Risk of suicide attempt and suicide associated with benzodiazepine: A nationwide case crossover study

Background

Previous studies that found an association between benzodiazepines and suicidal behaviours were confounded by indication bias.

Aims

To limit this bias, a case crossover study (CCO) was conducted to estimate the risk of suicide attempt and suicide associated with benzodiazepines.

Method

Patients ≥16 years, with hospitalised suicide attempt or suicide between 2013 and 2016, and at least one benzodiazepine dispensing within the 120 days before their act were selected in the nationwide French reimbursement healthcare system databases (SNDS). For each patient, frequency of benzodiazepine dispensing was compared between a risk period (days −30 to −1 before the event) and two matched reference periods (days −120 to −91, and −90 to −61).

Results

A total of 111,550 individuals who attempted suicide and 12,312 suicide victims were included, of who, respectively, 77,474 and 7958 had recent psychiatric history. Benzodiazepine dispensing appeared higher in the 30-day risk period than in reference ones. The comparison yielded adjusted odds ratios of 1.74 for hospitalised suicide attempt (95% confidence interval 1.69–1.78) and 1.45 for suicide (1.34–1.57) in individuals with recent psychiatric history, and of 2.77 (2.69–2.86) and 1.80 (1.65–1.97) for individuals without.

Conclusion

This nationwide study supports an association between recent benzodiazepine use and both suicide attempt and suicide. These results strengthen the need for screening for suicidal risk carefully before initiation and during treatment when prescribing benzodiazepines. Registration No. EUPAS48070 ( http://www.ENCEPP.eu ).     

The feasibility of implementing Toronto childhood cancer stage guidelines and estimating the impact on outcome for childhood cancers in seven pediatric oncology units in sub-Saharan Africa. A study from the Franco-African Pediatric Oncology Group

Background

The improvement of childhood cancer outcome is determined by early diagnosis, effective treatment, supportive care, and adequate medical follow-up. Stage at diagnosis may reflect timeliness of diagnosis, therefore standardized registration of stage is essential for interpretation of regional differences and time trends in survival. Here, we describe the feasibility of implementing the Toronto Childhood Cancer Stage Guidelines (hereafter Toronto Guidelines [TG]) in the hospital-based cancer registry of the Franco-African Pediatric Oncology Group (GFAOP), and assess the impact of TG stage on outcome in pediatric oncology units (POUs) in seven low- and middle-income countries in sub-Saharan Africa (SSA).

Methods

All cancer patients diagnosed before 15 years of age with one of the 15 cancer types defined in TG, resident in one of the participating countries, and attending one of the selected POUs in 2017–2019 were included. Stage was assigned according to TG. Patients were followed-up for vital status for at least 12 months post diagnosis. Survival at 3, 6, and 12 months was calculated using Kaplan–Meier method and compared between POUs and tumor groups using log-rank test.

Results

TG stage was assigned to 1772 of 2446 (89%) cases diagnosed with one of 11 cancer types. It was not possible to assign TG stage to acute lymphoblastic leukemia (ALL) and the three types of the central nervous system tumors included in the TG. One-year overall survival (OS) was 58% [95% confidence interval: 55–60] and varied between POUs. Survival declined with increasing stage for four tumor types and was statistically significant for two.

Conclusion

Except for ALL and brain tumors, we demonstrated feasibility of TG implementation for childhood solid cancers in participating POUs in SSA, and provided a baseline assessment of childhood cancer outcomes against which future stage distribution and survival can be measured as timelines of diagnosis improve over time within the GFAOP network.     

Design,development and usability of an educational AI chatbot for People with Haemophilia in Senegal

Introduction

Gaps in the disease knowledge of People with Haemophilia (PWH) in Senegal are important barriers to the effective management of haemophilia. Digital health systems for chronic diseases in low- and middle-income countries are suggested to improve education and self-management. Artificial Intelligence (AI) chatbots could improve knowledge and support symptom monitoring.

Aim

Development process and usability testing of an AI chatbot to assess its future adoption in Senegal.

Methods

An AI chatbot prototype was designed based on a multilingual conversational engine using Natural Language Processing. A sequential mixed method was used including a co-creative design process with a task force made up of PWH and medical doctors. Usability was assessed through the System Usability Scale (SUS) questionnaire.

Results

An AI chatbot in French and Wolof, named Saytù Hemophilie, was developed for Android and Apple iOS devices. It was assessed as a very usable system with a SUS score of 81.7, above average. 42% would prefer to use the Wolof version even if they were very satisfied with the French version. The level of Wolof in the app did not always correspond to users’ levels. Participants praised its accessibility and reliability, and its ability to enhance self-learning.

Conclusions

Findings suggest that a culturally adapted digital conversational agent is likely to be used by PWH in Senegal and their families to improve education and self-management of haemophilia. Relevance and impact are foreseen for other communities in Africa and beyond.