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1. Measures of stimulant medications: A population-based study in Alberta, Canada

Author

Cerina Dubois, Ming Ye, Olivia Weaver, Salim Samanani, Ed Jess, Fizza Gilani, and Dean T. Eurich

Subjects
Stimulant, Opioid, Alberta, Population, Epidemiology, Pharmacy and materia medica, RS1-441
Abstract

Objectives: Stimulants are a class of drugs approved for the treatment of attention-deficit hyperactivity disorder (ADHD) and narcolepsy. However, they are also often used “off-label” as adjunct therapies for the treatment of obesity and depression. The objective of this study is to summarize how stimulant use is globally measured in the literature and to explore rates of stimulant use in Alberta, Canada. Methods: A traditional narrative literature review was conducted to summarize global methods of stimulant assessment. Then using definitions guided by the literature and current regulatory bodies in Alberta, we conducted a series of descriptive analyses to assess how frequent stimulant use was in Alberta patients from 2019 to 2021: 1) number of dispenses by year; 2) average days of drug supply; 3) proportion of days covered (PDC); and 4) defined daily dose (DDDs). Results: In the literature review, the most frequently used measures of stimulant drug use were trends over time (prevalence), types of drug use, and dispensations of prescriptions. In all, there is a global trend of increased use of stimulants among both adults and children. In Alberta, 173,789 patients were prescribed stimulant medication in 2019–2021, representing approximately 4 % of the entire Alberta population. Overall, 61.1 % were between the ages of 10–34 and 46.8 % were female. The number of dispensations rose from 713,896 in 2019 to 973,930 in 2021 – with up to 43 % being lisdexamfetamine stimulant dispenses. Conclusions: Although stimulant use in AB was measured using similar trend estimates as the literature, there is a lack of research to support whether these measures are accurate and effective at the population-level. Future steps to standardize both medical and nonmedical use of prescription stimulants are warranted in efforts to fully quantify both benefits and risks associated with stimulant use.

Published
2024
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2. Dual Enrollment and College and Career Readiness: An Investigation of One School System

Author

Olivia Weaver Pearson

Abstract

Too few students are graduating from high school college and career-ready. For this dissertation, a qualitative design that included a data analysis was implemented to review a dual enrollment program and the impact of implementing various change ideas to increase enrollment of students in the program. The study was conducted in two phases. Phase 1 was a quantitative review of dual enrollment eligibility and registration data of all comprehensive high schools in the studied district over four years. Phase 2 was a focus group comprised of school-based personnel involved with dual enrollment. The focus group provided a more in-depth understanding of school needs in support of dual enrollment. Three research questions guided the study: (1) What does data suggest about implementing change ideas designed to reduce barriers to enrollment in schools and the enrollment of eligible students in college courses? (2) What additional support of the dual enrollment program do school personnel suggest that may increase eligible student enrollment? (3) How do the school personnel's perceptions of dual enrollment impact the way they interact with and support eligible dual enrollment students? Findings from this research suggest that schools that implemented a change idea observed an overall increase in dual enrollment registration over the four-year review period. The research findings also indicate that multiple factors can influence the implementation of a dual enrollment program such as the knowledge and support of the principal and counselor, and how dual enrollment fits into each school's overall culture. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Published
2024

3. Dual Enrollment and College and Career Readiness: An Investigation of One School System

Author

Pearson, Olivia Weaver and Pearson, Olivia Weaver

Abstract

Too few students are graduating from high school college and career-ready. For this dissertation, a qualitative design that included a data analysis was implemented to review a dual enrollment program and the impact of implementing various change ideas to increase enrollment of students in the program. The study was conducted in two phases. Phase 1 was a quantitative review of dual enrollment eligibility and registration data of all comprehensive high schools in the studied district over four years. Phase 2 was a focus group comprised of school-based personnel involved with dual enrollment. The focus group provided a more in-depth understanding of school needs in support of dual enrollment. Three research questions guided the study: (1) What does data suggest about implementing change ideas designed to reduce barriers to enrollment in schools and the enrollment of eligible students in college courses? (2) What additional support of the dual enrollment program do school personnel suggest that may increase eligible student enrollment? (3) How do the school personnel’s perceptions of dual enrollment impact the way they interact with and support eligible dual enrollment students? Findings from this research suggest that schools that implemented a change idea observed an overall increase in dual enrollment registration over the four-year review period. The research findings also indicate that multiple factors can influence the implementation of a dual enrollment program such as the knowledge and support of the principal and counselor, and how dual enrollment fits into each school's overall culture.

Published
2024

4. Defining opioid naïve and implications for monitoring opioid use: A population-based study in Alberta, Canada

Author

Dean Eurich, Cerina Lee, Ming Ye, Olivia Weaver, Ed Jess, Fizza Gilani, and Salim Samanani

Abstract

Purpose: Reducing initial exposure of “opioid naïve” patients to opioids is a public health priority. Identifying opioid naïve patients is difficult, as numerous definitions are used. The objective is to summarize current definitions and evaluate their impact on opioid naïve measures in Alberta. Methods: Using dispense data (2017-2021) and definitions guided by a scoping review, we determined the number of “opioid naïve” patients using descriptive analyses. Three definitions were identified: 1) no opioid use within the previous 30 days/6 months/1 year, based on dispensation date; 2) definition 1, based on dispensation date plus days of supply; 3) exclusion of codeine from definitions 1 and 2. Results: Of over a dozen definitions of opioid naïve identified in the scoping review, most used an ‘opioid free’ period (commonly 30 days/6 months/1 year). Other definitions included “availability of drug” based on days of supply and/or excluded certain opioid products. Approximately 36.4% of Albertans (n=1,551,075) had an opioid dispensation in 2017-2021. The average age was 46.6±18.8 and 52.8% were female. Results were most affected by the “opioid free” period, with 97.4%, 83.2% and 65.6% being classified as opioid naïve using time windows from definition 1. Definitions 2 and 3 did not materially change the results. Conclusions: The most convenient definition for “opioid naïve” was definition 1 using a 1-year window, which aligns with the Canadian Institutes for Health Information definition. Irrespective of definition used, a large proportion of opioid users would be considered opioid naïve despite initiatives to curb opioid prescription in Alberta.

Published
2023
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5. A Pilot Trial: Fish Oil and Metformin Effects on ApoB-Remnants and Triglycerides in Women With Polycystic Ovary Syndrome

Author

Katerina Maximova, Mahua Ghosh, Donna F. Vine, Spencer D. Proctor, Ethan Proctor, and Olivia Weaver

Subjects
medicine.medical_specialty, Apolipoprotein B, endocrine system diseases, ApoB-lipoproteins, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Context (language use), 030204 cardiovascular system & hematology, Gastroenterology, fish oil, metabolic syndrome, lipids, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, PCOS, nonfasting lipids, triglycerides, Clinical Research Articles, postprandial lipemia, biology, obese, business.industry, digestive, oral, and skin physiology, Area under the curve, nutritional and metabolic diseases, Fish oil, medicine.disease, Polycystic ovary, 3. Good health, Metformin, Postprandial, biology.protein, Metabolic syndrome, business, metformin, AcademicSubjects/MED00250, medicine.drug
Abstract

Context Women with polycystic ovary syndrome (PCOS) have increased incidence of atherogenic dyslipidemia and cardiovascular disease (CVD). Interventions targeting atherogenic dyslipidemia to reduce CVD risk are limited in women with PCOS. Objective This pilot study was conducted to determine the effect of 12 weeks of high dose fish oil (FO), metformin, and FO as an adjunct to metformin (FO-metformin) therapy on fasting and nonfasting plasma lipids and ApoB-remnants in young women with the metabolic syndrome (MetS) and PCOS. Methods In this open-label parallel pilot trial, women with MetS and PCOS (18-30 years of age) were randomized into 1 of 3 interventions: (1) FO; (2) metformin; and (3) FO-metformin. Plasma lipids and ApoB (48 and 100)-lipoproteins and triglycerides (TG) were measured in the fasted and postprandial state following a high-fat meal at baseline and postintervention. Results FO-metformin significantly lowered fasting plasma TG by >40% compared with FO and metformin treatments. Fasting plasma apoB48 was lowered 40% in FO-metformin and 15% in the FO groups from baseline to postintervention. ApoB48 area under the curve (ApoB48AUC), ApoB48 incremental AUC (ApoB48iAUC), ApoB100AUC, and ApoB100iAUC decreased in all groups from baseline to postintervention; however, these findings did not reach statistical significance. Conclusion The findings of this pilot trial show that high dose FO and FO-metformin combination therapy tend to lower fasting and postprandial plasma TG and ApoB-lipoprotein remnants compared with metformin; however, the study is limited by small sample size. These results may be clinically significant in individuals with PCOS for management of atherogenic dyslipidemia.

Published
2021

7. SUN-022 Metformin-Fish Oil Adjunct Therapy Improves apoB-Remnant Lipoprotein and Triglyceride Levels in Women with Polycystic Ovary Syndrome

Author

Donna F. Vine, Ethan Proctor, Mahua Ghosh, Olivia Weaver, Spencer D. Proctor, and Katerina Maximova

Subjects
medicine.medical_specialty, Triglyceride, Remnant Lipoprotein, Apolipoprotein B, biology, endocrine system diseases, business.industry, Endocrinology, Diabetes and Metabolism, digestive, oral, and skin physiology, nutritional and metabolic diseases, Fish oil, Polycystic ovary, Metformin, chemistry.chemical_compound, Endocrinology, chemistry, Internal medicine, biology.protein, Medicine, Reproductive Endocrinology, business, Hyperandrogenism, AcademicSubjects/MED00250, medicine.drug
Abstract

Background: Polycystic ovary syndrome (PCOS) is highly associated with the metabolic syndrome (MetS): obesity, insulin resistance and atherogenic dyslipidemia. Women with PCOS-MetS are at higher risk of developing ischemic cardiovascular disease (CVD) and Type-2 Diabetes. First-line intervention in PCOS-MetS includes targeting diet and lifestyle, and metformin is commonly prescribed to treat insulin resistance, however these interventions have shown limited effectiveness to improve dyslipidemia. At present there are limited safe and efficious options to target atherogenic dyslipidemia in young women with PCOS. Fish oil (FO) and Icosapentyl ethyl supplementation have been shown to reduce fasting TG, apoB and to improve ischemic CVD outcomes. The efficacy of FO or as an adjunct therapy to metformin to improve ApoB-remnant lipemia in PCOS-MetS is unknown. The aim of this pilot study was to determine the effect of metformin, FO and FO-metformin combination treatment on fasting and non-fasting plasma TG and apoB-remnant lipoprotein metabolism in patients with PCOS-MetS. Methods: Participants diagnosed with PCOS aged 18-30yrs received dietary counselling and were randomly assigned to receive FO (n=8), metformin (n=7) or FO-metformin (n=12) treatment for 12 wks. Plasma lipids (TG and cholesterol), ApoB48 and ApoB100 lipoprotein metabolism were assessed in the fasting and non-fasting state using a standardized high-fat meal test. Results: At baseline, the fasting plasma TG, ApoB48 and ApoB100 was 238.0 ± 21.0 mg/dL, 9.00 ± 1.12 ug/ml and 290 ± 18.00 mg/dL. FO and FO-metformin decreased fasting plasma TG by 10% and 30% compared to the metformin treatment group (7%). Fasting ApoB48 was reduced 45%, 16% and 19% in FO-metformin, FO and metformin treatment groups, respectively. Non-fasting plasma TG and apoB48 lipoprotein area under the curve were reduced by 30% in the FO-metformin treatment group. Conclusion: These pilot findings demonstrate FO-metformin adjunct therapy may have greater efficacy to improve atherogenic apoB-dyslipidemia compared to metformin or FO alone in high-risk patients with PCOS-MetS. A larger clinical trial is warranted to determine the long term effects of FO-metformin intervention on apoB-dyslipidemia and atherosclerotic cardiovascular disease indices.

Published
2020

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