This title provides a more comprehensive account of internment and assesses previously unexplored aspects of its use. Drawing on archival sources the high politics and intelligence surrounding the ...introduction of internment are considered and in doing so accepted narratives regarding the measure are challenged.
This article addresses the scholarly debate over sectarianism and the Provisional Irish Republican Army's (PIRA) campaign during the Northern Ireland Troubles. It argues that although there is much ...merit in the contributions made in this discourse, unfortunately, for, the most part, there is a lack of engagement with the deeper meaning of sectarianism. Consequently, it seeks to enhance the understanding of sectarianism within this arena before considering the nature of the PIRA campaign. By conducting a thorough analysis of the killings conducted by this organisation in the early years of the conflict it is ultimately concluded that, at the very least, PIRA tolerated, and likely sanctioned, sectarian violence from within its ranks.
On 9 August 1971 the Stormont administration in Northern Ireland introduced internment without trial. This article challenges accepted narratives of Operation Demetrius and provides a more nuanced ...interpretation of the nature of the operation. It argues that intelligence on loyalist paramilitaries and their activities was ignored by the authorities because of the fear of a Protestant backlash. It establishes that there was ample intelligence on known IRA activists for a more targeted arrest operation to be carried out but that the arrest lists were augmented, most probably in an effort to provide intelligence and reduce support for the IRA. In addition, it argues that Operation Demetrius was not an indiscriminate attack on the nationalist community. The article maintains that the operation was carried out in part to placate demands for tougher security measures from hard-line unionists.
Legacies of internment McCleery, Martin J
Operation Demetrius and Its Aftermath,
07/2015
Book Chapter
There is no doubt that the way in which internment was introduced dramatically increased support for the IRA, especially the PIRA. As the British admitted, as early as November 1971, it had made the ...‘IRA look for the first time like a mass movement instead of a small body using Catholics as cover’.¹ The PIRA declared 1972 would be their year of victory; however, this was to be far from the truth. Nationalist support for the PIRA did continue to increase, and this increase was due, in no small part, to the mistakes made by the authorities. Paradoxically, this period
Following the introduction of internment, in August 1971, a civil-rights campaign was initiated across Northern Ireland when ‘the Northern opposition parties met on 9 August at Dungannon, Co. Tyrone. ...The combined meeting of SDLP, Nationalist and Republican Labour parties expressed great concern at the direction events were taking and called for the withholding of all rents and rates.’² Those assembled agreed on a number of demands. All those in public positions should oppose internment by withdrawing from office; the public should withhold all rent and rates; everyone should support all the organisations who called meetings to oppose internment; the military
Many commentators regard the Falls Road Curfew as a watershed in the relationship between the security forces and the nationalist community.¹ As McLoughlin outlines,
From the burning of Bombay Street ...in August 1969, through to the draconian Falls Road Curfew of July 1970, militant republicans had established a significant foothold within the minority community, a position from which they were able to promote their interpretation of the emerging political conflict, and so attempt to set the agenda for nationalist politics.²
Perhaps unsurprisingly, this analysis is also favoured by many Belfast republicans.³ Admittedly, this version of the curfew has been contested.
In 1963, the South African Minister of Justice, B. J. Vorster, speaking in the South African Parliament, offered to exchange the Bill he was presenting for one clause of the Northern Ireland Special ...Powers Act.¹ One of these clauses authorised the power to introduce internment without trial. The British themselves had used internment in a number of former colonies such as Kenya when during the Mau Mau uprising:
Under the emergency laws, suspects could be detained without trial on the basis of a Delegated Detention Order … These sparse documents set down the detainees name, pass number, and location of
Background
Medications with anticholinergic properties are commonly prescribed to older adults. The cumulative anticholinergic effect of all the medications a person takes is referred to as the ...'anticholinergic burden' because of its potential to cause adverse effects. It is possible that high anticholinergic burden may be a risk factor for development of cognitive decline or dementia. There are various scales available to measure anticholinergic burden but agreement between them is often poor.
Objectives
To assess whether anticholinergic burden, as defined at the level of each individual scale, is a prognostic factor for future cognitive decline or dementia in cognitively unimpaired older adults.
Search methods
We searched the following databases from inception to 24 March 2021: MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCOhost), and ISI Web of Science Core Collection (ISI Web of Science).
Selection criteria
We included prospective and retrospective longitudinal cohort and case‐control observational studies with a minimum of one year' follow‐up that examined the association between an anticholinergic burden measurement scale and future cognitive decline or dementia in cognitively unimpaired older adults.
Data collection and analysis
Two review authors independently assessed studies for inclusion, and undertook data extraction, assessment of risk of bias, and GRADE assessment. We extracted odds ratios (OR) and hazard ratios, with 95% confidence intervals (CI), and linear data on the association between anticholinergic burden and cognitive decline or dementia. We intended to pool each metric separately; however, only OR‐based data were suitable for pooling via a random‐effects meta‐analysis. We initially established adjusted and unadjusted pooled rates for each available anticholinergic scale; then, as an exploratory analysis, established pooled rates on the prespecified association across scales. We examined variability based on severity of anticholinergic burden.
Main results
We identified 25 studies that met our inclusion criteria (968,428 older adults). Twenty studies were conducted in the community care setting, two in primary care clinics, and three in secondary care settings. Eight studies (320,906 participants) provided suitable data for meta‐analysis. The Anticholinergic Cognitive Burden scale (ACB scale) was the only scale with sufficient data for 'scale‐based' meta‐analysis. Unadjusted ORs suggested an increased risk for cognitive decline or dementia in older adults with an anticholinergic burden (OR 1.47, 95% CI 1.09 to 1.96) and adjusted ORs similarly suggested an increased risk for anticholinergic burden, defined according to the ACB scale (OR 2.63, 95% CI 1.09 to 6.29). Exploratory analysis combining adjusted ORs across available scales supported these results (OR 2.16, 95% CI 1.38 to 3.38), and there was evidence of variability in risk based on severity of anticholinergic burden (ACB scale 1: OR 2.18, 95% CI 1.11 to 4.29; ACB scale 2: OR 2.71, 95% CI 2.01 to 3.56; ACB scale 3: OR 3.27, 95% CI 1.41 to 7.61); however, overall GRADE evaluation of certainty of the evidence was low.
Authors' conclusions
There is low‐certainty evidence that older adults without cognitive impairment who take medications with anticholinergic effects may be at increased risk of cognitive decline or dementia.
This is a protocol for a Cochrane Review (Prognosis). The objectives are as follows:
Primary objective:
to assess whether ACB in older adults is a prognostic factor for future cognitive decline or ...dementia.
Secondary objective(s):
to assess whether ACB is a prognostic factor for older adults recruited in primary care, secondary care, or community settings (with setting used as the basis for subgroup analyses); whether ACB is associated with mortality; to compare the prognostic validity of respective ACB scales; and to examine the effect of duration of exposure and duration of follow‐up on the ACB‐dementia risk association.
Background
Anticholinergics are medications that block the action of acetylcholine in the central or peripheral nervous system. Medications with anticholinergic properties are commonly prescribed to ...older adults. The cumulative anticholinergic effect of all the medications a person takes is referred to as the anticholinergic burden. A high anticholinergic burden may cause cognitive impairment in people who are otherwise cognitively healthy, or cause further cognitive decline in people with pre‐existing cognitive problems. Reducing anticholinergic burden through deprescribing interventions may help to prevent onset of cognitive impairment or slow the rate of cognitive decline.
Objectives
Primary objective
• To assess the efficacy and safety of anticholinergic medication reduction interventions for improving cognitive outcomes in cognitively healthy older adults and older adults with pre‐existing cognitive issues.
Secondary Objectives
• To compare the effectiveness of different types of reduction interventions (e.g. pharmacist‐led versus general practitioner‐led, educational versus audit and feedback) for reducing overall anticholinergic burden. • To establish optimal duration of anticholinergic reduction interventions, sustainability, and lessons learnt for upscaling • To compare results according to differing anticholinergic scales used in medication reduction intervention trials • To assess the efficacy of anticholinergic medication reduction interventions for improving other clinical outcomes, including mortality, quality of life, clinical global impression, physical function, institutionalisation, falls, cardiovascular diseases, and neurobehavioral outcomes.
Search methods
We searched CENTRAL on 22 December 2022, and we searched MEDLINE, Embase, and three other databases from inception to 1 November 2022.
Selection criteria
We included randomised controlled trials (RCTs) of interventions that aimed to reduce anticholinergic burden in older people and that investigated cognitive outcomes.
Data collection and analysis
Two review authors independently assessed studies for inclusion, extracted data, and assessed the risk of bias of included studies. The data were not suitable for meta‐analysis, so we summarised them narratively. We used GRADE methods to rate our confidence in the review results.
Main results
We included three trials with a total of 299 participants. All three trials were conducted in a cognitively mixed population (some cognitively healthy participants, some participants with dementia). Outcomes were assessed after one to three months. One trial reported significantly improved performance on the Digit Symbol Substitution Test (DSST) in the intervention group (treatment difference 0.70, 95% confidence interval (CI) 0.11 to 1.30), although there was no difference between the groups in the proportion of participants with reduced anticholinergic burden. Two trials successfully reduced anticholinergic burden in the intervention group. Of these, one reported no significant difference between the intervention versus control in terms of their effect on cognitive performance measured by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) immediate recall (mean between‐group difference 0.54, 95% CI −0.91 to 2.05), CERAD delayed recall (mean between‐group difference −0.23, 95% CI−0.85 to 0.38), CERAD recognition (mean between‐group difference 0.77, 95% CI −0.39 to 1.94), and Mini‐Mental State Examination (mean between‐group difference 0.39, 95% CI −0.96 to 1.75). The other trial reported a significant correlation between anticholinergic burden and a test of working memory after the intervention (which suggested reducing the burden improved performance), but reported no effect on multiple other cognitive measures. In GRADE terms, the results were of very low certainty.
There were no reported between‐group differences for any other clinical outcome we investigated. It was not possible to investigate differences according to type of reduction intervention or type of anticholinergic scale, to measure the sustainability of interventions, or to establish lessons learnt for upscaling. No trials investigated safety outcomes.
Authors' conclusions
There is insufficient evidence to reach any conclusions on the effects of anticholinergic burden reduction interventions on cognitive outcomes in older adults with or without prior cognitive impairment. The evidence from RCTs was of very low certainty so cannot support or refute the hypothesis that actively reducing or stopping prescription of medications with anticholinergic properties can improve cognitive outcomes in older people. There is no evidence from RCTs that anticholinergic burden reduction interventions improve other clinical outcomes such as mortality, quality of life, clinical global impression, physical function, institutionalisation, falls, cardiovascular diseases, or neurobehavioral outcomes. Larger RCTs investigating long‐term outcomes are needed. Future RCTs should also investigate potential benefits of anticholinergic reduction interventions in cognitively healthy populations and cognitively impaired populations separately.
PDF
