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2.
Salud Publica Mex ; 59(5): 592-600, 2017.
Artículo en Español | MEDLINE | ID: mdl-29267657

RESUMEN

When discussing the public health approach to the use of marijuana, the complexity of rigorous regulatory interventions for population protection is omitted. Using the experience of governments where these practices already exist, regulation is introduced as an essential public health function, spelling out seven purposes for controlling marijuana. The technical elements of institutional capacity -including the technical and financial capacity- and of governance that must be covered by any rigorous regulation of its use are detailed below. The difficulty of regulating psychoactive substances is addressed when considering the capacity to control other legal substances manifested with their increased consumption. It is concluded that for an effective regulation of marijuana, the need for strengthening the institutional and governance aspects of the regulatory authority should not be minimized.


Asunto(s)
Uso de la Marihuana/legislación & jurisprudencia , Salud Pública/legislación & jurisprudencia , Consumo de Bebidas Alcohólicas/epidemiología , Humanos , Uso de la Marihuana/epidemiología , Marihuana Medicinal , México , Medición de Riesgo , Fumar/epidemiología , Poblaciones Vulnerables
3.
Braz Oral Res ; 31: e102, 2017 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-29267663

RESUMEN

The objective of this study was to assess the oral health status of users of illicit drugs such as marijuana and cocaine/crack and compare it with individuals not using these chemical substances. Questionnaires were applied to 35 illicit drugs users to gather information on demographic status, general health, and use of drugs. Then, a clinical assessment of the oral health condition was performed to collect data on decayed, missing and filled teeth (DMFT) index, salivary flow rate (SFR), and mucosal lesions. The control group was composed of 35 non-illicit drug users. In the experimental group, 91.43% were males, 80% were smokers, and 42.85% were alcoholics. Cocaine was the most common drug used (77.15%), followed by marijuana (68.6%), and crack (51.4%). The average DMFT index was 9.8 and the SFR was reduced in 60% of subjects. Mucosal alterations were detected, but no potentially malignant disorders or oral cancer were diagnosed. Compared to control group, significantly higher values for gender (40%, p = 0.0001), smoking (22.86%) and heavy drinking (5.7%) habits (p = 0.0001), SFR (31.4%; p = 0.0308), and oral lesions (p = 0.0488) were found for the experimental group, although significantly higher values were found in the control group for DMFT index (p = 0.0148). It can be concluded that the use of illicit drugs contributed to an increased prevalence of oral mucosa lesions. In addition, a decline on SFR and a reduced DMFT index was observed for illicit drug users.


Asunto(s)
Trastornos Relacionados con Cocaína/complicaciones , Abuso de Marihuana/complicaciones , Enfermedades de la Boca/inducido químicamente , Mucosa Bucal/efectos de los fármacos , Salud Bucal/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Alcoholismo/complicaciones , Alcoholismo/epidemiología , Estudios de Casos y Controles , Trastornos Relacionados con Cocaína/epidemiología , Estudios Transversales , Índice CPO , Femenino , Humanos , Masculino , Abuso de Marihuana/epidemiología , Persona de Mediana Edad , Enfermedades de la Boca/epidemiología , Factores de Riesgo , Salivación/efectos de los fármacos , Tasa de Secreción/efectos de los fármacos , Distribución por Sexo , Fumar/efectos adversos , Fumar/epidemiología , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
4.
Artículo en Inglés | MEDLINE | ID: mdl-29258185

RESUMEN

Clinicians often ask pregnant women about tobacco smoking, but their practices of asking about other smoking and nicotine exposures are unknown. This study analysed how often clinicians ask pregnant women about their use of e-cigarettes, cannabis, chewing tobacco, and second-hand smoke (SHS) exposure. Two cross-sectional surveys were undertaken. A random sample of 500 General Practitioner (GP) members were invited from the National Faculty of Aboriginal and Torres Strait Islander Health (NFATSIH) to complete an on-line survey, and 5571 GP and Obstetrician (OBS) members of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) were sent a paper survey by mail. Questions on frequency of asking about the exposures used Likert Scales, later dichotomized to "often-always" and "never-sometimes". Logistic regressions estimated associations between clinician type and asking about cannabis, e-cigarettes, chewing tobacco, and SHS. An adjusted model reduced potential confounders of location, guidelines, gender and population. n = 378 GPs and OBS participated (6.2% response). In total, 13-14% asked "often-always" about e-cigarettes; 58% cannabis; 38% cannabis with tobacco; 27% SHS, and 10% chewing tobacco-compared to 95% of the sample asking about cigarette smoking. After adjustment, the odds of RANZCOG GPs (OR 0.34) and OBS (OR 0.63) asking about cannabis were lower compared to NFATSIH GPs. Clinician type was non-significant for asking about e-cigarettes, chewing tobacco and SHS. Surveyed Australian GPs and obstetricians asked less frequently about e-cigarettes, chewing, SHS exposure, and cannabis, potentially missing important exposures for mother and child.


Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Fumar Marihuana/epidemiología , Prevención del Hábito de Fumar/estadística & datos numéricos , Contaminación por Humo de Tabaco/estadística & datos numéricos , Adulto , Australia/epidemiología , Cannabis , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Embarazo , Fumar/epidemiología , Encuestas y Cuestionarios , Tabaco , Tabaco sin Humo
7.
J Int Neuropsychol Soc ; 23(9-10): 893-902, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-29198276

RESUMEN

Cannabis use has been linked to impairments in neuropsychological functioning across a large and continually expanding body of research. Yet insight into underlying causal relations remains limited due to the historically cross-sectional nature of studies in this area. Recently, however, studies have begun to use more informative design strategies to delineate these associations. The aim of this article is to provide a critical evaluation and review of research that uses longitudinal designs to examine the link between cannabis use and neuropsychological functioning. In summarizing the primary findings across these studies, this review suggests that cannabis use leads to neuropsychological decline. However, across most studies, these associations were modest, were present only for the group with the heaviest cannabis use, and were often attenuated (or no longer significant) after controlling for potential confounding variables. Future studies with neuropsychological data before and after initiation of cannabis use, along with careful measurement and control of "shared risk factors" between cannabis use and poorer neuropsychological outcomes, are needed to better understand who, and under what conditions, is most vulnerable to cannabis-associated neuropsychological decline. (JINS, 2017, 23, 893-902).


Asunto(s)
Estudios Longitudinales , Fumar Marihuana/fisiopatología , Trastornos Neurocognitivos/diagnóstico , Trastornos Neurocognitivos/etiología , Pruebas Neuropsicológicas , Humanos
8.
Psychol Addict Behav ; 31(8): 922-943, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-29199844

RESUMEN

The rates of co-occurring cannabis and tobacco use are higher among African Americans relative to other racial/ethnic groups. One plausible approach to treating co-use among African Americans is to examine the effectiveness of treatments for the sole use of cannabis and tobacco to identify effective approaches that might be combined to treat the dual use of these substances. The current meta-analysis sought to include studies that reported cannabis and/or tobacco use outcomes from randomized clinical trials (RCTs) with 100% African American samples. A total of 843 articles were considered for inclusion, 29 were reviewed by independent qualitative coders, and 22 were included in the review. There were no articles on cannabis use treatment with a 100% African American sample, resulting in a need to lower the threshold (60%) and conduct a scoping review of cannabis studies. Preliminary evidence from a small number of studies (k = 7) supports the use of Motivational Interviewing and Cognitive-Behavioral Therapy to treat cannabis use among African Americans, but not Contingency Management. Results from a meta-analysis of 15 tobacco studies found higher rates of smoking abstinence in the treatment condition relative to control conditions overall and across short and long-term follow-up periods. Significant differences in smoking abstinence were also found when examining the effects of pharmacological treatments relative to their control conditions. The clinical and research implications of these findings for future psychosocial and pharmacological trials for cannabis and tobacco use and co-use among African Americans are described. (PsycINFO Database Record


Asunto(s)
Afroamericanos , Terapia Cognitivo-Conductual , Fumar Marihuana/psicología , Fumar Marihuana/terapia , Entrevista Motivacional , Uso de Tabaco/psicología , Uso de Tabaco/terapia , Afroamericanos/estadística & datos numéricos , Humanos , Fumar Marihuana/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/terapia , Uso de Tabaco/epidemiología
9.
Addict Sci Clin Pract ; 12(1): 34, 2017 Dec 12.
Artículo en Inglés | MEDLINE | ID: mdl-29229000

RESUMEN

BACKGROUND: Substance use is common among people living with HIV (PLHIV) and is associated with worse outcomes along the HIV care continuum. One potentially effective clinic-based approach to addressing unhealthy substance use is screening, brief intervention, and referral to treatment (SBIRT). METHODS: We conducted a two-arm randomized trial to examine the effects of a self-administered, computerized SBIRT intervention compared to a clinician-administered SBIRT intervention in an HIV primary clinic. Patients were surveyed before receiving the intervention and again at 1, 3, and 6 months. We administered the WHO Alcohol, Smoking and Substance Involvement Screening Test to determine Specific Substance Involvement Scores (SSIS) and to assign participants to categories of lower, moderate, or high risk to health and other problems for each substance. We collapsed moderate or severe risk responses into a single moderate-high risk category. Based on low rates of participation in the computerized arm, we conducted an "as treated" analysis to examine 6-month changes in mean SSIS among SBIRT intervention participants. RESULTS: For the overall sample (n = 208), baseline mean SSIS were in the moderate risk category for alcohol, tobacco, cannabis, cocaine, amphetamine, sedatives and opioids. Of those enrolled, 134 (64.4%) received the intervention, and 109 (52.4%) completed the 6-month follow up. There was a statistically significant decline in mean SSIS for all substances except tobacco and cannabis among participants who were at moderate-high risk at baseline. We also observed a statistically significant increase in mean SSIS for all substances except amphetamines and sedatives among participants who were at lower risk at baseline. CONCLUSIONS: Substance use among patients in this urban, safety-net, HIV primary care clinic was near universal, and moderate risk substance use was common. Among participants who received the SBIRT intervention, mean SSISs decreased among those at moderate-high risk at baseline, but increased among those at lower risk at baseline over the 6-month study period. Additional research should examine the clinical significance of SSIS changes for PLHIV, which SBIRT components drive changes in substance use scores, and what other interventions might support those patients at lower risk to maintain health and engagement along the HIV care continuum. Trial registration ClinicalTrials.gov study NCT01300806.


Asunto(s)
Recolección de Datos/métodos , Infecciones por VIH/epidemiología , Atención Primaria de Salud/organización & administración , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Alcoholismo/diagnóstico , Alcoholismo/epidemiología , Instituciones de Atención Ambulatoria , Femenino , Humanos , Masculino , Abuso de Marihuana/diagnóstico , Abuso de Marihuana/epidemiología , Tamizaje Masivo , Persona de Mediana Edad , Derivación y Consulta/organización & administración , Factores de Riesgo , Fumar/epidemiología , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/terapia , Encuestas y Cuestionarios
13.
Rev. Hosp. Ital. B. Aires (2004) ; 37(4): 142-145, dic. 2017. ilus
Artículo en Español | LILACS | ID: biblio-1095740

RESUMEN

La infección diseminada por Fusarium se ha convertido en un problema creciente en las personas con neoplasias hematológicas malignas, principalmente en pacientes con leucemias agudas; se describen cada vez más casos en aquellos sometidos a un trasplante de médula ósea. No existe un tratamiento óptimo establecido para la fusariosis diseminada. La mortalidad global comunicada de esta infección oscila entre el 50 y el 80%. Se presenta a continuación el caso de un paciente de sexo masculino de 29 años, con diagnóstico de leucemia mieloide aguda, que presenta como complicación una fusariosis diseminada, y logra sobrellevar un trasplante alogénico de médula ósea en el Hospital Italiano de San Justo (Argentina) de forma exitosa. (AU)


Disseminated fusariosis has become an increasing problem in people with hematopoietic neoplasms, mainly in patients affected by acute leukemias, and even more in those who undergo hematopoietic cell transplantation. There is not an optimal treatment for disseminated fusariosis. The global mortality described in the literature is between 50% and 80%. We introduce a case of a 29 year old patient with diagnosis of acute myeloid leukemia complicated with disseminated fusariosis, who copes with an allogeneic hematopoietic cell transplantation with a successful outcome in the "Hospital Italiano de San Justo" (Argentina). (AU)


Asunto(s)
Humanos , Masculino , Adulto , Leucemia Mieloide Aguda/cirugía , Trasplante de Médula Ósea/tendencias , Fusariosis/terapia , Azacitidina/efectos adversos , Tabaquismo , Trasplante Homólogo , Leucemia Mieloide Aguda/complicaciones , Anfotericina B/administración & dosificación , Anfotericina B/uso terapéutico , Mitoxantrona/administración & dosificación , Mitoxantrona/uso terapéutico , Corticoesteroides/uso terapéutico , Citarabina/administración & dosificación , Citarabina/uso terapéutico , Tomografía de Emisión de Positrones , Quimioterapia , Fiebre , Fusariosis/microbiología , Fusariosis/mortalidad , Fusariosis/epidemiología , Fusariosis/diagnóstico por imagen , Mialgia , Voriconazol/administración & dosificación , Voriconazol/uso terapéutico , Filgrastim/uso terapéutico , Uso de la Marihuana , Fumar Cocaína , Terbinafina/uso terapéutico , Melfalán/administración & dosificación , Melfalán/uso terapéutico , Antibacterianos/uso terapéutico
16.
Rev Pneumol Clin ; 73(6): 283-289, 2017 Dec.
Artículo en Francés | MEDLINE | ID: mdl-29126755

RESUMEN

Cannabis use increased sharply from 2010 to 2014 in France. Cannabis is often consumed with tobacco, although the use of marijuana is developing. Tobacco and cannabis smoke have many common characteristics in terms of irritants, carcinogens and carbon monoxide. They also differentiate by their dependence mechanisms, with nicotine and its receptors for tobacco and tetra-hydro-cannabinol (THC) and its specific receptors for cannabis. Chronic inhalation (700,000 daily users in France) over a long period most likely increases the relative risk of bronchial cancer. But long-term cohort studies targeting this group of strong cannabis users, especially over time, are lacking. Inhalation of cannabis smoke, despite an acute bronchodilator effect, is associated with the risk of chronic bronchitis in the case of regular use. However, the risk of developing COPD in the exclusive marijuana smoker group with no associated tobacco is not yet clear, with studies yielding discordant results. There is also a lack of long-term follow-up studies of respiratory investigations in large cannabis users. Finally, cannabis smoke contains various cannabinoids, for example cannabidiol which also have anti-inflammatory and antifibrotic properties, with the unconfirmed hypothesis that these properties can partially modulate the deleterious action of cannabis smoke.


Asunto(s)
Cannabis/efectos adversos , Enfermedades Pulmonares/etiología , Pulmón/patología , Fumar Marihuana/efectos adversos , Cannabinoides/efectos adversos , Francia , Humanos , Factores de Riesgo
18.
BMC Med Educ ; 17(1): 232, 2017 Nov 28.
Artículo en Inglés | MEDLINE | ID: mdl-29183315

RESUMEN

BACKGROUND: Poor mental health among medical students is widely acknowledged. Studies on mental health among medical students of Nepal are lacking. Therefore, we conducted a study to determine the prevalence of mental disorders. METHODS: A cross-sectional study was conducted among medical students at KIST Medical College and Teaching Hospital, Nepal from December 2016 to February 2017. Our survey instrument consisted of the Patient Health Questionnaire (PHQ) and questions about socio-demographic factors, smoking, marijuana use, suicidal ideation and thoughts of dropping out of medical school. RESULTS: The prevalence rates were 29.2% (95% CI, 24.4% - 34.3%) depression, 22.4% (95% CI, 18.0% - 26.9%) medium to highly severe somatic symptoms, 4.1% (95% CI, 2.0% - 6.2%) panic syndrome, 5.8% (95% CI, 3.4% - 8.3%) other anxiety syndrome, 5% (95% CI, 2.7% - 7.3%) binge eating disorder and 1.2% (95% CI, 0.0% - 2.3%) bulimia nervosa. Sixteen students [4.7% (95% CI, 2.4% - 6.9%)] seriously considered committing suicide while in medical school. Thirty-four students [9.9% (95% CI, 6.8% - 13.1%)] considered dropping out of medical school within the past month. About 15% (95% CI, 11.1% - 18.6%) of the students reported use of marijuana during medical school. CONCLUSIONS: We found high prevalence of poor mental health among medical students of Nepal. Future studies are required to identify the factors associated with poor mental health.


Asunto(s)
Ansiedad/epidemiología , Depresión/epidemiología , Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Uso de la Marihuana/epidemiología , Fumar/epidemiología , Estrés Psicológico/epidemiología , Abandono Escolar/psicología , Estudios Transversales , Femenino , Humanos , Masculino , Salud Mental , Nepal/epidemiología , Prevalencia , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Facultades de Medicina , Factores Socioeconómicos , Abandono Escolar/estadística & datos numéricos , Estudiantes de Medicina , Ideación Suicida , Adulto Joven
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