Conflicting forces in the implementation of medicinal cannabis regulation in Uruguay.

BACKGROUND: Uruguay is widely known as a pioneer country regarding cannabis regulation policies, as it was the first state to regulate the cannabis market for both recreational and medicinal purposes in 2013. However, not all aspects of the regulation have moved forward at the same speed. Medicinal uses keep facing several challenges that undermine patients' effective access to treatments and products. What are those persistent challenges for the medicinal cannabis policy in Uruguay? This paper aims to describe and understand the current state of medicinal cannabis in the country and identify the most critical challenges and conflicting forces for its proper implementation. METHODS: To do so, we conduct twelve in-depth interviews with key informants, including governments officials, activists, entrepreneurs, researchers, and doctors. These interviews are complemented with information from the congressional committees' public records and other documentary sources. RESULTS: This research shows that the legal framework was thought to assure quality products over access. The main challenges of medicinal cannabis in Uruguay are related to three issues: (i) the timid development of the industry, (ii) a limited and expensive supply, and (iii) the emergence of an informal productive sector. CONCLUSIONS: The political decisions regarding medicinal cannabis made in the last seven years have derived from a halfway policy that fails to guarantee patient access or promote the growth of a vibrant national industry. Positively, the several actors involved are aware of the extent of these challenges and new decisions have been made to overcome them, meaning that monitoring the future of the policy is very much needed.

Effectiveness of Unilateral Training of the Uninjured Limb on Muscle Strength and Knee Function of Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis of Cross-Education.

CONTEXT: Unilateral training of the uninjured limb could be a useful therapeutic tool to induce cross-education in periods of immobilization, however, the effectiveness of this training in patients with anterior cruciate ligament (ACL) reconstruction is unknown. OBJECTIVE: To determine the effectiveness of unilateral training of the uninjured limb on muscle strength and knee function in patients with ACL reconstruction. DESIGN: Systematic review and meta-analysis. EVIDENCE ACQUISITION: An electronic search was performed in the MEDLINE, LILACS, CENTRAL, Embase, Scopus, Web of Science, CINAHL, SPORTDiscus, and PEDro databases from inception until March 2021. The authors included randomized clinical trials that evaluated the effectiveness of unilateral training of the uninjured limb on muscle strength and knee function in patients after ACL reconstruction. EVIDENCE SYNTHESIS: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. The standardized mean difference for isometric quadriceps strength was 0.60 at 8 to 12 weeks (95% confidence interval, 0.29 to 0.92; P = .01; I2 = 6%). There was a high quality of evidence according to the Grading of Recommendation, Assessment, Development and Evaluation rating. Four studies assessed knee function through different self-administered questionnaires at 8, 24, and 26 weeks. Only one study reported significant differences in knee function at 8 weeks, favoring the unilateral training group. CONCLUSIONS: There was a moderate to high quality of evidence, with statistical significance that the addition of unilateral training to standard rehabilitation improved the cross-education of quadriceps strength after ACL reconstruction. More research is needed to assess the consistency of these results. International Prospective Register of Systematic Reviews registration number: CRD42020199950.

Uruguayan Cannabis Social Clubs: From activism to dispensaries?

BACKGROUND: In 2013 Uruguay regulated three models for the supply of cannabis for recreational use (Law 19.172), including Cannabis Social Clubs (CSCs). According to the Cannabis Regulation and Control Institute, 110 CSCs are active at the time of writing. OBJECTIVES: This paper has a twofold goal. Firstly, it aims to take stock of how the CSC model has continued to be implemented in practice, drawing on the first-hand accounts of those involved in its management. Secondly, our analysis seeks to contribute to the understanding of the CSC model by considering the different variants of the model that have emerged in Uruguay. METHODOLOGY: Our analysis draws on qualitative research conducted in Uruguay between June and October of 2018. We conducted 15 semi-structured and face-to-face interviews with representatives of registered Uruguayan CSCs and with 13 other stakeholders. RESULTS/CONCLUSIONS: CSCs' role as cannabis suppliers is perceived positively in terms of the type of cannabis produced and the means of distribution. We found that truly social CSCs co-exist with, and may be losing ground to, quasi-dispensary clubs. A number of factors may have contributed to this, including the Uruguayan regulatory framework, institutional context, and disengagement of members and/or CSC managers. This raises potential new challenges as to the contribution of the CSC model from a harm reduction perspective.

Why Uruguay legalized marijuana? The open window of public insecurity.

BACKGROUND AND AIMS: In 2013, Uruguay became the first country in the world to fully regulate its marijuana market. This ambitious policy was also an unexpected one: none of the usual explanations for legalization of marijuana in other contexts was present in the Uruguayan case. This paper offers an explanation of why Uruguay legalized marijuana. Drawing on Kingdon's theoretical approach, we argue that a window of opportunity opened in mid-2012, making it both necessary and possible for the government to move towards legalization. METHODS: A congruence case study using evidence from a series of interviews with political actors and policy makers, media reports and official documents. RESULTS: There is evidence that marijuana legalization was possible in Uruguay because of the coincidence of a demand for more public safety (problem stream) with the presence of pro-legalization leaders in strategic political positions (policy stream) and a favorable political environment (political stream) CONCLUSIONS: Applying Kingdon's theory of windows of opportunity, Uruguay may have moved towards full regulation of its marijuana market in 2013 because of the convergence of a specific set of problem, policy and political circumstances in May 2012.

Marcadores de inflamación y disfunción endotelial en sujetos obesos con/sin diabetes mellitus tipo 2 / Inflammatory markers and endothelial dysfunction in obeses with or without type 2 diabetes mellitus

La obesidad y la diabetes son patologías que desarrollan cambios en el ambiente molecular del organismo favoreciendo la expresión de citoquinas y diferentes mediadores pro-inflamatorios, proporcionado así, el daño al endotelio. El objetivo fue analizar la asociación entre la obesidad y los marcadores de inflamación y disfunción endotelial (PCRus, Fibrinógeno, IL-6, TNF-a,ICAM-1 y VCAM-1). Se tomaron muestras de sangre a 96 sujetos obesos con DT2, 24 sujetos obesos sin DT2, 24 sujetos no obesos con DT2 y 24 sujetos no obesos sin DT2 (controles). Siendo clasificados en obesos aquellos con un índice de masa corporal >30kg/m². El diagnóstico de diabetes tipo (2) (DT2) fue asignado según los criterios de la ADA. Se determinaron parámetros bioquímicos (glucosa e insulina), además se realizó el perfil inflamatorio (PCRus, fibrinógeno, IL-6, TNF-a), y de activación endotelial (VCAM-1, ICAM-1). Comparados con el grupo control los sujetos obesos con/sin DT2 y los sujetos no obesos con DT2 tienen niveles más elevados de PCRus (3,64± 1,72; 2,67±1,48; 1,25±1,02 frente a 0,75±0,49 de los controles), fibrinógeno (395,00±123,59; 431,13±118,32; 346,67±86,74 frente a 315,67±86,15 de los controles) e IL-6 (1,81±0,30; 2,71±0,80; 3,98±1,54 frente a 0,83±0,16 de los controles. Por otro lado, los sujetos obesos y no obesos con DT2 tenían valores más elevados de ICAM-1 (655,46±35,31 y 660,99±39,52 frente a 462,92±28,63 de los controles) y VCAM-1 ( 647,62±85,03 y 809,05±104,29 frente a 442,48±22,72 de los controles) el TNF-á no presentó diferencias entre los grupos en estudio. El incremento de los valores de VCAM-1 en los sujetos con DT2 (obesos o no), refleja lesión endotelial asociada a DT2 e indica la importancia de la prevención en los sujetos con síndrome metábolico en el que se está iniciando el daño al endotelio.

Obesity and Diabetes are pathologies tat are involved in the changes in the organ molecular environment that favor the expression of endothelial markers and secretion of different pro-inflammatory cytokines that injured the endothelium. Analyze the association between obesity, inflammatory marker and endothlial dysfunction (usCRP, fibrinogen, TNF-a, ICAM-1 and VCAm-1. Blood specimens were harvested of 96 subjects, 24 obeses with type 2 Diabetes Mellitus (T2DM), 24 obeses without T2DM, 24 non obeses with T2DM and 24 non obeses without T2DM (controls). The obeses were classified with a corporal mass index (CMI)>30kg/m². he diagnosis of T2DM was done following the ADA's criteria. Glucose, insulin, usCPR, fibrinogen, IL6, TNF-a, ICAM-1 and VCAM-1 levels were measured. The obeses with/Without T2DM and the non obeses with T2DM showed highly significant elevation levels of usCPR (3,64± 1,72; 2,67±1,48; 1,25±1,02 compared to 0,75±0,49 in controls), fibrinogen (395,00±123,59; 431,13±118,32; 346,67±86,74 compared to 315,67±86,15 in controls) and IL-6 (1,81±0,30; 2,71±0,80; 3,98±1,54 compared to 0,83±0,16 in controls) In the other hand, obeses y non obeses with T2DM showed highly significant elevations levels of ICAM-1 655,46±35,31 y 660,99±39,52 compared to 462,92±28,63 in controls) and VCAM-1 (647,62±85,03 y 809,05±104,29 compared to 442,48±22,72 in controls. TNF-á did not have significant differences between groups. Highly levels of VCAM-1 and ICAM-1 in subjects with T2DM (obeses or non obeses), likely to endothelial injure associated to T"DM and important markers of the beginning of endothelial injue and the cardiovascular disease.

Estudio exploratorio sobre una escala de autoevaluación para la depresiónm en niños y adolescentes / Exploratory study on a self-evaluation scale for depression in children and adolescents

Se aplicó el cuestionario para la depresión infantil de Birleson en una muestra de 100 pacientes del Servicio de Psiquiatría Infantil del Hospital Ezequiel González Cortés. El mismo instrumento se utilizó en un grupo control. Se comprobó que los resultados del cuestionario tenían alta correlación con el diagnóstico clínico de Depresión