Effects of Light Treatment on Sleep, Cognition, Mood, and Behavior in Alzheimer’s Disease: A Systematic Review Tetrahydrocannabinol (THC) impairs encoding but not retrieval of verbal information When Should Open Reduction and Internal Fixation Ankle Fractures Begin Weight Bearing? A Systematic Review Plants with hypoglycemic activity in humans. FAAH selectively influences placebo effects Psychomotor performance in relation to acute oral administration of Δ9-tetrahydrocannabinol and standardized cannabis extract in healthy human subjects Valerian for insomnia: a systematic review of randomized clinical trials. [Optimization of calcium intake for the prevention of osteoporosis and osteoporotic fractures: a review of the evidence]. The interplay of cannabinoid and NMDA glutamate receptor systems in humans: Preliminary evidence of interactive effects of cannabidiol and ketamine in healthy human subjects Dronabinol and Marijuana in HIV-Positive Marijuana Smokers: Caloric Intake, Mood, and Sleep Implant loading protocols for the partially edentulous posterior mandible. Reinforcing and subjective effects of oral delta 9-THC and smoked marijuana in humans. Optimizing Medication Adherence in Older Patients: A Systematic Review. The identification of bias in studies of the diagnostic performance of imaging modalities. Implant loading protocols for partially edentulous maxillary posterior sites. A Systematic Review of Experimental and Clinical Acupuncture in Chemotherapy-Induced Peripheral Neuropathy Effects of haloperidol on the behavioral, subjective, cognitive, motor, and neuroendocrine effects of Δ-9-tetrahydrocannabinol in humans Indications for compression therapy in venous and lymphatic disease consensus based on experimental data and scientific evidence. Under the auspices of the IUP. Social capital and health: Does egalitarianism matter? A literature review Cannabinoids in the management of difficult to treat pain A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer Acute effects of THC on time perception in frequent and infrequent cannabis users Efficacy, tolerability and safety of cannabis‐based medicines for chronic pain management – An overview of systematic reviews Dietary macronutrients and food consumption as determinants of long-term weight change in adult populations: a systematic literature review Mindfulness-Based Interventions for Physical Conditions: A Narrative Review Evaluating Levels of Evidence The use of acupuncture in dentistry: a review of the scientific validity of published papers. An enriched-enrolment, randomized withdrawal, flexible-dose, double-blind, placebo-controlled, parallel assignment efficacy study of nabilone as adjuvant in the treatment of diabetic peripheral neuropathic pain Naltrexone does not attenuate the effects of intravenous Δ9-tetrahydrocannabinol in healthy humans. Dose-Related Modulation of Event-Related Potentials to Novel and Target Stimuli by Intravenous Δ9-THC in Humans Medical Marijuana: Is the Cart Before the Horse? A methodology for conducting retrospective chart review research in child and adolescent psychiatry.
Background : Bright light treatment is a therapeutic intervention mainly used to treat sleep and circadian disturbances in Alzheimer ’s disease ( AD ) patients . Recently , a h and ful of studies also focused on the effect on cognition and behavior . Conflicting findings are reported in the literature , and no definite conclusions have been drawn about its specific therapeutic effect . Summary : The aim of this review is to provide a critical evaluation of available evidence in this field , highlighting the specific characteristics of effective bright light treatment . Eligible studies were required to assess at least one of the following outcome measures : sleep , cognition , mood , and /or behavior ( e.g. , depression , agitation ) . A total of 32 articles were included in this systematic review and identified as research intervention studies about light treatment in AD . The quality of the papers was evaluated based on the US Preventive Service Task Force guidelines . Key Messages : Overall , the current literature suggests that the effects of light treatment  in AD patients are mixed and may be influenced by several factors , but with a general trend toward a positive effect . Bright light seems to be a promising intervention treatment without significant adverse effects ; therefore , further well- design ed r and omized controlled trials are needed taking into account the highlighted recommendations INTRODUCTION Cannabis and agonists of the brain cannabinoid receptor ( CB1R ) produce acute  memory impairments in humans . However , the extent to which cannabinoids impair the component processes of encoding and retrieval has not been established in humans . The objective of this analysis was to determine whether the administration of Δ9-Tetrahydrocannabinol ( THC ) , the principal psychoactive constituent of cannabis , impairs encoding and /or retrieval of verbal information . MATERIAL S AND METHODS Healthy subjects were recruited from the community . Subjects were administered the Rey-Auditory Verbal Learning Test ( RAVLT ) either before administration of THC ( experiment # 1 ) ( n=38 ) or while under the influence of THC ( experiment # 2 ) ( n=57 ) . Immediate and delayed recall on the RAVLT was compared . Subjects received intravenous THC , in a placebo-controlled , double-blind , r and omized manner at doses known to produce behavioral and subjective effects consistent with cannabis intoxication . RESULTS Total immediate recall , short delayed recall , and long delayed recall were reduced in a statistically significant manner only when the RAVLT was administered to subjects while they were under the influence of THC ( experiment # 2 ) and not when the RAVLT was administered prior . CONCLUSIONS THC acutely interferes with encoding of verbal memory without interfering with retrieval . These data suggest that learning information prior to the use of cannabis or cannabinoids is not likely to disrupt recall of that information . Future studies will be necessary to determine whether THC impairs encoding of non-verbal information , to what extent THC impairs memory consolidation , and the role of other cannabinoids in the memory-impairing effects of cannabis . CLINICAL TRIAL INFORMATION Cannabinoids , Neural Synchrony , and Information Processing ( THC-Gamma ) http:// clinical trials.gov/ct2/show/ study /NCT00708994 NCT00708994 Pharmacogenetics of Cannabinoid Response http:// clinical trials.gov/ct2/show/NCT00678730 NCT00678730 The objective of this paper was to review the literature to assess when  open reduction and internal fixation ankle fractures should commence weight bearing for the best outcome . An electronic search was undertaken of the data bases AMED , Cinahl , Embase , Medline ( via Ovid ) , Pedro and Pubmed , from their inception to November 2005 . References lists were scrutinised and a h and search was also performed . We included all English language , human subject , controlled clinical trials , comparing the effects of early against later weight bearing following  open reduction and internal fixation of ankle fractures . Two review ers independently assessed the method ological quality of the literature using the PEDro ( Physiotherapy Evidence Data base ) scoring system . Five papers comprising of 366 ankle fractures were review ed . Overall , there was no significant difference between commencing early , compared to later weight bearing in subjects following open reduction and internal fixation , when evaluated against function , pain , range of movement , radiological assessment , complications , and return to work . The evidence review ed was generally poor , with numerous method ological design limitations . The literature suggested that were was little difference between encouraging early or delayed weight bearing after open reduction and internal fixation of ankle fractures . Neither early nor later weight bearing significantly improves or jeopardises outcomes . However , due to the plethora of method ological limitations and limited evidence , it is not possible to reference this conclusion with conviction . Further large , well- design ed r and omized controlled trials are required to evaluate this area More than 400 plants with suspected glucose-lowering potential are known . In most cases , the evidence for this action is based purely on animal experiments or traditional use . This , however , provides only limited information about its clinical usefullness . Therefore this paper review s direct evidence from clinical trials . A systematic literature search identified 22 such papers . The majority reported positive effects . However , much of the data are of poor method ological quality . Only five r and omised controlled trials were found , and even these do not convincingly demonstrate the usefulness of the remedies in question . It is concluded that the use of hypoglycemic plant remedies is not supported by results from rigorous clinical trials and requires further investigation Endogenous opioid and cannabinoid systems are thought to act synergistically regulating antinociceptive and reward mechanisms . To further underst and the human implication s of the interaction between these two systems , we investigated the role of the common , functional missense variant Pro129Thr of the gene coding fatty acid amide hydrolase ( FAAH ) , the major degrading enzyme of endocannabinoids , on psychophysical and neurotransmitter ( dopaminergic , opioid ) responses to pain and placebo-induced analgesia in humans . FAAH Pro129/Pro129 homozygotes , who constitute nearly half of the population , reported higher placebo analgesia and more positive affective states immediately and 24 h after placebo administration ; no effects on pain report in the absence of placebo were observed . Pro129/Pro129 homozygotes also showed greater placebo-induced μ-opioid , but not D2/3 dopaminergic , enhancements in neurotransmission in regions known involved in placebo effects . These results show that a common genetic variation affecting the function of the cannabinoid system is serving as a probe to demonstrate the involvement of cannabinoid and opioid transmitters on the formation of placebo effects Abnormalities in psychomotor performance are a consistent finding in schizophrenic patients as well as in chronic cannabis users . The high levels of central cannabinoid ( CB1 ) receptors in the basal ganglia , the cerebral cortex and the cerebellum indicate their implication in the regulation of motor activity . Based on the close relationship between cannabis use , the endogenous cannabinoid system and motor disturbances found in schizophrenia , we expected that administration of cannabinoids may change pattern of psychomotor activity like in schizophrenic patients . This prospect i ve , double-blind , placebo-controlled cross-over study investigated the acute effects of cannabinoids on psychomotor performance in 24 healthy right-h and ed volunteers ( age 27.9 ± 2.9 years , 12 male ) by comparing Δ9-tetrahydrocannabinol ( Δ9-THC ) and st and ardized cannabis extract containing Δ9-THC and cannabidiol .  Psychomotor performance was assessed by using a finger tapping test series . Cannabis extract , but not Δ9-THC , revealed a significant reduction of right-h and tapping frequencies that was also found in schizophrenia . As to the pure Δ9-THC condition , left-h and tapping frequencies were correlated with the plasma concentrations of the Δ9-THC metabolite 11-OH-THC . These effects are thought to be related to cannabinoid actions on CB1 receptors in the basal ganglia , the cerebral cortex and the cerebellum . Our data further demonstrate that acute CB1 receptor activation under the cannabis extract condition may also affect intermanual coordination ( IMC ) as an index of interhemispheric transfer . AIR-Scale scores as a measure of subjective perception of intoxication were dose-dependently related to IMC which was shown by an inverted U-curve . This result may be due to functional changes involving GABAergic and glutamatergic neurotransmission within the corpus callosum Objective : To systematic ally review the evidence for the effects of the herb valerian ( Valeriana officinalis ) on  insomnia  , based on r and omized , placebo-controlled , double-blind trials . Background : Valerian has long been advocated and used for promoting sleep but until quite recently evidence was solely anecdotal . However , during the last two decades a number of clinical trials have been conducted . Material s and methods : Systematic literature search es were performed to locate r and omized , placebo-controlled , double-blind trials measuring the effect of  valerian monopreparations on sleep in human participants . Data were extracted in a st and ardized manner and method ological quality was assessed by the Jadad score . Results : Nine trials were located meeting the selection criteria . The findings of the studies were contradictory and there was great inconsistency between trials in terms of patients , experimental design and procedures and method ological quality . Conclusion : The evidence for valerian as a treatment for  insomnia  is inconclusive . There is a need for rigorous trials to determine its efficacy One of the main focuses of lifestyle modification for the prevention of osteoporosis and osteoporotic fractures  in Japan is improvement in dietary calcium intake . However , virtually no r and omized controlled trial to assess the preventive effects of administration of calcium on the risk of fractures has been conducted in Japan . In this study , we review ed all the scientific papers currently available from medical literature data bases to propose evidence -based recommendations on the preventive procedures for osteoporosis . The result of the present systematic review gives the evidence showing that calcium supplementation or optimal dietary calcium intake increases bone density in childhood and adolescence and reduces the risk of fracture due to osteoporosis in the elderly people regardless of the gender . The evidence also supports the current health policy guiding the elderly to increase their dietary calcium intake in daily life BACKGROUND Interactions between glutamatergic and endocannabinoid systems may contribute to schizophrenia , dissociative states , and other psychiatric conditions . Cannabidiol ( CBD ) , a cannabinoid-1/2 ( CB1/2 ) receptor weak partial agonist or antagonist , may play a role in the treatment of schizophrenia . OBJECTIVE This study tested the hypothesis that CBD would attenuate the behavioral effects of the NMDA receptor antagonist , ketamine , in healthy human subjects . METHODS Ten male healthy volunteers were evaluated twice in a r and omized order . In both sessions they received ketamine ( bolus of 0.26 mg/kg/1 min followed by IV infusion of 0.25mg/kg over 30 min ) preceded by either CBD ( 600 mg ) or placebo . Psychopathology was assessed using the Brief Psychiatric Rating Scale ( BPRS ) and the CADSS ( Clinician Administered Dissociative States Scale ) at regular intervals from 30 min before to 90 min after ketamine administration . RESULTS CBD significantly augmented the activating effects of ketamine , as measured by the activation subscales of the BPRS . However , CBD also showed a non-significant trend to reduce ketamine-induced depersonalization , as measured by the CADSS . CONCLUSION These data describe a complex pattern of psychopharmacologic interactions between CBD and ketamine at the doses of each agent studied in this experiment Objectives : Individuals with HIV constitute the largest group using cannabinoids for medicinal reasons ; yet , no studies have directly compared the tolerability and efficacy of smoked marijuana and oral dronabinol maintenance in HIV-positive marijuana smokers . This placebo-controlled within-subjects study evaluated marijuana and dronabinol across a range of behaviors : eating topography , mood , cognitive performance , physiologic measures , and sleep . Methods : HIV-positive marijuana smokers ( n = 10 ) completed 2 16-day inpatient phases . Each dronabinol ( 5 and 10 mg ) and marijuana ( 2.0 % and 3.9 % Δ9-tetrahydrocannabinol [ THC ] ) dose was administered 4 times daily for 4 days , but only 1 drug was active per day , thereby maintaining double-blind dosing . Four days of placebo washout separated each active cannabinoid condition . Results : As compared with placebo , marijuana and dronabinol dose dependently increased daily caloric intake and body weight in HIV-positive marijuana smokers . All cannabinoid conditions produced significant intoxication , except for low-dose dronabinol ( 5 mg ) ; the intoxication was rated positively ( eg , “ good drug effect ” ) with little evidence of discomfort and no impairment of cognitive performance . Effects of marijuana and dronabinol were comparable , except that only marijuana ( 3.9 % THC ) improved ratings of sleep . Conclusions : These data suggest that for HIV-positive marijuana smokers , both dronabinol ( at doses 8 times current recommendations ) and marijuana were well tolerated and produced substantial and comparable increases in food intake PURPOSE To evaluate the predictability of early and immediate loading protocol s of  implants in the posterior m and ible and to investigate whether there is a difference in success rates , survival rates , and peri-implant parameters , including marginal bone level changes , between loading protocol s. MATERIAL S AND METHODS A comprehensive systematic review of the literature was conducted . The selection of publications reporting on human clinical studies was based on predetermined inclusion criteria and was agreed upon by two review ers . RESULTS A total of 19 papers were selected : 8 on early loading , 9 addressing immediate loading , and 2 comparing immediate and early loading . Of the 19 studies , 5 were r and omized clinical trials and 14 were prospect i ve studies . CONCLUSIONS Existing literature supports the early loading of  microroughened dental implants in the partially edentulous posterior m and ible at 6 to 8 weeks in the absence of modifying factors . Therefore , loading within this time frame can be considered routine for the majority of clinical situations in the posterior m and ible , either with single crowns or fixed dental prostheses . Immediate loading of microroughened dental implants in the partially edentulous posterior m and ible proved to be a viable treatment alternative . Caution is necessary when interpreting published outcomes for immediate loading , as the inclusion exclusion criteria are inconsistent and many subjective confounding factors are evident . Additional studies with longer follow-ups , specifically r and omized clinical trials , are needed to consoli date the data for immediate loading . Priority should be given to trials testing immediate loading The reinforcing and subjective effects of oral delta-9-tetrahydrocannabinol ( THC ) and smoked marijuana were studied in two groups of regular marijuana users . One group ( N = 10 ) was tested with smoked marijuana and the other ( N = 11 ) with oral THC .  Reinforcing effects were measured with a discrete-trial choice procedure which allowed subjects to choose between the self-administration of active drug or placebo on two independent occasions . Subjective effects and heart rate were measured before and after drug administration . Smoked active marijuana was chosen over placebo on both choice occasions by all subjects . Similarly , oral THC was chosen over placebo on both occasions by all but one subject . Both active drug treatments produced qualitatively and quantitatively similar subjective effects , and both significantly increased heart rate , although the time course of effects differed substantially between the two treatments . The results demonstrate that both smoked marijuana and oral THC can serve as positive reinforcers in human subjects under laboratory conditions . The experimental paradigm used here should prove useful for identifying factors that influence the self-administration of marijuana and other cannabinoids by humans OBJECTIVE : To review the literature on strategies to optimize medication adherence in community-dwelling older adults and to make recommendations for clinical practice . METHODS : A systematic literature search was conducted using the MEDLINE , CINAHL , PsycINFO , International Pharmaceutical Abstract s , and EMBASE data bases for r and omized controlled trials examining strategies to optimize medication adherence in patients aged 65 or older prescribed long-term medication regimens . Additional studies were found by examining the reference lists of systematic review s and selected papers . 34 papers reporting on 33 studies met the eligibility criteria and were included in this review . RESULTS : Improvement in adherence was mixed across the studies examining educational interventions , with only 12 of the 28 studies showing improvement in adherence ; most were delivered by pharmacists . Effect sizes for the statistically significant educational interventions ranged from Cohen 's d = 0.14 to 4.93 . Four of the 5 interventions using memory aids and cues , some in conjunction with newer technologies , improved adherence . Effect sizes for the statistically significant interventions using memory aids and cues ranged from Cohen 's d = 0.26 to 2.72 . CONCLUSION : The evidence from this review does not clearly support one single intervention to optimize medication adherence in older patients . Future studies should explore suggestive strategies , such as tailored interventions involving ongoing contact , and should endeavor to correct method ologic weaknesses found in the literature The dem and for evidence -based healthcare is increasing nationally and internationally and it is equally necessary in both diagnostic and therapeutic practice . Evidence may be collected and combined by means of a systematic literature review of published and unpublished data on a well-defined topic . The output of such review s is then available to guide health policy , influence good practice or direct research . Published guidelines are available on the performance of systematic review s , especially those of r and omized controlled trials . Although there is an extensive literature base of research data in diagnostic imaging there are few such trials , but it is still possible to perform systematic review s. With the alternative study design s encountered it is important to be aware of the main threats to study validity . In this paper the biases likely to be encountered in studies of diagnostic performance are review ed , with particular reference to diagnostic imaging tests . The biases are sub-divided into three categories . The first category is patient selection and covers the validity of generalizing results beyond the study population . The other two , concerning study design and execution and the interpretation of results , affect the likely validity of the results of a study . An underst and ing of these factors is an essential prerequisite for those undertaking or using a systematic literature review in the field of diagnostic imaging . The definitions form the foundations of a defensible review protocol PURPOSE To evaluate early and immediate loading of implants in the posterior maxilla and to investigate whether there is a difference in success rates , survival rates , and peri-implant parameters , including marginal bone level changes . MATERIAL S AND METHODS A comprehensive systematic review of the literature was conducted . The selection of publications reporting on human clinical studies was based on predetermined inclusion criteria and was agreed upon by two review ers . RESULTS Twelve papers were identified on early loading ( two r and omized controlled clinical trials [ RCTs ] and 10 prospect i ve case series studies ) . Six papers were found on immediate loading ( one RCT , four prospect i ve case series , and one retrospective study ) . CONCLUSIONS Under certain circumstances it is possible to successfully load dental implants in the posterior maxilla early or immediately after their placement in selected patients . The success rate appears to be technique sensitive , although no study has directly assessed this . A high degree of primary implant stability ( high value of insertion torque ) and implant surface characteristics play an important role . It is not possible to draw evidence -based conclusions concerning contraindications , threshold values for implant stability , bone quality and quantity needed , or impact of occlusal loading forces . As for the impact of the surgical technique on implant outcome in different bone densities , no studies prove significant superior results with one technique over another . Well- design ed RCTs with a large number of patients are necessary to make early/immediate loading protocol s in posterior maxilla evidence based , but ethical and practical considerations may limit the real possibility of such studies in the near future Chemotherapy-induced peripheral neuropathy ( CIPN ) is a common side effect that can be very disabling and can limit or delay the dose of chemotherapy that can be administered . Acupuncture may be effective for treating peripheral neuropathy . The aim of this study was to review the available literature on the use of acupuncture for CIPN . The systematic literature search was performed using MEDLINE , Google Scholar , Cochrane Data base , CINHAL , and ISI Proceedings . H and search ing was conducted , and consensus was reached on all extracted data . Only papers in the English language were included , irrespective of study design . From 3989 retrieved papers , 8 relevant papers were identified . One was an experimental study which showed that  electroacupuncture suppressed CIPN pain in rats . In addition , there were 7 very heterogeneous clinical studies , 1 controlled r and omised study using auricular acupuncture , 2 r and omized controlled studies using somatic acupuncture , and 3 case series/case reports which suggested a positive effect of acupuncture  in CIPN . Conclusions . Only one controlled r and omised study demonstrated that acupuncture may be beneficial for CIPN . All the clinical studies review ed had important method ological limitations . Further studies with robust methodology are needed to demonstrate the role of acupuncture for treating CIPN result ing from cancer treatment Introduction Cannabinoids produce a spectrum of effects in humans including euphoria , cognitive impairments , psychotomimetic effects , and perceptual alterations . The extent to which dopaminergic systems contribute to the effects of Δ-9-tetrahydrocannabinol ( Δ-9-THC ) remains unclear . This study evaluated whether pretreatment with a dopamine receptor antagonist altered the effects of Δ-9-THC in humans . Material s and methods In a 2-test-day double-blind study , 28 subjects including healthy subjects ( n = 17 ) and frequent users of cannabis ( n = 11 ) were administered active ( 0.057 mg/kg ) or placebo oral haloperidol in r and om order followed 90 and 215 min later by fixed order intravenous administration of placebo ( vehicle ) and active ( 0.0286 mg/kg ) Δ-9-THC , respectively . Results Consistent with previous reports , intravenous Δ-9-THC produced psychotomimetic effects , perceptual alterations , and subjective effects including “ high . ” Δ-9-THC also impaired verbal recall and attention .  Haloperidol pretreatment did not reduce any of the behavioral effects of Δ-9-THC . Haloperidol worsened the immediate free and delayed free and cued recall deficits produced by Δ-9-THC . Haloperidol and Δ-9-THC worsened distractibility and vigilance . Neither drug impaired performance on a motor screening task , the Stockings of Cambridge task , or the delayed match to sample task . Frequent users had lower baseline plasma prolactin levels and blunted Δ-9-THC induced memory impairments . Conclusions The deleterious effects of haloperidol pretreatment on the cognitive effects of Δ-9-THC are consistent with the pre clinical literature in suggesting crosstalk between DAergic and CBergic systems . However , it is unlikely that DA D2 receptor mechanisms play a major role in mediating the psychotomimetic and perceptual altering effects of Δ-9-THC . Further investigation is warranted to underst and the basis of the psychotomimetic effects of Δ-9-THC and to better underst and the crosstalk between DAergic and CBergic systems AIM The aim of this study was to review published literature concerning the use of compression treatments in the management of venous and lymphatic diseases and establish where reliable evidence exists to justify the use of medical compression and where further research is required to address areas of uncertainty . METHODS The authors search ed medical literature data bases and review ed their own collection s of papers , monographs and books for papers providing information about the effects of compression and r and omized clinical trials of compression devices . Papers were classified in accordance with the recommendations of the GRADE group to categorize their scientific reliability . Further classification was made according to the particular clinical problem that was addressed in the papers . The review included papers on compression stockings , b and ages and intermittent pneumatic compression devices . RESULTS The International Compression Club met once in Vienna and corresponded by email in order to reach an agreement of how the data should be interpreted . A wide range of compression levels was reported to be effective . Low levels of compression 10 - 30 mmHg applied by stockings are effective in the management of telangiectases after sclerotherapy , varicose veins in pregnancy , the prevention of edema and deep vein thrombosis ( DVT ) . High levels of compression produced by b and aging and strong compression stockings ( 30 - 40 mmHg ) are effective at healing leg ulcers and preventing progression of post-thrombotic syndrome as well as in the management of lymphedema . In some areas no reliable evidence was available to permit recommendations of level of compression or duration of treatment . These included : management of varicose veins to prevent progression , following surgical treatment or sclerotherapy for varicose veins , and the level of compression required to treat acute DVT . CONCLUSION This review shows that whilst good evidence for the use of compression is available in some clinical indications , there is much still to be discovered . Little is know about dosimetry in compression , for how long and at what level compression should be applied . The differing effects of elastic and short-stretch compression are also little understood The aim of the paper is to critically review the notion of  social capital  and review empirical literature on the association between social capital and health across countries . The methodology used for the review includes a systematic search on electronic data bases for peer- review ed published literature . We categorize studies according to level of analysis ( single and multilevel ) and examine whether studies reveal a significant health impact of individual and area level social capital . We compare the study conclusions according to the country 's degrees of economic egalitarianism . Regardless of study design , our findings indicate that a positive association ( fixed effect ) exists between social capital and better health irrespective of countries degree of egalitarianism . However , we find that the between-area variance ( r and om effect ) in health tends to be lower in more egalitarian countries than in less egalitarian countries . Our tentative conclusion is that an association between social capital and health at the individual level is robust with respect to the degree of egalitarianism within a country . Area level or context ual social capital may be less salient in egalitarian countries in explaining health differences across places This article review s recent research on cannabinoid analgesia via the endocannabinoid system and non-receptor mechanisms , as well as r and omized clinical trials employing cannabinoids in pain treatment .  Tetrahydrocannabinol ( THC , Marinol ® ) and nabilone ( Cesamet ® ) are currently approved in the United States and other countries , but not for pain indications . Other synthetic cannabinoids , such as ajulemic acid , are in development . Crude herbal cannabis remains illegal in most jurisdictions but is also under investigation . Sativex ® , a cannabis derived oromucosal spray containing equal proportions of THC ( partial CB1 receptor agonist ) and cannabidiol ( CBD , a non-euphoriant , anti-inflammatory analgesic with CB1 receptor antagonist and endocannabinoid modulating effects ) was approved in Canada in 2005 for treatment of central neuropathic pain in multiple sclerosis , and in 2007 for intractable cancer pain . Numerous r and omized clinical trials have demonstrated safety and efficacy for Sativex in central and peripheral neuropathic pain , rheumatoid arthritis and cancer pain . An Investigational New Drug application to conduct advanced clinical trials for cancer pain was approved by the US FDA in January 2006 . Cannabinoid analgesics have generally been well tolerated in clinical trials with acceptable adverse event profiles . Their adjunctive addition to the pharmacological armamentarium for treatment of pain shows great promise Purpose This study aims to provide recommendations on the optimal strategies and interventions for the prevention , screening , assessment , and management of  cancer-related sleep disturbance ( insomnia and insomnia syndrome ) in adult cancer population s. Methods A systematic search of the published health literature was conducted to identify r and omized controlled trials , clinical practice guidelines , systematic review s , and other guidance documents . The Sleep Disturbance Expert Panel [ comprised of nurses , psychologists , primary care physicians , oncologists , physicians specialized in sleep disturbances , research ers , and guideline method ologists ] review ed , discussed , and approved the final version of the guideline . Health care professionals across Canada were asked to provide feedback through an external review process . Results Three clinical practice guidelines and 12 r and omized controlled trials were identified as the evidence base . Overall , despite the paucity of evidence , the evidence and expert consensus suggest that it is important to screen and assess adult cancer patients for sleep disturbances using st and ardized screening tools on a routine basis . While prevention of sleep disturbance is the desired objective , cognitive behavioral therapies are effective in improving sleep outcomes . As part of the external review with 16 health care providers , 81 % indicated that they agreed with the recommendations as written . Conclusions Sleep difficulty is a prevalent problem in cancer population s that needs greater recognition by health professionals . Prevention , screening , assessment , and treatment strategies supported by the best available evidence are critical . Recommendations and care path algorithms for practice are offered Rationale Cannabinoids have been shown to alter time perception , but existing literature has several limitations . Few studies have included both time estimation and production tasks , few control for subvocal counting , most had small sample sizes , some did not record subjects ’ cannabis use , many tested only one dose , and used either oral or inhaled administration of Δ9-tetrahydrocannabinol ( THC ) , leading to variable pharmacokinetics , and some used whole-plant cannabis containing cannabinoids other than THC . Our study attempted to address these limitations . Objectives This study aims to characterize the acute effects of THC and frequent cannabis use on seconds-range time perception . THC was hypothesized to produce transient , dose-related time overestimation and underproduction . Frequent cannabis smokers were hypothesized to show blunted responses to these alterations . Methods IV THC was administered at doses from 0.015 to 0.05 mg/kg to 44 subjects who participated in several double-blind , r and omized , counterbalanced , crossover , placebo-controlled studies . Visual time estimation and production tasks in the seconds range were presented to subjects three times on each test day . Results All doses induced time overestimation and underproduction . Chronic cannabis use had no effect on baseline time perception . While infrequent/nonsmokers showed temporal overestimation at medium and high doses and temporal underproduction at all doses , frequent cannabis users showed no differences . THC effects on time perception were not dose related . Conclusions A psychoactive dose of THC increases internal clock speed as indicated by time overestimation and underproduction . This effect is not dose related and is blunted in chronic cannabis smokers who did not otherwise have altered baseline time perception Medicinal cannabis has already entered mainstream medicine in some countries . This systematic review ( SR ) aim ed at evaluating the efficacy , acceptability and safety of cannabis-based medicines for chronic pain management . Qualitative systematic review of SRs of r and omized controlled trials with cannabis-based medicines for chronic pain management . The Cochrane data bases of SRs , Data base of Abstract s of Review s of Effects and PubMed were search ed for SR published in the period January 2009 to January 2017 . Assessment of the method ological quality of SR was performed by the AMSTAR checklist . Out of 748 papers identified , 10 SRs met the inclusion criteria . The method ological quality was high in four and moderate in six SRs . There were inconsistent findings of four SRs on the efficacy of cannabis-based medicines in neuropathic pain and of one SR for painful spasms in multiple sclerosis . There were consistent results that there was insufficient evidence of any cannabis-based medicine for pain management in patients with rheumatic diseases ( three SRs ) and in cancer pain ( two SRs ) . Cannabis-based medicines undoubtedly enrich the possibilities of drug treatment of chronic pain conditions . It remains the responsibility of the health care community to continue to pursue rigorous study of cannabis-based medicines to provide evidence that meets the st and ard of 21st century clinical care . SIGNIFICANCE We provide an overview of systematic review s on the efficacy , tolerability and safety of cannabis-based medicines for chronic pain management . There are inconsistent findings of the efficacy of cannabinoids in neuropathic pain and painful spasms in multiple sclerosis . There are inconsistent results on tolerability and safety of cannabis-based medicines for any chronic pain This systematic literature review examined the role of dietary macronutrient composition , food consumption and dietary patterns in predicting  weight or waist circumference ( WC ) change , with and without prior weight reduction . The literature search covered year 2000 and onwards . Prospect i ve cohort studies , case – control studies and interventions were included . The studies had adult ( 18–70 y ) , mostly Caucasian participants . Out of a total of 1,517 abstract s , 119 full papers were identified as potentially relevant . After a careful scrutiny , 50 papers were quality grade d as A ( highest ) , B or C. Forty-three papers with grading A or B were included in evidence grading , which was done separately for all exposure- outcome combinations . The grade of evidence was classified as convincing , probable , suggestive or no conclusion . We found probable evidence for high intake of dietary fibre and nuts predicting less weight gain , and for high intake of meat in predicting more weight gain . Suggestive evidence was found for a protective role against increasing weight from whole grains , cereal fibre , high-fat dairy products and high scores in an index describing a prudent dietary pattern . Likewise , there was suggestive evidence for both fibre and fruit intake in protection against larger increases in WC . Also suggestive evidence was found for high intake of refined grains , and sweets and desserts in predicting more weight gain , and for refined ( white ) bread and high energy density in predicting larger increases in WC . The results suggested that the proportion of macronutrients in the diet was not important in predicting changes in weight or WC . In contrast , plenty of fibre-rich foods and dairy products , and less refined grains , meat and sugar-rich foods and drinks were associated with less weight gain in prospect i ve cohort studies . The results on the role of  dietary macronutrient composition  in prevention of weight regain ( after prior weight loss ) were inconclusive Research on mindfulness-based interventions ( MBIs ) for treating symptoms of a wide range of medical conditions has proliferated in recent decades . Mindfulness is the cultivation of nonjudgmental awareness in the present moment . It is both a practice and a way of being in the world . Mindfulness is purpose fully cultivated in a range of structured interventions , the most popular of which is mindfulness-based stress reduction ( MBSR ) , followed by mindfulness-based cognitive therapy ( MBCT ) . This paper begins with a discussion of the phenomenological experience of coping with a chronic and potentially life-threatening illness , followed by a theoretical discussion of the application of mindfulness in these situations . The literature evaluating MBIs within medical conditions is then comprehensively review ed , applying a levels of evidence rating framework within each major condition . The bulk of the research looked at diagnoses of cancer , pain conditions ( chronic pain , low back pain , fibromyalgia , and rheumatoid arthritis ) , cardiovascular disease , diabetes , human immunodeficiency virus (HIV)/acquired immune deficiency syndrome ( AIDS ) , and irritable bowel syndrome . Most outcomes assessed are psychological in nature and show substantial benefit , although some physical and disease-related parameters have also been evaluated . The field would benefit from more adequately powered r and omized controlled trials utilizing active comparison groups and assessing the moderating role of patient characteristics and program “ dose ” in determining outcomes OBJECTIVE To review the scientific validity of published papers on the efficacy of acupuncture in dentistry based on predefined method ological criteria . MATERIAL S A literature search performed by the Royal Society of Medicine and the University Library , Copenhagen , Denmark was able to identify 74 papers written in English , German , Danish , Swedish , Norwegian , Italian , French and Russian published between 1966 and 1996 . The search words were : acupuncture and electro-acupuncture , r and omised controlled trials ( RCT ) , dental pain , postoperative dental pain , painrelieving in dentistry , and dental analgesia . Among the 74 listed papers , 48 papers were review ed in the following language s : English , Danish , Swedish , Norwegian and German . Fifteen papers were excluded because they were written in French , Italian or Russian ; 11 papers were excluded because the abstract clearly indicated the paper was not a RCT or the paper was of a general nature without relevance to acupuncture . METHODS To assess the method ological quality of the included papers , all papers were scored on the basis of predefined criteria . A total of 92 points could be achieved and on the basis of this scale papers were rated as : Excellent ( 85 - 100 % ) , Good ( 70 - 84 % ) , Fair ( 60 - 69 % ) and Bad ( < 60 % ) . MAIN OUTCOME Fifteen out of 48 papers met the inclusion criteria . RESULTS Only one study met the criteria with more than 85 % . Five studies met the criteria with 70 - 84 % . Three studies met the criteria with 60 - 69 % . Six studies did not meet the criteria . Acupuncture in 11 out of 15 studies proved effective in the treatment of  temperom and ibular dysfunction ( TMD )  and as analgesia . Four studies showed no effect of acupuncture . CONCLUSION The value of acupuncture as an analgesic must be question ed . The effect of acupuncture in treating TMD and facial pain seems real and acupuncture could be a valuable alternative to orthodox treatment TOC summary This enriched‐enrollment , r and omized , double‐blind , placebo‐controlled , flexible‐dose adjuvant study demonstrated that nabilone provided improvements in pain , anxiety , quality of life and patient satisfaction for patients with diabetic neuropathic pain . ABSTRACT Cannabinoids are emerging as potential options for neuropathic pain treatment . This study evaluated an oral cannabinoid , nabilone , in the treatment of refractory human diabetic peripheral neuropathic pain ( DPN ) . We performed a single‐center , r and omized , double‐blind , placebo‐controlled , flexible‐dose study with an enriched enrolment r and omized withdrawal design . DPN subjects with a pain score ⩾4 ( 0‐10 scale ) continued regular pain medications and were administered single‐blinded adjuvant nabilone for 4 weeks . Subjects achieving ⩾30 % pain relief ( 26/37 ) were then r and omized and treated with either flexible‐dose nabilone 1‐4 mg/day ( n = 13 ) or placebo ( n = 13 ) in a further 5‐week double‐blind treatment period , with 30 % ( 11/37 ) of subjects deemed run‐in‐phase nabilone nonresponders . For nabilone run‐in‐phase responders , there was an improvement in the change in mean end‐point neuropathic pain  vs placebo ( mean treatment reduction of 1.27 ; 95 % confidence interval 2.29‐0.25 , P = 0.02 ) , with an average nabilone dose at end point of 2.9 ± 1.1 mg/day , and improvements from baseline for the anxiety subscale of the Hospital Anxiety and Depression Scale , the Medical Outcomes Study sleep scale problems index , and the European Quality of Life‐5‐Domains index score ( each P < 0.05 ) . Nabilone run‐in‐phase responders reported greater global end‐point improvement with nabilone than with placebo ( 100 % vs 31 % ; P < 0.05 ) . Medication‐related confusion led to discontinuation in 2/37 subjects during single‐blind nabilone treatment . Potential unmasking occurred in 62 % of both groups . Flexible‐dose nabilone 1‐4 mg/day was effective in relieving DPN symptoms , improving disturbed sleep , quality of life , and overall patient status . Nabilone was well tolerated and successful as adjuvant in patients with DPN Although a wealth of pre clinical evidence indicates an interplay between the μ-opioid ( MOR ) and cannabinoid 1 receptor ( CB1R ) systems , the precise nature of the cross modulation in humans is unclear . The objective of this study was to evaluate the effects of pretreatment with the MOR antagonist , naltrexone , on the subjective , behavioural and cognitive effects of the CB1R agonist , Δ9-tetrahydrocannabinol ( THC ) , in healthy human subjects . Healthy human subjects , screened carefully for any medical or psychiatric illness , were administered either placebo or active naltrexone ( 25 mg ) orally on each test day , followed 45 min later by placebo and 165 min later by active i.v . THC ( 0.025 mg/kg ) in a r and omized , fixed-order , double-blind manner . Subjective , behavioural and cognitive effects were assessed before and at several points after each drug administration . THC produced expected effects , including euphoria , anxiety , transient perceptual alterations , transient psychotomimetic effects and cognitive impairments .  However , naltrexone did not produce any effects alone , nor did it attenuate any of THC 's effects . Thus , in healthy human subjects who use cannabis intermittently , MOR antagonism does not modulate the common acute subjective , behavioural and cognitive effects of THC Cannabinoids induce a host of perceptual alterations and cognitive deficits in humans . However , the neural correlates of these deficits have remained elusive . The current study examined the acute , dose-related effects of delta-9-tetrahydrocannabinol ( Δ9-THC ) on psychophysiological indices of information processing in humans . Healthy subjects ( n=26 ) completed three test days during which they received intravenous Δ9-THC ( placebo , 0.015 and 0.03 mg/kg ) in a within-subject , double-blind , r and omized , cross-over , and counterbalanced design . Psychophysiological data ( electroencephalography ) were collected before and after drug administration while subjects engaged in an event-related potential ( ERP ) task known to be a valid index of attention and cognition ( a three-stimulus auditory ‘ oddball ’ P300 task ) . Δ9-THC dose-dependently reduced the amplitude of both the target P300b and the novelty P300a . Δ9-THC did not have any effect on the latency of either the P300a or P300b , or on early sensory-evoked ERP components preceding the P300 ( the N100 ) . Concomitantly , Δ9-THC induced psychotomimetic effects , perceptual alterations , and subjective ‘ high ’ in a dose-dependent manner . Δ9-THC -induced reductions in P3b amplitude correlated with Δ9-THC-induced perceptual alterations . Lastly , exploratory analyses examining cannabis use status showed that whereas recent cannabis users had blunted behavioral effects to Δ9-THC , there were no dose-related effects of Δ9-THC on P300a/b amplitude between cannabis-free and recent cannabis users . Overall , these data suggest that at doses that produce behavioral and subjective effects consistent with the known properties of cannabis , Δ9-THC reduced P300a and P300b amplitudes without altering the latency of these ERPs . Cannabinoid agonists may therefore disrupt cortical processes responsible for context updating and the automatic orientation of attention , while leaving processing speed and earlier sensory ERP components intact . Collectively , the findings suggest that CB1R systems modulate top-down and bottom-up processing There is apressingneed todevelopnewmedications formany debilitating conditions . Novel approaches based onmarijuana or its constituent cannabinoids , if proven , could be added to the armamentarium of available treatments . In this issue of JAMA , review s byWhiting et al1 and Hill2 provide detailed assessment of thepharmacology , indications , benefits , adverseeffects , and laws related tomedicalmarijuana and thecannabinoids , and the results and conclusions are consistent . There is some evidence to support the use of marijuana for nausea and vomiting related tochemotherapy , specificpain syndromes , and spasticity from multiple sclerosis . However , for most other indications that qualifyby state lawforuseofmedicalmarijuana , suchashepatitis C , Crohn disease , Parkinson disease , or Tourette syndrome , the evidence supporting its use is of poor quality . State laws vary widely regarding conditions for which marijuana is approved and thedispensable legal limit . Both review sraise important issues worthy of further discussion . First , for most qualifying conditions , approval has relied on low- quality scientific evidence , anecdotal reports , individual testimonials , legislative initiatives , and public opinion . Imagine if other drugs were approved through a similar approach . The US Food and Drug Administration ( FDA ) requires evidence from at least 2 adequately powered r and omized clinical trials before approving a drug for any specific indication . For most of the conditions that qualify for medical marijuanause , the evidence fails tomeet FDA st and ards . It has beenargued that the lackof high- quality evidence reflects the difficulty inconductingmarijuana research intheUnitedStates . If so , the federal and state governments should support and encourage such research so that high- quality evidence canbe generated to guidedecisions aboutmedicalmarijuanause for the conditions forwhich the existing evidence is either insufficient or of poor quality . Second , there are inconsistencies in how medical conditionsarequalified formedicalmarijuanausewithina state and between states . For example , in Connecticut , psoriasis and sickle cell disease but not Tourette syndrome qualify , even though the supporting evidence for all 3 conditions is uniformly of very low quality . Similarly , posttraumatic stress disorder ( PTSD ) is approvedas aqualifying condition in somebut not all US states . These differences reflect inconsistencies in evaluating and applyingcurrent evidence towarddecisionmaking about qualifying indications for medical marijuana use . Third , unlikemost FDA -approveddrugs that typicallyhave 1or2activeconstituents , marijuanaisacomplexofmorethan400 compounds including flavonoids and terpenoids and approximately 70 cannabinoids other than Δ9-tetrahydrocannabinol (THC)3.Thesecannabinoidshaveindividual , interactive , and even entourageeffects(effectsofacompoundthatareonlyappreciable inthepresenceofothercompounds)thatarenotfullyunderstood and thatcontributetotheneteffectofmarijuana . Although clinical trials forsomeof thequalifyingconditions and studies inanimalmodelsof thoseconditionshavebeenconductedwith individual cannabinoids ( eg , THCor cannabidiol [ CBD ] ) , given that marijuanahas somanyconstituents , the results of studies with individualcannabinoids(eg , THCorCBD)cannotbeextrapolated tomarijuana and vice versa . In addition , unlike FDA -approved medicationsthathavearelativelyuniformcomposition , thecompositionofcannabispreparationscanvarysubstantiallyinitscontent of THC and CBD , such that precise dosingmaybe difficult . Giventhevariablecomposition , patients willhavetoexperiment with different strains and doses to achieve the desired effects , withoutmuch input or oversight by physicians . Fourth , some individual cannabinoids are already commercially available in the form of dronabinol and nabilone . Thesedrugs are administeredorally , and somepublished data are available to guide dosing . In contrast , there are few data on dosing smoked medical marijuana for many of the qualifying medical conditions for which it is used . Fifth , while theacuteadverseeffectsofmarijuanaarequite well known , the effects of repeated exposure , aswould occur withmedicalmarijuana , need further study . Approximately 1 in 10 adult users of marijuana  develops addiction , and this number is evenhigher amongadolescents.4Tolerance and dependence with accompanying down-regulation and desensitization of type 1 cannabinoid receptors occur with repeated exposure.5 Based on this profile , marijuana dosing will have to be increased over time to achieve the same effect . A distinct withdrawal syndrome is also well recognized . There is also a small but definite risk of psychotic disorder associated with marijuana use , as well as a significant risk of symptom exacerbations and relapse in patients with an establishedpsychoticdisorder.6Thus , explicitcontraindicationssuch as schizophrenia , bipolar disorder , or substance dependence need tobe identifiedalongwith measures tominimize the likelihoodthatpersonswithcontraindicationswouldbeable toobtain medical marijuana . Perhaps US states should establish clinical follow-upprogramstomonitor long-term outcomes prospect ively , especiallynegative outcomes ( eg , newcasesofpsychosis ) in patients with contraindications . Author Audio Interview at INTRODUCTION Retrospective research has become largely undervalued and underutilized in child and adolescent psychiatry with the increasing singular focus on r and omized control trials , despite the wealth of clinical ly relevant data available in historical medical records . In this paper a systematic and scientific approach to chart review research methodology for psychiatry is described . METHOD Informed by available literature , a method ological stepwise approach for retrospective chart review was developed . RESULTS A nine step method aim ed at maximizing benefits and minimizing limitations is discussed . CONCLUSIONS Retrospective chart review is an important methodology with distinct advantages and has the potential to provide psychiatry with valuable research opportunities . This method of study should not be lost in the field of psychiatry
Findings were mixed and showed various effects of cannabinoid administration on several aspects of sleep .
This paper review s the literature regarding the effects of cannabinoid administration on  sleep in humans .