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Research Briefs November 2017

More Kids Are Getting the HPV Vaccine

The human papillomavirus (HPV) vaccine has led to “dramatic declines” in HPV infections, according to the Centers for Disease Control and Prevention (CDC). Since the first HPV vaccine was introduced 10 years ago, infections that cause cancers and genital warts have dropped by 71% among teenage girls and 61% among young women. According to the annual National Immunization Survey-Teen report, 60% of teens 13 to 17 years of age received one or more doses of HPV vaccine in 2016, up four percentage points from 2015.

More boys are getting the vaccine, too. About 56% of boys received their first dose (although that’s still less than the 65% seen in girls)—representing a 6% increase from 2015; rates for girls remained stable.

As encouraging as those numbers are, there’s more work to do, the CDC says. While most adolescents have received the first dose, only 43% are up to date on all the recommended doses. The CDC recommends that children 11 to 12 years of age get two doses of HPV vaccine at least six months apart. The CDC updated its HPV vaccine recommendations in 2016 when new evidence showed that two doses of the vaccine provided levels of protection similar to those seen for three doses in older adolescents and young adults.

Parents can get the vaccine for their child during any doctor’s visit, but the CDC recommends that adolescents get the HPV vaccine during the same visit where they get the whooping cough and meningitis vaccines.

Source: CDC, August 2017

VA Shares Lessons Learned From Combating Opioid Crisis

The Department of Veterans Affairs (VA) has boiled down its experience in dealing with the opioid epidemic to eight best practices, which it’s now sharing with others in government and the health care industry who work to balance pain management and opioid prescribing.

The best practices are summed up by the acronym “STOP PAIN,” which stands for:

  • Stepped care model, which encourages a continuum of care from onset through treatment. It also incorporates self-management through participation in groups such as Narcotics or Alcoholics Anonymous; counseling; treatment programs; primary care; and other medical specialists.
  • Treatment alternatives/complementary care, expanding provider options beyond standard care in treating chronic pain. “Complementary health” includes evidence-based treatments, such as acupuncture, yoga, and progressive relaxation.
  • Ongoing monitoring of usage.
  • Practice guidelines providing evidence-based recommendations for minimizing harm and increasing patient safety.
  • Prescription monitoring. The VA has a number of data sources to allow it to monitor opioid use to target specific education in real time. The practice patterns of providers differ, along with the case mixes: A provider with relatively high opioid prescribing may have an appropriate practice, or be someone who could benefit from education. These tools allow the VA to drill down to the patient level to evaluate use. Other tools can evaluate the treatment of patient panels and the veterans’ risk of potential abuse. Together, these allow identification of potential problems, educational targeting, and tracking of progress.
  • Academic detailing. The Academic Detailing program, a one-to-one peer education program for front-line providers, gives specific information on practice alternatives, resources, and opioid safety, and can compare the practice of the provider to that of peers.
  • Informed consent for patients prior to long-term opioid therapy. This process includes education on the risks of opioid therapy, opioid interactions, and safe prescribing practices such as urine drug screens.
  • Naloxone distribution. The Opioid Overdose Education and Naloxone Distribution program focuses on educating providers.

For more information on the VA’s best practices and guidelines for pain management and opioid prescribing, visit www.va.gov/painmanagement..

Source: VA, August 2017

Genes Hold Key to Immunotherapy Resistance

Why do some tumors not respond to immunotherapy? Why do some respond at first but then develop resistance? A National Institutes of Health (NIH) study holds some clues to the answer. Using patient samples from The Cancer Genome Atlas, the researchers found more than 100 genes that may help T cells destroy tumors.

The researchers used CRISPR, a gene-editing technology that stops the expression of individual genes in cancer cells. By first “knocking out” every known protein-encoding gene in the human genome and then testing the ability of modified melanoma cells to respond to T cells, they identified “candidate” genes.

A number of the genes identified by the CRISPR screen were associated with cytolytic activity. One, APLNR, which produces a protein called the apelin receptor, had been “suspected to contribute” to cancer development—now, the NIH researchers say, they have the first indication of a role in response to T cells. In some patients who were resistant to immunotherapies, the apelin receptor protein was nonfunctional, indicating that the loss of that protein could limit the response to immunotherapy.

“Many more genes than we originally expected play a vital role in dictating the success of cancer immunotherapies,” said Shashank Patel, PhD, lead author of the study. Their “gene list” could serve as a blueprint to study the emergence of tumor resistance, the researchers say, and lead to more effective treatments.

Source: NIH, August 2017

HIV Testing Low Among Transgender Adults

Transgender men and women are at high risk for human immunodeficiency virus (HIV) infection: In a recent analysis of more than nine million HIV test results funded by the Centers for Disease Control and Prevention (CDC), transgender women had the highest percentage of confirmed positive results (2.7%) of any gender category. But this group also tends to have too-low testing numbers: In a CDC study, only 36% of transgender women and 32% of transgender men reported having ever been tested; only 10% of both groups had been tested in the past year. By comparison, gay and bisexual men reported getting tested at roughly twice the rates (61.8% ever and 21.6% in the past year).

African-American transgender women and men had twice the prevalence of ever testing, compared with their white counter-parts (63%–67% versus 31%–33%, respectively). Transgender women who had been diagnosed with a depressive disorder had the highest prevalence of ever getting tested for HIV (69%).

Transgender men and women face “unique barriers to testing,” the CDC researchers say, such as the HIV stigma within the transgender community, gender identity stigma in health care settings, and socioeconomic marginalization. The CDC says it is working on “innovative approaches” to delivering HIV testing and other prevention and support services to transgender people who are at risk for or have newly diagnosed HIV.

Source: Morbidity and Mortality Weekly Report, August 2017

Stroke Deaths: Reversing a Healthy Trend?

After decades of decline, progress has slowed in preventing stroke deaths, according to a Centers for Disease Control and Prevention (CDC) Vital Signs report. The report is a “wake-up call,” says CDC Director Brenda Fitzgerald, MD.

About three in every four states showed stalled rates of decline between 2000 and 2015. In some states, the trend of declining stroke deaths has actually reversed. It’s a “disturbing” finding, the researchers say—particularly because 80% of strokes are preventable.

Every 40 seconds, someone in the U.S. has a stroke. Each year, more than 140,000 die. African-Americans continue to be hardest hit by stroke, but stroke deaths are on the rise among Hispanics (by 6% each year between 2013 and 2015) and people living in the South.

Death rates continued to drop steadily between 2000 and 2015 among adults 35 years of age and older. However, people are dying of stroke at younger ages. Over the last 15 years, stroke hospitalizations have increased among adults 18 to 54 years of age. But the researchers note that risk factors, like high blood pressure, high cholesterol, obesity, and diabetes are also appearing in younger people. Moreover, those risk factors may not be recognized and treated in middle-aged adults (35 to 64 years old).

The study categorizes stroke deaths in the U.S. from 2000 to 2015 by age, gender, race/ethnicity, and geographic area. It does not, however, address causes for the slowdown, although it cites other studies that point to obesity, high blood pressure, and diabetes as contributors. High blood pressure is the “single most important preventable and treatable risk factor for stroke,” the CDC says.

Source: CDC, September 2017

Getting Creative About Reducing Kidney Stones

A “smart” water bottle—or money—or a coach? What’s the best way to encourage people at risk for kidney stones to drink more water? The prevalence of urinary stones has nearly doubled in the past 15 years, affecting one in 11 people, according to the National Institutes of Health (NIH). The NIH says little high-quality research exists related to how to prevent stones, and most therapies treat people with the condition only after they’re in excruciating pain.

To test new solutions, researchers from the Urinary Stone Disease Research Network and Duke Clinical Research are recruiting 1,642 participants for Prevention of Urinary Stones with Hydration (PUSH), a two-year multisite clinical trial funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

People with kidney stones, when counseled to drink more water, usually increase intake only by small amounts. So participants in the intervention group will receive “smart” Spark water bottles (Hidrate, Inc.) that connect to an app and monitor how much they drink, with a goal of 2.5 L of urine per day. They’ll also receive financial incentives if they achieve their fluid targets and will meet with a health coach who will help them identify barriers to drinking more liquids and help devise solutions.

“Urinary stones are painful and debilitating, and their treatment is expensive,” said Ziya Kirkali, MD, program director of urology clinical research and epidemiology in NIDDK’s Division of Kidney, Urologic, and Hematologic Diseases. “If successful, the study could change management of kidney stones.”

Source: NIH, September 2017