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.

Colecistectomía laparoscópica: experiencia de dos décadas en el Hospital Militar de Cuenca, Ecuador / Laparoscopic cholecystectomy: experience of two decades in the military hospital of Cuenca, Ecuador

Objetivo: identificar los factores socio-demográficos y clínicos, en la colecistectomía laparoscópica en dos décadas de experiencia en el Hospital Militar de la ciudad de Cuenca. La colecistectomía es la cirugía más común para tratar patologías como la colelitiasis, colecistitis agudas y poliposis vesicular, siendo en la actualidad la técnica laparoscópica el tratamiento de elección. Materiales y Métodos: estudio de tipo descriptivo, retrospectivo, de pacientes sometidos a colecistectomía laparoscópica en las últimas dos décadas; se trabajaron con 468 historias clínicas que cumplieron los criterios de inclusión. Resultados: un 61,8% fueron mujeres con una edad media de 50,77 años y un desvío estándar (DS) de 0,727. Las indicaciones quirúrgicas fueron colelitiasis 60,2%, colecistitis aguda 29,2%, poliposis vesiculares 4,7%, coledocolitiasis 4,5%, vesícula esclerotrófica 0,9%. La estancia postoperatoria fue de 80,6% menos de tres días y el 19,4% igual o mayor a 4 días; con un promedio de 1,09 y un DS=0,292. El porcentaje de conversión a cirugía abierta fue del 0,4%. El tiempo quirúrgico fue en 50,2% dentro de 31-60min y 46,2% más de 60 minutos con un promedio de 42,43 min y un DS=0,564. Al relacionar la edad y el tiempo operatorio se evidenció que en los mayores de 60 años tenían más días de hospitalización con significancia estadística,con un valor de p=0,0006. Conclusión: la colecistectomía laparoscópica disminuye los tiempos operatorios y de hospitalización, contribuyendo directamente al descenso de la morbilidad y mortalidad por este tipo de patologías y permitiendo a los servicios de salud, de países en vías de desarrollo, mejorar la calidad de la atención de sus poblaciones..(AU)

Objective: to identify the socio-demographic and clinical factors in laparoscopic cholecystectomy in two decades of experience in the Military Hospital of the city of Cuenca. Cholecystectomy is the most common surgery to treat pathologies such as cholelithiasis, acute cholecystitis and vesicular polyposis, currently the laparoscopic technique is the treatment of choice. Materials and Methods: a descriptive, retrospective study of patients undergoing laparoscopic cholecystectomy in the last two decades; we worked with 468 clinical records that met the inclusion criteria.. Results: 61,8% were women and 38,2% were men with a mean age of 50,77 years and standard deviation (SD) of 0,727. The surgical indications were cholelithiasis 60,2%, acute cholecystitis 29,2%, vesicular polyposis 4,7%, choledocholithiasis 4,5%, sclerotrophic vesicle 0,9%. The postoperative stay was 80,6% less than three days and 19.4% equal to or greater than 4 days; with an average of 1,09 and DS = 0,292. The conversion percentage to open surgery was 0,4%. The surgical time was 50,2% within 31-60 min and 46,2% more than 60 minutes with an average of 42,43min and DS = 0,564. When the age and operative time were related, it was evidenced that in those older than 60 years, they had more days of hospitalization with statistical significance, with a value of p= 0,0006. Conclusion: laparoscopic cholecystectomy decreases the operative and hospitalization times, contributing directly to the decrease in morbidity and mortality due to this type of pathologies and allowing health services in developing countries to improve the quality of care for their populations..(AU)

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

The legalization of cannabis derivatives in Spain: Hypothesis on a potential emerging market. / La legalización de los derivados del cannabis en España: Hipótesis sobre un potencial mercado emergente.

First, this paper estimates the dimensions of the market for cannabis in Spain using data on the extent of consumption and the main patterns of use of consumers. Then the paper reviews the hypothetical production and distribution costs of these drugs in different production regimes under different legal conditions. The review shows that current prices of cannabis in the illegal market could be notably reduced if production and distribution of cannabis were decriminalized and even more if they were performed by legal enterprises. Thirdly, we examine the relationship between prices and consumption levels by analysing the price elasticity of demand. A fall in the prices of cannabis products will likely result in an increase in the number of users and in the total amount consumed. Lastly we consider several alternatives for the taxation of cannabis derivatives to counteract the likely fall in prices, and their pros and cons.

En este artículo se analiza en primer lugar las dimensiones que tiene el mercado de cannabis en España en base a los datos disponibles sobre la extensión del consumo y las pautas de uso de los consumidores. A continuación se repasan y comparan los costes de producción y distribución del cannabis en distintos regímenes de producción y diversas condiciones jurídicas. Se observa cómo los precios del cannabis al detalle en el mercado ilegal son bastante altos y podrían reducirse considerablemente si se legalizasen la producción y la comercialización. En tercer lugar, se examina la relación que hay entre los precios y el consumo a través del análisis de la elasticidad del precio de la demanda. Se pone de manifiesto cómo una caída de los precios probablemente resulte en un aumento tanto en el número de usuarios como en la cantidad total consumida por estos. Por último, se consideran distintas alternativas de fiscalización destinadas a contrarrestar la caída de precios de los derivados del cannabis, mostrando sus fortalezas y debilidades.

La legalización de los derivados del cannabis en España: Hipótesis sobre un potencial mercado emergente / The legalization of cannabis derivatives in Spain: Hypothesis on a potential emerging market

En este artículo se analiza en primer lugar las dimensiones que tiene el mercado de cannabis en España en base a los datos disponibles sobre la extensión del consumo y las pautas de uso de los consumidores. A continuación, se repasan y comparan los costes de producción y distribución del cannabis en distintos regímenes de producción y diversas condiciones jurídicas. Se observa cómo los precios del cannabis al detalle en el mercado ilegal son bastante altos y podrían reducirse considerablemente si se legalizasen la producción y la comercialización. En tercer lugar, se examina la relación que hay entre los precios y el consumo a través del análisis de la elasticidad del precio de la demanda. Se pone de manifiesto cómo una caída de los precios probablemente resulte en un aumento tanto en el número de usuarios como en la cantidad total consumida por estos. Por último, se consideran distintas alternativas de fiscalización destinadas a contrarrestar la caída de precios de los derivados del cannabis, mostrando sus fortalezas y debilidades

First, this paper estimates the dimensions of the market for cannabis in Spain using data on the extent of consumption and the main patterns of use of consumers. Then the paper reviews the hypothetical production and distribution costs of these drugs in different production regimes under different legal conditions. The review shows that current prices of cannabis in the illegal market could be notably reduced if production and distribution of cannabis were decriminalized and even more if they were performed by legal enterprises. Thirdly, we examine the relationship between prices and consumption levels by analysing the price elasticity of demand. A fall in the prices of cannabis products will likely result in an increase in the number of users and in the total amount consumed. Lastly we consider several alternatives for the taxation of cannabis derivatives to counteract the likely fall in prices, and their pros and cons

Cannabis cultivation in Spain: A profile of plantations, growers and production systems.

BACKGROUND: The European market for cannabis derivatives is being transformed. The cultivation of cannabis within the EU and the shift of demand from hashish to domestic marihuana are key aspects of this transformation. Spain, formerly central to the trade of Moroccan hashish, is becoming a marihuana-producing country. The emergence of "import-substitution" has been researched in other EU countries, but thus far the Spanish case remains undocumented. METHODS: This paper is based on analysis of data of 748 cannabis plantations seized by Spanish police in 2013. The sample comprises reports of seizures identified through a survey of online news and police reports. "Event-analysis" methods were applied to these sources. RESULTS: The analysis offers a typology of plantations, a profile of participants and the different production systems, and a model of regional distribution. Half of the plantations were small (less than 42 plants) and half contained between 100 and 1000 plants, with an average size of 261 plants. About three-quarters of plants were cultivated indoors using stolen electricity. 86% of all plants seized were from large-scale plantations (more than 220 plants). Most plantations were located along the Mediterranean coast, where population and tourism are concentrated. Over three-quarters of those indicted by police were Spanish (85%). Among the foreign owners of big plantations, Dutch nationals predominated. The number of seized plants by province was directly associated with the number of grow shops (ß=0.962, p<0.001). CONCLUSION: The rise of large-scale cannabis plantations in the Spanish Mediterranean coast is increasingly replacing import of Moroccan hashish. Indoor cultivation supported by grow shops, that provide the technology and know-how, seem to be the dominant form of organization in this emerging industry. Large-scale plantations may have met most of the demand for marihuana in 2013.

A general model for designing networks of marine reserves.

There is debate concerning the most effective conservation of marine biodiversity, especially regarding the appropriate location, size, and connectivity of marine reserves. We describe a means of establishing marine reserve networks by using optimization algorithms and multiple levels of information on biodiversity, ecological processes (spawning, recruitment, and larval connectivity), and socioeconomic factors in the Gulf of California. A network covering 40% of rocky reef habitat can fulfill many conservation goals while reducing social conflict. This quantitative approach provides a powerful tool for decision-makers tasked with siting marine reserves.