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McKendrick G, Davis W, Sklar M, Brown N, Pattillo E, Finan PH, Antoine D, Walters V, Dunn KE. The IMPOWR Network Divided or Single Exposure Study (DOSE) Protocol: A Randomized Controlled Comparison of Once Versus Split Dosing of Methadone for the Treatment of Comorbid Chronic Pain and Opioid Use Disorder. Subst Use Addctn J 2024:29767342241239167. [PMID: 38528704 DOI: 10.1177/29767342241239167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND The Divided or Single Exposure (DOSE) trial is a double-blind, placebo-controlled examination of once versus split dosing of methadone for comorbid pain and opioid use disorder (OUD) among persons receiving methadone for OUD treatment. METHODS This multisite trial consists of a 12-week active intervention phase and 6-month follow-up period. Persons receiving methadone who endorse clinically-significant chronic pain are randomized into once-daily dosing or split dosing that is managed remotely via an electronic pillbox. Clinical pain is assessed weekly and using ecological momentary assessments. Experimentally-evoked pain is assessed using a quantitative sensory testing battery. Additional outcomes related to OUD, including withdrawal and craving, are also collected. RESULTS The study hypothesizes that persons assigned to the split dosing condition will report lower pain and opioid withdrawal relative to persons assigned to the traditional once-daily dosing strategy. CONCLUSIONS Split dosing is a relatively common technique in OUD treatments; therefore, if data support this hypothesis, there is high potential for implementation.
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Affiliation(s)
| | - Will Davis
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Michael Sklar
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Nicole Brown
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Emma Pattillo
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Patrick H Finan
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Denis Antoine
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Vickie Walters
- Institute for Behavior Resources, Inc., REACH Health Services, Baltimore MD, USA
| | - Kelly E Dunn
- Johns Hopkins University School of Medicine, Baltimore MD, USA
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Adams LB, Watts T, DeVinney A, Haroz EE, Thrul J, Stephens JB, Campbell MN, Antoine D, Lê Cook B, Joe S, Thorpe RJ. Acceptability and Feasibility of a Smartphone-Based Real-Time Assessment of Suicide Among Black Men: Mixed Methods Pilot Study. JMIR Form Res 2024; 8:e48992. [PMID: 38252475 PMCID: PMC10845025 DOI: 10.2196/48992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Suicide rates in the United States have increased recently among Black men. To address this public health crisis, smartphone-based ecological momentary assessment (EMA) platforms are a promising way to collect dynamic, real-time data that can help improve suicide prevention efforts. Despite the promise of this methodology, little is known about its suitability in detecting experiences related to suicidal thoughts and behavior (STB) among Black men. OBJECTIVE This study aims to clarify the acceptability and feasibility of using smartphone-based EMA through a pilot study that assesses the user experience among Black men. METHODS We recruited Black men aged 18 years and older using the MyChart patient portal messaging (the patient-facing side of the Epic electronic medical record system) or outpatient provider referrals. Eligible participants self-identified as Black men with a previous history of STB and ownership of an Android or iOS smartphone. Eligible participants completed a 7-day smartphone-based EMA study. They received a prompt 4 times per day to complete a brief survey detailing their STB, as well as proximal risk factors, such as depression, social isolation, and feeling like a burden to others. At the conclusion of each day, participants also received a daily diary survey detailing their sleep quality and their daily experiences of everyday discrimination. Participants completed a semistructured exit interview of 60-90 minutes at the study's conclusion. RESULTS In total, 10 participants completed 166 EMA surveys and 39 daily diary entries. A total of 4 of the 10 participants completed 75% (21/28) or more of the EMA surveys, while 9 (90%) out of 10 completed 25% (7/28) or more. The average completion rate of all surveys was 58% (20.3/35), with a minimum of 17% (6/35) and maximum of 100% (35/35). A total of 4 (40%) out of 10 participants completed daily diary entries for the full pilot study. No safety-related incidents were reported. On average, participants took 2.08 minutes to complete EMA prompts and 2.72 minutes for daily diary surveys. Our qualitative results generally affirm the acceptability and feasibility of the study procedures, but the participants noted difficulties with the technology and the redundancy of the survey questions. Emerging themes also addressed issues such as reduced EMA survey compliance and diminished mood related to deficit-framed questions related to suicide. CONCLUSIONS Findings from this study will be used to clarify the suitability of EMA for Black men. Overall, our EMA pilot study demonstrated mixed feasibility and acceptability when delivered through smartphone-based apps to Black men. Specific recommendations are provided for managing safety within these study designs and for refinements in future intervention and implementation science research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/31241.
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Affiliation(s)
- Leslie B Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Thomasina Watts
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Aubrey DeVinney
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emily E Haroz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | | | - Mia N Campbell
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Denis Antoine
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Benjamin Lê Cook
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, United States
| | - Sean Joe
- George Warren Brown School of Social Work, Washington University at St. Louis, St. Louis, MO, United States
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Dunn KE, Huhn AS, Finan PH, Mange A, Bergeria CL, Maher BS, Rabinowitz JA, Strain EC, Antoine D. Polymorphisms in the A118G SNP of the OPRM1 gene produce different experiences of opioids: A human laboratory phenotype-genotype assessment. Addict Biol 2024; 29:e13355. [PMID: 38221808 PMCID: PMC10898793 DOI: 10.1111/adb.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/31/2023] [Accepted: 10/16/2023] [Indexed: 01/16/2024]
Abstract
Allelic variations in the A118G SNP of the OPRM1 gene change opioid signaling; however, evaluations of how allelic differences may influence opioid effects are lacking. This human laboratory paradigm examined whether the AA versus AG/GG genotypes determined opioid response profiles. Individuals with limited opioid exposure (N = 100) completed a five-day within-subject, double-blind, placebo-controlled, residential study. Participants were admitted (Day 1), received 4 mg hydromorphone (Day 2) and 0 mg, 2 mg and 8 mg hydromorphone in randomized order (Days 3-5) and completed self-reported visual analog scale (VAS) ratings and Likert scales, observed VAS, and physiological responses at baseline and for 6.5 h post-dose. Outcomes were analysed as peak/nadir effects over time as a function of genotype (available for N = 96 individuals; AG/GG = 13.5%, AA = 86.4%). Participants with AG/GG rated low and moderate doses of hydromorphone as significantly more positive (e.g., Good Effects VAS, coasting, drive, friendly, talkative, stimulation) with fewer negative effects (e.g., itchy skin, nausea, sleepiness), and were also observed as being more talkative and energetic relative to persons with AA. Persons with AG/GG were less physiologically reactive as determined by diastolic blood pressure and heart rate, but had more changes in core temperature compared with those with AA. Persons with AA also demonstrated more prototypic agonist effects across doses; persons with AG/GG showed limited response to 2 mg and 4 mg. Data suggest persons with AG/GG genotype experienced more pleasant and fewer unpleasant responses to hydromorphone relative to persons with AA. Future studies should replicate these laboratory findings in clinical populations to support a precision medicine approach to opioid prescribing.
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Affiliation(s)
- Kelly E. Dunn
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Andrew S. Huhn
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Patrick H. Finan
- Department of AnesthesiologyUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Ami Mange
- Yale School of MedicineNew HavenConnecticutUSA
| | - Cecilia L. Bergeria
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Brion S. Maher
- Department of Mental HealthJohns Hopkins University School of Public HealthBaltimoreMarylandUSA
| | - Jill A. Rabinowitz
- Department of Mental HealthJohns Hopkins University School of Public HealthBaltimoreMarylandUSA
| | - Eric C. Strain
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Denis Antoine
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Bergeria CL, Tan H, Antoine D, Weerts EM, Huhn AS, Hobelmann JG, Dunn KE. A double-blind, randomized, placebo-controlled, pilot clinical trial examining buspirone as an adjunctive medication during buprenorphine-assisted supervised opioid withdrawal. Exp Clin Psychopharmacol 2023; 31:194-203. [PMID: 35266779 PMCID: PMC11000212 DOI: 10.1037/pha0000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Successful management of opioid withdrawal improves long-term treatment outcomes and reduces opioid use-related morbidity and mortality. Mechanistically supported pharmacotherapeutic approaches are needed to effectively manage acute and protracted opioid withdrawal. Buspirone is a D2 antagonist and 5-HT1a agonist that may decrease opioid withdrawal. Individuals (n = 15) admitted to a residential treatment center for opioid use disorder (OUD) were enrolled into a double-blind randomized clinical trial to assess the efficacy and acceptability of buspirone (45 mg/day) as an adjunctive medication to buprenorphine-assisted, supervised opioid withdrawal. Participants completed daily questionnaires which consisted of the Subjective Opiate Withdrawal Scale (SOWS) and a consensus sleep diary, which assessed total sleep time, time to sleep onset, and sleep quality. Total SOWS scores, individual opioid withdrawal symptoms and sleep outcomes were assessed between treatment groups (Placebo and Buspirone) and over time in a repeated measures linear mixed model. Total SOWS scores significantly decreased across study phases for both groups but decreased to a greater extent among individuals assigned to buspirone during both the first and second week of stable buspirone. Greater decreases in withdrawal were observed during Week 2 of stable buspirone relative to Week 1 of stable buspirone. Participants also reported significant increases in sleep duration and significant decreases in latency to sleep onset. This study provides further support that buspirone can help mitigate opioid withdrawal during a supervised opioid taper. Buspirone may confer unique benefits during protracted withdrawal periods. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Cecilia L Bergeria
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Hongjun Tan
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Denis Antoine
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Elise M Weerts
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Andrew S Huhn
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - J Gregory Hobelmann
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Kelly E Dunn
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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5
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Tassey TE, Ott GE, Alvanzo AAH, Peirce JM, Antoine D, Buresh ME. OUD MEETS: A novel program to increase initiation of medications for opioid use disorder and improve outcomes for hospitalized patients being discharged to skilled nursing facilities. J Subst Abuse Treat 2022; 143:108895. [PMID: 36215913 DOI: 10.1016/j.jsat.2022.108895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/09/2022] [Accepted: 09/20/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Rates of hospitalizations from medical complications of opioid use disorder (OUD) are rising and many of these patients require post-acute care at skilled nursing facilities (SNFs). However, access to medication for OUD (MOUD) at SNFs remains low and patients with OUD have high rates of patient-directed discharge (PDD) and hospital readmissions. METHODS Opioid Use Disorder Medical Patient Engagement, Enrollment in treatment and Transitional Supports (OUD MEETS) program was a clinical pilot designed to increase initiation of buprenorphine and methadone for hospitalized patients with OUD requiring post-acute care. The program comprises a hospital partnership with two SNFs and two opioid treatment programs (OTPs) to improve recovery supports and access to MOUD for patients discharged to SNF. RESULTS Between August 2019 and August 2020, study staff approached 49 hospitalized patients with OUD for participation in OUD MEETS. Twenty-eight of 30 eligible patients enrolled in the program and initiated buprenorphine or methadone. Twenty-seven (96 %) enrolled patients successfully completed hospital treatment. Twenty-three (85 %) patients successfully completed medical treatment at SNF. Thirteen (46 %) enrolled patients had confirmed linkage to OUD treatment post-SNF. One patient left the hospital (4 %) and four patients left SNF (15 %) via PDD. CONCLUSION OUD MEETS demonstrates feasibility of hospital, SNF, and OTP partnership to integrate MOUD treatment into SNFs, with high rates of completion of medical treatment and low rates of PDD. Future research should find sustainable ways to improve access to MOUD at post-acute care facilities, including through regulatory and policy changes.
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Affiliation(s)
- Theresa E Tassey
- Behavioral Health Systems Baltimore, Baltimore, MD, United States of America
| | - Geoffrey E Ott
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Anika A H Alvanzo
- Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America; Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Jessica M Peirce
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Denis Antoine
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Megan E Buresh
- Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
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6
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Speed TJ, Hanks L, Turner G, Gurule E, Kearson A, Buenaver L, Smith MT, Antoine D. A comparison of cognitive behavioral therapy for insomnia to standard of care in an outpatient substance use disorder clinic embedded within a therapeutic community: a RE-AIM framework evaluation. Trials 2022; 23:965. [DOI: 10.1186/s13063-022-06885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Rates of substance use disorders (SUDs) continue to rise in the USA with parallel rises in admissions to outpatient SUD treatment programs. Insomnia symptoms reduce treatment adherence, trigger relapse, and generally undermine SUD recovery efforts. Cognitive-behavioral therapy for insomnia (CBT-I) is the first-line treatment recommended for chronic insomnia. No study has examined the effectiveness of CBT-I for individuals who recently entered an outpatient SUD treatment program embedded within a therapeutic community (i.e., long-term drug-free residential setting).
Methods
A randomized controlled trial conducted at a SUD program embedded in a therapeutic community aimed to compare group-based CBT-I (gCBT-I) (N = 10) with the standard of care (SOC) (N = 11) among individuals who have SUDs and comorbid insomnia. We present a RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework evaluation to provide empirical data on gCBT-I feasibility and facilitators and barriers of conducting an insomnia-focused clinical effectiveness study within a therapeutic community.
Results
Participants in both study arms reported moderately severe insomnia symptoms at admission and reductions in insomnia symptoms over time. Among participants who completed the Insomnia Severity Index (ISI) beyond admission, ISI decreased to ≤ 8 (the clinical cutoff for mild insomnia) in 80% of individuals in the gCBT-I group compared with 25% of individuals in the SOC group. A RE-AIM framework evaluation showed initial success with Reach and Adoption while Implementation, and Maintenance were limited. Effectiveness was inconclusive because of challenges with recruitment, intervention integrity, and missing data that precluded meeting the planned recruitment and study aims and led to study termination. Coordination and communication with staff and leadership facilitated gCBT-I implementation, yet well-known CBT-I barriers including time- and resource-intensive sleep medicine training for interventionalists and maintenance of treatment integrity during an 8-week intervention limited gCBT-I sustainability.
Conclusions
This analysis supports the feasibility of conducting behavioral sleep medicine research in outpatient SUD treatment programs embedded within therapeutic communities. Implementation of an insomnia-focused intervention was widely accepted by patients and providers and has potential to address insomnia symptoms in early SUD recovery. Addressing patient- and organizational-level implementation barriers may enhance the sustainability and scalability of sleep interventions and provide new hope to effectively treat insomnia among people living with SUDs.
Trial registration
Clinicaltrials.gov: NCT03208855. Registered July 6, 2017https://clinicaltrials.gov/ct2/show/NCT03208855?term=NCT03208855&draw=2&rank=1
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7
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Sweeney MM, Prichett L, Fingerhood MI, Antoine D, Umbricht A, Dunn KE, Buresh ME. Buprenorphine treatment retention and comorbidities among patients with opioid use disorder in a primary care setting. Am J Addict 2022; 31:256-260. [PMID: 35385169 PMCID: PMC9117419 DOI: 10.1111/ajad.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES: More information is needed about comorbidities among patients receiving buprenorphine maintenance treatment and their relationship with retention. METHODS: Retrospective electronic health record data over a 5-year period from primary care patients receiving buprenorphine for the treatment of opioid use disorder were examined (N = 899). The present analysis determined the prevalence of comorbidities and examined associations with treatment retention as defined by cumulative duration of buprenorphine prescription. RESULTS: Tobacco use and comorbidities including hypertension were prevalent but did not predict retention according to survival analyses controlling for demographic characteristics. Retention was poorer among patients testing positive for cocaine (HR = 1.38, 95% CI: 1.09-1.74, p = .007) and patients with hepatitis C virus (HR = 1.17, 95% CI: 1.01-1.37, p = .04). CONCLUSION AND SCIENTIFIC SIGNIFICANCE: This study provides new knowledge of previously unexamined associations between comorbidities (e.g., hypertension) and buprenorphine treatment retention. The robust association between cocaine use and poorer buprenorphine retention serves to resolve prior conflicting data in the literature.
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Affiliation(s)
- Mary M Sweeney
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura Prichett
- Department of Pediatrics, Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael I Fingerhood
- Department of Medicine, Division of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Denis Antoine
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Annie Umbricht
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly E Dunn
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Megan E Buresh
- Department of Medicine, Division of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Huhn AS, Brooner RK, Sweeney MM, Antoine D, Hammond AS, Ayaz H, Dunn KE. The association of prefrontal cortex response during a natural reward cue-reactivity paradigm, anhedonia, and demoralization in persons maintained on methadone. Addict Behav 2021; 113:106673. [PMID: 33022538 PMCID: PMC7736228 DOI: 10.1016/j.addbeh.2020.106673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/27/2020] [Accepted: 09/19/2020] [Indexed: 12/23/2022]
Abstract
Persons with opioid use disorder (OUD) often experience anhedonia and demoralization, yet there is relatively little research on the pathophysiology of anhedonia and demoralization in OUD treatment and recovery. In the current study, persons maintained on methadone (N = 29) underwent a natural reward-cue paradigm during functional near-infrared spectroscopy (fNIRS) imaging. Natural reward cues included highly palatable food, positive social interactions (e.g., a happy family at the dinner table), and emotional intimacy (e.g. couples embracing or kissing, but no erotic images). Participants also self-reported symptoms of anhedonia on the Snaith-Hamilton Pleasure Scale (SHPS) and demoralization on the Demoralization Scale II (DS-II). Participants who reported clinically-significant anhedonia on the SHPS displayed decreased neural activity in the right prefrontal cortex (PFC) in response to natural reward cues (F(1,25) = 3.612, p = 0.027, ηp2 = 0.302). In linear regression models of positive social cues, decreased neural activity in the right VMPFC was associated with increased SHPS total score (F(1,27) = 7.131, R2 = 0.209, p = .013), and decreased neural activity in an area encompassing the right lateral VMPFC and DLPFC was associated with increased DS-II total score (F(1,27) = 10.641, R2 = 0.283, p = 0.003). This study provides initial evidence that the prefrontal cortex is involved in the pathophysiology of anhedonia and demoralization in persons in recovery from OUD. Anhedonia and demoralization are important treatment outcomes that should be queried along with a constellation of physical and mental health outcomes, to assess areas of needed improvement in methadone maintenance and other OUD treatment modalities.
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Affiliation(s)
- Andrew S Huhn
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States.
| | - Robert K Brooner
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Mary M Sweeney
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Denis Antoine
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Alexis S Hammond
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
| | - Hasan Ayaz
- Drexel University, School of Biomedical Engineering, Science and Health Systems, United States; Drexel University, College of Arts and Sciences, Department of Psychology, United States; University of Pennsylvania, Department of Family and Community Health, United States; Children's Hospital of Philadelphia, Center for Injury Research and Prevention, United States
| | - Kelly E Dunn
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States
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Antoine D, Huhn AS, Strain EC, Turner G, Jardot J, Hammond AS, Dunn KE. Method for Successfully Inducting Individuals Who Use Illicit Fentanyl Onto Buprenorphine/Naloxone. Am J Addict 2020; 30:83-87. [PMID: 32572978 DOI: 10.1111/ajad.13069] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/25/2020] [Accepted: 06/07/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Individuals exposed to fentanyl are at risk of precipitated withdrawal using typical buprenorphine/naloxone induction procedures. METHODS This case series describes buprenorphine/naloxone inductions of four individuals who tested positive for fentanyl. RESULTS Buprenorphine-precipitated withdrawal was observed in two individuals who completed a conventional buprenorphine/naloxone induction strategy. Two more individuals completed a revised buprenorphine/naloxone induction strategy that did not precipitate withdrawal. DISCUSSION AND CONCLUSION Using multiple 2 mg doses of buprenorphine/naloxone in patients already in mild/moderate withdrawal improved outcomes. SCIENTIFIC SIGNIFICANCE Persons who use illicit fentanyl might be less likely to experience precipitated withdrawal from this revised buprenorphine/naloxone induction strategy. (Am J Addict 2021;30:83-87).
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Affiliation(s)
- Denis Antoine
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gavin Turner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jasmyne Jardot
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexis S Hammond
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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10
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Galera O, Antoine D, Soukarie L, Huet I, Bajon D. [Smoking cessation: Overcoming "nicotinophobia" in patients … and prescribers?]. Presse Med 2019; 48:1368-1369. [PMID: 31822337 DOI: 10.1016/j.lpm.2019.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- O Galera
- Clinique de rééducation cardio-vasculaire et pulmonaire de Saint-Orens, 12, avenue de Revel, 31650 Saint-Orens de Gameville, France.
| | - D Antoine
- Clinique de rééducation cardio-vasculaire et pulmonaire de Saint-Orens, 12, avenue de Revel, 31650 Saint-Orens de Gameville, France.
| | - L Soukarie
- Clinique de rééducation cardio-vasculaire et pulmonaire de Saint-Orens, 12, avenue de Revel, 31650 Saint-Orens de Gameville, France.
| | - I Huet
- Clinique de rééducation cardio-vasculaire et pulmonaire de Saint-Orens, 12, avenue de Revel, 31650 Saint-Orens de Gameville, France.
| | - D Bajon
- Clinique de rééducation cardio-vasculaire et pulmonaire de Saint-Orens, 12, avenue de Revel, 31650 Saint-Orens de Gameville, France.
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Cooper C, Coleman J, Irvin N, Lee A, Antoine D. Personal trauma among healthcare providers: implications for screening practices. Women Health 2019; 60:570-584. [PMID: 31665985 DOI: 10.1080/03630242.2019.1683122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Screening rates for trauma are low in health care settings. We examined the association between health care providers' (HCPs) experience of physical or sexual trauma and their screening of female patients for trauma. HCPs at an urban academic medical institution were surveyed from September through November 2016. The Brief Trauma (BTQ) and Sexual and Physical Abuse History Questionnaires (SPAHQ) assessed their own experiences of trauma. The Screening Practices Questionnaire (SPQ) assessed HCPs trauma screening. Multiple regression analyses were performed. Among 212 respondents aged 22-67 years, most were female (78.3%) and white (76.1%). Nurses (41.0%) were the largest occupational group. Overall, 85.8% reported having experienced trauma. No significant difference was observed in median SPQ scores between HCPs who had experienced trauma (3.88 [Interquartile Range (IQR) 3.44-4.31]) and those who had not (4.00 [IQR 3.47-4.33], p = .645). In an adjusted model, screening policy awareness and having an obstetrics & gynecology or psychiatry specialty were associated with higher SPQ scores (p < .001). The prevalence of trauma experience in this sample was high, but not associated with screening. Screening policy awareness and practice specialty were associated with screening. HCP factors associated with greater trauma screening should be explored.
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Affiliation(s)
- Conisha Cooper
- Department of Psychiatry, UCLA Medical Center, Los Angeles, California, USA
| | - Jenell Coleman
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Nathan Irvin
- Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Amy Lee
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Denis Antoine
- Department of Psychiatry, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Frey P, Hosu I, Akret C, Irles D, Antoine D. Dysfonction de prothèses cardiaques implantables soumises à la radiothérapie : résultats d’une étude prospective monocentrique. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Morales Trejo A, Antoine D, Valle-Fimbres A, Bernal Barragán H, Camacho L, Cervantes Ramírez M. 172 Feed intake level and ambient temperature affect the body temperature of pigs exposed to heat stress. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - D Antoine
- UABC,Mexicali, Baja California, Mexico
| | | | | | - L Camacho
- Autonomous University of Baja California,Mexicali, Mexico
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Abstract
Chronic pain (CP) and opioid use disorder (OUD) remain challenging complex public health concerns. This is an updated review on the relationship between CP and OUD and the use of stepped care models for assessment and management of this vulnerable population. A literature search was conducted from 2008 to the present in PubMed, Embase, and PsycInfo using the terms pain or chronic pain and opioid-related disorders, opiate, methadone, buprenorphine, naltrexone, opioid abuse, opioid misuse, opioid dependen*, heroin addict, heroin abuse, heroin misuse, heroin dependen*, or analgesic opioids, and stepped care, integrated services, multidisciplinary treatment, or reinforcement-based treatment. Evidenced-based data exists on the feasibility, implementation, and efficacy of stepped care models in primary care settings for the management of CP and opioid use. Although these studies did not enroll participants with OUD, they included a sub-set of patients at risk for the development of OUD. There remains a dearth of treatment options for those with comorbid CP and OUD. Future research is needed to explore the aetiology and impact of CP and OUD, and greater emphasis is needed to improve access to comprehensive pain and substance use programmes for high-risk individuals.
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Affiliation(s)
- Traci J Speed
- a Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Vinay Parekh
- a Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - William Coe
- a Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Denis Antoine
- a Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Ollier V, Antoun F, Thouvenin G, Faye A, Kone-Paut I, Benoist G, Antoine D, Charlois C, Delacourt C. Potentially preventable tuberculosis cases in children exposed to a contaminant case. Arch Pediatr 2018; 25:421-425. [DOI: 10.1016/j.arcped.2018.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/11/2018] [Accepted: 07/23/2018] [Indexed: 11/16/2022]
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Lefèvre E, Rolland LG, Vincent A, Renaud S, Alexandre K, Antoine D, Eric R, Ludovic D, Noëlle PM, Alfred M. Résultats au long cours de la transplantation rénale pour une vascularite associée aux ANCA : une analyse de 39 patients. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Antoine D, Heffernan S, Chaudhry A, King V, Strain EC. Age and gender considerations for technology-assisted delivery of therapy for substance use disorder treatment: A patient survey of access to electronic devices. Addict Disord Their Treat 2017; 15:149-156. [PMID: 28503100 DOI: 10.1097/adt.0000000000000088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Technology-assisted treatment (TAT) can be an effective supplement to established face-to-face therapy modalities with a growing literature in substance use disorder (SUD) treatment. TAT access, interest, and familiarity are potential limitations to the use and efficacy of these approaches to treatment. METHODS 174 participants in outpatient SUD treatment were administered a survey regarding technology device and Internet access, and interest in engaging in TAT SUD counseling (SUDC). The group was dichotomized by mean age and gender to examine potential variations in in these subgroups. RESULTS Forty-three (43%) of participants were female, and the mean age was 44.8 years, and 89% of participants had Internet access. 83% of participants were interested in TAT for SUD counseling; 81% expected it to be at least "moderately helpful." 34% of participants noted they would choose to continue face-to-face therapy exclusively. 91% of participants had cell phones, but only 50% could access data or the Internet via their handheld device. 80% of participants stated they would be interested in trying SUDC via their phone. Women had a higher preference for computer-based SUDC than men, with gender being significantly correlated with TAT perceive helpfulness. CONCLUSION These findings suggest that patients in outpatient SUD treatment have access to resources for TAT implementation, although access was not always readily available. Future research will be needed to determine whether the technology that this population possesses will be able to support the evolving TAT modalities and whether interest in TAT across age and gender groups equalizes over time.
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Affiliation(s)
- Denis Antoine
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sean Heffernan
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amina Chaudhry
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Van King
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric C Strain
- Johns Hopkins University School of Medicine, Baltimore, MD
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Harris CM, Cheskin LJ, Khaliq W, Antoine D, Landis R, Steinberg EM, Wright S. Hospitalists' utilization of weight loss resources with discharge texts and primary care contact: a feasibility study. Hosp Pract (1995) 2016; 44:98-102. [PMID: 26882132 DOI: 10.1080/21548331.2016.1155396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Obesity affects a large proportion of the U.S. population, and hospitalizations may serve as an opportunity to promote weight loss. We sought to determine if multidisciplinary patient-centered inpatient weight loss intervention that included counseling, consults, post-discharge telephone text messages, and primary care follow up was feasible. METHODS We conducted a feasibility study focusing on 25 obese hospitalized patients to understand the issues related to rolling out an intensive intervention. Actual weight loss was a secondary outcome and we compared these 25 patients to 28 control patients who were exposed to usual care; weight change was assessed at 1 and 6 months. RESULTS Ninety-six percent (24/25) of nutritional consults and 92% (23/25) of physical therapy consults were submitted by hospital providers. All of these doctors were also reminded to counsel their patients about the detrimental health consequences. Fifty-two percent (13/25) and 40% (10/25) were actually seen and counseled by nutrition and physical therapy services respectively, before being discharged. Sixty-eight percent (17/25) received a motivational interviewing counseling session from the principal investigator. All patients were sent text messages and followed with their primary care provider after discharge who received the personalized weight loss discharge instructions that had been given to the patient. The feasibility group lost a mean of 3.0 kg at 6 months and the control group gained an average of 0.20 kg at 6 months post discharge (p = 0.03). CONCLUSION Executing a multifaceted weight loss intervention for hospitalized obese patients is feasible, and there may be associated persistent improvements in weight status over time.
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Affiliation(s)
- Ché Matthew Harris
- a Divisions of General Internal Medicine , Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center , Baltimore , MD , USA
| | - Lawrence J Cheskin
- a Divisions of General Internal Medicine , Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center , Baltimore , MD , USA
| | - Waseem Khaliq
- a Divisions of General Internal Medicine , Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center , Baltimore , MD , USA
| | - Denis Antoine
- b Division of Psychiatry , Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center , Baltimore , MD , USA
| | - Regina Landis
- a Divisions of General Internal Medicine , Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center , Baltimore , MD , USA
| | - Emma M Steinberg
- c University of California , San Francisco School of Medicine , San Francisco , CA , USA
| | - Scott Wright
- a Divisions of General Internal Medicine , Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center , Baltimore , MD , USA
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Gaskell H, Sharma P, Colley H, Murdoch C, Antoine D, Sathish J, Williams D, Webb S. Development and characterisation of a functional 3D liver spheroid model. Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Vliegenthart B, Scullion K, Oosthuyzen W, Antoine D, Park K, Webb D, Dhaun N, Dear J. Circulating miRNAs as potential biomarker for acute endothelial toxicity. Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Girard D, Antoine D, Che D. Epidemiology of pulmonary tuberculosis in France. Can the hospital discharge database be a reliable source of information? Med Mal Infect 2015; 44:509-14. [PMID: 25455077 DOI: 10.1016/j.medmal.2014.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/05/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In France, tuberculosis surveillance is based on mandatory notification (MN) of cases. However, the MN does not allow the full description of cases, and underreporting limits data interpretation. Aiming at better describing the cases of tuberculosis, the hospital record database (PMSI) was analyzed. PATIENTS AND METHOD Incident cases of active pulmonary tuberculosis identified in 2010 in France in the PMSI were included and their characteristics were compared with those of the cases identified through the MN. RESULTS In 2010, 5158 incident cases of pulmonary tuberculosis were identified in the PMSI. The mean duration of hospitalization was higher for cases considered contagious — at least one positive test result on pulmonary sample — (22 vs 13 days, P < 0.001). Among all cases, 5% were infected by HIV. Death was reported for 4% of cases. The number of pulmonary TB cases reported in the MN was 3781 in 2010. PMSI data by sex, region of residence and month of diagnosis were similar with those of the MN but patients were older in the PMSI (52 vs 47 years, P < 0.001). Considering the PMSI as exhaustive, sensitivity of the MN was estimated at 73.3% in 2010. CONCLUSION PMSI data were compatible with those of the MN and the estimation of the sensitivity was close to other French studies. PMSI can be considered as an interesting tool aiming at improving our knowledge about tuberculosis (TB) cases and strengthening awareness where the sensitivity of the MN is low.
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Affiliation(s)
- D Girard
- Institut de veille sanitaire, 12, rue du Val-d’Osne, 94415 Saint Maurice cedex, France
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Affiliation(s)
- M J van der Werf
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - D Antoine
- Institut de Veille Sanitaire, Saint Maurice, France
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Van Bui T, Lévy-Bruhl D, Che D, Antoine D, Jarlier V, Robert J. Impact of the BCG vaccination policy on tuberculous meningitis in children under 6 years in metropolitan France between 2000 and 2011. ACTA ACUST UNITED AC 2015; 20. [PMID: 25811645 DOI: 10.2807/1560-7917.es2015.20.11.21064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In France, Bacillus Calmette–Guérin (BCG) vaccination by multipuncture device was withdrawn in 2006. In 2007, universal mandatory BCG vaccination was replaced by vaccination of high-risk children. To evaluate the impact of these changes on tuberculous meningitis (TBM) epidemiology, data on culture-positive and culture-negative (or unknown microbiological result) TBM in ≤5 years olds were collected from 2000–2011. Ten culture-positive and 17 culture-negative TBM cases were identified, with an annual incidence rate ranging from 0.16 to 0.66 cases per 10 million inhabitants. The average annual numbers of TBM cases were 2.7 and 1.8 from 2000–2005 and 2006–2011, respectively. In Ile-de-France where all children are considered at risk, the overall incidence rates were 1.14 and 0.29 per million for the two periods. In other regions where only at-risk children are vaccinated since 2007, rates were 0.30 and 0.47, respectively. None of these differences were significant. Annual incidence rates for each one year age group cohort were comparable before and after changes. Childhood TBM remains rare in France. No increase in incidence was observed after changes in BCG vaccination strategy. Ongoing surveillance should be maintained, as a slight increase in TBM in the coming years remains possible, in the context of suboptimal vaccination coverage of high-risk children.
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Affiliation(s)
- T Van Bui
- Sorbonne Universites, UPMC Univ Paris 06, CR7, Centre d Immunologie et des Maladies Infectieuses, CIMI, Team E13 (Bacteriology), Paris, France
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24
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Guglielmetti L, Veziris N, Bernard C, Martin D, Sougakoff W, Raskine L, Antoine D, Tattevin P, Andrejak C, Jarlier V, Robert J. Registre électronique pour la prise en charge, le suivi et la surveillance des cas de tuberculose à bacilles multi-résistants en France. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2014.10.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Barnay JL, Wauquiez G, Bonnin-Koang HY, Anquetil C, Pérennou D, Piscicelli C, Lucas-Pineau B, Muja L, le Stunff E, de Boissezon X, Terracol C, Rousseaux M, Bejot Y, Binquet C, Antoine D, Devilliers H, Benaim C. Feasibility of the cognitive assessment scale for stroke patients (CASP) vs. MMSE and MoCA in aphasic left hemispheric stroke patients. Ann Phys Rehabil Med 2014; 57:422-35. [PMID: 24953703 DOI: 10.1016/j.rehab.2014.05.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 05/20/2014] [Accepted: 05/21/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Post-stroke aphasia makes it difficult to assess cognitive deficiencies. We thus developed the CASP, which can be administered without using language. Our objective was to compare the feasibility of the CASP, the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) in aphasic stroke patients. MATERIAL AND METHODS All aphasic patients consecutively admitted to seven French rehabilitation units during a 4-month period after a recent first left hemispheric stroke were assessed with CASP, MMSE and MoCA. We determined the proportion of patients in whom it was impossible to administer at least one item from these 3 scales, and compared their administration times. RESULTS Forty-four patients were included (age 64±15, 26 males). The CASP was impossible to administer in eight of them (18%), compared with 16 for the MMSE (36%, P=0.05) and 13 for the MoCA (30%, P=0.21, NS). It was possible to administer the CASP in all of the patients with expressive aphasia, whereas the MMSE and the MoCA could not be administered. Administration times were longer for the CASP (13±4min) than for the MMSE (8±3min, P<10(-6)) and the MoCA (11±5min, P=0.23, NS). CONCLUSION The CASP is more feasible than the MMSE and the MoCA in aphasic stroke patients.
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Affiliation(s)
- J-L Barnay
- Pôle de rééducation et réadaptation, CHU de Dijon, 23, rue Gaffarel, 21079 Dijon, France
| | - G Wauquiez
- Pôle de rééducation et réadaptation, CHU de Dijon, 23, rue Gaffarel, 21079 Dijon, France
| | - H Y Bonnin-Koang
- Unité de rééducation neurologique, département de MPR, CHU de Nîmes, 30240 Le Grau du Roi, France.
| | - C Anquetil
- Unité de rééducation neurologique, département de MPR, CHU de Nîmes, 30240 Le Grau du Roi, France
| | - D Pérennou
- Clinique MPR, institut de rééducation, hôpital sud, CHU de Grenoble, BP 338, avenue de Kimberley, 38434 Échirolles, France; Laboratoire TimC CNRS, université Joseph-Fourier, Grenoble-1, 38041 Saint-Martin-d'Hères, France.
| | - C Piscicelli
- Clinique MPR, institut de rééducation, hôpital sud, CHU de Grenoble, BP 338, avenue de Kimberley, 38434 Échirolles, France
| | - B Lucas-Pineau
- CRF COS DIVIO, 12, rue Saint-Vincent-de-Paul, 21000 Dijon, France.
| | - L Muja
- Pôle de soins de suites et de réadaptation, centre hospitalier de Tonnerre, chemin des Jumeriaux, 89700 Tonnerre, France.
| | - E le Stunff
- Pôle de soins de suites et de réadaptation, centre hospitalier de Tonnerre, chemin des Jumeriaux, 89700 Tonnerre, France
| | - X de Boissezon
- Pole neurosciences, CHU Purpan, place du Dr-Baylac, 31059 Toulouse, France; Inserm, imagerie cérébrale et handicaps neurologiques UMR 825, 31059 Toulouse, France; UPS, imagerie cérébrale et handicaps neurologiques UMR 825, université de Toulouse, CHU Purpan, place du Dr-Baylac, 31059 Toulouse, France.
| | - C Terracol
- Pole neurosciences, CHU Purpan, place du Dr-Baylac, 31059 Toulouse, France
| | - M Rousseaux
- Service de rééducation neurologique, hôpital Swynghedauw, CHRU de Lille, 59037 Lille, France.
| | - Y Bejot
- Service de neurologie, CHU de Dijon, 1, boulevard Jeanne-d'Arc, 21379 Dijon, France.
| | - C Binquet
- Inserm, CIC1432, centre d'investigation clinique, module épidémiologie clinique, CHU de Dijon, 21000 Dijon, France
| | - D Antoine
- Pôle de rééducation et réadaptation, CHU de Dijon, 23, rue Gaffarel, 21079 Dijon, France
| | - H Devilliers
- Inserm, CIC1432, centre d'investigation clinique, module épidémiologie clinique, CHU de Dijon, 21000 Dijon, France
| | - C Benaim
- Pôle de rééducation et réadaptation, CHU de Dijon, 23, rue Gaffarel, 21079 Dijon, France; Inserm, CIC1432, centre d'investigation clinique, module épidémiologie clinique, CHU de Dijon, 21000 Dijon, France; Inserm, U1093, 21000 Dijon, France.
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van Hest NA, Aldridge RW, de Vries G, Sandgren A, Hauer B, Hayward A, Arrazola de Oñate W, Haas W, Codecasa LR, Caylà JA, Story A, Antoine D, Gori A, Quabeck L, Jonsson J, Wanlin M, Orcau Å, Rodes A, Dedicoat M, Antoun F, van Deutekom H, Keizer S, Abubakar I. Tuberculosis control in big cities and urban risk groups in the European Union: a consensus statement. ACTA ACUST UNITED AC 2014; 19. [PMID: 24626210 DOI: 10.2807/1560-7917.es2014.19.9.20728] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In low-incidence countries in the European Union (EU), tuberculosis (TB) is concentrated in big cities, especially among certain urban high-risk groups including immigrants from TB high-incidence countries, homeless people, and those with a history of drug and alcohol misuse. Elimination of TB in European big cities requires control measures focused on multiple layers of the urban population. The particular complexities of major EU metropolises, for example high population density and social structure, create specific opportunities for transmission, but also enable targeted TB control interventions, not efficient in the general population, to be effective or cost effective. Lessons can be learnt from across the EU and this consensus statement on TB control in big cities and urban risk groups was prepared by a working group representing various EU big cities, brought together on the initiative of the European Centre for Disease Prevention and Control. The consensus statement describes general and specific social, educational, operational, organisational, legal and monitoring TB control interventions in EU big cities, as well as providing recommendations for big city TB control, based upon a conceptual TB transmission and control model.
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Affiliation(s)
- N A van Hest
- Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, the Netherlands
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Kidorf M, Brooner RK, Gandotra N, Antoine D, King VL, Peirce J, Ghazarian S. Reinforcing integrated psychiatric service attendance in an opioid-agonist program: a randomized and controlled trial. Drug Alcohol Depend 2013; 133:30-6. [PMID: 23866988 PMCID: PMC3786041 DOI: 10.1016/j.drugalcdep.2013.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/06/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The benefits of integrating substance abuse and psychiatric care may be limited by poor service utilization. This randomized clinical trial evaluated the efficacy of using contingency management to improve utilization of psychiatric services co-located and integrated within a community-based methadone maintenance treatment program. METHODS Opioid-dependent outpatients (n=125) with any current psychiatric disorder were randomly assigned to: (1) reinforced on-site integrated care (ROIC), with vouchers (worth $25.00) contingent on full adherence to each week of scheduled psychiatric services; or (2) standard on-site integrated care (SOIC). All participants received access to the same schedule of psychiatrist and mental health counseling sessions for 12-weeks. RESULTS ROIC participants attended more overall psychiatric sessions at month 1 (M=7.53 vs. 3.97, p<.001), month 2 (M=6.31 vs. 2.81, p<.001), and month 3 (M=5.71 vs. 2.44, p<.001). Both conditions evidenced reductions in psychiatric distress (p<.001) and similar rates of drug-positive urine samples. No differences in study retention were observed. CONCLUSIONS These findings suggest that contingency management can improve utilization of psychiatric services scheduled within an on-site and integrated treatment model. Delivering evidenced-based mental health counseling, or modifying the contingency plan to include illicit drug use, may be required to facilitate greater changes in psychiatric and substance abuse outcomes.
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Affiliation(s)
- Michael Kidorf
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD 21224, United States.
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Zenner D, Southern J, van Hest R, DeVries G, Stagg HR, Antoine D, Abubakar I. Active case finding for tuberculosis among high-risk groups in low-incidence countries. Int J Tuberc Lung Dis 2013; 17:573-82. [PMID: 23575321 DOI: 10.5588/ijtld.12.0920] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In low-incidence countries, tuberculosis (TB) is now largely concentrated in high-risk groups such as migrants, homeless people, illicit drug users, alcoholics and prisoners. This has led to increased efforts to implement targeted active case finding for TB among specific populations. This review examines the evidence supporting active case finding in migrants and social risk groups, as well as the cost-effectiveness of interventions. While data from observational studies support active case finding in defined high-risk groups, further research to determine the effectiveness of specific tools and the cost-effectiveness of screening strategies is needed to inform evidence-based control methods in low-incidence countries. Inevitably, addressing TB in low-incidence countries will depend on effective disease control in high-burden countries.
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Affiliation(s)
- D Zenner
- Tuberculosis Section, Respiratory Diseases Department, Health Protection Agency, Colindale, London, UK
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Mailles A, Blanckaert K, Chaud P, van der Werf S, Lina B, Caro V, Campese C, Guéry B, Prouvost H, Lemaire X, Paty MC, Haeghebaert S, Antoine D, Ettahar N, Noel H, Behillil S, Hendricx S, Manuguerra JC, Enouf V, La Ruche G, Semaille C, Coignard B, Lévy-Bruhl D, Weber F, Saura C, Che D. First cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infections in France, investigations and implications for the prevention of human-to-human transmission, France, May 2013. Euro Surveill 2013; 18:20502. [PMID: 23787161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
In May 2013, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection was diagnosed in an adult male in France with severe respiratory illness, who had travelled to the United Arab Emirates before symptom onset. Contact tracing identified a secondary case in a patient hospitalised in the same hospital room. No other cases of MERS-CoV infection were identified among the index case’s 123 contacts, nor among 39 contacts of the secondary case, during the 10-day follow-up period.
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Affiliation(s)
- A Mailles
- Institut de veille sanitaire (InVS), Saint Maurice, France.
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Mailles A, Blanckaert K, Chaud P, van der Werf S, Lina B, Caro V, Campese C, Guéry B, Prouvost H, Lemaire X, Paty MC, Haeghebaert S, Antoine D, Ettahar N, Noel H, Behillil S, Hendricx S, Manuguerra JC, Enouf V, La Ruche G, Semaille C, Coignard B, Lévy-Bruhl D, Weber F, Saura C, Che D, The investigation team C. First cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infections in France, investigations and implications for the prevention of human-to-human transmission, France, May 2013. Euro Surveill 2013. [DOI: 10.2807/ese.18.24.20502-en] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A Mailles
- Institut de veille sanitaire (InVS), Saint Maurice, France
| | - K Blanckaert
- These authors contributed equally to this work
- Antenne Régionale de Lutte contre les Infections Nosocomiales (ARLIN), Lille, France
| | - P Chaud
- Institut de Veille Sanitaire, Lille, France
- These authors contributed equally to this work
| | - S van der Werf
- National Reference Center for influenza viruses (coordinating center) and Unit of Molecular Genetics of RNA Viruses, coordinating center, Institut Pasteur, Paris, France
| | - B Lina
- National Reference Center for influenza viruses, Hospices Civils de Lyon and Virpath, Université Claude Bernard Lyon1, Lyon, France
| | - V Caro
- Cellule d'Intervention Biologique d'Urgence (CIBU), Institut Pasteur, Paris, France
| | - C Campese
- Institut de veille sanitaire (InVS), Saint Maurice, France
| | - B Guéry
- Centre Hospitalier Régional et Universitaire, Université de Lille 2, Lille, France
| | - H Prouvost
- Institut de Veille Sanitaire, Lille, France
| | | | - M C Paty
- Institut de veille sanitaire (InVS), Saint Maurice, France
| | | | - D Antoine
- Institut de veille sanitaire (InVS), Saint Maurice, France
| | - N Ettahar
- Centre Hospitalier, Valenciennes, France
| | - H Noel
- Institut de veille sanitaire (InVS), Saint Maurice, France
| | - S Behillil
- National Reference Center for influenza viruses (coordinating center) and Unit of Molecular Genetics of RNA Viruses, coordinating center, Institut Pasteur, Paris, France
| | | | - J C Manuguerra
- Cellule d'Intervention Biologique d'Urgence (CIBU), Institut Pasteur, Paris, France
| | - V Enouf
- National Reference Center for influenza viruses, Hospices Civils de Lyon and Virpath, Université Claude Bernard Lyon1, Lyon, France
| | - G La Ruche
- Institut de veille sanitaire (InVS), Saint Maurice, France
| | - C Semaille
- Institut de veille sanitaire (InVS), Saint Maurice, France
| | - B Coignard
- Institut de veille sanitaire (InVS), Saint Maurice, France
| | - D Lévy-Bruhl
- Institut de veille sanitaire (InVS), Saint Maurice, France
| | - F Weber
- Institut de veille sanitaire (InVS), Saint Maurice, France
| | - C Saura
- Institut de veille sanitaire (InVS), Saint Maurice, France
| | - D Che
- Institut de veille sanitaire (InVS), Saint Maurice, France
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McCarron EP, Welters I, Williams D, Antoine D, Kipar A. Exploring the translational disconnect between the murine and human inflammatory response: in vitro analysis of the dose-response relationship of LPS and NFκB activation in murine and human immune cells. Crit Care 2013. [PMCID: PMC3642420 DOI: 10.1186/cc11956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Abstract
The proportion of patients considered to be cured is a key indicator to assess national tuberculosis (TB) control. In France, TB treatment outcome monitoring was implemented in 2007. This article presents national results on treatment outcome among patients with pulmonary TB reported in France in 2009 and explores determinants of potentially unfavourable outcome. Information on treatment outcome was reported for 63% of eligible pulmonary cases of whom 70% had a successful outcome. In a multivariate analysis, potentially unfavourable outcome (17%), compared to treatment success, was significantly associated with being male, born abroad and having lived in France for less than 10 years, being in congregate settings when treatment was initiated, or having a previous history of anti-TB treatment. Enhanced awareness of treatment outcome monitoring is essential to improve the coverage and the quality of information. Earlier diagnosis and improved management of the disease in the elderly may reduce death due to TB. The high proportion of potentially unfavourable outcomes should be further investigated as they may require additional vigilance and/or actions in term of efforts of TB control in some population groups.
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Affiliation(s)
- D Antoine
- Institut de Veille Sanitaire, Saint Maurice cedex, France
| | - D Che
- Institut de Veille Sanitaire, Saint Maurice cedex, France
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33
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Antoine D, Che D. Treatment outcome monitoring of pulmonary tuberculosis cases notified in France in 2009. Euro Surveill 2013; 18:20434. [PMID: 23557945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
The proportion of patients considered to be cured is a key indicator to assess national tuberculosis (TB) control. In France, TB treatment outcome monitoring was implemented in 2007. This article presents national results on treatment outcome among patients with pulmonary TB reported in France in 2009 and explores determinants of potentially unfavourable outcome. Information on treatment outcome was reported for 63% of eligible pulmonary cases of whom 70% had a successful outcome. In a multivariate analysis, potentially unfavourable outcome (17%), compared to treatment success, was significantly associated with being male, born abroad and having lived in France for less than 10 years, being in congregate settings when treatment was initiated, or having a previous history of anti-TB treatment. Enhanced awareness of treatment outcome monitoring is essential to improve the coverage and the quality of information. Earlier diagnosis and improved management of the disease in the elderly may reduce death due to TB. The high proportion of potentially unfavourable outcomes should be further investigated as they may require additional vigilance and/or actions in term of efforts of TB control in some population groups.
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Affiliation(s)
- D Antoine
- Institut de Veille Sanitaire, Saint Maurice cedex, France.
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34
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Tattevin P, Che D, Fraisse P, Gatey C, Guichard C, Antoine D, Paty MC, Bouvet E. Factors associated with patient and health care system delay in the diagnosis of tuberculosis in France. Int J Tuberc Lung Dis 2012; 16:510-5. [PMID: 22325560 DOI: 10.5588/ijtld.11.0420] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To analyse diagnostic delay in tuberculosis (TB) patients. DESIGN Cross-sectional study: all patients with TB notified to the French national surveillance system from April to June 2010 were interviewed face-to-face using a standardised questionnaire to assess symptom history and health-seeking trajectories. RESULTS Of 225 patients enrolled, 172 (76.4%) had pulmonary TB, including 88 who were smear-positive. Mean delay between first symptoms and diagnosis (total delay) was 97 days (median 68, IQR 33-111), with a mean of 47 days (median 14, IQR 0-53) between first symptoms and health care contact (patient delay), and 48 days (median 25, IQR 6-67) between health care contact and diagnosis (health system delay). Factors independently associated with shortened total delay were medical insurance (OR 0.24, P = 0.014) and previous TB (OR 0.28, P = 0.049). Those associated with reduced patient delay were initial fever (OR 0.42, P = 0.03) and being followed by a general practitioner (OR 0.22, P = 0.004), while those associated with reduced health system delay were first health care contact within a hospital (OR 0.15, P < 0.001). Empirical antibiotic treatment was associated with increased health system delay (OR 4.4, P = 0.001). CONCLUSION TB diagnostic delay needs to be reduced in France. This may be achieved through improved access to care, earlier hospital referral, and less use of empirical antibiotic treatment.
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Affiliation(s)
- P Tattevin
- Unité des Maladies Infectieuses et Réanimation Médicale, CHU Pontchaillou, Rennes, France.
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35
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Che D, Antoine D. Épidémiologie de la tuberculose en France en 2008. Med Mal Infect 2011; 41:372-8. [DOI: 10.1016/j.medmal.2010.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 11/25/2010] [Accepted: 12/02/2010] [Indexed: 11/16/2022]
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Guthmann JP, Antoine D, Fonteneau L, Che D, Lévy-Bruhl D. Assessing BCG vaccination coverage and incidence of paediatric tuberculosis following two major changes in BCG vaccination policy in France. Euro Surveill 2011. [DOI: 10.2807/ese.16.12.19824-en] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- J P Guthmann
- French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Saint-Maurice, France
| | - D Antoine
- French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Saint-Maurice, France
| | - L Fonteneau
- French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Saint-Maurice, France
| | - D Che
- French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Saint-Maurice, France
| | - D Lévy-Bruhl
- French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Saint-Maurice, France
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37
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Guthmann JP, Antoine D, Fonteneau L, Che D, Lévy-Bruhl D. Assessing BCG vaccination coverage and incidence of paediatric tuberculosis following two major changes in BCG vaccination policy in France. Euro Surveill 2011; 16:19824. [PMID: 21457685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
We report data on BCG vaccination coverage and paediatric tuberculosis (TB) incidence collected after the disappearance of the multipuncture device for BCG vaccination in January 2006 and the shift from universal to targeted vaccination in July 2007 in France.Vaccination coverage estimates in children for whom BCG is recommended allow assessing whether the recommendations are followed by doctors and/or accepted by the target population. In January and February 2006, BCG sales to the private sector in Îlede-France region were 74.2% and 41.3% of the ones for the same months the previous year. Total sales in 2006 amounted to 57.3% of those in 2005. Coverage decreased immediately after withdrawal of the multipuncture device, and remained generally insufficient in high risk children in the following years. However,the impact on paediatric TB incidence in 2008 seems very limited, although the duration of follow-up is still short. Training of doctors in intra-dermal vaccination and communication on the new vaccination policy should be strengthened
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Affiliation(s)
- J P Guthmann
- French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Saint-Maurice, France.
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38
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Sylvie C, Anne T, Antoine D, Anne-Marie S. 283 Impact of a training and organisational program on the care of CVA in the acute phase. BMJ Qual Saf 2010. [DOI: 10.1136/qshc.2010.041624.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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39
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Gilbert RL, Antoine D, French CE, Abubakar I, Watson JM, Jones JA. The impact of immigration on tuberculosis rates in the United Kingdom compared with other European countries. Int J Tuberc Lung Dis 2009; 13:645-651. [PMID: 19383200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To investigate whether trends in tuberculosis (TB) rates across Europe are linked to patterns of migration. DESIGN Descriptive analysis of Organisation for Economic Co-operation and Development population statistics and EuroTB data for 21 European countries for 1996-2005. RESULTS TB notification rates increased in only three of the 21 countries: the United Kingdom, Norway and Sweden. In all three countries, approximately three quarters of cases were foreign-born. The UK had the third highest number of foreign nationals overall, but the highest number from a country with a TB incidence > or =250 cases/100000 (219000, 13%). European countries with declining TB rates had varying patterns of migration, but did not generally receive migrants from very high-incidence countries and/or had a smaller proportion of their total TB cases in their migrant population. CONCLUSIONS The increase in the rate of TB in the UK, which contrasts with most other European countries, may, at least in part, be due to the fact that a high proportion of UK cases occur in the foreign-born, coupled with a comparatively large number of foreign nationals from countries with a very high incidence of TB.
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Affiliation(s)
- R L Gilbert
- Health Protection Agency Centre for Infections, London, UK.
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40
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Murugavel K, Antoine D, Raju M, López-Gatius F. The effect of addition of equine chorionic gonadotropin to a progesterone-based estrous synchronization protocol in buffaloes (Bubalus bubalis) under tropical conditions. Theriogenology 2009; 71:1120-6. [DOI: 10.1016/j.theriogenology.2008.12.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2008] [Revised: 12/10/2008] [Accepted: 12/10/2008] [Indexed: 12/01/2022]
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41
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Che D, Antoine D. Immigrants et tuberculose : données épidémiologiques récentes. Med Mal Infect 2009; 39:187-90. [DOI: 10.1016/j.medmal.2008.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 12/01/2008] [Indexed: 11/16/2022]
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42
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Gremeaux V, Lemoine Y, Fargeot A, D’Athis P, Beer JC, Laurent Y, Cottin Y, Antoine D, Casillas JM. The Dijon Physical Activity Score: Reproducibility and correlations with physical fitness in patients with coronary artery disease. ACTA ACUST UNITED AC 2008; 51:366-78. [DOI: 10.1016/j.annrmp.2008.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Accepted: 05/06/2008] [Indexed: 11/30/2022]
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43
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Chemardin J, Paty MC, Renard-Dubois S, Veziris N, Antoine D. Contact tracing of passengers exposed to an extensively drug-resistant tuberculosis case during an air flight from Beirut to Paris, October 2006. ACTA ACUST UNITED AC 2007; 12:E071206.2. [PMID: 18067848 DOI: 10.2807/esw.12.49.03325-en] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Contact tracing of air travellers exposed to cases of multi-drug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) has become an increasingly important issue.
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Affiliation(s)
- J Chemardin
- Direction générale de la santé, Ministère de la santé, de la jeunesse et des sports, Paris, France.
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44
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Abstract
On 11 July 2007, the French Minister of Health launched the National Tuberculosis Control Program and a new policy on Bacille Calmette-Guérin (BCG) vaccination.
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Affiliation(s)
- D Levy Bruhl
- Institut de veille sanitaire, Saint-Maurice, France.
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45
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Abstract
This article presents results on cases of tuberculosis disease notified in France in 2005 by mandatory notification. In 2005, a total of 5,374 cases were notified in France, representing a rate of 8.9 cases per 100,000. The notification rate per 100,000 was below 10 in all French regions, except the Ile-de-France and French Guyana (with respective rates of 19.7/10(5) and 44.0/10(5)). Notification rates were higher in some population groups such as people born abroad (41.5/10(5)), especially those born in sub-Saharan Africa (160/10(5)), and those recently (<2 years) arrived in France (251/10(5)), in homeless people (214/10(5)), and in persons aged 80 years and over (21.7/10(5)). Pulmonary tuberculosis accounted for 73% of notified cases, 79% of which were contagious (positive direct examination of sputum, positive culture). Results from the notification of tuberculosis disease in 2005 indicate a continuing decrease of incidence in France. However, the high incidence in some population groups requires adapting public health actions to the needs of population groups more exposed to tuberculosis.
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Affiliation(s)
- D Antoine
- Institut de veille sanitaire, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
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46
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French CE, Antoine D, Gelb D, Jones JA, Gilbert RL, Watson JM. Tuberculosis in non-UK-born persons, England and Wales, 2001-2003. Int J Tuberc Lung Dis 2007; 11:577-84. [PMID: 17439685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
SETTING England and Wales, 2001-2003. OBJECTIVES To describe demographic and clinical characteristics of tuberculosis (TB) in non-UK-born persons and compare with UK-born cases to inform public health action and health service provision. DESIGN Analysis of surveillance data. RESULTS Among the 67% of cases who were non-UK-born, TB incidence was 88/100000 compared to 4/100000 among the UK-born. UK-born minority ethnic groups were also at increased risk of TB. Although the highest TB incidence occurred in recent entrants to the UK, nearly half the cases had been resident for >or=5 years. The majority of non-UK-born cases originated from South Asia (48%) and sub-Saharan Africa (35%). The demographic characteristics of non-UK-born and UK-born cases differed. In addition, non-UK-born cases were less likely to have pulmonary TB than the UK-born (52% vs. 73%, chi(2) P<0.001), but were more likely to have isoniazid-resistant disease (8% vs. 6%, chi(2) P=0.002), depending on region of birth. CONCLUSIONS During 2001-2003, most TB cases were non-UK-born. TB services need to take the characteristics of TB in this group into account. Furthermore, awareness of the risk of disease is required among the non-UK-born for many years after arrival into the UK, and among UK-born minority ethnic groups.
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Affiliation(s)
- C E French
- Tuberculosis Section, Respiratory Diseases Department, Health Protection Agency Centre for Infections, London, United Kingdom
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47
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Abstract
As in other countries with low tuberculosis incidence, tuberculosis in England and Wales tends to be concentrated in some subgroups of the population, and is mainly a problem in large cities. In 2003, almost half of all tuberculosis cases reported in England and Wales were from London, where the incidence was almost five times higher than in the rest of England and Wales. While the highest proportion of cases occur in foreign born patients, evidence from a large outbreak of drug resistant tuberculosis points to ongoing active transmission among marginalised groups including homeless people, hard drug users, and prisoners. Increasing rates of disease and levels of drug resistance, combined with a concentration of disease in hard-to-reach risk groups now present a major challenge to tuberculosis control in the city. To respond to the changing epidemiology observed in recent years, treatment and control services are being reconfigured, surveillance has been improved with the implementation of the London TB register, and the utility of mobile digital x ray screening for at risk populations such as homeless people and prisoners is being evaluated. However, tuberculosis in London is not yet under control and more needs to be done. Services must adapt to the needs of those groups now most affected. This will require continued improvements to surveillance and monitoring, combined with improved access to care, better case detection, rapid diagnosis and active social support for people undergoing treatment.
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Affiliation(s)
- D Antoine
- Health Protection Agency, Centre for Infections, London, United Kingdom
| | - H Maguire
- Health Protection Agency, Regional Epidemiology Unit, London, and St Georges Hospital Medical School, London, United Kingdom
| | - A Story
- Health Protection Agency, Centre for Infections, London, United Kingdom
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48
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Antoine D, Maguire H, Story A. Epidemiology and response to the growing problem of tuberculosis in London. Euro Surveill 2006; 11:25-8. [PMID: 16567877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
As in other countries with low tuberculosis incidence, tuberculosis in England and Wales tends to be concentrated in some subgroups of the population, and is mainly a problem in large cities. In 2003, almost half of all tuberculosis cases reported in England and Wales were from London, where the incidence was almost five times higher than in the rest of England and Wales. While the highest proportion of cases occur in foreign born patients, evidence from a large outbreak of drug resistant tuberculosis points to ongoing active transmission among marginalised groups including homeless people, hard drug users, and prisoners. Increasing rates of disease and levels of drug resistance, combined with a concentration of disease in hard-to-reach risk groups now present a major challenge to tuberculosis control in the city. To respond to the changing epidemiology observed in recent years, treatment and control services are being reconfigured, surveillance has been improved with the implementation of the London TB register, and the utility of mobile digital x ray screening for at risk populations such as homeless people and prisoners is being evaluated. However, tuberculosis in London is not yet under control and more needs to be done. Services must adapt to the needs of those groups now most affected. This will require continued improvements to surveillance and monitoring, combined with improved access to care, better case detection, rapid diagnosis and active social support for people undergoing treatment.
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Affiliation(s)
- D Antoine
- Health Protection Agency, Centre for Infections, London, United Kingdom
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49
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Antoine D, Nobileau D. Recent increase of Saharan dust transport over the Mediterranean Sea, as revealed from ocean color satellite (SeaWiFS) observations. ACTA ACUST UNITED AC 2006. [DOI: 10.1029/2005jd006795] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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50
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Robert H, Casillas JM, Iskandar M, D'Athis P, Antoine D, Taha S, Didier V, Scaglioni G, Caillaux BX, Van Hoecke J. [The Dijon Physical Activity Score: reproducibility and correlation with exercise testing in healthy elderly subjects]. Ann Readapt Med Phys 2004; 47:546-54. [PMID: 15465159 DOI: 10.1016/j.annrmp.2004.03.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/04/2003] [Accepted: 03/30/2004] [Indexed: 11/30/2022]
Abstract
PURPOSE To validate a French physical activity score for current use in healthy elderly people. PATIENTS AND METHODS A brief questionnaire was developed for healthy elderly subjects older than 72 years. Questions asked about self-assessed physical fitness (1), daily activity (2), leisure and sport activity (5) and rest time (1). Correlations were searched between the score and several parameters of physical fitness: maximal exercise stress test (peak VO(2)), six-minute walk test, 200-meter long walk test, timed up an go test. RESULTS A total of 57 subjects were studied (mean age, 77.6 +/-3.6 years; 28 females and 29 males). The mean time to complete the questionnaire was 3.96 minutes. Reproducibility was 0.606, as determined by Spearman's coefficient. Correlations were found between the physical activity score and peak VO(2) (0.302, P <0.05) and peak power (0.257, P <0.10). CONCLUSIONS This easily obtained physical activity score provides a new way to assess physical activity in active elderly subjects. The physical score correlated in part with maximal ability but must be validated in several diseases.
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Affiliation(s)
- H Robert
- Inserm, ERITm 0207, pôle de rééducation-réadaptation, CHU de Dijon, 23, rue Gaffarel, 21079 Dijon cedex, France
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