Hospital morbidity of alcohol use disorders in the center of France.

BACKGROUND: The Auvergne region of central France has the third highest mortality rate in the country for alcohol-related disorders and the highest level of alcohol consumption among young people. METHODS: An exhaustive cross-sectional study of regional hospital morbidity related to alcohol was undertaken on a single day in May 1998, including 9,552 hospital beds. All inpatients age 16 and older in the Departments of Medicine, Surgery, Obstetrics and Gynecology, Psychiatry, and Medium-Stay Services were studied. The aim was to define alcohol-related behavior patterns (by using the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV] criteria of abuse and dependence and the CAGE questionnaire) and to measure the proportion of nonsomatic alcohol-related care dispensed in hospital. RESULTS AND CONCLUSIONS: The prevalence of alcohol use disorders in all wards was 20%. Half of these patients were alcohol dependent, a quarter were diagnosed as alcohol abusers, and a quarter had an alcohol-related problem that was not identified during the stay. Alcohol use disorders were more common in male inpatients (34% vs. 8% in female inpatients) and in certain age groups. One male subject in two and one female subject in five between 34 and 45 years had an alcohol-related problem. Almost 25% of male inpatients studied between the ages of 16 and 20 years had an alcohol-related problem, but only half had been diagnosed previously. Hospital care for alcohol-related health problems was seriously inadequate. On average, 38% of patients diagnosed with an alcohol use disorder received relevant nonsomatic alcohol care, of which 13% were alcohol abusers and 50% were alcohol-dependent patients. SIGNIFICANCE: This exhaustive study demonstrates the degree of alcohol-related morbidity among hospitalized patients, which is particularly high in men, in the Auvergne region of France. The study emphasizes the lack of diagnosis, particularly for the young, and the apparent deficiencies in the hospital management of these patients.

Prevalence of drugs of abuse in urine of drivers involved in road accidents in France: a collaborative study.

The collaborative, anonymous, case-control study was intended to determine the prevalence of opiates, cocaine metabolites, cannabinoids and amphetamines in the urine of drivers injured in road accidents and to compare these values with those of non-accident subjects ("patients") in France. Recruitment was performed nationwide in the emergency departments of five hospitals and comprised 296 "drivers" aged 18 to 35 and 278 non-traumatic "patients" in the same age range. Females represented 28.4% of "drivers" and 44.2% of "patients." Screening for drugs in urine was performed by fluorescence polarization immunoassays in each center. Each positive result was verified using gas chromatography-mass spectrometry (GC-MS), in a single laboratory. Statistical analysis comprised single-step logistic regression and simultaneously took account of confounding factors and the final differences in prevalence values between the two populations or different subgroups. Cannabinoids were found in 13.9% of drivers (16.0% of males and 8.3% of females, p < 0.05) and 7.5% of patients (12.3% of males, 1.6% of females, p < 0.0001); only in females was this prevalence higher in injured drivers than in patients (p < 0.05). Opiates were present in 10.5% of drivers' and 10.4% of patients' urine samples (NS), and were more frequent in urine samples positive for cannabinoids, in drivers (p < 0.01) as well as in patients (p < 0.001). The prevalence of cocaine metabolites in drivers and patients was 1.0 and 1.1% and that of amphetamines 1.4 and 2.5%, respectively. No causal relationship between drugs and accidents should be inferred from this retrospective study. Nevertheless, the high prevalence of cannabis and opiate (licit or illicit) use in young people, whether injured drivers or patients, has potential implications for road traffic safety in France. Cocaine and amphetamines did not appear to be a major problem, unlike the experience in other countries.

[Epidemiology of adolescent suicide]. / Epidémiologie du suicide de l'adolescent.

Among the more noticeable health and social indicators used for adolescents, the epidemiologic data on suicide point out one of the most serious risks in the present context of violence. In France, during the year 1995, 5,324 adolescent deaths from 14 to 24 of age were reported. The corresponding mortality rate is 66 for 100,000. The cause-of-death distribution shows the importance of violent deaths among adolescents. Actually, these deaths represent 70% of the 5,324 adolescent deaths. The proportion is higher for males (74%) than for females (60%). The most part of these violent deaths is due to accidents, especially transport accidents (38%). Deaths due to suicides are lower, however they constitute a significant part of the deaths concerning adolescents: 11% of the deaths that occurred from 15 to 19 of age, 17% of the deaths that occurred from 20 to 24 of age. At this time of life, the percentage of suicides is higher than for the whole population, where suicides are only responsible for 2% of the total deaths.

[Epidemiological aspects of drug addiction: morbidity and evaluation of care]. / Abords épidémiologiques de la toxicomanie: morbidité et évaluation des soins.

As regards drug addicts morbidity, no register of patients exists; several studies are conducted with complementary aims. The annual survey of the Health Ministry since 1987 registers over one month the consultants of the whole services: specialized, psychiatric, medical or non specialized social service. The Inserm network involving clinicians and epidemiologists has been running from 1987 focusing on the topic "Drug addiction and public health". In order to know better drug addicted individuals on a socio-demographic and medical level, surveys are carried out in different counselling and treatment centres, where very different degrees of infections (HIV and hepatitis) can be observed. Inserm (Unit 302) has been entrusted with the evaluation of the program of methadone's prescription. A limited sample has led to some descriptions. 92% of the sample have carried out the HIV test and 26% are HIV-positive, 54% have had a B or C hepatitis. These are heroin addicted subjects whose endeavour to wean off failed several times and whose environmental factors represent a support to the treatment. Their state of health is severe enough to be protected within the framework of secondary prevention actions.

[Role of INSERM in descriptive epidemiologic studies]. / Rôle de l'INSERM dans les études épidémiologiques descriptives.

The foundation of INSERM and its development over the past 30 years have led to the formation of a public body known in France as EPST. With scientific and technological interests, the general aim is to promote the advancement of science and to improve the diffusion of information among scientists, teachers or decision-makers and also the general public. Epidemiology counts among the medical disciplines which are methodologically well developed and widely used by many health sectors from clinical research to public health. In the face of more stringent social demands, there is a great need for appropriate use and exploitation of knowledge and resources. In this context, epidemiological research is acquiring a great importance in the production of medical information and also in the evaluation of health practices. A good example is provided by the epidemiological studies on drug abuse which, in spite of the restrictions, furnish new information regarding this problem. 1. Epidemiological studies are limited by legislation (Public Health Code). The Mortality Bureau (INSERM) is charged with the establishment of a register of the medical causes of death. 2. Research proposals are provided by the scientific community. 3. Evaluation studies are most often requested by the Ministry of Health, but, more and more frequently, may originate in other ministerial offices and local governing bodies. The role of the researcher in relation to external collaborations (politicians, administrators and consumers) should be precisely defined.

[Epidemiologic surveys in the field of drug abuse]. / Enquêtes épidémiologiques dans le domaine des toxicomanies.

Among the various approaches used to study behaviours of use and abuse of drugs, epidemiology is now being called upon to direct its attention to two other approaches. Firstly, it should provide a more global view of subject groups than the specific descriptions of a few specialized centres. Secondly, it should take part in studies assessing public health policies for drug addiction. In relation to procedures used by epidemiologists in other fields of health sciences, the distinctive features of drug addiction need limitations and adaptation of methods. In France, anonymity and free health care are guaranteed to all drug addicts who request them. The direct consequences of this legislation is the absence of a drug addict register, unlike in other countries, such as Great Britain. There are no either registers nor survey data base from which representative samples can be constructed. Moreover, since those definitions used are multicriteria definitions, the assessment of a case on a drug addiction scale is in practice usually highly subjective and associated with the particular orientations of a clinical team or of a school of thought, because the notion of dependence is not used in the same way. Since drug addiction develops beyond adolescence and has social and/or medical consequences, specialized or non-specialized public health services or prisons are the main areas of observation for epidemiologists. Surveys are conducted through teams specialized in the treatment of drug addicted volunteers. The anonymity of centres is guaranteed by the INSERM and the centres themselves guarantee the anonymity of subjects studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug addicts and syringe sharing in France: epidemiological study 1988.

A cross-sectional study was carried out in France in March 1988 to measure the impact made on drug abusers by educational campaigns concerning HIV transmission and the lifting of restrictions on the sale of syringes. Thirty-two drug-dependence centers provided a sample of 479 subjects who, compared with 4,846 subjects enrolled in 1986, were found to differ particularly in the type of substance used. Since no observations were made before the introduction of the preventive measures, the changes cannot be attributed to these alone. However, mean profiles were obtained by comparing the different groups, the results obtained remaining dependent on the method of recruitment (specialized centers) and the retrospective nature of the data.

Drug addicts attending specialised institutions: towards a drug addiction data bank?

In 1986, a national survey was carried out in France among 4846 drug abusers attending specialised agencies and treatment centres. Data are analysed and compared with the results of a previous study in 1972. Most French drug abusers are men (74%) ranged in age from 20 to 29 years (68%). Data suggest increasing problems with heroin (69%), cocaine (13%), solvents (5%), alcohol (26%) and multiple drug dependence. Women are younger, they have attempted suicide more often than men but have been incarcerated half as often. Concerning drug abuse trends, women appear to use increasingly sedatives in combination with other drugs. Partial data concerning HIV seropositivity reveal a rate of 48% among drug abusers having been tested.

[Use of psychotropic drugs and addiction: approaches to epidemiologic research]. / Usage de psychotropes et toxicomanie: voies de recherche epidemiologique.

Although the phenomenon of drug abuse in France is well delimited, it constitutes a public health problem. The way it spreads is sometimes 'epidemic' in sub-groups especially exposed. The somtic or relational consequences are short-term and it concerns more and more adolescents or young adults. Two main research axes have been developed: studies in the general population, adolescents or adults, in order to know the general context of licit and illicit psychotropic use in France, and specific studies in detoxification centers in order to describe the characteristics of drug addicts and to evaluate their requirements. Results of some recent surveys can illustrate these axes. Total abstinence is exceptional. Psychotropic drug abuse is deeply established in traditional French social customs. Most subjects had a narrow relation with psychoactive drugs. The variety as well as quantity of products allow everyone to adopt a style of consumption. Globally, alcohol consumption has decreased. Moderate consumers seem to be those who especially confine their drinking to daily wine consumption. On the other hand, the consumption of aperitifs and other drinks in on the increase. The dissociation of alcohol consumption from meals enhances drunkness. Nicotine-poisoning in men had a parallel evolution and has increased in women. Psychotropic drugs (tranquillizers and hypnotics) are specially used by aged women on medical prescription. For the study of drug abuse, data is collected in specialised centers and prisons regarding socio-demographic variables, intoxication profile and medical and social consequences. For both the general and addict population, epidemiological research, especially typological analysis, allows to identify some sub-groups at risk of drug addiction.

[Evaluation of the risk factors of suicide in patients treated for mental disorders. Review of the literature from 1978 to 1988]. / Evaluation des facteurs de risque de suicide chez les malades mentaux traités. Revue de la littérature de 1978 à 1988.

Research on suicide risk factors among psychiatric patients has developed considerably over the last 10 years. The methodological problems are numerous. Tentatives of global prediction have been unsuccessful in describing one complete and specific picture of the mentally ill suicide, whereas lawsuits against psychiatrists are frequent after patients' suicides. Through the analysis of 37 publications from 1978 to 1988 the authors review the main suicide risk factors identified among treated psychiatric patients.

[Suicidal alcoholic patients: profile, risk factors and review of the literature from 1955 to 1988]. / Le patient alcoolique suicidaire: profil, facteurs de risque et revue de la littérature de 1955 à 1988.

Alcoholism and suicide are two Public Health problems which are linked at the epidemiological and clinical levels. Research over suicide risk factors among alcoholic subjects has developed mainly among medicalized psychiatric populations. Suicide occurs late among alcoholic patients, and affects particularly men and socially isolated subjects. The main risk factors relate to the decrease of the socio-economic status. loss of job and of income-, to the interpersonal loss--i.e. family bereavement or breach of relation, to the existence of a suicidal ideation often communicated or of suicidal antecedents, to a degradation of the physical state or the presence of some affections like gastro-duodenal ulcer. The identified factors are of little specificity. It is difficult to assess their interrelations and their respective true values. The reliable prediction of a later suicide remains presently impossible. Progress in analytic research over the alcoholic patients' suicide could result from the standardization of populations and of studied factors and from the use of multivariate analysis statistical methods.

Drug abuse in France: a review of statistical data.

In France, drug abuse among the young population first appeared at the end of the sixties. Repressive and therapeutic measures were then combined and specific sanitary structures set up. The authors describe the historical and social backgrounds of this phenomenon and review the sources of relevant statistical information records of offenses against the drug law; statistics of special care centres; epidemiological studies on confirmed drug addicts. These sources are various and the approaches quite different. However, they reveal socio-demographic characteristics of French drug abusers and a typology of substances abused and identify different periods in drug career. These studies also allow identification and evaluation of risk factors of drug abuse by typological analysis and by psychometric tests. The authors outline the benefit of collaboration between researchers and clinicians: partial interviews of small addicted populations and national surveys provide complementary information. Systematic epidemiological studies would give global measures of changes in addiction.

[Presence of benzodiazepines in the serum of patients after accidents. Relation to alcoholism]. / Présence de benzodiazépines dans le sérum de sujets accidentés. Relation avec l'alcoolisme.

In a study of 2.021 injured persons (accidents at home or at work, road accidents), qualitative assays of serum benzodiazepines by the EMIT method were positive in 9.6 per cent of the cases, including 3.2 per cent who had blood alcohol levels in excess of 0.10 g/l. Benzodiazepines were more frequently found in accidents at home and on roads than in accidents at work. These results raise the question of the role played by benzodiazepines as a possible risk factor of accidents, notably road accidents.

Detection of blood benzodiazepines in injured people. Relationship with alcoholism.

In 2021 accident victims (household, work and road accidents) the qualitative test for benzodiazepines in the serum by the EMIT method was positive in 9.6% of cases, including 3.2% of subjects who also had a blood alcohol level greater than 0.10 milligram. Benzodiazepines were detected with a particularly high frequency in household accidents and road accidents and rarely in work accidents. These results raise the problem of the role of benzodiazepines as a possible risk factor for accidents, particularly road accidents.