Identifying co-morbidities and risk in people with epilepsy: The Maltese experience

Background: People with epilepsy are at increased risk of multiple co-morbidities that may influence risk of adverse outcomes including impact on quality of life and premature mortality. These risk factors include potentially modifiable clinical characteristics associated with sudden unexpected death in epilepsy (SUDEP). For services to tackle risk, the clinical complexity of the target epilepsy population needs to be defined. While this has been comprehensively studied in large, economically developed countries little knowledge of these issues exist in small economically developed countries, like Malta (population: 500,000). Methods: This was a single centre study focused exclusively on patients attending Gozo General Hospital (GGH) Malta. STROBE guidance for reporting cross sectional studies was used to design and report the study. This was a retrospective review of standard care and SUDEP and seizure risks provided to all adults (over 18 years) with epilepsy attending GGH (2018–2021). Results: The review identified 68 people and 92% were compliant with their anti-seizure medication. A fifth (21%) had an intellectual disability. Despite only one patient having a psychotic illness, 19% were on antipsychotic medication. Only 18% of patients had a specific epilepsy care plan, 6% nocturnal surveillance and none had received advice on SUDEP. Discussion: Patient outcomes may be improved with increasing rates of personalized epilepsy care plans, appropriate nocturnal surveillance and reducing the prescription of antipsychotic medication as it is associated with greater risk of mortality. Issues such as stigma and shame appear to play a significant role in small communities and their access to care

EU-NATO relations:Running on the fumes of informed deconfliction

This article provides the framework for the contributions to this special issue. It first puts the theme into context and outlines the main issues that justify further analytical engagement with European Union (EU)–North Atlantic Treaty Organization (NATO) relations to the extent we propose here. We then provide some historical background to frame the discussion, and in doing so also outline the current state of interaction between the EU and NATO. We then briefly contextualise the changing strategic environment shaping the relationship, including recent proposals to implement their declared “strategic partnership”. This introduction then presents an overview of the existing literature to set the stage for a renewed look at the research agenda that has emerged over the last two decades. We close with an outline of the individual contributions to this special issue, which are presented in two sections: one focusing on theoretical and conceptual approaches to the study of EU of EU–NATO relations, and one on the inter-organisational relationship in practice, followed by a concluding synopsis and outlook