The primary barriers to accessing methamphetamine treatment are psychosocial/internal. Services and treatment models that address these barriers are urgently required. There is a growing need for methamphetamine-appropriate treatment services. Further research evaluating treatment engagement and effectiveness for methamphetamine and polysubstance use, including the development of effective pharmacotherapies is warranted.

a b s t r a c tBackground: The use of amphetamines is a global public health concern. We summarise global data on use of amphetamines and mental health outcomes. Methods: A systematic review and meta-analysis (CRD 42017081893). We searched Medline, EMBASE, PsycInfo for methamphetamine or amphetamine combined with psychosis, violence, suicidality, depression or anxiety. Included studies were human empirical cross-sectional surveys, case-control studies, cohort studies and randomised controlled trials that assessed the association between methamphetamine and one of the mental health outcomes. Random effects meta-analysis was used to pool results for any use of amphetamines and amphetamine use disorders. Findings: 149 studies were eligible and 59 were included in meta-analyses. There was significant heterogeneity in effects. Evidence came mostly from cross-sectional studies. Any use of amphetamines was associated with higher odds of psychosis (odds ratio [OR] = 2.0, 95%CI 1.3-3.3), violence (OR = 2.2, 95%CI 1.2-4.1; adjusted OR [AOR] = 1.4, 95%CI 0.8-2.4), suicidality OR = 4.4, 95%CI 2.4-8.2; AOR = 1.7, 95%CI 1.0-2.9) and depression (OR = 1.6, 95%CI 1.1-2.2; AOR = 1.3, 95%CI 1.2-1.4). Having an amphetamine use disorder was associated with higher odds of psychosis (OR = 3.0, 95%CI 1.9-4.8; AOR = 2.4, 95%CI 1.6-3.5), violence (OR = 6.2, 95%CI 3.1-12.3), and suicidality (OR = 2.3, 95%CI 1.8-2.9; AOR = 1.5, 95%CI 1.3-1.8). Interpretation: Methamphetamine use is an important risk factor for poor mental health. High quality population-level studies are needed to more accurately quantify this risk. Clinical responses to methamphetamine use need to address mental health harms.

Purpose Homelessness is a colossal issue, precipitated by a wide array of social determinants, and mirrored in substantial health disparities and a revolving hospital door. Connecting people to safe and secure housing needs to be part of the health system response. The paper aims to discuss these issues. Design/methodology/approach This mixed-methods paper presents emerging findings from the collaboration between an inner city hospital, a specialist homeless medicine GP service and Western Australia’s inaugural Housing First collective impact project (50 Lives 50 Homes) in Perth. This paper draws on data from hospitals, homelessness community services and general practice. Findings This collaboration has facilitated hospital identification and referral of vulnerable rough sleepers to the Housing First project, and connected those housed to a GP and after hours nursing support. For a cohort (n=44) housed now for at least 12 months, significant reductions in hospital use and associated costs were observed. Research limitations/implications While the observed reductions in hospital use in the year following housing are based on a small cohort, this data and the case studies presented demonstrate the power of care coordinated across hospital and community in this complex cohort. Practical implications This model of collaboration between a hospital and a Housing First project can not only improve discharge outcomes and re-admission in the shorter term, but can also contribute to ending homelessness which is itself, a social determinant of poor health. Originality/value Coordinated care between hospitals and programmes to house people who are homeless can significantly reduce hospital use and healthcare costs, and provides hospitals with the opportunity to contribute to more systemic solutions to ending homelessness.

The results from this pilot study would suggest no increased benefit, in terms of treatment completion, from the additional use of sevoflurane in combination with nitrous oxide and oxygen. There was, however, a small but significant patient preference in favour of nitrous oxide with sevoflurane and oxygen.

The aim of a thoracic epidural is to selectively block pain fibres from the surgical site and the thoracic sympathetic chain bilaterally. Selective sympathetic block is associated with respiratory, cardiac, gastrointestinal and metabolic benefits. Unilateral block is more likely to be caused by catheter malposition than anatomical barriers to spread. Lumbar epidural block is inappropriate for abdominal and thoracic surgery. Freedom from pain allows early mobilization and feeding.

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It has become common for scholars of nations and nationalism to use banknotes, coins and postage stamps as passing examples of everyday objects expressive of nationalism. Until recently, however, it has been less common for these objects to form the focus of empirical enquiries that substantiate their contribution to the creation and transmission of national symbolism. This article addresses this lacuna through an empirical investigation of over 300 years of Scottish banknote iconography. In their symbolic content, banknotes are shown to be amenable to the service of both national and non-national political agendas. To explain this phenomenon, we advance three interrelated arguments. First, we contend that variations in banknote iconography reflect the different political contexts in which notes were produced and the distinctive loyalties and customer constituencies of the banks that issue them. Second, we argue that changes in banknote imagery reflect changes in the scale of their circulation. Third, we argue that Scottish banknotes have always included iconography that constructs the image of the bank and advertises its reliability, often through association with national images. The article concludes by addressing Scotland's place in wider understandings of the iconographic power of banknotes.