This first Australian population-based study of environmental risk factors confirms that smoking, childhood immunological events and dietary factors play a role in IBD development; while high caffeine intake and pet ownership offer a protective effect.

IBD in HK was diagnosed at an older age, and had more complicated disease behavior than in Melbourne. Medical therapy, however, was less intense in HK. These differences may relate to real differences in disease or delayed diagnosis due to late presentation and less disease recognition in HK.

Deficiencies exist in current transition care of adolescents with IBD in Australia and New Zealand. Standardising transition care practices with strategies aimed at optimising communication, patient education, self-efficacy and adherence may improve outcomes.

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Providers and patients may feel more comfortable treating depression and anxiety disorders than substance use or psychosis via interactive video.

BackgroundResidential drug rehabilitation is often seen as a treatment of last resort for people with severe substance abuse issues. These clients present with more severe symptoms, and frequent psychiatric comorbidities relative to outpatients. Given the complex nature of this client group, a high proportion of clients seeking treatment often do not enter treatment, and of those who do, many exit prematurely. Given the highly social nature of residential drug rehabilitation services, it has been argued that social anxieties might decrease the likelihood of an individual entering treatment, or increase the likelihood of them prematurely exiting treatment. The current paper reports on the protocol of a Randomised Control Trial which examined whether treatment of social anxiety prior to entry to treatment improves entry rates and retention in residential drug rehabilitation.Method/designA Randomised Control Trial comparing a social skills treatment with a treatment as usual control group was employed. The social skills training program was based on the principles of Cognitive Behaviour Therapy, and was adapted from Ron Rapee’s social skills training program. A permutated block randomisation procedure was utilised. Participants are followed up at the completion of the program (or baseline plus six weeks for controls) and at three months following entry into residential rehabilitation (or six months post-baseline for participants who do not enter treatment).DiscussionThe current study could potentially have implications for addressing social anxiety within residential drug treatment services in order to improve entry and retention in treatment. The results might suggest that the use of additional screening tools in intake assessments, a focus on coping with social anxieties in support groups for clients waiting to enter treatment, and greater awareness of social anxiety issues is warranted.Australian New Zealand clinical trials registryAustralian New Zealand Clinical Trials Registry (ACTRN) registration number: ACTRN12611000579998

Clinical recurrence occurs in a majority of patients soon after surgery. In this cohort, there was no clinical benefit from colonoscopy or increased drug therapy within 1 year after operation. However, the response to the endoscopic findings was not standardized and immunosuppressive therapy was uncommon. Standardizing timing of colonoscopy and drug therapy, including more intense therapy, may improve outcome, although this remains to be proven.

We read with interest the articles by Shimakawa et al. outlining a new score to determine treatment eligibility in Africans living with chronic hepatitis B (CHB) 1,2 and by Johannessen et al. 3 validating this score in a hospital-based Ethiopian cohort. The TREAT-B algorithm is a simple score using widely-available alanine aminotransferase (ALT) and HBeAg tests to determine CHB treatment eligibility and to overcome barriers to treatment assessment arising from limited access to HBV DNA nucleic acid testing and transient elastography. 4 Johannessen and colleagues found the TREAT-B algorithm did not perform as well as described previously. 2,5 Both groups found WHO guidelines performed poorly for treatment eligibility. Given the high CHB prevalence in the Asia-Pacific (>115 million people affected) 6 and urgent need for simplified treatment algorithms in lowresource countries within this region, we validated the TREAT-B algorithm in a large Asian-Pacific cohort of patients with CHB. Complete clinical data for 1,358 treatment-naïve patients with CHB from 2 prospective clinical studies conducted in Melbourne, Australia were analysed; 976 (72%) were recruited from a single large metropolitan hospital and 382 (28%) were recruited from primary practice sites. Patients with HIV, HCV or HDV coinfection, hepatocellular carcinoma, decompensated cirrhosis or pregnancy were excluded. We validated the TREAT-B algorithm against the gold standard EASL 2017 guidelines, 7 which replaced the previous EASL 2012 guidelines against which TREAT-B was originally validated. 1 EASL 2017 guidelines recommend treatment in patients with a) cirrhosis and a detectable viral load; b) F2 or greater fibrosis stage and viral load >2,000 IU/L; c) ALT greater than 80 IU/L and viral load >20,000 IU/L; d) Metavir score (liver biopsy) > − A2 and viral load >2,000 IU/ml; e) HBeAg-positive, age >30 years-old and viral load >2,000 IU/L; and f) family history of hepatocellular carcinoma. 1 To define severe fibrosis/ cirrhosis for the purposes of treatment eligibility, we used a transient elastography (TE) cutoff of >12 kPa (Fibroscan®, Echosens, France) for those with elevated ALT and >9 kPa if normal ALT, in accordance with EASL guidelines (2017) 7,8 or cirrhosis confirmed on liver histology. The TREAT-B score was derived by addition of HBeAg status (positive 1 point, negative 0 points) to ALT level (<20 IU/L, 0 points; 20-39 IU/L, 1 point; 40-79 IU/L, 2 points; > − 80 IU/L, 3 points) 1 ; an overall score > − 2 was deemed eligible for treatment. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TREAT-B was compared to EASL 2017 guidelines. 7