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Biomedical subjects

S S Jick

Publications and source records attributed to S S Jick.

At least 37 records · Page 2Linked to original sources
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↗
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↗
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↗
PubMed1993

Estrogens, progesterone, and endometrial cancer.

We conducted a case-control study to evaluate the effect of replacement estrogen use alone, and the combined effect of estrogen and progesterone use, on the risk for endometrial cancer. We studied women age 50-64 years at Group Health Cooperative of Puget Sound. We identified 172 incident cases of endometrial cancer diagnosed during the years 1979-1989, and controls of similar age and duration of membership in the plan. Women who had used conjugated estrogens alone for 5 or more years were at increased risk for developing endometrial cancer compared with nonusers [adjusted rate ratio (RR) = 22.0; 95% confidence interval (CI) = 6.5-74.1]. Users of unopposed estrogens of 3-4 years' duration had a relative risk of 1.9 (95% CI = 0.4-8.7). Women who had used medroxyprogesterone acetate in combination with the estrogen therapy for 3 or more years had a risk near that of nonusers (adjusted RR = 1.3; 95% CI = 0.5-3.4) and that of users of unopposed estrogens for less than 5 years. There were insufficient women who used estrogen and progesterone together for 5 or more years to derive a separate risk estimate for these women.

Cross-Sectional Studies↗
PubMed1993

Oral contraceptives and endometrial cancer.

OBJECTIVE: To evaluate the effect of ever-use of oral contraceptives (OCs) on the risk of endometrial cancer in women aged 50-64 years. METHODS: A case-control study was carried out using 142 incident cases of endometrial cancer and 1042 matched controls, aged 50-64. All subjects were members of Group Health Cooperative of Puget Sound in Seattle, Washington. Relative risk (RR) estimates were calculated for ever-users of OCs compared to never-users. RESULTS: Twenty-six cases (18%) and 270 controls (26%) had taken OCs at some time, yielding an RR of 0.48 (95% confidence interval [CI] 0.26-0.89) for ever-users compared to never-users. This estimate was adjusted for multiple risk factors. There was little effect of duration of OC use, age at first use, or number of years since last use in these data. CONCLUSION: Women aged 50-64 years at Group Health Cooperative who had taken OCs at some time appear to be protected from developing endometrial cancer later in life, compared to women who had never taken OCs.

Case-Control Studies↗
PubMed1992

Maternal heat exposure and neural tube defects.

OBJECTIVE: To determine if exposure to hot tub, sauna, fever, or electric blanket during early pregnancy was associated with an increased risk for neural tube defects (NTDs). DESIGN: Prospective follow-up study. SETTING: Mostly private obstetric practices, primarily in New England. PARTICIPANTS: A cohort of 23,491 women having serum alpha-fetoprotein screening or an amniocentesis were identified. Complete exposure and outcome information was available for 97% of these women. OUTCOME MEASURES: Relative risks (RRs) were used to compare incidence of NTD in those exposed to heat with those who were not exposed to any heat. Crude RRs were calculated directly from the data. Unconfounded RRs were calculated using logistic regression. RESULTS: Women reporting any heat exposure (sauna, hot tub, fever, or electric blanket) in early pregnancy had a crude risk of their fetuses developing NTD of 1.6 (95% CI [confidence interval], 0.9 to 2.9). Women reporting exposure to sauna, hot tub, or fever in early pregnancy had a crude risk of their fetuses developing NTD 2.2 times that of women without heat exposure (95% CI, 1.2 to 4.1). For hot tub use, the crude RR was 2.9 (95% CI, 1.4 to 6.3); for sauna, 2.6 (95% CI, 0.7 to 10.1); for fever, 1.9 (95% CI, 0.8 to 4.1); and for electric blanket, 1.2 (95% CI, 0.5 to 2.6). Multivariate adjusted RRs for individual heat sources, after controlling for maternal age, folic acid supplements, family history of NTD, and exposure to other heat sources, were for hot tub use, 2.8 (95% CI, 1.2 to 6.5); sauna, 1.8 (95% CI, 0.4 to 7.9); fever, 1.8 (95% CI, 0.8 to 4.1); and electric blanket, 1.2 (95% CI, 0.5 to 2.6). When only hot tub, sauna, and fever were considered and the women's exposure to each tallied, compared with no heat exposure, the RR for NTDs increased from 1.9 (95% CI, 0.9 to 3.7) after one type of heat exposure to 6.2 (95% CI, 2.2 to 17.2) after two types of heat exposure. CONCLUSIONS: Exposure to heat in the form of hot tub, sauna, or fever in the first trimester of pregnancy was associated with an increased risk for NTDs. Hot tub exposure appeared to have the strongest effect of any single heat exposure. Exposure to electric blanket was not materially associated with increased risk for NTDs.

Cohort Studies↗
PubMed1992

Maternal zinc and fetal neural tube defects.

Among the factors implicated in the heterogeneous etiology of neural tube defects (NTDs) is the trace element zinc (Zn). In a case-control study, we collected midtrimester maternal toenail samples for multiple trace element analyses, including Zn, which were assayed by neutron activation analysis. We studied 17 women with NTD offspring and 1,787 controls. The crude OR for NTD comparing Zn values greater than normal range to normal Zn values was 3.2 (95% CI 1.1,9.7). These results were not materially affected when adjustment was made for folic acid supplementation. An overall increased risk for NTD associated with increasing toenail Zn was also evident. A matched subset of 17 cases and 73 controls yielded a crude OR of 3.1 (95% CI 0.9,10.3) when cases with elevated Zn (greater than or equal to 120 ppm) were compared to those with normal Zn. Matched analyses controlling for folic acid supplements, family history of NTD, assay batch, age of mother and year of delivery yielded an OR of 5.0 (95% CI 1.1,21.6). This study reveals an association between increased toenail Zn in the second trimester of pregnancy and the risk of having a child with an NTD. Whether Zn sequestration has resulted in relative Zn deficiency at the site of neural tube closure remains uncertain.

Case-Control Studies↗
PubMed1992

Urinary tract infections and estrogen use in older women.

OBJECTIVE: To examine the relationship between exogenous estrogen use and risk of clinically diagnosed urinary tract infection (UTI) in older women. DESIGN: A case-control study. SETTING: Two hundred seventy-six general practices. PATIENTS: Cases (n = 3,616) were women, age 50-69 years, with a first recorded UTI in the calendar years 1989 or 1990. Controls (n = 19,162) were matched for age and practice. MAIN OUTCOME MEASURE: Clinical diagnosis of UTI. RESULTS: Women using estrogens for greater than or equal to 1 year had an increased risk of being diagnosed with a UTI compared to non-users, crude odds ratio (OR) 1.9 (95% CI 1.5-2.2). All of this excess risk was observed in women with intact uteri, OR 2.1 (CI 1.7-2.7). Hysterectomized women had no increased risk, OR 1.1 (CI 0.8-1.5). Controlling for diabetes, neurologic deficit, atrophic vaginitis, incontinence, and age did not affect the observed associations. CONCLUSION: Estrogen use is associated with an increased risk of UTI in older women with intact uteri but not in hysterectomized women. This observed differential effect on women with or without uteri may be explained by prescribing biases between these two groups of women, but we lack any evidence to support this conclusion over several alternative possibilities.

Age Factors↗
PubMed1992

Antidepressants and convulsions.

We reviewed available computer records and clinical charts in an estimated 42,000 recipients of antidepressant drugs. The study was restricted to persons with no known condition predisposing to convulsions. Only 16 study subjects developed a convulsive disorder that we judged could have been caused by an antidepressant. We conclude that the frequency of convulsions caused by these drugs used at usual prescribed doses in the settings studied is substantially less than one per 1,000 recipients who have no conditions predisposing to convulsions.

Adult↗
PubMed1992

Liver disease associated with diclofenac, naproxen, and piroxicam.

Based on information derived from computers used by general practitioners in the United Kingdom, we identified all patients with any recorded diagnosis of a liver disorder within 90 days of a prior prescription for diclofenac, naproxen, or piroxicam, three nonsteroidal antiinflammatory drugs (NSAIDs). The follow-up cohort consisted of 102,644 persons who used one or more of these drugs. A case history was requested from the physician to provide a description of the liver disorder and its relation to NSAID exposure. One case of clinically important liver disease was likely to have been caused by a study drug and another appeared to be caused by use of numerous NSAIDs. In 10 additional patients a causal connection between a study NSAID and the liver disorder seemed unlikely but could not be fully ruled out. We conclude that serious liver disease caused by diclofenac, naproxen, or piroxicam appears to be uncommon.

Adolescent↗
PubMed1991

Validation of information recorded on general practitioner based computerised data resource in the United Kingdom.

OBJECTIVE: To determine the extent of agreement between clinical information recorded on surgery computers of selected general practitioners and similar information in manual records of letters received from hospital consultants and kept in the general practitioners' files. DESIGN: Hospital consultants' letters in the manual records of selected general practitioners were photocopied and the consultants' clinical diagnoses were compared with diagnoses recorded on computer. SETTING: General practices in the United Kingdom using computers provided by VAMP Health for recording clinical information. SUBJECTS: 2491 patients who received one of three non-steroidal anti-inflammatory drugs and who attended 58 practices whose computer recorded data were considered after a preliminary review to be of satisfactory quality. RESULTS: Among 1191 patients for whom consultants' letters were forwarded a clinical diagnosis reflecting the diagnosis noted on a consultant letter was present on the computer record for 1038 (87%). CONCLUSION: Clinical information available on the computer records of the general practitioners who participated in this study is satisfactory for many clinical studies.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1990

The relationship of oral contraceptive use to rheumatoid arthritis.

Current use of oral contraceptives among 71 women aged 17 to 45 diagnosed for the first time as having definite or probable rheumatoid arthritis at Group Health Cooperative of Puget Sound was compared with oral contraceptive use among matched controls. Twenty-three percent of cases and 13% of controls were current users of oral contraceptives at the index date (relative risk estimate = 2.0, 95% CI = 0.97-4.21). We conclude that current oral contraceptive use was not protective against the development of rheumatoid arthritis in this population.

Adolescent↗
PubMed1990

Cimetidine use and gastric cancer.

We conducted a case-control study at Group Health Cooperative of Puget Sound to investigate the relation between long-term cimetidine use and gastric cancer. Five of 99 cases of gastric cancer were exposed to cimetidine at least two years before diagnosis, whereas nine of 365 controls (selected from among users of the Group Health Cooperative pharmacy, matched on age, sex, and first year of pharmacy use) were similarly exposed. The odds ratio comparing users with nonusers was 2.3 (95% CI = 0.8-6.9). The odds ratio comparing users of antacids with nonusers was similar, 1.9 (95% CI = 1.0-3.7). Although a causal relation between gastric cancer and cimetidine is possible, the similarity of the findings for cimetidine and antacids lends support to other explanations.

Adenocarcinoma↗
PubMed1990

A comparison of the risk of hypoglycemia between users of human and animal insulins. 1. Experience in the United Kingdom.

In a case-control study of 121 young insulin-dependent diabetics diagnosed as having an episode of hypoglycemia, the relative risk estimate comparing human with animal insulins was 0.8 (95% confidence interval 0.4, 1.6) controlling for age, general practice, and calendar time. We conclude that in this study population derived from general practices in the United Kingdom, the risk of hypoglycemia was no higher in users of human insulin than it was in users of animal insulins.

Adolescent↗
PubMed1990

Hospitalizations because of hypoglycemia in users of animal and human insulins. 2. Experience in the United States.

In a 10-year (1979-1988) follow-up study of young insulin-dependent diabetics carried out at Group Health Cooperative of Puget Sound, the frequency of hospitalization for hypoglycemia remained constant. During the early years only animal insulins were available; during the latter years, human insulins were used in a majority of patients. The adjusted relative risk estimate for hospitalizations for hypoglycemia comparing users of human with users of animal insulins was 0.6 (95% confidence interval 0.2, 2.3). We conclude that the use of human insulins is not associated with an increased risk of hospitalization for hypoglycemia as compared with animal insulins in this population.

Animals↗
PubMed1990

Hospital admission for xanthine toxicity.

A follow-up study of 35,909 outpatients who filled more than 220,000 prescriptions for theophylline over 9 years revealed 30 hospitalizations for xanthine toxicity. The overall estimated incidence rate of 7.8/10,000 person-years at risk indicates that in this population, hospitalization for xanthine toxicity is a relatively rare event.

Adolescent↗