e-Bulletin 18: Health and Wellbeing at Xmas 


Welcome to the Christmas edition of the Hepatitis Scotland e-bulletin.  Hepatitis Scotland  wish you all a Merry Christmas!


This edition offers healthy living tips for those affected by viral hepatitis so that Christmas can be enjoyed  whilst still being good to both body and your mind.


It is also important to recognise that for some, Christmas can be a lonely, stressful period, where money worries and indeed your health is concerned. We have included a further story on homelessness and also the impact deprivation can have on health is highlighted in the latest  Audit Scotland report


Accompanying this e-bulletin are video presentations by Amy Solon of Waverley Care discussing tips on how to cope over Christmas, and by Vincent Chudy of Citizens Advice Scotland discussing money management.


We hope Yule eat well!

 As we approach Christmas in the middle of a cold winter it is often easy to over indulge on "comfort" food. What you eat affects your quality of life. Maintaining  a healthy diet can help to:

• relieve some of the symptoms related to hepatitis C infection and treatment, such as nausea
• enhance your immune system
• maintain the nutrients necessary to maintain liver health.


You can find a very useful healthy eating resource aimed specifically at those affected by hepatitis C listed below. It also features other useful information on the possible benefits of complementary therapies. (This resource is published by Hepatitis Australia.)


Healthy Living part 1.

Healthy Living part 2.



Don't Scrooge up your finances!


Over the festive period there are many pressures put on our finances. Between buying gifts, attending parties,getting in food and drink, not to mention ever increasing fuel bills, it can be easy to overspend.  Parents in particular may find themselves spending more money than they have to try to make their childrens Christmas as special as possible. This can lead to debt worries in the new year.  Those who are affected by viral hepatitis, and particularly those on treatment can find financial worries greatly increase the stress people are feeling.


If you would like some advice on your finances, particularly on budgeting and debt worries, you can contact either visit National Debtline Scotland, telephone number 0808 808 4000 or find your local Citizens Advice Scotland branch, where you can access impartial advice which should help ease your concerns.


You can view a video presentation by Vincent Chudy of Citizens Advice Scotland on this subject on our Youtube channel.


National Debtline Scotland has some very useful information and toolkits which may help with budgeting and debt management.


National Debtline Scotland information and toolkits.



"Have yourself a merry little Christmas"


At Christmas time some people may feel isolated, lonely, stressed or depressed. Christmas can put stress on families and relationships for all kinds of reasons. Not to mention money worries. Then there are those who on top of all that may be having to cope with a chronic illness like hepatitis C.


Waverley Care have provided us with some useful tips from their life coaching and self management programme which may help to make Christmas that bit easier if you are struggling.


You can also view a video presentation on this topic by Amy Solon of Waverley Care by visiting our Youtube channel.


What do you do that keeps you well on a daily basis?


Self management is all about looking at the things that you are currently doing to keep yourself physically, emotionally and mentally well. It’s always good to consider these things that you are already doing in your normal everyday life. Simple things like exercising, looking after your diet by eating the right foods, keeping in touch with your social network be it friends, family, groups etc. Getting rest is important for all of us as can be keeping busy with hobbies. Staying away from alcohol and drugs is crucial for a lot of people also. Money can be a really big cause of worry for people and action planning around this can cut out a lot of unnecessary worrying particularly during Christmas where the pressure can really be on.


Do you have any particular tips to help people manage financially around the festive period?


Lots of organisations such as the Samaritans expect that there will be a rise in calls around debt over the Christmas period as people can be very tempted to live beyond their means. Remember though that Christmas is just one day and it is far more important to have sufficient money to keep you going all year round. People come to us every day with financial worries and it’s really important to remember that there is always a way out. There is always a solution to your money problems.


Planning is key. Know when money is going to be going into your account over the Christmas period and if there are any direct debits that are going to be going out. Bearing this in mind, consider how much you can afford to spend over the Christmas period and what are the key things that you need to spend your money on.


Once you have decided how much you have to spend, stick to paying with cash. When you pay with a debit or credit card, it can be really easy to forget how much you have spent in total. And every £3 or £4 adds up. If you have a certain amount of cash in your wallet that you have allowed yourself to spend, it is much easier to keep yourself within budget.


Remember not to spend needlessly. Commit to making a list of the things that you need and try not to buy anything that is not on the list. You can food shop sensibly by avoiding named brands and getting the stores own brand.


At Christmas there is often a lot of pressure to buy expensive gifts. Consider curbing your gift giving. A lot of people can’t afford the gift giving tradition and instead opt to do a secret santa where everyone is only responsible for giving one gift within a group of friends or family. It can also be good to set a price limit on gifts. Remember there’s lots of lovely second shops across Scotland. There’s no rule that it has to be bought brand new!


If you're really strapped for cash this Christmas, consider giving out non-monetary gifts. For example, you may offer to help a friend out with babysitting duties or help a family member paint their house.


What are the issues that people can have around Christmas?


Loneliness and isolation

Money and finance

Anniversary events (Loss and trauma)

Family friction


High expectations (Internal and external discord)

Children being off


What are the warning signs that you’re not coping?


Learn to take stock of your situation. If you lose interest in things or if you are feeling depressed look out for the emotional signs that you may not be coping. Things like;


Increased anxiety


Feeling irritable/ tired

Not answering the phone

Not getting out of bed

Feeling worthless

Putting things off

Not being able to sleep

Being angry

Excessive drinking


Emotions and the behaviours that result from these emotions are your body’s way of saying that something is wrong. Refer back to the things that keep you well and help yourself to take action.


What has kept you well in the past? What would be the things that you could do to help yourself?


So what are the kinds of things that you have done in the past to help yourself keep well? Things like:


  • Eating sensibly and getting a good night’s sleep
  • Reconnecting with friends. What positive people are there in your life who can help life your spirits?
  • Exercise has been proven to help raise your mood and clear your mind through release of a chemical endorphins.

Christmas is known for overindulgence and gorging on chocolates and treats. Although you should always treat yourself, try and do so in moderation. Overindulgence can mean temporary highs before your mood drops again.


Enjoy sunlight when you get the chance. We live in Scotland which unfortunately means that we are lacking in sunlight which means that we can be lacking in vitamin D one of the vitamins that is essential for a healthy immune system. Not only does the sunshine make you feel better but by getting out and getting some light exercise you are also going to help improve your mood.


  • Take time out for yourself; Maybe take a bath – give yourself a treat
  • Self talk ‘It’s only a day’

I’m sure you will often have heard the expression ‘a problem shared is a problem halved’. Is there someone who you can trust that you can speak to? Maybe a friend, family member, someone who works for an organisation that supports you? By speaking to someone who you trust, who will keep everything confidential you are not only sharing your problems, but you are also helping to deal with unexpressed emotions which can cause us not to cope in difficult times. Once you talk about what’s going on in your head, you will find that you will be able to think more clearly, and you’ll be in a better place to start making the steps to sort things out.


Please don’t be afraid to ask for help. It is something that we all need from time to time and it really does help to talk.


How to change your thinking?


Focus on the things you do have

What could you start now so that next year feels different


2013 – new year, good time to start making plans. What do you want to achieve? College, family etc. What kinds of things do you need to do now to get you there?


"It'll be lonely this Christmas....."

In our 16th e-bulletin, the Needle Exchange Edition, we included an article citing a study into tuberculosis, hepatitis C and HIV among the homeless. Between 2011 and 2012 45, 322 people in Scotland made homeless applications to their local authority.


There are no accurate estimates of the number of people sleeping rough. Shelter Scotland are currently running a children's campaign, with the stark message that this Christmas day, 5,300 children will wake up homeless, and 75,000 across the UK.  The issue of homelessness also arose in the news last week, with UK Housing Minister Mark Prisk controversially saying that people should not give food or money to homeless people, but instead give them the phone number of a charity or local authority. 


It is unfortunate but true, that some people will spend Christmas day alone and in the cold, or in unsuitable or temporary accomodation and shelters. Homelessness can have an extremely detrimental effect on a person's mental and physical health, putting them at greatly increased risk of a number of infectious diseases. In this article, we take a look at the findings of the aforementioned study, and consider the implications for Scotland's homeless population.


A review of an Oxford University Study: Prevalence of tuberculosis, hepatitis C virus and HIV in homeless people: a systematic review and meta-analysis.


It is estimated that 100 million people worldwide are homeless, with around 380,000 people homeless in the UK at any one time. Mortality rates are four times higher amongst this group than the general population and morbidity (incidence of illness) is substantially increased in homeless populations. This study compiled reports, studies and data from many countries around the world.


Prevalence of hepatitis C ranged from 3.9% to 36.2% and estimates of the prevalence of HIV infection ranged from 0.3% to 21.1%, so hepatitis C had by far the highest prevalence in homeless populations.


Commonly occurring risk factors for HIV and hepatitis C infection were injection drug use, sharing injection paraphernalia, sex work, being male and previous imprisonment - most of which are very common among homeless people.


Main findings:

  • Substantial heterogeneity was found between the studies, suggesting the need for locally based studies to inform service planning and public health measures.
  • Although prevalence of hepatitis C could be lower than what is established in the study (given that positive serology can be an indicator of past infection), both past and active infections are potentially infective and therefore carry a public health risk.
  • Whilst prevalence of tuberculosis in homeless populations was positively associated with prevalence in the general population, this was not the case for hepatitis C and HIV. This suggests that general population measures to reduce rates of hepatitis C and HIV might not translate into lower prevalence in homeless people.
  • High rates of infection with hepatitis A and B, as well as diphtheria and influenza have been reported in homeless people.

One of the authors of the study, Dr.Seena Fazel, said, 'Infections in homeless people can lead to community infections and are associated with malnutrition, long periods of homelessness and high use of medical services..........Improvements in care of homeless people could have pronounced effects on public health.'


If you or someone you know are worried about homelessness or your housing situation, you can obtain advice and information from Shelter Scotland on 0808 800 444.


If you work in homelessness and would like to receive training on viral hepatitis, contact our training officer Graham MacIntosh on 0141 225 0419 or e-mail graham@hepatitisscotland.org.uk.


Wider issues around poverty

 The subject of poverty and increased likelihood of suffering from health problems was highlighted with some stark figures in a report by Audit Scotland into Health Inequalities in Scotland.  The Joseph Rowntree Foundation also released a report last week highlighting the concerted UK Government campaign inferring welfare recipients come from multiple generations of the work shy. . It found no evidence to support these claims but in the rare event that there is more than one generation out of work in a family they found that this was usually the result of multiple problems associated with living in deep poverty over many years. They said that a range of serious problems associated with social exclusion and poverty combined over time to keep them out of the labour market. 


These problems included poor schooling and educational underachievement, problematic drug and alcohol use, the attraction of illicit opportunities (e.g. drug dealing) when legitimate opportunities were scarce, criminal victimisation, offending and imprisonment, domestic violence, family and housing instability. Most commonly however, and sometimes as an outcome of these cumulative adversities, was physical and mental ill-health. 


Also published on December the 18th was the Scottish Index of Multiple Deprivation. 49.1% of Glasgow's datazones are in the 20% most deprived datazones in Scotland. The 7 domains used to calculate deprivation were employment, income, health, education, skills, and training, geographic access to services, crime and housing. 44.4% of the datazones in Glasgow City are in the 15% most health deprived datazones of the country.


 Many of these domains overlap with the problems cited by the Joseph Rowntree Foundation report into intergenerational worklessness. As previously stated, that report said that as well as physical and mental health problems contributing to worklessness, these problems were often the direct consequence of these multiple indicators. It should therefore come as no great surprise that 40% of hepatitis C cases in Scotland are to be found in Glasgow. It comes as a worry that this is the position in Glasgow now given that many of the welfare cuts announced have not yet come into effect. One could extrapolate from these reports that issues of homelessness, poverty and ill health are only likely to get worse as welfare cuts bite. To see a report published jointly by Hepatitis Scotland and HIV Scotland focusing on the implications of Welfare Reforms on those living with hepatitis C or HIV, click here.


You may also be interested to view the following reports which are related to the topics discussed above.


Scottish Drug Misuse Database: Report on people in treatment.

National Drug and Alcohol Treatment Waiting Times report


Hep C and your health


Throughout many of our previous e-bulletins we have covered research and reports into various topics around living healthily with viral hepatitis, including research into how certain vitamins etc can improve your response to treatment. 


If you or someone you know is affected by viral hepatitis, and have not already done so, you should contact your GP to get a free winter flu jab. Visit the Immunisation Scotland website for more details.


In previous e-bulletins we have cited many studies and growing evidence that vitamin D can be very beneficial for many health conditions, and some evidence that it may also improve responses to hepatitis C treatment. Check out e-bulletins 7, 13 and 17 for stories relating to vitamin D.


We also cited a study in e-bulletin 4 which suggested that drinking 3 cups of coffee a day may improve your response to hepatitis C treatment, slow progression of liver disease and reduce the negative side effects of hepatitis C treatment. However, in e-Bulletin 17 we included an article cautioning people on over use of highly caffeinated energy drinks due to a number of fatalities in the US which appeared to be linked to them.


A good nights sleep is important for all of us, but in e-Bulletin 15 we cited research suggesting that getting less than 6 hours sleep a night may have a negative effect on the success of hepatitis B vaccination.


However, we haven't focused on physical health alone. When living with viral hepatitis, and especially whilst on hepatitis C treatment, many people can suffer from mental health problems. We produced a webinar on mental health and hepatitis C treatment which you can view here.


Hold the date: Minorities, communities and BBVs

Improving our responses to blood borne viruses amongst Scotland’s diverse population


Conference: Wednesday, 13th March, 2013, City Chambers, Glasgow


Hepatitis Scotland and HIV Scotland, supported by Health Protection Scotland, are hosting a one day conference in Glasgow on 13th March, 2013.  The conference will increase the knowledge base and share best practice in responding to issues around BBVs in these often hard to reach populations and communities.


With key input from international and local speakers exploring the demography and epidemiology of BBV in Scotland’s diverse communities and organisations providing examples of good and innovative practice in local and international contexts this mix of plenary talks and how-to workshops will be of interest to:

  • People affected by BBVs from diverse populations
  • Services working with minority ethnic communities
  • Third Sector Practitioners, Voluntary and Community Organisations
  • MCN and BBV networks
  • Cultural and/or faith organisations
  • Local Authority Officers and Councillor
  • Addiction services
  • Public Health and General Practitioners
  • Pharmacists
  • Commissioners and policy makers Health Promotion Advisers and Health Improvement Teams
  • Community Development teams
  • Family Health Teams and Outreach Workers
  • Local Pregnancy Advisory Services
  • Mental Health Practitioners
  • Social Services

The programme, including keynote speakers will be published in the near future.


Service opening hours


All Waverley Care services will close at 5pm on Friday the 21st of December and reopen at 9am on Monday the 7th of January.


C-Plus, Edinburgh: Close at 5pm on Friday the 21st of December and reopens at 9am on Thursday the 3rd of January. If you have an urgent query, call 01896757843.


Positive Help, Edinburgh: Closes  at 5pm on Friday the 21st December and reopens at 9.30am on Monday the 7th of January.


C-Clear, Fife: Closed on Christmas day and Boxing day, as well as New Years Day and January 2nd. Otherwise open as normal. Contact on 01592619090.


Positive Support, Lanarkshire: Closes at noon on Christmas eve. Reopens at 9am on January 3rd.


If you have any questions on viral hepatitis you can also call the NHS Inform Helpline on 0800 22 44 00. Lines are open daily from 8am until 10pm.


Latest viral hepatitis updates


HCV updates


Triple therapy boosts HCV response after liver transplant - read article here.


Telaprevir works as well twice a day as 4 times a day - read article here.


Liver cancer spikes in Spanish HCV/HIV co-infected - read article here.


Latest HPS stats on hepatitis C in Scotland. View here.


NICE Guidance on promoting hepatitis B and C testing in those at increased risk. View here.


Study suggesting Genotype 1 hepatitis C with low viral load and rapid virologic response can be treated without the need of a protese inhibitor, providing further evidence for the consensus guidelines regarding lead in therapy and rapid viral response.


Dietry Cholesterol intake associated with with liver disease progression in hepatitis C infection: Analysis of HALT-C trial. View full study here.


HBV updates


Improving Hep B vaccination rates in Hemodialysis patients - read article here. (Login required)


Needle exchange/harm reduction updates


Russia reports 12% rise in HIV cases - read article here.


Adjunctive counselling during brief and extended buprenorphine/naloxone treatment for prescription opioid dependence - read full study here.


General updates

Small pox vaccine kills liver cancer - read article here.


Hepatitis Scotland
91 Mitchell Street
G1 3LN

Telephone: 0141 225 0419
Fax: 0141 248 6414