%0 Journal Article %J J Subst Abuse Treat %D 2011 %T Risk of drug-related mortality during periods of transition in methadone maintenance treatment: a cohort study %A Cousins, G %A Teljeur, C %A Motterlini, N %A McCowan, Colin %A Dimitrov, B %A Fahey, T %K Adolescent %K Adult %K Cohort Studies %K Databases, Factual %K Female %K Humans %K Lung Diseases %K Male %K Medical Records %K Methadone %K Middle Aged %K Opiate Substitution Treatment %K Opioid-Related Disorders %K Patient Dropouts %K Prescriptions %K Risk %K Time Factors %K Young Adult %X This study aims to identify periods of elevated risk of drug-related mortality during methadone maintenance treatment (MMT) in primary care using a cohort of 3,162 Scottish drug users between January 1993 and February 2004. Deaths occurring during treatment or within 3 days after last methadone prescription expired were considered as cases "on treatment." Fatalities occurring 4 days or more after leaving treatment were cases "off treatment." Sixty-four drug-related deaths were identified. The greatest risk of drug-related death was in the first 2 weeks of treatment (adjusted hazard ratio 2.60, 95% confidence interval 1.03-6.56). Risk of drug-related death was lower after the first 30 days following treatment cessation, relative to the first 30 days off treatment. History of psychiatric admission was associated with increased risk of drug-related death in treatment. Increasing numbers of treatment episodes and urine testing were protective. History of psychiatric admission, increasing numbers of urine tests, and coprescriptions of benzodiazepines increased the risk of mortality out of treatment. The risk of drug-related mortality in MMT is elevated during periods of treatment transition, specifically treatment initiation and the first 30 days following treatment dropout or discharge. %B J Subst Abuse Treat %V 41 %P 252-60 %8 2011 Oct %G eng %U http://www.sciencedirect.com/science/article/pii/S0740547211000973 %N 3 %R 10.1016/j.jsat.2011.05.001 %0 Journal Article %J Respir Med %D 2011 %T Chronic respiratory disease and multimorbidity: prevalence and impact in a general practice setting %A O'Kelly, Siobhan %A Smith, SM %A Lane, S %A Teljeur, C %A O'Dowd, T %K Adolescent %K Adult %K Aged %K Chronic Disease %K Comorbidity %K Cross-Sectional Studies %K Female %K General Practice %K Humans %K Ireland %K Lung Diseases %K Male %K Middle Aged %K Prevalence %K Socioeconomic Factors %K Urban Health Services %K Young Adult %X BACKGROUND: Multimorbidity is defined as two or more co-existing chronic conditions in an individual and is common in general practice. It is associated with poorer outcomes for patients. This study aimed to establish the prevalence of multimorbidity in patients with chronic respiratory disease in general practice and to describe its impact on health service use. METHODS: Cross-sectional study based in general practice in Dublin. Drug and disease code searches were performed to identify adult patients with a diagnosis of chronic respiratory disease. Medical records were reviewed for chronic respiratory diagnosis, other chronic conditions, demographic characteristics, General Practitioner (GP) and practice nurse utilisation rates, and numbers of medications. RESULTS: In a general practice population of 16,946 patients 3.9% had chronic respiratory disease and 60% of these had one or more co-existing chronic condition(s). GP and practice nurse utilisation rates, and number of medications were significantly higher among those with multimorbidity compared with those with respiratory disease alone. Multivariate analysis showed that increasing age and low socio-economic status were significantly associated with multimorbidity. CONCLUSION: The majority of patients with chronic respiratory disease have multimorbidity. Clinical guidelines based on single disease entities and outcomes are not as easy to implement and may not be as effective in this group. %B Respir Med %V 105 %P 236-42 %8 2011 Feb %G eng %U http://www.sciencedirect.com/science/article/pii/S0954611110003409 %N 2 %R 10.1016/j.rmed.2010.07.019