TY - JOUR T1 - Medication use in early pregnancy-prevalence and determinants of use in a prospective cohort of women JF - Pharmacoepidemiol Drug Saf Y1 - 2010 A1 - Cleary, B A1 - Butt, Hajeera A1 - Strawbridge, Judith D A1 - Gallagher, Paul J A1 - Fahey, T A1 - Murphy, Deirdre J KW - Adult KW - Cohort Studies KW - Drug Utilization Review KW - Female KW - Fetal Development KW - Gestational Age KW - Humans KW - Pharmaceutical Preparations KW - Plant Preparations KW - Pregnancy KW - Pregnancy Complications KW - Prescription Drugs KW - Prevalence KW - Prospective Studies KW - Questionnaires KW - Street Drugs KW - United States KW - United States Food and Drug Administration KW - Young Adult AB - PURPOSE: To examine the extent, nature and determinants of medication use in early pregnancy. METHODS: We reviewed early pregnancy medication use, as reported to a midwife at the booking interview, in women delivering between 2000 and 2007 in a large maternity hospital in Dublin, Ireland (n = 61 252). RESULTS: Excluding folic acid, at least one medication was reported in 23 989 (39.2%) pregnancies. Over the counter (OTC) medications were reported in 11 970 (19.5%) pregnancies, illicit drugs or methadone in 545 (0.9%) and herbal medicines/supplements in 352 (0.58%). FDA category D and X medications were reported by 1532 (2.5%) and 1987 (3.2%) women. Asthma, depression and hypertension were among the most commonly reported chronic medical disorders. Medications with potential for foetal harm were reported by 86 (15.7%) women treated for depression and 68 (20%) women treated for hypertension. Factors associated with reporting the use of medications with potential for foetal harm included unplanned pregnancy (adjusted odds ratio [aOR] 1.31, 95% confidence interval [CI] 1.12-1.52), booking at less than 12 weeks gestation (aOR 1.83, 95%CI 1.58-2.13), being above 25 years of age, unemployed (aOR 2.58, 95%CI 2.03-3.29), nulliparous (aOR 1.41; 95%CI 1.22-1.63), single (aOR 1.28; 95%CI 1.06-1.54) or smoking during pregnancy (aOR 1.96, 95%CI 1.67-2.28). CONCLUSIONS: Women frequently report medication use in early pregnancy. Women and prescribers need to be aware of the lack of pregnancy safety data for many medications, and the need for pre-pregnancy planning. Prescribers should ensure that optimal medications are used when treating women of childbearing potential with chronic medical disorders. VL - 19 UR - http://onlinelibrary.wiley.com/doi/10.1002/pds.1906/abstract IS - 4 ER - TY - JOUR T1 - Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer JF - Br J Cancer Y1 - 2010 A1 - Olde Bekkink, M A1 - McCowan, Colin A1 - Falk, G A1 - Teljeur, C A1 - Van de Laar, F A A1 - Fahey, T KW - Adenocarcinoma KW - Adult KW - Aged KW - Anemia KW - Barium Sulfate KW - Cohort Studies KW - Colonoscopy KW - Colorectal Neoplasms KW - Enema KW - Family Practice KW - Female KW - Gastrointestinal Hemorrhage KW - Humans KW - Male KW - Middle Aged KW - Pain KW - Primary Health Care KW - Prospective Studies KW - Rectum KW - Reference Standards KW - Risk KW - Sensitivity and Specificity KW - Sigmoidoscopy KW - Weight Loss AB - BACKGROUND: Rectal bleeding is a recognised early symptom of colorectal cancer. This study aimed to assess the diagnostic accuracy of symptoms, signs and diagnostic tests in patients with rectal bleeding in relation to risk of colorectal cancer in primary care. METHODS: Diagnostic accuracy systematic review. Medline (1966 to May 2009), Embase (1988 to May 2009), British Nursing Index (1991 to May 2009) and PsychINFO (1970 to May 2009) were searched. We included cohort studies that assessed the diagnostic utility of rectal bleeding in combination with other symptoms, signs and diagnostic tests in primary care. An eight-point quality assessment tool was produced to assess the quality of included studies. Pooled positive likelihood ratios (PLRs), sensitivities and specificities were calculated. RESULTS: Eight studies incorporating 2323 patients were included. Average weighted prior probability of colorectal cancer was 7.0% (range: 3.3-15.4%, median: 8.1%). Age > or = 60 years (pooled PLR: 2.79, 95% confidence interval (CI) 2.00-3.90), weight loss (pooled PLR: 1.89, 95% CI: 1.03-3.07) and change in bowel habit (pooled PLR: 1.92, 95% CI: 0.54-3.57) raise the probability of colorectal cancer into the range of referral to secondary care but do not conclusively 'rule in' the diagnosis. Presence of severe anaemia has the highest diagnostic value (pooled PLR: 3.67, 95% CI: 1.30-10.35), specificity 0.95 (95% CI: 0.93-0.96), but still only generates a post-test probability of 21.6%. CONCLUSIONS: In patients with rectal bleeding who present to their general practitioner, additional 'red flag' symptoms have modest diagnostic value. These findings have implications in relation to recommendations contained in clinical practice guidelines. VL - 102 UR - http://www.nature.com/bjc/journal/v102/n1/full/6605426a.html IS - 1 ER -