This Week in PLOS Medicine: Poor Health in Rich Countries, Perinatal Mental Health, HIV treatment for Children, and Public Health Models
This week PLOS Medicine publishes the following new articles:
In the October editorial, the PLOS Medicine Editors issue a call for papers on the health of poor people in rich countries and discuss why Open Access journals are particularly well suited to facilitate research and commentary on this topic. As rich countries with wide income disparities, such as the United States, address the need to rein in health-care costs and at the same time improve health disparities, knowledge gained in resource-limited settings, regardless of the host country’s overall wealth, will gain increasingly global relevance. The universal availability of such knowledge in the peer-reviewed literature without subscription-fee or copyright barriers is essential to improving health. The editors conclude that, as part of a commitment to global issues in health, open-access medical journals should take the lead in prioritizing research on the health problems of lower-income people in high- as well as lower-income countries.
In a systematic review and meta-analysis, Kelly Clarke and colleagues examine the effect of psychosocial interventions delivered by non-mental health specialists for perinatal common mental disorders in low- and middle-income countries. The study found that psychological and health promotion interventions given to women during the perinatal period were linked to improved mental health compared with usual care. These findings are important given that low-resource settings have limited access to mental health specialists such as psychiatrists and psychologists, and also to medications. Although these findings are encouraging, they should be interpreted with caution given that the results are based on a small number of studies with a large amount of variation in the way the studies were done.
Using data from the ARROW (Anti-Retroviral Research for Watoto) trial, Joanna Lewis and colleagues investigate the CD4 cell count recovery profiles of children infected with HIV who are starting antiretroviral therapy in Sub-Saharan Africa. Although younger children with HIV are at high risk of disease progression if not treated, they have good potential for achieving high CD4 counts (a measure of a type of white blood cell that correlates with immune function) in later life provided antiretroviral therapy (ART) is initiated according to current treatment guidelines. In this study the researchers used children’s CD4 counts that were collected every 12 weeks for approximately 4 years to analyze how the long-term CD4 count outcomes changed after ART initiation. However, the research also suggests that the recommended CD4 count thresholds for ART initiation are unlikely to maximize immunological health in children who have never received ART before the age of ten years.
In a new Guidelines and Guidance article, Sanjay Basu and colleagues explain how models are increasingly used to inform public health policy yet readers may still struggle to evaluate the quality of those models.
Thanks for posting! In studies that compare licensed psychotherapists to peers and compassionate volunteers, the licensed psychotherapists fail to get better results. There is scarce justification for the huge expense of licensed psychotherapists when cheaper alternatives and active placebos do just as well (and may have fewer harmful side-effects).