Mei-Ling Blank

A nationwide nested case-control study indicates an increased risk of acute interstitial nephritis with proton pump inhibitor use

The magnitude of the suspected increase in risk of acute interstitial nephritis among proton pump inhibitor users is uncertain. Here, we conducted a nested case-control study using routinely collected national health and drug dispensing data in New Zealand to estimate the relative and absolute risks of acute interstitial nephritis resulting in hospitalization or death in users of proton pump inhibitors. The cohort included 572,661 patients without a history of interstitial nephritis or other renal diseases who started a new episode of proton pump inhibitor use between 2005 and 2009. Cases had a first diagnosis after cohort entry of acute interstitial nephritis confirmed by hospital discharge letter or death record, and renal histology (definite, 46 patients), or discharge letter or death record only (probable, 26 patients). Ten controls, matched by birth year and sex, were randomly selected for each case. In the case-control analysis based on definite cases and their controls, the unadjusted matched odds ratio (95% confidence interval) for current versus past use of proton pump inhibitors was 5.16 (2.21–12.05). The estimate was similar when all cases (definite and probable) and their corresponding controls were analyzed, and when potential confounders were added to the models. The crude incidence rates and confidence intervals per 100,000 person-years were 11.98 (9.11–15.47) and 1.68 (0.91–2.86) for current and past use, respectively. Thus, current use of a proton pump inhibitor was associated with a significantly increased risk of acute interstitial nephritis, relative to past use.

Dual use of electronic nicotine delivery systems (ENDS) and smoked tobacco: a qualitative analysis

Introduction Electronic nicotine delivery systems (ENDS) arguably pose fewer health risks than smoking, yet many smokers adopt ENDS without fully relinquishing smoking. Known as ‘dual use’, this practice is widespread and compromises the health benefits that ENDS may offer. To date, few studies have explored how dual use practices arise and manifest. Methods We conducted in-depth, semi-structured interviews with 20 current ENDS users from New Zealand who reported smoking tobacco at least once a month. We explored participants’ smoking history, their recent and current smoking, trial, uptake and patterns of ENDS use, and future smoking and vaping intentions. We managed the data using NVivo V.11 and used a thematic analysis approach to interpret the transcripts. Results Dual use practices among participants evolved in four ways. First, as an attempt to manage the ‘inauthenticity’ of vaping relative to smoking and to retain meaningful rituals. Second, as complex rationalisations that framed decreased tobacco use, rather than smoking cessation, as ‘success’. Third, as a means of alleviating the financial burden smoking imposed and to circumvent smoke-free policies. Lastly, dual use reflected attempts to comply with social group norms and manage stigma. Conclusions Dual use reflects both social and physical cues. It assisted participants to navigate smoking restrictions and allowed them to manage divergent norms. Policies that discourage smoking, particularly excise tax increases on smoked tobacco and smoke-free space restrictions, appear important in prompting ENDS use. Future research could explore whether these policies also help foster complete transition from smoking to exclusive ENDS use.

Screening for hazardous alcohol use among university students using individual questions from the Alcohol Use Disorders Identification Test-Consumption

INTRODUCTION AND AIMS Abbreviated versions of the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) instrument have not been investigated among students. We compared a modified second item (AUDIT-2*) (typical quantity per occasion as the number of drinks, rather than categorical responses) and the third item (AUDIT-3) (heavy episodic drinking frequency) with AUDIT-C scores and described their associations with sociodemographic variables. DESIGN AND METHODS We analysed cross-sectional data from the 2011 baseline of the Graduate Longitudinal Study New Zealand, including respondents aged up to 25 years (n = 5082, response rate 65%). Hazardous drinking was defined as an AUDIT-C score of seven or greater for men and five or greater for women. We calculated the area under receiver operating characteristic curves, sensitivities, specificities, and positive and negative predictive values for the AUDIT-2* and AUDIT-3. Odds ratios and 95% confidence intervals were calculated to describe the associations between drinking patterns and sociodemographic factors. RESULTS Based on the sex-specific AUDIT-C cut-points, 36% of participants reported drinking at hazardous levels. For the AUDIT-2*, the best combination of sensitivity and specificity was obtained for a cut-point of five standard drinks. The best cut-point for the AUDIT-3 was for monthly heavy episodic drinking. Positive and negative predictive values were above 0.80 for both cut-points. Consumption was associated with age, degree level, domestic/international status, accommodation type, relationship status and employment. DISCUSSION AND CONCLUSIONS The AUDIT-2* and the AUDIT-3 appear to be promising standalone screening items for detecting hazardous drinking in this population of heavy-drinking students. [Blank M-L, Connor J, Gray A, Tustin K. Screening for hazardous alcohol use among university students using individual questions from the Alcohol Use Disorders Identification Test-Consumption. Drug Alcohol Rev 2015;34:540-8].

Young adult susceptible non-smokers’ and smokers’ responses to capsule cigarettes

Background Flavour capsule cigarette variants (FCVs), which allow users to customise their smoking experience and reduce the harshness of smoking, have captured an increasing share of many markets. We examined tobacco companies’ argument that such product innovations aim simply to shift market share, by estimating smokers’ and susceptible non-smokers’ responses to FCVs. Methods We conducted an online survey of 425 smokers (daily and non-daily), susceptible non-smokers (n=224) and former smokers (n=166) aged between 18 and 25. Restrpondents completed a choice experiment, a behavioural probability measure and a perception task. We analysed the choice data using a conditional logistic regression and a rank-ordered logistic regression, and the probability and perception data using t-tests and descriptive statistics. Results Non-smokers preferred an FCV relative to an unflavoured cigarette, whereas the opposite was the case for smokers. Susceptible non-smokers and former smokers were more likely to try a fruit flavoured FCV than an unflavoured stick, while daily smokers were more likely than non-daily smokers to do the same. Susceptible non-smokers, former smokers and non-daily smokers also had more positive perceptions of FCVs relative to unflavoured sticks than did daily smokers. Conclusions FCVs appeal more to non-smokers than to smokers, and more to non-daily smokers than to daily smokers. They thus appear likely to recruit non-smokers and potentially increase overall smoking prevalence. Policy responses include ensuring standardised packaging legislation disallows FCVs by specifically regulating the appearance and design of tobacco products, or introducing bespoke regulation that addresses the threat posed by FCVs.

Layers of engagement: Staff perceptions of spiritual care in residential aged care

ABSTRACT Addressing the spiritual care needs of residents living in aged-care facilities should be an important dimension of quality care. We conducted semi-structured interviews with residential aged-care staff (including caregivers, nurses, managers, and chaplains) in New Zealand to explore how spiritual care is understood and operationalized. Many participants appeared to equate spiritual care with holistic care that respects the whole person. Participants discussed five types of spiritual care engagement requiring different skills, knowledge, and personal commitment, including information gathering, facilitation, companionship, end-of-life care, and counseling. Our findings suggest that the spiritual care that was offered by our participants, clergy and non-clergy alike, was predominantly informal and unplanned.

A qualitative exploration of information-seeking by electronic nicotine delivery systems (ENDS) users in New Zealand.

Objectives Given recent increases in awareness and uptake of electronic nicotine delivery systems (ENDS), we aimed to explore ENDS users’ information needs and search behaviours and whether information gaps exist. Design Qualitative study using semistructured interviews that probed participants’ smoking behaviours and ENDS use; data in this study examine ENDS information-seeking behaviours. We used qualitative description to analyse interview transcripts. Participants and setting We recruited 39 current ENDS users (20 dual users and 19 exclusive ENDS users who reported having previously smoked cigarettes regularly) aged 18 and over, from three urban centres in New Zealand. Results Several participants used Google to search for information on ENDS’ health effects, but described the material they retrieved as vague or contradictory. Some interpreted the absence of information on long-term health effects as evidence ENDS did not pose potential health risks, and several perceived e-liquids as benign. Many relied on information sourced from other ENDS users, gleaned from online forums, YouTube or from discussions with friends and acquaintances; these sources typically presented ENDS positively. Several participants found specialist ENDS retailers provided valuable advice; non-specialist store staff generally lacked detailed product knowledge and sometimes offered inaccurate information. Conclusion People seeking information on ENDS’ health effects are more likely to retrieve recommendations, product reviews and endorsements from online sources or through exchanges with other users, than they are to find scientific data. Health authorities could help meet potential users’ information needs by, first, creating and frequently updating objective lay summaries of the latest scientific evidence; second, by mandating licensing for retailers with guidelines to disclose uncertainty over ENDS’ efficacy for cessation and longer-term health effects, and the need for complete substitution of ENDS for combustible cigarettes among those who use these products.

Simvastatin dose and acute kidney injury without concurrent serious muscle injury: A nationwide nested case-control study

Background Inconsistent findings from four observational studies suggest that the risk of acute kidney injury (AKI) may increase with increasing statin dose or potency, but none of the studies took statin-related severe muscle injury, including rhabdomyolysis, into account. We undertook a nationwide nested case-control study in New Zealand to examine the risk of AKI without concurrent serious muscle injury according to simvastatin dose in two cohorts: people without a history of renal disease and people with non-dialysis dependent chronic kidney disease. Materials and methods A total of 334,710 people aged ≥ 18 years without a history of renal disease (cohort 1) and 5,437 with non-dialysis dependent chronic kidney disease (cohort 2) who initiated simvastatin therapy between 1 January 2006 and 31 December 2013 were identified using national pharmaceutical dispensing and hospital discharge data. Patients who developed AKI without concurrent serious muscle injury during follow-up (cases) were ascertained using hospital discharge and mortality data (n = 931 from cohort 1, n = 160 from cohort 2). Up to 10 controls per case, matched by date of birth, sex, and cohort entry date were randomly selected from the relevant cohort using risk set sampling. Results Relative to current use of 20mg simvastatin daily, the adjusted odds ratios and 95% confidence intervals (95% CI) in cohort 1 for current use of 40mg and 80mg were 0.9 (95% CI 0.7–1.2) and 1.3 (95% CI 0.7–2.3), respectively. The adjusted odds ratio for 40mg in cohort 2 was 1.1 (95% CI 0.7–1.9); the numbers taking 80mg were very small and the confidence interval was correspondingly wide. Conclusion The findings of this study suggest that a relationship between statin dose and AKI may not exist independent of serious muscle injury.