How many drinks did you have on September 11, 2001?

OBJECTIVE: This study tested the predictability of error in retrospective self-reports of alcohol consumption on September 11, 2001, among 80 Vermont light, medium and heavy drinkers. METHOD: Subjects were 52 men and 28 women participating in daily self-reports of alcohol consumption for a total of 2 years, collected via interactive voice response technology (IVR). In addition, retrospective self-reports of alcohol consumption on September 11, 2001, were collected by telephone interview 4-5 days following the terrorist attacks. Retrospective error was calculated as the difference between the IVR self-report of drinking behavior on September 11 and the retrospective self-report collected by telephone interview. Retrospective error was analyzed as a function of gender and baseline drinking behavior during the 365 days preceding September 11, 2001 (termed "the baseline"). RESULTS: The intraclass correlation (ICC) between daily IVR and retrospective self-reports of alcohol consumption on September 11 was .80. Women provided, on average, more accurate self-reports (ICC = .96) than men (ICC = .72) but displayed more underreporting bias in retrospective responses. Amount and individual variability of alcohol consumption during the 1-year baseline explained, on average, 11% of the variance in overreporting (r = .33), 9% of the variance in underreporting (r = .30) and 25% of the variance in the overall magnitude of error (r = .50), with correlations up to .62 (r2 = .38). CONCLUSIONS: The size and direction of error were clearly predictable from the amount and variation in drinking behavior during the 1-year baseline period. The results demonstrate the utility and detail of information that can be derived from daily IVR self-reports in the analysis of retrospective error.     

Willingness to receive intravenous buprenorphine treatment in opioid-dependent people refractory to oral opioid maintenance treatment: results from a community-based survey in France

Background

Injectable opioids are an interesting option for people who inject drugs (PWID) that do not respond to oral Opioid Maintenance Treatment (OMT). To date, intravenous (IV) buprenorphine - a safer drug than full-opioid agonists in terms of overdose risk - has never been tested in a clinical trial on opioid dependence. We designed a survey to better understand the profile of PWID eligible for IV buprenorphine, and their willingness to receive it.

Methods

This cross-sectional community-based national survey was conducted through face-to-face interviews (in low-threshold and addiction care services) and online questionnaires (on https://psychoactif.org and other websites). Among the 557 participants, we selected those who were eligible for IV buprenorphine treatment (history of oral OMT, regular opioid injection) (n = 371). We used regression models to study factors associated with willingness to receive IV buprenorphine treatment among those with data on willingness (n = 353). In those who were willing (n = 294), we subsequently studied their willingness to receive daily supervised IV buprenorphine treatment.

Results

Among the selected 353 participants, 59% mainly injected buprenorphine, 15% heroin, 16% morphine sulfate and 10% other opioids. Eighty-three percent of the sample reported willingness to receive IV buprenorphine treatment. Factors associated with willingness were: more than 5 injection-related complications, regular buprenorphine injection, no lifetime overdose, and completion of the questionnaire online. Factors associated with unwillingness to receive daily supervised treatment were younger age (OR[IC95%]=1.04[1.01; 1.07]) and stable housing (OR[IC95%]=0.61[0.37;1.01]) while regular heroin injectors were more willing to receive daily supervision (OR[IC95%]=2.94 [1.42; 6.10]).

Conclusions

PWID were very willing to receive intravenous buprenorphine as a treatment, especially those with multiple injection-related complications. In addition, our findings show that IV buprenorphine may be less acceptable to PWID who inject morphine sulfate. Young PWID and those with stable housing were unwilling to receive IV buprenorphine if daily supervision were required. This preliminary study provides useful information for the development of a clinical trial on IV buprenorphine treatment.

     

Pre-frailty,frailty, and multimorbidity: Prevalences and associated characteristics from two French national surveys

Objective

To estimate the prevalence of pre-frailty, frailty and multimorbidity in individuals without disability in France. To describe independent determinants of each indicators.

Design

Two nationally representative cross-sectional French surveys.

Settings

Wave 2012 of the Health, Health Care and Insurance Survey (Enquête Santé et Protection Sociale, ESPS) and data from the Disability Healthcare Household section Survey (Enquête Handicap Santé–Ménages, HSM) from 2008.

Participants

Two representative samples of the French population aged 55 and older (n=4,328 and n=12,295).

Measurements

Frailty was assessed using Fried’s frailty phenotype and multimorbidity was defined as having had at least two groups of the following groups of comorbidities in the last 12 months (cardio or cerebrovascular disease, diabetes, chronic respiratory disease, arthralgia, depression). Independent determinants were studied using weighted logistic regressions.

Results

In the French population over 55 and free of disability, 55 to 62% of individuals were either frail, pre-frail or multimorbid, 22 to 25% being frail or multimorbid. ESPS and HSM prevalences for frailty (11.1% [9.3%-12.1%] and 12.3% [11.5%-13.0%]) and multimorbidity (14.9% [13.6%-16.2%] and 16.8% [15.9%-17.7%]) were consistent across studies. Both frailty and multimorbidity prevalences were associated with age. On the other hand, pre-frailty prevalence varied consistently between studies (from 38 to 48%) and was not significantly associated with age. We found that more than 60% of frail subjects did not present with multimorbidity and around 70% of subjects with multimorbidity were not frail. Determinants of pre-frailty and multimorbidity but not frailty depended on sex. Similar factors were associated with frailty and multimorbidity in women (older age, functional decline, poor mental health, financial difficulties) while only poor mental health was independently associated with both indicators in men.

Conclusion

Our study highlights that in France, among individuals older than 55 years-old and free of disability, around 25% are either frail or multimorbid; another 30% to 40% being pre-frail. Pre-frailty, frailty and multimorbidity are known to be associated with adverse health outcomes and important economic costs. The health system must adapt to respond to the needs of its aging population. In addition, given the efficient impact of prevention actions, our findings emphasize the need to implement prevention strategies against Frailty and multimorbidity in France.

     

Occupational exposure to indium: what does biomonitoring tell us?

Background

The industrial uses of indium, a rare metal with no known physiological role in humans, have increased dramatically over the past 15 years.The results of animal toxicity studies showing pulmonary and systemic effects as well as some reports in workers have created a growing concern about the possible occurrence of toxic effects in exposed workers. Validated biomarkers to assess exposure to indium are not available.

Objectives

This work aimed at investigating the kinetics of indium in urine (In-U) and plasma (In-Pl) in workers manufacturing In ingots and mainly exposed to hardly water-soluble In compounds. All nine workers from the In department of a large metallurgical concern participated in the study as well as 5 retired workers and 20 controls.

Methods

Personal breathing zone air was collected throughout the work shift on Monday and Friday. Blood and urine samples were collected, before and after the shift, on the same day as the air sampling and on preshift the next Monday after a non-working week-end. Moreover, rats were given either InCl₃ by intraperitoneal injection or In₂O₃ by pharyngeal aspiration, In was followed in plasma during 120 days and measured in tissues 120 days after exposure.

Results

Higher In-Pl and In-U concentrations were found in both current (range 0.32–12.61 μg/L plasma; 0.22–3.50 μg/g creat) and former (0.03–4.38 μg/L plasma; 0.02–0.69 μg/g creat) workers compared with controls (<0.03 μg/L plasma; <0.02 μg/g creat). Both biological parameters were highly correlated but no correlation was found between In-air (10–1030 μg/m³) and In-Pl or In-U. Normalizing In-U by the urinary creatinine concentration reduced the inter- (from 90% to 70%) and intra-individual variability (from 54% to 35%). In-Pl remained remarkably stable along the working week (inter- and intra-individual variability: 89% and 10%, respectively). Neither In-U nor In-Pl significantly increased during the day or the week. A week-end without occupational exposure was not sufficient to reach the background In-Pl and In-U levels measured in controls. The results of the experimental investigations confirmed the hypothesis that inhalation of hardly soluble In compounds may cause accumulation of In in the body leading to a prolonged “endogenous exposure” from both a lung depot of “insoluble” particles that are progressively absorbed and from a retention depot in other internal organs.

Conclusion

This study shows that in workers exposed to hardly soluble In compounds, In-U and In-Pl are very sensitive to detect exposure and mainly reflect long-term exposure. In-Pl levels are particularly stable for a given individual. In-U might be more influenced than In-Pl by recent exposure. Both parameters remained high years after withdrawal from exposure, indicating a possible endogenous exposure and a prolonged risk of pulmonary and systemic diseases even after work exposure has ceased.     

Buprenorphine sniffing as a response to inadequate care in substituted patients: results from the Subazur survey in south-eastern France

Background

Despite the safety profile of buprenorphine, which makes this treatment highly acceptable for many countries, the risk of its diversion raises several public health and drug policy concerns. Although buprenorphine injection has been investigated quite extensively, diversion by sniffing has been overlooked. The Subazur survey gave us the opportunity to identify factors associated with buprenorphine sniffing in patients receiving buprenorphine in primary care.

Methods

We studied a population of 111 stabilized patients receiving office-based buprenorphine in south-eastern France. The design of the study consisted of two longitudinal assessments by phone interviews (at enrolment and 6 months later) detailing patients' socio-demographic characteristics, addictive behaviors, treatment experience and general health status. We used a logistic regression based on generalized estimating equations (GEE) to identify factors associated with buprenorphine sniffing at any interview.

Results

Among the 111 interviewed subjects, 33 (30%) patients reported sniffing buprenorphine after having initiated treatment. After multivariate analysis, 4 variables remained significantly associated with buprenorphine sniffing: not living in a stable relationship, having had only one or no parents during childhood, a history of drug sniffing and dissatisfaction with buprenorphine treatment.

Conclusions

Our findings underline the need to address these patients to appropriate social and mental services as well as diversifying therapeutic options, in order to provide them with adequate care and minimize diversion. The issues highlighted in the study reflect the need for recommendations for physicians prescribing OST in primary care to consider buprenorphine diversion during treatment more as non-adherence behavior than an abuse.     

Quantification of diffuse and focal delta activity in hypsarrhythmia

In order to determine whether or not there is any correlation between the various aspects of hypsarrhythmia and the etiology, we studied one of the major components of this pattern, delta activity, in patients with infantile spasms. In 3 different etiologic groups of patients (prenatal, perinatal and cryptogenic) we divided this activity into 2 types: diffuse (DSA) and focal slow activity (FSA). These two activities were quantified in 3 consecutive minute periods of wakefulness, drowsiness and slow sleep. The mean values of DSA and FSA remained unchanged during the 3 consecutive minute periods and in the different stages of vigilance. DSA and FSA differed significantly according to the etiology, with a predominance of DSA in the cryptogenic group and of FSA in the prenatal group. DSA was not correlated with either sex or age. The focal component seems to be related to brain lesions, whereas the diffuse component appears to be as a stereotyped neurophysiological phenomenon independent of brain lesions, sex or age.     

Nonconvulsive status epilepticus: Epilepsy Research Foundation workshop reports.

In April 2004, a group of physicians with an interest in nonconvulsive status epilepticus representing a spectrum of opinion met in Oxford, sponsored by the Epilepsy Research Foundation (a charitable organization), to discuss and debate the definition, diagnosis and treatment of nonconvulsive status epilepticus. We felt that such a meeting would be useful, as nonconvulsive status epilepticus is a subject that provokes strong reactions, perhaps largely due to the relative lack of evidence and the surfeit of opinion. The meeting was arranged such that there were formal talks followed by a discussion led by one of the attendees. We present here the extended abstracts of the main talks with the points raised by the discussants. Despite disagreements on certain issues there was much in the way of consensus. First, it was agreed that nonconvulsive status epilepticus is a term that covers a range of disparate conditions with varying prognoses and treatments. The agreed definition was thus suitably vague, A. Secondly, it was agreed that even within a specific condition (e.g. complex partial status epilepticus), the prognosis and treatment depends upon the context in which the condition occurs (e.g. in the critically ill, in coma, in the A and in people with prior epilepsy). Perhaps, most importantly it was agreed that we lacked good clinical data, and the challenge was to design good studies for a condition that is underrecognised and often difficult to diagnose.