bluuebunny/crossref_metadata_2025 huggingface dataset:
Maria's Burden: Contract Cleaning and the Crisis of Social Reproduction in Post‐apartheid South Africa
Authors: Bezuidenhout Andries , Fakier Khayaat
Published: June 2006

The life of Maria Dlamini, a contract cleaner at the University of the Witwatersrand, is used to explore continuities and discontinuities between the apartheid labour regime and the neoliberal, post‐apartheid order in South Africa. As South African institutions have adopted neoliberal market strategies, the growth in the contracting‐out of cleaning has intensified work and reduced wages and benefits for many workers. Significantly, as was the case with the migrant labor system under apartheid, it has also increasingly displaced the burden of social reproduction onto the households and communities of the working poor. Whereas the racial spatial order under apartheid was dictated by national‐level political decisions, through use of the concept of “boundary drawing”, we show how the language of the market justifies new exclusions based upon the micro‐politics of the “rational” restructuring of institutions such as universities.
Restructuring the Architecture of State Regulation in the Australian and Aotearoa/New Zealand Cleaning Industries and the Growth of Precarious Employment
Authors: Ryan Shaun , Herod Andrew
Published: June 2006

This paper examines changes in the commercial cleaning industry in Australasia which are occurring against a backdrop of significant transformation in the mode of labour market regulation in both countries. Specifically, whereas for most of the twentieth century both Aotearoa/New Zealand and Australia had systems of labour market regulation in which the state provided minimum wage and work protections through the interventions of arbitration courts, in the past few years these courts have either been abolished (in the case of New Zealand) or severely restricted in their ambit (in the case of Australia), all as part of a neoliberal effort to introduce “flexibility” into labour markets. The result has been an erosion of wages and a worsening of conditions of employment for cleaners and many other groups of workers. At the same time, this transformation in the architecture of labour market regulation poses significant challenges to unions seeking to represent cleaners and other low‐paid service sector workers.
Manufacturing Modernity: Cleaning, Dirt, and Neoliberalism in Chile
Authors: Tomic Patricia , Trumper Ricardo , Dattwyler Rodrigo Hidalgo
Published: June 2006

Since the coming to power in 1973 of the military dictatorship of General Augusto Pinochet, neoliberalism in Chile has been discursively tied to the goal of “modernizing” Chilean society. This discourse of modernization has relied for its articulation upon another important discourse, that of “cleanliness” as a marker of progress: clean spaces are seen as those of modernity whereas dirty spaces are taken to represent social and economic “backwardness”. In this paper, then, we explore how spaces which are considered emblematic of the modern economy—shopping malls, giant office complexes, university campuses—are maintained as clean spaces. However, in order for the discourse of cleanliness as modernity to work, it is crucial that the corridors of mobility—train routes, subways, city streets—which allow passage between these nodes of the modern economy also be maintained as sanitary spaces. The result is the construction discursively of an almost seamless nexus of hygienic spaces, one which stands in contrast to the dirty spaces of the “other” Chile. The paradox in all of this, however, is that the workers who are crucial to this project—janitors—have suffered greatly as a result of neoliberalism.
The Cleaners You Aren’t Meant to See: Order, Hygiene and Everyday Politics in a Bangkok Shopping Mall
Authors: Brody Alyson
Published: June 2006

Although thousands of rural Thai migrants to Bangkok are employed as janitors, to date little research has been conducted on this industry. This paper addresses this lacuna by providing a detailed ethnography of working practices among cleaners in a Bangkok shopping mall, focusing upon how ideas of hygiene, order, and discipline are used to construct a “modern” janitorial workforce. The paper discusses the significance of these qualities in terms of a broader plan to “civilize” rural Thais, itself part of a wider project to foster rapid economic growth and bring global recognition to Thailand. Finally, by focusing on the small freedoms they seek as part of a “hidden transcript” of everyday resistance, the paper considers the cleaners’ responses to attempts to “modernize” and “civilize” them through rules aimed at limiting their movements and proscribing their behaviors in the mall.
Cleaning Up After Globalization: An Ergonomic Analysis of Work Activity of Hotel Cleaners
Authors: Seifert Ana María , Messing Karen
Published: June 2006

Hotels and hotel chains are responding to globalization and increased competition through new marketing initiatives, employment practices, and restructuring decisions that are intensifying the work of cleaners. In this paper, we report on how such work intensification at two hotels in Montréal, Canada, is changing the nature of cleaners’ jobs. Specifically, we found that the numbers of operations to be completed, the numbers and weights of items to be cleaned, and the effort involved have all increased. “Flexible” employment relationships and outsourcing have also worsened cleaners’ workloads. In response to our research, the labour union representing cleaners has negotiated a lower number of room assignments per cleaner, as well as an improved way of taking into account the variability of work when determining the quota of rooms to be cleaned. Despite this, new marketing strategies continue to intensify work. We conclude that standards and regulation on a governmental level are a necessary complement to union actions.
Justice for Janitors: Scales of Organizing and Representing Workers
Authors: Savage Lydia
Published: June 2006

Low levels of unionization in the United States have led to much attention being devoted recently to the development of new models of organizing workers. In contrast to those which dominated for most of the past half century, the models currently being embraced by many labor leaders are typically grassroots and bottom‐up in nature and call for a high level of participation by rank‐and‐file workers. The Justice for Janitors (JfJ) campaign is an example of just such a model, one which has been widely lauded for its innovativeness and success. However, whereas the campaign is often thought of as representing a highly decentralized approach to organizing because of the sensitivity it pays to local labor market conditions, the Service Employees’ International Union which developed it has recently called for a concentration of power in a small number of national union bodies. This has raised questions about the geographical scale at which power should rest within the union movement and how to develop organizing strategies which are locally sensitive yet also capable of challenging nationally and/or globally organized firms.
Systematic review: the safety and tolerability of pharmacological agents for treatment of irritable bowel syndrome – a European perspective
Authors: HEADING R. , BARDHAN K. , HOLLERBACH S. , LANAS A. , FISHER G.
Published: June 2006

Aim

To use an evidence‐based approach to evaluate the safety and tolerability of the treatments available for irritable bowel syndrome (IBS), or in clinical development, in Europe. A separate review appraises the evidence for the efficacy of these therapies.

Methods

A literature search (for 1980 to 2005) was completed for all relevant clinical trial data and other articles which included safety information on the use of pharmacological IBS therapies. Clinical trials were scored according to the level of safety information, and adverse event incidence reported when possible.

Results

The tolerability of many of the agents used to treat IBS in Europe is poorly understood. However, serotonergic agents, such as tegaserod and alosetron, which are currently unavailable in Europe, have undergone rigorous assessment in IBS and their benefits have been established. Following initial marketing of alosetron for use in patients with IBS with diarrhoea, concerns about severe constipation and ischaemic colitis resulted in restriction of its use to women with severe IBS symptoms. This highlights the importance of post‐marketing surveillance and post‐marketing studies in refining the therapeutic indication of new IBS therapies, which will help to identify appropriate recipients for the drug and establish the impact of adverse reactions in clinical practice.

Conclusions

There is a significant lack of data on the safety and tolerability of the therapies currently used routinely to treat IBS in Europe. The newer agents have undergone rigorous assessment, such that their benefits and risks in treating IBS are established. Defining their place among the spectrum of available therapies remains challenging when the benefits and risks of the older treatments are so poorly characterized.
Systematic review: the efficacy of treatments for irritable bowel syndrome – a European perspective
Authors: TACK J. , FRIED M. , HOUGHTON L. A. , SPICAK J. , FISHER G.
Published: June 2006

Background

Irritable bowel syndrome (IBS) is a common, chronic disorder, characterized by abdominal pain/discomfort, bloating and altered bowel habit.

Aim

To conduct a systematic evidence‐based review of pharmacological therapies currently used, or in clinical development, for the treatment of IBS in Europe. The safety and tolerability of these therapies are the subject of an accompanying review.

Methods

A literature search was completed for randomized controlled studies which included adult patients with IBS and an active or placebo control, assessed IBS symptoms, and were published in English between January 1980 and June 2005. The level of evidence for efficacy was graded according to the quality of the trial design and the study outcome.

Results

There is some evidence for improvement of individual IBS symptoms with antidiarrhoeals (diarrhoea), antispasmodics (abdominal pain/discomfort), bulking agents (constipation), tricyclic antidepressants (abdominal pain/discomfort) and behavioural therapy. In contrast, there is strong evidence for the improvement of global IBS symptoms with two new serotonergic agents: the 5‐HT4 selective agonist tegaserod (IBS with constipation) and the 5‐HT3 antagonist alosetron (IBS with diarrhoea). Further data are required for the 5‐HT3 antagonist, cilansetron, and the mixed 5‐HT3antagonist/5‐HT4 agonist renzapride before their utility in IBS can be appraised.

Conclusions

There is limited evidence for the efficacy, safety and tolerability of therapies currently available in Europe for the treatment of IBS. Overall, there is an absence of pharmacological agents licensed specifically for the treatment of IBS subtypes, and new agents are awaited in Europe that will allow changes in clinical practice to focus on and improve global IBS symptoms.
Significance of Rome II‐defined functional constipation in Taiwan and comparison with constipation‐predominant irritable bowel syndrome
Authors: LU C.‐L. , CHANG F.‐Y. , CHEN C.‐Y. , LUO J.‐C. , LEE S.‐D.
Published: June 2006

>Background

The epidemiology and impact of functional constipation on Asians remain unclear.

>Aim

To determine the prevalence of functional constipation, its social/medical impact, and its distinction from constipation‐predominant irritable bowel syndrome (C‐IBS) in Taiwan.

>Methods

A Rome II questionnaire was administered to an apparently healthy adult Chinese population (n = 2865).

>Results

The prevalence of functional constipation was 8.5% and it was 2.7% for C‐IBS. The functional constipation subjects were predominantly female and had excessive gastrointestinal‐related doctor visits, absenteeism and sleep disturbance compared with controls (P < 0.01). Among functional constipation subjects, approximately 40% were ‘consulters’ with excessive doctor consultations, absenteeism and sleep disturbance. Female gender, the presence of sleep difficulty and higher constipation symptom scores were predictive of their consultation behaviour (P < 0.05). No differences existed in demographic variables, doctor consultations and absenteeism between 172 functional constipation and 54 C‐IBS subjects. However, the C‐IBS subjects experienced more severe constipation symptoms and sleep disturbance than functional constipation subjects.

>Conclusions

Functional constipation in Taiwan is comparable with that in other countries. The clinical presentation of constipation‐predominant irritable bowel syndrome differ somewhat from that of functional constipation.
Meta‐analysis: antioxidant supplements for primary and secondary prevention of colorectal adenoma
Authors: BJELAKOVIC G. , NAGORNI A. , NIKOLOVA D. , SIMONETTI R. G. , BJELAKOVIC M. , GLUUD C.
Published: June 2006

Background

Colorectal cancer may be prevented by reducing the development of adenomatous polyps.

Aim

To assess the benefits and harms of antioxidant supplements in preventing colorectal adenoma.

Methods

Using the Cochrane Collaboration methodology we reviewed all randomized clinical trials comparing antioxidant supplements with placebo or no intervention. We searched electronic databases and the reference lists until October 2005. Outcome measures were development of colorectal adenoma adverse events. We analysed dichotomous outcomes with fixed‐ and random‐effects model meta‐analyses and calculated the relative risk with 95% confidence interval.

Results

We identified eight randomized trials (17 620 participants). Neither fixed‐effect (relative risk: 0.93, 95% CI: 0.81–1.1) nor random‐effect model meta‐analyses (0.82, 0.60–1.1) showed statistically significant effects of supplementation with β‐carotene, vitamins A, C, E and selenium alone or in combination. Antioxidant supplements seemed to increase the development of colorectal adenoma in three low‐bias risk trials (1.2, 0.99–1.4) and significantly decrease its development in five high‐bias risk trials (0.59, 0.47–0.74). The estimates difference is significant (P < 0.0001). There was no significant difference between the intervention groups regarding adverse events, including mortality (0.82, 0.47–1.4).

Conclusion

We found no convincing evidence that antioxidant supplements have significant beneficial effect on primary or secondary prevention of colorectal adenoma.
Systematic review: sphincter of Oddi dysfunction – non‐invasive diagnostic methods and long‐term outcome after endoscopic sphincterotomy
Authors: SGOUROS S. N. , PEREIRA S. P.
Published: June 2006

Background

Sphincter of Oddi dysfunction is a benign, functional gastrointestinal disorder for which invasive endoscopic therapy with potential complications is often recommended.

Aims

To review the available evidence regarding the diagnostic accuracy of non‐invasive methods that have been used to establish the diagnosis and to estimate the long‐term outcome after endoscopic sphincterotomy.

Methods

A systematic review of English language articles and abstracts containing relevant terms was performed.

Results

Non‐invasive diagnostic methods are limited by their low sensitivity and specificity, especially in patients with Type III sphincter of Oddi dysfunction. Secretin‐stimulated magnetic resonance cholangiopancreatography appears to be useful in excluding other potential causes of symptoms, and morphine‐provocated hepatobiliary scintigraphy also warrants further study. Approximately 85%, 69% and 37%, of patients with biliary Types I, II and III sphincter of Oddi dysfunction, respectively, experience sustained benefit after endoscopic sphincterotomy. In pancreatic sphincter of Oddi dysfunction, approximately 75% of patients report symptomatic improvement after pancreatic sphincterotomy, but the studies have been non‐controlled and heterogeneous.

Conclusions

Patients with suspected sphincter of Oddi dysfunction, particularly those with biliary Type III, should be carefully evaluated before considering sphincter of Oddi manometry and endoscopic sphincterotomy. Further controlled trials are needed to justify the invasive management of patients with biliary Type III and pancreatic sphincter of Oddi dysfunction.
Early treatment with ursodeoxycholic acid for cholestasis in children on parenteral nutrition because of primary intestinal failure
Authors: DE MARCO G. , SORDINO D. , BRUZZESE E. , DI CARO S. , MAMBRETTI D. , TRAMONTANO A. , COLOMBO C. , SIMONI P. , GUARINO A.
Published: June 2006

Background

There is conflicting evidence as to whether ursodeoxycholic acid (UDCA) reduces the incidence of parenteral nutrition‐associated cholestasis.

Aim

To investigate the efficacy of UDCA on parenteral nutrition‐associated cholestasis in children with intestinal failure due to short bowel syndrome or to other causes.

Methods

Children with cholestasis received 30 mg/kg/day UDCA. Improvement or normalization of parenteral nutrition‐associated cholestasis was evaluated at 6 months of therapy and at the last follow‐up. In a subgroup of children, serum UDCA levels were measured while receiving UDCA and after 4 weeks withdrawal.

Results

Twelve children were treated with UDCA. Full remission or partial improvement of parenteral nutrition‐associated cholestasis occurred in 11 of 12 children. In three of four children, withdrawal of UDCA was associated with a rebound rise of cholestasis. Only one of 12 treated children showed no improvement and in this patient, in contrast to four other patients, plasma levels of UDCA did not increase during treatment.

Conclusions

Ursodeoxycholic acid was effective in controlling parenteral nutrition‐associated cholestasis. The efficacy of UDCA also in children with short bowel is related to intestinal absorption.
Prospective assessment of the impact of feedback on colonoscopy performance
Authors: HAREWOOD G. C. , PETERSEN B. T. , OTT B. J.
Published: June 2006

Background

Colonoscopy is an operator‐dependent procedure. The medical literature describes disparity in colonoscopy performance with respect to polyp detection, caecal intubation rates and procedural times.

Aim

To assess prospectively the impact of feedback among a large cohort of colonoscopists on three performance parameters: caecal intubation rate, insertion time and withdrawal time.

Method

In a prospective clinical study, procedural data from all out‐patient colonoscopies performed by attending gastroenterologists at our institution were recorded routinely in a computerized database. Enhanced serial feedback was provided on a quarterly basis for three procedure parameters: intubation to caecum, insertion time and withdrawal time. Feedback (absolute value, % rank and group distribution) was sent by email every 3 months beginning with January 2005 feedback for all of 2004, and subsequently quarterly in April 2005 (for January–March 2005), July 2005 (for April–June 2005) and October 2005 (for July–September 2005).

Results

Feedback was provided to 58 endoscopists with a median experience level of 8 years. There was a relative decline of 19% in incomplete procedures, with median caecal non‐intubation rates decreasing from 4.7% to 3.8% following the introduction of feedback while median insertion times declined from 10.6 to 9.5 mins, P = 0.02. Median withdrawal times did not change significantly, 9.1–8.9 mins, P = 0.6.

Conclusions

Feedback by email appears to improve colonoscopy performance, enhancing completion rates and shortening insertion times without compromising withdrawal times.
Papillotomy Performance Scoring Scale – a pilot validation study focused on the cut axis
Authors: LEUNG J. W. , LEUNG F. W.
Published: June 2006

Background

No published Papillotomy Performance Scoring Scale exists.

Aims

To develop such a scale and to apply it to stratify the quality of performance of recorded papillotomies.

Method

Expert biliary endoscopists were polled regarding their opinion of a ‘perfect’ biliary papillotomy and experience with complications in relation to the cut axis. Based on these responses a scoring scale encompassing two components – wire alignment and cut orientation, was proposed. This scoring scale was presented to experienced and trainee endoscopists, who scored recording of five biliary papillotomies. The mean final combined score was used for stratification.

Results

The experts’ opinion of a ‘perfect’ biliary papillotomy is one cut along the axis of the distal bile duct and papilla. Their reported experience with complications occurring outside of the perfect axis validated their consensus. Application of the scoring scale stratified recorded papillotomies based on the mean final combined scores.

Conclusions

These pilot data support the hypothesis that a scoring scale focused on the cut axis can be constructed based on expert opinion, experience and consensus. The possibility of stratification of mean final combined scores that are significantly different validates application of the scoring scale for assessment of papillotomy performance.
Healthcare seeking for constipation: a population‐based survey in the Mediterranean area of Spain
Authors: GÁLVEZ C. , GARRIGUES V. , ORTIZ V. , PONCE M. , NOS P. , PONCE J.
Published: June 2006

Background

The use of healthcare resources for the management of constipation is not well‐known.

Aim

To analyse healthcare seeking for constipation, defined by three different criteria, and its related factors and to assess the frequency of use of laxatives, suppositories and enemas for the treatment of constipation.

Methods

A cross‐sectional study in the general community. A questionnaire comprising 21‐items was developed and delivered by mail to a random sample of 506 subjects aged 18–65 years, and belonging to a Spanish population.

Results

Seeking of health care was high in the sample (16%) and was similar for all definitions of constipation (over 40% of constipated subjects). It was associated with female gender, a higher educational level and two symptoms, such as prolonged defecation and abdominal pain. A 14% of the sample used laxatives, and about a 25% of constipated subjects used laxatives at least once a week. Utilization was more frequent in women, with no differences by age group.

Conclusions

Chronic constipation is a problem that causes an important consumption of resources in our setting, derived from laxative use and the seeking of medical help to combat the problem. The use of these resources is higher in women.
Persistence and adherence to proton pump inhibitors in daily clinical practice
Authors: VAN SOEST E. M. , SIERSEMA P. D. , DIELEMAN J. P. , STURKENBOOM M. C. J. M. , KUIPERS E. J.
Published: June 2006

Background

Proton pump inhibitors are widely used, but little is known about the usage pattern in different indications.

Aim

To analyse proton pump inhibitor usage patterns in the general population.

Methods

A cohort of 16 311 incident proton pump inhibitor users was identified in the Integrated Primary Care Information database, a Dutch general practice research database. Persistence and adherence were calculated by indication. Risk factors were identified by logistic regression analysis.

Results

One‐year persistence was 31% in patients using proton pump inhibitors for gastro‐oesophageal reflux. Persistence was higher in oesophagitis grade A/B (54%), grade C/D (73%) and Barrett's oesophagus (72%), compared to patients with only reflux symptoms (27%). Approximately 25% of patients with non‐reflux dyspepsia or Helicobacter pylori‐associated indications used proton pump inhibitors for more than 6 months. Half of all patients used proton pump inhibitors <80% of time indicating intermittent use, which was independent of indication. Exception were patients with Barrett's oesophagus, who were most adherent.

Conclusions

A substantial proportion of patients with indications not requiring long‐term treatment use proton pump inhibitors for an extended period. Half of the patients used proton pump inhibitors on‐demand or intermittently. Such usage pattern is probably sufficient for most patients, but may be inadequate if proton pump inhibitors are used for serious diseases, such as severe oesophagitis or Barrett's oesophagus.
Predictors of treatment response in patients with non‐erosive reflux disease
Authors: TALLEY N. J. , ARMSTRONG D. , JUNGHARD O. , WIKLUND I.
Published: June 2006

Background

Up to 40% of patients with non‐erosive reflux disease (NERD) fail to respond to proton pump inhibitor therapy.

Aim

To determine useful prognostic factors for response to and suppression in NERD.

Methods

A pooled analysis from three multicentre, double‐blind trials of patients with a normal endoscopy and heartburn for 4 days or more during the 7 days prior to the start of each treatment. Patients received omeprazole 20 mg, esomeprazole 20 mg or esomeprazole 40 mg/day for 4 weeks. Complete resolution of heartburn was defined as no heartburn during the last week.

Results

Of 2458 patients included, complete heartburn resolution was achieved in 63% at the end of 4 weeks treatment. Response on days 5–7 provided an 85% probability of complete resolution of heartburn at 4 weeks; the probability of complete heartburn resolution at 4 weeks in those with moderate to severe symptoms on days 5–7 was 22%. Sensitivity and specificity of no heartburn on days 5–7 was 55% and 83% respectively. Patient demographics, duration of symptoms, medications used, other symptoms and body mass index were not predictors.

Conclusion

Assessment of heartburn resolution during the first week of therapy was the best predictor of treatment success at 4 weeks in non‐erosive reflux disease, but was suboptimal as a test.
Review article: the pathogenesis and management of eosinophilic oesophagitis
Authors: FURUTA G. T. , STRAUMANN A.
Published: June 2006

Background

Eosinophilic oesophagitis is a clinicopathological disease affecting both children and adults that is characterized by symptoms of gastro‐oesophageal reflux disease (feeding refusal, vomiting, heartburn, dysphagia and food impaction) and dense oesophageal eosinophilia both of which are unresponsive to proton pump inhibition.

Aim

To present a review of the recent literature examining the pathogenesis and treatments of eosinophilic oesophagitis.

Methods

We performed a PubMed search for eosinophilic oesophagitis, pathogenesis and treatments.

Results

Translational and basic studies suggest that this disease is sparked by food or by aeroallergens. To date, effective treatments include systemic/topical corticosteroids, specific food elimination or an elemental diet. While several studies identified oesophageal strictures as potential complications of unbridled eosinophilia, the natural history of the disease is still not certain. Recent studies suggest a role for interleukin‐5 and eotaxin‐3 in the pathogenesis of eosinophilic oesophagitis and suggest an impact of future targeted therapeutic agents.

Conclusions

Eosinophilic oesophagitis represents a immune‐mediated disease of undetermined pathogenesis. While many patients develop clinicopathological findings following ingestion of foods, others do not. Natural history studies will be critical to defining future treatment paradigms.
Validation of administrative data used for the diagnosis of upper gastrointestinal events following nonsteroidal anti‐inflammatory drug prescription
Authors: ABRAHAM N. S. , COHEN D. C. , RIVERS B. , RICHARDSON P.
Published: June 2006

Aims

To validate veterans affairs (VA) administrative data for the diagnosis of nonsteroidal anti‐inflammatory drug (NSAID)‐related upper gastrointestinal events (UGIE) and to develop a diagnostic algorithm.

Methods

A retrospective study of veterans prescribed an NSAID as identified from the national pharmacy database merged with in‐patient and out‐patient data, followed by primary chart abstraction. Contingency tables were constructed to allow comparison with a random sample of patients prescribed an NSAID, but without UGIE. Multivariable logistic regression analysis was used to derive a predictive algorithm. Once derived, the algorithm was validated in a separate cohort of veterans.

Results

Of 906 patients, 606 had a diagnostic code for UGIE; 300 were a random subsample of 11 744 patients (control). Only 161 had a confirmed UGIE. The positive predictive value (PPV) of diagnostic codes was poor, but improved from 27% to 51% with the addition of endoscopic procedural codes. The strongest predictors of UGIE were an in‐patient ICD‐9 code for gastric ulcer, duodenal ulcer and haemorrhage combined with upper endoscopy. This algorithm had a PPV of 73% when limited to patients ≥65 years (c‐statistic 0.79). Validation of the algorithm revealed a PPV of 80% among patients with an overlapping NSAID prescription.

Conclusions

NSAID‐related UGIE can be assessed using VA administrative data. The optimal algorithm includes an in‐patient ICD‐9 code for gastric or duodenal ulcer and gastrointestinal bleeding combined with a procedural code for upper endoscopy.
Disturbed bowel habits in patients with non‐ulcer dyspepsia
Authors: HAMMER J. , TALLEY N. J.
Published: June 2006

Background

Emerging medications for non‐ulcer‐dyspepsia, such as the serotonin‐receptor modulators, also affect bowel habits by altering colonic transit. If drugs that alter colonic function were to prove useful in non‐ulcer dyspepsia, knowledge of baseline bowel habit disturbances would be potentially critical.

Aim

To estimate the rate of non‐ulcer dyspepsia patients with clinically relevant constipation or diarrhoea potentially precluding use of motility agents.

Methods

Consecutive patients with non‐ulcer dyspepsia (n = 79), gastro‐oesophageal reflux disease (n = 135) and organic upper gastrointestinal disease (upper gastrointestinal disease; n = 36) completed a validated symptom questionnaire evaluating predominant bowel habits in the last year.

Results

Prevalence of constipation was higher in non‐ulcer dyspepsia (34%) than in gastro‐oesophageal reflux disease (P = 0.01) and organic upper gastrointestinal disease (P = 0.01), prevalence of alternating diarrhoea/constipation (24%) and diarrhoea (22%) was similar, while prevalence of normal bowel habits was significantly less in non‐ulcer dyspepsia (20%; P = 0.01 vs. gastro‐oesophageal reflux disease and P < 0.01 vs. organic upper gastrointestinal disease). Constipation was particularly frequent in ulcer‐like and dysmotility‐like non‐ulcer dyspepsia, while prevalence of diarrhoea was lowest in dysmotility‐like non‐ulcer dyspepsia. A normal bowel habit was equally uncommon in male (21%) and female non‐ulcer dyspepsia patients (20%).

Conclusions

Only one of five non‐ulcer dyspepsia patients had normal bowel habits based on clinical symptoms; constipation is particularly prevalent. Patients with functional dyspepsia who are prescribed motility altering drugs should be evaluated by taking a thorough bowel habit history.
Systematic review: the impact of gastro‐oesophageal reflux disease on work productivity
Authors: WAHLQVIST P. , REILLY M. C. , BARKUN A.
Published: June 2006

Background

Gastro‐oesophageal reflux disease has wide‐ranging effects on patients’ lives.

Aim

To review systematically the effects of gastro‐oesophageal reflux disease on work productivity.

Methods

Studies of gastro‐oesophageal reflux disease and work productivity were identified in a systematic literature search and their results were valued in US dollars using the human capital method. Work productivity loss was defined as absence from work (absenteeism) plus reduced effectiveness while working (presenteeism).

Results

Eight eligible studies were included. Reported work productivity loss among individuals with gastro‐oesophageal reflux disease ranged from 6% to 42% and was primarily because of presenteeism (6–40%) rather than absenteeism (<1% to 7%). Reported losses were greatest in patients experiencing sleep disturbance because of gastro‐oesophageal reflux disease, and lowest in individuals from the general population taking appropriate prescription medication. Work productivity impairment correlated with symptom severity and responded to acid‐suppressive therapy. Assuming a 40‐h working week and average wages in the US, the weekly mean productivity loss per employee with gastro‐oesophageal reflux disease can be estimated between 2.4 ($62) and 16.6 h ($430), depending on the population studied.

Conclusions

Gastro‐oesophageal reflux disease has a substantial impact on employee productivity, primarily by impairing productivity while working. Further studies are needed to confirm that this impact can be decreased by acid‐suppressive therapy.
The impact of organ failures and their relationship with outcome in intensive care: analysis of a prospective multicentre database of adult admissions
Authors: Nfor T. K. , Walsh T. S. , Prescott R. J.
Published: June 2006

The database of a multicentre cohort study was analysed to determine the impact of intensive care unit (ICU) organ failures and their association with ICU mortality using sequential organ failure assessment (SOFA). A consecutive sample of 873 adult patients with a non‐neurological diagnosis was identified. SOFA scores were measured every 24 h of ICU stay. The odds of ICU death within 7 days doubled (95% CI 1.3–2.9) for a 5‐unit increase in total SOFA score at admission, p < 0.001. However ICU death after 7 days was not associated with total SOFA score at admission, p = 0.36. Compared to patients with a day 6 total SOFA score = 5, there was a 1‐unit (95% CI 0.8–3.1) increase in the odds ratio of ICU death after 7 days with every 5‐unit increase in SOFA score on day 6, p = 0.009. Continuous assessments of organ failures during an ICU admission are more useful than scores measured at admission to determine outcome and to compare ICUs.
Basic airway management by junior doctors: assessment and training on human apnoeic subjects in the anaesthetic room*
Authors: Kidner K. , Laurence A. S.
Published: June 2006

We assessed the airway management skills of 20 junior doctors on patients in the anaesthetic room, using a self‐inflating bag with digital flowmeter to measure exhaled tidal volume. Following induction of anaesthesia the junior doctor attempted to ventilate the patient's lungs with five breaths. If two of these breaths were > 250 ml the assessment was completed. If not, a period of instruction was given followed by a further five‐breath assessment. Eight doctors did not need further training; of these, six were senior house officers and seven had been on an Advanced Life Support course. Twelve doctors required instruction and re‐assessment. Four were senior house officers and two had been on an Advanced Life Support course. They showed some improvement following the instruction period but never reached the standard of the other eight. Validated courses improve resuscitation skills but hands‐on training in the anaesthetic room can also be of benefit in maintaining these skills.
The effect of peribulbar block with ropivacaine on bi‐hemispheric cerebral oxygen saturation in aged patients
Authors: Fodale V. , Di Pietro R. , Ferreri F. , Tescione M. , Russo G. , Santamaria S. , Praticò C.
Published: June 2006

We evaluated the effects of peribulbar block for eye surgery on bi‐hemispheric regional cerebral oxygenation (rSO2) of aged patients. In 66 adult patients, peribulbar block was performed using ropivacaine 10 mg.ml−1 with hyaluronidase 100 IU.ml−1. Cerebral oxygenation was monitored using continuous non‐invasive, near‐infrared spectroscopy. The rSO2 data on the side where the eye block was performed were evaluated as eye block side values, whereas the data recorded on the other side were taken as control values. Mean rSO2 values on the side where regional block was performed were not significantly different from control values (p > 0.05). Nevertheless, in several patients, a slight desaturation in the cerebral hemisphere on the block side was detected. Therefore, in aged patients, peribulbar block with ropivacaine does not significantly modify bi‐hemispheric rSO2, but rSO2 monitoring during peribulbar block should be a field of future research in aged patients with brain injury or disease.
Monitoring cardiac output using the femoral and radial arterial pressure waveform
Authors: De Wilde R. B. P. , Breukers R. B. G. E. , Van Den Berg P. C. M. , Jansen J. R. C.
Published: June 2006

This study was performed to determine the interchangeability of femoral artery pressure and radial artery pressure measurements as the input for the PiCCO system (Pulsion Medical Systems, Munich, Germany). We studied 15 intensive care patients following cardiac surgery. Five‐second averages of the cardiac output derived from the femoral artery pressure (COfem) were compared to 5‐s averages derived from the radial artery pressure (COrad). One patient was excluded due to problems in the pattern recognition of the arterial pressure signal. In the remaining 14 patients, 14 734 comparative cardiac output values were analysed. The mean sample time was 88 min, range [30–119 min]. Mean (SD) COfem was 6.24 (1.1) l.min−1 and mean COrad 6.23 (1.1) l.min−1. Bland‐Altman analysis showed an excellent agreement with a bias of − 0.01 l.min−1, and limits of agreement from 0.60 to − 0.62 l.min−1. If changes in CO were > 0.5 l.min−1, the direction of changes in COfem and COrad were equal in 97% of instances. We conclude that femoral artery pressure and radial artery pressure are interchangeable as inputs for the PiCCO device.
Characteristics and mortality of severe hyponatraemia – a hospital‐based study
Authors: Gill Geoffrey , Huda Bobby , Boyd Alice , Skagen Karolina , Wile David , Watson Ian , Van Heyningen Charles
Published: June 2006

Objective  To determine the characteristics, causes and outcome of severe hyponatraemia (< 125 mmol/l) in hospitalized patients, and to identify mortality predictors.

Design   Prospective case controlled study of sequentially presenting patients with a serum sodium (Na) < 125 mmol/l.

Patients and methods  One hundred and four hyponatraemic and 104 randomly chosen normonatraemic (Na > 135 mmol/l) adult patients were studied. We measured hospital mortality and days in hospital, diagnoses, drug history and cause of hyponatraemia. Na was recorded at admission, as well as the closest level measured before death or discharge. In addition, the lowest Na was recorded (if this was not at admission).

Results  Hyponatraemic patients were older (mean age ± 1 SD 69 ± 14 years) than controls (61 ± 16 years, P < 0·001), but of similar sex ratio. On admission, Na in the hyponatraemic group was 125 ± 7 mmol/l compared with 139 ± 3 mmol/l in controls (P < 0·0001), but fell to 120 ± 4 mmol/l before rising at discharge to 131 ± 7 mmol/l (all changes P < 0·001). Overall mortality was 27% in hyponatraemic patients compared with 9% in controls (P = 0·009), and length of admission was also greater (16 ± 12 vs. 13 ± 11 days, P < 0·005). Mortality was greater in patients whose Na levels fell during admission (34%vs. 16%, P < 0·05), and these patients appeared to have an excess of diuretic‐induced and possibly iatrogenic hyponatraemia.

Conclusions  Severe hyponatraemia in hospital patients is associated with prolonged admissions and significantly increased mortality compared with normonatraemic patients. A particular group at high risk of death are those whose Na levels fall after admission. They may represent a ‘sicker’ group, and deserve increased monitoring and surveillance.
Using a 1‐D mixing model to assess the potential impact of year‐to‐year changes in weather on the habitat of vendace (Coregonus albula) in Bassenthwaite Lake, Cumbria
Authors: GEORGE D. G. , BELL V. A. , PARKER J. , MOORE R. J.
Published: June 2006

1. Bassenthwaite Lake in Cumbria is one of only two English lakes containing a population of vendace (Coregonus albula). The spatial distribution and survival of this fish is strongly influenced by the temperature and oxygen content of the water. In summer, this fish moves into deeper, colder water but avoids areas where the oxygen content is low.

2. In recent years, there has been a dramatic decline in the number of vendace found in the lake, a trend that may have been exacerbated by a succession of warm summers. Bassenthwaite only becomes stably stratified during calm, warm periods when a significant proportion of the deep water becomes anoxic.

3. Here, a one dimensional (1‐D) process‐based temperature‐oxygen model is used to simulate the year‐to‐year variations in the severity of these ‘extreme events’. The model is validated using field measurements acquired in the 1990s and used to predict the range of depths accessible to the vendace.

4. An empirical, weather‐driven model is then used to ‘hindcast’ the mixing characteristics of the lake in the 1980s and estimate the proportion of the habitat lost during warm, calm summers. These simulations show that periods of stable thermal stratification have become increasingly common in recent years. In the 1980s, only one ‘extreme event’ was identified but four such events were recorded in the 1990s.

5. The results are discussed in relation to the conservation status of the species and the potential effect of climate change on its survival in the English Lake District.
Variation in probability of first reproduction of Weddell seals
Authors: HADLEY GILLIAN L. , ROTELLA JAY J. , GARROTT ROBERT A. , NICHOLS JAMES D.
Published: June 2006

For many species, when to begin reproduction is an important life‐history decision that varies by individual and can have substantial implications for lifetime reproductive success and fitness.

We estimated age‐specific probabilities of first‐time breeding and modelled variation in these rates to determine age at first reproduction and understand why it varies in a population of Weddell seals in Erebus Bay, Antarctica. We used multistate mark–recapture modelling methods and encounter histories of 4965 known‐age female seals to test predictions about age‐related variation in probability of first reproduction and the effects of annual variation, cohort and population density.

Mean age at first reproduction in this southerly located study population (7·62 years of age, SD = 1·71) was greater than age at first reproduction for a Weddell seal population at a more northerly and typical latitude for breeding Weddell seals (mean = 4–5 years of age). This difference suggests that age at first reproduction may be influenced by whether a population inhabits the core or periphery of its range.

Age at first reproduction varied from 4 to 14 years, but there was no age by which all seals recruited to the breeding population, suggesting that individual heterogeneity exists among females in this population.

In the best model, the probability of breeding for the first time varied by age and year, and the amount of annual variation varied with age (average variance ratio for age‐specific rates = 4·3%).

Our results affirmed the predictions of life‐history theory that age at first reproduction in long‐lived mammals will be sensitive to environmental variation. In terms of life‐history evolution, this variability suggests that Weddell seals display flexibility in age at first reproduction in order to maximize reproductive output under varying environmental conditions. Future analyses will attempt to test predictions regarding relationships between environmental covariates and annual variation in age at first reproduction and evaluate the relationship between age at first reproduction and lifetime reproductive success.
How the west was once: vegetation change in south‐west Queensland from 1930 to 1995
Authors: Bradd Witt G. , Luly Jon , Fairfax Russell J.
Published: June 2006

Aim  Conflicting perceptions of past and present rangeland condition and limited historical data have led to debate regarding the management of vegetation in pastoral landscapes both internationally and in Australia. In light of this controversy we have sought to provide empirical evidence to determine the trajectory of vegetational change in a semi‐arid rangeland for a significant portion of the 20th century using a suite of proxy measures.

Location  Ambathala Station, approximately 780 km west of Brisbane, in the semi‐arid rangelands of south‐western Queensland, Australia.

Methods  We excavated stratified deposits of sheep manure which had accumulated beneath a shearing shed between the years 1930 and 1995. Multi‐proxy data, including pollen and leaf cuticle analyses and analysis of historical aerial photography were coupled with a fine resolution radiocarbon chronology to generate a near annual history of vegetation on the property and local area.

Results  Aerial photography indicates that minor (< 5%) increases in the density of woody vegetation took place between 1951 and 1994 in two thirds of the study area not subjected to clearing. Areas that were selectively or entirely cleared prior to the 1950s (approximately 16% of the study area) had recovered to almost 60% of their original cover by the 1994 photo period. This slight thickening is only partially evident from pollen and leaf cuticle analyses of sheep faeces. Very little change in vegetation is revealed over the nearly 65 years based on the relative abundances of pollen taxonomic groups. Microhistological examination of sheep faeces provides evidence of dramatic changes in sheep diet. The majority of dietary changes are associated with climatic events of sustained above‐average rainfall or persistent drought. Most notable in the dietary analysis is the absence of grass during the first two decades of the record.

Main conclusions  In contrast to prevailing perceptions and limited research into long‐term vegetation change in the semi‐arid areas of eastern Australia, the record of vegetation change at the Ambathala shearing shed indicates only a minor increase in woody vegetation cover and no decrease in grass cover on the property over the 65 years of pastoral activity covered by the study. However, there are marked changes in the abundance of grass cuticles in sheep faeces. The appearance and persistence of grass in sheep diets from the late 1940s can be attributed to the effects of periods of high rainfall and possibly some clearing and thinning of vegetation. Lower stock numbers may have allowed grass to persist through later drought years. The relative abundances of major groups of plant pollen have not changed significantly over the past 65 years.
Who do they think they are? Undergraduate perceptions of the definition of supernumerary status and how it works in practice
Authors: McGowan Brian
Published: June 2006

Aims and objectives.  The aim of this study was threefold and was based on three research questions; how did students define supernumerary status, how was it implemented in practice and what effect did it have on them?

Background.  Whilst there has been much debate about supernumerary status and its value to nursing practice and education there has been little work carried out from the student's point of view.

Design.  The study was qualitative in nature.

Methods.  Focus group interviews were the method of choice based on the premise that the interaction between students/participants would generate rich experiential data.

Results.  Nine themes were generated that addressed the three questions asked. The themes to emerge from the category definition of supernumerary status were: not counted in the staff numbers and lack of student preparation. The themes to emerge from the category implementation of supernumerary status were: leadership style, experiences of mentorship, an extra pair of hands and not allowed to study. The themes to emerge from the category effect of supernumerary status were: their learning was enhanced, feelings of being used and reduction in self‐confidence.

Conclusions.  There is a need to review what is meant or indeed expected from students who are supernumerary and increased clarity is required about what it is supposed to achieve.

Relevance to clinical practice.  The status of student nurses in practice has a direct link to the quality of the work they produce. This has a domino effect that may have far reaching consequences. Making sure that they are clear about what is expected of them from the outset will reduce confusion and allow them to move forward with skills acquisition and building their experience.