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Bakhai A, Petri H, Vahidnia F, Wolf C, Ding Y, Foskett N, Sculpher M. Real-world data on the incidence, mortality, and cost of ischaemic stroke and major bleeding events among non-valvular atrial fibrillation patients in England. J Eval Clin Pract 2021; 27:119-133. [PMID: 32314853 PMCID: PMC7891325 DOI: 10.1111/jep.13400] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 12/23/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Several novel oral anticoagulants (NOACs) are licensed for atrial fibrillation (AF) treatment in the United Kingdom. We describe the incidence and mortality from ischaemic stroke and major bleeding in non-valvular atrial fibrillation (NVAF) patients in England, including treatment patterns before/following introduction of NOACs, healthcare resource utilization (HRU), and costs post-onset of these events. METHOD Data were extracted from the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics secondary care and Office for National Statistics mortality data. RESULTS Of 42 966 patients with a first AF record between 2011 and 2016, 9143 patients (21.3%) remained without AF (antiplatelets/antithrombotics) treatment post-index diagnosis. The proportion of patients receiving aspirin for ≥3 months post-index declined during the study (50.6%-5.5%), irrespective of CHA2 DS2 -VASc score, while the proportion prescribed NOACs increased (2.0%-70.1%). Rates of ischaemic stroke per 1000 patient-years (95% CI) were 9.4 (3.8-15.0) with NOACs, 10.4 (8.0-12.9) with warfarin, 20.1 (16.4-23.8) with aspirin, 21.3 (5.3-37.2) with other antiplatelets and 43.6 (39.3-47.8) in patients without AF prescription. Major bleeding occurred at a similar rate with different treatments. All-cause mortality rates were 42.8 (31.4-54.3) with NOACs, 46.3 (41.1-51.5) with warfarin, 56.5 (50.5-62.4) with aspirin, 102.2 (76.2-128.3) with other antiplatelets and 412.8 (399.6-426.0) with no AF prescription. Mean annual National Health Service healthcare costs up to 1 year post-index were lowest in patients receiving aspirin plus other antiplatelets without an event (£6152), and highest in patients with an event without AF prescriptions (£17 957). By extrapolation, national AF HRU in the United Kingdom in 2016 was estimated at £8-16 billion annually. CONCLUSIONS These data provide temporal insights into AF treatment patterns and outcomes for NVAF patients in England and highlight the need to review higher stroke risk AF patients not receiving antiplatelet/antithrombotic prescriptions.
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Affiliation(s)
- Ameet Bakhai
- Royal Free London NHS Foundation Trust, Barnet General Hospital, Cardiology Department, Barnet, and Amore Health Ltd, London, UK
| | | | - Farnaz Vahidnia
- Real-World Data Group, Diagnostics Information Solutions, Pleasanton, California, USA
| | - Cyrill Wolf
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | | | | | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
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Mehta VS, Petri H, Vahidnia F, Ding Y, Foskett N, Bakhai A. P2570Campaign in the english national health service dramatically reduces aspirin initiation in patients with non-valvular atrial fibrillation (NVAF), temporal trends from the CPRD and integrated databases. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V S Mehta
- Royal Free Hospital, London, United Kingdom
| | - H Petri
- Hans Petri Consulting Ltd, St Albans, United Kingdom
| | - F Vahidnia
- Real-World Data Group, Diagnostics Information Solutions, Pleasanton, California, United States of America
| | - Y Ding
- Genesis Research Ltd, Hoboken, New Jersey, United States of America
| | - N Foskett
- Roche Products Ltd, Welwyn Garden City, United Kingdom
| | - A Bakhai
- Royal Free Hospital, London, United Kingdom
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Mehta VS, Petri H, Vahidnia F, Wolf C, Ding Y, Foskett N, Bakhai A. P288National prescribing and adverse event rates of patients at risk of stroke with non-valvular AF from CPRD linked database: does “big data” reflect clinical trials and identify areas for improvement? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V S Mehta
- Royal Free Hospital, London, United Kingdom
| | - H Petri
- Hans Petri Consulting Ltd, St Albans, United Kingdom
| | - F Vahidnia
- Real-World Data Group, Diagnostics Information Solutions, Pleasanton, California, United States of America
| | - C Wolf
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | - Y Ding
- Genesis Research Ltd, Hoboken, New Jersey, United States of America
| | - N Foskett
- Roche Products Ltd, Welwyn Garden City, United Kingdom
| | - A Bakhai
- Royal Free Hospital, London, United Kingdom
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Alexander M, Ding Y, Foskett N, Petri H, Wandel C, Khwaja O. Population prevalence of Down's syndrome in the United Kingdom. J Intellect Disabil Res 2016; 60:874-878. [PMID: 27018385 DOI: 10.1111/jir.12277] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 01/20/2016] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Aim was to estimate the age and sex-stratified prevalence of Down's syndrome (DS) in the United Kingdom (UK) general population using a large primary care database. METHOD Data source was the Clinical Practice Research Datalink. We divided the number of individuals with a record of DS present on 01/07/2014 by the total number of individuals, and computed Wilson's confidence intervals. Prevalence by age and sex was represented using local linear smoothing plots. RESULTS On July 1(st) 2014, 1159 females and 1317 males with DS were present in the data, corresponding to a prevalence of 5.9 per 10 000 (95% CI: 5.5; 6.2) in females and 6.8 (6.5; 7.2) per 10 000 in males. Prevalence of DS was increased in individuals aged 40 to 55 years compared to adjacent age groups. CONCLUSIONS A relative peak prevalence of DS at age 40-55 years may be attributed to the combined effects of a rise in life expectancy and the still limited availability of selective abortion.
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Affiliation(s)
- M Alexander
- Roche Products Limited, United Kingdom of Great Britain and Northern Ireland
| | - Y Ding
- Genesis Research Limited, USA
| | - N Foskett
- Roche Products Limited, United Kingdom of Great Britain and Northern Ireland
| | - H Petri
- Petri Consulting Ltd, United Kingdom of Great Britain and Northern Ireland
| | - C Wandel
- Roche Product Development, Switzerland
| | - O Khwaja
- Roche Pharmaceutical Research and Early Development, Switzerland
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Alexander M, Petri H, Ding Y, Wandel C, Khwaja O, Foskett N. Morbidity and medication in a large population of individuals with Down syndrome compared to the general population. Dev Med Child Neurol 2016; 58:246-54. [PMID: 26282180 DOI: 10.1111/dmcn.12868] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2015] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to describe the incidence of morbidities and the prevalence of medical prescriptions in a large Down syndrome population. METHOD A retrospective cohort study was carried out using the UK Clinical Practice Research Datalink from 1 January 2004 to 31 December 2013. We matched individuals with Down syndrome to randomly selected control participants by practice site, sex, birth year, and recording period. RESULTS A total of 6430 individuals with Down syndrome (3009 females, 3421 males) and 19 176 controls (8966 females, 10,210 males) were included in the study. The incidence of cardiovascular disorders, gastrointestinal diseases (incidence rate ratio [IRR] 7.9 at 3 to <6y: yearly prevalence ratio [YPR] for laxatives 4.7), and sleeping disorders (IRR 4.8 in 3 to <6y) was increased in children with Down syndrome versus control participants. New onset of congenital heart malformation, ear diseases, eye disorders, autism, hypothyroidism, diabetes, and obesity were more frequent in childhood and remained elevated in adulthood (overall IRR 35.5, 1.7, 3.1, 4.4, 13.1, 1.3, and 2.6 respectively), whereas the gap widened in adulthood for epilepsy and intellectual disability (IRR 15.2 and 158 respectively, in participants older than 30y). At ≥ 30 years, the incidence of hypotension and dementia was raised (IRR 3.0 and 92.1 respectively; YPR for dementia drugs: 76.3); and that of hypertension, depression and anxiety was lowered (IRR 0.2, 0.5, and 0.4 respectively). INTERPRETATION The profile of newly occurring morbidities in Down syndrome varies across the developmental lifespan.
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Affiliation(s)
| | | | | | | | - Omar Khwaja
- Roche Pharmaceutical Research and Early Development, Basel, Switzerland
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Werlauff U, Petri H, Witting N, Vissing J. Frequency and Phenotype of Myotubular Myopathy Amongst Danish Patients with Congenital Myopathy Older than 5 Years. J Neuromuscul Dis 2015; 2:167-174. [PMID: 27858727 PMCID: PMC5271486 DOI: 10.3233/jnd-140040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Centronuclear myopathy (CNM) is one of four main subtypes of congenital myopathy. X-linked myotubular myopathy (XLMTM) is considered one of the most severe forms, but survivors past infancy have been described. However, detailed information on XLMTM phenotypes in patients who survive infancy is scarce. Objective: The aim of the study was to report the genetic findings in patients with a predominant centronuclear finding on muscle biopsy and describe the prevalence, phenotypes and the course of the disease in patients with XLMTM in a Danish cohort of patients with congenital myopathies older than five years. Methods: Ninety-four out of 119 invited patients older than five years were included in the study and assessed by muscle tests, functional tests, muscle biopsy, plasma creatine kinase levels and genetic testing. Genes related to CNM were sequenced in patients who had centronuclear findings on muscle histology. In patients with MTM1 mutations, medical records from local hospitals were reviewed to obtain information on birth history and course of disease. Results: Sixteen of 94 patients had CNM on muscle biopsy; three male patients, aged 14–25 years, carried a pathogenic MTM1 mutation, six patients carried a pathogenic DNM2 mutation and two carried pathogenic RYR1 mutations. The mutations have all been described before to cause CNM. The MTM phenotypes ranged from severe (classical) to mild; one patient had always been non-ambulant, one had lost ambulation, and one was still ambulant at 25 years. Conclusions: Our findings show that CNM caused by DNM2 mutations is the most common form of CNM in Danish patients older than 5 years, but XLMTM is not negligible even past age 5 years, and the phenotype may be much milder than generally described - also in patients with the classically described infantile form of the disease.
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Affiliation(s)
- U Werlauff
- The Danish National Rehabilitation Centre for Neuromuscular Diseases, Kongsvang Allé, Aarhus C, Denmark
| | - H Petri
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - N Witting
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Petri H, Nevitt A, Sarsour K, Napalkov P, Collinson N. Incidence of Giant Cell Arteritis and Characteristics of Patients: Data-Driven Analysis of Comorbidities. Arthritis Care Res (Hoboken) 2015; 67:390-5. [DOI: 10.1002/acr.22429] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 07/29/2014] [Indexed: 11/06/2022]
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Storjohann B, Pliszewski M, Diezel U, Bieberstein H, Petri H, Hübner A, Korn-Clicqué R, Beckmann MW. Tod am Anfang des Lebens – Eine Wanderaustellung. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Witting N, Mensah A, Køber L, Bundgaard H, Petri H, Duno M, Milea D, Vissing J. Ocular, bulbar, limb, and cardiopulmonary involvement in oculopharyngeal muscular dystrophy. Acta Neurol Scand 2014; 130:125-30. [PMID: 24611576 DOI: 10.1111/ane.12244] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess skeletal muscle weakness and progression as well as the cardiopulmonary involvement in oculopharyngeal muscular dystrophy (OPMD). MATERIALS AND METHODS Cross-sectional study including symptomatic patients with genetically confirmed OPMD. Patients were assessed by medical history, ptosis, ophthalmoplegia, facial and limb strength, and swallowing capability. Cardiopulmonary function was evaluated using forced expiratory capacity in 1 s (FEV1), electrocardiogram (ECG), Holter monitoring, and echocardiography. RESULTS We included 13 symptomatic patients (six males, mean age; 64 years (41-80) from 8 families. Ptosis was the first symptom in 8/13 patients followed by limb weakness in the remaining 5 patients Dysphagia was never the presenting symptom. At the time of examination, all affected patients had ptosis or had previously been operated for ptosis, while ophthalmoplegia was found in 9 patients. Dysphagia, tested by cold-water swallowing test, was abnormal in 9 patients (17-116 s, ref <8 s). Six patients could not climb stairs of whom two were wheelchair bound and one used a rollator. Six patients had reduced FEV1 (range 23%-59%). No cardiac involvement was identified. CONCLUSIONS Limiting limb weakness is common in OPMD and can even be the presenting symptom of the disease. In contrast, dysphagia was not the initial symptom in any of our patients, although it was obligatory for diagnosing OPMD before genetic testing became available. Mild respiratory dysfunction, but no cardiac involvement, was detected.
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Affiliation(s)
- N. Witting
- Department of Neurology and Neuromuscular Research Unit; University of Copenhagen; Rigshospitalet; Copenhagen Denmark
| | - A. Mensah
- Department of Ophthalmology; Glostrup Hospital; Glostrup Denmark
| | - L. Køber
- Department of Cardiology; The Heart Centre; University of Copenhagen; Rigshospitalet; Copenhagen Denmark
| | - H. Bundgaard
- Department of Cardiology; The Heart Centre; University of Copenhagen; Rigshospitalet; Copenhagen Denmark
| | - H. Petri
- Department of Cardiology; The Heart Centre; University of Copenhagen; Rigshospitalet; Copenhagen Denmark
| | - M. Duno
- Clinical Genetics; University of Copenhagen; Rigshospitalet; Copenhagen Denmark
| | - D. Milea
- Department of Ophthalmology; Glostrup Hospital; Glostrup Denmark
- Singapore National Eye Centre; Singapore Eye Research Institute and Duke-NUS; Singapore City Singapore
| | - J. Vissing
- Department of Neurology and Neuromuscular Research Unit; University of Copenhagen; Rigshospitalet; Copenhagen Denmark
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Sabaté M, Pacheco JF, Ballarín E, Ferrer P, Petri H, Hasford J, Schoonen MW, Rottenkolber M, Fortuny J, Laporte JR, Ibáñez L. A compilation of research working groups on drug utilisation across Europe. BMC Res Notes 2014; 7:143. [PMID: 24625054 PMCID: PMC4008312 DOI: 10.1186/1756-0500-7-143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/01/2014] [Indexed: 11/12/2022] Open
Abstract
Background The assessment of the benefit-risk of medicines needs careful consideration concerning their patterns of utilization. Systems for the monitoring of medicines consumption have been established in many European countries, and several international groups have identified and described them. No other compilation of European working groups has been published. As part of the PROTECT project, as a first step in searching for European data sources on the consumption of five selected groups of medicines, we aimed to identify and describe the main characteristics of the existing collaborative European working groups. Findings Google and bibliographic searches (PubMed) of articles containing information on databases and other sources of drug consumption data were conducted. For each working group the main characteristics were recorded. Nineteen selected groups were identified, focusing on: a) general drug utilisation (DU) research (EuroDURG, CNC, ISPE’S SIG-DUR, EURO-MED-STAT, PIPERSKA Group, NorPEN, ENCePP, DURQUIM), b) specific DU research: b.1) antimicrobial drugs (ARPAC, ESAC, ARPEC, ESGAP, HAPPY AUDIT), b.2) cardiovascular disease (ARITMO, EUROASPIRE), b.3) paediatrics (TEDDY), and b.4) mental health/central nervous system effects (ESEMeD, DRUID, TUPP/EUPoMMe). Information on their aims, methods and activities is presented. Conclusions We assembled and updated information on European working groups in DU research and in the utilisation of five selected groups of drugs for the PROTECT project. This information should be useful for academic researchers, regulatory and health authorities, and pharmaceutical companies conducting and interpreting post-authorisation and safety studies. European health authorities should encourage national research and collaborations in this important field for public health.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Luisa Ibáñez
- Fundació Institut Català de Farmacologia, Pg, Valld'Hebron 119-129, Barcelona 08035, Spain.
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Prieto-Alhambra D, Petri H, Goldenberg JSB, Khong TP, Klungel OH, Robinson NJ, de Vries F. Excess risk of hip fractures attributable to the use of antidepressants in five European countries and the USA. Osteoporos Int 2014; 25:847-55. [PMID: 24448776 DOI: 10.1007/s00198-013-2612-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/17/2013] [Indexed: 11/30/2022]
Abstract
SUMMARY The association between antidepressant use and hip fracture remains unclear. We conducted a systematic review to estimate Population Attributable Risks (PAR) for France, Germany, Italy, Spain, UK, and the USA. We report a heterogeneous prevalence of antidepressant use and related PARs, both lowest for Italy and highest for the USA. INTRODUCTION Antidepressant use has been associated with an increased hip fracture risk in observational studies. However, the potential contribution of antidepressant consumption on the population rate of hip fractures has not been described. Our aim was to estimate the impact of the use of different classes of antidepressants on the rate of hip fracture at a population-level in France, Germany, Italy, Spain, the UK, and the USA. METHODS We conducted a systematic literature review to estimate the pooled relative risk (RR) of hip fracture according to use of antidepressants. Prevalence rates of antidepressant use (Pe) in 2009 were calculated for each country using the The Intercontinental Medical Statistics database and three public databases from Denmark, the Netherlands, and Norway. Both the RR and Pe were used to calculate PAR of hip fractures associated with antidepressant use. RESULTS The literature review showed an increased risk of hip fractures in antidepressant users (RR, 1.7; 95 % confidence interval (CI), 1.5-2.0). Rates of antidepressant use showed considerable differences between countries, ranging from 4.4 % (Italy) to 11.2 % (USA) in the year 2009. The estimated PAR of antidepressants on hip fracture rates were 3.0 % (95 % CI, 2.0-4.1; Italy), 3.1 % (95 % CI, 2.1-4.3; Germany), 3.8 % (95 % CI, 2.6-5.3; France), 4.8 % (95 % CI, 3.3-6.5; Spain), 4.9 % (95 % CI, 3.4-6.8; UK), and 7.2 % (95 % CI, 5.0-9.9; USA). PARs differed for different types of antidepressants, with highest attributable risks for selective serotonin reuptake inhibitors. CONCLUSIONS These findings suggest that the potential contribution of antidepressant use to the population rate of hip fractures in the five large EU countries and the USA varies between 3 and 7 %.
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Affiliation(s)
- D Prieto-Alhambra
- Oxford National Institute for Health and Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Petri H, Ahtarovski KA, Witting N, Vissing J, Koeber L, Bundgaard H. Cardiac fibrosis in myotonic dystrophy type 1; an early marker of cardiac involvement. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Altman M, Bergerot C, Thibault H, Aussoleil A, Skuldadt Davidsen E, Barthelet M, Derumeaux GA, Grapsa J, Zimbarra Cabrita I, Afilalo J, Paschou S, Dawson D, Durighel G, O'regan D, Howard L, Gibbs J, Nihoyannopoulos P, Morenate Navio M, Mesa Rubio M, Ortega MD, Ruiz Ortiz M, Castillo Bernal F, Del Pino CL, Toledano F, Alvarez-Ossorio MP, Ojeda Pineda S, Lezo Cruz-Conde JSD, Jasaityte R, Claus P, Teske A, Herbots L, Verheyden B, Rademakers F, D'hooge J, Tocchetti CG, Coppola C, Rea D, Quintavalle C, Guarino L, Castaldo N, De Lorenzo C, Condorelli G, Arra C, Maurea N, Voilliot D, Huttin O, Camara Y, Djaballah W, Carillo S, Zinzius P, Sellal J, Angioi M, Juilliere Y, Selton-Suty C, Dobrowolski P, Klisiewicz A, Florczak E, Prejbisz A, Szwench E, Rybicka J, Januszewicz A, Hoffman P, Jurado Roman A, De Dios Perez S, De Nicolas JMM, Diaz Anton B, Rubio Alonso B, Martin Asenjo R, Mayordomo Gomez S, Villagraz Tecedor L, Blazquez L, De Meneses RT, Bernard A, Hernandez AI, Reynaud A, Lerclercq C, Daubert J, Donal E, Arjan Singh R, Sivarani S, Lim S, Azman W, Almeida M, Cardim N, Fonseca V, Carmelo V, Santos S, Santos T, Toste J, Kosmala W, Orda A, Karolko B, Mysiak A, Przewlocka-Kosmala M, Farsalinos K, Tsiapras D, Kyrzopoulos S, Avramidou E, Vassilopoulou D, Voudris V, Hayrapetyan H, Adamyan K, Jurado Roman A, De Dios Perez S, Rubio Alonso B, De Nicolas JMM, Diaz Anton B, Martin Asenjo R, Montero Cabezas J, Granda Nistal C, Garcia Aranda B, Sanchez Sanchez V, Sestito A, Lamendola P, Di Franco A, Lauria C, Lanza G, Kukucka M, Unbehaun A, Buz S, Mladenow A, Kuppe H, Pasic M, Habazettl H, Gemma D, Montoro Lopez N, De Celix MGR, Lopez Fernandez T, De Torres Alba F, Del Valle DI, Ramirez U, Mesa J, Moreno Yanguela M, Lopez Sendon J, Eveborn GW, Schirmer H, Lunde P, Heggelund G, Rasmussen K, Wang Z, Lasota B, Mizia-Stec K, Mizia M, Chmiel A, Adamczyk T, Chudek J, Gasior Z, Venkatesh A, Johnson J, Sahlen A, Brodin L, Winter R, Shahgaldi K, Manouras A, Valbuena S, Iniesta A, Lopez T, De Torres F, Salinas P, Garcia S, Ramirez U, Mesa J, Moreno M, Lopez-Sendon J, Lebid I, Kobets T, Kuzmenko T, Katsanos S, Yiu K, Clavel M, Nina Ajmone N, Van Der Kley F, Rodes Cabau J, Schalij M, Bax J, Pibarot P, Delgado V, Fusini L, Tamborini G, Muratori M, Gripari P, Marsan N, Cefalu' C, Ewe S, Maffessanti F, Delgado V, Pepi M, Hasselberg N, Haugaa K, Petri H, Berge K, Leren T, Bundgaard H, Edvardsen T, Ancona R, Comenale Pinto S, Caso P, Coppola M, Rapisarda O, Cavallaro C, Vecchione F, D'onofrio A, Calabro' R, Rimbas R, Mihaila S, Enescu O, Patrascu N, Dragoi R, Rimbas M, Pop C, Vinereanu D, Gustafsson S, Morner S, Gronlund C, Suhr O, Lindqvist P, Di Bella G, Zito C, Minutoli F, Madaffari A, Cusma Piccione M, Mazzeo A, Massimo R, Pasquale M, Vita G, Carerj S, Rangel I, Goncalves A, Sousa C, Correia A, Martins E, Silva-Cardoso J, Macedo F, Maciel M, Pfeiffer B, Rigopoulos A, Seggewiss H, Alvarez Fuente M, Sainz Costa T, Medrano C, Navarro M, Blazquez Gamero D, Ramos J, Mellado M, De Jose M, Munoz M, Maroto E, Gargani L, Gosciniak P, Pratali L, Agoston G, Bruni C, Guiducci S, Matucci Cerinic M, Varga A, Sicari R, Picano E, Yiu K, Zhao C, Mei M, Yeung C, Siu C, Tse H, Florescu M, Enescu O, Magda L, Mincu R, Vinereanu D, Daha I, Stanescu CM, Chirila L, Baicus C, Vlase A, Dan G, Montoro Lopez M, Florez Gomez R, Alonso Ladreda A, Itziar Soto C, Rios Blanco J, Gemma D, De Torres Alba F, Moreno Yanguela M, Lopez Sendon J, Guzman Martinez G, Lichodziejewska B, Kurnicka K, Goliszek S, Kostrubiec M, Dzikowska-Diduch O, Ciurzynski M, Labyk A, Krupa M, Palczewski P, Pruszczyk P, De Sousa CC, Rangel I, Correia A, Martins E, Vigario A, Pinho T, Silva Cardoso J, Goncalves A, Macedo F, Maciel M, Park SJ, Song JE, Lee YJ, Ha MR, Chang SA, Choi JO, Lee SC, Park S, Oh J, Van De Bruaene A, De Meester P, Buys R, Vanhees L, Delcroix M, Voigt J, Budts W, Blundo A, Buccheri S, Monte IP, Leggio S, Tamburino C, Sotaquira M, Fusini L, Maffessanti F, Pepi M, Lang R, Caiani E, Floria M, De Roy L, Xhaet O, Blommaert D, Jamart J, Gerard M, Deceuninck O, Marchandise B, Seldrum S, Schroeder E, Unsworth B, Sohaib S, Kulwant-Kaur K, Malcolme-Lawes L, Kanagaratnam P, Malik I, Ren B, Mulder H, Haak A, Van Stralen M, Szili-Torok T, Pluim J, Geleijnse M, Bosch J, Baglini R, Amaducci A, D'ancona G, Van Den Oord S, Akkus Z, Bosch J, Ten Kate G, Renaud G, Sijbrands E, De Jong N, Van Der Lugt A, Van Der Steen A, Schinkel A, Bjallmark A, Larsson M, Grishenkov D, Brodin LA, Brismar T, Paradossi G, Sveen KA, Nerdrum T, Hanssen K, Dahl-Jorgensen K, Steine K, Cimino S, Pedrizzetti G, Tonti G, Canali E, Petronilli V, Cicogna F, Arcari L, De Luca L, Iacoboni C, Agati L, Abdel Moneim SS, Eifert Rain S, Bernier M, Bhat G, Hagen M, Bott-Kitslaar D, Castello R, Wilansky S, Pellikka P, Mulvagh S, Delithanasis I, Celutkiene J, Kenny C, Monaghan M, Park W, Hong G, Son J, Lee S, Kim U, Park J, Shin D, Kim Y, Toutouzas K, Drakopoulou M, Aggeli C, Felekos I, Nikolaou C, Synetos A, Stathogiannis K, Tsiamis E, Siores E, Stefanadis C, Plicht B, Kahlert P, Grave T, Buck T, Konorza T, Gursoy M, Gokdeniz T, Astarcioglu M, Bayram Z, Cakal B, Karakoyun S, Kalcik M, Acar R, Kahveci G, Ozkan M, Maffessanti F, Tamborini G, Tsang W, Weinert L, Gripari P, Fusini L, Muratori M, Caiani E, Lang R, Pepi M, Yurdakul S, Avci B, Sahin S, Dilekci B, Aytekin S, Ancona R, Comenale Pinto S, Caso P, Arenga F, Coppola M, Rapisarda O, Calabro' R, Hascoet S, Martin R, Dulac Y, Peyre M, Benzouid C, Hadeed K, Acar P, Celutkiene J, Zakarkaite D, Skorniakov V, Zvironaite V, Grabauskiene V, Burca J, Ciparyte L, Laucevicius A, Di Salvo G, Rea A, D'aiello A, Del Gaizo F, Pergola V, D'andrea A, Caso P, Pacileo G, Calabro R, Russo M, Dedobbeleer C, Hadefi A, Naeije R, Unger P, Mornos C, Cozma D, Ionac A, Mornos A, Valcovici M, Pescariu S, Petrescu L, Hu K, Liu D, Niemann M, Herrmann S, Cikes M, Stoerk S, Knop S, Ertl G, Bijnens B, Weidemann F, De Knegt M, Biering-Sorensen T, Sogaard P, Sivertsen J, Jensen J, Mogelvang R, Dedobbeleer C, Hadefi A, Unger P, Naeije R, Lam W, Tang M, Chan K, Yang Y, Fang F, Sun J, Yu C, Lam Y, Panoulas V, Sulemane S, Bratsas A, Konstantinou K, Nihoyannopoulos P, Cimino S, Canali E, Petronilli V, Cicogna F, Arcari L, De Luca L, Francone M, Iacoboni C, Agati L, Schau T, Seifert M, Ridjab D, Schoep M, Gottwald M, Neuss M, Meyhoefer J, Zaenker M, Butter C, Tarr A, Stoebe S, Pfeiffer D, Hagendorff A, Maret E, Ahlander BM, Bjorklund PG, Engvall J, Staskiewicz G, Czekajska-Chehab E, Adamczyk P, Siek E, Przybylski P, Maciejewski R, Drop A, Jimenez Rubio C, Isasti Aizpurua G, Miralles Ibarra J, Al-Mallah M, Somg T, Alam S, Chattahi J, Zweig B, Dhanalakota K, Boedeker S, Ananthasubramaniam K, Park C, March K, Jones S, Mayet J, Tillin T, Chaturvedi N, Hughes A, Hamodraka E, Kallistratos E, Karamanou A, Tsoukas T, Mavropoulos D, Kouremenos N, Zaharopoulou I, Nikolaidis N, Kremastinos D, Manolis A, Loboz-Rudnicka M, Jaroch J, Bociaga Z, Kruszynska E, Ciecierzynska B, Dziuba M, Dudek K, Uchmanowicz I, Loboz-Grudzien K, Silva D, Magalhaes A, Jorge C, Cortez-Dias N, Carrilho-Ferreira P, Silva Marques J, Portela I, Pascoa C, Nunes Diogo A, Brito D, Roosens B, Bala G, Droogmans S, Hostens J, Somja J, Delvenne E, Schiettecatte J, Lahoutte T, Van Camp G, Cosyns B. Poster Session: Right ventricular systolic function. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Khong TP, de Vries F, Goldenberg JSB, Klungel OH, Robinson NJ, Ibáñez L, Petri H. Potential impact of benzodiazepine use on the rate of hip fractures in five large European countries and the United States. Calcif Tissue Int 2012; 91:24-31. [PMID: 22566242 PMCID: PMC3382650 DOI: 10.1007/s00223-012-9603-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022]
Abstract
Benzodiazepine use increases the risk of falls and has been associated with an increased risk of hip fractures. Our aim was to estimate the possible population impact of the use of benzodiazepines on the rate of hip fracture in France, Germany, Italy, Spain, the United Kingdom, and the United States. We conducted a literature review to estimate the pooled relative risk (RR) for hip fractures and use of benzodiazepines. Prevalence rates of benzodiazepine use in 2009 were calculated for each country using the IMS MIDAS database and three public databases in Denmark, the Netherlands, and Norway. Both the RR and prevalence rates were used for calculation of population attributable risks (PARs) of hip fractures associated with benzodiazepine use. The literature review showed an increased risk of hip fractures in benzodiazepine users (RR = 1.4, 95 % CI 1.2-1.6). Rate of benzodiazepine use showed considerable differences between countries, ranging from 4.7 % to 22.3 % of population ever in a 1-year period. These are reflected in results for the PARs; estimated attributions of benzodiazepines to the rate of hip fractures were 1.8 %, 95 % CI 1.1-2.6 (Germany); 2.0 %, 95 % CI 1.2-2.8 (United Kingdom); 5.2 %, 95 % CI 3.2-7.3 (Italy); 7.4 %, 95 % CI 4.5-10.0 (France); 8.0 %, 95 % CI 4.9-11.0 (United States); and 8.2 %, 95 % CI 5.1-12.0 (Spain). PAR estimates suggest that the potential attribution of benzodiazepine use on the population rate of hip fractures in the five specified European countries and the United States varies between 1.8 % and 8.2 %. During the next phase of the IMI-PROTECT study, a comparison with individual patient data will show whether this approach is valid.
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Affiliation(s)
- T. P. Khong
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, Utrecht, The Netherlands
- Epidemiology and Patient Reported Outcomes, Roche Products Limited, Shire Park, 6 Falcon Way, Welwyn Garden City, AL7 1TW UK
| | - F. de Vries
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, Utrecht, The Netherlands
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J. S. B. Goldenberg
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, Utrecht, The Netherlands
- Epidemiology and Patient Reported Outcomes, Roche Products Limited, Shire Park, 6 Falcon Way, Welwyn Garden City, AL7 1TW UK
| | - O. H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, Utrecht, The Netherlands
| | - N. J. Robinson
- Epidemiology and Patient Reported Outcomes, Hoffman-La Roche, Building 663, Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Luisa Ibáñez
- Department of Pharmacology, Therapeutics and Toxicology, Foundation of the Catalan Institute of Pharmacology (FICF), Autonomous University of Barcelona, Barcelona, Spain
- Clinical Pharmacology Service, Vall d’Hebron University Hospital, Barcelona, Spain
| | - H. Petri
- Epidemiology and Patient Reported Outcomes, Roche Products Limited, Shire Park, 6 Falcon Way, Welwyn Garden City, AL7 1TW UK
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Petri H, Maldonato D, Robinson NJ. Data-driven identification of co-morbidities associated with rheumatoid arthritis in a large US health plan claims database. BMC Musculoskelet Disord 2010; 11:247. [PMID: 20973999 PMCID: PMC2987972 DOI: 10.1186/1471-2474-11-247] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 10/25/2010] [Indexed: 01/12/2023] Open
Abstract
Background In drug development, it is important to have an understanding of the full spectrum of co-morbidities to be expected in the group of patients with the disease of interest. It is usually a challenge to identify the less common events associated with the target disease, even if these events are severe. The purpose of this study is to identify co-morbidities associated with rheumatoid arthritis (RA) as compared with a control group, using a large health care database. Methods Marketscan US claims database was used for this retrospective cohort study. Selected were records of persons aged at least 16 Y with at least two claims for RA, and with active insurance status on June 30,2007. The control group had at least two claims for eczema/dermatitis. Controls were matched by age, gender and insurance status (Medicare or not). All co-morbidities with an ICD9 diagnostic code were identified in the RA and control groups, during a one-year window. Relative risks (RRs) were calculated. Diagnoses were rank-ordered by magnitude of RR. Codes covering RA and arthropathy were excluded. In order to get stable estimates, rank-ordering was performed for diagnoses occurring in at least 20 persons in the control group. Results Records were selected of 62,681 persons with RA (mean age was 59.0 Y, with 73.8% female, Medicare-covered 35%). A total of 6897 different ICD9 diagnostic codes were recorded, with 2220 codes in at least 20 persons of the control group [listed with Relative Risk]. Apart from joint/bone related conditions, strong associations with RA (RR > 3) were found for Adverse effect medicinal and biological substance not elsewhere classified, Unspecified adverse effect drug properly administered, Idiopathic fibrosing alveolitis, Osteomyelitis, Immune deficiency, Elevated sedimentation rate, Tuberculin test reaction abnormal or positive, Anemia and Cushing syndrome. Conclusions Data on a large number (> 60,000) of patients with a diagnosis of RA were used to analyze and to list a large number (> 2,000) of co-morbidities. Rank-ordering of RRs of diagnostic codes is a tool to identify quickly many conditions associated with RA.
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Affiliation(s)
- Hans Petri
- Epidemiology and Patient Reported Outcomes, Roche Products Limited, Shire Park, 6 Falcon Way, Welwyn Garden City AL7 1TW, UK.
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Geborek P, Nitelius E, Noltorp S, Petri H, Jacobsson L, Larsson L, Saxne T, Leden I. Population based studies of biological antirheumatic drug use in southern Sweden: comparison with pharmaceutical sales. Ann Rheum Dis 2006; 64:1805-7. [PMID: 16284356 PMCID: PMC1755306 DOI: 10.1136/ard.2005.036715] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Souverein PC, Webb DJ, Petri H, Weil J, Van Staa TP, Egberts T. Incidence of Fractures among Epilepsy Patients: A Population-based Retrospective Cohort Study in the General Practice Research Database. Epilepsia 2005; 46:304-10. [PMID: 15679512 DOI: 10.1111/j.0013-9580.2005.23804.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the incidence of various fractures in a cohort of patients with epilepsy with a reference cohort of patients not having epilepsy. METHODS Patients were included in the epilepsy cohort if they had at least one diagnosis of epilepsy in their medical history and had sufficient evidence of "active" epilepsy (use of antiepileptic drugs, diagnoses) after the practice was included in the General Practice Research Database (GPRD). Two reference patients were sampled for each patient with epilepsy from the same practice. Primary outcome was the occurrence of any fracture during follow-up. Poisson regression analysis was used to estimate incidence density ratios (IDRs). RESULTS The study population comprised 40,485 and 80,970 patients in the epilepsy and reference cohorts, respectively. The median duration of follow-up was approximately 3 years. The overall incidence rate in the epilepsy cohort was 241.9 per 10,000 person-years. This rate was about twice as high as that in reference cohort: age- and sex-adjusted IDR, 1.89 (95% CI, 1.81-1.98). When comparing IDRs among the different groups of fractures, the highest relative-risk estimate was found for hip and femur fractures (adjusted IDR, 2.79; 95% CI, 2.41-3.24). IDRs were consistently elevated across age and sex groups and across fracture subtypes. CONCLUSIONS The overall risk of fractures was nearly twice as high among patients with epilepsy compared with the general population. The relative fracture risk was highest for hip and femur. Further study is necessary to elucidate whether this elevated risk is due to the disease, the use of antiepileptic drugs, or both.
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Affiliation(s)
- Patrick C Souverein
- Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
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Maru S, Koch GG, Stender M, Clark D, Gibowski L, Petri H, White AD, Simpson RJ. Antidiabetic drugs and heart failure risk in patients with type 2 diabetes in the U.K. primary care setting. Diabetes Care 2005; 28:20-6. [PMID: 15616228 DOI: 10.2337/diacare.28.1.20] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the effects of antidiabetic drugs on the risk of heart failure in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study with a newly diagnosed diabetes cohort of 25,690 patients registered in the U.K. General Practice Research Database, 1988-1999. We categorized person-time drug exposures to monotherapies in insulin, sulfonylureas (SUs), metformins, and other oral hypoglycemic agents (i.e., acarbose, guar gum) and combination therapy including insulin, combination therapy without insulin, and triple combination therapy with or without insulin. A drug-free time interval served as a reference category. Cox interval-wise (piece-wise) regression analyses were used. The main outcome was incident heart failure. RESULTS Among 43,390 drug exposure intervals for 25,690 patients who had a mean follow-up period of 2.5 years, 1,409 patients developed heart failure. Heart failure occurred most frequently in SU monotherapy exposure. After adjusting for duration of diabetes, the timing and order of treatments received, and known risk factors for heart failure, we found no differential effects among type-specific therapies. Patients with any drug use within the first year after diabetes diagnosis had a 4.75-fold higher risk (hazard ratio) for heart failure than those with drug-free status but had no increased risk during subsequent years. CONCLUSIONS In conclusion, the use of any pharmacological therapy for type 2 diabetes appears to be associated with an increased risk of heart failure. This risk does not persist beyond the first year after diagnosis of diabetes and does not appear to differ among the types of drug therapy examined. This observation suggests that the severity of diabetes or the preclinical duration of diabetes and the need for drug therapy, and not the therapy itself, is an explanation for heart failure in patients with type 2 diabetes.
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Affiliation(s)
- Shoko Maru
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina 27599-7075, USA
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Van De Vijver DAMC, Walley T, Petri H. Epidemiology of restless legs syndrome as diagnosed in UK primary care. Sleep Med 2004; 5:435-40. [PMID: 15341887 DOI: 10.1016/j.sleep.2004.07.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2004] [Revised: 07/01/2004] [Accepted: 07/02/2004] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Restless legs syndrome (RLS) is a sensorimotor disorder with a general-population prevalence of 5-10%. Although, data on the prevalence of clinically diagnosed RLS are limited, and there are none regarding incidence, a shortfall compared with general-population values is likely, as not all patients are driven to consult. There may also be poor awareness of the condition among primary care physicians (PCPs). PATIENTS AND METHODS The General Practice Research Database was used to gather prevalence and incidence data from UK PCPs and to investigate PCP awareness over the period 1994-1998. A total of 1,561,692 persons were covered by the database on January 1, 1999. RESULTS A diagnosis of RLS was registered in 3877 patients, giving a prevalence of 0.25%. Incidence values were also low (41.0 per 100,000 person-years), increased with age and were higher in women than in men. Although, at least one RLS diagnosis was made in 94% of medium-to-large practices, sufferers were more likely than age/sex-matched controls to be diagnosed with conditions commonly confused with RLS in 2 years before receiving their RLS diagnosis. Furthermore, at the time of diagnosis, many sufferers were prescribed medications not effective in RLS (principally, oxerutins and quinine). CONCLUSION These data are largely consistent with a lack of awareness of RLS among PCPs in the UK in the period studied.
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Affiliation(s)
- David A M C Van De Vijver
- Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute of Pharmaceutical Sciences (UIPS), P.O. Box 80 082, 3508 TB Utrecht, The Netherlands.
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Sastri CS, Iyengar V, Demirel-Gülen S, Heck M, Hoffmann P, Ortner HM, Blondiaux G, Tessier Y, Sauvage T, Petri H. Determination of boron, fluorine and some medium Z elements in diet samples. J Radioanal Nucl Chem 2004. [DOI: 10.1023/b:jrnc.0000020929.61045.40] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Sastri CS, Petri H, Erdtmann G. Determination of 13 elements with atomic numbers between 12 and 47 by 14-MeV helium-3 activation analysis. Anal Chem 2002. [DOI: 10.1021/ac50019a014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Versluis RG, Papapoulos SE, de Bock GH, Zwinderman AH, Petri H, van de Ven CM, Springer MP. Clinical risk factors as predictors of postmenopausal osteoporosis in general practice. Br J Gen Pract 2001; 51:806-10. [PMID: 11677703 PMCID: PMC1314125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Case-finding strategies to identify women with high risk for osteoporotic fractures have recently been proposed, but little information about such an approach in general practice is known. AIM To study the validity of the proposed case-finding strategy for osteoporosis. DESIGN OF STUDY Survey using case-finding strategy. SETTING Seven hundred and twelve women aged between 55 and 84 years, randomly selected from a general practice in The Netherlands. METHOD Of the 712 randomly selected women, 449 women participated. Information was obtained from a questionnaire, direct questioning, and computerised patients files. Bone mineral density of the femoral neck was measured by dual energy X-ray absorptiometry and vertebral morphometry was performed on lateral X-rays of the spine. Osteoporosis was defined by a bone mineral density T-score of less than 2.5 and/or the presence of severe vertebral deformities. Sensitivity, specificity, and predictive values were calculated for the whole set of risk factors; those significantly associated with osteoporosis and in logistic models. RESULTS Clinical risk factors were present in 55% of the women and identified 68% of the women with osteoporosis. Three risk factors--a low body mass index, fragility fractures, and severe kyphosis and/or loss of height--were associated significantly with osteoporosis; they were present in 33% of the women and identified 60% of those with osteoporosis. A logistic model based on age and fragility fractures selected 32% of the women and identified 76%. CONCLUSION No single risk factor could assist in identifying women with osteoporosis. A simplified case-finding strategy using only three risk factors, that is suitable for primary care, reduces the number of women to be evaluated by two-thirds; however, this is at the cost of missing the diagnosis in 40% of the women with osteoporosis. Addition of spine radiographs to the case-finding approach helped to obtain a better risk profile of the women and had also practical consequences for the management of some. We propose that radiographs should be included in any case-finding strategy.
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Affiliation(s)
- R G Versluis
- Department of General Practice, Leiden University Medical Centre, PO Box 2088, 2301 CB Leiden, The Netherlands.
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Sastri CS, Iyengar V, Blondiaux G, Tessier Y, Petri H, Hoffmann P, Aras NK, Zaichick V, Ortner HM. Fluorine determination in human and animal bones by particle-induced gamma-ray emission. Fresenius J Anal Chem 2001; 370:924-9. [PMID: 11569877 DOI: 10.1007/s002160100900] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Fluorine was determined in the iliac crest bones of patients and in ribs collected from post-mortem investigations by particle-induced gamma-ray emission based on the 19F(p,p'gamma)19F reaction, using 2.0/2.5 MeV protons. The results indicate that for 68% of the human samples the F concentration is in the range 500-1999 microg g(-1). For comparison purposes fluorine was also determined in some animal bones; in some animal tissues lateral profiles of fluorine were measured.
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Affiliation(s)
- C S Sastri
- Fachbereich Material und Geowissenschaften, Technische Universität Darmstadt, Germany.
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Groeneveld Y, Petri H, Hermans J, Springer M. An assessment of structured care assistance in the management of patients with type 2 diabetes in general practice. Scand J Prim Health Care 2001; 19:25-30. [PMID: 11303543 DOI: 10.1080/028134301300034585] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVE To study differences in diabetes-related parameters in type 2 diabetic patients treated with the support of a Diabetes Service compared to conventional general practice care. DESIGN Parallel clinical trial with randomisation at practice level. SETTING Fifteen general practices. PATIENTS Type 2 diabetic patients, aged < 76 years, treated by a GP. MAIN OUTCOME MEASURES Level of glycated haemoglobin (HbA1c). RESULTS 246 patients entered the study. Final mean HbA1c of all evaluable patients allocated to the intervention (n = 84) was 7.1+/-1.2%, vs 7.5+/-1.8% in the controls (n = 140) (p = 0.06). Patients who were initially poorly controlled (Fasting Blood Glucose > 10 mmol/l) had a significantly lower final HbA1c if they were in an intervention practice (p=0.001). Fewer patients in intervention practices were referred to hospital specialists (1 vs 14). CONCLUSIONS Support by the Dutch Diabetes Service did not significantly influence glycated haemoglobin. The subgroup of initially poorly controlled patients developed a significantly lower HbA1c in intervention practices (supported by a Diabetes Service) than in control practices.
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Affiliation(s)
- Y Groeneveld
- Department of General Practice, Leiden University Medical Centre, The Netherlands.
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Petri H, Graffelman AW, Knuistingh Neven A, Springer MP, Mearin L, Von Blomberg BM, Visser JT. Coeliac disease and chronic fatigue syndrome. Int J Clin Pract 2001; 55:71. [PMID: 11219326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Sastri CS, Blondiaux G, Hoffmann P, Ortner HM, Petri H. Oxygen determination in calcium fluoride by deuteron activation analysis. Fresenius J Anal Chem 2000; 366:218-20. [PMID: 11225662 DOI: 10.1007/s002160050043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Oxygen at trace level in calcium fluoride was determined by instrumental deuteron activation analysis based on the 16O(d,n)17F reaction. The irradiations were performed with 2.5 MeV deuterons for 60 s at currents ranging from 300 to 500 nA. The results obtained for powders and single crystals were compared.
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Affiliation(s)
- C S Sastri
- Fachbereich Materialwissenschaft, Technische Universität Darmstadt, Germany
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Abstract
Radiographic absorptiometry (RA) of the phalanges is a convenient and reliable technique for measuring bone mineral density (BMD). It needs only a radiograph of the hand, which can be sent for evaluation to a central facility, whereas other techniques require specialized equipment. We assessed the relationship between RA measurements and the presence of vertebral deformities in a population-based cohort of postmenopausal women, and to compare the results with simultaneously obtained BMD of the hip by dual-energy X-ray absorptiometry (DXA). A total of 389 women aged 55-84 (mean age 67.2 years, SD 8.7) were randomly selected from a large general practice. RA, DXA of the hip, and vertebral deformities in the lateral spine X-rays by vertebral morphometry were assessed. Thirty-eight women (9.8%) had severe (grade II) vertebral deformities, and their BMD at the phalanges and femoral neck was significantly lower than that of women without severe vertebral deformities. Odds ratios for the presence of severe vertebral deformities of 1.5 (95% CI: 1.1-2.1) for RA and 1.3 (95% CI: 0.9-1. 9) for DXA, together with similar receiver operating characteristics curves, were found using age-adjusted logistic regression. Phalangeal BMD is related to vertebral deformities at least as closely as BMD of the femoral neck BMD. RA may therefore help to evaluate fracture risk, especially if no DXA equipment is available.
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Affiliation(s)
- R G Versluis
- Department of General Practice, Leiden University Medical Centre, PO-box 2088, 2301 CB Leiden, The Netherlands
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Schauer U, Thurau A, Seitz M, Nowak L, Petri H, Leinhaas C, Rieger C. Infants colonized with enterotoxin-producing staphylococci at 3 months display a decreased frequency of interferon-gamma-producing CD45RO lymphocytes upon stimulation with staphylococcal enterotoxin A at birth but not at 6 months of age. Pediatr Allergy Immunol 1999; 10:241-8. [PMID: 10678719 DOI: 10.1034/j.1399-3038.1999.00035.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The aim of the study was to elucidate the relationship between the cytokine response to staphylococcal enterotoxin A (SEA) at birth and subsequent staphylococcal colonization in the first months of life. In a cohort of 45 newborns, cord blood lymphocytes were stimulated with SEA (10 ng/ml) in vitro, re-stimulated with PMA (phorbol myristate acetate) and ionomycin at day 3 and assessed for CD45RO expression and cytokine generation by flow cytometry. The infants were classified into three groups according to nasal staphylococcal colonization and enterotoxin generation at 3 months: There were 16 infants with either no colonization or non-enterotoxin-producing staphylococci, 16 infants with enterotoxins B, C, D and E, and 13 infants colonized with SEA-producing staphylococci. At birth, the group without subsequent colonization displayed a significantly higher frequency of CD45RO-positive interferon-gamma-producing cells (1.7%; range 0.0-9.3%) in comparison to the SEA-positive group (0.1%; range 0.0-0.4%) and also to the group positive for other enterotoxins (0.50%; range 0.0-2.5%). Comparable but less pronounced results were found for interleukin-5 but not for interleukins 2 and 4. At 6 months, no differences in cytokine generation were detected between the three groups. The results provide evidence that a non-specific immunologic immaturity at birth is a risk factor for early bacterial colonization. Furthermore, it is remarkable that this immaturity is similar to that seen in infants destined to be atopic with respect to disequilibrium of interferon-gamma to interleukin-4 generation. Thus the link between early staphylococcal colonization and subsequent atopy requires further investigation.
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Affiliation(s)
- U Schauer
- Klinik für Kinder- und Jugendmedizin der Ruhr Universität im St Josef Hospital Bochum, Germany
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Versluis RG, Vismans FJ, van de Ven CM, Springer MP, Petri H. Radiographic absorptiometry of the phalanges as a screening instrument to detect osteoporosis of the hip. Acta Radiol 1999; 40:418-21. [PMID: 10394871 DOI: 10.3109/02841859909177757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the validity of radiographic absorptiometry (RA) of the phalanges in detecting osteoporosis of the femoral neck, measured by dual energy X-ray absorptiometry (DXA). MATERIAL AND METHODS In a group practice, 494 Caucasian women aged 55 to 84 years were recruited. Hand radiographs and DXA measurements of the hip were performed in 449 women. 409 (91.1%) hand radiographs had sufficient quality for analysis by RA. Change of bone mass by age was obtained by using linear regression. Correlations between RA and DXA were calculated. Sensitivity and specificity of RA were calculated for several RA cut-off levels. RESULTS The mean bone mineral density at the femoral neck was 0.866 g/cm2 and 92.57 arbitrary units at the phalanges. A moderate correlation of 0.53 (p<0.01) was found between RA and DXA. Depending on the cut-off level used, the sensitivity and specificity of RA in detecting osteoporosis at the femoral neck was 0.84-0.55 and 0.61-0.88, respectively. CONCLUSION RA may be used as a screening technique to detect osteoporosis, but confirmation is necessary in the subgroup with a positive outcome on RA.
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Affiliation(s)
- R G Versluis
- Department of General Practice, Leiden University Medical Centre, The Netherlands
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Versluis RG, Petri H, van de Ven CM, Scholtes AB, Papapoulos SE, Springer MP. [Prevalence of osteoporosis in postmenopausal women in family practice]. Ned Tijdschr Geneeskd 1999; 143:20-4. [PMID: 10086093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To assess the prevalence of osteopenia, osteoporosis and severe vertebral deformities in general practice. DESIGN Cross-sectional study. METHODS Of a randomly selected group of 712 women aged 55 to 84 years in a general practice in Noordwijk, the Netherlands, 449 (63%) participated in a study in 1996, in which Dual Energy X-ray Absorptiometry (DXA) of the femoral neck was performed: in 428 women vertebral morphometry of lateral radiographs of the spine was also done. The World Health Organization definitions of osteopenia and osteoporosis were used. RESULTS The mean bone mineral density (BMD) was 0.866 g/cm2 (SD: 0.135). With increasing age the BMD decreased statistically significantly by 0.0073 g/cm2/year. There were 189 women with osteopenia (42%). 33 (7%) with osteoporosis and 44 (10%) with one or more severe vertebral deformities. A significantly lower mean BMD was found in those with severe vertebral deformities than in those without.
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Versluis RG, Petri H, van de Ven CM, Scholtes AB, Broerse ER, Springer MP, Papapoulos SE. Usefulness of armspan and height comparison in detecting vertebral deformities in women. Osteoporos Int 1999; 9:129-33. [PMID: 10367039 DOI: 10.1007/s001980050125] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The prevalence of vertebral fractures in women increases with age but only about one third of these fractures are symptomatic. On the other hand, the presence of vertebral fractures is an independent risk factor for new osteoporotic fractures. In the present study we examined the hypothesis that differences between armspan and height are related to the presence of vertebral deformities in a cohort of 494 women aged between 55 and 84 years (mean age 67.6 years, SD 8.2 years) who were randomly selected from a large general practice in The Netherlands. Height and armspan were measured and vertebral morphometry of lateral radiographs of the spine was performed. Both height and armspan decreased significantly with age. The correlation between armspan and height was 0.83. Vertebral deformities were present in 32.7% of the women (grade I in 22.4% and grade II in 10.3%). Only the prevalence of grade II deformities rose with age. The variation of the difference between armspan and height in the groups with or without grade II vertebral deformities was comparable and relatively large (range > 15 cm). The difference in mean values was small between those groups (1.6 cm) and could not differentiate between women with and without vertebral deformities. Our data show that the presence of vertebral deformities cannot be detected by the difference between armspan and height.
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Affiliation(s)
- R G Versluis
- Department of General Practice, Leiden University Medical Centre
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Abstract
AIM To review the relationship between blood glucose level and mortality in patients with Type 2 diabetes mellitus (DM) as reported in the literature. METHODS Literature search using Medline Search: January 1966 - April 1998. KEYWORDS Diabetes, Non Insulin Dependent, Mortality. Inclusion criteria for papers were: Type 2 DM; follow-up for at least 3 years; glucose or glycated haemoglobin (HbA1c) was used as parameter; published in the form of an article. Additionally all references in the selected articles that dealt with the relationship between blood glucose level and mortality in Type 2 DM were included in the search. RESULTS Twenty-seven eligible articles were found. Twenty-three of them showed a positive association: measures of elevated blood glucose concentrations were associated with higher mortality; in 15 out of 23 studies the positive association was statistically significant, in two only for postprandial blood glucose. One study found a nonsignificant negative relationship in a very old population. CONCLUSION In the literature there is a positive, but rather weak, association between the measures of blood glucose control and the risk of dying of patients with Type 2 DM. In the six larger studies (more than 100 deceased patients) that used a continuous categorization of glycaemia, the Risk ratio per unit varies from 1.03 to 1.12.
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Affiliation(s)
- Y Groeneveld
- Department of General Practice, Leiden University Medical Centre, The Netherlands.
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Boekhout I, Van Marwijk HW, Petri H, Schipperheyn JJ, Hermans J, Springer MP. [Incidental high blood pressure in family practice: due to hypertension and/or left ventricular hypertrophy in more than half of the patients]. Ned Tijdschr Geneeskd 1998; 142:2404-8. [PMID: 9864536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To determine if patients with incidentally high blood pressure actually have hypertension and if these patients have an increased left ventricular mass. DESIGN Cross-sectional study. SETTING Two family practices with 8 general practitioners in Leiden and Noordwijk, the Netherlands. METHODS From the Family Practice Network in the Leiden area 133 (67%) out of 200 patients with incidental high blood pressure, who did not receive antihypertensive medication, participated in the study. Their blood pressure was measured 6 times with a mercury manometer, an automatic, non-invasive ambulatory blood pressure monitoring during 24 hours was performed once and their left ventricular mass was measured by means of echocardiography. RESULTS Of the 133 selected patients 46% had a mean diastolic blood pressure > 95 mmHg measured with the mercury manometer and 64% had a mean 24-hr diastolic blood pressure > 90 mmHg measured with the ambulatory blood pressure monitor. The correlation between both blood pressure measurements was moderate (correlation coefficient 0.73). Left ventricular hypertrophy was found in 53% of the patients, irrespective of their blood pressures. CONCLUSION In this investigation 45-65% of patients with an incidentally high blood pressure had a mean diastolic pressure > 95 mmHg as measured with a mercury manometer and (or) a mean 24-hr diastolic blood pressure > 90 mmHg as measured with the ambulatory blood pressure monitor; 53% had left ventricular hypertrophy.
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Affiliation(s)
- I Boekhout
- Vakgroep Huisarts- en Verpleeghuisgeneeskunde, Leids Universitair Medisch Centrum, Leiden
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Abstract
Inhaled steroid therapy is the most important treatment in the management of chronic asthma and currently twice-daily administration is recommended in mild to moderate asthma. Compliance is often a problem in asymptomatic patients and may lead to reduced disease control. Our aim was to investigate whether budesonide 0.2 mg once daily administered via the Turbuhaler is as effective as 0.1 mg twice daily. A randomized, double-blind, parallel group study was carried out in which 76 adult patients with mild to moderate asthma (FEV1 86% of predicted) were allocated to budesonide once or twice daily. After a run-in period of 2 weeks on present inhaled steroid treatment (0.2-0.5 mg day-1) there was an 8 week treatment period, followed by a washout period in which patients received no steroid for 4 weeks unless a drop in morning peak flow of at least 20% occurred or the use of beta 2-agonists increased by 50%. Both treatment groups improved minimally in peak flow (1.7 and 4.31 min-1 in the once-daily and twice-daily groups respectively) but the differences between the two groups were not significant. Testing the reverse hypothesis revealed clinical equivalence. The 90% confidence interval of the difference in the change of peak flow from run-in was between +30 and -30 l min-1, the limits deemed to be clinically relevant. There were no differences in symptom scores, beta 2-agonist use or spirometry measurements between the two groups. In the washout period there was a significant deterioration in peak flow and symptoms. This study shows that 0.2 mg budesonide given once a day is as affective as 0.1 mg given twice daily in patients with mild to moderate asthma.
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Affiliation(s)
- S L Chisholm
- Department of General Practice, Leiden University, The Netherlands
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Crobach MJ, Hermans J, Kaptein AA, Ridderikhoff J, Petri H, Mulder JD. The diagnosis of allergic rhinitis: how to combine the medical history with the results of radioallergosorbent tests and skin prick tests. Scand J Prim Health Care 1998; 16:30-6. [PMID: 9612876 DOI: 10.1080/028134398750003377] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To identify the most useful combinations of symptoms and the results of radioallergosorbent tests (RASTs) and skin prick tests (SPTs) for the diagnosis of allergic rhinitis. DESIGN A prospective comparison was made of symptoms and the results of RASTs and SPTs with 7 different nasal allergies; the references used were the "consensus diagnoses" provided by 3 experts. SETTING Nineteen general practices in The Netherlands. PATIENTS 365 consecutive patients aged 12 or over who visited their general practitioner because of chronic or recurrent nasal symptoms between 1 March 1990 and 1 March 1991. MAIN OUTCOME MEASURES The most useful combinations of items from the history, RASTs, and SPTs, for the diagnosis of 7 different nasal allergies; the predictive probabilities of these combinations. RESULTS Diagnostic criteria could be drawn up resulting in a near-perfect discrimination between patients diagnosed as having allergic rhinitis and patients diagnosed as not having allergic rhinitis. Most of these criteria combined only a single item from the history with either RAST or SPT. For nearly all nasal allergies, both the negative predictive probabilities and the positive predictive probabilities were 97% or more. CONCLUSIONS The common nasal allergies can be diagnosed with a very high certainty with the aid of simple diagnostic criteria. Data from a strictly limited case history combined with either RAST or SPT are sufficient.
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Affiliation(s)
- M J Crobach
- Department of General Practice, Leiden University, The Netherlands
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Versluis RG, de Waal MW, Opmeer C, Petri H, Springer MP. [Prevalence of chronic fatigue syndrome in 4 family practices in Leiden]. Ned Tijdschr Geneeskd 1997; 141:1523-6. [PMID: 9543740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the prevalence of chronic fatigue syndrome (CFS) in general practice. DESIGN Descriptive. SETTING General practice and primary health care centres in Leyden region, the Netherlands. METHOD RNUH-LEO is a computerized database which contains the anonymous patient information of one general practice (with two practitioners) and four primary health care centres. The fourteen participating general practitioners were asked what International Classification of Primary Care (ICPC) code they used to indicate a patient with chronic fatigue or with CFS. With these codes and with the code for depression patients were selected from the database. It then was determined whether these patients met the criteria of CFS by Holmes et al. RESULTS The general practitioners used 10 codes. Including the code for depression a total of 601 patients were preselected from a total of 23,000 patients in the database. Based on the information from the patients' records in the database, 42 of the preselected patients were selected who might fulfill the Holmes' criteria of CFS. According to the patients' own general practitioner, 25 of the 42 patients would fulfil the Holmes' criteria. The men:women ratio was 1:5. The prevalence of CFS in the population surveyed was estimated to be at least 1.1 per 1,000 patients.
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Affiliation(s)
- R G Versluis
- Rijksuniversiteit, vakgroep Huisartsgeneeskunde, Leiden
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Abstract
OBJECTIVE The aim of this study was to investigate how many blood pressure measurements are necessary in diagnosing mild to moderate hypertension. METHODS The subjects were 99 outpatients who were included on the basis of elevated diastolic (95 < or = DBP < or = 115 mmHg) and/or systolic (160 < or = SBP < or = 200 mmHg) blood pressure. After the initial measurement all patients underwent nine subsequent blood pressure measurements over a period of 7 months. None of the patients received anti-hypertensive drug treatment during the study. RESULTS Between the first (initial) and second measurements, there was a significant reduction in systolic (161.0 to 152.5 mmHg) and diastolic (101.5 to 97.1 mmHg) blood pressures (P < 0.01). The differences between pairs of subsequent measurements were not statistically significant. The average of the last five assessment sessions (two readings per session) was regarded as the "conceptual average blood pressure'. Comparing the blood pressure at repeat measurement with the conceptual average blood pressure revealed misclassification in 19% of cases, even after four repeat measurements (threshold value 95 mmHg). Analysis of the subgroups (95 < or = DBP < 105 mmHg and 105 < or = DBP < or = 115 mmHg) revealed that the proportion of misclassification greatly depended on the initial value and the accepted threshold value. At a threshold value of 95 mmHg, patients with "high' initial diastolic blood pressure (105 < or = DBP < or = 115 mmHg) required only two repeat measurements (misclassification in 7% of cases after four repeat measurements). Of those with initial diastolic blood pressure values between 95 and 105 mmHg, 24% were misclassified after four repeat measurements. CONCLUSIONS For these "borderline' diastolic values, we propose larger numbers of measurements than are recommended in international guidelines. Our advice for values in this borderline region is to be reticent in starting antihypertensive drug treatment. The presence or absence of other cardiovascular risk factors should be taken into account when deciding whether treatment is required or not.
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Affiliation(s)
- M M Brueren
- Department of General Practice, University of Limburg, Maastricht, The Netherlands
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Brueren M, Petri H, Schouten H, van Weel C, van Ree J. Are four duplicate remeasurements sufficient for diagnosing mild hypertension? J Hum Hypertens 1996; 10:349-52. [PMID: 8872796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of this study was to investigate if four duplicate blood pressure (BP) remeasurements are sufficient for diagnosing hypertension in potentially hypertensive subjects. The subjects were 99 outpatients who were included on the basis of elevated diastolic (95 < or = DBP < or = 115 mm Hg) or systolic (160 < or = SBP < or = 200 mm Hg) BP. After inclusion all patients underwent nine subsequent duplicate BP measurements over a period of 7 months. None of the patients received hypotensive drug treatment during the study. Between the first (initial) and second measurements there were significant reductions in systolic (161.0-152.5 mm Hg) and diastolic (101.5-97.1 mm Hg) BPs (P < 0.01). Differences between the subsequent measurements were not statistically significant. A linear regression analysis proved that the "conceptual average BP' (the average of the last five visits) which was chosen as the reference value was stable. The decline of standard deviations of differences between two, three and four duplicate remeasurements on one hand, and the reference value on the other was found to be strikingly small. After four duplicate remeasurements, there was misclassification in 56% (systolic) and 38% (diastolic). We conclude that the numbers of two, three or four BP measurements recommended by international guidelines for diagnosing hypertension are too low. Even after four duplicate remeasurements a considerable amount of misclassification remains.
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Affiliation(s)
- M Brueren
- Department of General Practice, University of Limburg, Maastricht, The Netherlands
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Stichele RHV, Petri H. Utilization patterns of subsidized and nonsubsidized reimbursable peptic ulcer medication in Belgium. Pharmacoepidemiol Drug Saf 1995. [DOI: 10.1002/pds.2630040404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Petri H. ["I came as a stranger, will leave as a stranger." From alienation to hostility to foreigners in the young generation]. Prax Kinderpsychol Kinderpsychiatr 1994; 43:247-53. [PMID: 7991502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
After a historical review of the discussion of the concept of strangeness and alienation since the beginning of the 19th century, the question of the background of the current discussion of "the alien" arises. The assumption is that the experience of strangeness and self-alienation took a qualitative and quantitative leap at the point in technological development when the dialectic between human and machine was resolved in favor of the machine's domination, and when the "mega-machine" made the end of the human species conceivable and probable. Findings from empirical research on children and youth support this assumption. The causes are traced why the younger generation in particular is affected by the structural violence of strangeness that permeates all areas of life. Its inflating influence on the development of the ego and self is depicted. In accordance with the assumption, hostility toward and hatred of foreigners are to be grasped as symptoms of a loss of identity, caused by experiences of alienation deeper and more comprehensive than current societal triggers reveal.
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Affiliation(s)
- M J Kruip
- Department of Epidemiology, University of Limburg, The Netherlands
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De Corte F, Simonits A, Bellemans F, Freitas MC, Jovanović S, Smodiš B, Erdtmann G, Petri H, De Wispelaere A. Recent advances in the k0-standardization of neutron activation analysis: Extensions, applications, prospects. J Radioanal Nucl Chem 1993. [DOI: 10.1007/bf02046790] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Leufkens HG, Urquhart J, Stricker BH, Bakker A, Petri H. Channelling of controlled release formulation of ketoprofen (Oscorel) in patients with history of gastrointestinal problems. J Epidemiol Community Health 1992; 46:428-32. [PMID: 1431721 PMCID: PMC1059614 DOI: 10.1136/jech.46.4.428] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE The aim was to determine if a new controlled release formulation (Oscorel) of the non-steroidal anti-inflammatory drug (NSAID) ketoprofen has been preferentially prescribed in patients with prior history of gastro-intestinal disturbances. DESIGN The study was a pharmacy records based comparison of the rates of prior prescribing of drugs indicated for peptic ulcer treatment in first recipients of Oscorel in 1989 versus recipients of other NSAID products. SETTING A representative panel of Dutch community pharmacies serving approximately 425,000 people was used. MAIN RESULTS Oscorel was launched in January 1989. Data on prescriptions dispensed in 1987-1988 to a total of 837 first users of Oscorel were analysed and compared with the dispensing history of a reference population including 30,787 patients who did not receive a prescription for Oscorel during 1989. Compared to the reference population, first users of Oscorel included a greater proportion of females, of patients 75 years and older, of heavy users of NSAIDs, and of patients switching among different NSAIDs. A total of 24.1% of first users of Oscorel had received peptic ulcer therapy in 1987-1988, versus 15.7% of the reference population. The rate ratio was 1.54, with 95% confidence interval of 1.36-1.74. Adjustment for stratifying variables caused only minor changes in the rate ratio, which remained stable on 1.5. CONCLUSIONS Oscorel appears to have been channelled into use in patients with recognised risk factors for gastrointestinal toxicity. This preferential prescribing probably resulted from expectations and claims that this product has a lower risk of such toxicity.
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Affiliation(s)
- H G Leufkens
- Department of Pharmaco-epidemiology, Utrecht University, The Netherlands
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Petri H. [Psychoanalytic aspects of the poisoned childhood]. Psychother Psychosom Med Psychol 1991; 41:155-65. [PMID: 1871248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The primary assumption of the paper is that the destruction of the environment, in particular the physical poisoning of the human being himself, simultaneously produces a creeping psychological destruction of the subject's inner world, especially in children and youth. On the basis of Melanie Klein's theory, the fate of the mother as persecuting object is examined. Further, the generation change that can be expected through the ecological situation is worked out on the basis of Boszormenyi-Nagy and Spark's family theory concept of loyalty. Using unsystematic materials, the inner object world of the child in the face of the destroyed environment can be depicted, which in turn allows the fear of the future to be interpreted as fear of disintegration.
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Petri H, Kessels F, Kamakura T. Markers of adverse drug reactions in medication histories. An analysis of inhaled steroid utilization. Pharm Weekbl Sci 1991; 13:97-106. [PMID: 1870950 DOI: 10.1007/bf01974988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Prescription sequence analysis is based on the observation that a subset of adverse drug reactions are themselves indications for the prescription of another drug. We propose an approach to the analysis of clustering of prescriptions in medication histories that contain records of a presumed side-effect-causing drug A and a side-effect-alleviating drug B. This set of histories with records of both A and B is analysed in a logistic regression model that considers the start of B against exposure and non-exposure of A, stratified on the level of the individual histories. A correction is presented for the periods of B use, during which a new start of B cannot occur. Prescription sequence analysis is demonstrated with a set of histories of use of inhaled steroids (A) and topical oral anticandida drugs (B). A can cause oral candidiasis, B is therapy for this condition. An odds ratio of 1.43 was found for the association of A use and the initiation of therapy with B.
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Affiliation(s)
- H Petri
- Department of Epidemiology, University of Limburg, Maastricht, The Netherlands
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