Postdetoxification Factors Predicting Alcohol-Related Emergency Room Visits 12 to 24 Months After Discharge: Results from a Prospective Study of Patients with Alcohol Dependence

International audienceBACKGROUND: Relapse is common in patients with alcohol dependence, even after detoxification. The aims of this prospective study were to investigate changes affecting patients during the first 6 months after discharge from hospitalization for detoxification and to determine the influence of these changes on the likelihood of alcohol-related emergency room (ER) visits in the following 18-month period. METHODS: The study included 88 patients hospitalized for participation in a detoxification program in the addiction department of a university hospital in Rennes, France. Alcohol consumption, psychiatric symptoms, and life events were investigated by addiction specialists during hospitalization and 6 months afterward. For each patient, the number of alcohol-related ER visits in the last 6 months was prospectively recorded at the hospital 12, 18, and 24 months after hospitalization. The rate ratios of ER visits as a function of sociodemographic variables and changes observed 6 months after discharge were estimated using Poisson regression with autoregressive errors. RESULTS: Nearly half of the patients (47.7%) had ER visits in the 12- to 24-month period following discharge. The likelihood of ER visits was higher for patients living with friends/parents and for those with aggravated psychiatric symptoms, negative changes in their family life, and who had a medical follow-up in the 6 months after discharge. In contrast, the likelihood of ER visits was lower for patients living with children and those with improved psychiatric morbidity. Alcohol consumption and psychiatric symptoms at baseline had no significant effect. CONCLUSIONS: Monitoring changes in psychiatric symptoms and family life early after a detoxification program may help identify patients who are vulnerable to relapse in the subsequent 18-month period. Systematic screening for these changes as early as possible, in combination with appropriate treatment and the establishment of a social support system, could be fundamental in avoiding further relapses and ER visits

Preferential binding of a G-quadruplex ligand to human chromosome ends

The G-overhangs of telomeres are thought to adopt particular conformations, such as T-loops or G-quadruplexes. It has been suggested that G-quadruplex structures could be stabilized by specific ligands in a new approach to cancer treatment consisting in inhibition of telomerase, an enzyme involved in telomere maintenance and cell immortality. Although the formation of G-quadruplexes was demonstrated in vitro many years ago, it has not been definitively demonstrated in living human cells. We therefore investigated the chromosomal binding of a tritiated G-quadruplex ligand, (3)H-360A (2,6-N,N′-methyl-quinolinio-3-yl)-pyridine dicarboxamide [methyl-(3)H]. We verified the in vitro selectivity of (3)H-360A for G-quadruplex structures by equilibrium dialysis. We then showed by binding experiments with human genomic DNA that (3)H-360A has a very potent selectivity toward G-quadruplex structures of the telomeric 3′-overhang. Finally, we performed autoradiography of metaphase spreads from cells cultured with (3)H-360A. We found that (3)H-360A was preferentially bound to chromosome terminal regions of both human normal (peripheral blood lymphocytes) and tumor cells (T98G and CEM1301). In conclusion, our results provide evidence that a specific G-quadruplex ligand interacts with the terminal ends of human chromosomes. They support the hypothesis that G-quadruplex ligands induce and/or stabilize G-quadruplex structures at telomeres of human cells

Overexpression of Bcl-2 is associated with apoptotic resistance to the G-quadruplex ligand 12459 but is not sufficient to confer resistance to long-term senescence

The triazine derivative 12459 is a potent G-quadruplex interacting agent that inhibits telomerase activity. This agent induces time- and dose-dependent telomere shortening, senescence-like growth arrest and apoptosis in the human A549 tumour cell line. We show here that 12459 induces a delayed apoptosis that activates the mitochondrial pathway. A549 cell lines selected for resistance to 12459 and previously characterized for an altered hTERT expression also showed Bcl-2 overexpression. Transfection of Bcl-2 into A549 cells induced a resistance to the short-term apoptotic effect triggered by 12459, suggesting that Bcl-2 is an important determinant for the activity of 12459. In sharp contrast, the Bcl-2 overexpression was not sufficient to confer resistance to the senescence-like growth arrest induced by prolonged treatment with 12459. We also show that 12459 provokes a rapid degradation of the telomeric G-overhang in conditions that paralleled the apoptosis induction. In contrast, the G-overhang degradation was not observed when apoptosis was induced by camptothecin. Bcl-2 overexpression did not modify the G-overhang degradation, suggesting that this event is an early process uncoupled from the final apoptotic pathway

Santé publique et économie de la santé : ébauche d'un bilan

Public health and the economics of health : a rough evaluation. Public health and the economics of health have a common purpose : the optimization of health options. Various professional origins have permitted the protagonists to clain their specificity in a changing field. Anyhow, other lines of différenciation exist ; they are related to strategic choices (the positioning of both actors and administrators of medical care) or theoretical ones.Santé publique et économie de la santé ont un objet commun : l'optimisation des choix sanitaires. Des origines professionnelles différentes ont pu conduire les protagonistes à revendiquer leur spécificité dans un champ en évolution. Toutefois d'autres lignes de fracture existent, liées à des choix stratégiques (positionnement entre acteurs et gestionnaires du système de soins) ou théoriques différents.Riou Françoise. Santé publique et économie de la santé : ébauche d'un bilan. In: Les Cahiers du LERASS, n°22, 1991. Santé publique : esquisse d'un bilan. pp. 27-34

LA PRISE EN CHARGE DES ACCIDENTS VASCULAIRES CEREBRAUX CONSTITUES AU CHU DE RENNES (ETUDE PROSPECTIVE CONCERNANT LE COURT SEJOUR ET L'ORIENTATION)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Analyse des pratiques du dépistage néonatal en Bretagne

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Opinions et attentes des médecins et internes des höpitaux publics de la région Bretagne à l'égard des recommandations de pratique clinique

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Evaluation des réseaux de santé (état des lieux, enjeux et perspectives ; application au réseau périnatal des Côtes d'Armor)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Stefan Fisch, Stadtplanung im 19 Jahr-hundert. Der Beispiel München bis zur Ara Theodor Fischer

Riou Françoise, Gaudin Jean-Pierre. Stefan Fisch, Stadtplanung im 19 Jahr-hundert. Der Beispiel München bis zur Ara Theodor Fischer. In: Annales. Économies, Sociétés, Civilisations. 45ᵉ année, N. 2, 1990. pp. 470-471

Stefan Fisch, Stadtplanung im 19 Jahr-hundert. Der Beispiel München bis zur Ara Theodor Fischer

Riou Françoise, Gaudin Jean-Pierre. Stefan Fisch, Stadtplanung im 19 Jahr-hundert. Der Beispiel München bis zur Ara Theodor Fischer. In: Annales. Économies, Sociétés, Civilisations. 45ᵉ année, N. 2, 1990. pp. 470-471