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Bird SM. Threat level in the Gaza Strip: fatalities per 1000 person-years. Lancet 2024; 403:1139-1140. [PMID: 38458220 DOI: 10.1016/s0140-6736(24)00402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Affiliation(s)
- Sheila M Bird
- MRC Biostatistics Unit, Cambridge CB2 0SR, UK; University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK.
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Hughes DM, Bird SM, Cheyne CP, Ashton M, Campbell MC, García-Fiñana M, Buchan I. Rapid antigen testing in COVID-19 management for school-aged children: an observational study in Cheshire and Merseyside, UK. J Public Health (Oxf) 2023; 45:e38-e47. [PMID: 35137216 PMCID: PMC8903429 DOI: 10.1093/pubmed/fdac003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 11/19/2021] [Revised: 12/22/2021] [Accepted: 01/02/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Twice weekly lateral flow tests (LFTs) for secondary school children was UK Government policy from 8 March 2021. We evaluate use of LFTs (both supervised at test centres, and home test kits) in school-aged children in Cheshire and Merseyside. METHODS We report (i) number of LFT positives (ii) proportion of LFT positive with confirmatory reverse transcription polymerase chain reaction (PCR) test within 2 days, and (iii) agreement between LFT-positive and confirmatory PCR, and dependence of (i-iii) on COVID-19 prevalence. FINDINGS 1 248 468 LFTs were taken by 211 255 12-18 years old, and 163 914 by 52 116 5-11 years old between 6 November 2020 and 31 July 2021. Five thousand three hundred and fourteen (2.5%) 12-18 years old and 1996 (3.8%) 5-11 years old returned LFT positives, with 3829 (72.1%) and 1535 (76.9%) confirmatory PCRs, and 3357 (87.7%) and 1383 (90.1%) confirmatory PCR-positives, respectively.Monthly proportions of LFT positive with PCR negative varied between 4.7% and 35.3% in 12-18 years old (corresponding proportion of all tests positive: 9.7% and 0.3%).Deprivation and non-White ethnicity were associated with reduced uptake of confirmatory PCR. INTERPRETATION Substantial inequalities in confirmatory testing need more attention to avoid further disadvantage through education loss. When prevalence is low additional measures, including confirmatory testing, are needed. Local Directors of Public Health taking more control over schools testing may be needed. FUNDING DHSC, MRC, NIHR, EPSRC.
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Affiliation(s)
- David M Hughes
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Sheila M Bird
- MRC Biostatistics Unit, Cambridge, UK.,Edinburgh University's College of Medicine and Veterinary Medicine, Edinburgh, UK
| | | | - Matthew Ashton
- Department of Public Health, Liverpool City Council, Liverpool, UK
| | | | | | - Iain Buchan
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
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Mullins E, McCabe R, Bird SM, Randell P, Pond MJ, Regan L, Parker E, McClure M, Donnelly CA. Tracking the incidence and risk factors for SARS-CoV-2 infection using historical maternal booking serum samples. PLoS One 2022; 17:e0273966. [PMID: 36054212 PMCID: PMC9439206 DOI: 10.1371/journal.pone.0273966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/25/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
The early transmission dynamics of SARS-CoV-2 in the UK are unknown but their investigation is critical to aid future pandemic planning. We tested over 11,000 anonymised, stored historic antenatal serum samples, given at two north-west London NHS trusts in 2019 and 2020, for total antibody to SARS-CoV-2 receptor binding domain (anti-RBD). Estimated prevalence of seroreactivity increased from 1% prior to mid-February 2020 to 17% in September 2020. Our results show higher prevalence of seroreactivity to SARS-CoV-2 in younger, non-white ethnicity, and more deprived groups. We found no significant interaction between the effects of ethnicity and deprivation. Derived from prevalence, the estimated incidence of seroreactivity reflects the trends observed in daily hospitalisations and deaths in London that followed 10 and 13 days later, respectively. We quantified community transmission of SARS-CoV-2 in London, which peaked in late March / early April 2020 with no evidence of community transmission until after January 2020. Our study was not able to determine the date of introduction of the SARS-CoV-2 virus but demonstrates the value of stored antenatal serum samples as a resource for serosurveillance during future outbreaks.
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Affiliation(s)
- Edward Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- The George Institute for Global Health, Queen Charlotte’s and Chelsea Hospital, London, United Kingdom
- * E-mail:
| | - Ruth McCabe
- Department of Statistics, University of Oxford, Oxford, United Kingdom
- NIHR Health Research Protection Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Sheila M. Bird
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Paul Randell
- Department of Infection and Immunity, North West London Pathology, London, United Kingdom
| | - Marcus J. Pond
- Department of Infection and Immunity, North West London Pathology, London, United Kingdom
| | - Lesley Regan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Department of Obstetrics & Gynaecology, St Mary’s Hospital, London, United Kingdom
| | - Eleanor Parker
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Myra McClure
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Christl A. Donnelly
- Department of Statistics, University of Oxford, Oxford, United Kingdom
- NIHR Health Research Protection Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
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Bird SM. Study-design in pandemics: From surveillance and performance-evaluation to licensing and pharmacovigilance. Pharm Stat 2022; 21:764-777. [PMID: 35819118 PMCID: PMC9544724 DOI: 10.1002/pst.2217] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/10/2022]
Abstract
Andy Grieve, the first pharmaceutical statistician to be President of the Royal Statistical Society, practiced in the regulated world of drug development. With reduction in drug development costs as his motivation, Grieve advanced Bayesian methods for developing predictive methods for efficacy and toxicity - to be used as early as possible in the drug development process; and his presidential address exhorted statisticians to weigh-in wherever data are used to make decisions. Diagnostic tests for infectious diseases are less regulated than drugs and vaccines unless the blood supply is at risk. Unlike in the HIV and HCV pandemics of the late 20th century, even well-designed surveys linked to a volunteered biological sample (to be tested for SARS-CoV-2 antigen or antibodies) have had modest or low consent rates. Record-linkage, statistical design and reporting standards have seen triumph and tragedy. Among the triumphs are: Liverpool's insistence on dual testing (lateral flow device; polymerase chain reaction [PCR]) of some 6000 asymptomatic citizens who attended for SARS-CoV-2-screening; two tricky randomized controlled public-policy trials on daily contact testing for close contacts of index cases of SARS-CoV-2 infection versus self-isolation (with or without initial PCR); and among already-consented participants in surveillance, over 80% secondary consent for linkage to their health records, including the Immunization Management Service. Before the next pandemic we need to entrench better regulation of diagnostic tests, better informed consent (not via weblinks), better feedback to participants, and transparency about basic safety data.
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Affiliation(s)
- Sheila M Bird
- MRC Biostatistics Unit, Cambridge, UK.,College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Mesa-Eguiagaray I, Wild SH, Bird SM, Williams LJ, Brewster DH, Hall PS, Figueroa JD. Breast cancer incidence and survival in Scotland by socio-economic deprivation and tumour subtype. Breast Cancer Res Treat 2022; 194:463-473. [PMID: 35648299 PMCID: PMC9239954 DOI: 10.1007/s10549-022-06632-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/09/2022] [Indexed: 11/04/2022]
Abstract
Background Women from socio-economically deprived areas are less likely to develop and then to survive breast cancer (BC). Whether associations between deprivation and BC incidence and survival differ by tumour molecular subtypes and mode of detection in Scotland are unknown. Methods Data consisted of 62,378 women diagnosed with invasive BC between 2000 and 2016 in Scotland. Incidence rates and time trends were calculated for oestrogen receptor positive (ER+) and negative (ER−) tumours and stratified by the Scottish Index of Multiple Deprivation (SIMD) quintiles and screening status. SIMD is an area-based measure derived across seven domains: income, employment, education, health, access to services, crime and housing. We calculated adjusted hazard ratios (aHR [95% confidence intervals]) for BC death by immunohistochemical surrogates of molecular subtypes for the most versus the least deprived quintile. We adjusted for mode of detection and other confounders. Results In Scotland, screen-detected ER+tumour incidence increased over time, particularly in the least deprived quintile [Average Annual Percentage Change (AAPC) = 2.9% with 95% CI from 1.2 to 4.7]. No marked differences were observed for non-screen-detected ER+tumours or ER− tumours by deprivation. BC mortality was higher in the most compared to the least deprived quintile irrespective of ER status (aHR = 1.29 [1.18, 1.41] for ER+ and 1.27 [1.09, 1.47] for ER− tumours). However, deprivation was associated with significantly higher mortality for luminal A and HER2−enriched tumours (aHR = 1.46 [1.13, 1.88] and 2.10 [1.23, 3.59] respectively) but weaker associations for luminal B and TNBC tumours that were not statistically significant. Conclusions Deprivation is associated with differential BC incidence trends for screen-detected ER+tumours and with higher mortality for select tumour subtypes. Future efforts should evaluate factors that might be associated with reduced survival in deprived populations and monitor progress stratified by tumour subtypes and mode of detection. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06632-1.
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Affiliation(s)
- Ines Mesa-Eguiagaray
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
| | - Sarah H Wild
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Sheila M Bird
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.,Cambridge University's MRC Biostatistics Unit, Cambridge, UK
| | - Linda J Williams
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - David H Brewster
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Peter S Hall
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.,Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Jonine D Figueroa
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK. .,Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
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Bird SM. Medical research, data sharing, and properly informed consent. Significance 2022; 19:4-5. [PMID: 35602418 PMCID: PMC9111332 DOI: 10.1111/1740-9713.01603] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
When Sheila M. Bird agreed to participate in a Covid surveillance study, she did not realise her negative test result and personal details would be passed to NHS Test and Trace. Here, she calls for closer scrutiny of privacy policies by research ethics committees, and clearer communication with study participants When Sheila M. Bird agreed to participate in a Covid surveillance study, she did not realise her negative test result and personal details would be passed to NHS Test and Trace. Here, she calls for closer scrutiny of privacy policies by research ethics committees, and clearer communication with study participants.
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Affiliation(s)
- Sheila M. Bird
- Formerly programme leader at the MRC Biostatistics Unit, Cambridge University. She is a member of the Significance editorial board and the Royal Statistical Society's Covid‐19 Task Force. She writes here in a personal capacity
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McDonald SA, McAuley A, Hickman M, Bird SM, Weir A, Templeton K, Gunson R, Hutchinson SJ. Increasing drug-related mortality rates over the last decade in Scotland are not just due to an ageing cohort: A retrospective longitudinal cohort study. Int J Drug Policy 2021; 96:103286. [PMID: 34011449 DOI: 10.1016/j.drugpo.2021.103286] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/16/2021] [Accepted: 04/23/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND In Europe, North America, and Australia, mortality due to drug-related (DR) causes amongst people who inject drugs (PWID) is a major issue. Our objective was to characterise temporal trends in DR mortality rates in a large cohort of PWID in Scotland over the past decade, all of whom had been diagnosed with hepatitis C virus (HCV) infection, and to investigate factors associated with DR mortality. METHODS Retrospective longitudinal cohort study linking Scotland's national HCV Diagnosis Database and deaths registry. The study cohort consisted of all individuals with likely injection drug use-related route of HCV acquisition, who had been diagnosed with HCV between 1991 and 2018, and were alive and aged under 65 years on 1 January 2009. We used Lexis expansion to adjust for ageing cohort effects and calculated the mortality rate from an underlying/contributing DR cause over the period 2009-2018. We fitted Poisson regression models to estimate the temporal trend adjusting for attained age, sex, referral setting, region, and viraemic status at baseline. RESULTS Amongst the study population (n = 35,065; 236,914 person-years), a total of 1900 DR deaths occurred; the DR mortality rate increased from 5.6/1000 [101 deaths] in 2009 to 12.4/1000 [342] person-years in 2018. Increasing trends were observed for all age-groups except 55-64 years. The overall DR mortality rate was highest for referrals for HCV testing from prison (11.0/1000) and hospital settings (10.0/1000). Mortality increased with calendar time period, with significantly raised adjusted rate ratios (RRs) from 2015 (RR=1.40, 95% CI:1.16-1.69) to 2018 (RR=2.23, 95% CI:1.88-2.64), compared with 2011-2012, for older age (35-44: RR=1.37, 95% CI:1.20-1.56; 45-54: RR=1.32, CI:1.14-1.53) compared with <35 years, for persons diagnosed with HCV since 2009 (RR=1.34, 95% CI:1.21-1.49), and for prison and hospital referrals (RRs of 1.30, 1.37) compared with GP referrals. CONCLUSION Increasing DR mortality rates in Scotland over the past decade are not just due to an ageing cohort. Harm reduction services will likely need to expand and adapt to reverse the recent upward trends in DR mortality in PWID.
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Affiliation(s)
- S A McDonald
- Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK; Health Protection Scotland, 5 Cadogan Street, Glasgow G2 6QE, UK.
| | - A McAuley
- Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK; Health Protection Scotland, 5 Cadogan Street, Glasgow G2 6QE, UK
| | - M Hickman
- University of Bristol, Bristol BS8 1TL, UK
| | - S M Bird
- MRC Biostatistics Unit, Robinson Way, Cambridge CB2 OSR, UK
| | - A Weir
- Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK; Health Protection Scotland, 5 Cadogan Street, Glasgow G2 6QE, UK
| | - K Templeton
- Edinburgh Royal Infirmary, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - R Gunson
- West of Scotland Specialist Virology Centre, 8-16 Alexandra Parade, Glasgow G31 2ER, UK
| | - S J Hutchinson
- Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK; Health Protection Scotland, 5 Cadogan Street, Glasgow G2 6QE, UK
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Abstract
Sheila Bird offers a personal account of the debate over rapid coronavirus screening in secondary schools, and the efforts to reinstate confirmatory PCR tests Sheila Bird offers a personal account of the debate over rapid coronavirus screening in secondary schools, and the efforts to reinstate confirmatory PCR tests.
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Affiliation(s)
- Sheila M Bird
- Formerly programme leader at the MRC Biostatistics Unit, Cambridge University. She is a member of the Significance editorial board and the Royal Statistical Society's Covid-19 Task Force. She writes here in a personal capacity
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Kiguba R, Karamagi C, Bird SM. Quality of care for adult in-patients with malaria in a tertiary hospital in Uganda. Malar J 2021; 20:178. [PMID: 33836769 PMCID: PMC8034187 DOI: 10.1186/s12936-021-03712-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 03/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prompt detection and appropriate treatment of malaria prevents severe disease and death. The quality of care for adult malaria in-patients is not well documented in sub-Saharan Africa, particularly in Uganda. The study sought to describe the patterns of malaria diagnosis and treatment among adult in-patients admitted to the medical and gynaecological wards of Uganda's 1790-bed Mulago National Referral Hospital from December 2013 to April 2014. METHODS A prospective cohort of 762 consented in-patients aged ≥ 18 years was assembled. Proportions of in-patients who received preadmission and in-hospital anti-malarials, missed Day 1 dosing of hospital-initiated anti-malarials and/or had malaria microscopy done were determined. Multivariable logistic regression was used to identify risk-factors for missed Day 1 dosing of anti-malarials. RESULTS One in five (19%, 146/762) in-patients had an admission or discharge malaria diagnosis or both; with median age of 29 years (IQR, 22-42 years). Microscopy was requested in 77% (108/141) of in-patients with an admission malaria diagnosis; results were available for 46% (50/108), of whom 42% (21/50) tested positive for Plasmodium falciparum malaria parasitaemia. Only 13% (11/83) of in-patients who received in-hospital injectable artesunate (AS) or quinine (Q) received follow-up oral artemether-lumefantrine (AL); 2 of 18 severe malaria cases received follow-up oral AL. Injectable AS only (47%, 47/100) was the most frequent hospital-initiated anti-malarial treatment followed by injectable Q only (23%, 23/100) amongst in-patients who received in-hospital anti-malarials. A quarter (25%, 25/100; 95% CI: 17-35%) of in-patients missed Day 1 dosing of hospital-initiated anti-malarials. Each additional admission diagnosis was more than two-fold likely to increase the odds of missed Day 1 dosing of in-hospital anti-malarials (aOR = 2.6, 95% CI: 1.52-4.56; P-value = 0.001). CONCLUSIONS Half the malaria microscopy results were not available; yet, the rate of testing was high. The majority of in-patients initiated on injectable AS or Q did not receive the recommended follow-up oral AL. One in four in-patients delayed to initiate hospital anti-malarials by at least one calendar day. The hospital should encourage prompt availability of malaria test-results to promote the timely initiation and completion of anti-malarial treatment, thereby improving the quality of care for hospitalized malaria patients in Uganda.
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Affiliation(s)
- Ronald Kiguba
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Charles Karamagi
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sheila M Bird
- Medical Research Council Biostatistics Unit, Cambridge, UK
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Gao L, Roy Robertson J, Bird SM. Scotland's 2009-2015 methadone-prescription cohort: Quintiles for daily dose of prescribed methadone and risk of methadone-specific death. Br J Clin Pharmacol 2021; 87:652-673. [PMID: 32530053 PMCID: PMC7612180 DOI: 10.1111/bcp.14432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS As methadone clients age, their drug-related death (DRD) risks increase, more than doubling at 45+ years for methadone-specific DRDs. METHODS Using Community Health Index (CHI) numbers, mortality to 31 December 2015 was ascertained for 36 347 methadone-prescription clients in Scotland during 2009-2015. Cohort entry, quantity of prescribed methadone and daily dose (actual or recovered by effective, simple rules) were defined by clients' first CHI-identified methadone prescription after 30 June 2009 and used in proportional hazards analysis. As custodian of death records, National Records of Scotland identified non-DRDs from DRDs. Methadone-specific DRD means methadone was implicated but neither heroin nor buprenorphine. RESULTS The cohort's 192 928 person-years included 1857 non-DRDs and 1323 DRDs (42%), 546 of which were methadone specific. Actual/recovered daily dose was available for 26 533 (73%) clients who experienced 420 methadone-specific DRDs. Top quintile for daily dose at first CHI-identified methadone prescription was >90 mg. Age 45+ years at cohort-entry (hazard ratio vs 25-34 years: 3.1, 95% confidence interval: 2.4-4.2), top quintile for baseline daily dose of prescribed methadone (vs 50-70 mg: 1.9, 1.1-3.1) and being female (1.3, 1.0-1.6) significantly increased clients' risk of methadone-specific DRD. CONCLUSION Extra care is needed when methadone daily dose exceeds 90 mg. Females' higher risk for methadone-specific DRD is new and needs validation. Further analyses of prescribed daily dose linked to mortality for large cohorts of methadone clients are needed internationally, together with greater pharmacodynamic and pharmacokinetic understanding of methadone by age and sex. Balancing age-related risks is challenging for prescribers who manage chronic opiate dependency against additional uncertainty about the nature, strength and pharmacological characteristics of drugs from illegal markets.
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Affiliation(s)
- Lu Gao
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Sheila M. Bird
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- University of Edinburgh Centre for Medical Informatics, Edinburgh, UK
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Bird SM. Fatal accident inquiries into 83 deaths in Scottish prison custody: 2010-2013. BJPsych Open 2020; 6:e132. [PMID: 33121556 PMCID: PMC7745234 DOI: 10.1192/bjo.2020.121] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 09/02/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The only non-legal reference in Lord Cullen's Review of fatal accident inquiry (FAI) Legislation in Scotland (2009) was my audit of FAIs into 97 deaths in prison custody in Scotland, 1999-2003: recommending that waiting time from prisoner death to end of FAI should be less than 1 year for 90% of FAIs, and epidemiological rules for FAIs to have a written determination versus formal findings. AIMS Audit of FAIs into 83 deaths in Scottish prison custody in the period 2010-2013. METHOD Assessement of waiting times from prisoner death to end of FAI; dissemination of written determinations; self-inflicted death rate per 1000 prisoner-years; cause of natural deaths; and yellow card submissions. Detailed cross-checking was nec37essary between Scottish Prison Service and courts' websites and the Scottish Fatalities Investigation Unit. RESULTS Of 83 FAIs into deaths in Scottish prison custody, 2010-2013, 37 (45%) were long-awaited (ongoing >2 years after the prisoner's death); 16 (19%, 95% CI 11-28%) beyond 3 years. Of 37 long-awaited FAIs, 27 made written determinations but only 12 of these (44%) were published. Self-inflicted deaths numbered 36: 1.1 per 1000 prisoner-years (95% CI 0.75-1.48). Of 47 deaths from natural causes, cardiovascular disease accounted for 23 (49%, 95% CI 34-63%); liver disease was implicated in 10 of 47. To support pharmacovigilance, submissions were made to Medicines and Healthcare Regulatory Agency for eight deaths (10%, 95% CI 4-19%). CONCLUSIONS FAIs into prisoner deaths in Scotland are too long-awaited given that four (5%) identified precautions that could have prevented death.
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Affiliation(s)
- Sheila M. Bird
- Cambridge University's MRC Biostatistics Unit, UK; and Edinburgh University's College of Medicine and Veterinary Medicine, UK
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12
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Affiliation(s)
- Sheila M Bird
- University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, Scotland; MRC Biostatistics Unit, Institute of Public Health, Cambridge CB2 0SR, UK.
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Mesa-Eguiagaray I, Wild SH, Rosenberg PS, Bird SM, Brewster DH, Hall PS, Cameron DA, Morrison D, Figueroa JD. Distinct temporal trends in breast cancer incidence from 1997 to 2016 by molecular subtypes: a population-based study of Scottish cancer registry data. Br J Cancer 2020; 123:852-859. [PMID: 32555534 PMCID: PMC7463252 DOI: 10.1038/s41416-020-0938-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 01/02/2020] [Revised: 05/18/2020] [Accepted: 05/28/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We describe temporal trends in breast cancer incidence by molecular subtypes in Scotland because public health prevention programmes, diagnostic and therapeutic services are shaped by differences in tumour biology. METHODS Population-based cancer registry data on 72,217 women diagnosed with incident primary breast cancer from 1997 to 2016 were analysed. Age-standardised rates (ASR) and age-specific incidence were estimated by tumour subtype after imputing the 8% of missing oestrogen receptor (ER) status. Joinpoint regression and age-period-cohort models were used to assess whether significant differences were observed in incidence trends by ER status. RESULTS Overall, ER-positive tumour incidence increased by 0.4%/year (95% confidence interval (CI): -0.1, 1.0). Among routinely screened women aged 50-69 years, we observed an increase in ASR from 1997 to 2011 (1.6%/year, 95% CI: 1.2-2.1). ER-negative tumour incidence decreased among all ages by 2.5%/year (95% CI: -3.9 to -1.1%) over the study period. Compared with the 1941-1959 birth cohort, women born in 1912-1940 had lower incidence rate ratios (IRR) for ER+ tumours and women born in 1960-1986 had lower IRR for ER- tumours. CONCLUSIONS Future incidence and survival reporting should be monitored by molecular subtypes to inform clinical planning and cancer control programmes.
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Affiliation(s)
- Ines Mesa-Eguiagaray
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Sarah H Wild
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Philip S Rosenberg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Sheila M Bird
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.,Cambridge University's MRC Biostatistics Unit, Cambridge, CB2 0SR, UK
| | - David H Brewster
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Peter S Hall
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.,Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - David A Cameron
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - David Morrison
- NHS National Services and University of Glasgow, Glasgow, UK
| | - Jonine D Figueroa
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK. .,Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
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14
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Bird SM. Health in the UK. Lancet 2019; 394:827-828. [PMID: 31498093 DOI: 10.1016/s0140-6736(19)31246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 05/10/2019] [Indexed: 11/22/2022]
Affiliation(s)
- Sheila M Bird
- Edinburgh University College of Medicine and Veterinary Medicine, Edinburgh, Scotland; MRC Biostatistics Unit, Cambridge University School of Clinical Medicine, Cambridge, UK.
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Affiliation(s)
- Roy Robertson
- Usher Institute, Edinburgh University, Edinburgh, UK
| | - Sheila M Bird
- Biostatistics Unit, University of Cambridge and College of Medicine and Veterinary Medicine, University of Edinburgh, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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16
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Parmar MKB, Strang J, Choo L, Meade AM, Bird SM. Clarification re naloxone administered to study subject versus other overdose victim in the N-ALIVE pilot randomized trial. Addiction 2019; 114:1325. [PMID: 31161681 DOI: 10.1111/add.14284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - John Strang
- National Addiction Centre at King's College London, London, UK
| | - Louise Choo
- MRC Clinical Trials Unit at University College London, London, UK
| | - Angela M Meade
- MRC Clinical Trials Unit at University College London, London, UK
| | - Sheila M Bird
- MRC Biostatistics Unit, University of Cambridge Institute of Public Health, Cambridge, UK
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Affiliation(s)
- Sheila M Bird
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SR, UK; Usher Institute, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK.
| | - Andrew McAuley
- Health Protection Scotland, Meridian Court, Glasgow, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow
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Bijral P, Hayhurst KP, Bird SM, Millar T. Prevalence of recent fentanyl use among treated users of illicit opioids in England: based on piloted urine drug screens. Clin Toxicol (Phila) 2018; 57:368-371. [PMID: 30554543 DOI: 10.1080/15563650.2018.1527927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 10/27/2022]
Abstract
OBJECTIVE To use a pilot of national fentanyl screening to establish the current prevalence of recent fentanyl use among treated users of illicit opioids in the English treatment system and inform the design of a full study. DESIGN Cross-sectional fentanyl metabolite urine screening in randomly-selected study sites, stratified to cover all nine geographical regions of England, supplemented with self-report subsequent to a positive fentanyl test. PATIENTS 468 adult (18 years of age and above) patients receiving treatment for opioid use disorder, screened December 2017 to May 2018. RESULTS The fentanyl-positive rate in patients receiving treatment for opioid use disorder in the English treatment system was 3% (15/468, 95% CI 1.8% to 5.2%) with a per-site range (for the 10 sites in 9 regions where fentanyl was detected) of between 2% (1/57) and 15% (4/27). Self-report data indicated that the majority of fentanyl-positives (12/15, 80%) was unaware of having purchased fentanyl. CONCLUSIONS Despite alerts already in place, patients receiving treatment for opioid use disorder, who were fentanyl-positive, were unwittingly purchasing and consuming fentanyl.
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Affiliation(s)
| | - Karen P Hayhurst
- b Centre for Mental Health and Safety , University of Manchester , Manchester , UK
| | - Sheila M Bird
- c Usher Institute of Population Health Sciences and Informatics , University of Edinburgh , Edinburgh , UK.,d MRC Biostatistics Unit, School of Clinical Medicine, Institute for Public Health , University of Cambridge , Cambridge , UK
| | - Tim Millar
- b Centre for Mental Health and Safety , University of Manchester , Manchester , UK
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McAuley A, Bird SM. Take-home naloxone is a global issue, in practice and in research: A response to Heavey et al. Int J Drug Policy 2018; 63:111-112. [PMID: 30553230 DOI: 10.1016/j.drugpo.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/16/2018] [Accepted: 08/09/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Andrew McAuley
- Health Protection Scotland, Glasgow, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
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20
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Pierce M, Millar T, Robertson JR, Bird SM. Ageing opioid users' increased risk of methadone-specific death in the UK. Int J Drug Policy 2018; 55:121-127. [PMID: 29573622 PMCID: PMC6004035 DOI: 10.1016/j.drugpo.2018.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/15/2018] [Accepted: 02/12/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The first evidence that the hazard ratio (HR) for methadone-specific death rises more steeply with age-group than for all drug-related deaths (DRDs) came from Scotland's cohort of 33,000 methadone-prescription clients. We aim to examine, for England, whether illicit opioid users' risk of methadone-specific death increases with age; and to pool age-related HRs for methadone-specific deaths with those for Scotland's methadone-prescription clients. METHODS The setting is all services in England that provide publicly-funded, structured treatment for illicit opioid users, the methodology linkage of the English National Drug Treatment Monitoring System and mortality database, and key measurements are DRDs, methadone-specific DRDs, or heroin-specific DRDs, by age-group and gender, with proportional hazards adjustment for substances used, injecting status and periods in/out of treatment. RESULTS Linkage was achieved for 129,979 adults receiving prescribing treatment modalities for opioid dependence during April 2005 to March 2009 and followed-up for 378,009 person-years (pys). There were 1,266 DRDs: 271 methadone-specific (7 per 10,000 pys: irrespective of gender) and 473 heroin-specific (15 per 10,000 pys for males, 7 for females). Methadone-specific DRD-rate per 10,000 person-years was 3.5 (95% CI: 2.7-4.4) at 18-34 years, 8.9 (CI: 7.3-10.5) at 35-44 years and 18 (CI: 13.8-21.2) at 45+ years; heroin-specific DRD-rate was unchanged with age. Relative to 25-34 years, pooled HRs for UK clients' methadone-specific deaths were: 0.87 at <25 years (95% CI: 0.56-1.35); 2.14 at 35-44 years (95% CI: 1.76-2.60); 3.75 at 45+ years (95% CI: 2.99-4.70). CONCLUSION International testing and explanation are needed of UK's sharp age-related increase in the risk of methadone-specific death. Clients should be alerted that their risk of methadone-specific death increases as they age.
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Affiliation(s)
- Matthias Pierce
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Tim Millar
- Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester M13 9PL, United Kingdom
| | - J Roy Robertson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH16 4UX, United Kingdom
| | - Sheila M Bird
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH16 4UX, United Kingdom; MRC Biostatistics Unit, University of Cambridge, School of Clinical Medicine, Institute for Public Health, Cambridge CB2 0SR, United Kingdom; Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, United Kingdom.
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Abstract
Estimating population sizes has long been of interest, from the estimation of the human or ecological population size within regions or countries to the hidden number of civilian casualties in a war. Total enumeration of the population, for example, via a census, is often infeasible or simply impractical. However, a series of partial enumerations or observations of the population is often possible. This has led to the ideas of capture-recapture methods, which have been extensively used within ecology to estimate the size of wildlife populations, with an associated measure of uncertainty, and are most effectively applied when there are multiple capture occasions. Capture-recapture ideology can be more widely applied to multiple data-sources, by the linkage of individuals across the multiple lists. This is often referred to as Multiple Systems Estimation (MSE). The MSE approach has been preferred when estimating "capture-shy" or hard-to-reach populations, including those caught up in the criminal justice system; or homeless; or trafficked; or civilian casualties of war. Motivated by a range of public policy applications of MSE, each briefly introduced, we discuss practical problems with potentially substantial methodological implications. They include: "period" definition; "case" definition; when an observed count is not a true count of the population of interest but an upper bound due to mismatched definitions; exact or probabilistic matching of "cases" across different lists; demographic or other information about the "case" which may influence capture-propensities; required permissions to access extant-lists; list-creation by research-teams or interested parties; referrals (if presence on list A results - almost surely - in presence on list B); different mathematical models leading to widely different estimated population sizes; uncertainty in estimation; computational efficiency; external validation; hypothesis-generation; and additional independent external information. Returning to our motivational applications, we focus on whether the uncertainty which qualified their estimates was sufficiently narrow to orient public policy; and, if not, what options were available and/or taken to reduce the uncertainty or to seek external validation. We also consider whether MSE was hypothesis-generating: in the sense of having spawned new lines of inquiry.
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Affiliation(s)
- Sheila M Bird
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine, Institute for Public Health Cambridge CB2 0SR
- University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh EH16 4UX
| | - Ruth King
- University of Edinburgh, School of Mathematics, Edinburgh EH9 3FD
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Pierce M, Bird SM, Hickman M, Marsden J, Dunn G, Seddon T, Millar T. Effect of initiating drug treatment on the risk of drug-related poisoning death and acquisitive crime among offending heroin users. Int J Drug Policy 2018; 51:42-51. [PMID: 29156402 PMCID: PMC5788328 DOI: 10.1016/j.drugpo.2017.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/17/2017] [Accepted: 09/26/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND A recent Cochrane review of randomised trials identified a lack of evidence for interventions provided to drug-using offenders. We use routine data to address whether contact with treatment services reduces heroin users' likelihood of a future acquisitive offence or drug-related poisoning (DRP) death. METHODS Heroin-users were identified from probation assessments and linked to drug-treatment, mortality and offending records. The study cohort was selected to ensure that the subject was not: in prison, in treatment or had recently left treatment. Subjects were classed as initiators if they attended a triage appointment within two weeks of their assessment; non-initiators otherwise. Initiator and non-initiators were compared over a maximum of one year, with respect to their risk of recorded acquisitive offence or DRP-death. Balance was sought using propensity score matching and missing data were accounted for using multiple imputation. RESULTS Nine percent of assessments identified for analysis were classed as initiators. Accounting for observed confounding and missing data, there was a reduction in DRPs associated with initiator assessments, however there was uncertainty around this estimate such that a null-effect could not be ruled out (HR: 0.42, 95% CI 0.17-1.04). There was no evidence of a decrease in the recidivism risk, in fact the analysis showed a small increase (HR: 1.10, 95% CI 1.02-1.18). CONCLUSION For heroin-using offenders, initial contact with treatment services does not appear to reduce the likelihood of a future acquisitive offence.
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Affiliation(s)
- Matthias Pierce
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.
| | - Sheila M Bird
- MRC Biostatistics Unit at University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, UK
| | - John Marsden
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Graham Dunn
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | | | - Tim Millar
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
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Bird SM. Survey representativeness, quantifying uncertainty, and the importance of well-posed questions about the administration of take-home naloxone. Int J Drug Policy 2017; 51:18-19. [PMID: 29154108 DOI: 10.1016/j.drugpo.2017.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/11/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Sheila M Bird
- MRC Biostatistics Unit, Cambridge CB2 0SR, United Kingdom.
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Pierce M, Hayhurst K, Bird SM, Hickman M, Seddon T, Dunn G, Millar T. Insights into the link between drug use and criminality: Lifetime offending of criminally-active opiate users. Drug Alcohol Depend 2017; 179:309-316. [PMID: 28837946 PMCID: PMC5608072 DOI: 10.1016/j.drugalcdep.2017.07.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/20/2017] [Accepted: 07/22/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND We test whether the offending trajectory of those who test positive for opiates is greater than test-negative controls and whether the relationship is constant both prior to, and post, opiate initiation. We consider whether these relationships differ according to gender and offence type. METHODS The study provides an analysis of historical offending records in adults linked to test results for opiate and cocaine metabolites. Those testing positive for opiates were linked to treatment records to retrieve data on age of opiate initiation. Rate ratios (RR) were calculated to compare opiate positive testers to opiate and cocaine negative controls, separately by gender and adjusting for age and birth cohort. Age of opiate initiation was included in a second model as a time-dependent variable. Within-subject clustering was accounted for using generalised estimating equations. RESULTS Opiate-positive cases had higher rates of offending than test-negative controls, both prior to, and post, opiate initiation. Initiation of opiate use increased the RR by 16% for males but doubled it for females. The RR increase in non-serious acquisitive crime was greater than that seen in serious crime. For males only, opiate initiation narrowed the difference in violent offending rate between cases and controls. A larger offending increase was associated with opiate initiation in female, compared to male, users. CONCLUSIONS For most crime categories, the difference between groups is exacerbated by opiate initiation. The findings indicate that opiate prevention initiatives might be effective in reducing offending, particularly among females.
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Affiliation(s)
- Matthias Pierce
- Centre for Mental Health and Safety, University of Manchester, 4th Floor, Ellen Wilkinson Building, Oxford Road, M13 9PL, UK.
| | - Karen Hayhurst
- Centre for Mental Health and Safety, University of Manchester, 4th Floor, Ellen Wilkinson Building, Oxford Road, M13 9PL, UK.
| | - Sheila M. Bird
- MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Toby Seddon
- School of Law, University of Manchester, 4.46A Williamson Building, Oxford Road, M13 9PL, UK.
| | - Graham Dunn
- Centre for Biostatistics, University of Manchester, Jean McFarlane Building (First Floor), Oxford Road, M13 9PL, UK.
| | - Tim Millar
- Centre for Mental Health and Safety, University of Manchester, 4th Floor, Ellen Wilkinson Building, Oxford Road, M13 9PL, UK.
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25
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Bird SM. Record-linkage studies: dates and event-definitions matter hugely. Lancet Public Health 2017; 2:e164. [PMID: 29253446 PMCID: PMC6037292 DOI: 10.1016/s2468-2667(17)30044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Sheila M Bird
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine and Institute of Public Health, Cambridge CB2 0SR, UK.
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26
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Bird SM, McAuley A, Munro A, Hutchinson SJ, Taylor A. Prison-based prescriptions aid Scotland's National Naloxone Programme. Lancet 2017; 389:1005-1006. [PMID: 28290986 DOI: 10.1016/s0140-6736(17)30656-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/06/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Sheila M Bird
- MRC Biostatistics Unit, Cambridge CB2 0SR, UK; Department of Mathematics and Statistics, Strathclyde University, Glasgow, UK.
| | - Andrew McAuley
- Health Protection Scotland, Glasgow, UK; Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Alison Munro
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK
| | - Sharon J Hutchinson
- Health Protection Scotland, Glasgow, UK; Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Avril Taylor
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK
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Parmar MKB, Strang J, Choo L, Meade AM, Bird SM. Randomized controlled pilot trial of naloxone-on-release to prevent post-prison opioid overdose deaths. Addiction 2017; 112:502-515. [PMID: 27776382 PMCID: PMC5324705 DOI: 10.1111/add.13668] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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] [Received: 05/20/2016] [Revised: 08/08/2016] [Accepted: 10/14/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Naloxone is an opioid antagonist used for emergency resuscitation following opioid overdose. Prisoners with a history of heroin injection have a high risk of drug-related death soon after release from prison. The NALoxone InVEstigation (N-ALIVE) pilot trial (ISRCTN34044390) tested feasibility measures for randomized provision of naloxone-on-release (NOR) to eligible prisoners in England. DESIGN Parallel-group randomized controlled pilot trial. SETTING English prisons. PARTICIPANTS A total of 1685 adult heroin injectors, incarcerated for at least 7 days pre-randomization, release due within 3 months and more than 6 months since previous N-ALIVE release. INTERVENTION Using 1 : 1 minimization, prisoners were randomized to receive on release a pack containing either a single 'rescue' injection of naloxone or a control pack with no syringe. MEASUREMENTS Key feasibility outcomes were tested against prior expectations: on participation (14 English prisons; 2800 prisoners), consent (75% for randomization), returned prisoner self-questionnaires (RPSQs: 207), NOR-carriage (75% in first 4 weeks) and overdose presence (80%). FINDINGS Prisons (16) and prisoners (1685) were willing to participate [consent rate, 95% confidence interval (CI) = 70-74%]; 218 RPSQs were received; NOR-carriage (95% CI = 63-79%) and overdose presence (95% CI = 75-84%) were as expected. We randomized 842 to NOR and 843 to control during 30 months but stopped early, because only one-third of NOR administrations were to the ex-prisoner. Nine deaths within 12 weeks of release were registered for 1557 randomized participants released before 9 December 2014. CONCLUSIONS Large randomized trials are feasible with prison populations. Provision of take-home emergency naloxone prior to prison release may be a life-saving interim measure to prevent heroin overdose deaths among ex-prisoners and the wider population.
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Affiliation(s)
| | - John Strang
- National Addiction Centre at King's College LondonLondonUK
| | - Louise Choo
- MRC Clinical Trials Unit at University College LondonLondonUK
| | - Angela M. Meade
- MRC Clinical Trials Unit at University College LondonLondonUK
| | - Sheila M. Bird
- MRC Biostatistics UnitUniversity of Cambridge Institute of Public HealthCambridgeUK
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Bird SM, Strang J, Ashby D, Podmore J, Robertson JR, Welch S, Meade AM, Parmar MK. External data required timely response by the Trial Steering-Data Monitoring Committee for the NALoxone InVEstigation (N-ALIVE) pilot trial. Contemp Clin Trials Commun 2017; 5:100-106. [PMID: 28424796 PMCID: PMC5389338 DOI: 10.1016/j.conctc.2017.01.006] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/20/2016] [Accepted: 01/14/2017] [Indexed: 11/24/2022] Open
Abstract
The prison-based N-ALIVE pilot trial had undertaken to notify the Research Ethics Committee and participants if we had reason to believe that the N-ALIVE pilot trial would not proceed to the main trial. In this paper, we describe how external data for the third year of before/after evaluation from Scotland's National Naloxone Programme, a related public health policy, were anticipated by eliciting prior opinion about the Scottish results in the month prior to their release as official statistics. We summarise how deliberations by the N-ALIVE Trial Steering-Data Monitoring Committee (TS-DMC) on N-ALIVE's own interim data, together with those on naloxone-on-release (NOR) from Scotland, led to the decision to cease randomization in the N-ALIVE pilot trial and recommend to local Principal Investigators that NOR be offered to already-randomized prisoners who had not yet been released.
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Affiliation(s)
| | - John Strang
- National Addiction Centre, King's College London, London SE5 8BB, UK
| | - Deborah Ashby
- Imperial Clinical Trials Unit School of Public Health, London W12 7RH, UK
| | - John Podmore
- Durham University School of Applied Social Sciences, Durham DH1 3LE, UK
| | - J. Roy Robertson
- Edinburgh University Usher Institute of Population Health Sciences and Informatics, Edinburgh EH16 4UX, UK
| | | | - Angela M. Meade
- MRC Clinical Trials Unit at University College London, London WC2B 6NH, UK
| | - Mahesh K.B. Parmar
- MRC Clinical Trials Unit at University College London, London WC2B 6NH, UK
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29
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Kiguba R, Karamagi C, Bird SM. Antibiotic-associated suspected adverse drug reactions among hospitalized patients in Uganda: a prospective cohort study. Pharmacol Res Perspect 2017; 5:e00298. [PMID: 28357124 PMCID: PMC5368962 DOI: 10.1002/prp2.298] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 12/09/2016] [Accepted: 12/15/2016] [Indexed: 11/09/2022] Open
Abstract
We sought to determine the prevalence at admission and incidence during hospitalization of antibiotic-associated suspected adverse drug reactions (aa-ADRs) among Ugandan inpatients; and to characterize these aa-ADRs. We conducted a prospective cohort study of 762 consented adults admitted on medical and gynecological wards of the 1790-bed Mulago National Referral Hospital. Thirty percent were known HIV-seropositive (232/762). Nineteen percent (148/762; 95% CI: 17-22%) of inpatients experienced at least one aa-ADR. At hospital admission, 6% (45/762; 95% CI: 4-8%) of patients had at least one aa-ADR; and 15% (45/300; 11-20%) of those who had received antibiotics in the 4-weeks preadmission. Twenty-four (53%) of these 45 patients had serious aa-ADRs. The incidence of aa-ADRs was 19% (117/629; 95% CI: 16-22%) of patients who received antibiotics [community-acquired: 9% (27/300; 95% CI: 6-13%); hospital-acquired: 16% (94/603; 95% CI: 13-19%)]: 39 (33%) of 117 patients had serious aa-ADRs. Of 269 aa-ADRs, 115 (43%) were community-acquired, 66 (25%) probable/definite, 171 (64%) preventable, 86 (32%) serious, and 24 (9%) rare. Ceftriaxone was the most frequently implicated for serious hospital-acquired aa-ADRs. Cotrimoxazole, isoniazid, rifampicin, ethambutol, and pyrazinamide were the most frequently linked to serious community-acquired aa-ADRs. Fatal jaundice (isoniazid), life-threatening difficulty in breathing with shortness of breath (rifampicin) and disabling itchy skin rash with numbness of lower swollen legs (ethambutol, isoniazid) were observed. Pharmaceutical quality testing of implicated antibiotics could be worthwhile. Periodic on-ward collection and analysis of antibiotic-safety-data standardized by consumption is an efficient method of tracking antibiotics with 1%-risk for serious aa-ADRs.
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Affiliation(s)
- Ronald Kiguba
- Department of Pharmacology and Therapeutics Makerere University College of Health Sciences Kampala Uganda
| | - Charles Karamagi
- Clinical Epidemiology Unit Makerere University College of Health Sciences Kampala Uganda
| | - Sheila M Bird
- Medical Research Council Biostatistics Unit Cambridge United Kingdom
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30
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Bird SM, Bailey RA, Grieve AP, Senn S. Statistical issues in first-in-human studies on BIA 10-2474: Neglected comparison of protocol against practice. Pharm Stat 2017; 16:100-106. [PMID: 28206702 DOI: 10.1002/pst.1801] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/31/2016] [Accepted: 01/05/2017] [Indexed: 02/04/2023]
Abstract
By setting the regulatory-approved protocol for a suite of first-in-human studies on BIA 10-2474 against the subsequent French investigations, we highlight 6 key design and statistical issues, which reinforce recommendations by a Royal Statistical Society Working Party, which were made in the aftermath of cytokine release storm in 6 healthy volunteers in the United Kingdom in 2006. The 6 issues are dose determination, availability of pharmacokinetic results, dosing interval, stopping rules, appraisal by safety committee, and clear algorithm required if combining approvals for single and multiple ascending dose studies.
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Affiliation(s)
- Sheila M Bird
- MRC Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Rosemary A Bailey
- School of Mathematics and Statistics, University of St Andrews, St Andrews, UK
| | | | - Stephen Senn
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
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Abstract
OBJECTIVES To determine the incidence and risk factors of hospital-acquired suspected adverse drug reactions (ADRs) among Ugandan inpatients. We also constructed risk scores to predict and qualitatively assess for peculiarities between low-risk and high-risk ADR patients. METHODS Prospective cohort of consented adults admitted on medical and gynaecological wards of the 1790-bed Mulago National Referral Hospital. Hospital-acquired suspected ADRs were dichotomised as possible (possible/probable/definite) or not and probable (probable/definite) or not, using the Naranjo scale. Risk scores were generated from coefficients of ADR risk-factor logistic regression models. RESULTS The incidence of possible hospital-acquired suspected ADRs was 25% (194/762, 95% CI: 22% to 29%): 44% (85/194) experienced serious possible ADRs. The risk of probable ADRs was 11% (87/762, 95% CI 9% to 14%): 46% (40/87) had serious probable ADRs. Antibacterials-only (51/194), uterotonics-only (21/194), cardiovascular drugs-only (16/194), antimalarials-only (12/194) and analgesics-only (10/194) were the most frequently implicated. Treatment with six or more conventional medicines during hospitalisation (OR=2.31, 95% CI 1.29 to 4.15) and self-reported herbal medicine use during the 4 weeks preadmission (OR=1.96, 95% CI 1.22 to 3.13) were the risk factors for probable hospital-acquired ADRs. Risk factors for possible hospital-acquired ADRs were: treatment with six or more conventional medicines (OR=2.72, 95% CI 1.79 to 4.13), herbal medicine use during the 4 weeks preadmission (OR=1.68, 95% CI 1.16 to 2.43), prior 3 months hospitalisation (OR=1.57, 95% CI 1.09 to 2.26) and being on gynaecological ward (OR=2.16, 95% CI 1.36 to 3.44). More drug classes were implicated among high-risk ADR-patients, with cardiovascular drugs being the most frequently linked to possible ADRs. CONCLUSIONS The risk of hospital-acquired suspected ADRs was higher with preadmission herbal medicine use and treatment with six or more conventional medicines during hospitalisation. Our risk scores should be validated in large-scale studies and tested in routine clinical care.
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Affiliation(s)
- Ronald Kiguba
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Charles Karamagi
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sheila M Bird
- Medical Research Council Biostatistics Unit, Cambridge, UK
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Gao L, Dimitropoulou P, Robertson JR, McTaggart S, Bennie M, Bird SM. Risk-factors for methadone-specific deaths in Scotland's methadone-prescription clients between 2009 and 2013. Drug Alcohol Depend 2016; 167:214-23. [PMID: 27593969 PMCID: PMC5047032 DOI: 10.1016/j.drugalcdep.2016.08.627] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/01/2016] [Accepted: 08/22/2016] [Indexed: 01/31/2023]
Abstract
AIM To quantify gender, age-group and quantity of methadone prescribed as risk factors for drugs-related deaths (DRDs), and for methadone-specific DRDs, in Scotland's methadone-prescription clients. DESIGN Linkage to death-records for Scotland's methadone-clients with one or more Community Health Index (CHI)-identified methadone prescriptions during July 2009 to June 2013. SETTING Scotland's Prescribing Information System and National Records of Scotland. MEASUREMENTS Covariates defined at first CHI-identified methadone prescription, and person-years at-risk (pys) thereafter until the earlier of death-date or 31 December 2013. Methadone-specific DRDs were defined as: methadone implicated but neither heroin nor buprenorphine. Hazard ratios (HRs) were assessed using proportional hazards regression. FINDINGS Scotland's CHI-identified methadone-prescription cohort comprised 33,128 clients, 121,254 pys, 1,171 non-DRDs and 760 DRDs (6.3 per 1,000 pys), of which 362 were methadone-specific. Irrespective of gender, methadone-specific DRD-rate, per 1,000 pys, was higher in the 35+ age-group (4.2; 95% CI: 3.6-4.7) than for younger clients (1.9; 95% CI: 1.5-2.2). For methadone-specific DRDs, age-related HRs (e.g., 2.9 at 45+ years; 95% CI: 2.1-3.9) were steeper than for all DRDs (1.9; 95% CI: 1.5-2.4); there was no hazard-reduction for females; no gender by age-group interaction; and, unlike for all DRDs, the highest quintile for quantity of prescribed methadone at cohort-entry (>1960mg) was associated with increased HR (1.8; 95% CI: 1.3-2.5). CONCLUSION Higher methadone-specific DRD rates in older clients, irrespective of gender, call for better understanding of methadone's pharmaco-dynamics in older, opioid-dependent clients, many with progressive physical or mental ill-health.
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Affiliation(s)
- Lu Gao
- MRC Biostatistics Unit, Cambridge CB2 0SR, United Kingdom
| | | | - J Roy Robertson
- Usher Institute of Population Health Sciences and Informatics, Edinburgh University, EDINBURGH EH16 4UX, United Kingdom
| | - Stuart McTaggart
- Information Services Division, NHS National Services Scotland, Edinburgh EH12 9EB, United Kingdom
| | - Marion Bennie
- Information Services Division, NHS National Services Scotland, Edinburgh EH12 9EB, United Kingdom; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, United Kingdom
| | - Sheila M Bird
- MRC Biostatistics Unit, Cambridge CB2 0SR, United Kingdom; Department of Mathematics and Statistics, Strathclyde University, Glasgow G1 1XH, United Kingdom.
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Affiliation(s)
- Sheila M. Bird
- MRC Biostatistics Unit, Cambridge and Department of Statistics and Modelling Science, University of Strathclyde, Glasgow
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Bird SM, McAuley A, Perry S, Hunter C. Effectiveness of Scotland's national naloxone programme: response to letter to editor. Addiction 2016; 111:1304-6. [PMID: 27095522 DOI: 10.1111/add.13391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/03/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Sheila M Bird
- MRC Biostatistics Unit, Cambridge, UK. .,Department of Mathematics and Statistics, Strathclyde University, Glasgow, UK.
| | - Andrew McAuley
- NHS Health Scotland, Public Health Science Directorate, Glasgow, UK.,Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Carole Hunter
- Addiction Services for NHS Greater Glasgow and Clyde, Possilpark Health and Care Centre, Glasgow, UK
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Bird TG, Dimitropoulou P, Turner RM, Jenks SJ, Cusack P, Hey S, Blunsum A, Kelly S, Sturgeon C, Hayes PC, Bird SM. Alpha-Fetoprotein Detection of Hepatocellular Carcinoma Leads to a Standardized Analysis of Dynamic AFP to Improve Screening Based Detection. PLoS One 2016; 11:e0156801. [PMID: 27308823 PMCID: PMC4911090 DOI: 10.1371/journal.pone.0156801] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 03/05/2016] [Accepted: 05/19/2016] [Indexed: 02/06/2023] Open
Abstract
Detection of hepatocellular carcinoma (HCC) through screening can improve outcomes. However, HCC surveillance remains costly, cumbersome and suboptimal. We tested whether and how serum Alpha-Fetoprotein (AFP) should be used in HCC surveillance. Record linkage, dedicated pathways for management and AFP data-storage identified i) consecutive highly characterised cases of HCC diagnosed in 2009–14 and ii) a cohort of ongoing HCC-free patients undergoing regular HCC surveillance from 2009. These two well-defined Scottish patient cohorts enabled us to test the utility of AFP surveillance. Of 304 cases of HCC diagnosed over 6 years, 42% (129) were identified by a dedicated HCC surveillance programme. Of these 129, 47% (61) had a detectable lesion first identified by screening ultrasound (US) but 38% (49) were prompted by elevated AFP. Despite pre-HCC diagnosis AFP >20kU/L being associated with poor outcome, ‘AFP-detected’ tumours were offered potentially curative management as frequently as ‘US-detected’ HCCs; and had comparable survival. Linearity of serial log10-transformed AFPs in HCC cases and in the screening ‘HCC-free’ cohort (n = 1509) provided indicators of high-risk AFP behaviour in HCC cases. An algorithm was devised in static mode, then tested dynamically. A case/control series in hepatitis C related disease demonstrated highly significant detection (p<1.72*10−5) of patients at high risk of developing HCC. These data support the use of AFP in HCC surveillance. We show proof-of-principle that an automated and further refine-able algorithmic interpretation of AFP can identify patients at higher risk of HCC. This approach could provide a cost-effective, user-friendly and much needed addition to US surveillance.
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Affiliation(s)
- Thomas G Bird
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom.,Cancer Research UK Beatson Institute, Glasgow, G61 1BD, United Kingdom
| | | | | | - Sara J Jenks
- Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - Pearce Cusack
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - Shiying Hey
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - Andrew Blunsum
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - Sarah Kelly
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - Catharine Sturgeon
- Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - Peter C Hayes
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - Sheila M Bird
- MRC Biostatistics Unit, Cambridge, CB2 0SR, United Kingdom.,Department of Mathematics and Statistics, Strathclyde University, Glasgow, G1 1XH, United Kingdom
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Galloway JM, Bird SM, Talbot JE, Shepley PM, Bradley RC, El-Zubir O, Allwood DA, Leggett GJ, Miles JJ, Staniland SS, Critchley K. Nano- and micro-patterning biotemplated magnetic CoPt arrays. Nanoscale 2016; 8:11738-11747. [PMID: 27221982 DOI: 10.1039/c6nr03330j] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Patterned thin-films of magnetic nanoparticles (MNPs) can be used to make: surfaces for manipulating and sorting cells, sensors, 2D spin-ices and high-density data storage devices. Conventional manufacture of patterned magnetic thin-films is not environmentally friendly because it uses high temperatures (hundreds of degrees Celsius) and high vacuum, which requires expensive specialised equipment. To tackle these issues, we have taken inspiration from nature to create environmentally friendly patterns of ferromagnetic CoPt using a biotemplating peptide under mild conditions and simple apparatus. Nano-patterning via interference lithography (IL) and micro-patterning using micro-contact printing (μCP) were used to create a peptide resistant mask onto a gold surface under ambient conditions. We redesigned a biotemplating peptide (CGSGKTHEIHSPLLHK) to self-assemble onto gold surfaces, and mineralised the patterns with CoPt at 18 °C in water. Ferromagnetic CoPt is biotemplated by the immobilised peptides, and the patterned MNPs maintain stable magnetic domains. This bioinspired study offers an ecological route towards developing biotemplated magnetic thin-films for use in applications such as sensing, cell manipulation and data storage.
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Affiliation(s)
- J M Galloway
- School of Physics and Astronomy, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK and School of Chemistry, University of Bristol, Cantock's Close, Bristol, BS8 1TS, UK.
| | - S M Bird
- Department of Chemistry, University of Sheffield, Dainton Building, Brook Hill, S3 7HF, UK
| | - J E Talbot
- School of Computer Science, University of Manchester, Kilburn Building, Oxford Road, Manchester, M13 9PL, UK
| | - P M Shepley
- School of Physics and Astronomy, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - R C Bradley
- Department of Materials Science and Engineering, University of Sheffield, Sir Robert Hadfield Building, Maplin Street, Sheffield, S1 3JD, UK
| | - O El-Zubir
- Department of Chemistry, University of Sheffield, Dainton Building, Brook Hill, S3 7HF, UK and School of Chemistry, University of Newcastle, Chemical Nanoscience Laboratories, Bedson Building, Newcastle Upon Tyne, NE1 7RU, UK
| | - D A Allwood
- Department of Materials Science and Engineering, University of Sheffield, Sir Robert Hadfield Building, Maplin Street, Sheffield, S1 3JD, UK
| | - G J Leggett
- Department of Chemistry, University of Sheffield, Dainton Building, Brook Hill, S3 7HF, UK
| | - J J Miles
- School of Computer Science, University of Manchester, Kilburn Building, Oxford Road, Manchester, M13 9PL, UK
| | - S S Staniland
- Department of Chemistry, University of Sheffield, Dainton Building, Brook Hill, S3 7HF, UK
| | - K Critchley
- School of Physics and Astronomy, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
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Kiguba R, Ononge S, Karamagi C, Bird SM. Herbal medicine use and linked suspected adverse drug reactions in a prospective cohort of Ugandan inpatients. BMC Complement Altern Med 2016; 16:145. [PMID: 27229463 PMCID: PMC4881043 DOI: 10.1186/s12906-016-1125-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/13/2016] [Indexed: 11/14/2022]
Abstract
Background Clinical history-taking can be employed as a standardized approach to elucidate the use of herbal medicines and their linked suspected adverse drug reactions (ADRs) among hospitalized patients. We sought to identify herbal medicines nominated by Ugandan inpatients; compare nomination rates by ward and gender; confirm the herbs’ known pharmacological properties from published literature; and identify ADRs linked to pre-admission use of herbal medicines. Methods Prospective cohort of consented adult inpatients designed to assess medication use and ADRs on one gynaecological and three medical wards of 1790-bed Mulago National Referral Hospital. Baseline and follow-up data were obtained on patients’ characteristics, including pre-admission use of herbal medicines. Results Fourteen percent (26/191) of females in Gynaecology nominated at least one specific herbal medicine compared with 20 % (114/571) of inpatients on medical wards [20 % (69/343) of females; 20 % (45/228) of males]. Frequent nominations were Persea americana (30), Mumbwa/multiple-herb clay rods (23), Aloe barbadensis (22), Beta vulgaris (12), Vernonia amygdalina (11), Commelina africana (7), Bidens pilosa (7), Hoslundia opposita (6), Mangifera indica (4), and Dicliptera laxata (4). Four inpatients experienced 10 suspected ADRs linked to pre-admission herbal medicine use including Commelina africana (4), multiple-herb-mumbwa (1), or unspecified local-herbs (5): three ADR-cases were abortion-related and one kidney-related. Conclusions The named herbal medicines and their nomination rates generally differed by specialized ward, probably guided by local folklore knowledge of their use. Clinical elicitation from inpatients can generate valuable safety data on herbal medicine use. However, larger routine studies might increase the utility of our method to assess herbal medicine use and detect herb-linked ADRs. Future studies should take testable samples of ADR-implicated herbal medicines for further analysis. Electronic supplementary material The online version of this article (doi:10.1186/s12906-016-1125-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheila M Bird
- Department of Mathematics and Statistics, Strathclyde University, Glasgow, G1 1XH, UK.
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Bird SM, El-Zubir O, Rawlings AE, Leggett GJ, Staniland SS. A novel design strategy for nanoparticles on nanopatterns: interferometric lithographic patterning of Mms6 biotemplated magnetic nanoparticles. J Mater Chem C Mater 2016; 4:3948-3955. [PMID: 27358738 PMCID: PMC4894075 DOI: 10.1039/c5tc03895b] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/21/2015] [Indexed: 06/05/2023]
Abstract
Nanotechnology demands the synthesis of highly precise, functional materials, tailored for specific applications. One such example is bit patterned media. These high-density magnetic data-storage materials require specific and uniform magnetic nanoparticles (MNPs) to be patterned over large areas (cm2 range) in exact nanoscale arrays. However, the realisation of such materials for nanotechnology applications depends upon reproducible fabrication methods that are both precise and environmentally-friendly, for cost-effective scale-up. A potentially ideal biological fabrication methodology is biomineralisation. This is the formation of inorganic minerals within organisms, and is known to be highly controlled down to the nanoscale whilst being carried out under ambient conditions. The magnetotactic bacterium Magnetospirillum magneticum AMB-1 uses a suite of dedicated biomineralisation proteins to control the formation of magnetite MNPs within their cell. One of these proteins, Mms6, has been shown to control formation of magnetite MNPs in vitro. We have previously used Mms6 on micro-contact printed (μCP) patterned self-assembled monolayer (SAM) surfaces to control the formation and location of MNPs in microscale arrays, offering a bioinspired and green-route to fabrication. However, μCP cannot produce patterns reliably with nanoscale dimensions, and most alternative nanofabrication techniques are slow and expensive. Interferometric lithography (IL) uses the interference of laser light to produce nanostructures over large areas via a simple process implemented under ambient conditions. Here we combine the bottom-up biomediated approach with a top down IL methodology to produce arrays of uniform magnetite MNPs (86 ± 21 nm) with a period of 357 nm. This shows a potentially revolutionary strategy for the production of magnetic arrays with nanoscale precision in a process with low environmental impact, which could be scaled readily to facilitate large-scale production of nanopatterned surface materials for technological applications.
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Affiliation(s)
- S M Bird
- University of Sheffield , Department of Chemistry , Dainton Building , Sheffield , S3 7HF , UK .
| | - O El-Zubir
- University of Sheffield , Department of Chemistry , Dainton Building , Sheffield , S3 7HF , UK . ; University of Newcastle , Chemical Nanoscience Laboratories , School of Chemistry , Bedson Building , Newcastle Upon Tyne , NE1 7RU , UK
| | - A E Rawlings
- University of Sheffield , Department of Chemistry , Dainton Building , Sheffield , S3 7HF , UK .
| | - G J Leggett
- University of Sheffield , Department of Chemistry , Dainton Building , Sheffield , S3 7HF , UK .
| | - S S Staniland
- University of Sheffield , Department of Chemistry , Dainton Building , Sheffield , S3 7HF , UK .
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McAuley A, Munro A, Bird SM, Hutchinson SJ, Goldberg DJ, Taylor A. Engagement in a National Naloxone Programme among people who inject drugs. Drug Alcohol Depend 2016; 162:236-40. [PMID: 26965105 PMCID: PMC5854250 DOI: 10.1016/j.drugalcdep.2016.02.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 12/23/2015] [Revised: 02/19/2016] [Accepted: 02/20/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Availability of the opioid antagonist naloxone for lay administration has grown substantially since first proposed in 1996. Gaps remain, though, in our understanding of how people who inject drugs (PWID) engage with naloxone programmes over time. AIMS This paper aimed to address three specific evidence gaps: the extent of naloxone supply to PWID; supply-source (community or prisons); and the carriage of naloxone among PWID. MATERIALS AND METHODS Analysis of Scotland's Needle Exchange Surveillance Initiative (NESI) responses in 2011-2012 and 2013-2014 was undertaken with a specific focus on the extent of Scotland's naloxone supply to PWID; including by source (community or prisons); and on the carriage of naloxone. Differences in responses between the two surveys were measured using Chi-square tests together with 95% confidence intervals for rate-differences over time. RESULTS The proportion of NESI participants who reported that they had been prescribed naloxone within the last year increased significantly from 8% (175/2146; 95% CI: 7-9%) in 2011-2012 to 32% (745/2331; 95% CI: 30% to 34%) in 2013-2014. In contrast, the proportion of NESI participants who carried naloxone with them on the day they were interviewed decreased significantly from 16% (27/169; 95% CI: 10% to 22%) in 2011-2012 to 5% (39/741; 95% CI: 4% to 7%) in 2013-2014. CONCLUSIONS The supply of naloxone to PWID has increased significantly since the introduction of a National Naloxone Programme in Scotland in January 2011. In contrast, naloxone carriage is low and decreased between the two NESI surveys; this area requires further investigation.
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Affiliation(s)
- Andrew McAuley
- Health Protection Scotland, Meridian Court, Cadogan Street, Glasgow G2 6QE, UK; Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK.
| | - Alison Munro
- School of Media, Culture and Society, University of the West of Scotland, Paisley PA1 2BE, UK
| | - Sheila M. Bird
- MRC Biostatistics Unit, Cambridge CB2 0SR, UK,Department of Mathematics and Statistics, Strathclyde University, Glasgow G1 1XH, UK
| | - Sharon J. Hutchinson
- Health Protection Scotland, Meridian Court, Cadogan Street, Glasgow G2 6QE, UK,Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - David J. Goldberg
- Health Protection Scotland, Meridian Court, Cadogan Street, Glasgow G2 6QE, UK,Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Avril Taylor
- School of Media, Culture and Society, University of the West of Scotland, Paisley PA1 2BE, UK
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Bird SM, McAuley A, Perry S, Hunter C. Effectiveness of Scotland's National Naloxone Programme for reducing opioid-related deaths: a before (2006-10) versus after (2011-13) comparison. Addiction 2016; 111:883-91. [PMID: 26642424 PMCID: PMC4982071 DOI: 10.1111/add.13265] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/15/2015] [Accepted: 11/30/2015] [Indexed: 12/26/2022]
Abstract
AIMS To assess the effectiveness for Scotland's National Naloxone Programme (NNP) by comparison between 2006-10 (before) and 2011-13 (after NNP started in January 2011) and to assess cost-effectiveness. DESIGN This was a pre-post evaluation of a national policy. Cost-effectiveness was assessed by prescription costs against life-years gained per opioid-related death (ORD) averted. SETTING Scotland, in community settings and all prisons. INTERVENTION Brief training and standardized naloxone supply became available to individuals at risk of opioid overdose. MEASUREMENTS ORDs as identified by National Records of Scotland. Look-back determined the proportion of ORDs who, in the 4 weeks before ORD, had been (i) released from prison (primary outcome) and (ii) released from prison or discharged from hospital (secondary). We report 95% confidence intervals for effectiveness in reducing the primary (and secondary) outcome in 2011-13 versus 2006-10. Prescription costs were assessed against 1 or 10 life-years gained per averted ORD. FINDINGS In 2006-10, 9.8% of ORDs (193 of 1970) were in people released from prison within 4 weeks of death, whereas only 6.3% of ORDs in 2011-13 followed prison release (76 of 1212, P < 0.001; this represented a difference of 3.5% [95% confidence interval (CI) = 1.6-5.4%)]. This reduction in the proportion of prison release ORDs translates into 42 fewer prison release ORDs (95% CI = 19-65) during 2011-13, when 12,000 naloxone kits were issued at current prescription cost of £225,000. Scotland's secondary outcome reduced from 19.0 to 14.9%, a difference of 4.1% (95% CI = 1.4-6.7%). CONCLUSIONS Scotland's National Naloxone Programme, which started in 2011, was associated with a 36% reduction in the proportion of opioid-related deaths that occurred in the 4 weeks following release from prison.
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Affiliation(s)
- Sheila M. Bird
- MRC Biostatistics UnitCambridgeUK
- Department of Mathematics and StatisticsStrathclyde UniversityGlasgowUK
| | - Andrew McAuley
- NHS Health ScotlandPublic Health Science DirectorateGlasgowUK
- Institute for Applied Health Research, School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | | | - Carole Hunter
- Addiction Services for NHS Greater Glasgow and ClydePossilpark Health and Care CentreGlasgowUK
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Kiguba R, Karamagi C, Bird SM. Extensive antibiotic prescription rate among hospitalized patients in Uganda: but with frequent missed-dose days. J Antimicrob Chemother 2016; 71:1697-706. [PMID: 26945712 PMCID: PMC4867101 DOI: 10.1093/jac/dkw025] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 01/20/2016] [Indexed: 01/29/2023] Open
Abstract
Objectives To describe the patterns of systemic antibiotic use and missed-dose days and detail the prescription, dispensing and administration of frequently used hospital-initiated antibiotics among Ugandan inpatients. Methods This was a prospective cohort of consented adult inpatients admitted on the medical and gynaecological wards of the 1790 bed Mulago National Referral Hospital. Results Overall, 79% (603/762; 95% CI: 76%–82%) of inpatients received at least one antibiotic during hospitalization while 39% (300/762; 95% CI: 36%–43%) had used at least one antibiotic in the 4 weeks pre-admission; 1985 antibiotic DDDs, half administered parenterally, were consumed in 3741 inpatient-days. Two-fifths of inpatients who received at least one of the five frequently used hospital-initiated antibiotics (ceftriaxone, metronidazole, ciprofloxacin, amoxicillin and azithromycin) missed at least one antibiotic dose-day (44%, 243/558). The per-day risk of missed antibiotic administration was greatest on day 1: ceftriaxone (36%, 143/398), metronidazole (27%, 67/245), ciprofloxacin (34%, 39/114) and all inpatients who missed at least one dose-day of prescribed amoxicillin and azithromycin. Most patients received fewer doses than were prescribed: ceftriaxone (74%, 273/371), ciprofloxacin (90%, 94/105) and metronidazole (97%, 222/230). Of prescribed doses, only 62% of ceftriaxone doses (1178/1895), 35% of ciprofloxacin doses (396/1130) and 27% of metronidazole doses (1043/3862) were administered. Seven percent (13/188) of patients on intravenous metronidazole and 6% (5/87) on intravenous ciprofloxacin switched to oral route. Conclusions High rates of antibiotic use both pre-admission and during hospitalization were observed, with low parenteral/oral switch of hospital-initiated antibiotics. Underadministration of prescribed antibiotics was common, especially on the day of prescription, risking loss of efficacy and antibiotic resistance.
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Affiliation(s)
- Ronald Kiguba
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Charles Karamagi
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sheila M Bird
- Medical Research Council Biostatistics Unit, Cambridge, UK
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Pierce M, Bird SM, Hickman M, Marsden J, Dunn G, Jones A, Millar T. Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England. Addiction 2016; 111:298-308. [PMID: 26452239 PMCID: PMC4950033 DOI: 10.1111/add.13193] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/20/2015] [Accepted: 10/06/2015] [Indexed: 11/29/2022]
Abstract
AIMS To compare the change in illicit opioid users' risk of fatal drug-related poisoning (DRP) associated with opioid agonist pharmacotherapy (OAP) and psychological support, and investigate the modifying effect of patient characteristics, criminal justice system (CJS) referral and treatment completion. DESIGN National data linkage cohort study of the English National Drug Treatment Monitoring System and the Office for National Statistics national mortality database. Data were analysed using survival methods. SETTING All services in England that provide publicly funded, structured treatment for illicit opioid users. PARTICIPANTS Adults treated for opioid dependence during April 2005 to March 2009: 151,983 individuals; 69% male; median age 32.6 with 442,950 person-years of observation. MEASUREMENTS The outcome was fatal DRP occurring during periods in or out of treatment, with adjustment for age, gender, substances used, injecting status and CJS referral. FINDINGS There were 1499 DRP deaths [3.4 per 1000 person-years, 95% confidence interval (CI) = 3.2-3.6]. DRP risk increased while patients were not enrolled in any treatment [adjusted hazard ratio (aHR) = 1.73, 95% CI = 1.55-1.92]. Risk when enrolled only in a psychological intervention was double that during OAP (aHR = 2.07, 95% CI = 1.75-2.46). The increased risk when out of treatment was greater for men (aHR = 1.88, 95% CI = 1.67-2.12), illicit drug injectors (aHR = 2.27, 95% CI = 1.97-2.62) and those reporting problematic alcohol use (aHR = 2.37, 95% CI = 1.90-2.98). CONCLUSIONS Patients who received only psychological support for opioid dependence in England appear to be at greater risk of fatal opioid poisoning than those who received opioid agonist pharmacotherapy.
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Affiliation(s)
- Matthias Pierce
- Institute of Brain Behaviour and Mental Health, Faculty of Medical and Human SciencesUniversity of ManchesterUK
- Institute of Population Health, Faculty of Medical and Human SciencesUniversity of ManchesterUK
| | | | - Matthew Hickman
- School of Social and Community MedicineUniversity of BristolUK
| | - John Marsden
- Addictions Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonUK
| | - Graham Dunn
- Institute of Population Health, Faculty of Medical and Human SciencesUniversity of ManchesterUK
| | - Andrew Jones
- Institute of Population Health, Faculty of Medical and Human SciencesUniversity of ManchesterUK
| | - Tim Millar
- Institute of Brain Behaviour and Mental Health, Faculty of Medical and Human SciencesUniversity of ManchesterUK
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Affiliation(s)
- Sheila M Bird
- Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge CB2 0SR, UK.
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White SR, Bird SM, Merrall ELC, Hutchinson SJ. Drugs-Related Death Soon after Hospital-Discharge among Drug Treatment Clients in Scotland: Record Linkage, Validation, and Investigation of Risk-Factors. PLoS One 2015; 10:e0141073. [PMID: 26539701 PMCID: PMC4634860 DOI: 10.1371/journal.pone.0141073] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 08/05/2014] [Accepted: 10/05/2015] [Indexed: 11/25/2022] Open
Abstract
We validate that the 28 days after hospital-discharge are high-risk for drugs-related death (DRD) among drug users in Scotland and investigate key risk-factors for DRDs soon after hospital-discharge. Using data from an anonymous linkage of hospitalisation and death records to the Scottish Drugs Misuse Database (SDMD), including over 98,000 individuals registered for drug treatment during 1 April 1996 to 31 March 2010 with 705,538 person-years, 173,107 hospital-stays, and 2,523 DRDs. Time-at-risk of DRD was categorised as: during hospitalization, within 28 days, 29–90 days, 91 days–1 year, >1 year since most recent hospital discharge versus ‘never admitted’. Factors of interest were: having ever injected, misuse of alcohol, length of hospital-stay (0–1 versus 2+ days), and main discharge-diagnosis. We confirm SDMD clients’ high DRD-rate soon after hospital-discharge in 2006–2010. DRD-rate in the 28 days after hospital-discharge did not vary by length of hospital-stay but was significantly higher for clients who had ever-injected versus otherwise. Three leading discharge-diagnoses accounted for only 150/290 DRDs in the 28 days after hospital-discharge, but ever-injectors for 222/290. Hospital-discharge remains a period of increased DRD-vulnerability in 2006–2010, as in 1996–2006, especially for those with a history of injecting.
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Affiliation(s)
- Simon R. White
- Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom
- * E-mail:
| | - Sheila M. Bird
- Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom
| | - Elizabeth L. C. Merrall
- Novartis Pharam BV, Novartis Vaccines & Diagnostics, Hullenbergweg 83–85, 1101 CL Amsterdam, Netherlands
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Pierce M, Bird SM, Hickman M, Millar T. Corrigendum to "National record linkage study of mortality for a large cohort of opioid users ascertained by drug treatment or criminal justice sources in England, 2005-2009" [Drug Alcohol Depend. 146 (2015) 17-23]. Drug Alcohol Depend 2015; 156:315. [PMID: 28965977 PMCID: PMC5599427 DOI: 10.1016/j.drugalcdep.2015.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Matthias Pierce
- Institute of Brain Behaviour & Mental Health, Faculty of Medical and Human Sciences, University of Manchester, UK
| | - Sheila M Bird
- Medical Research Council, Cambridge, University of Strathclyde, UK
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, UK
| | - Tim Millar
- Institute of Brain Behaviour & Mental Health, Faculty of Medical and Human Sciences, University of Manchester, UK.
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Bird SM, Fischbacher CM, Graham L, Fraser A. Impact of opioid substitution therapy for Scotland's prisoners on drug-related deaths soon after prisoner release. Addiction 2015; 110:1617-24. [PMID: 25940815 PMCID: PMC4744745 DOI: 10.1111/add.12969] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/13/2015] [Accepted: 04/27/2015] [Indexed: 11/28/2022]
Abstract
AIM To assess whether the introduction of a prison-based opioid substitution therapy (OST) policy was associated with a reduction in drug-related deaths (DRD) within 14 days after prison release. DESIGN Linkage of Scotland's prisoner database with death registrations to compare periods before (1996-2002) and after (2003-07) prison-based OST was introduced. SETTING All Scottish prisons. PARTICIPANTS People released from prison between 1 January 1996 and 8 October 2007 following an imprisonment of at least 14 days and at least 14 weeks after the preceding qualifying release. MEASUREMENTS Risk of DRD in the 12 weeks following release; percentage of these DRDs which occurred during the first 14 days. FINDINGS Before prison-based OST (1996-2002), 305 DRDs occurred in the 12 weeks after 80 200 qualifying releases, 3.8 per 1000 releases [95% confidence interval (CI) = 3.4-4.2]; of these, 175 (57%) occurred in the first 14 days. After the introduction of prison-based OST (2003-07), 154 DRDs occurred in the 12 weeks after 70 317 qualifying releases, a significantly reduced rate of 2.2 per 1000 releases (95% CI = 1.8-2.5). However, there was no change in the proportion which occurred in the first 14 days, either for all DRDs (87: 56%) or for opioid-related DRDs. CONCLUSIONS Following the introduction of a prison-based opioid substitution therapy (OST) policy in Scotland, the rate of drug-related deaths in the 12 weeks following release fell by two-fifths. However, the proportion of deaths that occurred in the first 14 days did not change appreciably, suggesting that in-prison OST does not reduce early deaths after release.
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Pierce M, Hayhurst K, Bird SM, Hickman M, Seddon T, Dunn G, Millar T. Quantifying crime associated with drug use among a large cohort of sanctioned offenders in England and Wales. Drug Alcohol Depend 2015; 155:52-9. [PMID: 26361712 PMCID: PMC4768078 DOI: 10.1016/j.drugalcdep.2015.08.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 12/03/2022]
Abstract
AIM To assess the relationship between testing positive for opiates and/or cocaine and prior offending. METHODS 139,925 persons (107,573 men) identified from a saliva test for opiate and cocaine metabolites following arrest in England and Wales, 1 April 2005-31 March 2009, were case-linked with 2-year recorded offending history. The prior offending rate, accounting for estimated incarceration periods, was calculated by: drug-test outcome; gender; four main crime categories (acquisitive, non-acquisitive, serious acquisitive, and non-serious acquisitive) and 16 sub-categories. Rate ratio (RR) compared opiate and/or cocaine positive to dual-negative testers. Adjusted rate ratio (aRR) controlled for age at drug test. RESULTS The relationship between testing positive for opiates and cocaine and prior 2-year offending was greater for women than men (aRR men 1.77; 95% CI: 1.75-1.79: women 3.51; 3.45-3.58). The association was weaker for those testing positive for opiates only (aRR: men: 1.66, 1.64-1.68; women 2.73, 2.66-2.80). Men testing positive for cocaine only had a lower rate of prior offending (aRR: 0.93, 0.92-0.94), women had a higher rate (aRR: 1.69, 1.64-1.74). The strongest associations were for non-serious acquisitive crimes (e.g. dually-positive: prostitution (women-only): aRR 24.9, 20.9-29.7; shoplifting: aRR men 4.05, 3.95-4.16; women 6.16, 5.92-6.41). Testing positive for opiates and cocaine was associated with violent offences among women (aRR: 1.54, 1.40-1.69) but not men (aRR: 0.98, 0.93-1.02). CONCLUSIONS Among drug-tested offenders, opiate use is associated with elevated prior offending and the association is stronger for women than men. Cocaine use is associated with prior offending only among women.
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Affiliation(s)
- Matthias Pierce
- Centre for Mental Health and Risk, University of Manchester, 4th Floor, Ellen Wilkinson Building, Oxford Road, M13 9PL Manchester, UK.
| | - Karen Hayhurst
- Centre for Mental Health and Risk, University of Manchester, 4th Floor, Ellen Wilkinson Building, Oxford Road, M13 9PL Manchester, UK.
| | - Sheila M Bird
- MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, CB2 0SR Cambridge, UK.
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, BS8 2PS Bristol, UK.
| | - Toby Seddon
- School of Law, University of Manchester, 4.46A Williamson Building, Oxford Road, M13 9PL Manchester, UK.
| | - Graham Dunn
- Centre for Biostatistics, University of Manchester, Jean McFarlane Building (First Floor), Oxford Road, Manchester M13 9PL, UK.
| | - Tim Millar
- Centre for Mental Health and Risk, University of Manchester, 4th Floor, Ellen Wilkinson Building, Oxford Road, M13 9PL Manchester, UK.
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White SR, Hutchinson SJ, Taylor A, Bird SM. Modeling the initiation of others into injection drug use, using data from 2,500 injectors surveyed in Scotland during 2008-2009. Am J Epidemiol 2015; 181:771-80. [PMID: 25787265 PMCID: PMC4423524 DOI: 10.1093/aje/kwu345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 11/12/2014] [Indexed: 11/14/2022] Open
Abstract
The prevalence of injection drug use has been of especial interest for assessment of the impact of blood-borne viruses. However, the incidence of injection drug use has been underresearched. Our 2-fold aim in this study was to estimate 1) how many other persons, per annum, an injection drug user (IDU) has the equivalent of full responsibility (EFR) for initiating into injection drug use and 2) the consequences for IDUs' replacement rate. EFR initiation rates are strongly associated with incarceration history, so that our analysis of IDUs' replacement rate must incorporate when, in their injecting career, IDUs were first incarcerated. To do so, we have first to estimate piecewise constant incarceration rates in conjunction with EFR initiation rates, which are then combined with rates of cessation from injecting to model IDUs' replacement rate over their injecting career, analogous to the reproduction number of an epidemic model. We apply our approach to Scotland's IDUs, using over 2,500 anonymous injector participants who were interviewed in Scotland's Needle Exchange Surveillance Initiative during 2008–2009. Our approach was made possible by the inclusion of key questions about initiations. Finally, we extend our model to include an immediate quit rate, as a reasoned compensation for higher-than-expected replacement rates, and we estimate how high initiates' quit rate should be for IDUs' replacement rate to be 1.
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Affiliation(s)
- Simon R. White
- Correspondence to Dr. Simon R. White, MRC Biostatistics Unit, Cambridge Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 0SR, United Kingdom (e-mail: )
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