Perception and practices regarding cannabis consumption in Karachi, Pakistan: A cross-sectional study.

Several studies have been carried out regarding the awareness and usage of cannabis around the world, especially in developed countries. Pakistan ranks amongst the top nations in regards to cannabis consumption. However, the amount of literature shedding light on people's perception, knowledge and practices are scarce. Therefore, the authors sought to establish a baseline study to ignite the discussion on the possibility of cannabis' induction in the medical field in Pakistan, and additionally provide a foundation for further research. The purpose of this study was to investigate the level of understanding and consumption practices in Karachi with respondents from different socio-economic backgrounds, age groups and gender regarding cannabis use and assessing the awareness of the general population. The null hypothesis is that the usage of cannabis does not have a significant correlation with age, gender, or socio-economic status of a population. We conducted a cross-sectional study in November 2018 using convenience sampling and interviewed 518 individuals for their gender, age, and socio-economic status, to determine their knowledge, attitudes, and practices regarding cannabis usage. The participants were questioned about their knowledge and its source. Attitudes were judged using three and five-point Likert scales while questions regarding practices centered upon the past and current usage of cannabis. One-way analysis of variance and chi-square tests were used as the primary statistical tests. Out of the 518 people who responded, more than half of the respondents were males (n = 340, 65.6%). The majority was familiar with the use of cannabis (n = 514, 99.2%), and the different ways in which it is consumed (n = 435, 84%). About one-third of the participants happened to consume cannabis (n = 168, 32.4%), and a quarter mentioned recreational use/curiosity as the principal reason (n = 134, 25.9%). Majority of the respondents agreed upon the harmful effects of consuming cannabis (n = 364, 70.3%), while when compared to other inimical drugs, half of them believed it to be less harmful (n = 259, 50%). Besides, an overwhelming majority stated, that if they were to consume cannabis, they would not consider taking permission from their parents/guardians (n = 441, 85.2%). Concerning legality, three-fifths of the participants chose cannabis to remain illegal in Pakistan (n = 307, 59.3%) and, for not consuming/quitting cannabis, the primary reason chosen was its harmful consequences (n = 210, 40.5%). Our study revealed that knowledge about usage of cannabis still requires a great deal of attention. Only individuals from higher socio-economic backgrounds have a positive attitude towards cannabis usage and are aware of it. There is an urgent need for awareness programs that especially reach out to the lower socio-economic status population, who otherwise do not have access to essential information resources. We also found that males were more likely to be consumers and to have more knowledge about cannabis, therefore, it is equally important to educate females about this topic so that an informed discussion about cannabis use and its medical benefits can be generated in Pakistan.

Prevalence of Multiplicity and Appropriate Adjustments Among Cardiovascular Randomized Clinical Trials Published in Major Medical Journals.

Importance: Multiple analyses in a clinical trial can increase the probability of inaccurately concluding that there is a statistically significant treatment effect. However, to date, it is unknown how many randomized clinical trials (RCTs) perform adjustments for multiple comparisons, the lack of which could lead to erroneous findings. Objectives: To assess the prevalence of multiplicity and whether appropriate multiplicity adjustments were performed among cardiovascular RCTs published in 6 medical journals with a high impact factor. Design, Setting, and Participants: In this cross-sectional study, cardiovascular RCTs were selected from all over the world, characterized as North America, Western Europe, multiregional, and rest of the world. Data were collected from past issues of 3 cardiovascular journals (Circulation, European Heart Journal, and Journal of the American College of Cardiology) and 3 general medicine journals (JAMA, The Lancet, and The New England Journal of Medicine) with high impact factors published between August 1, 2015, and July 31, 2018. Supplements and trial protocols of each of the included RCTs were also searched for multiplicity. Data were analyzed December 20 to 27, 2018. Exposures: Data from the selected RCTs were extracted and verified independently by 2 researchers using a structured data instrument. In case of disagreement, a third reviewer helped to achieve consensus. An RCT was considered to have multiple treatment groups if it had more than 2 arms; multiple outcomes were defined as having more than 1 primary outcome, and multiple analyses were defined as analysis of the same outcome variable in multiple ways. Multiplicity was examined only for the analysis of the primary end point. Main Outcomes and Measures: Outcomes of interest were percentages of primary analyses that performed multiplicity adjustment of primary end points. Results: Of 511 cardiovascular RCTs included in this analysis, 300 (58.7%) had some form of multiplicity; of these 300, only 85 (28.3%) adjusted for multiplicity. Intervention type and funding source had no statistically significant association with the reporting of multiplicity risk adjustment. Trials that assessed mortality vs nonmortality outcomes were more likely to contain a multiplicity risk in their primary analysis (66.3% [177 of 267] vs 50.4% [123 of 244]; P < .001), and larger trials vs smaller trials were less likely to make any adjustments for multiplicity (35.6% [52 of 146] vs 21.4% [33 of 154]; P = .001). Conclusions and Relevance: Findings from this study suggest that cardiovascular RCTs published in medical journals with high impact factors demonstrate infrequent adjustments to correct for multiple comparisons in the primary end point. These parameters may be improved by more standardized reporting.