Factors associated with high anticholinergic burden in aging adults with intellectual disabilities:a cross-sectional study

Background: Anticholinergic (AC) medications are associated with cognitive and functional decline in older people, with risk of adverse outcomes increasing with increasing AC exposure. Older people with intellectual disabilities are at increased risk of high AC exposure owing to higher prevalence of multimorbidity, particularly psychiatric morbidities. Objectives: The aims of this study were to determine individual’s AC exposure using the AC cognitive burden (ACB) scale, identify therapeutic classes contributing to burden and determine clinical and demographic factors associated with two levels of AC exposure (ACB score 1–4, ACB 5+). Methods: Cross-sectional (self-report/proxy report)medication data were drawn from Wave 1 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing, a study on ageing of 753nationally representative people with ID aged over40 randomly selected from the National Intellectual Disability Database. Medication data were available for 736 (98%). Each individual’s cumulative AC exposure was calculated using the ACB. Multinomiallogistic regression was performed identifying clinical and demographic factors associated with ACB score1–4, and ACB 5+. Results: In the eligible population of 736 participants(mean (±SD) age 54.1 (±8.8) years,55% female), 522(70.9%) were exposed to an ACB medicine (ACB 1+); 214 (29%) had an ACB score of 5+; mean total ACB score= 4.5 (±3.0). Antipsychotics accounted for35.6% of the cumulative ACB score. Age over 65yearswas associated with increased likelihood of both levels of AC exposure (ACB 1–4—adjusted OR 3.28; 95%CI 1.49–7.25, ACB 5+—adjusted OR 3.08; 95%CI1.21–7.63) and having a mental health condition(ACB 1–4—adjusted OR 9.79; 95%CI 5.63–17.02, ACB 5+—adjusted OR 23.74; 95%CI 12.29–45.83). Conclusions: Using a simple cumulative measure proved an effective means to capture total burden and established that AC exposure was high and associated with older age and mental health morbidity. This highlights need for comprehensive medication reviews for older people with intellectual disabilities.

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.

Out in psychology:lesbian, gay, bisexual, trans and queer perspectives

There has been a recent explosion of interest in Lesbian, Gay, Bisexual and Trans Perspective Psychology amongst students and academics, and this interest is predicted to continue to rise. Recent media debates on subjects such as same–sex marriage have fuelled interest in LGBTQ perspectives. This edited collection showcases the latest thinking in LGBTQ psychology. The book has 21 chapters covering subjects such as same sex parenting, outing, young LGBTQ people, sport, learning disabilities, lesbian and gay identities etc. The book has an international focus, with contributors from UK, US, Canada, Australia and New Zealand List of Contributors. Foreword by Jerry J. Bigner. 1. Introducing Out in Psychology (Victoria Clarke and Elizabeth Peel). 2. From lesbian and gay psychology to LGBTQ psychologies: A journey into the unknown (Victoria Clarke and Elizabeth Peel) 3. What comes after discourse analysis for LGBTQ psychology(Peter Hegarty). 4. Recognising race in LGBTQ psychology: Power, privilege and complicity (Damien W. Riggs). 5. Personality, individual differences and LGB psychology (Gareth Hagger Johnson). 6. Heteronormativity and the exclusion of bisexuality in psychology (Meg Barker). 7. A minority within a minority: Experiences of gay men with intellectual disabilities.(Christopher Bennett and Adrian Coyle). 8. Closet talk: The contemporary relevance of the closet in lesbian and gay interaction (Victoria Land and Celia Kitzinger) 9. Romance, rights, recognition, responsibilities and radicalism: Same-sex couples’ accounts of civil partnership and marriage (Victoria Clarke, Carole Burgoyne and Maree Burns). 10. The experience of social power in the lives of trans people (Clair Clifford and Jim Orford). 11. What do they look like and are they among us? Bisexuality, (dis.closure and (Maria Gurevich, Jo Bower, Cynthia M. Mathieson and Bramilee Dhayanandhan). 12. Heterosexism at work: Diversity training, discrimination law and the limits of liberal individualism (Rosie Harding and Elizabeth Peel). 13. Out on the ball fields: Lesbians in sport (Vikki Krane and Kerrie J. Kauer). 14. Homophobia, rights and community: Contemporary issues in the lives of LGB people in the UK (Sonja J. Ellis). 15. Striving for holistic success: How lesbians come out on top (Faith Rostad and Bonita C. Long). 16. On Passing: The Interactional Organization of Appearance Attributions in the Psychiatric Assessment of Transsexual Patients (Susan A. Speer and Richard Green). 17. Alcohol and gay men: Consumption, promotion and policy responses (Jeffrey Adams, Timothy McCreanor and Virginia Braun). 18. Towards a clinical-psychological approach to address the hetero sexual concerns of intersexed women (Lih-Mei Liao). 19. Educational psychology practice with LGB youth in schools: Individual and institutional interventions (Jeremy J. Monsen and Sydney Bailey). 20. Que(e)rying the meaning of lesbian health: Individual(izing and community discourses (Sara MacBride-Stewart). 21. Transsexualism: Diagnostic dilemmas, transgender politics and the future of transgender care (Katherine Johnson). Index.

Common variance in amplitude envelope perception tasks and their impact on phoneme duration perception and reading and spelling in Finnish children with reading disabilities

Our goal was to investigate auditory and speech perception abilities of children with and without reading disability (RD) and associations between auditory, speech perception, reading, and spelling skills. Participants were 9-year-old, Finnish-speaking children with RD (N = 30) and typically reading children (N = 30). Results showed significant group differences between the groups in phoneme duration discrimination but not in perception of amplitude modulation and rise time. Correlations among rise time discrimination, phoneme duration, and spelling accuracy were found for children with RD. Those children with poor rise time discrimination were also poor in phoneme duration discrimination and in spelling. Results suggest that auditory processing abilities could, at least in some children, affect speech perception skills, which in turn would lead to phonological processing deficits and dyslexia.

Training staff in voluntary organisations:challenges in providing a service to adults with learning disabilities

DUE TO COPYRIGHT RESTRICTIONS ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY AND INFORMATION SERVICES WITH PRIOR ARRANGEMENT

Disabling a family? Emotional dilemmas experienced in becoming a parent of a child with learning disabilities

Becoming the parent of a child diagnosed with learning disabilities can have a dramatic impact. Chrissie Rogers, the author of this article, is both a lecturer in education studies at Keele University and the mother of a daughter who has learning disabilities. She argues here that the pressures on mothers to produce ‘perfect’ babies and to meet all their needs are immense. These pressures arise from both internalised norms and societal expectations and, in the face of these pressures, parents may feel shock, loss and disappointment. These feelings may lead, in turn, to denial, anxiety and conflict affecting both the parents and the professionals involved with the family. Drawing on a series of in-depth interviews and personal narratives, Chrissie Rogers makes a powerful case for the importance of support, whether that support is formal or informal. She suggests that, without the right levels of support and understanding, having a child with a diagnosis of learning disability can disable the whole family.

Anticholinergic burden in older adults with intellectual disability; relationships with multimorbidity and adverse effects

Background: Anticholinergic medications may be associated with adverse clinical outcomes, including acute impairments in cognition and anticholinergic side effects, the risk of adverse outcomes increasing with increasing anticholinergic exposure. Older people with intellectual disability may be at increased risk of exposure to anticholinergic medicines due to their higher prevalence of comorbidities. We sought to determine anticholinergic burden in ageing people with intellectual disability. Methods: Medication data (self-report/proxy-report) was drawn from Wave 1 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a study on the ageing of 753nationally representative people with an IDC40 years randomly selected from the National Intellectual Disability Database. Each individual’s cumulative exposure to anticholinergic medications was calculated using the Anticholinergic Cognitive Burden Scale (ACB) amended by a multi-disciplinary group with independent advice to account for the range of medicines in use in this population. Results: Overall, 70.1 % (527) reported taking medications with possible or definite anticholinergic properties (ACBC1), with a mean (±SD) ACB score of 4.5 (±3.0) (maximum 16). Of those reporting anticholinergic exposure (n=527), 41.3 % (217) reported an ACB score o fC5. Antipsychotics accounted for 36.4 % of the total cumulative ACB score followed by anticholinergics (16 %) and antidepressants (10.8 %). The most frequently reported medicine with anticholinergic activity was carbamazepine 16.8 % (127). The most frequently reported medicine with high anticholinergic activity (ACB 3) was olanzapine13.4 % (101). There was a significant association between higher anti-cholinergic exposure and multimorbidity, particularly mental health morbidity, and some anticholinergic adverse effects such as constipation and day-time drowsiness but not self-rated health. Conclusion: Using simple cumulative measures proved an effective means to capture total burden and helped establish that anticholinergic exposure in the study population was high. The finding highlights the need for comprehensive reviews of medications.

Managing students' option choices with technology

This poster outlines the system which the Business School Undergraduate Programme has developed to manage the choice of options by students studying on its programmes. This involves the production of a networked computer package which presents students with the options available to them and leads them through the process of choosing their options on-line. The reasons for developing this system are outlined and the advantages which it has brought to the administration of large numbers of students are discussed.

Intellectual property asset management:how to identify, protect, manage and exploit intellectual property within the business environment

In the new ‘knowledge-intensive economies’ Intellectual assets increasingly play a key part on balance sheets. There is an increasing global awareness that in order to promote innovation and the growth of the economy, businesses must fully recognise and exploit their intellectual assets. A company’s ability to innovate rapidly and successfully is now regarded as essential and most breakthroughs are made by Small and Medium-sized Enterprises (SMEs), usually with no in-house legal professionals to help them. It is essential that those working with or creating intellectual property rights (IPR) are aware of the basics of Intellectual Property Law. Intellectual Property Asset Management provides business and management students at all levels with an accessible-straight-forward explanation of what the main Intellectual Property rights are and how these rights are protected. Locating the subject squarely in a business context and using case studies and examples throughout drawn from a wide range of business organisations, it explains how an organisation can exploit their rights through licensing, franchising and other means in order to make the best possible use of their IP assets. This book will provide students with: • the basic Intellectual Property law knowledge needed to identify a potential IP issue • the tools and understanding to assess an IP breach • the ability to identify where the problem cannot be solved in house and where expert legal assistance is required • the knowledge required to work effectively with lawyers and other legal professionals to achieve the desired outcome