Impact of recreational cannabis legalization on patient self-reporting of cannabis use at a pharmacist-led primary care clinic.

BACKGROUND: The Cannabis Act, introduced in Canada in 2018, legalized the use of recreational cannabis. The impact of the announcement and implementation of this act on patient self-reporting of cannabis use has not been explored. OBJECTIVE: The study objective was to determine if patient self-reported cannabis use increased after the announcement and implementation of legislative changes to legalize recreational cannabis. METHODS: A repeated cross-sectional design was used for a retrospective chart review of patients seen at a pharmacist-led primary care clinic. A convenience sample of patient records was divided into 3 panels, corresponding with the preannouncement (November 1, 2013-October 4, 2015), postannouncement (October 5, 2015-October 16, 2018), and postimplementation (October 17, 2018-October 17, 2019) stages of the legalization of recreational cannabis. Search terms used included cannabis, marijuana, marihuana, recreational drugs, natur∗, medicinal, pot, joint, oil, butter, brownies, edibles, cannabin∗, THC, tetrahydro∗, sativa, and indica (∗ = string wild card). The frequency of reporting use and the number of queries related to cannabis were assessed. The analysis of variance test and Pearson correlation (chi-square) were used to compare the 3 panels. RESULTS: A total of 298 patient charts were included in the analysis. One hundred, 99, and 99 patient charts corresponded with panels 1, 2, and 3, respectively. At each time point, 6%, 8%, and 14% of the patients reported cannabis use (P = 0.03). A statistically significant increase in topical oil use and a decrease in prescription tablet or capsule use between panels 1 and 3 (P = 0.036) were identified. CONCLUSION: This study found an increase in self-reporting of cannabis use across the 3 consecutive panels. The change in the product formulations used may reflect the various products available. Frontline pharmacists are encouraged to initiate conversations regarding cannabis use as part of routine practice.

Assessment of antiretroviral third agent virologic durability after initiation of first antiretroviral regimen.

Information on the virologic durability of modern antiretroviral regimens is important to clinicians. We aimed to describe virologic durability of first-line integrase strand transfer inhibitor (INSTI)-, nonnucleoside reverse transcriptase inhibitor (NNRTI)-, or protease inhibitor (PI)-based antiretroviral regimens. This was a retrospective study of antiretroviral-naïve patients that initiated first-line antiretroviral regimens with two nucleoside reverse transcriptase inhibitors and an INSTI, NNRTI, or PI between January 2006 and June 2016. The outcome was time to virologic failure, which was assessed by Kaplan-Meier survival analysis and Cox regression models. There were 780 patients (median age = 37 years [interquartile range (IQR) = 30-45], 93.3% male, 56.2% Caucasian, median HIV duration = 1.8 years [IQR = 0.4-5.4], baseline log10 viral load [VL]=4.6 [IQR = 4.1-5.1], and baseline CD4+ cell count = 320 cells/µl [IQR = 217-440]). In total, 189/780 were on a third agent INSTI, 339/780 on a third agent NNRTI, and 252/780 on a third agent PI. Kaplan-Meier survival probability revealed longer time to virologic failure for INSTI, followed by NNRTI then PI (p < 0.001). Multivariable Cox regression revealed that being on an INSTI regimen (aHR = 0.27; 95%CI = 0.18-0.41) or NNRTI regimen (aHR = 0.64; 95%CI = 0.47-0.87) versus PI regimen, frequent VL testing (per year), (aHR = 0.64; 95%CI = 0.47-0.87), and duration of ART (aHR = 0.22; 95%CI = 0.17-0.30) (years) were inversely associated with time to virologic failure, and log10 of baseline VL (aHR = 1.94; 95%CI = 1.58-2.39 per log10) increased risk. Virologic failure was delayed and virologic durability prolonged for INSTI- compared to NNRTI- and PI-based regimens, supporting current antiretroviral therapy guidelines.

Disrupting the key circadian regulator CLOCK leads to age-dependent cardiovascular disease.

The circadian mechanism underlies daily rhythms in cardiovascular physiology and rhythm disruption is a major risk factor for heart disease and worse outcomes. However, the role of circadian rhythms is generally clinically unappreciated. Clock is a core component of the circadian mechanism and here we examine the role of Clock as a vital determinant of cardiac physiology and pathophysiology in aging. ClockΔ19/Δ19 mice develop age-dependent increases in heart weight, hypertrophy, dilation, impaired contractility, and reduced myogenic responsiveness. Young ClockΔ19/Δ19 hearts express dysregulated mRNAs and miRNAs in the PTEN-AKT signal pathways important for cardiac hypertrophy. We found a rhythm in the Pten gene and PTEN protein in WT hearts; rhythmic oscillations are lost in ClockΔ19/Δ19 hearts. Changes in PTEN are associated with reduced AKT activation and changes in downstream mediators GSK-3ß, PRAS40, and S6K1. Cardiomyocyte cultures confirm that Clock regulates the AKT signalling pathways crucial for cardiac hypertrophy. In old ClockΔ19/Δ19 mice cardiac AKT, GSK3ß, S6K1 phosphorylation are increased, consistent with the development of age-dependent cardiac hypertrophy. Lastly, we show that pharmacological modulation of the circadian mechanism with the REV-ERB agonist SR9009 reduces AKT activation and heart weight in old WT mice. Furthermore, SR9009 attenuates cardiac hypertrophy in mice subjected to transverse aortic constriction (TAC), supporting that the circadian mechanism plays an important role in regulating cardiac growth. These findings demonstrate a crucial role for Clock in growth and renewal; disrupting Clock leads to age-dependent cardiomyopathy. Pharmacological targeting of the circadian mechanism provides a new opportunity for treating heart disease.

Enlaces do grafo do desejo com os discursos, a partir do Seminário 16, de Jacques Lacan / Bonds of graph of desire with the discourses, from J. Lacan's Seminar 16

A partir do Seminário 16: de um Outro ao outro, de Lacan (1968-69), este artigo apresenta uma discussão em torno do grafo do desejo numa vertente pouco explorada: na sua relação com o Eu e com um certo "questionamento fundamental", necessário em qualquer trabalho analítico. Neste momento, Lacan se debruça sobre o conceito de sujeito na sua íntima relação com o gozo. O sujeito, aqui, é apresentado essencialmente como uma função, indissociável dos conceitos de dizer e real, podendo ser localizado no S() no grafo do desejo, como seu efeito. O artigo ainda mostra relações entre o grafo e os discursos, em plena construção nesse seminário.(AU)

Stemming from Lacan's Seminar 16, From Another to the other (1968-69), this article brings a discussion about the graph of desire under a not so common perspective: in its relationship with the "I" (Je) and with a certain "fundamental questioning", required to all psychoanalytic work. At the time of the Seminar, Lacan was working on the concept of Subject within its intimate relationship with jouissance. The Subject here is presented essentially as a function, inseparable from the concepts of saying and real, which might be located at the graph of desire as its effect. In addition, the article also presents relationships between the graph and the discourses, in full construction in the Seminar.(AU)

Reflexões sobre a função desejo do analista, a partir da topologia das superfícies / Reflections over the analyst's function desire, from the topology of the surfaces

Pretendemos, com este artigo, trazer algumas reflexões sobre a função desejo do analista a partir do que podem nos ensinar as figuras topológicas apresentadas por Lacan no seu Seminário 11, Os quatro conceitos fundamentais da psicanálise. Procuraremos também marcar a contraposição entre os conceitos de transferência e desejo do analista utilizando um artigo de Pearl King, audaciosa analista inglesa da IPA, abordado por Lacan no seu seminário seguinte, Problemas Cruciais para a Psicanálise. A partir destes elementos, procuraremos também discutir a direção de tratamento proposta pela clínica lacaniana e a sua diferença com as demais terapias e análises. Os conceitos de demanda, identificação, transferência, objeto a e desejo do analista serão abordados para tal propósito.(AU)

A psicanálise pode atender os sujeitos com Asperger? - pensando a direção de tratamento no autismo a partir dos conceitos de gozo e linguagem / Can psychoanalysis work with subjects with Asperger?

Este artigo tem como objetivo apresentar a problemática dos sujeitos com Asperger. Preocupa-se em discutir se a psicanálise tem condições de tratá-los. Tomando por base textos como o de Nominé e Maleval e relatos de Donna Williams, será abordada a relação do autismo com a linguagem e com o corpo. Trabalhando a questão do Outro, tratado por Lacan, propor-se-á, então, a pensar no Outro real e na questão da direção de tratamento para esses sujeitos(AU)

This article aims to present the problems of subjects with Asperger's. Focuses on discussing whether psychoanalysis is able to treat them. Based on texts of Nominé and Maleval as well as reports from Donna Williams, will be discussed the relationship of autism with language and with the body. Working the question of the Other, treated by Lacan, it will propose, then, the thinking of real Other and the issue of the direction of the treatment for these subjects(AU)