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2 Minute Medicine Rewind May 4, 2026
1. Co-use of cannabis edibles and alcohol augmented driving impairment and subjective intoxication.
Evidence Rating Level: 2 (Good)
Previous research has found that the co-use of cannabis and alcohol impairs driving ability and cognitive and behavioral performance to a greater extent than when used individually. While previous studies focused on inhaled forms of cannabis and alcohol, there is a lack of research on the co-use of cannabis edibles and alcohol. This study thus examined the individual and interactive effects of cannabis edibles and alcohol on simulated driving, as well as subjective and objective impairment measures. This crossover study included healthy adults aged 21-55 who underwent 7 outpatient experimental sessions at Johns Hopkins University School of Medicine from February 2022 to August 2025. During the sessions, participants consumed a cannabis-infused brownie (10 mg or 25 mg THC) or a placebo brownie, followed by an alcohol-containing drink adjusted to reach breath alcohol concentrations (BrAC) of 0.05% or 0.08% or a placebo drink. The primary driving outcome was the global drive score (GDS). Field sobriety was assessed using the Standardized Field Sobriety Tests (SFST). Subjective drug effects were assessed with the various questionnaires. In total, 25 participants were included in the study (mean [SD] age, 25.6 [4.9] years, 15 males [60%]). Based on mean peak GDS, all active drug conditions except 10 mg THC reduced driving performance compared with placebo. Compared to consuming alcohol alone at 0.08% BrAC, driving impairment was similar at 0.05% BrAC and 10 mg THC (mean [SD] peak GDS, 1.6 [1.6] vs 1.6 [1.4]) but worse at 0.05% BrAC and 25 mg THC (mean [SD] peak GDS, 2.5 [1.7]; P = .02). Driving impairment and subjective intoxication were often greater under co-use conditions compared with cannabis or alcohol alone. Compared to placebo, SFST performance worsened at 0.08% BrAC (mean [SD] score, 2.2 [2.2] vs 0.2 [1.3]; P = .008). Overall, this study found that co-use of cannabis edibles and alcohol augmented driving impairment and subjective intoxication. These findings suggest that the legal alcohol intoxication limit of 0.08% BrAC in most of the US may be too liberal if a driver has also used cannabis.
Housing Insecurity, Incident Geriatric Conditions, and Mortality in Community-Living Older Persons
1. Poor housing affordability and poor housing quality were associated with the development of geriatric conditions and mortality over 5 years.
Evidence Rating Level: 2 (Good)
Housing insecurity is defined by a lack of housing affordability, quality, and stability, and is an important modifiable social determinant of health (SDOH). It is estimated that over 1 in 3 community-living older individuals in the US are experiencing housing insecurity. Yet, research examining the association between housing insecurity and health outcomes among persons aged >65 years is lacking. This study thus examined associations between different forms of housing insecurity and the development of geriatric conditions and mortality. This prospective cohort study used data from the National Health and Aging Trends Study (NHATS) from 2015 to 2020 and included community-living persons aged >65 years in the US. Three forms of housing insecurity were assessed: poor housing affordability, poor housing quality, and poor neighborhood quality. The primary outcomes were time to onset of frailty, disability, and dementia, and time to death over 5 years. In total, 7,499 participants were included in the study (mean [SD] age, 78.2 [7.8] years; 4335 [55.3%] female). After adjusting for covariates, poor housing affordability was associated with a 23% higher risk of frailty (relative risk ratio [RRR], 1.23; 95% CI, 1.01-1.49), 24% higher risk of disability (RRR, 1.24; 95% CI, 1.01-1.54), 37% higher risk of dementia (RRR, 1.37; 95% CI, 1.11-1.69), and 51% higher hazard of mortality (hazard ratio [HR], 1.51; 95% CI, 1.34-1.70). Similarly, poor housing quality was associated with 30% higher risk of frailty (RRR, 1.30; 95% CI, 1.04-1.62), 33% higher risk of disability (RRR, 1.33; 95% CI, 1.13-1.57), and 15% higher hazard of mortality (HR, 1.15; 95% CI, 1.01-1.32), but not significantly associated with dementia (RRR, 1.16; 95% CI, 0.90-1.49). No association was found between poor neighborhood quality and any outcome in the adjusted analyses. Overall, this study found that poor housing affordability and poor housing quality were associated with the development of geriatric conditions and mortality over 5 years among older persons. These findings indicate that housing insecurity is a clinically relevant social determinant of health among this population.
1. Maternal use of benzodiazepines or Z-hypnotics during pregnancy was not associated with an increased risk of psychiatric disorders in offspring after controlling for shared familial factors.
Evidence Rating Level: 2 (Good)
Benzodiazepines and non-benzodiazepine hypnotics (Z-hypnotics) are frequently prescribed drugs among pregnant women who commonly experience psychiatric conditions such as anxiety and insomnia. Although previous studies have not found benzodiazepine or Z-hypnotic exposure during pregnancy to increase risk of congenital malformations, the risk of neurodevelopmental consequences remains uncertain. This study thus examined the associations between prenatal exposure to benzodiazepines and Z-hypnotics and the risk of psychiatric disorders in offspring. This population-based cohort study used data from the National Health Information Database (NHID) and included all liveborn children between 2010 and 2022 who were followed until 2023. Children were classified into three cohorts: those exposed to benzodiazepines or Z-hypnotics during pregnancy, unexposed, and those whose mothers used benzodiazepines or Z-hypnotics before pregnancy (past users). Sibling-controlled analysis was conducted to account for shared familial factors by only including children with at least one sibling with a discordant exposure status. The main outcomes were overall and 12 specific psychiatric disorders in offspring. Among the 3,809,949 liveborn children included in the study, 94,482 (2.5%) were exposed to benzodiazepines or Z-hypnotics during pregnancy, 3,715,467 were unexposed, and 147,307 were born to past users. Offspring exposed to benzodiazepines or Z-hypnotics had a higher risk of any psychiatric disorders compared with those unexposed (hazard ratio [HR] 1.15, 95% CI 1.13 to 1.18) and offspring of past users (HR 1.12, 95% CI 1.09 to 1.15); however, this association was no longer significant in the sibling-controlled analysis (HR 0.99, 95% CI 0.94 to 1.04). No significant associations were observed between offspring exposed to benzodiazepines or Z-hypnotics and risk of individual psychiatric disorders. Modestly elevated but non-significant hazard ratios were observed during the second half of pregnancy and both first and second half of pregnancy with benzodiazepine or Z-hypnotic exposure, and with 30 or more days of Z-hypnotic exposure. Overall, this study found that maternal use of benzodiazepines or Z-hypnotics during pregnancy was not associated with an increased risk of psychiatric disorders in offspring after controlling for shared familial factors. However, modest elevations in point estimates in subgroup analyses cannot rule out the potential for slightly increased risk.
1. Five days of accelerated continuous theta burst stimulation (a-cTBS) targeting the left primary motor cortex improved social communication impairment in children with autism spectrum disorder.
Evidence Rating Level: 1 (Excellent)
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neurostimulation technique that has shown efficacy in treating various neuropsychiatric conditions. Research on the application of rTMS to autism spectrum disorder (ASD), particularly among young children and people with comorbid intellectual disability, has been limited and inconclusive. This study thus examined the efficacy and safety of an accelerated continuous theta burst stimulation (a-cTBS) protocol of rTMS in improving social communication impairment in children with ASD and those with co-occurring intellectual disability. This multicentre randomised controlled trial was conducted at three hospitals in China, between July 2023 and October 2024 and included children aged 4-10 years with ASD with a full-scale intelligence quotient ≥50. Participants were randomised 1:1 to receive active a-cTBS or sham treatment (10 sessions/day for five consecutive days) targeting the left primary motor cortex. The primary outcomes were changes in social communication impairment from baseline to post-intervention and from baseline to one-month follow-up, assessed using the Social Responsiveness Scale, second edition (SRS-2). Secondary outcomes included language improvements assessed from baseline to one-month follow-up, measured by the Multilingual Assessment Instrument for Narratives. In total, 198 were included in the modified intention-to-treat analysis (99 in each group), and 193 completed the full intervention. Compared with the sham group, participants who received a-cTBS had greater reductions in SRS-2 scores post-intervention (mean difference, −6.25; 95% CI, −8.69 to −3.81; Cohen’s d, −0.92) and at one-month follow-up (mean difference, −6.17; 95% CI, −8.65 to −3.70; Cohen’s d, −0.90). The a-cTBS group also showed greater improvements in language abilities (Cohen’s d 0.12 to 0.47; all P < 0.02). Adverse events were mild to moderate and resolved without intervention. Overall, this study found that a five-day a-cTBS protocol targeting the left primary motor cortex improved social communication impairment in children with ASD, highlighting its potential as a viable therapeutic option for this population.
1. Robotic component separation for ventral hernia repair was associated with lower postoperative complication rates, shorter length of stay, and fewer readmissions compared to the open approach.
Evidence Rating Level: 2 (Good)
Surgical repair of complex ventral hernias is challenging and associated with high morbidity. While component separation is commonly used to repair complex ventral hernias, the optimal approach remains debated. Large multicenter studies comparing robotic vs open component separation are lacking. This study thus compared the complication rates and clinical outcomes of robotic vs open component separation for ventral hernia repair. This retrospective cohort study used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and included patients undergoing component separation for ventral hernia repair. Study outcomes included 30-day surgical, wound, medical, and overall complications, as well as length of stay and readmission. Patients were split into either the robotic or open surgery groups. Among the 6,207 patients included, 4,443 (71.6%) underwent open technique and 1,764 (28.4%) robotic approach to component separation. After propensity matching (n = 5,259; mean [SD] age, 58.71 [12.78], 2,659 [50.6%] female), robotic repair was independently associated with lower overall complication rates (4.8% vs. 19.6%, adjusted odds ratio [aOR] 0.193, p < 0.001), including wound (2.2% vs. 10.2%, aOR 0.164, p < 0.001), surgical (2.9% vs. 10.0%, aOR 0.271, p < 0.001), and medical complications (2.0% vs. 7.0%, aOR 0.229, p < 0.001). Compared to open surgery, robotic surgery was also associated with shorter length of stay (1.34 vs. 3.86 days, p < 0.001) and lower readmission rates (4.4% vs. 9.1%, p < 0.001). Overall, this study found that robotic component separation for ventral hernia repair was associated with lower postoperative complication rates, shorter length of stay, and fewer readmissions compared to the open approach. These findings highlight the robotic approach as a promising alternative to the open approach. Future studies are needed to examine long-term outcomes.
Image: PD
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