[Smoking behaviours among staff of two university hospitals in Paris, 2021]. / Tabagisme du personnel de deux hôpitaux de l'Assistance Publique­Hôpitaux de Paris, 2021.

INTRODUCTION: A survey on smoking prevalence was conducted among staff at the Georges Pompidou and Corentin Celton hospitals in the framework of the "smoke-free hospital" project. It aimed to determine the smoking status of different categories of personnel, their desire to be helped to quit and, as regards healthcare staff, whether or not they were encouraging patients who smoked to try to quit. METHODS: From February to May 2021, an anonymous survey was distributed, first on paper in the occupational health unit, and then online in all wards. RESULTS: All in all, 775 people, three quarters of whom were women, participated in the survey (15% of the workforce). Among the respondents, 27% said they smoked: 29.6% of the men and 26.1% of the women. Unsurprisingly, the age group with the highest prevalence was 18-24years. High prevalence was likewise found among technical and administrative staff. More than half of the smokers, who consumed an average of 8 cigarettes a day, were interested in receiving smoking cessation support. As regards smoking cessation support for patients, 49% of medical and nursing staff (70% of the doctors) frequently or systematically advised them to quit. CONCLUSION: Our results illustrate a need to reach high-prevalence categories of smokers in a hospital setting, the objective being to help them to consider quitting, and also a need to train health professionals in smoking cessation counseling.

[Smoking cessation services during "Mois sans tabac": Smokers' profile and effectiveness]. / Consultations de tabacologie pendant le mois sans tabac : profil des fumeurs et sevrage.

INTRODUCTION: In November 2016, France implemented "Mois sans tabac", with the objective of promoting smoking cessation in November for at least one month. This study consisted of: (1) the description of the characteristics of smokers registered in the French cessation database during November 2014-2015 compared to November 2016-2017; (2) the comparison of abstinence factors between the two periods. METHODS: We used data from CDTnet with 4659 registered adults' smokers who came for a first visit in November from 2014 to 2017 and were followed up at least one month. Our endpoint was 1 month-validated abstinence among the 1943 smokers followed up. We performed descriptive analyses of smokers, and predictors of abstinence were determined using a logistic regression model. RESULTS: A 6.9% significant increase of first visits was observed during "Mois sans tabac" versus before Mois sans tabac (P<0.001). Furthermore, more women (56.3% vs. 52.2%) as well as more light smokers (28.7% vs. 23.7%) sought help between these two periods. Finally, in 2016-2017, more smokers consulted by personal initiative than were hospital-referred (45.8% vs. 36.3%) in comparison with 2014-2015. Nevertheless, there was no significant difference of cessation rate between the 2014-2015 group (44.6%) and the 2016-2017 group (45.6%). In multivariate logistic regression, being a light smoker was the only factor that increased the chances of abstinence in 2016-2017 compared to 2014-2015 (OR: 1.68 [1.03-2.75]). CONCLUSION: It seems important to refer smokers to cessation services during Mois sans tabac to reach high rates of abstinence.

[Systematic identification of smokers and tobacco smoking management in the general hospital]. / Repérage systématique et prise en charge du tabagisme à l'hôpital général.

INTRODUCTION: The prevalence of daily smoking in France was 24 % in 2019 and tobacco control remains a major public health issue. A hospital stay provides an opportunity for smoking cessation intervention. Identification and management of smokers during a hospital stay may be variously integrated into electronic health records (EHR). STATE OF THE ART: Smoking status identification, which have included pre-filled forms, check-box, reminders, icons, is heterogeneous. Specific modules in EHR have been implemented for smoking cessation management such as counselling sessions, tobacco cessation prescriptions, smoking cessation guidelines and long-term follow-up. EHR-based intervention to identify and manage smokers with a long-term follow-up for at least one month after hospital discharge has shown an increase in smoking abstinence at 6-12 months. OUTLOOK: Due to the lower quality of free data about smoking status, systematic identification with check-box, reminders or icons in EHR may be more appropriate. Integration of functionalities such as help for prescription, reminders and follow-up of patients would make tobacco cessation management easier for health professionals. CONCLUSION: EHR interventions to identify smokers and manage smoking cessation during hospital stays are an opportunity to increase smoking cessation.

Does substance use explain social differences in terms of depression? Findings from the Constances cohort.

BACKGROUND: The role of alcohol, tobacco and cannabis use in social differences in terms of depression is poorly understood. METHOD: We have applied mediation and moderated-mediation models stratified by gender to a population-based sample (N = 37,192) of French men and women from the Constances cohort with baseline and follow-up measures of depressive states. We have examined whether socioeconomic status (SES, measured by education and income) differences in the prevalence of depressive states may be explained by both differences in prevalence of substance use according to SES (mediating effects) and differential effects of substance use on depressive state according to SES (moderating effects). RESULTS: In the mediation models, substance use only explained 5.3% and 2.4% of the association between low education and depressive state in men and women respectively, and was not a significant mediator for income. Moderated mediation models showed robust moderation effects of education and income in both men and women. The association of tobacco use with depressive symptoms, which was the only substance for which a mediation effect remained and for which the moderation effect of SES was the strongest, was significantly higher in participants with low SES. LIMITATIONS: The partially cross-sectional nature of the data restricts the possibility of drawing causality with regards to associations between SES and substance use. CONCLUSION: Targeting substance use, particularly tobacco, can especially reduce depression risk in individuals of low SES.

[Interventions for smoking cessation in 2018]. / Les outils du sevrage tabagique en 2018.

Smoking cessation treatments have been proved effective to stop smoking. For pharmacological treatments, nicotine replacement therapies (NRT) as well as bupropion allow to increase 6 month-abstinence rates by more than 80% in comparison with placebo while varenicline prescription doubles success rates in the same conditions. These results mean that for 10 smokers who quit with placebo, 18 are expected to quit with NRT or bupropion and 28 are expected to quit with varenicline. Varenicline is 50% more effective than nicotine patch and 70% more effective than nicotine gum. Nevertheless, a combination including NRT patch and oral nicotine forms is as effective as varenicline, thus leading to encourage the prescription of a combination NRT when NRT are chosen. For these three pharmacological treatments, cardiovascular as well as neuropsychiatric tolerance were not found statistically different from placebo in randomized controlled trials. Yet, bupropion prescription leads to an increasing risk of seizure (1/1000 to 1/1500). For behavioral treatment, motivational interviewing as well as cognitive behavior therapies are been proven to be effective to stop smoking but few smokers have access to this treatment. Smoking cessation mobile application and smartphone application seem to be promising in terms of effectiveness and might be useful to reach more smokers.

Tomodensitometric survey of the distance between thoracic and abdominal vital organs and the wall according to BMI, abdominal diameter and gender: proposition of an indicative chart for the forensic activities.

INTRODUCTION: Forensic doctors are frequently asked by magistrates when dealing principally with knife wounds, about the depth of the blade which may have penetrated the victim's body. Without the use of imaging, it is often difficult to respond to this question, even in an approximate way. Knowledge of the various distances between organs and the skin wall would allow an assessment to be made of the minimum blade length required to obtain the injuries observed. The objective of this study is thus to determine average distances between the vital organs of the thorax and abdomen, and the skin wall, taking into account the person's body mass index (BMI). MATERIALS AND METHODS: This is a prospective single-center study, carried out over a 2-month period at University Hospital in Angers. A sample of 200 people was studied. The inclusion criteria were as follows: all patients coming to the radiology department and the emergency department for an abdominal, thoracic or thoraco-abdominal scan with injection. The exclusion criteria included patients presenting a large lymphoma, a large abdominal or retroperitoneal tumor, a tumor in one of the organs targeted by our study and patients presenting ascites. The organs focused on were: the pericardium, pleura, aorta, liver, spleen, kidneys, abdominal aorta and femoral arteries. The shortest distance between the organ and the skin wall was noted. Median distances were calculated according to gender, abdominal diameter and BMI. RESULTS: We associated these values to propose an indicative chart which may be used by doctors in connection with their forensic activities. DISCUSSION: The problem of the depth of a wound is frequently exposed to the expert. Without a reliable tool, it is difficult to value and a personal interpretation is often done. Even if, in current days, tomodensitometry is frequently done in vivo or after death, measurement can be difficult because of the local conditions. We classified values according to the different factors of fat repartition (BMI, abdominal diameter, gender). These tables, collectively used, permit evaluation of the distance between wall and thoracic or abdominal vital organs. CONCLUSION: We suggest an indicative chart designed for forensic doctors in their professional life to help determine the minimum penetration length for a knife, which may wound a vital organ.

[Homicide and acute cortico-induced psychosis: A case report]. / Homicide et épisode psychotique aigu cortico-induit : à propos d'un cas.

BACKGROUND: Since their commercialization in 1950, the first psychiatric side effects of steroids have been reported. Today, steroids have become an important therapeutic tool in many diseases, but pharmacological mechanisms responsible for their side effects are still little known. The neuropsychiatric side effects concern 15% of patients while severe reactions occur in 5% of cases, mostly as acute psychotic episodes such as delusion. Serious forensic risks in this context are poorly documented and underestimated. CASE REPORT: We report the case of a 77 year-old man, treated by methylprednisolone for chronic lymphoid leukemia. After two months of treatment, although stabilized for the neoplastic disease, he stabbed his wife to death with a knife. In the emergency unit, an acute delirious state, a disorganization syndrome, and confusion items such as amnesia, disorientation and symptomatology fluctuation were observed. Mr. M also presented with hyponatremia and infectious pneumonia. Steroids were stopped and his condition rapidly declined, he died one month later during the hospitalization. DISCUSSION: This clinical case underlines the importance of the early detection of steroid psychosis and its management. Treatment should not be stopped brutally and a dose reducing strategy should be applied in combination with a mood stabilizer or antipsychotic treatment. Disease management strategies are insufficiently documented to be recommended. The extremely acute onset of the symptoms, a partial insight into delusions, a history of iatrogenic neuropsychiatry, the existence of somatic precipitating disorders and confusion factors should always alert the practitioner. The patient, and eventually his family circle, must be aware of the risks of adverse psychiatric effects of steroids for both ethical and forensic reasons, and must report them as early as possible to the clinician if they occur.

Homicide and associated steroid acute psychosis: a case report.

We report the case of an old man treated with methylprednisolone for chronic lymphoid leukemia. After two months of treatment, he declared an acute steroid psychosis and beat his wife to death. Steroids were stopped and the psychotic symptoms subsided, but his condition declined very quickly. The clinical course was complicated by a major depressive disorder with suicidal ideas, due to the steroid stoppage, the leukemia progressed, and by a sudden onset of a fatal pulmonary embolism. This clinical case highlights the importance of early detection of steroid psychosis and proposes, should treatment not be stopped, a strategy of dose reduction combined with a mood stabilizer or antipsychotic treatment. In addition have been revised the risks of the adverse psychiatric effects of steroids.