Reasons For Use Research Articles

Reasons for Preoperative Opioid Use Are Associated with Persistent Use following Surgery Among Patients Undergoing Total Knee and Hip Arthroplasty

Abstract Objective Most studies on preoperative opioid use only describe whether or not patients use opioids without characterizing reasons for use. Knowing why patients use opioids can help inform perioperative opioid management. The objective of this study was to explore pain specific reasons for preoperative opioid use prior to total hip and knee arthroplasty (THA and TKA) and their association with persistent use. Methods This is a prospective study of 197 patients undergoing THA (n = 99) or TKA (n = 98) enrolled in the Analgesic Outcomes Study between December 2015 and November 2018. All participants reported preoperative opioid use. Results Reasons for preoperative opioid use were categorized as surgical site pain only (81 [41.1%]); pain in other body areas only (22 [11.2%]); and combined pain (94 [47.7%]). Compared to patients taking opioids for surgical site pain, those with combined reasons for use had 1.24 (P = .40) and 2.28 (P = .16) greater odds of persistent use at 3 and 6 months postoperatively, adjusting for relevant covariates. Conclusions This study provides novel insights into the heterogeneity of reasons for presurgical opioid use in patients undergoing a THA or TKA. One key take away is that not all preoperative opioid use is the same and many patients are taking opioids preoperatively for more than just pain at the surgical site. Combined reasons for use was associated with long-term use, suggesting nonsurgical pain, in part, drives persistent opioid use after surgery. Future directions in perioperative care should focus on pain and non-pain reasons for presurgical opioid use to create tailored postoperative opioid weaning plans.

Use of Complementary and Alternative Medicine for Prostate Cancer among African Americans, African Immigrants and Caribbean Immigrants.

Black men have the highest rate of prostate cancer (PCa) morbidity and mortality in the US, and often receive delayed and/or poorer-quality treatment. This inequity has led many to turn to complementary and alternative medicine/therapies (CAM). However, little is known about the use of these therapies within the Black community. The purpose of this study was to describe types of CAM therapies used, and the reasons behind their use for overall health and PCa treatment and prevention among three groups of Black males, namely African Americans, Caribbean Immigrants and African Immigrants. This study used a mixed-methods design with a quantitative phase (n = 575) followed by a qualitative phase (n = 61) with participants recruited from various parts of the country. Results revealed differences among subgroups in CAM use for overall health and PCa, as well as differences in the types of CAM therapies used and differences in the reasons behind their use. The findings of this study reveal a prevalence of CAM use for overall health and PCa within three different groups of Black men and identifies the specific CAM used. There were significant differences in the types of CAM used by each subgroup for both overall health and PCa. This study also shows that there is value in looking at Black subgroups distinctively, for their rates of CAM use and reasons for use, are distinctly different.

Role of Directional Configuration in Deep Brain Stimulation for Essential Tremor: A Single Center Experience.

Background:Traditionally, the standard of care for medication refractory essential tremor has been to utilize omnidirectional deep brain stimulation of the ventral intermediate nucleus. The advent of directional stimulation allows for spatial restriction of the stimulation on selected targets without involving the neighboring structures, thereby limiting off-target side effects and improving clinical utility.Methods:We performed a retrospective review of patients between February 2017 and September 2019 who had received ventral intermediate nucleus deep brain stimulation that allowed for directional programming (specifically Abbott/St. Jude). Initial and final major programming sessions post-operatively (approximately 30- and 90-days post-surgery) were examined to determine frequency and reason for use of directional programming.Results:A total of 33 total patients were identified. A little over half were males (58%, N = 19), with an average age of 68 years old (SD 9.3) at the time of surgery, and a disease duration of almost 30 years (27.2, SD 19) with a wide range from 2–62 years. After initial programming, over 50% (17 of 33) of patients were using directional configurations. This increased to 85% (28 of 33) at the 90-day programming. Reasons for conversion to directional configuration included avoidance of side effects (specifically, muscle contractions (9/33), paresthesia (5/33), dysarthria (1/33) and gait ataxia (1/33)) or improved tremor control (12/33).Discussion:Our single-center experience suggests that in the large majority of cases, directional leads were utilized and offered advantages in tremor control or side effect avoidance.

Pain medication use in youth athletes: A cross‐sectional study of 466 youth handball players

The aim of this study was to determine the 4-week prevalence of pain medication use in youth athletes, the type of medication used, the reasons for use, and from where the athletes obtained the medication. 466 handball players (aged 14-18) were surveyed about their pain medication use within the preceding 4 weeks. The questionnaire consisted of 3 parts: type of pain medication used (if any; non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen/paracetamol, and acetylsalicylic acid (ASA)), the reasons for use, and from where it was obtained. 190 players (41% [95% CI 36%-45%]) reported pain medication use within the last 4 weeks. Paracetamol was the most reported type (n = 157, 83% [95% CI 77%-88%]), followed by NSAIDs (n = 98, 52% [95% CI 44%-59%]); 67 reported “injury-related reasons” for their use, and most participants reported to obtain the pain medication via “from home or bought over-the-counter (OTC)” (n = 167, 88% [95% CI 82%-92%]). Pain medication use in youth handball players is common, particularly among female players, and a substantial proportion of the overall use is due to injury-related reasons. The vast majority of the players got their pain medication from home or purchased it OTC. Further research is needed to comprehend these patterns of use, including the long-term use.

More Reasons, More Use and Problems? Examining the Influence of Number of Motives on Consumption and Consequences Across Alcohol-Only, Cannabis-Only, and Simultaneous-Use Days

Alcohol and cannabis use as well as their simultaneous use are common among U.S. college students. Reasons for use are proximal predictors of consumption and consequences. Little research has examined possible adverse effects of endorsing multiple motives on a given use day. We examined the effects of the number of motives on consumption and negative consequences for alcohol-only, cannabis-only, and simultaneous-use days. College students (N = 341; 53% women; mean age = 19.79 years) who reported past-month simultaneous alcohol and cannabis use completed 54 days of data collection. We used generalized linear mixed-effects models to examine the effects of endorsing multiple motives on consumption and consequences. Across models, endorsing more motives than typical on a given use day (within person) and more motives in general (between person) was related to greater alcohol and cannabis consumption. Endorsing more alcohol-only motives and cannabis-only motives than typical resulted in greater odds of experiencing a negative consequence when accounting for consumption. This within-person effect was not statistically significant for simultaneous-use motives/consequences. Endorsing a greater number of motives across the study (i.e., between person) was not significantly related to consequences beyond consumption. Research has documented the robust effects of specific motives on substance use outcomes. Our novel findings extend this work by demonstrating the risks associated with endorsing multiple motives on a given use day. In addition to motive type, we recommend that the number of motives endorsed on a given day be considered as a potential risk factor to be targeted to reduce harms associated with substance use.

Awareness, use and perceptions of cigarillos, heated tobacco products and nicotine pouches: A survey among Dutch adolescents and adults

ObjectivesMany tobacco and related products (TRPs) are less strictly regulated and marketed as less harmful than cigarettes. Little is known about their awareness, use, user profile, use behavior, reasons for use and risk perception, especially for the newest products. In an exploratory survey study among Dutch adolescents and adults, we have investigated three examples of non-cigarette TRPs available on the worldwide market. MethodsIn a two-step web-based design, data on cigarillos, heated tobacco products (HTPs) and nicotine pouches were collected. In the first step (N = 5805), a representative sample (≥13 years) was studied to quantify their awareness, ever and current use in the Dutch population. In the second step (N = 526), in-depth data regarding use behavior, reasons for use and risk perception were collected among users and non-users. ResultsAwareness (<50%) and use (<15% ever use and <2% current use) is relatively low for all three products, but overall higher among men, (e-)cigarette users and respondents with higher education and social economic status. Most participants became aware of the products through people they knew. Reasons for use were mainly curiosity, pleasant taste, flavour variety, and lower harmfulness. All products were perceived as (slightly) less harmful and addictive than cigarettes. ConclusionsThis study is one of the first to investigate awareness and use of cigarillos, HTPs and nicotine pouches. To prevent increased use, we recommend regulators to extend flavour and smoking bans to these products. In addition, public information may discourage use by increasing awareness of health risks.

A Survey of Breast Cancer Patients’ Use of Cannabis During Radiation Therapy

Cannabis use is rapidly expanding and cancer is a qualifying condition in all 33 states allowing medical cannabis. However, the patterns of cannabis use among breast cancer patients receiving radiation therapy is unknown. The goal of this study was to better understand how and why cannabis is used among breast cancer patients undergoing adjuvant and palliative radiation therapy.Between 12/16/2019 and 1/19/2020, U.S.-based members of the Breastcancer.org Community (a nonprofit organization providing medical information and peer support) and Healthline, ≥ age 18 and diagnosed with breast cancer within 5 years, were invited to participate in a cannabis survey. After informed consent, anonymous data were collected and analyzed in aggregate. The study was led by Socanna (advancing the science of cannabis), conducted by Outcomes Insights, and supported by a grant from Ananda Health/Ecofibre.A total of 725 were screened and met eligibility criteria, of whom 612 subjects completed the survey. Overall, 42% (257/612) of participants had used medical cannabis products to relieve breast cancer symptoms or treatment side effects. Of the 120 respondents who received adjuvant radiation, 49% (59/120) used cannabis during breast radiotherapy; and 47% (14/30) used cannabis during palliative radiotherapy. Methods of cannabis product delivery were similar during adjuvant vs palliative radiation: edibles (75% vs 67%), liquids/tinctures (71% vs 83%), smoking (46% vs 47%), vaping (43% vs 43%), and pills/capsules/gel caps (18% vs 23%). Pain was the most common reason for using cannabis during adjuvant vs. palliative radiation treatment groups (77% vs 87%). Except for chronic pain (43% vs 67%, P < 0.05), no other pain subtype was statistically significantly different between adjuvant vs palliative care groups: acute pain (37% vs 47%), nerve pain (43% vs 57%), and joint/muscle aches/stiffness/pain (56% vs 60%). Pain was rarely the only reason for cannabis use, however. Other common symptoms for cannabis use during adjuvant vs palliative radiation included: insomnia (69% vs 77%), anxiety (58% vs 50%), stress (50% vs 43%), nausea/vomiting (47% vs 43%), and anorexia (38% vs 47%).Almost half of all participants reported using cannabis during adjuvant or palliative radiation to relieve breast cancer symptoms or treatment side effects, most commonly: pain, insomnia, anxiety, stress, nausea/vomiting, and anorexia. Patients undergoing palliative radiation were more likely to use cannabis to relieve chronic pain compared to patients undergoing adjuvant radiation. Both oral and inhalational methods of cannabis delivery were commonly utilized, regardless of stage. Although preliminary research shows that cannabis helps to relieve pain, nausea, insomnia and anxiety, safety studies are needed regarding the use of inhalational cannabis products during breast radiation, given the known risk of pulmonary toxicity from cigarette smoking during breast radiation.

The use of elctronic cigarettes among medical student in Casablanca

Abstract Introduction The electronic cigarette is an electronic device containing or not nicotine that produces vapours that are inhaled by users, thus mimicking the use of conventional cigarettes. These devices nevertheless contain components that are harmful to health. They have become particularly popular in recent years, especially among young people. Objective To estimate the frequency of e-cigarette use among medical students and to describe perceptions and practices of e-cigarette use. Methods This was a descriptive cross-sectional study conducted from August 2020 to March 2021 among medical students at the Faculty of Medicine and Pharmacy in Casablanca. The data were collected through a selfadministered, pre-tested, online questionnaire. The sample size was calculated a priori and statistical analyses were carried out using RStudio software. Results A total of 491 students were collected with a mean age of 21.03+/- 2.35 years, 66% were female, 51.9% were undergraduates and 20.6% were first year students. The frequency of e-cigarette use was 20.2%, and smoking was 20.8%. Of the 99 e-cigarette users, 75.75% had used e-cigarettes in the past 12 months. More than 21.9% of e-cigarette users used it daily, the most frequent reasons for use were curiosity (88.6%) and imitation (58.4%). Regarding perceptions, 22.1% felt more or less informed about the risks of e-cigarettes, 54.8% agreed that e-cigarettes are an effective way to quit smoking and 29.5% thought they would be more effective than nicotine replacement therapies. Conclusions The frequency of e-cigarette use is high among future doctors despite their knowledge of the health effects of its use. Preventive measures should be implemented to improve the health of students. Key messages Medical student are a subgroup particulary vulnarable to e-cigarette use. The perceptions of medical students, future health care providers, are heterogeneous.

Staying active during Covid-19 crisis: why it would have been important to keep public parks opened

BackgroundIn 2020, the Covid 19 pandemic and associated restrictions, including limited access to public urban green space (UGS), have led to a decrease in the ability of city dwellers to engage in physical activity. In France, more than 52% people reported being physically active in urban parks. Based on the GREENH-City research carried out in cities of the French network of WHO healthy cities, this presentation aims to show that UGS, depending on different drivers, can support a wide variety of physical activities, but also offer multiple other functions that contribute more or less directly to the health of the population.MethodsA qualitative survey was conducted among users of 3 different parks in each of the 6 selected cities with both observations and semi-directive interviews and a thematic analyzes were performed. Observed activities were classified into 8 groups including physical activity (non-sport, sports). Interview's analysis aimed to describe the reasons for coming and the type of activity made.Results186 observations and 591 recorded and unrecorded interviews with individuals or groups were conducted in the 18 parks. 24 types of physical activity have been described as possible uses of UGS. The most important, regardless of UGS location, is children activities in playgrounds. The most common activities are walking (with a social function) and jogging (individual function). Proximity and the accessibility are two reasons for use.ConclusionsUGS are an open access amenity for physical activities. From a social justice perspective, policy makers should ensure that every neighborhood is sufficiently close to an UGS. In addition to promoting physical activity, UGS also serve an important social function and impact the collective physical and mental health of the population in many other ways (e.g., as environmental risk regulators). Their coping role during crisis for population would worth to be studied further.Key messages Proximity and accessibility should shape local policies related to UGS renewal towards more equity.Different typologies of urban parks at the city level can offer multiple functions, including facilitation of physical activity that contribute to the health of the population.

Factors influencing providers' willingness to deprescribe medications

AbstractBackgroundPolypharmacy (taking ≥ five medications) is common and associated with adverse drug events, medication nonadherence, and increased mortality and healthcare costs. Primary care providers are uniquely positioned to deprescribe unnecessary medications, yet little is known about factors that influence their deprescribing decisions.ObjectivesWe sought to identify factors that influence primary care providers' recommendations to deprescribe potentially unnecessary medications.MethodsThis study represents a secondary data analysis from a national, cross‐sectional survey assessing providers' beliefs, attitudes, and experiences regarding medication deprescribing. A random sample of 2475 providers in Veterans Affairs (VA) primary care clinics were invited; 411 responded (16.6% response rate). Respondents included physicians (n = 304), nurse practitioners/physician assistants (n = 68), and clinical pharmacists (n = 39). Respondents estimated the proportion of their patients taking a potentially unnecessary medication. Of these patients, providers then identified the proportion for whom they recommended medication deprescribing (response options: &lt;20%, 20%‐39%, 40%‐59%, 60%‐79%, ≥80%). We used multivariable logistic regression to determine factors associated with recommending deprescribing to ≥80% of candidate patients.ResultsAlthough most respondents indicated having patients taking unnecessary medications, less than one‐third reported recommending deprescribing to most (≥80%) of their candidate patients. In adjusted analyses, factors significantly associated with increased likelihood of recommending deprescribing included having more patients who asked for medication information, providers' self‐rated comfort with deprescribing, and having support to monitor patients after deprescribing. When the indication for a medication was unclear, providers reported being less likely to recommend deprescribing.ConclusionMost providers indicated caring for patients taking potentially unnecessary medications, yet they did not consistently say they recommended deprescribing to these patients. Our findings suggest that requiring prescriptions to include their reason for use and models of primary care designed to strengthen interdisciplinary teamwork and communication, such as the patient‐centered medical home, could address barriers providers face to deprescribing medications.

Gender Differences in the Prevalence of Electronic Nicotine Product Use Among College Students in the U.S. - Analyses of the 2017 Population Assessment of Tobacco and Health (PATH) Study

The objective of this study was to analyze, among a nationally representative sample of college students in the U.S., gender differences in the lifetime, past 12-months, and past 30-day prevalence of e-nicotine products (ENPs) use, reasons for use, and susceptibility to ENP use among never users. We analyzed data from the Population Assessment of Tobacco and Health (PATH) Study. The study population included college-aged individuals (18-24 years old) enrolled in a degree program. The results of the study revealed that males were more likely to use ENPs than females. Both males and females reported a high proportion of misconception about ENPs, particularly with regards to ENPs being less harmful to the user than cigarettes. It also indicated that 36% of male and 32% of female college students were susceptible to start using ENPs. Our results highlight the need to provide comprehensive, tobacco-prevention education among U.S. youth.

401 - Cannabis and Older Adults

The National Cannabis Survey results indicates that cannabis consumption among older adults has been accelerating at a much faster pace than other age groups in Canada. Internationally, an increasing number of countries and U.S. states have also legalized medical and non-medical cannabis.More than 1500 physicians, nurse practitioners, other healthcare providers, healthcare students, older adults and caregivers of older adults responded to a needs assessment survey on Cannabis and Older Adults distributed by the Canadian Coalition for Seniors’ Mental Health (CCSMH) in the fall of 2020.Responses showed that 89% of physicians and nurse practitioners and 76% of other healthcare providers are aware of older patients in their practice using cannabis. Despite this fact, only 39% of physicians and nurse practitioners and 26% of other healthcare providers feel strongly or very strongly that they have sufficient knowledge and expertise to address older patients’ and theircaregivers’ questions about cannabis.Older adults who responded to the survey indicated that their most common reasons for using cannabis were pain, sleep and anxiety. Fifty-one percent responded that they had talked to their doctor or healthcare provider about cannabis but 41% of those older adults stated that their doctor or healthcare provider were unable to answer their questions. Older adults reported they access information on cannabis from the internet (45%), physicians (40%), friends and family (34%), cannabis stores and clinics (28%), the media (24%), and other healthcare providers (16%). Fifty-four percent of older adult respondents who use cannabis do so with a prescription or medical authorization from their physician/nurse practitioner for medical/therapeutic reasons. One quarter of respondents indicated they use cannabis for non-medical reasons (for recreational use).Although there is a reported gap in knowledge regarding cannabis and older adults, physicians, nurse practitioners, other healthcare providers and healthcare students all reported they are eager to learn more about how to talk with patients, how to authorize and prescribe cannabis appropriately, how to mitigate risks and assess for cannabis use disorder in older adults. CCSMH will be launching a physician- accredited e-learning course on Cannabis and Older Adults in January 2022.

Vitamin prescription pattern in Sudan: An evidence of supply induced demand

A growing trend of using vitamins has been documented, yet prescription pattern and reasons for use were not studied. The vitaminsindustry claims benefit in treating several neurological disorders in the absence of supportive evidence. The aim of this study was to explore the prescription pattern among patients attending neurology clinic.

The causes of I.C.T. use which increase time spent on the Internet by secondary school students and affect exposure to bullying from other students

The goal of the article is to explore the relationship between reasons for using the Internet and time spent on the Internet. The article also deals with reasons for using the Internet and exposure to bullying among adolescents. The survey was carried out on 710 secondary school students, based on a questionnaire about the habits and frequency of using information and communication technology (I.C.T.) The basic statistical values and multiple linear regression analysis were used. Based on the evaluation of the obtained data, the main reason for Internet use are video games, which confirms the first hypothesis, i.e., the relationship between the reason for using the Internet and the time spent using it. The second hypothesis can also be confirmed, i.e., that there is a significant statistical correlation between the time spent using the Internet and exposure to bullying, in the sense that certain reasons for using I.C.T. contribute to lower exposure to bullying. The results point to the resilience factors under consideration in a sense that some of these variables contribute to a shorter use of the Internet, and so to a lower exposure to bullying. Based on the obtained results it is possible to plan further preventive interventions in that sense.

Survey of Patients Employing Cannabigerol-Predominant Cannabis Preparations: Perceived Medical Effects, Adverse Events, and Withdrawal Symptoms.

Introduction: Cannabigerol (CBG), and its precursor before decarboxylation, cannabigerolic acid is sometimes labeled the "mother of all cannabinoids." The purpose of the present study was to investigate reasons for use and self-reported therapeutic effects in CBG-predominant cannabis users. Usage patterns and adverse effects, including withdrawal symptoms were also explored. Methods: Cannabidiol-predominant cannabis users were recruited online to complete an online survey assessing CBG use patterns, conditions treated with CBG-predominant cannabis (containing >50% CBG), perceived efficacy, associated adverse events, and withdrawal symptoms. One hundred twenty-seven eligible participants (U.S. residents ages 21+ who reported using CBG-predominant cannabis in the past 6 months) completed the survey. Results: Most of the samples (n=65; 51.2%) reported use of CBG-predominant products solely for medical purposes (n=46; 36.2% reported use for medical and recreational purposes; n=8; 6.3% reported recreational use only, and n=8 were missing). The most common conditions the complete sample reported using CBG to treat were anxiety (51.2%), chronic pain (40.9%), depression (33.1%), and insomnia/disturbed sleep (30.7%). Efficacy was highly rated, with the majority reporting their conditions were "very much improved" or "much improved" by CBG. Furthermore, 73.9% claimed superiority of CBG-predominant cannabis over conventional medicines for chronic pain, 80% for depression, 73% for insomnia, and 78.3% for anxiety. Forty-four percent of CBG-predominant cannabis users reported no adverse events, with 16.5% noting dry mouth, 15% sleepiness, 11.8% increased appetite, and 8.7% dry eyes. Around 84.3% reported no withdrawal symptoms, with sleep difficulties representing the most frequently endorsed withdrawal symptom (endorsed by two respondents). Conclusions: This is the first patient survey of CBG-predominant cannabis use to date, and the first to document self-reported efficacy of CBG-predominant products, particularly for anxiety, chronic pain, depression, and insomnia. Most respondents reported greater efficacy of CBG-predominant cannabis over conventional pharmacotherapy, with a benign adverse event profile and negligible withdrawal symptoms. This study establishes that humans are employing CBG and suggests that CBG-predominant cannabis-based medicines should be studied in randomized controlled trials.

The perceptions and beliefs of cannabis use among Canadian genitourinary cancer patients.

The legalization of recreational cannabis in Canada in 2018 has led to many patients being curious about the benefits of taking cannabis in conjunction with their cancer treatment. We investigated the perceptions among genitourinary (GU) cancer patients regarding cannabis use as part of their care plans. A survey was created to explore current cannabis use behaviors, reasons for cannabis use, and the beliefs of cannabis usefulness towards cancer-related care, including cancer treatment, among GU cancer patients. The survey was distributed across Canada online via RedCAP through social media platforms, email, and patient advocacy groups. The survey was active from August to December 2020. Of eighty-five responses, 52 met inclusion for analysis. Participants included 11 bladder, 26 kidney, and 15 prostate cancer patients. Many (48.1%) participants used cannabis daily and 75% had been using it for more than one year. Cannabis was consumed through oil-based products, edibles, and smoking. The most common reasons for using cannabis were cancer-related anxiety, to prevent cancer progression, cancer-related pain, recreational use, and other, non-cancer-related illness or symptoms. Participants believed cannabis improved their sleep (70.2%), anxiety (65.9%), and overall mood (72.3%). Most participants were either unsure (38.3%) or neutral (31.9%) in the belief that cannabis might decrease their cancer progression. GU cancer patients use cannabis for a variety of cancer- and non-cancer-related symptoms. Many patients believe cannabis has benefited their cancer-related symptoms. These findings highlight the importance of healthcare providers remaining familiar with current evidence on cannabis to support patient conversations about cannabis use.

Antidepressant use in low- middle- and high-income countries: a World Mental Health Surveys report.

The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries. Face-to-face interviews with community samples totaling n = 49 919 respondents in the World Health Organization (WHO) World Mental Health (WMH) Surveys asked about ADM use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses and asked of all respondents. 3.1% of respondents reported ADM use within the past 12 months. In high-income countries (HICs), depression (49.2%) and anxiety (36.4%) were the most common reasons for use. In low- and middle-income countries (LMICs), depression (38.4%) and sleep problems (31.9%) were the most common reasons for use. Prevalence of use was 2-4 times as high in HICs as LMICs across all examined diagnoses. Newer ADMs were proportionally used more often in HICs than LMICs. Across all conditions, ADMs were reported as very effective by 58.8% of users and somewhat effective by an additional 28.3% of users, with both proportions higher in LMICs than HICs. Neither ADM class nor reason for use was a significant predictor of perceived effectiveness. ADMs are in widespread use and for a variety of conditions including but going beyond depression and anxiety. In a general population sample from multiple LMICs and HICs, ADMs were widely perceived to be either very or somewhat effective by the people who use them.

The significant health threat from sunbed use as a self treatment in patients with acne.

Patients with acne are increasingly using sunbeds as a self treatment despite the harmful effects. Little is known about sunbed use in adult patients with acne under dermatology care. This questionnaire study explored prevalence and behaviours surrounding sunbed use in patients with acne at a UK dermatology centre. Over a quarter (26%) of respondents used sunbeds and of these, 72% used them at least weekly. Respondents using sunbeds were more likely to be older, to be female, to have a longer duration of acne diagnosis and to have previously been offered blue-light therapy by their doctor (P < 0.05 for all) Reasons for use included recommendations from external sources (including the Internet), the perceived greater efficacy compared with physician-prescribed treatments and that light therapy was not offered by their doctor. Nearly half (49%) of respondents were taking isotretinoin at the time of sunbed use, which carries an increased risk for photosensitivity and sunburn in this cohort. Dermatologists have a responsibility to address this gap in public awareness by directly counselling patients at risk of sunbed use, particularly for those concomitantly prescribed oral retinoid therapy.

Use of biologicals in dermatology – following the agreed path or going off-piste? A brief report

Introduction: Biological medicines are used to treat a range of conditions according to National Institute for Health and Care Excellence (NICE) technology appraisals. The annual drug treatment cost per patient per year varies depending on various factors, including newer or older biological, and availability of a biosimilar. Our biologicals pathway for dermatology (moderate or severe psoriasis) listed less expensive older biologicals (including biosimilars) early on in the treatment choices and more recently approved (and generally more expensive) choices lower down the pathway. Objective: We aimed to identify which biologicals or selective immunosuppressants were used first line in adult patients with moderate or severe psoriasis, and ascertain if the reasons for use of treatments other than adalimumab were in accordance with the locally agreed pathway. Methods: Medical records were reviewed for a sample of patients prescribed biologicals during late 2019 and early 2020. We identified patients who had commenced any treatment. Contact was made with lead dermatology nurses if needed. Results: There were 33 patients commenced on a biological – 17 had newly started biological therapy and 16 had switched from a prior biological therapy to a new therapy. Of the 17 new patients, two commenced apremilast (biological contraindicated), 10 commenced adalimumab, and five commenced other biologicals. Of these five who commenced other biologicals, two were on guselkumab, two on ustekinumab, and one on certolizumab. In all five instances there was a valid reason for not using adalimumab as first choice though this was not always explicit in the multidisciplinary team (MDT) documentation. Discussion: Though the number of psoriasis patients (17) newly starting a biological medicine was relatively small, it was reassuring that for five of these who commenced a subcutaneous biological other than adalimumab, there was a valid reason for this choice, though not always explicit in the MDT letter, which Dermatology will ensure is clear for future decisions. Hence going ‘off-piste’ was deemed justified. Conclusion: This very small-scale study found that the local guideline was followed with patients commencing treatments other than biosimilar adalimumab for valid reasons.

The role of attachment, coping style and reasons for substance use in substance users with psychosis.

Seventy substance users with psychosis who were participating in a clinical trial of a psychological therapy for psychosis were additionally assessed for attachment, coping styles and self-reported reasons for substance use in order to test a hypothesized sequential mediation model. In this model the relationship between insecure attachment and problematic substance use was assumed to be sequentially mediated by dysfunctional coping and the use of substances to cope with distress. Hypothesized associations between insecure-avoidant attachment and substance use were not supported, but the relationship between insecure-anxious attachment and problematic substance use was confirmed and found to be fully mediated by dysfunctional coping and coping reasons for use. Findings suggest that fostering secure attachments in people with psychosis might promote more successful coping and could prevent or reduce substance use related problems in this group.