The Moondance Bowel Cancer Project schools initiative.

BACKGROUND: The 5-year survival rate for bowel cancer in Wales is poor and lags behind the rest of the UK. The aim of the pilot phase of the Moondance Schools Initiative was to develop, deliver and assess a bowel cancer learning module for secondary school students in South Wales. Ultimately, we aim to introduce this programme into the National Curriculum across Wales. METHODS: Two programmes regarding bowel cancer and screening were designed and delivered to a cohort of secondary school pupils in South Wales. This involved interactive teaching with patients and clinicians, practical sessions and live-streamed videos of bowel cancer surgery. Feedback regarding the events and bowel screening was collected from students and their families. RESULTS: The programmes were delivered to 185 secondary school students and feedback was extremely positive. The students delivered a live event at the end of the programme to demonstrate their learning to their families and invited guests. Feedback from family members revealed that 100% of respondents were more likely to take a bowel screening test as a result of attending the event. CONCLUSION: This project established that a pilot to create young bowel screening ambassadors is feasible and was positively received by students, their families and the local community. Future work will disseminate the programme further and correlate changes in bowel screening participation in the local area as a result of these events.

Evidence for the ambiguity of the term constipation: the role of irritable bowel syndrome.

A satisfactory definition of constipation is elusive. An important and measurable element is slow colonic transit. Whole gut transit time, a proxy for colonic transit time, can be estimated from self recorded data on stool form and frequency. Our aim was to compare whole gut transit time with subjective definitions in the context of the general population. In a community based sample of 731 women aged 25-69 years the estimated whole gut transit time was compared with two subjective assessments of constipation-the woman's own perception and a symptom based definition proposed by an international working team (Rome definition). We have defined slow whole gut transit time as > 2 SD above the mean in women who seldom passed lumpy stools (that is, > 92 hours). Slow transit was present in 9.3% of the sample. Similar numbers met the subjective definitions (8.5% and 8.2%). However, the overlap between the three definitions was poor. Of 68 women with estimated slow transit, 28 had self perceived constipation, 20 had Rome defined constipation, and only 11 had both. Of subjects classified as constipated by the subjective definitions only 37% had slow transit; they had a high prevalence of irritable bowel symptoms. In conclusion, this study showed that the term constipation is ambiguous and often misleading and that attempts to base a definition on symptoms are misguided. In epidemiological studies, conclusions about the prevalence of constipation should be based on records of stool type and timing.

Bowel function and irritable bowel symptoms after hysterectomy and cholecystectomy--a population based study.

Because unsubstantiated beliefs link hysterectomy and cholecystectomy with bowel function, this study examined all the women who had had these operations in a defined population (79 and 37 respectively, out of 1058) with respect to bowel habits, irritable bowel syndrome symptoms, and whole gut transit time calculated from records of three defecations. Compared with unoperated controls, women after hysterectomy were more likely to consider themselves constipated; they also strained more and admitted more often to bloating and feelings of incomplete evacuation. Their stools tended to be lumpier and, in women over 50 years, transit time was longer. When women treated by cholecystectomy were compared with women having newly discovered, asymptomatic gall stones, they more often described defecation as urgent but had no other detectable differences. In conclusion symptomatic constipation is frequent in women after hysterectomy; after cholecystectomy, bowel habit is not consistently changed but the rectum seems to be more irritable.

Straining at stool and laxative taking in an English population.

A population-based sample of 834 men (ages 40-69 years) and 1058 women (25-29 years) was investigated with respect to straining to defecate, stool form, bowel habit, and use of laxatives, by means of a questionnaire and a three-stool record form. Straining was common but, contrary to standard teaching, far from universal. It was unrelated to age but was commoner in women than men. Many people underestimated how often they strained. Overall, 32% of defecations in women and 22% of defecations in men were associated with straining to start and 15% and 9%, respectively, with straining to finish. Straining was to some extent related to stool type: the lumpier a stool, the more often it elicited straining. However, it seems likely that straining in some people is just a habit. Use of laxatives was found to be less prevalent than in the past, and most people with evidence of constipation did not use them. Use of laxatives increased with age, and some older people used them inappropriately. The most popular laxatives were based on phenolphthalein, senna, or magnesium.

Defecation frequency and timing, and stool form in the general population: a prospective study.

Because the range of bowel habits and stool types in the community is unknown we questioned 838 men and 1059 women, comprising 72.2% of a random stratified sample of the East Bristol population. Most of them kept records of three consecutive defecations, including stool form on a validated six point scale ranging from hard, round lumps to mushy. Questionnaire responses agreed moderately well with recorded data. Although the most common bowel habit was once daily this was a minority practice in both sexes; a regular 24 hour cycle was apparent in only 40% of men and 33% of women. Another 7% of men and 4% of women seemed to have a regular twice or thrice daily bowel habit. Thus most people had irregular bowels. A third of women defecated less often than daily and 1% once a week or less. Stools at the constipated end of the scale were passed more often by women than men. In women of child bearing age bowel habit and the spectrum of stool types were shifted towards constipation and irregularity compared with older women and three cases of severe slow transit constipation were discovered in young women. Otherwise age had little effect on bowel habit or stool type. Normal stool types, defined as those least likely to evoke symptoms, accounted for only 56% of all stools in women and 61% in men. Most defecations occurred in the early morning and earlier in men than in women. We conclude that conventionally normal bowel function is enjoyed by less than half the population and that, in this aspect of human physiology, younger women are especially disadvantaged.

Potential availability of cadaver organs for transplantation.

OBJECTIVE: To determine the potential number of cadaver kidney donors by applying defined donor criteria to people dying in hospital. DESIGN: Prospective study of all deaths occurring in 21 hospitals from 1 September 1988 to 31 August 1989. Questionnaires were administered to medical and nursing staff and families of potential donors aged 1-69. SETTING: Acute care hospitals in Gwent, South Glamorgan, Mid Glamorgan, West Glamorgan, Pembrokeshire, and East Dyfed health authorities, serving a population of 2.2 million. MAIN OUTCOME MEASURES: Cause of death, age, ventilation at time of death, diagnosis of brain death, and consideration of consent. RESULTS: Adequate data were available for 9840 of 10,095 hospital deaths (97.5% coverage). 188 patients aged 0-69 were identified as potential organ donors (widest definition), and of these 108 died without being ventilated at the time of death. Tests of brain stem death were formally completed in 57 cases, and organ donation was considered by the families of 47 of these potential donors. 26 patients became organ donors. Patients aged 50-69 with stroke were less likely to be ventilated than those aged less than or equal to 49 (21/96 v 24/34). Families of potential donors aged 20-39 were least likely to give permission. CONCLUSIONS: The supply of donor organs (specifically kidneys) could be increased by altering the management of patients aged 50-69 dying of severe cerebrovascular disease in general medical wards, in particular by increasing the proportion ventilated. The ethics of elective ventilation for the purposes of organ donation require discussion.

Chronic physical illness in childhood: psychological and social effects in adolescence and adult life.

A national birth cohort followed for 36 years was used to compare the life chances of individuals with chronic physical illness in childhood with those of controls. The majority of those who had been chronically physically ill in childhood were found to differ very little in social and psychological circumstances by 36 years of age, but earlier in adult life there had been signs of difficulties. However, there was a disturbing tendency for those from lower social-group families to be in significantly worse social and psychological circumstances, and by 36 years they showed signs of relatively poor life chances and of basic social support, including the death of both parents.

Social and regional differences in food and alcohol consumption and their measurement in a national birth cohort.

The problem of collecting detailed dietary information on a large population scattered throughout England, Wales and Scotland was resolved by use of a 7 day dietary diary, introduced at home interviews. Information on food types and quantities was coded to provide data on a wide range of nutrients. Reported levels of iron and fibre intake were found to be particularly low in relation to current recommended daily intakes, which were more often achieved by men than by women. Best dietary habits were associated with good educational attainment, whatever the social class of origin, but in women this was in some circumstances associated also with relatively high intakes of alcohol, protein and fats. Worst dietary habits were associated with low social class of family of origin and low educational attainment. Mean intakes of some nutrients varied significantly by region, in most cases independently of class and education. The implications of these findings are discussed.

Differences between high-affinity forskolin binding sites in dopamine-rich and other regions of rat brain.

[3H]Forskolin bound to high- and low-affinity sites in the rat brain. The high-affinity site was discretely located, with highest densities in the striatum, nucleus accumbens, olfactory tubercule, substantia nigra, hippocampus, and the molecular layers of the cerebellum. This site did not correlate well with the distribution of adenylate cyclase. The high-affinity striatal binding site may be associated with a stimulatory guanine nucleotide-binding protein. Thus, the number of sites was increased by the addition of Mg2+ and guanylyl imidodiphosphate. Cholera toxin stereotaxically injected into one rat striatum increased the number of binding sites, and no further increase was noted following the subsequent addition of guanyl nucleotide. High-affinity forskolin binding sites in non-dopamine-rich brain areas (hippocampus and cerebellum) were modulated in a qualitatively different manner by guanyl nucleotides. In these areas the number of binding sites was significantly reduced by the addition of guanyl nucleotide. These results suggest that forskolin may have a potential role in identifying different functional/structural guanine nucleotide-binding proteins.

Synergistic interactions between forskolin, isoprenaline and substance P as secretagogues in rat parotid glands.

Substance P, forskolin and isoprenaline stimulated rat parotid alpha-amylase secretion in vitro. Synergistic responses were observed with combinations of any two of the three secretagogues such that subthreshold doses of one caused a pronounced shift in the dose-response curve to the second. This potentiation of secretion could neither be explained by an interaction at the receptor recognition binding site, as identified by ligand binding, nor wholly by interactions in second messenger systems. Thus forskolin and isoprenaline were unable to alter substance P-induced changes in phosphatidylinositol metabolism. Similarly substance P was without effect on forskolin or isoprenaline-stimulated cAMP production. In contrast the potentiation of isoprenaline-induced amylase secretion by forskolin was preceded by a marked enhancement of cAMP production suggesting that the activation of the adenylate cyclase complex is reflected in the cellular response.

UV spectrophotometric determination of piperine in pepper preparations: collaborative study.

Eight collaborating laboratories performed replicate analyses for piperine on 5 samples representing pepper raw spice, oleoresins, and soluble seasonings. Piperine is extracted into ethylene dichloride and measured at maximal absorbance 342-345 nm with a UV light source. Piperine content is calculated using an absorbance factor derived from piperine. Intralaboratory coefficients of variation (CVo) ranged from 0.5 to 3.1%; interlaboratory coefficients of variation (CVx) ranged from 3.0 to 5.8%. The method has been adopted as an official method of the American Spice Trade Association and as an official first action method by AOAC.

Blood pressure in a national birth cohort at the age of 36 related to social and familial factors, smoking, and body mass.

Blood pressure was measured in a birth cohort of 5362 subjects at the age of 36. The prevalence of hypertension in men (blood pressure greater than 140/90 mm Hg) was almost twice that in women, although women received treatment more often. Deaths of fathers of subjects from hypertensive and ischaemic heart disease were associated with significantly higher mean systolic and diastolic pressures in both sexes. Cigarette smoking was not strongly associated with blood pressure in men and not associated at all in women. Of the social factors, low social class of family of origin was associated with high blood pressure in both sexes; but the strongest association was with current body mass, and birth weight also contributed. Differences in blood pressures between the sexes may have been related to protective biological factors, such as endogenous sex hormones, in women and also to differences in types of employment, smoking habits, and body mass. Differences in blood pressures related to the social class of family of origin may reflect long term influences of class differences on diet, exercise, and educational achievement. The importance of measuring secular trends in obesity and blood pressures is emphasised.

Vascular responses and noradrenaline overflows in the isolated blood-perfused cat spleen: some effects of cocaine, normetanephrine and -blocking agents.

1. Vascular responses and noradrenaline overflows have been studied in the isolated blood-perfused cat spleen in response to electrical stimulation of the splenic nerve with trains of 200 supramaximal pulses at a frequency of 10 Hz given at 10 min intervals.2. In the absence of blocking agents the spleen gave well-defined responses and a mean maximum overflow of 436 +/- 96 pg noradrenaline per stimulus (n = 4) at the third train of stimuli.3. Cocaine (2 x 10(-5)M) increased the response nearly threefold and raised the overflow to 840 +/- 131 pg/stim (n = 4). At later stimulations the responses remained stable, but the overflows rose progressively to 1076 +/- 51 pg/stim after five trains of stimuli.4. Normetanephrine (10(-4)M) had no significant effect on response, but elevated the overflow to a mean maximum of 868 +/- 169 pg/stim (n = 4).5. Cocaine (2 x 10(-5)M) and normetanephrine (10(-4)M) given together increased the response by a factor of 6.5 and raised the overflow to 1258 +/- 247 pg/stim (n = 4).6. Hydergine (approx. 10(-5)M) almost completely abolished the response and raised the overflow to 859 +/- 173 pg/stim (n = 4).7. Cocaine (2 x 10(-5)M), normetanephrine (10(-4)M) and hydergine (approx. 10(-5)M) given in combination abolished the response and raised the overflow to 4089 +/- 1148 pg/stim (n = 4).8. Phenoxybenzamine (10(-4)M) abolished the response and elevated the overflow to 4215 +/- 738 pg/stim (n = 4).9. These results are interpreted in terms of selective and combined block of ;uptake I', ;uptake II' and alpha-adrenergic receptors. Facilitation of transmitter release by alpha-blocking drugs, and the possible existence of an uptake process associated with the alpha-receptors are discussed.

Enhancement of noradrenaline depletion in the cat spleen by phenoxybenzamine and phentolamine.

The noradrenaline content of the microsomal fraction of cat spleen was reduced by nerve stimulation. The reduction was greater in the presence of phenoxybenzamine and phentolamine, but was not affected by the presence of cocaine. The results suggest that phenoxybenzamine and phentolamine are able to increase the impulse-evoked release of noradrenaline.