[Consumption of cannabis in adolescents]. / Abus et dépendance au cannabis à l'adolescence : diagnostic.

Over the past 10 years, the consumption of cannabis among adolescents has dramatically increased. Today, adolescent cannabis use is a major public health problem. Two forms of cannabis are commonly smoked: herb (marijuana) and resin. These forms have a high concentration of tetrahydrocannabinol, the active molecule of cannabis. Recent research has helped understand how the cannabinoid system works. This system combines specific receptors and specific molecules: the endocannabinoids. The effects of cannabis use are now well documented. Some adolescents report subjective positive effects. They use it not only on a recreational basis, but also to deal with their emotions. Over the long term, cannabis increases the risk of depression and schizophrenia for those adolescents who are at risk. Use, misuse, and dependence are frequently associated with heavy psychopathologic problems such as vulnerability and depression. Many cannabis dependence psychotherapies have shown their efficacy and efficiency. Motivational interviews, cognitive behavioral therapy, multidimensional family therapy (MDFT), and residential treatment have proved highly effective. MDFT seems very effective, especially in cases of heavy use.

[Increasing trends in screening for addictives behaviors among general practitioners in France]. / Le développement du repérage des pratiques addictives en médecine générale en France.

BACKGROUND: Make an inventory of screening of addictive behaviours among general practice since the end of the 1990s. METHODS: A representative sample of 2,083 general practitioners was surveyed in 2008/2009. They were asked about their prevention practices. RESULTS: Two thirds of the general practitioners (GPs) reported discussing tobacco consumption at least once with each patient. This assessment was less systematic for alcohol (23% of GPs) and cannabis (8% of GPs). Approximatively 70% reported addressing cannabis or alcohol use issues only with patients at risk. One third reported using tobacco smoking screening questionnaires, while there were only 6% in 2003. Only 13% of GPs used alcohol standardized questionnaires, a clear rise since 1998 (1.4% in 1998, 2.0% in 2003). Using alcohol standardized screening tests was more frequent among GPs belonging to a drug addiction network, but no significant link was found with gender, age or area. Only 2% of GPs used cannabis use screening tests. The care for cannabis users seemed particularly linked to the practitioners' inclination to discuss this issue without waiting for a demand arising from the patient. The proportion of practitioners reporting helping patients kick their nicotine addiction in the last seven days proved stable since 2003, after a very significant increase between 1998 and 2003. The proportion of GPs reporting seeing a patient for an alcoholic weaning (52%) was stable since 1998. CONCLUSION: This study illustrates the development of addiction care practices integrating smoking cessation help and, to a more limited extent, screening of alcohol and cannabis abuse, evidenced by the expanded application of standardized questionnaires in general practice. Consideration given to cannabis and alcohol use assessment appeared correlated to GPs feeling at ease with addressing drug use issues, this feeling being linked to their ability to rely on institutional directives or validated screening tools. It seems thus important to encourage the implementation of a health educational approach including early screening and brief intervention during consultation.

[Diagnostic importance of fibronectin in chronic liver diseases]. / Dijagnosticki znacaj fibronektina u hronicnim bolestima jetre.

Plasma fibronectin was determined in 29 patients with decompensated cirrhosis (7 patients had bacterial infection) and 23 patients with malignant liver disease. The obtained values were compared with the fibronectin values in 20 healthy subjects belonging to the control group in order to determine the possible diagnostic value of this dimer glycoprotein of high molecular weight whose role in the organism has not been completely explained. Fibronectin was determined on nephelometer with the use of specific antiserum by Behringwerke. The results expressed as mean values and SD were compared with monofactorial variance analysis (method One-way ANOVA). Fibronectin values in patients with liver cirrhosis were statistically significantly lower than in the control group (p < 0.01), which is also the case with correlation with malignant liver disease (p < 0.01). The fibronectin values in patients with malignant diseases were almost the same as the control group values (p < 0.01). In 7 patients with liver cirrhosis and bacterial infection the fibronectin values were statistically significantly higher in relation to those in the remaining 22 patients with cirrhosis but without bacterial infection (p < 0.001). The investigation in this study indicated that the decrease of mean fibronectin values is related to hepatic failure which is of diagnostic value, while normal values in malignant diseases do not favor the opinion on fibronectin as a tumor marker. Higher fibronectin values in infection in patients with liver cirrhosis are not clear, which indicated the total complexity of the relation between fibronectin as a dimer glycoprotein and chronic liver diseases including malignant.