Hypertension prevalence and awareness in older Irish adults: Evidence from the Irish Longitudinal Study on Ageing (TILDA)

Introduction: Hypertension prevalence is increasing worldwide: population ageing and an increase in the prevalence of obesity are contributing to this rise. Hypertension is a major modifiable risk factor for stroke, coronary heart disease, end stage renal disease and has been associated with cognitive impairment. The aim of this study is to determine the prevalence of hypertension and to identify determinants of awareness of hypertension in older Irish adults. Methods: The Irish Longitudinal Study on Ageing (TILDA) is a population based prospective cohort study representative of community living adults. Each member of the Irish population aged 50 years and older had an equal probability of participation in the study. Face to face interviews and objective health assessments were conducted between Oct 2009 and July 2011. Descriptive statistics and logistic regression analysis were used to calculate prevalence and determinants of awareness of hypertension. Survey weights were applied to the estimates to adjust for selection and non-response bias in the survey. Results: The household response rate was 62%. Of the 8,175 respondents who took part in the study 5857 (71.6%) completed a comprehensive health assessment including blood pressure measurement. Hypertension was defined as a mean systolic blood pressure (SBP) ≥140mmHg and/or a mean diastolic blood pressure (DBP) ≥90mmHg and/or currently taking antihypertensive medications. The overall prevalence of hypertension was 64% (95% CI 62-65%) in those aged 50 years and older. Hypertension prevalence was higher in men than in women (69% vs 59%, p<.007) and prevalence increased with age to 87% (95% CI 84-89%) in those aged 75 years and older. Of those classified as hypertensive 55% (95% CI 53-57%) self-reported a previous doctor’s diagnosis of hypertension. Strong determinants of awareness included older age, female sex, overweight and obesity. Conclusions: This study documents a high prevalence of hypertension in adults aged 50 years and older in Ireland and identifies a low level of awareness of hypertension in this group. Raising awareness of hypertension is a major public health challenge. These findings provide reliable information which can contribute to practice and policy aimed at decreasing the prevalence of hypertension

Ariel - Volume 2 Number 6

Editors Richard J. Bonanno Robin A. Edwards Associate Editors Steven Ager Stephen Flynn Shep Dickman Tom Williams Lay-out Editor Eugenia Miller Contributing Editors Michael J. Blecker W. Cherry Light James J. Nocon Lynne Porter Editors Emeritus Delvyn C. Case, Jr. Paul M. Fernhof

Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review

Objective To review systematically the evidence of effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses

Threat or opportunity? An analysis of perceptions of cultured meat in the UK farming sector

The environmental and social impacts of cultured meat, and its economic viability, are contingent on its implications for food production and for agriculture. However, the implications of cultured meat production for farmers have not yet been thoroughly investigated and are poorly understood. The aim of this research was to engage with the farming sector in critically assessing cultured meat as a technology which could profoundly affect future farm livelihoods, land use, rural and farming communities and agricultural value chains. Ensuring farmers' voices, and potential 'counternarratives' inform the development of cultured meat is not only inclusive, but could identify unexpected impacts of this emerging technology and contribute to the framing of the social license of the industry developing them.Six focus groups were undertaken with 75 UK farmers from a variety of farming sectors and regions. Questions focused on what the term 'cultured meat' means to farmers, the potential impacts of cultured meat, and potential business scenarios arising for farmers. All meetings were recorded, transcribed, and thematically analyzed.Farmers expressed complex and considered reflections on cultured meat, raising several perceived opportunities and risks associated with the themes of 'ethics and affective' narratives, 'environmentbased' narratives, and 'socio-economic' narratives. Aspects of foci of power, food system control and transparency associated with cultured meat emerged from the conversations, as well as cultured meat's potential impacts on the environment and on jobs, farming/rural communities and connecting with the land.Globally, meat production underpins the livelihoods of many rural communities, so a transition to cultured meat is likely to have deep-seated ethical, environmental, and socio-economic impacts. Within the discourse on cultured meat the voices of farmers are often lost. While not claiming to be representative of all UK farming, this study engaged UK farmer perspectives as a way of starting the substantive process of greater stakeholder inclusion in cultured meat innovation pathways, and which should underpin responsible technology transitions in agriculture

Threat or opportunity? An analysis of perceptions of cultured meat in the UK farming sector

Background: The environmental and social impacts of cultured meat, and its economic viability, are contingent on its implications for food production and for agriculture. However, the implications of cultured meat production for farmers have not yet been thoroughly investigated and are poorly understood. The aim of this research was to engage with the farming sector in critically assessing cultured meat as a technology which could profoundly affect future farm livelihoods, land use, rural and farming communities and agricultural value chains. Ensuring farmers’ voices, and potential ‘counter-narratives’ inform the development of cultured meat is not only inclusive, but could identify unexpected impacts of this emerging technology and contribute to the framing of the social license of the industry developing them. Methods: Six focus groups were undertaken with 75 UK farmers from a variety of farming sectors and regions. Questions focused on what the term ‘cultured meat’ means to farmers, the potential impacts of cultured meat, and potential business scenarios arising for farmers. All meetings were recorded, transcribed, and thematically analyzed. Results and discussion: Farmers expressed complex and considered reflections on cultured meat, raising several perceived opportunities and risks associated with the themes of ‘ethics and affective’ narratives, ‘environment-based’ narratives, and ‘socio-economic’ narratives. Aspects of foci of power, food system control and transparency associated with cultured meat emerged from the conversations, as well as cultured meat’s potential impacts on the environment and on jobs, farming/rural communities and connecting with the land. Conclusion: Globally, meat production underpins the livelihoods of many rural communities, so a transition to cultured meat is likely to have deep-seated ethical, environmental, and socio-economic impacts. Within the discourse on cultured meat the voices of farmers are often lost. While not claiming to be representative of all UK farming, this study engaged UK farmer perspectives as a way of starting the substantive process of greater stakeholder inclusion in cultured meat innovation pathways, and which should underpin responsible technology transitions in agriculture

Ethical choices behind quantifications of fair contributions under the Paris Agreement

The Parties to the UNFCCC and Paris Agreement agreed to act on the basis of equity to protect the climate system. Equitable effort sharing is an irreducibly normative matter, yet some influential studies have sought to create quantitative indicators of equitable effort that claim to be value-neutral (despite evident biases). Many of these studies fail to clarify the ethical principles underlying their indicators, some mislabel approaches that favour wealthy nations as ‘equity approaches’ and some combine contradictory indicators into composites we call derivative benchmarks. This Perspective reviews influential climate effort-sharing assessments and presents guidelines for developing and adjudicating policy-relevant (but not ethically neutral) equity research

Culture Clash? What cultured meat could mean for UK farming

Headlines It may one day be possible to substitute meat grown through cell culture imperceptibly for meat from livestock. Farmers’ concerns about cultured meat go beyond the impact on their bottom line, including that it is: ■ Uncertain: there are still too many unanswered questions. ■ Unreliable: unbiased data is hard to come by. ■ Unrealistic: work is needed to map how new supply chains could work in practice. ■ Unintended: having many potential knock-on effects. ■ Unfair: questioning who benefits from this further industrialisation of our food system. ■ Unnatural: in contrast to the ‘real’ food the farmers produced. Factors such as business diversification, tenure, assets and contractual relationships affect farmers’ resilience or precarity to this potentially disruptive technology. Yet, under the right circumstances, cultured meat could present opportunities for some UK farmers: ■ Sharpening their competitive edge for selling high-value ‘real meat’. ■ Developing potential new markets such as supplying animal cells or raw materials. ■ Generating income from processing crop or animal by-products as ingredients. ■ Harnessing private investment to produce cultured meat on their own farm. ■ Developing new, fairer supply-chain relationships. Initial analysis suggests that using crop and animal by-products as amino acid sources for cultured meat production could reduce its cost and environmental footprint, while farm-scale production would cost about 30% more than factory-scale. While some farmers were interested in exploring these possibilities further, caring for livestock remained central to their identity. Moving beyond a polarised debate would benefit the cultured meat industry, but it may also benefit farming. Advocates of cultured meat can support this through more inclusive communication: acknowledging uncertainties, celebrating farmer innovation and working with honest brokers. The cultured meat industry and farmers could build common ground through: ■ Joint research and innovation, particularly into waste valorisation and on-farm production. ■ Developing practical partnerships and mechanisms for continued dialogue, such as a platform for interested farmers to connect with cultured meat businesses and a short guide to cultured meat for farmers. ■ Investors expecting cultured meat companies to include farmers in their Environmental, Social and Governance commitments to support a ‘just transition’

Primary Care and Youth Mental Health in Ireland: Qualitative Study in Deprived Urban Areas

BACKGROUND: Mental disorders account for six of the 20 leading causes of disability worldwide with a very high prevalence of psychiatric morbidity in youth aged 15-24 years. However, healthcare professionals are faced with many challenges in the identification and treatment of mental and substance use disorders in young people (e.g. young people\u27s unwillingness to seek help from healthcare professionals, lack of training, limited resources etc.) The challenge of youth mental health for primary care is especially evident in urban deprived areas, where rates of and risk factors for mental health problems are especially common. There is an emerging consensus that primary care is well placed to address mental and substance use disorders in young people especially in deprived urban areas. This study aims to describe healthcare professionals\u27 experience and attitudes towards screening and early intervention for mental and substance use disorders among young people (16-25 years) in primary care in deprived urban settings in Ireland. METHODS: The chosen method for this qualitative study was inductive thematic analysis which involved semi-structured interviews with 37 healthcare professionals from primary care, secondary care and community agencies at two deprived urban centres. RESULTS: We identified three themes in respect of interventions to increase screening and treatment: (1) Identification is optimised by a range of strategies, including raising awareness, training, more systematic and formalised assessment, and youth-friendly practices (e.g. communication skills, ensuring confidentiality); (2) Treatment is enhanced by closer inter-agency collaboration and training for all healthcare professionals working in primary care; (3) Ongoing engagement is enhanced by motivational work with young people, setting achievable treatment goals, supporting transition between child and adult mental health services and recognising primary care\u27s longitudinal nature as a key asset in promoting treatment engagement. CONCLUSIONS: Especially in deprived areas, primary care is central to early intervention for youth mental health. Identification, treatment and continuing engagement are likely to be enhanced by a range of strategies with young people, healthcare professionals and systems. Further research on youth mental health and primary care, including qualitative accounts of young people\u27s experience and developing complex interventions that promote early intervention are priorities