Neuroimaging alterations and relapse in early-stage psychosis.

BACKGROUND: Recent reports have indicated that symptom exacerbation after a period of improvement, referred to as relapse, in early-stage psychosis could result in brain changes and poor disease outcomes. We hypothesized that substantial neuroimaging alterations may exist among patients who experience relapse in early-stage psychosis. METHODS: We studied patients with psychosis within 2 years after the first psychotic event and healthy controls. We divided patients into 2 groups, namely those who did not experience relapse between disease onset and the magnetic resonance imaging (MRI) scan (no-relapse group) and those who did experience relapse between these 2 timings (relapse group). We analyzed 3003 functional connectivity estimates between 78 regions of interest (ROIs) derived from resting-state functional MRI data by adjusting for demographic and clinical confounding factors. RESULTS: We studied 85 patients, incuding 54 in the relapse group and 31 in the no-relapse group, along with 94 healthy controls. We observed significant differences in 47 functional connectivity estimates between the relapse and control groups after multiple comparison corrections, whereas no differences were found between the no-relapse and control groups. Most of these pathological signatures (64%) involved the thalamus. The Jonckheere-Terpstra test indicated that all 47 functional connectivity changes had a significant cross-group progression from controls to patients in the no-relapse group to patients in the relapse group. LIMITATIONS: Longitudinal studies are needed to further validate the involvement and pathological importance of the thalamus in relapse. CONCLUSION: We observed pathological differences in neuronal connectivity associated with relapse in early-stage psychosis, which are more specifically associated with the thalamus. Our study implies the importance of considering neurobiological mechanisms associated with relapse in the trajectory of psychotic disorders.

WHO target product profiles to shape global research and development.

Research and development leading to new and improved health products is essential for achieving healthier lives for populations worldwide. However, new products in development do not always match the global need for products for neglected diseases and populations. To promote research, provide an incentive for investment and align products with the needs of end-users, research needs to be better coordinated and prioritized. The World Health Organization (WHO) has developed target product profiles that define the characteristics required in new health products to address the greatest public health needs. A WHO target product profile document presents a need and provides guidance on what to include to consider access and equity as part of the research and development plan from the outset. WHO has also set up the Target Product Profile Directory, a free-to-use online database of characteristics used to describe desired health products, including medicines, vaccines, diagnostic tools and medical equipment. Here we describe the process of developing a WHO target product profile, and the benefits of this type of guidance. We urge product developers to share product profiles addressing unmet needs in public health, to help in progress towards global targets for better health and well-being.

Promouvoir la santé des populations à travers le monde va de pair avec la recherche-développement responsable de la conception et de l'optimisation de produits sanitaires. Pourtant, les nouveaux produits à l'étude ne répondent pas toujours aux exigences mondiales des populations et maladies négligées. En vue de promouvoir la recherche, de favoriser les investissements et d'aligner les produits sur les besoins des utilisateurs finaux, les travaux doivent être mieux coordonnés et leurs priorités, mieux définies. L'Organisation mondiale de la Santé (OMS) a donc élaboré des profils de produits cibles qui déterminent les caractéristiques requises pour les nouveaux produits sanitaires, afin qu'ils correspondent davantage aux besoins les plus criants en matière de santé publique. Un profil de produit cible établi par l'OMS est un document qui met en évidence un besoin et fournit des indications sur les aspects à prendre en compte pour garantir l'accès et l'équité dès le départ dans le plan de recherche-développement. L'OMS a également publié un Répertoire des profils de produits cibles, une base de données en ligne consultable gratuitement qui reprend les caractéristiques employées pour décrire les produits sanitaires souhaités (médicaments, vaccins, outils diagnostiques et équipements médicaux). Dans le présent document, nous détaillons le processus de développement d'un profil de produit cible par l'OMS, mais aussi les avantages que comportent de telles indications. Nous encourageons vivement les laboratoires à partager les profils de produits qui répondent à des besoins non satisfaits en matière de santé publique, afin de contribuer à avancer vers les objectifs mondiaux de santé et de bien-être.

La investigación y el desarrollo de productos sanitarios nuevos y mejorados son esenciales para que las poblaciones de todo el mundo vivan más sanas. Sin embargo, los productos nuevos en desarrollo no siempre se ajustan a las necesidades mundiales de productos para enfermedades y poblaciones desatendidas. Para promover la investigación, incentivar la inversión y adaptar los productos a las necesidades de los usuarios finales, es necesario coordinar mejor la investigación y establecer prioridades. La Organización Mundial de la Salud (OMS) ha elaborado perfiles de productos específicos que definen las características que deben reunir los productos sanitarios nuevos para satisfacer las principales necesidades de salud pública. Un documento de perfil de producto específico de la OMS presenta una necesidad y ofrece orientación sobre lo que debe incluirse para tener en cuenta el acceso y la equidad como parte del plan de investigación y desarrollo desde el principio. La OMS también ha creado el Directorio de Perfiles de Productos Específicos, una base de datos en línea de uso gratuito con las características utilizadas para describir los productos sanitarios deseados, incluidos medicamentos, vacunas, herramientas de diagnóstico y equipos médicos. En el presente documento, describimos el proceso de elaboración de un perfil de producto específico de la OMS y las ventajas de este tipo de orientación. Instamos a los desarrolladores de productos a compartir perfiles de productos que aborden necesidades no cubiertas en salud pública para contribuir al avance hacia los objetivos mundiales de mejora de la salud y el bienestar.

Active involvement of people with lived experience of suicide in suicide research: a Delphi consensus study.

BACKGROUND: The importance and value of involvement of people with lived experience of suicide has been recognized in suicide research and prevention. Nonetheless, clear guidance on research collaboration and co-production is lacking. This study aimed to address this gap by developing a set of guidelines on active involvement of people with lived experience of suicide in suicide studies., i.e., conducting research with or by people with lived experience, rather than to, about or for them. METHODS: The Delphi method was used to determine statements on best practice for the active involvement of people with lived experience of suicide in suicide research. Statements were compiled through a systematic search of the scientific and grey literature, and reviewing qualitative data from a recent related study conducted by the authors. Two expert panels: people with lived experience of suicide (n = 44) and suicide researchers (n = 29) rated statements over three rounds of an online survey. Statements endorsed by at least 80% of panellists of each panel were included in the guidelines. RESULTS: Panellists endorsed 96 out of 126 statements in 17 sections covering the full research cycle from deciding on the research question and securing funding, to conducting research and disseminating and implementing outcomes. Overall, there was a substantial level of agreement between the two panels regarding support from research institutions, collaboration and co-production, communication and shared decision making, conducting research, self-care, acknowledgment, and dissemination and implementation. However, panels also disagreed on specific statements regarding representativeness and diversity, managing expectations, time and budgeting, training, and self-disclosure. CONCLUSIONS: This study identified consensus recommendations on active involvement of people with lived experience of suicide in suicide research, including co-production. Support from research institutions and funders, and training on co-production for researchers and people with lived experience, are needed for successful implementation and uptake of the guidelines.

Tracking global resources and capacity for health research: time to reassess strategies and investment decisions.

The COVID-19 pandemic and more recently the Monkeypox outbreak emphasize the urgency and importance of improving the availability and equitable distribution of resources for health research across rich and poor countries. Discussions about the persistent imbalances in resource allocation for health research between rich and poor countries are not new, but little or no progress has been made in redressing these imbalances over the years. This is critical not only for emergency preparedness, but for the worlds' ability to improve population health in an equitable manner. Concerned with the lack of progress in this area, Member States of the World Health Organization requested the establishment of a Global Observatory on Health Research and Development, with the aim of consolidating, monitoring and analyzing relevant information on health research and development, with a view to informing the coordination and prioritization of new investments. In this commentary, we highlight some of the striking disparities from the Observatory's analysis over the 5 years since its establishment and reflect on what is needed to overturn stagnant progress.

Pilot trial of a media intervention with journalism students on news reporting of mental illness in the context of violence and crime.

ISSUE ADDRESSED: News reports linking mental illness to violent crime are among the most stigmatising portrayals. These portrayals can perpetuate stereotypes of dangerousness, negatively influencing public attitudes and having a harmful impact on people with lived experience of mental illness. With the aim of improving the quality of news portrayals and mitigating harm, best-practice guidelines for media reporting on mental illness, violence and crime have been developed. To increase understanding of the guidelines' content, a 1-hour workshop based on the main principles was developed for journalism students. METHODS: In this study, the workshop was piloted with a pre and 3-week follow-up evaluation with a cohort of journalism students (n = 29). RESULTS: Three weeks after the workshop, there were significant improvements in attitudes towards severe mental illness, knowledge of best-practice reporting, intentions and confidence to report consistently with the best-practice guidelines and performance on an editing task designed to assess adherence to the guidelines. Belief in dangerousness/unpredictability reduced markedly, demonstrating that the workshop effectively addressed misinformation about people with severe mental illness being a risk to the public. CONCLUSIONS: This pilot trial provides promising initial results and provides a basis for wider implementation and evaluation of media training on this topic. SO WHAT: Improved understanding of best-practice media guidelines, as generated through this workshop, has potential to reduce stigmatising news reporting on people with mental illness, and consequently reduce public stigma.

Eliminating mother-to-child transmission of human immunodeficiency virus, syphilis and hepatitis B in sub-Saharan Africa.

Triple elimination is an initiative supporting the elimination of mother-to-child transmission of three diseases - human immunodeficiency virus (HIV) infection, syphilis and hepatitis B. Significant progress towards triple elimination has been made in some regions, but progress has been slow in sub-Saharan Africa, the region with the highest burden of these diseases. The shared features of the three diseases, including their epidemiology, disease interactions and core interventions for tackling them, enable an integrated health-systems approach for elimination of mother-to-child transmission. Current barriers to triple elimination in sub-Saharan Africa include a lack of policies, strategies and resources to support the uptake of well established preventive and treatment interventions. While much can be achieved with existing tools, the development of new products and models of care, as well as a prioritized research agenda, are needed to accelerate progress on triple elimination in sub-Saharan Africa. In this paper we aim to show that health systems working together with communities in sub-Saharan Africa could deliver rapid and sustainable results towards the elimination of mother-to-child transmission of all three diseases. However, stronger political support, expansion of evidence-based interventions and better use of funding streams are needed to improve efficiency and build on the successes in prevention of mother-to-child transmission of HIV. Triple elimination is a strategic opportunity to reduce the morbidity and mortality from HIV infection, syphilis and hepatitis B for mothers and their infants within the context of universal health coverage.

La triple élimination est une initiative visant à soutenir l'éradication de la transmission mère-enfant de trois maladies ­ l'infection au virus de l'immunodéficience humaine (VIH), la syphilis et l'hépatite B. Bien que des avancées considérables aient été observées en ce sens dans certaines régions, les progrès demeurent lents en Afrique subsaharienne, pourtant durement touchée par ces maladies. Les caractéristiques communes aux trois affections, notamment leur épidémiologie, les interactions entre elles et les principales interventions nécessaires à leur prise en charge permettent aux systèmes de santé d'adopter une approche intégrée pour éviter la transmission mère-enfant. Plusieurs obstacles entravent actuellement la triple élimination en Afrique subsaharienne, parmi lesquels l'absence de politiques, de stratégies et de ressources pour garantir la disponibilité de traitements préventifs et curatifs bien établis. Les outils existants offrent déjà de nombreuses solutions; mais pour accélérer la progression de cette triple élimination en Afrique subsaharienne, il est indispensable de développer de nouveaux produits et modèles de soins, ainsi qu'un programme de recherche prioritaire. Dans le présent document, nous voulons montrer que si les systèmes de santé collaborent avec les communautés en Afrique subsaharienne, ils pourront obtenir des résultats rapides et durables en vue d'éradiquer la transmission mère-enfant des trois maladies susmentionnées. Néanmoins, une telle démarche implique un soutien politique massif, l'expansion des interventions fondées sur des données scientifiques, et une meilleure utilisation des sources de financement afin d'améliorer l'efficacité et de s'appuyer sur les réussites en matière de prévention de la transmission du VIH de la mère à l'enfant. La triple élimination représente une occasion stratégique de réduire la morbidité et la mortalité liées à l'infection au VIH, à la syphilis et à l'hépatite B, tant chez les mères que chez les nourrissons, dans un contexte de couverture maladie universelle.

La triple eliminación es una iniciativa que apoya la eliminación de la transmisión maternoinfantil de tres enfermedades: la infección por el virus de la inmunodeficiencia humana (VIH), la sífilis y la hepatitis B. En algunas regiones se han logrado avances significativos hacia la triple eliminación, pero los progresos se han desarrollado con mayor lentitud en el África subsahariana, la región con la mayor carga de estas enfermedades. Las características comunes de las tres enfermedades, como su epidemiología, las interacciones entre ellas y las intervenciones básicas para combatirlas, permiten un enfoque integrado de los sistemas de salud para la eliminación de la transmisión maternoinfantil. Los obstáculos actuales para la triple eliminación en el África subsahariana incluyen la falta de políticas, estrategias y recursos para apoyar la adopción de intervenciones preventivas y de tratamiento bien establecidas. Aunque se puede lograr mucho con las herramientas existentes, se necesita el desarrollo de nuevos productos y modelos de atención, así como una agenda de investigación prioritaria, para acelerar el progreso de la triple eliminación en el África subsahariana. En este documento pretendemos demostrar que los sistemas de salud que trabajan conjuntamente con las comunidades del África subsahariana podrían obtener resultados rápidos y sostenibles hacia la eliminación de la transmisión maternoinfantil de las tres enfermedades. Sin embargo, se necesita un mayor apoyo político, la ampliación de las intervenciones basadas en la evidencia y un mejor uso de los flujos de financiación para mejorar la eficiencia y aprovechar los éxitos en la prevención de la transmisión maternoinfantil del VIH. La triple eliminación es una oportunidad estratégica para reducir la morbilidad y la mortalidad de la infección por el VIH, la sífilis y la hepatitis B para las madres y sus hijos en el contexto de la cobertura sanitaria universal.

How best to provide help to bereaved adolescents: a Delphi consensus study.

BACKGROUND: Many adolescents struggle with their grief and mental health issues after the death of a close person, such as a family member or a friend. Given the potentially devastating impact of the loss on the adolescent and their family, professional help can be warranted. However, little is known about how to best help these adolescents. This study aimed to address this gap by determining what help professionals (i.e., counselors) should provide to bereaved adolescents. METHODS: The Delphi method was used to achieve consensus regarding the importance of statements that describe actions a helping professional can take to help a bereaved adolescent. Statements were compiled through a systematic search of the scientific and grey literature, and reviewing interview data from a recent related research study with bereaved adolescents, parents and counselors. An expert panel (N = 49) comprising 16 adolescents, 14 parents and 19 helping professionals, rated each statement. Statements that were endorsed by at least 80% of panellists were considered consensus recommendations. RESULTS: Panellists endorsed 130 out of 190 statements as appropriate actions. These included help for a bereaved adolescent being offered on an ongoing basis, with support to be provided flexibly to meet individual adolescent needs and to acknowledge the agency of the adolescent. Support after a loss by suicide should be tailored to address specific suicide-related issues. Parents of bereaved adolescents should also be offered support so that they are better equipped to help their bereaved adolescent. CONCLUSIONS: This study identified consensus recommendations on how a helping professional might best help bereaved adolescents. It is hoped that these recommendations will guide helping professionals and enhance adolescent grief interventions.

A systematic review of the impact of media reports of severe mental illness on stigma and discrimination, and interventions that aim to mitigate any adverse impact.

PURPOSE: This review aims to summarise the evidence on the impact of news media and social media reports of severe mental illness (SMI) on stigma, and interventions that aim to mitigate any adverse impact. METHODS: A systematic search of electronic databases was conducted in December 2017 to identify studies that report on the impact of media coverage or media interventions on stigma related to schizophrenia, psychosis, bipolar disorder, or mental illness in general. Data were synthesised narratively. RESULTS: 12 studies met inclusion criteria; seven explored the impact of news media on stigma towards SMI or general mental illness, two explored the impact of social media, while three evaluated interventions that aimed to mitigate this impact. These studies showed that positive news reports and social media posts are likely to lead to reductions in stigmatizing attitudes and negative reports and social media posts are likely to increase stigmatizing attitudes. There were a limited number of interventions aiming to mitigate the negative impact of news reports of mental illness on stigma; however, these were ineffective. Interventions with media professionals appear to be successful at reducing their stigmatizing attitudes, but can also act to increase both positive and negative reports in the media. CONCLUSIONS: Given the limited research evidence on the impact of news and social media on stigma towards SMI, and on the effectiveness of interventions aiming to mitigate this impact, further studies of higher quality are needed in this area. Due to mixed findings, interventions with media professionals are also an area of research priority.

Cross-cultural generalizability of suicide first aid actions: an analysis of agreement across expert consensus studies from a range of countries and cultures.

BACKGROUND: A number of Delphi expert consensus studies have been carried out with different countries and cultural groups to develop guidelines on how a member of the public should provide assistance to a person who is suicidal. The present study aimed to determine whether cross-culturally generalizable suicide first aid actions are possible by comparing agreement across these Delphi studies. METHODS: Data on endorsement rates for items were compared across six Delphi studies. These studies involved panels of professionals and consumer advocates from English-speaking countries, professionals from Sri Lanka, professionals from Japan, professionals from India, professionals from the Philippines, and professionals and consumer advocates in refugee and immigrant mental health. Correlations were calculated between item endorsement rates across panels. RESULTS: There were 18 items that were highly endorsed across all eight of the Delphi panels and an additional 15 items highly endorsed across the panels from the three lower middle-income countries (India, Philippines and Sri Lanka). Correlations across panels in item endorsement rates were all 0.60 or above, but were higher between panels from countries that are socioeconomically similar. CONCLUSIONS: There is broad agreement across the diverse expert panels about what are appropriate suicide first aid actions for members of the public, indicating that cross-cultural generalizability is possible. However, there is also some cultural specificity, indicating the need for local tailoring.

Re-development of mental health first aid guidelines for suicidal ideation and behaviour: a Delphi study.

BACKGROUND: Suicide continues to be a leading cause of death globally. Friends and family are considered best positioned to provide initial assistance if someone is suicidal. Expert consensus guidelines on how to do this were published in 2008. Re-developing these guidelines is necessary to ensure they contain the most current recommended helping actions and remain consistent with the suicide prevention literature. METHODS: The Delphi consensus method was used to determine the importance of including helping statements in the guidelines. These statements describe helping actions a member of the public can take, and information they should have, to help someone who is experiencing suicidal thoughts. Systematic searches of the available suicide prevention literature were carried out to find helping statements. Two expert panels, comprising 41 suicide prevention professionals and 35 consumer advocates respectively, rated each statement. Statements were accepted for inclusion in the guidelines if they were endorsed by at least 80% of each panel. RESULTS: Out of 436 statements, 164 were endorsed as appropriate helping actions in providing assistance to someone experiencing suicidal thoughts or engaging in suicidal behaviour. These statements were used to form the re-developed guidelines. CONCLUSION: The re-development of the guidelines has resulted in more comprehensive guidance than the earlier version, with the endorsement of 164 helping actions, compared to 30 previously. These guidelines will form the basis of a suicide prevention course aimed at educating members of the public on providing first aid to someone who is experiencing suicidal thoughts.

Re-development of mental health first aid guidelines for non-suicidal self-injury: a Delphi study.

BACKGROUND: Up to 12% of Australian adults and almost one in five adolescents are estimated to have engaged in non-suicidal self-injury (NSSI) at some time in their life. Friends and family are most likely to notice signs of NSSI, but may be unsure how to intervene. Mental health first aid guidelines were developed in 2008 on how to do this through providing initial support and encouraging appropriate professional help-seeking. This study aims to re-develop the 2008 NSSI first aid guidelines to ensure they contain current recommended helping actions and remain consistent with the NSSI intervention literature. METHODS: The Delphi consensus method was used to determine the importance of the inclusion of helping statements in the guidelines. These statements describe helping actions a member of the public can take, and information they should have, to help someone who is engaging in NSSI. Systematic searches of the available NSSI intervention literature were conducted to find helping statements. Two expert panels, comprising 28 NSSI professionals and 33 consumer advocates, rated the importance of each statement. RESULTS: 98 out of 220 statements were endorsed as appropriate helping actions in providing assistance to someone engaging in NSSI. These statements were used to form the updated mental health first aid guidelines for NSSI. CONCLUSION: The re-development of the guidelines has resulted in more comprehensive guidance than the original version (98 versus 30 statements containing helping actions). This substantial increase in endorsed statements adds detail and depth to the guidelines, as well as covers additional ways of providing guidance and support.

Impact of Breastfeeding Barriers on Racial/Ethnic Disparities in Breastfeeding Outcomes in North Dakota.

OBJECTIVE: Exclusive breastfeeding is recommended for the first 6 months of life, but there are racial/ethnic disparities in meeting this recommendation. METHODS: 2017-2020 North Dakota Pregnancy Risk Assessment Monitoring System (weighted N = 11,754) data were used to examine racial/ethnic differences in the association between self-reported breastfeeding barriers and breastfeeding duration. Breastfeeding duration was self-reported breastfeeding at 2 and 4 months, and number of weeks until breastfeeding cessation. Self-reported breastfeeding barriers were yes/no responses to 13 barriers (e.g., "difficulty latching," "household duties"). Logistic regression estimated odds ratios and 95% confidence intervals to determine if barriers accounted for breastfeeding disparities by race/ethnicity. Cox proportional hazard models estimated hazard ratios for stopping breastfeeding for American Indian and other race/ethnicity individuals, compared to White individuals. Models were adjusted for birthing parents' demographic and medical factors. RESULTS: Logistic regression results suggest American Indian birthing parents had similar odds for breastfeeding duration (2-month duration: OR 0.94 (95%CI 0.50, 1.77); 4-month duration: OR 1.24 (95%CI 0.43, 3.62)) compared to White birthing parents, after accounting for breastfeeding barriers. Cox proportional hazard models suggest American Indian birthing parents had a lower hazard of stopping breastfeeding (HR 0.76 (95%CI 0.57, 0.99)) than White parents, after accounting for breastfeeding barriers. CONCLUSIONS: Accounting for breastfeeding barriers eliminated observed disparities in breastfeeding outcomes between American Indian and White birthing parents. Targeted and culturally safe efforts to reduce barriers to breastfeeding are warranted to reduce racial/ethnic disparities in breastfeeding.

Oversight of Dual-Use Research: What Role for Ethics Committees?

The World Health Organization (WHO) Global Guidance Framework for the Responsible Use of the Life Sciences addresses the governance of biorisks, including dual-use research, for countries. It emphasizes engaging multisectoral stakeholders such as governments, scientific bodies, health and research institutes, standard-setting organizations, funding bodies, and others. Ethics constitutes a key component of the framework. Given the high social impact of such research and the importance of trust, risk, and benefit, national ethics committees could make a valuable contribution by providing ethical guidance in the decisionmaking process. The purpose of this study was to examine the role of national ethics committees in the context of governance and oversight of dual-use research at the national level. We conducted a landscape analysis of the activities of ethics committees in dual-use research oversight. We also searched the WHO database on National Ethics Committees for publications related to dual-use research and/or misuse of life sciences research and gathered additional documentation from national ethics committees websites and through author contacts. Results showed that in the context of the wide range of oversight mechanisms for dual-use research in countries, national ethics committees have contributed to guiding policy and assessing dual-use research risks in only a limited number of countries. Recommendations from those countries include establishing a multistakeholder, coordinated oversight mechanism at the country level; strengthening international linkages to guide, harmonize, and reinforce national and international efforts; and involving ethics committees as an expert resource in the governance and oversight process.

The development of a recovery coaching training curriculum to facilitate linkage to and increase retention on medications for opioid use disorder.

Introduction: Medication treatment for opioid use disorder (MOUD) decreases opioid overdose risk and is the standard of care for persons with opioid use disorder (OUD). Recovery coach (RC)-led programs and associated training curriculums to improve outcomes around MOUD are limited. We describe our comprehensive training curriculum including instruction and pedagogy for novel RC-led MOUD linkage and retention programs and report on its feasibility. Methods­pedagogy and training development: The Kentucky HEALing (Helping to End Addiction Long-termSM) Communities Study (HCS) created the Linkage and Retention RC Programs with a local recovery community organization, Voices of Hope-Lexington. RCs worked to reduce participant barriers to entering or continuing MOUD, destigmatize and educate on MOUD and harm reduction (e.g., safe injection practices), increase recovery capital, and provide opioid overdose education with naloxone distribution (OEND). An extensive hybrid (in-person and online, both synchronous and asynchronous), inclusive learning-focused curriculum to support the programs (e.g., motivational interviewing sessions, role plays, MOUD competency assessment, etc.,) was created to ensure RCs developed the necessary skills and could demonstrate competency before deployment in the field. The curriculum, pedagogy, learning environment, and numbers of RCs trained and community venues receiving a trained RC are reported, along with interviews from three RCs about the training program experience. Results: The curriculum provides approximately 150 h of training to RCs. From December 2020 to February 2023, 93 RCs and 16 supervisors completed the training program; two were unable to pass a final competency check. RCs were deployed at 45 agencies in eight Kentucky HCS counties. Most agencies (72%) sustained RC services after the study period ended through other funding sources. RCs interviewed reported that the training helped them better explain and dispel myths around MOUD. Conclusion: Our novel training and MOUD programs met a current unmet need for the RC workforce and for community agencies. We were able to train and deploy RCs successfully in these new programs aimed at saving lives through improving MOUD linkage and retention. This paper addresses a need to enhance the training requirements around MOUD for peer support specialists.

Towards an HIV cure: science and debate from the International AIDS Society 2013 symposium.

The International AIDS Society convened the multi-stakeholder "Towards an HIV Cure" symposium in Kuala Lumpur, Malaysia in 2013 to address the significant research challenges posed by the search for a cure for HIV infection. Current antiretroviral regimens select for a small reservoir of cells that harbour latent HIV provirus, produce few or no HIV virions, and resist detection or clearance by host immunity. The symposium examined basic molecular science and animal model data, and emerging and ongoing clinical trial results to prioritise strategies and determine the viral and immune responses that could lead to HIV remission without ART. Here we review the presentations that scrutinized the molecular mechanisms controlling virus expression from proviral DNA, and the intrinsic cellular restriction and immune mechanisms preventing viral production. Insights from the basic science have translated into new therapeutic strategies seeking HIV remission without ongoing therapy, and much interest was focused on these ongoing trials. We also summarise the emerging ethical issues and patient expectations as concepts move into the clinic.

Examining the quality of news media reporting of complex mental illness in relation to violent crime in Australia.

PURPOSE: News reporting on mental illness can perpetuate stigma. An understanding of the current picture of such reporting is important to identify areas for improvement. This study investigated the quality of Australian news media coverage of complex mental illness in the context of crime and violence over a 2-year period, prior to the release of new media guidelines. METHODS: This research utilised a systematic search of Australian news articles that were published between July 2018 and July 2020 and reported on mental illness in relation to violent crime. Researchers developed a Mental Illness and Crime Reporting Quality Framework to determine quality scores for news articles according to 11 relevant factors in media guidelines. An additional 11 characteristics of articles were extracted for further descriptive analysis. RESULTS: One-hundred and twenty-eight Australian news articles met inclusion criteria. The average quality score was 50 (SD = 13.91) out of a possible maximum score of 100 (range 11-78). Strengths and weaknesses were identified as some criteria were consistently met, and other criteria were met rarely or not at all. There were emerging trends between quality scores and article characteristics, including publication source, though these analyses were not statistically significant. CONCLUSION: The findings indicate that Australian news coverage of complex mental illness and violent crime met half of the criteria of reporting guidelines that minimises risk of perpetuating or reinforcing stigma. This demonstrates significant opportunity to improve the overall quality of media reporting on crime and mental illness. Future research should evaluate the impact of the guidelines on the quality of news reporting after their implementation by utilising a similar methodology, using these findings as a baseline measure.