Such prevalence not only require support from health and social care services, at times it require an emergency response from front line services. The police are increasingly involved in responding to crisis and transporting people to emergency departments rather than paramedics. Such police intervention can escalate situations and intensify levels of distress resulting in unintended consequences including increasing public stigma and the criminalization of mental illness. My experience suggests that often the response to psychiatric pain is different to when we are experiencing physical pain. In this narrative I explore the various emergency pathways I experienced when in psychiatric distress including experiences with law enforcement services, emergency departments and psychiatric services. The potential impact of the responses and whether there are opportunities to develop better, more compassionate response. © 2020 John Wiley & Sons Ltd.BACKGROUND AND AIMS When measuring inequalities in health, public health and addiction research has tended to focus on differences in average life-span between socio-economic groups. This does not account for the extent to which age of death varies between individuals within socio-economic groups or whether this variation differs between groups. This study assesses (1) socio-economic inequalities in both average life-span and variation in age at death, (2) the extent to which these inequalities can be attributed to alcohol-specific causes (i.e. those attributable only to alcohol) and (3) how this contribution has changed over time. DESIGN Cause-deleted life table analysis of national mortality records. SETTING England and Wales, 2001-16. CASES All-cause and alcohol-specific deaths for all adults aged 18+, stratified by sex, age and quintiles of the index of multiple deprivation (IMD). MEASUREMENTS Life expectancy at age 18 yearss and standard deviation in age at death within IMD quintiles and the contribution Using both measures can provide a fuller picture of overall inequalities in health. © 2020 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.BACKGROUND Hyponatremia is common in patients with acute heart failure (HF). Our aim was to determine the impact of sodium disturbances on mortality and readmissions in HF with reduced left ventricular ejection fraction (HFrEF), preserved ejection fraction (HFpEF), and mid-range ejection fraction (HFmrEF). METHODS Prospective multicentre consecutive registry in 20 hospitals including patients admitted due to acute HF in cardiology departments. Sodium 145 mmol/L hypernatremia, and 135-145 mmol/L normal. RESULTS A total of 1309 patients were included. Mean age was 72.0 ± 11.9 years, 810 (61.9%) were male. Mean serum sodium level was 138.6 ± 4.7 mmol/L at hospital admission, and 138.1 ± 4.1 mmol/L at discharge. The evolution of sodium levels was normal-at-admission/normal-at-discharge 941 (71.9%), abnormal-at-admission/normal-at-discharge 127 (9.7%), normal-at-admission/abnormal-at-discharge 155 (11.8%), and abnormal-at-admission/abnormal-at-discharge 86 (6.6%). Hyponatremia at discharge was more common in HFrEF (109 (20.7%)) than in HFpEF (79 (13.9%)) and HFmrEF (27 (12%)), P = 0.003. The prevalence of hypernatremia at discharge was similar in the three groups HFrEF (10 (1.9%)), HFpEF (12 (2.1%)), and HFmrEF (4 (1.9%)), P = 0.96. In multivariate analysis, abnormal sodium concentrations at hospital admission (Hazard Ratio (HR) 1.42, 95% confidence interval (CI) 1.15-1.76, P = 0.001), and discharge (HR 1.33, 95% CI 1.08-1.64, P = 0.007) were both independently associated with increased mortality and readmissions at 12 months. CONCLUSIONS Hyponatremia and hypernatremia at admission and discharge predict a poor outcome in patients with acute HF, regardless of LVEF. Hyponatremia at discharge is more frequent in HFrEF than in the other LVEF groups. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.PURPOSE A significant number of patients with acute coronary syndrome (ACS) are nonadherent to aspirin after hospital discharge, with an associated increased risk of subsequent cardiovascular events. The purpose of this pilot study was to test the efficacy of a telehealth intervention based on behavioral economics to improve aspirin adherence following hospitalization for ACS. METHODS We enrolled 130 participants (c¯X = 58 ± 10.7 years of age, 38% female, 45% black) from two hospitals. Patients were eligible if they owned a smartphone and were admitted to the hospital for ACS, prescribed aspirin at discharge, and responsible for administering their own medications. Consenting participants were randomized to the intervention or usual care group. The intervention group was eligible to receive up to $50 per month if they took their medicine daily, with $2 per day deducted if a dose was missed. All participants received an electronic monitoring (EM) pill bottle containing a 90-day supply of aspirin, which was used to measure adherence calculated as the proportion of prescribed drug taken using the EM device. Based on the skewness in the adherence distribution, quantile regression was used to evaluate the effect of the intervention on median adherence over time. RESULTS After 90 days, adherence fell in the control group but remained high in the intervention group (median adherence 81% vs 90%, P = .18). Rehospitalization was higher in the control group (24% vs 13%, P = .17). CONCLUSION A loss aversion behavioral economics-based telehealth intervention is a promising approach to improving aspirin adherence following hospitalization for ACS. © 2020 John Wiley & Sons Ltd.Despite improvements in medications, devices and understanding of the disease, about half of all asthma patients worldwide remain inadequately controlled, suggesting the need for a new approach to asthma management. read more Poor adherence to prescribed maintenance therapy and over-reliance on SABA reliever medication is a common cause of inadequate control. This article reviews published data from 6- to 12-month, double-blind, RCT and open-label real-world studies involving budesonide/formoterol maintenance and reliever therapy (MART) and relevant comparator approaches to asthma management, and considers how these compare in achieving the treatment goals described in guidelines. The data confirm that patients with asthma treated with budesonide/formoterol MART achieved the same or better asthma symptom control compared with ICS/LABA plus SABA regimens at similar or higher ICS doses, with consistently lower rates of exacerbations and considerably lower annual requirement for oral corticosteroids. These findings have been confirmed across a range of severities of persistent asthma.