scholarly journals Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e025840 ◽  
Author(s):  
Natasa Gisev ◽  
Sallie-Anne Pearson ◽  
Timothy Dobbins ◽  
David C Currow ◽  
Fiona Blyth ◽  
...  
Keyword(s):  
Risk Factors ◽  
Opioid Dependence ◽  
Service Use ◽  
Population Level ◽  
Ethics Committee ◽  
Adverse Outcomes ◽  
Opioid Use ◽  
Research Committee ◽  
Services Research ◽  
Wide Range

IntroductionOpioid prescribing has increased 15-fold in Australia in the past two decades, alongside increases in a range of opioid-related harms such as opioid dependence and overdose. However, despite concerns about increasing opioid use, extramedical use and harms, there is a lack of population-level evidence about the drivers of long-term prescribed opioid use, dependence, overdose and other harms.Methods and analysisWe will form a cohort of all adult residents in New South Wales (NSW), Australia, who initiated prescribed opioids from 2002 using Pharmaceutical Benefits Scheme dispensing records. This cohort will be linked to a wide range of other datasets containing information on sociodemographic and clinical characteristics, health service use and adverse outcomes (eg, opioid dependence and non-fatal and fatal overdose). Analyses will initially examine patterns and predictors of prescribed opioid use and then apply regression and survival analysis to quantify the risks and risk factors of adverse outcomes associated with prescribed opioid use.Ethics and disseminationThis study has received full ethical approval from the Australian Institute of Health and Welfare Ethics Committee, the NSW Population and Health Services Research Committee and the ACT Health Human Research Ethics Committee. This will be the largest postmarketing surveillance study of prescribed opioids undertaken in Australia, linking exposure and outcomes and examining risk factors for adverse outcomes of prescribed opioids. As such, this work has important translational promise, with direct relevance to regulatory authorities and agencies worldwide. Project findings will be disseminated at scientific conferences and in peer-reviewed journals. We will also conduct targeted dissemination with policy makers, professional bodies and peak bodies in the pain, medicine and addiction fields through stakeholder workshops and advisory groups. Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely collected Data (RECORD) Statement.

scholarly journals A Population Perspective on Prevention of Dementia

2019 ◽  
Vol 8 (6) ◽  
pp. 834 ◽  
Author(s):  
Esmé Eggink ◽  
Eric P. Moll van Charante ◽  
Willem A. van Gool ◽  
Edo Richard
Keyword(s):  
Risk Factors ◽  
Health Care Systems ◽  
Population Level ◽  
Convincing Evidence ◽  
Middle Income ◽  
Effective Prevention ◽  
People With Dementia ◽  
Dementia Prevention ◽  
Wide Range ◽  
Care Systems

The global number of people living with dementia is expected to increase to 130 million in 2050. Based on extensive evidence from observational studies, it is estimated that about 30% of dementia cases may be attributable to potentially modifiable risk factors. This suggests that interventions targeting these factors could perhaps delay or prevent the onset of dementia. Since the vast majority of people with dementia live in low- and middle-income countries, such interventions should preferably be easy and affordable to implement across a wide range of health care systems. However, to date, results from dementia prevention trials do not provide convincing evidence that treatment of these risk factors reduces the risk of dementia. The current paper aims to give an overview of available evidence for the potential for dementia prevention. In particular, we discuss methodological issues that might complicate the development of effective prevention interventions and explore the opportunities and challenges for future dementia prevention research. Currently, several ongoing and planned trials are testing the effect of multi-domain interventions on dementia risk in high-risk populations. It is desirable that future dementia strategies also target the wider population, through interventions on the individual, community, and population level, in order to constrain the growing prevalence of dementia worldwide.

Unexpected deaths and unplanned re-admissions in infants discharged home after cardiac surgery: a systematic review of potential risk factors

2014 ◽  
Vol 25 (5) ◽  
pp. 839-852 ◽  
Author(s):  
Jenifer Tregay ◽  
Jo Wray ◽  
Catherine Bull ◽  
Rodney C. Franklin ◽  
Piers Daubeney ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Hospital Discharge ◽  
Care Pathway ◽  
Early Postoperative Period ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Post Discharge ◽  
Feeding Difficulties ◽  
Wide Range

AbstractBackgroundBabies with CHDs are a particularly vulnerable population with significant mortality in their 1st year. Although most deaths occur in the hospital within the early postoperative period, around one-fifth of postoperative deaths in the 1st year of life may occur after hospital discharge in infants who have undergone apparently successful cardiac surgery.AimTo systematically review the published literature and identify risk factors for adverse outcomes, specifically deaths and unplanned re-admissions, following hospital discharge after infant surgery for life-threatening CHDs.MethodsA systematic search was conducted in MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and PsycINFO electronic databases, supplemented by manual searching of conference abstracts.ResultsA total of 15 studies were eligible for inclusion. Almost exclusively, studies were conducted in single US centres and focussed on children with complex single ventricle diagnoses. A wide range of risk factors were evaluated, and those more frequently identified as having a significant association with higher mortality or unplanned re-admission risk were non-Caucasian ethnicity, lower socio-economic status, co-morbid conditions, age at surgery, operative complexity and procedure type, and post-operative feeding difficulties.ConclusionsStudies investigating risk factors for adverse outcomes post-discharge following diverse congenital heart operations in infants are lacking. Further research is needed to systematically identify higher risk groups, and to develop interventions targeted at supporting the most vulnerable infants within an integrated primary and secondary care pathway.

scholarly journals Chronic abdominal pain and persistent opioid use after bariatric surgery

2020 ◽  
Vol 20 (2) ◽  
pp. 239-251 ◽  
Author(s):  
Amalie H. Simoni ◽  
Louise Ladebo ◽  
Lona L. Christrup ◽  
Asbjørn M. Drewes ◽  
Søren P. Johnsen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bariatric Surgery ◽  
Health Care ◽  
Weight Loss ◽  
Abdominal Pain ◽  
Pain Treatment ◽  
Chronic Abdominal Pain ◽  
Adverse Outcomes ◽  
Opioid Use ◽  
Pain Status

AbstractBackground and aimsBariatric surgery remains a mainstay for treatment of morbid obesity. However, long-term adverse outcomes include chronic abdominal pain and persistent opioid use. The aim of this review was to assess the existing data on prevalence, possible mechanisms, risk factors, and outcomes regarding chronic abdominal pain and persistent opioid use after bariatric surgery.MethodsPubMed was screened for relevant literature focusing on chronic abdominal pain, persistent opioid use and pharmacokinetic alterations of opioids after bariatric surgery. Relevant papers were cross-referenced to identify publications possibly not located during the ordinary screening.ResultsEvidence regarding general chronic pain status after bariatric surgery is sparse. However, our literature review revealed that abdominal pain was the most prevalent complication to bariatric surgery, presented in 3–61% of subjects with health care contacts or readmissions 1–5 years after surgery. This could be explained by behavioral, anatomical, and/or functional disorders. Persistent opioid use and doses increased after bariatric surgery, and 4–14% initiated a persistent opioid use 1–7 years after the surgery. Persistent opioid use was associated with severe pain symptoms and was most prevalent among subjects with a lower socioeconomic status. Alteration of absorption and distribution after bariatric surgery may impact opioid effects and increase the risk of adverse events and development of addiction. Changes in absorption have been briefly investigated, but the identified alterations could not be separated from alterations caused solely by excessive weight loss, and medication formulation could influence the findings. Subjects with persistent opioid use after bariatric surgery achieved lower weight loss and less metabolic benefits from the surgery. Thus, remission from comorbidities and cost effectiveness following bariatric surgery may be limited in these subjects.ConclusionsPain, especially chronic abdominal, and persistent opioid use were found to be prevalent after bariatric surgery. Physiological, anatomical, and pharmacokinetic changes are likely to play a role. However, the risk factors for occurrence of chronic abdominal pain and persistent opioid use have only been scarcely examined as have the possible impact of pain and persistent opioid use on clinical outcomes, and health-care costs. This makes it difficult to design targeted preventive interventions, which can identify subjects at risk and prevent persistent opioid use after bariatric surgery. Future studies could imply pharmacokinetic-, pharmacodynamics-, and physiological-based modelling of pain treatment. More attention to social, physiologic, and psychological factors may be warranted in order to identify specific risk profiles of subjects considered for bariatric surgery in order to tailor and optimize current treatment recommendations for this population.

A Systematic Review of the Impact of Disaster on the Mental Health of Medical Responders

2019 ◽  
Vol 34 (6) ◽  
pp. 632-643 ◽  
Author(s):  
Vamanjore Aboobaker Naushad ◽  
Joost JLM Bierens ◽  
Kunnummel Purayil Nishan ◽  
Chirakkal Paramba Firjeeth ◽  
Osama Hashim Mohammad ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Psychological Health ◽  
Well Being ◽  
Psychological Outcomes ◽  
Adverse Outcomes ◽  
Mitigation Strategies ◽  
Mass Casualties ◽  
Wide Range ◽  
The Impact

AbstractIntroduction:Medical responders are at-risk of experiencing a wide range of negative psychological health conditions following a disaster.Aim:Published literature was reviewed on the adverse psychological health outcomes in medical responders to various disasters and mass casualties in order to: (1) assess the psychological impact of disasters on medical responders; and (2) identify the possible risk factors associated with psychological impacts on medical responders.Methods:A literature search of PubMed, Discovery Service, Science Direct, Google Scholar, and Cochrane databases for studies on the prevalence/risk factors of posttraumatic stress disorder (PTSD) and other mental disorders in medical responders of disasters and mass casualties was carried out using pre-determined keywords. Two reviewers screened the 3,545 abstracts and 28 full-length articles which were included for final review.Results:Depression and PTSD were the most studied outcomes in medical responders. Nurses reported higher levels of adverse outcomes than physicians. Lack of social support and communication, maladaptive coping, and lack of training were important risk factors for developing negative psychological outcomes across all types of disasters.Conclusions:Disasters have significant adverse effects on the mental well-being of medical responders. The prevalence rates and presumptive risk factors varied among three different types of disasters. There are certain high-risk, vulnerable groups among medical responders, as well as certain risk factors for adverse psychological outcomes. Adapting preventive measures and mitigation strategies aimed at high-risk groups would be beneficial in decreasing negative outcomes.

scholarly journals Neuropsychiatric disorders as risk factors and consequences of COVID-19: A Mendelian randomization study

2021 ◽  
Author(s):  
Yong XIANG ◽  
Jinghong QIU ◽  
Ruoyu ZHANG ◽  
Carlos Kwan-Long CHAU ◽  
Shitao RAO ◽  
...  
Keyword(s):  
Risk Factors ◽  
Genetic Correlation ◽  
Mendelian Randomization ◽  
Severe Disease ◽  
Severe Infection ◽  
Neuropsychiatric Disorders ◽  
Post Traumatic Stress ◽  
Opioid Use ◽  
Multiple Testing Correction ◽  
Wide Range

Background More than 170 million cases of COVID-19 have been reported worldwide. It has been proposed that psychiatric disorders may be risk factors and/or consequences of COVID-19 infection. However, observational studies could be affected by confounding bias. Methods We performed bi-directional two-sample Mendelian randomization (MR) analysis to evaluate causal relationships between liability to COVID-19 (and severe/critical infection) and a wide range of neuropsychiatric disorders or traits. We employed the latest GWAS summary statistics from the COVID-19 Host Genetics Initiative. A variety of MR methods including those accounting for horizontal pleiotropy were used. Results Overall we observed evidence that liability to COVID-19 or severe infection may be causally associated with higher risks of post-traumatic stress disorder (PTSD), bipolar disorder (BD) (especially BD II), schizophrenia (SCZ), attention deficit hyperactivity disorder (ADHD) and suicidal thought (ST) when compared to the general population. On the other hand, liability to a few psychiatric traits/disorders, for example ADHD, alcohol and opioid use disorders may be causally associated with higher risks of COVID-19 infection or severe disease. In genetic correlation analysis, cannabis use disorder, ADHD, and anxiety showed significant and positive genetic correlation with critical or hospitalized infection. All the above findings passed multiple testing correction at a false discovery rate (FDR)<0.05. For pneumonia, in general we observed a different pattern of associations, with bi-directional positive associations with depression- and anxiety-related phenotypes. Conclusions In summary, this study provides evidence for tentative bi-directional causal associations between liability to COVID-19 (and severe infection) and a number of neuropsychiatric disorders. Further replications and prospective studies are required to verify the findings.

scholarly journals Risk factors of adverse outcomes of various interventions when treating patients with concomitant lesions of the coronary bed and carotid arteries in 30-day follow-up

2018 ◽  
Vol 22 (1) ◽  
pp. 36 ◽  
Author(s):  
R. S. Tarasov ◽  
A. N. Kazantsev ◽  
S. V. Ivanov ◽  
A. A. Golovin ◽  
N. N. Burkov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Conflict Of Interest ◽  
Carotid Arteries ◽  
Bypass Graft ◽  
Prognostic Significance ◽  
Atherosclerotic Lesion ◽  
Adverse Outcomes ◽  
Comorbid Condition ◽  
Wide Range

<p><strong>Aim.</strong> The study looks at clinical and instrumental factors associated with adverse outcomes in the hospital and long-term follow-up when using various surgical strategies for treatment of patients with multifocal atherosclerosis.<br /><strong>Methods.</strong> From 2011 to 2015, three hundred ninety-one patients with combined hemodynamically significant atherosclerotic lesion of the coronary bed and internal carotid arteries were included in this study in a continuous sampling mode. A detailed analysis of the prognostic significance of a wide range of clinical-instrumental, anatomical-angiographic and perioperative factors was performed.<br /><strong>Results.</strong> Against the background of patients’ initially severe comorbid condition, the most significant hospital risk factors were III–IV functional class angina and stroke in the anamnesis. It is important to note a high risk of complications, with bleeding reaching three points or higher on the Bleeding Academic Research Consortium (BARC) scale during simultaneous coronary artery bypass graft surgery and carotid endarterectomy. At the same time, EuroSCORE II value not higher than 2% and the duration of artificial circulation 74 minutes or less turned out to be protective factors. <br /><strong>Conclusion.</strong> The study is not randomized and requires further research on the algorithms for choosing the optimal option of revascularization in this group of patients. The results obtained can form the basis for further research aimed at developing optimal surgical protocols for patients with multifocal atherosclerosis.</p><p>Received 2 August 2017. Revised 16 October 2017. Accepted 25 October 2017.</p><p><strong>Funding:</strong> The research was done with support of the grant (No. 12090ГУ/2017) awarded by the Fund for Facilitation of Innovations within the framework of the “Umnik-2016” project (Kemerovo).</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: R.S. Tarasov<br />Data collection and analysis: A.A. Golovin, N.N. Burkov, M.G. Zinets<br />Drafting the article: A.N. Kazantsev<br />Critical revision of the article: S.V. Ivanov, A.I. Anoufriev<br />Final approval of the version to be published: R.S. Tarasov, A.N. Kazantsev, S.V. Ivanov, A.A. Golovin, N.N. Burkov, A.I. Anoufriev, M.G. Zinets, L.S. Barbarash</p>

scholarly journals Postoperative Opioid Dependence following Orthopaedic Foot and Ankle Surgery: A Cohort Study of 448 Patients

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0013
Author(s):  
Daniel D. Bohl ◽  
Emily Hejna ◽  
Nasima Mehraban ◽  
Johnny L. Lin ◽  
George B. Holmes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Opioid Dependence ◽  
Management Strategies ◽  
Monitoring Program ◽  
Current Smoker ◽  
Foot And Ankle ◽  
Opioid Use ◽  
Ankle Surgery ◽  
Antidepressant Use ◽  
Baseline Characteristics

Category: Other Introduction/Purpose: Surgeon prescription of narcotic medications has been identified as a contributor to the nation’s devastating opioid epidemic. The purpose of this study is to identify risk factors for postoperative opioid dependence following orthopaedic foot and ankle surgery. Methods: Four hundred and forty-eight patients undergoing orthopaedic foot and ankle surgery at a single institution over a 6- month period were identified. The Illinois Prescription Monitoring Program was used to track opioid prescriptions filled in the preoperative, perioperative, and postoperative periods. Preoperative use was defined as the filling of a prescription during the six months prior to the procedure, excluding the 30 days prior to the procedure. Postoperative dependence was defined as the filling of opioid prescriptions beyond the initial postoperative prescription. Baseline characteristics, including preoperative opioid use, were tested for association with opioid dependence. Results: The rate of preoperative opioid use was 20.5%. The rate of postoperative opioid dependence was 31.3%. Patients who used opioids during the preoperative period had the highest risk for postoperative opioid dependence, at 59.6% (RR=2.5, 95% confidence interval = 1.9-3.2, p<0.001; Table 1). Other baseline characteristics associated with postoperative opioid dependence included antiepileptic use (RR=1.8, p=0.001), recreational drug use (RR=1.7, p=0.022), Charlson comorbidity index >= 2 (RR=1.6, p=0.002), benzodiazepine use (RR=1.5, p=0.010), current smoker status (RR=1.5, p<0.001), age >=60 years (RR=1.4, p=0.022), body mass index >= 30 kg/m2 (RR=1.4, p=0.027), antidepressant use (RR=1.4, p=0.050), and <1 drink per week (RR=1.3 p=0.045). Conclusion: The single strongest predictor of postoperative opioid dependence was preoperative opioid use, which was associated with more than a doubling in risk. Of note, the chronicity of the foot or ankle condition did not predict postoperative opioid dependence. Preoperative discussion of opiate treatment duration, multimodal pain management strategies and judicious prescription of narcotics should be considered in patients with the above-noted risk factors in an effort to avoid dependence on this potentially addictive and harmful class of medications. [Table: see text]

scholarly journals Opioid dependence among people with haemophilia in a low-resource tropical setting: prevalence and risk factors in northern Nigeria

2019 ◽  
Vol 6 (1) ◽  
pp. 19-28
Author(s):  
Sagir G. Ahmed ◽  
Umma A. Ibrahim ◽  
Modu B. Kagu
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Blood Group ◽  
Opioid Dependence ◽  
Blood Groups ◽  
Northern Nigeria ◽  
Abo Blood Groups ◽  
Opioid Use ◽  
Tropical Countries ◽  
Chronic Arthropathy

Abstract Background: In tropical countries such as Nigeria, where factor VIII (FVIII) is scarce, severe pain due to musculoskeletal bleeding complications, leading to frequent opioid prescription, is not uncommon in poorly managed people with haemophilia (PWH). The relationship between opioid use and dependence is intensively studied in other painful diseases, such as cancer and rheumatoid arthritis, but surprisingly little is known about opioid dependence in haemophilia. We hypothesise that the risk of opioid dependence among PWH in tropical countries like Nigeria is multi-factorial, encompassing demographic (age), clinical (haemophilia severity and chronic arthropathy) and biological (ABO blood groups and haemoglobin (Hb) phenotypes) factors that may directly or indirectly increase incidence of bleeding and/or pain. Aims: To determine the prevalence of opioid dependence and relative risks (RR) associated with age, haemophilia severity, chronic arthropathy, ABO blood groups and Hb phenotypes, and to elucidate the pathophysiological roles of each risk factor in the development of opioid dependence among haemophilia-A patients in five hospitals in northern Nigeria. Methodology: A retrospective review of the medical records of 88 PWH seen between 1996 and 2012 was used to collate data on age, sex, haemophilia severity, painful chronic haemophilic arthropathy, ABO blood group, haemoglobin phenotypes, presence or absence of opioid dependence, and the types of opioids on which the patients were dependent. The prevalence of opioid dependence among the cohort was expressed as a percentage. The frequency of each putative risk factor for opioid dependence in patients with and without opioid dependence were compared using Fisher’s exact test; RR associated with each risk factor was determined by regression analysis. P<0.05 was taken as significant. Results: Of the 88 PWH studied,15 (17%) were shown to be opioid-dependent. Compared with PWH who were not opioid-dependent, this group had higher frequencies of severe haemophilia (86.7% vs. 49.3%: RR= 5.2, p=0.02), survival to adulthood (73.3% vs. 12.3%: RR= 9.5, p=0.0001), chronic arthropathy in one or more joints (86.7% vs. 21.9%: RR= 13.2, p=0.0004), blood group-O (80% vs. 49.3%: RR= 3.3, p=0.04), and HbAA phenotype (86.7% vs. 54.8%: RR= 4.3, p=0.04). Conclusion: Prevalence of opioid dependence among PWH treated at five hospitals in northern Nigeria was 17% during the study period. Significant risk factors were directly or indirectly associated with increased rates of bleeding and/or pain, which can only be prevented or treated through optimal application of FVIII. There is a need for the Nigerian government to establish standard haemophilia care centres with adequate FVIII for optimal prophylaxis and treatment in order to minimise painful complications, thereby helping to prevent undue opioid use and dependence.

Four-Corner Arthrodesis versus Proximal Row Carpectomy: Risk Factors and Complications Associated with Prolonged Postoperative Opioid Use

2020 ◽  
Author(s):  
Neill Y. Li ◽  
Alexander S. Kuczmarski ◽  
Andrew M. Hresko ◽  
Avi D. Goodman ◽  
Joseph A. Gil ◽  
...  
Keyword(s):  
Risk Factors ◽  
International Classification Of Diseases ◽  
Opioid Use ◽  
Proximal Row Carpectomy ◽  
Use Patterns ◽  
Patient Demographics ◽  
Implant Complications ◽  
Increased Risk ◽  
Classification Of Diseases

Abstract Introduction This article compares opioid use patterns following four-corner arthrodesis (FCA) and proximal row carpectomy (PRC) and identifies risk factors and complications associated with prolonged opioid consumption. Materials and Methods The PearlDiver Research Program was used to identify patients undergoing primary FCA (Current Procedural Terminology [CPT] codes 25820, 25825) or PRC (CPT 25215) from 2007 to 2017. Patient demographics, comorbidities, perioperative opioid use, and postoperative complications were assessed. Opioids were identified through generic drug codes while complications were defined by International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification codes. Multivariable logistic regressions were performed with p < 0.05 considered statistically significant. Results A total of 888 patients underwent FCA and 835 underwent PRC. Three months postoperatively, more FCA patients (18.0%) continued to use opioids than PRC patients (14.7%) (p = 0.033). Preoperative opioid use was the strongest risk factor for prolonged opioid use for both FCA (odds ratio [OR]: 4.91; p < 0.001) and PRC (OR: 6.33; p < 0.001). Prolonged opioid use was associated with an increased risk of implant complications (OR: 4.96; p < 0.001) and conversion to total wrist arthrodesis (OR: 3.55; p < 0.001) following FCA. Conclusion Prolonged postoperative opioid use is more frequent in patients undergoing FCA than PRC. Understanding the prevalence, risk factors, and complications associated with prolonged postoperative opioid use after these procedures may help physicians counsel patients and implement opioid minimization strategies preoperatively.

Sign in / Sign up

Export Citation Format

Share Document