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See detailElectromagnetic hypersensitivity and occupational exposure to electromagnetic fields (EMF)
Demaret, Isabelle ULg

Conference (2014, April 07)

Introduction Scientific publications on electromagnetic hypersensitivity began in the early 80' and were first related to video display terminals in the professional environment. Electromagnetic ... [more ▼]

Introduction Scientific publications on electromagnetic hypersensitivity began in the early 80' and were first related to video display terminals in the professional environment. Electromagnetic hypersensitivity is now more heterogeneous and complaints about electromagnetic fields (EMF) are often associated to mobile phone or wifi. Provocation studies did not find that persons claiming to have electromagnetic hypersensitivity were more able to detect EMF than others or that they displayed any special physiological changes when exposed to EMF. Since 1996, WHO defined this syndrome as Idiopathic Environmental Intolerance to ElectroMagnetic Fields (IEI-EMF), characterised by symptoms attributed to EMF. The diagnostic is made by the person itself. The symptoms are heterogeneous and are frequently encountered in the general population. Despite the lack of a proven causal relationship with EMF, these symptoms, and the anxiety related, can lead to important suffering. Some persons with IEI-EMF are even unable to work. IEI-EMF is classified among the functional somatic syndromes as other syndromes with no physiological basis (as multiple chemical sensitivity). Directive and IEI-EMF Studies showed that persons who feel more stressed in their professional environment and are less satisfied with their work are more prone to IEI-EMF. There are some elements in the directive that could frighten these persons: the directive does not consider long term effects; the limit values can be exceeded temporarily and a worker must be informed that he can have transient symptoms. Discussion Persons with IEI-EMF are afraid of adverse health effects and often think that these effects are not taken into account by official agency. For them, everything that can aggravate their fears will be difficult to handle. [less ▲]

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See detailProjet TADAM: RAPPORT FINAL 2007-2013
Demaret, Isabelle ULg; Litran, Géraldine; Magoga, Cécile et al

Report (2013)

Background: Heroin-assisted treatment (HAT) can improve the condition of heroin addicts resistant to other treatment. A new trial compared HAT and methadone treatment with HAT limited to 12 months in ... [more ▼]

Background: Heroin-assisted treatment (HAT) can improve the condition of heroin addicts resistant to other treatment. A new trial compared HAT and methadone treatment with HAT limited to 12 months in order to assess its feasibility and efficacy in Belgium. Methods: TADAM (Treatment Assisted by Diacetylmorphine) was an open label randomised controlled trial. The experimental treatment was based upon the Swiss model of HAT developed in 1994. The primary efficacy criterion was determined by an improvement in street heroin use or in (physical or mental) health or a decrease in criminal involvement. Participants were assessed every 3 months. Self-reported data were complemented with toxicological analyses and criminal proceedings. Findings: 74 participants were randomised in the trial: 36 in the experimental group and 38 in the control group. The experimental group counted 30% of responders more than the control group at 3 months (p<0.05), 6 months (p<0.05), and 9 months (p<0.01). At 12 months, the number of responders was still higher in the experimental group (11%) but the difference was no longer significant (p=0.35). Street heroin use increased in the experimental group at the 12-month assessment just before the end of HAT. Conclusion: HAT is feasible and effective. However, HAT should not have a predetermined duration for heroin users for which heroin addiction became a chronic relapsing disease. Other data: In addition to the outcomes of the randomised controlled trial, the report contains other exploratory data and analysis: satisfaction of in treatment, criminological data, opinion of heroin users not included in the trial, opinion of caregivers and field workers (in the HAT centre, in the partner centres, and in other centres in the addiction field), impact of the HAT centre on its neighbourhood and a socio-economic evaluation. Funding: The TADAM trial was funded at 80% by the Federal Minister of Social Affairs and Public Health. It was also funded the City and the University of Liège. [less ▲]

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See detailL'héroïne
Demaret, Isabelle ULg; Lemaître, André ULg; Ansseau, Marc ULg

in Revue Médicale de Liège (2013), 68(5-6), 287

Summary : Heroin (or diacetylmorphine), a depressant of the nervous central system, is a semi-synthetic opiate. Its main adverse effect, respiratory depression, can lead to death, especially after an ... [more ▼]

Summary : Heroin (or diacetylmorphine), a depressant of the nervous central system, is a semi-synthetic opiate. Its main adverse effect, respiratory depression, can lead to death, especially after an intravenous injection. By loss of tolerance, an overdose can be lethal following heroin use after a period of abstinence (voluntary or not). Mortality rate among heroin users is between 1 and 3%. Addiction, following a regular and continuous use, occurs in less than a quarter of persons who ever tried heroine. Heroin addicts often present with different problems (for instance, a criminal behaviour), without any obvious link with addiction. For a fraction of the addicts, addiction becomes a chronic relapsing disease, requiring a long term maintenance substitution therapy. However, relapses and sometimes continuous heroin use are frequent. For treatment resistant and severe heroin addicts, heroinassisted treatment can be a solution. Despite the numerous available therapies, heroin is considered to be the drug with the most negative effects on the user. [less ▲]

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See detailTADAM L’avis des usagers non inclus dans le traitement par héroïne
Magoga, Cécile; Demaret, Isabelle ULg

Conference (2012, October)

Introduction : Le projet TADAM, une étude contrôlée randomisée, comparait un nouveau traitement assisté par héroïne avec des traitements existants par méthadone à Liège, en Belgique. Nous avons réalisé ... [more ▼]

Introduction : Le projet TADAM, une étude contrôlée randomisée, comparait un nouveau traitement assisté par héroïne avec des traitements existants par méthadone à Liège, en Belgique. Nous avons réalisé une étude qualitative sur l'attitude des personnes dépendantes de l'héroïne envers ce type de projet, ainsi que sur l'attitude des intervenants d'institutions de soins travaillant avec ces personnes Méthode : Avant qu'un patient ne soit inclus dans le projet TADAM, il lui était demandé d'expliquer pourquoi il souhaitait rentrer en traitement (n=80). Des interviews ont également été réalisées auprès de consommateurs d'héroïne non inclus dans le projet, avant la période d'inclusion (n=65), au milieu de celle-ci (n=30) et dans ses derniers mois (n=23). Pendant le projet, des interviews ont également été réalisées auprès d'intervenants travaillant dans des institutions de soins pour personnes dépendantes de substances, soit de manière individuelle (n=10), soit en groupe (n=6) pour connaître leur attitude face au projet TADAM. Résultats : De nombreux patients souhaitaient rentrer dans ce projet pour améliorer leurs conditions de vie. La raison principale de ne pas rentrer dans ce type de traitement était la peur de devenir plus dépendant. Cette raison était renforcée par le fait que le traitement par héroïne proposé ne durait que 12 mois et les patients s'inquiétaient de leur situation après ce traitement : ils avaient peur d'être plus dépendants et donc dans une situation plus difficile qu'avant le traitement. L'attitude des intervenants étaient plutôt favorable mais prudente. Conclusion : Contrairement aux craintes préalables, les usagers d'héroïne ne se précipitent pas en masse et sans réfléchir vers un traitement assisté par héroïne. Certains réfléchissent longtemps avant de s'y engager. Une information précise et un traitement sans durée minimum sont nécessaires. [less ▲]

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See detailTADAM Traitement Assisté par DiAcétylMorphine: Profil des patients
Deblire, Clémence; Demaret, Isabelle ULg; Lemaître, André ULg

Poster (2012, October)

Background : TADAM est une étude contrôlée randomisée comparant un traitement par héroïne (HAT) avec des traitements par méthadone existants. Ce projet est toujours en cours mais nous disposons déjà de ... [more ▼]

Background : TADAM est une étude contrôlée randomisée comparant un traitement par héroïne (HAT) avec des traitements par méthadone existants. Ce projet est toujours en cours mais nous disposons déjà de données sur les patients au moment de leur inclusion. Nous analysons leur profil, particulièrement leurs caractéristiques criminologiques, et nous le comparons avec celui des participants aux autres expériences HAT. Méthodologie : Lors de l’inclusion, chaque patient a répondu à des questionnaires standardisés ainsi qu’à un questionnaire de délinquance et de victimisation auto-rapportées. Comme point de comparaison, nous avons sélectionné trois études européennes contrôlées randomisées sur le HAT. Nous avons ajouté une étude suisse, sans groupe contrôle, évaluant les effets de la prescription d’héroïne sur la délinquance des patients. Résultats : Nos patients sont plus âgés et plus souvent de sexe masculin. Ils bénéficient plus souvent d’allocations sociales et ont connu plus de traitements pour un problème d'addiction. Ces patients avaient un passé judiciaire aussi important qu’à l’étranger. Sur les six derniers mois, ils sont moins nombreux à avoir commis des actes délinquants mais le nombre d'actes commis est plus important. Les faits sont surtout liés à la drogue ou à la propriété. Conclusion : Nos patients étaient moins nombreux à être délinquants mais il y aurait plus de professionnalisation qu'à l'étranger. Le plus petit nombre de délinquants pourrait s'expliquer par la moyenne d'âge plus élevée de nos patients, la plus grande proportion d'allocataires sociaux ou encore par le recours plus important à des traitements pour leur(s) addiction(s). [less ▲]

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See detailTADAM Belgian Heroin-Assisted Treatment: Patients’ characteristics
Demaret, Isabelle ULg

Conference (2012, May 25)

Did the Belgian heroin-assisted treatment, TADAM, included the expected target group of severe heroin addicts? Background: TADAM is a randomised controlled trial comparing heroin-assisted treatment (HAT ... [more ▼]

Did the Belgian heroin-assisted treatment, TADAM, included the expected target group of severe heroin addicts? Background: TADAM is a randomised controlled trial comparing heroin-assisted treatment (HAT) to existing methadone maintenance treatment. This trial began in Belgium in January 2011 in the city of Liège. The inclusion phase ends January 16th, 2012 and the experimental treatment in 2013. It was developed in order to treat severe heroin addicts. We will examine if the Belgian HAT trial included the target group as the other HAT trials. Methodology: In this open-label randomised controlled trial, each patient must fulfil inclusion criteria before entering the trial and must sign an informed consent form. By randomisation, the patient is allocated either to the experimental group (HAT) or to the control group (methadone maintenance treatment in existing centres). The patients were interviewed at baseline (and every three months) with standardised instruments such as EuropASI, MAP-HSS and SCL-90-R. Results: 74 patients were included and randomised between the two groups. A typical patient is over 40 years old, has been taking heroin for 20 years and methadone for 15 years. He is male, Belgian, long-term unemployed, with physical, mental and/or social problems. Conclusion: Patients are older and slightly more severe addicted than in other HAT trials. [less ▲]

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See detailStaff concerns in heroin-assisted treatment centres
Demaret, Isabelle ULg; Lemaître, André ULg; ANSSEAU, Marc ULg

in Journal of Psychiatric & Mental Health Nursing (2012), 19

Heroin-assisted treatment (HAT) is a solution for improving the condition of treatmentresistant heroin addicts. Since 1994, six randomized controlled trials have concluded that HAT is more efficacious ... [more ▼]

Heroin-assisted treatment (HAT) is a solution for improving the condition of treatmentresistant heroin addicts. Since 1994, six randomized controlled trials have concluded that HAT is more efficacious than oral methadone for severe heroin addicts.We visited seven HAT treatment centres in four countries in order to observe diacetylmorphine (DAM) administration and to study the main concerns of the staff. Nurses were concerned by the risk taken if a previously intoxicated patient received his dose of DAM. Another concern was the smuggling of DAM doses. The HAT centres face a dilemma: treating patients while at the same time allowing their risky street habits in the centre. [less ▲]

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See detailFeasibility assessment of heroin-assisted treatment in Liège, Belgium
Demaret, Isabelle ULg; Herné, Patrick ULg; Lemaître, André ULg et al

in Acta Psychiatrica Belgica (2011), 111(1), 3-8

A new heroin-assisted treatment, TADAM, has begun in Liège, Belgium. With the number of methadone patients (n=2046) in 2007, we estimated the geographical distribution of methadone treatments in the ... [more ▼]

A new heroin-assisted treatment, TADAM, has begun in Liège, Belgium. With the number of methadone patients (n=2046) in 2007, we estimated the geographical distribution of methadone treatments in the province of Liège, of heroin addicts and of potential participants for TADAM. The methadone treatments were unequally distributed. Some urban areas showed a signifi cant number of heroin addicts: more than 14/1000 of the population aged 15-64. As a conclusion, the trial is appropriately targeted to those high-density addiction areas. [less ▲]

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See detailL’efficacité du traitement assisté par diacétylmorphine (héroïne pharmaceutique) à l’étranger
Demaret, Isabelle ULg; Lemaître, André ULg; Ansseau, Marc ULg

in Revue Médicale de Liège (2010), 65(12), 681-687

Before implementing the TADAM project in Belgium (a heroin-assisted treatment trial), our research team studied the trials in other countries. Since 1994, six randomised controlled trials have been ... [more ▼]

Before implementing the TADAM project in Belgium (a heroin-assisted treatment trial), our research team studied the trials in other countries. Since 1994, six randomised controlled trials have been developed using the same treatment model of heroin-assisted treatment (HAT). Each trial concluded that HAT had more efficacy than methadone treatment. We analysed those trials in order to find on which levels patients in a HAT treatment are expected to improve. Improvements appeared after at least six months on the level of street heroin use, (physical and mental) health and criminal behaviour. In the longer term, the continuation of treatment had positive but limited effects on the social level. Due to his higher cost, this treatment should remain a second-line treatment for this special target group: severe heroin addicts, using continuously street heroin in spite of a methadone treatment. [less ▲]

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See detailHeroin-Assisted Treatment as a treatment of criminal behaviour?
Demaret, Isabelle ULg; Litran, Géraldine; ANSSEAU, Marc ULg et al

Conference (2010, September 08)

Background: TADAM, a randomised controlled trial of heroin-assisted treatment, will begin in Liège, Belgium, in 2010. This trial will compare two groups of patients: one in a heroin-assisted treatment and ... [more ▼]

Background: TADAM, a randomised controlled trial of heroin-assisted treatment, will begin in Liège, Belgium, in 2010. This trial will compare two groups of patients: one in a heroin-assisted treatment and the other in oral methadone treatment. In this new medical treatment, the criminal behaviour of the patients will also be assessed. It is one of the three efficacy criteria. Why? Methodology: We based our presentation on papers published on heroin-assisted treatment concerning changes in criminal behaviour. Results: Heroin-assisted treatment of treatment resistant heroin addicts has been successfully tested in six countries: Switzerland, The Netherlands, Spain, Germany, Canada and United-Kingdom. Each country has also assessed the criminal behaviour before and after the treatment with better results for heroin-assisted treatment than for methadone treatment. Conclusion: HAT seems a good way to treat criminal behaviour of a group: severely heroin addicts who already tried other treatments. [less ▲]

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See detailPrerequisites for the implementation of a new heroin-assisted centre
Demaret, Isabelle ULg

Conference (2010, May 28)

Prerequisites for the implementation of a new heroin-assisted centre Background: TADAM, a randomised controlled trial of heroin-assisted treatment, will begin in Liège, Belgium, in 2010. Heroin-assisted ... [more ▼]

Prerequisites for the implementation of a new heroin-assisted centre Background: TADAM, a randomised controlled trial of heroin-assisted treatment, will begin in Liège, Belgium, in 2010. Heroin-assisted treatment of treatment resistant heroin addicts has been successfully tested in six countries: Switzerland, The Netherlands, Spain, Germany, Canada and United-Kingdom. Each country used a randomised controlled trial to assess this new treatment. It has now a strong evidence-based foundation. However in the peer-reviewed articles, there is little information on the concrete conditions to fulfil before implementing this treatment. With the experience of the other countries and ours, we have listed those conditions. Methodology: We collected information concerning the randomised controlled trial. This included articles published in international peer-review journals, reports, visits to heroin-assisted treatment centres and information given by researchers who participated in those experiments. We will illustrate our presentation with the example of Liège. Results: Before all, a political agreement at the national level is mandatory. It is never guaranteed even if it was already given in the past. Methadone treatments must be available and the collaboration with the addiction network will be an advantage for the project. There must be a sufficiently high number of heroin addicted in the concerned area and they must be correctly informed about the heroin-assisted treatment. But even if it is the case, the inclusion of the foreseen number of patients can be more difficult than expected because it is problematic to assess the exact number of patients fulfilling the inclusion criteria and because not all the eligible participants will accept to enter this treatment. Conclusion: For reasons other than medical or scientific ones, implementing a new heroin-assisted centre is still a challenge. [less ▲]

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See detailLes effets sociaux du cannabis
Demaret, Isabelle ULg; Born, Michel ULg; Lemaître, André ULg

in Seutin, Vincent; Scuvée, Jacqueline; Quertemont, Etienne (Eds.) Regards croisés sur le cannabis (2010)

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