Polymorphisms in the dopamine D2 receptor (DRD2 C/T and DRD2 A/G) and in dopamine beta hydroxylase (DBH A/G) have been implicated in modulation of smoking and other reward-seeking behaviours. We hypothesized that these alleles would predict the outcome of nicotine patch therapy for smoking cessation. In 1991-93, we performed a randomized controlled trial of the nicotine patch on 1686 heavy smokers (> or = 15 cigarettes/day). In 1999-2000, we contacted 1532 of the 1612 subjects still available; 767 (50%) completed a questionnaire and gave a blood sample. In the 755 cases in which DNA was successfully genotyped, we examined associations between the polymorphisms in DRD2 and DBH, and smoking cessation. At 1 week, the patch was more effective for smokers with DRD2 CT/TT genotype [patch/placebo odds ratio (OR) 2.8, 95% confidence interval (CI) 1.7-4.6] than with CC (OR 1.4, 0.9-2.1; P for difference in ORs 0.04). Smokers with both DRD2 CT/TT and DBH GA/AA genotypes had an OR of 3.6 (2.0-6.5) compared to 1.4 (1.0-2.1) for others (P = 0.01). At 12 weeks, the ORs for these genotypic groups were 3.6 (1.7-7.8) and 1.4 (0.9-2.3), respectively (P = 0.04). There was no association between patch effectiveness and DRD2 exon 8. Short-term effectiveness of the nicotine patch may be related to dopamine beta-hydroxylase and dopamine D2 receptor genotype. Our results support the need for further investigation into personalized therapies for smoking cessation based on individual genotype.

New graduates are the life blood of the occupational therapy profession. It is important that they are equipped to practise in the current health care environment and are confident about their professional contribution. This New Zealand study explored new graduates' perceptions of how well they had been prepared for practice, using three focus groups of graduates from one occupational therapy programme. The findings confirmed that the biggest issues for new graduates were searching for role clarity, inadequate supervision, an insufficient grasp of skills and uncertainty in team responsibility, underpinned by a lack of confidence. Conversely, they felt confident about their ability to research and find information in response to gaps in their knowledge.This study demonstrates that learning how to 'be' an occupational therapist is as important as receiving formal supervision, and suggests that learning how to contextualise and reconstruct knowledge is essential in preparation for graduation. The stressful situations experienced in the first months of practice could be minimised through opportunities to learn how to repackage knowledge, observe role models and have supervision that provides confirmation of plans and bridges the theory-practice divide.■ New graduates are confident in finding theoretical information but lack confidence in its application to practice.■ New graduates need role models as well as supervisory therapists.What the study has added This study contributes to the understanding of how new graduates view their abilities to use information gained from their undergraduate studies, the supports they require and the concerns they identify. ReferencesAdamson B, Hunt A, Harris L, Hummel J (1998) Occupational therapists' perceptions of their undergraduate preparation for the workplace.

The overall effectiveness of nicotine replacement therapy could be greater if the therapy were targeted at those most likely to respond. Variants of the dopamine D2 receptor (DRD2 32806 C/T) have been implicated in the initiation and maintenance of smoking, 1 2 and these variants may also be related to response to nicotine replacement therapy.3 Additionally, mechanisms of nicotine addiction may differ in men and women. 4 With this evidence in mind, we examined whether the response to nicotine replacement therapy is modified by sex and genotype. Participants, methods, and resultsA randomised controlled trial of nicotine patches in 1991-2 recruited 1686 heavy smokers ( ≥ 15 cigarettes a day).5 The participants wore patches for 12 weeks. Abstinence from smoking was confirmed at one week by expired carbon monoxide concentration ≤ 10 ppm, and at 12, 24, and 52 weeks by salivary cotinine concentration ≤ 20 ng/ml (89% of cases) or by expired carbon monoxide concentration ≤ 10 ppm.In 1999-2000, we contacted 1532 of the 1625 participants still alive; the mean time from trial to follow up was 8.3 years. In all, 752/1532 (49%) gave a blood sample from which DRD2 32806 was successfully typed. Reported abstinence at follow up was confirmed by plasma cotinine concentration ≤ 20 ng/ml. Throughout, non-respondents were assumed to be smoking.Participants were older than non-participants (mean age at entry to trial, 43.0 years v 41.5 years; P = 0.002), more likely to be female (59% (445/752) v 53% (410/780); P = 0.01), and more likely to have quit for a year in the trial (11% (82) v 4% (33), P < 0.0001); 744 (99%) reported their racial background as white.The variant T allele of the dopamine D2 receptor DRD2 32806 (CT or TT genotype) was found in 41% (183/445) of women and 41% of men (127/307). Within each sex, there was no difference between the genotype groups in age, number of cigarettes a day, or dependency score.We measured effectiveness of the patches by the relative odds of abstinence for active and placebo patches over five cumulative time periods: one week, 12 weeks, 24 weeks, 52 weeks, and to follow up. Treatment by genotype and sex, and their interaction, was examined in a full logistic regression model. The three way interaction by genotype by sex was significant for all time periods (P = 0.009, P = 0.03, P = 0.006, P = 0.006, P = 0.004 respectively), and we therefore analysed the data for men and women separately.In women, the effectiveness of the patches differed with genotype at all time points (table). In men the genotype groups did not differ significantly at any time. In men with CC genotype an apparent trend in effectiveness was in an implausible direction, the patches being most effective long after therapy had stopped. In both sexes, when active and placebo groups were combined, the quit rate was not related to genotype. CommentIn women the effectiveness of nicotine patches seems to be related to genotype. Women with the variant T allele of the dopamine D2 receptor DRD2 32806 showed considerable benefit from...

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