Tour d’horizon sur les principales approches de traitement du jeu pathologique chez les adultes et les adolescents

L’industrie des jeux de hasard et d’argent a connu un essor important au cours des dernières années. Parallèlement, les gouvernements ont beaucoup investi dans la recherche et le développement de programmes de traitement afin d’aider les joueurs aux prises avec un problème de jeu. Bien que l’offre de traitement soit diversifiée, on ne dispose pas actuellement de données probantes permettant de statuer sur les meilleures pratiques en matière de traitement du jeu pathologique. Les études évaluatives qui ont été menées auprès de joueurs pathologiques comportent des failles méthodologiques. Néanmoins, certaines approches chez les adultes semblent prometteuses. Par exemple, l’approche cognitivo-béhaviorale et les groupes de soutien de type Gamblers Anonymes (GA) se démarquent en termes de maintien de l’abstinence au jeu. D’autres travaux récents présentent des résultats encourageants obtenus avec l’approche pharmacologique. L’administration de Naltrexone aux joueurs pathologiques permettrait de diminuer l’envie obsessive de jouer. On commence aussi à reconnaître que le modèle transthéorique du changement et l’approche de thérapie conjugale contribuent certainement à améliorer la rétention des joueurs adultes en traitement. Pour les adolescents, l’offre de traitement est moins développée. Les initiatives de programmes d’intervention pour les jeunes présentant un problème de jeu sont encore embryonnaires et empruntent généralement les paradigmes de l’approche cognitivo-béhaviorale. Il sera nécessaire aussi de réfléchir aux critères retenus correspondant à la réussite d’un traitement, que ce soit pour les adultes ou pour les adolescents. L’abstinence complète de tous les jeux de hasard et d’argent n’est peut-être pas le seul indicateur de rétablissement.The gaming industry has expanded considerably over the past years. During this time, governments have invested a lot in research and development for treatment programs to help problem gamblers. Despite the diversity of treatments offered, there are currently no data that enable us to determine the best practises in terms of treatment for pathological gambling. There are methodological flaws in the evaluative studies involving pathological gamblers, so treatment effectiveness cannot be determined. Nevertheless, some approaches used with adults appear promising. Notably, the cognitive behavioural approach and Gamblers Anonymous (GA) support groups stand out in terms of maintaining abstinence from gambling. Other recent research shows encouraging results using the pharmacological approach. It appears that administering Naltrexone to pathological gamblers would help reduce the obsessive desire to gamble. Also gaining recognition is the definite contribution of the transtheoretical model of change and couple-therapy approaches to keeping gamblers in treatment. For adolescents, treatment options are less developed. Intervention program initiatives for youths exhibiting a gambling problem are still at the embryonic stage and borrow paradigms from the cognitive behavioural approach. Thought must be given to determining which criteria correspond to the success of a treatment, whether for adults or adolescents. Complete abstinence from all gambling may not be the only indicator of recovery.La industria de los juegos de azar y de dinero ha tenido un progreso importante en los últimos años. Al mismo tiempo, los gobiernos han invertido mucho en la investigación y el desarrollo de programas de tratamiento destinados a ayudar a los jugadores que se enfrentan con un problema de juego. Si bien la oferta de tratamiento es diversificada, no se dispone en la actualidad de datos convincentes que permitan determinar cuáles son las mejores prácticas en materia de tratamiento del juego patológico. Los estudios de evaluación que se han llevado a cabo con jugadores patológicos presentan fallas metodológicas. Sin embargo, ciertos enfoques parecen ser prometedores entre los adultos. Por ejemplo, en lo que respecta al mantenimiento de la abstinencia del juego, se destacan el método cognitivo-conductista y los grupos de apoyo del tipo Gamblers Anonymes (GA). Otros trabajos recientes presentan resultados alentadores obtenidos con la aplicación del enfoque farmacológico. La administración de Naltrexone a los jugadores patológicos permitiría disminuir el deseo obsesivo de jugar. Se comienza de esta manera a reconocer que el modelo transteórico del cambio y el método de terapia conyugal contribuyen por cierto a mejorar la retención de los jugadores adultos en tratamiento. La oferta de tratamiento está menos desarrollada en el caso de los adolescentes. Las iniciativas de programas de intervención para los jóvenes que presentan un problema de juego son todavía embrionarias y adoptan en general los paradigmas del enfoque cognitivo-conductista. Será necesario también reflexionar sobre los criterios escogidos correspondientes con el éxito de un tratamiento, ya sea para los adultos o para los adolescentes. La abstinencia completa de todos los juegos de azar y de dinero es quizás el único indicador de restablecimiento

Strategic research and innovation agenda on circular economy

CICERONE aims to bring national, regional and local governments together to jointly tackle the circular economy transition needed to reach net-zero carbon emissions and meet the targets set in the Paris Agreement and EU Green Deal. This document represents one of the key outcomes of the project: a Strategic Research & Innovation Agenda (SRIA) for Europe, to support owners and funders of circular economy programmes in aligning priorities and approaching the circular economy transition in a systemic way

Lower-risk gambling limits : linked analyses across eight countries

The Lower Risk Gambling Guidelines project was funded by a grant to the Canadian Centre on Substance Use and Addiction from Mise sur Tois a now defunct, independent, not-for-profit organization that received an annual contribution to conduct safer gambling initiatives from the Quebec crown corporation in charge of conducting and managing gambling in the province of Quebec, Canada. Publisher Copyright: © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.A common public health initiative in many jurisdictions is provision of advice to people to limit gambling to reduce the risk of gambling-related harm. The purpose of this study is to use consistent methodology with existing population-based prevalence surveys of gambling and related harms from different countries to identify quantitative limits for lower risk gambling. Risk curve analyses were conducted with eleven high quality data sets from eight Western countries. Gambling indicators were monthly expenditure, percentage of income spent on gambling, monthly frequency, and number of different types of gambling. Harm indicators included financial, emotional, health, and relationship impacts. Contributing data sets produced limit ranges for each gambling indicator and each harm indicator, which were compared. Gender differences in limit ranges were minor. Modal analysis, an assessment of the mean of the upper and lower range limits, indicated that the risk of harm increases if an individual gambles at these levels or greater: $60 to$120 CAD monthly, five to eight times monthly, spends more than 1 to 3% of gross monthly income or plays three to four different gambling types. This study provides further evidence that lower-risk gambling guidelines can be based upon empirically derived limits.Peer reviewe

Cost-Effectiveness of Magnetic Resonance Imaging with a New Contrast Agent for the Early Diagnosis of Alzheimer's Disease

Background: Used as contrast agents for brain magnetic resonance imaging (MRI), markers for beta-amyloid deposits might allow early diagnosis of Alzheimer’s disease (AD). We evaluated the cost-effectiveness of such a diagnostic test, MRI+CLP (contrastophore-linker-pharmacophore), should it become clinically available. Methodology/Principal Findings: We compared the cost-effectiveness of MRI+CLP to that of standard diagnosis using currently available cognition tests and of standard MRI, and investigated the impact of a hypothetical treatment efficient in early AD. The primary analysis was based on the current French context for 70-year-old patients with Mild Cognitive Impairment (MCI). In alternative ‘‘screen and treat’ ’ scenarios, we analyzed the consequences of systematic screenings of over-60 individuals (either population-wide or restricted to the ApoE4 genotype population). We used a Markov model of AD progression; model parameters, as well as incurred costs and quality-of-life weights in France were taken from the literature. We performed univariate and probabilistic multivariate sensitivity analyses. The base-case preferred strategy was the standard MRI diagnosis strategy. In the primary analysis however, MRI+CLP could become the preferred strategy under a wide array of scenarios involving lower cost and/or higher sensitivity or specificity. By contrast, in the ‘‘screen and treat’’ analyses, the probability of MRI+CLP becoming the preferred strategy remained lower than 5%. Conclusions/Significance: It is thought that anti-beta-amyloid compounds might halt the development of dementia i

A Combined CXCL10, CXCL8 and H-FABP Panel for the Staging of Human African Trypanosomiasis Patients

The actual serological and parasitological tests used for the diagnosis of human African trypanosomiasis (HAT), also known as sleeping sickness, are not sensitive and specific enough. The card agglutination test for trypanosomiasis (CATT) assay, widely used for the diagnosis, is restricted to the gambiense form of the disease, and parasitological detection in the blood and cerebrospinal fluid (CSF) is often very difficult. Another very important problem is the difficulty of staging the disease, a crucial step in the decision of the treatment to be given. While eflornithine is difficult to administer, melarsoprol is highly toxic with incidences of reactive encephalopathy as high as 20%. Staging, which could be diagnosed as early (stage 1) or late (stage 2), relies on the examination of CSF for the presence of parasite and/or white blood cell (WBC) counting. However, the parasite is rarely found in CSF and WBC count is not standardised (cutoff set between 5 and 20 WBC per µL). In the present study, we hypothesized that an early detection of stage 2 patients with one or several proteins in association with clinical evaluation and WBC count would improve staging accuracy and allow more appropriate therapeutic interventions

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Place de la femme médecin en médecine générale : sa représentativité dans les structures universitaires, académiques, ordinales, syndicales et associatives

CONTEXTE : la démographie médicale est en changement. La profession se féminise. Au 1er janvier 2021, 51,5 % des médecins généralistes en exercice sont des femmes. Dans d’autres domaines professionnels en cours de féminisation, les femmes peinent à occuper les postes à responsabilités. Cette difficulté que rencontrent les femmes à occuper des postes à responsabilité est-elle également présente en médecine générale ?OBJECTIF : décrire le sex-ratio homme-femme en 2021 des postes à responsabilités des structures universitaires, académiques, ordinales, syndicales et associatives de médecine générale. Secondairement, description de leur âge, comparaison des résultats avec l’année 2011.MÉTHODE : étude épidémiologique, observationnelle, descriptive. Définition des structures et des postes. Recueil des données par adressage d’un courriel aux structures concernées ou par internet si nécessaire. L’analyse statistique a été réalisée avec le logiciel stata.RÉSULTATS : 550 structures ont été sollicitées. 24 % des données ont été obtenues par courriel et 76 % ont été recueillies sur internet. Le sexe-ratio global tous postes et structures confondus est de 37 % de femmes. Les structures où les femmes sont le plus représentées sont les structures universitaires (43 %) et celles où elles le sont le moins sont les structures associatives (30 %) (p = 0.007). Les femmes sont moins présentes dans les postes à haute responsabilité (présidence, direction) (24 %) que dans les autres postes (39 %) (p < 0.001). Il y a une augmentation significative (p < 0.001) du pourcentage de femmes tous postes et structures confondus entre l’année 2011 (21 %) et l’année 2021 (37 %). Les femmes occupant les postes à responsabilité sont plus jeunes que les hommes : la médiane d’âge chez les femmes est de 40.5 ans et chez les hommes 57 ans.CONCLUSION : les femmes sont minoritaires dans les postes à responsabilité des structures universitaires, académiques, ordinales, syndicales et associatives de médecine générale. Elles sont plus jeunes que leurs homologues masculins. Leur pourcentage s’est accru entre 2011 et 2021