Humanitarian emergencies, an opportunity for fresh start in providing sustainable, long-term mental health services

16 August 2013 | Geneva - Humanitarian agencies work hard to help people with their mental health and psychosocial needs in the aftermath of emergencies, but too often opportunities are missed to strengthen mental health systems for the long-term, according to a new World Health Organization (WHO) report, "Building back better: Sustainable mental health care after emergencies" released for World Humanitarian Day (August 19).

“In spite of their tragic nature, emergency situations are opportunities to improve the lives of large numbers of people through improving mental health services,” says Dr Bruce Aylward, WHO’s Assistant Director-General overseeing the Organization’s work in humanitarian emergencies. "We can do better for emergency-affected populations by working with the government on sustainable mental health care from the outset.”

The report provides guidance for strengthening mental health systems after emergencies and examples from Afghanistan, Burundi, Indonesia (Aceh Province), Iraq, Jordan, Kosovo, Somalia, Sri Lanka, Timor-Leste, and West Bank and Gaza Strip.

Contributors from each area report not only their major achievements, but also their most difficult challenges and how they were overcome. Key overlapping practices emerging from these experiences are summarized.

Findings from the report include:

• Indonesia (Aceh): Like many provinces in Indonesia, Aceh had only institution-based care before the tsunami of 2004. Today, most districts have primary mental health services supported by secondary care at district general hospitals.
• Iraq: Since 2004, significant progress has been made toward the creation of a comprehensive mental health system. More than 50% of general practitioners have received mental health training.
• Kosovo: Starting from a hospital-based model of care in 1999 after the conflict, a system of community-based mental health care is now available.
• Sri Lanka: Since the 2004 tsunami, a new national mental health policy has guided reform, which now extends to most parts of the country. Several new cadres of community-based mental health workers have been developed.
• Timor-Leste: Building from a complete absence of mental health services in 1999, the country today has a comprehensive community-based mental health system.

The possibilities presented by emergency situations are significant because major gaps remain worldwide in the realization of comprehensive, community-based mental health care.

“The current situation is alarming,” says Dr Shekhar Saxena, WHO Director for Mental Health. “Health systems have not yet adequately responded to the burden of mental disorders. We know that the vast majority of people with severe mental disorders receive no treatment whatsoever in low-income and middle-income countries.”

Transforming the mental health care systems in turn would improve the well-being, functioning, and resilience of individuals, societies, and countries recovering from emergencies, the report notes.

By releasing this report, WHO aims to help guide policymakers to reform their mental health systems, especially those which may be susceptible to future emergencies. Already in 2013, the world has witnessed numerous emergency situations, from the crisis in Syria and neighbouring countries to heavy fighting in Mali and the Central African Republic, major flooding in parts of the Americas, Africa, and Asia, and others.

For more information please contact:

Tarik Jasarevic
WHO Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 793 676 214
E-mail: jasarevict@who.int

View the original article here

Biomarker predicts long-term risk of breast cancer recurrence

Sep. 11, 2013 — A comparison of three methods of predicting the risk of recurrence in women treated for estrogen-receptor (ER)-positive breast cancer finds that only the breast cancer index (BCI) -- a biomarker based on the expression levels of seven tumor-specific genes -- accurately identifies patients who continue to be at risk after five years of treatment with either tamoxifen or the aromatase inhibitor anastrozole. The study comparing the BCI with two other prognostic tests has been published online in Lancet Oncology.

"We have validated a unique 'fingerprint' in the primary tumor of breast cancer patients that can help identify a high or low risk of cancer recurrence," says study co-author Paul Goss, MD, PhD, director of the Breast Cancer Research Program at Massachusetts General Hospital (MGH) Cancer Center. "This should enable us to offer prolonged treatment to patients who remain at risk and, importantly, to avoid the costs and side effects of treatment in those at low risk."

Standard treatment for early-stage, ER-positive breast cancer includes five years of treatment with either tamoxifen or an aromatase inhibitor, drugs that block the action of estrogen. While that approach is sufficient for most patients, some continue to experience recurrence during subsequent years. The study authors note that knowing whether or not a patient continues to be at risk is essential to determining whether prolonged treatment is necessary.

MGH researchers previously developed, in collaboration with investigators from bioTheranostics, Inc., two biomarkers for recurrence risk assessment -- the molecular grade index, which measures expression levels of five genes related to tumor proliferation; and the H/I ratio, which compares expression levels of two other genes. BCI is a combination of both biomarkers and has been shown to identify patients who are at risk of early recurrence despite receiving hormonal treatment.

The current study, led by Dennis Sgroi, MD, of the MGH Cancer Center and Department of Pathology, was designed to compare the ability of the BCI to predict long-term recurrence risk with that of two other gene-expression signatures that can predict risk in the first five years -- the Oncotype Dx Recurrence Score, the current gold standard for guiding clinical decision making, and the less frequently used ICH4 gene signature. All three methods were used to analyze primary tumor samples from more than 650 participants in a clinical trial comparing tamoxifen with anastrozole. Assay results were compared with patient records to determine individual rates of recurrence up to 10 years after initial surgical treatment.

While all three methods were able to predict recurrence risk in the first five years, only the BCI was able to accurately assess long-term recurrence risk. In fact, the BCI was able to clearly distinguish 60 percent of patients whose risk was quite low from 40 percent who continued to be at significant long-term risk. "We know that more than half the instances of recurrence in ER-positive breast cancer occur after five years of therapy with tamoxifen or anastrozole, so these findings are highly relevant to clinical management," says Sgroi. "Since the BCI identifies two distinct risk groups, it may provide a much-needed tool in determining those patients who need extended hormonal therapy and those who may be spared its well-known adverse side effects."

View the original article here

Humanitarian emergencies, an opportunity for fresh start in providing sustainable, long-term mental health services

16 August 2013 | Geneva - Humanitarian agencies work hard to help people with their mental health and psychosocial needs in the aftermath of emergencies, but too often opportunities are missed to strengthen mental health systems for the long-term, according to a new World Health Organization (WHO) report, "Building back better: Sustainable mental health care after emergencies" released for World Humanitarian Day (August 19).

“In spite of their tragic nature, emergency situations are opportunities to improve the lives of large numbers of people through improving mental health services,” says Dr Bruce Aylward, WHO’s Assistant Director-General overseeing the Organization’s work in humanitarian emergencies. "We can do better for emergency-affected populations by working with the government on sustainable mental health care from the outset.”

The report provides guidance for strengthening mental health systems after emergencies and examples from Afghanistan, Burundi, Indonesia (Aceh Province), Iraq, Jordan, Kosovo, Somalia, Sri Lanka, Timor-Leste, and West Bank and Gaza Strip.

Contributors from each area report not only their major achievements, but also their most difficult challenges and how they were overcome. Key overlapping practices emerging from these experiences are summarized.

Indonesia (Aceh): Like many provinces in Indonesia, Aceh had only institution-based care before the tsunami of 2004. Today, most districts have primary mental health services supported by secondary care at district general hospitals.Iraq: Since 2004, significant progress has been made toward the creation of a comprehensive mental health system. More than 50% of general practitioners have received mental health training.Kosovo: Starting from a hospital-based model of care in 1999 after the conflict, a system of community-based mental health care is now available. Sri Lanka: Since the 2004 tsunami, a new national mental health policy has guided reform, which now extends to most parts of the country. Several new cadres of community-based mental health workers have been developed. Timor-Leste: Building from a complete absence of mental health services in 1999, the country today has a comprehensive community-based mental health system.

The possibilities presented by emergency situations are significant because major gaps remain worldwide in the realization of comprehensive, community-based mental health care.

“The current situation is alarming,” says Dr Shekhar Saxena, WHO Director for Mental Health. “Health systems have not yet adequately responded to the burden of mental disorders. We know that the vast majority of people with severe mental disorders receive no treatment whatsoever in low-income and middle-income countries.”

Transforming the mental health care systems in turn would improve the well-being, functioning, and resilience of individuals, societies, and countries recovering from emergencies, the report notes.

By releasing this report, WHO aims to help guide policymakers to reform their mental health systems, especially those which may be susceptible to future emergencies. Already in 2013, the world has witnessed numerous emergency situations, from the crisis in Syria and neighbouring countries to heavy fighting in Mali and the Central African Republic, major flooding in parts of the Americas, Africa, and Asia, and others.

Tarik Jasarevic
WHO Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 793 676 214
E-mail: jasarevict@who.int

View the original article here