scholarly journals High-Risk Medication Use and Polypharmacy in Older Veterans Who Attempt Suicide

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 747-747
Author(s):  
Ruth Morin ◽  
Yixia Li ◽  
Michael Steinman ◽  
Ilse Wiechers ◽  
Amy Byers
Keyword(s):  
High Risk ◽  
Suicide Risk ◽  
Medication Use ◽  
Late Life ◽  
Health Concern ◽  
Prescription Medications ◽  
Similar Time ◽  
Medical Diagnoses ◽  
Risk Of Death ◽  
Time Period

Abstract Late-life veteran suicide is a public health concern, and may overlap with recent high-risk medication use. We identified use in the 6 months prior to attempt and assessed salient risk factors. 13,872 veterans aged 50 years and older that attempted suicide were compared with demographically-matched controls utilizing VHA healthcare in a similar time period. Medications potentially related to suicide risk were included. Other variables were psychiatric and medical diagnoses, fatality of attempt and means. Compared with controls, veterans who attempted were nearly 3 times more likely to have been prescribed benzodiazepines and opioids, even when controlling for other diagnoses. Those taking 3 or more high-risk medications were between 7 and 11 times more likely to attempt than controls, with a higher risk of death particularly by drug overdose. These findings begin to uncover the complex contribution of prescription medications and polypharmacy to late-life veteran suicide, with implications for prevention. Part of a symposium sponsored by the Aging, Alcohol and Addictions Interest Group.

scholarly journals A Novel Score for Predicting Alzheimer’s Disease Risk from Late Life Psychopathological and Health Risk Factors

2021 ◽  
Vol 18 (4) ◽  
pp. 1802
Author(s):  
Javier Santabárbara ◽  
Juan Bueno-Notivol ◽  
Darren M. Lipnicki ◽  
Concepción de la Cámara ◽  
Raúl López-Antón ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
High Risk ◽  
Risk Index ◽  
Late Life ◽  
Health Concern ◽  
Risk Scores ◽  
Risk Of Death ◽  
Dementia Risk

With the increasing size of the aging population, dementia risk reduction has become a main public health concern. Dementia risk models or indices may help to identify individuals in the community at high risk to develop dementia. We have aimed to develop a novel dementia risk index focused on the late-life (65 years or more) population, that addresses risk factors for Alzheimer’s disease (AD) easily identifiable at primary care settings. These risk factors include some shown to be associated with the risk of AD but not featured in existing indices, such as hearing loss and anxiety. Our index is also the first to account for the competing risk of death. The Zaragoza Dementia and Depression Project (ZARADEMP) Alzheimer Dementia Risk Score predicts an individual´s risk of developing AD within 5 years. The probability of late onset AD significantly increases in those with risk scores between 21 and 28 and, furthermore, is almost 4-fold higher for those with risk scores of 29 or higher. Our index may provide a practical instrument to identify subjects at high risk of AD and to design preventive strategies targeting the contributing risk factors.

scholarly journals Spatiotemporal Clustering of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Incidence in Saudi Arabia, 2012–2019

2019 ◽  
Vol 16 (14) ◽  
pp. 2520 ◽  
Author(s):  
Khalid Al-Ahmadi ◽  
Sabah Alahmadi ◽  
Ali Al-Zahrani
Keyword(s):  
Saudi Arabia ◽  
High Risk ◽  
Middle East ◽  
Infection Risk ◽  
Middle East Respiratory Syndrome ◽  
Scan Statistics ◽  
Health Concern ◽  
Temporal Cluster ◽  
Time Period ◽  
Spatiotemporal Clustering

Middle East respiratory syndrome coronavirus (MERS-CoV) is a great public health concern globally. Although 83% of the globally confirmed cases have emerged in Saudi Arabia, the spatiotemporal clustering of MERS-CoV incidence has not been investigated. This study analysed the spatiotemporal patterns and clusters of laboratory-confirmed MERS-CoV cases reported in Saudi Arabia between June 2012 and March 2019. Temporal, seasonal, spatial and spatiotemporal cluster analyses were performed using Kulldorff’s spatial scan statistics to determine the time period and geographical areas with the highest MERS-CoV infection risk. A strongly significant temporal cluster for MERS-CoV infection risk was identified between April 5 and May 24, 2014. Most MERS-CoV infections occurred during the spring season (41.88%), with April and May showing significant seasonal clusters. Wadi Addawasir showed a high-risk spatial cluster for MERS-CoV infection. The most likely high-risk MERS-CoV annual spatiotemporal clusters were identified for a group of cities (n = 10) in Riyadh province between 2014 and 2016. A monthly spatiotemporal cluster included Jeddah, Makkah and Taif cities, with the most likely high-risk MERS-CoV infection cluster occurring between April and May 2014. Significant spatiotemporal clusters of MERS-CoV incidence were identified in Saudi Arabia. The findings are relevant to control the spread of the disease. This study provides preliminary risk assessments for the further investigation of the environmental risk factors associated with MERS-CoV clusters.

scholarly journals Mental health services, suicide and 7-day working

2016 ◽  
Vol 209 (4) ◽  
pp. 334-339 ◽  
Author(s):  
Nav Kapur ◽  
Saied Ibrahim ◽  
Isabelle M. Hunt ◽  
Pauline Turnbull ◽  
Jenny Shaw ◽  
...  
Keyword(s):  
Mental Health ◽  
High Risk ◽  
Mental Health Services ◽  
Health Services ◽  
Suicide Risk ◽  
Weekend Effect ◽  
Post Discharge ◽  
Risk Of Death ◽  
Increased Risk ◽  
Mental Health Patients

BackgroundPatients admitted to hospital at the weekend appear to be at increased risk of death compared with those admitted at other times. However, a ‘weekend effect’ has rarely been explored in mental health and there may also be other times of year when patients are vulnerable.AimsTo investigate the timing of suicide in high-risk mental health patients.MethodWe compared the incidence of suicide at the weekend v. during the week, and also in August (the month of junior doctor changeover) v. other months in in-patients, patients within 3 months of discharge and patients under the care of crisis resolution home treatment (CRHT) teams (2001–2013).ResultsThe incidence of suicide was lower at the weekends for each group (incidence rate ratio (IRR) = 0.88 (95% CI 0.79–0.99) for in-patients, IRR = 0.85 (95% CI 0.78–0.92) for post-discharge patients, IRR = 0.87 (95% CI 0.78–0.97) for CRHT patients). Patients who died by suicide were also less likely to have been admitted at weekends than during the week (IRR = 0.52 (95% CI 0.45–0.60)). The incidence of suicide in August was not significantly different from other months.ConclusionsWe found evidence of a weekend effect for suicide risk among high-risk mental health patients, but with a 12–15% lower incidence at weekends. Our study does not support the claim that safety is compromised at weekends, at least in mental health services.

scholarly journals Parental mental health and risk of poor mental health and death by suicide in offspring

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Aideen Maguire ◽  
Foteini Tseliou ◽  
Dermot O'Reilly
Keyword(s):  
Mental Health ◽  
Suicide Risk ◽  
Poor Mental Health ◽  
Health Concern ◽  
Parental Mental Health ◽  
Risk Of Death ◽  
Increased Risk ◽  
Child Suicide ◽  
Multi Level

BackgroundSuicide is a major public health concern. Identifying those most at risk is vital for effective targeting of interventions. Mental health (MH) has a genetic component and parental MH is associated with child’s MH. However, little is known onthe effect of parental MH on a child’s risk of death by suicide. MethodsData from 2011 Northern Ireland Census was linked to 5 years’ death records (2011-2015) to construct multi-level regression models to determine if children living with parents with poor self-rated MH are at an increased risk of poor MH themselves and an increased risk of death by suicide. Results618,970 individuals live with their parents; with almost 1 in 7 (13.7%) living with parents with poor MH and 225 (0.1%) dying by suicide during follow-up. Interim results suggest after full adjustment, children with 2 parents with poor MH were5 times more likely to have poor MH themselves (OR=5.30, 95% CI 4.62,6.09), and children with 1 parent with poor MH were 67% more likely to die by suicide compared to children of parents with good MH (OR=1.67, 95%CI 1.19, 2.33). ConclusionsParental MH is associated with child suicide risk even after adjustment for their own MH status.

TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention

2020 ◽  
Vol 14 ◽  
Author(s):  
Johny Nicolas ◽  
Usman Baber ◽  
Roxana Mehran
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
High Risk Patients ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Risk Patients

A P2Y12 inhibitor-based monotherapy after a short period of dual antiplatelet therapy is emerging as a plausible strategy to decrease bleeding events in high-risk patients receiving dual antiplatelet therapy after percutaneous coronary intervention. Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT), a randomized double-blind trial, tested this approach by dropping aspirin at 3 months and continuing with ticagrelor monotherapy for an additional 12 months. The study enrolled 9,006 patients, of whom 7,119 who tolerated 3 months of dual antiplatelet therapy were randomized after 3 months into two arms: ticagrelor plus placebo and ticagrelor plus aspirin. The primary endpoint of interest, Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, occurred less frequently in the experimental arm (HR 0.56; 95% CI [0.45–0.68]; p<0.001), whereas the secondary endpoint of ischemic events was similar between the two arms (HR 0.99; 95% CI [0.78–1.25]). Transition from dual antiplatelet therapy consisting of ticagrelor plus aspirin to ticagrelor-based monotherapy in high-risk patients at 3 months after percutaneous coronary intervention resulted in a lower risk of bleeding events without an increase in risk of death, MI, or stroke.

scholarly journals PNS105 ASSOCIATION OF LOW-INCOME SUBSIDY/DUAL ELIGIBILITY AND DISABILITY WITH HIGH-RISK MEDICATION USE AMONG PART D MEDICARE BENEFICIARIES

2020 ◽  
Vol 23 ◽  
pp. S303
Author(s):  
C. Chinthammit ◽  
S. Bhattacharjee ◽  
M. Slack ◽  
W. Lo-Ciganic ◽  
J.P. Bentley ◽  
...  
Keyword(s):  
High Risk ◽  
Low Income ◽  
Medication Use ◽  
Medicare Beneficiaries ◽  
Part D ◽  
Dual Eligibility

scholarly journals POS1260 FACTORS ASSOCIATED WITH SEVERE SARS-COV-2 INFECTION IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES IN MADRID: RESULTS FROM REUMA-COVID SORCOM REGISTRY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 914-914
Author(s):  
A. Boteanu ◽  
A. García Fernández ◽  
N. De la Torre ◽  
M. Pavia Pascual ◽  
O. Sanchez Pernaute ◽  
...  
Keyword(s):  
High Risk ◽  
Rheumatic Diseases ◽  
Connective Tissue Diseases ◽  
Severe Infection ◽  
Pulmonary Involvement ◽  
Inflammatory Rheumatic Diseases ◽  
Factors Associated ◽  
Risk Of Death ◽  
Cardiovascular Comorbidities ◽  
Male Sex

Background:Patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 may be at risk to develop a severe course of COVID-19 due to the immune dysregulation or the influence of immunomodulating drugs on the course of the infection. For a better understanding of SARS-CoV-2 infections in patients with IRD and due to the high incidence of COVID-19 in Madrid from the beginning of this pandemic infection in Spain, the Society of Rheumatology from Madrid (SORCOM) established a registry (REUMA-COVID SORCOM) shortly after the beginning of the pandemic in Spain.Objectives:To determine factors associated with severity of infection with SARS-CoV-2 in patients with inflammatory rheumatic diseases in MadridMethods:The REUMA-COVID SORCOM registry is a multicenter, retrospective, observational cohort study conducted in Madrid, a SORCOM initiative. All rheumatology departments from Madrid were invited to participate. The study includes patients with IRD presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020, and November 10, 2020. We consider severe infection death or need of hospitalization. Inclusion criteria was having an IRD and at least 1 of the following 4 criteria: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a SARS-CoV-2 polymerase chain reaction (PCR) test on a nasopharyngeal swab; (2) Detection of IgM or IgG anti SARS-CoV2 in a symptomatic or asymptomatic patients (3)typical thoracic computed tomography (CT) abnormalities (ground-glass opacities) in epidemic areas; (4) COVID19–typical symptoms in an epidemic zone of COVID-19.Results:As of November 10, 2020, 417 patients with IRD were included in the REUMA-COVID SORCOM registry. 5 patients were discharged for incomplete data. Of 412 patients (mean age 57 years, 87.4% Caucasian race, 66.3% female) 174 need hospitalization (42.2%) and 33 patients died (18.4% mortality in hospitalized patients). 82.3% had comorbidities. 234 (56.8%) patients were classified as inflammatory arthropathy, 133 (32.3%) had connective tissue diseases (CTD). 41.1% of the patients had a large history of IRD (> 10 years). 10.4% of patients had previously pulmonary involvement. The study includes 143 patients taking Methotrexate, 89 patients taking anti-TNFα therapy and 27 Rituximab. In the univariant analysis, no differences were seen in the severity of COVID-19 infection in patients taking methotrexate. 63% of the all patients taking Rituximab included in the registry need hospitalization and 22% of them died. Hypertension, COPD or cardiovascular disease was associated with hospitalization.Independent factors associated with COVID-19 hospitalization in the multivariate analysis was: age (>62 years), male sex, IMC >30, previous cardiovascular comorbidities and the IRD disease duration (> 10 years). Independent factors associated with COVID-19 related death was: age (> 62 years), having a CTD diagnose, pulmonary involvement before infection and chronical GC treatment.Conclusion:Patients with IRD represent a population of particular interest in the pandemic context because the baseline immunological alteration and the treated with immunosuppressants agents they receive, comorbidities and the well-known risk of severe infection. Older age, male sex, cardiovascular comorbidities were factors associated with high risk of hospitalization in IRD patients. CTD diseases, previously pulmonary involvement and chronical GC treatment with more than 10mg/day were associated with high risk of death. Neither anti TNF-α treatment nor Methotrexate were risk factor for hospitalization or death COVID-19 related in IRD patients.Disclosure of Interests:None declared

Suicide risk assessment in a large public mental health service: do suicide risk classifications identify those at risk?

2021 ◽  
pp. 103985622098403
Author(s):  
Marianne Wyder ◽  
Manaan Kar Ray ◽  
Samara Russell ◽  
Kieran Kinsella ◽  
David Crompton ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Risk Assessment ◽  
High Risk ◽  
Suicide Risk ◽  
Public Mental Health ◽  
Assessment Tools ◽  
Suicide Risk Assessment ◽  
Public Mental Health Service ◽  
Risk Assessment Tools

Introduction: Risk assessment tools are routinely used to identify patients at high risk. There is increasing evidence that these tools may not be sufficiently accurate to determine the risk of suicide of people, particularly those being treated in community mental health settings. Methods: An outcome analysis for case serials of people who died by suicide between January 2014 and December 2016 and had contact with a public mental health service within 31 days prior to their death. Results: Of the 68 people who had contact, 70.5% had a formal risk assessment. Seventy-five per cent were classified as low risk of suicide. None were identified as being at high risk. While individual risk factors were identified, these did not allow to differentiate between patients classified as low or medium. Discussion: Risk categorisation contributes little to patient safety. Given the dynamic nature of suicide risk, a risk assessment should focus on modifiable risk factors and safety planning rather than risk prediction. Conclusion: The prediction value of suicide risk assessment tools is limited. The risk classifications of high, medium or low could become the basis of denying necessary treatment to many and delivering unnecessary treatment to some and should not be used for care allocation.

scholarly journals Modelling local patterns of child mortality risk: a Bayesian Spatio-temporal analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alejandro Lome-Hurtado ◽  
Jacques Lartigue-Mendoza ◽  
Juan C. Trujillo
Keyword(s):  
High Risk ◽  
Mexico City ◽  
Child Mortality ◽  
Mortality Risk ◽  
Temporal Analysis ◽  
Health Concern ◽  
The North ◽  
Greater Mexico ◽  
Spatio Temporal ◽  
Child Mortality Rate

Abstract Background Globally, child mortality rate has remained high over the years, but the figure can be reduced through proper implementation of spatially-targeted public health policies. Due to its alarming rate in comparison to North American standards, child mortality is particularly a health concern in Mexico. Despite this fact, there remains a dearth of studies that address its spatio-temporal identification in the country. The aims of this study are i) to model the evolution of child mortality risk at the municipality level in Greater Mexico City, (ii) to identify municipalities with high, medium, and low risk over time, and (iii) using municipality trends, to ascertain potential high-risk municipalities. Methods In order to control for the space-time patterns of data, the study performs a Bayesian spatio-temporal analysis. This methodology permits the modelling of the geographical variation of child mortality risk across municipalities, within the studied time span. Results The analysis shows that most of the high-risk municipalities were in the east, along with a few in the north and west areas of Greater Mexico City. In some of them, it is possible to distinguish an increasing trend in child mortality risk. The outcomes highlight municipalities currently presenting a medium risk but liable to become high risk, given their trend, after the studied period. Finally, the likelihood of child mortality risk illustrates an overall decreasing tendency throughout the 7-year studied period. Conclusions The identification of high-risk municipalities and risk trends may provide a useful input for policymakers seeking to reduce the incidence of child mortality. The results provide evidence that supports the use of geographical targeting in policy interventions.

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