%0 Journal Article
%~ PubMed
%A Taylor, Lee
%A Hutchinson, Delyse
%A Rapee, Ron
%A Burns, Lucy
%A Stephens, Christine
%A Haber, Paul S
%T Clinical features and correlates of outcomes for high-risk, marginalized mothers and newborn infants engaged with a specialist perinatal and family drug health service.
%B Obstetrics and Gynecology International
%D 2012
%C United States
%I Hindawi Publishing Corporation
%V 2012
%N 
%P 867265
%@ 1687-9597
%X 
%Z FOR Codes: 111402 110399


%0 Journal Article
%~ PubMed
%A Deacon, Rachel M
%A Topp, Libby
%A Wand, Handan
%A Day, Carolyn A
%A Rodgers, Craig
%A Haber, Paul S
%A van Beek, Ingrid
%A Maher, Lisa
%T Correlates of Susceptibility to Hepatitis B among People Who Inject Drugs in Sydney, Australia.
%B Journal of Urban Health
%D 2012
%C United States
%I Springer New York LLC
%V 89
%N 5
%P 769-778
%@ 1468-2869
%X Despite a safe, effective vaccine, hepatitis B virus (HBV) vaccination coverage remains low among people who inject drugs (PWID). Characteristics of participants screened for a trial investigating the efficacy of financial incentives in increasing vaccination completion among PWID were examined to inform targeting of vaccination programs. Recruitment occurred at two health services in inner-city Sydney that target PWID. HBV status was confirmed via serological testing, and questionnaires elicited demographic, drug use, and HBV risk data. Multinomial logistic regression was utilized to determine variables independently associated with HBV status. Of 172 participants, 64% were susceptible, 17% exposed (HBV core antibody-positive), and 19% demonstrated evidence of prior vaccination (HBV surface antibody?????????10??mIU/ml). Compared with exposed participants, susceptible participants were significantly more likely to be aged less than 35??years and significantly less likely to be receiving current opioid substitution therapy (OST) and to test hepatitis C antibody-positive. In comparison to vaccinated participants, susceptible participants were significantly more likely to be male and significantly less likely to report daily or more frequent injecting, current OST, and prior awareness of HBV vaccine. HBV vaccination uptake could potentially be increased by targeting younger, less frequent injectors, particularly young men. In addition to expanding vaccination through OST, targeting "at risk" youth who are likely to have missed adolescent catch-up programs may be an important strategy to increase coverage. The lack of an association between incarceration and vaccination also suggests increasing vaccination uptake and completion in adult and juvenile correctional facilities may also be important.
%Z FOR Codes: 111799 60506 1116


%0 Journal Article
%A Schwarz, B
%A Haber, Paul
%T Detection and management of problem drinking in general practice
%B Medicine Today
%D 2012
%C Australia
%I Medicine Today Pty. Ltd.
%V 13
%N 7
%P 44-52
%@ 1443-430X
%X 
%Z FOR Codes: 110399


%0 Journal Article
%~ PubMed
%A Gidding, Heather F
%A Law, Matthew G
%A Amin, Janaki
%A Ostapowicz, George
%A Weltman, Martin
%A Macdonald, Graeme A
%A Sasadeusz, Joe J
%A Haber, Paul Aw
%A George, Jacob
%A Dore, Gregory J
%T Hepatitis C treatment outcomes in Australian clinics.
%B Medical Journal of Australia
%D 2012
%C Australia
%I Australasian Medical Publishing Company Pty. Ltd.
%V 196
%N 10
%P 633-637
%@ 1326-5377
%X To determine hepatitis C (HCV) treatment effectiveness and predictors of response in the "real-world" Australian clinic setting.
%Z FOR Codes: 110309


%0 Journal Article
%~ PubMed
%A Alavi, Maryam
%A Grebely, Jason
%A Matthews, Gail V
%A Petoumenos, Kathy
%A Yeung, Barbara
%A Day, Carolyn
%A Lloyd, Andrew R
%A Van Beek, Ingrid
%A Kaldor, John M
%A Hellard, Margaret
%A Dore, Gregory J
%A Haber, Paul S
%A , on behalf of the ATAHC Study Group
%T Impact of pegylated interferon alfa-2a treatment on mental health during recent hepatitis C virus infection.
%B Journal of Gastroenterology and Hepatology
%D 2012
%C Australia, Japan, Hong Kong
%I Wiley-Blackwell Publishing Asia
%V 27
%N 5
%P 957-965
%@ 0815-9319
%X Background: Pegylated interferon (PEG-IFN) treatment for hepatitis C virus (HCV) infection has neuropsychiatric side effects. Data on the impact of HCV treatment on mental health among injecting drug users (IDUs) are limited. We assessed mental health during treatment of recently acquired HCV, within a predominantly IDU population. Methods: Participants with HCV received PEG-IFN ??-2a (180??g/week) for 24 weeks; HCV/HIV received PEG-IFN with ribavirin. Depression was assessed using the Mini-International Neuropsychiatric Interview (MINI). Logistic regression was used to identify factors associated with depression at enrolment and during treatment. Also, the impact of depression prior to and during treatment on SVR was assessed. Results: Of 163 participants, 111 received treatment (HCV, n = 74; HCV/HIV, n = 37), with 76% ever reporting IDU. At enrolment, 16% had depression (n = 25). In adjusted analysis, depression at enrolment occurred less often in participants full-/part-time employed (AOR 0.23; 95% CI: 0.06, 0.82, P = 0.023) and more often in recent IDUs (AOR 3.04; 95% CI: 1.19, 7.72, P = 0.019). During treatment, 35% (n = 31) developed new-onset depression. In adjusted analysis, poorer social functioning (higher score) was associated with new-onset depression (score < 9 vs. score > 17; OR 5.69; 95% CI: 1.61, 20.14, P= 0.007). SVR was similar among participants with and without depression at enrolment (60% vs. 61%, P= 0.951) and in those with and without new-onset depression (74% vs. 63%, P= 0.293). Conclusions: Although depression at enrolment and during treatment was common among participants with recent HCV, neither impacted SVR. Participants with poor social functioning may be most at risk of developing depression during HCV therapy.
%Z FOR Codes: 110307 170101


%0 Journal Article
%~ PubMed
%A Day, Carolyn A
%A Demirkol, Apo
%A Tynan, Maggie
%A Curry, Kenneth
%A Hines, Susan
%A Lintzeris, Nick
%A Haber, Paul S
%T Individual versus team-based case-management for clients of opioid treatment services: An initial evaluation of what clients prefer.
%B Drug and Alcohol Review
%D 2012
%C United Kingdom, Australia
%I Wiley-Blackwell Publishing Ltd.
%V 31
%N 4
%P 499-506
%@ 0959-5236
%X Introduction and Aims. Case-management is a client-centred intervention to improve the coordination and continuity of delivery of services for people with complex needs. This service has been incorporated into opioid treatment programs in various ways. This study was undertaken to compare two case-management models, termed individual case-management (ICM) and team-based case-management (TBCM). This study aims to describe the new TBCM and client attitudes to, and acceptance of, this model compared with ICM. Design and Methods. Clients from two opioid treatment programs, one implementing ICM and one implementing the TBCM, were recruited to undertake a self-complete survey examining satisfaction with case-management during dosing hours over 7???months. Surveys took approximately 10???min to complete. Results. One hundred and sixty-three clients were surveyed (62 ICM, 101 TBCM). Clients were demographically similar, but differed in terms of treatment and drug use characteristics. Significantly higher ratings of case-management were reported from TBCM compared with ICM clients for help with opiate use (P???<???0.001), other drug use (P???<???0.001), mental health (P???<???0.001), accommodation (P???=???0.023), relationships/parenting (P???=???0.003) and physical health (P???=???0.002) and clinic services in terms of fairness and consistency, safety, respect, staff quality and confidentiality (P???<???0.001). Compared with ICM clients, TBCM clients were more likely to report ease of access to case-management (P???<???0.001), wait significantly less time to see a case-manager (38% vs. 7% seen same day) and 93% and 47% of clients, respectively, reported satisfaction with treatment (P???<???0.001). Discussion and Conclusions. These initial data indicate client acceptance and satisfaction with the TBCM model. Further evaluation of the model, including cost-effectiveness, is warranted.[Day CA, Demirkol A, Tynan M, Curry K, Hines S, Lintzeris N, Haber PS. Individual versus team-based case-management for clients of opioid treatment services: An initial evaluation of what clients prefer. Drug Alcohol Rev 2011].
%Z FOR Codes: 110319 111709


%0 Journal Article
%~ PubMed
%A Islam, M Mofizul
%A Topp, Libby
%A Conigrave, Katherine M
%A White, Ann
%A Reid, Sharon E
%A Grummett, Sara
%A Haber, Paul S
%A Day, Carolyn A
%T Linkage into specialist hepatitis C treatment services of injecting drug users attending a needle syringe program-based primary healthcare centre.
%B Journal of Substance Abuse Treatment
%D 2012
%C United States
%I Elsevier Inc.
%V 43
%N 4
%P 440-445
%@ 1873-6483
%X Injecting drug users (IDUs), the key risk population for hepatitis C virus (HCV) infection, constitute just a small proportion of HCV treatment clients. This study describes an HCV treatment assessment model developed by an inner-city IDU-targeted primary healthcare (PHC) facility and, using a retrospective clinical audit, documents predictors of successful referrals to a tertiary liver clinic. Between July 2006-December 2010, 479 clients attended the PHC, of whom 353 (74%) were screened for HCV antibody. Sixty percent (212/353) tested positive, of whom 93% (197/212) were screened for HCV-RNA with 73% (143/197) positive. Referrals to a tertiary liver clinic were provided to 96 clients, of whom 68 (71%) attended. Eleven clients commenced antiviral therapy (AVT), with seven achieving sustained virological responses by December 2010. Clients who had not recently injected drugs and those with elevated ALT levels were more likely to attend the referrals, while those not prescribed psychiatric medications were more likely to commence AVT. The relatively high uptake of referrals, the number of individuals commencing AVT and final treatment outcomes are reasonably encouraging, highlighting the potential of targeted PHC services to facilitate reductions in liver disease burden among IDUs.
%Z FOR Codes: 111002 111717 111708


%0 Journal Article
%~ PubMed
%A Black, Kirsten I
%A Haber, Paul S
%A Lintzeris, Nicholas
%T Offering incentives to drug-using women to take up contraception: The ethical and clinical issues
%B Addiction
%D 2012
%C United Kingdom
%I Wiley-Blackwell Publishing Ltd.
%V 107
%N 7
%P 1361-1362
%@ 1360-0443
%X 
%Z FOR Codes: 111799 111402


%0 Journal Article
%~ PubMed
%A Islam, M Mofizul
%A Reid, Sharon E
%A White, Ann
%A Grummett, Sara
%A Conigrave, Katherine M
%A Haber, Paul S
%T Opportunistic and continuing health care for injecting drug users from a nurse-run needle syringe program-based primary health-care clinic.
%B Drug and Alcohol Review
%D 2012
%C United Kingdom
%I Wiley-Blackwell Publishing Ltd.
%V 31
%N 1
%P 114-115
%@ 0959-5236
%X 
%Z FOR Codes: 111799 110309 111717


%0 Journal Article
%A Morley, Kirsten
%A Haber, Paul
%A Morgan, Madeleine L
%A Samara, Fares
%T Pericyazine in the treatment of cannabis dependence in general practice: a naturalistic
pilot trial
%B Substance Abuse and Rehabilitation
%D 2012
%C United Kingdom
%I Dove Medical Press Ltd.
%V 3
%N 
%P 43-47
%@ 1179-8467
%X 
%Z FOR Codes: 111502 111717


%0 Journal Article
%~ PubMed
%A Black, Kirsten I
%A Stephens, Christine
%A Haber, Paul S
%A Lintzeris, Nicholas
%T Unplanned pregnancy and contraceptive use in women attending drug treatment services.
%B The Australian & New Zealand Journal of Obstetrics & Gynaecology
%D 2012
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 52
%N 2
%P 146-150
%@ 1479-828X
%X At an international level, there are calls for a greater focus on women and harm reduction in recognition that female drug users have a unique set of issues that are not routinely assessed in drug treatment programs.
%Z FOR Codes: 111799 111402


%0 Journal Article
%~ PubMed
%A Islam, M Mofizul
%A Grummett, Sarah
%A White, Ann
%A Reid, Sharon E
%A Day, Carolyn A
%A Haber, Paul S
%T A primary healthcare clinic in a needle syringe program may contribute to HIV prevention by early detection of incident HIV in an injecting drug user.
%B Australian and New Zealand Journal of Public Health
%D 2011
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 35
%N 3
%P 294-295
%@ 1326-0200
%X 
%Z FOR Codes: 111717 110309


%0 Journal Article
%~ PubMed
%A Grebely, Jason
%A Matthews, Gail V
%A Hellard, Margaret
%A Shaw, David
%A van Beek, Ingrid
%A Petoumenos, Kathy
%A Alavi, Maryam
%A Yeung, Barbara
%A Haber, Paul S
%A Lloyd, Andrew R
%A Kaldor, John M
%A Dore, Gregory J
%A , for the ATAHC Study Group
%T Adherence to treatment for recently acquired hepatitis C virus (HCV) infection among injecting drug users.
%B Journal of hepatology
%D 2011
%C Netherlands, Denmark
%I Elsevier BV
%V 55
%N 1
%P 76-85
%@ 0168-8278
%X Adherence to HCV therapy impacts sustained virological response (SVR) but there are limited data on adherence, particularly among injecting drug users (IDUs). We assessed 80/80 adherence (???80% of PEG-IFN doses, ???80% treatment), on-treatment adherence, and treatment completion in a study of treatment of recent HCV infection (ATAHC).
%Z FOR Codes: 110309 110307 1103


%0 Journal Article
%~ PubMed
%A Day, Carolyn A
%A Islam, M Mofizul
%A White, Ann
%A Reid, Sharon E
%A Hayes, Stephen
%A Haber, Paul S
%T Development of a nurse-led primary healthcare service for injecting drug users in inner-city Sydney.
%B Australian Journal of Primary Health
%D 2011
%C Australia
%I CSIRO Publishing
%V 17
%N 1
%P 10-15
%@ 1448-7527
%X Injecting drug users (IDUs) experience numerous health problems, but report barriers to utilising general practitioners (GPs). A nurse-led Harm Minimisation-based Primary Healthcare (HMPH) service for IDUs was established within a needle and syringe program in inner-city Sydney with Area Health Service medical support and clinical governance. This paper aimed to describe the HMPH service, review service utilisation and assess nurses'' perceptions of their work with IDUs. A review of the most recent 200 clinic files was undertaken. Service utilisation, GP and other health service use and access were extracted and analysed using SPSS. A semi-structured qualitative interview with clinic nurses regarding their experience working with IDUs and local GPs was conducted and analysed. Since its inception in mid-2006, the service has been utilised by 417 clients. Of the most recent 200 files, blood-borne virus and sexually transmitted infection screening were the primary reason for presentation (64.5%). At least one follow-up visit was attended by 90% of clients. A total of 62% of clients reported consulting a GP in the last 12 months. The service provided 102 referrals. Nurses believed that IDUs tend to utilise GPs ineffectively and that self-care is a low priority, but that they can support IDUs to overcome some barriers to GPs and facilitate access. Targeted primary health care services led by nurses with focussed medical support and co-located with needle and syringe programs can fill an important gap in delivering and facilitating health care to IDUs.
%Z FOR Codes: 111717 1117


%0 Book Section
%A Haber, Paul
%T Gastrointestinal disorders related to alcohol and other drug use
%B Principles of Addiction Medicine: The Essentials
%D 2011
%C United States
%I Lippincott Williams & Wilkins
%V 
%N 
%P 0
%@ 9781605477763
%E Cavacuiti, Christopher A.
%X 
%Z FOR Codes: 110307


%0 Journal Article
%~ PubMed
%A Haber, Paul S
%T International perspectives in postgraduate medical training in addiction medicine.
%B Substance Abuse
%D 2011
%C United States
%I Routledge
%V 32
%N 2
%P 75-76
%@ 1547-0164
%X 
%Z FOR Codes: 130209 110399 111799


%0 Book Section
%A Haber, Paul
%A Batey, Robert
%T Liver disorders related to alcohol and other drug use
%B Principles of Addiction Medicine: The Essentials
%D 2011
%C United States
%I Lippincott Williams & Wilkins
%V 
%N 
%P 0
%@ 9781605477763
%E Cavacuiti, Christopher A.
%X 
%Z FOR Codes: 110307


%0 Journal Article
%~ PubMed
%A Seth, Devanshi
%A Haber, Paul S
%A Syn, Win-Kin
%A Diehl, Anna Mae
%A Day, Christopher P
%T Pathogenesis of Alcohol-induced Liver Disease - classical concepts and recent advances.
%B Journal of gastroenterology and hepatology
%D 2011
%C Australia, Japan, Hong Kong
%I Wiley-Blackwell Publishing Asia
%V 26
%N 7
%P 1089-105
%@ 0815-9319
%X Alcoholic liver disease (ALD) is a primary consequence of heavy and prolonged drinking. ALD contributes to the bulk of liver disease burden worldwide. Progression of ALD is a multifactorial and multistep process that includes many genetic and environmental risk factors. The molecular pathogenesis of ALD involves alcohol metabolism and secondary mechanisms such as oxidative stress, endotoxin, cytokines and immune regulators. The histopathological manifestation of ALD occurs as an outcome of complex but controlled interactions between hepatic cell types. Hepatic stellate cells (HSCs) are the key drivers of fibrogenesis, but transformation of hepatocytes to myofibroblastoids also implicate parenchymal cells as playing an active role in hepatic fibrogenesis. Recent discoveries indicate that lipogenesis during the early stages of ALD is a risk for advancement to cirrhosis. Other recently identified novel molecules and physiological/cell signaling pathways include fibrinolysis, osteopontin, transforming growth factor-??-SMAD and hedgehog signaling, and involvement of novel cytokines in hepatic fibrogenesis. The observation that ALD and non-alcoholic steatohepatitis share common pathways and genetic polymorphisms suggests operation of parallel pathogenic mechanisms. Future research involving genomics, epigenomics, deep sequencing and non-coding regulatory elements holds promise to identify novel diagnostic and therapeutic targets for ALD. There is also a need for adequate animal models to study pathogenic mechanisms at the molecular level and targeted therapy.
%Z FOR Codes: 110307 111506


%0 Journal Article
%~ PubMed
%A Demirkol, Apo
%A Haber, Paul
%A Conigrave, Katherine
%T Problem drinking - detection and assessment in general practice.
%B Australian Family Physician
%D 2011
%C Australia
%I Royal Australian College of General Practitioners
%V 40
%N 8
%P 570-574
%@ 0300-8495
%X BACKGROUND Alcohol has long been an integral part of the social life of many Australians. However, alcohol is associated with significant harm to drinkers, and also to nondrinkers. OBJECTIVE This article explores the role of the general practitioner in the detection and assessment of problem drinking. DISCUSSION Excessive alcohol use is a major public health problem and the majority of people who drink excessively go undetected. General practitioners are in a good position to detect excessive alcohol consumption; earlier intervention can help improve outcomes. AUDIT-C is an effective screening tool for the detection of problem drinking. National Health and Medical Research Council guidelines suggest that no more than two standard drinks on each occasion will keep lifetime risk of death from alcohol related disease or injury at a low level. Once an alcohol problem is detected it is important to assess for alcohol dependence, other substance use, motivation to change, psychiatric comorbidities and examination and investigation findings that may be associated with excessive alcohol use. A comprehensive assessment of the impact and risk of harm of the patient''s drinking to themselves and others is vital, and may require several consultations.
%Z FOR Codes: 1103


%0 Journal Article
%~ PubMed
%A Demirkol, Apo
%A Conigrave, Katherine
%A Haber, Paul
%T Problem drinking - management in general practice.
%B Australian Family Physician
%D 2011
%C Australia
%I Royal Australian College of General Practitioners
%V 40
%N 8
%P 576-582
%@ 0300-8495
%X BACKGROUND Management of problem drinking presents the general practitioner with similar challenges and rewards to those associated with the management of other chronic conditions. OBJECTIVE This article presents a framework for managing alcohol problems in general practice based on national guidelines for the treatment of alcohol problems. DISCUSSION General practitioners are well placed to undertake the management of drinking problems following an assessment of the amount of alcohol taken and the risks this poses for the individual and the people around them. This assessment starts the process of engagement and reflection on drinking habits and will inform the appropriate management approach. Brief interventions can result in reduction in drinking in nondependent drinkers. For dependent drinkers, treatment steps include assessing need for withdrawal management and developing a comprehensive management plan, which includes consideration of relapse prevention pharmacotherapy and psychosocial interventions. The patient''s right to choose what they drink must be respected, and those who continue to drink in a problematic way can still be assisted, with compassion, within a harm reduction framework.
%Z FOR Codes: 1117


%0 Journal Article
%~ PubMed
%A Burns, Lucy
%A Conroy, Elizabeth
%A Moore, Elizabeth A
%A Hutchinson, Delyse
%A Haber, Paul S
%T Psychosocial characteristics and obstetric health of women attending a specialist substance use antenatal clinic in a large metropolitan hospital.
%B International Journal of Pediatrics
%D 2011
%C United States
%I Hindawi Publishing Corporation
%V 2011
%N 
%P 729237
%@ 1687-9759
%X Objective. This paper reports the findings comparing the obstetrical health, antenatal care, and psychosocial characteristics of pregnant women with a known history of substance dependence (n = 41) and a comparison group of pregnant women attending a general antenatal clinic (n = 47). Method. Face-to-face interviews were used to assess obstetrical health, antenatal care, physical and mental functioning, substance use, and exposure to violence. Results. The substance-dependent group had more difficulty accessing antenatal care and reported more obstetrical health complications during pregnancy. Women in the substance-dependent group were more likely to report not wanting to become pregnant and were less likely to report using birth control at the time of conception. Conclusions. The profile of pregnant women (in specialised antenatal care for substance dependence) is one of severe disadvantage and poor health. The challenge is to develop and resource innovative and effective multisectoral systems to educate women and provide effective care for both women and infants.
%Z FOR Codes: 110399 111402 111799


%0 Journal Article
%~ PubMed
%A Haber, Paul S
%A Murnion, Bridin P
%T Training in addiction medicine in australia.
%B Substance Abuse
%D 2011
%C United States
%I Routledge
%V 32
%N 2
%P 115-119
%@ 1547-0164
%X Barriers to entering addiction medicine (AM) have led to a persisting workforce shortage. To address this problem, the Chapter of Addiction Medicine (AChAM) was formed in 2001 as a subdivision of the Royal Australasian College of Physicians (RACP). Through consultation, AChAM has identified the scope of practice and offered fellowship to suitable established practitioners. The Chapter successfully applied to the Australian Government for recognition of AM as a medical specialty, which was finalized in November 2009. Specialist reimbursement item numbers were incorporated into that decision process and commence operating in November 2010. AChAM has designed and implemented a training scheme using a model similar to that of the RACP internal medicine training program. This comprises 3 years of basic general medical training post internship followed by 3 years of discipline-specific supervised training. The training is broadly based, with experience in both ambulatory care and inpatient care, and including physical health as well as mental health. Assessment is continuous and competency based. There is no exit examination. The overriding clinical approach rests upon the harm minimization framework consistent with long-established national drug policy in Australia and favors evidence-based treatment.
%Z FOR Codes: 110399 111799


%0 Journal Article
%~ PubMed
%A Lipworth, Wendy L
%A Wodak, Alex D
%A Haber, Paul S
%A Day, Richard O
%T Why is disulfiram not on the PBS?
%B The Medical journal of Australia
%D 2011
%C Australia
%I Australasian Medical Publishing Company Pty. Ltd.
%V 195
%N 7
%P 371-2
%@ 1326-5377
%X High public interest does not guarantee affordability.
%Z FOR Codes: 111799 110399


%0 Journal Article
%~ PubMed
%A Seth, Devanshi
%A D'Souza El-Guindy, Nympha B
%A Apte, Minoti
%A Mari, Montserrat
%A Dooley, Steven
%A Neuman, Manuela
%A Haber, Paul S
%A Kundu, Gopal C
%A Darwanto, Agus
%A de Villiers, Willem J
%A Vonlaufen, A
%A Xu, Z
%A Phillips, P
%A Yang, S
%A Goldstein, D
%A Pirola, R M
%A Wilson, J S
%A Moles, Anna
%A Fernández, Anna
%A Colell, Anna
%A García-Ruiz, Carmen
%A Fernández-Checa, José C
%A Meyer, Christoph
%A Meindl-Beinker, Nadja M
%T Alcohol, Signaling, and ECM Turnover.
%B Alcoholism, clinical and experimental research
%D 2010
%C United States
%I Wiley-Blackwell Publishing, Inc.
%V 34
%N 1
%P 4-18
%@ 1530-0277
%X Alcohol is recognized as a direct hepatotoxin, but the precise molecular pathways that are important for the initiation and progression of alcohol-induced tissue injury are not completely understood. The current understanding of alcohol toxicity to organs suggests that alcohol initiates injury by generation of oxidative and nonoxidative ethanol metabolites and via translocation of gut-derived endotoxin. These processes lead to cellular injury and stimulation of the inflammatory responses mediated through a variety of molecules. With continuing alcohol abuse, the injury progresses through impairment of tissue regeneration and extracellular matrix (ECM) turnover, leading to fibrogenesis and cirrhosis. Several cell types are involved in this process, the predominant being stellate cells, macrophages, and parenchymal cells. In response to alcohol, growth factors and cytokines activate many signaling cascades that regulate fibrogenesis. This mini-review brings together research focusing on the underlying mechanisms of alcohol-mediated injury in a number of organs. It highlights the various processes and molecules that are likely involved in inflammation, immune modulation, susceptibility to infection, ECM turnover and fibrogenesis in the liver, pancreas, and lung triggered by alcohol abuse.
%Z FOR Codes: 111799


%0 Journal Article
%~ PubMed
%A Morley, Kirsten C
%A Teesson, Maree
%A Sannibale, Claudia
%A Baillie, Andrew
%A Haber, Paul S
%T Clinical Predictors of Outcome from an Australian Pharmacological Relapse Prevention Trial.
%B Alcohol and alcoholism (Oxford, Oxfordshire)
%D 2010
%C United Kingdom
%I Oxford University Press
%V 45
%N 
%P 520-6
%@ 1464-3502
%X To assess which baseline characteristics of patients predict response to treatment with acamprosate (ACAMP) and naltrexone (NTX) in alcohol dependence.
%Z FOR Codes: 1701


%0 Journal Article
%~ PubMed
%A Dore, Gregory J
%A Hellard, M
%A Matthews, G
%A Grebely, J
%A Haber, P S
%A Petoumenos, K
%A Yeung, B
%A Marks, P
%A van Beek, I
%A McCaughan, G
%A White, P
%A French, R
%A Rawlinson, W
%A Lloyd, A R
%A Kaldor, J M
%A , Australian Trial In Acute Hepatitis C Study Group
%T Effective Treatment of Injecting Drug Users With Recently Acquired Hepatitis C Virus Infection.
%B Gastroenterology
%D 2010
%C United States
%I WB Saunders Co.
%V 138
%N 1
%P 123-35.e1-2
%@ 0016-5085
%X Patients with acute hepatitis C virus (HCV) infection who receive treatment achieve high rates of sustained virologic response (SVR), but few studies have examined outcomes among injecting drug users (IDUs). We evaluated the efficacy of treatment of recent HCV infection in IDUs with acute and early chronic HCV.
%Z FOR Codes: 110307 110309


%0 Journal Article
%~ PubMed
%A Boonwaat, Leng
%A Haber, Paul S
%A Levy, Michael H
%A Lloyd, Andrew R
%T Establishment of a successful assessment and treatment service for Australian prison inmates with chronic hepatitis C.
%B The Medical Journal of Australia
%D 2010
%C Australia
%I Australasian Medical Publishing Company Pty. Ltd.
%V 192
%N 9
%P 496-500
%@ 0025-729X
%X OBJECTIVE: To evaluate the assessment and treatment outcomes of a prison hepatitis service. DESIGN AND SETTING: A retrospective, observational cohort study of prison inmates who attended hepatitis clinics from 1996 to 2005 at correctional centres in New South Wales. PATIENTS: Inmates who attended the clinics, including a nested case-control series of patients who received antiviral treatment and age- and sex-matched patients who did not receive treatment. MAIN OUTCOME MEASURES: Demographic and clinical characteristics of patients who attended the service; correlates of selection for antiviral treatment; and clinical and virological outcomes of treatment. RESULTS: Of the 1043 inmates who attended the clinics, 851 were men (82%) and 994 (95%) were referred for HCV infection; the mean age for this group was 33 years (range, 18-74 years). In the case-control series (185 treated and 186 untreated patients), selection for treatment was not biased by culturally and linguistically diverse background, current methadone treatment or psychiatric status. In the treated group, 76 of 138 genotyped patients had a genotype that is predictive of favourable treatment response, and a small minority of those with available liver biopsy results had established cirrhosis (7/119 patients). Of treated patients for whom complete follow-up data were available, 55% achieved sustained virological response and 100% adhered to therapy. In addition, treatment episodes were not especially complicated. CONCLUSION: Although the prison population has high rates of injecting drug use and poor mental health, imprisonment offers an opportunity for assessment and treatment of chronic HCV infection.
%Z FOR Codes: 110307 110309


%0 Journal Article
%~ PubMed
%A Grebely, J
%A Petoumenos, K
%A Matthews, G V
%A Haber, P
%A Marks, P
%A Lloyd, A R
%A Kaldor, J M
%A Dore, G J
%A Hellard, M
%A , for the ATAHC Study Group
%T Factors associated with uptake of treatment for recent hepatitis C virus infection in a predominantly injecting drug user cohort: The ATAHC Study.
%B Drug and alcohol dependence
%D 2010
%C Ireland
%I Elsevier Ireland Ltd
%V 107
%N 2-3
%P 244-9
%@ 1879-0046
%X Despite that the majority of hepatitis C virus (HCV) infection occurs among injection drug users (IDUs), little is known about HCV treatment uptake in this group, particularly during recent infection. We evaluated uptake of treatment for recent HCV infection, including associated factors, within a population predominantly made up of IDUs. The Australian Trial in Acute Hepatitis C was a study of the natural history and treatment of recent HCV infection. All participants with detectable HCV RNA at screening were offered HCV treatment, assessed for eligibility and those initiating treatment were identified. Logistic regression analyses were used to identify predictors of HCV treatment uptake. Between June 2004 and February 2008, 163 were enrolled, with 146 positive for HCV RNA at enrolment. The mean age was 35 years, 77% (n=113) participants had ever injected illicit drugs and 23% (n=34) reported having ever received methadone or buprenorphine treatment. The uptake of HCV treatment was 76% (111 of 146) among those who were eligible on the basis of positive HCV RNA. Estimated duration of HCV infection (OR=1.03 per week, 95% CI=1.00-1.06, P=0.035) and log(10) HCV RNA (OR=1.92 per log(10) increase, 95% CI=1.36-2.73, P<0.001) were independently associated with treatment uptake whereas injection drug use was not. This study demonstrates that a high uptake of HCV treatment can be achieved among participants with recently acquired HCV infection. Decisions about whether to initiate treatment for recently acquired HCV were mainly driven by clinical factors, rather than factors related to sociodemographics or injecting behaviors.
%Z FOR Codes: 110309 110307 110399


%0 Journal Article
%~ PubMed
%A Sanson-Fisher, Rob
%A Brand, Matthew
%A Shakeshaft, Anthony
%A Haber, Paul
%A Day, Carolyn
%A Conigrave, Katherine
%A Mattick, Richard
%A Lintzeris, Nicholas
%A Teesson, Maree
%T Forming a national multicentre collaboration to conduct clinical trials: increasing high-quality research in the drug and alcohol field.
%B Drug and Alcohol Review
%D 2010
%C United Kingdom, Australia
%I Wiley-Blackwell Publishing Ltd.
%V 29
%N 5
%P 469-474
%@ 0959-5236
%X ISSUES: There is a shortage of high-quality intervention-based evidence in the drug and alcohol misuse field. That is, evidence based on replicated effects using rigorous methodology, to establish a causal knowledge base around ethical, cost-effective methods relevant to clinical practice. The knowledge base in this field is limited participant recruitment challenges; difficulty generalizing results from single-centre studies; lack of research culture; issues in managing research teams; incentives for descriptive research; and limited expertise in research design and working in multidisciplinary teams. APPROACH: An Australian national multicentre collaboration is proposed to overcome these barriers, and reduce the burden of drug and alcohol misuse by increasing the number of high-quality clinical trials in this field. It would involve: selecting a representative sample of centres nation-wide with expertise in specific drug and alcohol issues; creating an expert multidisciplinary team to facilitate clinical trials; simultaneous recruitment and implementation of clinical trials across centres; establishing a virtual infrastructure; forming an independent data-integrity and methodology review panel; and attracting and allocating funding for clinical trials. IMPLICATIONS: The ability to allocate funding, the involvement of multidisciplinary experts in drug and alcohol research, and the establishment of infrastructure and procedures are likely to result in the national multicentre group''s capacity to prescribe the type of research conducted under its auspices. CONCLUSION: The proposed initiative is likely to increase the volume of high-quality clinical trials in the Australian drug and alcohol field, a key step towards reducing the burden of drug and alcohol misuse.
%Z FOR Codes: 111717


%0 Journal Article
%~ PubMed
%A Dolan, Kate
%A Teutsch, Suzy
%A Scheuer, Nicolas
%A Levy, Michael
%A Rawlinson, William
%A Kaldor, John
%A Lloyd, Andrew
%A Haber, Paul
%T Incidence and risk for acute hepatitis C infection during  imprisonment in Australia.
%B European Journal of Epidemiology
%D 2010
%C Netherlands
%I Springer Netherlands
%V 25
%N 2
%P 143-148
%@ 1573-7284
%X To determine hepatitis C incidence and the demographic and behavioural predictors in seronegative drug injecting prisoners. Prisoners in New South Wales, Australia who: were aged 18 years and over; reported IDU; had been continuously imprisoned; had a documented negative HCV antibody test result in prison in the last 12 months; provided written informed consent. Subjects were interviewed about their demographic characteristics and detailed risk factors for transmission prior to, and since, imprisonment. A blood sample was collected to screen for HCV antibodies by ELISA and RNA by PCR. Of 253 inmates recruited, 120 were continuously imprisoned and included in this analysis. Sixteen acquired HCV infection indicating an incidence of 34.2 per 100 person years (CI: 19.6-55.6). Risk factors for transmission included prior imprisonment, methadone treatment and greater than 10 years of education. Although the frequency of injecting was reduced in prison, 33.6% continued to inject drugs, most commonly methamphetamine, and 90% of these reported sharing injecting equipment. Prison inmates were at high risk of HCV infection, despite some reduction in high-risk behaviours and access to prevention services. To prevent HCV transmission in prisons, better prevention strategies are required.
%Z FOR Codes: 110309 111706 111716


%0 Journal Article
%~ PubMed
%A Teutsch, Suzy
%A Luciani, Fabio
%A Scheuer, Nicolas
%A McCredie, Luke
%A Hosseiny, Parastu
%A Rawlinson, William
%A Kaldor, John
%A Dore, Gregory J
%A Dolan, Kate
%A Ffrench, Rosemary
%A Lloyd, Andrew
%A Haber, Paul
%A Levy, Michael
%T Incidence of primary hepatitis C infection and risk factors for transmission in an Australian prisoner cohort.
%B BMC Public Health
%D 2010
%C United Kingdom
%I BioMed Central Ltd.
%V 10
%N 
%P 633
%@ 1471-2458
%X ABSTRACT: BACKGROUND: Hepatitis C virus (HCV) infection is common in prisoner populations, particularly those with a history of injecting drug use (IDU). Previous studies of HCV incidence have been based on small case numbers and have not distinguished risk events in prison from those in the community. METHODS: HCV incidence was examined in a longitudinal cohort of 488 Australian prisoners with a history of IDU and documented to be seronegative within 12 months prior to enrolment. Inmates were tested for anti-HCV antibodies and viremia, and interviewed about demographic and behavioral risk factors for transmission. RESULTS: The cohort was predominantly male (65%) with high rates of prior imprisonment (72%) and tattooing (73%), as well as longstanding IDU (mean 8.5 years). Ninety-four incident HCV cases were identified (incidence 31.6 per 100 person years). Independent associations were observed between incident infection and prior imprisonment (p = 0.02) and tattooing (p = 0.03), and surprisingly also with methadone maintenance treatment (MMT) (p < 0.001). CONCLUSIONS: High rates of new HCV infection were found in this prisoner cohort reflecting their substantive risk behavior profile, despite having remained uninfected for many years. The association with MMT is challenging and highlights the need for better understanding of prison-specific HCV transmission risks, as well as the uptake and effectiveness of prevention programs.
%Z FOR Codes: 111706 111716 110309


%0 Journal Article
%~ PubMed
%A Seth, Devanshi
%A Daly, Ann K
%A Haber, Paul S
%A Day, Christopher P
%T Patatin-like phospholipase domain containing 3: a case in point linking genetic susceptibility for alcoholic and nonalcoholic liver disease.
%B Hepatology
%D 2010
%C United States
%I John Wiley & Sons, Inc.
%V 51
%N 4
%P 1463-1465
%@ 1527-3350
%X 
%Z FOR Codes: 110307


%0 Journal Article
%~ PubMed
%A Teesson, Maree
%A Hall, Wayne
%A Slade, Tim
%A Mills, Katherine
%A Grove, Rachel
%A Mewton, Louise
%A Baillie, Andrew
%A Haber, Paul
%T Prevalence and correlates of DSM-IV alcohol abuse and dependence in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing.
%B Addiction (Abingdon, England)
%D 2010
%C United Kingdom
%I Wiley-Blackwell Publishing Ltd.
%V 105
%N 
%P 2085-94
%@ 1360-0443
%X To report nationally representative data on the prevalence and correlates (including psychiatric comorbidity and treatment) of DSM-IV alcohol abuse and dependence in Australian adults.
%Z FOR Codes: 111706


%0 Journal Article
%~ PubMed
%A Baillie, Andrew J
%A Stapinski, Lexine
%A Crome, Erica
%A Morley, Kirsten
%A Sannibale, Claudia
%A Haber, Paul
%A Teesson, Maree
%T Some new directions for research on psychological interventions for comorbid anxiety and substance use disorders.
%B Drug and Alcohol Review
%D 2010
%C United Kingdom, Australia
%I Wiley-Blackwell Publishing Ltd.
%V 29
%N 5
%P 518-524
%@ 0959-5236
%X Abstract Issues. Comorbidity between anxiety and substance use disorders is common, yet it is poorly understood and poorly treated. Approach. Narrative literature review. PsycINFO and Medline databases were searched for clinical trials of anxiety and substance use disorders using clinical queries for 2005-2009. Key Findings. There are few well-conducted treatment outcome trials for comorbid anxiety and substance use disorders. Some recent (2005-2009) outcome literature has focused on specific mechanisms (anxiety sensitivity and tension reduction alcohol expectancies) that may underlie comorbidity between anxiety and substance use disorders and may lead to more targeted intervention. Implications and Conclusion: The research base for understanding and treating comorbid anxiety and substance use disorders needs to be broadened. In particular research is needed with a focus on: (i) specifying particular comorbid relationships between anxiety and substance use disorders; (ii) the mechanisms that may underlie and maintain those relationships; and (iii) well-conducted evaluations of treatments that target those mechanisms.[Baillie AJ, Stapinski L, Crome E, Morley K, Sannibale C, Haber P, Teesson M. Some new directions for research on psychological interventions for comorbid anxiety and substance use disorders. Drug Alcohol Rev 2010;29;518-524].
%Z FOR Codes: 111714


%0 Journal Article
%~ PubMed
%A Ramasamy, Parameswaran
%A Lintzeris, Nicholas
%A Sutton, Yvonne
%A Taylor, Helen
%A Day, Carolyn A
%A Haber, Paul S
%T The outcome of a rapid hepatitis B vaccination programme in a methadone treatment clinic.
%B Addiction
%D 2010
%C United Kingdom
%I Wiley-Blackwell Publishing Ltd.
%V 105
%N 2
%P 329-334
%@ 1360-0443
%X AIM: Injecting drug users are a high-risk population for hepatitis B (HBV), but are difficult to engage in vaccination programmes. This study examines the completion rates of a HBV vaccination schedule and seroconversion in a group of patients in methadone maintenance treatment. METHODS: Patients at a public methadone maintenance programme in Sydney, Australia, were screened for viral hepatitis (hepatitis A, B and C) and offered a rapid HBV vaccination schedule (0, 1 and 2 months). Hepatitis B surface antibody (antiHBs) was retested on completion of the vaccination schedule. RESULTS: A total of 143 patients [71.3% male, mean age 33.1 (standard deviation +/- 8.3)] enrolled in the project. Forty-nine per cent of patients were HAV antibody (Ab) positive, 81.1% hepatitis C virus (HCV) antibody (Ab) positive and 38.9% antiHBs positive. Exposure to multiple hepatitis viruses was common, with 24.5% testing positive for all three viruses. Seventy-three (83%) of the 88 antiHBs negative patients completed the vaccination schedule. Post-vaccination serology indicated a seroconversion rate of 75.4% (55 of 73) of completors, or 62.5% of eligible participants (55 of 88). CONCLUSION: While there was a high rate of completion of the rapid vaccination schedule in this population, a moderate seroconversion rate was achieved. Further work is required to identify an optimal vaccination schedule in opioid substitution patients.
%Z FOR Codes: 111716 111502


%0 Book Section
%A Haber, Paul
%A Neasham, Katherine
%T Alcohol and Drug Abuse
%B Palliative Medicine
%D 2009
%C United States
%I Saunders
%V 
%N 
%P 451-458
%@ 9780323056748
%E Glare, Paul
%E Goh, Cynthia
%E Walsh, T Declan
%E Caraceni, Augusto T
%E Fainsinger, Robin
%E Foley, Kathleen
%E Lloyd-Williams, Mari
%E Olarte, Juan Nunez
%E Radbruch, Lukas
%X 
%Z FOR Codes: 111717


%0 Journal Article
%~ PubMed
%A Matthews, G V
%A Hellard, M
%A Haber, P
%A Yeung, B
%A Marks, P
%A Baker, D
%A McCaughan, G
%A Sasadeusz, J
%A White, P
%A Rawlinson, W
%A Lloyd, A
%A Kaldor, J
%A Dore, G J
%A , Australian Trial in Acute Hepatitis C Study Group
%T Characteristics and treatment outcomes among HIV-infected individuals in the Australian Trial in Acute Hepatitis C.
%B Clinical Infectious Diseases
%D 2009
%C United States
%I University of Chicago Press
%V 48
%N 5
%P 650-658
%@ 1058-4838
%X BACKGROUND: The Australian Trial in Acute Hepatitis C (ATAHC) is a National Institutes of Health-funded prospective cohort study of the natural history and efficacy of treatment in individuals with recently acquired hepatitis C. Enrollment is open to both human immunodeficiency virus (HIV)-infected and -uninfected individuals. The aim of this article was to evaluate characteristics and virological outcomes among HIV-infected individuals enrolled in ATAHC. METHODS: Eligibility criteria included the first positive result of testing for anti-hepatitis C virus (HCV) antibody within 6 months and either clinical hepatitis diagnosed within the past 12 months or documented anti-HCV seroconversion within the past 24 months. RESULTS: Of the initial 103 patients enrolled, 27 (26%) were HIV infected. HIV-infected patients were more likely to be older, to have HCV genotype 1 infection and high levels of HCV RNA at baseline than were HCV-monoinfected patients. Sexual acquisition accounted for the majority (56%) of HCV infections among HIV-infected patients, compared with only 8% of HCV-monoinfected patients. The median duration from estimated HCV infection to treatment was 30 weeks. Treatment with 24 weeks of pegylated interferon and ribavirin resulted in rates of undetectability of HCV RNA of 95%, 90%, and 80% at weeks 12, 24, and 48, respectively. Undetectability at week 4 was achieved in 44% of patients and yielded positive and negative predictive values for sustained virological response of 100% and 33%, respectively. CONCLUSIONS: Significant differences were demonstrated between HIV-infected and HIV-uninfected individuals enrolled in ATAHC. Treatment responses among HIV-infected individuals with both acute and early chronic infection are encouraging and support regular HCV screening of high-risk individuals and early treatment for recently acquired HCV infection.
%Z FOR Codes: 110309 110307 1103


%0 Journal Article
%~ PubMed
%A Leong, Mario
%A Murnion, Bridin
%A Haber, Paul S
%T Examination of Opioid Prescribing in Australia from 1992-2007.
%B Internal medicine journal
%D 2009
%C Australia
%I Blackwell Publishing Asia
%V 39
%N 10
%P 676-81
%@ 1444-0903
%X Opioid prescribing is controversial with evidence of both significant under-utilization and over-utilization. There is some evidence to support efficacy for chronic non-malignant pain, but community and individual harms are increasingly reported.
%Z FOR Codes: 111799 111599


%0 Journal Article
%~ PubMed
%A Colagiuri, Ben
%A Morley, Kirsten
%A Boakes, Robert
%A Haber, Paul
%T Expectancy in double-blind placebo-controlled trials: an example from alcohol dependence.
%B Psychotherapy and Psychosomatics
%D 2009
%C Switzerland
%I S. Karger AG
%V 78
%N 3
%P 167-171
%@ 1423-0348
%X BACKGROUND: Double-blind placebo-controlled trials are intended to control for the impact of expectancy on outcomes. Whether they always achieve this is, however, questionable. METHODS: Reanalysis of a clinical trial of naltrexone and acamprosate for alcohol dependence investigated this issue further. In this trial, 169 alcohol-dependent patients received naltrexone, acamprosate or placebo for 12 weeks. In addition to being assessed on various indices of alcohol dependence, they were asked whether they believed they received active medication or placebo. RESULTS: While there were no differences in outcomes between treatment groups, those who believed they had been taking active medication consumed fewer alcoholic drinks and reported less alcohol dependence and cravings. That is, irrespective of actual treatment, perceived medication allocation predicted health outcomes. CONCLUSIONS: These results highlight the differences between treatment administration in clinical trials and standard medical practice, a discrepancy that may sometimes decrease the validity of these types of trials.
%Z FOR Codes: 110399 170101


%0 Book
%A Haber, Paul
%A Lintzeris, Nicholas
%A Proude, Elizabeth
%A Lopatko, Olga
%T Guidelines for the Treatment of Alcohol Problems
%B 
%D 2009
%C Australia
%I Commonwealth of Australia
%V 
%N 
%P 
%@ 1741869773
%X 
%Z FOR Codes: 111717


%0 Journal Article
%~ PubMed
%A Haber, Paul S
%A Demirkol, Abdullah
%A Lange, Kezia
%A Murnion, Bridin
%T Management of injecting drug users admitted to hospital.
%B Lancet
%D 2009
%C United Kingdom
%I The Lancet Publishing Group
%V 374
%N 9697
%P 1284-1293
%@ 0140-6736
%X General hospital clinicians frequently deal with injecting drug users because substance use has diverse medical and psychiatric complications. Non-specialist clinicians often initiate management when specialist consultation is not available or accepted by the patient. Here, we summarise evidence for the management of hospitalised injecting drug users. The first challenge is to engage a drug user into medical care. A non-judgmental approach towards patients and acceptance of their lifestyle choices facilitates engagement. Pragmatic clinical goals can be negotiated and achieved. We also describe common conditions of injecting drug users. Accurate diagnosis and appropriate management focus on common issues such as intoxication, withdrawal, pain management, drug seeking, psychological comorbidity, behavioural difficulties, and pregnancy. Effective management can reduce the medical and social effect of these conditions and is not difficult.
%Z FOR Codes: 110399 110309


%0 Book Section
%A Day, Carolyn
%A Haber, Paul
%T Managing drug dependence in people with hepatitis C
%B Hepatitis C: An Expanding Perspective
%D 2009
%C Australia
%I IP Communications
%V 
%N 
%P 288-307
%@ 9780980458657
%E Dore, Gregory
%E Temple-Smith, Meredith
%E Lloyd, Andrew
%X 
%Z FOR Codes: 110399


%0 Book Section
%A Morley, Kirsten
%A Haber, Paul
%A Lintzeris, Nicholas
%T Pharmacotherapies for alcohol dependence
%B Guidelines for the Treatment of Alcohol Problems
%D 2009
%C Australia
%I Commonwealth of Australia
%V 
%N 
%P 93-106
%@ 1741869773
%E Haber, Paul
%E Proude, Elizabeth
%E Lintzeris, Nick
%E Lopatko, Olga
%X 
%Z FOR Codes: 111502


%0 Journal Article
%A Morley, Kirsten
%A Teesson, M
%A Sannibale, C
%A Haber, Paul
%T Sample bias from different recruitment strategies in a randomised controlled trial for alcohol dependence
%B Drug and Alcohol Review
%D 2009
%C United Kingdom, Australia
%I Wiley-Blackwell Publishing Ltd.
%V 28
%N 3
%P 222-229
%@ 0959-5236
%X 
%Z FOR Codes: 111799


%0 Journal Article
%~ Isi
%A Addolorato, G.
%A Russell, M.
%A Albano, E.
%A Haber, P. S.
%A Wands, J. R.
%A Leggio, L.
%T Understanding and Treating Patients With Alcoholic Cirrhosis: An Update
%B Alcoholism-Clinical and Experimental Research
%D 2009
%C United States
%I Wiley-Blackwell Publishing, Inc.
%V 33
%N 7
%P 1136-1144
%@ 0145-6008
%X 
%Z FOR Codes: 110307


%0 Journal Article
%~ PubMed
%A Seth, Devanshi
%A Hogg, Philip J
%A Gorrell, Mark D
%A McCaughan, Geoffrey W
%A Haber, Paul S
%T Direct effects of alcohol on hepatic fibrinolytic balance: implications for alcoholic liver disease.
%B Journal of hepatology
%D 2008
%C Netherlands
%I Elsevier BV
%V 48
%N 4
%P 614-627
%@ 0168-8278
%X BACKGROUND/AIMS: The pathogenesis of alcoholic liver disease (ALD) remains uncertain. Fibrin production and degradation are altered in experimental liver injury. We have recently identified increased expression of a number of genes (annexin A2 (ANXA2), p11, tPA and PAI-1) that implicate fibrinolysis in ALD progression. Aim of our study was to study the direct effect of alcohol on fibrinolysis and plasmin activity in hepatic cell lines and in vivo. METHODS: Expression of pro- and anti-fibrinolytic genes was determined in liver biopsies from patients with progressive ALD and in HepG2, Huh7 and LX-2 cells exposed to alcohol. The functional effects on fibrinolysis and plasmin activities were determined. C57BL6 female mice were given a single dose of alcohol and serum and liver triglyceride content and serum plasmin activity determined. RESULTS: Alcohol induced a significant up-regulation of ANXA2, PLG, PAI-1 and p11 in human ALD, cell lines and in mice exposed to alcohol. Up-regulation of ANXA2 and p11 was inhibited by the alcohol dehydrogenase inhibitor 4-methylpyrazole. Fibrinolysis and plasmin were increased in HepG2 and LX-2 cells by 10mM alcohol and was inhibited by ANXA2 blocking antibody. Plasmin also increased in mice given a moderate dose of alcohol. By contrast, there was striking up-regulation of PAI-1 in mice given a high dose of alcohol with associated decrease in plasmin. CONCLUSIONS: Alcohol directly alters hepatic expression of pro- and anti-fibrinolytic genes in a dose dependent manner with low dose promoting fibrinolysis and high dose inhibiting fibrinolysis. After a large dose of alcohol in vivo, the dominant effect was up-regulation of hepatic PAI-1 with suppression of plasmin. The effect of alcohol on fibrinolysis and plasmin is mediated in part by ANXA2. Alcohol directly influences hepatic pathways of fibrinolysis that may contribute to ALD.
%Z FOR Codes: 110106 111506 110307


%0 Journal Article
%~ PubMed
%A Richardson, Kylie
%A Baillie, Andrew
%A Reid, Sophie
%A Morley, Kirsten
%A Teesson, Maree
%A Sannibale, Claudia
%A Weltman, Martin
%A Haber, Paul
%T Do acamprosate or naltrexone have an effect on daily drinking by reducing craving for alcohol?
%B Addiction
%D 2008
%C United Kingdom
%I Wiley-Blackwell Publishing Ltd.
%V 103
%N 6
%P 953-959
%@ 0965-2140
%X Aim To explore the effect of acamprosate and naltrexone on craving and alcohol consumption in the treatment of alcohol dependence. Design A randomized, double-blind, single-dummy, placebo-controlled trial. Setting Three treatment centres in Sydney, Australia. Participants A total of 169 alcohol-dependent subjects were given naltrexone (50 mg/day), acamprosate (1998 mg/day) or placebo for 12 weeks, in conjunction with manualized medication compliance therapy. Intervention During the course of the trial, participants kept a daily diary which included the number of standard drinks they consumed and their peak craving for alcohol that day rated on a 0-10 scale. Measurements Subjective ratings of daily craving and daily drinking for the first 6 weeks of treatment. Findings Mixed/hierarchical linear models were employed on an intention-to-treat basis. Analyses revealed that craving was a significant predictor of daily drinking and baseline levels of depression were the best predictor of daily craving. There was no significant improvement in model fit when treatment group was added both in models of daily craving and daily drinking. Daily alcohol consumption was best predicted by a model incorporating baseline dependence and depression scores, and daily craving, entered as a time-varying covariate. However, there was a significant craving x time x treatment interaction (t = -3.365, df = 4413.712, P < 0.001), suggesting that at higher levels of craving drinking was reduced at a significantly greater rate with naltrexone compared to acamprosate. Conclusions Naltrexone had a greater effect on drinking when craving was high. These results support the role of naltrexone in reducing craving when that craving is highly salient. The role of acamprosate in reducing craving was not supported by these findings.
%Z FOR Codes: 110399 111502


%0 Journal Article
%~ PubMed
%A Gong, Maokai
%A Castillo, Leslie
%A Redman, Robert S
%A Garige, Mamatha
%A Hirsch, Kenneth
%A Azuine, Magnus
%A Amdur, Richard L
%A Seth, Devanshi
%A Haber, Paul S
%A Lakshman, M Raj
%T Down-regulation of liver Galbeta1, 4GlcNAc alpha2, 6-sialyltransferase gene by ethanol significantly correlates with alcoholic steatosis in humans.
%B Metabolism: Clinical and Experimental
%D 2008
%C United States
%I W. B. Saunders
%V 57
%N 12
%P 1663-1668
%@ 1532-8600
%X Hepatic steatosis and steatohepatitis are frequent results of long-term ethanol exposure. We have previously demonstrated that long-term ethanol down-regulates Galbetal, 4GlcNAc alpha2, 6-sialyltransferase (ST6Gal1), leading to defective glycosylation of a number of proteins including apolipoprotein (apo) E and apo J and the appearance of asialoconjugates in the blood of continuously alcohol-fed animals as well as in human alcoholics. In the current study, we have explored the possibility of whether ethanol-induced down-regulation of ST6Gal1 could contribute toward alcoholic steatosis in human alcoholics presumably because of impaired lipid and lipoprotein transport caused by this down-regulation. Real-time quantitative polymerase chain reaction analyses of liver samples from nondrinkers, moderate drinkers, and heavy drinkers as well as from subjects with and without alcoholic liver disease revealed direct evidence that the down-regulation of ST6Gal1 may be due to ethanol per se. The ST6Gal1 messenger RNA level was reduced by as much as 70% in moderate and heavy drinkers as well as in patients with alcoholic liver disease, but was not changed in subjects with liver disease due to causes other than alcohol exposure. Biochemical and histopathologic analysis demonstrated that the liver total cholesterol was increased by more than 30% (P < .05) and 75% (P < .01), respectively, in moderate and heavy drinkers compared with nondrinkers, with even more dramatic changes in triglyceride levels. Significantly, there was a strong inverse correlation between ST6Gal1 messenger RNA level and liver lipid deposit (F = 8.68, P < .001) by statistical analysis. Thus, it is suggested that alcohol-mediated down-regulation of hepatic ST6Gal1 gene leads to defective glycosylation of lipid-carrying apolipoproteins such as apo E and apo J, resulting in defective intracellular lipid and lipoprotein transport, which in turn may contribute to alcoholic steatosis.
%Z FOR Codes: 111103 110307


%0 Journal Article
%~ PubMed
%A Proude, Elizabeth M
%A Conigrave, Katherine M
%A Britton, Annette
%A Haber, Paul S
%T Improving alcohol and tobacco history taking by junior medical officers.
%B Alcohol and alcoholism
%D 2008
%C United Kingdom
%I Oxford University Press
%V 43
%N 3
%P 320-325
%@ 1464-3502
%X AIMS: We aimed to determine the effectiveness of individual feedback and group feedback in improving recording, assessment, and management of risky alcohol use and of tobacco smoking by Junior Medical Officers (JMOs). METHOD: Medical records of patients admitted by JMOs were examined for recording of alcohol use, alcohol withdrawal, intervention for alcohol, a consultation with the Drug and Alcohol team, tobacco use, and prescription of nicotine replacement therapy (NRT). In year 1, JMOs from hospital 1 received printed individual feedback on their own and their group''s performance, while JMOs at hospital 2 attended a presentation of their group feedback. The following year, they reversed roles. RESULTS: A total of 3025 patient records were examined for 130 JMOs. After individual feedback, the percentage of alcohol histories that were quantified rose significantly, from 69% to 82%. More smokers were detected, and NRT prescribing rates rose significantly. Group feedback showed no change. Logistic regression showed that JMOs were significantly more likely to record an alcohol history if located at the smaller hospital and in first year of hospital practice, if the patient was admitted during business hours, was male, and/or was younger than the median age of 70 years; JMOs were significantly more likely to quantify alcohol consumption after individual feedback, but this had no effect on tobacco history recording. CONCLUSION: Our study suggests that individual feedback on performance with education about desired standards is effective in improving the quality of recording of alcohol histories by Junior Medical Officers.
%Z FOR Codes: 111716 111717


%0 Journal Article
%~ PubMed
%A Neuman, Manuela G
%A Sha, Kevin
%A Esguerra, Rustan
%A Zakhari, Sam
%A Winkler, Robert E
%A Hilzenrat, Nir
%A Wyse, Jonathan
%A Cooper, Curtis L
%A Seth, Devanshi
%A Gorrell, Mark D
%A Haber, Paul S
%A McCaughan, Geoffrey W
%A Leo, Maria A
%A Lieber, Charles S
%A Voiculescu, Mihai
%A Buzatu, Eugenia
%A Ionescu, Camelia
%A Dudas, Jozsef
%A Saile, Bernhard
%A Ramadori, Giuliano
%T Inflammation and repair in viral hepatitis C.
%B Digestive Diseases and Sciences
%D 2008
%C United States
%I Springer
%V 53
%N 6
%P 1468-1487
%@ 0163-2116
%X Hepatitis C viral infection (HCV) results in liver damage leading to inflammation and fibrosis of the liver and increasing rates of hepatic decompensation and hepatocellular carcinoma (HCC). However, the host''s immune response and viral determinants of liver disease progression are poorly understood. This review will address the determinants of liver injury in chronic HCV infection and the risk factors leading to rapid disease progression. We aim to better understand the factors that distinguish a relatively benign course of HCV from one with progression to cirrhosis. We will accomplish this task by discussion of three topics: (1) the role of cytokines in the adaptive immune response against the HCV infection; (2) the progression of fibrosis; and (3) the risk factors of co-morbidity with alcohol and human immunodeficiency virus (HIV) in HCV-infected individuals. Despite recent improvements in treating HCV infection using pegylated interferon alpha (PEGIFN-alpha) and ribavirin, about half of individuals infected with some genotypes, for example genotypes 1 and 4, will not respond to treatment or cannot be treated because of contraindications. This review will also aim to describe the importance of IFN-alpha-based therapies in HCV infection, ways of monitoring them, and associated complications.
%Z FOR Codes: 110307


%0 Journal Article
%~ PubMed
%A Thomson, Clare L
%A Morley, Kirsten C
%A Teesson, Maree
%A Sannibale, Claudia
%A Haber, Paul S
%T Issues with recruitment to randomised controlled trials in the drug and alcohol field: a literature review and Australian case study.
%B Drug and alcohol review
%D 2008
%C United Kingdom
%I Informa Healthcare
%V 27
%N 2
%P 115-122
%@ 0959-5236
%X ISSUES: The randomised control trial (RCT) is a widely used tool for measuring the effectiveness of health treatments and services. However, subject recruitment is an ongoing challenge for those conducting RCTs and may have a serious impact on the success of the study and the reliability of the outcomes. APPROACH: In this review we present an examination of the problems and strategies associated with recruitment to RCTs, with particular reference to studies conducted in the drug and alcohol field. A case study of recruitment to an RCT for the treatment of alcohol dependence is presented, supplemented by PubMed, Current Contents and Medline searches to identify relevant publications. KEY FINDINGS: The literature suggests that the most common barriers to patient participation involve fears of assignment to placebo treatment, insufficient compensation and poor attendance at initial appointments. Moreover, subject referrals from staff may be a greater problem than reluctance of patients. Referrals are inhibited by complicated entry criteria, time constraints due to busy work schedules or a limited research culture. IMPLICATIONS: Subject recruitment may be promoted by financial reimbursement, close partnerships between research and referral staff; increasing the treatment group ratio in multi-drug trials to minimise randomisation to placebo; addressing negative staff attitudes; and simplifying the referral process. CONCLUSION: The need for multi-centre sites in Australian drug and alcohol treatment studies is highlighted.
%Z FOR Codes: 111502 110399


%0 Journal Article
%~ PubMed
%A Lane, Jennifer
%A Proude, Elizabeth M
%A Conigrave, Katherine M
%A de Boer, Jelle Pieter
%A Haber, Paul S
%T Nurse-provided screening and brief intervention for risky alcohol consumption by sexual health clinic patients.
%B Sexually transmitted infections
%D 2008
%C United Kingdom
%I BMJ Publishing Group
%V 84
%N 7
%P 524-7
%@ 1368-4973
%X Brief intervention for excessive alcohol consumption is effective yet not implemented widely. Alcohol misuse is implicated in unsafe sex and sexually transmitted infections and is common in clients of sexual health services. Our aims were to assess feasibility, acceptability and effectiveness of screening and brief intervention for risky alcohol consumption by a nurse in a sexual health clinic.
%Z FOR Codes: 110324 111002 110399


%0 Journal Article
%~ PubMed
%A Dore, Gregory J
%A Haber, Paul S
%T Tell me it ain't so: Patient-to-patient transmission of hepatitis C in an endoscopy clinic.
%B Hepatology (Baltimore, Md.)
%D 2008
%C United States
%I John Wiley & Sons
%V 48
%N 4
%P 1333-5
%@ 1527-3350
%X On January 2, 2008, the Nevada State Health Division (NSHD) contacted CDC concerning surveillance reports received by the Southern Nevada Health District (SNHD) regarding two persons recently diagnosed with acute hepatitis C. A third person with acute hepatitis C was reported the following day. This raised concerns about an outbreak because SNHD typically confirms four or fewer cases of acute hepatitis C per year. Initial inquiries found that all three persons with acute hepatitis C underwent procedures at the same endoscopy clinic (clinic A) within 35-90 days of illness onset. A joint investigation by SNHD, NSHD, and CDC was initiated on January 9, 2008. The epidemiologic and laboratory investigation revealed that hepatitis C virus (HCV) transmission likely resulted from reuse of syringes on individual patients and use of single-use medication vials on multiple patients at the clinic. Health officials advised clinic A to stop unsafe injection practices immediately, and approximately 40,000 patients of the clinic were notified about their potential risk for exposure to HCV and other bloodborne pathogens. This report focuses on the six cases of acute hepatitis C identified during the initial investigation, which is ongoing; additional cases of acute hepatitis C associated with exposures at clinic A might be identified. Comprehensive measures involving viral hepatitis surveillance, health-care provider education, public awareness, professional oversight, licensing, and improvements in medical devices can help detect and prevent transmission of HCV and other bloodborne pathogens in health-care settings.
%Z FOR Codes: 110307 110309


%0 Journal Article
%~ PubMed
%A Williams, Gerard
%A Daly, Michelle
%A Proude, Elizabeth M
%A Kermode, Steven
%A Davis, Michelle
%A Barling, Jan
%A Haber, Paul S
%T The influence of alcohol and tobacco use in orthopaedic inpatients on complications of surgery.
%B Drug and Alcohol Review
%D 2008
%C United Kingdom
%I Informa Healthcare
%V 27
%N 1
%P 55-64
%@ 0959-5236
%X INTRODUCTION AND AIMS: Tobacco use and heavy alcohol consumption are associated with increased morbidity and mortality. There is limited research on the correlation between tobacco and risky levels of alcohol use and the possible complications associated with a hospital admission. The underestimation of problem drinking, in particular, has obvious repercussions for the management of patients in hospital. If alcohol-related problems go undetected or unrecorded, treatment may be inadequate or inappropriate. The aims of the project were to assess the prevalence of high-risk alcohol and tobacco use in orthopaedic in-patients and to examine any relationship between alcohol and tobacco use and the number and type of complications, management and length of stay. DESIGN AND METHOD: One hundred and fifty-three consecutive orthopaedic admissions to the Orthopaedic Ward at Lismore Base Hospital were screened using the Drinkcheck questionnaire, which is based on the Alcohol Use Disorders Identification Test (AUDIT), but which also screens for tobacco use. Nursing staff on the ward completed a Complications Evaluation Questionnaire (CEQ). The risk status of the subjects was compared to the number and type of complications, to assess any effects of alcohol and tobacco on post-surgical complications. RESULTS: Significant correlations were found between tobacco use, hazardous and harmful alcohol use and numerous medical complications and behavioural problems. Behavioural problems associated with risky alcohol use included verbal abuse, agitation and sleep disturbances, particularly in men; problems associated with tobacco use included agitation and non-compliance. DISCUSSION AND CONCLUSIONS: Orthopaedic patients who smoke and/or drink heavily prior to surgery may have more non-medical complications than non-smokers and light or non-drinkers. All surgery patients should thus be screened for alcohol and tobacco use and alcohol withdrawal, which may cause other symptoms such as behavioural problems, non-compliance and verbal abuse post-surgery.
%Z FOR Codes: 111003 111506


%0 Journal Article
%~ PubMed
%A Lintzeris, Nicholas
%A Lee, Soung
%A Scopelliti, Lucinda
%A Mabbutt, James
%A Haber, Paul S
%T Unplanned admissions to two Sydney public hospitals after naltrexone implants.
%B The Medical Journal of Australia
%D 2008
%C Australia
%I Australasian Medical Publishing Company Pty. Ltd
%V 188
%N 8
%P 441-444
%@ 0025-729X
%X OBJECTIVE: To describe hospital presentations related to the use of naltrexone implants, an unlicensed product used in Australia for treating heroin dependence. DESIGN: Retrospective case file audit. SETTING: Two Sydney teaching hospitals. PATIENTS: Identified through referrals to Drug and Alcohol Consultation-Liaison services over a 12-month period, August 2006 to July 2007. MAIN OUTCOME MEASURES: Diagnosis, management and duration of admission. RESULTS: Twelve cases were identified: eight were definitely or probably related to naltrexone implants or the implantation procedure (rapid detoxification). Of these, six patients had severe opiate withdrawal and dehydration, with an average hospital stay of 2.3 days. One patient had an infection at the implant site, and one an underlying anxiety disorder requiring psychiatric admission. Three patients had analgesia complications, and one had unrelated cardiac arrhythmia. CONCLUSIONS: These severe adverse events challenge the notion that naltrexone implants are a safe procedure and suggest a need for careful case selection and clinical management, and for closer regulatory monitoring to protect this marginalised and vulnerable population.
%Z FOR Codes: 110305 111003 111506


%0 Journal Article
%~ PubMed
%A Haber, Paul S
%A McCaughan, Geoffrey W
%T "I'll never touch it again, doctor!" - harmful drinking after liver transplantation.
%B Hepatology (Baltimore, Md.)
%D 2007
%C United States
%I John Wiley & Sons Inc.
%V 46
%N 4
%P 1302-4
%@ 0270-9139
%X Alcohol relapse can negatively influence the outcome after liver transplantation (LT). The aim of our study was to identify factors that could be associated with the recurrence of harmful alcohol consumption after LT.
%Z FOR Codes: 110307


%0 Journal Article
%~ PubMed
%A Wurst, Friedrich M
%A Haber, Paul S
%A Wiesbeck, Gerhard
%A Watson, Bianca
%A Wallace, Cate
%A Whitfield, John B
%A Halter, Claudia
%A Weinmann, Wolfgang
%A Conigrave, Katherine M
%T Assessment of alcohol consumption among hepatitis C-positive people receiving opioid maintenance treatment using direct ethanol metabolites and self-report: a pilot study.
%B Addiction biology
%D 2007
%C United Kingdom
%I Wiley-Blackwell Publishing Ltd.
%V 13
%N 0
%P 416-22
%@ 1355-6215
%X This study was conducted to identify the alcohol consumption among hepatitis C-positive people receiving opioid maintenance therapy using self-report and biomarkers. A total of 49 people (28 male, 21 female) were hepatitis C virus (HCV) positive and were included. The alcohol use disorder identification test (AUDIT) and self-reported ethanol intake in the last 28 days were assessed. In addition to gamma-glutamyl-transferase (GGT) and mean corpuscular volume (MCV), ethyl glucuronide (EtG) and ethyl sulphate (EtS) were determined in serum and urine (UEtG, UEtS, SEtG) using liquid chromatography/tandem mass-spectroscopy (LC/MS-MS) with deuterated internal standards. Abstinence from alcohol was reported for the last 28 days by 13 participants and for the last 7 days by 22. AUDIT was > 8 in 27 cases. The maximum values were 34.8 mg/l for UEtG, 5.3 mg/l for UEtS and 0.15 for SEtG. Among the 19 UEtG positives, 8 had not reported any ethanol intake in the 7 days prior to the study. Six participants reported intake of up to 320 g of ethanol in the last 7 days, but were negative for SEtG, UEtG and UEtS. Self-reported ethanol intake in the last 28 days correlated with AUDIT score (r = 0.733, P < 0.001), with the direct ethanol metabolites and MCV. In this population, abstinence and episodic heavy drinking are more common than in the general population. Episodic heavy drinking is a significant cause of acute risk in this population. Results from biomarker testing could indicate cases of under- as well as over-reporting of alcohol consumption. Further research on the diagnostic accuracy of direct ethanol metabolites, including the use of phosphatidylethanol (PEth), in this setting is needed.
%Z FOR Codes:


%0 Journal Article
%~ PubMed
%A Shourie, Swati
%A Conigrave, Katherine M
%A Proude, Elizabeth M
%A Haber, Paul S
%T Detection of and intervention for excessive alcohol and tobacco use among adult hospital in-patients.
%B Drug and alcohol review
%D 2007
%C United Kingdom, Aust
%I Carfax Publishing Ltd
%V 26
%N 2
%P 127-33
%@ 0959-5236
%X Early detection and intervention for alcohol problems have been shown to reduce subsequent health consequences. However, the extent to which these practices have been implemented is unclear. The study assessed among hospital in-patients (1) the prevalence of at-risk drinking and smoking, (2) current practice in detection and intervention for at-risk drinking and smoking and (3) self-reported effect of any intervention. A brief self-administered questionnaire was administered to adult in-patients addressing alcohol use [Alcohol Use Disorders Identification Test (AUDIT) questionnaire], smoking and self-reported effect of any recent intervention for drinking or smoking. The participant''s smoking status and alcohol use as recorded by medical and nursing staff was compared to self-reports. Of 448 in-patients, 50% (226) participated in the study; 38% (170) were ineligible and 12% (52) refused. Participants were aged 61.3 (+/-18.9) years. A higher number of problem drinkers (11.9% vs. 3.5%, p < 0.0001) and current smokers (17.3% vs. 9.3%, p < 0.0001) were identified by the questionnaire compared to the medical records. Hospital staff quantified smoking more consistently than alcohol (54% vs. 42%, p = 0.02). Of those who recalled an intervention, 19% of drinkers and 27% of smokers said they had stopped drinking or smoking for a period since that intervention. Further improvement is required in the rates of detection and interventions for alcohol use disorders and smoking in the hospital setting.
%Z FOR Codes:


%0 Journal Article
%~ Isi
%A DAngelo, C
%A Addolorato, G
%A Haber, PS
%A Gasbarrini, G
%A Zambon, A
%A Caputo, F
%A Abenavoli, L
%A Mirijello, A
%A Vonghia, L
%A Cardone, S
%A Leggio, L
%A Ferrulli, A
%T Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study
%B LANCET
%D 2007
%C US
%I The Lancet Publishing group
%V 370
%N 9603
%P 1915-1922
%@ 1474-547X
%X 
%Z FOR Codes: 110502


%0 Book Section
%A McCaughan, Geoffrey
%A Shackel, Nicholas
%A Williams, Rohan
%A Seth, Devanshi
%A Haber, Paul
%A Gorrell, Mark
%T Genomics,gene arrays and proteomics in the study of liver disease
%B The Textbook of Hepatology: From Basic Science to Clinical Practice
%D 2007
%C United States
%I Blackwell Publishing Ltd
%V 
%N 
%P 398-420
%@ 9781405127417
%E Rodes, Juan
%E Benhamou, Jean-Pierre
%E Blei, Andres
%E Reichen, Juerg
%E Rizzetto, Mario
%X 
%Z FOR Codes: 110307


%0 Journal Article
%~ PubMed
%A Watson, Bianca
%A Conigrave, Katherine M
%A Wallace, Cate
%A Whitfield, John B
%A Wurst, Friedrich
%A Haber, Paul S
%T Hazardous alcohol consumption and other barriers to antiviral treatment among hepatitis C positive people receiving opioid maintenance treatment.
%B Drug and alcohol review
%D 2007
%C United Kingdom, Aust
%I Carfax Publishing Ltd
%V 26
%N 3
%P 231-239
%@ 0959-5236
%X Amongst people on opioid maintenance treatment (OMT), chronic hepatitis C (HCV) is common but infrequently treated. Numerous barriers, including misuse of alcohol may limit efforts at anti-viral treatment. The aim of this study was to define barriers, including alcohol misuse, to the effective treatment of HCV amongst OMT recipients. Ninety-four OMT patients completed the 3-item Alcohol Use Disorders Identification Test (AUDIT-C). A semi-structured interview was used in 53 subjects to assess alcohol use in detail, psychological health, discrimination and access to HCV treatment. Feasibility of brief intervention for alcohol misuse was assessed. Of the screening participants, 73% reported they were HCV positive. Of the detailed interview participants, 26% reported no drinking in the past month, but 53% scored 8 or more on AUDIT and 42% exceeded NHMRC drinking guidelines. Twenty subjects received brief intervention and among 17 re-interviewed at one month, alcohol consumption fell by 3.1 g/day (p = 0.003). Severe or extremely severe depression, stress and anxiety were found in 57%, 51% and 40% of interviewees respectively. Episodic heavy drinking, mental health problems, perceived discrimination, limited knowledge concerning HCV were all common and uptake of HCV treatment was poor. Brief intervention for alcohol use problems was acceptable to OMT patients, and warrants further study.
%Z FOR Codes: 111706


%0 Journal Article
%~ PubMed
%A Shourie, Swati
%A Conigrave, Katherine M
%A Proude, Elizabeth M
%A Ward, Jeanette E
%A Wutzke, Sonia E
%A Haber, Paul S
%T Pre-operative screening for excessive alcohol consumption among patients scheduled for elective surgery.
%B Drug and alcohol review
%D 2007
%C United Kingdom, Aust
%I Carfax Publishing Ltd
%V 26
%N 2
%P 119-125
%@ 0959-5236
%X Pre-operative intervention for excessive alcohol consumption among patients scheduled for elective surgery has been shown to reduce complications of surgery. However, successful intervention depends upon an effective and practical screening procedure. This study examines current screening practices for excessive alcohol consumption amongst patients scheduled for elective surgery in general hospitals. It also examines the appropriateness of potential sites and staff for pre-operative screening. Forms used routinely to assess alcohol consumption in the pre-admission clinics (PAC) of eight Sydney hospitals were examined. In addition, the appropriateness of six staff categories (surgeons, surgeons'' secretaries, junior medical officer, anaesthetists, nurses and a research assistant) and of two sites (surgeons'' office and PAC) in conducting additional screening was assessed at two hospitals. Outcomes included observed advantages and disadvantages of sites and personnel, and number of cases with excessive drinking identified. There was duplication in information collected routinely on alcohol use in the PACs in eight Sydney Hospitals. Questions on alcohol consumption in patient self-completion forms were not validated. The PAC provided for efficient screening but time to surgery was typically too short for successful intervention in many cases. A validated tool and efficient screening procedure is required to detect excessive drinking before elective surgery. Patients often present to the PAC too close to the time of surgery for any change in drinking to reverse alcohol''s effects. The role of the referring general practitioner and of printed advice from the surgeon in preparing patients for surgery needs further investigation.
%Z FOR Codes:


%0 Journal Article
%~ PubMed
%A Haber, Paul S
%A Young, Margaret M
%A Dorrington, Lloyd
%A Jones, Andrew
%A Kaldor, John
%A De Kanzow, Sophie
%A Rawlinson, William D
%T Transmission of hepatitis C virus by needle-stick injury in community settings.
%B Journal of gastroenterology and hepatology
%D 2007
%C 54 University St,P O
%I Blackwell Science Asia
%V 22
%N 11
%P 1882-1885
%@ 1440-1746
%X Background: Hepatitis C virus (HCV) is predominantly transmitted by blood-to-blood contact, typically by sharing of needles by injecting drug users. Discarded needles could act as a vector for transmission of this infection. Methods: Two cases of HCV seroconversion following a needle-stick injury in a community setting were identified. The effects of specimen processing and storage conditions on detection of HCV RNA were assessed to provide information about the likelihood of discarded needles containing infectious HCV. Results: Consistent with a role for discarded needles in viral transmission, in vitro studies demonstrated that viral load declined by less than one log following storage for 24 h. Conclusion: All needle-stick injuries should be promptly investigated by serology and HCV-PCR.
%Z FOR Codes: 110804


%0 Journal Article
%~ Isi
%A van Beek, IA
%A Lloyd, AR
%A Kaldor, JM
%A Rowlinson, WD
%A Ffrench, R
%A Pan, Y
%A McCaughan, GW
%A Petoumenos, K
%A Yeung, BY
%A Shaw, DR
%A Haber, PS
%A Matthews, GV
%A Dore, GJ
%A Hellard, ME
%T Treatment of recently acquired hepatitis C infection in injecting drug users: Preliminary results from the australian trial in acute hepatitis C (ATAHC)
%B HEPATOLOGY
%D 2007
%C United States
%I John Wiley & Sons
%V 46
%N 
%P 358A-358A
%@ 
%X 
%Z FOR Codes: 110502