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Naji L, Dennis B, Rodrigues M, Bawor M, Hillmer A, Chawar C, Deck E, Worster A, Paul J, Thabane L, Samaan Z. Assessing fragility of statistically significant findings from randomized controlled trials assessing pharmacological therapies for opioid use disorders: a systematic review. Trials 2024; 25:286. [PMID: 38678289 PMCID: PMC11055220 DOI: 10.1186/s13063-024-08104-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 04/10/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The fragility index is a statistical measure of the robustness or "stability" of a statistically significant result. It has been adapted to assess the robustness of statistically significant outcomes from randomized controlled trials. By hypothetically switching some non-responders to responders, for instance, this metric measures how many individuals would need to have responded for a statistically significant finding to become non-statistically significant. The purpose of this study is to assess the fragility index of randomized controlled trials evaluating opioid substitution and antagonist therapies for opioid use disorder. This will provide an indication as to the robustness of trials in the field and the confidence that should be placed in the trials' outcomes, potentially identifying ways to improve clinical research in the field. This is especially important as opioid use disorder has become a global epidemic, and the incidence of opioid related fatalities have climbed 500% in the past two decades. METHODS Six databases were searched from inception to September 25, 2021, for randomized controlled trials evaluating opioid substitution and antagonist therapies for opioid use disorder, and meeting the necessary requirements for fragility index calculation. Specifically, we included all parallel arm or two-by-two factorial design RCTs that assessed the effectiveness of any opioid substitution and antagonist therapies using a binary primary outcome and reported a statistically significant result. The fragility index of each study was calculated using methods described by Walsh and colleagues. The risk of bias of included studies was assessed using the Revised Cochrane Risk of Bias tool for randomized trials. RESULTS Ten studies with a median sample size of 82.5 (interquartile range (IQR) 58, 179, range 52-226) were eligible for inclusion. Overall risk of bias was deemed to be low in seven studies, have some concerns in two studies, and be high in one study. The median fragility index was 7.5 (IQR 4, 12, range 1-26). CONCLUSIONS Our results suggest that approximately eight participants are needed to overturn the conclusions of the majority of trials in opioid use disorder. Future work should focus on maximizing transparency in reporting of study results, by reporting confidence intervals, fragility indexes, and emphasizing the clinical relevance of findings. TRIAL REGISTRATION PROSPERO CRD42013006507. Registered on November 25, 2013.
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Affiliation(s)
- Leen Naji
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main St W, 3rdFloor, Hamilton, ON, L8P 1H6, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
- Department of Medicine, Montefiore Medical Center, New York, NY, USA.
| | - Brittany Dennis
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Myanca Rodrigues
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Monica Bawor
- Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Alannah Hillmer
- Department of Psychiatry and Behavaioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Caroul Chawar
- Physician Assistant Program, University of Toronto, Toronto, ON, Canada
| | - Eve Deck
- Department of Family Medicine, Western University, London, ON, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Research Institute at St Joseph's Healthcare, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
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Martin LJ, Bawor M, Bains S, Burns J, Khoshroo S, Massey M, DeJesus J, Lennox R, Cook-Chaimowitz L, O'Shea T, MacKillop J, Dennis BB. Clinical characteristics and prognostic factors among hospitalized patients with substance use disorders: Findings from a retrospective cohort study of a Canadian inpatient addiction medicine service. J Subst Use Addict Treat 2024; 157:209210. [PMID: 37931685 DOI: 10.1016/j.josat.2023.209210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/19/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Inpatient addiction medicine services (AMS) were developed in response to the growing needs of hospitalized individuals with substance use disorders (SUDs). AMS aim to enable timely initiation of pharmacologic treatment, build hospital capacity to support patients who use substances, and facilitate transition to community services. As an emerging service being adopted in hospitals across North America, the model of care, populations served, substance use trends, and clinical trajectory has not been widely described. This work aims to characterize patients accessing care through the AMS, establishing predictors for clinical trajectories in hospital including patient-initiated discharge (PID) and hospital re-admission. METHODS Using a retrospective cohort design, we describe all patients seen by the AMS between 2018 and 2022 across four hospitals in Hamilton, Ontario. Patients seen by AMS were hospitalized and qualified for a SUD based on DSM-V criteria. The study used descriptive statistics to describe the cohort, where appropriate adjusted time-to-event survival models were constructed to identify predictors for hospital re-admission. RESULTS Patients seen by the AMS (n = 695) frequently lacked access to primary care (47.0 %) and less than half (44.3 %) were receiving community addiction services on admission. The majority met criteria for opioid use disorder (OUD), with injecting being the primary consumption route (54.8 %). Patients exhibited high acuity, with 34.2 % requiring critical care measures. Provision of OAT substantially increased to 77.9 % of patients (29 % on admission). PID occurred in 17.8 % of patients and was significantly associated with an admitting diagnosis of suicidal ideation, infection, heart failure, and distinct substance use profiles including methamphetamine, fentanyl, and heroin use (p < 0.05). PID conferred a 66 % increased risk for re-admission (Hazard-Ratio: 1.66; 95 % CI: 1.08, 2.54; p = 0.02). CONCLUSION Patients served by AMS primarily include individuals with OUD presenting with the associated medical complications and substantial deficits in the social determinants of health (e.g., high housing insecurity, poverty, and disability). PID occurs among 1 in 5 people and is associated with higher rates of re-admission. By identifying individuals at higher risk of adverse outcomes, these results provide an opportunity to improve outcomes in this high-risk, high-vulnerability population.
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Affiliation(s)
- Leslie J Martin
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada.
| | - Monica Bawor
- Department of Medicine, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, UK, W68RF.
| | - Supriya Bains
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON L8S4L8, Canada.
| | - Jacinda Burns
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON L8S4L8, Canada.
| | - Saba Khoshroo
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON L8S4L8, Canada.
| | - Myra Massey
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON L8S4L8, Canada.
| | - Jane DeJesus
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON L8S4L8, Canada.
| | - Robin Lennox
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada.
| | - Lauren Cook-Chaimowitz
- Department of Emergency Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada.
| | - Tim O'Shea
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada.
| | - James MacKillop
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON L8S4L8, Canada; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON L8S4L8, Canada.
| | - Brittany B Dennis
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada; British Columbia Centre on Substance Use, Vancouver, BC V6Z2A9, Canada.
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Bawor M, Gu K, Um K, Dennis B, Leong D. Ejection dynamics in native aortic valve stenosis using echocardiography: can it be helpful? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The assessment of aortic stenosis (AS) severity has a major impact on the management of affected patients. Ejection dynamics, including acceleration time (AT), ejection time (ET), and acceleration time/ejection time ratio (AT/ET) measured using doppler echocardiography are established in the evaluation of prosthetic aortic valve stenosis with high sensitivity and specificity. However, their clinical utility in native AS has not been well described.
Purpose
The aim of this systematic review was to evaluate the diagnostic accuracy of ejection dynamics to identify severe AS and to assess whether ejection dynamics can differentiate low flow, low gradient severe AS from pseudo-severe AS.
Methods
We conducted a systematic review of Medline, Embase, and Web of Science from database inception until January 2021. We included observational studies and randomized controlled trials (RCTs) in which the diagnostic accuracy of ejection dynamics by doppler echocardiography for severe AS was compared with standard echocardiographic diagnostic criteria including peak velocity, mean pressure gradient, aortic valve area, and dimensionless index. Studies were eligible if they included AS of at least mild severity. Two authors independently screened and extracted data.
Results
We included 12 studies in the review (RCT=1, observational=11) with a total of 5182 participants. There was significant inconsistency in outcome measurement and reporting of results therefore a meta-analysis was not suitable. We used narrative synthesis to report our results. All included studies used standard echocardiographic criteria to ascertain the presence of severe AS. Mean age was 72 years and 53% of the participants were male. 1983 participants (38.3%) were classified as having severe AS. AT >94–109ms had sensitivity of 74–92% and specificity of 72–89% at identifying severe AS. AT/ET >0.34–0.35 showed sensitivity of 67–77% and specificity of 68–100%. Only one study compared low-flow, low-gradient AS with pseudo-severe AS, showing that an AT >100ms had sensitivity 62%, specificity 76%; and AT/ET >0.33, sensitivity 65%, specificity 84%. Data for ET showed insufficient consistency and diagnostic accuracy.
Conclusions
AT and AT/ET may be useful to corroborate the presence of severe AS. However, more research is needed to understand whether these parameters add incremental prognostic value to standard echocardiographic measures of AS severity.
Funding Acknowledgement
Type of funding sources: None. Summary of evidence search and selection
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Affiliation(s)
- M Bawor
- Queen Elizabeth Hospital, Lewisham & Greenwich NHS Trust, Department of Medicine, London, United Kingdom
| | - K Gu
- McMaster University, Division of Cardiology, Hamilton, Canada
| | - K Um
- McMaster University, Division of Cardiology, Hamilton, Canada
| | - B Dennis
- McMaster University, Division of Cardiology, Hamilton, Canada
| | - D Leong
- Population Health Research Institute, Hamilton, Canada
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Bawor M, Kesse-Adu R, Gardner K, Marino P, Howard J, Webb J. Prevalence of cardiac abnormalities in sickle cell disease identified using cardiac magnetic resonance imaging. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sickle cell disease (SCD) affects thousands of individuals in the United Kingdom causing significant morbidity and mortality. Modern therapies have been successful in increasing life expectancy, however these patients have an increased risk of cardiovascular complications and the extent to which sickle cell disease affects cardiac function is not well understood. Cardiac magnetic resonance imaging (MRI) is the gold standard imaging modality for evaluating myocardial function. It is known that sickle cell patients can present with pulmonary hypertension, left ventricular diastolic dysfunction, and atrial enlargement however the prevalence of other cardiac abnormalities has not been sufficiently investigated with cardiac MRI. In addition, the European Society of Cardiology (ESC) updated their definition of Heart Failure in 2016 and therefore will need to be re-assessed in this population.
Purpose
To evaluate the prevalence of cardiac abnormalities in the sickle cell population using cardiac MRI and based on the recently updated diagnostic criteria.
Methods
We conducted a retrospective review including all patients with sickle cell disease at a large tertiary hospital in London, United Kingdom who had been referred for cardiac MRI between 2011 and 2019. Data was collected data on various measures of cardiac function including: left ventricular ejection fraction (LVEF), left ventricular hypertrophy, left and right atrial enlargement, regional wall motion abnormalities, valvular disease, myocardial scarring, and cardiac iron load.
Results
82 patients and 123 cardiac MRI scans were reviewed in this study. 68% of patients were female and the average age at time of scan was 37 years. The average left ventricular ejection fraction was 57% (n=82). Cardiac abnormalities were identified in 60% of patients. The most common cardiac abnormalities reported were: valvular regurgitation (46%; n=28), left atrial enlargement (28%; n=19), right atrial enlargement (16%; n=11), left ventricular hypertrophy (11%; n=8), regional wall motion abnormalities (10%; n=7), and myocardial scar with late gadolinium enhancement (9%; n=7). 28% of the patients were diagnosed with Heart Failure; 11% of the patients satisfied the diagnostic criteria for HFpEF (Heart failure with preserved ejection fraction, n=9), 10% with HFrEF (Heart Failure with reduced ejection fraction, n=8), and 7% with HFmrEF (Heart Failure with mid-range ejection fraction, n=6).
Conclusion
Sickle cell disease affects cardiac function in the majority of patients resulting in numerous cardiac abnormalities. We have described the overall extent of these effects using data from cardiac MRI scans, which has not been commonly used thus far. This has implications for both the diagnosis and subsequent management of cardiac abnormalities in this population, and it can be used to further investigate and guide the development of targeted treatments for these patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Bawor
- Guys and St Thomas Hospital, London, United Kingdom
| | - R Kesse-Adu
- Guys and St Thomas Hospital, London, United Kingdom
| | - K Gardner
- Guys and St Thomas Hospital, London, United Kingdom
| | - P Marino
- Guys and St Thomas Hospital, London, United Kingdom
| | - J Howard
- Guys and St Thomas Hospital, London, United Kingdom
| | - J Webb
- Guys and St Thomas Hospital, London, United Kingdom
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D’Elia A, Bawor M, Dennis BB, Bhatt M, Litke K, McCabe K, Whattam J, Garrick L, O’Neill L, Simons S, Chalmers S, Key B, Goyert S, Laplante P, Vanstone M, Xie F, Guyatt G, Thabane L, Samaan Z. Feasibility of behavioral activation group therapy in reducing depressive symptoms and improving quality of life in patients with depression: the BRAVE pilot trial. Pilot Feasibility Stud 2020; 6:61. [PMID: 32411381 PMCID: PMC7206724 DOI: 10.1186/s40814-020-00596-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 04/07/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Depression impacts the lives of millions of people worldwide. Behavioral activation (BA), derived from cognitive behavioral therapy, has the potential for improving depressive symptoms in patients with depression. Studies evaluating the effectiveness of BA specifically in the context of group therapy programs in a hospital setting for patients with depression are limited. In this study, we report findings from a pilot trial evaluating group BA for major depressive disorder. OBJECTIVE The objectives of this pilot trial are to assess the potential of a full trial of BA group therapy in a large-scale tertiary care setting and to provide preliminary information about possible results regarding mood symptoms and quality of life in adults with depression. METHODS Using a parallel single-cohort pragmatic pilot randomized controlled trial design, we evaluated the potential of conducting a large trial of BA effectiveness among adults with depression. Participants were randomized to the intervention (BA in addition to usual care) or control (support group in addition to usual care) groups and were assessed weekly for 18 consecutive weeks. Participants randomized to intervention underwent 28 2-h group BA therapy visits administered by trained therapists and completed assessments to examine treatment outcomes. Feasibility was measured in terms of enrollment rates (min. 20%), completion rates of study (min. 80%), and completion rates of weekly measurement scales (min. 80%). The reporting of this pilot trial is in accordance with the CONSORT extension for randomized pilot and feasibility trials. RESULTS We randomized 20 individuals of mean age of 48.8 years (standard deviation = 9.7) with a DSM-5 diagnosis of major depressive disorder to intervention (n = 10) or control (n = 10) groups. Based on our feasibility criteria, our recruitment rate was excellent (20/27; 74%), study completion was found to be a moderate (80% of the total participants in both arms completed the study; BA = 100%, control = 60%), and completeness of measurements on a weekly basis was adequate overall (82%; BA = 86%, control = 79%). CONCLUSIONS The study has demonstrated the potential feasibility to perform a larger scale trial upon modifications to the control group to avoid the low rate of study completion (60%) in this group. TRIAL REGISTRATION ClinicalTrials NCT02045771, Registered January 22, 2014.
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Affiliation(s)
- Alessia D’Elia
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 100 West 5th Street, Hamilton, ON Canada
| | - Monica Bawor
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 100 West 5th Street, Hamilton, ON Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Brittany B. Dennis
- Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W, Hamilton, ON Canada
- Department of Health Research, Evidence and Impact, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Meha Bhatt
- Department of Health Research, Evidence and Impact, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Kathryn Litke
- Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Kathleen McCabe
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 100 West 5th Street, Hamilton, ON Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, 100 West 5th St, Hamilton, ON Canada
| | - Jeff Whattam
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, 100 West 5th St, Hamilton, ON Canada
| | - Laura Garrick
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, 100 West 5th St, Hamilton, ON Canada
| | - Laura O’Neill
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 100 West 5th Street, Hamilton, ON Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, 100 West 5th St, Hamilton, ON Canada
| | - Scott Simons
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, 100 West 5th St, Hamilton, ON Canada
| | - Sandra Chalmers
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, 100 West 5th St, Hamilton, ON Canada
| | - Brenda Key
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 100 West 5th Street, Hamilton, ON Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, 100 West 5th St, Hamilton, ON Canada
| | - Stefanie Goyert
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, 100 West 5th St, Hamilton, ON Canada
| | - Phillip Laplante
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 100 West 5th Street, Hamilton, ON Canada
| | - Meredith Vanstone
- Department of Health Research, Evidence and Impact, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Feng Xie
- Department of Health Research, Evidence and Impact, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Gordon Guyatt
- Department of Health Research, Evidence and Impact, McMaster University, 1280 Main St. W, Hamilton, ON Canada
- Department of Medicine, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Lehana Thabane
- Department of Health Research, Evidence and Impact, McMaster University, 1280 Main St. W, Hamilton, ON Canada
- Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, ON Canada
- System-Linked Research Unit, McMaster University, 1280 Main St. W, Hamilton, ON Canada
- Department of Anesthesia, McMaster University, 1280 Main St. W, Hamilton, ON Canada
- Department of Pediatrics, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 100 West 5th Street, Hamilton, ON Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W, Hamilton, ON Canada
- Department of Health Research, Evidence and Impact, McMaster University, 1280 Main St. W, Hamilton, ON Canada
- Mood Disorders Program, St. Joseph’s Healthcare Hamilton, 100 West 5th St, Hamilton, ON Canada
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Dennis BB, Sanger N, Bawor M, Naji L, Plater C, Worster A, Woo J, Bhalerao A, Baptist-Mohseni N, Hillmer A, Rice D, Corace K, Hutton B, Tugwell P, Thabane L, Samaan Z. A call for consensus in defining efficacy in clinical trials for opioid addiction: combined results from a systematic review and qualitative study in patients receiving pharmacological assisted therapy for opioid use disorder. Trials 2020; 21:30. [PMID: 31907000 PMCID: PMC6945391 DOI: 10.1186/s13063-019-3995-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background Given the complex nature of opioid addiction treatment and the rising number of available opioid substitution and antagonist therapies (OSAT), there is no ‘gold standard’ measure of treatment effectiveness, and each successive trial measures a different set of outcomes which reflect success in arbitrary or opportune terms. We sought to describe the variation in current outcomes employed across clinical trials for opioid addiction, as well as determine whether a discrepancy exists between the treatment targets that patients consider important and how treatment effectiveness is measured in the literature. Methods We searched nine commonly used databases (e.g., EMBASE, MEDLINE) from inception to August 1, 2015. Outcomes used across trials were extracted and categorized according to previously established domains. To evaluate patient-reported goals of treatment, semi-structured interviews were conducted with 18 adults undergoing methadone treatment. Results We identified 60 trials eligible for inclusion. Once outcomes were categorized into eight broad domains (e.g., abstinence/substance abuse), we identified 21 specific outcomes with furthermore 53 subdomains and 118 measurements. Continued opioid use and treatment retention were the most commonly reported measures (46%, n = 28). The majority of patients agreed that abstinence from opioids was a primary goal in their treatment, although they also stressed goals under-reported in clinical trials. Conclusions There is inconsistency in the measures used to evaluate the effectiveness of OSATs. Individual and population level decision making is being guided by a standard of effect considered useful to researchers yet in direct conflict with what patients deem important. Trial registration PROSPERO, CRD42013006507.
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Affiliation(s)
- Brittany B Dennis
- McMaster University Internal Medicine Residency Program, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Nitika Sanger
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Monica Bawor
- McMaster University Internal Medicine Residency Program, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Leen Naji
- Department of Family Medicine Residency Program, Michael G. Degroote School of Medicine, McMaster University, Hamilton, Canada
| | - Carolyn Plater
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Medicine, Hamilton General Hospital, Hamilton, Canada
| | - Julia Woo
- University of Toronto Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Anuja Bhalerao
- University of Toronto Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Natasha Baptist-Mohseni
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Alannah Hillmer
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Danielle Rice
- Faculty of Science, Department of Psychology, McGill University, Montreal, Canada.,Center for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kim Corace
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tugwell
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Centre for Evaluation of Medicine, Hamilton, Canada.,System Linked Research Unit, Hamilton, Canada
| | - Zainab Samaan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada. .,Population Genomics Program, Chanchlani Research Center, McMaster University, Hamilton, Canada.
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Naji L, Randhawa H, Sohani Z, Dennis B, Lautenbach D, Kavanagh O, Bawor M, Banfield L, Profetto J. Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis. Ann Fam Med 2018; 16. [PMID: 29531107 PMCID: PMC5847354 DOI: 10.1370/afm.2205] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Although the digital rectal examination (DRE) is commonly performed to screen for prostate cancer, there is limited data to support its use in primary care. This review and meta-analysis aims to evaluate the diagnostic accuracy of DRE in screening for prostate cancer in primary care settings. METHODS We searched MEDLINE, Embase, DARE (Database of Abstracts of Reviews of Effects), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) from their inception to June 2016. Six reviewers, in pairs, independently screened citations for eligibility and extracted data. Pooled estimates were calculated for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DRE in primary care settings using an inverse-variance meta-analysis. We used QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) and GRADE (Grades of Recommendation Assessment, Development, and Evaluation) guidelines to assess study risk of bias and quality. RESULTS Our search yielded 8,217 studies, of which 7 studies with 9,241 patients were included after the screening process. All patients analyzed underwent both DRE and biopsy. Pooled sensitivity of DRE performed by primary care clinicians was 0.51 (95% CI, 0.36-0.67; I2 = 98.4%) and pooled specificity was 0.59 (95% CI, 0.41-0.76; I2 = 99.4%). Pooled PPV was 0.41 (95% CI, 0.31-0.52; I2 = 97.2%), and pooled NPV was 0.64 (95% CI, 0.58-0.70; I2 = 95.0%). The quality of evidence as assessed with GRADE was very low. CONCLUSION Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting.
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Affiliation(s)
- Leen Naji
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Harkanwal Randhawa
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Zahra Sohani
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Deanna Lautenbach
- Profetto-Savatteri Family Medicine, McMaster University, Hamilton, Canada
| | - Owen Kavanagh
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Monica Bawor
- St George's University of London, London, United Kingdom
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Canada
| | - Jason Profetto
- Department of Family Medicine, McMaster University, Hamilton, Canada
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Samaan Z, Dennis B, Bawor M, Bhatt M, Zielinski L, Sanger N, Thabane L. Chronic pain in patients with opioid use disorder receiving methadone. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Mouravska N, Zielinski L, Bhatt M, Sanger N, Bawor M, Dennis B, Banfield L, MacKillop J, Paul J, Worster A, Laplante P, Thabane L, Samaan Z. Adverse outcomes associated with opioid prescription for acute low back pain: a systematic review protocol. Syst Rev 2017; 6:163. [PMID: 28807047 PMCID: PMC5557568 DOI: 10.1186/s13643-017-0556-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 08/01/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Acute low back pain (ALBP) is the top cause of global disability, demonstrating a significant impact on individuals and society and demanding the need for appropriate management. There is a trend towards an increasing number of opioid prescriptions for ALBP despite the lack of investigation for its various short- and long-term outcomes. The objective of this review is to examine adverse outcomes associated with opioid use for ALBP. METHODS/DESIGN Using a search strategy, the search will be conducted using the following electronic databases: PubMed/MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Cochrane Library, the National Institutes for Health Clinical Trials Registry and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We will include randomized clinical trials and observational studies investigating the impact of opioid use in ALBP in the adult population. All phases of screening, data extraction and assessment of methodological quality will be performed by two independent reviewers. We will perform quality and risk of bias assessment for the included articles and compare high and low risk of bias with a sensitivity analysis. We will conduct random- and fixed-effects meta-analyses with heterogeneity calculated using the I 2 statistic and evaluate publication bias. DISCUSSION There are current guidelines published to alert clinicians in prescribing opioids for ALBP due to its likelihood of misuse, yet there is little change in prescribing patterns. To date, there is an absence of systematic information about the outcomes of prescription opioid in patients with ALBP. We will address this gap by providing evidence that will be useful for clinical practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033090.
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Affiliation(s)
- Natalia Mouravska
- Juravinski Hospital, Hamilton Health Sciences, 711 Concession Street, Hamilton, ON, L8V 1C1, Canada.,Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Laura Zielinski
- Juravinski Hospital, Hamilton Health Sciences, 711 Concession Street, Hamilton, ON, L8V 1C1, Canada.,Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Meha Bhatt
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Health Research Methodology Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Nitika Sanger
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Monica Bawor
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Brittany Dennis
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Laura Banfield
- Health Science Library, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - James Paul
- Department of Anaesthesia, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Andrew Worster
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.,Department of Medicine, Hamilton General Hospital, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
| | - Philip Laplante
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Biostatistics Unit, Research Institute at St Joes, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue E, Hamilton, ON, L8N 4A6, Canada
| | - Zainab Samaan
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada. .,MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada. .,Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St, Hamilton, ON, L8N 3K7, Canada.
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10
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Naji L, Dennis BB, Bawor M, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, MacKillop J, Thabane L, Samaan Z. The association between age of onset of opioid use and comorbidity among opioid dependent patients receiving methadone maintenance therapy. Addict Sci Clin Pract 2017; 12:9. [PMID: 28347350 PMCID: PMC5369183 DOI: 10.1186/s13722-017-0074-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/04/2017] [Indexed: 12/03/2022] Open
Abstract
Background Opioid use disorder (OUD) affects approximately 21.9 million people worldwide. This study aims to determine the association between age of onset of opioid use and comorbid disorders, both physical and psychiatric, in patients receiving methadone maintenance treatment (MMT) for OUD. Understanding this association may inform clinical practice about important prognostic factors of patients on MMT, enabling clinicians to identify high-risk patients. Methods This study includes data collected between June 2011 and August 2016 for the Genetics of Opioid Addiction research collaborative between McMaster University and the Canadian Addiction Treatment Centers. All patients were interviewed by trained health professionals using the Mini-International Neuropsychiatric Interview and case report forms. Physical comorbidities were verified using patients’ electronic medical records. A multi-variable logistic regression model was constructed to determine the strength of the association between age of onset of opioid use and the presence of physical or psychiatric comorbidity while adjusting for current age, sex, body mass index, methadone dose and smoking status. Results Data from 627 MMT patients with a mean age of 38.8 years (SD = 11.07) were analyzed. Individuals with an age of onset of opioid use younger than 18 years were found to be at higher odds for having a physical or psychiatric comorbid disorder compared to individuals with an age of onset of opioid use of 31 years or older (odds ratio 2.94, 95% confidence interval 1.20, 7.19, p = 0.02). A significant association was not found between the risk of having a comorbidity and an age of onset of opioid use between 18 and 25 years or 26 and 30 years, compared to an age of onset of opioid use of 31 years or older. Conclusion Our study demonstrates that the younger one begins to use opioids, the greater their chance of having a physical or psychiatric co-morbidity. Understanding the risk posed by an earlier onset of opioid use for the later development of comorbid disorders informs clinical practice about important prognostic predictors and aids in the identification of high-risk patients.
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Affiliation(s)
- Leen Naji
- Michael Degroote School of Medicine, McMaster University, Hamilton, Canada
| | - Brittany Burns Dennis
- St. George's University of London, London, UK.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | | | | | - Jeff Daiter
- Canadian Addiction Treatment Centres, Richmond Hill, Canada
| | - Carolyn Plater
- Canadian Addiction Treatment Centres, Richmond Hill, Canada
| | - Guillaume Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - David C Marsh
- Canadian Addiction Treatment Centres, Richmond Hill, Canada.,Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Andrew Worster
- Canadian Addiction Treatment Centres, Richmond Hill, Canada.,Department of Medicine, Hamilton General Hospital, Hamilton, Canada
| | - Dipika Desai
- Population Genomic Program, Chanchalani Research Centre, McMaster University, Hamilton, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, Hamilton, Canada.,Department of Psychiatry and Behavioural Neuroscience, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Lehana Thabane
- Departments of Pediatrics and Anesthesia, McMaster University, Hamilton, Canada.,Centre for Evaluation of Medicine, St Joseph's Healthcare, Hamilton, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. .,Population Genomic Program, Chanchalani Research Centre, McMaster University, Hamilton, Canada. .,Peter Boris Centre for Addictions Research, Hamilton, Canada. .,Department of Psychiatry and Behavioural Neuroscience, McMaster University, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.
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11
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Woo J, Bhalerao A, Bawor M, Bhatt M, Dennis B, Mouravska N, Zielinski L, Samaan Z. "Don't Judge a Book Its Cover": A Qualitative Study of Methadone Patients' Experiences of Stigma. Subst Abuse 2017; 11:1178221816685087. [PMID: 28469424 PMCID: PMC5398333 DOI: 10.1177/1178221816685087] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/29/2016] [Indexed: 11/23/2022]
Abstract
Introduction: Despite its efficacy and widespread use, methadone maintenance treatment (MMT) continues to be widely stigmatized. Reducing the stigma surrounding MMT will help improve the accessibility, retention, and treatment outcomes in MMT. Methods: Semi-structured interviews were conducted with 18 adults undergoing MMT. Thematic content analysis was used to identify overarching themes. Results: In total, 78% of participants reported having experienced stigma surrounding MMT. Common stereotypes associated with MMT patients included the following: methadone as a way to get high, incompetence, untrustworthiness, lack of willpower, and heroin junkies. Participants reported that stigma resulted in lower self-esteem; relationship conflicts; reluctance to initiate, access, or continue MMT; and distrust toward the health care system. Public awareness campaigns, education of health care workers, family therapy, and community meetings were cited as potential stigma-reduction strategies. Discussion and Conclusion: Stigma is a widespread and serious issue that adversely affects MMT patients’ quality of life and treatment. More efforts are needed to combat MMT-related stigma.
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Affiliation(s)
- Julia Woo
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Anuja Bhalerao
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Monica Bawor
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Meha Bhatt
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Brittany Dennis
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Natalia Mouravska
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Laura Zielinski
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
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12
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Dehghan M, Ge Y, El Sheikh W, Bawor M, Rangarajan S, Dennis B, Vair J, Sholer H, Hutchinson N, Iordan E, Mackie P, Samaan Z. Comparability of a short food frequency questionnaire to assess diet quality: the DISCOVER study. Int J Food Sci Nutr 2017; 68:726-732. [PMID: 28100088 DOI: 10.1080/09637486.2016.1276520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aims to assess comparability of a short food frequency questionnaire (SFFQ) used in the Determinants of Suicide: Conventional and Emergent Risk Study (DISCOVER Study) with a validated comprehensive FFQ (CFFQ). A total of 127 individuals completed SFFQ and CFFQ. Healthy eating was measured using Healthy Eating Score (HES). Estimated food intake and healthy eating assessed by SFFQ was compared with the CFFQ. For most food groups and HES, the highest Spearman's rank correlation coefficients between the two FFQs were r > .60. For macro-nutrients, the correlations exceeded 0.4. Cross-classification of quantile analysis showed that participants were classified between 46% and 81% into the exact same quantiles, while 10% or less were misclassified into opposite quantiles. The Bland-Altman plots showed an acceptable level of agreement between the two dietary measurement methods. The SFFQ can be used for Canadian with psychiatric disorders to rank them based on their dietary intake.
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Affiliation(s)
- Mahshid Dehghan
- a Population Health Research Institute, Department of Medicine, McMaster University , Hamilton , ON , Canada
| | - Yipeng Ge
- a Population Health Research Institute, Department of Medicine, McMaster University , Hamilton , ON , Canada
| | - Wala El Sheikh
- a Population Health Research Institute, Department of Medicine, McMaster University , Hamilton , ON , Canada
| | - Monica Bawor
- b Population Genomics Program, Chanchlani Research Centre, Department of Medicine, McMaster University , Hamilton , ON , Canada
| | - Sumathy Rangarajan
- a Population Health Research Institute, Department of Medicine, McMaster University , Hamilton , ON , Canada
| | - Brittany Dennis
- c Population Genomics Program, Chanchlani Research Centre, McMaster University , Hamilton , ON , Canada
| | - Judith Vair
- d St. Joseph's Healthcare Hamilton , Hamilton , ON , Canada
| | - Heather Sholer
- d St. Joseph's Healthcare Hamilton , Hamilton , ON , Canada
| | | | | | - Pam Mackie
- a Population Health Research Institute, Department of Medicine, McMaster University , Hamilton , ON , Canada
| | - Zainab Samaan
- e Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , ON , Canada
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13
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Rosic T, Naji L, Bawor M, Dennis BB, Plater C, Marsh DC, Thabane L, Samaan Z. The impact of comorbid psychiatric disorders on methadone maintenance treatment in opioid use disorder: a prospective cohort study. Neuropsychiatr Dis Treat 2017; 13:1399-1408. [PMID: 28579787 PMCID: PMC5449137 DOI: 10.2147/ndt.s129480] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE There is a significant interindividual variability in treatment outcomes in methadone maintenance treatment (MMT) for opioid use disorder (OUD). This prospective cohort study examines the impact of comorbid psychiatric disorders on continued illicit opioid use in patients receiving MMT for OUD. METHODS Data were collected from 935 patients receiving MMT in outpatient clinics between June 2011 and June 2015. Using linear regression analysis, we evaluated the impact of having a comorbid psychiatric disorder on continued illicit opioid use during MMT, adjusting for important confounders. The main outcome measure was percentage of opioid-positive urine screens for 6 months. We conducted a subgroup analysis to determine the influence of specific comorbid psychiatric disorders, including substance use disorders, on continued illicit opioid use. RESULTS Approximately 80% of participants had at least one comorbid psychiatric disorder in addition to OUD, and 42% of participants had a comorbid substance use disorder. There was no significant association between having a psychiatric comorbidity and continuing opioid use (P=0.248). Results from subgroup analysis, however, suggest that comorbid tranquilizer (β=20.781, P<0.001) and cocaine (β=6.344, P=0.031) use disorders are associated with increased rates of continuing opioid use. CONCLUSION Results from our study may serve to guide future MMT guidelines. Specifically, we find that cocaine or tranquilizer use disorder, comorbid with OUD, places patients at high risk for poor MMT outcomes. Treatment centers may choose to gear more intensive therapy toward such populations.
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Affiliation(s)
| | - Leen Naji
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | - Lehana Thabane
- Biostatistics Unit, Research Institute, St Joseph's Healthcare.,Department of Clinical Epidemiology and Biostatistics, McMaster University.,Peter Boris Centre for Addictions Research
| | - Zainab Samaan
- Biostatistics Unit, Research Institute, St Joseph's Healthcare.,Department of Clinical Epidemiology and Biostatistics, McMaster University.,Peter Boris Centre for Addictions Research.,Mood Disorders Research Unit, St Joseph's Healthcare.,Population Genomics Program, Chanchlani Research Centre.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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14
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Dennis BB, Bawor M, Paul J, Plater C, Pare G, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Thabane L, Samaan Z. Pain and Opioid Addiction: A Systematic Review and Evaluation of Pain Measurement in Patients with Opioid Dependence on Methadone Maintenance Treatment. ACTA ACUST UNITED AC 2016; 9:49-60. [PMID: 27021147 DOI: 10.2174/187447370901160321102837] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 01/25/2016] [Accepted: 01/28/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND While chronic pain has been said to impact patient's response to methadone maintenance treatment for opioid dependence, the reported findings are inconsistent. These discrepancies may be a direct result of variations in the measurement of chronic pain or definitions of response to methadone treatment. The goal of this study is to evaluate the association between pain and substance use behaviour to determine the real impact of comorbid pain in the methadone population. We also aim to examine sources of variation across the literature with a specific focus on the measurement of pain. METHODS/DESIGN We performed a systematic review using an electronic search strategy across CINAHL, MEDLINE, Web of Science, PsychINFO, EMBASE, and the Cochrane Library including Cochrane Reviews and the Cochrane Central Register of Controlled Trials databases. Title, abstract, as well as full text screening and extraction were performed in duplicate. Studies evaluating the association between chronic pain and methadone maintenance treatment response were eligible for inclusion in this review. Using a sample of 297 methadone patients from the Genetics of Opioid Addiction (GENOA) research collaborative, we assessed the reliability of patient self-reported pain and the validated Brief Pain Inventory (BPI) assessment tool. RESULTS After screening 826 articles we identified five studies eligible for full text extraction, of which three showed a significant relationship between the presence of pain and the increase in substance abuse among patients on methadone for the treatment of opioid dependence. Studies varied largely in the definitions and measurement of both pain and response to treatment. Results from our validation of pain measurement in the GENOA sample (n=297) showed the use of a simple self-reported pain question is highly correlated to the use of the BPI. Simply asking patients whether they have pain showed a 44.2% sensitivity, 88.8% specificity, 84.4% PPV and 53.6% NPV to the BPI. The area under the ROC curve was 0.67 and the Pearson χ(2) was 37.3; (p<0.0001). DISCUSSION The field of addiction medicine is at a lack of consensus as to the real effect of chronic pain on treatment response among opioid dependent patients. Whether it be the lack of a single "gold standard" measurement of response, or a lack of consistent measurement of pain, it is difficult to summarize and compare the results of these relatively small investigations. In comparison to the BPI, use of the simple self-reported pain has lower sensitivity for identifying patients with pain, suggesting the inconsistencies in these studies may result from differences in pain measurement. Future validation studies of pain measurement are required to address the predictive value of self-reported pain.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Z Samaan
- Department of Psychiatry and Behavioural Neuroscience McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, Ontario, Canada.
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15
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Samaan Z, Dennis BB, Kalbfleisch L, Bami H, Zielinski L, Bawor M, Litke K, McCabe K, Whattam J, Garrick L, O'Neill L, Tabak TA, Simons S, Chalmers S, Key B, Vanstone M, Xie F, Guyatt G, Thabane L. Behavioral activation group therapy for reducing depressive symptoms and improving quality of life: a feasibility study. Pilot Feasibility Stud 2016; 2:22. [PMID: 27965841 PMCID: PMC5154036 DOI: 10.1186/s40814-016-0064-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 04/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is associated with a loss of productivity and noticeable personal, social, and economic decline; it affects more than 350 million people worldwide. Behavioral activation (BA), derived from cognitive behavioral therapy, has drawn increasingly more interest as a means of treatment for major depressive disorder due to its relative cost-effectiveness and efficacy. In this study, we disseminate findings from a feasibility study evaluating barriers to implementing a group BA program for major depressive disorder. The purpose of this feasibility study is to assess both patient and clinician perceptions on components of a group-based behavioral activation (BA) program. In particular, this feasibility study provides in-depth evaluation of the acceptability of BA prior to the design and implementation of a randomized trial to investigate BA effectiveness. Findings from this study directly informed decisions regarding the design and implementation of BA during the pilot trial. Specific components of BA were assessed and modified based on the results of this study. METHODS This qualitative study was completed through the Mood Disorders Program at St. Joseph's Healthcare Hamilton. The authors of this study used data from two focus group sessions, one consisting of an interdisciplinary group of clinicians working in the Mood Disorders Program, and the other of registered outpatients of the Mood Disorders Program with a confirmed clinical diagnosis of depression. The benefits of offering this program in a group format, mainly social skill development opportunities and the use of technology such as activity tracking device, smart phones, and tablets during the therapy sessions, are a major focus of both the clinician and patient groups. Both groups emphasized the importance of offering sustainable activation. RESULTS Differences in opinions existed between staff and patient groups regarding the use of technology in the program, though ultimately it was agreed upon that technology could be useful as a therapeutic aid. All participants agreed that behavioral activation was essential to the development of positive habits and routines necessary for recovery from depression. Patients agreed the program looked sustainable and stressed the potential benefit for improving depressive symptoms. CONCLUSIONS Discussions from clinician and patient-centered focus groups directly informed decisions regarding the design and implementation of BA during the pilot trial. Specific components of BA were assessed and modified based on the results of this study. These findings provide insight for clinicians providing behavioral activation programming, and will serve as a framework for the development of the Out of the Blues program, a group-based BA program to be piloted in the Mood Disorders Program at St. Joseph's Healthcare Hamilton. TRIAL REGISTRATION Clinical Trials registration number NCT02045771.
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Affiliation(s)
- Zainab Samaan
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Brittany B Dennis
- St. George's University of London, Cranmer Terrace, London, UK ; Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Lindsay Kalbfleisch
- Recreational Therapy Program, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Herman Bami
- Faculty of Health Science, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Laura Zielinski
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Monica Bawor
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; St. George's University of London, Cranmer Terrace, London, UK
| | - Kathryn Litke
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Kathleen McCabe
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Jeff Whattam
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Laura Garrick
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Laura O'Neill
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Terri Ann Tabak
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Scott Simons
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Sandra Chalmers
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Brenda Key
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Meredith Vanstone
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Feng Xie
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Gordon Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Medicine, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Biostatistics Unit, Centre for Evaluation of Medicine, ON, Canada ; System-Linked Research Unit, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Anaesthesia, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Paediatrics, McMaster University, 1280 Main St. W, Hamilton, ON Canada
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16
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Dennis BB, Roshanov PS, Bawor M, ElSheikh W, Garton S, DeJesus J, Rangarajan S, Vair J, Sholer H, Hutchinson N, Lordan E, Thabane L, Samaan Z. Re-examination of classic risk factors for suicidal behavior in the psychiatric population. Crisis 2016; 36:231-40. [PMID: 26440619 PMCID: PMC4614877 DOI: 10.1027/0227-5910/a000342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract.Background: For decades we have understood the risk factors for
suicide in the general population but have fallen short in understanding what
distinguishes the risk for suicide among patients with serious psychiatric
conditions. Aims: This prompted us to investigate risk factors
for suicidal behavior among psychiatric inpatients. Method: We
reviewed all psychiatric hospital admissions (2008–2011) to a centralized
psychiatric hospital in Ontario, Canada. Using multivariable logistic regression
we evaluated the association between potential risk factors and lifetime history
of suicidal behavior, and constructed a model and clinical risk score to predict
a history of this behavior. Results: The final risk prediction
model for suicidal behavior among psychiatric patients (n =
2,597) included age (in three categories: 60–69 [OR = 0.74, 95%
CI = 0.73–0.76], 70–79 [OR = 0.45, 95% CI = 0.44–0.46], 80+
[OR = 0.31, 95% CI = 0.30–.31]), substance use disorder
(OR = 1.30, 95% CI = 1.27–1.32), mood disorder
(OR = 1.49, 95% CI = 1.47–1.52), personality disorder
(OR = 2.30, 95% CI = 2.25–2.36), psychiatric disorders due
to general medical condition (OR = 0.52, 95% CI = 0.50–0.55),
and schizophrenia (OR = 0.42, 95% CI = 0.41–0.43). The risk
score constructed from the risk prediction model ranges from −9 (lowest risk, 0%
predicted probability of suicidal behavior) to +5 (highest risk, 97% predicted
probability). Conclusion: Risk estimation may help guide
intensive screening and treatment efforts of psychiatric patients with high risk
of suicidal behavior.
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Affiliation(s)
- Brittany B Dennis
- 1 St. George's University of London, UK.,2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Pavel S Roshanov
- 3 Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Monica Bawor
- 1 St. George's University of London, UK.,4 McMaster Integrative Neuroscience and Discovery Program, McMaster University, Hamilton, ON, Canada
| | - Wala ElSheikh
- 5 Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada
| | - Sue Garton
- 6 St. Joseph's Healthcare Hamilton, ON, Canada
| | - Jane DeJesus
- 5 Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- 5 Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada
| | - Judith Vair
- 6 St. Joseph's Healthcare Hamilton, ON, Canada
| | | | | | | | - Lehana Thabane
- 2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- 2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,7 Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.,8 Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, ON, Canada
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17
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Perera S, Eisen RB, Dennis BB, Bawor M, Bhatt M, Bhatnagar N, Thabane L, de Souza R, Samaan Z. Body Mass Index Is an Important Predictor for Suicide: Results from a Systematic Review and Meta-Analysis. Suicide Life Threat Behav 2016; 46:697-736. [PMID: 27094229 DOI: 10.1111/sltb.12244] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 01/12/2016] [Indexed: 12/21/2022]
Abstract
Public health concerns for the independent management of obesity and suicidal behavior are rising. Emerging evidence suggests body weight plays an important role in quantifying the risk of suicide. In light of these findings, we aimed to clarify the association between body mass index (BMI) and suicidal behavior by systematically reviewing and evaluating the literature. Studies were identified by searching MEDLINE, EMBASE, PsycINFO, and CINAHL from inception to January 2015, supplemented by hand and grey literature searches. Study screening, data extraction, and risk of bias assessment were conducted in duplicate. We included 38 observational studies. Meta-analyses supported an inverse association between BMI and completed suicide. Pooled summary estimates demonstrated that underweight was significantly associated with an increased risk of completed suicide (HR = 1.21, 95% CI 1.07 to 1.36, p = .002), and obesity (HR = 0.71, 95% CI 0.56 to 0.89, p = .003) and overweight (HR = 0.78, 95% CI 0.75 to 0.82, p < .0001) were significantly associated with a decreased risk of completed suicide relative to normal weight. A qualitative summary of the literature demonstrated conflicting evidence regarding the association between BMI and attempted suicide and revealed no association between BMI and suicidal ideation. BMI may be used to aid the assessment of suicide risk, especially that of completed suicide. However, unmeasured confounders and systematic biases of individual studies limit the quality of evidence.
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Affiliation(s)
- Stefan Perera
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Rebecca B Eisen
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Monica Bawor
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Meha Bhatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Neera Bhatnagar
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, ON, Canada
| | - Russell de Souza
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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18
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Samaan Z, McDermid Vaz S, Bawor M, Potter TH, Eskandarian S, Loeb M. Neuropsychological Impact of West Nile Virus Infection: An Extensive Neuropsychiatric Assessment of 49 Cases in Canada. PLoS One 2016; 11:e0158364. [PMID: 27352145 PMCID: PMC4924871 DOI: 10.1371/journal.pone.0158364] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 06/14/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND West Nile virus emerged as an important human pathogen in North America and continues to pose a risk to public health. It can cause a highly variable range of clinical manifestations ranging from asymptomatic to severe illness. Neuroinvasive disease due to West Nile virus can lead to long-term neurological deficits and psychological impairment. However, these deficits have not been well described. The objective of this study was to characterize the neuropsychological manifestations of West Nile virus infection with a focus on neuroinvasive status and time since infection. METHODS Patients from Ontario Canada with a diagnosis of neuroinvasive disease (meningitis, encephalitis, or acute flaccid paralysis) and non-neuroinvasive disease who had participated in a cohort study were enrolled. Clinical and laboratory were collected, as well as demographics and medical history. Cognitive functioning was assessed using a comprehensive battery of neuropsychological tests. RESULTS Data from 49 individuals (32 with West Nile fever and 17 with West Nile neuroinvasive disease) were included in the present cross-sectional analysis. Patterns of neuropsychological impairment were comparable across participants with both neuroinvasive and non-neuroinvasive West Nile virus infection on all cognitive measures. Neuropsychiatric impairment was also observed more frequently at two to four years post-infection compared to earlier stages of illness. CONCLUSIONS Our data provide objective evidence for cognitive difficulties among patients who were infected with West Nile virus; these deficits appear to manifest regardless of severity of West Nile virus infection (West Nile fever vs. West Nile neuroinvasive disease), and are more prevalent with increasing illness duration (2-4 years vs. 1 month). Data from this study will help inform patients and healthcare providers about the expected course of recovery, as well as the need to implement effective treatment strategies that include neuropsychological interventions.
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Affiliation(s)
- Zainab Samaan
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie McDermid Vaz
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Cleghorn Early Intervention in Psychosis Program, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Monica Bawor
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Tammy Hlywka Potter
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Sasha Eskandarian
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
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19
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Eisen RB, Perera S, Bawor M, Dennis BB, El-Sheikh W, DeJesus J, Rangarajan S, Vair J, Sholer H, Hutchinson N, Iordan E, Mackie P, Islam S, Dehghan M, Brasch J, Anglin R, Minuzzi L, Thabane L, Samaan Z. Exploring the Association between Serum BDNF and Attempted Suicide. Sci Rep 2016; 6:25229. [PMID: 27121496 PMCID: PMC4848497 DOI: 10.1038/srep25229] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/12/2016] [Indexed: 12/20/2022] Open
Abstract
Suicide is a leading cause of death and a significant public health concern. Brain-derived neurotrophic factor (BDNF), a protein important to nervous system function, has been implicated in psychiatric disorders and suicidal behaviour. We investigated the association between serum levels of BDNF and attempted suicide in a sample of 281 participants using a case-control study design. Participants were recruited from clinical and community settings between March 2011 and November 2014. Cases (individuals who had attempted suicide) (n = 84) were matched on sex and age (within five years) to both psychiatric controls (n = 104) and community controls (n = 93) with no history of suicide attempts. We collected fasting blood samples, socio-demographic information, physical measurements, and detailed descriptions of suicide attempts. We used linear regression analysis to determine the association between BDNF level (dependent variable) and attempted suicide (key exposure variable), adjusting for age, sex, body mass index, current smoking status, and antidepressant use. 250 participants were included in this analysis. In the linear regression model, attempted suicide was not significantly associated with BDNF level (β = 0.28, SE = 1.20, P = 0.82). Our findings suggest that no significant association exists between attempted suicide and BDNF level. However, the findings need to be replicated in a larger cohort study.
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Affiliation(s)
- Rebecca B Eisen
- MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Stefan Perera
- Health Research Methodology Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Monica Bawor
- MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.,St. George's University of London, London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.,St. George's University of London, London, Cranmer Terrace, London SW17 0RE, United Kingdom
| | - Wala El-Sheikh
- Population Health Research Institute, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Jane DeJesus
- Population Health Research Institute, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Judith Vair
- St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada
| | - Heather Sholer
- St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada
| | - Nicole Hutchinson
- St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada
| | - Elizabeth Iordan
- St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada
| | - Pam Mackie
- Population Health Research Institute, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Shofiqul Islam
- Population Health Research Institute, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Mahshid Dehghan
- Population Health Research Institute, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Jennifer Brasch
- St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada.,Biostatistics Unit, Centre for Evaluation of Medicine, 25 Main Street West Suite 2000, Hamilton, ON L8P 1H1, Canada
| | - Rebecca Anglin
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Luciano Minuzzi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.,Population Health Research Institute, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.,St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada.,Biostatistics Unit, Centre for Evaluation of Medicine, 25 Main Street West Suite 2000, Hamilton, ON L8P 1H1, Canada.,System-Linked Research Unit on Health and Social Service Utilization, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.,St. George's University of London, London, Cranmer Terrace, London SW17 0RE, United Kingdom.,Population Health Research Institute, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.,Peter Boris Centre for Addiction Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8P 3R2, Canada
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20
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Naji L, Dennis BB, Bawor M, Plater C, Pare G, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Thabane L, Samaan Z. A Prospective Study to Investigate Predictors of Relapse among Patients with Opioid Use Disorder Treated with Methadone. Subst Abuse 2016; 10:9-18. [PMID: 27103815 PMCID: PMC4827793 DOI: 10.4137/sart.s37030] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Concomitant opioid abuse is a serious problem among patients receiving methadone maintenance treatment (MMT) for opioid use disorder. This is an exploratory study that aims to identify predictors of the length of time a patient receiving MMT for opioid use disorder remains abstinent (relapse-free). METHODS Data were collected from 250 MMT patients enrolled in addiction treatment clinics across Southern Ontario. The impact of certain clinical and socio-demographic factors on the outcome (time until opioid relapse) was determined using a Cox proportional hazard model. RESULTS History of injecting drug use behavior (hazard ratio (HR): 2.26, P = 0.042), illicit benzodiazepine consumption (HR: 1.07, P = 0.002), and the age of onset of opioid abuse (HR: 1.10, P < 0.0001) are important indicators of accelerated relapse among MMT patients. Conversely, current age is positively associated with duration of abstinence from illicit opioid use, serving as a protective factor against relapse (HR: 0.93, P = 0.003). CONCLUSION This study helps to identify patients at increased risk of relapse during MMT, allowing health care providers to target more aggressive adjunct therapies toward high-risk patients.
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Affiliation(s)
- Leen Naji
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Brittany B Dennis
- St. George's University of London, London, United Kingdom.; Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Hamilton, Canada
| | - Monica Bawor
- St. George's University of London, London, United Kingdom
| | - Carolyn Plater
- Canadian Addiction Treatment Centre, Richmond Hill, ON, Canada
| | - Guillaume Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Hamilton, Canada
| | - Andrew Worster
- Canadian Addiction Treatment Centre, Richmond Hill, ON, Canada.; Department of Medicine, Hamilton General Hospital, Hamilton, ON, Canada
| | | | - Jeff Daiter
- Canadian Addiction Treatment Centre, Richmond Hill, ON, Canada
| | - David C Marsh
- Canadian Addiction Treatment Centre, Richmond Hill, ON, Canada.; Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Center, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Hamilton, Canada.; Centre for Evaluation of Medicine, Hamilton, ON, Canada.; System Linked Research Unit, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Hamilton, Canada.; Population Genomics Program, Chanchlani Research Center, McMaster University, Hamilton, ON, Canada.; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.; Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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21
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Dennis BB, Roshanov PS, Bawor M, Paul J, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, Thabane L, Samaan Z. Usefulness of the Brief Pain Inventory in Patients with Opioid Addiction Receiving Methadone Maintenance Treatment. Pain Physician 2016; 19:E181-E195. [PMID: 26752486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Chronic pain is implicated as a risk factor for illicit opioid use among patients with opioid addiction treated with methadone. However, there exists conflicting evidence that supports and refutes this claim. These discrepancies may stem from the large variability in pain measurement reported across studies. OBJECTIVES We aim to determine the clinical and demographic characteristics of patients reporting pain and evaluate the prognostic value of different pain classification measures in a sample of opioid addiction patients. STUDY DESIGN Multi-center prospective cohort study. SETTING Methadone maintenance treatment facilities for managing patients with opioid addiction. METHODS This study includes participants from the Genetics of Opioid Addiction (GENOA) prospective cohort study. We assessed the prognostic value of different pain measures for predicting opioid relapse. Pain measures include the Brief Pain Inventory (BPI) and patients' response to a direct pain question all study participants were asked from the GENOA case report form (CRF) "are you currently experiencing or have been diagnosed with chronic pain?" Performance characteristics of the GENOA CRF pain measure was estimated with sensitivity and specificity using the BPI as the gold standard reference. Prognostic value was assessed using pain classification as the primary independent variable in an adjusted analysis using 1) the percentage of positive opioid urine screens and 2) high-risk opioid use (= 50% positive opioid urine screens) as the dependent variables in a linear and logistic regression analyses, respectively. RESULTS Among participants eligible for inclusion (n = 444) the BPI was found to be highly sensitive, classifying a large number of GENOA participants with pain (n = 281 of the 297 classified with pain, 94.6%) in comparison to the GENOA CRF (n = 154 of 297 classified with pain, 51.8%). Participants concordantly classified as having pain according to the GENOA CRF and BPI were found to have an estimated 7.79% increase in positive opioid urine screens (estimated coefficient: 7.79; 95% CI 0.74, 14.85: P = 0.031) and a 4 times greater odds (odds ratio [OR]: 4.10 P = 0.008; 95% CI: 1.44, 11.63) of engaging in a "high risk" level of illicit opioids use. The prognostic relevance of pain classification was not maintained for the additional participants classified by the BPI (n = 143 discordant). CONCLUSION These results suggest that while the BPI may be more sensitive in capturing pain among patients with opioid addiction, this tool is of less value for predicting the impact of pain on illicit opioid use for opioid addiction patients on methadone maintenance treatment. The GENOA CRF showed high predictive ability, whereby patients classified according to the GENOA CRF are at serious risk for opioid relapse. Using the appropriate tool to assess pain in opioid addiction may serve to improve the current detection and management of comorbid pain. LIMITATIONS We caution the interpretation of these result since they are still reflective of participants already maintained on an opioid substitution therapy (OST), which can largely differ from patients who drop out of methadone maintenance treatment (MMT) or never seek treatment altogether.
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Affiliation(s)
- Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Population Genomic Program, Chanchalani Research Centre, McMaster University, Hamilton, Canada
| | - Pavel S Roshanov
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Monica Bawor
- Population Genomic Program, Chanchalani Research Centre, McMaster University, Hamilton, Canada; McMaster Integrative Neuroscience Discovery & Study (MiNDS) Program, McMaster University, Hamilton, Canada
| | - James Paul
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Department of Anesthesia, McMaster University, Hamilton, Canada
| | - Michael Varenbut
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Jeff Daiter
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Carolyn Plater
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Guillame Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - David C Marsh
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada; Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Andrew Worster
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada; Department of Medicine, Hamilton General Hospital, Hamilton, Canada
| | - Dipika Desai
- Population Genomic Program, Chanchalani Research Centre, McMaster University, Hamilton, Canada; Departments of Pediatrics and Anesthesia, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Departments of Pediatrics and Anesthesia, McMaster University, Hamilton, Canada; Centre for Evaluation of Medicine, St Joseph's Healthcare-Hamilton, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare-Hamilton, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Population Genomic Program, Chanchalani Research Centre, McMaster University, Hamilton, Canada; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Canada; Peter Boris Centre for Addictions Research, Canada
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22
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de Souza RJ, Eisen RB, Perera S, Bantoto B, Bawor M, Dennis BB, Samaan Z, Thabane L. Best (but oft-forgotten) practices: sensitivity analyses in randomized controlled trials. Am J Clin Nutr 2016; 103:5-17. [PMID: 26675766 DOI: 10.3945/ajcn.115.121848] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/04/2015] [Indexed: 01/15/2023] Open
Abstract
A randomized controlled clinical trial is the best way to minimize bias in ascertaining treatment effects, but the credibility of the results of a trial depends on the validity of the methods used to analyze the data, and the conditions under which such methods produce valid answers. A sensitivity analysis is a method to determine the robustness of trial findings by examining the extent to which results are affected by changes in methods, models, values of unmeasured variables, or assumptions. The goal of a sensitivity analysis is to identify results that are most dependent on questionable or unsupported assumptions. In this article, we briefly review the current use of sensitivity analyses in a random sample of published nutrition literature and provide a guide on the use of sensitivity analyses in randomized trials as to when to consider them, what to consider when planning them, and different methods of implementing them. We propose an 8-step strategy for improving the approach to conducting and reporting sensitivity analyses in nutrition-based trials.
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Affiliation(s)
- Russell J de Souza
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Rebecca B Eisen
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences
| | - Stefan Perera
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences
| | - Bianca Bantoto
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences
| | - Monica Bawor
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences
| | - Brittany B Dennis
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences
| | - Zainab Samaan
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, Department of Psychiatry and Behavioral Neurosciences, St. Joseph's Healthcare Hamilton and Hamilton Health Sciences Mood Disorders Program, Hamilton, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, Center for Evaluation of Medicine, Population Health Research Institute, Hamilton Health Sciences, and System-Linked Research Unit, McMaster University, Hamilton, Canada; and
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23
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Bawor M, Dennis BB, Varenbut M, Daiter J, Marsh DC, Plater C, Worster A, Steiner M, Anglin R, Pare G, Desai D, Thabane L, Samaan Z. Sex differences in substance use, health, and social functioning among opioid users receiving methadone treatment: a multicenter cohort study. Biol Sex Differ 2015; 6:21. [PMID: 26557977 PMCID: PMC4640383 DOI: 10.1186/s13293-015-0038-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 10/05/2015] [Indexed: 11/25/2022] Open
Abstract
Background Despite the growing numbers of men and women with opioid use disorder in Canada, sex-specific issues in treatment have not been re-examined in the current population of patients with opioid addiction. We aimed to evaluate sex differences in substance use, health, and social functioning among men and women currently receiving methadone treatment for opioid use disorder in Ontario, Canada. Methods We recruited 503 participants with opioid dependence disorder receiving methadone maintenance treatment. We collected data on demographics, treatment characteristics, psychiatric history, addiction severity, and drug use patterns through urinalysis. We performed adjusted univariate analyses and logistic regression to identify distinct factors affecting men and women. Results Among our sample of 54 % (n = 266) men and 46 % women (n = 226) with mean age 38.3 years, less than half of participants were employed (35.6 %) and married (31.8 %) and had completed a high school education (27.9 %). Compared to men, women had frequent physical and psychological health problems, family history of psychiatric illness, and childcare responsibilities and began using opioids through a physician prescription. Men had higher rates of employment, cigarette smoking, and cannabis use compared to women. Conclusions Our results have revealed different patterns of substance use, health, and social functioning among men and women currently receiving methadone treatment for opioid addiction in Ontario, Canada. This information can be used to develop an integrative treatment regimen that caters to the individual needs of men and women, as well as to inform methadone treatment protocols to include specialized services (including vocational counseling, childcare and parenting assistance, medical assistance, relationship or domestic violence counseling, etc.) and increase their availability and accessibility on a larger scale.
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Affiliation(s)
- Monica Bawor
- MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, Ontario Canada ; St. George's, University of London, London, UK ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario Canada ; Peter Boris Centre for Addiction Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario Canada
| | - Brittany B Dennis
- St. George's, University of London, London, UK ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario Canada ; Peter Boris Centre for Addiction Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada
| | - Michael Varenbut
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, Ontario Canada
| | - Jeff Daiter
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, Ontario Canada
| | - David C Marsh
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, Ontario Canada ; Northern Ontario School of Medicine, Laurentian Campus, Sudbury, Ontario Canada
| | - Carolyn Plater
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, Ontario Canada
| | - Andrew Worster
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada ; Canadian Addiction Treatment Centres (CATC), Richmond Hill, Ontario Canada ; Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Meir Steiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario Canada ; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario Canada ; Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario Canada
| | - Rebecca Anglin
- Department of Medicine, McMaster University, Hamilton, Ontario Canada ; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario Canada
| | - Guillaume Pare
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada ; Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, Ontario Canada
| | - Zainab Samaan
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario Canada ; Peter Boris Centre for Addiction Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada ; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario Canada ; Mood Disorders Program, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, Ontario L8N 3K7 Canada
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Dennis BB, Roshanov PS, Naji L, Bawor M, Paul J, Plater C, Pare G, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Samaan Z, Thabane L. Opioid substitution and antagonist therapy trials exclude the common addiction patient: a systematic review and analysis of eligibility criteria. Trials 2015; 16:475. [PMID: 26489415 PMCID: PMC4618532 DOI: 10.1186/s13063-015-0942-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 09/03/2015] [Indexed: 01/01/2023] Open
Abstract
Background Eligibility criteria that result in the exclusion of a substantial number of patients from randomized trials jeopardize the generalizability of treatment effect to much of the clinical population. This is important when evaluating opioid substitution and antagonist therapies (OSATs), especially given the challenges associated with treating the opioid-dependent population. We aimed to identify OSAT trials' eligibility criteria, quantify the percentage of the clinical population excluded by these criteria, and determine how OSAT guidelines incorporate evidence from these trials. Methods We performed a systematic review to identify the eligibility criteria used across trials. We searched Medline, EMBASE, PsycINFO, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry (CTR), World Health Organization International CTR Platform Search Portal, and the National Institutes of Health CTR databases from inception to January 1, 2014. To quantify the effect of trials' eligibility criteria on generalizability, we applied these criteria to data from an observational study of opioid-dependent patients (n = 394). We then accessed the Canadian, American, British, and World Health Organization (WHO) OSAT guidelines to evaluate how evidence is used in the recommendations. Results Among the 60 trials identified the majority (≥50 % of trials) exclude patients with psychiatric (60 %) and physical comorbidity (51.7 %). Additionally, we found 19 trials exclude patients with current alcohol/substance-use problems (31.7 %), and 29 (48.3 %) exclude patients taking psychotropic medications. These criteria were restrictive and in some cases rendered 70 % of the observational sample ineligible. North American OSAT guidelines made strong recommendations supported by evidence with poor generalizability. National Institute of Health and Care Excellence (NICE) and WHO guidelines for opioid misuse provide a critical assessment of the literature used to inform their recommendations. Conclusions Trials assessing OSATs often exclude patients with concurrent disorders. If the excluded patients respond differently to treatment, results from these trials are likely to overestimate the true effectiveness of OSATs. North American guidelines should consider these limitations when drafting clinical recommendations. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0942-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Pavel S Roshanov
- Schulich School of Medicine and Dentistry, University of Western Ontario, 4, 1465 Richmond Street, London, ON, N6G 2M1, Canada.
| | - Leen Naji
- Michael G. Degroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Monica Bawor
- McMaster Integrative Neuroscience Discovery and Study Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - James Paul
- Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Carolyn Plater
- Canadian Addiction Treatment Centres, 13291 Yonge Street, Richmond Hill, ON, L4E 4L6, Canada.
| | - Guillaume Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Andrew Worster
- Canadian Addiction Treatment Centres, 13291 Yonge Street, Richmond Hill, ON, L4E 4L6, Canada. .,Department of Medicine, Hamilton General Hospital, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada.
| | - Michael Varenbut
- Canadian Addiction Treatment Centres, 13291 Yonge Street, Richmond Hill, ON, L4E 4L6, Canada.
| | - Jeff Daiter
- Canadian Addiction Treatment Centres, 13291 Yonge Street, Richmond Hill, ON, L4E 4L6, Canada.
| | - David C Marsh
- Canadian Addiction Treatment Centres, 13291 Yonge Street, Richmond Hill, ON, L4E 4L6, Canada. .,Northern Ontario School of Medicine, Ramsey Lake Road, Sudbury, ON, P0M, Canada.
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. .,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L9C 0E3, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Centre for Evaluation of Medicine, 25 Main Street West, Hamilton, ON, L8P 1H1, Canada. .,System Linked Research Unit, 175 Longwood Road, South Hamilton, L8P 0A1, Canada.
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Bawor M, Dennis BB, Tan C, Pare G, Varenbut M, Daiter J, Plater C, Worster A, Marsh DC, Steiner M, Anglin R, Desai D, Thabane L, Samaan Z. Contribution of BDNF and DRD2 genetic polymorphisms to continued opioid use in patients receiving methadone treatment for opioid use disorder: an observational study. Addict Sci Clin Pract 2015; 10:19. [PMID: 26437921 PMCID: PMC4672523 DOI: 10.1186/s13722-015-0040-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 09/24/2015] [Indexed: 12/14/2022] Open
Abstract
Background The heritability of opioid use disorder has been widely investigated; however, the influence of specific genes on methadone treatment outcomes is not well understood. The association between response to methadone treatment and genes that are involved in substance use behaviors and reward mechanisms is poorly understood, despite evidence suggesting their contribution to opioid use disorder. The aim of this study was to investigate the effect of brain-derived neurotrophic factor (BDNF) and dopamine receptor D2 (DRD2) polymorphisms on continued opioid use among patients on methadone treatment for opioid use disorder. Methods BDNF 196G>A (rs6265) and DRD2-241A>G (rs1799978) genetic variants were examined in patients with opioid use disorder who were recruited from methadone treatment clinics across Southern Ontario, Canada. We collected demographic information, substance use history, blood for genetic analysis, and urine to measure opioid use. We used regression analysis to examine the association between continued opioid use and genetic variants, adjusting for age, sex, ethnicity, methadone dose, duration in treatment, and number of urine screens. Results Among 240 patients treated with methadone for opioid use disorder, 36.3 percent (n = 87) and 11.3 percent (n = 27) had at least one risk allele for rs6265 and rs1799978, respectively. These genetic variants were not significantly associated with continued opioid use while on methadone maintenance treatment [rs6265: odds ratio (OR) = 1.37, 95 % confidence interval (CI) = 0.792, 2.371, p = 0.264; rs1799978: OR 1.27, 95 % CI 0.511, 3.182, p = 0.603]. Conclusions Despite an association of BDNFrs6265 and DRD2rs1799978 with addictive behaviors, these variants were not associated with continued illicit opioid use in patients treated with methadone. Problematic use of opioids throughout treatment with methadone may be attributed to nongenetic factors or a polygenic effect requiring further exploration. Additional research should focus on investigating these findings in larger samples and different populations.
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Affiliation(s)
- Monica Bawor
- MiNDS Neuroscience Program, McMaster University, Hamilton, ON, Canada. .,Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada. .,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
| | - Brittany B Dennis
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada. .,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
| | - Charlie Tan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Guillaume Pare
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. .,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
| | - Michael Varenbut
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, ON, Canada.
| | - Jeff Daiter
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, ON, Canada.
| | - Carolyn Plater
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, ON, Canada.
| | - Andrew Worster
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. .,Canadian Addiction Treatment Centres (CATC), Richmond Hill, ON, Canada. .,Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - David C Marsh
- Canadian Addiction Treatment Centres (CATC), Richmond Hill, ON, Canada. .,Northern Ontario School of Medicine, Laurentian Campus, Sudbury, ON, Canada.
| | - Meir Steiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada. .,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. .,Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada.
| | - Rebecca Anglin
- Department of Medicine, McMaster University, Hamilton, ON, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada.
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. .,Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, ON, Canada. .,System Linked Research Unit, Hamilton, ON, Canada.
| | - Zainab Samaan
- MiNDS Neuroscience Program, McMaster University, Hamilton, ON, Canada. .,Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada. .,Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada. .,Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON, L8N 3K7, Canada.
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Dennis BB, Bawor M, Naji L, Chan CK, Varenbut J, Paul J, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, Thabane L, Samaan Z. Impact of Chronic Pain on Treatment Prognosis for Patients with Opioid Use Disorder: A Systematic Review and Meta-analysis. Subst Abuse 2015; 9:59-80. [PMID: 26417202 PMCID: PMC4573077 DOI: 10.4137/sart.s30120] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/12/2015] [Accepted: 07/14/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND While a number of pharmacological interventions exist for the treatment of opioid use disorder, evidence evaluating the effect of pain on substance use behavior, attrition rate, and physical or mental health among these therapies has not been well established. We aim to evaluate these effects using evidence gathered from a systematic review of studies evaluating chronic non-cancer pain (CNCP) in patients with opioid use disorder. METHODS We searched the Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Database of Systematic Reviews, ProQuest Dissertations and theses Database, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform Search Portal, and National Institutes for Health Clinical Trials Registry databases to identify articles evaluating the impact of pain on addiction treatment outcomes for patients maintained on opioid agonist therapy. RESULTS Upon screening 3,540 articles, 14 studies with a combined sample of 3,128 patients fulfilled the review inclusion criteria. Results from the meta-analysis suggest that pain has no effect on illicit opioid consumption [pooled odds ratio (pOR): 0.70, 95%CI 0.41–1.17; I2 = 0.0] but a protective effect for reducing illicit non-opioid substance use (pOR: 0.57, 95%CI 0.41–0.79; I2 = 0.0). Studies evaluating illicit opioid consumption using other measures demonstrate pain to increase the risk for opioid abuse. Pain is significantly associated with the presence of psychiatric disorders (pOR: 2.18; 95%CI 1.6, 2.9; I2 = 0.0%). CONCLUSION CNCP may increase risk for continued opioid abuse and poor psychiatric functioning. Qualitative synthesis of the findings suggests that major methodological differences in the design and measurement of pain and treatment response outcomes are likely impacting the effect estimates.
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Affiliation(s)
- Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
| | - Monica Bawor
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada. ; McMaster Integrative Neuroscience Discovery and Study (MiNDS) Program, McMaster University, Hamilton, ON, Canada
| | - Leen Naji
- Michael G. Degroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Carol K Chan
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Jaymie Varenbut
- Department of Biological Sciences, Western University, London, ON, Canada
| | - James Paul
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. ; Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | | | - Jeff Daiter
- Canadian Addiction Treatment Centres, Richmond Hill, ON, Canada
| | - Carolyn Plater
- Canadian Addiction Treatment Centres, Richmond Hill, ON, Canada
| | - Guillaume Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - David C Marsh
- Canadian Addiction Treatment Centres, Richmond Hill, ON, Canada. ; Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Andrew Worster
- Canadian Addiction Treatment Centres, Richmond Hill, ON, Canada. ; Department of Medicine, Hamilton General Hospital, Hamilton, ON, Canada
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada. ; Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. ; Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada. ; Departments of Pediatrics and Anesthesia, McMaster University, Hamilton, ON Canada. ; Centre for Evaluation of Medicine, St Joseph's Healthcare, Hamilton, ON, Canada. ; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. ; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada. ; Peter Boris Centre for Addictions Research, Hamilton, ON, Canada
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Bawor M, Dennis BB, Bhalerao A, Plater C, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Steiner M, Anglin R, Pare G, Thabane L, Samaan Z. Sex differences in outcomes of methadone maintenance treatment for opioid use disorder: a systematic review and meta-analysis. CMAJ Open 2015; 3:E344-51. [PMID: 26457294 PMCID: PMC4596116 DOI: 10.9778/cmajo.20140089] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Opioid use disorder is a serious international concern with limited treatment success. Men and women differ in their susceptibility to opioid use disorder and response to methadone treatment and can therefore benefit from sex-specific treatment. We performed a systematic review of the literature on outcomes of methadone maintenance treatment for opioid use disorder in men and women related to drug use, health status and social functioning. METHODS We searched PubMed, Embase, PsycINFO and CINAHL for observational or randomized controlled studies involving adults 18 years of age or older undergoing methadone treatment for opioid use disorder. Studies were included if they investigated sex differences in methadone treatment outcomes. Two authors independently reviewed and extracted data. Meta-analyses were performed when possible; risk of bias and quality of evidence were also assessed. RESULTS Twenty studies with 9732 participants were included, of which 18 were observational and 2 were randomized controlled trials. Men and women differed significantly in alcohol use (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31 to 0.86), amphetamine use (OR 1.47, 95% CI 1.12 to 1.94), legal involvement (OR 0.63, 95% CI 0.47 to 0.84) and employment during treatment (OR 0.39, 95% CI 0.21 to 0.73). Opioid use patterns were similar among men and women. Risk of bias was moderate, and quality of evidence was generally low. INTERPRETATION Sex differences were evident in polysubstance use, legal involvement and employment status among men and women receiving methadone treatment for opioid use disorders. Although the quality of evidence was low, our review highlights the need for improved implementation of sex-specific treatment strategies.
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Affiliation(s)
- Monica Bawor
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Brittany B Dennis
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Anuja Bhalerao
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Carolyn Plater
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Andrew Worster
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Michael Varenbut
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Jeff Daiter
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - David C Marsh
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Dipika Desai
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Meir Steiner
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Rebecca Anglin
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Guillaume Pare
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Lehana Thabane
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Zainab Samaan
- MiNDS Neuroscience Graduate Program (Bawor), McMaster University, Hamilton, Ont.; Population Genomics Program (Bawor, Dennis, Desai, Pare, Samaan), Chanchlani Research Centre, McMaster University, Hamilton, Ont.; Department of Clinical Epidemiology and Biostatistics (Dennis, Pare, Thabane), McMaster University, Hamilton, Ont.; Bachelor of Health Sciences Undergraduate Program (Bhalerao), McMaster University, Hamilton, Ont.; Ontario Addiction Treatment Centre (Plater, Worster, Varenbut, Daiter), Richmond Hill, Ont.; Department of Medicine (Worster, Marsh, Anglin), McMaster University, Hamilton, Ont.; Northern Ontario School of Medicine (Marsh), Sudbury, Ont.; Department of Psychiatry and Behavioural Neurosciences (Steiner, Anglin, Samaan), McMaster University, Hamilton, Ont.; Women's Health Concerns Clinic (Steiner), St. Joseph's Healthcare Hamilton, Hamilton, Ont.; Department of Obstetrics and Gynecology (Steiner), McMaster University, Hamilton, Ont.; Biostatistics Unit (Thabane), Centre for Evaluation of Medicine, Hamilton, Ont.; Peter Boris Centre for Addiction Research (Samaan), St. Joseph's Healthcare Hamilton, Hamilton, Ont
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Samaan Z, Bawor M, Dennis BB, El-Sheikh W, DeJesus J, Rangarajan S, Vair J, Sholer H, Hutchinson N, Iordan E, Mackie P, Islam S, Deghan M, Brasch J, Thabane L. Exploring the Determinants of Suicidal Behavior: Conventional and Emergent Risk (DISCOVER): a feasibility study. Pilot Feasibility Stud 2015; 1:17. [PMID: 27965796 PMCID: PMC5154080 DOI: 10.1186/s40814-015-0012-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 05/01/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Suicidal behavior is a growing public health concern resulting in morbidity and premature death. Although certain factors such as age, sex, and psychiatric disorders have been consistently reported to be associated with suicidal behavior, other factors including biological markers, diet, and physical activity may also influence suicidal behavior. The purpose of this pilot study was to evaluate the feasibility of conducting a full-scale study to identify the conventional and novel risk factors of suicidal behavior in individuals who made a recent suicide attempt. METHODS This pilot study was a case-control study of participants with recent (within 1 month of admission) suicide attempts admitted to hospital and compared to two control groups: 1) psychiatric inpatient participants without a history of suicide attempts and 2) community-based controls. We collected information on demographic variables, circumstances of suicide attempts (for cases), medical and psychiatric diagnoses, behavioral patterns, physical measurements, and social factors. Blood and urine samples were also collected for biological markers. Feasibility outcomes are as follows: 1) 50 % of all eligible cases will consent to participate, 2) 50 cases and 100 controls per year can be recruited, and 3) at least 80 % of the participants will provide blood samples for DNA and biological markers. RESULTS We recruited 179 participants in total; 51 cases, 57 psychiatric controls without suicide attempt, and 71 non-psychiatric controls in Hamilton, Ontario. Recruitment rate was 70 % (213/304), and we obtained urine and blood specimens from 90 % (191/213) of participants. Questionnaire completion rates were high, and data quality was very good with few data-related queries to resolve. We learned that cases tended to be hospitalized for long periods of time and the suicide attempt occurred more than a month ago in many of the cases; therefore, we expanded our inclusion criterion related to timing of suicide attempt to 3 months instead of 1 month. CONCLUSIONS The study procedures needed certain modifications including extending the time between suicide attempt and date of recruitment, and more detailed questionnaires related to diet were necessary while other questionnaires such as social support needed to be shortened. Overall, this study showed that it is feasible to conduct a larger-scale study.
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Affiliation(s)
- Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON Canada
- MiNDS Neuroscience Program, McMaster University, Hamilton, ON Canada
- Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada
- St. Joseph’s Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada
| | - Monica Bawor
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON Canada
- MiNDS Neuroscience Program, McMaster University, Hamilton, ON Canada
| | - Brittany B. Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON Canada
| | - Wala El-Sheikh
- Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada
| | - Jane DeJesus
- Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada
| | - Judith Vair
- St. Joseph’s Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada
| | - Heather Sholer
- St. Joseph’s Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada
| | - Nicole Hutchinson
- St. Joseph’s Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada
| | - Elizabeth Iordan
- St. Joseph’s Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada
| | - Pam Mackie
- Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada
| | - Shofiqul Islam
- Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada
| | - Mahshid Deghan
- Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada
| | - Jennifer Brasch
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
- St. Joseph’s Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
- Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON Canada
- St. Joseph’s Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7 Canada
- Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, ON Canada
- System Linked Research Unit, Hamilton, ON Canada
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Eisen R, Perera S, Bawor M, Banfield L, Anglin R, Minuzzi L, Samaan Z. Association between BDNF levels and suicidal behaviour: a systematic review protocol. Syst Rev 2015; 4:56. [PMID: 25908105 PMCID: PMC4410596 DOI: 10.1186/s13643-015-0047-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 04/15/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Suicide is a worldwide public health concern that claims close to 1 million lives each year. Suicidal behaviour is a significant risk factor for completed suicide and is much more prevalent than completed suicide. Many internal and external factors contribute to the risk of suicidal behaviour. Recent research has focused on biological markers in suicide risk, including brain-derived neurotrophic factor (BDNF). BDNF is a protein involved in the growth, function, and maintenance of the nervous system. It has been implicated in psychiatric disorders and suicide. While some evidence suggests that reduced levels of BDNF are associated with suicide, the precise relationship has yet to be determined. The aim of this study is to review the literature examining the relationship between levels of BDNF and suicidal behaviour. METHODS A predefined search strategy will be implemented to search the following electronic databases: PubMed/MEDLINE, Excerpta Medica Database (EMBASE), PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception. The articles will be screened by two independent authors (RE and SP) using predetermined inclusion and exclusion criteria. Discrepancies will be resolved by consensus, or by a third author (ZS) in cases of disagreement. The primary outcome will be the association between levels of BDNF and suicidal behaviour. A meta-analysis will be conducted if appropriate. Quality of evidence and risk of bias will be evaluated. DISCUSSION The findings of this review will assist in identifying and treating individuals at increased risk of suicide. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015015871 .
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Affiliation(s)
- Rebecca Eisen
- MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Stefan Perera
- Health Research Methodology Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Monica Bawor
- MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Laura Banfield
- Health Sciences Library, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Rebecca Anglin
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Luciano Minuzzi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,Peter Boris Centre for Addiction Research, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8P 3R2, Canada.
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Perera S, Eisen R, Bawor M, Dennis B, de Souza R, Thabane L, Samaan Z. Association between body mass index and suicidal behaviors: a systematic review protocol. Syst Rev 2015; 4:52. [PMID: 25927506 PMCID: PMC4424510 DOI: 10.1186/s13643-015-0038-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 03/31/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Suicide is among the leading causes of death worldwide. Suicide attempts and suicidal ideation are more common than completed suicide and are associated with psychological distress. These behaviors are considered risk factors of completed suicide. Considering the psychosocial stigma and medical comorbidities associated with obesity, an accumulating body of studies have investigated body mass index (BMI) as a potential risk factor of suicide. However, several cohort studies have demonstrated an inverse relationship between BMI and completed suicide, suggesting a protective effect of increasing BMI against completed suicide. The association between BMI and attempted suicide is more equivocal, with several studies reporting both positive and negative relationships between BMI and attempted suicide. The primary objective of this study is to systematically review the literature to determine the association between BMI and suicidal behavior (including completed suicide, attempted suicide, suicidal ideation) in an adult population (18 years and older). The secondary objective is to explore whether sex, age, and the method used in suicide modify the relationship between BMI and suicidal behavior. METHODS/DESIGN An electronic search will be conducted using PubMed/MEDLINE, PsycINFO, CINAHL, and EMBASE using a predefined search strategy; databases will be searched from their inception. Two authors (SP and RE) will independently screen articles using predefined inclusion and exclusion criteria and will extract pertinent data using a pilot tested extraction form. At all levels of screening, discrepancies between the two authors will be resolved by consensus, and in the case of disagreement, by consulting a third author (ZS). The primary outcomes include the association between BMI and completed suicide, attempted suicide, and suicidal ideation. If appropriate, a meta-analysis will be conducted. Risk of bias and quality of evidence will be assessed. DISCUSSION The results of this systematic review will inform health care professionals and researchers about whether BMI has a significant role in suicidal behavior and psychological well-being. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014014739 .
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Affiliation(s)
- Stefan Perera
- Health Research Methodology Graduate Program, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada.
| | - Rebecca Eisen
- MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street W., Hamilton, ON, L8S 4L8, Canada.
| | - Monica Bawor
- MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main Street W., Hamilton, ON, L8S 4L8, Canada. .,Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada.
| | - Brittany Dennis
- Health Research Methodology Graduate Program, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada. .,Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada.
| | - Russell de Souza
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada. .,Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada.
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada. .,Biostatistics Unit, Centre for Evaluation of Medicine, 25 Main Street W. Suite 2000, Hamilton, ON, L8P 1H1, Canada.
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada. .,Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, L8S 4L8, Canada.
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Dennis BB, Bawor M, Paul J, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, Thabane L, Samaan Z. The impact of chronic pain on opioid addiction treatment: a systematic review protocol. Syst Rev 2015; 4:49. [PMID: 25927914 PMCID: PMC4403999 DOI: 10.1186/s13643-015-0042-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/02/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The consequences of opioid relapse among patients being treated with opioid substitution treatment (OST) are serious and can result in abnormal cardiovascular function, overdose, and mortality. Chronic pain is a major risk factor for opioid relapse within the addiction treatment setting. There exist a number of opioid maintenance therapies including methadone, buprenorphine, naltrexone, and levomethadyl acetate (LAAM), of which the mediating effects of pain on treatment attrition, substance use behavior, and social functioning may differ across therapies. We aim to 1) evaluate the impact of pain on the treatment outcomes of addiction patients being managed with OST and 2) identify the most recently published opioid maintenance treatment guidelines from the United States, Canada, and the UK to determine how the evidence is being translated into clinical practice. METHODS/DESIGN The authors will search Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Database of Systematic Reviews, ProQuest Dissertations and theses Database, Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization International Clinical Trials Registry Platform Search Portal, and the National Institutes for Health Clinical Trials Registry. We will search www. GUIDELINES gov and the National Institute for Care and Excellence (NICE) databases to identify the most recently published OST guidelines. All screening and data extraction will be completed in duplicate. Provided the data are suitable, we will perform a multiple treatment comparison using Bayesian meta-analytic methods to produce summary statistics estimating the effect of chronic pain on all OSTs. Our primary outcome is substance use behavior, which includes opioid and non-opioid substance use. We will also evaluate secondary endpoints such as treatment retention, general physical health, intervention adherence, personal and social functioning, as well as psychiatric symptoms. DISCUSSION This review will capture the experience of treatment outcomes for a sub-population of opioid addiction patients and provide an opportunity to distinguish the best quality guidelines for OST. If chronic pain truly does result in negative consequences for opioid addiction patients, it is important we identify which OSTs are most appropriate for chronic pain patients as well as ensure the treatment guidelines incorporate this information. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014014015 http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014014015#.VS1Qw1wkKGM.
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Affiliation(s)
- Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,Population Genomics Program, Chanchlani Research Centre, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada.
| | - Monica Bawor
- Population Genomics Program, Chanchlani Research Centre, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,McMaster Integrative Neuroscience Discovery & Study (MiNDS) Program, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada.
| | - James Paul
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada.
| | - Michael Varenbut
- Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada.
| | - Jeff Daiter
- Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada.
| | - Carolyn Plater
- Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada.
| | - Guillaume Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada.
| | - David C Marsh
- Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada. .,Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, Ontario, P3E 2C6, Canada.
| | - Andrew Worster
- Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada. .,Department of Medicine, Hamilton General Hospital, 237 Barton St East, Hamilton, Ontario, L8L 2X2, Canada.
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,Departments of Pediatrics and Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada.
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,Departments of Pediatrics and Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,St. Joseph's Healthcare Hamilton, Centre for Evaluation of Medicine, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada. .,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada.
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,Population Genomics Program, Chanchlani Research Centre, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. .,Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada. .,Peter Boris Centre for Addictions Research, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.
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Bawor M, Bami H, Dennis BB, Plater C, Worster A, Varenbut M, Daiter J, Marsh DC, Steiner M, Anglin R, Coote M, Pare G, Thabane L, Samaan Z. Testosterone suppression in opioid users: a systematic review and meta-analysis. Drug Alcohol Depend 2015; 149:1-9. [PMID: 25702934 DOI: 10.1016/j.drugalcdep.2015.01.038] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 01/13/2015] [Accepted: 01/29/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Whether used for pain management or recreation, opioids have a number of adverse effects including hormonal imbalances. These imbalances have been reported to primarily involve testosterone and affect both males and females to the point of interfering with successful treatment and recovery. We conducted a systematic review and meta-analysis to determine the extent that opioids affect testosterone levels in both men and women, which may be relevant to improved treatment outcomes for opioid dependence and for pain management. METHODS We searched PubMed, EMBASE, PsycINFO, and CINAHL for relevant articles and included studies that examined testosterone levels in men and women while on opioids. Data collection was completed in duplicate. RESULTS Seventeen studies with 2769 participants (800 opioid users and 1969 controls) fulfilled the review inclusion criteria; 10 studies were cross-sectional and seven were cohort studies. Results showed a significant difference in mean testosterone level in men with opioid use compared to controls (MD=-164.78; 95% CI: -245.47, -84.08; p<0.0001). Methadone did not affect testosterone differently than other opioids. Testosterone levels in women were not affected by opioids. Generalizability of results was limited due to high heterogeneity among studies and overall low quality of evidence. CONCLUSIONS Our findings demonstrated that testosterone level is suppressed in men with regular opioid use regardless of opioid type. We found that opioids affect testosterone levels differently in men than women. This suggests that opioids, including methadone, may have different endocrine disruption mechanisms in men and women, which should be considered when treating opioid dependence.
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Affiliation(s)
- Monica Bawor
- MiNDS Neuroscience Graduate Program, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Herman Bami
- Undergraduate BHSc Program, Faculty of Health Sciences, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Brittany B Dennis
- Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Health Research Methodology Graduate Program, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Carolyn Plater
- Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada
| | - Andrew Worster
- Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada; Department of Medicine, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Michael Varenbut
- Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada
| | - Jeff Daiter
- Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada
| | - David C Marsh
- Ontario Addiction Treatment Centres, 13291 Yonge St., Suite 403, Richmond Hill, ON L4E 4L6, Canada; Northern Ontario School of Medicine, 935 Ramsey Lake Rd., Sudbury, ON P3E 2C6, Canada
| | - Meir Steiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue E., Hamilton, ON L8N 4A6, Canada; Department of Obstetrics and Gynecology, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Rebecca Anglin
- Department of Medicine, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Margaret Coote
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue E., Hamilton, ON L8N 4A6, Canada
| | - Guillaume Pare
- Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Biostatistics Unit, Centre for Evaluation of Medicine, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue E., Hamilton, ON L8N 4A6, Canada
| | - Zainab Samaan
- Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4L8, Canada.
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Dennis BB, Naji L, Bawor M, Bonner A, Varenbut M, Daiter J, Plater C, Pare G, Marsh DC, Worster A, Desai D, Samaan Z, Thabane L. The effectiveness of opioid substitution treatments for patients with opioid dependence: a systematic review and multiple treatment comparison protocol. Syst Rev 2014; 3:105. [PMID: 25239213 PMCID: PMC4171401 DOI: 10.1186/2046-4053-3-105] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/03/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Opioids are psychoactive analgesic drugs prescribed for pain relief and palliative care. Due to their addictive potential, effort and vigilance in controlling prescriptions is needed to avoid misuse and dependence. Despite the effort, the prevalence of opioid use disorder continues to rise. Opioid substitution therapies are commonly used to treat opioid dependence; however, there is minimal consensus as to which therapy is most effective. Available treatments include methadone, heroin, buprenorphine, as well as naltrexone. This systematic review aims to assess and compare the effect of all available opioid substitution therapies on the treatment of opioid dependence. METHODS/DESIGN The authors will search Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry, World Health Organization International Clinical Trials Registry Platform Search Portal, and the National Institutes for Health Clinical Trials Registry. The title, abstract, and full-text screening will be completed in duplicate. When appropriate, multiple treatment comparison Bayesian meta-analytic methods will be performed to deduce summary statistics estimating the effectiveness of all opioid substitution therapies in terms of retention and response to treatment (as measured through continued opioid abuse). DISCUSSION Using evidence gained from this systematic review, we anticipate disseminating an objective review of the current available literature on the effectiveness of all opioid substitution therapies for the treatment of opioid use disorder. The results of this systematic review are imperative to the further enhancement of clinical practice in addiction medicine. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013006507.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
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Bawor M, Dennis BB, Samaan MC, Plater C, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Steiner M, Anglin R, Coote M, Pare G, Thabane L, Samaan Z. Methadone induces testosterone suppression in patients with opioid addiction. Sci Rep 2014; 4:6189. [PMID: 25155550 PMCID: PMC4143768 DOI: 10.1038/srep06189] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/06/2014] [Indexed: 11/29/2022] Open
Abstract
Sex hormones may have a role in the pathophysiology of substance use disorders, as demonstrated by the association between testosterone and addictive behaviour in opioid dependence. Although opioid use has been found to suppress testosterone levels in men and women, the extent of this effect and how it relates to methadone treatment for opioid dependence is unclear. The present multi-centre cross-sectional study consecutively recruited 231 patients with opioid dependence from methadone clinics across Ontario, Canada between June and December of 2011. We obtained demographic details, substance use, psychiatric history, and blood and urine samples from enrolled subjects. The control group included 783 non-opioid using adults recruited from a primary care setting in Ontario, Canada. Average testosterone level in men receiving methadone treatment was significantly lower than controls. No effect of opioids including methadone on testosterone level in women was found and testosterone did not fluctuate significantly between menstrual cycle phases. In methadone patients, testosterone level was significantly associated with methadone dose in men only. We recommend that testosterone levels be checked in men prior and during methadone and other opioid therapy, in order to detect and treat testosterone deficiency associated with opioids and lead to successful methadone treatment outcomes.
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Affiliation(s)
- Monica Bawor
- 1] MiNDS Neuroscience Graduate Program, McMaster University, Hamilton, ON [2] Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON
| | - Brittany B Dennis
- 1] Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON [2] Health Research Methodology Graduate Program, McMaster University, Hamilton, ON [3] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON
| | - M Constantine Samaan
- Division of Pediatric Endocrinology, Department of Pediatrics, McMaster University, Hamilton, ON
| | | | - Andrew Worster
- 1] Ontario Addiction Treatment Centres, Ontario, Canada [2] Department of Medicine, McMaster University, Hamilton, ON
| | | | - Jeff Daiter
- Ontario Addiction Treatment Centres, Ontario, Canada
| | - David C Marsh
- 1] Ontario Addiction Treatment Centres, Ontario, Canada [2] Northern Ontario School of Medicine, Sudbury, ON
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON
| | - Meir Steiner
- 1] Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON [2] Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON [3] Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON
| | - Rebecca Anglin
- 1] Department of Medicine, McMaster University, Hamilton, ON [2] Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON
| | - Margaret Coote
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON
| | - Guillaume Pare
- 1] Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON [2] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON
| | - Lehana Thabane
- 1] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON [2] Biostatistics Unit, Centre for Evaluation of Medicine, Hamilton, ON, Canada
| | - Zainab Samaan
- 1] Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON [2] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON [3] Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON
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Mistry CJ, Bawor M, Desai D, Marsh DC, Samaan Z. Genetics of Opioid Dependence: A Review of the Genetic Contribution to Opioid Dependence. ACTA ACUST UNITED AC 2014; 10:156-167. [PMID: 25242908 PMCID: PMC4155832 DOI: 10.2174/1573400510666140320000928] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 08/14/2013] [Accepted: 01/15/2014] [Indexed: 02/08/2023]
Abstract
This narrative review aims to provide an overview of the impact of opioid dependence and the contribution of genetics to opioid dependence. Epidemiological data demonstrate that opioid dependence is a global trend with far-reaching effects on the social, economic, and health care systems. A review of classical genetic studies of opioid use suggests significant heritability of drug use behavior, however the evidence from molecular genetic studies is inconclusive. Nonetheless, certain genetic variants are important to consider given their role in the pathophysiology of addictive behavior. We undertook a literature review to identify the current state of knowledge regarding the role of genes in opioid dependence. Determining the association of genetic markers could change the current understanding of the various factors contributing to opioid dependence and therefore may improve recognition of individuals at risk for the disorder and prevention and treatment strategies.
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Affiliation(s)
- Chetna J Mistry
- Arts & Science Undergraduate Program, McMaster University, ON, Canada
| | - Monica Bawor
- McMaster Integrative Neuroscience Discovery & Study (MiNDS), McMaster University, ON, Canada
| | - Dipika Desai
- Population Health Research Institute, Hamilton, ON, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Zainab Samaan
- Population Health Research Institute, Hamilton, ON, Canada ; Department of Psychiatry and Behavioural Neurosciences, McMaster University, ON, Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, ON, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Canada
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Dennis BB, Bawor M, Thabane L, Sohani Z, Samaan Z. Impact of ABCB1 and CYP2B6 genetic polymorphisms on methadone metabolism, dose and treatment response in patients with opioid addiction: a systematic review and meta-analysis. PLoS One 2014; 9:e86114. [PMID: 24489693 PMCID: PMC3906028 DOI: 10.1371/journal.pone.0086114] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/04/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Genetic variability may influence methadone metabolism, dose requirements, and risk of relapse. OBJECTIVES To determine whether the CYP2B6*6 or ABCB1 (rs1045642) polymorphisms are associated with variation in methadone response (plasma concentration, dose, or response to treatment). METHODS Two independent reviewers searched Medline, EMBASE, CINAHL, PsycINFO, and Web of Science databases. We included studies that reported methadone plasma concentration, methadone response, or methadone dose in relation to the CYP2B6*6 or ABCB1 polymorphisms. RESULTS We screened 182 articles and extracted 7 articles for inclusion in the meta-analysis. Considerable agreement was observed between the two independent raters on the title (kappa, 0.82), abstract (kappa, 0.43), and full text screening (kappa, 0.43). Trough (R) methadone plasma concentration was significantly higher in CYP2B6*6 homozygous carriers when compared to non-carriers (standardized mean difference [SMD] = 0.53, 95% confidence interval [CI], 0.05-1.00, p = 0.03) with minimal heterogeneity (I(2) = 0%). Similarly, trough (S) methadone plasma concentration was higher in homozygous carriers of the *6 haplotype when compared to non-carriers, (SMD = 1.44, 95% CI 0.27-2.61, p = 0.02) however significant heterogeneity was observed (I(2) = 69%). Carriers of the CYP2B6*6 haplotype were not found to be significantly different from non-carriers with respect to dose or response to treatment. We found no significant association between the ABCB1 polymorphism and the trough (R), (S) plasma concentrations, methadone dose, or methadone response. CONCLUSION Although the number of studies included and sample size were modest, this is the first meta analysis to show participants homozygous for the CYP2B6*6 genotype have higher trough (R) and (S) methadone plasma concentrations, suggesting that methadone metabolism is significantly slower in *6 homozygous carriers.
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Affiliation(s)
- Brittany B. Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Population Genomics Program, McMaster University, Hamilton, Ontario, Canada
| | - Monica Bawor
- Population Genomics Program, McMaster University, Hamilton, Ontario, Canada
- McMaster Integrative Neuroscience Discovery & Study (MiNDS) Program, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Population Genomics Program, McMaster University, Hamilton, Ontario, Canada
- Departments of Pediatrics and Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Zahra Sohani
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Population Genomics Program, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Population Genomics Program, McMaster University, Hamilton, Ontario, Canada
- McMaster Integrative Neuroscience Discovery & Study (MiNDS) Program, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Dennis BB, Samaan MC, Bawor M, Paul J, Plater C, Pare G, Worster A, Varenbut M, Daiter J, Marsh DC, Desai D, Thabane L, Samaan Z. Evaluation of clinical and inflammatory profile in opioid addiction patients with comorbid pain: results from a multicenter investigation. Neuropsychiatr Dis Treat 2014; 10:2239-47. [PMID: 25429222 PMCID: PMC4242695 DOI: 10.2147/ndt.s72785] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Chronic pain is the most commonly reported comorbidity among patients with opioid addiction receiving methadone maintenance treatment (MMT), with an estimated prevalence ranging between 30% and 55%. Evidence suggests that patients with comorbid pain are at high risk for poor treatment response, including continued illicit substance use. Due to the important relationship between the presence of pain and illicit substance abuse within the MMT setting, it is imperative that we target our efforts toward understanding the characteristics of this patient population. METHODS The primary objective of this study was to explore the clinical and inflammatory profile of MMT patients reporting comorbid pain. This multicenter study enrolled patients (n=235) on MMT for the treatment of opioid dependence. Clinical history and blood and urine data were collected. Blood samples were obtained for estimating the serum levels of inflammatory markers (tumor necrosis factor [TNF]-α, interleukin-1 receptor antagonist [IL-1ra], IL-6, IL-8, IL-10, interferon [IFN]-γ and chemokine (C-C motif) ligand 2 [CCL2]). The study objectives were addressed using a descriptive statistical summary and a multivariable logistic regression model constructed in STATA version 12. RESULTS Among the participants eligible for inclusion (n=235), serum IFN-γ level and substance abuse behavior proved to be important delineating characteristics for the detection of comorbid pain. Analysis of inflammatory profile showed IFN-γ to be significantly elevated among patients reporting comorbid pain (odds ratio [OR]: 2.02; 95% confidence interval [CI]: 1.17, 3.50; P=0.01). Patients reporting comorbid pain were also found to have an increase in positive opioid urine screens (OR: 1.02; 95% CI: 1.00, 1.03; P=0.01), indicating an increase in illicit opioid consumption. CONCLUSION MMT patients with comorbid pain were shown to have elevated IFN-γ and higher rates of continued opioid abuse. The ability to objectively distinguish between patients with comorbid pain may help to both improve the prediction of poor responders to MMT as well as identify treatment approaches such as anti-inflammatory medications as safe alternatives for MMT patients with comorbid pain.
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Affiliation(s)
- Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - M Constantine Samaan
- Department of Pediatrics, Division of Pediatric Endocrinology, McMaster University, Hamilton, ON, Canada
| | - Monica Bawor
- McMaster Integrative Neuroscience Discovery and Study Program, McMaster University, Hamilton, ON, Canada
| | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Carolyn Plater
- Ontario Addiction Treatment Centres, Richmond Hill, ON, Canada
| | - Guillaume Pare
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Andrew Worster
- Department of Medicine, Hamilton General Hospital, Hamilton, ON, Canada
| | | | - Jeff Daiter
- Ontario Addiction Treatment Centres, Richmond Hill, ON, Canada
| | - David C Marsh
- Ontario Addiction Treatment Centres, Richmond Hill, ON, Canada ; Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada ; Centre for Evaluation of Medicine, Hamilton, ON, Canada ; System Linked Research Unit, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada ; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Samaan Z, Bawor M, Dennis BB, Plater C, Varenbut M, Daiter J, Worster A, Marsh DC, Tan C, Desai D, Thabane L, Pare G. Genetic influence on methadone treatment outcomes in patients undergoing methadone maintenance treatment for opioid addiction: a pilot study. Neuropsychiatr Dis Treat 2014; 10:1503-8. [PMID: 25187714 PMCID: PMC4149396 DOI: 10.2147/ndt.s66234] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Treatment of opioid addiction with methadone is effective; however, it is known to produce interindividual variability. This may be influenced in part by genetic variants, which can increase the initial risk of developing opioid addiction as well as explain differences in response to treatment. This pilot study aimed to assess the feasibility of conducting a full-scale genetic analysis to identify genes that predict methadone treatment outcomes in this population. METHODS This was a cross-sectional observational study of patients admitted to a methadone maintenance treatment program for opioid addiction. We obtained demographic and clinical characteristics in addition to blood and urine samples, for the assessment of treatment outcomes. RESULTS The recruitment process yielded 252 patients, representing a 20% recruitment rate. We conducted genetic testing based on a 99.6% rate of provision of DNA samples. The average retention in treatment was 3.4 years, and >50% of the participants reported psychiatric and medical comorbidities. BDNF rs6265 and DRD2 rs1799978 were the common single nucleotide polymorphisms (SNPs) selected for the feasibility study. DISCUSSION This study met our predetermined feasibility criteria; recruitment, response rates, and genetic testing were feasible; treatment duration was sufficient for follow up; and the prevalence of comorbid conditions indicated the need for reliable psychiatric and chronic pain measures. The study strengths included effective collaboration with clinics and the generalizability of sample population. Key learning points show the need for assessment of treatment outcomes on multiple domains, implementation of follow up, and the development of standardized training for the study clinical staff.
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Affiliation(s)
- Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada ; MiNDS Neuroscience Program, McMaster University, Hamilton, Ontario, Canada
| | - Monica Bawor
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada ; MiNDS Neuroscience Program, McMaster University, Hamilton, Ontario, Canada
| | - Brittany B Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Carolyn Plater
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Michael Varenbut
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Jeffrey Daiter
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada
| | - Andrew Worster
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada ; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David C Marsh
- Ontario Addiction Treatment Centres, Richmond Hill, Ontario, Canada ; Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada
| | - Charlie Tan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dipika Desai
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada ; Biostatistics Unit, Centre for Evaluation of Medicine, McMaster University, Hamilton, Ontario, Canada ; System Linked Research Unit, McMaster University, Hamilton, Ontario, Canada
| | - Guillaume Pare
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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Thabane L, Mbuagbaw L, Zhang S, Samaan Z, Marcucci M, Ye C, Thabane M, Giangregorio L, Dennis B, Kosa D, Debono VB, Dillenburg R, Fruci V, Bawor M, Lee J, Wells G, Goldsmith CH. A tutorial on sensitivity analyses in clinical trials: the what, why, when and how. BMC Med Res Methodol 2013; 13:92. [PMID: 23855337 PMCID: PMC3720188 DOI: 10.1186/1471-2288-13-92] [Citation(s) in RCA: 450] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 07/10/2013] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Sensitivity analyses play a crucial role in assessing the robustness of the findings or conclusions based on primary analyses of data in clinical trials. They are a critical way to assess the impact, effect or influence of key assumptions or variations--such as different methods of analysis, definitions of outcomes, protocol deviations, missing data, and outliers--on the overall conclusions of a study.The current paper is the second in a series of tutorial-type manuscripts intended to discuss and clarify aspects related to key methodological issues in the design and analysis of clinical trials. DISCUSSION In this paper we will provide a detailed exploration of the key aspects of sensitivity analyses including: 1) what sensitivity analyses are, why they are needed, and how often they are used in practice; 2) the different types of sensitivity analyses that one can do, with examples from the literature; 3) some frequently asked questions about sensitivity analyses; and 4) some suggestions on how to report the results of sensitivity analyses in clinical trials. SUMMARY When reporting on a clinical trial, we recommend including planned or posthoc sensitivity analyses, the corresponding rationale and results along with the discussion of the consequences of these analyses on the overall findings of the study.
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Affiliation(s)
- Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Departments of Pediatrics and Anesthesia, McMaster University, Hamilton, ON, Canada
- Center for Evaluation of Medicine, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Shiyuan Zhang
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Population Genomics Program, McMaster University, Hamilton, ON, Canada
| | - Maura Marcucci
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Chenglin Ye
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Marroon Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- GSK, Mississauga, ON, Canada
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Brittany Dennis
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Daisy Kosa
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Department of Nephrology, Toronto General Hospital, Toronto, ON, Canada
| | - Victoria Borg Debono
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | | | - Vincent Fruci
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Monica Bawor
- McMaster Integrative Neuroscience Discovery & Study (MiNDS) Program, McMaster University, Hamilton, ON, Canada
| | - Juneyoung Lee
- Department of Biostatistics, Korea University, Seoul, Korea
| | - George Wells
- Department of Clinical Epidemiology, University of Ottawa, Ottawa, ON, Canada
| | - Charles H Goldsmith
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Center, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Samaan Z, Mbuagbaw L, Kosa D, Borg Debono V, Dillenburg R, Zhang S, Fruci V, Dennis B, Bawor M, Thabane L. A systematic scoping review of adherence to reporting guidelines in health care literature. J Multidiscip Healthc 2013; 6:169-88. [PMID: 23671390 PMCID: PMC3649856 DOI: 10.2147/jmdh.s43952] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Reporting guidelines have been available for the past 17 years since the inception of the Consolidated Standards of Reporting Trials statement in 1996. These guidelines were developed to improve the quality of reporting of studies in medical literature. Despite the widespread availability of these guidelines, the quality of reporting of medical literature remained suboptimal. In this study, we assess the current adherence practice to reporting guidelines; determine key factors associated with better adherence to these guidelines; and provide recommendations to enhance adherence to reporting guidelines for future studies. Methods We undertook a systematic scoping review of systematic reviews of adherence to reporting guidelines across different clinical areas and study designs. We searched four electronic databases (Cumulative Index to Nursing and Allied Health Literature, Web of Science, Embase, and Medline) from January 1996 to September 2012. Studies were included if they addressed adherence to one of the following guidelines: Consolidated Standards of Reporting Trials (CONSORT), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Quality of Reporting of Meta-analysis (QUOROM), Transparent Reporting of Evaluations with Nonrandomized Designs (TREND), Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). A protocol for this study was devised. A literature search, data extraction, and quality assessment were performed independently by two authors in duplicate. This study reporting follows the PRISMA guidelines. Results Our search retrieved 5159 titles, of which 50 were eligible. Overall, 86.0% of studies reported suboptimal levels of adherence to reporting guidelines. Factors associated with better adherence included journal impact factor and endorsement of guidelines, publication date, funding source, multisite studies, pharmacological interventions and larger studies. Conclusion Reporting guidelines in the clinical literature are important to improve the standards of reporting of clinical studies; however, adherence to these guidelines remains suboptimal. Action is therefore needed to enhance the adherence to these standards. Strategies to enhance adherence include journal editorial policies endorsing these guidelines.
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Affiliation(s)
- Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada ; Population Genomics Program, McMaster University, Hamilton, ON, Canada
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