Securing sustainable funding for viral hepatitis elimination plans.

The majority of people infected with chronic hepatitis C virus (HCV) in the European Union (EU) remain undiagnosed and untreated. During recent years, immigration to EU has further increased HCV prevalence. It has been estimated that, out of the 4.2 million adults affected by HCV infection in the 31 EU/ European Economic Area (EEA) countries, as many as 580 000 are migrants. Additionally, HCV is highly prevalent and under addressed in Eastern Europe. In 2013, the introduction of highly effective treatments for HCV with direct-acting antivirals created an unprecedented opportunity to cure almost all patients, reduce HCV transmission and eliminate the disease. However, in many settings, HCV elimination poses a serious challenge for countries' health spending. On 6 June 2018, the Hepatitis B and C Public Policy Association held the 2nd EU HCV Policy summit. It was emphasized that key stakeholders should work collaboratively since only a few countries in the EU are on track to achieve HCV elimination by 2030. In particular, more effort is needed for universal screening. The micro-elimination approach in specific populations is less complex and less costly than country-wide elimination programmes and is an important first step in many settings. Preliminary data suggest that implementation of the World Health Organization (WHO) Global Health Sector Strategy on Viral Hepatitis can be cost saving. However, innovative financing mechanisms are needed to raise funds upfront for scaling up screening, treatment and harm reduction interventions that can lead to HCV elimination by 2030, the stated goal of the WHO.

Big Events in Greece and HIV Infection Among People Who Inject Drugs.

Big Events are processes like macroeconomic transitions that have lowered social well-being in various settings in the past. Greece has been hit by the global crisis and experienced an HIV outbreak among people who inject drugs. Since the crisis began (2008), Greece has seen population displacement, inter-communal violence, cuts in governmental expenditures, and social movements. These may have affected normative regulation, networks, and behaviors. However, most pathways to risk remain unknown or unmeasured. We use what is known and unknown about the Greek HIV outbreak to suggest modifications in Big Events models and the need for additional research.

Artists and psychoactive substances use.

It is a well-established common notion that artists appear to use and abuse psychoactive substances more frequently and heavily than non-artists. The purpose of this study was to investigate if this holds true. The sample consisted of 118 participants, both artists and non-artists. They were asked to complete the ASSIST questionnaire, developed by the World Health Organization, that includes closed questions on substance use along with an additional questionnaire on demographic characteristics. The questionnaires were posted online in a digital platform. The artists scored significantly higher on substance use than the other professionals. Women reported less psychoactive substance use compared to men. The results confirmed the study hypothesis, in line with previous research findings. The number of similar studies in the international literature is limited. Our results are particularly useful but due to significant limitations of this study further investigation is suggested, as well as further examination of the causes of the phenomenon.

Opioid substitution therapy: Lowering the treatment thresholds.

BACKGROUND: Opioid substitution therapy (OST) has been established as the gold standard in treating opioid use disorders. Nevertheless, there is still a debate regarding the qualitative characteristics that define the optimal OST intervention, namely the treatment threshold. The aim of this review is twofold: first, to provide a summary and definition of "treatment thresholds", and second, to outline these thresholds and describe how they related to low and high threshold treatment characteristics and outcomes. METHOD: We searched the main databases of Medline, PubMed, PsycInfo, EMBASE, CINAHL and the Cochrane Library. Original published research papers, reviews, and meta-analyses, containing the eligible keywords: "opioid substitution", "OST", "low threshold", "high threshold" were searched alone and in combination, up to June, 2015. RESULTS: Treatment thresholds were defined as barriers a patient may face prior to and during treatment. The variables of these barriers were classified into treatment accessibility barriers and treatment design barriers. There are increasing numbers of studies implementing low threshold designs with an increasing body of evidence suggesting better treatment outcomes compared to high threshold designs. CONCLUSION: Clinical characteristics of low threshold treatments that were identified to increase the effectiveness of OST intervention include increasing accessibility so as to avoid waiting lists, using personalized treatment options regarding medication choice and dose titration, flexible treatment duration, a treatment design that focuses on maintenance and harm reduction with emphasis on the retention of low adherence patients.

Extra care burden in comorbid mental-somatic illnesses.

PURPOSE OF REVIEW: Caregivers play a fundamental role in the lives of mental patients with whom they have an interdependent relationship. The current review provides evidence supporting the association between providing care for a mentally ill person and an often unrecognized burden on the life of the caregiver. RECENT FINDINGS: Caregivers often sustain a significant physical, emotional, social, and financial stress related to providing care for a loved one with a mental disease. Caregiver-oriented psychoeducational programs and caregiver participation in mutual support groups are among interventions that could assist in relief from this burden. SUMMARY: Further work needs to be done regarding the burden experienced by caregivers who are responsible for mental patients with somatic symptoms. Participation of the caregiver in programs that target this burden should be encouraged. Physicians should take into consideration caregivers' needs and worries and incorporate them in the healing process.