Epidemiology of emergency ambulance service calls related to mental health problems and self harm: a national record linkage study.

Background: People experiencing a mental health crisis receive variable and poorer quality care than those experiencing a physical health crisis. Little is known about the epidemiology, subsequent care pathways of mental health and self-harm emergencies attended by ambulance services, and subsequent all-cause mortality, including deaths by suicide. This is the first national epidemiological analysis of the processes and outcomes of people attended by an ambulance due to a mental health or self-harm emergency. The study aimed todescribe patient characteristics, volume, case-mix, outcomes and care pathways following ambulance attendance in this patient population.Methods: A linked data study of Scottish ambulance service, emergency department, acute inpatient and death records for adults aged ?16 for one full year following index ambulance attendance in 2011.Results: The ambulance service attended 6802 mental health or self harm coded patients on 9014 occasions. This represents 11% of all calls attended that year. Various pathways resulted from these attendances. Most frequent were those that resulted in transportation to and discharge from the emergency department (n =4566/9014; 51%). Some patients were left at home (n = 1003/9014 attendances, 11%). Others were admitted to hospital (n = 2043/9014, 23%). Within 12 months of initial attendance, 279 (4%) patients had died, 97 of these were recorded as suicide.Conclusions: This unique study finds that ambulance service and emergency departments are missing opportunities to provide better care to this population and in potentially avoidable mortality, morbidity and service burden. Developing and testing interventions for this patient group in pre-hospital and emergency department settings could lead to reductions in suicide, patient distress, and service usag

Guest editorial: partnerships and public mental health

Guest editorial for special edition of the Journal of Public Mental Health. Focuses on partnerships and public mental health

The ASPEN project - work package 4 - best practice : Challenging stigma and discrimination against people with depression: Best practice guidelines, values and resources

This section contains elaborate ‘Best Practice Guidelines, Values and Resources/Toolkit’ to challenge stigma and discrimination against people with depression. This is informed by the review of evidence and programmes and is intended to be a pragmatic and usable resource for policy makers, practitioners and activists. A summary of these guidelines has been translated and adapted by each participating EU country for local use

NSC32114

Cigarette on-pack messages are one of the principal vehicles for informing smokers about the risks of smoking and research has highlighted their role as a valid health communication tool. Furthermore, they have the potential to disrupt the powerful cigarette brand imagery associated with tobacco packaging. Responding to concerns within Europe that the old style on-pack messages were ineffective and the introduction of new tobacco product legislation across Europe (EU Directive 2001/37/EC), this study was conducted to explore European smokers' response to the changes. The research draws upon two main areas of health communication: the need to pre-test messages to ensure they are appropriate for their intended audience; and the increased effectiveness of targeting messages to specific segments of the population. Two main research areas were addressed. First, the extent to which the new messages were appropriate for smokers in Europe and second, the potential to provide targeted and personally relevant messages to smokers via tobacco packs. Fifty-six focus groups were conducted across seven European countries (Finland, France, Germany, Greece, Spain, Sweden and the UK) with 17-64-year-old smokers, half of whom were not thinking about quitting (pre-contemplators) and half of whom were thinking of quitting in the next 6 months (contemplators and preparers). Implications for future labelling practices within Europe are discussed

BET, SRC, and BCL2 family inhibitors are synergistic drug combinations with PARP inhibitors in ovarian cancer

Homologous recombination deficiencies (HRD) are present in approximately half of epithelial ovarian cancers, for which PARP inhibitors (PARPi) are becoming a preferred treatment option. However, a considerable proportion of these carcinomas acquire resistance or harbour de novo resistance, posing a significant challenge to treatment. To identify new combinatorial therapeutics to overcome resistance to PARPi, we employed high-throughput conditional RNAi and drug screening of patient-derived ovarian cancer cells. To prioritise clinically relevant drug combinations, we integrated empirical validation with analysis of The Cancer Genome Atlas (TCGA) and Genomics of Drug Sensitivity in Cancer (GDSC) datasets to nominate candidate targets and drugs, reaching three main findings. Firstly, we found that the PARPi rucaparib enhanced the effect of BET inhibitors (CPI-203 & CPI-0610) irrespective of clinical subtype or HRD status. Additional drug combination screens identified that dasatinib, a non-receptor tyrosine kinase inhibitor, augmented the effects of rucaparib and BET inhibitors, proposing a potential broadly applicable triple-drug combination for high-grade serous and clear cell ovarian carcinomas. Secondly, rucaparib synergised with the BCL2 family inhibitor navitoclax, with preferential activity in ovarian carcinomas that harbour alterations in BRCA1/2, BARD1, or MSH2/6. Thirdly, we identified potentially antagonistic drug combinations between the PARPi rucaparib and vinca alkaloids, anthracyclines, and antimetabolites, cautioning their use in the clinic. These findings propose therapeutic strategies to address PARP inhibitor resistance using agents that are already approved or are in clinical development, with the potential for rapid translation to benefit a broad population of ovarian cancer patients