Children with HIV/AIDS falling through the cracks of treatment scale-up efforts

ScienceDaily (Dec. 1, 2011) — Less than one-quarter (23%) of children with HIV/AIDS who need treatment are getting it, according to a report released by the World Health Organization (WHO) on the occasion of World AIDS Day (1 December 2011). Although treatment coverage for adults has been steadily climbing and has now reached approximately half of those in need, coverage for children is lagging far behind, highlighted the Drugs for Neglected Diseases initiative (DNDi), a non-profit research and development organization that has recently launched a new paediatric HIV drug development programme.

'Children with HIV/AIDS are falling through the cracks', said Dr Bernard Pécoul, Executive Director of the DNDi. '250,000 children died of HIV-related complications in 2010 -- that's nearly 700 each day. This is simply unacceptable.'

There are several reasons for this situation -- including lack of access for pregnant women to antenatal care, HIV testing, and antiretrovirals (ARVs) to prevent mother-to-child transmission and treat expecting mothers, as well as difficulties diagnosing HIV in infants. But one of the most important, and overlooked, is the lack of suitable formulations of ARVs adapted for children, particularly babies and toddlers. The reason for this neglect lies, ironically, with the success of the virtual elimination of HIV among newborns in wealthy countries.

'There's little profit to be made from developing treatments for the millions of children with HIV/AIDS, 90% of whom are the poorest of the poor in sub-Saharan Africa, and the lack of market incentive means pharmaceutical companies do not develop ARVs adapted to their needs', Dr Pécoul continued. 'Without treatment, half of the children born with HIV die before their second birthday.'

WHO recommends immediate ART for all HIV-positive children less than two years old, but the safety and correct dosing have not been established in very young children for the majority of ARVs approved for adults. In addition, key existing paediatric ARV formulations taste bad, require impractical multiple liquid preparations and refrigeration, and have undesirable interactions with tuberculosis (TB) drugs.

DNDi's new paediatric HIV programme aims to develop an improved first-line therapy for children under three years of age. Ideally, this ARV combination therapy needs to be easy to administer and better tolerated by children than current drugs, as well as heat stable and easily dispersible (dissolvable in water or breast milk). It must also carry minimal risk for developing resistance and require minimum weight adjustments. Finally, any new formulations must be compatible with TB drugs.

'Given the current funding crisis, we are deeply concerned that children with HIV/AIDS -- who are already invisible and largely voiceless -- will fall even further down on the agenda', said Dr Marc Lallemant, Head of DNDi's Paediatric HIV Programme. 'And while everything possible needs to be done to achieve the long-term goal of "eliminating" new infections among infants, including through scale-up of prevention of mother-to-child transmission programmes, a more serious response is urgently needed for HIV-positive children today.'

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Training in 'concrete thinking' can be self-help treatment for depression, study suggests

ScienceDaily (Nov. 17, 2011) — New research provides the first evidence that depression can be treated by only targeting an individual's style of thinking through repeated mental exercises in an approach called cognitive bias modification.

The study suggests an innovative psychological treatment called 'concreteness training' can reduce depression in just two months and could work as a self-help therapy for depression in primary care.

Led by the University of Exeter and funded by the Medical Research Council, the research shows how this new treatment could help some of the 3.5 million people in the UK living with depression.

People suffering from depression have a tendency towards unhelpful abstract thinking and over-general negative thoughts, such as viewing a single mistake as evidence that they are useless at everything. Concreteness training (CNT) is a novel and unique treatment approach that attempts to directly target this tendency. Repeated practice of CNT exercises can help people to shift their thinking style.

CNT teaches people how to be more specific when reflecting on problems. This can help them to keep difficulties in perspective, improve problem-solving and reduce worry, brooding, and depressed mood. This study provided the first formal test of this treatment for depression in the NHS.

121 individuals who were currently experiencing an episode of depression were recruited from GP practices. They took part in the clinical trial and were randomly allocated into three groups. A third received their usual treatment from their GP, plus CNT, while some were offered relaxation training in addition to their usual treatment and the remainder simply continued their usual treatment. All participants were assessed by the research team after two months and then three and six months later to see what progress they had made.

The CNT involved the participants undertaking a daily exercise in which they focused on a recent event that they had found mildly to moderately upsetting. They did this initially with a therapist and then alone using an audio CD that provided guided instructions. They worked through standardised steps and a series of exercises to focus on the specific details of that event and to identify how they might have influenced the outcome.

CNT significantly reduced symptoms of depression and anxiety, on average reducing symptoms from severe depression to mild depression during the first two months and maintaining this effect over the following three and six months. On average, those individuals who simply continued with their usual treatment remained severely depressed.

Although concreteness training and relaxation training both significantly reduced depression and anxiety, only concreteness training reduced the negative thinking typically found in depression. Moreover, for those participants who practised it enough to ensure it became a habit, CNT reduced symptoms of depression more than relaxation training.

Professor Edward Watkins of the University of Exeter said: "This is the first demonstration that just targeting thinking style can be an effective means of tackling depression. Concreteness training can be delivered with minimal face-to-face contact with a therapist and training could be accessed online, through CDs or through smartphone apps. This has the advantage of making it a relatively cheap form of treatment that could be accessed by large numbers of people. This is a major priority in depression treatment and research, because of the high prevalence and global burden of depression, for which we need widely available cost-effective interventions."

The researchers are now calling for larger effectiveness clinical trials so that the feasibility of CNT as part of the NHS's treatment for depression can be assessed.

Published in the journal Psychological Medicine, this study was carried out by a team from the Mood Disorders Centre, which is a partnership between the NHS and the University of Exeter and the Peninsula College of Medicine and Dentistry, a joint entity of the Universities of Exeter and Plymouth and the NHS in the South West.

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Mesothelioma Cancer Treatment.

Mesothelioma is a rare form of lung cancer caused by prolonged exposure to asbestos. This disease has no cure. Part of the problem with treating this condition is that more than 20-30 years can have passed since the original exposure. In this timeframe the condition has a strong hold on the body and when it is finally diagnosed the patient usually has less than one year to live. The treatment to slow the disease and hopefully extend the patient’s life includes surgery, chemotherapy and radiation.

It’s no wonder that given such a dismal prognosis, many patients are taking a new look at alternative therapies. Under this wide category are treatments such as acupuncture, homeopathy, herbs, massage and even meditation.


Meditation is actually a group of techniques, which started in Eastern cultures and/or spiritual traditions. This technique is used by people all over the world for many different reasons. In meditation, a person focuses his attention and quiets their mind, letting go of the constant stream of thoughts (don’t kid yourself - this is not easy to learn). This practice helps to bring a greater state of physical relaxation, mental calmness, and balance to a patient’s world. With practice a person can learn to change their flow of emotions and thoughts.

There are four main elements common to most mediation techniques. First, a quiet location is required. Most people prefer solitude or at minimum, few distractions. This is especially true for beginners. Those with more experience can block out unnecessary and disturbing noises and can even meditate successfully in public places like planes, trains and even the doctor’s office.

The second requirement is a comfortable posture. Some people prefer to lie down while they meditate, others prefer to sit or even stand. Sometimes the posture depends on the type of meditation being practiced.

The third requirement is to have a focus of attention. It is usually part of the mediation to focus one’s attention on something. This could be a mantra, which is a word or set of words that are continually repeated and for some it is an object and for other people, they foc
us on their breathing.

The fourth requirement is an open attitude. This means letting thoughts come and go without getting upset or judging them. The goal is to eventually watch the thoughts flow and just observe them as they move through the mind.

There are many ways in which people use meditation to help improve various health problems, such as: anxiety, pain, depression, insomnia, stress, self esteem, even to uplift their moods. Its proven effective with physical and emotional symptoms associated with severe illnesses, such as mesothelioma.

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