University Times

$1.3 million goes to GSPH researcher to study changes in adolescent managed care

Graduate School of Public Health (GSPH) researcher Jan Jernigan has won a $1.3 million grant to study changes in adolescent managed care.

The study, one of six such federally funded projects in the United States and Puerto Rico, looks at the variety of help teenagers may receive and how satisfied they and their families are with that help.

Such services may include counseling, health care, drug and alcohol treatment, legal services and mental health care. Jernigan, an assistant professor of health services administration, is the principal investigator for Pitt.

"Rapid transition to managed care for Medicaid recipients could have a major impact on adolescents with substance abuse problems whose special needs may not be addressed in standard treatment programs," Jernigan explained. "We have an opportunity here to examine these effects. Our goal is to assemble hard data that will help public agencies and providers deliver the most appropriate services to adolescents and their families." Jernigan has the cooperation of several drug and alcohol treatment agencies in southwestern Pennsylvania to ask approximately 500 adolescents between the ages of 12 and 19 years to participate in this study.

Jernigan expects to follow up with at least 300 adolescents for a year to determine treatment efficacy and satisfaction. For more information, contact Jernigan toll-free at 887/624-2255.

***********

DOD awards grant for artificial lung research

Brack Hattler, director of the artificial lung program at UPMC Health System's cardiothoracic surgery division, has been awarded a $1.5 million renewal grant from the U. S. Department of Defense to continue developing an artificia l lung that will provide temporary support for people with compromised lungs. These new funds continue Department of Defense support that began in 1994 with the initial awarding of $1 million to the project.

Another $1 million has been granted for research in 1999.

Also known as an intravenous membrane oxygenator (IMO), the IMO is intended for patients with acute respiratory distress syndrome, pneumonia and chronic lung disease, organ transplant patients and patients in intensive care units.

The defense department has an interest in the development of an easily and rapidly inserted artificial lung for battlefield use in treating wounded soldiers and combat personnel exposed to chemical agents that damage the lungs, according to Hattler, professor of surgery and the inventor of the IMO.

The device is inserted through a peripheral vein into the patient's vena cava, a large vein which carries blood back to the heart. The objective of the IMO is to oxygenate the blood before it gets to the patient's lungs, allowing the lungs to rest and hea l as the patient recovers from his injury.

"The lungs would then add whatever help they can. It will be used for patients who have a chance to reverse their respiratory problems," Hattler said. "Because prolonged use of respirators could eventually cause damage to the patient's lung over a period of days or weeks, the artificial lung may eventually replace existing mechanical ventilation in patients with respiratory failure.

"This will be good news to the approximately 240,000 patients annually who have acute respiratory problems with the need for prolonged use of ventilators," he said.

Hattler's patented device consists of about 1,000 hollow fiber membranes that have tiny pores. Oxygen enters these membranes through an external tube and flows through the fibers under vacuum pressure. Oxygen within each fiber diffuses through the tiny po res in the fiber wall into the blood and is exchanged for carbon dioxide, which diffuses into the fibers and exits the device through a second tube.

***********

Study indicates most effective treatment for elderly who are depressed

In the first-ever study to compare different therapies for treatment and prevention of recurrent major depression in the elderly, UPMC Health System researchers have found that a combination of medication and psychotherapy is significantly more effective than medication or psychotherapy alone and that continued treatment can significantly reduce the risk of recurrence.

The study, in the Jan. 6 Journal of the American Medical Association, examined the rate of recurrence among 124 depressed elderly people aged 60 and older who had been split into four groups to compare the effectiveness of different treatments.

One group received both the antidepressant drug nortriptyline, a tricyclic antidepressant, and monthly interpersonal therapy (IPT). A second group received only the medication, while a third group received only IPT. The fourth group received a placebo. A ll were followed for three years.

The results showed that the combination of nortriptyline and IPT prevented recurrence of depression in 80 percent of the patients, while medication alone prevented recurrence in 57 percent of the patients and IPT in 36 percent. Only 10 percent of patients in the placebo group remained well.

"These results clearly show that a combination of medication and interpersonal therapy is the best treatment for preventing recurrence of depression in the elderly," said principal investigator Charles F. Reynolds III, professor of psychiatry and neurosci ence at the Western Psychiatric Institute and Clinic (WPIC). "These results are at odds with the way treatment standards are moving under managed care. If our results hold true, combination therapy would not only be better for the patients, but save heal th care dollars in the long run." Depression in old age affects at least one in six people and an even higher percentage among those in hospitals and nursing homes. It has serious health consequences, including suicide, illness and increased health care costs to society.