Primary Sjögren's syndrome (SS) and malignant lymphoma. A retrospective cohort study of 55 patients with SS.

The aim of this study was to assess the prevalence of malignant lymphomas in patients with long-standing primary Sjögren's syndrome (pSS). We retrospectively studied a cohort of 55 patients with pSS over a mean follow-up period of 12 years. Five patients (9%) developed malignant lymphoma. The interval between the diagnoses of SS and lymphoma ranged from four to 12 years (mean = 6.5 years). The lymphoma arose in the lymph nodes in two cases, the parotid gland in one case, the lacrimal gland in one case, and the lung in one case. All five cases were B-cell low-grade lymphomas. Among our SS patients, those with extraglandular manifestations and/or a mixed cryoglobulin were at increased risk for lymphoma development. Secondary lymphoma carried a poor prognosis in our study. Three of the six SS patients who died during the follow-up period had lymphoma.

Detecting and measuring deprivation in primary care: development, validity and reliability of a self-reported questionnaire - the DiPCare-Q

Background: General practitioners play a central role in taking deprivation into consideration when caring for patients in primary care. Validated questions to identify deprivation in primary-care practices are still lacking. For both clinical and research purposes, this study therefore aims to develop and validate a standardized instrument measuring both material and social deprivation at an individual level. Methods: The Deprivation in Primary Care Questionnaire (DiPCare-Q) was developed using qualitative and quantitative approaches between 2008 and 2011. A systematic review identified 199 questions related to deprivation. Using judgmental item quality, these were reduced to 38 questions. Two focus groups (primary-care physicians, and primary-care researchers), structured interviews (10 laymen), and think aloud interviews (eight cleaning staff) assured face validity. Item response theory analysis was then used to derive the DiPCare-Q index using data obtained from a random sample of 200 patients who were to complete the questionnaire a second time over the phone. For construct and criterion validity, the final 16 questions were administered to a random sample of 1,898 patients attending one of 47 different private primary-care practices in western Switzerland (validation set) along with questions on subjective social status (subjective SES ladder), education, source of income, welfare status, and subjective poverty. Results: Deprivation was defined in three distinct dimensions (table); material deprivation (eight items), social deprivation (five items) and health deprivation (three items). Item consistency was high in both the derivation (KR20 = 0.827) and the validation set (KR20 = 0.778). The DiPCare-Q index was reliable (ICC = 0.847). For construct validity, we showed the DiPCare-Q index to be correlated to patients' estimation of their position on the subjective SES ladder (rs = 0.539). This position was correlated to both material and social deprivation independently suggesting two separate mechanisms enhancing the feeling of deprivation. Conclusion: The DiPCare-Q is a rapid, reliable and validated instrument useful for measuring both material and social deprivation in primary care. Questions from the DiPCare-Q are easy to use when investigating patients' social history and could improve clinicians' ability to detect underlying social distress related to deprivation.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

Self-reported smoking cessation activities among Swiss primary care physicians.

ABSTRACT: BACKGROUND: Individual counselling, pharmacotherapy, and group therapy are evidence-based interventions that help patients stop smoking. Acupuncture, hypnosis, and relaxation have no demonstrated efficacy on smoking cessation, whereas self-help material may only have a small benefit. The purpose of this study is to assess physicians' current clinical practice regarding smokers motivated to stop smoking. METHODS: The survey included 3385 Swiss primary care physicians. Self-reported use of nine smoking cessation interventions was scored. One point was given for each positive answer about practicing interventions with demonstrated efficacy, i.e. nicotine replacement therapy, bupropion, counselling, group therapy, and smoking cessation specialist. No points were given for the recommendation of acupuncture, hypnosis, relaxation, and self-help material. Multivariable logistic analysis was performed to identify factors associated with a good practice score, defined as >1. RESULTS: The response rate was 55%. Respondents were predominately over the age of 40 years (88%), male (79%), and resided in urban areas (74%). Seventeen percent reported being smokers. Most of the physicians prescribed nicotine replacement therapy (84%), bupropion (65%), or provided counselling (70%). A minority of physicians recommended acupuncture (26%), hypnosis (8%), relaxation (7%), or self-help material (24%). A good practice score was obtained by 85% of respondents. Having attended a smoking cessation training program was the only significant predictor of a good practice score (odds ratio: 6.24 , 95% CI 1.95-20.04). CONCLUSION: The majority of respondents practice recommended smoking cessation interventions. However, there is room for improvement and implementing an evidence-based smoking cessation-training program could provide additional benefit.

Une cause de cardiomyopathie dilatée chez l'enfant: le déficit primaire en carnitine [A cause of dilated cardiomyopathy in child: primary carnitine deficiency].

AIM: The aim of this case report was to show the importance to research metabolic etiology, especially a carnitine deficiency in dilated cardiomyopathy of children. CASE REPORT: A three years old Togolese child presented muscular hypotonia, dyspnea. Examination showed left galop murmur and systolic murmur 2/6. Chest X-ray showed cardiomegaly (CTI: 0.66), electrocardiogram, a sinusal rythm, left ventricle hypertrophy and T wave abnormalities. Echocardiogram showed a markedly dilated left ventricle with reduced systolic function (EF: 0.43; reference range 0.55-0.80) and moderate mitral regurgitation. The inflammatory signs where negatives. Magnetic resonance imaging don't show signs of ischemic or myocarditis. The levels of free and total plasmatic carnitine decreased: 3μmol/L (N: 18-48μmol/L) and 5μmol/l (N: 29-70μmol/L) respectively. Mutation analysis of the gene SLC22A5 confirms the diagnosis of primary systemic carnitine deficiency. Treatment with oral carnitine was started at 200mg/kg per day. Within three weeks of treatment, we observed the decrease of all symptoms and the left ventricular size and function normalized (EF: 0.62). He has now been on oral carnitine for live. CONCLUSION: Primary carnitine deficiency is a cause of dilated cardiomyopathy in child. It must systematically be suspected when a child presents a primitive cardiomyopathy. The treatment with oral carnitine for live is simple, with excellent prognosis.

Carbonic anhydrase activity in primary sensory neurons. II. Influence of environmental factors on the phenotypic expression of the enzyme in dissociated cultures of chicken dorsal root ganglion cells.

Neuronal subpopulations of dorsal root ganglion (DRG) cells in the chicken exhibit carbonic anhydrase (CA) activity. To determine whether CA activity is expressed by DRG cells maintained in in vitro cultures, dissociated DRG cells from 10-day-old chick embryos were cultured on a collagen substrate. The influence exerted by environmental factors on the enzyme expression was tested under various conditions of culture. Neuron-enriched cell cultures and mixed DRG-cell cultures (including numerous non-neuronal cells) were performed either in a defined medium or in a horse serum-supplemented medium. In all the tested conditions, subpopulations of cultured sensory neurons expressed CA activity in their cell bodies, while their neurites were rarely stained; in each case, the percentage of CA-positive neurons declined with the age of the cultures. The number and the persistence of neurons possessing CA activity as well as the intensity of the reaction were enhanced by addition of horse serum. In contrast, the expression of the neuronal CA activity was not affected by the presence of non-neuronal cells or by the rise of CO2 concentration. Thus, the appearance and disappearance of neuronal subpopulations expressing CA activity may be decisively influenced by factors contained in the horse serum. The loss of CA-positive neurons with time could result from a cell selection or from genetic repression. Analysis of the time curves does not support a preferential cell death of CA-positive neurons but suggests that the eventual conversion of CA-positive neurons into CA-negative neurons results from a loss of the enzyme activity. These results indicate that the phenotypic expression of cultured sensory neurons is dependent on defined environmental factors.

Creating a list of low-value health care activities in Swiss primary care.

Trisomy 21 is the most frequent genetic cause of cognitive impairment. To assess the perturbations of gene expression in trisomy 21, and to eliminate the noise of genomic variability, we studied the transcriptome of fetal fibroblasts from a pair of monozygotic twins discordant for trisomy 21. Here we show that the differential expression between the twins is organized in domains along all chromosomes that are either upregulated or downregulated. These gene expression dysregulation domains (GEDDs) can be defined by the expression level of their gene content, and are well conserved in induced pluripotent stem cells derived from the twins' fibroblasts. Comparison of the transcriptome of the Ts65Dn mouse model of Down's syndrome and normal littermate mouse fibroblasts also showed GEDDs along the mouse chromosomes that were syntenic in human. The GEDDs correlate with the lamina-associated (LADs) and replication domains of mammalian cells. The overall position of LADs was not altered in trisomic cells; however, the H3K4me3 profile of the trisomic fibroblasts was modified and accurately followed the GEDD pattern. These results indicate that the nuclear compartments of trisomic cells undergo modifications of the chromatin environment influencing the overall transcriptome, and that GEDDs may therefore contribute to some trisomy 21 phenotypes.

A program of nurse algorithm-guided care for adult patients with acute minor illnesses in primary care

Background: Attention to patients with acute minor-illnesses requesting same-day consultation represents a major burden in primary care. The workload is assumed by general practitioners in many countries. A number of reports suggest that care to these patients may be provided, at in least in part, by nurses. However, there is scarce information with respect to the applicability of a program of nurse management for adult patients with acute minor-illnesses in large areas. The aim of this study is to assess the effectiveness of a program of nurse algorithm-guided care for adult patients with acute minor illnesses requesting same-day consultation in primary care in a largely populated area. Methods: A cross-sectional study of all adult patients seeking same day consultation for 16 common acute minor illnesses in a large geographical area with 284 primary care practices. Patients were included in a program of nurse case management using management algorithms. The main outcome measure was case resolution, defined as completion of the algorithm by the nurse without need of referral of the patient to the general practitioner. The secondary outcome measure was return to consultation, defined as requirement of new consultation for the same reason as the first one, in primary care within a 7-day period. Results: During a two year period (April 2009-April 2011), a total of 1,209,669 consultations were performed in the program. Case resolution was achieved by nurses in 62.5% of consultations. The remaining cases were referred to a general practitioner. Resolution rates ranged from 94.2% in patients with burns to 42% in patients with upper respiratory symptoms. None of the 16 minor illnesses had a resolution rate below 40%. Return to consultation during a 7-day period was low, only 4.6%. Conclusions: A program of algorithms-guided care is effective for nurse case management of patients requesting same day consultation for minor illnesses in primary care.

PKCθ/β and CYLD are antagonistic partners in the NFκB and NFAT transactivation pathways in primary mouse CD3+ T lymphocytes.

In T cells PKCθ mediates the activation of critical signals downstream of TCR/CD28 stimulation. We investigated the molecular mechanisms by which PKCθ regulates NFκB transactivation by examining PKCθ/β single and double knockout mice and observed a redundant involvement of PKCθ and PKCβ in this signaling pathway. Mechanistically, we define a PKCθ-CYLD protein complex and an interaction between the positive PKCθ/β and the negative CYLD signaling pathways that both converge at the level of TAK1/IKK/I-κBα/NFκB and NFAT transactivation. In Jurkat leukemic T cells, CYLD is endoproteolytically processed in the initial minutes of stimulation by the paracaspase MALT1 in a PKC-dependent fashion, which is required for robust IL-2 transcription. However, in primary T cells, CYLD processing occurs with different kinetics and an altered dependence on PKC. The formation of a direct PKCθ/CYLD complex appears to regulate the short-term spatial distribution of CYLD, subsequently affecting NFκB and NFAT repressional activity of CYLD prior to its MALT1-dependent inactivation. Taken together, our study establishes CYLD as a new and critical PKCθ interactor in T cells and reveals that antagonistic PKCθ/β-CYLD crosstalk is crucial for the adjustment of immune thresholds in primary mouse CD3(+) T cells.

AT-RISK ALCOHOL USE IN YOUNG ADULTS - EFFECTIVENESS AND MECHANISMS OF BRIEF MOTIVATIONAL INTERVENTION AS A PRIMARY AND SECONDARY PREVENTION MEASURE

SummaryThe alcohol use of adolescents and young adults is one of the world's most important and costliest health problems. Particularly, binge drinking (i.e. drinking an important amount of alcohol in one occasion) among young people increase the risk of detrimental consequences such as blackouts, injuries, at-risk sexual behaviors, involvement in violent acts, academic failure, and suicide attempts. In countries with mandatory conscription mechanisms, such as Switzerland, the army provides a unique opportunity to reach a large portion of this high risk population. We used this sample to evaluate the prevalence of binge drinking among young men, to test the efficacy of brief motivational interventions (BMI) as a primary and secondary preventive measure, and to examine the mechanisms underlying BMI in this age group.We showed that binge drinking among young French-speaking Swiss men is less of an exception than it is the norm. Of those using alcohol, 75.5% had a binge drinking episode at least monthly, and 69.3% of all consumption reported in a one-week diary was due to binge drinking days.We used two different inclusion modes to evaluate the success of alcohol BMI. In the first randomized controlled trial, inclusion relied on a random selection of conscripts. BMI efficacy was evaluated in a sample of conscripts who visited the army recruitment centre that is potentially generalizable to the entire population. In the second randomized controlled trial, we included subjects voluntarily participating in BMI. This venue might be more realistic for young adults; it is more akin to the MI spirit, in which it is crucial for individuals to control their own decisions.Regarding BMI efficacy as a secondary prevention measure (i.e. to help decrease alcohol use among at-risk drinkers, defined here as those having a binge drinking episode at least monthly), it was effective among randomly selected at-risk drinkers, whereas it was not effective among at-risk drinkers who voluntarily showed up. Individuals who showed interest in BMI had more severe patterns of alcohol use, which may have made change more difficult and calls for treatment that is more intensive. BMI demonstrated a 20% reduction in weekly alcohol use among randomly selected participants, indicating potential interest in BMI implementation within similar community settings.Regarding BMI efficacy as a primary prevention measure (i.e. to help maintain low levels of use among low-risk drinkers), it had significant protective effects among low-risk drinkers voluntarily showing up whereas it was not effective among low-risk drinkers randomly selected. This suggests that BMI might help young individuals keep their drinking at low levels, especially when they are interested in discussing their alcohol use. Therefore, BMI has potentially promising uses in primary prevention efforts. The content of these interventions for low-risk drinkers who do not seek BMI on their own should be further evaluated.BMI mechanisms were addressed since little is known about exactly which elements of it work, or which of the counselor and subject communication behaviors are most effective in triggering behavior changes. The causal chain hypothesis developed in the motivational interviewing (MI) theory was followed, and it was found that counselor behaviors consistent with the MI approach (MICO) were significantly more likely to be followed by participant language in favor of change (change talk, CT), while behaviors inconsistent with MI (MIIN) were significantly less likely to do so. Several CT dimensions measured during BMI (particularly Ability, Desire, and Need to change) were predictive of change in alcohol use. Our findings lend strong support for the use of MICO behaviors and the avoidance of MIIN behaviors in eliciting CT, and point out that particular attention should be paid to the utterances in several sub-dimensions of CT and to the strength of expression, since these are good indicators of potential actual behavior change in future.RésuméLa consommation d'alcool chez les adolescents et les jeunes adultes est un des problèmes de santé les plus importants et les plus coûteux dans le monde. En particulier, les consommations importantes d'alcool en une occasion (binge drinking) parmi les jeunes adultes ont été liées à des conséquences telles que pertes de connaissance, accidents et blessures, comportements sexuels à risque, violences, difficultés scolaires et tentatives de suicide. Les pays qui, comme la Suisse, connaissent un processus de recrutement obligatoire pour l'armée offrent une opportunité unique d'atteindre une large portion de cette population à hauts risques. Nous avons utilisé cet échantillon pour évaluer la prévalence du binge drinking parmi les jeunes hommes, pour tester l'efficacité de l'intervention brève motivationnelle (IBM) comme mesure de prévention primaire et secondaire, et pour examiner les mécanismes sous-tendant ce type d'interventions.La première partie de cette étude montre que le binge drinking est moins une exception que la norme parmi les jeunes hommes suisses francophones. 75.5% des personnes consommant de l'alcool avaient au moins un épisode de binge drinking par mois et 69.3% du total des boissons alcoolisées reportées comme consommation de la semaine précédant le questionnaire avaient été consommées lors d'épisodes de binge drinking.Pour évaluer l'efficacité de l'IBM dans ce cadre, nous avons utilisé deux modes d'inclusion. Dans une première étude randomisée contrôlée, nous avons inclus des personnes sélectionnées au hasard parmi toutes celles se présentant au centre de recrutement, créant ainsi un groupe potentiellement représentatif de l'ensemble du collectif. Dans la deuxième étude randomisée contrôlée, nous avons inclus des sujets se présentant volontairement pour recevoir une IBM, prendre des volontaires pouvant être plus proche de la réalité et plus proche de l'esprit motivationnel dans lequel il est crucial que l'individu contrôle ses décisions.En regardant l'IBM comme mesure de prévention secondaire (c'est-à-dire aider à diminuer la consommation d'alcool chez les consommateurs à risque, définis ici comme au moins un épisode de binge drinking par mois), l'IBM était efficace lorsque les participants étaient inclus au hasard et inefficace lorsqu'ils étaient volontaires. Les jeunes hommes volontaires pour un IBM avaient un mode de consommation particulièrement sévère qui pourrait être plus difficile à changer et nécessiter un traitement plus intensif. Parmi les personnes sélectionnées au hasard, l'IBM permettait une diminution de 20% de la consommation hebdomadaire d'alcool, montrant l'intérêt potentiel d'une implémentation de ce type de mesures dans des contextes communautaires similaires.En ce qui concerne l'IBM comme mesure de prévention primaire (c'est-à-dire aider à maintenir une consommation à bas risque chez les consommateurs à bas risque), l'IBM avaient un effet protectif significatif parmi les jeunes hommes volontaires pour une IBM, mais pas d'effet chez ceux sélectionnés au hasard. Ces résultats suggèrent que l'IBM pourrait aider de jeunes personnes à maintenir un niveau de consommation à bas risque si celles-ci s'intéressent à discuter cette consommation et aurait ainsi un potentiel intéressant comme mesure de prévention primaire. Le contenu de l'IBM pour des consommateurs à bas risque non-volontaires pour une IBM devra encore être évalué.Nous avons ensuite examiné les mécanismes de l'IBM car son fonctionnement est encore peu expliqué et les comportements de l'intervenant et du sujet les plus à même de provoquer le changement ne sont pas bien définis. En suivant l'hypothèse d'une chaine causale développée dans la littérature de l'entretien motivationnel (EM), nous avons pu montrer qu'un discours en faveur du changement chez le sujet était plus probable après des comportements de l'intervenant recommandés dans l'EM et moins probable après des comportements à éviter dans l'EM ; et que plusieurs dimensions de ce discours en faveur du changement (notamment la capacité, le désir et le besoin de changer) prédisaient un changement effectif dans la consommation d'alcool. Ces résultats encouragent donc à utiliser des comportements recommandés dans l'EM pour favoriser un discours en faveur du changement. Ils montrent aussi qu'une attention particulière doit être portée à la fréquence et à la force avec laquelle sont exprimées certaines dimensions de ce discours car ceux-ci indiquent un potentiel changement effectif de comportement.Résumé vulgariséLa consommation d'alcool chez les adolescents et les jeunes adultes est un des problèmes de santé les plus importants et les plus coûteux dans le monde. En particulier, les consommations importantes d'alcool en une occasion (binge drinking) parmi les jeunes adultes augmentent fortement les risques de conséquences telles que pertes de connaissance, accidents et blessures, comportements sexuels à risque, violences, difficultés scolaires et tentatives de suicide. Les pays qui, comme la Suisse, connaissent un processus de recrutement obligatoire pour l'armée offrent une opportunité unique d'atteindre une large portion de cette population à hauts risques. Nous avons utilisé cet échantillon pour évaluer l'importance du phénomène de binge drinking, pour tester l'efficacité de l'intervention brève motivationnelle (IBM) comme mesure de prévention de la consommation à risque d'alcool, et pour examiner comment fonctionne ce type d'interventions.La première partie de cette étude montre que le binge drinking est moins une exception que la norme parmi les jeunes hommes suisses francophones. Trois quart des personnes consommant de l'alcool avaient au moins un épisode de binge drinking par mois. Presque 70% du total des boissons alcoolisées consommées durant la semaine précédant le questionnaire avaient été consommées lors d'épisodes de binge drinking.Nous avons ensuite mené deux études pour évaluer l'efficacité de l'IBM dans ce cadre. Dans une première étude, nous avons sélectionné des personnes au hasard parmi toutes celles se présentant au centre de recrutement, créant ainsi un groupe potentiellement représentatif de l'ensemble du collectif. Dans la deuxième étude, nous avons inclus toutes les personnes se présentant volontairement pour recevoir une IBM, prendre des volontaires pouvant être plus proche de la réalité et plus proche de l'approche motivationnelle dans laquelle il est crucial que l'individu contrôle ses décisions. Dans les deux études, nous testions l'efficacité de l'IBM comme mesure de prévention primaire et secondaire (voir ci-dessous).En regardant l'IBM comme mesure de prévention secondaire (c'est-à-dire aider à diminuer la consommation d'alcool chez les consommateurs à risque, définis ici comme au moins un épisode de binge drinking par mois), l'IBM était efficace lorsque les participants étaient inclus au hasard et inefficace lorsqu'ils étaient volontaires. Les jeunes hommes volontaires pour un IBM avaient un mode de consommation particulièrement sévère qui pourrait être plus difficile à changer et nécessiter un traitement plus intensif. Parmi les personnes sélectionnées au hasard, l'IBM permettait une diminution de 20% de la consommation hebdomadaire d'alcool, montrant l'intérêt potentiel de la mise en place de ce type de mesures dans des contextes communautaires similaires.En ce qui concerne l'IBM comme mesure de prévention primaire (c'est-à-dire aider à maintenir une consommation à bas risque chez les consommateurs à bas risque), l'IBM avaient un effet protectif parmi les jeunes hommes volontaires pour une IBM, mais pas d'effet chez ceux sélectionnés au hasard. Ces résultats suggèrent que l'IBM pourrait aider de jeunes personnes à maintenir un niveau de consommation à bas risque si celles-ci s'intéressent à discuter de cette consommation. Le contenu de l'IBM pour des consommateurs à bas risque non-volontaires pour une IBM devra encore être évalué.Nous avons ensuite examiné le fonctionnement de l'IBM et cherché quels comportements de l'intervenant et du jeune homme pouvaient être les plus à même d'amener à un changement dans la consommation. Nous avons pu montrer que 1) un discours en faveur du changement chez le jeune homme était plus probable après des comportements de l'intervenant recommandés dans l'approche motivationnelle et moins probable après des comportements non-recommandés ; et 2) plusieurs dimensions de ce discours en faveur du changement (notamment la capacité, le désir et le besoin de changer) prédisaient un changement effectif dans la consommation d'alcool. Ces résultats encouragent donc à utiliser des comportements recommandés dans l'EM pour favoriser un discours en faveur du changement. Ils montrent aussi qu'une attention particulière doit être portée à certaines dimensions de ce discours car celles-ci indiquent un potentiel changement effectif de comportement.

The habenula encodes negative motivational value associated with primary punishment in humans.

Learning what to approach, and what to avoid, involves assigning value to environmental cues that predict positive and negative events. Studies in animals indicate that the lateral habenula encodes the previously learned negative motivational value of stimuli. However, involvement of the habenula in dynamic trial-by-trial aversive learning has not been assessed, and the functional role of this structure in humans remains poorly characterized, in part, due to its small size. Using high-resolution functional neuroimaging and computational modeling of reinforcement learning, we demonstrate positive habenula responses to the dynamically changing values of cues signaling painful electric shocks, which predict behavioral suppression of responses to those cues across individuals. By contrast, negative habenula responses to monetary reward cue values predict behavioral invigoration. Our findings show that the habenula plays a key role in an online aversive learning system and in generating associated motivated behavior in humans.