Cannabis Use: A New Risk Behaviour Among Adults With Congenital Heart Disease.

Background: Cannabis use has increased in Canada and can be associated with adverse cardiovascular events. Given increased use and accessibility to cannabis, there is a need among clinicians to better understand cannabis use in adults with congenital heart disease. Methods: A cross-sectional survey (May to September 2018) was used to investigate cannabis use among 252 patients with adult congenital heart disease in a quaternary care centre. Results: Of the 252 patients, 53 (21%) reported using cannabis. The majority of cannabis users were men (62%), between the ages of 25 and 39 years (mean age = 32 ± 16 years), and more likely to use tobacco (n = 9, 17%; P = 0.001) and alcohol (n = 37, 60%; P = 0.001). Significant differences (P = 0.011) were found between the age of onset for tobacco use among cannabis users (mean age: 16 ± 8 years) and non-cannabis users (mean age: 20 ± 3 years). Users reported consuming cannabis for recreational purposes (n = 29, 55%), anxiety (n = 22, 42%), depression (n = 15, 28%), and pain management (n = 4, 8%). Conclusions: This study supports our clinical experience that a high proportion of patients with adult congenital heart disease use cannabis. Cannabis users represent a patient population who may demonstrate less optimal health behaviours, including tobacco and alcohol use. Assessment of cannabis use should be an integral part of risk behaviour and cardiovascular risk profile at each clinic visit. Given the current legalization of cannabis in Canada and the growing increase of cannabis use, educational support should be provided to patients and caregivers.

Contexte: La consommation de cannabis, en hausse au Canada, a été associée à des manifestations cardiovasculaires indésirables. Puisque l'usage et la disponibilité du cannabis ont augmenté, il est nécessaire pour les cliniciens de mieux comprendre cet usage chez les adultes qui présentent une cardiopathie congénitale. Méthodologie: Nous avons mené une enquête transversale (mai à septembre 2018) sur l'usage du cannabis auprès de 252 adultes atteints d'une cardiopathie congénitale dans un centre de soins quaternaires. Résultats: Cinquante-trois patients sur 252 (21 %) ont indiqué consommer du cannabis. Les utilisateurs de cannabis étaient en majorité des hommes (62 %), ils étaient âgés de 25 à 39 ans (âge moyen de 32 ans ± 16), et ils étaient plus susceptibles de consommer du tabac (n = 9; 17 %; p = 0,001) et de l'alcool (n = 37; 60 %; p = 0,001). Une différence significative a été notée entre l'âge au moment de commencer l'usage de tabac chez les utilisateurs de cannabis (âge moyen de 16 ± 8 ans) et chez les non-utilisateurs (âge moyen de 20 ± 3 ans). Les personnes consommaient du cannabis pour un usage récréatif (n = 29; 55 %), ou pour la prise en charge de l'anxiété (n = 22; 42 %), de la dépression (n = 15; 28 %) ou de la douleur (n = 4; 8 %). Conclusion: Notre étude corrobore notre expérience clinique, selon laquelle une proportion importante des adultes atteints d'une cardiopathie congénitale consomment du cannabis. Les patients qui font usage de cannabis constituent une population qui pourrait adopter des comportements moins favorables pour la santé, comme la consommation d'alcool et de produits de tabac. Une évaluation de l'usage de cannabis devrait faire partie intégrante du profil de comportements à risque et du risque cardiovasculaire réalisé à chacune des visites des patients. Étant donné la légalisation du cannabis au Canada et l'augmentation constante de son usage, un soutien éducatif devrait être offert aux patients et à leurs proches.

Do you see what I see? The influence of self-objectification on appearance anxiety, intrinsic motivation, interoceptive awareness, and physical performance.

Self-objectification negatively impacts body image, mental health, and cognitive performance outcomes in women and has been correlated with poorer physical performance. The purpose of this study was to determine if trying on a swimsuit (versus a sweater) impacted state self-objectification, body shame, social physique anxiety, intrinsic motivation, bodily awareness, and physical performance in university women. Female undergraduate students (N = 52) were randomly assigned to try on either a swimsuit (objectification condition) or sweater (control condition) and complete measures of self-objectification, body shame, appearance anxiety, intrinsic motivation, and interoceptive awareness, and perform a series of balance tasks. Women in the swimsuit condition reported higher state self-objectification, body-related shame and appearance anxiety, and lower intrinsic motivation compared to women in the sweater condition. In addition, women in the swimsuit condition restricted body movements during a 1-legged stand balance task. Consistent with objectification theory, women may have made smaller physical movements in an attempt to hide or cover up the body. Findings could have implications for promoting positive experiences during physical activity for women, such as in sport, exercise or rehabilitation settings.

The effect of preoperative cognitive impairment and type of vascular surgery procedure on postoperative delirium with associated cost implications.

OBJECTIVE: Postoperative delirium (POD) has a high prevalence among vascular surgery patients, increasing morbidity, mortality, and length of stay. We prospectively studied preoperative risk factors for delirium that can be assessed by the surgical team to identify high-risk patients and assessed its impact on hospital costs. METHODS: There were 173 elective vascular surgery patients assessed preoperatively for cognitive function using the Montreal Cognitive Assessment (MoCA) and the Confusion Assessment Method for POD, which was verified by chart and clinical review. Demographic information, medications, and a history of substance abuse, psychiatric disorders, and previous delirium were prospectively recorded. An accompanying retrospective chart review of an additional 434 (elective and emergency) vascular surgery patients provided supplemental cost information related to sitter use and prolonged hospitalization secondary to three factors: delirium alone, dementia alone, and delirium and dementia. RESULTS: Prospective screening of 173 patients (73.4% male; age, 69.9 ± 10.97 years) identified that 119 (68.8%) had MoCA scores <24, indicating cognitive impairment, with 7.5% having severe impairment (dementia). Patients who underwent amputation had significantly (P < .000) lower MoCA scores (17 of 30) compared with open surgery and endovascular aneurysm repair patients (23.7 of 30). The incidence of delirium was 11.6% in the elective cohort. Regression analysis identified predictors of delirium to be type of surgical procedure, including lower limb amputation (odds ratio [OR], 16.67; 95% confidence interval [CI], 3.41-71.54; P < .000) and open aortic repair (OR, 5.33; 95% CI, 1.91-14.89; P < .000); cognitive variables (dementia: OR, 5.63; 95% CI, 2.08-15.01; P < .001); MoCA scores ≤15, indicating moderate to severe impairment (OR, 6.13; 95% CI, 1.56-24.02; P = .02); and previous delirium (OR, 2.98; 95% CI, 1.11-7.96; P = .03). Retrospective review (N = 434) identified differences in sitter needs for patients with both delirium and dementia (mean, 13.6 days), delirium alone (mean, 3.9 days), or dementia alone (mean, <1 day [17.7 hours]). Fifteen patients required >200 hours (8.3 days), accounting for 69.7% of sitter costs for the surgical unit; 43.7% of costs were accounted for by patients with pre-existing cognitive impairment. CONCLUSIONS: POD is predicted by type of vascular surgery procedure, impaired cognition (MoCA), and previous delirium. Costs and morbidity related to delirium are greatest for those with impaired cognitive burden. Preoperative MoCA screening can identify those at highest risk, allowing procedure modification and informed care.