Overcoming Obstacles Essay

After reading the article by Ms. Ann Harrington, â€Å"Where there is a will, there’s a way†, it opened my eyes and my way of thinking to a hold different level. I always wondered how people who have experienced some of the same levels of disappointment, setbacks, successes, and failures walk away with very different attitudes, circumstances and results (Werner, 2004). It has always been my belief that in order to overcome any obstacle in life, whether it’s professional or personal that it does come from within and it is a mind thing (Davies, 2009). Each individual really does control whether they succeed or fail; this is a very hard pill to swallow, because I haven’t quite grab the ability to do it yet, but I do know this is true. Just like the limits that we set on ourselves is the reason why some of us do fail. We tend to make mistakes and instead of owning up to them we want to blame others. The key here is just like mentioned in the article to be tota lly honest with ourselves. To be able to look at our situation and face the fact this was our own fault and do what we have to, to correct the situation. In the article the first thing Ms. Harrington talked about was resilience in the workplace (Absence Management: Annual Survey Report, 2011). It was right on point, when I thought back on days when I worked outside the home, there was not much compassion from my employer whether his employees felt good physically, mentally, or spiritually (Davies, 2009). They were not concerned with anything about the employees except whether you came to work on time, you performed the duties of your job, you treated their customers fairly, and they were able to keep their stockholders happy. The bottom line was the bottom line and that was all they were concerned about. I do agree, that it’s very important for a person to have a good mental health not just about the It’s also important for someone to be able not only to encourage others but themselves as well, and for them to be able to be totally honest about their own personal strengths and weaknesses. To be able to look at a bad or mundane situation and make it better. Not just looking at what others can do to make it better, but what can they do, and what we need to do, to turn the situation around. I find that too many higher ups look for the people who work under them to put their thoughts in action when things get rough, but what they don’t understand, when times are rough that when they throw  themselves in the work force and roll up their sleeves to help their employees get things back on track. When they get involved like that it tends to change the way the workers feel not only about their but about management too. It gives the employees the secure feeling that they can admit that they have flaws, they will make and have made mistakes, that they are not perfect, but that they will learn from them and that life does go on. Also, not everyone will not like them, agree with their ideas, or feel about them the way they feel about themselves, but once again they must be able to recognize that life goes on and they will survive. My favorite quote has always been â€Å"What doesn’t kill me, will make me stronger (Nietzsche, 1888). Everyone doesn’t understand that, but you must be able to look at all of life’s situations and look for the good in them; not being able to do this is a major reason for people getting depressed and committing suicide,they begin to feel overwhelmed and don’t see a way out. This is why I feel the United States Armed forces ha ve failed so many of its employees/soldiers. You cannot treat all of these individuals the same, they come from different backgrounds, family values, cultures, and set of morals and principals. These are individuals that may have had struggles of trying to be their own person, not being shown love, just trying to find that place where they fit in, or just trying to find their way. When you try to use the army’s method where no one is different everyone is the same, they may do some good for a while in that position; but what happens to a soldier when he comes home, gets hurt and can no longer do the job that you so strategically trained him/her for. Too me, this is sort of a brainwashing system, everything that these people were taught and believed in has been washed away to believe what you want them too. When it’s time for them to return to their lives before you entered into it, they wonder why the world has changed; and it’s hard for them to believe that it’s not just the world, but them as well. In order for a person to survive and end up on their feet, no matter what you need to be flexible(tugade et, al, 2004), and adaptable, just like the article says. Life changes and so do we, more than we would like to admit. I have had to failed marriages, one was a drunker and abusive, and the next one thought he was the smartest person on earth and a womanizer. When I realized that it was me who was going through all this pain, and I was not doing my children any good by putting them through  all of that, I ended it. It hurt me to leave the first time, I was young and had never been on my own before; but what you call resilience I call just being plain stubborn. You have to have some sort of confidence in yourself, be able to trust yourself to make good sound decisions, have one or two people in your corner that will help you make rational decisions, love of yourself and above all your trust, love and belief in GOD. REFERENCES Harrington, Anna Occupational Health; Mar 2012 64, 3; AB1/Inform Complete Top of Form Bottom of Form

Employer Associations & Modern Awards Essay

There have been substantial changes to modern awards over the years that employer associations have historically and are currently advocating. In this regard, issues such as penalty rates and flexibility stemming from employer association submissions have been researched and examined by (Sheldon & Thornthwaite 2013) portraying evidence that employer associations relatively prefer cost cutting and enhanced managerial prerogative as oppose to productivity. Entailed within this essay the key concepts such as penalty rates, managerial prerogative, flexibility and productivity will be discussed with particular focus the modern award reviews combined with an overview of Sheldon and Thornthwaite’s argument in summary and concurrence. According to (Boxall & Purcell, 2011) management goals are predominantly associated with cost efficiency, controllable flexibility, legitimacy and managerial power. It is these goals that evidently become the concern of relevant employer associations, as such they take on the role of combining, allocating and utilising resources in order to achieve organisational objectives. There have however been significant changes over the years regarding employer association involvement particularly seen over the course of the 1980’s. Employer associations aim to influence and negotiate with the Government of the day as well as tribunals in an effort to ensure that the mutual concerns of organisations are being met. (Sheldon & Thornthwaite, 2013) discuss key system issues with regard to employer associations mainly focusing on restricting union’s right of entry, penalty rates and other provisions incorporating aspects of substantive and procedural rules. Modern Award reviews primarily began in 2012, it is during this time that leading associations took the opportunity to not only push for more workable provisions but also to campaign for more substantial changes within various awards. Employer associations accounted for a large number of submissions to the tribunal on a broad range of issued in particular penalty rates, public holidays and flexibility. In the technical sense, penalty rates are a form of tangible benefit within the financial context which generally refers to those payments made to workers outside normal working hours. Regulator motivations for including penalty rates in modern awards as stated by (Sloane, 2014) are twofold: firstly, to compensate workers for work performed during what was historically known as ‘unsociable hours’ and secondly, to dissuade employers from operating within those hours. However,  as advocated by (Sheldon & Thornthwaite, 2013) the modern award reviews have ‘provided a forum for employers and their associations to escalate their campaign to the significance of penalty rates in industries operating during the traditionally ‘unsociable hours’, which is evidence that employer associations prefer to enhance managerial prerogative over productivity which is predominantly concerned with the cost of resources. The push for the examination of provisions regarding penalty rates has mostly been seen to affect the tourism and retail industries. Flexibility is made up of numerous components however, within in the context of the workplace involves thinking creatively about how working lives can be better structured to match individual and business needs (Job Access, 2012). Following the review of penalty rate provisions, amendments to the flexibility clause were sought after with particular attention paid to the manufacturing industry. Greater flexibility was requested in the taking and cashing out of annual leave in a further attempt to enhance cost cutting initiatives through control measures which ultimately leads to the underlying concept of elevated managerial prerogative. Managerial prerogative may be defined as management’s unqualified authority to exercise its discretion in certain areas under the belief that they have exclusive rights to make decisions and therefore resist any interference with that control (Storey, 1983). Sheldon & Thornthwaite make reference to managerial prerogative in the defensive context through aggressive industrial action which has historically been used as a means of strengthening managerial prerogative. The 2011 Qantas lockout serves as one of the most significant demonstrations of managerial prerogative through the organisations decision to engage in a lockout. As part of a wider push to entrench managerial prerogative employers were also seen to be engaging in aggressive bargaining strategies in order to escalate disputes with the intention of gaining access to arbitration which has an adverse affect on productivity. (Stewart, 2005) promotes the fact that there needs to be greater emphasis on productivity which forges greater efficiency and high trust work systems founded on flexible and fair employment. Productivity is the economic factor stemming from the adequate use of resources; productivity is essentially the measure of achievement through the amount of output that is achieved as result of the input predominantly referring to land, labour and capital as the key resources. Between penalty rates and productivity there is no association they are separated by the contexts of which they are defined. (AI Group, 2012) identify key problem areas within the Fair Work Act Review and state that it is ‘hampering productivity growth, workplace flexibility and competitiveness’ thus meaning that penalty rates do not influence productivity levels. (Sheldon & Thornthwaite, 2013) do make it apparent that employer association’s main concerns do in fact favour cost cutting and managerial prerogative rather than focusing on the importance of productivity enhancement. (Sheldon & Thornthwaite, 2013) further explored critiques from employer associations whose predominant concern was based on the fact that managerial prerogative was reduced through the increasing weakness of employer’ freedom to contract. (DEEWR, 2012) Released a report referring to more productive and equitable workplaces which disappointed employer associations thus further confirming productivity enhancement to be of no concern. It is clearly demonstrated that employer associations’ main concerns were that of cost cutting and managerial prerogative it is however, the amalgamation of all the relevant key concepts discussed that essentially equip organisations with a competitive advantage. The core concepts behind the submissions made by employer associations clearly obscure the importance of larger issues which further represents that employer associations prioritise the ease of managements working lives over that of the worker. Bibliography Australian Industry (AI) Group (2012), Applications to Vary a Modern Award – 2012 Review, Stephen Smith, Director – National Workplace Relations. Boxall, P and Purcell, J (2011), The Goals of Human Resource Management, Strategy and Human Resource Management, 3rd Edition, Palgrave Macmillan, New York, pp. 1-36. Department of Employment, Education and Workplace Relations (DEEWR) (2012), Towards More Productive and Equitable Workplaces: An Evaluation of the Fair Work Legislation, Australian Government. Job Access, Flexibility in the Workplace, Australian Government, Accessed 1st May 2014 Sheldon, P and Thornthwaite, L. (2013), Employer and Employer Association Matters in 2012, Journal of Industrial Relations, Vol. 55: No. 3, pp. 386-402. Sloane, J (2014), Pay Penalty Rates, but not Through Awards System, The Australian. Stewart, A (2005), A Simple Plan for Workplace Regulation, Industrial Law News, Issue 7. Storey, J (1983). Managerial Prerogative and the Question of Control, Routledge & Kegan Paul Publishing, London.

Liebeck v. McDonalds 1994

The case of Liebeck vs. McDonald’s, also known as the McDonald’s case is one of the most controversial tort cases, which according to many did not end with victory either on the part of the plaintiff or of the strong defense, but rather on the time’s growing debates on tort laws and how courts deal and resolve tort cases.   It may sound ridiculous but this case started with a simple cup of coffee.   This is not an ordinary case wherein one could easily which party has been negligent.   In fact, it can be said that both parties have been negligent and have their own faults of the incident that gave rise to the dispute.   In important to order to understand the case better, it is important to know the facts of the case and how the court decided. The Facts: This case was filed by Stella Liebeck of New Mexico, who, in February 1992, while in the passenger seat of her grandson’s car, was severely burned by McDonalds’ (The Actual facts About the McDonald’s Coffee Case, n.d.) coffee after it spilled on her legs, groin and buttocks causing third-degree burns (Bracken, 2005).   From an ordinary perspective, one can view this as an ordinary scenario in restaurants and coffee shops and among coffee drinkers, especially those who consume their coffee in moving vehicles. But this is not the case in the McDonald’s case. The case was anchored on the claim that McDonald’s have been negligent and that their coffee has been extremely hot beyond the normal temperatures of coffee served in other coffee shops and restaurants.   According to the article, The Actual Facts About the McDonalds’ Coffee Case, â€Å"McDonalds’ coffee was not only hot, it was scalding—capable of almost instantaneous destruction of skin, flesh and muscle†. Ms. Liebeck, was at that time 79 years old and ordered coffee from the local McDonald’s which in turn served the hot coffee in a Styrofoam cup at the drive-through window.   After receiving the order, his grandson allegedly pulled his car forward to give way to other customers and again stopped to allow Ms. Liebeck to add creamer and sugar to her coffee.   In order to do this, she held the cup with her legs so that she may be able to open the lid and add in the creamer and sugar.   However, as she removed the lid, the hot content poured to her lap causing the complained damages. This is as opposed to the claim that the car was in motion and the Liebeck was driving the car when the incident happened (The Actual Facts About the McDonald’s case, n.d.).   With this incident, it can be seen that at one point, the Liebeck’s can be said to have been contributors to the accident as what McDonald’s have claimed that Liebeck was the proximate cause of the injuries she sustained.  Ã‚   McDonald’s claimed that it was Liebeck who has been negligent and not them because as customers, they should have known that coffee is hot and they should be extra cautious in handling coffee especially while in a vehicle whether it be in motion or in full stop. According to the vascular surgeon, Ms. Liebeck suffered full thickness burns at about six percent of her body.   She stayed in the hospital for eight days and underwent skin grafting, debridement treatments.   She now comes to the court for the settlement of her claim for $20,000 to cover her m edical expenses as a result of the incident.   However, McDonald’s refused to pay. In its argument, McDonald’s argued that consumers know coffee is hot and that its customers want it that way.   They however admitted that its customers were unaware that they could suffer third-degree burns from the coffee and that a statement on the side of the cup was not a warning but a reminder since the location of the writing would not warn customers of the hazard (The Actual Facts About the McDonald’s Case, n.d.). The Issue The issue in this case is whether or not McDonald’s has been negligent causing the accident complained off making it liable to pay the medical expenses. Held: The decision of the court is anchored mainly on tort laws and decided by determining who has been negligent in the incident that caused the harm being complained about.   After trial, the jury ruled in favor of Liebeck awarding her a total of $200,000 in compensatory damages, which however was alter reduced to only $160,000 after a finding of the jury that McDonald’s was not solely responsible for the accident but instead, Liebeck was also 20 percent at fault for the coffee spill (The Actual Facts About the McDonald’s Case, n.d.). In addition, the jury also awarded some $2.7 million as punitive damages, an amount equal to McDonald’s total sales for two days.   However, the court again lower this punitive award of damages to $480,000 although the judge found McDonald’s to be â€Å"reckless, callous, and willful†Ã‚   (The Actual Facts About the McDonald’s Case, n.d.). According to Bracken (2005), this ruling of the jury is based upon the determination from the documents presented that Liebeck’s medical bills totaled to about $10,000 due to the injuries she suffered.   Bracken (2005) also explained that this case â€Å"is an example of why tort cases should not be merely decided on the simple facts†.   Nevertheless, despite the public nature of the case and the loud news that the incident has made, the public really don’t know how the case really ended as the parties came into a secret settlement whose nature and stipulations have never been revealed to the public at all (The Actual Facts About the McDonald’s Case, n.d.). As it is provided by Bracken (2005), the McDonald’s case illustrates the implication that cases should not be decided on based solely on the face value of the case because at first instance, it can be easily said that McDonald’s was negligent.   However, reviewing the facts of the case and based on human experience, Liebeck has also been negligent enough that the injuries she suffered cannot be blamed on one party alone.   Her own actions and decisions may have also contributed to the happening of the accident. She has been negligent in handling the cup of coffee, which a normal person would always believed to be hot and can cause injury even without actually knowing its actual temperature.   This is the reason why I think the jury made a mistake in the case because I consider the incident as purely an accident, which may have only been aggravated by Liebeck’s negligent handling of the hot coffee.   A normal person would always take extra precaution in handling potentially harmful objects.   I consider McDonald’s serving of the hot coffee to be totally acceptable in its aim to provide the best coffee for its customers. The case of McDonald’s should have been judged after an in-depth investigation to determine McDonald’s alleged negligence for three main reasons (Bracken, 2005).   First, according to Bracken (2005), â€Å"this is not the first lawsuit regarding the temperature of McDonald’s coffee illustrating continual negligence by McDonald’s†.   Perhaps one of the strongest arguments against McDonald’s is the fact that there have been previous complaints and similar incidents that may somehow pertain to its negligence in handling its products and in serving them to customers. Past experiences should have been enough to encourage the company to do something with their hot coffee in order to avoid future similar incidents.   But, this did not happen; McDonald’s seems to have neglected its responsibility to its customers over and above their responsibility to provide the best coffee in town; which is to provide them with safe products as well. Secondly, â€Å"the testimony indicated that McDonald’s coffee is served at between 180 and 190 degrees† (Bracken, 2005).   According to McDonald’s, this temperature is based upon a recommendation that coffee should be served on the above mentioned temperature in order to achieve the best taste that customers crave about (Bracken, 2005).   On this aspect, there can be not much question but only on issues why McDonald’s seems to have neglected the fact that they knowingly know that the extreme temperature of their coffee can cause serious injuries.   They should have at least used more secure packaging than Styrofoam cups. Thirdly, Bracken (2005) also noted how the articles presented failed to indicate that â€Å"McDonald’s attempted to warn consumers of its extreme nature since the company served coffee above the temperature a reasonable nature since the company served coffee above the temperature a reasonable person would expect to receive or consume coffee† (Bracken, 2005). Admittedly, McDonald’s have been negligent on this aspect.   In sum however, after considering all premises, I still believe that the jury erred in ruling in favor of Liebeck and the awards for damages to be excessive. This case could in fact serve as a precedent for all other future cases wherein complainants may come to court of similar complaints only to extort sum of money from companies like McDonald’s.   Clearly, it can be said that McDonald’s has not been solely accountable and negligent in the case.   Liebeck was also negligent.   Hence, it could have been enough thet the court awarded her sum of money to cover all her medical expenses and small amount in compensatory and punitive damages for the injuries she sustained.   This could have been one way to educate the consumers that they also have the corresponding responsibility to themselves and not to fully pass it on to providers like McDonald’s. As a restaurant owner, perhaps one of the waking realization that this case brought is the fact that because tort cases are almost always linked to negligent acts, it is important to be very careful in all aspects of safety in the overall operations of the business.   One very obvious mistake on the part of McDonald’s is their failure to give sufficient warning to the customers of the extreme temperature that may cause damage to them.   Incidents like the McDonald’s case could have been avoided if customers have been warned, the least on cup labels or by the restaurant staff that extreme temperature could be harmful. It is sad to note that although many businesses have genuine intentions to satisfy and to protect their customers; negligent acts, probably by reason of lack of knowledge or foresight seem to cause more controversial issues that lead to the numerous cases decided and being heard in court dockets. References Bracken, K.   (2005).   Liebeck v. McDonald’s. Retrieved February 17, 2008, from https://listserv.du.edu/pipermail/torts-russell/2005-August/000010.html The Actual Facts About the McDonalds’ Coffee Case.   (n.d.).   Retrieved February 17, 2008, from http://www.lectlaw.com/files/cur78.htm      

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Attitudes,values and job satisfaction Research Paper

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Cost Accounting Case Study Example | Topics and Well Written Essays - 500 words

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Death Penalty - Research Paper Example There are different views and opinions regarding the question and this paper will try to address the arguments for and the arguments against. The paper will also analyze the ethics in the justice system regarding the death penalty. Those who are against the death sentence have their concrete reasons why they think that it should not exist. They define the penalty as an unbearable denunciation of civil liberties and term it as being inconsistent with the basic values of the democratic society. They believe that the penalty is a theory that is uncivilized, unmerited, and unfair in practice. Most who argue against it are of the view that the system of the penalty is applied in an unjust and unfair manner against people. This unfairness largely depends on the amount of money they have, their attorneys’ skills, the victim’s race, and the place of occurrence of the crime (American Civil Liberties Union). It is true that human life is valuable. This can even be justified by the Bible during the creation process when God created man in His image. Therefore, those against the death penalty are of the belief that even the most horrible murderers ought not to be killed themselves. The offender’s life value cannot be destroyed due to his or her bad conduct even in the case where they have killed another person. They argue that life should be preserved. Every other person has an absolute human right to life. This is defined by the Bill of Rights. This right to life is a right for every person even those that have committed a murder. By imposing a death penalty and executing a murderer, the state violates that person’s rights. However, some argue that when a person commits a murderous act, then that individual gives up his or her right to life (Ethic Guide). This is a familiar argument in opposition to the death sentence and it insists that in the imposition of capital punishment, innocent people sometimes are killed for flaws or mistakes in the

Increasing or Restricting Andragogy Essay Example | Topics and Well Written Essays - 3250 words

Increasing or Restricting Andragogy - Essay Example This paper outlines that we have to take into account both the objective semantics of the term as well as try and locate it within a specific twentieth century educational context. The term ‘adult education’ is a comparatively new one, coined much after it was actually in practice. It is a result of many years of evolutions, and its meaning, even now is far from simple and monolithic. Even as early as in 1927, Hall-Quest conceded the difficulties in defining the term. One of the biggest problems related to the definition of ‘adult education’ is, whether it refers to a set of methodologies by which ‘adults’ can be taught, or is it a holistic term that includes the general endeavor of educating adults in a specific way as well as a detailed study of government adaptation and subsequent implementation of policies that target the adults specifically as the subject of educational instruction. Theorists like Alan Rogers have defined adult education as a process ‘whereby anyone over 16 (or whatever) are treated as adults – capable, experienced, responsible and balanced people’. Such a definition has two major problems; first ‘adult education’ becomes synonymous with ‘andragogy’ thus affecting the semantic rigor of the term.  

Psychiatric Nursing Essay Example for Free

Psychiatric Nursing Essay Psychiatric treatment or psychological welfare treatment refers to the field of treatment that is concerned with individuals of each and every age with psychological sickness or psychological suffering, like; bipolar disorder, schizophrenia, despair, dementia or neurosis. However, professionals in this field are given extra teaching in mental treatment, establishing a beneficial coalition that is based on challenging conduct, and the management of psychiatric treatment. The following are some issues facing BC psychiatric nursing; the issue of prisoners, chronic illness, gender, old age and child trauma. Others include; healing choice creation and treatment involvement; medicinal healing and treatment responsibility; nurse and customer verdict creation and crisis resolving; verdict approaches; position clash and position uncertainty. Prisoners Correctional psychological welfare program mainly focuses on suicide avoidance, recognition and healing of the psychologically sick, and continuity of psychiatric healing. The psychiatric professional takes part in an essential function in every one of these plan. The psychiatric professional’s responsibility in a correctional situation is exclusive. This is because the nurse might operate like a staff nurse on an inpatient element giving psychiatric treatment care to prisoners on a given unit or proceed as an outpatient nurse, giving assessments, therapy, or disaster involvement to prisoners in the universal inhabitants. Programs differ in size and range of services in quantity to the inhabitants of the region prison, financial support, and court go-ahead. For instance, a big region prison could give inpatient healing on an inpatient element inside the prison or through an agreement by a psychiatric hospital. Smaller region locks up classically agreement their sensitive services with a local psychiatric hospital. Outpatient-rank services are more often than not given twenty four hours every day in a bigger confinement, whereas minor prisons could give services merely on the day transfer. A minor prison can hire psychological welfare nurses on a part-time basis or none. Countries time and again choose particular jails inside their jail arrangements to give sensitive psychiatric concern or employ sanatorium surroundings inside every jail to become constant and take care of intensely psychologically unwell prisoners. A particular inpatient element in a prison could be a set of cells particularly selected to reside psychiatric patients. Depending on the condition, the region psychological health sector of psychological health services may select or certify the elements for sensitive concern. The elements can be simply confined or empirical accommodation for psychological health patients getting services, apart from an inpatient rank of concern (Achenbach Edelbrock, 1981, p. 281). Chronic illness Treatment dwellings: since individuals who are psychologically unwell at times require lasting therapeutic concern, at times when a treatment residence may be essential. Nevertheless, several treatment dwellings are not set to effectively tackle psychological health concern matters. However, while choosing a treatment dwelling for a cherished individual, make sure that it concentrates on attending to those with persistent psychological sickness. Housing Care services: majority of individuals with persistent psychological sickness obtain the correct rank of concern in inhabited care services. Normally, they give twenty hour recruitment, space and panel, and support with prescription and preparing psychological welfare care arrangements. Grown-up Care services: the services are additionally household oriented than housing care services. However; usually give similar level of concern. They are additionally suitable for individuals whose circumstances are constant. Grown-up care services are not locked, as well as a number them do not give twenty hour employment. However, household Care dwellings: location is more of a distinctive house in that it provides to a larger extent lesser amount of inhabitants and is not normally organized twenty four hours a day. Unluckily, lots of funding for those with persistent psychological sickness will cover this rank of attention, yet people might require the services of a grown-up attention. Supported existing elements: A supported dwelling element, as its name entails, is most suitable for those individuals who are high performing and constant. With supported livelihood, there is less staff control and inhabitants normally exist in apartments are be given services like food, laundry, and medicinal management. Supported livelihood can also be a link to autonomous dwelling, in that if an individual fruitfully contributes in supported existence yearly, one can be capable of changing to a customary residence. Psychiatric elements: they are either supported in or united with sickbays. A single category of psychiatric element focuses in temporary sensitive concern, nearly when an individual is a threat to him or herself, or others. The aim of this circumstance is to stabilize the person and relocate herself or himself to an additional type of competence. Another form of psychiatric component is the one that is united with a state sickbay, and is frequently a protected capacity for those who need long lasting attention. Sexual characteristics. The stand for deed pressurizes that women are allowed to enjoy the uppermost achievable set of bodily and psychological fitness. Creating a relationship between womens individual existence and welfare and their responsibilities in the society, the stand affirms that the pleasure of this right is very important to their existence and welfare and their capacity to take part in every area of communal and personal living. The global meeting on residents and progress accepted that reproductive privileges hold confident individual civil liberties that are already familiar in state rules, global individual human rights credentials and other agreement credentials. omprise of general announcement of individual human rights and its 2 original executive agreements, the global agreement on financial, communal and civilized privileges , which refers to the right of everybody to the pleasure of the uppermost possible set of material and psychological fitness, and the global agreement on public and Political civil liberties , which consists of an amount of welfare related individual civil liberties, such like the freedom of existence, the right to freedom and safety of the individual and the freedom to solitude (Ahmann, 1994, p. 4). However, constructing on the global talks on people and growth and its Program of deed, the policy for an act affirms that the individual privileges of women consist of their freedom to be in charge and come to a decision without restraint and sensibly on issues linked to their sexuality, as well as sexual and reproductive wellbeing, liberated of intimidation, favoritism and hostility. Hard work has improved to regard physical condition in the support of individual civil rights. When physical situation is measured as an individual right, and not simply a societal excellent, civil liberties and tasks require to be explained consequently. The connection between womens individual civil liberties and welfare has been initiated through the joint hard work of womens welfare and womens privileges supporters. In concentration and overlook of womens welfare matters, especially reproductive fitness, in the lawmaking and modifying frameworks of nations, have been accepted as an element of an organized favoritism besides women. Old age Psychiatric ill health is a severe physical condition trouble in old people. Mental ill health is linked to poorer health result in addition to enlarged expenses intended for aged patients with recurring medical situation that are very much common in old age, for instance hip cracks, cancer and heart attack. In older people, the interaction of synchronized medical conditions and psychiatric and results to overwhelming disability and transience, creating exceptional therapies that have largely been neglected by the health care system. The largest part destructive essentials of unfairness in America include; the stigmatization of the very aged and the mentally ill. These prejudiced burdens are apparent in a lack of investigate, and insufficient access to suitable services and healing. Psychological fitness facilities based in the community level mostly lack appropriate services for the aged and personnel qualified to tackle medical needs. Investigation has verified that adults are more probable to be given suitable psychological wellbeing attention, and to contain improved medical results, whilst psychological fitness services are incorporated with universal health check care in the chief care background. Several schedules with numerous suppliers in numerous surroundings add up to an intolerable weight to individuals for whom persistent sickness and bodily disability are severe restraints. In addition, fewer stigmas related to getting psychiatric attention when they are a fundamental element of universal medicinal concern. Mental health in practice ought to have life-altering outcome. For example, sign of pain and despair can be treated even in older age, even in the presence of severe disease and disability, and also for those who stay in the nursing homes. However our health system has done little to convert this systematic information into clinical practice. The persistent approach among clinicians, patients and the society in general believes that being old implies living with pain and despair. For this reason the older people don’t receive the treatment they deserve. Further than the failure to recognize, diagnose, and initiate treatment, recent the next generation of troubles facing older people with mental ill health is unfortunate quality of care follow up. In most studies elderly nursing home people who receive antidepressant medication care, just about half of them continue to have sign, yet they don’t need treatment changes to make sure that they get well. Infant trauma Expert qualified in the nursing and medical treatment of child sexual oppression are often the first specialists taking care of the child and assess needs and can also bare witnesses in court trials. The prime intention of any medical involvement for the child is carryout a physical assessment, a psychological estimate and legal proof for potential proceedings. Children who have sexually been subjugated get to the interest of nurses and physicians in a multiplicity of ways. The child may be attended to by a private doctor or a nurse practitioner in the urgent situation department of a hospital. Big town repeatedly have selected hospitals that attend to child victims of sexual harassments and abuse with qualified, skilled doctors, social workers and nurses. Family may be asked to take a trip some far distance so as to have their child observed and evaluated at one of the dedicated healthcare facilities. A child may also be attended to in the healthcare system through the community or public health, school nurse and outpatient services. Alleged cases of child sexual abuse may moreover be seen first by law enforcement officer who will after that refers the child to the suitable healthcare for assessment. On arrival at the healthcare clinic, the child’s parents will be asked to present their complains. The health evaluation of the sexually assaulted child has a number of steps which include taking of history, Interviewing the child, physical test, and psychological assessment. History taking is the initial step in the health evaluation. The information about the growth and development of the child is provided by the parents (Ahia, 1997, p. 36). The researcher will generally commence with questions that examines the child’s Knowledge about family members, familiar events, and personal data. For example, the interviewer may want to establish that the child knows his or her name, date of birth, and grade in school. From these responses, the researcher will decide the finest way for the child to talk about the assault. The realistic Interviewing practice is the third step where the interviewer remains objective and neutral in inquiring the child. The questioning should not be threatening to the child or the parents. Researcher should stay as unbiased and goal as probable in enquiring the child is the second step which varies depending on the age of the child and the level of development. The interviewer will evaluate the child’s verbal communication skills and mental and poignant development. The research will usually commence with inquiries that examine the child’s knowledge about family members, familiar events, and personal data. For example, the interviewer may want to establish that the child knows his or her name, date of birth, and grade in school. From these responses, the researcher will decide the finest way for the child to talk about the assault. Certain people should not be allowed in the research area. For instance, asking a child questions in front of the alleged offender or interviewing a child in a room full of adult strangers is stressful and will limit dialogue with the child. A parent or guardian in the room may be reassuring for the child and, after the child becomes comfortable with the interviewer, the parent is often able to exit quietly. A suitable tone should be situated in the research from the beginning. A proper introduction of everyone present is necessary, as is a coherent, understandable explanation of why the interview is taking place. The researcher should request for, not take for granted, teamwork, and assure the child that the interview will be as comfortable as possible. The young person must be given authorization to inquire queries concerning everything that is not understood. A victorious research is one in which the young person is provided with some measure of control, even if it simply means a choice of a toy. Many children who have been sexually harassed have lost an intelligence of power and control over their own bodies and behavior and have learned to be overly compliant and passive. The researcher should set up a universal relationship with the young person before trying to obtain specific information about the victimization. It is over and over again is important to begin by playing with dolls or requesting the child to draw a picture. It is through this early stage that it is most suitable to ask the child’s full name. The researcher may require the young person to write it down on the drawing paper. The young person should not be forced to open up right away; instead the interviewer should try to determine what is preventing the child from talking about the abuse. For instance, a parent may be angry and confused because a child is making allegations about a boyfriend. That parent may have intimidated the child prior to the interview or may have threatened the child with removal from the home. It may be essential for the parent to depart the area organized for the interviewer to obtain certain information. Conclusion Psychiatric nursing face cultural and contextual issues in dealing with psychological sicknesses which may include infant disturbances, gender, issues with the inmates, sexual characteristics, chronic illness and old age . The researcher should set up a universal relationship with the different groups so as to come up with proper results as they assist the clients.

Changing social and medical attitudes affect ill health

Changing social and medical attitudes affect ill health Health was defined by The World Health Organisation in 1948 as, a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Varying definitions of health can be found depending on an individuals perspective. Medics will focus on biological cause while sociologists argue that health is a product of social and environmental factors. (Naidoo Wills, 2009a: chapters 12) In the early 19th Century there was focus on the elimination of diseases such as plague, smallpox and cholera. With industrialization and rapid urbanization, as the 19th century progressed, health issues became focused on environmental issues such as clean water supplies, disposal of waste and better housing. (Naidoo Wills, 2009b:p3) Health inequalities have been recognised in the UK since William Farr first published statistics in 1837. It remains the case today that health is directly influenced by social class and the effects of poverty and associated behaviour factors. (Ewles, 2005: pp243-245) Urbanisation is the process of population concentration. The 19th century saw the massive growth of cities and the migration of the population from the country and into cities on a scale never seen before. Houses became over crowded with entire families living in one room. The process caused huge problems for public health. (Pathfinder pack on Urbanisation the move to the city in the 19th century, n.d.) (Urbanisation in the nineteenth and twentieth centuries, n.d.) Urbanisation was the most profound effect of the Industrial Revolution which developed at a pace in Britain between 1800 and 1850. Cities grew rapidly and lacked sanitation, accumulated sewage, had high rates of crime and poverty and consequently high rates of disease. Heavy use of coal led to an accumulation of dirt and grime. (Urbanisation, n.d.) Larger cities were a necessity of industrial growth but the conditions they brought were in many ways regressive. (Lee, 1995:p48) The Growth of Cities 1801-1901 in thousands. City 1801 1851 1901 Birmingham 71 233 523 Bradford 13 105 280 Leeds 53 172 429 Liverpool 82 376 704 Manchester 70 303 645 Newcastle 33 88 247 Nottingham 29 57 240 Sheffield 46 135 407 (Reynoldson 1996:p10) A part of London was described by Thomas Southwood-Smith in 1838 as follows, Beckwith Row has an open drain. The houses have common, open privies (toilets) which are in the most offensive condition. In one house I found six persons living in a very small room, two in bed, ill with fever. (Reynoldson, 1996: p110) http://t2.gstatic.com/images?q=tbn:HcwSJOrT5lACaM:http://www.makingthemodernworld.org.uk/stories/the_industrial_town/06.ST.02/img/IM.1064_zp.jpg Slums in 1872 London [Making the modern world, n.d.) There were no controls on the standard of housing and the Government maintained a laissez-faire attitude. That is they believed there should be no central government intervention. Local efforts were haphazard and insufficient. (Todd, 2002:p31) Smallpox was the greatest killer at the beginning of the 19th century. Jenner observed that milkmaids who caught a mild form of the disease or cowpox didnt develop smallpox. From this study, Jenner discovered a method of vaccination against smallpox. He faced much opposition to his discovery as some people simply didnt like anything new while others described his theory as bizarre. Jenner wasnt a fashionable London Doctor and he couldnt explain how or why vaccination worked so he wasnt taken seriously. Some people called it an interference with nature. (Lee 1995:p44) (Todd, 2002:p32) Success of the vaccine was put down to coincidence by some Doctors who made money through an older practice of inoculation. (Lee, 1995:p44) A smallpox epidemic, during which 40,000 people died, resulted in the government making the smallpox vaccination compulsory in 1840 even though some continued to argue that this measure was against human rights. Smallpox declined, until by 1900 it had almost disappeared. This was the first example of the government accepting responsibility for an area of public health. (Lee, 1995:p44) Cartwright in A social History of Medicine (1977) describes Jenners discovery as one of the most beneficial changes in the history of social medicine.his work is recognised as the starting point of attempts to combat infection by immunization. (adapted from Lee, 1995:p45) Jenners work and the train of events that followed affected a social revolution. Individual choice was sacrificed for the interests of the community. (Cartwright, 1977:p92) At the same time, two other diseases also presented a challenge. TB cholera were more difficult to tackle as both diseases spread as a result of poor living conditions. TB or consumption took hold as towns grew and took over from smallpox as the greatest killer disease. Cholera epidemics struck several times during the first half of the 19th century. In 1854 John Snow proved that cholera was connected with polluted water. He was able to show that a water pump in the Broadgate area of London was the origin of 500 cases. People using another pump nearby did not catch the disease. Once the Broadgate pump was put out of action, no further cases were reported in the area. (Lee, 1995:p51) http://t3.gstatic.com/images?q=tbn:dkmPPVrjlaE3NM:http://historyday.coldray.com/wp-content/uploads/2008/12/john-snow.jpg John Snow (1813-1858) http://t2.gstatic.com/images?q=tbn:fd12xpKjN8GveM:http://thedoublethink.com/wp-content/uploads/2009/04/450px-john_snow_memorial_and_pub.jpg Replica Broadgate pump (www.health.eku.edu/ehs/faculty/darryl_barnett.htm) A fierce debate raged about responsibility for public health with strong views about the role of the government. Several arguments for non-intervention were put forward including that government intervention would interfere with peoples basic rights or the freedom to be dirty. Some people believed that if the state acted to improve housing the moral courage of the poor would be reduced. (Lee 1953: p53) A letter to The Times in 1854 read, We prefer to take our chance with cholera than be bullied into health. Many people have died from a good washing. (Quoted in Lee, 1995:p53) But several important people put the case for action by the state including William Farr and Thomas Southwood-Smith who both recommended government intervention. Tonge in Challenging History 1700-1914 says, Of all the campaigners for improved public health, Edwin Chadwick stands monumentally above the rest. Chadwick stressed the connection between public health and disease and how such factors needed to be addressed by government intervention. Chadwicks report The sanitary conditions of the Labouring Population of Great Britain was published in 1842 and recommended that the government take steps to improve drainage, remove rubbish from the streets and improve the water supply. (Wilkes: 2007: p 92) (Reynoldson: 1996, p 113) http://t0.gstatic.com/images?q=tbn:iK4kyWJkVFmbWM:http://wpcontent.answers.com/wikipedia/commons/thumb/9/9e/SirEdwinChadwick.jpg/200px-SirEdwinChadwick.jpg Edwin Chadwick (www.answers.com/topic/edwin-chadwick) The government distanced itself from Chadwicks report largely because of the influential figures he has discredited and the laissez-faire debate lasted for much of the 19th century. Loosely translated this means do not interfere. Some members of parliament were making money from rent on the slums and refused to tear them down. Eventually, however, the social effects of economic growth were so severe that gradually the state became more involved in issues of public health. The great stink in 1858 (when a heat wave caused the Thames to smell worse than ever) inspired the government into action. (Wilkes 2007). In 1861, Prince Alberts death from typhoid was attributed to contaminated water from the Thames and put further pressure on the government to do something. (Cartwright, 1977, p95) In 1867, working class men were given the right to vote. Political parties realised that by promising to improve living conditions, they could secure the working class vote. When the Conservatives won the 1874 election, they introduced many public health reforms. Aaron Wilkes (Medicine through Time) sees this as the most important reason why politicians began to make improvements. Some cities including Birmingham and Liverpool started some clearance of slums, built sewers, improved refuse collection services and opened public baths. Some private companies such as Lever, Cadbury and Rowntree saw the benefits of providing good housing for their workers. It was, however, not until after the First World War that extensive slum clearance was commenced. (Lee 1995:p57) Miasma or the infectious mist given off by rotting animals, rubbish and human waste was thought to be the cause of many of the epidemics in the 19th Century. Scientists identified germs using a microscope but believed that the disease caused germs rather than the other way round. This was known as spontaneous generation. Louis Pasteur questioned this theory and was able to prove that germs caused disease but many Doctors wouldnt entertain his ideas. It took the German Doctor, Koch, to apply Pasteurs theory to human disease. Koch was able to prove that germs caused TB, cholera and anthrax. (Mantin Pulley, 1988:p49) http://t2.gstatic.com/images?q=tbn:OdyqTCWJiq49tM:http://web.ukonline.co.uk/b.gardner/pasteur.jpg Louis Pasteur (web.ukonline.co.uk/b.gardner/pasteur.htm) Pasteur built on Kochs work and developed a vaccine for rabies. Soon the germs responsible for typhus, tetanus, typhoid, pneumonia, meningitis, plague, septicaemia and dysentery were identified. Once germs were discovered vaccines could be made. Scientists now had a powerful new weapon to fight disease. (Wilkes, 2007:p88) Vaccination is one of the greatest success stories of modern medicine. Smallpox has been wiped out and tuberculosis and polio have been significantly reduced. Children are now regularly vaccinated against a number if diseases. (Lee, 1995:82) The smallpox vaccine was given free in 1840 but it was another 100 years before vaccination against TB was provided. This was followed by vaccines for diphtheria, whooping cough and tetanus (1954), polio (1955), measles (1964) and rubella (1969). (Lee, 1995:p82) Progress continues today as a new vaccine has been introduced this year which protects girls against the virus that causes cervical cancer. The 19th Century also saw developments in surgery. The problems were pain and infection. The breakthrough came with the development of anaesthetics and antiseptics. (Lee, 1995: pp5961) William Moston experimented with ether and James Simpson tried chloroform. As with most medical discoveries, the first reaction of surgeons was criticism. Some argued that the long term effects were unknown and others objected on religious grounds. In some cases patients still died if the anaesthetic wasnt correctly administered. Some people thought that surgeons would cut off whatever they liked while the patient was unconscious and army Doctors thought the use of anaesthetic was soft. (Reynoldson, 1996:97). Others said that it was unnatural to ease a womans pain during childbirth. The breakthrough came when Queen Victoria used chloroform during the birth of her eighth baby and use of anaesthetics then became common practice. (Wikes, 1988: p101) The use of anaesthetics was a great step forward but it didnt stop deaths from infection after the operation. In the 19th Century hospitals were dirty places. Patients with disease were herded together, the same instruments were used on many patients and Doctors didnt change their blood stained coats between operations. Doctor Joseph Lister was influenced by Pasteur and believed it important to kill the bacteria in the operating theatre. He did this by spraying carbolic acid (although his theory wasnt quite accurate as the bacteria was really on the instruments not in the air, but the incidence of infection was reduced by some of the antiseptic also landing on the instruments in use). Lister encountered much opposition as nurses and doctors complained about the smell and the amount of time taken to clean the theatre. Lister didnt communicate well and surgeons who didnt work with him were not convinced. (Lee.1995: p64) Eventually antiseptics and cleanliness came together to form the modern approach to surgery or asepsis. By the beginning of the 20th century Doctors were operating in a germ free environment, using sterilised equipment and wearing gowns masks. Death rates reduced massively; at Newcastle Infirmary before 1873, 59.2% of patients died after an operation (pre antisepsis), after 1873 only 4% died (post antisepsis). (Figures from The Lancet in 1878 in Lee, 1995:p65). Use of a carbolic spray during an operation circa. 1880 and the sterile environment of a modern operating department. http://t0.gstatic.com/images?q=tbn:476AON2yuy0EGM:http://www.answersingenesis.org/assets/images/articles/aid/v4/antiseptic-surgery.jpg http://t0.gstatic.com/images?q=tbn:sgiACWjAMvVpNM:http://www.workingmats.com/images/Operating_Theatre_115313_08.jpg (www.history.langtreeshout.org/tag/lister/) (www.workingmats.com/images/Operating_Theatre) During the Crimean war (1854/56) Florence Nightingales influence saw death rates reduce as she was responsible for organising better water supplies and food and keeping the wards clean. Fiona Reynoldson in Medicine Through Time says the death rate of wounded soldiers in hospital reduced by 40% under Nightingales influence. In 1899 a recruitment campaign for men to fight in the Boar War highlighted the fact that around 40% of those volunteering were unfit for military duty. In 1904 a government report concluded that there needed to be more government intervention to improve the health of children. When the Liberal government was elected in 1905, a large number of reforms were introduced including free school meals for poor children, a free school medical service and women were taught about hygiene and childcare. Pensions for over 70s and basic sick and unemployment pay were also introduced. Over the next 30 years successive governments took measures to improve the health of children and mortality rates dropped. (Wilkes, 2007:p114) During the 1st World War, Prime Minister Lloyd George promised soldiers returning homes fit for heroes. The government set itself a target of building half a million decent homes by 1933. The war revolutionized society and made us move in a new and different direction. (Fenwick-Baines, 2009) When Britain was plunged into the First World War the need for a way to combat staphylococcus, a highly resistant bacteria, was urgently needed. Many soldiers died, not from the bullets, but from the infection caused by the bullets deep in the body. Conditions in the trenches were appalling and wounds quickly turned septic. Alexander Fleming worked on wounds and infections during the war and made an important discovery that the penicillin mould would attack and kill certain bacteria. Fleming is credited with its discovery but other scientists went on to develop the drug for human use. Initially, money wasnt available for its manufacture but The Second World War was vital in progressing its mass production. The American government recognised its value and agreed to pay drug companies to manufacture vast quantities to treat injured soldiers. Penicillin is still the most widely used antibiotic and is used to treat many bacterial infections, many other antibiotics followed . By the end o f the war, drug companies made it available for general use. (Wilkes, 2007: p118) (Board works, 2003) The problem of blood shortage baffled Doctors for centuries but hundreds of wounded soldiers provided the strongest possible reason for expediting the establishment of the new blood transfusion service. This is another typical example of war acting as a catalyst for change. The 2nd World War actually saw the health of the nation improve as rationing meant that fatty sugary foods were in short supply. The government urged people to dig for victory and grow their own vegetables. The government promoted healthy living including basic hygiene and immunisation against diphtheria all part of a campaign to have a healthy nation able to stand up to Hitler.(Board works, 2003) Dig For Victory http://www.5aday.nhs.uk/images/top_tips_2/pic_carrot_eyes.jpg The Dig for Victory campaign during the 2nd World War is remarkably similar to todays Try 5 message. (www.bbc.co.uk/dna/h2g :2009) (www.5aday.nhs.uk: ) Birth rates reduced with the availability of contraception and with fewer mouths to feed, better food was provided for children. Between the wars little changed as the economy experienced difficulties (the 1930s depression) but during and after the Second World War there was a further huge development. In 1942 The Beveridge Report recommended a welfare state and that the government should help people from the cradle to the grave. After the war people wanted change and a social revolution. The war was over and it was time to look to the future. Some people did not like the new ideas and said everyone should be independent, the rich objected to paying heavier taxes to fund the welfare state. (Cartwright 1977: p173) The suggestions made by Beveridge were not immediately put into force as the cost was questioned but when Labour took power in 1945, the NHS was born. From the introduction of the NHS in 1948, everyone was entitled to free medical treatment. The welfare state and the NHS in particular met with opposition. Churchill and the conservative party felt the cost was too much for the economy to bear. Critics suggested the health service was wasteful and that people were getting things they didnt need. The service was also free to overseas visitors and some argued that this was over-generous. The BMA objected, initially fearing Doctors would lose their independence and that their income would reduce as an employee of the NHS. Compromise was only reached when agreement was given that Doctors would still be able to take on private, fee-paying patients. (Lee 1995:95) (Reynoldson, 1996:118) (Lloyd T. 1986:289) (Wilkes, 2007:123) The dawn of the NHS was a huge change in the way people accessed healthcare. After the war New Towns were built to replace the inner city slums. The 1947 Town and Country Planning Act identified green belts where houses would not be allowed to swallow up the countryside. In 1954 the clean air act reduced smoke and smog in cities. In 1980, The Black Report stated that although health had improved since the introduction of the welfare state, huge inequalities in still existed between the rich and the poor. It concluded the reason for the disparity to be poverty. (BBC History, 2009) 1992 saw the publication of The Health of the Nation. This was the first ever strategy for healthcare improvement setting out objectives and measurable targets in four key areas: heart disease stroke, cancers, mental health, HIV/AIDS and accidents. The areas were selected because they were either a major cause of premature death or avoidable, interventions were possible and achievements could be monitored. (Childs, 1996) In 2000 health authorities became more autonomous and the establishment of a healthy competition between them. However, postcode can now determine the quality of healthcare provided and whether the hospital can afford or is willing to pay for the specific drugs and treatments, Press reports in recent months have highlighted how some patients been declined expensive cancer drugs by a particular hospital while it is provided to patients of a neighbouring authority. This contradicts the ethos of the NHS its position of equality of provision for all. Massive changes took place throughout the 19th and 20th centuries in terms of public health provision and scientific and medical discoveries. The NHS didnt stay completely free. It is rarely out of the news as waiting lists get longer because people are living longer. The main problem is funding as modern drugs and treatments are expensive.Most Infections and diseases can be prevented or cured but Doctors still struggle with heart disease and cancer. Viral infections like the common cold and AIDS cannot be cured and emphasis is now placed on educating people about how to avoid diseases like AIDS and lung cancer through lifestyle changes. (Wilkes A. 2007:p124) Two aspects of modern living which can have a detrimental effect on the health of the population are; smoking and diet. Although initially promoted as cleansing the lungs by tobacco manufacturers, the detrimental effects of smoking have been know for half a century. Naidoo Willis in Public Health and Health Promotion: developing practice highlight smoking as the single most preventable cause of ill health and premature death. A third of cancer deaths are linked to smoking and it is also linked to heart and lung disease. Smoking is estimated to cost the NHS  £1.7billion each year (Dept of Health 1998 Royal College of Physicians 1992 in Naidoo Willis 2009) Marlboros for Mummy Examples of early cigarette advertising. http://news.bbc.co.uk/nol/shared/spl/hi/pop_ups/03/uk_goodbye_tobacco_ads/img/2.jpg (news.bbc.co.uk//html/2.stm) (news.bbc.co.uk//html/2.stm, 2009) Early Cigarette advertising actually promoted the health benefits claiming relief from asthma, wheezing and hay fever. Craven called itself the Doctors Choice. Marlbroro promoted the benefits of smoking to Mothers. In 1998 the government banned tobacco advertising and targeted an anti-smoking campaign at children, pregnant women and disadvantaged adults. Demand is controlled by taxation and a ban on smoking in a public places including pubs. Obesity is a growing problem and has trebled since 1980. It is linked to social disadvantage and the way childrens lifestyles have changed over the last 50 years (more TV/computer time, less physical activity, convenience foods, working Mothers with less time). There is mounting pressure to ban the advertising of junk food. A high fat diet has been linked to heart disease and some cancers. NHS spending on sickness attributed to obesity has been estimated to exceed  £3.6billion. (Joint Health Surveys Unit, 2002 Mulvihill Quigley, 2003 Naidoo Willis 2009:p239). Last year the government launched the change4life education campaign to promote the message eat well, move more, live longer which encourages parents to make sure their children have a minimum of one hour exercise each day and reduce the amount of fat in their diet. http://t2.gstatic.com/images?q=tbn:lg0Gy-_B7JmSnM:http://www.sunseaandcycling.com/Files/Images/C4L_master-logo-rgb.jpg http://t1.gstatic.com/images?q=tbn:n39JMfcD3UH9DM:http://images.teamsugar.com/files/upl2/1/15111/11_2009/cb3240a4f35793dc_uk-change-4-life-ad.jpg (www.nhs.uk/Change4life, 2009) Public Health interventions have evolved as the government have taken responsibility for living conditions and health service provision, mass vaccination and immunization programmes. The epidemiological transition in the 20th Century saw the main causes of death and illness shift from infections to illness such as heart disease and cancer where lifestyle is a huge factor. (Naidoo Wills 2005:4) Current public health measures include mass screening programmes for example for breast and cervical cancers, extensive vaccination programmes as well as education and advice delivered by practitioners and the media campaigns. Examples of recent/current health media campaigns. http://t1.gstatic.com/images?q=tbn:vS8pq7HettyShM:http://www2.glos.ac.uk/offload/staff/news/swineflu.jpg http://t3.gstatic.com/images?q=tbn:qNfrnzs-ahQTYM:http://draust.files.wordpress.com/2009/01/nhs-measles-poster.jpg http://t0.gstatic.com/images?q=tbn:gslEVyv3VyG7SM:http://www.elements4health.com/images/stories/conditions/breast-cancer-ribbon-2.jpg (www.chesterfield.gov.uk/lowgraphic).. (draust.wordpress.com) (www.elements4health.com/report-highlights-ser) The political agenda is dominated by social responsibility and recognition of the links between poverty and ill health. Acheson defines health promotion as the science and art of preventing disease, prolonging life and promoting health through the organised efforts of society. (Acheson 1988 in Naidoo Wills, 2005:4)

Handedness and Lateralization

Handedness and Lateralization Handedness and Lateralization Cortical Organisation and Lateralization Of The Brain In Handedness And Dominance According to Annett most people in our society define handedness as the hand that you use for writing (1970). Researchers define handedness as the hand that performs faster or specifically on physical tests. Paul Broca (1979), suggested that a persons handedness was opposite from that specialised hemisphere (so a right-handed person probably has a left-hemispheric language specialization). However, a majority of left-hemispheric brain specialise for language abilities. Many researchers have try to this correlation between handedness and brain lateralisation. The key reason that hand-brain link is important and is an accepted methodology is that clinicians use handedness as a marker for brain lateralization. Language is a distributed cerebral network with differences in area involvement that relate to specific language functions (Frith et al., 1991). Vital regions in network lateralize to one hemisphere and determine lesion (Ojemann, 1991). In most people this lateralization is to the left. The only consistent information on the variability of hemispheric control between individuals are aphasias following a stroke or hemispheric inactivation by procedure in patients with brain lesions (Wada and Rasmussen, 1960). Pertaining to the unevenness of language control there is a chance of functional hemispheric reform (Rasmussen and Milner, 1977). It assumes that variation from left hemisphere language power is related to a difference like left-handedness. In right-handed subjects there is puzzling correlation of verbal language and hand dominance, both confines to a small area to the left hemisphere (Mayeux and Kandel, 1991). The actual variability of language lateralization in the general popu lation is practically unknown. Evaluations in a representative number of healthy subjects do not exist because, in the past, no technique was available to determine language lateralization effectively and non-invasively. This lack of information has hampered the assessment of language disturbances. There is an ongoing debate on the role of the right hemisphere in recovery from aphasia after left hemispheric strokes (Weiller et al., 1993Go; Heiss et al., 1997Go; Mimura et al., 1998Go). Particularly, in retrospective evaluations it would be important to know how many patients with left hemispheric strokes and transient disturbance of language can be expected to have been right hemisphere language dominant and to have suffered speech impairment due to other, more unspecific causes like decreased vigilance. Moreover, knowledge concerning the exact incidence of right hemisphere language dominance in healthy righthanders would be important for functional neuroimaging studies. Here, due to lack of information, researchers often need to rely on the assumption that restricting examinations to healthy right-handers will control for a possible variability in hemispheric dominance. Recently, a simplified functional imaging technique, functional transcranial Doppler-ultrasonography (fTCD) has become available (Aaslid, 1987Go; Hartje et al., 1994Go; Silvestrini et al., 1994Go; Rihs et al., 1995Go). It allows determination of hemispheric dominance in individual subjects in an effective, reliable and non-invasive way (Deppe et al., 1997Go; Knecht et al., 1998). This technique has now made it possible to establish the variability in the side and degree of language dominance in a representative number of healthy subjects. fTCD measures cerebral perfusion changes related to neuronal activation in a way comparable to functional MRI (fMRI) and 15O-PET (Kuschinsky, 1991Go; Jueptner and Weiller, 1995Go; Deppe et al., 1997Go, 1998Go). fTCD makes it possible to compare perfusion changes (by measuring blood flow velocities) within the territories of the two middle cerebral arteries (MCAs), which comprise the potential language areas (van der Zwan and Hillen, 1991Go). It thus provides an operational index of laterality which, in many respects, resembles the one obtained by the intracarotid amobarbital procedure (Wada test) (Wada and Rasmussen, 1960Go). Determination of language lateralization by fTCD matches precisely both the results of fMRI and the Wada test with concordance in every single case (Deppe et al., 1998Go; Knecht et al., 1998aGo). As in many previous studies of this kind, word generation was chosen as an activation paradigm because it is one of the most effective measures of language production (Neils-Strunjas, 1998Go). On this basis language dominance was determined in a total of 188 healthy subjects. Left-handers were excluded from the study because of possible confounding effects of handedness on hemispheric dominance (Kimura, 1983Go). A careful history for brain damage in the prenatal period or in infancy was taken in order to exclude subjects with possible plastic reorganization of hemispheric dominance after brain lesions (Rasmussen and Milner, 1977Go). The work was part of the Munster functional imaging study on the variability of hemispheric specialization in health and disease (Deppe et al., 1997Go; Knecht et al., 1998aGo, bGo). Hemispheric language dominance was assessed in 188 healthy volunteers with 111 females (mean age 26  ± 5.5 years, range 17-50 years) and 77 males (mean age 27  ± 3.7 years, range 21-40 years). Subjects were excluded if, on a standardized questionnaire, they reported delayed or disturbed language development or a history of other neurological disorders, particularly perinatal asphyxia or kernicterus, head trauma, loss of consciousness, epileptic seizures, meningitis or encephalitis. They were further required to have successfully completed the equivalent of high school (`Realschule or `Gymnasium). Right-handedness was assessed by a handedness index in the Edinburgh Inventory of greater than 30% (Oldfield, 1971Go). Left-handers were excluded from the study, as were right-handers with a score for right-h andedness lower than 30%, because, due to the small number of these subjects, an adequate evaluation of the effect of handedness on language lateralization would not have been possible. Approximately 75% of the subjects recruited had an index of more than 80% right-handedness. All subjects gave informed consent to participate in this study, which was approved by the Ethics Committee of the University of Mà ¼nster. Assessment of hemispheric language dominance was performed by a standardized fTCD technique (used in a number of previous studies) and a word generation task, validated by direct comparison with the intracarotid amobarbital injection and fMRI (Knecht et al., 1996Go, 1997Go, 1998aGo, bGo; Deppe et al., 1997Go, 1998Go). Briefly, subjects were presented with a letter on a computer screen 2.5 s after a cueing tone. Silently they had to find as many words as possible starting with the displayed letter. For fTCD an activation paradigm strongly based on verbal fluency was used, corresponding to the fields of reported female superiority (Basso et al., 1982Go; Pizzamiglio et al., 1985Go). Task performance was controlled by instructing the subjects to report the words after a second auditory signal following 15 s after presentation of the letter. All words had to be reported within a 5-s time period. The next letter was presented in the same way after a relaxation period of 60 s. Letters were presented in random order and no letter was displayed more than once. `Q, `X and `Y were excluded because very few words have these as initial letters. Changes in the cerebral blood flow velocity (CBFV) in the basal arteries were measured as an indicator of the downstream increase of the regional metabolic activity during the language task. Dual fTCD of the MCAs was performed with two 2 MHz transducer probes attached to a headband and placed bilaterally at the temporal skull windows (1Go). Details of the insonation technique, particularly the correct identification of the MCA, have been published elsewhere (Ringelstein et al., 1990Go). The spectral envelope curves of the Doppler signal were analysed off-line with the fTCD software AVERAGE developed by one of the authors (M.D.) (Deppe et al., 1997Go). 1 Schematic diagram of the way language lateralization was determined. Perfusion increases and therefore neuronal activation during word generation were assessed in the vascular territories of the left (marked in red) and right (marked in green) MCAs, which comprise the language areas. This was achieved by fTCD measurements of the CBFV changes in these arteries. Systemic effects were eliminated by calculating the differences in perfusion changes between sides. Averaging the responses over 20 repetitions (on average) in each individual made the results highly reliable. (For details, see Deppe et al., 1997.) After automated artefact rejection, data were integrated over the corresponding cardiac cycles, segmented into epochs which related to the cueing tone and then averaged. The epochs were set to begin 15 s before and to end 35 s after the cueing tone. The mean velocity in the 15-s pre-cueing interval (Vpre.mean) was taken as the base-line value. The relative CBFV changes (dV) during cerebral activation were calculated using the formula: dV = [V(t) Vpre.mean] x 100 / Vpre.mean where V(t) is the CBFV over time. Relative CBFV changes from repeated presentations of letters (on average 20 runs) were averaged time-locked to the cueing tone. The number of repetitions was less than 22, because no letter was presented more than once during the word generation task. A functional TCD laterality index LIfTCDwas calculated using the formula: Statistics The Kolmogorov-Smirnov test was used to assess the hypothesis that laterality indices in males and females were drawn from different populations. Unlike the parametric t-test for independent samples or the Mann-Whitney U test, which tests for differences in the location of two samples (differences in means, differences in average ranks, respectively), the Kolmogorov-Smirnov test is sensitive to differences in the general shapes of the distributions in the two samples, i.e. to differences in dispersion and skewness (Spence et al., 1990Go). The Mann-Whitney test for equivalence (Wellek, 1996Go) was employed to confirm equivalence of laterality indices in men and women. A significant result in this test provides a strong positive measure for a lack of gender differences in laterality indices. We tested the null hypothesis H0: |P[LImale > LIfemale] 1/2| >={varepsilon}versus the alternative hypothesis of equivalence H1: |P[LImale > LIfemale] 1/2| In six of the 194 right-handed subjects determination of language lateralization was not possible due to lack of a temporal bone window, i.e. inadequate ultrasonographic penetration of the skull by the ultrasound beam. In the remaining 188 subjects (59% females, 41% males) the overall distribution of language lateralization was bimodal with 7.5% being right hemisphere and 92.5% left hemisphere language dominant (2Go). The distribution of language lateralization was equivalent in men and women (3Go). The Kolmogorov-Smirnov test did not detect any significant differences between females and males in the overall distribution (P > 0.05). In the subgroup of left hemisphere language dominant subjects, the Mann-Whitney test for equivalence showed equivalence with P The average number of words found during the activation task per letter presented was not statistically different between men and women (Mann-Whitney U test, P = 0.81) or subjects with left or right hemisphere language dominance (Mann-Whitney U test, P = 0.26). It was also independent of the index of lateralization (correlation coefficient r = 0.027). These are the first data on the natural distribution of language dominance in a large series of healthy right-handed subjects. They demonstrate equivalence of language lateralization for word generation in males and females, and they suggest that 1 in 13 healthy right-handed subjects is right hemisphere dominant for language. Methodology There is debate whether language can be treated as a separate mental faculty or should be approached as part of a more general cognitive system (Fodor, 1983Go). Moreover, language comprises receptive and expressive aspects and is intertwined with prosody, memory and attention (Knecht et al., 1996Go; Binder et al., 1997Go). Therefore, the assessment of language lateralization based on a single activation task provides just one index of the interindividual variability in language processing. This approach can nevertheless serve as a first step in elucidating the factors underlying the diversity of large scale neural language organization. fTCD lends itself to determination of hemispheric language dominance. The index of lateralization obtained by fTCD based on word generation is very reliable and closely corresponds to (i) the outcome of the intracarotid amobarbital procedure and (ii) the index of lateralization obtained by fMRI (Deppe et al., 1998Go; Knecht et al., 1998aGo). Other techniques like head turning, event-related potentials, transcranial high frequency magnetic stimulation or the dichotic listening test used for the evaluation of language dominance have so far failed to provide results that are reproducible and in sufficient concordance with the intracarotid amobarbital procedure (Bryden and Allard, 1981Go; Jancke et al., 1992Go; Jennum et al., 1994Go; Segalowitz and Berge, 1995Go; OLeary et al., 1996Go; Hugdahl et al., 1997Go). Unlike the intracarotid amobarbital procedure and as opposed to brain lesions, functional imaging techniques including fTCD assess brain activation and not inactivation. They are set to determine the location and relative amount of the maximal activation while diffuse or bilateral activations are cancelled out. Thus, fTCD is insensitive to a lesser activation in the contralateral hemisphere. Moreover, fTCD cannot determine whether an activated region during a task is a critical region that, when damaged, will result in a loss of that particular function. This shortcoming holds for all functional imaging techniques. However, the fact that determination of language lateralization by fMRI and fTCD correspond closely to that determined by the intracarotid amobarbital inactivation suggests that activated regions match critical regions and therefore provide essential information on the risk for language loss (Desmond et al., 1995Go; Binder et al., 1996Go; Knecht et al., 1998aGo). Sex Fuelled by the general interest in `la petite diffà ©rence, the lack of information about the natural distribution of language dominance has led to far-reaching speculations about possible differences in language lateralizations between the sexes. This discussion has been characterized by a high acceptance for positive results. Thus, despite considerable data to the contrary, there is a strong belief that language in women, on average, is less lateralized than in men (Bakan and Putnam, 1974Go; Levy and Reid, 1976Go; McGlone, 1980Go; McKeever et al., 1983Go; Hough et al., 1994Go; Rugg, 1995Go). The idea of an increased bilaterality in women has received support by a recent fMRI study in 19 males and 19 females (Shaywitz et al., 1995Go) in which activation related to a rhyming task was found to be more bilateral in women than in men. It has been conjectured that an increased bilaterality of language in women would lead to a decreased susceptibility to unilateral infarctions explaining a greater male than female proportion of aphasics (McGlone, 1980Go). Kertesz and Sheppard then showed that aphasias were as frequent in males as in females, as long as sex differences in the incidence of infarcts were taken into account (Kertesz and Sheppard, 1981Go). Similar results were obtained in a more recent epidemiological study (Pedersen et al., 1995Go). Recently, using fMRI, Frost and colleagues found no differences between sexes during a language comprehension task when group averages were compared (Frost et al., 1999Go). Our data provide the first direct evidence that language lateralization during word generation in men and women is also equivalent in variablity. In fact, they not only show a lack of significant differences but they positively demonstrate significance of equivalence in healthy subjects even though this finding is based on a word generation task, i.e. a field of reported female superiority (Kimura and Harshman, 1984Go). Equivalence of hemispheric lateralization between sexes during word generation does not exclude gender di fferences in subfunctions of language like rhyming, which we did not investigate. As was pointed out before, such a difference has been reported by Shaywitz and colleagues in a small series of subjects examined by fMRI (Shaywitz et al., 1995Go). However, in line with our results, these researchers did not find gender differences in other language tasks. Right hemisphere language dominance The predominance of right-handedness and left hemisphere language lateralization has led some theorists to suggest that a gestural system of communication with dominance of the right hand provided the neural architecture for vocal articulation in human evolution (Hewes, 1973Go; Kimura, 1987Go). If indeed handedness and language were coupled because they share the same neural resources, then any deviation from this pattern would have to be pathological. Right hemisphere language dominance in right-handers or left hemisphere language dominance in left-handers reported from the intracarotid amobarbital procedure does not challenge this view, because this procedure is only performed in patients with brain pathology. However, the present findings in healthy subjects indicate that even under natural conditions the association between handedness and language dominance is not an absolute one. Because 75% of subjects were strongly right-handed (>80%) and the remaining had handedness indices o f >30%, the effect of the degree of handedness on language lateralization could not be evaluated in the present study. Comparison of left- and right-handers will be necessary to test whether a relative association between handedness and language dominance exists in healthy subjects. The extreme argument could be put forward that all of our presumed healthy subjects with right hemisphere dominance must have suffered covert brain damage resulting in a shift of language into the right hemisphere. A similar argument has been made to explain left-handedness in healthy subjects (Coren, 1990Go). We believe that covert brain damage was unlikely. The medical history in all subjects was unrevealing and the scholastic achievement was similar. The average number of words produced during the task did not differ between subjects with left or right hemisphere language dominance and the pattern of language lateralization variability was bimodal with maxima for left- and right-hemisphere dominance (2Go). If there had been subclinical damage to language relevant areas in the left hemisphere resulting in a shift to the right, one would have expected impaired word fluency and more cases with little lateralization because of a bilateral representation of language functions. This was not the case. We therefore suggest that right hemisphere language dominance is not a pathological but a natural phenomenon. Previous estimates of `atypical right hemisphere language dominance were either based on the results from the intracarotid amobarbital test in patients evaluated for resective neurosurgery or on the occurrence of `crossed aphasia, i.e. aphasias after right hemispheric lesions. In patients with epilepsy submitted to the intracarotid amobarbital test the number of right-handers with right hemisphere language dominance was 4% in a large series and rose to 12% when a left hemisphere lesion was defined (Rasmussen and Milner, 1977Go). Because the Wada test is only performed in patients with brain lesions, which are often associated with a secondary transfer of cortical functions from the damaged to the intact hemisphere, these numbers cannot be extrapolated to healthy subjects (Helmstaedter et al., 1994Go). By evaluation of stroke-patients with crossed aphasia, the incidence of right hemisphere language dominance in right-handers has been inferred to be between 1 and 2% in the majority of series (Gloning, 1977Go; Borod et al., 1985Go; Kertesz, 1985Go). On the one hand, this low estimate of right hemisphere language dominance in previously healthy subjects made aphasias in right-handers after right-sided lesions seem an exceptional event and has resulted in almost 100 reports on `crossed aphasia in the last 30 years. On the other hand, difficulties in the assessment of language performance due to physical exhaustion and deficits in sustained attention in the early stages after stroke and reorganizational restitution in the later stages may have facilitated an underdiagnosis of aphasia in right hemispheric stroke patients in many studies. Not every patient with a cerebral infarction in the respective language dominant hemisphere will suffer damage of the language areas and become aphasic. The overall rate of aphasia due to stroke has been found to be 38% in the acute state and 18% at discharge from the hospital (Pedersen et al., 1995Go). Reasoning from the effects of brain activation to the effects of brain lesions is problematic but results from activation studies may be conceptually useful to the understanding of lesion-deficit variability in the clinical context (Willmes and Poeck, 1993Go). In a single recent study on 880 stroke patients it was reported, in passing, that of right-handed aphasics 9% had right hemispheric lesions (Pedersen et al., 1995Go). In a study on language deficits in servicemen who had suffered penetrating brain wounds, 18% of the aphasics had suffered right hemispheric lesions (Mohr et al., 1980Go). However, here the possible effects of diffuse brain damage by the impact of a bullet and the effect of variable handedness pose methodological limitations. Our cohort was similar in age to these soldiers. We found an incidence of 7.5% of right hemisphere dominance in our activation study of healthy subjects. This combined evidence suggests that about 1 in 13 previously healthy right-handed patients with a right hemispheric infarction could be at risk of suffering language impairments becaus e this is the hemisphere dominant for word generation. Conversely, after left hemispheric infarctions right-handed patients, who in retrospective evaluations seem to have recovered well from language disturbances, and on fMRI or PET may even show language related activation in the right hemisphere, may do so because they had been right hemisphere language dominant to begin with. Presently, we do not know the relevance of the extent of language lateralization by fTCD. Low indices of lateralization indicate that there is a bihemispheric activation during word generation. 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