Randomized controlled trial of motivational interviewing compared with drug information and advice for early intervention among young cannabis users

Aim To test the effectiveness of motivational interviewing (MI) in comparison with drug information and advice in opportunistically securing reductions in drug‐related risk among young cannabis users not seeking help. Design Randomized controlled trial. Setting Eleven London Further Education colleges. Participants A total of 326 students aged 16–19 years who smoked cannabis weekly or more frequently. Interventions Participants were randomized to a single‐session intervention of MI or drug information and advice‐giving. Measurements Cannabis use, cigarette smoking and alcohol consumption and harm outcomes were assessed after both 3 and 6 months. Findings No differences were found between MI and drug information and advice, although MI fidelity was not high. There were wide‐ranging individual practitioner effects on observed outcomes and a practitioner–intervention interaction was detected in relation to cannabis cessation after 3 months. Change over time was more pronounced for cannabis use than for other drug use. Conclusions Further study of the nature and consequences of MI fidelity, and individual practitioner effects more generally, is needed. Advice may be an effective brief intervention with young cannabis users in its own right and should be evaluated further in trials.     

Possible age-associated bias in reporting of clinical features of drug dependence: epidemiological evidence on adolescent-onset marijuana use

Aims To probe recent evidence on apparent excess occurrence of marijuana dependence when marijuana smoking starts in adolescence. Design and participants A national sample of recent‐onset marijuana users was identified within public data files of the National Household Survey on Drug Abuse (NHSDA), 1995–98 (1866 adolescents and 762 adults). Measurements Marijuana dependence was assessed via seven standardized questions about its clinical features, such as being unable to cut down. Multivariate response models (GLM/GEE and MIMIC) were used to evaluate adolescent excess risk and possible item biases. Findings Among people who had just started to use marijuana, clinical features of marijuana dependence occurred twice as often among adolescents compared to adults, even with statistical adjustment for other covariates (P < 0.01 from GLM/GEE). MIMIC analyses suggest that adolescent‐onset users have somewhat higher levels of marijuana dependence, and they also provide evidence of age‐associated response bias for some but not all clinical features of marijuana dependence. That is, even with level of marijuana dependence held constant, adolescent recent‐onset users were more likely than adults to report being unable to cut down (P = 0.01) and tolerance (P = 0.029). Conclusion Nosologic, methodological and substantive reasons for observed age‐related excess in occurrence of marijuana dependence problems among early onset users deserve more attention in future research.     

Split-dose menthol-enhanced PEG vs PEG-ascorbic acid for colonoscopy preparation

AIM:To compare the efficacy and palatability of 4L polyethylene glycol electrolyte(PEG)plus sugar-free menthol candy(PEG+M)vs reduced-volume 2 L ascorbic acid-supplemented PEG(Asc PEG).METHODS:In a randomized controlled trial setting,ambulatory patients scheduled for elective colonoscopy were prospectively enrolled.Patients were randomized to receive either PEG+M or Asc PEG,both splitdosed with minimal dietary restriction.Palatability was assessed on a linear scale of 1 to 5(1=disgusting;5=tasty).Quality of preparation was scored by assignment-blinded endoscopists using the modified Aronchick and Ottawa scales.The main outcomes were the palatability and efficacy of the preparation.Secondary outcomes included patient willingness to retake the same preparation again in the future and completion of the prescribed preparation.RESULTS:Overall,200 patients were enrolled(100patients per arm).PEG+M was more palatable than Asc PEG(76%vs 62%,P=0.03).Completing the preparation was not different between study groups(91%PEG+M vs 86%Asc PEG,P=0.38)but more patients were willing to retake PEG+M(54%vs 40%respectively,P=0.047).There was no significant difference between PEG+M vs Asc PEG in adequate cleansing on both the modified Aronchick(82%vs77%,P=0.31)and the Ottawa scale(85%vs 74%,P=0.054).However,PEG+M was superior in the left colon on the Ottawa subsegmental score(score0-2:94%for PEG+M vs 81%for Asc PEG,P=0.005)and received significantly more excellent ratings than Asc PEG on the modified Aronchick scale(61%vs 43%,P=0.009).Both preparations performed less well in afternoon vs morning examinations(inadequate:29%vs 15.2%,P=0.02).CONCLUSION:4 L PEG plus menthol has better palatability and acceptability than 2 L ascorbic acidPEG and is associated with a higher rate of excellentpreparations;Clinicaltrial.gov identifier:NCT01788709.     

医院制剂参芪益肺糖浆药理分析及抗肺癌功效

目的分析参芪益肺糖浆药理,探讨其抗肺癌功效。方法将67例肺癌患者随机为两组,对照组(32例)以EP方案化疗,结合组(35例)在对照组基础上加用参芪益肺糖浆,观察两组疗效。结果结合组患者血液流变学指标低于对照组,有效稳定率高于对照组,差异有统计学意义(P0.05)。结论参芪益肺糖浆补脾肺之气,益虚损,抗凝,提升白细胞,有较强抗肺癌功效。     

Medical use of cannabis: an addiction medicine perspective

The use of cannabis for medical purposes, evident throughout history, has become a topic of increasing interest. Yet on the present medical evidence, cannabis‐based treatments will only be appropriate for a small number of people in specific circumstances. Experience with cannabis as a recreational drug, and with use of psychoactive drugs that are prescribed and abused, should inform harm reduction in the context of medical cannabis.     

Decoding sequential finger movements from preparatory activity in higher‐order motor regions: a functional magnetic resonance imaging multi‐voxel pattern analysis

Performing a complex sequential finger movement requires the temporally well‐ordered organization of individual finger movements. Previous behavioural studies have suggested that the brain prepares a whole sequence of movements as a single set, rather than the movements of individual fingers. However, direct neuroimaging support for this hypothesis is lacking and, assuming it to be true, it remains unclear which brain regions represent the information of a prepared sequence. Here, we measured brain activity with functional magnetic resonance imaging while 14 right‐handed healthy participants performed two types of well‐learned sequential finger movements with their right hands. Using multi‐voxel pattern analysis, we examined whether the types of the forthcoming sequence could be predicted from the preparatory activities of nine regions of interest, which included the motor, somatosensory and posterior parietal regions in each hemisphere, bilateral visual cortices, cerebellum and basal ganglia. We found that, during preparation, the activity of the contralateral motor regions could predict which of the two sequences would be executed. Further detailed analysis revealed that the contralateral dorsal premotor cortex and supplementary motor area were the key areas that contributed to the prediction consistently across participants. These contrasted with results from execution‐related brain activity where a performed sequence was successfully predicted from the activities in the broad cortical sensory‐motor network, including the bilateral motor, parietal and ipsilateral somatosensory cortices. Our study supports the hypothesis that temporary well‐organized sequences of movements are represented as a set in the brain, and that preparatory activity in higher‐order motor regions represents information about upcoming motor actions.