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1.
Soins Psychiatr ; 45(351): 20-25, 2024.
Artigo em Francês | MEDLINE | ID: mdl-38527868

RESUMO

The majority of teenagers benefit from scientific advances, whether pharmacological or technological, but the most vulnerable use them to their detriment. While only certain substances or activities are potentially "addictive", the psyche, personality and environment play a major role in the onset of an addiction. Pleasure-seeking motivates gambling and drug use. Suffering will drive the adolescent to pursue this practice, which provides pleasure and relief, to the detriment of any other activity. It becomes exclusive, toxic and alienating. The therapist must rise to the challenge.


Assuntos
Comportamento Aditivo , Jogo de Azar , Transtornos Relacionados ao Uso de Substâncias , Humanos , Adolescente , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos da Personalidade , Prazer
2.
J Public Health (Oxf) ; 45(3): e400-e408, 2023 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-37169578

RESUMO

BACKGROUND: Research evidence shows a strong association between adverse childhood experiences (ACEs) and later-life substance use. But little is known about the prevalence and impact of ACEs among young people using drugs (YPUD) in Vietnam. METHOD: A cross-sectional study using respondent-driven sampling and peer recruitment methods was conducted among YPUD aged 16-24 in three cities in Vietnam. Eligible participants were screened for ACEs using the ACE-IQ, tested for HIV and hepatitis C, and assessed for sociodemographic and behavioral characteristics. RESULTS: Data were collected on 553 individuals whose median age was 20: 79% were male, 18.3% women and 2.7% transgender. Methamphetamine use was reported by 75.8% of participants. 85.5% reported at least one ACE and 27.5% had four ACEs or more. An ACE score of 4 or higher was associated with female and transgender, lower educational level, methamphetamine use, buying sex, depression, psychotic symptoms and expressed need for mental health support. CONCLUSIONS: ACEs were found to be very common among YPUD in Vietnam. It is therefore strongly recommended that these young people should be provided with a comprehensive and secure assessment and care that includes not only essential harm reduction and addiction treatment needs but also addresses their mental health needs.


Assuntos
Experiências Adversas da Infância , Metanfetamina , Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Estudos Transversais , Vietnã/epidemiologia , Saúde Mental , Metanfetamina/efeitos adversos
3.
Rev Med Suisse ; 19(816): 401-405, 2023 Mar 01.
Artigo em Francês | MEDLINE | ID: mdl-36876389

RESUMO

Chronic renal failure (CRF) during pregnancy increases the risk of fetomaternal complications such as preeclampsia, premature delivery and, above all, a deterioration of renal function. A multidisciplinary preconceptional assessment is necessary in this complex clinical situation. Progress in neonatal resuscitation and a better understanding of the pathophysiological mechanisms of autoimmune nephropathy have improved the prognosis of these high-risk pregnancies. This article provides an overview of the issues related to the follow-up of pregnant women with renal disease. It summarizes the glomerular and hemodynamic physiological changes during pregnancy, the fetal and maternal risk, and the adaptation of antihypertensive and immunosuppressive drug treatments.


La présence d'une insuffisance rénale chronique (IRC) lors d'une grossesse augmente le risque de complications fœto-maternelles, comme une prééclampsie, un accouchement prématuré et surtout une péjoration de la fonction rénale. Un bilan préconceptionnel multidisciplinaire permet d'optimiser une situation clinique complexe. Les progrès de la réanimation néonatale et une meilleure compréhension des mécanismes physiopathologiques des néphropathies auto-immunes permettent une amélioration du pronostic de ces grossesses à risque. Cet article donne une vue d'ensemble des problématiques liées au suivi des femmes enceintes souffrant d'une maladie rénale. Il résume les modifications physiologiques glomérulaires et hémodynamiques durant la grossesse, le risque fœto-maternel ainsi que l'adaptation des traitements médicamenteux antihypertenseurs et immunosuppresseurs.


Assuntos
Falência Renal Crônica , Insuficiência Renal Crônica , Feminino , Humanos , Recém-Nascido , Gravidez , Anti-Hipertensivos , Família , Ressuscitação
4.
Kidney Int ; 101(5): 874-877, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35461613

RESUMO

The progression of chronic kidney disease is difficult to stop once established. Metformin and sodium-glucose cotransporter 2 inhibitors show promise, but clinical trials with a head-to-head comparison in patients with more advanced (stage 3b-4) chronic kidney disease are largely lacking, partly for safety reasons. In this issue, Corremans et al. compare the effects of metformin and canagliflozin in rats with adenine-induced moderate (stage 2-4) chronic kidney disease. Metformin halted progression, whereas canagliflozin did not. This commentary puts the results in a wider clinical context.


Assuntos
Metformina , Insuficiência Renal Crônica , Inibidores do Transportador 2 de Sódio-Glicose , Animais , Feminino , Humanos , Masculino , Ratos , Canagliflozina/efeitos adversos , Hipoglicemiantes/efeitos adversos , Metformina/farmacologia , Metformina/uso terapêutico , Insuficiência Renal Crônica/induzido quimicamente , Insuficiência Renal Crônica/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
5.
Harm Reduct J ; 17(1): 13, 2020 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-32093700

RESUMO

INTRODUCTION: The aim of this study is to identify the profiles of young people who use drugs (YPUD) and their exposure to HIV risks in the 3 main cities of Vietnam, Haiphong, Hanoi, and Ho Chi Minh City (HCMC), in order to design a community-based intervention to prevent HIV. METHODS: A survey using respondent-driven sampling (RDS) was conducted among YPUD aged 16-24. Participants were eligible if they reported drug use, confirmed by a urine test. After obtaining informed consent, they were screened for HIV/HCV and assessed using face-to-face questionnaires and self-report. A cluster analysis was conducted, taking into account risk behaviors and confirmed HIV-positive status. RESULTS: Seven hundred and three YPUD aged 16-24 were recruited between October 2016 and February 2017, 584 of whom were included in the final analysis. Median age was 21 (17.7, 23.0); 79% were male, 18% female, and 2% transgender. Methamphetamines use was reported by 77%, followed by cannabis (51%) and heroin (17%); polydrug use was common; 15% had "ever" injected drugs. HIV prevalence was 7%. Among all participants, 48% reported non-consistent condom use and 1% reported needle/syringe sharing during the previous month. Four distinct profiles of HIV risk behaviors were identified: The high multiple-risk group mixed unsafe drug use with unsafe sexual practices and had higher prevalence of HIV; the second group practiced high-risk sex with non-consistent condom combined with methamphetamine use; the third group was a moderate-risk group with limited unsafe sexual practices; and the fourth was considered at "low-risk" as reportedly, most never had sex and never injected. The highest risk group included more female YPUD, living in HCMC, who used heroin and had unsafe sex with their regular partners. The second high-risk group included most of the MSM and all transgender people and frequently reported mental health disorders. CONCLUSIONS: The profiles of YPUD who are at risk of HIV vary according to age, location, and population group. Injecting YPUD are the most exposed to risk and need immediate attention. Sexual exposure to HIV is very common. Mental health is a major concern. Interventions need to be integrated in a differentiated but holistic approach.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Sexo sem Proteção/estatística & dados numéricos , Adolescente , Adulto , Análise por Conglomerados , Comorbidade , Feminino , Humanos , Masculino , Assunção de Riscos , População Urbana/estatística & dados numéricos , Vietnã/epidemiologia , Adulto Jovem
6.
Rev Med Suisse ; 15(653): 1132-1139, 2019 May 29.
Artigo em Francês | MEDLINE | ID: mdl-31148425

RESUMO

Hemodialysis (HD) centers are facing an increasing number of patients with diabetes. These cases require an intensive multidisciplinary approach of the consequences of renal failure, glycemic control and nutrition and the management of frequent co-morbidities, in particular the diabetic foot. A major challenge is to decrease glycemic variability and the risk of hypoglycemia. Because of increased risk of hypoglycemia-associated mortality, the HbA1C target is loosened in the majority of HD patients. Continuous glucose monitoring technology has identified important glycemic fluctuations during and after dialysis. However, their reliability in HD needs to be improved. New therapeutic pathways that decrease glucose excursions and hypoglycemia, such as GLP1 receptor agonists and sensor-coupled insulin pumps, have yet to be validated in HD.


Les centres d'hémodialyse (HD) sont confrontés à un nombre croissant de patients diabétiques. Leur prise en charge multidisciplinaire tient compte de l'insuffisance rénale, du contrôle glycémique, de la nutrition et des comorbidités fréquentes, en particulier le pied diabétique. La réduction de la variabilité glycémique et des hypoglycémies qui sont associées à une mortalité accrue reste un défi. La cible de l'HbA1C est assouplie chez la majorité des patients. L'usage du contrôle en continu de la glycémie permet d'identifier les fluctuations glycémiques per et interdialytiques importantes. Sa fiabilité doit cependant être améliorée en HD. Les nouvelles voies thérapeutiques qui diminuent les excursions glycémiques et le risque d'hypoglycémie comme les GLP1 agonistes et les pompes à insuline couplées aux sensors restent à valider en HD.


Assuntos
Complicações do Diabetes , Falência Renal Crônica , Diálise Renal , Glicemia , Automonitorização da Glicemia , Complicações do Diabetes/terapia , Diabetes Mellitus/tratamento farmacológico , Hemoglobinas Glicadas , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Reprodutibilidade dos Testes
7.
Rev Med Suisse ; 13(551): 450-456, 2017 Feb 22.
Artigo em Francês | MEDLINE | ID: mdl-28714645

RESUMO

Extra-renal complications of autosomal dominant polycystic kidney disease (ADPKD) are often unrecognized. Liver cysts are usually benign, but may cause chronic pain, may interfere with nutrition and may necessitate partial liver resection or even liver transplant. Somatostatin analogs may be an alternative therapy. Cerebral aneurisms are rare, but devastating. They must be investigated in case of positive familial history. Cardiac valvulopathies will be searched for by echocardiography. Abdominal wall herniae are often identified during the physical exam in ADPKD patients. ADPKD patients may present with higher incidence of diverticulitis. Cysts of the seminal vesicle are frequent but are usually asymptomatic. Recognizing extra-renal complications helps improving the overall survival of ADPKD patients.


Cet article porte sur les atteintes extrarénales de la maladie polykystique autosomique dominante et leur prise en charge. Les kystes hépatiques sont souvent bénins, mais peuvent devenir invalidants, mener à une dénutrition et nécessiter des mesures chirurgicales allant jusqu'à la transplantation hépatique. Les analogues de la somatostatine sont une alternative thérapeutique. Les anévrismes cérébraux, plus rares, nécessitent un dépistage systématique par l'anamnèse familiale. Les valvulopathies cardiaques seront recherchées par échographie. Les hernies de la paroi abdominale sont souvent associées à la polykystose. Les patients atteints de polykystose peuvent présenter une incidence accrue de diverticulite. Les kystes des vésicules séminales sont fréquents, mais en général asymptomatiques.


Assuntos
Rim Policístico Autossômico Dominante/complicações , Cistos/etiologia , Cardiopatias/etiologia , Humanos , Hepatopatias/etiologia , Doenças Vasculares/etiologia
9.
BMC Psychiatry ; 14: 26, 2014 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-24485347

RESUMO

BACKGROUND: US-based trials have shown that Multidimensional Family Therapy (MDFT) not only reduces substance abuse among adolescents, but also decreases mental and behavioural disorder symptoms, most notably externalising symptoms. In the INCANT trial, MDFT decreased the rate of cannabis dependence among Western European youth. We now focus on other INCANT outcomes, i.e., lessening of co-morbidity symptoms and improvement of family functioning. METHODS: INCANT was a randomised controlled trial comparing MDFT with individual therapy (IP) at and across sites in Berlin, Brussels, Geneva, The Hague, and Paris. We recruited 450 boys and girls aged 13 up to 18 years with a cannabis use disorder, and their parent(s), and followed them for 12 months. Mental and behavioural characteristics (classified as 'externalising' or 'internalising') and family conflict and cohesion were assessed. RESULTS: From intake through 12 months, MDFT and IP groups improved on all outcome measures. Models including treatment, site, and referral source showed that MDFT outperformed IP in reducing externalising symptoms.Adolescents were either self-referred to treatment (mostly on the initiative from people close to the teen) or referred under some measure of coercion by an external authority. These two groups reacted equally well to treatment. CONCLUSIONS: Both MDFT and IP reduced the rate of externalising and internalising symptoms and improved family functioning among adolescents with a cannabis use disorder. MDFT outperformed IP in decreasing the rate of externalising symptoms. Contrary to common beliefs among therapists in parts of Western Europe, the 'coerced' adolescents did at least as well in treatment as the self-referred adolescents.MDFT shows promise as a treatment for both substance use disorders and externalising symptoms. TRIAL REGISTRATION ISRNCT: ISRCTN51014277.


Assuntos
Relações Familiares , Terapia Familiar/métodos , Abuso de Maconha/terapia , Adolescente , Cannabis , Europa (Continente) , Feminino , Humanos , Masculino , Abuso de Maconha/psicologia , Pais , Resultado do Tratamento
10.
Rev Med Suisse ; 10(441): 1668-72, 2014 Sep 10.
Artigo em Francês | MEDLINE | ID: mdl-25322626

RESUMO

Hypertension is a frequent finding in patients with chronic kidney disease. Whether primary or secondary to renal disease, hypertension remains an important risk factory for the progression of chronic kidney disease and the occurrence of cardiovascular events. The objective of this paper is to review different treatment strategies in hypertensive CKD patients, with the exclusion of patients with renal replacement therapy such as dialysis or renal transplantation.


Assuntos
Hipertensão/complicações , Hipertensão/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Dieta , Humanos , Insuficiência Renal Crônica/fisiopatologia , Sistema Renina-Angiotensina/efeitos dos fármacos
11.
Nordisk Alkohol Nark ; 41(3): 326-345, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38903888

RESUMO

Aims: Harmful patterns of alcohol consumption, such as binge drinking, are prevalent among the student population at universities. Despite the risks of this behaviour, few secondary prevention programmes have been created to meet the specific needs of this population. The PEERCARE programme is a peer-based prevention programme that seeks harm reduction for alcohol overuse in party environments, among other goals. To do so, a "chill-out" space is created by peer educators in party environments to limit the risks associated with alcohol overuse. This study sought to examine peer educators' experience with a chill-out space to identify their specific actions, difficulties and needs, and to consider possibilities for improvement. Methods: Nine engineering students from one French grandes écoles campus trained as peer educators (six men and three women; mean age 21 years) participated. Semi-structured interviews were used for data collection. Results: The thematic analysis showed that the peer educators were highly engaged with this programme in response to alcohol overuse on their campus. The chill-out space was lauded for its non-judgemental and non-moralising nature. In addition, the numerous risk reduction activities that were enacted confirmed the benefits of these spaces during parties. The peer educators' experience was positive, and acting as managers of the chill-out space seemed to answer to a sense of competence recognitiontion. Conclusion: This study confirms the relevance of utilising chill-out spaces during parties and provides preliminary data on the deployment and management of peer-led chill-out space approaches. Expanding the implementation of such spaces to more educational institutions is recommended.

12.
J Pharmacol Exp Ther ; 346(2): 281-9, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23697346

RESUMO

Chronic renal failure (CRF) is associated with the development of secondary hyperparathyroidism and vascular calcifications. We evaluated the efficacy of PA21, a new iron-based noncalcium phosphate binder, in controlling phosphocalcic disorders and preventing vascular calcifications in uremic rats. Rats with adenine-diet-induced CRF were randomized to receive either PA21 0.5, 1.5, or 5% or CaCO3 3% in the diet for 4 weeks, and were compared with uremic and nonuremic control groups. After 4 weeks of phosphate binder treatment, serum calcium, creatinine, and body weight were similar between all CRF groups. Serum phosphorus was reduced with CaCO3 3% (2.06 mM; P ≤ 0.001), PA21 1.5% (2.29 mM; P < 0.05), and PA21 5% (2.21 mM; P ≤ 0.001) versus CRF controls (2.91 mM). Intact parathyroid hormone was strongly reduced in the PA21 5% and CaCO3 3% CRF groups to a similar extent (1138 and 1299 pg/ml, respectively) versus CRF controls (3261 pg/ml; both P ≤ 0.001). A lower serum fibroblast growth factor 23 concentration was observed in the PA21 5%, compared with CaCO3 3% and CRF, control groups. PA21 5% CRF rats had a lower vascular calcification score compared with CaCO3 3% CRF rats and CRF controls. In conclusion, PA21 was as effective as CaCO3 at controlling phosphocalcic disorders but superior in preventing the development of vascular calcifications in uremic rats. Thus, PA21 represents a possible alternative to calcium-based phosphate binders in CRF patients.


Assuntos
Compostos Férricos/uso terapêutico , Falência Renal Crônica/tratamento farmacológico , Calcificação Vascular/prevenção & controle , Adenina , Animais , Aorta/efeitos dos fármacos , Aorta/patologia , Pressão Sanguínea/efeitos dos fármacos , Cálcio/sangue , Carbonato de Cálcio/uso terapêutico , Fatores de Crescimento de Fibroblastos/sangue , Frequência Cardíaca/efeitos dos fármacos , Falência Renal Crônica/induzido quimicamente , Falência Renal Crônica/patologia , Masculino , Hormônio Paratireóideo/sangue , Fósforo/sangue , Ratos , Ratos Wistar , Calcificação Vascular/patologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-37107872

RESUMO

In French Grandes Écoles, heavy alcohol consumption seems to be generalized and largely tolerated, leading to particular concerns about Alcohol Use Disorder and harmful alcohol practices among students. The COVID-19 pandemic led to increased psychological difficulties, and two coexisting scenarios seemed to emerge regarding alcohol consumption: A decrease in alcohol consumption linked to the absence of festive events, and an increase in solitary alcohol consumption to cope with lockdowns. The aim of this exploratory study is to investigate the evolution of alcohol consumption, consumption motives and the relationship of these factors to the anxiety and the depression of French Grandes Écoles students during the COVID-19 pandemic, depending on their residential status. After the last lockdown, 353 students completed a questionnaire measuring alcohol consumption, motivation to drink, anxiety and depression during and after the COVID-19 period. Although students confined to campus were more likely to increase their alcohol use, they also presented higher well-being scores than those who lived off campus. A significant proportion of students were aware of their increased alcohol use due to the COVID-19 pandemic, and the motives attributed to their increased consumption highlight the need for vigilance and specialized support facilities.


Assuntos
COVID-19 , Pandemias , Humanos , COVID-19/epidemiologia , Adaptação Psicológica , Controle de Doenças Transmissíveis , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Ansiedade/epidemiologia , Ansiedade/psicologia , Estudantes/psicologia , Motivação , Universidades
14.
Eur Addict Res ; 18(4): 193-200, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22472963

RESUMO

The present study aims at validating the Cannabis Abuse Screening Test (CAST) in a clinical sample of adolescent and young adult cannabis users seeking treatment. Applying a classical test theory approach using DSM-IV diagnoses as gold standard, two versions of the CAST questionnaire are compared. The sample consisted of 140 subjects aged 15-26 years (mean 18.9) recruited from two cannabis treatment centers. Gold standard diagnoses were assessed using the Adolescent Diagnostic Interview-Light. Internal structure and consistency of the CAST were assessed by principal component analysis and Cronbach's α. Optimal thresholds were defined using receiver operating characteristic analysis. Both the binary and the full test version revealed unidimensional structures with moderate to satisfactory internal consistency (α = 0.66 and 0.73). Screening properties were unsatisfactory when the CAST was compared against cannabis dependence. With regard to cannabis use disorders, both test versions yielded comparable and good sensitivity and specificity at cut-off 3 (binary: 92.2%, 66.7%) and 6 (full: 93.0%, 66.7%). Overall, the full CAST may be used for screening cannabis use disorders in clinical settings. Further research may use validation methods that do without gold standard.


Assuntos
Pacientes Internados , Abuso de Maconha/diagnóstico , Inquéritos e Questionários/normas , Adolescente , Adulto , Feminino , Humanos , Masculino , Abuso de Maconha/psicologia , Programas de Rastreamento , Psicometria , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Centros de Tratamento de Abuso de Substâncias , Adulto Jovem
15.
BMC Psychiatry ; 11: 110, 2011 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-21749677

RESUMO

BACKGROUND: MDFT (Multidimensional Family Therapy) is a family based outpatient treatment programme for adolescent problem behaviour. MDFT has been found effective in the USA in adolescent samples differing in severity and treatment delivery settings. On request of five governments (Belgium, France, Germany, the Netherlands, and Switzerland), MDFT has now been tested in the joint INCANT trial (International Cannabis Need of Treatment) for applicability in Western Europe. In each of the five countries, study participants were recruited from the local population of youth seeking or guided to treatment for, among other things, cannabis use disorder. There is little information in the literature if these populations are comparable between sites/countries or not. Therefore, we examined if the study samples enrolled in the five countries differed in baseline characteristics regarding demographics, clinical profile, and treatment delivery setting. METHODS: INCANT was a multicentre phase III(b) randomized controlled trial with an open-label, parallel group design. It compared MDFT with treatment as usual (TAU) at and across sites in Berlin, Brussels, Geneva, The Hague and Paris.Participants of INCANT were adolescents of either sex, from 13 through 18 years of age, with a cannabis use disorder (dependence or abuse), and at least one parent willing to take part in the treatment. In total, 450 cases/families were randomized (concealed) into INCANT. RESULTS: We collected data about adolescent and family demographics (age, gender, family composition, school, work, friends, and leisure time). In addition, we gathered data about problem behaviour (substance use, alcohol and cannabis use disorders, delinquency, psychiatric co-morbidity).There were no major differences on any of these measures between the treatment conditions (MDFT and TAU) for any of the sites. However, there were cross-site differences on many variables. Most of these could be explained by variations in treatment culture, as reflected by referral policy, i.e., participants' referral source. We distinguished 'self-determined' referral (common in Brussels and Paris) and referral with some authority-related 'external' coercion (common in Geneva and The Hague). The two referral types were more equally divided in Berlin. Many cross-site baseline differences disappeared when we took referral source into account, but not all. CONCLUSIONS: A multisite trial has the advantage of being efficient, but it also carries risks, the most important one being lack of equivalence between local study populations. Our site populations differed in many respects. This is not a problem for analyses and interpretations if the differences somehow can be accounted for. To a major extent, this appeared possible in INCANT. The most important factor underlying the cross-site variations in baseline characteristics was referral source. Correcting for referral source made most differences disappear. Therefore, we will use referral source as a covariate accounting for site differences in future INCANT outcome analyses. TRIAL REGISTRATION NUMBER: ISRCTN: ISRCTN51014277.


Assuntos
Comportamento do Adolescente/psicologia , Terapia Familiar/estatística & dados numéricos , Cooperação Internacional , Abuso de Maconha/epidemiologia , Abuso de Maconha/psicologia , Adolescente , Comorbidade , Demografia/estatística & dados numéricos , Europa (Continente)/epidemiologia , Terapia Familiar/métodos , Feminino , Humanos , Masculino , Abuso de Maconha/terapia , Encaminhamento e Consulta/estatística & dados numéricos
16.
BMC Psychiatry ; 10: 28, 2010 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-20380718

RESUMO

BACKGROUND: In 2003, the governments of Belgium, France, Germany, the Netherlands and Switzerland agreed that there was a need in Europe for a treatment programme for adolescents with cannabis use disorders and other behavioural problems. Based on an exhaustive literature review of evidence-based treatments and an international experts meeting, Multidimensional Family Therapy (MDFT) was selected for a pilot study first, which was successful, and then for a joint, transnational randomized controlled trial named INCANT (INternational CAnnabis Need for Treatment). METHODS/DESIGN: INCANT is a randomized controlled trial (RCT) with an open-label, parallel group design. This study compares MDFT with treatment as usual (TAU) at and across sites in Brussels, Berlin, Paris, The Hague and Geneva. Assessments are at baseline and at 3, 6, 9 and 12 months after randomization. A minimum of 450 cases in total is required; sites will recruit 60 cases each in Belgium and Switzerland, and a maximum of 120 each in France, Germany and the Netherlands.Eligible for INCANT are adolescents from 13 through 18 years of age with a cannabis use disorder (dependence or abuse), with at least one parent willing to take part in the treatment. Randomization is concealed to, and therefore beyond control by, the researcher/site requesting it. Randomization is stratified as to gender, age and level of cannabis consumption.Assessments focus on substance use; mental function; behavioural problems; and functioning regarding family, school, peers and leisure time.For outcome analyses, the study will use state of the art latent growth curve modelling techniques, including all randomized participants according to the intention-to-treat principle.INCANT has been approved by the appropriate ethical boards in Belgium, France, Germany, the Netherlands, Switzerland, and the University of Miami Miller School of Medicine. INCANT is funded by the (federal) Ministries of Health of Belgium, Germany, the Netherlands, Switzerland, and by MILDT: the Mission Interministerielle de Lutte Contra la Drogue et de Toximanie, France. DISCUSSION: Until recently, cannabis use disorders in adolescents were not viewed in Europe as requiring treatment, and the co-occurrence of such disorders with other mental and behavioural problems was underestimated. This has changed now.Initially, there was doubt that a RCT would be feasible in treatment sectors and countries with no experience in this type of study. INCANT has proven that such doubts are unjustified. Governments and treatment sites from the five participating countries agreed on a sound study protocol, and the INCANT trial is now underway as planned. TRIAL REGISTRATION: ISRCTN51014277.


Assuntos
Terapia Familiar/métodos , Cooperação Internacional , Abuso de Maconha/terapia , Adolescente , Adulto , Lista de Checagem , Terapia Cognitivo-Comportamental/métodos , Serviços Comunitários de Saúde Mental/métodos , Comparação Transcultural , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Abuso de Maconha/epidemiologia , Projetos Piloto , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Projetos de Pesquisa , Inquéritos e Questionários , Resultado do Tratamento
17.
Nat Commun ; 11(1): 721, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024848

RESUMO

Myo-inositol hexakisphosphate (IP6) is a natural product known to inhibit vascular calcification (VC), but with limited potency and low plasma exposure following bolus administration. Here we report the design of a series of inositol phosphate analogs as crystallization inhibitors, among which 4,6-di-O-(methoxy-diethyleneglycol)-myo-inositol-1,2,3,5-tetrakis(phosphate), (OEG2)2-IP4, displays increased in vitro activity, as well as more favorable pharmacokinetic and safety profiles than IP6 after subcutaneous injection. (OEG2)2-IP4 potently stabilizes calciprotein particle (CPP) growth, consistently demonstrates low micromolar activity in different in vitro models of VC (i.e., human serum, primary cell cultures, and tissue explants), and largely abolishes the development of VC in rodent models, while not causing toxicity related to serum calcium chelation. The data suggest a mechanism of action independent of the etiology of VC, whereby (OEG2)2-IP4 disrupts the nucleation and growth of pathological calcification.


Assuntos
Fosfatos de Inositol/química , Fosfatos de Inositol/farmacologia , Calcificação Vascular/tratamento farmacológico , 6-Fitase/metabolismo , Adenina/efeitos adversos , Animais , Células Cultivadas , Avaliação Pré-Clínica de Medicamentos/métodos , Difusão Dinâmica da Luz , Etilenoglicol/química , Humanos , Injeções Subcutâneas , Fosfatos de Inositol/farmacocinética , Masculino , Músculo Liso Vascular/citologia , Músculo Liso Vascular/efeitos dos fármacos , Ratos Sprague-Dawley , Uremia/tratamento farmacológico , Uremia/fisiopatologia , Calcificação Vascular/induzido quimicamente , Difração de Raios X
18.
Rev Med Suisse ; 5(192): 457-8, 460-2, 2009 Feb 25.
Artigo em Francês | MEDLINE | ID: mdl-19317312

RESUMO

Tobacco consumption is a major public health problem. More than 20 years ago smoking has been identified to contribute substantially to the degradation of renal function in patients suffering from diabetic nephropathy. Recently it has been shown that smoking alters renal hemodynamics and contributes to albuminuria. Smoking increases the risk of progression of renal failure in patients suffering from IgA nephropathy and polycystic kidney disease. Furthermore smoking has a deleterious effect on patients on hemodialysis and on the transplanted kidney. Nonetheless, it is important to realize that smoking not only is deleterious for the progression of vascular and pulmonary diseases, but also has a strong negative effect on kidney function.


Assuntos
Nefropatias/etiologia , Fumar/efeitos adversos , Albuminúria/etiologia , Progressão da Doença , Humanos
19.
J Behav Addict ; 8(3): 537-553, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31537087

RESUMO

BACKGROUND AND AIMS: The aim of this study was to evaluate the effects of a prevention intervention on French adolescents' Internet and video games use and on their beliefs concerning gaming and Internet Gaming Disorder (IGD), in order to adjust prevention programs further. METHODS: The study comprised a prevention intervention group (PIG) and a control group assessed at three times - baseline, post-test, and 4-month follow-up. At baseline, a total of 434 junior high adolescents from five secondary schools were assessed (Mage = 13.2 years; SD = 0.5). The main outcome measures were adolescents' gaming and Internet use (amount of time spent during the week and the weekend), the number of adolescents with IGD, and beliefs about gaming and IGD. RESULTS: The results showed significant effects of the prevention intervention on Internet and gaming use (at T2, time spent was significantly lower in the PIG), an important increase of IGD prevalence between baseline and follow-up in the control group, and decreased rates of IGD among adolescents in the PIG between post-intervention and follow-up. Between baseline and follow-up, the control group showed a more significant increase of minutes per day during the week and the weekend on Internet versus during the week on video games. The impact of the prevention intervention on adolescents' beliefs varied according to gender. Girls had a better understanding generally of the potential dangers of and reasons for IGD. DISCUSSION: Implications for future research and prevention approaches are discussed in this study.


Assuntos
Comportamento do Adolescente , Comportamento Aditivo/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Internet , Psicoterapia de Grupo/métodos , Tempo de Tela , Jogos de Vídeo , Adolescente , Feminino , Seguimentos , Humanos , Masculino , Fatores de Tempo , Resultado do Tratamento
20.
Artigo em Inglês | MEDLINE | ID: mdl-31861283

RESUMO

Among adolescents, heavy video game use and socializing online may be valued socially by peers, depending on gender and age, which can increase life satisfaction. However, heavy video gaming may also be linked to symptoms of Internet Gaming Disorder, which can decrease life satisfaction. Overall, when symptoms of Internet Gaming Disorder are present, do subjects experience decreased or increased life satisfaction, all other things being equal? The aim of this study was to explore the association between Internet Gaming Disorder symptoms and life satisfaction, while controlling for gender, age, and other conditions that may impact life satisfaction. More than 2000 adolescents filled out an anonymous questionnaire at school, and 43 patients in a care center filled out the same questionnaire. Sociodemographic characteristics, family life conditions, use of screens (videos, video games, and social networks), mental health screenings, and a life satisfaction measure were collected. Distribution of participants' characteristics was provided, and stratified multivariate analyses by young male, older male, young female, and older female school populations were carried out. Results suggested that Internet Gaming Disorder symptoms had similar prevalence before and after the age of 15 in males (21% vs. 19%) and in females (6% vs. 7%) respectively and was significantly associated with decreased life satisfaction in older males, even after adjusting for parental support, depression, and economic conditions. Associations between symptoms of Internet Gaming Disorder and life satisfaction may be different depending on adolescent gender and age group.


Assuntos
Comportamento Aditivo/epidemiologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/epidemiologia , Satisfação Pessoal , Jogos de Vídeo/estatística & dados numéricos , Adolescente , Criança , Transtornos Disruptivos, de Controle do Impulso e da Conduta/etiologia , Feminino , Humanos , Internet , Masculino , Paris/epidemiologia , Prevalência , Adulto Jovem
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