A multi-centre, tolerability study of a cannabidiol-enriched Cannabis Herbal Extract for chronic headaches in adolescents: The CAN-CHA protocol.

INTRODUCTION: Cannabis products have been used in the management of headaches in adults and may play a role in pediatric chronic pain. Canadian pediatricians report increasing use of cannabis for the management of chronic headaches, despite no well-controlled studies to inform its dosing, safety, and effectiveness. The aim of our clinical trial is to determine the dosing and safety of a Cannabidiol (CBD)-enriched Cannabis Herbal Extract (CHE) for the treatment of chronic headaches in adolescents. METHODS AND ANALYSIS: Youth, parents, and an expert steering committee co-designed this tolerability study. Twenty adolescents (aged 14 to 17 years), with a chronic migraine diagnosis for more than 6 months that has not responded to other therapies will be enrolled into an open label, dose escalation study across three Canadian sites. Study participants will receive escalating doses of a CBD-enriched CHE (MPL-001 with a THC:CBD of 1:25), starting at 0.2-0.4 mg/kg of CBD per day and escalating monthly up to 0.8-1.0 mg/kg of CBD per day. The primary objective of this study is to determine the safety and tolerability of CBD-enriched CHE in adolescents with chronic migraine. Secondary objectives of this study will inform the development of subsequent randomized controlled trials and include investigating the relationship between the dose escalation and change in the frequency of headache, impact and intensity of pain, changes in sleep, mood, function, and quality of life. Exploratory outcomes include investigating steady-state trough plasma levels of bioactive cannabinoids and investigating how pharmacogenetic profiles affect cannabinoid metabolism among adolescents receiving CBD-enriched CHE. DISCUSSION: This protocol was co-designed with youth and describes a tolerability clinical trial of CBD-enriched CHE in adolescents with chronic headaches that have not responded to conventional therapies. This study is the first clinical trial on cannabis products in adolescents with chronic headaches and will inform the development of future comparative effectiveness clinical trials. TRIAL REGISTRATION: CAN-CHA trial is registered with ClinicalTrials.gov with a number of register NCT05337033.

Medical cannabis in schools: The experiences of caregivers.

Objectives: Implementing medical cannabis (MC) into a child's daily routine can be challenging and there is a lack of guidance for its therapeutic use in schools in Canada. Our objective was to learn about the experiences of caregivers of school-aged children who require MC. Methods: Qualitative description was used and caregivers were interviewed about MC in schools and in general. The transcripts were entered into Dedoose software for qualitative analysis and content analysis was performed. Sentences and statements were ascribed line by line into meaning units and labelled with codes, and organized according to categories and subcategories. Results: Twelve caregivers of school-aged children who take MC participated. The most common reasons for treatment were drug-resistant epilepsy (DRE), autism, or other developmental disorders. Approximately half of the participants' children (n = 6) took MC during the school day and most (5/6) perceived their experiences to be positive or neutral but reported a lack of knowledge about MC. While data saturation was not reached regarding MC in schools, rich dialogues were garnered about MC in general and three categories were identified: challenges (subcategories stigma, finding an authorizer, cost, dosing, and supply); parents as advocates (subcategories required knowledge, attitudes, skills, and sources of information); and caregiver relief for positive outcomes. Conclusions: Caregivers demonstrate remarkable tenacity despite the many challenges associated with MC use. Education and practice change are needed to ensure that children using MC can benefit from or continue to experience its positive outcomes within the school environment and beyond.

Factors Associated with Outdoor Winter Walking in Older Adults: A Scoping Review.

The purpose of this study was to identify internal and external factors associated with outdoor winter walking in older adults. In this scoping review, 12 databases were searched. Inclusion criteria included English language, focus on adults 65 years of age or older, and evaluation of factors associated with outdoor winter walking. Two authors screened titles/abstracts and full text. Conflicts were resolved by consensus. Data were extracted, organized into tables, and summarized as pertaining to barriers/facilitators and internal/external factors associated with outdoor winter walking. A total of 6,843 articles were identified, 1,898 duplicates were removed, 4,789 were excluded during title/abstract screening, and 148 were excluded during full-text review. Eight studies were included. Four categories of factors affecting outdoor winter walking in older adults were identified: adverse weather conditions, physical environment, physical function, and perceptions relating to winter walking conditions. Rehabilitation and exercise professionals can use the results to educate their clients and implement the facilitators of and alternatives and solutions to barriers to outdoor winter walking.

The Two Dimensions of Passion for Sport: A New Look Using a Quadripartite Approach.

Research relying on the dualistic model of passion has consistently found that harmonious passion for sport is positively associated with adaptive outcomes and that obsessive passion for sport is positively associated with maladaptive outcomes. In this research, we tested if various sport outcomes were related to within-person combinations of both harmonious and obsessive passion. Three samples of athletes (total N = 1,290) completed online surveys that assessed various sport outcomes (e.g., sport enjoyment, goal attainment), along with harmonious and obsessive passion for their sport. We found that athletes were best served by having either high harmonious passion or low obsessive passion or, in many cases, high harmonious passion that was combined with low obsessive passion. These results add to our understanding of passion by showing that combinations of harmonious and obsessive passion for sport are differentially associated with indicators of a positive sport experience.

Healthcare Professionals' Perspective on Implementing a Detector of Behavioural Disturbances in Long-Term Care Homes.

The number of Canadians with dementia is expected to rise to 674,000 in the years to come. Finding ways to monitor behavioural disturbance in patients with dementia (PwDs) is crucial. PwDs can unintentionally behave in ways that are harmful to them and the people around them, such as other residents or care providers. Current practice does not involve technology to monitor PwD behaviours. Events are reported randomly by nonstaff members or when a staff member notices the absence of a PwD from a scheduled event. This study aims to explore the potential of implementing a novel detector of behavioural disturbances (DBD) in long-term care homes by mapping the perceptions of healthcare professionals and family members about this technology. Qualitative information was gathered from a focus group involving eight healthcare professionals working in a tertiary care facility and a partner of a resident admitted in the same facility. Thematic analysis resulted in three themes: (A) the ability of the DBD to detect relevant dementia-related behavioural disturbances that are typical of PwD; (B) the characteristics of the DBD and clinical needs and preferences; (C) the integration of the DBD into daily routines. The results tend to confirm the adequacy of the DBD to the day-to-day needs for the detection of behavioural disturbances and hazardous behaviours. The DBD was considered to be useful and easy to use in the tertiary care facility examined in this study. The participants intend to use the DBD in the future, which means that it has a high degree of acceptance.