Transforming Urban Governance to Manage Uncertainty and Climate Change in Mumbai, India

Despite unprecedented wealth accumulation, coastal Mumbai suffers from a myriad of socioeconomic and ecological challenges as well as connected uncertainties. These include endemic flooding, shrinking of sensitive ecosystems, inequality, and marginalisation of natural resource-dependent communities, such as fishers. These are in addition to existing risks, including building collapse, fire hazards, infrastructure collapse, industrial accidents, and landslides. The spectre of climate change looms large and further complicates the situation. Urban governance mechanisms and strategies respond insufficiently to the growing threats the city faces. More needs to be done to manage and address these uncertainties through a strategic, adaptation-focused, and communicative urban governance framework that emphasises both reducing risk and strengthening social justice.Research Council of Norwa

Characteristics associated with quality of life among people with drug-resistant epilepsy

Quality of Life (QoL) is the preferred outcome in non-pharmacological trials, but there is little UK population evidence of QoL in epilepsy. In advance of evaluating an epilepsy self-management course we aimed to describe, among UK participants, what clinical and psycho-social characteristics are associated with QoL. We recruited 404 adults attending specialist clinics, with at least two seizures in the prior year and measured their self-reported seizure frequency, co-morbidity, psychological distress, social characteristics, including self-mastery and stigma, and epilepsy-specific QoL (QOLIE-31-P). Mean age was 42 years, 54% were female, and 75% white. Median time since diagnosis was 18 years, and 69% experienced ≥10 seizures in the prior year. Nearly half (46%) reported additional medical or psychiatric conditions, 54% reported current anxiety and 28% reported current depression symptoms at borderline or case level, with 63% reporting felt stigma. While a maximum QOLIE-31-P score is 100, participants’ mean score was 66, with a wide range (25–99). In order of large to small magnitude: depression, low self-mastery, anxiety, felt stigma, a history of medical and psychiatric comorbidity, low self-reported medication adherence, and greater seizure frequency were associated with low QOLIE-31-P scores. Despite specialist care, UK people with epilepsy and persistent seizures experience low QoL. If QoL is the main outcome in epilepsy trials, developing and evaluating ways to reduce psychological and social disadvantage are likely to be of primary importance. Educational courses may not change QoL, but be one component supporting self-management for people with long-term conditions, like epilepsy