Seizure action plans in the pediatric population with epilepsy: Uptake, determinants, and parental interest in a mobile application.

BACKGROUND: Status epilepticus (SE) is a common pediatric neurological emergency that requires timely treatment to minimize morbidity and mortality, yet administration of rescue medications is often delayed and underdosed. Seizure action plans (SAPs) outline the steps that should be taken by parents and caregivers in case of SE in order to optimize patient outcomes. Our study determined the uptake of SAPs in a pediatric population with epilepsy and assessed parental interest in a SAP mobile application. METHODS: A survey was distributed to parents of patients with epilepsy aged 1 month to 19 years at British Columbia Children's Hospital. Following chart review, univariate and multivariate analyses were performed to identify variables that predict whether patients have SAPs. A systematic search of available mobile applications for epilepsy management was conducted. RESULTS: Of 192 participants, 62% have SAPs. On univariate analysis, history of prior SE and male gender increased likelihood of SAP. On logistic regression, Nagelkerke R2 was 0.204 and our model correctly predicted 82% of patients with SAPs. 83% of parents were interested in a SAP mobile application. There are currently 40 mobile applications available for epilepsy management, but only 15% of respondents reported using them. CONCLUSIONS: There is a need to increase the percentage of patients with epilepsy with SAPs, particularly in those at greater risk of SE. Most parents would find a SAP mobile application valuable in their child's epilepsy management. There is a gap between the high parental interest in mobile applications for epilepsy management and their current use of such applications.

Comorbidity and polypharmacy among women living with HIV in British Columbia.

OBJECTIVE: To characterize comorbid disease and medication burden among women living with HIV (WLWH) in British Columbia (BC), Canada. DESIGN: We examined baseline data from 267 WLWH and 276 HIV-negative women, aged at least 19 years, enrolled in the Children and Women: Antiretrovirals and Markers of Aging (CARMA) cohort. METHODS: Self-reported demographic, medical condition, medication, vitamin, and substance exposure data were collected at baseline CARMA study visits. We considered conditions with appropriate concomitant medications to be 'treated'. Wilcoxon rank-sum and Fisher's exact tests compared continuous and categorical variables between WLWH and HIV-negative women. Number of diagnoses, prescribed medications (excluding HIV/antiretrovirals), vitamins, and prevalence of depression/anxiety/panic disorder were compared using negative binomial and logistic regressions for continuous and binary variables, respectively. RESULTS: WLWH were younger [median, interquartile range (IQR) 39.9, 33.6-46.9 vs. 43.6, 31.8-54.6 years; P = 0.01], attained lower education (40.5 vs. 69.6% college/university; P < 0.001), and more often currently smoked tobacco (47.9 vs. 31.9%; P < 0.001) or had income less than $15 000/year (49.0 vs. 43.1%; P < 0.001). Although younger, and despite omitting HIV infection, WLWH had a greater number of diagnoses (incidence rate ratio, 95% confidence interval 1.58, 1.38-1.81; P < 0.001), and more depression/anxiety/panic disorder vs. controls (odds ratio, 95% CI 1.86, 1.22-2.83; P = 0.004). Our model predicts that with mean BMI (26.3), WLWH and HIV-negative peers would have two comorbid diagnoses by age 30 and 60, respectively. CONCLUSIONS: WLWH living in BC have more comorbid illness earlier in life than their HIV-negative peers, and have very high rates of depression/anxiety/panic disorder. Addressing mental health and comorbid conditions is essential to improving health outcomes among WLWH.