Suchergebnisse

Resumé Dans un même service hospitalier, on soigne ensemble toxicomanes, fumeurs de tabac et dépendants à l'alcool.

Abstinence from alcohol has been the prevailing treatment goal for individuals with alcohol dependence (AD) within the context of specialty alcohol treatment. Yet, alcohol use has been conceptualized as existing on a continuum. Importantly, most people who meet criteria for AD and could benefit from treatment never receive treatment. About half of these individuals do not seek treatment because they report a desire to continue drinking. To increase acceptability of treatment, reductions in alcohol consumption have been examined as alternative outcomes in treatment trials for AD. The current study reviews data which indicate that long-term reduction in alcohol consumption among patients with AD is possible. Controlled studies have tested reduced alcohol consumption and show sustained improvements in drinking reductions for many patients following behavioral treatments and pharmacotherapy. Evidence-based treatment guidelines and medicines development guidance authorities have taken note of these developments and accept "intermediate harm reduction" (European Medicines Agency) or "low-risk drinking limits" (US Federal Drug Administration) as optional trial endpoints. In conclusion, while abstinence remains the safest treatment goal for individuals with AD, evidence supports that reduced drinking approaches may be an important extension in the treatment of AD.

Nalmefene is the first drug approved for reduction of alcohol consumption. The aim of this study was to evaluate the clinical relevance of treatment with nalmefene in alcohol-dependent patients with a high drinking risk level from two randomised placebo-controlled 6-month studies (NCT00811720 and NCT00812461). Response criteria were based on alcohol consumption, Clinical Global Impression, and Short Form Health Survey mental component summary scores at month 6, analysed using logistic regression. The proportion of responders was higher in the nalmefene group than in the placebo group with odds ratios significantly in favour of nalmefene for all responder criteria; numbers-needed-to-treat ranged from 6 to 10. Significant differences from placebo in clinician-rated and patient-reported outcomes, and liver enzymes further supported the clinical relevance of the treatment effect. In conclusion, this study supports the clinical relevance of nalmefene treatment in patients with alcohol dependence. Nalmefene may help to reduce the alcohol-related burden and the large treatment gap, with currently less than 10% of alcohol-dependent patients in Europe receiving treatment.

Background Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets. Methods A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded. Results Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries. Conclusions The ...

Abstract Background Despite increasing governmental anti-smoking measures, smoking prevalence remains at a high level in France. Methods The objectives of this panel study were (1) to estimate smoking prevalence in France, (2) to identify smokers' profiles according to their perceptions, attitudes and behaviour in relation to smoking cessation, (3) to determine predictive factors of quit attempts, and (4) to assess tobacco-related behaviours and their evolutions according to the changes in the smokers' environments. A representative sample of French population was defined using the quota method. The identified cohort of smokers was assessed, in terms of smoking behaviour, previous quit attempts, and intention to quit smoking. Results A response rate of 66% for the screening enabled to identify a representative sample of the French population (N = 3 889) comprising 809 current smokers (21%). A majority of current smokers (63%) had made an attempt to quit smoking. Main reasons for having made the last attempt were cost (44%), social pressure (39%), wish to improve physical fitness (36%), fear of a future smoking-related disease (24%), and weariness of smoking (21%). Few attempts (16%) were encouraged by a physician. In those who used some kind of support (38%), NRT was the mostly used. Relapse was triggered by craving (45%), anxiety/stress (34%), a significant life event (21), weight gain (18%), and irritability (16%). Depression was rarely quoted (5%). Forty percent of smokers declared they intended to quit smoking permanently. Main reasons were cost (65%), physical fitness improvement (53%), fear of a future smoking-related disease (43%), weariness of tobacco (34%), and social pressure (30%). Using a smoking cessation treatment was considered by 43% of smokers that intended to quit. Barriers to smoking cessation were mainly fear of increased stress (62%), irritability (51%), and anxiety (42%), enjoying smoking (41%), and weight concerns (33%). Conclusion Smoking prevalence and smoking cessation attempts rate were lower in this survey than in previous reports. Cost and social pressure were the main reasons for quitting smoking, maybe an effect of dramatic tax increases and smoking ban.

Consumo de alcohol; Presión sanguínea; Atención primaria; Recomendaciones ; Consum d'alcohol; Pressió sanguínea; Atenció primària; Recomanacions ; Alcohol use; Blood pressure; Primary healthcare; Recommendations ; Background: Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets. Methods: A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded. Results: Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries. Conclusions: The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation. ; The workshop entitled "Screening and intervention for harmful alcohol use as a tool to improve the management of hypertension in primary care", held on November 12, 2015, in Barcelona, Spain, was financially supported by Lundbeck (in providing travel allowances for some participants). An agenda of the workshop can be found in Additional file 1: Appendix 1.

Abstract

Aims
Two complementary studies were used to assess the real-life use of nalmefene in alcohol-dependent patients and its impact on alcohol use health status.


Methods
USE-PACT was a prospective cohort study designed to evaluate the real-life effectiveness of nalmefene in the management of alcohol dependence, as assessed by total alcohol consumption (TAC) and number of heavy drinking days (HDD) at 1 year. USE-AM was a cohort study using data from the French nationwide claims database and was used to evaluate the external validity of the population in the prospective study.


Results
Overall, 256 of 700 new nalmefene users enrolled in the USE-PACT study had valid data at 1 year. After 1 year, patients treated with nalmefene showed a mean ± SD reduction from baseline in TAC (−41.5 ± 57.4 g/day) and number of HDD (−10.7 ± 11.7 days/4 weeks). Patients took a mean ± SD of 20.0 ± 12.0 tablets/4 weeks (median of 1 tablet/day) for the first 3 months and then reduced the dose. The proportion of patients who no longer took nalmefene gradually increased from 5% at 1 month to 52% at 1 year. The USE-AM study identified 486 patients with a first reimbursement for nalmefene in 2016; baseline characteristics confirmed external validity of the USE-PACT study. Overall, 46.3% of initial USE-AM prescriptions were made by GPs; most (91.8%) patients stopped treatment during follow-up. However, 15.2% of patients resumed treatment after stopping.


Conclusions
In this analysis of French routine practice, patients with alcohol dependence treated with nalmefene showed reduced alcohol consumption, and nalmefene was generally well tolerated.

Rehm, J., Rehm, M. X., Alho, H., Allamani, A., Aubin, H., Bühringerm G,m Daeppen, J., Frick, U., Gual, A., & Heather, N. (2013). Alcohol dependence treatment in the EU: A literature search and expert consultation about the availability and use of guidelines in all EU countries plus Iceland, Norway, and Switzerland. International Journal of Alcohol and Drug Research, 2(2), 53-67. doi:10.7895/ijadr.v2i2.89 (http://dx.doi.org/10.7895/ijadr.v2i2.89)Aim: To describe guidelines and common practices for alcohol dependence treatment in Europe.Design: Systematic and qualitative review; for each country, guidelines were identified via systematic literature research, followed by interviews with treatment experts.Setting: European Union (EU) countries plus Iceland, Norway, and Switzerland.Participants: Experts in alcohol dependence treatments and treatment systems.Measure: Semi-structured questionnaire for interviews.Findings: While fewer than half of EU countries have formal national guidelines for alcohol dependence treatment, a majority of these countries have guidelines by professional organizations such as psychiatric or neuropsychopharmacologic societies, and several are currently developing such guidelines. Abstinence is the usual treatment goal, but the majority of countries accept reduction of drinking as an intermediate or secondary goal, in practice even more than in the guidelines. Psychotherapy, mainly cognitive-behavioral approaches, motivational interviewing, and family therapy, is the most common treatment for relapse prevention, in part accompanied by pharmacotherapy (disulfiram, acamprosate and naltrexone being used most often).Conclusions: There are differences in treatment for alcohol dependence in Europe. The introduction of reduction of drinking as one treatment goal may attract more patients.

D'après l'Organisation mondiale de la santé (OMS), le tabac est actuellementresponsable de près de 5 millions de décès par an dans le monde. Lalutte contre le tabagisme est devenue une priorité de santé publique justifiantles initiatives prises au plan international telles que « Pour un monde sanstabac ». La convention-cadre proposée par l'OMS et adoptée en mai 2003par 47 états invite les pays à prendre des mesures reconnues comme efficaceset de les inscrire dans un cadre législatif (hausses des prix et des taxes,interdiction de la publicité, interdiction de fumer sur les lieux de travail et leslieux publics, campagnes d'éducation et de sensisbilisation, interdiction devente aux mineurs{).Le rapport Tobacco Control Country Profiles (TCCP) rassemblant les donnéesde 196 pays en 2003 met l'accent sur la très forte progression du tabagismedans les pays en développement. Si environ 50 % des décès surviennentactuellement dans les pays riches, 70 % concerneront les pays en développementd'ici 2020. Dans les pays riches, la prévalence du tabagisme masculinest approximativement de 35 % et de 50 % dans les pays en développementet plus de 60 % en Chine. Si le tabagisme suit son rythme actuel, le tabacsera responsable d'un milliard de décès au cours du 21e siècle. La dépendancetabagique touche actuellement 1 milliard d'individus.En France, d'après l'enquête EROPP 20021 près de 12 millions de personnesparmi les 18 à 75 ans sont des fumeurs réguliers, c'est-à-dire qu'ils fument aumoins une cigarette par jour. Le tabagisme est reconnu comme la premièrecause de mortalité évitable. Les données les plus récentes indiquent que letabac est responsable chaque année de 60 000 décès. La prévalence tabagiquechez les jeunes de 18 à 25 ans si l'on considère tous ceux qui déclarent fumerne serait-ce que de temps en temps est proche de 50 %. Ces données justi-fient pleinement la priorité politique française donnée à la lutte anti-tabaccomme celle suscitée au niveau international par l'OMS.La Mission interministérielle de lutte contre la ...

D'après l'Organisation mondiale de la santé (OMS), le tabac est actuellementresponsable de près de 5 millions de décès par an dans le monde. Lalutte contre le tabagisme est devenue une priorité de santé publique justifiantles initiatives prises au plan international telles que « Pour un monde sanstabac ». La convention-cadre proposée par l'OMS et adoptée en mai 2003par 47 états invite les pays à prendre des mesures reconnues comme efficaceset de les inscrire dans un cadre législatif (hausses des prix et des taxes,interdiction de la publicité, interdiction de fumer sur les lieux de travail et leslieux publics, campagnes d'éducation et de sensisbilisation, interdiction devente aux mineurs{).Le rapport Tobacco Control Country Profiles (TCCP) rassemblant les donnéesde 196 pays en 2003 met l'accent sur la très forte progression du tabagismedans les pays en développement. Si environ 50 % des décès surviennentactuellement dans les pays riches, 70 % concerneront les pays en développementd'ici 2020. Dans les pays riches, la prévalence du tabagisme masculinest approximativement de 35 % et de 50 % dans les pays en développementet plus de 60 % en Chine. Si le tabagisme suit son rythme actuel, le tabacsera responsable d'un milliard de décès au cours du 21e siècle. La dépendancetabagique touche actuellement 1 milliard d'individus.En France, d'après l'enquête EROPP 20021 près de 12 millions de personnesparmi les 18 à 75 ans sont des fumeurs réguliers, c'est-à-dire qu'ils fument aumoins une cigarette par jour. Le tabagisme est reconnu comme la premièrecause de mortalité évitable. Les données les plus récentes indiquent que letabac est responsable chaque année de 60 000 décès. La prévalence tabagiquechez les jeunes de 18 à 25 ans si l'on considère tous ceux qui déclarent fumerne serait-ce que de temps en temps est proche de 50 %. Ces données justi-fient pleinement la priorité politique française donnée à la lutte anti-tabaccomme celle suscitée au niveau international par l'OMS.La Mission interministérielle de lutte contre la ...

D'après l'Organisation mondiale de la santé (OMS), le tabac est actuellementresponsable de près de 5 millions de décès par an dans le monde. Lalutte contre le tabagisme est devenue une priorité de santé publique justifiantles initiatives prises au plan international telles que « Pour un monde sanstabac ». La convention-cadre proposée par l'OMS et adoptée en mai 2003par 47 états invite les pays à prendre des mesures reconnues comme efficaceset de les inscrire dans un cadre législatif (hausses des prix et des taxes,interdiction de la publicité, interdiction de fumer sur les lieux de travail et leslieux publics, campagnes d'éducation et de sensisbilisation, interdiction devente aux mineurs{).Le rapport Tobacco Control Country Profiles (TCCP) rassemblant les donnéesde 196 pays en 2003 met l'accent sur la très forte progression du tabagismedans les pays en développement. Si environ 50 % des décès surviennentactuellement dans les pays riches, 70 % concerneront les pays en développementd'ici 2020. Dans les pays riches, la prévalence du tabagisme masculinest approximativement de 35 % et de 50 % dans les pays en développementet plus de 60 % en Chine. Si le tabagisme suit son rythme actuel, le tabacsera responsable d'un milliard de décès au cours du 21e siècle. La dépendancetabagique touche actuellement 1 milliard d'individus.En France, d'après l'enquête EROPP 20021 près de 12 millions de personnesparmi les 18 à 75 ans sont des fumeurs réguliers, c'est-à-dire qu'ils fument aumoins une cigarette par jour. Le tabagisme est reconnu comme la premièrecause de mortalité évitable. Les données les plus récentes indiquent que letabac est responsable chaque année de 60 000 décès. La prévalence tabagiquechez les jeunes de 18 à 25 ans si l'on considère tous ceux qui déclarent fumerne serait-ce que de temps en temps est proche de 50 %. Ces données justi-fient pleinement la priorité politique française donnée à la lutte anti-tabaccomme celle suscitée au niveau international par l'OMS.La Mission interministérielle de lutte contre la ...