Differentiating people who use cannabis heavily through latent class analysis.

BACKGROUND: People who use cannabis daily or near-daily vary considerably in their daily dosage and use frequency, impacting both experienced effects and adverse consequences. This study identified heavy cannabis user groups according to consumption patterns and factors associated with class membership. METHODS: We conducted a cross-sectional study of 380 Spanish residents (61.8% male; average age = 30.3 years) who had used cannabis ≥ 3 days/week throughout the past year. Participants were recruited through chain referral and cannabis social clubs. We applied latent class analysis (LCA) to cluster participants according to use intensity. LCA indicators included frequency of weekly cannabis use, joints smoked each day, cannabis dosage, and if cannabis was consumed throughout the day or only at specific times. Associations between class membership and socio-demographics, use patterns, motives, supply sources, adverse outcomes, and use of other substances were measured using ANOVA and chi-squared tests. Multinomial regression identified the factors associated with latent class membership. RESULTS: Three latent classes (moderately heavy: 21.8%, heavy: 68.2%, very heavy: 10%) had average weekly cannabis intakes of 2.4, 5.5, and 18.3 g, respectively. Very heavy users were older ([Formula: see text]=17.77, p < 0.01), less educated [Formula: see text]=36.80, p < 0.001), and had used cannabis for longer (F = 4.62, p = 0.01). CAST scores (F = 26.51, p < 0.001) increased across the classes. The prevalence of past-month alcohol use was lower among the heaviest users ([Formula: see text]=5.95, p = 0.05). Cannabis was usually obtained from a club by very heavy users ([Formula: see text]=20.95, p < 0.001). CONCLUSIONS: People who use cannabis heavily present three groups according to frequency and quantity of cannabis consumption. Use intensity is associated with increased cannabis-related problems. Differences among heavy users must be considered in harm reduction interventions in cannabis clubs and indicated prevention.

Esclerosis múltiple, pérdida de funcionalidad y género / Multiple sclerosis, loss of functionality and gender

Objetivo: Identificar qué ayudas necesitan las personas con esclerosis múltiple para afrontar su pérdida de funcionalidad y mostrar cómo influye el sistema de género en la percepción de estas necesidades. Método: Estudio cualitativo fenomenológico-interpretativo. Emplazamiento: Granada. Año: 2014. Muestra intencional: 30 personas afectadas y 20 familiares que las cuidan. Datos recopilados mediante 26 entrevistas y cuatro grupos focales. Se codificaron y analizaron con NVivo. Resultados: La percepción de la pérdida de capacidades para el desempeño de las actividades básicas de la vida diaria es desigual para las personas con esclerosis múltiple y los/las familiares que las cuidan. La última frontera de la autonomía son los autocuidados. Las mujeres afectadas intentan mantener la responsabilidad de las tareas domésticas; los varones cuidadores se implican paulatinamente en ellas. Se produce una redefinición de los roles de género en las funciones domésticas. Se evidencia la necesidad de apoyos emocionales. Algunos varones llegan a aceptar la ruptura del estereotipo de la fortaleza masculina ante la quiebra de la salud. Las adaptaciones en el hogar se realizan de manera sobrevenida. El empleo de ayudas técnicas comienza de manera ocasional. El temor al estigma es un obstáculo para su uso regular. Conclusiones: La atención sanitaria a personas con esclerosis múltiple debe incluir a los/las familiares que las cuidan. La percepción de las ayudas que necesitan para optimizar su calidad de vida ambos colectivos está mediatizada por el género. Ello evidencia distintas áreas de intervención para el seguimiento y los cuidados de larga duración de estas personas en el sistema sanitario

Objective: To identify the type of support and assistance that patients with multiple sclerosis need in order to cope with the loss of functionality, and to show how gender affects the perception of these needs. Method: Interpretative-phenomenological qualitative study. Location: Granada (Spain). Year: 2014. Intentional sample: 30 patients and 20 family caregivers. Data were gathered from 26 interviews and 4 focus groups. The data were coded and analysed with the NVivo programme. Results: The multiple sclerosis patients and family caregivers had different perceptions of the loss of capacity to undertake activities of daily living. Being able to self care was considered the last vestige of autonomy. The women with multiple sclerosis tried to take on the responsibility of housework, but the male caregivers became gradually involved in these tasks. Gender roles were redefined with respect to housekeeping. The multiple sclerosis patients showed a need for emotional support. Some of the men had abandoned the stereotype of the strong male as a result of the decline in their health. Adaptations in the home took place without planning them in advance. The use of mobility devices started on an occasional basis. A fear of stigma was an obstacle for regular use of assistive technology. Conclusions: Health care for people with multiple sclerosis should include family caregivers. Gender influences the perception that caregivers and patients have of the assistance they require to maximise their quality of life. This flags up several intervention areas for the follow-up and long-term care of these patients by the healthcare system

[Multiple sclerosis, loss of functionality and gender]. / Esclerosis múltiple, pérdida de funcionalidad y género.

OBJECTIVE: To identify the type of support and assistance that patients with multiple sclerosis need in order to cope with the loss of functionality, and to show how gender affects the perception of these needs. METHOD: Interpretative-phenomenological qualitative study. LOCATION: Granada (Spain). Year: 2014. Intentional sample: 30 patients and 20 family caregivers. Data were gathered from 26 interviews and 4 focus groups. The data were coded and analysed with the NVivo programme. RESULTS: The multiple sclerosis patients and family caregivers had different perceptions of the loss of capacity to undertake activities of daily living. Being able to self care was considered the last vestige of autonomy. The women with multiple sclerosis tried to take on the responsibility of housework, but the male caregivers became gradually involved in these tasks. Gender roles were redefined with respect to housekeeping. The multiple sclerosis patients showed a need for emotional support. Some of the men had abandoned the stereotype of the strong male as a result of the decline in their health. Adaptations in the home took place without planning them in advance. The use of mobility devices started on an occasional basis. A fear of stigma was an obstacle for regular use of assistive technology. CONCLUSIONS: Health care for people with multiple sclerosis should include family caregivers. Gender influences the perception that caregivers and patients have of the assistance they require to maximise their quality of life. This flags up several intervention areas for the follow-up and long-term care of these patients by the healthcare system.

La legalización del cannabis: un experimento americano de consecuencias globales / The legalization of cannabis: An American experiment with global consequences

Casi todos los países del mundo han firmado los tratados internacionales que prohíben la produc-ción, distribución y posesión de cannabis. No obstante, algunos han ido despenalizado el uso de estas drogas, llegando incluso a desarrollar formas de legalización atenuada. El caso más conocido es el de Holanda, que implementó una legalización de facto desde 1976. Sin embargo, estas tendencias se han mantenido al margen del sistema internacional prohibitivo, que ha liderado Estados Unidos desde sus inicios. Sorprendentemente, en la última década algunos países americanos han desarrollado importantes procesos para despenalizar el uso y legalizar la producción y venta de marihuana y sus derivados. Estos cambios legales se restringieron inicialmente a los usos terapéuticos y paliativos, pero recientemente han involucrado también el uso libre o "recreativo". En este artículo revisamos brevemente los procesos de legalización que están teniendo lugar en Uruguay, Canadá y Estados Unidos, así como los principales factores que pueden haberlos facilitado. Luego repasamos los efectos ya perceptibles de estos cambios en lo que concierne a los niveles y patrones de consumo, la percepción pública de los riesgos y la transformación de los productos cannábicos y sus formas de administración. También revisamos los datos disponibles sobre el impacto de estos procesos en el uso de otras drogas, los accidentes de tráfico, las intoxicaciones y la delincuencia. Finalmente nos planteamos cómo estos experimentos americanos podrían afectar al estatus legal y las políticas dominantes en Europa con respecto a las drogas ilegales más demandadas

Most countries have signed the international treaties banning the production, distribution, and possession of cannabis. Several countries have nevertheless decriminalized the use of these drugs, and even implemented some forms of attenuated or "de facto" legalization, the best-known case being found in the Netherlands since 1976. These trends nonetheless remained marginal to the international prohibitive system, which was headed by the U.S. since its inception. Surprisingly, in the last decade, some American countries have implemented major processes decriminalizing the use and legalizing the production and sale of marijuana and its derivatives. These legal changes were initially restricted to therapeutic and palliative uses, but recently they have involved free or "recreational" use as well. In this paper, we briefly review the legalization processes that are taking place in Uruguay, Canada, and the United States, as well as the main factors that may have facilitated them. Then we review the main aspects of the legalization processes as well as the initial perceptible effects of these changes on consumption levels and patterns, on the public perception of risks, and on the transformation of cannabis products, and their forms of administration. We also appraise the data available on the effect of these processes on the use of other psychoactive drugs, traffic accidents, intoxications and levels of criminality. We conclude by questioning how these American experiments could affect the legal status and the dominant policies in Europe concerning the most widely-demanded of illegal drugs