International perspective on physician knowledge, attitude and practices related to medical cannabis.

Background: The trends of recreational use of cannabis and use of cannabis for medical indications (i.e. "medical cannabis") have grown in recent years. Despite that, there is still limited scientific evidence to guide clinical decision-making and the strength of evidence for the medical use of cannabis is currently considered to be low. In contrast, there's growing evidence for negative health outcomes related to use of cannabis. In this rapidly shifting landscape, the role of physician's attitudes regarding the therapeutic value of cannabis has become essential. This study aimed to characterize knowledge/experience, attitudes, and potential predictors of clinical practice regarding medical cannabis. Methods: We conducted a cross-sectional survey of physicians from 17 countries between 2016-2018. The survey comprised of 28 questions designed to explore physician knowledge, attitude, and practices regarding the use of medical cannabis. Descriptive statistics were used to examine willingness to recommend medical cannabis for medical and psychiatric indications, followed by regression analysis to identify predictors of physician willingness to recommend medical cannabis. Results: A total of 323 physicians responded to the survey. Mean age was 35.4± 9.5 years, with 10.04 ±8.6 years of clinical experience. 53 percent of physicians were women. Clinical experience with medical cannabis was overall limited (51.4% noted never having recommended medical cannabis; 33% noted inadequate knowledge regarding medical cannabis). Overall willingness to recommend medical cannabis was highest for chemotherapy-induced nausea, refractory chronic neuropathic pain, and spasticity in amyotropic lateral sclerosis (ALS). Conclusion: This international study examining knowledge, attitudes and practices related to medical cannabis among physicians revealed that there are significant gaps in domain-specific knowledge related to medical cannabis. There is wide variability in willingness to recommend medical cannabis that is not consistent with the current strength of evidence. This study thus highlights the need for greater education related to domain-specific knowledge about medical cannabis.

Changes in substance use and engagement in gaming/gambling in persons with severe mental illness during the COVID-19 pandemic and earthquakes: a community study in two points.

Introduction: External stressors, such as COVID-19 pandemic and earthquake, can cause an increase in substance use and addictive behavior in persons with severe mental illnesses (SMI). We analyzed the changes and predictors of substance use and addictive behavior in SMI during these double disasters in Croatia. Methods: Questionnaires exploring the presence of substance or behavior addiction disorder, mental ill health [Depression Anxiety Stress Scales-21 (DASS-21), Insomnia Severity Index (ISI), Perceived Stress Scale (PSS), Obsessive-Compulsive Inventory-Revised], coping mechanisms, and perceived social support [Multidimensional Scale of Perceived Social Support (MSPSS)] were administered among 90 participants with SMI included in the RECOVER-E study in May/June 2020 (first COVID-19 wave, Zagreb earthquake) and in December 2020/January 2021 (second COVID-19 wave, Petrinja earthquake). Results: In both time points, a major increase was observed in tobacco smoking (25.0%; 28.6%, respectively) predicted by discontinuation of antidepressants and higher DASS-21 score. Increased sedative use was observed (24.4%; 23.8%, respectively) predicted by higher PSS and ISI scores, lower MSPSS scores, antipsychotic discontinuation and not receiving community mental health team (CMHT) service. Discussion: In persons with SMI during a double disaster special attention needs to be given to reducing mental-ill health and stress, providing social support and continuity of psychiatric care, through medications and CMHTs.

Internet use and internet-based addictive behaviours during coronavirus pandemic.

PURPOSE OF REVIEW: The COVID-19 outbreak profoundly influenced human lives on different levels. This narrative review aims to present recent data relating to the COVID-19 pandemic and internet use and internet-based addictive behaviours [problematic Internet use (PIU), Internet addiction, Internet gaming disorder, problem gambling or gambling disorder, social media addiction including smartphone use disorder, problematic pornography use, and compulsive buying]. RECENT FINDINGS: During the COVID-19 pandemic, the prevalence of Internet use and Internet-based addictive behaviours increased in all age groups. The COVID-19 pandemic and related containment measures were been associated with increased levels of stress, anxiety, and depression in the general population, especially among children and adolescents, which are the vulnerable groups for the development of mental disorders during the crisis. Furthermore, the fear resulting from the disease, the 'lockdown' measures, high levels of uncertainty regarding the future, and financial insecurity increased levels of loneliness, PIU, and Internet addiction. SUMMARY: Longitudinal researches focused on the negative impacts of Internet use in prolonged stress situations on mental health, vulnerable groups, and quality of life (QoL) are needed to help clinicians and policymakers to reduce adverse consequences. Prevention programs for Internet use and Internet-based addictive behaviours must be customized to meet the needs of children, adolescents, and adults. Also, treatment programs must be tailored to the needs of patients with different Internet-based addictions.

Predictors of Exclusive Breastfeeding 6-9 Weeks After Delivery: a Prospective Cohort Study. Public Mental Health Perspective.

BACKGROUND: There are numerous benefits of exclusive breastfeeding (EBF) on mother and child wellbeing. The objective was to find out whether depression, posttraumatic stress disorder and personality traits at the time of delivery are associated with EBF six to nine weeks after delivery. SUBJECTS AND METHODS: The targeted population were women who delivered in Croatian largest University maternity hospital. The scores of The Edinburgh Postnatal Depression Scale (EPDS), The Big Five Inventory (BFI) and The Impact of Events Scale (revised) - IES-R three to five days after childbirth were measured to predict self-reported EBF status six to nine weeks after the delivery. Six to nine weeks after the delivery data on breastfeeding were collected for 259 (69.6%) out of initially 372 enrolled women. RESULTS: Six to nine weeks after the delivery 151/259 (58.3%) were still exclusively breastfeeding their child. After adjustment for all other variables, women who gave their second childbirth had significantly higher odds for longer EBF than primiparous women (OR=2.12; 95% CI 1.10-4.10). Higher EPDS result was significantly associated with lower odds for EBF (OR=0.92; 95% CI 0.85-0.99). CONCLUSION: Parity and depressed mood immediately after the delivery are associated with EBF six to eight weeks after the delivery. Depression symptoms are a moderator between parity and exclusive breastfeeding, so multiparous women without depressive symptomatology are more prone for EBF.

[Passive smoking--active killer]. / Pasivno pusenje--aktivni ubojica.

Although still not perceived in this way, passive smoking is a public health issue of great importance. World Health Organization estimates that as a result of passive exposure to tobacco smoke each year 600,000 people die, of which 165,000 children. There are 33% of men, 35% of women and 40% of children who do not smoke, but are exposed to second hand smoke, and still only 11% of the world population is protected by adequate smoke-free legislation. Scientific literature provides evidence that passive exposure to tobacco smoke can result in numerous adverse health effects: asthma and allergies, respiratory infections and (middle) ear infections, cancers of various localization, accelerated atherosclerosis and cardiovascular diseases, retardation of growth and development in children, and in pregnancy it can lead to congenital anomalies and premature birth as well as lower body weight and length of the child. Certainly, the scariest consequence of all is sudden infant death syndrome, also called "death in the crib". Smoke-free policies have proven their effectiveness, but while implementing the laws, it is necessary to raise public awareness of the hazards of, both active and passive, exposure to tobacco smoke.

General practice meeting the needs for psychiatric care in Croatia.

BACKGROUND: In recent decades, general practitioners (GPs) have become critical components of mental health services. However, in Croatia the role of GPs in mental health services is still mostly perceived as "gate keeping", whereas seeking help for serious mental illnesses is mostly restricted to psychiatrists. The aim of this study is to investigate the practices and attitudes of family doctors in providing care for psychiatric patients. SUBJECTS AND METHODS: The study included 111 GPs, working in 38 different locations in four major towns in Croatia. Data were collected using a questionnaire, specifically designed for the purpose of this study. RESULTS: By their own estimation, GPs prescribed antidepressants without a psychiatrist's recommendation in about 37% of patients who use them. Also, GPs prescribed sedatives without a psychiatrist's recommendation in about 60% of patients who use them. Although certain categories of psychiatric patients (elderly, patients with PTSD) were almost always referred to a psychiatrist, it was GPs' attitudes toward psychiatric casualties and their proneness to prescribe antidepressants and sedatives without a psychiatrist's recommendation that predicted whether a patient will be treated by himself of referred to a psychiatrist. "Interest/Competency" and "Knowledge" of the GPs positively correlated with the number of courses attended as a part of continuous medical education (CME). CONCLUSION: Overall, the role of GPs in mental health services in Croatia is changing into a more active one, as a significant portion of patients with depression and anxiety are being treated by GPs. Personal interest and self confidence in proper knowledge and skills, in part acquired also from current CME programs, are determinants of higher autonomy of GPs in treating psychiatric patients. Psychiatrists, as active promoters of community mental health should more actively encourage their alliance with GPs, especially through offering higher quality CME courses.