Anticholinergic medication use and cognitive impairment in the older population:the Medical Research Council cognitive function and ageing study

OBJECTIVES: To determine whether the use of medications with possible and definite anticholinergic activity increases the risk of cognitive impairment and mortality in older people and whether risk is cumulative. DESIGN: A 2-year longitudinal study of participants enrolled in the Medical Research Council Cognitive Function and Ageing Study between 1991 and 1993. SETTING: Community-dwelling and institutionalized participants. PARTICIPANTS: Thirteen thousand four participants aged 65 and older. MEASUREMENTS: Baseline use of possible or definite anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years. RESULTS: At baseline, 47% of the population used a medication with possible anticholinergic properties, and 4% used a drug with definite anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonanticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI)=0.03–0.64, P=.03) than not taking anticholinergics, whereas the use of possible anticholinergics at baseline was not associated with further decline (0.02, 95% CI=-0.14–0.11, P=.79). Two-year mortality was greater for those taking definite (OR=1.68; 95% CI=1.30–2.16; P<.001) and possible (OR=1.56; 95% CI=1.36–1.79; P<.001) anticholinergics. CONCLUSION: The use of medications with anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.

A moral economy of whiteness:behaviours, belonging and Britishness

This article outlines the complex stories through which national belonging is made, and some ways in which class mediates the racialisation process. It is based on fieldwork on the ways in which white UK people in provincial cities construct identities based on positioning vis-a`-vis other groups, communities and the nation. I argue that this relational identity work revolves around fixing a moral-ethical location against which the behaviour and culture of Others is measured, and that this has a temporal and spatial specificity. First, attitudinal trends by social class emerge in our work as being to do with emphasis and life experience rather than constituting absolute distinctions in attitudes. Second, in an era supposedly marked by the hegemony of ‘new’ or ‘cultural’ racism, bloodlines and phenotypes are still frequently utilised in race-making discursive work. Third, in provincial urban England, there is a marked ambivalence towards Britishness (as compromised by Others) and an openness to Englishness as a more authentic source of identification.

Language and identity in englishes

Key features include: • Discussion of language in relation to various aspects of identity, such as those connected with nation and region, as well as in relation to social aspects such as social class and race. • A chapter on undertaking research that will equip students with appropriate research methods for their own projects. • An analysis of language and identity within the context of written as well as spoken texts. Language and Identity in Englishes examines the core issues and debates surrounding the relationship between English, language and identity. Drawing on a range of international examples from the UK, US, China and India, Clark uses both cutting-edge fieldwork and her own original research to give a comprehensive account of the study of language and identity. With its accessible structure, international scope and the inclusion of leading research in the area, this book is ideal for any student taking modules in language and identity or sociolinguistics.

The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK

This paper examines UK and US primary care doctors' decision-making about older (aged 75 years) and midlife (aged 55 years) patients presenting with coronary heart disease (CHD). Using an analytic approach based on conceptualising clinical decision-making as a classification process, it explores the ways in which doctors' cognitive processes contribute to ageism in health-care at three key decision points during consultations. In each country, 56 randomly selected doctors were shown videotaped vignettes of actors portraying patients with CHD. The patients' ages (55 or 75 years), gender, ethnicity and social class were varied systematically. During the interviews, doctors gave free-recall accounts of their decision-making. The results do not establish that there was substantial ageism in the doctors' decisions, but rather suggest that diagnostic processes pay insufficient attention to the significance of older patients' age and its association with the likelihood of co-morbidity and atypical disease presentations. The doctors also demonstrated more limited use of 'knowledge structures' when diagnosing older than midlife patients. With respect to interventions, differences in the national health-care systems rather than patients' age accounted for the differences in doctors' decisions. US doctors were significantly more concerned about the potential for adverse outcomes if important diagnoses were untreated, while UK general practitioners cited greater difficulty in accessing diagnostic tests.

A copa do mundo FIFA na África do Sul/2010:como foi a experiência e o que podemos aprender com ela?

Neste ensaio pretendemos problematizar algumas lógicas sociais não explícitas que se articulam ao domínio de realização da Copa do Mundo FIFA. Para tanto, privilegiamos como recorte analítico a edição de 2010 deste evento, de modo a desvelarmos algumas das retóricas e ações estratégicas que permearam o contexto de sua realização na África do Sul. Com base em dados obtidos na literatura acadêmica e mídia, buscamos apresentar que as motivações para o evento se baseavam em discursos desenvolvimentistas por parte tanto da FIFA quanto das elites locais sul-africanas visando o convencimento e apoio por parte de diferentes grupos sociais. Entretanto, as consequências não foram necessariamente aquelas prometidas, sendo essas instituições as reais beneficiadas em seus interesses econômicos e políticos. Nesse ponto, argumentamos que a sociedade brasileira pode e deve aprender com essa experiência para avaliar de forma crítica os motivos menos aparentes de sediar eventos desse porte. In this essay, we intend to discuss some social logics not explicit that articulate the domain of the FIFA World Cup. Therefore, the 2010 edition of this event is used as analytical approach to reveal some of the rhetoric and strategic actions that permeated the context of its realization. Based on data obtained in the academic literature and media, we present that the motivations for the event were based on developmental discourses by both FIFA as well as local elites South African aiming to convince different social groups and conquer their support. However, the consequences are not necessarily those promised, and these institutions were the real beneficiaries in their economic and political mutual interests. At this point, we argue that Brazilian society can and should learn from the experience of South Africa to assess critically the motives less apparent to host such events.

Institutions matter: essays on the determinants and consequences of socio-political institutions

ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY WITH PRIOR ARRANGEMENT This thesis seeks to contribute to the socio-political literature. It comprises of three individual chapters examining the determinants and consequences of different social-political institutional factors. Specifically, the first study combines game theoretical and empirical techniques to examine how bureaucrats favour other agents within their social group and the effects this will have on the level of corruption in the economy. To this end, I develop a simple model of allocation of time between economic activities and leisure (time spent building social network ties), to illustrate the underlying causal mechanism between social network and corruption. It shows that large social networks and low levels of economic activities provides the condition for high levels of corruption. However, the ability of the government to punish corruption through well-established laws and property rights enforcement acts as a deterrent to corruption. he second work also combines game theoretical and empirical techniques. It aims to clarify the relationship between the degree of competition and political influence of firms, paying particular attention to the level of government regulations that exist in the countries in which the firms operates. The interplay between economic and political institutions is vital to any analysis on understanding the workings of political influence. The third study is purely empirical. It examines the role of two types of business network, namely, political connections and business group affiliations on a firm’s performance. Evidence was provided on Chinese firms’ performance during the 2008 financial crisis.

More Than Words, Brand Destruction in the Online Sphere

The focus of this paper is brand destruction, however in a slightly different sense than the traditional marketing literature depicts it. The concept of brand destruction basically tends to be discussed either (1) as an accidental, counter-productive event in a campaign which leads to the ruining of the brand, or (2) an intentional act by competitors in the market, which results the same breakdown mentioned above. As this paper shows, there are other ways to consider as well, when speaking about brand destruction. An often overlooked type of brand destruction is a rather new phenomenon: destroying the brand by customers or business partners. The adequate scene for this case is the internet itself, especially different social media platforms, e. g. Facebook, Twitter, Tumblr, Instagram, etc. Also popular weblogs can play an important role in brand destruction made by customers or business partners (general cases related to social media are depicted in Lipsman – Mud – Rich – Bruich, 2012). This paper presents a couple of cases in the online field and focuses basically on online communicative activities, in which a brand’s negative properties come to discussion. Both Hungarian and foreign examples are easy to find and they all demonstrate the growing power of consumers. This observation led marketing experts to start talking about the ‘smooth seizure of power by consumers’. Whilst the critic of this concept is considered to be relevant, this paper describes the elements and methods of the ‘seizure’ – from an online social point of view. The key of handling brand destruction cases efficiently lies in the role of social media users. They are not only consumers, but the opportunity for producing online contents is in their hands as well – this fact results in the idea of ‘prosumers’. Thus customers on social media platforms must be handled as a ‘critical mass’: as civic warriors with strong weapons in their armoury. No companies are allowed to feel safe, as the slightest error may well be punished by the crowd.

A méltányosság – egy kísérlet a fogalom tisztázására (The fairness: an attempt to clarify the term)

A méltányosság egyaránt szerepet játszik a társadalmi, szervezeti és szervezetközi kapcsolatokban. A szakirodalom szerint a mindkét fél által méltányosnak tekintett kapcsolatok növelik a részt vevő szervezetek aggregált eredményességét, hosszú távon a kölcsönös és közös versenyelőny kialakítását szolgálják. De mit jelent a méltányosság? A szerző ismerteti a méltányosság és a hozzá szorosan kötődő fogalmak általános meghatározását, majd megvizsgálja Arisztotelész nézeteit az igazságosságról és a méltányosságról. Érint néhány filozófiai koncepciót, melyek a társadalmi igazságosságot egymástól eltérő módon interpretálják, majd részletezi a közgazdaságtan, a kísérleti közgazdaságtan, valamint a szervezeti pszichológia legjelentősebb igazságossági és méltányossági koncepcióit. A tanulmány átfogó képet nyújt a méltányosság definícióiról az áttekintett szakirodalom és a további vállalatközi méltányosságkutatáshoz kötődő relevancia alapján. _______ Fairness plays a role in social,organizational and interorganizational relations. Relationships which are considered to be fair by both parties increase the aggregate effectiveness of the participating organizations and develop mutual and reciprocal competitive advantage in the long-run. But what does fairness mean? The author describes the general definition of fairness and its closely related notions, which is followed by a review of Aristotle’s understanding of justice and equity. Some of the philosophical concepts with different social justice interpretation are examined. The author details the most important concepts of justice, equity and fairness of economics, experimental economics, and organizational psychology. The study provides a comprehensive picture of fairness and equity definitions based on the literature overview and the relevance of further research related to inter-company fairness.

El discurso costumbrista colombiano del siglo XIX: Instrumento ideológico idealizado

Based on critical ideas from Michel Foucault, Benedict Anderson and Doris Sommer, this study analyzes the nation building function of the article of custom and manners and its literary mode "costumbrismo" in the Colombian literature of the 19th and beginning of the 20 th centuries. The discursive techniques and devices used in " costumbrismo" were put into effect by the Colombian intelligentsia to create a sense of national identity. Authors like, Ricardo Silva, José Caicedo Rojas, José David Guarín, Ignacio Gutiérrez Vergara, Eugenio Díaz, Juan de Dios Restrepo, José María Vergara y Vergara, Jorge Isaacs, José Eustaquio Palacios, José Manuel Marroquín, Tomás Carrasquilla, and José Eustasio Rivera became detailed observers that sometimes criticized and at other times just described customs and manners of different social classes and institutions. Through journalistic and literary discourse depicting regional customs and manners, these regionalist writers pretended to provide an objective and actual image of Colombian society, articulating, instead, a subjective message which expressed and reinforced their particular sense of nation based on a liberal or conservative political agenda. This discourse was used to shape the ideology of the republic thorough the idealization of a particular view of the nation.

Essays in economic growth, political economy and institutions

This dissertation analyzes the effects of political and economic institutions on economic development and growth.^ The first essay develops an overlapping-generations political economy model to analyze the incentives of various social groups to finance human capital accumulation through public education expenditures. The contribution of this study to the literature is that it helps explain the observed differences in the economic growth performance of natural resource-abundant countries. The results suggest that the preferred tax rates of the manufacturers on one hand and the political coalition of manufacturers and landowners, on the other hand, are equal to the socially optimal tax rate. However, we show that owners of natural resources prefer an excessively high tax rate, which suppresses aggregate output to a suboptimal level.^ The second essay examines the relationship between the political influence of different social classes and public education spending in panel data estimation. The novel contribution of this paper to the literature is that I proxy the political power and influence of the natural resource owners, manufacturers, and landowners with macroeconomic indicators. The motivation behind this modeling choice is to substantiate the definition of the political power of social classes with economic fundamentals. I use different governance indicators in the estimations to find out how different institutions mediate the overall impact of the political influence of various social classes on public education spending. The results suggest that political stability and absence of violence and rule of law are the important governance indicators.^ The third essay develops a counter argument to Acemoglu et al. (2010) where the thesis is that French institutions and economic reforms fostered economic progress in those German regions invaded by the Napoleonic armies. By providing historical data on urbanization rates used as proxies for economic growth, I demonstrate that similar different rates of economic growth were observed in the regions of France in the post-Napoleonic period as well. The existence of different economic growth rates makes it hard to argue that the differences in economic performance in the German regions that were invaded by the French and those that were spared a similar fate follow from regional differences in economic institutions.^

Age differences and conformity in juror decision -making

The purpose of this experiment was to investigate whether older adults conform more than young and middle-aged adults on a juror decision making task. Degree of group pressure, personality characteristics, gender, and social influence processes were also examined.^ Registered voters (208 participants) completed a personality questionnaire. Several weeks later, groups of six participants listened to a robbery case that portrayed the defendant as guilty. Afterwards, participants completed the first of two ballots. On the first, participants rated the defendant's degree of guilt and scored their degree of certainty in this verdict rating. They also indicated in writing which piece of information (a statement of evidence) from the robbery case supported their verdict ratings. Next, participants reviewed photocopies of five contrived first ballots. Then participants completed second ballots, in which they again rated the defendant's degree of guilt and scored their degree of certainty in this verdict rating. Finally, participants rated the importance of the five contrived first ballot verdict ratings (normative social influence) and statements of evidence (informational social influence) in reaching their second ballot verdict ratings.^ The results demonstrated that not only did older adults conform as expected, but all age groups conformed; that is, all age groups changed their verdict ratings. After reviewing the other jurors' contrived first ballots (group pressure), participants rated the defendant as less guilty on their second ballot than on their first. However, only older adults significantly changed their level of certainty in their verdict ratings from first to second ballot compared to young and middle-aged adults. With regard to personality characteristics, only rigidity predicted conformity in young and middle-aged adults but not in older adults. It was also found that females conformed more than males. Finally, all three age groups reported that different social influence processes (normative vs. informational) were important in reaching their second ballot verdict ratings. The results of this research indicate that various factors can influence young, middle-aged, and older adults as they reach verdicts. Knowledge of these factors may help alter stereotypes of older adults in terms of conformity, rigidity, and desirability as jurors. ^

[Poster] Friends of the Island

This poster presentation will exhibit the ongoing design work within two small islands adjacent to Diner Key Marina gifted by the City of Miami to the non-profit organization, Shake-A-Leg. This organization works to blur the lines between access, recreation, and skill, redefining what is possible. Abled and disabled children, adolescents, and young adults go to Shake-A-Leg to participate in a myriad of activities such as sailing, kayaking, swimming, painting, and socializing in these islands regardless of their inadequate walkways and installations. The users are people from different social statuses, physical and mental abilities. This poster will exhibit the design proposal to enhance the islands’ infrastructure to provide seamless access to all its visitors through the lush habitat in these islands. The proposed program challenges the disabilities of the person and helps them to mediate and transform them into new possibilities and abilities. The program proposes ten components which include a nature trail, restrooms, dinning center, art studio, and observation deck. The design of each space draws from the sailing boat to create solutions were the user will explore, participate and enjoy. The location encourages a feeling of challenge but at the same time it is a place for relief and freedom, allowing them to discover the diversity through experimentation and interaction with the environment. This poster presents design principles that value equal access and experience, celebrating the differences among users and the environment, blurring the lines between nature and access.

(A)cerca do espaço: a nacionalização da questão agrária pelo MST (1984-2002)

This work has as objective to analyze the social movement called Movimento dos Trabalhadores Rurais Sem Terra and their relation to land reform from the idea of nation. In the decade of its emergence, 1980, Brazilian nationalism was deeply tied to aspirations for democracy and this consisted of a kind of political language of the period that included not only the MST, but also conservative sectors of Brazilian politics. The MST then develop a way to realize their different social function of the movements that preceded it as the Ligas Camponesas, incorporating the element of the nation as political capital to strengthen their practice. This relationship will be studied from a debate on contemporary Marxism and its key concepts.

Validação do instrumento dos indicadores observáveis da qualidade do cuidado em instituições de longa permanência para idosos

The Nursing Homes are an important alternative care in the world, but Brazil still has no valid instrument to monitor the quality these institutions. In the United States, the Observable Indicators of Nursing Home Care Quality Instrument (OIQ) is used to assess the quality of Nursing Home care using 30 indicators of structure (2 dimensions) and process (5 dimensions) related to quality person-centered care. The present study aimed at cross-culturally adapting the OIQ in order to evaluate the quality of Nursing Home care in Brazil. Conceptual and item equivalence were determined to assess the relevance and viability of OIQ in the Brazilian context, using the Content Validity Index (CVI) and a group of specialists composed of 10 participants directly involved in the object of study. Next, operational, idiomatic and semantic equivalence were carried out concurrently. This consisted of 5 phases: (1) two translations and (2) their respective back translations; (3) formal appraisal of referential and general meaning; (4) review by a second group of specialists; (5) application of the pretest at three Nursing Homes by different social entities: health professionals, sanitary surveillance regulators and potential consumers. Measurement equivalence was evaluated by the Cronbach’s alpha test to verify the internal consistency of the instrument. To measure inter-evaluator agreement, the General Agreement Index (ICG) and Kappa coefficient were used. Timely compliance and 95% Confidence Interval of indicators, dimensions and total construct were estimated. The CVI obtained high results for both relevance (95.3%) and viability (94.3%) in the Brazilian context. With respect to referential meaning, similarity was observed, ranging between 90-100% for the first back translation and 70-100% for the second. In relation to general meaning, version 1 was better, classified as “unchanged” in 80% of the items, whereas in version 2 it was only 47%. In the pretest, the OIQ was easy to understand and apply. The following outcomes were obtained: a high Cronbach’s alpha (0.93), satisfactory ICG (75%) and substantial agreement between the pairs of evaluators (health professionals, regulators from the Superintendency of Sanitary Surveillance –SUVISA-, and potential consumers), according to the Kappa coefficient (0.65). It´s possible take the operational equivalence held since it preserved the original layout in the Brazilian version from the maintenance in application mode, response options, number of items, statements and scores. The performance of nursing homes obtained approximate average scores of 87, a variation 55-111 considering a range from 30 to 150 points. The worst outcomes were related to process indicators with a mean of 2.8 per item, while structure was 3.75 on a scale of 1 to 5. The lowest score was obtained for the care dimension (mean 2). The OIQ version was deemed to be a valid and reliable instrument in the Brazilian context. It is recommended that health professionals, regulators and potential consumers adopt it to access and monitor the quality of Nursing Home care and demonstrating opportunities for improvement.

O olhar das instituições de previdência sobre a casa e a cidade: promoção, financiamento e avaliação de imóveis

The investments of Caixas and Institutos de Aposentadoria e Pensões (CAP and IAP) in homes of Natal, between the decades of 1930-60, helped to boost up the local real estate market in consolidation at the time. Inserted in the first national policy on social housing in the country, these operations have demanded the creation of a wide qualified organizational structure, which would be from the "Central Offices" of Rio de Janeiro to the decentralized units of the federal states. The professionals linked to the Local Agencies have developed, on this matter, from activities related to the design and construction of residential complexes, to the daily study of financing proposals in isolated units. As from these studies, the evaluation of shelters was essential to the effectiveness of the policy, resulting in the production of data on the market value of the properties by observing and issuing judgments upon the living quarters of different social groups. Given these considerations, the aim here is to contribute to the understanding on how to operate these real estate actions in the legitimization of boundaries about the urban space and dwellings available to workers in Natal. Therefore, the views of the city and constructions expressed by the evaluating engineers in their technical reports have been taken as the focus. Being the main primary sources of work, these reports are part of the edifices process of CAP/IAP regarding Natal, whose content is systematized in the database "Enterprises", the HCUrb Research Group. In addition, there were used local newspapers at the time and interviews with professionals as complementary sources. It was found that, in general, the evaluations have configured – in a more everyday dimension of bureaucratic routines - a vehicle, among others, circulating ideas about "home" within the social security institutions, being imbued with assumptions historically constructed about the "modern habitat". Filled in loco, the reports expose the clash between modernizing ideals in vogue and clear limitations in the city scenario at the time. Fragmented images of the town are given to read through the labels assigned to the evaluated sites – these being coated of certain "scientific" character - which both legitimated and contributed to the dynamics of appreciation/depreciation of the soil and to the socio-spatial differentiation. Contradictions were evident in the endorsement given by the technicians when financing of admittedly precarious homes for insured disadvantaged categories at the local level - such as industrial workers - while strict regulations were imposed to new construction, designed, above all, to better paid categories. By identifying raters engineers as urban agents, members of a technical-focused operating system for safety and efficiency in the real estate investments of those authorities corporatist, it is desired the usefulness of further studies on these characters, their training, professional activity and participation in the construction of discourses and practices of intervention about the city and its buildings, discussing individual and grouped interests that were left behind.