Patterns of benzodiazepine use and risk of injury in the elderly

Background. Benzodiazepines are sedative-hypnotic medications frequently prescribed in elderly patients for several clinical indications. An association with increased risk for falls has been reported but there is continued debate regarding which specific benzodiazepines are associated with this risk.Objectives. To estimate the risk of injuries from falls associated with benzodiazepine use in an elderly cohort taking into account patient characteristics and changes in patterns of use over time.Methods. Using information from provincial administrative health databases, 462,543 community-dwelling, 66 year old Quebec residents were screened for benzodiazepine use in 1989. Subjects who did not use benzodiazepines in 1989 were observed for the next five years to estimate incidence rates and evaluate patient characteristics associated with new use for thirteen benzodiazepines. Patterns of use for incident users were characterized in terms of duration, dose and frequency of switching or adding benzodiazepines. New methods were developed to model the past cumulative dose and duration of benzodiazepine exposure. The impact of benzodiazepine exposure on risk of injury was estimated using Cox proportional hazards analyses with time-dependent covariates to take into account changes in dose and patterns of use.Results. The overall incidence rate for benzodiazepines was 88.7 per 1,000 person-years, with higher rates in women (95.0) than men (81.8). Predictors of incident use were different in individual products and there were systematic differences between users and non-users. Use of anti-depressants in 1989 was the strongest predictor for incident benzodiazepine use (HR 1.45 to 3.07, p < 0.0001). The median duration for uninterrupted periods of use was 31 days (mean = 75.5 days, sd = 137.2). The mean dose was almost half the recommended maximum adult daily dose and only 8.6% of subjects exceeded the maximum. Older age at date of first prescription significantly increased the likelihood of increasing duration and dose overtime (OR = 1.02, p < 0.0001). All benzodiazepines except clonazeparn were significantly associated with an increased risk of injuries from falls (p < 0.05). The best predictive model for most benzodiazepines included a cumulative measure of duration and current dose.Conclusion. Benzodiazepines are associated with an increased risk of injuries from falls in elderly patients, however duration of exposure may be more critical than dose. Physiological dependence and withdrawal symptoms appear to play an important role in increasing the risk for many benzodiazepines

"Society in Science": the DePGx Project and the Democratization of Helth Policy Strategies through Public Deliberation.

Corradetti, Claudio & Bartlett-Esquilant, Gillian (2011). "Society in Science": the DePGx Project and the Democratization of Helth Policy Strategies through Public Deliberation., In Ethics and Philosophy Center for Applied (ed.), Applied Ethics. Old Wine in New Bottles?. Center for Applied Ethics and Pilosophy. Copyright 2011 by Authors

The role of the excess weight status in the risk of hospitalizations for patients with depression prescribed obesogenic antidepressants

Puzhko S, Schuster T, Renoux C, Barnett TA, Munro K, Bartlett-Esquilant G. The role of the excess weight status in the risk of hospitalizations for patients with depression prescribed obesogenic antidepressants. Pharmacoepidemiology and Drug Safety . 2022;31(Suppl. 2):424-425

Association between annual exposure to air pollution and systolic blood pressure among adolescents in Montréal, Canada

IntroductionIn adults, chronic exposure to air pollution is associated with elevated blood pressure, but few studies have examined this relationship in youth. We investigated the association between annual ambient concentrations of air pollutants (fine particulate matter [PM2.5] and nitrogen dioxide [NO2]) and systolic blood pressure (SBP) among adolescents in Montréal, Canada. MethodsParticipants were students aged 15 to 17 years who provided SBP and residential postal code data in 2004/05 through their enrolment in the Nicotine Dependence in Teens study. Annual estimates for 2004 of residential exposure to NO2 and PM2.5 were provided by the Canadian Urban Environmental Health Research Consortium and linked to participants’ residential postal code. Elevated SBP was defined as SBP ≥ 90th percentile adjusted for age, sex and height. Logistic regression was used to estimate odds ratios and 95% confidence intervals (CIs) for each pollutant with respect to elevated SBP, adjusted for relevant confounders. ResultsThe sample consisted of 508 adolescents (mean age: 16.9, 46% male); 4% had elevated SBP. Although estimates were not statistically significant, there were generally modest positive associations between pollutant levels and SBP. The adjusted prevalence odds ratio of elevated SBP was 1.33 (95% CI: 0.64, 3.05) for every interquartile range (IQR) increase in residential PM2.5 levels (2.1μg/m3). Similarly, the adjusted prevalence odds ratio of elevated SBP was 1.17 (95% CI: 0.47, 2.70) for every IQR increase in residential NO2 levels (10.2 ppb). ConclusionFindings support a possible relationship between exposure to air pollutants and increased SBP in adolescents, warranting further investigation for this important public health concern

Association entre l’exposition annuelle à la pollution atmosphérique et la pression artérielle systolique chez des adolescents à Montréal (Canada)

IntroductionChez l’adulte, l’exposition chronique à la pollution atmosphérique est associée à une élévation de la pression artérielle, mais peu d’études ont porté sur ce lien chez les jeunes. Nous avons étudié l’association entre les concentrations ambiantes annuelles de polluants atmosphériques (particules fines [PM2,5] et dioxyde d’azote [NO2]) et la pression artérielle systolique (PAS) chez des adolescents à Montréal (Canada). MéthodologieLes participants étaient des élèves de 15 à 17 ans ayant fourni des données sur leur PAS et le code postal de leur lieu de résidence en 2004-2005 dans le cadre de l’étude sur la dépendance à la nicotine chez les adolescents (NICO). Les estimations annuelles de l’exposition résidentielle au NO2 et aux PM2,5 pour 2004, fournies par le Canadian Urban Environmental Health Research Consortium, ont été couplées au code postal du lieu de résidence des participants. La PAS a été jugée élevée lorsqu’elle était supérieure ou égale au 90e percentile ajusté pour l’âge, le sexe et la taille. Une régression logistique a servi à estimer les rapports de cotes et les intervalles de confiance (IC) à 95 % pour l’association entre chaque polluant et une PAS élevée, avec ajustement pour les variables de confusion pertinentes. RésultatsL’échantillon comprenait 508 adolescents (âge moyen : 16,9 ans; 46 % étant de sexe masculin), dont 4 % avec une PAS élevée. Même si les estimations ne sont pas statistiquement significatives, des associations positives généralement modestes ont été constatées entre les concentrations de polluants et la PAS. Le rapport de cotes ajusté de la prévalence d’une PAS élevée était de 1,33 (IC à 95 % : 0,64 à 3,05) par augmentation de chaque intervalle interquartile (IIQ) de concentration résidentielle de PM2,5 (2,1 μg/m3). De même, le rapport de cotes ajusté de la prévalence d’une PAS élevée était de 1,17 (IC à 95 % : 0,47 à 2,70) par augmentation de chaque IIQ de concentration résidentielle de NO2 (10,2 ppb). ConclusionLes résultats corroborent l’existence d’un lien possible entre l’exposition aux polluants atmosphériques et l’élévation de la PAS chez les adolescents, ce qui justifie une analyse approfondie portant sur cet important problème de santé publique

Predictors of hospitalization of tuberculosis patients in Montreal, Canada: a retrospective cohort study

Background: Hospitalization is the most costly health system component of tuberculosis (TB) control programs. Our objectives were to identify how frequently patients are hospitalized, and the factors associated with hospitalizations and length-of-stay (LOS) of TB patients in a large Canadian city. Methods: We extracted data from the Montreal TB Resource database, a retrospective cohort of all active TB cases reported to the Montreal Public Health Department between January 1996 and May 2007. Data included patient demographics, clinical characteristics, and dates of treatment and hospitalization. Predictors of hospitalization and LOS were estimated using logistic regression and Cox proportional hazards regression, respectively. Results: There were 1852 active TB patients. Of these, 51% were hospitalized initially during the period of diagnosis and/or treatment initiation (median LOS 17.5 days), and 9.0% hospitalized later during treatment (median LOS 13 days). In adjusted models, patients were more likely to be hospitalized initially if they were children, had co-morbidities, smear-positive symptomatic pulmonary TB, cavitary or miliary TB, and multi- or poly-TB drug resistance. Factors predictive of longer initial LOS included having HIV, renal disease, symptomatic pulmonary smear-positive TB, multi- or poly-TB drug resistance, and being in a teaching hospital. Conclusions: We found a high hospitalization rate during diagnosis and treatment of patients with TB. Diagnostic delay due to low index of suspicion may result in patients presenting with more severe disease at the time of diagnosis. Earlier identification and treatment, through interventions to increase TB awareness and more targeted prevention programs, might reduce costly TB-related hospital use.Medicine, Faculty ofOther UBCNon UBCMedicine, Department ofRespiratory Medicine, Division ofReviewedFacult

Circulaires et annexes (1840-1871)

[Acte. 1840-1871