Jozica Kutin

Linkage of high-affinity IgE receptor gene with bronchial hyperreactivity, even in absence of atopy

Asthma is a manifestation of bronchial hyperreactivity (BHR) and forms part of the spectrum of atopic disease. Some pedigree studies of atopy have suggested linkage with the high-affinity IgE receptor (Fc epsilon RI beta) gene on chromosome 11q13, but others find no linkage. The molecular genetics of asthma and BHR have not been studied in the general population. We examined the genetic linkage of the Fc epsilon RI beta gene with clinical asthma and the underlying phenotypes of BHR (to methacholine) and atopy (defined by skinprick testing) in 123 affected sibling-pairs recruited from the general population. We found evidence of significant linkage of a highly polymorphic microsatellite marker in the fifth intron of the Fc epsilon RI beta gene to a diagnosis of asthma (18.0% excess of shared alleles, p = 0.002) and to BHR (21.7% excess of shared alleles, p = 0.001). Significant linkage was also observed in siblings sharing BHR when those with atopy were excluded (32.8% excess of shared alleles, p = 0.004). Atopy in the absence of BHR did not show significant linkage to the Fc epsilon RI beta gene (7.2% excess of shared alleles, p = 0.124). These findings suggest that mutations in the Fc epsilon RI beta gene or a closely linked gene influence the BHR underlying asthma, even in the absence of atopy.

Risk factors for asthma among young adults in Melbourne, Australia

Abstract Asthma is more prevalent in Australia than in Europe or North America. As part of the European Community Respiratory Health Survey (ECRHS), we investigated exposure to risk factors for asthma among young adults in Melbourne. During this study, 553 randomly selected and 204 symptomatic participants aged between 20 and 44 years completed a detailed respiratory questionnaire, of whom 675 underwent measurement of bronchial hyperreactivity (BHR) by methacholine challenge and 745 had skin prick tests for atopy. Current asthma, defined as BHR and wheeze in the preceding 12 months, was present in 25.5% of those tested. A family history of asthma was a risk factor for current asthma (maternal asthma odds ratio [OR] 2.4, paternal asthma OR 2.1). Current smokers were 1.7 times more likely to have current asthma. A serious respiratory infection before 5 years of age increased the risk of current asthma 2.3‐fold. Atopy on skin testing was also strongly associated with current asthma (OR 5.9). The greatest risks were associated with positive skin tests to Cladosporium, house dust mite, cat and rye grass pollen. We conclude that female gender, maternal asthma, smoking, hayfever, early respiratory infection, occupational exposure and atopy are important risk factors for asthma in young adults.

Implementing Buprenorphine Treatment in Community Settings in Australia: Experiences from the Buprenorphine Implementation Trial

Buprenorphine was registered in Australia as a maintenance and detoxification agent for the management of opioid dependence in November, 2000, and became widely available in August, 2001. This paper provides an overview of key developments in the introduction of buprenorphine treatment in Australia, with an emphasis upon the delivery of services in community-based (primary care) settings. A central study in this work was the Buprenorphine Implementation Trial (BIT), a randomized, controlled trial comparing buprenorphine and methadone maintenance treatment delivered under naturalistic conditions by specialist and community-based service providers (general practitioners and community pharmacists) in 139 subjects across nineteen treatment sites. In addition to conventional patient outcome measures (treatment retention, drug use, psychosocial functioning, and cost effectiveness), the BIT study also involved the development and evaluation of clinical guidelines, training programs for clinicians, and client literature, which are described here. Integration of treatment systems (methadone with buprenorphine, specialist and primary-care programs) and factors thought to be important in the uptake of buprenorphine treatment in Australia since registration are discussed.

A Placebo‐controlled study of three clonidine doses for smoking cessation

Clonidine in doses of 150 to 450 μg per day has been reported to reduce symptoms of craving associated with tobacco withdrawal and, in some cases, to improve long‐term abstinence rates of smoking cessation programs. However, subjects frequently experienced symptoms of dry mouth and drowsiness. This study investigated the lower end of the effective dose range of clonidine for smoking cessation to identify the lowest useful dose and thus minimize the adverse effects of the drug.

The prevalence of asthma and respiratory symptoms among young adults : Is it increasing in Australia ?

The objective of this study was to determine the prevalence of self-reported asthma and respiratory symptoms among young adults and whether there had been any change since a previous survey. A cross-sectional postal community survey was conducted in three parliamentary electorates in the inner South East region of Melbourne, Australia. A total of 4500 individuals aged between 20 and 44 years were randomly selected from the electoral roll. After three mailings and telephone follow-up, an adjusted response rate of 79% was achieved. No intervention was performed. Self-reported asthma and respiratory symptoms were recorded from the European Community Respiratory Health Survey screening questionnaire. Respondents were most likely to report nasal allergies (41%), nocturnal cough (28.6%), and wheeze in the last 12 months (28.1%). Nocturnal cough was more common in females than males. The prevalence of wheeze, nocturnal chest tightness, and use of asthma medications decreased with age. An attack of asthma in the last 12 months was reported by 9.7% of young adults, and this fell to 8.2% after correction for nonresponse bias. The prevalence of current asthma had not increased significantly since a previous postal survey in 1990. However the prevalence of nocturnal chest tightness, nocturnal cough, and use of asthma medications had increased significantly over a 2-year period. Further research is required to investigate why asthma is so prevalent in Australia and why some features are increasing in prevalence.

Allergies, Upper Respiratory Tract Infections, and Asthma

The aims of this study were (1) to quantify the prevalence of aeroallergen hypersensitivity in presentations for emergency treatment of asthma and (2) to determine the strength of association between viral upper respiratory tract infections (URTIs) and admission for treatment of asthma. A series of 209 asthmatic patients presenting to the Emergency Department (ED) of the Alfred Hospital over 6 months underwent skin prick testing and venipuncture for serum IgE and rye grass pollen (RGP) RAST. A case-control study of 38 asthmatic inpatients and 90 controls admitted for road trauma or endoscopy underwent nasopharyngeal aspiration for viral culture and immunofluorescence (IF). Eighty-four percent of ED asthmatic patients had one or more positive skin tests to common aeroallergens, 57% had a positive skin test, and 45% had a positive RAST to RGP. Viral cultures or IF studies were positive in 8 asthmatic patients and 2 controls. Asthmatic inpatients were 6 times more likely to have a viral URTI than were controls. It is concluded that aeroallergen hypersensitivity is present in most asthmatic patients presenting to the ED, and that there is a strong association between viral URTIs and admission for asthma.

Economic abuse between intimate partners in Australia: prevalence, health status, disability and financial stress

Objective: Economic abuse is a form of domestic violence that has a significant impact on the health and financial wellbeing of victims, but is understudied. This study determined the lifetime prevalence of economic abuse in Australia by age and gender, and the associated risk factors.

Risk profiles for early adolescents who regularly use alcohol and other drugs compared with older youth

This mixed method article identifies how risk factors differ across the age range serviced by Australian youth alcohol and other drug (AOD) agencies. It is intended to inform the development of interventions targeting early adolescents aged 13–15 years. Focusing on survey variables concerning substance choice and identified risk factors for problematic AOD, we compare the characteristics of early adolescents against older youth aged 16–19 and 20–24 years within a sample of regular substance users (N = 163). Qualitative information from interviews with an additional group of regular substance users aged 13–15 is used to interpret survey findings (N = 20). Participants in both studies reported substance use at least monthly during the previous 6 months, were directly or indirectly connected with an AOD or welfare service and were interviewed in Victoria, Australia. Early adolescents in the survey were more likely than older participants to use alcohol and cannabis and less likely to use heroin as primary or secondary drugs of choice. They were less likely to be homeless, have been incarcerated, reported depression or being substance affected regularly during their last year of school. They were more likely to be connected with a network of close friends, but were also more likely to have recently committed property crime and begged. Similarly, high proportions across all three age groups reported school suspension and expulsion, being charged with a crime, selling drugs, attempting suicide and self-harm. In interviews, early adolescents argued that they wanted sustained relationships with reliable adults who would help them with issues of concern to them such as sadness, boredom, family conflict, housing insecurity and difficulty engaging in education or other day programmes, rather than giving primary attention to their AOD use. The study provides evidence for a targeted approach to working with early adolescents and the need for further research in this area.

Fast-tracking implementation through trial design: the case of buprenorphine treatment in Victoria

Objectives : We investigated how a randomised controlled trial (RCT) could be designed to incorporate features known or thought likely to enhance the uptake of the new treatment into clinical practice post‐trial.

Strike a Light; This Match Didn't Work! Evaluation of the Victorian Community Based Corrections Treatment and Testing Policy: Does Matching to Treatment Improve Outcomes?

The Victorian Department of Justice, between 1994 and 1996, had a policy of matching offenders sentenced to a community based order, who had problems assessed as arising from drug/alcohol use, to drug and alcohol treatment. In part the policy was grounded in the stages of change model of addictive behaviour and motivation developed by Prochaska and DiClemente (1986). The treatment was to be based on the offenders classification of risk of re-offending and motivation to change behaviour. This research was designed to test whether matching would yield better outcomes in terms of alcohol and drug use, rates of re-offending, order completion and levels of psychosocial functioning. A retrospective analysis of offender records in which there were two groups (matched and unmatched) and two testing times was used (order commencement and order completion). The study sample was recruited between August 1, 1996, and June 30, 1997. Analysis of data generated from a total sample of 358 offender files found that matching offenders to treatment based on risk of re-offending and motivation to change behaviour was not a significant factor in determining outcomes. However, matching to treatment did have a small effect on recidivism as measured by new arrests occurring during the order.