Cannabidiol im Kontext erstmaliger verkehrsmedizinischer Fahreignungsabklärungen in der Schweiz

Einleitung: Cannabidiol (CBD) ist neben Tetrahydrocannabinol (THC) ein bedeutender Bestandteil der Cannabis-Pflanze (C. sativa und C. indica). Dem CBD selbst wird keine bedeutsame psychoaktive Wirkung zugeschrieben und es wird nicht zu den Betäubungsmitteln gezählt; klinisch sind aber sedierende/entspannende Effekte bestätigt. Seit dem Jahr 2014 sind in der Schweiz CBD-haltige Tabakersatzprodukte mit einem THC-Gehalt <1 % frei verkäuflich. Fragestellung: Es ist unklar, ob und bei welchen Konzentrationen CBD einen Einfluss auf die Fahrfähigkeit (FF) und Fahreignung (FE) hat. Bei Konsum von Tabakersatzprodukten mit einem THC-Gehalt <1 % kann der Blutgrenzwert für THC (in der Schweiz: 1,5 µg/l) überschritten werden, was automatisch zu gesetzlicher Fahrunfähigkeit führt. In der vorliegenden Studie wurde der Stellenwert von CBD bei erstmaligen verkehrsmedizinischen Fahreignungsabklärungen von Cannabiskonsumenten untersucht. Methode: Retrospektive stichwortbasierte Recherche und Analyse der Datenbank der Abteilung Verkehrsmedizin des Instituts für Rechtsmedizin der Universität Zürich. Deskriptive statistische Analyse. Einschlusskriterien: abgeschlossene verkehrsmedizinische Gutachten im Administrativverfahren aufgrund von erstmaligem Fahren unter Cannabiseinfluss (Fahren unter Drogeneinfluss, FuD). Ausschluss von Konsum sonstiger Betäubungsmittel. Untersuchungszeitpunkt zwischen 01.01.2016 und 31.12.2019. Analyse nach Alter, Geschlecht und Beurteilungsentscheid. Resultat: Im untersuchten Zeitraum insgesamt 62.997 Fälle, davon 1082 Erst-FuD unter Cannabinoiden. Keine Fälle vor 01.01.2016, jedoch dann stetige Zunahme, bis 15,17 % aller Cannabis-Begutachtungen im Jahr 2019. (Bei‑)Konsum von CBD: 62 Fälle (5,7 %). Die meisten CBD-Konsumenten sind männlich (91,9 %). Unterschiedliche Altersverteilung zwischen CBD und THC-Konsumenten mit auffälliger Häufung bei 30- bis 40-jährigen Exploranden. Kaum Unterschiede in der Beurteilung der Fahreignung. Schlussfolgerung: Cannabidiol spielt in dieser Untersuchung zwar eine untergeordnete, jedoch zunehmende Rolle bei der Begutachtung erstmaligen Fahrens unter Cannabiseinfluss. Ein Einfluss von CBD auf die FF ist daraus somit nicht ableitbar und ergibt sich auch nicht aus anderen publizierten Untersuchungen. Aus Sicht der Autoren bedarf es klinisch-prospektiver Forschungsprojekte zur Klärung der Wirkung von CBD unter Berücksichtigung von subjektiver Fahrfähigkeitswahrnehmung und Fahrleistungsdefiziten

Internetsucht im Wandel der Zeit

So vielseitig die verschiedenen Aspekte des World Wide Webs sind, so komplex ist auch die Internetsucht. Personen, die süchtig nach Recherche sind, sind nicht zwingend auch süchtig nach Onlinespielen. Diese Unterschiede zeigen sich auch in der Symptomatik und den Einflussfaktoren. Wie sich das Wissen diesbezüglich über die Jahre weiterentwickelt hat, fassen die Autoren im folgenden Artikel zusammen

Relationships among Physical Activity, Pain, and Bone Health in Youth and Adults with Thalassemia: An Observational Study

Patients with thalassemia (Thal) engage in less physical activity than non-Thal populations, which may contribute to pain and osteoporosis. The purpose of this study was to assess relationships between physical activity, pain, and low bone mass in a contemporary sample of patients with Thal. Seventy-one patients with Thal (50 adults ≥18 years, 61% male, 82% transfusion-dependent) completed the Brief Pain Inventory Short Form and validated physical activity questionnaires for youth and adults. Nearly half of the patients reported daily somatic pain. Using multiple regression, after controlling for age and gender, sedentary behavior was positively associated with pain severity (p = 0.017, r2 = 0.28). Only 37% of adult participants met CDC recommendations for physical activity. Spine BMD Z-score was higher (−2.1 ± 0.7) in those who met activity guidelines compared to those who did not (−2.8 ± 1.2, p = 0.048). A positive relationship was observed between self-reported physical activity (hours/week) and hip BMD Z-score in adults with Thal after controlling for transfusion status and sedentary activity time (p = 0.009, r2 = 0.25). These results suggest that decreased physical activity and increased sedentary behavior contribute to low bone mass, which may be related to pain severity in some patients with Thal. Studies focused on increasing physical activity may contribute to improved bone health and reduced pain in patients with Thal

A complex intervention to improve implementation of World Health Organization guidelines for diagnosis of severe illness in low-income settings: a quasi-experimental study from Uganda

Background To improve management of severely ill hospitalized patients in low-income settings, the World Health Organization (WHO) established a triage tool called “Quick Check” to provide clinicians with a rapid, standardized approach to identify patients with severe illness based on recognition of abnormal vital signs. Despite the availability of these guidelines, recognition of severe illness remains challenged in low-income settings, largely as a result of infrequent vital sign monitoring. Methods We conducted a staggered, pre-post quasi-experimental study at four inpatient health facilities in western Uganda to assess the impact of a multi-modal intervention for improving quality of care following formal training on WHO “Quick Check” guidelines for diagnosis of severe illness in low-income settings. Intervention components were developed using the COM-B (“capability,” “opportunity,” and “motivation” determine “behavior”) model and included clinical mentoring by an expert in severe illness care, collaborative improvement meetings with external support supervision, and continuous audits of clinical performance with structured feedback. Results There were 5759 patients hospitalized from August 2014 to May 2015: 1633 were admitted before and 4126 during the intervention period. Designed to occur twice monthly, collaborative improvement meetings occurred every 2–4 weeks at each site. Clinical mentoring sessions, designed to occur monthly, occurred every 4–6 months at each site. Audit and feedback reports were implemented weekly as designed. During the intervention period, there were significant increases in the site-adjusted likelihood of initial assessment of temperature, heart rate, blood pressure, respiratory rate, mental status, and pulse oximetry. Patients admitted during the intervention period were significantly more likely to be diagnosed with sepsis (4.3 vs. 0.4%, risk ratio 10.1, 95% CI 3.0–31.0, p < 0.001) and severe respiratory distress (3.9 vs. 0.9%, risk ratio 4.5, 95% CI 1.8–10.9, p = 0.001). Conclusions Theory-informed quality improvement programs can improve vital sign collection and diagnosis of severe illness in low-income settings. Further implementation, evaluation, and scale-up of such interventions are needed to enhance hospital-based triage and severe illness management in these settings. Trial registration Severe illness management system (SIMS) intervention development, ISRCTN4697678

Additional file 1: Appendix S1. of A complex intervention to improve implementation of World Health Organization guidelines for diagnosis of severe illness in low-income settings: a quasi-experimental study from Uganda

Pre-training facility assessment tool. Appendix S2. Quick Check + hospital assessment report of existing severe illness practices. Table S1. Characteristics of inpatient health facilities participating in SIMS intervention. Table S2. Diagnostic criteria for severe illness conditions covered in Quick Check + training program, as defined by the World Health Organization District Clinician Manual. Table S3a. Barriers to executing target behaviors*, as documented by hospital staff while formulating implementation plans and placed into COM-B domains. Table S3b. Intervention functions targeting identified barriers and facilitators as defined in the Behavioral Change Wheel framework. Table S4a Between-site variation in vital sign collection before and after SIMS introduction, by site. Table S4b. Between-site variation in impact of SIMS on vital sign collection, by vital sign. Figure S1. Diagram illustrating the conceptual model based on components of the COM-B model that was utilized to develop the SIMS intervention. Figure S2. Staggered, pre-post quasi-experimental study design utilized for implementation of SIMS intervention. Baseline period indicates time period following Quick Check + training and before SIMS intervention. Intervention period indicates time period during which SIMS intervention was implemented. Figure S3. Flow diagram for patients included in study (DOCX 607 kb