Quality of life in restless legs syndrome: A systematic review of clinical trials and a critical review of instruments

Restless legs syndrome (RLS) is a neurological movement disorder characterized by sensory symptoms and motor disturbances. While the underlying cause remains unknown, it is suggested that 20–25% of people with RLS are affected seriously enough to require pharmacological treatment. Dopamine agonists (DAs) are the most common treatment and act by increasing the low levels of dopamine to which RLS is often attributed. A growing literature highlights the debilitating and distressing nature of this condition from the patient's perspective. While sleep problems are most commonly reported, the impact of RLS on quality of life (QOL) is wide ranging, affecting relationships with partners, sex life, family life, social life, leisure activities, friendships, everyday activities, concentration, travel, career/work, sleep, and health.

We conducted a systematic review of clinical trials in which DAs have been evaluated in terms of RLS-specific QOL, i.e. their impact on the QOL of people with RLS, and critically reviewed the development history and measurement properties of RLS-specific QOL instruments.

A systematic search using terms synonymous with RLS, DAs and QOL was conducted using Scopus software, which includes MEDLINE, PsycINFO, EMBASE, and CINAHL. Our search covered publications from 2000 (prior to which RLS-specific QOL measures did not exist) to August 2009. Trials were included in our review if they evaluated DAs for the treatment of adults with RLS and reported evaluation using an RLS-specific QOL measure. We also ran citation searches to identify papers reporting the development history and measurement properties of the identified RLS-specific QOL instruments.

Three measures of RLS-specific QOL have been developed in recent years and are reviewed here: the Restless Legs Syndrome Quality of Life (RLSQOL) questionnaire, the Restless Legs Syndrome Quality of Life Instrument (RLS-QLI), and the Quality of Life Restless Legs Syndrome (QOL-RLS) measure. Critical review indicates that each has limitations (particularly in terms of published developmental history and content validity). Eleven trials of DAs were identified that included assessment of RLS-specific QOL (nine using the RLSQOL and two using the QOL-RLS). In all studies, significant improvements in RLS-specific QOL were observed, although these were mostly short term (12 weeks) and large placebo effects were also noted.

In people with RLS, the use of DAs has been shown to improve RLS-specific QOL. Longer-term, large-scale studies may be needed to confirm these findings and demonstrate statistically significant improvements in RLS-specific QOL at lower doses. Further development of the RLS-specific QOL measures is needed to ensure that the full impact of RLS (and the full benefit of new treatments) on aspects of life identified as important to individuals is captured in future studies.

The effect of the work environment on accounting students' moral reasoning and development

Puxty et al. (1994) claim that professional accountants are induced to act ethically through two aspects of their socialisation, the education process, and the influence of work experience and role models who show what it means to be ethical. The education of accountants is not simply a matter of becoming technically competent, it is also a process of internalising accepted norms of professional conduct. Student accountants learn acceptable behaviour by learning the principles of good conduct in their education, and receiving advice and observing what significant others do in the workplace. The purpose of this paper is to explore the effect of the work environment on accounting students moral reasoning and development by comparing the DIT P-scores of accounting students pre and post cooperative education. Cooperative eduction is an industry placement program where students are required to work in commerce and industry for one year. Findings indicate that DIT P-scores decrease during cooperative education suggesting that accounting students, whilst in the work environment, do not reason according to their capability as measured by their pre-test scores.

Measuring work-study engagement in built environment undergraduate education in Australia

The cost of accessing higher education is expensive causing students to juggle the demands of paid work with study responsibilities. Whilst some work can be beneficial to student leaning this research seeks a more accurate understanding of why students undertake paid experience work to the level that they do. This paper examines the extent of work and study during an undergraduate program in construction at RMIT University Australia. Students responded to a questionnaire on the duration and nature of their work and study times. The results indicate that students who were involved in paid work do in excess of 20 hours per week, whist also enrolled as full-time undergraduates. The results of the study show that students in the early years of the program seem to be more engaged with study and spent slightly less time at work. This is contrasted with students in the final two years of the course spend considerable more time in paid work and less time undertaking study.
The paper concludes by suggesting that the results are partly the result of the unstructured work-experience requirements that occur from about year 3 of the program. Students who were encouraged by the university to undertake paid work-experience appeared to be increasingly disinterested in connecting with the broader university experience.

How precarious employment affects health and safety at work : the case of temporary agency workers

International studies indicate temporary agency workers are more likely to be injured at work than other types of employees. However explanations for this have been less forthcoming. This paper seeks to begin filling this gap. A study was undertaken in Victoria, Australia, of occupational health and safety (OHS) amongst temporary agency workers drawing upon workers' compensation claim files for injured agency and directly hired workers from 1995-2001, and focus groups of temporary agency workers conducted in 2003. In analyzing the results, use was made of risk factors identified in a model that has been developed to explain how precarious employment affects OHS--the pressure, disorganization and regulatory failure (PDR) model (Quinlan and Bohle, 2004, 2009). Drawing principally on qualitative data, the paper finds that whilst agency workers share common risk factors with other forms of precarious workers, unique characteristics associated with the triangular nature of agency employment heighten their vulnerability further.

Pandemic (H1N1) 2009 influenza in Australia : absenteeism and redeployment of emergency medicine and nursing staff

Objective: The aim of the present study was to examine the impact of Pandemic (H1N1) 2009 Influenza on the Australian emergency nursing and medicine workforce, specifically absenteeism and deployment.

Methods: Data were collected using an online survey of 618 members of the three professional emergency medicine or emergency nursing colleges.

Results: Despite significant increases in emergency demand during the Pandemic (H1N1) 2009 Influenza, 56.6% of emergency nursing and medicine staff reported absenteeism of at least 1 day and only 8.5% of staff were redeployed. Staff illness with influenza-like illness was reported by 37% of respondents, and 87% of respondents who became ill were not tested for the Pandemic (H1N1) 2009 Influenza. Of the respondents who became ill, 43% (n = 79) reported missing no days of work and only 8% of respondents (n = 14) reported being absent for more than 5 days. The mean number of days away from work was 3.73 (standard deviation = 3.63). Factors anecdotally associated with staff absenteeism (caregiver responsibilities, concern about personal illness, concern about exposing family members to illness, school closures, risk of quarantine, stress and increased workload) appeared to be of little or no relevance. Redeployment was reported by 8% of respondents and the majority of redeployment was for operational reasons.

Conclusion: Future research related to absenteeism, redeployment during actual pandemic events is urgently needed. Workforce data collection should be an integral part of organizational pandemic planning.

A probabilistic framework for extracting narrative act boundaries and semantics in motion pictures

This work constitutes the first attempt to extract the important narrative structure, the 3-Act storytelling paradigm in film. Widely prevalent in the domain of film, it forms the foundation and framework in which a film can be made to function as an effective tool for story telling, and its extraction is a vital step in automatic content management for film data. The identification of act boundaries allows for structuralizing film at a level far higher than existing segmentation frameworks, which include shot detection and scene identification, and provides a basis for inferences about the semantic content of dramatic events in film. A novel act boundary likelihood function for Act 1 and 2 is derived using a Bayesian formulation under guidance from film grammar, tested under many configurations and the results are reported for experiments involving 25 full-length movies. The result proves to be a useful tool in both the automatic and semi-interactive setting for semantic analysis of film, with potential application to analogues occuring in many other domains, including news, training video, sitcoms.

Age-specific trends in cardiovascular mortality rates in the Netherlands between 1980 and 2009

Recent analyses suggest the decline in coronary heart disease mortality rates is slowing in younger age groups in countries such as the US and the UK. This work aimed to analyse recent trends in cardiovascular mortality rates in the Netherlands. Analysis was of annual all circulatory, ischaemic heart disease (IHD), and cerebrovascular disease mortality rates between 1980 and 2009 for the Netherlands. Data were stratified by sex and 10-year age group (age 35–85+). The annual rate of change and significant changes in the trend were identified using joinpoint Poisson regression. For almost all age and sex groups examined the rate of IHD and cerebrovascular disease mortality in the Netherlands has more than halved between 1980 and 2009. The decline in mortality from both IHD and cerebrovascular disease is continuing for all ages and sex groups, with anacceleration in the decline apparent from the late 1990s/early 2000s. The decline in age-specific all circulatory, coronary heart disease and cerebrovascular disease mortality rates continues for all age and sex groups in the Netherlands.

International contact lens prescribing in 2009

This is the eighth consecutive year that we have presented data from a survey of international contact lens prescribing in Contact Lens Spectrum. In this article we report on an assessment of 25,801 fits across 28 contact lens markets located in North America, Europe, the Middle East, Asia, and Africa. As in previous years, we opted for a prospective approach to this work. Up to 1,000 survey forms were randomly disseminated in each market to contact lens practitioners (ophthalmologists, optometrists, and/or opticians depending on the market), and information about the first 10 patients prescribed with lenses after receipt of paper or electronic survey forms was anonymously recorded.

Can a media annotation tool enhance online engagement with learning? A multi-case work-in-progress report

The paper explores preliminary data of four cases in a larger study investigating the effects on learning of a new educational technology called Media Annotation Tool (MAT). In particular, the paper focuses on learning engagement with MAT and begins to raise questions about what factors promote or enhance engagement. Drawing on the work of Kirkwood (2009), the authors analyse the type of educational technology functions that were expressed through the ways teachers integrated the use of MAT into their curriculum. Another factor explored in the paper is student engagement. Barkley's (2010) theorising on the complexity of student engagement for learning argues that engagement is where motivation and active learning synergistically interact. Examining students reflections on their use of MAT, the authors identify that while MAT offers active learning, motivation for the use of MAT may be a missing factor for some disengaged students. This insight provides further themes to explore in further analysis of the projects data.

Making visible the invisible act of doping

This paper describes the construction of the visual space of surveillance by the global anti-doping apparatus, it is a space inhabited daily by professional cyclists. Two principal mechanisms of this apparatus will be discussed—the Whereabouts System and the Biological Passport; in order to illustrate how this space is constructed and how it visualises the invisible act of doping. These mechanisms act to supervise and govern the professional cyclist and work to classify them as either clean or dirty in terms of the use of prohibited doping substances or methods. Contrary to the analysis of liberal anti-doping scholars such as Hanstad, Loland and Møller this paper argues that Foucault’s Panopticon paradigm is a useful tool for the analysis of this apparatus. The Whereabouts System and Biological Passport are the instruments by which the anti-doping apparatus intensifies the construction of the space of surveillance in professional sport. This space of surveillance not only locates and makes visible the physical location of each individual cyclist, but it also makes visible their internal bodily functions, in this case the composition and the fluctuations of the composition of their blood. In making the cyclist visible the instruments do not allow the cause of doping, or the event of doping to be known or observed. Rather what they do is cast the body in terms of abnormalities of time, place or blood. In the case of an abnormality of the cyclist’s blood, the cause itself cannot be identified with any certainty, all that is made visible is a suggestion, or a probability, that doping may have occurred. The ultimate effects are twofold—an internalisation and continual monitoring of one’s self as well as by the authorities, and a radical change in the nature and the definition of the offence of doping. No longer is it positive evidence of doping that is punishable, but what becomes punishable is an abnormality, in the cyclist’s location, or their body, which suggests a probability that the invisible act of doping may have occurred. In the course of this process accepted manners of proving an offence by the use of scientific evidence and expert commentary are transformed. The Whereabouts System and the Biological Passport open up a new manner in which the invisible can be visualised. Through the discourse and the attendant commentary of the expert a new alliance between doping and the law is constructed. The result is a redistribution of the way in which the law visualises and treats the symptoms (the signifier) and the signified act of doping. The Whereabouts System and Biological Passport are the instruments by which the anti-doping apparatus intensifies the construction of the space of surveillance in professional sport. This space of surveillance not only locates and makes visible the physical location of each individual cyclist, but it also makes visible their internal bodily functions, in this case the composition and the fluctuations of the composition of their blood. In making the cyclist visible the instruments do not allow the cause of doping, or the event of doping to be known or observed. Rather what they do is cast the body in terms of abnormalities of time, place or blood. In the case of an abnormality of the cyclists’s blood, the cause itself cannot be identified with any certainty, all that is made visible is a suggestion, or a probability, that doping may have occurred. The ultimate effects are twofold—an internalisation and continual monitoring of one’s self as well as by the authorities, and a radical change in the nature and the definition of the offence of doping. No longer is it positive evidence of doping that is punishable, but what becomes punishable is an abnormality, in the cyclist’s location, or their body, which suggests a probability that the invisible act of doping may have occurred. In the course of this process accepted manners of proving an offence by the use of scientific evidence and expert commentary are transformed. The Whereabouts System and the Biological Passport open up a new manner in which the invisible can be visualised. Through the discourse and the attendant commentary of the expert a new alliance between doping and the law is constructed. The result is a redistribution of the way in which the law visualises and treats the symptoms (the signifier) and the signified act of doping.

Social work practice in mental health: an introduction

Book review of: Social Work Practice in Mental Health: An Introduction