TY - JOUR T1 - Prevalence, predictors and perinatal outcomes of peri-conceptional alcohol exposure--retrospective cohort study in an urban obstetric population in Ireland JF - BMC Pregnancy Childbirth Y1 - 2011 A1 - Mullally, Aoife A1 - Cleary, B A1 - Barry, Joe A1 - Fahey, T A1 - Murphy, Deirdre J KW - Adult KW - Age Factors KW - Alcohol Drinking KW - Cohort Studies KW - Female KW - Fertilization KW - Fetal Alcohol Syndrome KW - Humans KW - Ireland KW - Pregnancy KW - Premature Birth KW - Retrospective Studies KW - Risk Factors KW - Self Report KW - Socioeconomic Factors KW - Substance-Related Disorders KW - Urban Population AB - BACKGROUND: Evidence-based advice on alcohol consumption is required for pregnant women and women planning a pregnancy. Our aim was to investigate the prevalence, predictors and perinatal outcomes associated with peri-conceptional alcohol consumption. METHODS: A cohort study of 61,241 women who booked for antenatal care and delivered in a large urban maternity hospital between 2000 and 2007. Self-reported alcohol consumption at the booking visit was categorised as low (0-5 units per week), moderate (6-20 units per week) and high (>20 units per week). RESULTS: Of the 81% of women who reported alcohol consumption during the peri-conceptional period, 71% reported low intake, 9.9% moderate intake and 0.2% high intake. Factors associated with moderate alcohol consumption included being in employment OR 4.47 (95% CI 4.17 to 4.80), Irish nationality OR 16.5 (95% CI 14.9 to 18.3), private health care OR 5.83 (95% CI 5.38 to 6.31) and smoking OR 1.86 (95% CI 1.73 to 2.01). Factors associated with high consumption included maternal age less than 25 years OR 2.70 (95% CI 1.86 to 3.91) and illicit drug use OR 6.46 (95% CI 3.32 to 12.60). High consumption was associated with very preterm birth (<32 weeks gestation) even after controlling for socio-demographic factors, adjusted OR 3.15 (95% CI 1.26-7.88). Only three cases of Fetal Alcohol Syndrome were recorded (0.05 per 1000 total births), one each in the low, moderate and high consumption groups. CONCLUSIONS: Public Health campaigns need to emphasise the importance of peri-conceptional health and pre-pregnancy planning. Fetal Alcohol Syndrome is likely to be under-reported despite the high prevalence of alcohol consumption in this population. VL - 11 UR - http://www.biomedcentral.com/1471-2393/11/27 ER - TY - JOUR T1 - Prevalence and outcomes of use of potentially inappropriate medicines in older people: cohort study stratified by residence in nursing home or in the community JF - BMJ Qual Saf Y1 - 2011 A1 - Barnett, K A1 - McCowan, Colin A1 - Evans, J M M A1 - Gillespie, N D A1 - Davey, P G A1 - Fahey, T KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Drug Utilization KW - Female KW - Humans KW - Independent Living KW - Male KW - Medication Errors KW - Nursing Homes KW - Polypharmacy KW - Prescription Drugs KW - Prevalence KW - Scotland KW - Sex Factors AB - OBJECTIVES: To compare the prevalence of use of potentially inappropriate medicines (PIMs) between older patients living in their own homes versus those living in nursing or residential homes, and to test the association between exposure to PIMs and mortality. DESIGN: Cohort study stratified by place of residence. SETTING: Tayside, Scotland. PARTICIPANTS: All people aged between 66 and 99 years who were resident or died in Tayside from 2005 to 2006. MAIN OUTCOME MEASURES: The exposure variable was PIM use as defined by Beers' Criteria. All cause mortality was the main outcome measure. RESULTS: 70,299 people were enrolled in the cohort of whom 96% were exposed to any medicine and 31% received a PIM. Place of residence was not associated with overall risk of receiving PIMs, adjusted OR 0.94, 95% CI 0.87 to 1.01. Exposure to five of the PIMs (including long-acting benzodiazepines) was significantly higher in nursing homes whereas exposure to five other PIMs (including amitriptyline and NSAIDs) was significantly lower. Exposure to PIMs was similar (20-46%) across all 71 general practices in Tayside and was not associated with increased risk of mortality after adjustment for age, gender and polypharmacy (adjusted OR 0.98, 95% CI 0.92 to 1.05). CONCLUSIONS: The authors question the validity of the full list of PIMs as an indicator of safety of medicines in older people because one-third of the population is exposed with little practice variation and no significant impact on mortality. Future studies should focus on management of a shorter list of genuinely high-risk medicines. VL - 20 UR - http://qualitysafety.bmj.com/content/20/3/275.full IS - 3 ER - TY - JOUR T1 - Methadone and perinatal outcomes: a retrospective cohort study JF - Am J Obstet Gynecol Y1 - 2011 A1 - Cleary, B A1 - Donnelly, Jean A1 - Strawbridge, Judith D A1 - Gallagher, Paul J A1 - Fahey, T A1 - White, Martin J A1 - Murphy, Deirdre J KW - Age Factors KW - Dose-Response Relationship, Drug KW - Female KW - Humans KW - Infant, Newborn KW - Methadone KW - Narcotics KW - Neonatal Abstinence Syndrome KW - Odds Ratio KW - Opiate Substitution Treatment KW - Opioid-Related Disorders KW - Pregnancy KW - Premature Birth KW - Retrospective Studies KW - Risk Factors KW - Smoking KW - Treatment Outcome AB - OBJECTIVE: The purpose of this study was to examine the relationship among methadone maintenance treatment, perinatal outcomes, and neonatal abstinence syndrome. STUDY DESIGN: This was a retrospective cohort study of 61,030 singleton births at a large maternity hospital from 2000-2007. RESULTS: There were 618 (1%) women on methadone at delivery. Methadone-exposed women were more likely to be younger, to book late for antenatal care, and to be smokers. Methadone exposure was associated with an increased risk of very preterm birth <32 weeks of gestation (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.40-4.34), being small for gestational age <10th percentile (aOR, 3.27; 95% CI, 2.49-4.28), admission to the neonatal unit (aOR, 9.14; 95% CI, 7.21-11.57), and diagnosis of a major congenital anomaly (aOR, 1.94; 95% CI, 1.10-3.43). There was a dose-response relationship between methadone and neonatal abstinence syndrome. CONCLUSION: Methadone exposure is associated with an increased risk of adverse perinatal outcomes, even when known adverse sociodemographic factors have been accounted for. Methadone dose at delivery is 1 of the determinants of neonatal abstinence syndrome. VL - 204 UR - http://www.sciencedirect.com/science/article/pii/S0002937810012639 IS - 2 ER - TY - JOUR T1 - Interventions for improving outcomes in patients with multimorbidity in primary care and community settings JF - Cochrane Database Syst Rev Y1 - 2012 A1 - Smith, SM A1 - Soubhi, Hassan A1 - Fortin, M A1 - Hudon, Catherine A1 - O'Dowd, T KW - Age Factors KW - Chronic Disease KW - Community Health Services KW - Comorbidity KW - Disease Management KW - Humans KW - Patient-Centered Care KW - Primary Health Care KW - Randomized Controlled Trials as Topic KW - Risk Factors KW - Treatment Outcome AB - BACKGROUND: Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. While this is not a new phenomenon, there is greater recognition of its impact and the importance of improving outcomes for individuals affected. Research in the area to date has focused mainly on descriptive epidemiology and impact assessment. There has been limited exploration of the effectiveness of interventions for multimorbidity. OBJECTIVES: To determine the effectiveness of interventions designed to improve outcomes in patients with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. SEARCH METHODS: We searched MEDLINE, EMBASE, CINAHL, CAB Health, AMED, HealthStar, The Cochrane Central Register of Controlled Trials (CENTRAL), the EPOC Register and the Database of Abstracts of Reviews of Effectiveness (DARE), and the EPOC Register in April 2011. SELECTION CRITERIA: We considered randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs), and interrupted time series analyses (ITS) reporting on interventions to improve outcomes for people with multimorbidity in primary care and community settings. The outcomes included any validated measure of physical or mental health, psychosocial status including quality of life outcomes, well-being, and measures of disability or functional status. We also included measures of patient and provider behaviour including measures of medication adherence, utilisation of health services, and acceptability of services and costs. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for eligibility, extracted data, and assessed study quality. Meta-analysis of results was not possible so we carried out a narrative synthesis of the results from the included studies. MAIN RESULTS: Ten studies examining a range of complex interventions for patients with multimorbidity were identified. All were RCTs and there was low risk of bias. Two of the nine studies focused on specific co-morbidities. The remaining studies focused on multimorbidity, generally in older patients. All studies involved complex interventions with multiple elements. In six of the ten studies, the predominant intervention element was a change to the organisation of care delivery, usually through case management or enhanced multidisciplinary team work. In the remaining four studies, the interventions were predominantly patient oriented. Overall the results were mixed with a trend towards improved prescribing and medication adherence. The results indicate that it is difficult to improve outcomes in this population but that interventions focusing on particular risk factors or functional difficulties in patients with co-morbid conditions or multimorbidity may be more effective. Cost data were limited with no economic analyses included, though the improvements in prescribing and risk factor management in some studies provided potentially significant cost savings. AUTHORS' CONCLUSIONS: This review highlights the paucity of research into interventions to improve outcomes for multimorbidity with the focus to date being on co-morbid conditions or multimorbidity in older patients. The limited results suggest that interventions to date have had mixed effects but have shown a tendency to improve prescribing and medication adherence, particularly if interventions can be targeted at risk factors or specific functional difficulties in people with co-morbid conditions or multimorbidity. There is a need for clear definitions of participants, consideration of appropriate outcomes, and further pragmatic studies based in primary care settings. VL - 4 UR - http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006560.pub2/abstract;jsessionid=D2206ED1424E7EEAA91B88C4BA4F8E11.f03t01 ER - TY - JOUR T1 - Interventions for improving outcomes in patients with multimorbidity in primary care and community settings JF - Cochrane Database of Systematic Reviews Y1 - 2016 A1 - Smith, SM A1 - Wallace, E A1 - O'Dowd, T A1 - Fortin, M KW - Age Factors KW - Chronic Disease [therapy] KW - Community Health Services KW - Comorbidity KW - Disease Management KW - Humans[checkword] KW - Patient-Centered Care [methods] KW - Primary Health Care KW - Randomized Controlled Trials as Topic KW - Risk Factors KW - Treatment Outcome SN - 1465-1858 UR - http://dx.doi.org/10.1002/14651858.CD006560.pub3 IS - 3 ER -