There is extensive research on the safety, toxicology, potency, and therapeutic potential of cannabis. However, uncertainty remains facilitating continued debate on medical and recreational cannabis policies at the state and federal levels. This review will include a brief description of cannabinoids and the endocannabinoid system; a summary of the acute and long-term effects of cannabis; and a discussion of the therapeutic potential of cannabis. The conclusions about safety and efficacy will then be compared with the current social and political climate to suggest future policy directions and general guidelines.Electronic supplementary materialThe online version of this article (doi:10.1007/s13311-015-0380-8) contains supplementary material, which is available to authorized users.
Research shows that certain antihypertensives taken during midlife confer Alzheimer’s disease (AD) related benefits in later life. We conducted a clinical trial to evaluate the extent to which the angiotensin converting enzyme inhibitor (ACE-I), ramipril, affects AD biomarkers including CSF amyloid β levels (Aβ) and ACE activity, arterial function and cognition in participants with a parental history of AD.
This four month randomized, double-blind, placebo-controlled, pilot clinical trial evaluated the effects of ramipril, a blood-brain-barrier (BBB) crossing ACE-I, in cognitively healthy individuals with mild, or Stage I hypertension. Fourteen participants were stratified by gender and apolipoprotein E ε4 (APOE ε4) status and randomized to receive 5mg of ramipril or matching placebo daily. Participants were assessed at baseline and month 4 on measures of CSF Aβ1–42 and ACE activity, arterial function and cognition.
Participants were middle-aged (mean 54yrs) highly educated (mean 15.4yrs), and included 50% men and 50% APOEε4 carriers. While results did not show a treatment effect on CSF Aβ1–42 (p=0.836), data revealed that ramipril can inhibit CSF ACE activity (p=0.009) and improve blood pressure (BP), however there were no differences between groups in arterial function or cognition.
In this study, ramipril therapy inhibited CSF ACE activity and improved BP, but did not influence CSF Aβ1–42. While larger trials are needed to confirm our CSF Aβ results, it is possible that prior research reporting benefits of ACE-I during midlife may be attributed to alternative mechanisms including improvements in cerebral blood flow or the prevention of Angiotensin II-mediated inhibition of acetylcholine.
Whereas the extraordinary pressures of the COVID-19 pandemic on student mental health have received considerable attention, less attention has been placed on educator well-being. School system employees play a vital role in society, and teacher levels of well-being are associated with the educational outcomes of young people. We extend extant research on the prevalence and correlates of educator distress during the pandemic by reporting on a pragmatic randomized wait-list controlled trial (N = 662; 64% teachers) of an innovative mental health promotion strategy implemented during the pandemic; a free 4-week smartphone-based meditation app designed to train key constituents of well-being (Healthy Minds Program [HMP]). Following our preregistered analysis plan and consistent with hypotheses, assignment to the HMP predicted significantly larger reductions in psychological distress, our primary outcome, at post intervention (Cohen’s d = −.53, 95% CI [−.69, −.38], p < .001) and at the 3-month follow-up (d = −.33 [−.48, −.18], p < .001). Also consistent with hypotheses, we observed similar indications of immediate and sustained benefit following the HMP on all six preregistered secondary outcomes selected to tap skills targeted in the app (e.g., perseverative thinking, social connection, well-being; absolute ds = .19–.42, all ps < .031 corrected except mindful action at follow-up). We found no evidence for elevated adverse events, and the HMP was equally effective among participants with elevated baseline anxiety and depressive symptoms. These data suggest that the HMP may be an effective and scalable approach to supporting the mental health and well-being of teachers and other school system employees, with implications for employee retention and performance and student outcomes.
All-payer claims databases are being developed in states across the nation to fill gaps in information about the health care system. The value of such databases is becoming more apparent as these databases mature and are used more frequently to help states better understand their health care utilization and costs.
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