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.

Climate Change, national politics and grassroots action: an introduction

Climate change continues to dominate academic work within green/environmental politics. Indeed, there appears to be almost an inverse relationship between the lack of political leadership on tackling climate change and the growth in ever more sophisticated academic analyses of this complex and multifaceted problem. There is an increasing disjunction between the growth in our knowledge and understanding of the ethical, political, economic, sociological, cultural, and psychological aspects of climate change and the lack of political achievement in putting in place clear and binding targets, an agreed decarbonisation roadmap, and associated regulatory and policy instruments with enforcement. This gap might be taken as evidence that we do not need more reports on climate change. To quote that most unlikely of green politicians, Arnold Schwarzenegger, former Governor of California: ‘The debate is over. We know the science. We see the threat. And we know that the time for action is now’ (California Energy Commission 2007, p. 1). This special issue focuses on a variety of ways in which climate change is conceptualised in normative political and ethical theory, and addressed in policy and regulations.

Economic and social integration the challenge for EU constitutional law

'At a time of crisis and therefore a crucial juncture in European politics, Dagmar Schiek offers us an inspiring vision of the potential of the European Union. In her brilliant study, she exposes the obstacles that economic integration has posed for achievement of social justice, and provides a bold solution. Rejecting more limited models of constitutionalism, she presents a convincing alternative which is socially embedded, allowing space for action by manifold actors at multiple levels of governance.' - Tonia Novitz, University of Bristol, UK. © Dagmar Schiek 2012. All rights reserved.

Mobilizing against neoliberalism? Global affirmative action in context

This article uses the example of Northern Ireland to illustrate how political mobilization may
be deployed to challenge structural forms of inequality. The experience suggests that regulatory
models can be designed for particular contexts to shape approaches that present challenges to
dominant economic and political orthodoxies. The intention is not to overstate the significance
of this specific transitional context but simply to highlight elements that might feature in any
attempt to mobilize successfully around human rights and equality, and against aspects of neoliberal
thinking.