Habit retraining for the management of urinary incontinence in adults (review)

Background
Habit retraining is toileting assistance given by a caregiver to adults with urinary incontinence. It involves the identification of an incontinent person's natural voiding pattern and the development of an individualised toileting schedule which pre-empts involuntary bladder emptying.

Objectives
To assess the effects of habit retraining for the management of urinary incontinence in adults.

Search strategy
We searched the Cochrane Incontinence Group specialised register (9 May 2002), MEDLINE (January 1966 to February 2004), EMBASE (January 1980 to Week 18-2002), CINAHL (January 1982 to February 2001), PsychINFO (January 1972 to August 2002), Biological Abstracts (January 1980 to December 2000), Current Contents (January 1993 to December 2001) and the reference lists of relevant articles. We also contacted experts in the field, searched relevant websites and hand searched journals and conference
proceedings.

Selection criteria
All randomised or quasi-randomised controlled trials comparing habit retraining delivered either alone or in conjunction with another intervention for urinary incontinence in adults.

Data collection and analysis
Data extraction and quality assessment were undertaken by at least two people working independendy of each other. Any differences were resolved by discussion. The relative risks for dichotomous data were calculated with 95% confidence intervals. Where data were insufficient for a quantitative analysis, a narrative overview was undertaken.

Main results
Three trials with a total of 337 participants met the inclusion criteria, describing habit retraining combined with other approaches compared with usual care. Participants were primarily care-dependent elderly women with concurrent cognitive and/or physical impairment, residing in either a residential aged-care facility or in their own home. Outcomes included incidence and/or severity of urinary incontinence, the prevalences of urinary tract infection, skin rash and skin breakdown, cost and caregiver preparedness, role strain and burden. Caregivers found it difficult to maintain voiding records and to implement the toileting program. A 61% compliance rate was reported in one trial .

There were no statistically significant differences in the incidence and in the volume of incontinence between groups. Within group analyses did however show improvements on these measures. Reductions were also reported for the intervention group in one study for skin rash, skin breakdown and in caregivers' perceptions of their level of stress. Descriptive data on the. intervention suggests that habit retraining is a labour-intense activity. Electronic loggers, used as an adjunct to caregiver-delivered wet/dry checks, were reported as providing more accurate data than that from caregiver conducted wet/dry checks. To date, no analysis of the time and resources associated with these comparisons is available.

Reviewers' conclusions
Data on habit retraining are few and of insufficient quality to provide a firm basis for practice.

An ecologically mixed brachiopod fauna from Changhsingian deep-water basin of South China: consequence of end-Permian global warming

The Late Permian Shaiwa Group of the Ziyun area of Guizhou, South China is a deep-water facies succession characterized by deep-water assemblages of pelagic radiolarians, foraminifers, bivalves, ammonoids and brachiopods. Here we report 20 brachiopod species in 18 genera from the uppermost Shaiwa Group. This brachiopod fauna is latest Changhsingian in age and dominated by productides. The palaeoecologic and taphonomic analysis reveals that the brachiopod fauna is preserved in situ. The attachment modes and substratum preference demonstrate that the Shaiwa brachiopod fauna comprises admixed elements of deep-water and shallow-water assemblages. The presence of the shallow-water brachiopods in the Shaiwa faunas indicates the involuntary settlement of shallow-water brachiopods. The stressed ecologic pressure, triggered by warming surface waters, restricted ecospace and short food sources, may have forced some shallow-water elements to move to hospitable deep-water settings and others to modify their habiting behaviours and exploit new ecospace in deep-water environments. We infer that the end-Permian global warming and subsequent transgression event may have accounted for the stressed environmental pressure in the shallow-water communities prior to the end-Permian mass extinction.

Fear and loathing in public policy : ethical issues in laws for sex offenders

Laws intended to increase protection from sex offenders are often prompted by sensational crimes that provoke public outrage. As public policy, questions have been raised about the legality and effectiveness of these legislative initiatives as enacted in North America, Australasia and the UK since the early 1990s. Mental health professionals involved in the implementation of these laws are faced with ethical concerns that distinguish this area of forensic practice from other clinical roles. This article presents a brief description of the impetus for specific laws allowing for involuntary civil commitment, extended supervision and community notification of sex offenders in different jurisdictions. A model of human rights is then used to consider the ways in which these laws threaten the rights of offenders, and provides a framework for identifying ethical concerns inherent in professional practice in this area.

'The witness who saw, /He left little doubt' : a comparative consideration of expert testimony in mental disability law cases in common and civil law systems

The question of how courts assess expert evidence - especially when mental disability is an issue - raises the corollary question of whether courts adequately evaluate the content of the expert testimony or whether judicial decision making may be influenced by teleology (cherry picking evidence), pretextuality (accepting experts who distort evidence to achieve socially desirable aims), and/or sanism (allowing prejudicial and stereotyped evidence). Such threats occur despite professional standards in forensic psychology and other mental health disciplines that require ethical expert testimony. The result is expert testimony that, in many instances, is at best incompetent and at worst biased. The paper details threats to competent expert testimony in a comparative law context - in both the common law (involuntary civil commitment laws and risk assessment criminal laws) and, more briefly, civil law. We conclude that teleology, pretextuality, and sanism have an impact upon judicial decision making in both the common law and civil law. Finally, we speculate as to whether the new United Nations Convention on the Rights of Persons with Disabilities is likely to have any impact on practices in this area. Copyright © 2009 John Wiley & Sons, Ltd.

Surgical sterilisation : medical power, women's knowledge

An exploration of women's experience of tubal ligation and the social context in which their contraceptive decision making occurs. This study gives priority to women's knowledge about their own bodies and investigates how women negotiate contraceptive risks, the information provision process, the outcome of tubal ligation in terms of side-effects and the medical responses to women's reporting of their problems. It makes recommendations about the information women should have to meet the requirement of an informed consent when accepting contraceptive surgery.

Making a finding : guardianship and construction of substituted decisions about women's health and fertility

Substituted decisions about health and fertility of women deemed incompetent, because of a disability, expose the constitutive power of knowledge about the female, disabled body and its stereotypical place in social relations. This study addresses issues about the self of modern citizenship and feminist politics in a changing policy climate.

Using omeprazole to link the components of the post-prandial alkaline tide in the spiny dogfish, Squalus acanthias

After a meal, dogfish exhibit a metabolic alkalosis in the bloodstream and a marked excretion of basic equivalents across the gills to the external seawater. We used the H⁺, K⁺-ATPase pump inhibitor omeprazole to determine whether these post-prandial alkaline tide events were linked to secretion of H⁺ (accompanied by Cl^–) in the stomach. Sharks were fitted with indwelling stomach tubes for pretreatment with omeprazole (five doses of 5mg omeprazole per kilogram over 48 h) or comparable volumes of vehicle (saline containing 2% DMSO) and for sampling of gastric chyme. Fish were then fed an involuntary meal by means of the stomach tube consisting of minced flatfish muscle (2% of body mass) suspended in saline (4% of body mass total volume). Omeprazole pretreatment delayed the post-prandial acidification of the gastric chyme, slowed the rise in Cl^– concentration of the chyme and altered the patterns of other ions, indicating inhibition of H⁺ and accompanying Cl^– secretion. Omeprazole also greatly attenuated the rise in arterial pH and bicarbonate concentrations and reduced the net excretion of basic equivalents to the water by 56% over 48h. Arterial blood CO₂ pressure and plasma ions were not substantially altered. These results indicate that elevated gastric H⁺ secretion (as HCl) in the digestive process is the major cause of the systemic metabolic alkalosis and the accompanying rise in base excretion across the gills that constitute the alkaline tide in the dogfish.

"Look at him...he's failing" : male executives' experiences of redundancy

Participation and success in paid work is a key element of identity for many men. The increased prevalence of downsizing and the associated discarding of individuals from their workplaces, then, has particular relevance for men. This paper shares qualitative findings from an exploratory phenomenological study investigating the experiences of Australian executives who had been made redundant. Three themes related to male identity are presented here: Failing as the breadwinner; Being less of a person; and, Losing success. The participants in this study shared feelings of anger, sadness, fear and embarrassment as a result of the assault to their identity that accompanied their involuntary redundancies. The impacts of redundancy were not only felt in relation to their job loss, but continued after returning to work. At a time when downsizing continues to feature as a routine part of organisational life—for some, an experience repeated throughout their careers—further exploration of the experience of redundancy and its implications is required.

Animal–plant–microbe interactions : direct and indirect effects of swan foraging behaviour modulate methane cycling in temperate shallow wetlands

Wetlands are among the most important ecosystems on Earth both in terms of productivity and biodiversity, but also as a source of the greenhouse gas CH₄. Microbial processes catalyzing nutrient recycling and CH₄ production are controlled by sediment physico-chemistry, which is in turn affected by plant activity and the foraging behaviour of herbivores. We performed field and laboratory experiments to evaluate the direct effect of herbivores on soil microbial activity and their indirect effects as the consequence of reduced macrophyte density, using migratory Bewick’s swans (Cygnus columbianus bewickii Yarrell) feeding on fennel pondweed (Potamogeton pectinatus L.) tubers as a model system. A controlled foraging experiment using field enclosures indicated that swan bioturbation decreases CH₄ production, through a decrease in the activity of methanogenic Archaea and an increased rate of CH₄ oxidation in the bioturbated sediment. We also found a positive correlation between tuber density (a surrogate of plant density during the previous growth season) and CH₄ production activity. A laboratory experiment showed that sediment sterilization enhances pondweed growth, probably due to elimination of the negative effects of microbial activity on plant growth. In summary, the bioturbation caused by swan grazing modulates CH₄ cycling by means of both direct and indirect (i.e. plant-mediated) effects with potential consequences for CH₄ emission from wetland systems.

Extended supervision or civil commitment for managing the risk of sexual offenders : public safety and individual rights

Since the early 1990’s, there has been a proliferation of legislative initiatives in North America, the United Kingdom, and Australasia that are intended to improve public protection from high risk sexual offenders. These laws include extended supervision of sexual offenders once released from prison and indefinite involuntary civil commitment to secure treatment facilities following the expiration of a prison sentence. The enactment of these laws has sparked intense debate and numerous legal challenges on a variety of issues, including the need to strike a proper balance between public safety and the rights of individual offenders. Recent challenges to Extended Supervision Orders in New Zealand have included the assertion that this approach is inconsistent with the Bill of Rights Act. This article compares the use of Extended Supervision Orders in New Zealand to the use of civil commitment of Sexually Violent Predators in the United States, and particularly in California, which currently confines the largest number of offenders under this type of commitment. It is argued that Extended Supervision is more flexible, less intrusive, less punitive, and less costly than civil commitment. The degree to which it is effective in improving public safety remains an empirical question.

Role of dopamine D3 and serotonin 5-HT1A receptors in l-DOPA-induced dyskinesias and effects of sarizotan in the 6-hydroxydopamine-lesioned rat model of Parkinson's disease

Sarizotan, a 5-HT1A agonist with additional affinity for D3 and D4 receptors, has been demonstrated to have anti-dyskinetic effects. The mechanism by which these effects occur is not clear. Using unilateral 6-hydroxydopamine-lesioned rats that received chronic intraperitoneal (ip) administration of L-3,4-dihydroxyphenylalanine (L-DOPA) we investigated the involvement of D3 and 5-HT1A receptors in the effects of sarizotan on contraversive circling and abnormal involuntary movements (AIMs). Before sensitization by chronic L-DOPA treatment (12.5 with 3.25 mg/kg benserazide ip, twice daily for 21 days), no effect of the selective D3 agonist, PD128907 (1 or 3 mg/kg ip), or the selectiveD3 antagonist,GR103691 (0.5 or 1.5 mg/kg ip), was observed. Treatment with sarizotan (1 or 5 mg/kg ip) dosedependently inhibited the L-DOPA-induced contraversive turning and AIMs. In co-treatment with the 5-HT1A antagonist, WAY100635 (1 mg/kg ip), sarizotan failed to affect this behaviour, confirming the prominent 5-HT1A receptor-mediated mechanism of action. In the presence of PD128907 (3 mg/kg ip), the effects of sarizotan on contraversive turning, locomotive dyskinesia and axial dystonia, but not on orolingual and forelimb dyskinesia, were blocked. On its own, PD128907 had no effect on the behavioural effects of L-DOPA except that it tended to reduce orolingual and forelimb dyskinesia. GR103691 had no effect on its own or in combination with sarizotan. These data identify an involvement of D3 receptors in the action of sarizotan on some, but not all L-DOPA-induced motor side effects. This selective involvement is in contrast to the more general involvement of 5-HT1A receptors in the anti-dyskinetic effects of sarizotan.

Audit of the Douglas Hocking Research Institute bone bank : ten years of non-irradiated bone graft

Background:  An audit performed in the use of non-irradiated femoral head bone graft at the Geelong Hospital over a 10-year period. While it is thought the non-irradiated bone graft provides a better structural construct there is theoretical increased risk of infection transmission.

Methods:  We performed a retrospective review of prospectively collected data in the use of non-irradiated bone allograft used from the Geelong Hospital Douglas Hosking Research Institute bone bank over a 10-year period. The review was performed using data collected from the bone bank and correlating it with the patient’s medical record. All complications, including infections, related to the use of the allograft were recorded.

Results:  We found that over the 10 years to 2004 that 811 femoral heads were donated, with 555 being used over 362 procedures in 316 patients. We identified a total of nine deep infections, of which seven were in joint replacements. Overall this was a 2.5% deep infection rate, which was lowered to 1.4% if the previously infected joints that were operated on were excluded.

Conclusion:  The use of non-irradiated femoral head bone graft was safe in a regional setting.

Understanding the role of affect in producing a critical pedagogy for history museums

While the existence of uncritical exhibition practices that support nostalgic narratives about the past cannot be denied, this paper is focused on demonstrating both the existence of critical exhibitions and on explaining how they work. In particularly, this paper looks at the ways in which the production of affective, nonrational forms of experience aimed at inducing a heightened level of engagement on the part of visitors is being used to facilitate a more critical reflection on the relationship between past and present. My examples, drawn from curatorial practices in Australia dealing either with contact histories or histories of migration, will be used to explore how explicit forms of engagement with the senses in contemporary exhibition practices gesture toward not only a new understanding of the pedagogical role of museums but also to new forms of pedagogical practice.

Why are childless women childless? Findings from an exploratory study in Victoria, Australia

Childlessness in Australia is increasing yet there is limited research exploring women’s reasons for childlessness. Previous research has typically examined childlessness within the context of fertility rather than childlessness itself. The limited research that has moved beyond looking at involuntary childlessness has labelled women with a type of childlessness during recruitment rather than exploring women’s reasons for childlessness as a part of the research process.