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

Objectives Poisoning 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. Methods A 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. Results 18,653 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). Conclusions Our 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.

Public mental health and suicide

The full public health impact of mental health is largely unrecognized. The allocation of the burden of disease attributable to mental and behavioural disorders, which is already substantial, will probably increase steadily in the future, due to the transition of the global disease burden towards mental and behavioural disorders. In addition to the demands that mental disorders put on social welfare and health systems, they also cause decreased productivity in the workplace, prolonged disability, and diminished resources within families. Mental disorders are linked to socioeconomic disadvantages and addressing mental health determinants will reduce health inequalities. Stigma of mental disorders is widespread, and it is a barrier for help-seeking behaviours, as well as the development of healthcare services. Modern mental health policies should aim at improving psychosocial health by addressing determinants of mental health in all public policies. Key measures in effective public health suicide prevention programmes comprise improved awareness in the population about mental health promotion and suicide preventive measures, the restriction of access to lethal means of suicide, responsible media coverage of suicide issues, school-based awareness programmes, and improvements in the identification of depression and suicidality by peers, gatekeepers, and health professionals. Modern community-based mental health services, with a diversified service provision, result in better outcomes on a broader scale compared to ‘old school’ hospital-centred mental health service systems. Primary care physicians in collaboration with multidisciplinary teams have a central role in provision of mental health services to the population.

Regional features of the incidence of mental disorders in the population (on the example of the Irkutsk region): a retrospective study

Background. Mental and behavioural disorders pose a pressing challenge in healthcare as pertaining to socially significant diseases. The significance is conditioned by high morbidity rates, including temporary and permanent disability, high fi nancial burden of medical care andregular social subsidy to target groups. According to the World Health Organisation, mental burden currently aggravates to entail serious social, human-rights and economic impact around the globe.Objectives. A study of regional dynamics of mental and behavioural morbidity in the Irkutsk Region over a seven-year period.Methods. A retrospective descriptive study used statistics data on primary and overall morbidity of definitely diagnosed mental and behavioural disorders (other than substance use disorders; F00–F09, F20–F99). The analysis of mental and behavioural illness incidence was based on statistical reports over the period of 2013–2019. The inclusion criterion was definite diagnosis of a mental and behavioural disorder (other than substance use disorder; F00–F09, F20–F99) in children, adolescents and adults. The main study indicators were the regional mental morbidity rate and prevalence, mental and behavioural morbidity rates among “dispensary care” and “medical counselling” outpatients, and primary morbidity rates by mental and behavioural nosology groups.Results. The article reports the regional traits of mental morbidity dynamics exhibiting a growing trend in Irkutsk Region. The morbidity traits of primary diagnoses have been analysed in dispensary care and medical counselling outpatients. Growing psychoneurologic visits are observed along with the institutional redirection of fi rst diagnoses towards decreasing the numbers of dispensary care vs. medical counselling outpatients. Thus, the structure of fi rst mental diagnoses changed towards prevailed medical counselling. Primary morbidity rate in male population is higher almost 1.5-fold in the study period. Primary morbidity elevated in both men and women. A primary morbidity analysis in different age cohorts reveals its growth in ages 0–14, 40–59 and >60 years.Conclusion. Our analyses reveal a lowering primary morbidity rate of mental disorders in outpatients taken for dispensary care, given the overall higher incidence. This may occur due to an institutional and instructional change in medical care provided to this patient category, including ineffective diagnosis, poor aid access and visit rate, statistical reporting design and possible changes in the criteria of taking for dispensary care. This fact requires improvements in the legal regulation of outpatient management of mental and behavioural illness at psychoneurologic institutions and the development of clear criteria of registering for dispensary care.

The Development of the Programme of Health-Recreating Activities for Children of Primary School Age with Emotional and Behavioural Disorders, Using Rock Climbing

The aim of this article was to theoretically justify and develop the programme of health-recreating activities for children with emotional and behavioural disorders, using rock climbing. For the research such methods were used – theoretical analysis of vocational educational and methodical literature and documentary materials, generalization, systematization, abstraction, synthesis, analogy, induction, deduction, logical method, comparative method, structural-functional analysis, physiological, pedagogical methods of research. The development of this programme was based on such principals of health-recreating activities: systematicity; accessibility; voluntarism; compliance of leisure services to local conditions; the principle of interest. Proposed programme allows to compensate the lack of physical activity, contributes to the development of healthy and harmonious person, organisation of healthy and active leisure, teaching positive moral and behavioural qualities, health promotion, engaging children into healthy lifestyle. For the programme development was used such an algorithm: questionnaire of parents about motives and interests of children about the kinds of physical activities, initial evaluation of physical and emotional state, programme development and its implementation, operational control during the activities, the programme correction, if necessary, progressing the programme. The programme of activities included elements of rock climbing, quests and games. The programme was developed taking according to the level of physical readiness and functional disabilities of each child. The activities at the rock climbing wall proceeded by small group method: 3 to 5 people in the group. In each group, the activities were held 3 times a week, during 60 minutes.

The Effect of Adenotonsillectomy on Children’s Behavior and Cognitive Performance with Obstructive Sleep Apnea Syndrome: State of the Art

(1) Background: This systematic review was designed to analyze adenotonsillectomy’s role in treating behavioural disorders and sleep-related quality of life in pediatric OSAS. (2) Methods: Papers that report pre-operative and post-operative outcomes by using the Epworth sleepiness scale, OSA-18, NEPSY, Conners’ rating scale, BRIEF, PSQ-SRBD, PedsQL and CBCL. We performed a comprehensive review of English papers published during the last 20 years regarding behavioural disorders in OSAS patients and adenotonsillectomy. (3) Results: We included 11 studies reporting behavioral outcomes and sleep related quality of life after surgery. We investigated changes in behavior and cognitive outcomes after AT, and we found significant improvements of the scores post-AT in almost all studies. After comparing the AT group and control group, only one study had no difference that reached significance at one year post-AT. In another study, it did not show any significant improvement in terms of all behavioural and cognitive outcomes. The questionnaires on sleep-related quality of life after AT (PSQ-SRBD or ESS or OSA-18 or KOSA) may improve with positive changes in sleep parameters (AHI, ODI and SpO2). Furthermore, there is a significantly higher decrease in OSAS symptoms than the pre-AT baseline score. (4) Conclusion: Future studies should pay more attention to characterizing patient populations as well as rapid surgical treatments through existing criteria.

Scurvy: A Case Report

Scurvy is a rare case found in many countries, but it is often found in refugeeareas, especially in Africa. Vitamin C deficiency varies based on season and occursmore in men with age. The purpose of this research is to avoid misdiagnosis so thatit can be a reference in the field of medicine to diagnose and provide managementon scurvy. This prospective research was conducted with one sample of research.Observation had been carried out for two months, starting at one month after thepatient was suspected with the diagnosis of scurvy. Computer Tomography (CT)Scan lumbosacral to pelvic results were normal. Laboratory test of HB result was9.5 g/dl, in which MCV was 63.2 fL, MCH was 20.3 pg, and MCHC was 32.1 g/dl.Scurvy treatment in the first visit was 3x1 tablets vitamin C, 3x5 ml ibuprofen Syr,and physiotherapy. The results were that the patient still suffered swollen andbleeding gums, but the pain no longer existed, pale, behavioural disorders, unableto walk, and pain in both knees. After the second visit, the child got therapy of 4x50mg vitamin C, 1x1 tablets vitamin B12, 1x150 IU vitamin E, 1x1 tablets cavit D3,and physiotherapy. After two weeks of treatment, there were no complaints ofswelling, painful or bleeding gums. The child could straighten her legs, but she wasstill unable to walk due to the trauma of feeling great pain while walking. Specialattention is required to diagnose appropriately so the doctor can minimize andprevent complications.

Decreasing death rates and causes of death in Icelandic children—A longitudinal analysis

Background Global death rate in children has been declining during the last decades worldwide, especially in high income countries. This has been attributed to several factors, including improved prenatal and perinatal care, immunisations, infection management as well as progress in diagnosis and treatment of most diseases. However, there is certainly room for further progress. The aim of the current study was to describe the changes in death rates and causes of death in Iceland, a high-income country during almost half a century. Methods The Causes of Death Register at The Directorate of Health was used to identify all children under the age of 18 years in Iceland that died during the study period from January 1st, 1971 until December 31st, 2018. Using Icelandic national identification numbers, individuals could be identified for further information. Hospital records, laboratory results and post-mortem diagnosis could be accessed if cause of death was unclear. Findings Results showed a distinct decrease in death rates in children during the study period that was continuous over the whole period. This was established for almost all causes of death and in all age groups. This reduction was primarily attributed to a decrease in fatal accidents and fewer deaths due to infections, perinatal or congenital disease as well as malignancies, the reduction in death rates from other causes was less distinct. Childhood suicide rates remained constant. Interpretation Our results are encouraging for further prevention of childhood deaths. In addition, our results emphasise the need to improve measures to detect and treat mental and behavioural disorders leading to childhood suicide.

Sclerosi tuberosa ed everolimus: una nuova storia

Tuberous sclerosis complex (TSC) is a rare autosomal dominant disorder, due to inactivating muta-tions of TSC1 or TSC2 mTOR pathway genes and is characterized by variable multisystem manifestations ranging from hamartomas to malignant neoplasms. It frequently associated to seizures, intellectual disability and behavioural disorders. Surgical treatment has traditionally been used to manage subependymal giant cells astrocytomas (SEGA). The introduction of mTOR inhibitor rapamycin, with its definite role both as primary and as adjuvant treatment, has significantly modified the management opportunities in the clinical practice. It is important to consider both treatment options in a balanced way and not only the SEGA, but also the individual patient and their associated comorbidities. The pros and the cons of both options should be discussed by a multidisciplinary team before establishing an individualized treatment recommendation. The paper reports the case of a patient with an asymptomatic SEGA who was treated with everolimus. The treatment was effective in reducing the size of the tumour, it was safe and well tolerated.