Nonmedical Users Research Articles

Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits

AbstractThe legalization of cannabis for medical and recreational purposes has progressed internationally. Cannabis and cannabinoids are advocated for a plethora of medical indications. An increasing number of medical and nonmedical users regularly consume large doses of delta-9-Tetrahydrocannabinol (THC), the main active component of cannabis. Aim: to summarize the evidence on (1) risks of recreational cannabis use and (2) effectiveness and safety of medicinal cannabis. Findings on recreational use: Cannabis is mostly used to experience its acute rewarding effects. Regular use of high THC products can produce addiction (cannabis use disorder or CUD). Acute consumption of high THC doses (including unintentionally) can cause time-limited mental, gastrointestinal, and cardiovascular problems and motor vehicle accidents. Chronic patterns of cannabis use have been associated with multiple adverse outcomes that are of particular concern among adolescents and young adults, such as, disrupted learning, impaired cognitive performance, reduced educational attainment and an increased risk of CUD, psychosis/schizophrenia, mood and anxiety disorders and suicidal behaviors. There is debate about the extent to which cannabis use is a cause of these adverse outcomes. Physical health risks (e.g., respiratory and cardiovascular, prematurity and restricted fetal growth, hyperemesis syndrome among others) have also been linked with repeated consumption of cannabis with a high THC content. Findings on medical cannabis use: Herbal cannabis, medicines from extracted or synthetized cannabinoids—often used as adjuvants to standard medicines—may produce small to modest benefits. This is primarily the case in treating chronic pain, muscle spasticity, chemotherapy-induced nausea and vomiting, and refractory epilepsy (in the case of cannabidiol, CBD). The evidence is inconclusive on their value in treating mental disorders and other medical conditions. Safety: Cannabis-based medicine is generally well tolerated. There is a risk of mild to moderate adverse effects and CUD.

Evaluating large language models on medical, lay-language, and self-reported descriptions of genetic conditions

Large language models (LLMs) are generating interest in medical settings. For example, LLMs can respond coherently to medical queries by providing plausible differential diagnoses based on clinical notes. However, there are many questions to explore, such as evaluating differences between open- and closed-source LLMs as well as LLM performance on queries from both medical and non-medical users. In this study, we assessed multiple LLMs, including Llama-2-chat, Vicuna, Medllama2, Bard/Gemini, Claude, ChatGPT3.5, and ChatGPT-4, as well as non-LLM approaches (Google search and Phenomizer) regarding their ability to identify genetic conditions from textbook-like clinician questions and their corresponding layperson translations related to 63 genetic conditions. For open-source LLMs, larger models were more accurate than smaller LLMs: 7b, 13b, and larger than 33b parameter models obtained accuracy ranges from 21%-49%, 41%-51%, and 54%-68%, respectively. Closed-source LLMs outperformed open-source LLMs, with ChatGPT-4 performing best (89%-90%). Three of 11 LLMs and Google search had significant performance gaps between clinician and layperson prompts. We also evaluated how in-context prompting and keyword removal affected open-source LLM performance. Models were provided with 2 types of in-context prompts: list-type prompts, which improved LLM performance, and definition-type prompts, which did not. We further analyzed removal of rare terms from descriptions, which decreased accuracy for 5 of 7 evaluated LLMs. Finally, we observed much lower performance with real individuals' descriptions; LLMs answered these questions with a maximum 21% accuracy.

Endocannabinoids and related lipids linked to social exclusion in individuals with chronic non-medical prescription opioid use

Opioid-related overdose deaths are still on the rise in North America, emphasizing the need to better understand the underlying neurobiological mechanisms regarding the development of opioid use disorder (OUD). Recent evidence from preclinical and clinical studies indicate that the endocannabinoid system (ECS) may play a crucial role in stress and reward, both involved in the development and maintenance of substance use disorders. Animal models demonstrate a specific crosstalk between the ECS and the endogenous opioid system. However, translational studies in humans are scarce. Here, we investigated basal plasma levels of the endocannabinoids anandamide (AEA) and 2-arachidonoyglycerol (2-AG), and eight endocannabinoid-related lipids, including oleoylethanolamide (OEA) and palmitoylethanolamide (PEA), as well as whole blood fatty acid amide hydrolase (FAAH) activity in chronic non-medical prescription opioid users (NMPOU; n = 21) compared to opioid-naïve healthy controls (n = 29) considering age, sex, and cannabis use as potential confounders. Additionally, the association of endocannabinoids and related lipids with the participants’ response to experimentally induced social exclusion was examined. We found significantly elevated basal AEA, OEA, and PEA levels in NMPOU compared to controls, but no differences in FAAH activity, 2-AG, or other endocannabinoid-related lipids. Within NMPOU, higher AEA levels were associated with lower perception of social exclusion. Robust positive correlations within N-acylethanolamines (i.e., AEA, OEA, and PEA) indicate strong metabolic associations. Together with our recent findings of elevated basal 2-AG levels in dependent cocaine users, present results indicate substance-specific alterations of the ECS that may have implications in the search for novel therapeutic interventions for these populations.

Analysis of Factors that Influence Compliance in Complete Administration of BPJS Participant Patients at The Banten Girang Puskesmas Outpatient Registration Place

Health insurance in Indonesia is one of the rights that every citizen must have. Whenplanning a visit to the Community Health Center, patients hope to receive appropriatetreatment with humane, effective and efficient services, because everyone has theright to obtain safe, quality and affordable health services. In order to achieve a goodservice process, detailed work procedures are required and must be carried out andobeyed by all staff in the hospital, both medical and non-medical staff includinghospital service users, to be orderly and cooperative with each other. This study aimsto determine the analysis of factors that influence compliance in the completeness ofpatient administration for BPJS participants at the Banten Girang Community HealthCenter outpatient registration site in 2023. The research design used is an analyticaltype of research with a cross sectional approach. The population in this study was2,524 people and the sample used was 97 respondents. The sampling technique in thisstudy used accidental sampling technique. The results of this study indicate that thereare still 22 BPJS participating patients who do not comply with administrativerequirements (27.8%) at the Banten Girang Community Health Center outpatientregistration site in 2023. The factor that influences compliance with administrativerequirements for BPJS participating patients is knowledge (OR= 4.705; 95% CI: 1.471-15.045), education level (OR= 7.785; 95% CI: 2.510-24.149), source of information(OR= 4.796; 95% CI: 1.541-14.930). The most dominant factor contributing tocompliance in the complete administration of BPJS patient patients with a p-value of0.000 (OR= 7.785; 95% CI: 2.510-24.149). It is hoped that the results of this researchcan become study material for the Community Health Center to provide socializationor information regarding the administrative completeness of BPJS participants usingmethods that are easy to understand, so that they can increase the knowledge of BPJSparticipant patients.

Assessing the quality of breast cancer-related videos on TikTok: A cross-sectional study.

Breast cancer, the most common cancer in women globally, highlights the need for patient education. Despite many breast cancer discussions on TikTok, their scientific evaluation is lacking. Our study seeks to assess the content quality and accuracy of popular TikTok videos on breast cancer, to improve the dissemination of health knowledge. On August 22, 2023, we collected the top 100 trending videos from TikTok's Chinese version using "breast cancer/breast nodule" as keywords. We noted their length, TikTok duration, likes, comments, favorites, reposts, uploader types, and topics. Four assessment tools were used: Goobie's six questions, the Patient Educational Material Assessment Tool (PEMAT), the Video Information and Quality Index (VIQI), and the Global Quality Score (GQS). These instruments evaluate videos based on content, informational integrity, and overall quality. Among the 100 videos, content quality was low with Goobie's questions mostly scoring 0, except for management at 1.0 (QR 1.0). PEMAT scores were moderate: 54.1 (QR 1.6) for sum, 47.0 (QR 18.8) for PEMAT-A, and 52.3 (QR 11.7) for PEMAT-U. Regarding the quality of information, the VIQI (sum) median was 14.1 (QR 0.2). Additionally, the median GQS score was 3.5 (QR 0.1). Medical professionals' videos focused on breast cancer stages, while patient videos centered on personal experiences. Patient videos had lower content and overall quality compared to those by medical professionals (PEMAT, GQS: P < 0.001, P = 0.004) but received more comments, indicating higher engagement (all P < 0.05). TikTok's breast cancer content shows educational potential, but while informational quality is moderate, content quality needs improvement. Videos by medical professionals are of higher quality. We recommend increased involvement of healthcare professionals on TikTok to enhance content quality. Non-medical users should share verified information, and TikTok should strengthen its content vetting. Users must scrutinize the credibility of health information on social platforms.

Exercises for fibromyalgia syndrome: what YouTube tells us as a source of information for patient and physician education.

YouTube, a popular worldwide source to access health information online, may have an impact in enhancing exercise therapy for fibromyalgia patients. This study is aimed to investigate the quality and reliability of exercise videos prepared for fibromyalgia syndrome on YouTube. A thorough search on YouTube using six search terms related to fibromyalgia treatment and exercise was conducted. The videos with content on exercises for fibromyalgia, acceptable audio-video quality, and are in English language were included, whereas duplicates were excluded from the analysis. Quality was determined using the Global Quality Scale (GQS) and JAMA system, and reliability using the mDISCERN criteria. Out of a total of 600 videos, 70 videos that met the inclusion criteria were included in the analysis. Physicians were found to produce content mostly in high and medium quality (%70.2), other medical professionals mostly in low and medium quality (93.8%), while non-medical users mostly in low quality (86.7%). Ninety percent of the videos targeted patients, while 10% targeted healthcare professionals as an audience, and the majority (93.7%) of videos targeting patients were of low and medium quality, as most (85.7%) of the videos targeting healthcare professionals were of high quality. YouTube can be used as a tool to increase exercise adherence in fibromyalgia patients, as it offers a wide range of content that is easily accessible and useful at times. To implement this tool, physicians need to upload more content online as they stand for pioneers of high-quality information dissemination on the internet. KeyPoints • This research emphasizes the need for high-quality online healthcare information which is accessed by a vast number of individuals and the implementations that effectively address and prevent the spread of misinformation. • Additionally, it presents suggestions for the future regarding the uploading of such content on the internet. • Physicians hold the key responsibility in ensuring the availability of high-quality online health content, thereby carrying significant implications for its overall impact.

No decline in drug overdose deaths in Norway: An ecological approach to understanding at-risk groups and the impact of interventions.

Aim: This Norwegian case study examines groups at risk of drug overdose deaths, evidence-based harm reduction interventions, low-threshold services and treatment implemented, as well as trends in drug overdose deaths between 2010 and 2021. We aimed to explore the relevance of interventions for at-risk groups and discuss their potential impact on drug overdose trends. Method/data: Using an ecological approach, we analysed the following: (1) groups identified through latent profile analysis (LPA) among a sample of 413 high-risk drug users collected in 2010-2012, supplemented with other relevant studies up to 2021; (2) published information on harm-reduction interventions, low-threshold services and treatment in Norway; and (3) nationwide drug overdose mortality figures supplemented with published articles on the topic. Results: High-risk drug users in 2010-2012 commonly engaged in frequent illegal drug use, injecting and poly-drug use (including pharmaceutical opioids), which continued into following decade. The interventions implemented between 2010 and 2021 were relevant for at-risk groups identified in the surveys. However, there was no decrease in the trend of drug overdose deaths up to 2021. While relevant interventions may have mitigated a theoretical increase in mortality, new at-risk groups may have contributed to fatal outcomes associated with pharmaceutical opioids. Conclusion: The interventions were relevant to the risk groups identified among high-risk drug users and potentially effective in preventing an increase in drug overdose trends. However, tailored interventions are needed for individuals at risk of death from prescribed opioids. Comprehensive studies encompassing all at-risk populations, including both legal and non-medical users of prescription opioids, are needed.

Tramadol control measures and supply for health-care services: findings from Ghana and other West African countries

PurposeThis paper aims to explore the role of tramadol in pain management and the impact of regulatory measures on supply and medical access in Ghana and other African countries.Design/methodology/approachThe study adopted an exploratory design and qualitative methods to explore the perspectives of different actors, including officials of regulatory agencies, law enforcement agents, health-care providers and non-medical tramadol users. Data were collected through individual and group interviews, and transcripts were subjected to thematic analysis.FindingsFindings show that tramadol fills a critical gap in treating pain across Ghana in areas with an acute shortage of opioid analgesics due to scheduling-related barriers. This was partly due to porous borders allowing for an influx of tramadol into the countries. The study further found that most tramadol purchases in Ghana and other West African countries were made from market traders rather than from health-care settings and were mainly generic medicines categorised as “substandard/spurious/falsely-labelled/falsified/counterfeit medical products” within the World Health Organization standards.Research limitations/implicationsAlthough the findings are instructive, there were some limitations worth noting. The study encountered several limitations, especially with the non-medical users, because the environment is highly criminalised, People who use drugs were unwilling to avail themselves for fear of law enforcement officers’ harassment. Obtaining ethical clearance had its own bureaucracy – challenges that delayed the study time frame.Practical implicationsPlacing tramadol under the list of internationally controlled substances would create barriers to access to effective pain medications, particularly by the poor, and encourage victimisation of users by law enforcement authorities.Originality/valueThe study is based on empirical research on tramadol use and regulation in African countries, contributing to knowledge in an under-researched subject area on the continent. The comparative approach further adds value to the research.

A sensorized modular training platform to reduce vascular damage in endovascular surgery.

Endovascular interventions require intense practice to develop sufficient dexterity in catheter handling within the human body. Therefore, we present a modular training platform, featuring 3D-printed vessel phantoms with patient-specific anatomy and integrated piezoresistive impact force sensing of instrument interaction at clinically relevant locations for feedback-based skill training to detect and reduce damage to the delicate vascular wall. The platform was fabricated and then evaluated in a user study by medical ([Formula: see text]) and non-medical ([Formula: see text]) users. The users had to navigate a set of guidewire and catheter through a parkour of 3 modules including an aneurismatic abdominal aorta, while impact force and completion time were recorded. Eventually, a questionnaire was conducted. The platform allowed to perform more than 100 runs in which it proved capable to distinguish between users of different experience levels. Medical experts in the fields of vascular and visceral surgery had a strong performance assessment on the platform. It could be shown, that medical students could improve runtime and impact over 5 runs. The platform was well received and rated as promising for medical education despite the experience of higher friction compared to real human vessels. We investigated an authentic patient-specific training platform with integrated sensor-based feedback functionality for individual skill training in endovascular surgery. The presented method for phantom manufacturing is easily applicable to arbitrary patient-individual imaging data. Further work shall address the implementation of smaller vessel branches, as well as real-time feedback and camera imaging for further improved training experience.

Risk perceptions of driving under the influence of cannabis: Comparing medical and non-medical cannabis users

BackgroundReduced perception of potential harm resulting from cannabis use is associated with greater risk of driving under the influence of cannabis (DUIC). Understanding risk perceptions of DUIC among subgroups of users will positively inform targeting and content of anti-DUIC driver education and public awareness campaigns. The current study compared DUIC-related risk perceptions among individuals who use cannabis exclusively for non-medical purposes versus those who use cannabis for exclusively medical or for both medical and non-medical purposes (i.e., dual-purpose users). MethodData were drawn from a regionally stratified cross-sectional general population telephone survey of adults (18 + years) in Ontario, Canada conducted in 2017. Respondents who reported past-year use of cannabis and answered questions regarding DUIC risk perceptions were selected (weighted N = 343). Modified Poisson regression models with robust standard error estimation were conducted for three attitudes: disagree that DUIC increases motor vehicle collision risk, agree that DUIC is safer than driving under the influence of alcohol (DUIA), agree that chances of being caught by police for DUIA higher than DUIC. In addition to type of cannabis user (non-medical only versus medical or dual-purpose), covariates included demographic characteristics and past-year alcohol and cannabis use frequency. ResultsAdjusting for other covariates, regression analyses indicated that medical or dual-purpose cannabis users were 45 % more likely than non-medical users to agree that DUIC is safer than DUIA (Adjusted Prevalence Ratio = 1.45, 95 %CI = 1.10, 1.91, p = 0.007). No other differences in risk perception between medical or dual-purpose and non-medical cannabis users were found. DiscussionAlthough no difference between medical or dual-purpose and non-medical cannabis users was found in perceptions of collision risk associated with DUIC or risk of police enforcement, the perception that DUIC is safer than DUIA was stronger among medical or dual-purpose than non-medical users. Recognizing that the shift in public perception of DUIA as a high-risk behaviour contributed to reductions in incidence of DUIA, results of the current study support education and awareness campaigns that target medical or dual-purpose users and emphasize that, like DUIA, DUIC is also a high-risk behaviour.

MP18-06 IS TIKTOK A RELIABLE SOURCE OF EDUCATIONAL INFORMATION ON TESTICULAR TORSION?

You have accessJournal of UrologyCME1 Apr 2023MP18-06 IS TIKTOK A RELIABLE SOURCE OF EDUCATIONAL INFORMATION ON TESTICULAR TORSION? R. Craig Sineath, Kenneth Verlage, Kathryn Vu, and Casey Seideman R. Craig SineathR. Craig Sineath More articles by this author , Kenneth VerlageKenneth Verlage More articles by this author , Kathryn VuKathryn Vu More articles by this author , and Casey SeidemanCasey Seideman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: TikTok is a social media app has about 1 billion monthly users, most of which are 10-29 years of age. This platform allows users to create videos with music and graphics to share. No studies have been published evaluating thequality of testicular torsion information on this social media app that is predominantly used by age groups at risk of this condition. Our study evaluates the first 100 videos results when searching “testicular torsion” for variables related to education, quality, and engagement. METHODS: Videos were examined for type of content creator (medical professional vs non-medical person), information presented in the video (mention of torsion, discussion of the pathophysiology, recommending going the emergency room, potential loss of testis, infertility, or hypogonadism, inclusion of misinformation), and engagement (mention of personal story; use of humor, music, or diagrams; number of likes, comments, and views). Analyses focused on presence of clinically important information and how this impacted engagement. RESULTS: Only 20% of videos were made by medical professionals. Medical professionals tended to use diagrams, discuss pathophysiology, and advise going to the emergency roommore than videos made by non-medical users. 20% of videos included at least one of these pieces of information. Only 7% of the videos mentioned all three of these variables and were considered high quality; 61% of videos did not discuss any of these variables. Videos created by medical professionals had more likes, views, and comments compared to those made by non-medical people. Use of music was also found to increase engagement. Interestingly, videos considered high quality had more likes, views, and comments compared to those that did not mention the three important clinical variables. CONCLUSIONS: There is an opportunity to reach patients at risk for testicular torsion through TikTok. Currently, there is a paucity of engaging and high-quality educational material for testicular torsion on this social media app that is heavily used by a demographic with the greatest risk of developing this condition. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e225 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information R. Craig Sineath More articles by this author Kenneth Verlage More articles by this author Kathryn Vu More articles by this author Casey Seideman More articles by this author Expand All Advertisement PDF downloadLoading ...

Medical cannabis identity and public health paternalism

ObjectivesState-dependent and variable lists of medical conditions granting access to medical cannabis in the United States may be an example of public health paternalism. While purporting to ensure that medical use is clearly defined, the variability of approved conditions has created an atmosphere of ambiguity and medical precarity. The purpose of this study is to examine the relationship between “state” and “self” medical cannabis user identities and the ways non-medical users understand their cannabis consumption. Study designThis is a mixed methods study consisting of semi-structured interviews and survey data. MethodsIn Phase 1, we examined the relationship between self and state-sanctioned cannabis identity, drawing on the 2022 New Frontier Data Consumer Survey of current cannabis consumers (N = 4682). In Phase 2, we conducted eight semi-structured interviews with a separate sample of adults who use cannabis regularly but do not consider themselves “medical consumers”. ResultsSelf-reported cannabis identity was significantly related to the adoption of a cannabis consumer identity. Those who self-identified as solely medical or recreational consumers were more likely to reject the identity of “cannabis consumer” than those who identified as both. Self-medical identity was overshadowed by use for “wellness” among interviewees. Most interviewees, despite not identifying as medical users, report therapeutic benefit. Their identity as a cannabis consumer, is tied to the definition of “medical cannabis patient” where they live as well as the fluctuating role of cannabis related to their well-being across their lifespan. ConclusionsThe designation of medical vs. nonmedical use of cannabis varies from state to state, which is not the case for other medicine. This highly variable designation may be paternalistic in nature as governments attempt to differentiate between “legitimate” and “illegitimate” use in the context of federal cannabis prohibition. As a result, lines between medical use and wellness are blurred, which impacts consumer self-identity.

TikTok and adolescent vision health: Content and information quality assessment of the top short videos related to myopia.

Despite the increasing recognition of the public health value of social media platforms, TikTok short videos focusing on adolescent vision health have not received much attention. We aimed to evaluate the content, sources, and information quality of myopia-related videos on TikTok. The top 200 most-liked myopia-related videos on the Chinese version of TikTok were queried and screened on March 12, 2022. The descriptive characteristics, contents, and sources of the selected 168 videos were obtained, and their overall quality, reliability, understandability, and actionability were assessed using the validated scoring instruments DISCERN and PEMAT-A/V. Medical professionals were the main source (45.8%, 77/168) of videos. Misinformation (10.1%, 17/168) was mainly attributable to for-profit organizations (20%, 3/15) and individual non-medical users (31.3%, 10/32). However, their videos enjoyed the highest numbers of "likes," "comments," and "shares" (P < 0.05). The mean reliability and overall quality regarding treatment choice were (2.5 ± 0.5) and (3.1 ± 0.9), respectively. Videos on TikTok showed relatively high understandability (84.7%) and moderate actionability (74.9%). Video producers tended to partly or fully provide information regarding management (81.5%, 137/168) and outcome (82.1%, 138/168), and to ignore or only slightly mention content related to definition (86.9%, 146/169) and signs (82.1%, 138/168). The five video sources showed significant differences in the prevalence of misleading information (P < 0.001), publication reliability (P < 0.001), overall quality (P = 0.039), content score (P = 0.019), and understandability (P = 0.024). Considering the moderate-to-poor reliability and variable quality across video sources, the substantial myopia-related content on TikTok should be treated with caution. Nevertheless, TikTok videos may serve as a surrogate or supplement for information dissemination if providers can ensure more comprehensive and accurate content.

Can YouTube be used as a credible source of information for COVID-19 vaccination in Italy?

Abstract Background The COVID-19 pandemic led to an ‘infodemic', as defined by the WHO, which made it difficult to be accurately informed on public health topics. For this purpose, many people use social media as a source of information, mainly YouTube. Given the great resonance of this platform, our study aims at assessing quality and reliability of its content regarding the COVID-19 vaccination. Methods During March 2022, six searches were performed on the Italian YouTube platform using the following terms: “Covid vaccination”, “Covid vaccine”, “Coronavirus vaccination”, “Coronavirus vaccine”, “Sars-Cov-2 vaccination” and “Sars-Cov-2 vaccine”. A total of 329 videos were analysed, after removing 271 duplicated videos, and classified in seven types of channel. The reliability of the content was evaluated through the HoNCode score, while quality was tested using the validated DISCERN tool. Results The most frequent category was ‘Internet Media’ (33%), while the less frequent one was ‘Educational Medical’ (7%). The content reliability (i.e. HoNCode score) resulted higher for videos produced by medical healthcare workers than non-medical ones. Concerning the quality, the DISCERN score resulted significantly higher for the Educational channels (median 46.0 for medical and 41.3 non-medical ones) as compared to Internet Media (26.5) and New Agencies (24.3). Conclusions Although YouTube has implemented a policy against misinformation related to the COVID-19 vaccination, the study highlights that there is extreme heterogeneity in reliability and quality of videos. Content produced by non-medical users, especially “Internet Media” and “News Agencies” categories should be evaluated with attention by users, as their quality is not appropriate to the importance of the topic. Key messages • Because of to the heterogeneity of its content, YouTube should be evaluated carefully when used as a source of information for Covid-19 vaccination. • Content produced by non-medical users, is generally of poor quality, not appropriate to the importance of the topic.

Smartphone as an electronic stethoscope: factors influencing heart sound quality.

Smartphones are equipped with a high-quality microphone which may be used as an electronic stethoscope. We aim to investigate the factors influencing quality of heart sound recorded using a smartphone by non-medical users. An app named Echoes was developed for recording heart sounds using iPhone. Information on phone version and users' characteristics including sex, age, and body mass index (BMI) was collected. Heart sound quality was visually assessed and its relation to phone version and users' characteristics was analysed. A total of 1148 users contributed to 7597 heart sound recordings. Over 80% of users were able to make at least one good-quality recording. Good-, unsure- and bad-quality recordings amounted to 5647 (74.6%), 466 (6.2%) and 1457 (19.2%), respectively. Most good recordings were collected in the first three attempts of the users. Phone version did not significantly change the users' success rate of making a good recording, neither was sex in the first attempt (P = 0.41) or the first three attempts (P = 0.21). Success rate tended to decrease with age in the first attempt (P = 0.06) but not the first three attempts (P = 0.70). BMI did not significantly affect the heart sound quality in a single attempt (P = 0.73) or in three attempts (P = 0.14). Smartphone can be used by non-medical users to record heart sounds in good quality. Age may affect heart sound recording, but hardware, sex, and BMI do not alter the recording.

Poster 108: Narcotic Use Following Knee Arthroscopy in Adolescent Patients: A Prospective Evaluation

Poster 108: Narcotic Use Following Knee Arthroscopy in Adolescent Patients: A Prospective Evaluation

Effectiveness of brief interventions in primary care for cannabis users aged from 12 to 25 years old: a systematic review.

The aim of this systematic review was to assess the effectiveness of brief interventions realized in primary care in reducing cannabis use for adolescents and emerging adults. PubMed, CINAHL, Embase, PsycInfo, and Central (Cochrane Library) were searched until December 2020. Randomized controlled trials conducted in primary care, concerning in-person brief interventions for non-medical cannabis users aged from 12 to 25 years old were eligible for inclusion. Brief interventions had to last 30 min or less. Patients with comorbid mental health disorder or very specific populations were not included. One thousand eighty hundred and fifty-five studies were identified through database searching; only 8 studies involving 2,199 patients were included for qualitative synthesis after double reading and data extraction. Randomized controlled trials selected were heterogeneous regarding screening tools, initial levels of cannabis use and cannabis outcomes measures. Brief interventions were all based on motivational interviewing techniques or personalized feedback. Seven studies consisted in a single session of brief intervention. Six studies involved also other substance users. No significant reduction of cannabis use after brief intervention was found for most studies, especially in the long term. A trend of decreased cannabis consequences, such as negative psychosocial repercussions, perception of cannabis use by peers, or driving under the influence of cannabis, was reported. The current state of knowledge does not allow us to say that the brief intervention is effective in reducing cannabis use among adolescents in primary care. We found a mild positive effect on cannabis consequences after brief intervention. Mixed qualitative and quantitative studies are need to better evaluate the impact of brief intervention and his faisability. PROSPERO (International Prospective Register of Systematic Reviews): n° CRD42016033080.

Self-Reported Medical and Nonmedical Cannabis Use: Results from the 2018 Behavioral Risk Factor Surveillance System in 14 States.

As policies legalizing adult cannabis use increase in the United States, understanding and characterizing the proportion of individuals consuming cannabis for medical and nonmedical purposes is important to inform targeted health education efforts. Data came from 7672 adults (> = 18years) with past month cannabis use who responded to questions about reason for cannabis use on the 2018 Behavioral Risk Factor Surveillance System survey in 14 states. State and aggregated data were analyzed using weighted frequencies for descriptive analyses, and prevalence ratios were computed to identify demographic and substance use characteristics associated with medical only use or use for both medical and nonmedical reasons (vs. nonmedical use). Overall, 28.6% (95% CI: 26.7, 30.4) of adults who use cannabis reported using cannabis medically, 34.2% (95% CI: 32.3, 36.2) nonmedically, and 37.2% (95% CI: 35.2, 39.2) both medically and nonmedically. Characteristics associated with medical only use (compared with nonmedical only use) included being female; aged > 45years; out of work, a homemaker, or unable to work; having daily or near daily cannabis use; having past month cigarette use; having no past month alcohol use; self-reporting poor health; and ever having been diagnosed with certain chronic diseases. Medical only use of cannabis is the least prevalent reason for use; use for both medical and nonmedical reasons is the most prevalent. Monitoring reasons for cannabis use can aid states in understanding differences between medical and nonmedical cannabis users, providing context to use patterns, and targeting health education messages to appropriate audiences.

Substance Use Disorders and Psychoactive Drug Poisoning in Medically Authorized Cannabis Patients: Longitudinal Cohort Study.

ObjectivesPoisoning from psychoactive drugs and substance use disorders (SUD) have been reported among non-medical cannabis users. However, little is known about medical cannabis users and their risk for poisoning and/or development of SUD. This study assessed the risk of emergency department (ED) visits or hospitalization for 1) poisoning by psychoactive drugs and 2) mental/behavioural disorders due to the use of psychoactive drugs and other substances, in medically authorized cannabis patients in Ontario, Canada from 2014–2017.MethodsA cohort study of adult patients authorized for medical cannabis that were matched to population-based controls. ED visit/hospitalization were assessed with a main diagnostic code for: 1) poisoning by psychoactive drugs; 2) mental and behavioural disorder due to psychoactive drugs or other substance use. Conditional Cox proportional hazards regressions were conducted.Results18,653 cannabis patients were matched to 51,243 controls. During a median follow-up of 243 days, the incidence rate for poisoning was 4.71 per 1,000 person-years (95%CI: 3.71–5.99) for cases and 1.73 per 1,000 person-years (95% CI: 1.36–2.19) for controls. The adjusted hazard ratio (aHR) was 2.45 (95%CI: 1.56–3.84). For mental/behavioural disorders, the incident rates were 8.89 (95% CI: 7.47–10.57) and 5.01 (95% CI: 4.36–5.76) in the cannabis and the controls group. The aHR was 2.27 (95%CI: 1.66–3.11). No difference was observed between males and females (P-value for interaction > 0.05).ConclusionsOur study observed a short-term increased risk of ED visit/hospitalization for poisoning or for mental/behavioural disorders (from use of psychoactive drugs and other substances)- in medically authorized cannabis patients.

The Good, the Bad and the Ugly in App Diagnosis: Outcomes and Implications by Example

"The Clinical Decision Support (CDS), a form of artificial intelligence (AI), consider physician expertise and cognitive function along with patient’s data as the input and case-specific medical decision as an output. The improvements in physician’s performances when using a CDS ranges from 13% to 68%. The AI applications are of large interest nowadays, and a lot of effort is also put in the development of IT applications in healthcare. Medical decision support systems for non-medical staff users (MDSS-NMSF) as phone applications are nowadays available on the market. A MDSS-NMSF app is generally not accompanied by a scientific evaluation of the performances, even if they are freely available or not. Two clinical scenarios were created, and Doctor31 retrieved the diagnosis decisions. First scenario: man, 29 years old, and three symptoms: dysphagia, weight loss (normal body mass index), and tiredness. Second scenario: women, 47 years old with L5-S1 disk herniation, abnormal anti-TPO antibodies, lower back pain (burning sensations), constipation, and tiredness. The outcome possible effects and implications, as well as vulnerabilities induced on the used, are highlighted and discussed. "