The Cost of Stigma

Key Points Substance Use Disorder (SUD), formerly known as addiction or substance abuse, is a treatable medical condition, but fewer than 1 in 10 Tennesseans with SUD receive treatment. Stigma can lead to a view of those with SUD as weak-willed, unmotivated, and unlikely to recover. However, the reality is that about 60% of people with SUD experience full remission. Treatment is also fiscally sound: every $1 spent on evidence-based treatment for SUD saves$12 in healthcare and criminal justice costs. How we talk about SUD is the beginning of reducing stigma. Using person-first language such as “people with substance use disorder” as opposed to harmful words like “addict” or “junkie” is a start. The Recovery Research Institute’s “Addictionary” is an excellent resource for clinicians, policymakers, judicial authorities, and other stakeholders to refer to when seeking to destigmatize their vocabulary. See report attached, and for additional information, visit https://smart.tennessee.edu/policy-briefs/the-cost-of-stigma/

Substance Misuse and Incarceration in Tennessee

Key Points Corrections in Tennessee cost over $1 billion annually due to a rising incarceration rate. The State’s increasing incarceration rate is related to the growth in substance misuse which on its own costs Tennessee$2 billion each year and leads to over $1 billion in lost income from a shrinking work force. Prioritizing evidence-based treatment that targets the underlying medical and behavioral issues driving addictive habits for justice-involved individuals could simultaneously address rising recidivism, reincarceration, and growing substance misuse. See report attached, and for additional information, visit https://smart.tennessee.edu/policy-briefs/substance-misuse-incarceration-tn/

The Lifetime Cost of Current Human Immunodeficiency Virus Care in the United States

Objective: We sought to project the lifetime cost of medical care for human immunodefiency virus (HIV)-infected adults using current antiretroviral therapy (ART) standards. Methods: Medical visits and hospitalizations for any reason were from the HIV Research Network, a consortium of high-volume HIV primary care sites. HIV treatment drug regimen efficacies were from clinical guidelines and published sources; data on other drugs used were not available. In a computer simulation model, we projected HIV medical care costs in 2004 U.S. dollars. Results: From the time of entering HIV care, per person projected life expectancy is 24.2 years, discounted lifetime cost is $385,200, and undiscounted cost is$618,900 for adults who initiate ART with CD4 cell count Ͻ350/L. Seventy-three percent of the cost is antiretroviral medications, 13% inpatient care, 9% outpatient care, and 5% other HIV-related medications and laboratory costs. For patients who initiate ART with CD4 cell count Ͻ200/L, projected life expectancy is 22.5 years, discounted lifetime cost is $354,100 and undiscounted cost is$567,000. Results are sensitive to drug manufacturers' discounts, ART efficacy, and use of enfuvirtide for salvage. If costs are discounted to the time of infection, the discounted lifetime cost is $303,100. Conclusions: Effective ART regimens have substantially improved survival and have increased the lifetime cost of HIV-related medical care in the U.S

Characterization of apparently balanced chromosomal rearrangements from the developmental genome anatomy project.

Apparently balanced chromosomal rearrangements in individuals with major congenital anomalies represent natural experiments of gene disruption and dysregulation. These individuals can be studied to identify novel genes critical in human development and to annotate further the function of known genes. Identification and characterization of these genes is the goal of the Developmental Genome Anatomy Project (DGAP). DGAP is a multidisciplinary effort that leverages the recent advances resulting from the Human Genome Project to increase our understanding of birth defects and the process of human development. Clinically significant phenotypes of individuals enrolled in DGAP are varied and, in most cases, involve multiple organ systems. Study of these individuals\u27 chromosomal rearrangements has resulted in the mapping of 77 breakpoints from 40 chromosomal rearrangements by FISH with BACs and fosmids, array CGH, Southern-blot hybridization, MLPA, RT-PCR, and suppression PCR. Eighteen chromosomal breakpoints have been cloned and sequenced. Unsuspected genomic imbalances and cryptic rearrangements were detected, but less frequently than has been reported previously. Chromosomal rearrangements, both balanced and unbalanced, in individuals with multiple congenital anomalies continue to be a valuable resource for gene discovery and annotation

Clinical Clearance of the Cervical Spine in Blunt Trauma Patients Younger than 3 Years: a Multi-Center Study of the American Association for the Surgery of Trauma.

BACKGROUND: Cervical spine clearance in the very young child is challenging. Radiographic imaging to diagnose cervical spine injuries (CSI) even in the absence of clinical findings is common, raising concerns about radiation exposure and imaging-related complications. We examined whether simple clinical criteria can be used to safely rule out CSI in patients younger than 3 years. METHODS: The trauma registries from 22 level I or II trauma centers were reviewed for the 10-year period (January 1995 to January 2005). Blunt trauma patients younger than 3 years were identified. The measured outcome was CSI. Independent predictors of CSI were identified by univariate and multivariate analysis. A weighted score was calculated by assigning 1, 2, or 3 points to each independent predictor according to its magnitude of effect. The score was established on two thirds of the population and validated using the remaining one third. RESULTS: Of 12,537 patients younger than 3 years, CSI was identified in 83 patients (0.66%), eight had spinal cord injury. Four independent predictors of CSI were identified: Glasgow Coma Score CONCLUSIONS: CSI in patients younger than 3 years is uncommon. Four simple clinical predictors can be used in conjunction to the physical examination to substantially reduce the use of radiographic imaging in this patient population