherence and quality of life, and increases the risk of disability progression and care consumption.Objective: This study was to assess the prevalence of MDs in MS patients compared with healthy controls (HC) of the French general population and rheumatoid arthritis (RA) patients.Methods: The 2015 prevalence of MDs for MS patients, RA patients and general population was estimated using a random population-based data sample from ‘National Inter-Scheme Information System on Health Insurance’ in the 2011–2015 period. Two control groups (1:5 ratio for the HC and 1:1 for the RA group) were matched to the MS group for year of birth, gender, area of residence and health insurance scheme.Results: A total of 1145 MS patients were identified (sex ratio of 2.5 (F/M); median age 50 years). The prevalence of MDs was higher in the population of patients with MS (37.3%) than in the French general population (13.6%), and to a lesser extent in the RA group (21.1%) leading to the prevalence ratios of 2.8 (95% confidence intervals (CIs) 2.5–3.0) and 1.9 (95% CI 1.7–2.3), respectively.Conclusions:This study confirmed that MS patients are at a higher risk of MDs than the French general population or RA patients

Descriptif des caractéristiques des personnes ayant une sclérose en plaques en France et de leur recours aux soins à partir du Système National des Données de Santé en 2010-2015

International audienceIntroductionL’accès aux données de l’Assurance Maladie permet de décrire les caractéristiques démographiques et de recours aux soins des personnes ayant une sclérose en plaques (SEP) en France de façon quasi-exhaustive.ObjectifsDécrire la population des patients ayant une SEP en France sur 2010–2015, en particulier leur prise en charge et l’utilisation des traitements de fond.Patients et MéthodesÀ partir du Système National des Données de Santé (SNDS-97 % de la population générale française couverte), la population des personnes ayant une SEP en France entre 2010 et 2015 a été identifiée grâce à un algorithme utilisant le statut d’affection longue durée SEP, les traitements spécifiques à la SEP et les séjours hospitaliers pour la SEP. Au total, 112745 patients ont été identifiés. Les caractéristiques démographiques et de prise en charge, incluant les séquences thérapeutiques, sont présentées.RésultatsLe sex-ratio F :H était de 2,4 et l’âge médian en 2010 de 46 ans. Les nombres médians de consultations avec un médecin généraliste et un neurologue étaient respectivement de 6,2 et 1,3 par personne par an. Le suivi neurologique était exclusivement hospitalier pour 32,0 %, libéral pour 17,5 %, mixte pour 37,6 % et inexistant pour 12,9 %. Un tiers des patients ont été vus au moins une fois dans un centre expert. Au total, 47,4 % des patients ont reçu au moins un traitement de fond (injectable 38,2 %, oral 20,4 %, perfusion 7,3 %).DiscussionL’accès à ces données permet de caractériser finement la prise en charge de la SEP en France, en complément du recueil basé uniquement dans les centres experts SEP, et offre ainsi l’opportunité d’accéder à la population des patients n’ayant pas de suivi neurologique ou bénéficiant d’un suivi hors centre expert.ConclusionCette étude est la première à fournir des données quantifiées sur la population exhaustive des personnes ayant une SEP en France, sur leur niveau de recours aux soins et sur l’utilisation des traitements de fond

The Guttman errors as a tool for response shift detection at subgroup and item levels

International audiencePURPOSE:Statistical methods for identifying response shift (RS) at the individual level could be of great practical value in interpreting change in PRO data. Guttman errors (GE) may help to identify discrepancies in respondent's answers to items compared to an expected response pattern and to identify subgroups of patients that are more likely to present response shift. This study explores the benefits of using a GE-based method for RS detection at the subgroup and item levels.METHODS:The analysis was performed on the SatisQoL study. The number of GE was determined for each individual at each time of measurement (at baseline T0 and 6 months after discharge M6). Individuals showing discrepancies (with many GE) were suspected to interpret the items differently from the majority of the sample. Patients having a large number of GE at M6 only and not at T0 were assumed to present RS. Patients having a small number of GE at T0 and M6 were assumed to present no RS. The RespOnse Shift ALgorithm in Item response theory (ROSALI) was then applied on the whole sample and on both groups.RESULTS:Different types of RS (non-uniform recalibration, reprioritization) were more prevalent in the group composed of patients assumed to present RS based on GE. On the opposite, no RS was detected on patients having few GE.CONCLUSIONS:Guttman errors and item response theory models seem to be relevant tools to discriminate individuals affected by RS from the others at the item level

Comparison of SEM, IRT and RMT-based methods for response shift detection at item level: a simulation study

International audienceWhen assessing change in patient-reported outcomes, the meaning in patients' self-evaluations of the target construct is likely to change over time. Therefore, methods evaluating longitudinal measurement non-invariance or response shift (RS) at item-level were proposed, based on structural equation modelling (SEM) or on item response theory (IRT). Methods coming from Rasch Measurement Theory (RMT) could also be valuable. The lack of evaluation of these approaches prevents determining the best strategy to adopt. A simulation study was performed to compare and evaluate the performance of SEM, IRT and RMT approaches for item-level RS detection.Performances of these three methods in different situations were evaluated with the rate of false detection of RS (when RS was not simulated) and the rate of correct RS detection (when RS was simulated).The RMT-based method performs better than the SEM and IRT-based methods when recalibration was simulated. Consequently, the RMT-based approach should be preferred for studies investigating only recalibration RS at item-level. For SEM and IRT, the low rates of reprioritization detection raise issues on the potential different meaning and interpretation of reprioritization at item-level