Factors to Improve the Management of Hepatitis C in Drug Users: An Observational Study in an Addiction Centre

Barriers to management of HCV in injection drug users are related to patients, health providers, and facilities. In a primary care drug user's addiction centre we studied access to HCV standard of care before and after using an onsite total care concept provided by a multidisciplinary team and noninvasive liver fibrosis evaluation. A total of 586 patients were seen between 2002 and 2004. The majority, 417 patients, were HCV positive and of these patients 337 were tested positive for HCV RNA. In 2002, patients were sent to the hospital. with the Starting of 2003, patients were offered standard of care HCV management in the center by a team of general practitioners, a consultant hepatologist, psychiatrists, nurses, and a health counsellor. Liver fibrosis was assessed by a non invasive method. In 2002, 6 patients had liver fibrosis assessment at hospital facilities, 4 patients were assessed with liver biopsy and 2 patients with Fibrotest-Actitest. 2 patients were treated for HCV at hospital. In 2003 and 2004, 224 patients were assessed with Fibrotest-Actitest on site. Of these, 85 were treated for HCV. SVR was achieved in 43%. We conclude that the combination of an onsite multidisciplinary team with the use of a noninvasive assessment method led to improved management of HCV infection in drug users' primary care facility

Harmonizing Screening for Gambling Problems in Epidemiological Surveys – Development of the Rapid Screener for Problem Gambling (RSPG)

Background and aims The aim of this study was to test the screening properties of several combinations of items from gambling scales, in order to harmonize screening of gambling problems in epidemiological surveys. The objective was to propose two brief screening tools (three items or less) for a use in interviews and self-administered questionnaires. Methods We tested the screening properties of combinations of items from several gambling scales, in a sample of 425 gamblers (301 non-problem gamblers and 124 disordered gamblers). Items tested included interview-based items (Pathological Gambling section of the DSM-IV, lifetime history of problem gambling, monthly expenses in gambling, and abstinence of 1 month or more) and self-report items (South Oaks Gambling Screen, Gambling Attitudes, and Beliefs Survey). The gold standard used was the diagnosis of a gambling disorder according to the DSM-5. Results Two versions of the Rapid Screener for Problem Gambling (RSPG) were developed: the RSPG-Interview (RSPG-I), being composed of two interview items (increasing bets and loss of control), and the RSPG-Self-Assessment (RSPG-SA), being composed of three self-report items (chasing, guiltiness, and perceived inability to stop). Discussion and conclusions We recommend using the RSPG-SA/I for screening problem gambling in epidemiological surveys, with the version adapted for each purpose (RSPG-I for interview-based surveys and RSPG-SA for self-administered surveys). This first triage of potential problem gamblers must be supplemented by further assessment, as it may overestimate the proportion of problem gamblers. However, a first triage has the great advantage of saving time and energy in large-scale screening for problem gambling

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

Association between a high number of isolated lymph nodes in T1 to T4 N0M0 colorectal cancer and the microsatellite instability phenotype

Hypothèse : Les carcinomes colorectaux de stade I ou II microsatellites instables (MSI) sont caractérisés par plus de ganglions lymphatiques isolés sur la pièce de résection par rapport à leurs homologues microsatellites stables (MSS). Conception : Étude prospective. Patients : Le statut MSI a été déterminé de façon prospective chez 135 patients opérables, par l’utilisation d’une PCR pentaplex. Puis, les défauts de réparation des mésappariements de l’ADN ont été étudiés par immunohistochimie. Résultats : Parmi les 82 cancers colorectaux de stade I ou II, 11 étaient MSI et 71 MSS, avec une moyenne (écart-type) de 23,6 (3,1) et 13,7 (1,0) ganglions négatifs, respectivement (p = .001). Le nombre moyen de ganglions pour tous les cancers colorectaux de stade I ou II analysés dans notre hôpital était de 15. La prévalence des MSI dans les tumeurs avec plus de 15 ganglions prélevés était de 25 % (9 sur 36) et 82 % (9 sur 11) des tumeurs MSI appartenaient à ce groupe. Conclusions : Un nombre élevé de ganglions isolés en cas de cancer colorectal de stade I ou II est associé au phénotype MSI. Le bon pronostic qui est habituellement associé à des tumeurs ayant un nombre élevé de ganglions N0 pourrait refléter la prévalence élevée des MSI chez ces tumeurs. Le nombre de ganglions examinés comme un critère de qualité doit être utilisé avec prudence. Limiter le phénotypage MSI aux tumeurs colorectales de stade I ou II ayant plus que le nombre moyen de ganglions identifie presque toutes les tumeurs MSI.Hypothèse : Les carcinomes colorectaux de stade I ou II microsatellites instables (MSI) sont caractérisés par plus de ganglions lymphatiques isolés sur la pièce de résection par rapport à leurs homologues microsatellites stables (MSS). Conception : Étude prospective. Patients : Le statut MSI a été déterminé de façon prospective chez 135 patients opérables, par l’utilisation d’une PCR pentaplex. Puis, les défauts de réparation des mésappariements de l’ADN ont été étudiés par immunohistochimie. Résultats : Parmi les 82 cancers colorectaux de stade I ou II, 11 étaient MSI et 71 MSS, avec une moyenne (écart-type) de 23,6 (3,1) et 13,7 (1,0) ganglions négatifs, respectivement (p = .001). Le nombre moyen de ganglions pour tous les cancers colorectaux de stade I ou II analysés dans notre hôpital était de 15. La prévalence des MSI dans les tumeurs avec plus de 15 ganglions prélevés était de 25 % (9 sur 36) et 82 % (9 sur 11) des tumeurs MSI appartenaient à ce groupe. Conclusions : Un nombre élevé de ganglions isolés en cas de cancer colorectal de stade I ou II est associé au phénotype MSI. Le bon pronostic qui est habituellement associé à des tumeurs ayant un nombre élevé de ganglions N0 pourrait refléter la prévalence élevée des MSI chez ces tumeurs. Le nombre de ganglions examinés comme un critère de qualité doit être utilisé avec prudence. Limiter le phénotypage MSI aux tumeurs colorectales de stade I ou II ayant plus que le nombre moyen de ganglions identifie presque toutes les tumeurs MSI

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

L’ordalie : Au risque du hasard

Les conduites ordaliques ne sont que l’un des multiples angles sous lesquels peut être abordée la relation du sujet au risque. Elles permettent cependant d’éclairer certaines formes de conduites de risque, comme d’ailleurs un aspect de l’addiction aux drogues, mais aussi aux jeux de hasard et d’argent. Le recours à des épreuves ordaliques pourrait être considéré, à l’intérieur d’un processus addictif, comme une tentative pour le sujet, à travers un vécu de mort et de renaissance, de se refaire, de repartir à zéro, de redonner un sens à son existence.Trial-by-ordeal behavior is but one of the myriad angles from which the subject-at-risk relationship may be approached. It enables us, however, to shed light on certain forms of risk behavior, such as not only an aspect of drug addiction but also with games of chance and money. Turning to tests focusing on trial by ordeal could be considered, within an addictive process, as the subject’s attempt, through the experience of death and rebirth, of making oneself over, starting from scratch, and giving more meaning to his or her life