Lianne Parkin

Background: Antiemetic use during pregnancy is rising in high‐income countries. Increasing use of antiemetics has also been documented in Aotearoa New Zealand (NZ); however, the specific antiemetics dispensed have not been reported. Aim: To describe patterns of antiemetic dispensing during pregnancy in NZ, 2005–2020. Materials and Methods: Community‐based antiemetic dispensings were linked with 1.37 million pregnancies in the New Zealand Pregnancy Cohort. The proportions of pregnancies in which there was at least one dispensing of any and of specific antiemetics were calculated for each trimester and calendar year. Maternal characteristics and the sequence in which unique antiemetic regimens were introduced were described for pregnancies with first trimester exposure. Results: First trimester antiemetic exposure increased from 4.1% to 19.7% of pregnancies between 2005 and 2019. Although metoclopramide was the most commonly dispensed antiemetic during Trimester 1 in all years (increasing from 3.1% to 12.4%), there was a substantial increase in ondansetron dispensing (0.1% to 9.1%). Ondansetron users were more likely than metoclopramide users to be European/Other and have a hospital admission for hyperemesis gravidarum. Metoclopramide and ondansetron monotherapy were first‐line regimens in 70.0% and 1.9% of pregnancies with Trimester 1 exposure between 2005 and 2010 versus 46.5% and 26.5% between 2016 and 2020. Conclusions: Ondansetron dispensing increased substantially over time. Further exploration of the context of ondansetron prescribing in NZ is warranted, as is further research into potential adverse outcomes.

Background: Pain is common during pregnancy, yet there are few contemporary studies of opioid use in pregnancy. This study aimed to describe prescription analgesic opioid use during pregnancy across four regions: Oceania (New South Wales, Australia, and New Zealand), North America (Ontario, Canada, and United States), Northern Europe (Denmark, Finland, Iceland, Norway, Sweden, and United Kingdom), and East Asia (Hong Kong, South Korea, and Taiwan). Methods: A common protocol was applied to population-based data to measure analgesic opioid dispensing or prescriptions during pregnancy before birth in 2000 to 2020. The populations captured included those with public and private insurance in the United States, a sample of primary care practices in the United Kingdom, and whole-of-population cohorts in the remainder of the locations. This study examined prevalence of use, defined as at least one dispensing or prescribing and estimated trends over time. Use by sociodemographic and pregnancy characteristics is described. Results: Among a total of 20,306,228 pregnancies, 1,115,853 (55 per 1,000) had at least one analgesic opioid dispensing or prescription, ranging from 4 per 1,000 in the United Kingdom to 191 per 1,000 in the U.S. publicly insured population. The greatest relative decrease in prevalence was observed in Hong Kong (prevalence ratio, 0.2; 95% CI, 0.1 to 0.2 between 2005 and 2020), and the greatest increase was in Iceland (prevalence ratio, 4.4; 95% CI, 3.7 to 5.2 between 2004 and 2017). Codeine and tramadol were among the three most prevalent opioids in most populations. In a sensitivity analysis defining opioid use as two or more opioid -dispensing or -prescribing events, the prevalence of opioid use across populations was 17 per 1,000. Conclusions: In this large multinational study, wide global variation in the prevalence of analgesic opioid use in pregnancy was observed, yet patterns of use by sociodemographic and pregnancy characteristics were relatively consistent. Analgesic opioid use remained stable or downward trending over time in most, but not all, countries.

We reviewed clinical records to determine whether the use of bronchial brushings improved diagnostic yield in a setting where bronchoscopy for suspected primary lung cancer is routinely guided by prior chest computed tomography but endobronchial ultrasound-guided sampling is unavailable. For 29% of cases who had brushings and at least one other test taken (bronchial biopsies or washings), the histological diagnosis was made solely on the basis of samples obtained by brushings.

The New Zealand Medical Journal (NZMJ) is the principal scientific journal for the medical profession in New Zealand. The Journal has become a fundamental resource for providing research and written pieces from the health and medical industry.

Objectives The aims of this study were to describe the following: (1) the time to change of therapy in patients with type 2 diabetes who had initiated metformin monotherapy as first-line treatment and (2) the sequence in which subsequent therapeutic regimens were introduced. Design Cohort study. Setting National study based on linked data from the New Zealand Ministry of Health’s National Collections of health and pharmaceutical dispensing data. Participants People with type 2 diabetes mellitus who initiated metformin monotherapy between 1 January 2006 and 30 September 2014 (n=93 874). Primary outcome measures Cumulative incidence curves were plotted to show the time taken to move from one regimen to another, while sunburst plots were used to illustrate the sequence in which regimens were introduced. Results About 10% and 35% of cohort members had moved to a second regimen 1 year and 5 years, respectively, after initiating metformin monotherapy; the majority received a regimen recommended by New Zealand treatment guidelines (mostly metformin and a sulphonylurea). Of those who started a recommended second regimen, 37% and 67% had moved to a third regimen after 1 and 5 years, respectively; the corresponding proportions for those who started an ‘other’ (not listed as recommended) second regimen were 53% and 75%. Most of those who received a third regimen after a recommended second regimen were dispensed an ‘other’ third regimen. Of those who moved to a third regimen from an ‘other’ second regimen, similar proportions received recommended and ‘other’ third regimens. Conclusions Real-world type 2 diabetes treatment patterns in New Zealand are complex and not always consistent with guidelines.

Background: Reported associations between depression and myocardial infarction in some studies might be explained by use of psychotropic drugs, residual confounding, and/or reverse causation (whereby heart disease precedes depression). We investigated these hypotheses in a large prospective study of UK women with no previous vascular disease.Methods: At baseline in median year 2001 (IQR 2001–2003), Million Women Study participants reported whether or not they were currently being treated for depression or anxiety, their self-rated health, and medication use during the previous 4 weeks. Follow-up was through linkage to national hospital admission and mortality databases. Cox regression yielded adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the first myocardial infarction event in those reporting treatment for depression or anxiety (subdivided by whether or not the treatment was with psychotropic drugs) v. not, and stratified by self-reported health and length of follow-up.Results: During mean follow-up of 13.9 years of 690 335 women (mean age 59.8 years) with no prior heart disease, stroke, transient ischaemic attack, or cancer, 12 819 had a first hospital admission or death from myocardial infarction. The aHRs for those reporting treatment for depression or anxiety with, and without, regular use of psychotropic drugs were 0.96 (95% CI 0.89–1.03) and 0.99 (0.89–1.11), respectively. No associations were found separately in women who reported being in good/excellent or poor/fair health or by length of follow-up.Conclusion: The null findings in this large prospective study are consistent with depression not being an independent risk factor for myocardial infarction.

Background: Coronary heart disease occurs more frequently among patients with chronic obstructive pulmonary disease (COPD) compared to those without COPD. While some research suggests that long‐acting bronchodilators might confer an additional risk of acute coronary syndrome (ACS), information from real‐world clinical practice about the cardiovascular impact of using two versus one long‐acting bronchodilator for COPD is limited. We undertook a population‐based nested case–control study to estimate the risk of ACS in users of both a long‐acting muscarinic antagonist (LAMA) and a long‐acting beta2‐agonist (LABA) relative to users of a LAMA.Methods: The study was based on the primary care PREDICT Cardiovascular Disease Cohort and linked data from regional laboratories and the New Zealand Ministry of Health's national data collections. The underlying cohort (n= 29,993) comprised patients aged 45–84 years, who initiated treatment with a LAMA and/or LABA for COPD between 1 February 2006 and 11 October 2016. 1490 ACS cases were matched to 13,550 controls by date of birth, sex, date of cohort entry (first long‐acting bronchodilator dispensing), and COPD severity.Results: Relative to current use of LAMA therapy, current use of LAMA and LABA dual therapy was associated with a significantly higher risk of ACS (adjusted OR = 1.72; [95% CI: 1.28–2.31]).Conclusion: Dual long‐acting bronchodilator therapy, rather than LAMA mono‐therapy, could increase the risk of ACS by more than 50%. This has important implications for decisions about the potential benefit/harm ratio of COPD treatment intensification, given the modest benefits of dual therapy.

AIM: To explore the views of people with type 2 diabetes who had initiated metformin monotherapy about what influences adherence and persistence. METHODS: We recruited participants through primary care, using purposive sampling, and undertook face-to-face, audio-recorded, semi-structured interviews with 10 Maori, 10 Pacific, and 10 non-Maori non-Pacific patients who had started metformin monotherapy for type 2 diabetes within the previous two years. A thematic analysis was undertaken using the Theory of Planned Behaviour as the overall theoretical framework. RESULTS: The perceived benefits of taking metformin included improving gtycaemic control, preventing or slowing the progression of type 2 diabetes, and avoiding serious complications. Side effects (predominantly gastrointestinal) were the most commonly cited disadvantage. Participants employed a variety of strategies to help them take metformin regularly. Key reasons for initial sub-optimal adherence and persistence were side effects and not accepting the diagnosis of type 2 diabetes. Subsequently, omitting to take tablets was commonly unintentional (due to 'forgetfulness'). For many Pacific participants, changes in routine related to community and church events, or shift work, contributed to sub-optimal adherence. Some Maori participants would have preferred to use traditional medicines. CONCLUSION: We identified a number of factors within the scope of healthcare services that may assist healthcare providers to focus on, and address, some of the issues that appear to be of primary importance to people when they are prescribed metformin.