BMJ No. 7046 Volume 312 Saturday 22 June 1996
David Henry, Lynette L-Y Lim, Luis A Garcia Rodriguez, Susanne Perez Gutthann, Jeffrey L Carson, Marie Griffin, Ruth Savage, Richard Logan, Yola Moride, Chris Hawkey, Suzanne Hill, James T Fries
Objective - To compare the relative risks of serious gastrointestinal complications reported with individual non-steroidal anti-inflammatory drugs.
Design - Systematic review of controlled epidemiological studies that found a relation between use of the drugs and admission to hospital for haemorrhage or perforation.
Setting - Hospital and community based case-control and cohort studies.
Main outcome measures - (a) Estimated relative risks of gastrointestinal complications with use of individual drugs, exposure to ibuprofen being used as reference; (b) a ranking that best summarised the sequence of relative risks observed in the studies. Results - 12 studies met the inclusion criteria. 11 provided comparative data on ibuprofen and other drugs. Ibuprofen ranked lowest or equal lowest for risk in 10 of the 11 studies. Pooled relative risks calculated with exposure to ibuprofen used as reference were all significantly greater than 1.0 (interval of point estimates 1.6 to 9.2). Overall, ibuprofen was associated with the lowest relative risk, followed by diclofenac. Azapropazone, tolmetin, ketoprofen, and piroxicam ranked highest for risk and indomethacin, naproxen, sulindac, and aspirin occupied intermediate positions. Higher doses of ibuprofen were associated with relative risks similar to those with naproxen and indomethacin.
Conclusions - The low risk of serious gastrointestinal complications with ibuprofen seems to be attributable mainly to the low doses of the drug used in clinical practice. In higher doses ibuprofen is associated with a similar risk to other non-steroidal anti-inflammatory drugs. Use of low risk drugs in low dosage as first line treatment would substantially reduce the morbidity and mortality due to serious gastrointestinal toxicity from these drugs.
Centre for Clinical Epidemiology and Biostatistics, Faculty of Medicine and
Health Sciences,
University of Newcastle,
New South Wales,
Australia
David Henry, senior lecturer in clinical pharmacology
Lynette
L-Y Lim, senior lecturer in biostatistics
Centro Espanol de Investigacion,
Farmacoepidemiologica,
Universidad
Complutense
de Madrid, 28040 Madrid,
Spain
Luis A Garcia
Rodriguez, director
Pharmacoepidemiology Research,
Ciba-Geigy SA,
Medical Department,
08013
Barcelona,
Spain
Susanne Perez Gutthann, head of
pharmacoepidemiology research
Division of General Internal Medicine,
UMDNJ-Robert Wood Johnson Medical
School,
New Brunswick,
NJ 08903, USA
Jeffrey L Carson,
professor and chief
Department of Preventive Medicine,
Vanderbilt University School of
Medicine,
Nashville, TN 37232,
USA
Marie Griffin, associate
professor in medicine and preventive medicine
Correspondence to: Dr David Henry,
Centre for Clinical Epidemiology
and Biostatistics,
Royal Newcastle Hospital,
Newcastle, NSW 2300,
Australia.
email:mddah@alinga.newcastle.edu.au
Anna Graham, Lora Green, Anna F Glasier
Objective - To determine the level of knowledge of emergency
contraception among 14 and 15 year olds. Design - Confidential
questionnaire survey.
Setting - 10 secondary schools in Lothian, south
east Scotland.
Subject - l,206 pupils predominantly (98.7%) aged 14
and 15 in the fourth year of secondary school. Main outcome measures -
Knowledge of the existence of emergency contraception; of its safety, efficacy,
and time limits; and of where to obtain it.
Results - 1,121 (93.0%)
fourth year pupils aged 14-16 had heard of emergency contraception. 194 girls
(32.7%) and 168 boys (27.5%) had experienced sexual intercourse. Of girls who had
experienced sexual intercourse, 61 (31.4%) had used emergency contraception.
Knowledge of correct time limits was poor, sexually active girls being the most
knowledgeable. Pupils attending schools ranked lower than the national average
for academic attainment were less likely to have heard of emergency contraception
and more likely to have been sexually active. 861 (76.8%) pupils knew they could
obtain emergency contraception from their doctor. 925 (82.5%) pupils believed
emergency contraception to be effective but 398 (35.5%) thought it more dangerous
than the oral contraceptive pill.
Conclusion - One third of sexually
active girls aged under 16 in Lothian have used emergency contraception. This may
help explain the fairly constant teenage pregnancy rates despite increasing
sexual activity. Scottish teenagers are well informed about the existence of
emergency contraception. However, many do not know when and how to access it
properly. Health education initiatives should target teenagers from less academic
schools as they are more likely to be sexually active at a young age and are less
well informed about emergency contraception.
Edinburgh Healthcare NHS Trust Family Planning and Well Woman Services,
Edinburgh EH4 1NL
Anna Graham, senior house officer
Lora Green,
senior nurse
University of Edinburgh
Department of Obstetrics and Gynaecology,
Edinburgh EH8 9AG
Anna F Glasier, consultant
Correspondence to: Dr Anna Glasier,
Family Planning and Well Woman
Services,
18 Dean Terrace,
Edinburgh EH4 1NL
BMJ No. 7046 Volume 312 Saturday 22 June 1996
Shilu Tong, Peter Baghurst, Anthony McMichael, Michael Sawyer, Jane Mudge
Objective - To examine the association between environmental exposure to
lead and children's intelligence at age 11-13 years, and to assess the
implications of exposure in the first seven years of life for later childhood
development.
Design - Prospective cohort study.
Subjects -
375 children born in or around the lead smelting town of Port Pine, Australia,
between 1979 and 1982.
Main outcome measure - Children's intelligence
quotient (IQ) measured at 11 - 13 years of age.
Results - IQ was
inversely associated with both antenatal and postnatal blood lead concentrations.
Verbal, performance, and full scale IQ were inversely related to blood lead
concentration with no apparent threshold. Multivariate analyses indicated that
after adjustment for a wide range of confounders, the postnatal blood lead
concentrations (particularly within the age range 15 months to 7 years) exhibited
inverse associations with IQ. Strong associations with IQ were observed for
lifetime average blood lead concentrations at various ages. The expected mean
full scale IQ declined by 3.0 points (95% confidence interval 0.07 to 5.93) for
an increase in lifetime average blood lead concentration from 0.48 to 0.96
micro-mol/l (10 to 20 micro-g/dl).
Conclusion - Exposure to
environmental lead during the first seven years of life is associated with
cognitive deficits that seem to persist into later childhood.
Division of Human Nutrition,
Commonwealth Scientific Industrial Research
Organisation,
Adelaide, SA 5000,
Australia
Shilu Tong,
doctoral student
Peter Baghurst, principal research scientist
Jane Mudge, doctoral student
Department of Epidemiology and Population Sciences,
London School of Hygiene
and Tropical Medicine,
London WC1E 7HT
Anthony McMichael,
professor of epidemiology
Evaluation Unit,
Women's and Children's Hospital,
Adelaide,
SA
5000, Australia
Michael Sawyer, director
Correspondence to: Dr S Tong, Department of Health Services Management and
Public Health,
University of New England,
Armidale,
NSW 2351,
Australia.
BMJ No 7046 Vol 312 Saturday 22 June 1996
K M Venkat Narayan, S L Chadha, R L Hanson, R Tandon, S Shekhawat, R J Fernandes, N Gopinath
Objective - To determine
the prevalence and predictors of smoking in urban India.
Design -
Cross sectional.
Setting - Delhi, urban India, 1985-6.
Subjects
- Random sample of 13,558 men and women aged 25-64 years.
Main
outcome measure - Smoking prevalence; subjects who were currently smoking and who had smoked greater than
or equal to 100 cigarettes or beedis or chuttas in their lifetime were defined as
smokers.
Results - 45% (95% confidence interval 43.8 to 46.2) of men
and 7% (6.4 to 7.6) of women were smokers. Education was the strongest predictor of smoking,
and men with no education were 1.8 (1.5 to 2.0) times more likely to be smokers
than those with college education, and women with no education were 3.7 (2.9 to
4.8) times more likely. Among smokers, 52.6% of men and 4.9% of women smoked only
cigarettes while the others also smoked beedi or chutta. Compared with cigarette
smokers, people smoking beedi or chutta were more likely to be older and married;
have lower education, manual occupations, incomes, and body mass index; and not
drink alcohol or take part in leisure exercise.
Conclusion - There
are two subpopulations of smokers in urban India, and the prevention strategy required
for each may be different. The educated, white collar cigarette smoker in India
might respond to measures that make nonsmoking fashionable, while the less
educated, low income people who smoke beedi or chutta may need strategies aimed
at socioeconomic improvement.
Diabetes and Arthritis Epidemiology Section,
Phoenix Epidemiology and Clinical Research Branch,
National Institute of Diabetes
and Digestive and Kidney Diseases,
Phoenix, AZ 85014,
USA
K M Venkat Narayan,
visiting scientist
R L Hanson, senior staff fellow
R J Fernandes, visiting fellow
Sitaram Bhartia Institute of Science and Research,
B-16 Mehrauli Institutional
Area,
New Delhi-16,
India
S L Chadha, community health specialist
R Tandon,
consultant cardiologist
S Shekhawat, statistician N Gopinath, director
Correspondence to: Dr Venkat Narayan.
BMJ 1996;312:1576-9