Utilisation of specialist epilepsy services and antiseizure medication adherence rates in a cohort of people with epilepsy (PWE) accessing emergency care.

BACKGROUND: An epilepsy-related attendance at A&E is associated an increased risk of subsequent death within 6 months. Although further work is required to provide a definitive explanation to account for these findings, in the interim it would seem reasonable that services are designed to ensure timely access and provide support at a time of greatest risk. We aim to determine the frequency of patients accessing specialist neurology services following an epilepsy-related admission/unscheduled care episode and consider ASM adherence at the point of attendance. METHODS: Patients were identified retrospectively via the NHS Greater Glasgow and Clyde live integrated epilepsy Dashboard following an unscheduled epilepsy-related admission or A&E attendance between 1st January 2022 and 30th June 2022. We calculated adherence to anti-seizure medication for a period of 6 months prior to admission and defined poor medication adherence as a medication possession ratio of less than 80 %. We evaluated the rate of any outpatient neurology clinic attendance in the subsequent 3, 6 and 12 months following an epilepsy-related unscheduled care episode. Additional clinical information was identified via the electronic patient records. RESULTS: Between 1st Jan 2022 and 30th June 2022, there were 266 emergency care seizure-related attendances. The mean age at attendance was 46 years (range: 16-91). Most of PWE were males (63 %) and 37 % were females. Epilepsy classification-29.3 % had GGE, 41.7% had focal epilepsy, and in 29 % of cases the epilepsy was unclassified. Of the admissions, 107/ 266 (40.2 %) generated follow-up within 6 months of attendance. Poor medication adherence was noted in 54/266 (20.3 %). 28.2 % of cases had input from on-call neurology service during admission/ED attendance, and of those 60 % had ASM adjusted. 18 % of attendances had a background diagnosis of learning disability. One-third of attendances of PWE had a history of mental health disorder 35 % (93/266). 25 % of ED attendances noted an active history of alcohol consumption misuse or/and recreational drug use. 14 (5.5 %) of PWE died during the period of interest (12 months following the last ED visit). In 6/14 (42.3 %) death was associated with poor medication adherence. CONCLUSION: This study demonstrates that a significant proportion of patients who experienced seizure-related admissions/ attendance did not access specialist neurology services in a timely manner. In addition, poor medication adherence remains a problem for a substantial number of people living with epilepsy. Early access to specialist services may go some way to improving care and reducing excessive mortality in PWE by allowing anti-seizure medication to be titrated and poor medication adherence to be addressed in those at greatest risk.

Exploring the interconnections between gender, health and nature.

OBJECTIVES: Public health has recognized that nature is good for health but there are calls for a review of its gendered aspects. This review attempts to develop and explore a broad analytical theme - the differing interconnections between gender, health and nature. The paper summarizes the interconnections that have been subject to extensive academic enquiry between gender and health, health and space, and gender and space. METHODS: A combination of key terms including place; gender; health; outdoor space; green space; natural environment; national parks; femininity; masculinity; recreation; physical activity; sustainability; ecofeminism; feminism; environmental degradation; and environmental justice were used to search the electronic databases Sociological Abstracts, Web of Science and Scopus to identify relevant articles. We took two approaches for this review to provide an overview and analysis of the range of research in the field, and to present a framework of research that is an analysis of the intersection of gender, health and nature. RESULTS: Four dimensions are distinguished: (1) evaluations of health benefits and 'toxicities' of nature; (2) dimensions and qualities of nature/space; (3) environmental justice including accessibility, availability and usability; and (4) identification of boundaries (symbolic/material) that construct differential relationships between nature, gender and health. This paper offers an understanding of how environmental and social conditions may differentially shape the health of women and men. The dimensions direct analytical attention to the diverse linkages that constitute overlapping and inseparable domains of knowledge and practice, to identify complex interconnections between gender, health and nature. CONCLUSION: This review therefore analyses assumptions about the health benefits of nature, and its risks, for gender from an in-depth, analytical perspective that can be used to inform policy.