Trends in prescription medicine use by older people in New Zealand 2010- 2015: a national population-based study.

BACKGROUND: Research investigating trends in the general prescription medicine use of older people in New Zealand is limited. AIM: To examine trends in the use of outpatient medicines by older adults and assess changing patterns in use from 2010 to 2015. METHODS: A retrospective cohort study including all New Zealand primary care patients over 65 years of age utilising data from the national pharmaceutical claims database. We calculated the prevalence of use within three age groups and by sex in each year by anatomical therapeutic class, therapeutic group and individual medicine. Rate ratios were calculated to compare the prevalence of use in 2010 and 2015. RESULTS: The study included 829,026 patients with a mean of 4.4 years of potential drug exposure. Overall prevalence of medicine use was 92% in 2010 and 93% in 2015. The mean number of prescriptions per patient-year for patients >=85 years of age (39.2) was almost double that of patients 65-74 years (21.8). Prevalence of use was similar between females (94%) and males (92%). Antibacterials, analgesics, cardiovascular drugs and proton pump inhibitors were the most widely used medicines. The use of systemic antibiotics increased by 2% between 2010 and 2015, but there were significant decreases in use of antithrombotics (6%), beta blockers (6%), diuretics (19%), nitrates (19%) and antiarrhythmics (24%). CONCLUSION: Our findings indicate both positive changes in response to guidance on safe and appropriate medicine use and several areas of concern. Continued monitoring of changing patterns in the medicine use of older people will be important, particularly with regard to the use of combinations of medicines that increase their risk of adverse events.

Setting up new learning environments in regional and rural areas.

The shortage of doctors in New Zealand, especially in regional and rural areas, together with the recognition that medical students need to learn in a variety of contexts has led to new learning environments being developed. This paper describes some of the key factors that have led to the successful implementation of year-long regional and rural clinical placements for medical students in New Zealand.

Toxicity of aqueous and sediment-associated fluoride to freshwater organisms.

Inorganic fluorides were declared toxic under the Canadian Environmental Protection Act in 1993 based on their potential to cause long-term harmful effects in aquatic and terrestrial ecosystems, but information on the toxicity of sediment-associated fluoride to freshwater benthic organisms was considered incomplete. The purpose of this study was to determine the toxicity of aqueous and sediment-associated fluoride to several species of freshwater organisms and to determine if toxic effects could be expected under environmentally realistic exposures. Toxicity of fluoride (as NaF) in short-term (48-96-h) lethality tests was greatest for the amphipod Hyalella azteca (median lethal concentration [LC50] = 14.6 mg F-/L), followed by the mayfly Hexagenia limbata (32.3), the midge Chironomus tentans (124.1), the fathead minnow Pimephales promelas (262.4), and the cladoceran Daphnia magna (282.8). Relative toxicity in long-term (10-28-d) growth and survival tests in spiked sediment was similar. Hyalella azteca was the most sensitive species for growth (25% inhibitory concentration [IC25] = 290.2 microg F-/g), followed by C. tentans (661.4), H. limbata (1,221.3), and P. promelas (>5,600); H. azteca was also the most sensitive species for survival (LC50 = 1,114.6 microg F-/g), followed by H. limbata (1,652.2) and P. promelas and C. tentans (>5,600 for both). Concentrations of fluoride measured in sediments near some industrial point sources exceed some of these toxicity thresholds. Fluoride is highly mobile in aquatic systems and could potentially reach toxic levels in the water column during dredging to remove fluoride-contaminated sediment.