Tag Archives: featured

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.

 

 

 

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

The War on Disease: The Creation of a Global Vaccine-Development Fund

By Moses Im

Just recently, the Ebola outbreak lead to over 11,000 deaths. Yet, the pandemic also exposed the constant looming threats that affect global health due to the lack of necessary medicines and vaccines. Thus, as the world shook in fear, WHO (World Health Organization) and other supporting countries rushed in to control and stop the disease.

Coincidentally, before the outbreak occurred there were at least seven different vaccines that passed animal testing with promising results. Out of those only one went through further clinical trials before being abandoned due to costs and difficulties in the licensing process. Here, bureaucracy took precedence over safety and health. Due to the pandemic, however, the governments and organizations pushed the research further. Eventually the right vaccine was licensed but it came thousands of lives too late.

Out of those only one went through further clinical trials before being abandoned due to costs and difficulties in the licensing process. Here, bureaucracy took precedence over safety and health.

This pattern of pharmaceutical profit and insufficient government funding is seen in many diseases considered under the term of the “the valley of death.” For example, Ebola, West Nile, and the SARS virus are all included on this deathly list of diseases. If this reluctance for action continues many people around the globe will become vulnerable to death.

Yet, there is a new hope.

In July 2015 three prominent physicians, Stanley Plotkin, M.D., emeritus professor of pediatrics at the University of Pennsylvania, Adel Mahmoud, M.D., Ph.D, professor in the Molecular Biology Department and Woodrow Wilson School of International and Public Affairs at Princeton University, and Jeremy Farrar, M.D., Ph.D, director of the Wellcome Trust, in a published article called for a “global vaccine-development fund.” Their plan requires a $2 billion investment in vaccine research which will target “the valley of death.”Thus, the funds are meant to help vaccines and projects get past preliminary rounds of research and simplify the licensing process. Therefore, the ideology relies on paying large sums upfront and decreasing the costs later down the road. For context, the Ebola crisis alone costed the world about $8 billion. Overall, through their article, Plotkin, Mahmoud, and Farrar called the world to learn to adapt to “the lesson we [can] take from the Ebola crisis.” And it appears the world indeed learned.

The science community responded positively to the article, and, just as the authors hoped, great discussion grew out of this call to action. As a direct result, under the leadership of Director Jeremy Farrar, the Coalition of Epidemic Preparedness Innovations (CEPI) was formed and launched on January 18, 2017. The global company is backed by the European Commission, the Bill and Melinda Gates Foundation, the Wellcome Trust, World Economic Forum, and the governments of Norway, Japan, Germany, and India. Organizations like Pfizer, Johnson & Johnson, Johns Hopkins Vaccine Initiative, and many more have joined as well. CEPI have decided to start by targeting Lassa, Nipah and MERS as advised by their scientific advisory board. While CEPI may have been launched with a little less than $500 million, they hope to finish fundraising by the end of this year. Thus, CEPI has created a feeling of hopefulness for the creation of solutions to diseases. The world may soon be rest assured that another crisis like Ebola will not erupt.