[Smoking cessation among HIV smokers: Experience of a French hospital-based smoking cessation service]. / Sevrage tabagique chez les patients fumeurs VIH : expérience de la consultation de tabacologie de l'HEGP à Paris.

INTRODUCTION: There is a particular need among HIV-infected patients to stop smoking because of the risk of smoking-related complications and the high prevalence of cigarette smoking among them. Only a few studies have focused on this population in real-world settings. AIM OF THE STUDY: Investigate the effectiveness of a smoking cessation support for HIV-infected patients at the Georges Pompidou University hospital (HEGP) smoking cessation service during the 2011-2012 period. METHODS: A retrospective study of smoking cessation medical records was performed for 39 smokers who had visited for the first time the HEGP smoking cessation service during the 2011-2012 period and declared to be infected by the HIV on their smoking cessation self-questionnaire. The study has described smokers' characteristics and follow-up to measure the abstinence rate, validated by the patient declaration, the registration of the number of days without cigarettes between each visit and a measure of expired carbon monoxide ≤ 5ppm at each visit. We examined smokers lost to follow-up and they have been considered as smokers. Maintained abstinence rates at 3 month-follow-up and at 9 months/one year were registered. RESULTS: The 39 HIV-infected smokers registered in the study were mainly male (30/39), were heavy smokers with a consumption mean of nearly 23 cigarettes per day. One third presented high nicotine dependence with a Fagerström test ≥ 7. A depression history was reported among one third of them. Symptoms of anxiety and depression were declared by 20% and 33% respectively among them. Thirteen percent of them received opioid replacement therapies, 41% were cannabis users (one out of four were daily users) and 10 % declared alcohol abuse. 85% of patients received nicotine replacement therapy (patch and/or oral forms) and 15% varenicline®, along with behavioral support techniques. At 3 month-follow-up, smoking cessation was validated for 20.5% of patients and at 9 months/1 year, smoking cessation rate decreased at 13%. When considering smokers with ≥ 2 visits, the maintained abstinence rates were respectively 27.6 and 17.2%. DISCUSSION AND CONCLUSION: With a severe smoking profile, frequent co-addictions and anxiodepressive symptoms, our results suggest that behavioral techniques combined with nicotine replacement therapy or varenicline® among HIV-infected smokers can help severe smokers to quit. Our data underline the need to take into account the co-addictions and to maintain such patients in treatment to achieve smoking cessation in real-world settings.

[Smoking cessation during pregnancy]. / Sevrage tabagique au cours de la grossesse.

Smoking during pregnancy is associated with negative pregnancy and perinatal health outcomes. Physiological and societal particularities can modify the smoking behavior of pregnant women. Pregnancy is a teachable moment for smoking cessation. Increased nicotine clearance may lead to exacerbated tobacco withdrawal symptoms and desire to smoke, which need to be taken into account when helping pregnant smokers to quit. Although most pregnant smokers try to quit on their own, 12% of pregnant women in France reported smoking in 2021 during the 3rd trimester of pregnancy. Health care professionals should screen for tobacco consumption and assess the level of addiction. Management of smoking cessation can be multidisciplinary, including non-pharmacological support such as counselling, behavioral support, financial reward contingent on abstinence, and medication (nicotine replacement therapies). Assessment and limitation of secondhand smoke exposure (SHS) is needed because SHS can also have negative maternal and fetal consequences. Management of relapse during the postpartum period is also to be anticipated; in 2021, it concerned 22.4% of women who had stopped smoking during pregnancy. While electronic cigarette use is increasing overall and among pregnant women who smoke (5.4 before pregnancy, 1.3% during the 3rd trimester in 2021), well-conducted smoking cessation studies are necessary to assess its benefits and potential risks in this specific group of smokers.

[Cannabis cessation interventions offered to young French users: predictors of follow-up]. / Facteurs prédictifs de suivi des jeunes fumeurs de cannabis consultant pour sevrage.

INTRODUCTION: Cannabis use is very problematic among young French people, because of the young age of first consumption and its health consequences. Indeed, the average age of cannabis experimentation is about 15 in France and 49.5% of 17 year-olds report having used cannabis in their lives. To prevent this problem, tobacco and cannabis cessation services are dedicated to handle patients who want to stop tobacco and/or cannabis. Moreover, in 2004, specific medical outpatient services have been implemented to address the problem of young cannabis users. Since their establishment, some studies have reported demographic and clinical characteristics of the patients attending these services, but we still lack data on their follow-up and their medical and psychological care. OBJECTIVE: The aim of this study is to describe the clinical and psychiatric characteristics of young patients referred to tobacco/cannabis cessation consultations or specific young cannabis users' consultations and to evaluate their medical care and monitoring. PATIENTS AND METHODS: We designed a retrospective study in seven cessation clinics in the Paris area between 2005 and 2007. Eligible patients were regular cannabis users aged under 40. An electronic medical database was completed using patients' medical records. Medical files reported demographic and clinical data. Psychiatric disorders were assessed using the HAD and the Beck scores. Nicotine dependence was evaluated by Fagerström's score. The history of addictions, and data about consumption of cannabis, tobacco, alcohol and other drugs were recorded in the medical file. The follow-up of patients was defined by having at least two visits at the medical outpatient services. Tobacco and cannabis cessations were assessed at one-month follow-up. Univariate and multivariate logistic models were used to assess factors associated with patients' follow up and monitoring. RESULTS: Four cessation clinics accepted to participate in our study. One hundred and eight eligible patients were listed during the study period. One hundred and eleven patients (75%) were males and seventy-nine (53%) were employed. The average age of patients was 26 years old (±6.8). Fifty patients (34%) came to the clinic on their own decision, thirty-three (22%) were referred by a hospital and twenty-eight (19%) came because of their family's advice. The mean age of first cannabis consumption was 16 years old (±7.3) and cannabis consumption was most often associated with tobacco use. Fifty-nine percent of patients had anxiety disorders and 28% had depression according to D-HAD score. The dropout rate after first visit was about 40%. The most frequent therapy proposed to young cannabis users was nicotine replacement therapy. Follow-up data were collected for 135 patients and only 85 (37%) patients made at least two visits at the outpatient services. The average number of consultations was five (±3.8). Multivariate analysis found an association between follow-up and previous cannabis cessation (P=0.04), pharmacological treatment of tobacco withdrawal (P=0.04), and antidepressant treatment (P=0.04). Only one quarter of patients had quit cannabis and/or tobacco at one-month follow-up. DISCUSSION: This study describes clinical characteristics of patients attending cannabis consultations in France. As reported in other studies, anxiety disorders and depression are important problems in this population and should be considered during their medical care. The efficacy of specific French medical outpatient services is difficult to evaluate because of the high rate of dropout. Some patients' characteristics seem linked to their monitoring but other studies should be assessed to confirm these results. As pharmacological treatments seem associated with patients' follow-up, new research should be implemented to develop therapeutic solutions for cannabis addiction.

[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.

[Etiopathological factors of hepatocellular carcinoma in Bangui, Central African Republic: clinical, biological characteristics and virological aspects of patients]. / Etiopathologie du carcinome hépatocellulaire à Bangui, République centrafricaine : caractéristiques cliniques, biologiques et aspects virologiques des patients.

OBJECTIVES: To describe clinical, biological characteristics and virological aspects of patients with hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Sera obtained from consent patients with clinical suspicion of HCC. Routine biochemical tests and serological markers of hepatitis B virus (HBV), hepatitis D virus (HDV) and hepatitis C virus (HCV) were searched. A hepatic ultrasound scan was realized and, when a suspected mass lesion was observed, ultrasonographic-guided fine needle aspiration of the hepatic mass lesion was made to ascertain the diagnosis of HCC. RESULTS: One hundred and seventy-five sera were collected from 99 men and 76 women. Approximately 96.6% (169/175) of them had previous contact with HBV. HBs surface antigen was positive in 41% (69/169) of whom 53.6% (37/69) were co-infected by the HDV. Three patients (1.71%=3/175) were positive for anti-HCV antibodies. The other three patients (1.71%=3/175) did not present any markers for HBV or HCV. At the time of diagnosis, right upper quadrant pain, hepatomegaly, cachexia, were present in all patients. An increase in serum transaminases (70%), high bilirubin concentrations (40%), high AFP levels (40%) and low prothrombin levels (52%) were the most frequent biological abnormalities. Only 17 guided fine needle aspirations of mass lesions were realized. The diagnosis of HCC was confirmed by cytopathological examination for 14 of them. CONCLUSIONS: HCC is a frequent pathology in the Central African Republic (CAR). According to the ultrasound imaging data, patients consult at terminal stage of the disease. This study confirms also the association between HBV and HCC in CAR. Moreover, in 26.5% of patients HDV is associated with severe forms of the disease.

Smokers' reasons for quitting in an anti-smoking social context.

OBJECTIVE: To examine the impact of the social denormalization of smoking on smokers' motives for quitting and on subsequent abstinence in a context of intensified anti-smoking measures. STUDY DESIGN: This study is based on data from 13,746 French smokers who were registered in cessation services nationwide between September 2006 and September 2007. METHODS: Motives freely reported by smokers on their first visit to a cessation service were explored through open coding. Bivariate methods and multivariate logistic regression analyses were used to assess the association with biochemically validated abstinence at 1 month follow-up. RESULTS: Motives most frequently expressed by smokers were health concerns (55.0%) and cost of smoking (24.2%), but no significant association was found with abstinence. The highest abstinence rates were achieved by smokers motivated by their social network: 'motivated or pressured by others' (20.9%), 'setting a good example' (20.7%) and 'having a smoke-free social network' (20.3%). Smokers could no longer bear the social constraints of smoking: '[my] friends and family have all quit, [I] smoke outside all alone and feel left out' and 'I no longer want people to say with disgust that I smell of tobacco. I would like to be freed from this addiction because I'm ashamed of smoking, not at home but on the street'. CONCLUSION: French smokers' motives for quitting reflect a social unacceptability of smoking which has been buttressed by measures intended to reduce tobacco use. Through smoke-free social networks, the denormalization of smoking appears to improve short-term 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.

APOE genotyping: comparison of three methods.

Apolipoprotein E (apo E) polymorphism is associated with increased risk of cardiovascular and Alzheimer diseases, making its genotyping of potentially predictive value. We developed a rapid, reliable and specific method for determining APOE genotypes by fluorescent resonance energy transfer (FRET) over a high number of samples in a single run using a LightTyper device and dedicated probes. The method, validated with 75 blood samples, was designed to simultaneously detect three common APOE polymorphisms, epsilon(2,) epsilon(3) and epsilon(4), and to identify in a single reaction any of the six following genotypes: epsilon(2)/epsilon(2), epsilon(3)/epsilon(3), epsilon(4)/epsilon(4), epsilon(3)/epsilon(4), epsilon(4)/epsilon(2), epsilon(3)/epsilon(2). The assay involved three phases: (1) DNA extraction, (2) amplification, and (3) melting curve analysis using FRET technique. Briefly, genomic DNA of patients was extracted from total blood. Fragment of APOE was amplified by a first PCR run. Fluorescent labeled probes were added in a second PCR run. FRET genotyping showed following distribution: (1) 1.3% for epsilon(2)/epsilon(2) and epsilon(4)/epsilon(4) homozygotes, (2) 4.0, 6.6 and 14.7% for epsilon(2)/epsilon(4), epsilon(2)/epsilon(3) and epsilon(3)/epsilon(4) heterozygotes, respectively, and (3) 72.0% for epsilon(3)/epsilon(3) homozygotes. Moreover, a careful analysis of the FRET melting curves allowed us to determine the presence of a new polymorphism on the third position of the codon 158 (-AAGCGT-), namely, two nucleotides downstream from the known polymorphism. When the FRET analysis was compared to those obtained by RFLP and sequencing, the presence of this new polymorphism was confirmed only by sequencing thus indicating that RFLP analysis is not always reliable for genotyping.

Trends in the profile of smokers registered in a national database from 2001 to 2006: changes in smoking habits.

OBJECTIVE: In 2001, an electronic medical record system was designed to collect data from smoking cessation services in France. By comparing two periods (2001-2003 and 2004-2006), this study assessed trends in the profile of smokers registered in the database. STUDY DESIGN: A cross-sectional analysis on the 33,219 smokers registered in the database in 2001. METHODS: Sociodemographic details, psychological and medical history, and characteristics of tobacco consumption at baseline were examined. RESULTS: The proportion of young smokers increased from 5.1% to 6.9%, and the proportion of underprivileged smokers increased from 9.3% to 10.9% between 2001-2003 and 2004-2006 (P<0.0001). The medical profile was unchanged, with about 37% of cases with tobacco-related diseases and 31% of cases with past depressive episodes in 2001-2003 and 2004-2006. The main finding was an increase in the mean concentration of carbon monoxide (CO) in expired air [from 18.8 parts per million (ppm) (SD 14.4) to 23.5 ppm (SD 14.1)], despite a decrease in the number of cigarettes smoked per day. The concentration of CO per cigarette also increased from 0.9 (SD 0.9) to 1.3 (SD 1.4). CONCLUSION: As the number of cigarettes smoked per day decreased, the increase in mean concentration of CO per cigarette implies that increases in cigarette prices may have led to new smoking habits and/or compensatory smoking.

Alcohol withdrawal syndrome management: Is there anything new?

Patients with alcohol use disorder experience frequently alcohol withdrawal syndrome (AWS), which is a potentially life-threatening condition mainly caused by glutamate overactivity. The aim of therapeutic alcohol withdrawal is the entry into a process of complete and lasting abstinence. Therefore preparing withdrawal is crucial to optimize compliance and efficacy of aftercare. Indeed, performing repeated withdrawal per se without any project of subsequent abstinence may be deleterious, at least because of repeated exposure to glutamate neurotoxicity. Managing AWS mainly consists in anticipating severe withdrawal, decreasing the risk of complications, making this experience as comfortable as possible, preventing from long-term benzodiazepine use, and enhancing motivation to aftercare and long-term abstinence. In particular, there are specific guidelines to choose which benzodiazepine administration approach to adopt (i.e. symptom-triggered, fixed schedule or loading dosage) and which other drugs to deliver (e.g. thiamine, folate, magnesium). Specific precautions should be taken in the elderly.

[Standardized screening of alcohol misuse in emergency wards: The experience of a systematic use of the FACE scale in the European Georges-Pompidou Hospital]. / Repérage standardisé du mésusage de l'alcool au service d'accueil des urgences : l'exemple de la passation systématique du questionnaire FACE à l'hôpital Européen Georges-Pompidou.

INTRODUCTION: By using a standardized and systematic screening with the FACE questionnaire, our aims were : - to determine the prevalence of alcohol misuse (AM) among patients admitted in the emergency department of the European Georges-Pompidou Hospital; - to search for risk factors associated with AM. METHODS: Patients admitted between 9 am and 5 pm were included for 7 consecutive days in June 2017. The variables collected were age, gender, reason for and day of admission, acute alcohol intoxication, benzodiazepines misuse, use of illicit drugs, and the FACE. An AM was defined by a score ≥5 for men and ≥4 for women. Descriptive analyses calculated the prevalence of AM and logistic regressions calculated the risks for AM. RESULTS: A total of 190 men and 221 women were included, with 31% and 19% of them with AM, respectively. The risk of AM was positively associated with male gender, weekend admission and illicit drug use. It was negatively associated with age. The risk of AM was not significantly different according to the reason for admission (trauma versus medical). The risk of AM was not associated with misuse of benzodiazepines. Among the 100 patients with AM, only six had been admitted in acute alcohol intoxication. CONCLUSION: A systematic screening is crucial to identify patients that should benefit from brief intervention or specialized intervention in an addictology unit.

In vivo antiviral activity of ribavirin/alpha-cyclodextrin complex: evaluation on experimental measles virus encephalitis in mice.

Intracranial injection of the rodent adapted CAM/RB strain of measles virus (MV) induces encephalitis in CBA/ca mice. It has already been shown that cyclodextrins can be used as carriers to increase the antiviral activity of ribavirin (RBV) against MV in cellular model. In this study, the antiviral activity of a RBV/alpha-cyclodextrin complex has been evaluated in vivo using the above model. CBA/ca mice were treated by intraperitoneal injection of free ribavirin (40 mg/kg) or a RBV/alpha-cyclodextrin complex (molar ratio 1:3). After 21 days, intracerebral injection of CAM/RB resulted in 100% mortality in the mock group. In contrast, mortality rates of 80% and 40%, respectively, were observed in RBV and RBV/alpha-CD-treated mice (p<0.05 and p=0.06 for distilled water and RBV, respectively). The viral load of MV in the mouse brain was monitored daily by real-time PCR until day 6 after infection, to compare virus production in treated and non-treated mice. This data shows that RBV complexation with alpha-cyclodextrin can increase the antiviral activity of ribavirin in a measles virus encephalitis model in mice.

[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.

[The Chikungunya virus]. / Le virus Chikungunya.

Chikungunya virus (CHIKV), a member of the Alphavirus genus, represents a real public health problem in tropical regions of the Southeast Asia and Africa. It is transmitted to the man by Aedes mosquitoes and the illness, known as Chikungunya, is characterized by fever, eruptions and invalidating arthralgia. An increased surveillance in tropical and subtropical areas is necessary, as far as we have noticed recently the emergence of this new disease in regions where it had never existed before. The epidemic context is of a high importance for diagnosis. It is very important to know the clinical characteristics of the infection, to detect forms rarely or never described previously. Permanence of a highly technical core in specialized laboratories will allow, fast, specific and differential diagnosis. The knowledge of the epidemiological chain of transmission from reservoir, still unknown, to the host aims to protect populations by limiting the risks of exposure when it is possible. The only prevention measures available are individual protection against mosquitoes and antivectorial fight, in the absence of specific antiviral treatment and vaccine.

[Characteristics of smoker adolescents seeking smoking cessation services]. / Caractéristiques des adolescents fumeurs s'adressant aux consultations de tabacologie.

UNLABELLED: In France, the prevalence of tobacco consumption is 31% for teenagers between 15 and 19 years old. Nevertheless, few French studies have been published on the characteristics of young smokers seeking smoking cessation services. The development of smoking cessation centres in France since 1999 was associated to the setting up of a e-transfer system in order to evaluate the adequacy between these services and the needs of smokers. OBJECTIVE: To analyse the characteristics of smokers aged less than 19 years registered in the smoking cessation services national database. METHODS: A cross-sectional population-based study has been conducted in the smoking cessation services participating in the national database. The study population included 321 young smokers attending the smoking cessation centres during the period 2001-2005. RESULTS: The 321 smokers (mean age 16.6 years) were mostly girls (56.4%). A background of depression was declared by 19% of young smokers and an abnormal result was found for the hospital anxiety depression-screening test among 34% of the population for the anxiety scale and 6% for the depression scale. Mean daily tobacco consumption was 15.3 cigarettes per day and heavy nicotine dependence was found for 24.1% of the population. A nicotine replacement therapy was prescribed for every smoker. CONCLUSION: Nicotine dependence was heavy for 24.1% of the 321 young smokers seeking smoking cessation services. More than 1/3 had an abnormal result for the hospital anxiety depression-screening test. Tailored interventions for smoking cessation should be available for adolescent's smokers, especially school-based services.

[Smoking cessation support among persons in situation of precariousness]. / Précarité et sevrage tabagique : réflexions à partir des données de la consultation de tabacologie de l'hôpital européen Georges-Pompidou (AP­HP), Paris.

INTRODUCTION: Underprivileged people smoke more frequently, present with a more severe smoking profile and stop less often than wealthier smokers. They can have difficulties to afford smoking cessation treatments as the French medical insurance coverage system requires smokers to pay it in advance with a later reimbursement. The objective of this study was to compare the characteristics, treatment plans and cessation rates of smokers from disadvantaged population in comparison with smokers in wealthier condition. METHODS: Study population concerned smokers received for a first visit in the smoking cessation service at Georges-Pompidou European Hospital (Paris, France) in 2013. The EPICES score was used to define precariousness. The national file of smoking cessation consultation (CDT) was completed and the nicotine replacement therapy (NRT) prescriptions were detailed, as treatment could be given for free to precarious smokers on a weekly basis. Data were registered in CDTnet, the French national database of smoking cessation services. RESULTS: Precarious smokers (36.8%) presented with a more severe smoking profile and suffered more often from psychiatric disorders than wealthier smokers. They benefited most often from a combination NRT with patch and oral forms. The followed-up precarious smokers attended a greater number of consultations (4.7 against 3.4) and, if they were less often abstainers (22.2% against 41.3%), they were able to significantly reduce their consumption. CONCLUSIONS: Precarious smokers adhere to structured care with aid for access to TSN with a positive consequent impact on consumption.

Difficulties of smoking cessation in diabetic inpatients benefiting from a systematic consultation to help them to give up smoking.

AIM: To assess the value of systematic smoking cessation consultations for diabetic smokers admitted to hospital. METHODS: All diabetic smokers admitted to the Diabetes Department of Georges Pompidou European Hospital between February 2003 and February 2004 were systematically offered a consultation with a physician specialised in tobacco cessation. Follow-up visits at three, six and nine months were planned. RESULTS: Of the 306 diabetic patients admitted, 38 (12.4%) were smokers. There were more men than women in the group of smokers and the diabetic smokers were younger than the non-smokers. The smokers had fewer micro-angiopathic complications than the non-smokers, but there was no difference in the frequency of macro-angiopathic complications. The level of nicotine physical dependence was moderate or high for 60% of the smokers. Although all the smokers agreed to the consultation, less than half agreed to drug-based treatments to help them to give up smoking and only 15% returned for the six-month visit. Only one patient had stopped smoking at the six-month visit. CONCLUSION: This study demonstrates the difficulties in systematic interventions to help diabetic patients to stop smoking. Diabetic smokers probably constitute a specific population for which the barriers to giving up smoking should be explored.

[Feasibility of systematic screening for addictive behaviours of hospitalized patients]. / Faisabilité du dépistage systématique des comportements addictifs chez les patients hospitalisés.

BACKGROUND: The national policy against addiction led to the establishment of specialized units with liaison teams trained in addiction specifically to work with the in-patients. The aim of this study has been established within the context of the implementation of one of these addiction liaison units in a Parisian Hospital, the Georges Pompidou European Hospital (HEGP), that is namely to evaluate the feasibility of a systematic screening procedure concerning tobacco and alcohol dependence among inpatients in two of the hospital's specialization departments between December 6, 2001, and March 6, 2002. METHODS: Self-administered questionnaires on addictive behaviours were distributed to each patient admitted to the vascular health department and to the hypertension department They included the Fagerström Test for Nicotine Dependence and the AUDIT for evaluating levels of alcohol abuse. RESULTS: The response rate was 30.2% (110/364). Twenty-nine smokers were identified. Among them, 72.5% presented a low level of physical nicotine dependence. Nearly half of them (14/29) were not interested in participating in a smoking cessation intervention with the assistance of relevant hospital staff. Among eleven patients at risk of excessive alcohol abuse, only one accepted to be referred to a specialist. CONCLUSION: This study highlights the difficulties of the systematic screening for addictive behaviours in hospitalized patients. Nevertheless, the obstacles faced in terms of the acceptability of the screening, but the patients as well as by the hospital staff, do not lean against the development of this trend or oppose this type of approach. New methods of individual screening for addictive behaviours should be explored.

Thiosulfate, polythionates and elemental sulfur assimilation and reduction in the bacterial world.

Among sulfur compounds, thiosulfate and polythionates are present at least transiently in many environments. These compounds have a similar chemical structure and their metabolism appears closely related. They are commonly used as energy sources for photoautotrophic or chemolithotrophic microorganisms, but their assimilation has been seldom studied and their importance in bacterial physiology is not well understood. Almost all bacterial strains are able to cleave these compounds since they possess thiosulfate sulfur transferase, thiosulfate reductase or S-sulfocysteine synthase activities. However, the role of these enzymes in the assimilation of thiosulfate or polythionates has not always been clearly established. Elemental sulfur is, on the contrary, very common in the environment. It is an energy source for sulfur-reducing eubacteria and archaebacteria and many sulfur-oxidizing archaebacteria. A phenomenon still not well understood is the 'excessive assimilatory sulfur metabolism' as observed in methanogens which perform a sulfur reduction which exceeds their anabolic needs without any apparent benefit. In heterotrophs, assimilation of elemental sulfur is seldom described and it is uncertain whether this process actually has a physiological significance. Thus, reduction of thiosulfate and elemental sulfur is a common but incompletely understood feature among bacteria. These activities could give bacteria a selective advantage, but further investigations are needed to clarify this possibility. Presence of thiosulfate, polythionates and sulfur reductase activities does not imply obligatorily that these activities play a role in thiosulfate, polythionates or sulfur assimilation as these compounds could be merely intermediates in bacterial metabolism. The possibility also exists that the assimilation of these sulfur compounds is just a side effect of an enzymatic activity with a completely different function. As long as these questions remain unanswered, our understanding of sulfur and thiosulfate metabolism will remain incomplete.