Late Breaking News
- Categorized in: November 2009
Report Shows Many Substance Abuse Treatment Referrals Come From Criminal Justice System
The Substance Abuse and Mental Health Services Administration issued its latest Treatment Episode Data set report last month. According to the report, the criminal justice system was the largest single source of referrals to substance abuse treatment programs, accounting for 37% of all admissions (approximately 671,000 of the 1.8 million admissions).
Using TEDS, this report examines substance abuse treatment admissions referred by the criminal justice system and compares their characteristics with admissions referred by other sources. Understanding the impact of these admissions on the treatment system is critical for program planners and policy makers at all levels of government. Notably, the report found that criminal justice system referral admissions were less likely than all other referral admissions to drop out of treatment (22% versus 27%). In addition, the most rapid area of growth within criminal justice system referrals have been among those younger than 18 years of age, increasing from 38% of adolescent admissions in 1992 to 47% in 2007.
Five primary substances of abuse accounted for 96% of all substance abuse treatments admissions in 2007: alcohol, opiates (including heroin and prescription painkillers), marijuana, cocaine, and methamphetamine. Criminal justice system referrals were more likely than all other referral admissions to report primary alcohol abuse, marijuana abuse, methamphetamine abuse, and less likely to report primary opiate abuse. The high rate of criminal justice system referral admissions younger than 18 may have contributed significantly to the high rate of admissions with marijuana as a primary substance of abuse.
The data also showed that criminal justice referral admissions age 25 and over were more likely than all other admissions to be employed either full or part time (42% versus 22%). Male admissions referred by the criminal justice system outnumbered female admissions by a ratio of 3 to 1.The racial/ethnic composition of referrals from the criminal justice system as compared to other referral sources was similar: non-Hispanic White (60%); non-Hispanic Black (19%), and Hispanic (15%). TEDS includes admissions to facilities that are licensed or certified by state substance abuse agencies to provide substance abuse treatment.
New Tools Help Find Alternate Patient Care During Disasters
Two interactive computer tools released last month by the Agency for Healthcare Research and Quality will help emergency planners and responders select and run alternate care facilities during disaster situations. In such instances, hospitals experiencing a surge in seriously ill patients requiring acute care may need to transfer less ill patients efficiently to alternate care sites.
Alternate care facilities are locations that can easily and quickly be equipped to augment or replace health care services when hospitals and other traditional care sites are inoperable or overwhelmed. Potential alternate care sites include college campuses, gymnasiums, schools, community centers, health clubs, convention centers, and climate-controlled warehouses.
The two tools allow users to input information on their specific medical care needs and receive feedback on which facilities can become alternate care sites or which patients can appropriately be moved to those sites. The Disaster Alternate Care Facilities Selection Tool is an interactive worksheet that assists users in selecting sites and identifying what they need to prepare these sites for use. It evaluates the characteristics of several potential facilities and calculates the results into weighted scores that planners can use to select appropriate sites for care and plan for operations during a disaster. The Disaster Alternate Care Facility Patient Selection Tool is a decision support tool that matches a hospitalized patient’s clinical needs with the capabilities of an alternate care facility. This information may help clinicians determine which patients might be eligible for discharge or transfer to an alternate care facility in order to increase a hospital’s capacity for incoming patients.
Denver Health developed these new tools for AHRQ as an update of a previous alternate care site selection tool that it developed in 2004. In addition to changes that make the tools more user friendly, they possess the capability to capture richer demographic information, are a simplified system to rate facility characteristics, and feature a “necessity level” indicator that allows users to evaluate individual facility characteristics based on local or regional need. The two tools are available at http://www.ahrq.gov/prep/acfselection.
Second HPV Vaccine Approved
Cervarix, a new vaccine to prevent cervical cancer and precancerous lesions caused by human papillomavirus (HPV) types 16 and 18, was approved last month by the Food and Drug Administration The vaccine is approved for use in girls and women ages 10 years through 25 years.
Genital HPV infections are the most common sexually-transmitted diseases in the United States, and HPV types 16 and 18 are the cause of about 70% of cervical cancers worldwide. There will be an estimated 11,270 new cases and 4,070 deaths from cervical cancer in the United States during 2009, according to the National Cancer Institute.
The primary clinical study for Cervarix included more than 18,000 women ages 15 years through 25 years in the United States and 11 other countries. Of these women, about 9,000 received Cervarix and 9,000 received Havrix, a licensed hepatitis A virus vaccine, as a control. The results showed that among women who had not already been infected by HPV types 16 and/or 18 before the start of the study, Cervarix was about 93% effective in preventing precancerous cervical lesions caused by these HPV types. Among all Cervarix vaccinees, which included those who tested negative for HPV 16 and/or 18, and those who tested positive at the start of the study, Cervarix was approximately 53% effective in preventing precancerous cervical lesions.
Studies also were performed to measure the immune response to Cervarix in girls ages 10 through 14 years. Their immune response was similar to that of women ages 15 through 25 years, indicating that the vaccine should have similar effectiveness in the 10- through 14-year old age group. The current data show that Cervarix provides protection for about 6.4 years, but additional information on the length of protection is forthcoming.
Cervarix contains the adjuvant ASO4. ASO4 is a combination of aluminum hydroxide and monophosphoryl lipid A (MPL) and is the first vaccine licensed by the FDA that includes MPL as an adjuvant. An adjuvant is a substance incorporated into a vaccine that enhances or directs the immune response of the vaccinated individual.
Thesafetyofthevaccinewasevaluatedinabout24,000girlsandwomen,withabout13,000ofthesereceivingCervarix.Themostcommonlyreported adverse reactions in the Cervarix group included pain, redness, and swelling at the injection site, fatigue, headache, muscle and joint aches, and gastrointestinal distress.
Although Cervarix is not indicated for pregnant women, the FDA is requiring the manufacturer, GlaxoSmithKline Biologicals, to conduct a postmarketing study to assess the safety of Cervarix in pregnant women following vaccination prior to identification of pregnancy. Women who are pregnant, or think that they may be pregnant, or plan to become pregnant during the vaccination course, should not use Cervarix. Cervarix is administered in three separate shots, with the initial dose being followed by two additional shots at one and six months.
Rare Genetic Condition Linked To Parkinson’s Risk
An international team led by a National Institutes of Health researcher has found that carriers of a rare, genetic condition called Gaucher disease face a risk of developing Parkinson’s disease more than five times greater than the general public. The findings were published last month in the New England Journal of Medicine.
In previous studies, several genes have been linked to Parkinson’s disease. However, researchers say their work conclusively shows that mutations in the gene responsible for Gaucher disease are among the most significant risk factors found to date for Parkinson’s disease. The discovery was made by investigators from the National Human Genome Research Institute (NHGRI) and the National Institute on Aging (NIA) in collaboration with scientists from 16 research centers across four continents.
Gaucher disease occurs when an individual inherits two defective copies of the GBA gene, which codes for an enzyme called glucocerebrosidase. This enzyme breaks down a fatty substance called glucocerebroside, which when not properly disposed of, can harm the spleen, liver, lungs, bone marrow, and,in some cases, the brain. The enzyme functions in a part of the cell called the lysosome, where cellular components are broken down, or metabolized, for recycling.
In the past, it was thought that people who carry just one altered GBA gene were unaffected. However, in recent years, research groups at NHGRI and elsewhere have completed small studies suggesting that carriers of GBA alterations may have an increased risk of developing Parkinson’s disease.
The research team examined the frequency of GBA alterations in 5,691 patients with Parkinson’s disease, including 780 Ashkenazi Jews, a population in which a particular type of Gaucher disease is more prevalent. Those data were matched against 4,898 unaffected volunteers, called controls, which included 387 Ashkenazi Jews. At least one of the two common GBA alterations was found in 3.2% of Parkinson’s patients and 0.6% of controls. Among the Ashkenazi subjects, 15.3% of those with Parkinson’s disease carried a GBA alteration compared to 3.4% of Ashkenazi controls.
In addition to screening for the two common alterations, five of the research centers sequenced the entire GBA gene in 1,642 non-Ashkenazi patients with Parkinson’s disease and 609 non-Ashkenazi controls. Using this more thorough method, they found many additional alterations associated with Parkinson’s disease, and showed that 7% of patients carried an alteration, indicating that it is important to look beyond the two common alterations to gain a true picture of risk in the general population.
Besides significantly increasing the risk of Parkinson’s disease, GBA alterations also appear to increase the likelihood of early disease onset. According to the new study, Parkinson’s patients with GBA alterations developed symptoms an average of four years earlier than other Parkinson’s patients. Overall, the researchers found that the association between GBA and Parkinson’s disease is not confined to any single ethnicity or to specific GBA mutations, though they did find that some gene alterations are seen more frequently in certain populations. Compared with the general population, in which GBA alterations occur in fewer than 1 out of 100 people, GBA alterations occur in at least one out of 16 people of Ashkenazi descent. However, many GBA mutation carriers as well as patients with Gaucher disease never develop Parkinson’s disease, so this appears to be only one of several risk factors involved.
The researchers are pursuing ways to provide more accurate guidance based on the findings for genetic counseling and for the development of new therapeutic strategies for these disorders.
Parkinson’s Disease Data Bank Yields Potential Therapy
Individuals with Parkinson’s disease who have higher levels of a metabolite called urate in their blood and in cerebrospinal fluid (CSF) have a slower rate of disease progression, according to a study funded by the National Institutes of Health. A clinical trial is under way to examine the safety and potential benefits of supplemental urate elevation for recently diagnosed Parkinson’s patients who have low urate levels.
Investigators demonstrated the link with urate by mining a repository of clinical data and tissue samples collected from Parkinson’s patients more than 20 years ago as part of a pioneering study called DATATOP, funded by the National Institute of Neurological Disorders and Stroke. The new study appears in Archives of Neurology. It was funded primarily by NINDS, with additional support from the Department of Defense and private organizations.
Experts emphasize there is no proof that elevating urate levels will help against Parkinson’s disease, and that it should not be attempted outside of a clinical trial, where physicians can closely monitor possible benefits and risks such as gout and heart disease. Parkinson’s disease attacks cells in the brain that regulate movement by releasing a chemical called dopamine. The loss of those cells leads to progressively disabling symptoms, including involuntary shaking, slow movement, stiffened muscle tone, and impaired balance. Levodopa, a precursor of dopamine, provides some relief from those symptoms, but does not alter the disease course.
Urate (or uric acid) is a product of the body’s metabolism. Diets high in liver, seafood, dried beans and peas tend to cause higher levels of urate in the blood, and are also associated with gout—a painful buildup of urate crystals in the joints. Urate is a natural antioxidant and many studies have found that antioxidants slow the course of Parkinson’s disease in animal models. Also, prior research has shown that people who have gout or who consume foods associated with high urate have a lower incidence of Parkinson’s disease.
The NIH researchers were the first to examine whether urate levels are related to the course of Parkinson’s disease. Last year, after mining data from another large clinical trial, they reported that high levels of urate in blood were associated with a slower disease course. The new study is an expansion of that work and the first time that investigators have looked for a connection between the course of Parkinson’s and levels of urate in CSF, the fluid that fills spaces in the brain and spinal cord.
The DATATOP trial began in the late 1980s, and was designed to test whether vitamin E, the drug deprenyl (selegiline), or a combination of both could slow the course of early-stage Parkinson’s disease. The trial enrolled 800 patients and followed them for two years. Deprenyl, which inhibits the breakdown of dopamine, was found to provide short-term relief from symptoms. Vitamin E showed no significant benefit.
As part of the DATATOP trial, samples of blood and CSF were acquired from more than 90% of the participants at enrollment. In the new study, the researchers analyzed whether blood and CSF urate levels were related to the course of Parkinson’s by relying on blood measurements done at the time of the DATATOP trial, and by taking new measurements from the 20-year-old frozen samples of CSF.
Looking across all of the treatment groups in the study, the researchers found that patients with the highest urate levels in their blood and CSF had a slower functional decline as measured by their need for levodopa treatment. The results suggest that urate elevation might slow the course of Parkinson’s in patients with early-stage disease and low urate levels.