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1.
Medicine (Baltimore) ; 99(25): e20723, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569209

RESUMO

This study aimed to analyze the trends of opioid use disorders, cannabis use disorders, and palliative care among hospitalized patients with gastrointestinal cancer and to identify their associated factors.We analyzed the National Inpatient Sample data from 2005 to 2014 and included hospitalized patients with gastrointestinal cancers. The trends of hospital palliative care and opioid or cannabis use disorders were analyzed using the compound annual growth rates (CAGR) with Rao-Scott correction for χ tests. Multivariate logistic regression analyses were performed to identify the associated factors.From 2005 to 2014, among 4,364,416 hospitalizations of patients with gastrointestinal cancer, the average annual rates of opioid and cannabis use disorders were 0.4% (n = 19,520), and 0.3% (n = 13,009), respectively. The utilization rate of hospital palliative care was 6.2% (n = 268,742). They all sharply increased for 10 years (CAGR = 9.61%, 22.2%, and 21.51%, respectively). The patients with a cannabis use disorder were over 4 times more likely to have an opioid use disorder (Odds ratios, OR = 4.029; P < .001). Hospital palliative care was associated with higher opioid use disorder rates, higher in-hospital mortality, shorter length of hospital stay, and lower hospital charges. (OR = 1.527, 9.980, B = -0.054 and -0.386; each of P < .001)The temporal trends of opioid use disorders and hospital palliative care use among patients with gastrointestinal cancer increased from 2005 to 2014, which is mostly attributed to patients with a higher risk of in-hospital mortality. Cannabis use disorders were associated with opioid use disorders. Palliative care was associated with both reduced lengths of stay and hospital charge.


Assuntos
Neoplasias Gastrointestinais/epidemiologia , Hospitalização/tendências , Abuso de Maconha/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Cuidados Paliativos/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Preços Hospitalares/tendências , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
2.
Rev Fac Cien Med Univ Nac Cordoba ; 77(2): 79-85, 2020 05 10.
Artigo em Espanhol | MEDLINE | ID: mdl-32558509

RESUMO

Introduction: the use of cocaine and cannabis during pregnancy is a growing problem, of importance for the World Public Health. Women can present a wide range of complications during pregnancy and perinatally, although knowledge about evolution thereafter is scarce. Objectives: to describe and compare health trajectories up to 4 years pospartum of user and not user women of cocaine and/or cannabis during pregnancy. Methods: retrospective cohort study with a comparison group consisting of 2 not users women for each user during pregnancy. User women were detected in Neonatology Division of a public Hospital with an urine pospartum test, between 2009 and 2013. Results: 29 women cocaine and/or cannabis users during pregnancy, and 58 not users were evaluated. In the first group, 93% women were polydrug users. Users had higher frequency of: history of violence in childhood ((p<0,001), previous (p<0,0045) and acquired (p<0,0007) disease, medical (p<0,0001) and odontological (p=0,0002) emergency consultations, hospitalizations (p<0,0001), and violent deaths in relatives, compared with non users. Conclusions: women who used cocaine and/or cocaine during pregnancy had a greater history of violence and illness, emergency medical and dental consultation, hospitalization and deaths, than non users. Injuries where the main cause of hospitalization. In the variables evaluated, the differences between consumers and non-consumers of pregnancy were significative.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Abuso de Maconha/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Argentina/epidemiologia , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Adulto Jovem
3.
JAMA ; 323(20): 2067-2079, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32453373

RESUMO

Importance: Illicit and nonmedical (use in ways other than instructed) drug use is common in adolescents and young adults and increases the risk of harmful outcomes such as injuries, violence, and poorer academic performance. Objective: To review the benefits and harms of interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults to inform the US Preventive Services Task Force. Data Sources: MEDLINE, PubMED, PsycINFO, and the Cochrane Central Register of Controlled Trials (January 1, 2013, to January 31, 2019 [children and adolescents]; January 1, 1992, to January 31, 2019 [young adults <25 years]); surveillance through March 20, 2020. Study Selection: Clinical trials of behavioral counseling interventions to prevent initiation of illicit and nonmedical drug use among young people. Data Extraction and Synthesis: Critical appraisal was completed independently by 2 investigators. Data were extracted by 1 reviewer and checked by a second. Random-effects meta-analysis was used to estimate the effect sizes associated with the interventions. Main Outcomes and Measures: Number of times illicit drugs were used; any illicit drug or any cannabis use. Results: Twenty-nine trials (N = 18 353) met inclusion criteria. Health, social, or legal outcomes such as mental health symptoms, family functioning, consequences of drug use, and arrests were reported in 19 trials and most showed no group differences. The effects on illicit drug use in 26 trials among nonpregnant youth (n = 17 811) were highly variable; the pooled result did not show a clinically important or statistically significant association with illicit drug use (standardized mean difference, -0.08 [95% CI, -0.16 to 0.001]; 24 effects [from 23 studies]; n = 12 801; I2 = 57.0%). The percentage of participants using illicit drugs ranged from 2.3% to 38.6% in the control groups and 2.4% to 33.7% in the intervention groups at 3 to 32 months' follow-up. The median absolute risk difference between groups was -2.8%, favoring the intervention group (range, -11.5% to 14.8%). The remaining 3 trials provided a perinatal home-visiting intervention to pregnant Native American youth. One trial (n=322) found a reduction in illicit drug use at 38 months (eg, cannabis use in the previous month, 10.7% in the intervention group and 15.6% in the control group) but not at earlier follow-up assessments. Across all 29 trials, only 1 trial reported on harms and found no statistically significant group differences. Conclusions and Relevance: The evidence for behavioral counseling interventions to prevent initiation of illicit and nonmedical drug use among adolescents and young adults was inconsistent and imprecise, with some interventions associated with reduction in use and others associated with no benefit or increased use. Health, social, and legal outcomes were sparsely reported, and few showed improvements.


Assuntos
Terapia Comportamental , Aconselhamento , Educação em Saúde , Drogas Ilícitas , Medicamentos sob Prescrição , Atenção Primária à Saúde , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Consumo de Bebidas Alcoólicas/prevenção & controle , Criança , Ensaios Clínicos como Assunto , Humanos , Abuso de Maconha/prevenção & controle , Guias de Prática Clínica como Assunto , Uso de Tabaco/prevenção & controle , Adulto Jovem
4.
JAMA ; 323(20): 2060-2066, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32453374

RESUMO

Importance: In 2017, an estimated 7.9% of persons aged 12 to 17 years reported illicit drug use in the past month, and an estimated 50% of adolescents in the US had used an illicit drug by the time they graduated from high school. Young adults aged 18 to 25 years have a higher rate of current illicit drug use, with an estimated 23.2% currently using illicit drugs. Illicit drug use is associated with many negative health, social, and economic consequences and is a significant contributor to 3 of the leading causes of death among young persons (aged 10-24 years): unintentional injuries including motor vehicle crashes, suicide, and homicide. Objective: To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on the potential benefits and harms of interventions to prevent illicit drug use in children, adolescents, and young adults. Population: This recommendation applies to children (11 years and younger), adolescents (aged 12-17 years), and young adults (aged 18-25 years), including pregnant persons. Evidence Assessment: Because of limited and inadequate evidence, the USPSTF concludes that the benefits and harms of primary care-based interventions to prevent illicit drug use in children, adolescents, and young adults are uncertain and that the evidence is insufficient to assess the balance of benefits and harms. More research is needed. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care-based behavioral counseling interventions to prevent illicit drug use, including nonmedical use of prescription drugs, in children, adolescents, and young adults. (I statement).


Assuntos
Terapia Comportamental , Aconselhamento , Educação em Saúde , Drogas Ilícitas , Medicamentos sob Prescrição , Atenção Primária à Saúde , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Consumo de Bebidas Alcoólicas/prevenção & controle , Criança , Humanos , Abuso de Maconha/prevenção & controle , Programas de Rastreamento , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Uso de Tabaco/prevenção & controle , Adulto Jovem
5.
PLoS One ; 15(3): e0230419, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32226050

RESUMO

BACKGROUND: The notion that smoking cannabis may damage the respiratory tract has been introduced in recent years but there is still a paucity of studies on this subject. The aim of this study was to investigate the relationship between cannabis smoking, pneumothorax and bullous lung disease in a population of operated patients. METHODS AND FINDINGS: We performed a retrospective study on patients operated on for spontaneous pneumothorax. Patients were divided into three groups according to their smoking habit: cannabis smokers, only-tobacco smokers and nonsmokers. Cannabis lifetime exposure was expressed in dose-years (1d/y = 1 gram of cannabis/week for one year). Clinical, radiological and perioperative variables were collected. The variables were analyzed to find associations with smoking habit. The impact of the amount of cannabis consumption was also investigated by ROC curves analysis. Of 112 patients, 39 smoked cannabis, 23 smoked only tobacco and 50 were nonsmokers. Median cannabis consumption was 28 dose/years, median tobacco consumption was 6 pack/years. Cannabis smokers presented with more severe chronic respiratory symptoms and bullous lung disease and with a higher incidence of tension pneumothorax than both tobacco smokers and nonsmokers. Cannabis smokers also developed a larger pneumothorax, experienced prolonged postoperative stay and demonstrated a higher incidence of pneumothorax recurrence after the operation than nonsmokers did. The risk of occurrence of chronic respiratory symptoms and bullous lung disease in cannabis smokers was dose-related. CONCLUSIONS: Cannabis smoking seems to increase the risk of suffering from respiratory complaints and can have detrimental effects on lung parenchyma, in a dose-dependent manner. Cannabis smoking also negatively affected the outcome of patients operated for spontaneous pneumothorax. A history of cannabis abuse should always be taken in patients with pneumothorax. There may be need for a specific treatment for pneumothorax in cannabis smokers.


Assuntos
Vesícula/fisiopatologia , Fumar Maconha/efeitos adversos , Pneumotórax/fisiopatologia , Fumar Tabaco/efeitos adversos , Adulto , Vesícula/diagnóstico por imagem , Vesícula/etiologia , Vesícula/cirurgia , Cannabis/efeitos adversos , Feminino , Alucinógenos/efeitos adversos , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Abuso de Maconha/epidemiologia , Abuso de Maconha/fisiopatologia , Pessoa de Meia-Idade , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/cirurgia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/fisiopatologia , Enfisema Pulmonar/cirurgia , Sistema Respiratório/diagnóstico por imagem , Sistema Respiratório/fisiopatologia , Índice de Gravidade de Doença , Fumantes , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
Mo Med ; 117(1): 20, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32158037
10.
Sports Health ; 12(2): 189-199, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32023171

RESUMO

CONTEXT: Cannabis use has increased, in large part due to decriminalization. Despite this increase in usage, it remains unclear what proportion of athletes use cannabis and what effect it has on athletic performance and recovery. OBJECTIVE: To systematically review cannabis use among athletes, including epidemiology, effect on performance and recovery, and regulations for use in sport. DATA SOURCES: PubMed, MEDLINE, and EMBASE databases were queried from database inception through November 15, 2018. A hand search of policies, official documents, and media reports was performed for relevant information. STUDY SELECTION: All studies related to cannabis use in athletes, including impact on athletic performance or recovery, were included. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Demographic and descriptive data of included studies relating to epidemiology of cannabis use in athletes were extracted and presented in weighted means or percentages where applicable. RESULTS: Overall, 37 studies were included, of which the majority were cross-sectional studies of elite and university athletes. Among 11 studies reporting use among athletes (n = 46,202), approximately 23.4% of respondents reported using cannabis in the past 12 months. Two studies found a negative impact on performance, while another 2 studies found no impact. There was no literature on the influence of cannabis on athletic recovery. Across athletic organizations and leagues, there is considerable variability in acceptable thresholds for urine tetrahydrocannabinol levels (>15 to 150 ng/mL) and penalties for athletes found to be above these accepted thresholds. CONCLUSION: Overall, these results suggest that approximately 1 in 4 athletes report using cannabis within the past year. Based on the available evidence, cannabis does not appear to positively affect performance, but the literature surrounding this is generally poor. Given the variability in regulation across different sport types and competition levels, as well as the growing number of states legalizing recreational cannabis use, there is a need to improve our understanding of the effects of cannabis use on the athlete and perhaps adopt a clearer and overarching policy for the use of cannabis by athletes in all sports and at all levels.


Assuntos
Abuso de Maconha/epidemiologia , Fumar Maconha/epidemiologia , Esportes/estatística & dados numéricos , Desempenho Atlético/fisiologia , Dronabinol/urina , Humanos , Política Organizacional , Esportes/legislação & jurisprudência , Detecção do Abuso de Substâncias
14.
Am J Psychiatry ; 177(7): 611-618, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31964162

RESUMO

OBJECTIVE: Given changes in U.S. marijuana laws, attitudes, and use patterns, individuals with pain may be an emerging group at risk for nonmedical cannabis use and cannabis use disorder. The authors examined differences in the prevalence of nonmedical cannabis use and cannabis use disorder among U.S. adults with and without pain, as well as whether these differences widened over time. METHODS: Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, 2001-2002; N=43,093) and NESARC-III (2012-2013; N=36,309) were analyzed using logistic regression. Risk differences of past-year nonmedical cannabis use, frequent (at least three times a week) nonmedical use, and DSM-IV cannabis use disorder were estimated for groups with and without moderate to severe pain, and these risk differences were tested for change over time. RESULTS: Any nonmedical cannabis use was more prevalent in respondents with than without pain (2001-2002: 5.15% compared with 3.74%; 2012-2013: 12.42% compared with 9.02%), a risk difference significantly greater in the 2012-2013 data than in the 2001-2002 data. The prevalence of frequent nonmedical cannabis use did not differ by pain status in the 2001-2002 survey, but was significantly more prevalent in those with than without pain in the 2012-2013 survey (5.03% compared with 3.45%). Cannabis use disorder was more prevalent in respondents with than without pain (2001-2002: 1.77% compared with 1.35%; 2012-2013: 4.18% compared with 2.74%), a significantly greater risk difference in the data from 2012-2013 than from 2001-2002. CONCLUSIONS: The results suggest that adults with pain are a group increasingly vulnerable to adverse cannabis use outcomes, warranting clinical and public health attention to this risk. Psychiatrists and other health care providers treating patients with pain should monitor such patients for signs and symptoms of cannabis use disorder.


Assuntos
Abuso de Maconha/epidemiologia , Fumar Maconha/epidemiologia , Dor/epidemiologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Comorbidade/tendências , Feminino , Humanos , Masculino , Fumar Maconha/tendências , Pessoa de Meia-Idade , Prevalência , Estados Unidos/epidemiologia , Adulto Jovem
15.
J Clin Neurosci ; 72: 98-101, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31973920

RESUMO

BACKGROUND: Cannabis is the most consumed recreational drug in the world. It is possible that cannabis has an association with an increased risk of vasospasm-related strokes and delayed cerebral ischemia (DCI), which are major causes of morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH). Hence, this study aimed to explore the independent relationship between cannabis use and outcomes after aSAH using the 2016 United States Nationwide Inpatient Sample. METHODS: This study was conducted using the 2016 National Inpatient Sample with ICD-10 codes. Multivariate logistic regression was used to examine the association between cannabis use, the primary (inpatient mortality) and secondary outcomes. RESULTS: There were 42,394 patients identified with aSAH, of whom 925 were identified as cannabis users. Cannabis users and non-users were similar in terms of severity of aSAH. Although the unadjusted mortality rate was lower among cannabis users (16%) than non-users (22%), (p = 0.04), both the age-adjusted odds ratio (OR) (0.83, 95% confidence interval (CI): 0.56; 1.24) and the multivariate-adjusted OR (0.87, 95% CI: 0.54; 1.42) did not reach statistical significance. Secondary outcomes did not reach statistical significance. CONCLUSION: In this nationwide cohort, cannabis users with aSAH had similar outcomes compared to nonusers. However, these results are likely limited by underreporting of cannabis use. Future prospective studies are needed to elucidate the pathophysiology and association between cannabis and outcomes following aSAH.


Assuntos
Abuso de Maconha/epidemiologia , Hemorragia Subaracnóidea/epidemiologia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento , Estados Unidos
18.
J Forensic Sci ; 65(1): 170-182, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31211877

RESUMO

Forty-three fatalities involving the potent synthetic cannabinoid, 5-Fluoro-ADB, are summarized. For each case, a description of the terminal event, autopsy findings, cause of death, qualitative identification of 5-Fluoro-ADB and its ester hydrolysis metabolite, 5-Fluoro-ADB metabolite 7, in urine, and the quantitative values obtained in the blood specimens are outlined. Central blood concentrations ranged from 0.010 to 2.2 ng/mL for 5-Fluoro-ADB and 2.0 to 166 ng/mL for 5-Fluoro-ADB metabolite 7. Peripheral blood concentrations ranged from 0.010 to 0.77 ng/mL and 2.0 to 110 ng/mL for 5-Fluoro-ADB and 5-Fluoro-ADB metabolite 7, respectively. The majority of cases resulted in central to peripheral blood concentration ratios greater than 1 for 5-Fluoro-ADB (58%) and 5-Fluoro-ADB metabolite 7 (71%) suggesting that postmortem redistribution occurs to some extent. Combining the increased cardiac weight and/or gastric volume and toxicology data identifying 5-Fluoro-ADB, it is hypothesized that abuse of this substance may precipitate a dysrhythmia and cause sudden death.


Assuntos
Drogas Ilícitas/sangue , Drogas Ilícitas/urina , Indazóis/sangue , Indazóis/urina , Abuso de Maconha/mortalidade , Adulto , Cromatografia Gasosa , Cromatografia Líquida , Técnica de Imunoensaio Enzimático de Multiplicação , Ensaio de Imunoadsorção Enzimática , Toxicologia Forense , Humanos , Drogas Ilícitas/efeitos adversos , Indazóis/efeitos adversos , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Estrutura Molecular , Miocárdio/patologia , Tamanho do Órgão , Estômago/patologia
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