Association of anticholinergic burden with adverse effects in older people with intellectual disabilities:an observational cross-sectional study

BACKGROUND: No studies to date have investigated cumulative anticholinergic exposure and its effects in adults with intellectual disabilities. AIMS: To determine the cumulative exposure to anticholinergics and the factors associated with high exposure. METHOD: A modified Anticholinergic Cognitive Burden (ACB) scale score was calculated for a representative cohort of 736 people over 40 years old with intellectual disabilities, and associations with demographic and clinical factors assessed. RESULTS: Age over 65 years was associated with higher exposure (ACB 1-4 odds ratio (OR) = 3.28, 95% CI 1.49-7.28, ACB 5+ OR = 3.08, 95% CI 1.20-7.63), as was a mental health condition (ACB 1-4 OR = 9.79, 95% CI 5.63-17.02, ACB 5+ OR = 23.74, 95% CI 12.29-45.83). Daytime drowsiness was associated with higher ACB (P<0.001) and chronic constipation reported more frequently (26.6% ACB 5+ v. 7.5% ACB 0, P<0.001). CONCLUSIONS: Older people with intellectual disabilities and with mental health conditions were exposed to high anticholinergic burden. This was associated with daytime dozing and constipation

Obesity in adults: a 2022 adapted clinical practice guideline for Ireland

This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland, adapted from the Canadian CPG, defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity. It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management; validate patients' lived experiences; move beyond simplistic approaches of "eat less, move more" and address the root drivers of obesity. People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Education is needed for all healthcare professionals in Ireland to address the gap in skills, increase knowledge of evidence-based practice, and eliminate bias and stigma in healthcare settings. We call for people living with obesity in Ireland to have access to evidence-informed care, including medical, medical nutrition therapy, physical activity and physical rehabilitation interventions, psychological interventions, pharmacotherapy, and bariatric surgery. This can be best achieved by resourcing and fully implementing the Model of Care for the Management of Adult Overweight and Obesity. To address health inequalities, we also call for the inclusion of obesity in the Structured Chronic Disease Management Programme and for pharmacotherapy reimbursement, to ensure equal access to treatment based on health-need rather than ability to pay

The structuration of issue-based fields: social accountability, social movements and the Equator Principles issue-based field

This paper presents a longitudinal case study examining why and how commercial banks sought to integrate sustainability issues into their project finance operations between 2003 and 2008. We study the evolution of a set of influential environmental and social risk management guidelines for project finance – the Equator Principles (EP) – and the simultaneous structuration of a field around these guidelines focused on the issue of socially accountable project finance. The case is theoretically framed using Hoffman’s (1999) concept of an issue-based field and associated conceptualisations of the role of internal and external (social) movements in the structuration of these fields. The structuration of the issue-based field studied is shown to encompass a dynamic, contested process involving extensive interactions between a non-governmental organization (NGO) movement and a commercial bank movement. We unveil how the conflicting, collective rationales and actions of both movements fuelled the structuration process and facilitated an evolution in the social accountability of commercial banks. While prior work sees little potential for civil society actors to engage with and move corporate social responsibility and reporting in a more challenging direction, we reveal how the NGO movement evoked a progression in social responsibility and reporting in a sector that had previously shown little inclination to address its wider social accountability. Drawing on our case analysis, we theorize how issue-based fields cohere and crystallise, particularly how they build an institutional infrastructure based upon the infrastructure of the mature field which they straddle and which the relevant issue impacts upon

Stakeholder perspectives on a financial sector legitimation process:The case of NGOs and the equator principles

Purpose - The purpose of this paper is to present an in-depth, context rich, and stakeholder-focused perspective on the legitimation dynamics surrounding the initiation and evolution of one of the key financial sector environmental and social responsibility initiatives in recent years, the Equator Principles. Design/methodology/approach - The paper draws on a combination of in-depth interviews with non-governmental organization (NGO) leaders, extensive documentary analysis and participant observation in order to understand and explain, from an NGO perspective, the use of the Equator Principles as a central element in an attempt to legitimise financial institutions' project finance activities. Key aspects of legitimacy theory are used to theoretically frame the analysis. Findings - The paper reveals and analyses the process through which campaigning NGOs conferred a nominal level of legitimacy on financial institutions' project finance activities. It proceeds to unveil how and why this attained legitimacy unravelled. A perceived lack of accountability at an institutional, organisational and individual project level is identified as a central reason for this reduction in legitimacy. Research limitations/implications - The paper primarily focuses on one side of the story of the dynamics of the legitimation process underpinning the evolution of the Equator Principles until 2006. Future research could focus on obtaining and theorising financial institution perspectives on the Equator Principles' development, implementation, and progression as well as analysing developments beyond 2006. Originality/value - The paper advances our understanding of the dynamics of legitimation processes. These dynamics are studied from the perspective of a key "relevant public" thereby prioritising perceptions that are largely absent from corporate social accountability research seeking to empirically inform legitimacy theory

Stakeholder perspectives on a financial sector legitimation process: The case of NGOs and the Equator Principles

Purpose – The purpose of this paper is to present an in-depth, context rich, and stakeholder-focused perspective on the legitimation dynamics surrounding the initiation and evolution of one of the key financial sector environmental and social responsibility initiatives in recent years, the Equator Principles. Design/methodology/approach – The paper draws on a combination of in-depth interviews with non-governmental organization (NGO) leaders, extensive documentary analysis and participant observation in order to understand and explain, from an NGO perspective, the use of the Equator Principles as a central element in an attempt to legitimise financial institutions' project finance activities. Key aspects of legitimacy theory are used to theoretically frame the analysis. Findings – The paper reveals and analyses the process through which campaigning NGOs conferred a nominal level of legitimacy on financial institutions' project finance activities. It proceeds to unveil how and why this attained legitimacy unravelled. A perceived lack of accountability at an institutional, organisational and individual project level is identified as a central reason for this reduction in legitimacy. Research limitations/implications – The paper primarily focuses on one side of the story of the dynamics of the legitimation process underpinning the evolution of the Equator Principles until 2006. Future research could focus on obtaining and theorising financial institution perspectives on the Equator Principles' development, implementation, and progression as well as analysing developments beyond 2006. Originality/value – The paper advances our understanding of the dynamics of legitimation processes. These dynamics are studied from the perspective of a key “relevant public” thereby prioritising perceptions that are largely absent from corporate social accountability research seeking to empirically inform legitimacy theory.Benchmarking, Corporate social responsibility, Financial institutions, Non-governmental organizations, Stakeholder analysis

Continuation of opioid replacement program delivery in the aftermath of cyclones in Queensland, Australia: A qualitative exploration of the perspectives of pharmacists and opioid replacement therapy staff

Background Cyclones can significantly impact on communities and their healthcare services. Community members with chronic diseases, including opioid dependence, who rely on these healthcare services are placed at an increased risk of treatment disruption during a disaster event. Disruptions to the continuity of the opioid replacement therapy (ORT) service can potentially lead to relapse, withdrawal, and risky behaviours in clients with potential repercussions for the community. Objective To explore the effects of Queensland (QLD) cyclones on opioid treatment programs within Queensland community and hospital pharmacies from three perspectives. Method Qualitative research methods were used. Participants comprised five community pharmacists, four Queensland opioid treatment program (QOTP) employees, and five public hospital pharmacists. Participants were identified as they had worked in Townsville, Rockhampton, Mackay, or Yeppoon in a community impacted by a cyclone and involved with ORT supply. Interviews were recorded and data were analysed by two methods - manual coding and the text analytics software Leximancer®. Results The two themes that emerged from the manual coding process were ‘disaster preparedness’ and ‘continuity of service’. The key themes from the Leximancer® analysis aligned with the two manual coding themes with no new themes identified. Primary dosing site closures in disaster-affected areas led to increased pressures on hospitals and other community pharmacy dosing sites to supply ORT doses to clients. However, a lack of dosing information available to pharmacists and strict legislative requirements made continuity of ORT supply during these cyclones difficult. Conclusion Continuation of ORT services during and in the aftermath of a cyclone event is complex. This research highlighted a need for a coordination of efforts and shared dosing information between QOTP employees, community pharmacists, and hospital pharmacists. To improve continuity of ORT services, it is essential that these stakeholders engage with each other in preparing for and responding to future events

5-Azacytidine for the treatment of myelodysplastic syndromes

Introduction: 5-Azacytidine is a pyrimidine nucleoside analog of cytidine that undergoes incorporation into DNA and blocks DNA methyltransferase leading to hypomethylation and potentially beneficial re-expression of abnormally silenced genes. It is the first agent approved for use in patients with myelodysplastic syndromes (MDSs) based on its improvement in overall survival as monotherapy. Evidence of efficacy in combination with other agents is also accumulating. Areas covered: Key information on mechanisms of action is presented. Development, synthesis, and pharmacokinetics are also outlined. Key safety, tolerability, and efficacy data from clinical trials of 5-azacytidine as monotherapy as well as in combination are also presented. Expert opinion: Our understanding of the molecular basis and pathogenesis of MDS continues to evolve rapidly. 5-Azacytidine has been shown to improve both overall survival and quality of life in patients with high-risk MDS. Currently, the oral route of administration is undergoing evaluation in clinical trials. Used as a monotherapy and also in novel combinations, 5-azacytidine has the potential to further improve the prognosis of some patients with MDS