Clinical Practice Guideline: irritable bowel syndrome with constipation and functional constipation in the adult

In this Clinical Practice Guideline we discuss the diagnostic and therapeutic approach of adult patients with constipation and abdominal complaints at the confluence of the irritable bowel syndrome spectrum and functional constipation. Both conditions are included among the functional bowel disorders, and have a significant personal, healthcare, and social impact, affecting the quality of life of the patients who suffer from them. The first one is the irritable bowel syndrome subtype, where constipation represents the predominant complaint, in association with recurrent abdominal pain, bloating, and abdominal distension. Constipation is characterized by difficulties with or low frequency of bowel movements, often accompanied by straining during defecation or a feeling of incomplete evacuation. Most cases have no underlying medical cause, and are therefore considered as a functional bowel disorder. There are many clinical and pathophysiological similarities between both disorders, and both respond similarly to commonly used drugs, their primary difference being the presence or absence of pain, albeit not in an "all or nothing" manner. Severity depends not only upon bowel symptom intensity but also upon other biopsychosocial factors (association of gastrointestinal and extraintestinal symptoms, grade of involvement, and perception and behavior variants). Functional bowel disorders are diagnosed using the Rome criteria. This Clinical Practice Guideline has been made consistent with the Rome IV criteria, which were published late in May 2016, and discuss alarm criteria, diagnostic tests, and referral criteria between Primary Care and gastroenterology settings. Furthermore, all the available treatment options (exercise, fluid ingestion, diet with soluble fiber-rich foods, fiber supplementation, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antidepressants, psychological therapy, acupuncture, enemas, sacral root neurostimulation, surgery) are discussed, and practical recommendations are made regarding each of them.

Relatório de Estágio de Intervenção Comunitária

O presente Relatório reflete o percurso desenvolvido durante o estágio, realizado na Escola Secundária Mouzinho da Silveira, visando o desenvolvimento de competências de Enfermeira Especialista em Enfermagem Comunitária e tendo por base o Diagnóstico de Situação da Saúde dos adolescentes das turmas de 7º e 8º ano, no ano letivo de 2012/2013 e a implementação de um Projeto de Intervenção. O projeto desenvolvido insere-se no âmbito da Promoção da Saúde e Prevenção de comportamentos de risco na adolescência. Os adolescentes são considerados pela OMS, como um grupo que vivencia grandes mudanças a nível físico, psicológico, familiar e social sendo suscetíveis ao desenvolvimento de comportamentos de risco que se poderão perpetuar no futuro. É com base neste raciocínio, que se torna essencial uma intervenção multissectorial, planeada entre os profissionais dos vários contextos em que os adolescentes se inserem, especialmente no contexto escolar onde estes passam muito do seu tempo. O estágio, centrou-se nos hábitos de vida dos adolescentes, ou seja, conhecer os comportamentos de risco que os adolescentes praticam diariamente e através desses dados, programar um projeto de intervenção com vista à promoção de hábitos de vida saudáveis. Para isso, foram desenvolvidas várias atividades, nomeadamente reuniões com os docentes dado que, estes são elementos chave neste processo pela convivência e partilha de experiencias diárias com os adolescentes, e sessões de educação para a saúde. Na realização da intervenção foi utilizada a Metodologia do Planeamento em Saúde e as sessões de educação para a saúde sustentaram-se na Teoria da Aprendizagem Social de Bandura. Foram abrangidos 232 adolescentes, num total de 269, (no momento da aplicação do questionário) na Intervenção de Promoção de Hábitos de Vida Saudáveis dos adolescentes. Nesta intervenção obtivemos mais de 95.5% dos questionários respondidos com posicionamento na escala de satisfação na categoria de Satisfeito ou mais. Este relatório retrata o papel do Enfermeiro Especialista em Saúde Comunitária, que através das suas competências específicas, adequa as práticas, aplica um Planeamento em -Saúde eficaz, mobiliza os recursos comunitários e as equipas, na busca da excelência nos cuidados de Enfermagem prestados e de ganhos de Saúde da comunidade.

Relatório de Estágio de Intervenção Comunitária

Presentemente, a nossa sociedade sofre alterações diárias para as quais é exigido, aos enfermeiros, um elevado nível de qualificações que permitam dar resposta às necessidades e determinantes de saúde de cada comunidade. Assim, cabe cada vez mais aos enfermeiros enfatizar práticas conducentes a estilos de vida saudáveis, através da Promoção da Saúde, com o objetivo da obtenção de ganhos em saúde. Muitas doenças da idade adulta têm o seu início na adolescência, devido a hábitos de vida e à adoção de comportamentos de risco. É neste grupo etário, de grande vulnerabilidade, que deve incidir o papel da Educação para a Saúde, de forma a capacitar os adolescentes para opções saudáveis. O presente Relatório reflete o desenvolvimento do Estágio na área de Especialização em Enfermagem Comunitária e as competências adquiridas neste percurso. O Estágio decorreu no período de 16 de setembro de 2013 a 31 de janeiro de 2014 (2º Ano – 1º semestre), na Escola Secundária Mouzinho da Silveira, em Portalegre. Com base na Metodologia do Planeamento em Saúde, toda a intervenção foi dirigida para os problemas identificados através do Diagnóstico de Situação de Saúde. Assim, o Estágio teve como intervenção a Promoção de Hábitos de Vida Saudáveis dos Adolescentes do 8º e 9º Ano, da respetiva Escola. Dada a aplicabilidade da Teoria da Aprendizagem Social de Bandura na Promoção da Saúde, as sessões de Educação para a Saúde sustentaram-se nesta teoria com o intuito de capacitar os jovens para agirem de forma correta e consciente. O Estágio de intervenção comunitária foi enriquecedor do ponto de vista da diversidade de experiências que proporcionou, permitindo a aquisição das competências específicas do Enfermeiro Especialista em Enfermagem Comunitária definidas pela Ordem dos Enfermeiros

Cultural Heritage and Mobile Robotics Technologies

This paper reviews current research works at the authors’ Institutions to illustrate how mobile robotics and related technologies can be used to enhance economical fruition, control, protection and social impact of the cultural heritage. Robots allow experiencing on-line, from remote locations, tours at museums, archaeological areas and monuments. These solutions avoid travelling costs, increase beyond actual limits the number of simultaneous visitors, and prevent possible damages that can arise by over-exploitation of fragile environments. The same tools can be used for exploration and monitoring of cultural artifacts located in difficult to reach or dangerous areas. Examples are provided by the use of underwater robots in the exploration of deeply submerged archaeological areas. Besides, technologies commonly employed in robotics can be used to help exploring, monitoring and preserving cultural artifacts. Examples are provided by the development of procedures for data acquisition and mapping and by object recognition and monitoring algorithms.

El pulso urbano-industrial de O Porriño

En el planteamiento de la presente disertación, se tienen en consideración las premisas sobre los orígenes de la ciudad, su influencia industrial y su resolución a través de la Teoría de la Lógica Social del Espacio como herramienta de trabajo para los análisis sobre los planes urbanos propuestos para el municipio a estudio, su historia y para la elaboración de propuestas de interacción futuras. Inicialmente, la propuesta surge de la importancia de las vías de comunicación, como elemento creador urbano, es decir, de una determinada infraestructura, la calle-carretera como el “eje” de consolidación de la ciudad, donde se realizan la mayoría de recorridos o flujos en este caso, ejemplificado en la villa de Porriño. El urbanismo pos-moderno, hasta finales de 1970 e inicios de 1980, no abordaba una articulación entre social y técnica, una ciencia de lucha de clases. En este contexto, en 1984, Bill Hillier y Julienne Hanson escriben “La Lógica Social del Espacio” donde argumentan que los movimientos o flujos obedecen a una lógica racional, según la cual, cualquier desplazamiento es llevado a cabo por el menor recorrido y, por tanto, el urbanismo influye en esos flujos. La configuración urbana genera condiciones de accesibilidad y da origen a una diferenciación espacial jerarquizada con conceptos como la conectividad, integración y segregación en un espacio influenciado y construido por la dinámica social. De este modo, la Teoría de la Sintaxis Espacial describe la configuración del trazado urbano y las relaciones entre el espacio público y privado a través de medidas cuantitativas, las cuales permiten entender aspectos importantes del sistema urbano como la accesibilidad y la distribución y usos del suelo consolidado. Por tanto, en la teoría existe una correlación establecida entre las propiedades de los elementos presentados, espacio y sociedad, de modo que cada elemento incumbe al otro y no existiría sin su presencia, siendo fundamental para la definición de la forma. Esta herramienta, Space Syntax, busca la integración del espacio en la ciudad, mediante un análisis y una evaluación a diversas escalas en la red urbana, con una correcta distribución de los espacios, sus usos y las vías de transporte o comunicación necesarios para llegar a los diferentes lugares de la ciudad. La realización de la investigación se centrará en el análisis de la infraestructura viaria en el municipio de Porriño y sus regiones colindantes a lo largo del período histórico analizado, centrándose en tres momentos históricos, 1956, 1986 y la actualidad 2015, debido a los vuelos fotogramétricos de dichas etapas. Así, se obtendrán las respectivas mediciones correspondientes a través del programa informático Depthmap, las cuales se contrarrestarán y compararán entre sí en cada etapa analizada y entre los propios años examinados, para lograr obtener las consideraciones establecidas a lo largo del estudio en cuanto a la influencia comunicativa de los flujos de interacción social en el entorno urbano definido y la respectiva lucha de los sectores industriales y residenciales. En conclusión, se pretende la justificación del origen de la ciudad a través de la comparación sus vías, las cuales fueron fomentadas por el comercio e industria para su creación, dotando así a la industria del dominio del espacio para satisfacer sus necesidades, creando y ampliando su área de intervención, la cual puede ser analizada y tratada no sólo independientemente, sino en el conjunto urbano en el que se sitúa, Porriño.

Text message and internet support for coronary heart disease self-management: results from the text4heart randomized controlled trial

BACKGROUND: Mobile technology has the potential to deliver behavior change interventions (mHealth) to reduce coronary heart disease (CHD) at modest cost. Previous studies have focused on single behaviors; however, cardiac rehabilitation (CR), a component of CHD self-management, needs to address multiple risk factors. OBJECTIVE: The aim was to investigate the effectiveness of a mHealth-delivered comprehensive CR program (Text4Heart) to improve adherence to recommended lifestyle behaviors (smoking cessation, physical activity, healthy diet, and nonharmful alcohol use) in addition to usual care (traditional CR). METHODS: A 2-arm, parallel, randomized controlled trial was conducted in New Zealand adults diagnosed with CHD. Participants were recruited in-hospital and were encouraged to attend center-based CR (usual care control). In addition, the intervention group received a personalized 24-week mHealth program, framed in social cognitive theory, sent by fully automated daily short message service (SMS) text messages and a supporting website. The primary outcome was adherence to healthy lifestyle behaviors measured using a self-reported composite health behavior score (≥3) at 3 and 6 months. Secondary outcomes included clinical outcomes, medication adherence score, self-efficacy, illness perceptions, and anxiety and/or depression at 6 months. Baseline and 6-month follow-up assessments (unblinded) were conducted in person. RESULTS: Eligible patients (N=123) recruited from 2 large metropolitan hospitals were randomized to the intervention (n=61) or the control (n=62) group. Participants were predominantly male (100/123, 81.3%), New Zealand European (73/123, 59.3%), with a mean age of 59.5 (SD 11.1) years. A significant treatment effect in favor of the intervention was observed for the primary outcome at 3 months (AOR 2.55, 95% CI 1.12-5.84; P=.03), but not at 6 months (AOR 1.93, 95% CI 0.83-4.53; P=.13). The intervention group reported significantly greater medication adherence score (mean difference: 0.58, 95% CI 0.19-0.97; P=.004). The majority of intervention participants reported reading all their text messages (52/61, 85%). The number of visits to the website per person ranged from zero to 100 (median 3) over the 6-month intervention period. CONCLUSIONS: A mHealth CR intervention plus usual care showed a positive effect on adherence to multiple lifestyle behavior changes at 3 months in New Zealand adults with CHD compared to usual care alone. The effect was not sustained to the end of the 6-month intervention. A larger study is needed to determine the size of the effect in the longer term and whether the change in behavior reduces adverse cardiovascular events. TRIAL REGISTRATION: ACTRN 12613000901707; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364758&isReview=true (Archived by WebCite at http://www.webcitation.org/6c4qhcHKt).

A multimedia mobile phone-based youth smoking cessation intervention: findings from content development and piloting studies

BACKGROUND: While most young people who smoke want to quit, few access cessation support services. Mobile phone-based cessation programs are ideal for young people: mobile phones are the most common means of peer communication, and messages can be delivered in an anonymous manner, anywhere, anytime. Following the success of our text messaging smoking cessation program, we developed an innovative multimedia mobile phone smoking cessation intervention.

OBJECTIVE: The aim of the study was to develop and pilot test a youth-oriented multimedia smoking cessation intervention delivered solely by mobile phone.

METHODS: Development included creating content and building the technology platform. Content development was overseen by an expert group who advised on youth development principles, observational learning (from social cognitive theory), effective smoking cessation interventions, and social marketing. Young people participated in three content development phases (consultation via focus groups and an online survey, content pre-testing, and selection of role models). Video and text messages were then developed, incorporating the findings from this research. Information technology systems were established to support the delivery of the multimedia messages by mobile phone. A pilot study using an abbreviated 4-week program of video and text content tested the reliability of the systems and the acceptability of the intervention.

RESULTS: Approximately 180 young people participated in the consultation phase. There was a high priority placed on music for relaxation (75%) and an interest in interacting with others in the program (40% would read messages, 36% would read a blog). Findings from the pre-testing phase (n = 41) included the importance of selecting "real" and "honest" role models with believable stories, and an interest in animations (37%). Of the 15 participants who took part in the pilot study, 13 (87%) were available for follow-up interviews at 4 weeks: 12 participants liked the program or liked it most of the time and found the role model to be believable; 7 liked the role model video messages (5 were unsure); 8 used the extra assistance for cravings; and 9 were happy with two messages per day. Nine participants (60%) stopped smoking during the program. Some technical challenges were encountered during the pilot study.

CONCLUSIONS: A multimedia mobile phone smoking cessation program is technically feasible, and the content developed is appropriate for this medium and is acceptable to our target population. These results have informed the design of a 6-month intervention currently being evaluated for its effectiveness in increasing smoking cessation rates in young people.

Challenges for sport development: women's entry level cycling participation

Sport participation is an issue of relevance to sport managers, yet it is an often-neglected area of sport management research. Cycling is a particularly complex form of participation to examine given its many formats, including sport, recreational and commuter cycling, and the multifaceted nature of the cycling landscape involving a broad range of stakeholders. In Australia, women are underrepresented in cycling participation and membership (Australian Bureau of Statistics, 2012; Cycling Australia, 2014), yet women show an interest in cycling training courses. The present paper explores motivations, supports and constraints reported by a group of entry-level female cyclists who participated in a training programme accredited by AustCycle, an initiative led by Cycling Australia. We draw on a health and sport development driven framework, informed by social ecological theory (Rowe et al., 2013), and suited to examining the issue of women's cycling participation in Australia. Results show that a range of individual characteristics, and factors within the social and physical environment, were perceived by study participants as barriers to participation. Of these, skill level, confidence, traffic/road conditions, and social support networks held particular relevance. Participants also discussed specific cycling barriers and supports of relevance to certain forms of cycling. Preliminary insights into perceptions held by a group of entry-level female cyclists highlight overlaps between cycling formats and indicate that conceptual advancements in the development of sport, and development through sport could be collectively considered in the context of women's cycling participation. Further research opportunities were also identified.

Servant leadership and follower job performance: The mediating effect of public service motivation

This article advances our understanding of the effects of servant leadership, an employee- and community-focused leadership style, on followers' public service motivation (PSM) and job performance. Based on social learning theory, we argue that by emphasizing to their followers the importance of serving others both inside and outside the organization and by acting as role models by serving others themselves, servant leaders enhance job performance by engendering higher PSM in their followers. A multilevel analysis of three waves of multi-source data from a Chinese government agency reveals that PSM mediates the influence that servant leadership has on followers' job performance. The results are consistent with theoretical predictions that the altruistic behaviour displayed by servant leaders elicits higher levels of the altruistic behaviours that characterize PSM, which in turn increases job performance. Hence, this study contributes to our understanding of how leadership drives institutional change and performance in the public sector.

Is guanxi always good for employee self-development in China? Examining non-linear and moderated relationships

The nature of work and careers in China are constantly evolving as a result of market-oriented economic transition in the country. Increasingly, employees are required to be proactive and self-starting in skill and competency improvement for employability. Employee self-development (ESD) involves considerations embedded in a wide range of relationships including both work and non-work domains. This research draws from social exchange theory and information processing theory to investigate how guanxi, a relational phenomenon unique to traditional Chinese culture, influences ESD. Drawing from the experience of a sample (n = 404) of employees in China, an inverted U-shaped relationship between guanxi and ESD is found, suggesting that initial positive influences of guanxi on ESD diminish after reaching an inflexion point. We also found that these influences are stronger for gender congruent employee-supervisor dyads. The theoretical and managerial implications that too much guanxi is not necessarily good for ESD, particularly in the presence of gender congruence, are also discussed.

Globalization and the Public Provision of Higher Education: Empirical Evidence from Selected Countries

This research study was designed to examine the relationship between globalization as measured by the KOF index, its related forces (economic, political, cultural and technological) and the public provision of higher education. This study is important since globalization is increasingly being associated with changes in critical aspects of higher education. The public provision of education was measured by government expenditure and educational outcomes; that is participation, gender equity and attainment. The study utilized a non-experimental quantitative research design. Data collected from secondary sources for 139 selected countries was analyzed. The countries were geographically distributed and included both developed and developing countries. The choice of countries for inclusion in the study was based on data availability. The data, which was sourced from international organizations such as the United Nations and the World Bank, were examined for different time periods using five year averages. The period covered was 1970 to 2009. The relationship between globalization and the higher education variables was examined using cross sectional regression analysis while controlling for economic, political and demographic factors. The major findings of the study are as follows. For the two spending models, only one revealed a significant relationship between globalization and education with the R2 s ranging from .222 to .448 over the period. This relationship was however negative indicating that as globalization increased, spending on higher education declined. However, for the education outcomes models, this relationship was not significant. For the sub-indices of globalization, only the political dimension showed significance as shown in the spending model. Political globalization was significant for six periods with R2 s ranging from .31 to .52. The study concluded that the results are mixed for both the spending and outcome models. It also found no robust effects of globalization on government education provision. This finding is not surprising given the existing literature which sees mixed results on the social impact of globalization.

A study of employee affective organisational commitment and retention in Pakistan:the roles of psychological contract breach and norms of reciprocity

Social exchange theory and notions of reciprocity have long been assumed to explain the relationship between psychological contract breach and important employee outcomes. To date, however, there has been no explicit testing of these assumptions. This research, therefore, explores the mediating role of negative, generalized, and balanced reciprocity, in the relationships between psychological contract breach and employees’ affective organizational commitment and turnover intentions. A survey of 247 Pakistani employees of a large public university was analyzed using structural equation modeling and bootstrapping techniques, and provided excellent support for our model. As predicted, psychological contract breach was positively related to negative reciprocity norms and negatively related to generalized and balanced reciprocity norms. Negative and generalized (but not balanced) reciprocity were negatively and positively (respectively) related to employees’ affective organizational commitment and fully mediated the relationship between psychological contract breach and affective organizational commitment. Moreover, affective organizational commitment fully mediated the relationship between generalized and negative reciprocity and employees’ turnover intentions. Implications for theory and practice are discussed.

Representera och bli representerad : Elever med religiös positionering talar om skolans religionskunskapsundervisning

Hur kan lärare på bästa sätt möta elever med religiös positionering i religionskunskapsklassrummet?  Hur kan undervisningen utformas för att ge religiösa traditioner en framställning som elever med religiös positionering kan acceptera, relatera till och kanske också lära nytt av? Den här religionsdidaktiska studien handlar om hur elever som positionerar sig inom muslimsk, kristen, buddhistisk och judisk tradition talar om skolans religionskunskapsundervisning. Studien berör tre teman. För det första undersöks mötet mellan undervisningsinnehåll och elevernas erfarenheter av sin egen religiösa tradition och tro. För det andra riktas uppmärksamheten mot hur eleverna talar om sina erfarenheter av att vara eller att förväntas vara representant för sin egen tradition i undervisningen. Ett tredje tema handlar om hur eleverna beskriver ramar och förutsättningar för religionskunskapsundervisningen. Intervjumaterialet har analyserats med hjälp av kritisk diskursanalys. Resultaten visar bland annat att eleverna har svårt att känna igen och relatera till sin egen tradition i undervisningen. De befarar att undervisningen snarare förstärker än dekonstruerar stereotypa föreställningar om religion och religiöst liv. 

If we can't have it, then no one should : Shutting down versus selling in family business portfolios

How does a business family manage its business portfolio in times of declining performance to sustain the portfolio's long-term endurance? Drawing on social identity theory and six family business portfolios from Pakistan, we find that business families may prefer to shut down a satellite business rather than sell it, which is primarily driven by identity considerations. In addition, the family's goal to recycle the assets, the aim to restart the business later, and the increasing decline in performance are important contingency factors. This study contributes to the literature on portfolio entrepreneurship, business exit, and the enduring entrepreneurship of family firms.

Remotely delivered exercise-based cardiac rehabilitation: design and content development of a novel mHealth platform

BACKGROUND: Participation in traditional center-based cardiac rehabilitation exercise programs (exCR) is limited by accessibility barriers. Mobile health (mHealth) technologies can overcome these barriers while preserving critical attributes of center-based exCR monitoring and coaching, but these opportunities have not yet been capitalized on.

OBJECTIVE: We aimed to design and develop an evidence- and theory-based mHealth platform for remote delivery of exCR to any geographical location.

METHODS: An iterative process was used to design and develop an evidence- and theory-based mHealth platform (REMOTE-CR) that provides real-time remote exercise monitoring and coaching, behavior change education, and social support.

RESULTS: The REMOTE-CR platform comprises a commercially available smartphone and wearable sensor, custom smartphone and Web-based applications (apps), and a custom middleware. The platform allows exCR specialists to monitor patients' exercise and provide individualized coaching in real-time, from almost any location, and provide behavior change education and social support. Intervention content incorporates Social Cognitive Theory, Self-determination Theory, and a taxonomy of behavior change techniques. Exercise components are based on guidelines for clinical exercise prescription.

CONCLUSIONS: The REMOTE-CR platform extends the capabilities of previous telehealth exCR platforms and narrows the gap between existing center- and home-based exCR services. REMOTE-CR can complement center-based exCR by providing an alternative option for patients whose needs are not being met. Remotely monitored exCR may be more cost-effective than establishing additional center-based programs. The effectiveness and acceptability of REMOTE-CR are now being evaluated in a noninferiority randomized controlled trial.