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.

Inequality, state ownership and the European Union: How economic context and economic ideology shape support for the European Union

This article investigates the extent to which economic ideology affects people's support for European Union integration and how this is conditioned by economic context. We argue that people on the economic left who live in a country with conditions of high income inequality and little state ownership will support European integration, because more integration would move public policy in a left-wing direction. By contrast, people on the left who live in a country with conditions of low income inequality and widespread public ownership are likely to be eurosceptic, as further integration would result in a more right-wing public policy. We empirically confirm our hypotheses and discuss the implications for European Union democracy.

Economic Ideas and the Political Construction of the Financial Crash of 2008

This article is a short introduction to a special section on economic ideas and the political construction of the financial crash. It begins by explaining why economic ideas and the politics of appeals to certain ideas are so integral to the historical significance of the crash of 2008 and the question of whether it can be considered a crash at all. The first section covers the literature on ideas and economic crisis. The second section highlights that the contribution of the special section is to engage in a stock taking exercise of the empirical and conceptual patterns concerning the politics of ideational change underway in the areas of: comparative fiscal policy; monetary policy and Euro zone debt management; capital controls; and financial and securities market regulation and standard setting. The final section outlines the structure of this special section and content of the individual articles.

The African National Congress and its Critics: 'Predatory Liberalism', Black Empowerment and Intra-Alliance Tensions in Post-Apartheid South Africa

Post-apartheid South Africa is characterized by centralized, neo-liberal policymaking that perpetuates, and in some cases exaggerates, socio-economic inequalities inherited from the apartheid era. The African National Congress (ANC) leadership’s alignment with powerful international and domestic market actors produces tensions within the Tripartite Alliance and between government and civil society. Consequently, several characteristics of ‘predatory liberalism’ are evident in contemporary South Africa: neo-liberal restructuring of the economy is combined with an increasing willingness by government to assert its authority, to marginalize and delegitimize those critical of its abandonment of inclusive governance. A new form of oligarch power, combining entrenched economic interests with those of a new ‘black bourgeoisie’ promoted by narrowly implemented Black Economic Empowerment policies, diminishes prospects for broad-based socio-economic transformation. Because the new policy environment is failing to resolve tensions between global market demands for increasing market liberalization and domestic popular demands for poverty-alleviation and socio-economic transformation, the ANC leadership is forced increasingly to confront ‘ultra-leftists’ who are challenging its credentials as defender of the National Democratic Revolution which was the cornerstone in the anti-apartheid struggle.

North/South Infrastructure Development via Cross-border PPP Mechanism

Both Northern Ireland and Republic of Ireland governments recognise the current infrastructural deficits in their respective jurisdictions which, if not addressed, will undermine the future economic prosperity of both regions. This paper considers the adoption of a collaborative approach on the island to addressing the deficit, using public private partnerships (PPP) as the delivery vehicle. It presents a critical perspective of the challenges and opportunities posed by adopting such a cross-border approach. Whilst PPPs have the potential to bring about North-South co-operation, bridge gaps in infrastructure capacity and facilitate the advancement of sectoral knowledge, their adoption on a cross border basis will require significant reorganisation and change at administrative and sectoral levels. This review concludes that governments and construction sector representatives in Northern Ireland and the Republic of Ireland have still some work to do in order to enhance the capability and readiness of public and private partners to evolve an all-island PPP infrastructure development approach.

The Macroeconomic Factors Conditioning the Impact of Identity on Attitudes towards the EU

Factors relating to identity and to economics have been shown to be important predictors of attitudes towards the European Union (EU). In this article, we show that the impact of identity is conditional on economic context. First, living in a member state that receives relatively high levels of EU funding acts as a 'buffer', diluting the impact of an exclusive national identity on Euroscepticism. Second, living in a relatively wealthy member state, with its associated attractiveness for economic migrants, increases the salience of economic xenophobia as a driver of sceptical attitudes. These results highlight the importance of seeing theories of attitude formation (such as economic and identity theories) not as competitors but rather as complementary, with the predictive strength of one theoretical approach (identity) being a function of system-level variation in factors relating to the other theoretical approach (macro-level economic conditions).

Recognition and Redistribution in Theories of Justice Beyond the State

We consider here how cultural and socioeconomic dimensions of justice beyond the state are related. First we examine cosmopolitan theories that have drawn on John Rawls's egalitarian liberal framework to argue that a just global order requires substantive, transnational redistribution of material resources. We then assess the view, ironically put forward by Rawls himself, that this perspective is ethnocentric and insufficiently tolerant of non-liberal cultures. We argue that Rawls is right to be concerned about the danger of ethnocentrism, but wrong to assume that this requires us to reject the case for substantive redistribution across state boundaries. A more compelling account of justice beyond the state will integrate effectively socioeconomic and cultural aspects of justice. We suggest that this approach is best grounded in a critical theory of recognition that responds to the damage caused to human relations by legacies of historical injustice.

Global Governance and International Migration: A Case Study of Trafficking of Human Beings

The purpose of this article is to explore the concept of “global governance” and the way it applies to the management of international migration by using trafficking of human beings as a case study. Globalization has altered the scene of world politics. A traditional State-centric view of the world order has been overshadowed by the increasing importance of other actors, including the United Nations, multi-national corporations and non-governmental organizations. Globalization has also altered the dynamics of rule making and their enforcement within the international system, in that not only States but also these non-State actors exercise enormous influence. The concept of global governance acknowledges this as it aims to include all the pertinent actors involved. To illustrate this further, the author will use trafficking of human beings as a case study. Two key principles of global governance are participation and accountability. This article will analyse how these principles are reflected and implemented in the regime dealing with the prevention and suppression of trafficking of human beings.