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Biomedical subjects

J M Piper

Publications and source records attributed to J M Piper.

At least 55 records · Page 3Linked to original sources
PubMed1991

Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons.

OBJECTIVE: To evaluate the relative risk for peptic ulcer disease that is associated with the use of nonaspirin nonsteroidal anti-inflammatory drugs. DESIGN: Nested case-control study. SETTING: Tennessee Medicaid program. PARTICIPANTS: Medicaid enrollees 65 years of age or older were included in the study. The 1415 case patients had been hospitalized for confirmed peptic ulcer disease at some point from 1984 through 1986. The 7063 control persons represented a stratified random sample of other Medicaid enrollees. MEASUREMENTS AND MAIN RESULTS: The estimated relative risk for the development of peptic ulcer disease among current users of nonaspirin nonsteroidal anti-inflammatory drugs, compared with that among nonusers, was 4.1 (95% CI, 3.5 to 4.7). For current users, the risk increased with increasing dose, from a relative risk of 2.8 (CI, 1.8 to 4.3) for the lowest to a relative risk of 8.0 (CI, 4.4 to 14.8) for the highest dose category. The risk was greatest in the first month of use (relative risk, 7.2; CI, 4.9 to 10.5). If the association is fully causal, 29% of peptic ulcers in the study sample resulted from the use of these drugs, and the excess risk associated with such use was 17.4 hospitalizations for ulcer disease per 1000 person-years of exposure. CONCLUSIONS: These data support other findings indicating that a clinically significant risk for serious ulcer disease is associated with the use of nonaspirin nonsteroidal anti-inflammatory drugs. The data show that this risk increases with dose and recency of use and that use of these drugs may be responsible for a large proportion of peptic ulcer disease among elderly persons.

Age Factors↗
PubMed1991

The second stage of labor: factors influencing duration.

Prolonged second stage of labor is associated with increased perinatal mortality. Factors influencing second-stage duration are poorly understood. This study was undertaken to characterize those factors. A population of 473 nulliparous women and 491 multiparous women with spontaneous vaginal deliveries were analyzed extensively with history, physical examination (including clinical pelvimetry), labor and delivery data, and neonatal measurements. On the basis of stepwise multiple linear regression, epidural analgesia (p less than 0.0001), active-phase duration (p less than 0.0001), parity (p less than 0.0001), height (p less than 0.0004), birth weight (p less than 0.0003), and station at complete dilatation (p less than 0.027) predicted second-stage duration. The sum of their effect, however, accounted for less than 25% of the variability in second-stage length (total R2 = 0.233), leaving 75% of the variance unexplained.

Adult↗
PubMed1991

Oral contraceptive estrogen dose and the risk of deep venous thromboembolic disease.

Despite the well-recognized association between oral contraceptives and deep venous thromboembolism, little is known about the risks associated with currently marketed formulations containing less than 50 micrograms of estrogen. To assess the venous thrombogenicity of low-estrogen oral contraceptives (those containing less than 50 micrograms of estrogen) relative to intermediate-dose (50 micrograms of estrogen) and high-dose (greater than 50 micrograms of estrogen) formulations, we conducted a cohort study of oral contraceptive users between the ages of 15 and 44 years in the Michigan Medicaid population. The period of the study was from 1980 through the third quarter of 1986. A total of 2,739,400 oral contraceptive prescriptions received by 234,218 women were analyzed. Using the low-estrogen cohort as the referent group, the age and calendar period adjusted relative risk of venous thromboembolism in users of intermediate-dose formulations was 1.5 (95% confidence interval (CI) 1.0-2.1, p = 0.04), and the relative risk in users of high-dose formulations was 1.7 (95% CI 0.9-3.0, p = 0.06). These data provide evidence that the dose-response relation between oral contraceptive estrogen and venous thromboembolism extends from 50 to 30 micrograms of estrogen, the dose range of currently marketed formulations.

Chemistry, Pharmaceutical↗
PubMed1991

Prenatal hepatitis B testing in a midsize southern city.

Universal prenatal screening for hepatitis B in low-risk populations remains controversial. The purpose of this study was to characterize the obstetric population of the city/county hospital in a midsize southern city. A total of 2013 patients were screened for hepatitis B surface antigen and antibody between June 1988 and February 1990, with 1893 negative for both, 105 (5.2%) positive for surface antibody, and 15 (0.8%) positive for surface antigen. Only 25% of the patients with positive results of hepatitis B screening would have been identified by the 1984 Centers for Disease Control risk group criteria, and no other predictive features were identified. We conclude that universal prenatal screening for hepatitis B is indicated in low-risk populations because of the high prevalence and the lack of predictive features.

Adult↗
PubMed1991

Prenatal exposure to prescribed drugs in Tennessee Medicaid, 1983-1988.

This report describes the prenatal exposure histories of 107,804 women to prescribed drugs other than vitamins, iron and other minerals. The data were obtained from Tennessee Medicaid pharmacy files linked to birth and fetal death certificates for 1983-1988. The utility of these data to other investigators in predicting power or estimating sample size for studies of drug exposure in pregnancy associated with adverse birth outcomes is discussed.

Abnormalities, Drug-Induced↗
PubMed1991

Preventing and postponing death: trends in Tennessee infant mortality.

Infants born in Tennessee between 1984 and 1988 experienced reduced mortality compared with those born in the 5 years previous. For all birthweight singleton infants, the reduction from 10.2 to 8.4 deaths per 1000 live births represents an 18% decline in mortality. The most impressive gain made was for very low birthweight (less than 1500 g) infants in the neonatal period, where mortality was reduced 24%. However, for these infants there was nearly a sixfold increase in the postneonatal mortality associated with prematurity-related causes.

Birth Weight↗
PubMed1990

Effects of Medicaid eligibility expansion on prenatal care and pregnancy outcome in Tennessee.

To investigate the effects of a 1985 Tennessee Medicaid regulatory change that expanded eligibility coverage specifically for married women during pregnancy, we studied vital statistics files linked to Medicaid enrollment files. The greatest Medicaid coverage increase in terms of an absolute difference in rates and the number of women covered occurred in white married women younger than 25 years with less than 12 years of education, where enrollment increased 18%. However, in that group of mothers, as well as for the total of all mothers studied, there were no concomitant improvements in use of early prenatal care, birth weight, or neonatal mortality. Analysis of the timing of enrollment relative to the beginning of pregnancy showed that more than two thirds of the women who enrolled did so after the first trimester.

Eligibility Determination↗
PubMed1990

Oral contraceptive oestrogen and progestin potencies and the incidence of deep venous thromboembolism.

To assess possible differences in the incidence of venous thrombosis and pulmonary embolism associated with oral contraceptives of varying hormonal potencies, the authors conducted a retrospective cohort study in the 15-44 year old Michigan Medicaid population. Cohorts were defined by the progestin- and oestrogen-potencies of oral contraceptives in use at the time of follow-up as classified by an oral contraceptive potency scheme. Using the low-oestrogen-/low-progestin-potency formulations for reference (rate ratio = 1), adjusted rate ratios of 0.8 (95% CI: 0.5 to 1.3, P = 0.41) and 0.6 (95% CI 0.4 to 1.2, P = 0.13) were observed for intermediate-progestin-potency and high-progestin-potency formulations, respectively. Adjusted rate ratios of 1.4 (95% CI: 0.8 to 2.3, P = 0.21) and 2.6 (95% CI: 1.2 to 5.5, P = 0.01) were observed for intermediate- and high-oestrogen-potency formulations. These data suggest a dose-response relationship between oral contraceptive oestrogen potency and venous thromboembolism, whereas no such evidence for a dose-response relationship between oral contraceptive progestin potency and venous thrombo-embolism was found.

Adolescent↗
PubMed1990

Methodological issues in evaluating expanded Medicaid coverage for pregnant women.

In a recent effort to lower the US infant mortality rate, Congress has expanded the Medicaid coverage options that states may offer pregnant women. Careful evaluation of changes in perinatal outcome associated with this expanded coverage is needed. The linkage of Medicaid enrollment files of mothers and infants to birth, death, and fetal death certificates is an initial step in assessing the effectiveness that Medicaid coverage expansions have had on pregnancy outcome. Creation of such a database for Tennessee for 1984-1987 revealed that complete information on mother, delivery, and child is available for only three quarters of Medicaid-reimbursed births. Furthermore, Medicaid-reimbursed births that had all three data components had different characteristics and lower mortality rates than did births with missing elements. Those persons seeking to evaluate expanded Medicaid coverage for pregnant women need to be aware that consideration of only those births for whom there is information on mother, delivery, and child may lead to serious underascertainment of fetal, perinatal, and neonatal mortality rates.

Adolescent↗
PubMed1988

Maternal use of prescribed drugs associated with recognized fetal adverse drug reactions.

To quantitate the frequency of exposure in pregnancy to selected drugs listed by the American Medical Association's Department of Drugs as having known or suspected association with fetal adverse drug reactions, we examined the prescription records of 18,886 Michigan Medicaid recipients who delivered a liveborn infant between April 1, 1981, and March 31, 1983. Focusing only on specific trimesters considered risk periods for each drug-fetal occurrence of adverse drug reaction, the use of tetracyclines during the first trimester of pregnancy was the most prevalent (21.3 exposed women/1000) prescribed drug associated with known or suspected fetal adverse drug reactions. The second most prevalent was phenobarbital in the first trimester, with 10.8 women exposed/1000. Following a close third was the use of the sulfonamides in the second trimester, with 10.0 women exposed/1000. The prescribing of nitrofurantoin and the sulfonamides in the last trimester and tetracyclines throughout pregnancy appears excessive. There are few indications for the outpatient use of the tetracyclines during pregnancy. Practitioners caring for pregnant women need to carefully evaluate the need for these drugs and consider when risks may outweigh benefits.

Adolescent↗
PubMed1987

Prescription drug use before and during pregnancy in a Medicaid population.

This study describes prescription drug use before and during pregnancy and is based on data obtained from the paid Medicaid claims of 18,886 Michigan women aged 15 to 44 years who were delivered of a live infant. Rates of exposure to drugs within 15 therapeutic categories are presented for each of five 90-day periods preceding delivery. Overall dispensed drug use (excluding vitamins) decreased during pregnancy; however, there was still substantial exposure to drugs including drugs that are contraindicated during pregnancy. During the gestational period, study mothers received an average of 3.1 prescriptions for nonvitamin drugs. Black mothers received more exposure to drugs other than vitamins than did white mothers. Black mothers had higher rates of exposure to analgesics, ampicillin, codeine, and vaginal preparations. Similarities between black and white mothers in the use of vitamins with and without other drugs suggest there is no racial difference in attaining prenatal care within the Medicaid system, but that black mothers may have more medical problems that warrant the use of other medications in addition to vitamins during pregnancy.

Adolescent↗
PubMed1987

Oral contraceptives in the United States: trends in content and potency.

Data from the National Prescription Audit, a nationwide pharmaceutical marketing research data base, were reviewed to study changes in the type of oral contraceptives marketed in the US, their content and their relative oestrogen and progestin potency over the 21-year time period of 1964-84. Three major types and 42 brands of oral contraceptives were marketed in the US during this time period. All oral contraceptives dispensed in the US have contained one of nine different progestins and one of two oestrogens or, in the case of the progestin-only pills, no oestrogen at all. A comprehensive classification listing all 42 brands of oral contraceptives by content and strength is presented. Secular changes in oral contraceptive potency are described in terms of a categorization scheme which simultaneously ranks both the oestrogen and progestin potencies of each oral contraceptive. Over the time period studied, oral contraceptives have evolved from high strength, high potency drugs to much lower strength, lower potency drugs. The epidemiological implications of these shifts in oral contraceptive content and potency are discussed.

Contraceptives, Oral↗
PubMed1986

Bladder cancer in young women.

The authors describe a population-based case-control study of cancer of the urinary bladder in New York State women aged 20-49 years (173 matched pairs) in 1975-1980. Both known and suspected risk factors for bladder cancer were examined for these rare, early-onset female cases. The odds ratio (OR) for cigarette smoking was 2.4 (95% confidence interval (CI) = 1.5-4.0). Cases consumed more coffee per day than did controls (p less than 0.05). More cases than controls reported heavy use of drugs that contained phenacetin (OR = 6.5, 95% CI = 1.5-59.2). In addition, more cases than controls reported that they had had a thyroid uptake procedure with radioactive iodine (iodine-131) (OR = 3.7, 95% CI = 1.4-11.0). The odds ratios for these factors remained elevated after simultaneous adjustment with conditional logistic regression models. Consumption of artificial sweeteners, occupational history, bladder or kidney cancer in a first-degree relative, and a history of bladder infections were examined and found not to be risk factors for bladder cancer in this study.

Adult↗
PubMed1985

Heavy phenacetin use and bladder cancer in women aged 20 to 49 years.

We investigated the use of analgesics containing phenacetin or acetaminophen in 173 young women with urinary bladder cancer and 173 matched controls. The cases, who were 20 to 49 years old at the time of diagnosis of cancer, were 6.5 times more likely to report regular use of analgesics containing phenacetin at least one year before diagnosis than were their matched controls (odds ratio, 6.5; 95 per cent confidence interval, 1.5 to 59.2). Among the 15 women (13 cases and 2 controls) reporting regular use of phenacetin-containing drugs, 8 of the cases and 1 of the controls reported daily use for over one year (P = 0.04). Excessive use of analgesics containing acetaminophen was not reported. The increased risk of bladder cancer in young women who regularly used phenacetin-containing products remained present after adjustments for all other identified risk factors.

Acetaminophen↗
PubMed1980

Oral contraceptives and birth defects.

This report compares the history of oral contraceptive (OC) use for 715 New York state women who gave birth to malformed infants with the history for a group of 715 matched controls who gave birth to normal children. The case mothers were found to have used the OC after last menstrual period (LMP), or just before conception, slightly more often than the controls. Confidence intervals for the relative risk estimates were wide, and were significantly higher than 1.0 only among the group of women whose children had one or more major structural or anatomical malformations. Cytogenetic abnormalities and hypospadias were not associated with OC use around or after the time of conception. For women who had children with major anatomical or structural malformations, the association with OCs was stronger among the older age group. The authors found no evidence of an increased risk among women who had conveived their child after one or more pill-free menstrual cycles. Several reported studies, including this one, show a predominance of males among malformed offspring whose mothers used OCs during pregnancy. These findings indicate that the association between birth defects and OC use around the time of conception is not large, but the association is not easily reconciled with a non-causal explanation.

Abnormalities, Drug-Induced↗