All posts by PPHR

Expanding Therapy’s Reach: ‘Low-Intensity Interventions’ for Childhood Anxiety Disorders

By Alison Herman

Thirty-three percent on an assessment would be considered acute failure; our mental health systems regularly fail children and teenagers when less than a third of these patients receive the help they need. Given that “half of all lifetime anxiety disorders emerge before age 12,” neglect of this patient population remains both unwarranted and unacceptable. Cathy Creswell and her colleagues may have found a work-around of the under-supported psychiatry and psychotherapy industries.

Our mental health systems regularly fail children and teenagers when less than a third of these patients receive the help they need.

Two short-term treatment regimens, parent-guided cognitive behavioral therapy (CBT) and solution-focused therapy, were evaluated in a randomized control trial. Caregivers in the parent-guided CBT condition received self-help guidebooks in addition to eight sessions with therapists to prepare for the small-scale treatment plan that emphasizes skill-acquisition and recognizing and working against cognitive distortions. Solution focused therapy is “future-focused and works with the strengths and resources of the individual to build solutions.”

Altogether, both interventions require only five hours of contact with therapists. Length of treatment diminishes costs to patients and their families, and, in the case of this study, the “use of brief telephone contacts reduced the need for face-to-face consultations and associated travel costs and time off work or school to attend clinic appointments.” Researchers employed the Clinical Global Impressions of Improvement (CGI-I) to track the progress of the five- to twelve-year old subjects, with both therapies leading to patient betterment in most cases.

Paul Stallard, commenting on the study in The Lancet Psychiatry, summarizes the magnitude of the studies’ impact: “Twice as many children could be treated by brief guided parent-delivered CBT, [which researchers found to be the more cost-effective,] and solution-focused brief therapy than by traditional CAMHS interventions, which typically involve 12–16 sessions.”

Widespread implementation of parent-guided CBT, then, would still exclude approximately one-third of children and adolescents suffering from mental health afflictions. Further research into innovative, cost-minimizing solutions is needed. Early lessons on effective mental health management could save many from excess suffering in adulthood.

 

Sources

Creswell, Cathy, Mara Violato, Hannah Fairbanks, Elizabeth White, Monika Parkinson, Gemma Abitabile, Alessandro Leidi, and Peter Cooper. 2017. “Clinical Outcomes and Cost-Effectiveness of Brief Guided Parent-Delivered Cognitive Behavioural Therapy and Solution-Focused Brief Therapy for Treatment of Childhood Anxiety Disorders: A Randomised Controlled Trial.” The Lancet Psychiatry 4 (7): 529–39.

Stallard, Paul. 2017. “Low-Intensity Interventions for Anxiety Disorders.” The Lancet Psychiatry, May.

 

 

 

Midwifery as a Means to Bridge Global Health’s Gender Gap

By Alison Herman

On June 17, midwives from 113 countries could be found parading through the streets of Toronto, marshalling in the annual International Confederation of Midwives congress. These essential practitioners do much to lead the march forward toward global development goals, providing life-saving care to mothers and infants. The investment and attention paid to these healthcare workers is not always commensurate with their value.

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Are Video Games Really… “Mindless?”

By Ameyavikram Pathak

Hopewell Valley Central High School

We’ve all heard from, well, about everyone, that video games rot your brain. People often tell their kids to turn off their devices because they want their kids to have healthy eyes in this new era of technological advancements. Some can even argue that violence in certain video games such as Call of Duty, Battlefield, and Fallout, is causing many people to commit acts of violence, like Columbine. But, very few have come to think that maybe Pac-Man or Galaga actually can improve your senses and capabilities that no one has ever thought would do. These “mindless” video games that we assume are just entertainment today can actually help us tomorrow by improving our cognitive abilities, which will help everyone, even adults, complete everyday tasks more efficiently than before.

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Untreated Mental Illnesses: The Causes and Effects

By Milena Bimpong

Lawrence High School

People view taking time off from school or work because of the flu or a broken bone as perfectly acceptable, but taking time off because of stress from a mental illness such as anxiety or depression, unfortunately, is not. People usually believe that someone who takes time off from school or work because of a physical illness needs the time to recover quickly. However, when someone does the same for a mental illness, they are usually told that they are “lazy” or that the problem is “all inside their head.” Why is this the case?

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National Autism Awareness Month

By Nicholas Persaud

The month of April is National Autism Awareness Month. As suggested by the name, the purpose of this month is to educate and inform others about autism. This includes defining the disease, learning what it means to have autism, learning the difficulties that someone with autism faces, and of course learning how to accept and appreciate those living with autism. Considering that over 3.5 million Americans are currently living with autism, it is important that we are educated on this topic.

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April: Parkinson’s Awareness Month

By Barbara Gruszka

Parkinson’s disease is a progressive neurodegenerative brain disorder. While there are many neurodegenerative disorders such as Alzheimer’s, Amyotrophic Lateral Sclerosis (ALS), and Huntington’s, Parkinson’s is characterized by the development of tremors, impaired movement, and even trouble controlling emotions.[1]

Why does this occur? Current research points to the neurotransmitter dopamine. Neurotransmitters allow for the brain to send signals through neurons, known as “brain cells.” In Parkinson’s disease, the brain slowly stops producing dopamine and is unable to relay signals towards the parts of the brain that help us move. These signals typically stem from the substantia nigra, where the neurons that produce dopamine are heavily concentrated. In a Parkinson’s patient this area is inactive and dopamine is not produced.

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Predictive Measures for Organ Transplant Rejections

BY YUSHA SUN

While organ transplant operations have been increasingly successful over the past few years, the ultimate concern is whether the transplants will be successful in the long term. Unfortunately often, organ transplants get rejected, as the body’s immune system may suddenly attack the donor organ and cause it to fail. In heart transplants, the rate of organ rejection and patient mortality are the highest, even though the transplants are monitored by regular biopsies. Specifically, some 40% of heart recipients experience some type of severe rejection within one year of their transplant. It is clearly important to develop methods to detect the possible transplant rejection sooner, especially for organs like the heart. The solution might come from developing predictive measures for other types of organ transplants.

In heart transplants, the rate of organ rejection and patient mortality are the highest, even though the transplants are monitored by regular biopsies.

For example, patients with Type 1 diabetes sometimes undergo islet transplantation, which is the replacement of clusters of islet cells in the pancreas that control the blood sugar levels. High blood glucose levels are often indicators of tissue rejection; yet, this is only observed when rejection is imminent and at an advanced stage. Since almost 15% of islet transplant patients experience acute rejection, there clearly is a necessity for a better and earlier way to detect if an organ transplant might possibly be rejected, so that doctors can interfere before cell damage spreads dangerously and enhance patient survival rate. Recent studies have developed biomarkers to detect the possibility of islet transplant rejection, which shows promise in lowering the rate of acute rejection, and might plausibly be applicable to other organ transplants, such as the heart.

Here we present one such study. Specifically, researchers at University of Pennsylvania published a study in late March in which they used exosomes to determine whether islet cells might be rejected by the body. Exosomes are small vesicles, or bodies, outside of the cell that are released by various tissues into the bloodstream or other bodily fluids. Because these exosomes represent their tissue of origin biologically, quantifying and characterizing their presence within the bloodstream could serve as a biomarker for the new islet cells.

First, by transplanting islets from the human pancreas into diabetic mice, the researchers confirmed that exosomes released by islet cells express a certain protein on their surface, the HLA antigen. They then showed that a drastic decrease in the number of HLA-carrying exosomes in the bloodstream is almost always observed prior to an increase in blood sugar levels in the mice, which indicates a high likelihood of rejection. Besides the change in the number of exosomes detected in the bloodstream, an analysis of specific RNA and protein compositions of exosomes revealed numerical differences between normal exosomes and possible rejections.

To test their claim from their mouse models, the researchers attempted to detect islet-related exosomes in a clinical setting. In all the patients tested, exosomes from the donor islets could not be detected prior to transplant, as expected, while after the transplant, exosome levels became quantifiable. Notably, in one out of the five patients tested, a decrease in the number of cell exosomes was observed six months before the blood glucose levels rose, which thereafter led to rejection. The other four patients that did not show a drastic change in exosome level did not experience rejection, even after 5 years of follow-up. The researchers also managed to quantify and characterize exosomes from urine, showing the plausibility of utilizing this method in renal (kidney) transplantation, alongside pancreatic islet transplantation.

Indeed, the application of exosome detection as a biomarker for islet and renal transplants provides a solid foundation on which organ rejection can be predicted. Because the specific RNA and protein compositions of exosomes can also be analyzed, the exosome tool might have many future applications in other organ transplant models, such as heart or lung transplants, and even in other fields, such as stem cells and cancer. Overall, exosomes have been proposed to be a powerful predictive tool in the clinical realm of islet transplantation, which, with more research and trials, can be applied in predicting whether a patient will likely reject their organ many months before current standard techniques could.

 

 

Image source: http://sitsshow.blogspot.com/2016/12/Can-An-Organ-Transplant-Change-A-Recipients-Personality-Cell-Memory-Theory-Affirms-Yes.html

Development of Novel Flow Cytometry Technique to Study Yellow Fever Virus

By Devorah Saffern

Researchers in the Ploss lab of the Molecular Biology department at Princeton University have utilized a new technology to analyze the pathogenesis of the yellow fever virus (YFV), which can be applied to other viruses and lead to significant progress in understanding disease mechanisms. Published in Nature Communications on March 14, their study discusses the ways in which viruses interact with host cells, in an effort to discover more effective vaccines. Currently, there is a lack of scientific knowledge on how viruses interact with the host cells and cause illness or proper immune response, and their research begins to uncover these behaviors.

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