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Biomedical subjects

H Jick

Publications and source records attributed to H Jick.

At least 73 records · Page 4Linked to original sources
PubMed1997

Omeprazole, other antiulcer drugs and newly diagnosed gout.

AIMS: Case-reports describing patients who developed a first episode of acute gout while being treated with the proton pump inhibitor omeprazole led us to compare incidence rates of newly diagnosed gout cases among omeprazole, ranitidine and cimetidine users. METHODS: We conducted a cohort study with a nested case-control analysis using the UK-based General Practitioner Research Database (GPRD). The study encompassed a cohort of more than 53,000 subjects who received some 185,000 prescriptions for the three study drugs. RESULTS: Neither current omeprazole vs recent use (age- and sex-adjusted relative risk 1.1, 95% CI 0.5-2.1), nor current omeprazole use in comparison with current use of the two histamine H2-receptor blockers was associated with an increased risk of developing newly diagnosed gout. Higher age (RR 2.4, 95% CI 1.5-3.9), male gender (RR 5.4, 95% CI 2.8-10.3), high body mass index (OR 3.3, 95% CI 1.0-10.9) and hypertension (OR 4.5, 95% CI 1.6-12.9) were all important risk factors for gout. CONCLUSIONS: While other known risk factors were significantly associated with gout, current omeprazole use was not materially associated with an increased gout incidence.

Adult↗
PubMed1997

Antihypertensive drugs and fatal myocardial infarction in persons with uncomplicated hypertension.

We conducted a case-control study to evaluate the risk of fatal myocardial infarction in otherwise healthy treated hypertensive subjects according to the type of the antihypertensive drug used. The study encompassed 207 cases and 409 controls matched to cases on age, sex, and general practice. Compared with beta-blocker users, the matched relative risk estimates for fatal myocardial infarction, adjusted for recent blood pressure, body mass index, smoking, duration of hypertension, and prior use of other antihypertensive drugs, were 0.7 [95% confidence interval (CI) = 0.4-1.2] for angiotensin-converting enzyme inhibitor users, 0.9 (95% CI = 0.5-1.5) for calcium channel blocker users, and 0.7 (95% CI = 0.4-1.2) for diuretic users.

Adrenergic beta-Antagonists↗
PubMed1997

Drug use and pulmonary death rates in increasingly symptomatic asthma patients in the UK.

BACKGROUND: There is concern about an increase in deaths from respiratory causes in asthma patients using long acting beta agonists. According to the guidelines of the British Thoracic Society, long acting beta agonists, ipratropium bromide, and theophylline should be used to treat patients with increasing asthma severity who are already receiving treatment with short acting beta agonists and inhaled steroids. A study was therefore undertaken to compare the characteristics and short term respiratory mortality rates in first time users of one of these three drugs. METHODS: An open cohort study with a nested case-control analysis was performed on the UK based General Practice Research Database (GPRD). First time users of either salmeterol (n = 8386), ipratropium bromide (n = 4305), or theophylline (n = 4228) between 1 January 1992 and 30 April 1995 were identified and followed for 16 weeks. Drug usage patterns, predictors for respiratory mortality, and the number of deaths at 16 weeks in the three drug groups were compared. RESULTS: The three asthma drugs were most often prescribed to patients with severe asthma. Age, a concomitant diagnosis of chronic obstructive pulmonary disease or emphysema, number of asthma drug prescriptions, number of visits to the general practitioner, and whether or not the patient had been admitted to hospital due to the respiratory disease in the 12 months prior to the start of the new drug therapy were strong predictors for asthma mortality. After adjusting for several risk factors, the relative risk estimates of a respiratory death for ipratropium bromide and theophylline users compared with salmeterol users were 1.8 (95% CI 0.4 to 9.6) and 3.0 (95% CI 0.4 to 22.4), respectively. CONCLUSIONS: In the UK population studied, salmeterol, ipratropium bromide and theophylline are regularly used to treat patients with asthma of increasing severity. Salmeterol use was not associated with an increase in short term mortality compared with ipratropium bromide and theophylline.

Adolescent↗
PubMed1996

Risk of hospital admission for idiopathic venous thromboembolism among users of postmenopausal oestrogens.

BACKGROUND: At the request of researchers in the UK, we conducted a case-control study to explore the relation between use of postmenopausal oestrogen hormone replacement therapy (HRT) and idiopathic venous thromboembolism (VTE). METHODS: The study was based on information derived from Group Health Cooperative of Puget Sound for the period 1980 to 1994. Women aged 50-74 years admitted to hospital for idiopathic VTE were identified from hospital records. The diagnosis of idiopathic VTE was validated from the clinical record. Women who had medical conditions predisposing to VTE (a history of VTE or cancer, recent trauma, or surgery) were excluded as cases. Four control subjects matched to each case by age, duration of Cooperative membership, and calendar time were identified from the base population. Various potential risk factors were recorded based on record review. FINDINGS: An initial analysis of 42 cases and 168 matched controls yielded a matched relative risk estimate of 3.6 (95% CI 1.6-7.8) for current users of oestrogens compared with non-users. There was a substantial effect of daily oestrogen dose. The matched relative risk estimates for oestrogen users of 0.325 mg, 0.625 mg, and 1.25 mg or more daily were 2.1, 3.3, and 6.9, respectively. Body-mass index was independently associated with the risk of VTE but did not materially confound the relation of oestrogen and VTE. The absolute risk of idiopathic VTE is estimated to be low (0.9 x 10(-4) woman-years) in non-users of oestrogen; the risk in current users is estimated at 3.2 x 10(-4) woman-years. INTERPRETATION: The risk of idiopathic VTE is about three times higher among current users of replacement oestrogens than among non-users. However, the absolute risk is low for both groups and accounts for only a modest increase in morbidity.

Aged↗
PubMed1996

Acetaminophen and renal and bladder cancer.

Acetaminophen is a metabolite of phenacetin, a drug that has been implicated as a causal agent in the development of renal and bladder cancer. We conducted matched case-control studies to estimate the risk of renal and bladder cancer among heavy users of acetaminophen, using data from Group Health Cooperative of Puget Sound. For the renal cancer study, we identified 222 incident cases diagnosed in the years 1980-1991 and 885 controls. For bladder cancer, we identified 504 cases and 2,009 controls. Exposure was defined according to the number of prescriptions for acetaminophen and acetaminophen-containing drugs filled at the Group Health Cooperative pharmacy. The relative risk estimate for renal cancer for subjects who filled 40 or more prescriptions was 2.6 [95% confidence limits (CL) = 1.1, 6.0], compared with the risk for subjects who did not fill any prescriptions for acetaminophen. We found only a small increased risk of bladder cancer among subjects with heavy acetaminophen exposure (odds ratio = 1.3; 95% CL = 0.6, 2.8).

Acetaminophen↗
PubMed1996

Histamine-2 receptor antagonists and gastric cancer.

We conducted a case-control study at Group Health Cooperative of Puget Sound to evaluate the relation between longterm histamine-2 (H2) receptor antagonist use and gastric cancer. We identified 113 cases and 452 controls and estimated a relative risk (RR) of 2.0 [95% confidence interval (C1) = 1.0-3.9]. When we evaluated the effect of time-since-first-use, the RR estimates were 6.5, 1.2, and 1.0 for 2-4 years of use, 5-9 years, and > or = 10 years, respectively. The data provide substantial evidence that long-term H2 antagonist use is not associated with gastric cancer.

Aged↗
PubMed1996

Sudden unexplained death among subjects with refractory epilepsy.

PURPOSE: To address concerns about possible increases in rates of sudden unexplained death (SUD) after use of new anticonvulsants, more information on the rate of SUD among subjects with refractory epilepsy is needed to provide a comparison. METHODS: We conducted a study to estimate the incidence of SUD among subjects younger than 50 years with refractory epilepsy, by using information from the General Practice Research Database (GPRD) in the United Kingdom. For the purposes of this study, subjects receiving two or more anticonvulsant drugs concurrently were considered to have refractory epilepsy. Potential cases of SUD were identified from the computer records, and clinical records for these subjects were reviewed by two specialists in SUD in epilepsy. RESULTS: Fifteen subjects (eight male, seven female) of the 4,150 subjects with refractory epilepsy were considered to have definite/probable or possible SUD. CONCLUSIONS: The overall incidence rate of SUD in the population was 2.2 per 1,000 person-years (95% CI, 1.3-3.6). The rate for subjects with highly probable SUD was 1.5 per 1,000 person-years (95% CI, 0.8-2.7).

Adolescent↗
PubMed1996

The demand for eating disorder care. An epidemiological study using the general practice research database.

BACKGROUND: An epidemiological study of anorexia nervosa and bulimia nervosa in primary care was performed using the General Practice Research Database (GPRD). METHOD: The GPRD was screened between 1988 and 1994 for newly diagnosed cases of anorexia nervosa and bulimia nervosa. The validity of the computer diagnosis was established by obtaining clinical details from a random sample of the general practitioners (GPs). RESULTS: Incidence rates for detection of cases by GPs in 1993 was 4.2 per 100,000 population for anorexia nervosa, and 12.2 per 100,000 for bulimia nervosa. The relative risks of females to males was 40:1 for anorexia nervosa and 47:1 for bulimia nervosa. A threefold increase in the recording of bulimia nervosa was found from 1988 to 1993. Eighty per cent of anorexia nervosa cases and 60% of bulimia nervosa cases were referred to secondary care. CONCLUSION: There is a continuing expansion of service need for bulimia nervosa. The majority of cases of eating disorders are referred to secondary services. There is scope for more effective management of bulimia nervosa in primary care.

Adolescent↗
PubMed1995

Risk of idiopathic cardiovascular death and nonfatal venous thromboembolism in women using oral contraceptives with differing progestagen components.

Concern about the risks of cardiovascular illness in women using combined oral contraceptives (OC) containing the progestagens desogestrel and gestodene prompted two studies of data from the UK General Practice Research Database. We compared the risks of certain cardiovascular illnesses in otherwise healthy women exposed to one of three OCs containing < 35 micrograms oestrogen plus levonorgestrel, desogestrel, or gestodene. In the first study, based on some 470 general practices, there were 15 cases of unexpected idiopathic cardiovascular death among 303,470 women who were current users of one of the study OCs. The estimated incidence rates were 8/184,536 (4.3 per 100,000) woman-years at risk for users of combined OCs containing levonorgestrel, 2/135,567 (1.5 per 100,000) for desogestrel users, and 5/105,201 (4.8 per 100,000) for gestodene users. The relative risk (RR) estimates were 0.4 (95% CI 0.1-2.1) and 1.4 (CI 0.5-4.5) for desogestrel and gestodene, respectively, compared with levonorgestrel. In the second study, derived from some 370 general practices, there were 80 cases of nonfatal venous thromboembolism (VTE) in a cohort of 238,130 otherwise healthy women. The incidence rates of VTE per 100,000 woman-years at risk were 16.1 for levonorgestrel users, 29.3 for desogestrel, and 28.1 for gestodene. The adjusted RR estimates from the cohort analysis were 1.9 (1.1-3.2) and 1.8 (1.0-3.2) for desogestrel and gestodene users, respectively, compared with users of levonorgestrel. In a nested case-control analysis the adjusted matched RR estimates were 2.2 (1.1-4.4) and 2.1 (1.0-4.4) for desogestrel and gestodene users, respectively, compared with users of levonorgestrel. The excess risk for nonfatal VTE associated with the new generation of combined OCs containing low-dose oestrogen and the progestagens desogestrel or gestodene compared with levonorgestrel is estimated to be 16 per 100,000 woman-years.

Adult↗
PubMed1995

Antidepressants and suicide.

OBJECTIVE: To estimate the rate and means of suicide among people taking 10 commonly prescribed antidepressant drugs: dothiepin, amitriptyline, clomipramine, imipramine, flupenthixol, lofepramine, mianserin, fluoxetine, doxepin, and trazodone. DESIGN: Open cohort study with a nested case-control analysis. SETTING: General practices in the United Kingdom that used VAMP computers to maintain their patient records from January 1988 to February 1993. SUBJECTS: 172,598 people who had at least one prescription for one of the 10 antidepressants during the study period. MAIN OUTCOME MEASURE: Suicide confirmed by general practitioner or on death certificate, or both. RESULTS: 143 people committed suicide. The overall rate of suicide was estimated to be 8.5 per 10,000 person years (95% confidence interval 7.2 to 10.0). Rates of suicide were higher in men than women (relative risk 2.8 (95% confidence interval 1.9 to 4.0)), people with a history of feeling suicidal (19.2 (9.5 to 38.7)), and people who had taken several different antidepressants (2.8 (1.8 to 4.3)). People who received high doses of antidepressants and those who had had a prescription in the 30 days before they committed suicide were also at higher risk than those who had received low doses and had had their prescriptions 30 or more days previously (2.3 (1.4 to 3.7) and 2.3 (1.6 to 3.4)) respectively. Rates of suicide were higher in patients who received fluoxetine, but this may be explained by selection biases which were present for those drug users. CONCLUSION: Several factors correlate with the risk of suicide in people taking antidepressants. After controlling for these factors, the risk of suicide was similar among the 10 study antidepressants. Overdose with antidepressants accounted for only 14% of the suicides.

Adult↗
PubMed1994

Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs.

Exposure to non-steroidal anti-inflammatory drugs (NSAIDs) is known to increase substantially the risk of upper gastrointestinal bleeding and perforation (UGIB). We have carried out a population-based retrospective case-control study to assess the variation in risk associated with various individual NSAIDs, with adjustment for features of use and other independent risk factors. The study sample comprised 1457 cases of UGIB and 10,000 control subjects identified from general practitioners' computerised records in the UK. The adjusted estimate of relative risk of UGIB associated with current NSAID use was 4.7 (95% CI 3.8-5.7). Previous UGIB was the single most important predictor of UGIB (relative risk 13.5 [10.3-17.7]). For all NSAIDs together, the risk was greater for high doses than for low doses (7.0 [5.2-9.6] vs 2.6 [1.8-3.8]). The estimates of risk associated with the individual NSAIDs varied widely. Users of azapropazone (23.4 [6.9-79.5]) and piroxicam (18.0 [8.2-39.6]) had the highest risk of UGIB among the NSAIDs studied. All the other NSAIDs with sufficient data for individual analysis (ibuprofen, naproxen, diclofenac, ketoprofen, and indomethacin) had relative risks similar to that for overall NSAID use. NSAIDS should be used cautiously in patients who have other risk factors for UGIB; these include advanced age, smoking, history of peptic ulcer, and use of oral corticosteroids or anticoagulants.

Adult↗
PubMed1994

Risk of gynaecomastia associated with cimetidine, omeprazole, and other antiulcer drugs.

OBJECTIVE: To study the risk of gynaecomastia associated with cimetidine, misoprostol, omeprazole and ranitidine. DESIGN: Open cohort study with nested case-control analysis. SETTING: General practices in United Kingdom that had computerised offices, 1989-92. SUBJECTS: 81,535 men aged 25-84 years who received at least one prescription for cimetidine, misoprostol, omeprazole, or ranitidine during the study period. MAIN OUTCOME MEASURES: New occurrences of idiopathic gynaecomastia diagnosed by general practitioner. RESULTS: The relative risk of gynaecomastia for current users of cimetidine compared with non-users was 7.2 (95% confidence interval 4.5 to 11.3). Relative risks for misoprostol, omeprazole, and ranitidine were 2.0 (0.1 to 10.7), 0.6 (0.1 to 3.3), and 1.5 (0.8 to 2.6), respectively. Current users of cimetidine on a daily dose > or = 1000 mg had more than 40 times the risk of developing gynaecomastia than non-users. The period of highest risk was seven to 12 months after starting cimetidine treatment. Spironolactone (relative risk 9.3 (3.3 to 26.1)) and verapamil (9.7 (2.6 to 36.0)) were associated with a relative risk of gynaecomastia comparable to one for cimetidine. CONCLUSIONS: Use of cimetidine, but not the three other antiulcer drugs, is associated with a substantially greater risk of gynaecomastia in men. A strong dose-response relation was present among cimetidine users.

Adult↗
PubMed1994

Acute liver injury associated with nonsteroidal anti-inflammatory drugs and the role of risk factors.

BACKGROUND: Hospitalizations for acute liver injury in the absence of a viral infection or any other well-defined pathologic finding that could have caused it is rare. In this study, we included both outpatients and hospitalized patients with acute liver injury to estimate the risk of clinically important acute liver injury associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and to study the role of certain risk factors. METHODS: This was a retrospective cohort study with secondary case-control analysis. The study included 536 general practitioners' practices in England and Wales for the period October 1987 through August 1991. A total of 625,307 persons who received more than 2 million prescriptions for one of 12 NSAIDs were followed up to estimate the risk of newly diagnosed acute liver injury. RESULTS: There were 23 cases of acute liver injury. The incidence of acute liver injury was 3.7 per 100,000 NSAID users or 1.1 per 100,000 NSAID prescriptions. None of the cases had a fatal outcome. Sulindac was the only NSAID with a substantially greater risk than that for the overall NSAID group. Users of NSAIDs who had rheumatoid arthritis had a 10-fold increased risk of acute liver injury compared with NSAID-treated patients with osteoarthritis. Concomitant exposure to other hepatotoxic medications also increased the risk. Transient minor increases in liver test values were not a useful predictor of diagnosed NSAID-associated acute liver injury. CONCLUSIONS: Although NSAIDs have been found to be associated with acute liver injury in a small number of persons, the risk is sufficiently small as to be of minimal concern for most NSAIDs.

Acute Disease↗
PubMed1993

First trimester topical tretinoin and congenital disorders.

We used information from the Group Health Cooperative of Puget Sound, Washington, USA, to evaluate the risk of birth defects in mothers exposed to topical tretinoin--a retinoid preparation used to treat acne--in the first trimester of pregnancy. We identified 215 women who delivered live or stillborn infants at Group Health Cooperative hospitals and who were exposed to topical tretinoin early in pregnancy, and 430 age-matched nonexposed women who delivered live or stillborn infants at the same hospitals. The prevalence of major anomalies among babies born to the exposed women was 1.9% and among babies born to the nonexposed women was 2.6%. The relative risk estimate for having a baby with a major congenital anomaly for exposed versus nonexposed women was 0.7 (95% CI 0.2-2.3). We conclude that topical tretinoin is not associated with an increased risk for major congenital disorders.

Abnormalities, Drug-Induced↗