Overview of harm reduction in prisons in seven European countries.

While the last decade has seen a growth of support for harm reduction around the world, the availability and accessibility of quality harm reduction services in prison settings is uneven and continues to be inadequate compared to the progress achieved in the broader community. This article provides a brief overview of harm reduction in prisons in Catalonia (Spain), Greece, Ireland, Italy, Latvia, Poland, and Portugal. While each country provides a wide range of harm reduction services in the broader community, the majority fail to provide these same services or the same quality of these services, in prison settings, in clear violation of international human rights law and minimum standards on the treatment of prisoners. Where harm reduction services have been available and easily accessible in prison settings for some time, better health outcomes have been observed, including significantly reduced rates of HIV and HCV incidence. While the provision of harm reduction in each of these countries' prisons varies considerably, certain key themes and lessons can be distilled, including around features of an enabling environment for harm reduction, resource allocation, collection of disaggregated data, and accessibility of services.

Levosimendan: a new approach for the treatment of patients with severe heart failure. A brief summary based on a clinical case.

Looking at the clinical report of a single patients admitted with severely decompensated heart failure and successfully managed with levosimendan, the authors review the current knowledge about this new drug. The treatment of severely decompensated heart failure is currently based on classical catecholamines (dopamine and dobutamine). The various new positive inotropics investigated in the past have failed to improve survival. In spite of some symptomatic improvement an increase in long-term mortality was noticed in different trials testing different drugs. More recently a new concept has been introduced regarding a new way to improve myocardial contractility and vasodilation based on calcium-sensitizing properties with additional action on adenosine triphosphate-sensitive potassium channels. Levosimendan is a representative of this new class recently launched in the Portuguese market.