Silvia Alessi-Severini

Silvia Alessi-Severini
University of Manitoba | UMN · College of Pharmacy

Ph. D.

About

85
Publications
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Introduction

Publications

Publications (85)
Article
Full-text available
Objective To evaluate the relationship between initiation of atypical antipsychotic agents and the risk of hyperglycemic emergencies. Method We conducted a multicentre retrospective cohort study using administrative health data from 7 Canadian provinces and the UK Clinical Practice Research Datalink. Hospitalizations for hyperglycemic emergencies...
Article
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Description of demographics of an outpatient population of clozapine users. Retrospective chart review study of an urban population diagnosed with schizophrenia. Assessment of therapeutic histories in relation to clinical practice guidelines. Seventy-seven of the 467 patients were on clozapine therapy. Average patients' age was 39.4 ± 11.8 years) a...
Preprint
Background Conflicting evidence exists on the impact of the COVID-19 pandemic restrictions on preterm birth (PTB) and stillbirth rates. We aimed to evaluate changes in PTB and stillbirth rates before and during the pandemic period and assess the potential effect modification of socioeconomic status (SES). Methods Using the linked administrative he...
Article
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Background: The effectiveness of long-acting injectable antipsychotics (LAIAs) has been demonstrated in studies using prescription claims data. However, the validity of claims data for LAIAs has not been established. Objective: We aimed to validate date dispensed, quantity dispensed and days supplied fields in prescription claims data, and to co...
Article
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Objectives: The increasing spread of severe acute respiratory syndrome coronavirus-2 has prompted Canada to take unprecedented measures. The objective of this study was to examine the impact of the implemented public health measures on the incidence of COVID-19 in Manitoba. Results: Using the COVID-19 dataset, we examined the temporal trends of...
Article
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Introduction: Second-generation long-acting injectable antipsychotics (SG-LAIAs) may improve outcomes compared to other antipsychotics. Real-world studies using linked administrative databases play an important role in assessing the comparative effectiveness of antipsychotic medications. Methods: We used a prevalent new-user design in a population-...
Article
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Background: Evidence from developed countries demonstrates that the use of antiseizure medications (ASMs) has been increasing in the last decade. Pregnant women have a very challenging risk benefit trade-off in terms of ASM utilization, and it is crucial to know if increased utilization is seen among pregnant women. Objective: To examine time-trend...
Article
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Background: The coronavirus disease 2019 (COVID-19) pandemic and public health measures that took place have led to concerns regarding mental health and receipt of psychotropic medications. We aimed to study the changes in psychotropic medication dispensation rates before and during the COVID-19 pandemic in the general population. Methods: Administ...
Article
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Objective To measure the incidence of long-term benzodiazepine receptor agonist (BZRA) use among individuals with anxiety, mood and/or sleep disorders. To identify factors associated with long-term use following the first prescription. Methods This was a population-based retrospective cohort study using administrative databases in Manitoba, Canada...
Article
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Background Cardiovascular death is a common outcome in population-based studies about new healthcare interventions or treatments, such as new prescription medications. Vital statistics registration systems are often the preferred source of information about cause-specific mortality because they capture verified information about the deceased, but t...
Article
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Background The prevalence of epilepsy in pregnant women is estimated at 0.3-1%. Anti-epileptic drug (AED) exposure in-utero has been associated with various adverse health outcomes in neonates, including adverse birth weight outcomes. Objective This review aims to summarize the published evidence on the association between AED exposure in pregnanc...
Article
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Objective: To compare the risk of cardiovascular events between sodium glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors among people with type 2 diabetes in a real world context of clinical practice. Design: Multi-database retrospective cohort study using a prevalent new user design with subsequent meta-an...
Preprint
Full-text available
Background: The prevalence of epilepsy in pregnant women is estimated at 0.3- 1%. Antiepileptic drug (AED) exposure in-utero has been associated with various adverse health outcomes in neonates including adverse birth weight outcomes. Methods: To summarize the evidence on the association between AED exposure in pregnancy and adverse birthweight ou...
Research Proposal
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The main purpose of this systematic review is to identify and sum-up the available evidence related to the effect of body piercing and tattooing in developing Hepatitis-C (Hep-C).
Research Proposal
Full-text available
The main goal of this systematic review is to map and sum-up the real-world evidence (RWE) on the effectiveness and safety profiles of interferon-free, direct-acting antiviral drugs (DAAs) for the treatment of Hepatitis-C (Hep-C).
Article
OBJECTIVE Reports of amputations associated with sodium–glucose cotransporter 2 (SGLT2) inhibitors have been inconsistent. We aimed to compare the risk of below-knee amputation with SGLT2 inhibitors versus dipeptidyl peptidase 4 (DPP-4) inhibitors among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS This multicenter observational study...
Article
Background: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors could increase the risk for diabetic ketoacidosis (DKA). Objective: To assess whether SGLT-2 inhibitors, compared with dipeptidyl peptidase-4 (DPP-4) inhibitors, are associated with an increased risk for DKA in patients with type 2 diabetes. Design: Population-based cohort study; p...
Article
Background: Abnormal microbiota composition induced by prenatal exposure to antibiotics has been proposed as a potential contributor to the development of attention-deficit/hyperactivity disorder (ADHD). We examined the association between prenatal antibiotic exposure and risk of ADHD. Methods: We conducted a population-based retrospective cohor...
Article
Aims: The United States Food and Drug Administration has warned of an increased risk of serious urinary tract infection (UTI) and Fournier's gangrene in patients with diabetes mellitus type 2 treated with sodium-glucose cotransporter 2 inhibitors (SGLT2i). However, evidence on these risks is limited. We aimed to compare urosepsis rates in SGLT2i u...
Article
Background: Long-acting injectable antipsychotics (LAIAs) have advantages over oral antipsychotics but are not widely used. We aimed to evaluate the impact of market entry of second-generation LAIAs on prescribing trends. Methods: We used administrative health databases to describe trends in LAIA use from 1995 to 2015 in the Canadian province of...
Article
Early childhood antibiotic exposure induces changes in gut microbiota reportedly associated with the development of Attention-Deficit/Hyperactivity Disorder (ADHD). We conducted a population-based cohort study to examine the association between antibiotic use in the first year of life and ADHD risk. We included children born in the Manitoba, Canada...
Article
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Background: Prenatal antibiotic exposure induces changes in infants' gut microbiota composition and is suggested as a possible contributor in the development of autism spectrum disorders (ASD). In this study, we examined the association between prenatal antibiotic exposure and the risk of ASD. Methods: This was a population-based cohort study ut...
Article
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Background and aims: To estimate prevalence of continuous use (persistence) of prescribed cannabinoid medications for up to 1 year from initial prescription in Manitoba, Canada and predictors of duration of use. Design and setting: A retrospective, population-based, cohort study using administrative data from the Manitoba Population Research Dat...
Article
Objectives Autism spectrum disorders (ASD) are among the leading causes of disabilities in children. We examined the annual prevalence and incidence rate of ASD between 2004 and 2015 in children aged 1 to 5 years residing in Manitoba. Methods A population-based study was conducted using the Manitoba Population Research Data Repository. The study i...
Article
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Purpose: 1) To evaluate trends for benzodiazepines (BZD) and Z-Drugs over 15-years in a general Canadian adult population measured by: a) consumption b) pharmacologic exposure c) dose intensity and d) prevalence of use. 2) To demonstrate the utility of Diazepam Milligram Equivalence (DME) based measurements when used in conjunction with traditiona...
Article
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Objective To develop key performance indicators that evaluate the effectiveness of a prescription medication system. Methods A modified RAND/UCLA appropriateness method was used to develop key performance indicators (KPIs) for a prescription medication system. A broad list of potential KPIs was compiled. A multidisciplinary group composed of 21 ex...
Data
The seven key performance indicators that were highly ranked by 70 percent of respondents. (DOCX)
Data
Example response from the first rating exercise. (DOCX)
Article
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Background: Direct-acting antivirals (DAAs) have become the standard treatment for patients with chronic hepatitis C infections because of their high cure rates and favourable side effect profiles; however, access to this new class of agents has been limited because of its high cost. Public payers across Canada have implemented strict criteria for...
Article
Background: Changes in microbiota composition as a result of antibiotics use in early life has been proposed as a possible contributor in the aetiology of autism spectrum disorders (ASD). We aimed to examine the association between early life antibiotic exposure and risk of ASD. Methods: This was a population-based cohort study which included al...
Article
Full-text available
Purpose: Treatment of Autism Spectrum Disorders (ASD) is challenging. Parents/caregivers' perspective on the effectiveness of therapies and services available to their children is important but neglected in the literature on ASD. This study investigated such perspective through questionnaire-guided interviews with a group of parents in the provinc...
Article
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Drug utilization research on benzodiazepines remains important for measuring trends in consumption within and across borders over time for the sake of monitoring prescribing patterns and identifying potential population safety concerns. The defined daily dose (DDD) system by the World Health Organization (WHO) remains the internationally accepted s...
Article
Objectives: To describe a cohort of young users of risperidone and quetiapine in the province of Manitoba (Canada) and assess the risk for movement disorders in the two treatments. Methods: This was a population-based study conducted on all residents of the province of 19 years of age and younger who received prescriptions for risperidone or que...
Article
Objectives: At 17.3%, smoking rates in Manitoba continue to exceed the national average. In this province, a total health care spending of more than $200 million per year has been attributed to smoking. This study examined the use of smoking cessation agents, including nicotine replacement products and prescription medications, in a sample of smok...
Article
Purpose Pharmacy claims data is often used in pharmacoepidemiology studies, but no studies to date have examined whether it was possible to identify the use of blister packs in these databases. We aimed to determine whether medications dispensed in days divisible by 7 are more likely to be blister packed than medications dispensed in other quantiti...
Article
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OBJECTIVE: To describe the extent of increase in use and the rate of continuation versus discontinuation of psychotropic agents before, during, and after pregnancy. METHODS: Rates of psychotropic use (antidepressants, anxiolytic/sedative-hypnotics, antiepileptics, antipsychotics, lithium, stimulants) among women with a hospital-recorded pregnancy o...
Article
Background: Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are widely prescribed for mood and anxiety disorders. However, it is not clear whether SNRIs are more strongly associated with cardiovascular and cerebrovascular events than SSRIs. Methods: This was a propensity score-matched, pop...
Article
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Background Around 30% of the population will experience herpes zoster (HZ), 10% of whom develop postherpetic neuralgia (PHN). Together, these illnesses produce a significant economic burden to the healthcare system. Methods Administrative healthcare data collected over the period of April 1st 1997 to March 31st 2014 were analyzed to determine the...
Article
Background: Community pharmacists frequently encounter patients at risk of medication misuse, diversion, and intentional overdose. However, few studies have examined the perspective of the pharmacist on the identification and management of these patients. Objective: To understand the perspective of community pharmacists on the dispensing of select...
Article
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Background Pain is a main symptom of herpes zoster (HZ), and postherpetic neuralgia (PHN) is a frequent complication occurring in 5% to 15% of cases, causing moderate to severe neuropathic pain. A population-based observational study was conducted to evaluate the treatment patterns and economic burden of prescription drug treatment of HZ and PHN pa...
Poster
Full-text available
A population-based cohort study comparing the relative risk of cardiovascular and cerebrovascular events and death between SSRI and SNRI users.
Article
Objective: "Antibenzodiazepine" campaigns have been conducted worldwide to limit the prescribing of these drugs because of concerns about inappropriate use and addiction. The causal relationship between long-term use and escalation to high doses has not been proven. This study assessed the extent of dose escalation among individuals who were long-...
Article
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Background: Herpes zoster (HZ) is a common viral disease that produces a painful vesicular rash. Early use of antiviral medications is recommended, as it reduces pain and speeds healing. A population-based observational study was conducted to evaluate the changing burden of HZ in the province of Manitoba (Canada) over a period of 17 years. Method...
Article
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Community pharmacists frequently encounter patients suspected to be at risk of medication misuse, divergence and overdose; yet, little research exists in describing how pharmacists effectively identify and intervene during these encounters. This study aimed to understand the barriers and facilitators in community pharmacy practice using a focus gro...
Conference Paper
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Background: The misuse of prescription drugs is an important public health concern worldwide. We aim to understand the challenges faced by community pharmacists on the dispensing of select medications commonly associated with misuse, divergence, and overdose. Methods: An online survey was disseminated to pharmacists licensed to practice in Manitoba...
Conference Paper
Full-text available
Background: Means restriction is an evidence-based strategy in suicide prevention. Community pharmacists frequently encounter patients at risk of medication misuse, divergence, and intentional overdose. However, few studies have examined the perspective of pharmacists on the dispensing of select medications commonly associated with misuse, divergen...
Conference Paper
Full-text available
Background: Several practice guidelines have been introduced in recent years that advocate for appropriate prescribing of psychotropic agents in older adults. We aim to describe the trend in hospitalizations and level of morbidity among older adults with an incident antidepressant or sedative-hypnotic prescription over a 16-year period in Manitoba,...
Conference Paper
Full-text available
Problem: Misuse, divergence, and intentional overdose with the use of pharmaceuticals continue to be an important and prevalent problem in developed countries worldwide. Drug information systems provide pharmacists access to dispensing information, which may be used to limit the risk of providing inappropriate quantities of medications available fo...
Conference Paper
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Background: Clinical practice guidelines aim to encourage appropriate prescribing of medications in the elderly. This includes limiting the duration and use of sedative-hypnotics (benzodiazepines and non-benzodiazepine "Z-drugs") in this population. We aim to examine the extent of new sedative-hypnotic utilization for older adults in Manitoba, Cana...
Conference Paper
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Objective: There has been much attention on appropriate prescribing in older adults in recent years. Recent guidelines favor the use of newer antidepressants over older agents based on their safety profile in this population. This study aimed to examine whether there has been a decline in older antidepressants and an increase in newer antidepressa...
Article
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Background: Despite their favourable toxicology profile, benzodiazepines and the related Z-drugs (zopiclone, zolpidem and zaleplon) have been associated with physiological tolerance, dependence and addiction. Evidence of harm (e.g., falls, motor vehicle collisions and cognitive disturbances) has been reported in older populations. The aim of this...
Article
Objective: The purpose of this review is to describe the elements and enablers for interprofessional education (IPE) clinical placements in diabetes teams. Methods: We describe the development of an IPE clinical placement for health professional students in a diabetes team and share the lessons learned over 6 years, from 2008 to 2013. The 6 coll...
Article
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Clozapine effectiveness in the treatment of refractory schizophrenia has been sustained by published evidence in the last two decades, despite the introduction of safer options. Current clinical practice guidelines have strongly recommended the use of clozapine in treatment-resistant schizophrenia, but prescribing trends do not appear to have follo...
Article
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Background. Psychotropic medications, in particular second-generation antipsychotics (SGAs) and benzodiazepines, have been associated with harm in elderly populations. Health agencies around the world have issued warnings about the risks of prescribing such medications to frail individuals affected by dementia and current guidelines recommend their...
Article
Full-text available
Despite concerns over the potential for severe adverse events, antipsychotic medications remain the mainstay of treatment of behaviour disorders and psychosis in elderly patients. Second-generation antipsychotic agents (SGAs; e.g., risperidone, olanzapine, quetiapine) have generally shown a better safety profile compared to the first-generation age...
Article
Background: Antipsychotic medications have been widely used in elderly patients for treatment of a variety of diagnoses. The aim of our study was to compare the incidence of cerebrovascular and cardiac events as well as mortality in elderly persons treated with second-generation antipsychotics (SGAs) with that of elderly persons treated with conve...
Article
Generic drugs are less expensive than their branded equivalents, but receive limited promotion. This study sought to examine how user rates of individual selective serotonin reuptake inhibitors (SSRIs) changed after the introduction of their generic equivalents. Administrative health and census data were used to examine the rates of use of all 6 SS...
Article
Early clinical trials had suggested a better safety profile for the second-generation antipsychotics (SGAs; e.g. risperidone, olanzapine, quetiapine, aripiprazole) compared to the older first-generation agents (FGAs; e.g. haloperidol and phenothiazines); however, new long-term studies have determined that important adverse events are associated wit...
Article
Accounting literature provides many examples of how it has helped healthcare decision making. There is no evidence of how healthcare has helped accounting. This is a unique study which views accounting decision making from a non-business perspective of healthcare decision making, through treatment cost interactions. Relationships between illness an...
Article
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To report the prescribing of antipsychotics to the youth population of the Canadian province of Manitoba during the course of a decade. Use of antipsychotics in children and adolescents (aged 18 years or younger) was described using data collected from the administrative health databases of Manitoba Health and the Statistics Canada census between t...
Article
Full-text available
Abstract Early clinical trials had suggested a better safety profile for the second-generation antipsychotics (SGAs; e.g. risperidone, olanzapine, quetiapine, aripiprazole) compared to the older first-generation agents (FGAs; e.g. haloperidol and phenothiazines); however, new long-term studies have determined that important adverse events are assoc...