Economic aspects of pharmacotherapy for chronic constipation

Constipation is one of the most common digestive complaints. It is a symptom, not a disease. The subjectivity that this involves means that assessments of clinical epidemiology, socioeconomic costs and pharmacotherapy are difficult, since there is no definition of 'normal' bowel habit. Although constipation can affect all ages, the problem increases with age, and is of particular concern for those who are frail and in long term care. Cultural influences may affect the prevalence in older people. Drug therapy of constipation cannot be considered in isolation, since there are issues in the prevention of constipation and the principles of good management that also apply. Furthermore, some consideration of the pathophysiology and diagnosis is important. This is because a number of remediable causes can be identified, and the diagnostic process involves patient education, which in turn may be effective in reducing costs. It is the complaint of constipation which leads either to self-medication or to consultation with the medical profession. Both of these courses of action have a significant influence on utilisation of laxatives (cathartics), obtained both over-the-counter and by prescription. Although there are a large number of laxative preparations available, therapy has changed little in half a century. Costs may vary considerably, and with such a significant problem there is a need for comparative studies. However, study methodologies are difficult, and a significant placebo response may be found. Education and preventive measures have been shown to reduce laxative use and costs in institutions. Unfortunately, there are few comparative studies of individual laxatives and even fewer cost-effectiveness studies. Those that there are have been based in institutions, and so extrapolation to other situations may be difficult. In general, little attention is given to constipation. It is, however, an area with significant resource implications in which education and preventive measures have been shown to be beneficial. Even so, there is still a need for good comparative studies, particularly where cost effectiveness is concerned.

‘Towards a Green New Deal on the Island of Ireland: from economic crisis to a new political economy of sustainability’

This article begins from the assumption (which may seem controversial to many) that anyone who thinks that our current economic crisis is a temporary blip until ‘normal service’ (i.e. a return to ‘business as usual’) is resumed, profoundly misunderstands the severity and significance of what’s happening to the global economy and its impacts on the future prosperity of the island of Ireland. The economic recession represents nothing short of a re-structuring of the global economy and the creation of a new dispensation between governments, markets and citizens. The full implications of the re-regulation of the market, with the state bailing out and part nationalising the financial sector in both jurisdictions on the island (as in other parts of the world) have yet to be seen, but what we are witnessing is the emergence of a new economic model. Those who think we can, or even ought to, return to the pre-2008 economic model, are gravely mistaken. The current economic downturn marks the end of the ‘neo-liberal’ model and the beginnings of the transition (an inevitable transition, this article will argue) towards a new low carbon, renewable, green and sustainable economy and society.

Managing Island Life:Social, Economic and Political Dimensions of Formality and Informality in Island Life

"Managing Island Life: Social, Economic and Political Dimensions of Formality and Informality in Island Life" is a significant and timely contribution to the study of islands and island life. Wide-ranging in terms of both geographical and theoretical sweep, contributions consider the conceptualisation of the island as well as social, economic and political dimensions of island life and living. Showcasing the current state of island research, contributors cover diverse areas of island life such as: informal economies in the West Indies; the effects of natural convservation policies in the Highlands and Islands of Scotland; the role of internet sites in British Isles heritage tourism, and the impact of multicultural policies in the Indian Ocean. This volume will appeal to undergraduate social scientists as well as professional anthropologists, sociologists and geographers, policy makers and islands and regional specialists.

British Constructions with Constitutions:The Formal and Informal Nature of 'Island' Relations on Montserrat and Gibraltar

This article explores social, economic and political relations on two British Dependent Territories (BDTs) -- Montserrat and Gibraltar. This article notes that though BDTs are British colonial constructions, created, sustained and modelled upon and by Britain, they differ from Britain in that they have political constitutions. They also exhibit an ambiguous dependence and independence upon and with Britain. This article goes on to look at social and economic relations on Montserrat and Gibraltar before comparing and contrasting the political climates on each BDT. Throughout this article, it is suggested that there is a dynamic tension between formal and informal aspects to managing life. Finally, this article concludes with a discussion about the suitability of the split between Executive and Legislative Councils in these two BDTs.

Trends in Economic Stress and the Great Recession in Ireland: An Analysis of the CSO Survey in Income and Living Conditions (SILC)

Since 2008, Ireland has experienced the most severe economic and labour market crisis since the foundation of the State. These economic and labour market changes have had a stark impact on the standard of living across the Irish population. The rapid deterioration in the labour market, the rising level of household indebtedness and stringent austerity measures to plug the public finance deficit have had a widespread impact yet there is debate about where the heaviest burden has fallen and where the economic stress has been felt most. The paper analyses data from the Survey of Income and Living Conditions for the period 2004 to 2011. The aim of the paper is to develop and test a measure of economic stress, which will capture some of the aspects of the rapid change in economic fortunes on Irish households that are not picked up by income alone. This includes tapping into features of the recession such as debt problems, unsustainable housing costs, and other difficulties associated with managing on reduced household income in a period of uncertainty. In testing such a measure we examine trends over time from boom to bust in the Irish economy and consider how economic stress is distributed across different socio-economic groups. The paper explores the distribution and level of economic stress across income class groups, social classes and the life-course and tests the thesis of ‘middle class squeeze’.

The SPHERE Study: Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses. [ISRCTN24081411]

Background: The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease (CHD) in general practice across two different health systems on the island of Ireland.CHD is a common cause of death and a significant cause of morbidity in Ireland. Secondary prevention has been recommended as a key strategy for reducing levels of CHD mortality and general practice has been highlighted as an ideal setting for secondary prevention initiatives. Current indications suggest that there is considerable room for improvement in the provision of secondary prevention for patients with established heart disease on the island of Ireland. The review literature recommends structured programmes with continued support and follow-up of patients; the provision of training, tailored to practice needs of access to evidence of effectiveness of secondary prevention; structured recall programmes that also take account of individual practice needs; and patient-centred consultations accompanied by attention to disease management guidelines.

Methods: SPHERE is a cluster randomised controlled trial, with practice-level randomisation to intervention and control groups, recruiting 960 patients from 48 practices in three study centres (Belfast, Dublin and Galway). Primary outcomes are blood pressure, total cholesterol, physical and mental health status (SF-12) and hospital re-admissions. The intervention takes place over two years and data is collected at baseline, one-year and two-year follow-up. Data is obtained from medical charts, consultations with practitioners, and patient postal questionnaires. The SPHERE intervention involves the implementation of a structured systematic programme of care for patients with CHD attending general practice. It is a multi-faceted intervention that has been developed to respond to barriers and solutions to optimal secondary prevention identified in preliminary qualitative research with practitioners and patients. General practitioners and practice nurses attend training sessions in facilitating behaviour change and medication prescribing guidelines for secondary prevention of CHD. Patients are invited to attend regular four-monthly consultations over two years, during which targets and goals for secondary prevention are set and reviewed. The analysis will be strengthened by economic, policy and qualitative components.

Applied aspects of Rhodococcus genetics

Eubacteria of the genus Rhodococcus are a diverse group of microorganisms commonly found in many environmental niches from soils to seawaters and as plant and animal pathogens. They exhibit a remarkable ability to degrade many organic compounds and their economic importance is becoming increasingly apparent. Although their genetic organisation is still far from understood, there have been many advances in recent years. Reviewed here is the current knowledge of rhodococci relating to gene transfer, recombination, plasmid replication and functions, cloning vectors and reporter genes, gene expression and its control, bacteriophages, insertion sequences and genomic rearrangements. Further fundamental studies of Rhodococcus genetics and the application of genetic techniques to the these bacteria will be needed for their continued biotechnological exploitation.

A new landscape of arts-based buildings and comparative cultural policies on the island of Ireland: the curse of Jocasta's necklace

Much current cultural policy research focuses on activity traditionally viewed as arts practice: visual arts, music, literature and dance. Architecture’s role in the discussion of cultural policy is, however, less certain and thus less frequently interrogated. The study presented here both addresses this dearth of in-depth research while also contributing to the interdisciplinary discussion of cultural policy in wider terms. In seeking to better understand how architectural culture is regulated and administered in a specific case study, it unpacks how the complicated relationships of nominal and explicit policies on both sides of the Irish/Northern Irish border contributed to the significant expansion of arts-based buildings 1995-2008. It contrasts political and cultural motivations behind these projects during a period of significant economic growth, investment and inward immigration. Data has been gathered from both official published policies as well as interviews with elite actors in the decision-making field and architects who produced the buildings of interest in both countries. With the sizeable number of arts-based buildings now completed in both Republic of Ireland and Northern Ireland, one must wonder if this necklace of buildings is, like Jocasta’s, a thing of both beauty and redolent with a potential future curse. It is the goal of this project to contribute to the larger applied and critical discussion of these issues and to engage with future policy design, administration and, certainly, evaluation.