Concentration Camp Sourcework Essay Example for Free

Concentration Camp Sourcework Essay In Source 5 Reitlinger says that more than a hundred thousand people must have known. If this is correct then why did no-one take the blame for it at the end of the war? Or even do anything to help the Jews? How well supported this claim is depends on the other sources. Source two agrees with Reitlingers claim as it says All the same rumours did circulate about dreadful deeds in the East this concurs with had not heard the same story in Reitlingers source. Also in Source 2 it says Because of the Nazis much publicised resettlement plans this again agrees with Jews had disappeared in Reitlingers source. In conclusion Reitlinger is supported, by Source 2, about rumours being spread and that people had seen Jews disappear. Source three is a very neutral source to the credibility of Reitlingers as it says Workers at an extermination centre in Austria were told Keep quiet about this or face the death penalty' this almost contradicts what Reitlinger says about people knowing about the camps. If the workers in the camps were threatened with their lives then would the hardly gossip to neighbours? Also in source three is says that when the crematoria were turned on it caused a power- outage outside Dachau, the people would obviously notice if their power was turned off so this supports Reitlingers claims. Source 6 contains much information and it supports Reitlingers claims as it contains information concerning an SS man declaring on a train that 2000 Jews were being murdered every week at Auschwitz if this SS man was concerned about secrecy would he have said it on a busy train? Source 6 also goes into some detail about the BBC laughing a broadcast campaign on the extermination of the Jews which provided information for any Germans that held a radio and it also says that The leaflets dropped by Allied planes also relayed information on the annihilation policy I think that the German people would have had enough information to confirm the rumours they might have heard. Source 8 contradicts Reitlinger as it says All swore that during the past few years they had no idea what had been going on in the camp outside their town this is important to note as the people themselves are saying they hadnt heart anything. There is a possibility that they could have been lying or faking their knowledge of the situation as evidence shows the general knowledge of people living around the camps. Source 10 supports Reitlinger as the author says The Jews are disappearing in throngs this matches with Source 5s not know most of the Jews had disappeared I would have to conclude that Reitlinger was probably correct in his estimate of German knowledge of the concentration camps as a good portion of the evidence in the sources tells us that it is plausible to estimate figures as grand as a hundred thousand people. I think many of the Germans did in fact know about the camps either by the rumours or by radio or by information pamphlets and therefore it begs the question as to why they didnt do anything to help the suffering Jews. Were they afraid of the strict penalties? Some had put their lives on the line by telling people about the camps why didnt they do anything? The answer to this is that although the people may have known there was nothing that they could have done to stop it completely and therefore could not be really held responsible for not helping.

Respiratory Infections Caused By Bacteria Biology Essay

Respiratory Infections Caused By Bacteria Biology Essay -Respiratory infections caused by bacteria are quite so many. They can be differentiated by placing them into where they actually cause disease in the respiratory system or tract. Some bacteria cause disease in the upper respiratory tract whilst others affect the lower respiratory tract. The upper respiratory tract comprises the nasal cavity, pharynx and the larynx, whilst the lower respiratory tract is made up of the trachea, primary bronchi and the lungs. When it comes to aetiology, the respiratory infections caused by bacteria can be compared and contrasted as follows: Legionnaires disease is caused by the bacteria Legionalla pneumophila, which is a rod shaped, motile and gram negative, fastidious bacteria. Legionnaires disease is one of the most common causes of atypical pneumonia in hospitalized patients. It is the second most common cause of community-acquired bacterial pneumonia and travel-acquired pneumonia.Legionelloses can occur both sporadically and in epidemics. And over the past decade, Legionnaires Disease cases have increased. This is so because of the common use of central air conditioning, especially in office hotels, buildings and hospitals. In contrast to Legionalla pneumophila, Haemophilus influenzae is a nonmotile, but is also a fastidious, Gram-negative, rod-shaped bacterium like L. pneumophila. Non capsular type b H. influenzae causes is associated with acute exacerbations of chronic bronchitis. Disease is e much more common in children than older age groups.. Haemophilus influenzae can cause infection in the respiratory tract, which can spread to other organs. Many species of Haemophilus are normal residents in the upper airways of children and adults and rarely cause disease. Usually, Haemophilus influenzae can cause infections in children and sometimes in adults who have a chronic lung disorder or a weakened immune system. Diphtheria, which is an acute infectious bacterial disease primarily involving the mucous membrane of the upper respiratory tract (nose, tonsils, pharynx, and larynx), is caused by Corynebacterium diphtheriae. In comparison to L pneumophila and H influenzae, Corynebacterium diphtheria, is a also rod shaped but non motile like H influenza, and in contrast, is gram positive and non fastidious. Normally, streptococcus pneumoniae is a inhabitant of the human upper respiratory tract., but it causes infections like pneumonia, bacteremia, otitis media, meningitis, sinusitis, peritonitis and arthritis. Streptococcus pneumoniae cells are Gram-positive, coccus bacteria. Usually, they are seen as pairs of cocci (diplococci), but they may also occur singly and in short chains.They can be aerobic or anaerobic and are often capsulate. Streptococcus pneumoniae is known in medical microbiology as the pneumococcus, referring to its morphology and its consistent involvement in pneumococcal pneumonia. Streptococcus pneumonia caused pneumonia can be divided into two forms, bronchial pneumonia (100%), most prevalent in infants, young children and aged adults and and lobar pneumonia (80%), which is common in younger adults Streptococcus pyogene, a gram positive cocci, non motile and non spore forming bacteria, causes streptococcal pharyngitis, which is popularly known as strep throat. Strep throat is characterized by a painful, red throat with white patches on tonsils, and is accompanied by swollen lymph nodes, fever, and headache. Streptococcus pyogenes is considered to be an opportunistic pathogen. This is so because it is part of the normal flora of the respiratory tract in many people, not causing any complications until the persons natural defenses become immunocompromised. Mycobacteruim tuberculosis, are rods, gram positive, acid fast and obligate aerobic bacteria. They cause the disease Tuberculosis (TB) whose importance has been compounded by the emergence of AIDS and the appearance of multiple drug-resistant (MDR) strains of M. Tuberculosis. TB most commonly affects the lungs but also can involve almost any organ of the body. There is a vaccine against Tb called Bacille Calmette Guà ©rin, also known as BCG, which is a vaccine given throughout many parts of the world. TB is one of the most serious infectious disease of the resource poor world. It is persistent wherever poverty, malnutrition and poor housing prevail. It affects the apparently healthy as well as being a serious disease of the immunocompromised, as it is particularly with patients with HIV/AIDS. TB is primarily a disease of the lungs, but may spread to other sites Bordetella pertussis, the small gram negative coccobacilli, are slow growing and fastidious bacteria. They cause a disease called whooping cough, whose name is because of the characteristic sound produced when affected individuals attempt to inhale; the  whoop  originates from the inflammation and swelling of the laryngeal structures that vibrate when there is a rapid inflow of air during inspiration. Wooping cough is characterised in three main phases. The  first stage  of whooping cough is known as the catarrhal stage, in which symtoms are runny nose, sneezing, low-grade fever, mild, occasional  cough, similar to the common cold. The cough gradually becomes more severe, and after one to two weeks, the second stage begins. It is during the  second stage  (the paroxysmal stage) that the coughing is most severe. A series of closely spaced coughs occurs, followed by a `whoop` as air is inhaled. Vomitting may be stimulated by the coughing process. Coughing can occasionally be so severe as to rupture blood vessels in the eye or meninges. The  third stage  of whooping cough is the recovery or convalescent stage, where there is a marked decrease in vomiting and paroxysms becomes less frequent and the child sleeps better. And towards the end of this phase, the coughing stops. Whooping cough commonly affects infants and young children but can be prevented by immunization with pertussis vaccine Transmission L. pneumophila is not acquired through a person to a person transmission. The bacteria, thus the disease is acquired by inhalation of contaminated water from showers, Respiratory therapy equipment,air conditioning systems as well as cooling towers. And the bacteria will usually cause respiratory disease in humans after a susceptible host inhales aerosolized water containing the bacteria or aspirates water containing the bacteria. Legionnaires disease is one of the causes of atypical pneumonia and even after inhalation of the bacteria, disease is not obvious. There are therefore,e risk factors which are associated with one getting Legionnaires disease. These are, cancer, usually pulmonary or hematological malignancy, Smoking, Surgery,Diabetes, HIV/AIDS ,Chronic cardiopulmonary disease, Advanced age and Alcohol abuse Haemophilus influenza is a normal habitat of the upper respiratory tract of humans and other animals. The infective bacteria are transmitted from person to person, by air borne route. This is typically through sneezing, coughing, or touching. Corynebacterium diphtheria is a normal habitat of human nasopharynx and occasionally, the skin. Therefore, the disease Diphtheri,a is transmitted from the infected to others via airborne respiratory droplets or by direct contact with nasopharyngeal secretions or skin lesions. Quite, rarely, it can be spread by objects which are contaminated by an infected person. The spread of diphtheria is increased by overcrowding and poor living conditions. Raw milk has served as a vehicle. Infected individuals may develop symptoms of diphtheria, or they may become carriers of the bacteria with no symptoms (asymptomatic carriers). These asymptomatic carriers can serve as reservoirs for active infection and may transmit the disease to other individuals Streptococcus pneumonia is a normal habitat of the human respiratory tract. Therefore, the spread of the bacteria is primarily via droplet spread or aerosol or through contact with nasal secretions of the infected person. It is therefore. a transmission of person to person. Streptococcus pyogenes is a normal habitat of the human upper respiratory tract as well as the skin. The respiratory disease caused by these bacteria, Streptococcal pharyngitis is acquired by inhaling aerosols emitted by infected individuals. Spread is therefore by air-borne droplets, through sneezing and coughing and by contact. M. tuberculosis has the ability to survive in the environment due to the waxy outer coat and this is what aids the transmission of bacteria through air borne droplet spread because they can survive for long periods of time in air and house dust. Therefore, a person can become infected with M. tuberculosis when they inhale minute particles of infected sputum from the air. TB is acquired by inhalation of Mycobacterium tuberculosis in aerosols and dust. Air-borne transmission of TB is every effective because infected people release enormous numbers of mycobacterial into the environment, when they cough, sneeze, shout, or spit. In the transmission of TB, social and environmental factors as well as genetic predisposition have a role to play. B. pertussis causes whooping cough, which is a highly contagious disease and is spread among people by direct contact with the nose or mouth fluids from of infected people. People may contaminate their hands with respiratory secretions from an infected person and then touch their own mouth or nose. Another way is that small bacteria-containing droplets of mucus from the nose or lungs enter the air during a cough or sneeze and people can become infected by breathing in these drops. And in vaccinated populations, B.pertussis is brought home by an older person, like even a parent, then spread to the vulnerable population of children. Pathogenesis Once L. pneumophila bacterium is in inhaled, infection will begin. The bacteria virulence factors are unclear, but the bacteria have a way of surviving in the alveolar macrophages. The infection though, will be obvious, if the person has other predisposing risk factors like smoking, cancer, HIV/AIDS, surgery, advanced age, alcohol abuse and diabetes. About 2-9 days after inhaling the bacteria, symptoms will involve headaches, fever chills and a cough which is nonproductive but may become productive as disease progresses. There will also be other symptoms involving the gastrointestinal tract like vomiting, nausea and diarrhea Arthralgias and myalgias are the musculoskeletal symptoms often experienced. And when the L.pneumophila bacteria get to the alveoli, they are attacked by the alveolar macrophages. These alveolar macrophages, will take the bacteria into the food vacuole inside the cell. Most often, the infection will progress because instead of the bacteria being destroyed by the macrophages, the bacteria will instead stop the fusion of the lysosome and monocyte. This will result in the bacteria to multiply inside the macrophage, and they eventually lyse the cell as well as infect other cells. Disease will progress from here. H. influenza interfers with the local expression of the immune response in tissues. Therefore, it does not interfere with the development of an immune response, but will just actively interfere with its expression in tissues. This bacteria liberates a protease that cleaves human IgA antibogy. H. influenza is a resident or invades mucosa where IgA antibodies operate. H. influenzae   has a polysaccharide capsule which is an important virulence factor. This is because the capsule allows the bacteria to resist digestion by phagocytosis. These capsules also protect the bacteria when taken up by the lung macrophages. Diphtheria, the disease is due to production of diphtheria toxin which is controlled by the tax gene, which is integrated into the bacterial chromosome on a lysogenic phage. The toxin`s mode of action is the blocking of protein synthesis in the host epithelial cells by inactivating the elongation factor. The signs and symptoms of respiratory diphtheria, which begin after a 2-5 days incubation period, are because of the bacteriums ability to cause a localized inflammatory reaction of the cells lining the upper respiratory tract. The initial symptoms will be moderate fever, malaise, hoarseness, difficulty in breathing and swallowing and a sore throat. Later the complications may be cardiac, neurologic, infectious, like lung, bone and blood infection and death. So, when respiratory diphtheria progresses, the infected individual may also develop a gray membrane (pseudomembrane) which will form over the lining tissues of the tonsils and/or nasopharynx. In severe disease, patients may also develop neck swelling and enlarged neck lymph nodes. The extension of the pseudomembrane into the larynx and trachea can eventually lead to obstruction of the airway with subsequent suffocation and death. Immunization is the best prevention against diphtheria. The clinical symptoms of S. pneumoniae caused pneumonia include sudden onset of high fever, chest pains, dyspnea and a cough productiveof bloody sputum. In adults though, on set may be less sudden with shortness of breath, fever and altered mental status being the first symptoms of pneumonia. In young children and infants, vomiting, convultions and fever may be the first signs. Pnuemococcal pneumonia is one of the important causes of death in the elderly and infants. And the ones at high risk are those with chronic conditions and with immune deficiencies. Other complications that can arise from infection can be acute respiratory distress syndrome, septic shock, and empyema. S pneumoniae is a typical extracellular bacterial pathogen, which has a capsule that protects it from phagocytosis. Therefore, its pathogenicity requires adherence to host cells as well as the ability to replicate evade phagocytosis. It is in this effect that the organism must then gain access to areas where it can manifest infection, either through direct extension or lymphatic or hematogenous spread. Through direct extension, organisms may gain access to areas of the upper and/or lower respiratory tracts (sinuses, bronchi, eustachian tubes) after the colonization. Normally, in a healthy host, anatomic and ciliary clearance mechanisms will prevent clinical infection. But, clearance may be reduced by chronic (bronchitis, smoking, allergies,) or acute (viral infection, allergies) factors, which can lead to infection. Alternatively, by hematogenous spread and after mucosal invasion, pneumococci may reach normally sterile areas, such as the blood, peritoneum, cerebrospinal fluid, or joint fluid Symptoms of strep throat are sore throat, high fever, coughing, swollen lymph nodes and tonsils and a fiery red appearance to pharyngeal tissues which is du to tissue erosion. The M protein enhances the pathogenicity of S. Pyogenes. This protein, which is anchored in the cell wall and cell membrane, encourages adherence to the pharyngeal tissue and retards phagocytosis of the bacteria by the phagocytic cells of the host. Host immunity to Streptococcus pyogenes results from the development of antibodies specific to M protein. Over 80 specific types of M protein have been identified and complete immunity to streptococcal disease requires that a person produce antibodies against all 80 types. In developing countries, TB is a major cause of death and disability. In all cases, the disease begins with exposure to an infectious human source, thereafter, subsequent infection usually goes without notice. The first stage which is called primary infection causes no outward clinical manifestations. In this stage, the bacteria are engulfed by the alveolar macrophages where they can both survive and multiply. Primary TB is often mild and asymptomatic and often in 90% of cases, it does not proceed further. But clinical manifestations develop in the remaining 10% leading to active tuberculosis. and it may take several months from the time the infection initially gets into the lungs until the symptoms develop. In active TB infection, the usual symptoms are a generalized tiredness or  fever, weight loss, weakness, and night sweats. And if the infection in the lung worsens then, chest pain, coughing,  coughing up of sputum and/or blood, and shortness of breath may be experienced. In the event that there is spread of infection beyond the lungs, the symptoms will depend upon the organs involved. M. tuberculosis is an intracellular pathogen, meaning, it is capable of surviving within macrophages. It is capable of surviving intra-cellularly through the inhibition of phagosome-lysosome fusion. Cell mediated immunity alos comes into effect, which causes infiltration of macrophages and lymphocytes with development of granulomas (tubercles).. Much of the pathology of TB is due to host immune responsiveness rather than to direct bacterial toxicity. And at times, the bodys immune system becomes weakened, and the TB bacteria break through the scar tissue and can cause active disease, referred to as reactivation tuberculosis or secondary TB. Like the immune system can be weakened by old age, chemotherapy, HIV/AIDS and certain other medications. B.pertussis usually colonizes the ciliated respiratory epithelium of the trachea-bronchial tract. This colonization prevents the cilia from eliminating materials from the respiratory tract and it is this accumulation of materials which stimulates the coughing. It has been seen that capsulation of the bacteria canvplay a role in the successful colonization. A variety of virulence factors of B. pertussis have been demonstrated which are: The Pertussis toxin known for causing death Adenylate cyclise toxin play a role in inhibiting s the defensive functions of neutrophils Tracheal cytotoxin which kills the tracheal epithelial cells and causes local inflammation And the Endotoxin Pathogenesis of B. pertussis is that it colonizes an area which is normally bacteria-free i.e the respiratory epithelium and then disrupts or destroy the first line defense mechanism i.e the cilia The infection is promoted by the bacterium.. Laboratory Diagnosis Legionella pneumophila can be diagnosed in the lab by the following ways, Culture: The specimens are bronchial washings and bronchoalvealor lavage which are better collected before commencement of antibiotic therapy. Legionellae are fastidious organisms requiring cysteine and other essential growth promoting factors for their successful isolation and need 48 hours incubation before growth is visible for up to five days or more. A negative culture is not an obvious exclusion the diagnosis of legionellosis. Serological test Ideally, paired sera collected as soon as possible after the onset of illness and 3 to 6 weeks later should be tested. Direct Fluorescent antibody (DFA) Legionellae can be detected in respiratory secretions by DFA for several days after the start of antimicrobial therapy. DFA staining has also been used for serologic identification of Legionella isolates. Urine Antigen Detection Urinary antigen testing has helped in the recognition of outbreaks of Legionnaires disease allowing for a rapid public health response. Also urine antigen helps make an early diagnosis thus the initiation of appropriate antibiotic therapy. immunochromatographic (ICT) membrane assay. This is a very simple test, not needing special laboratory equipment, giving results within 15 min. Nucleic acid based tests Poymerase Chain Reaction (PCR) tests that have been developed for legionellae Diagnosis of H. influenzae pneumonia is made by successfully culturing, isolation and identification of the bacteria. Identifying H. influenzae needs a sample to be taken from infected tissue and be confirmed by laboratory tests. The specimen is usually grown on culture with the following conditions: On chocolate blood agar ( which is prepared by adding blood to an agar base at 80oC) Incubated at 35-37oC  with optimal pH of 7.6.   under aerobic conditions or under slight CO2  tension (5% CO2 The diagnosis of diphtheria is confirmed by isolation of the bacterium  Corynebacterium diphtheriae. Specimens are taken from the nose and throat in any individual suspected of having diphtheria, as well as their close contacts. For culture, Corynebacterium diphtheriae, can be isolated (and diphtheria can be diagnosed) using the following conditions: Using blood culture-identification is aided by a selective medium on which characteristic black colonies form within 48 hrs at 35 degrees celcius . Biochemically, it is catalase positive and reduces nitrate. The Elek test is used to demonstrate toxin production of the bacteria. Polymerase Chain Reaction (PCR) is also used for the identification of the toxin gene Streptococcus pneumoniae can be isolated and identified using culture and biochemical tests. The specimen is usually grown on culture with the following conditions: By use of at 5% blood agar which will grow colonies that characteristically produce a zone of alpha (green) hemolysis, and this differentiates S. pneumoniae from the group A (beta hemolytic) streptococcus, Biochemically, S. pneumoniae is catalase negative and is distinguished from other streptococci by inulin fermentation, optochin sensitivity and bile test. PCR is also available for diagnosis as well as for screening for S.pnumoniae by using respiratory samples or feces When cultured on blood agar, they are alpha hemolytic. Individual cells are between 0.5 and 1.25 micrometers in diameter. They do not form spores, and they are nonmotile. Like other streptococci, they lack catalase and ferment glucose to lactic acid. Unlike other streptococci, they do not display an M protein, they hydrolyze inulin, and their cell wall composition is characteristic both in terms of their peptidoglycan and their teichoic acid S.pyogenes caused Strep throat can be diagnosed through a throat culture or a rapid strep test. The throat culture will be grown on an enriched medium containing blood. S. pyogenes is fermentative, is a facultative anaerobe and is a catalase-negative TB can be diagnosed by a skin test for delayed hypersensitivity with tuberculin. A positive test does not necessarily indicate active disease; merely exposure to the organism Staining and microscopic exam of sputum specimens for the presence of acid-fast bacteria is a rapid test for tuberculosis. When cultured, M. tuberculosis grows very slowly, meaning culture results may delay commencing of treatment for the patient. Culture also requires the use of complex media. Polymerase Chain Reaction (PCR) can also be used to diagnose TB. This test detects the genetic material of the bacteria, it is extremely sensitive (it detects minute amounts of the bacteria) as well as specific (it detects only the TB bacteria). Results are usually ready within a few days. Culture of the bacterium  Bordetella pertussis  from nasal secretions can establish the diagnosis of whooping cough. Since there are difficulties in obtaining the adequate sample, swabs should be inoculated directly onto media at the patients` bedside. It is better to get both post and peri nasal swabs. B. pertussis fails to grow on routine blood agar and only requires enriched medium. Therefore, special media are used for isolation of B. pertussis, and these are Bordet Gengou medium and Lacey`s medium and it needs 3-7 days incubation in moist atmosphere. B.pertussis is then identified on colony appearance basis using the proper medium as well as agglutination tests. Polymerase Chain Reaction (PCR) has been used to successfully identify the bacterium and diagnose whooping cough. This test can identify genetic material from the bacterium in nasal secretions

Effective Treatment for Generalized Anxiety Disorder

Effective Treatment for Generalized Anxiety Disorder Introduction In primary care, as in other fields of medical practice, it is essential that doctors are able to apply the findings of scientific research to the circumstances of individual patients as part of their clinical decision-making process. This is known as evidence based medicine. In this review I have taken an illness which often presents in primary care, namely Generalized Anxiety Disorder (GAD), and by researching possible treatments have developed the skills necessary to search various databases for relevant articles and the ability to assess the validity of the evidence found. In this review I focus specifically on Cognitive-Behavioural Therapy (CBT) as a potential treatment for GAD. Generalized anxiety disorder is characterized by chronic, uncontrollable worry associated with a wide range of physical symptoms including fatigue, headaches, muscle aches, difficulty swallowing, trembling, twitching, sweating, nausea and shortness of breath. A diagnosis of GAD is made when a person worries excessively about a variety of every day problems for at least 6 months. The disorder is common in later life, with a prevalence of 11.2% in primary care where older adults most often seek treatment and overall is more prevalent than either severe cognitive impairment or depression in the over 65s. Despite this, anxiety disorders in the ageing population have received relatively little research attention. Anxiety in later life has been linked to increased risk of physical disability, memory difficulties, decreased quality of life and inappropriate use of medical services . There are currently several treatment options available for GAD including drugs such as Benzodiazepines, Selective Serotonin Re-uptake Inhibitors (SSRIs), Azapirones, Barbituates and Pregablins. There are also alternative treatment options such as herbal remedies and psychotherapy such as Cognitive-Behavioural Therapy and Psychodynamic Psychotherapy. Cognitive-behavioral therapy is a form of psychotherapy which targets problematic emotions and behaviours via a range of approaches and can be used alongside medication or as an alternative to it. When used to treat anxiety disorders the principle methods include education and awareness, motivational interviewing, relaxation training, cognitive restructuring, exposure, problem-solving skills training and behavioural sleep management. Unlike anxiolytics, CBT has no known side effects or risk of physical dependence. Anxiolytics are currently the most common treatment for late-life anxiety and surveys suggest that up to 20% of non-instituti onalized elderly persons may be using benzodiazepines. However, the use of these medications as a long term treatment for anxiety disorders is associated with potential risks for elderly patients such as cognitive impairment, falls and hip fractures, drug interactions and toxicity. Also an over-reliance on medication may neglect potentially important psychosocial factors such as social support, coping skills and interpersonal relationships. In light of this it is important that the effectiveness of CBT is assessed as it could prove a useful alternative to long term medication particularly in the ageing population. Method I conducted initial research using textbooks and the internet and then used different databases to search for relevant papers and articles. Searches were primarily conducted using MedLine (Medical Literature Analysis and Retrieval System) as it contains information from a wide range of fields including Medicine, Nursing, Pharmacy, Biology and Biochemistry and contains over 18 million records from approximately 5,000 publications. Web of Knowledge was also used as it encompasses not only MedLine but also other databases such as the Social Sciences Citation Index. I also conducted searches using Scopus and the Cochrane Library but often found that the Cochrane Library yielded few or no results so these searches have been omitted. By beginning with broad search terms it was possible to refine these to yield fewer, more relevant results. An initial search of the terms cognitive-behavioral therapy and generalized anxiety disorder yielded the following results. The search was also limited to include articles which had both these terms in the title and in the abstract. Various spellings and abbreviations such as CBT and GAD were used when searching for cognitive-behavioural therapy and generalized anxiety disorder in order to achieve a high number of results and to ensure articles werent overlooked. After searching through the results, reading abstracts and dismissing articles which werent relevant to this topic or freely available, 4 articles were chosen to be included in this review. I chose to specifically focus on RCTs as this is the strongest study design for testing cause and effect relationships. When critically appraising the papers included in this review, a series of questions primarily derived from the CASP (Critical Appraisal Skills Programme), but also incorporating other sources, were used and articles were judged on how much information they provide and the quality of the evidence. Examples of these questions are as follows. Did the trial have a clear objective? Is an RCT an appropriate study design to answer this question? How were the participants randomized? What was the average age of the participants? What were the exclusion criteria for participants? Were the subjects in each of the groups similar on demographic and baseline clinical variants? How did the trial adjust for attrition? When/how often was data collected from participants during follow up? How were outcomes measured? Were details of effect sizes and statistical significance given? Did the study have enough participants? Does the paper present a clear result? Results Discussion The first study looked at was an RCT published in 1996 entitled Treatments of Generalized Anxiety in Older Adults: A Preliminary Comparison of Cognitive-Behavioural and Supportive Approaches. This trial compared CBT with non directive Supportive Psychotherapy (SP), a form of therapy which involves education, guidance, listening to the patient and encouraging expression of emotions. Results showed significant improvement in all measured outcomes for both interventions and generally large effect sizes. However, no significant differences were found between the the two groups. The authors gave an extensive list of exclusion criteria, including current involvement in psychotherapy and low MMSE scores, which limits confounding factors and therefore the likelihood of type 1 errors. A major limitation of this study however is the high level of attrition. This study design could possibly be improved if it were to include another control group, which receives no treatment, with which to compa re the two interventions with. In this respect the more recent trial Treatment of generalized anxiety disorder in older adults, which is discussed later, improves on this trial and has a significantly lower attrition rate. However, the authors of this trial argue that by failing to include a waiting-list control group they alleviated the need to withhold treatment from any patients, which could be deemed ethically questionable. This trial had a follow-up assessment period of 6 months which is relatively short compared to the other studies in this review, one of which has a follow-up period of 15 months. It is arguable that this will limit conclusions made in this study regarding the long-term durability of treatment. Unlike other studies this study did not measure the effect of either intervention on the participants quality of life which is an important factor to consider as GAD has such a profound effect on the sufferers quality of life. An RCT published February 2003 entitled Treatment of generalized anxiety disorder in older adults, compared CBT with a discussion group (DG) and patients receiving no treatment on a waiting list period (WL). The discussion group was organized around worry provoking topics and was designed to be structurally comparable to CBT. DG consisted of a series of 12 discussions focused on topics known to be worry-provoking for older adults, including memory problems, health concerns, loss of independence and death of friends and family. Both the CBT and DG groups consisted of 4-6 participants and a group leader, one of four advanced doctoral students in clinical psychology. These leaders were spread across the two interventions and each leader chaired at least one CBT group and one DG in order to avoid confounding the effectiveness of the therapist with the effectiveness of the therapeutic model. Participants in both CBT and DG were asked to spend approximately 30 minutes a day on homework exe rcises. The study gave full details of exclusion criteria including commencement of psychotropic medication within the past 2 months. Patients who had started medication more than 2 months ago were included but were asked not to change their dose or type of medication for the duration of the trial. However, in light of this it is possible to argue that including participants on any form of anxiolytic medication restricts conclusions about the impact of CBT without concomitant pharmacological treatment. The authors included a table detailing demographic information about their study sample in order to support the generalisability of their findings. The table showed that participants came from a range of races, had differing marital and work statuses and suffered from a range of different medical conditions, the most common being osteoarthritis (36%) and hypertension (32%). Compared to the first study, participants not only scored themselves but were also assessed by trained research assistants who were unaware of which group the patient had been assigned to. This adds an element of blinding which is not present in the first study. This was the only study in which patients rated their impression of the treatment after the first session. The participants rated the credibility of the intervention, their enjoyment, perceived effectiveness, likelihood of recommending the intervention to a friend, likelihood of participating again in the future and perceived improvement. This is a useful addition to the trial as a patients satisfaction with a treatment method has a big impact on adherence and possibly symptom improvement. The results showed that participants in both CBT and DG improved compared to the waiting period but there was no significant difference between the two interventions. However, when effect sizes were calculated showed large effects whereas DG showed medium sized effects. Essentially this study shows that CBT is better than no treatment but gives no s ignificant evidence to suggest that it is better than other forms of intervention such as group discussion. This is an interesting point which mirrors the findings of the first trial which compared CBT to SP. An RCT published in April 2003 entitled Cognitive- Behavioral Treatment of late-life generalized anxiety disorder (M A Stanley et al. 2002) evaluated the efficacy of CBT compared to minimal contact control (MCC). The results showed a significant improvement in worry, anxiety, depression and quality of life following CBT compared to MCC. 45% of patients were classed as responding to treatment compared with 8% who received MCC. Importantly these gains were maintained or enhanced over a 1 year follow-up. However, as in the other RCTs in this review, patients did not report a complete return to normal functioning or a complete removal of symptoms. When recruiting participants for this trial the Anxiety Disorders Interview Schedule-IV was used as a diagnostic tool. Patients underwent two separate diagnostic interviews conducted by two different evaluators over a period of at least two weeks. These evaluators were unaware of any previous diagnoses made. This shows that all participants in the study had symptoms which were consistent and were not prone to varying over time, which means that any change during follow up assessment was more likely to be due to the intervention than to fluctuations in the severity of their GAD. The study commented on potential variance in results due to gender and explained how they had adjusted for this. Similarly to the last study, this study used not only self-reported scores but also independent clinician rated scores. Unlike previous studies this trial did not include any participants currently receiving medication for their GAD or associated symptoms in order to assess the effectiveness of CBT alone and not in conjunction with medication. A Randomised Control Trial, conducted by M A Stanley et al. entitled Cognitive Behaviour Therapy for Generalized Anxiety Disorder Among Older Adults in Primary Care (2009) compared group CBT conducted in primary care clinics over 3 months with a control of enhanced usual care (EUC). The authors chose to use group CBT rather than individual, one-on-one CBT as they believed that the loss of social support often experienced as a consequence of ageing indicated the potential benefits of group treatment. The results of this trial showed that CBT significantly improved worry severity, depressive symptoms and general mental health but there was no difference in GAD severity between the two groups. The authors clearly set out their objective and gave detailed information on where the study was set, where participants were chosen from, details of the intervention and main outcome measures at the start of the paper. The fact that the patients were recruited exclusively from a primary care sett ing and that the intervention was delivered in primary care makes this evidence particularly useful for this review. During recruitment all potential participants were screened using two questions from the Primary Care Evaluation of Mental Disorders, as well as undergoing the Mini-Mental State Examination and a Structured Diagnostic Interview, in order to ensure that all had the same diagnosis and similar GAD severity. Race and ethnicity of participants were identified and the data used to facilitate conclusions about the generalizability of the data. The authors commented on effect sizes and stated that the effect sizes for symptom improvement were comparable to or greater than those in recent primary care studies of younger adults with GAD and older adults with depression. The authors also commented that participants in this trial scored slightly lower mean change in worry severity over time scores in comparison with Treatment for Generalized Anxiety Disorder in older adults that was conducted several years earlier. One possible limitation of both this study and the previous study is that patients in the control group received minimal contact with health professionals compared to the intervention group. This may leave patients feeling neglected and as they are aware that theyre not receiving any form of treatment, they may not expect to get better and subsequently score themselves lower on assessment than otherwise. In this respect the first two studies are somewhat better designed, as they compare CBT to interventions which involve a similar contact. The second study in particular deals with this issue well by comparing CBT with a discussion group, which requires the patient to be involved with the intervention, and a waiting list period in which the patient is very much aware that they are receiving no treatment. Several studies of anxiety in older adults have been conducted using community or senior centre volunteers with self-diagnosed, subjective anxiety symptoms and therefore the findings from these studies may not be applicable to a clinical population. In contrast the four RCTs included in this review were all conducted on patients with diagnosed GAD and CBT and was delivered in a primary care setting. All the studies gave detailed information on how the participants were randomized and how drop-outs were dealt with and had a follow-up period of at least 6 months. Conclusion In conclusion, all four studies showed that CBT improves levels of anxiety, as well as other associated symptoms of GAD, when compared to both baseline measures and no treatment. However these studies also showed that when CBT is compared to other forms of therapy, namely Supportive Psychotherapy and discussion groups, there are no significant differences between the two interventions. Although CBT does lead to significant alleviation of symptoms, this evidence does not indicate that CBT is a long lasting cure for GAD and it does not prove CBT to be a better treatment option than other forms of psychotherapy. Therefore it is important to question whether or not the benefits felt by participants receiving CBT, SP or DG are due to a placebo effect compared to participants who are left on a waiting list who may feel they are being neglected and do not expect any improvement in symptoms. This raises the issue of blinding which is a limitation of most conceivable trials including CBT as i t is not possible to make the participant unaware of what intervention they are receiving when when they have to actively participate in treatment. The dearth of clinical trials, particularly RCT trials, investigating CBT as a treatment for GAD needs to be addressed if an acceptable amount of evidence in favour of CBT is to be established. Suggestions for future trials include RCTs comparing the effectiveness of group CBT compared with individual CBT for older adults and trials comparing CBT with anxiolytic medications such as benzodiazepines. This is a particularly pertinent issue considering the side effects associated with anxiolytics and old age, as previously mentioned. Future trials should aim to recruit a larger number of participants than seen in most of the studies discussed. In theory this should not be difficult if the prevalence of GAD in the elderly population is as alarmingly high as some statistics indicate.

Normandy Essay example -- essays research papers fc

The battle of Normandy was the major turning point in the Second World War. It was a very well planned out attack of the Allies on western France against the Germans. Many people know a little about the day, but few know about the long planning, strategy, and results for both sides. At the end of November, Roosevelt and Churchill journeyed to Tehran for their first meeting with Stalin. The president and the Prime Minister had already approved, under the code name Overlord, a plan for a cross-channel attack. Roosevelt wholeheartedly favored executing Overlord as early in 1944 as the weather permitted. Chief Meteorologist for Eisenhower said, â€Å"By the time the conference was due to start we could not expect to have a complete set of surface level and upper air charts but a handful of reports from one or two critical areas west and south-west of Ireland, if consistent among themselves, would decide the issue- the terrifying issue whether Overlord would be definitely postponed for at least 24 hours or go irrevocably forward to the assault on the coasts of France at dawn next mourning†(Stagg 100-101). At Tehran, Churchill argued for giving priority to Italy and possible new offensives in the Balkans or southern France, but he was outvoted by Roosevelt and Stalin. Overlord was set for May 1944. After the meeting, the CCS recalled Eisenhower from the Mediterranean and gave him command of the Supreme Headquarters Allied Expeditionary Forces (SHAEF), which was to organize and carry o...

Strategic Implementation Essay -- Business, Organizational Culture

Strategic Implementation When choosing strategies to gain a competitive advantage and increase performance, the company must develop ways to implement those strategies. The actions taken at the functional, business, and corporate levels to execute a strategic plan include putting quality improvement programs into place, changing product designs, and segmenting the market. Also, when implementing strategies, the organization must choose the best structure, culture, and control systems to put the strategies into action. A governance system is needed for the organization to act in a manner that is consistent with maximizing profitability, profit growth, and legal and ethical practices. Organizational Structure The Clorox Company has expanded over the year the company had divided its operations into several branches: Household, International, Lifestyle, and Cleaning. The Clorox Company has divided their products that they produce into product groups and categories. Each product group focused on satisfying the needs of their target customers or groups and is managed by its own team of managers. A company’s organizational structure is the framework of the various relationships within the organization. It sets the foundation for the common actions and functions of employees at every aspect of the company. Organizational structure is a key component in achieving superior efficiency, quality, innovation, and responsiveness to customers (Hill & Jones, 2008). The organizational structure of The Clorox Company is a product structure. This structure is appropriate for a company when it has multiple products in multiple market segments. The intent of product structuring is to break up a compa ny’s growing product line into a number of s... ... 2004 until 2006. With Mr. Knauss holding various positions as head management in several companies has developed a leadership ability that is very consistent and spreading his vision of a company that must continue to change for the better. Mr. Donald R. Knauss, Don has been Chairman and Chief Executive Officer of Clorox Corporation (formerly, the Clorox Co.), since October 2, 2006 and has overall responsibility for directing its worldwide business. Mr. Knauss has overall responsibility for directing the Clorox's worldwide business. He serves as an Executive officer of The Minute Maid Company. Mr. Knauss served as President and Chief Operating Officer of Coca-Cola North America at Coca-Cola Company from ..., including his director role at the Kellogg Company, provides him with a keen understanding of the company’s industry and customer and consumer dynamics.

Kudler Fine Foods Problem Statement Essay

The following is a problem statement explaining what is currently wrong with Kudlers plans on expansion, and how they can improve these plans. Introduction After reviewing the strategic plan for Kudlers Fine Foods it is obvious there are several issues that will stunt the growth and success of the organization. The company is suffering from a lack of management and poor organization planning. The issues that will be discussed are the poorly developed expansion and growth plans, and the lack of risk management in preparation of a competitor entering the market. Problem Statement The management at Kudler Fine Foods is planning on opening a new location when all of the current locations are not successful, and the company has not done a proper analysis of the need for their services in the area. Also Kudler is not prepared for factors that may decrease the profitability of the company, or factors that can contribute to the failure of a new location. Solution With the Del Mar location not producing profit as expected this is the location management should use to create a market research and analysis plan. By using this location they will be able to determine the factors that are hindering the success of this location and then develop ways to counteract those factors. The benefit is they will improve the business done at that location before opening a new location. By looking at factors like population, socio-economic status in locations surrounding area and health factors in the area can determine what the need are for the community. Management should also look to see where people are purchasing food in the community and what types of food and products are selling at the local grocery. If there are gourmet products selling out of the supermarket than that is a factor that needs to be accounted for. Once the market research is done Kudlers management can the focus on a risk management plan. Before a risk management plan can be established they must know what risk are out there and the market analysis and research will help the company determine what risk and challenges they face. Risk management is a part of a basic business plan, I see where threats are outlined in the strategic plan but there are no alternative plans to minimize each threat nor are there any plans for how to be competitive should a competitor arise. Kudler only considers other gourmet shops as competition they should also consider, grocery stores that sell gourmet foods a competitor. Then they should focus on how to maintain their existing book of business. If Kudler developed their website so customers could place orders online that would give them a way to expand while working on the risk management plans and the online based business would also help with the market research. A high concentration of orders coming from a specific location may be an indicator used to determine where to open a new store. Desired Resolution Kudler Fine Foods will be able to expand all facets of the business and have a risk management plan in place to counter act competition entering the market. Kudler will expand in to locations where they will be successful. Kudler will also have an effective and efficient model for future expansion and growth. Conclusion The goal of Kudler Fine Foods is expansion and growth while increasing profit and the current book of business. By doing the extra research and implementing a risk management program before opening a new location will increase the success of all three current locations and ensure the success of any future locations. It will also help Kudler organize and develop other facets of the business like the website. A little extra work goes along way and with the risk management plan in place and a new location market analysis model being used Kudler Fine Foods should be able to grow and meet all the organizations goals.

Child health issue Essay

The things that come to mind when we think about health are the well-being of mind and body, the mental and physical well-being, disease and illness, social well-being and many more. Although health is measured by the amount of disease and illnesses there are, it is difficult to define health. According to the World Health Organisation (WHO) (1948), health is defined as a complete state of physical, mental and social well-being. Another statement was recently modified, which includes the ability to lead a â€Å"socially and economically productive life†. There are many things that influence the health and well-being of a child, one of them being poverty. Poverty has a huge impact on a child’s health, simply because a family with a low income will not be able to provide the best environment and the best type of treatment for an ill child. Whereas a family who has a better income can provide much more for their ill child. According to Aber et al. (1997), poverty was shown to negatively influence child health. He says that because of poverty, there are increased neonatal and post-neonatal mortality rates and also greater risk of injuries resulting from accidents or physical abuse. Nutrition also comes as a problem together with poverty because, if a family cannot afford certain food types for the child, the child has a risk of bad health. As Rivera et al. (2004) states, â€Å"malnutrition causes death and impaired health in millions of children†. He draws attention to the fact that, every year more than 10.8 million children, under the age of 5 are dying because of malnutrition. Also as Hall (1996) states, iron deficiency is an important health problem in young children. (p. 6). There are socio-economic and demographic factors influencing childhood mortality, such as; education, ethnicity, sex and gender. Education can come into this because in certain countries, women do not get educated well enough, certainly because the man is seen as the breadwinner. In most cases if a child is a girl, she would not be sent to school just because she is a girl. If women received a good education, they would have a role in protecting their child’s health. Again in some places, the sex of the child is important because, if a woman is pregnant with a girl, she is most likely to have a termination. This is because the husband or the family would prefer having a boy so that he can carry on their surname. Hudelson (1996) states; socio-economic and cultural factors may be that they may play a role in determining overall gender differences in rates of infection and progression to disease. Secondly, they may lead to gender differentials in barriers to defection and successful treatment of the health issue. According to Neff and Anderson (1995), children who have chronic illnesses are more vulnerable. They have more needs, such as treatment so caring for a child with chronic illness is significantly more expensive than for the average child. For example having a child who has a major illness such as HIV or Cancer, would put more pressure on the family. Simply because the child will need a longer period of treatment and also will need to be treated in larger centres and this may not always be accessible by the family so they would have to travel long distances, to be able to get the right treatment for their ill child. There are also inequalities in health. A family who has a good income can provide their ill child with the best environment, best hospitals, the best treatment and well known best doctors. Whereas a family who does not have a good income will not have access to the best of everything. Therefore the health issue that the child has may cause more implications. It is always best to find out about a certain health issue while it is still recent, as treatment will be more successful. Families with a high income will have this chance, because they would be able to go for regular tests and check ups. Whereas a family with a low income will not even consider going to the doctor, unless condition gets really bad. In most cases, by the time a doctor is seen, it is too late. There may be all sorts of factors affecting health. Some of these can be named as; genetic inheritance, parental health and life style, and chronic illnesses such as Cancer and HIV. Parental influences in health and the well-being makes important contributions to the development of their child. Professionals, health workers, psychiatrists and doctors also have a major role in the child’s well-being. Cancer is less common in children. Only 1 in 600 children develop cancer and normally the cure is much higher in children than in adults. 70% of all children can now be completely cured. According to Cancer Backup Jamkit (2003), there have been huge improvements in the treatment of children’s cancer over the past 50 years. More than 7 in 10 children with cancer are now cured, compared with fewer than 3 in 10 in 1962-66. There are many types of cancers affecting a child’s health. Some of these are; brain tumors, retinoblastoma, liver tumors, neuroblastoma, rhandomyosarcoma, wilm’s tumor and leukaemia which is the most common cancer known in children. As seen in appendix 1 and 2. According to Cancer Backup Jamkit (2003), states that although there are many theories on what causes cancer, there is no clear explanation on what causes cancer. Cancers are not infectious so they cannot be passed on to someone that comes in contact with the child who has cancer. Also in most cases cancers are not caused by an inherited faulty gene and so it is very rare that, a second child in a family would develop cancer. According to Z. Jane et al. (2002), mothers of children with serious illnesses have lower levels of well-being than mothers in general population. Problem solving therapy (PST), a general cognitive-behavioural intervention, has been shown to be effective in treating negative affectivity (depression, anxiety) and other manifestations of reduced well-being. According to Statistics (2004), since the 1960s, there have been great advances in the treatment of most childhood cancers, resulting in markedly higher survival rates. By the mid 1990s, nearly 75% of children with cancer survived at least five years after diagnosis (known as five-year survival). Mainly in childhood leukaemia five-year survival was above 80% and exceeded 50% for every main type of childhood cancer. Statistics show that childhood cancer is about one fifth more common among boys than it is among girls. The different types of cancer tend to occur predominantly at different ages. For example, there is a peak in the most common type of leukaemia at ages 2 and 3. In Britain, the incidence of all is higher status, particularly in early childhood. When it comes with coping with treatment procedures it may be difficult for some families. Burton (1974, p. 74) states that, involvement in treatment, necessitating as it does, actively on the parents part can also be of use in helping parents to forget some of their otherwise, overwhelming anxiety. But as with any other excessive activity, it may tax their overall strength, producing a loss of personal energy and enthusiasm. Parents may find it hard to cope with the treatment because a child who has cancer would need to visit the hospital very often and treatment may cost too much. Cancer is mainly divided into four stages, these are as follows; stage 1 is, small and localised. Stage 2 is, when it has spread into surrounding structures. Stage 3 is, when it spreads to other parts of the body and the final stage is, if the cancer has spread to distant parts of the body, this is known as secondary or metastatic cancer, which is stage 4. It can be really tiring for the family and the child while in the process of the tests, as there are several tests such as; Biopsy, blood tests, bone marrow aspirate, lumbar puncture, x-rays, ultrasound, scan, bone scan, computerised tomography (CT), magnetic resonance imaging (MRI) and position of the cancer in the body and to asses the child’s general health, as this may affect the treatment that is given. Having to live with cancer is really hard for children and their families as it affects them in many ways. Some of these problems can be; firstly schooling, according to Cancer Backup Jamkit (2003), children with cancer often have gaps in their education: due to going into hospital, side effects from treatment, or generally because they do not feel well enough to fully take part in daily school life. Another issue may be that the child has a risk of catching an infection while at school, such as; chicken pox, measles, mumps or flu can be dangerous to children who have low immunity due to cancer treatment. Parents also come across some difficulties such as having to make hard decisions. One example of this can be that, if the child who is diagnosed with cancer and has not yet started school. Parents may have to choose whether they want to send their child to school throughout the treatment (with the risk of infection) or to keep their child at home. This means that they have less chance for social growth and development. Leukaemia is the most common type of cancer which occurs in children, as it can be seen in appendix 2. Leukaemia is divided into two types; one being, acute myeloid leukaemia (AML) and the other acute lymphoblasic leukaemia (ALL). Cancer Backup Jamkit (2003) describes leukaemia as types which can be divided into different sub-titles. Blood and bone marrow samples will be checked by haematologists and pathologists to find out which type of leukaemia a child has. They try and find out exactly which type of cell has become leukaemic and at which stage of their development. The cells may also be tested with antibodies for specific proteins on their surface. This process is known as immunophenotyping. The genetic make-up of the leukaemia cells will also be examined as different types can be associated with particular genetic changes. All of this process takes place because knowing the exact type of leukaemia helps the doctors to know which treatment is likely to be most effective in treating the leukaemia. Out of the two types of leukaemia, the most common type which occurs in children is acute lymphoblastic leukaemia (ALL). ALL can affect children at any age but is most common in children aged 1-4. It is also more common in boys than it is in girls. Leukaemia is a cancer of the white blood cells. All of these blood cells are produced in the bone marrow which contains; red blood cells, white blood cells and platelets. Although it is yet not known what causes leukaemia. According to Cancer Backup Jamkit (2003), children with certain genetic disorders, such as Down’s syndrome, are known to have higher risk of developing leukaemia. Also brothers and sisters of a child with ALL have a slightly increased risk of developing ALL themselves, but this risk is still very small. Like any other cancer, ALL is not infectious and cannot be passed on to other people. Generally the symptoms are just like of those viral infections. They may start to get tired and lethargic due to anaemia which is caused by lack of red blood cells. They may start to develop bruises. They may feel generally unwell and complain of aches and pains in the limbs, and may have swollen lymph glands. Once the type of leukaemia is diagnosed, the best type of treatment is identified. There are different types of treatments, this involves; Chemotherapy as being the main treatment for ALL together with combination of chemotherapy drugs and steroid medicines. Consolidation and central nervous system (CNS) treatment, to prevent the spreading of leukaemia. Maintenance treatment which involves the child taking daily tablets and having monthly injections of chemotherapy. This normally takes 2 years in girls and up to 3 years in boys. Bone-marrow transplantation, used for children whose leukaemia has come back. Testicular radiotherapy which involves boys having radiotherapy to their testicles. Lastly central nervous system (CNS) radiotherapy for children who have leukaemia cells in their CNS when they are first diagnosed with ALL. During the treatment there may be several side effects such as; hair loss, loss of appetite and weight loss, nausea and vomiting and an increased risk of bruising, bleeding and infection. In some cases there may be late side affects, which sometimes takes place many years later. These include possible problems with puberty and fertility, a change in the way their heart works, and a small increase in the risk of developing another cancer in later life. According to Hargrave et al. (2001), in the last 20 years, the survival rate for children with ALL has markedly improved, largely owing to a decrease in relapses. However children still die from complications of treatment and these are potentially preventable. While the child is diagnosed with cancer and the treatment has started. This will have a huge impact on the family. The child itself may be frightened and may have symptoms of the cancer or side effects of the treatment to cope with. They may become very clingy and argumentative and difficult to get on with. The child’s whole discipline will change, with stays in hospital and going to hospital for appointments. Therefore the family has to adapt themselves to this routine. Often as parents this is the worst situation to face. Every parent would be worried and under a lot of stress. In some cases parents may think that the diagnosis is a death sentence. The parents would worry about how the child will cope with this and family life will be disrupted. Some parents may absolutely be confused and feel numb and in some cases they may feel guilty that this has happened to their child. They may have all sorts of mixed feelings such as; fear-they may deny the fact that such a terrible thing has happened to their child. Sadness-at times they may feel hopeless about their child’s recovery. Anger and uncertainty- may feel angry with hospital staff or even at each other because, they have different ways of coping with cancer. It may also have an effect on their social life as they may not want to socialise with friends and family because they are feeling unhappy. Finance is another issue, such a major health issue will cost a lot and they may not be financially ready fort his. It is also very hard for the extended family and friends such as; grandparents, aunts, uncles to cope with this some may not be able to believe that this has happened to someone in their family. They may go through similar emotions as the parents. Some may avoid seeing the family, simply because they do not know what to say to the family or because they do not want to see the child going through pain. Siblings may also be affected by this, as all the attention will be given to the child that has cancer. Siblings may feel left out and not loved. Some may become very quiet and withdrawn. They may at times become frustrated and have outbursts of anger, because they keep their feelings bottled up inside. There may be disruptions to their daily routine because the family has to spend time taking the child to hospital for appointments. The Children Act (1989) states that; children should always be consulted (subject to age and understanding) and kept informed about what will happen to them. Children’s issues must be determined as soon as possible so that minimum disruption is caused to the child’s life. Every Child Matters (2005), children’s trust bring together all services for children and young people in an area, underpinned by the Children Act 2004 duty to cooperate to focus on improving outcomes for all children and young people. They will support those who work everyday with children, to deliver better outcomes. Alan Milburn, Secretary of State for Health (2000) today launched the first ever comprehensive NHS Cancer PlanA plan for investment. The plan sets out the future of cancer services, setting waiting time targets for the treatments of cancer patients and unprecedented investment in cancer hospices. The plan includes; maximum two months wait from urgent GP referral to treatment for all cancers by 2005. Extra specialist’s cancer nurses with new training and responsibilities. 1.000 more cancer specialist I the service over the next 6 years. New treatment equipment and 250 new cancer scanners. In concluding; a clear reference to the meaning of child health has been built. The types of health issue and the effects it has on the child’s health and also the impact it has upon the family has been covered. The health issue and the treatment have been discussed. Policies and procedures have also been looked at and were made clear that some policies and reports aim to fight against cancer. Total word count: 2852 Bibliography Aber JL; Bennet NG; Conley DC; Li J (1997) ‘ Annual Review of Public Health’, The effect of poverty on child health and development, 18, (1), pp. 463-483 [online]. Available at: http://arjournals.annualreviews.org/ (Accessed: 16 December 2007). Burton Lindy (1974) Care of the Child Facing Death. Routledge & Kegan Paul Hall David M.B. (1996) Health for all children 3rd edn. New York Tokyo. Oxford University Press. Hargrave D.R.; Hann I.M.; Richards S.M.; Hill F.G.; Lilleyman J.S.; Kirsey S.; Bailey C.C.; Chessels J.M.; Mitchell c.; Eden O.B. (2001) ‘Progressive Reduction in Treatment Related Deaths in Medical Reasearch Council Childhood Lyphoblastic Leukaemia Trials from 1988 to 1997 (UKALL VIII, X and XI)’ British Journal of Haematology 112, (2), pp. 293-299 [online]. Available at: http:// Blackwell-synergy.com/ (Accessed: 16 December 2007). Hudelson P. (1996) ‘Tubercle and Lung Disease’, Gender Differences in Tuberculosis: the Role of Socio-Economic and Cultural Factors’, 77, (5), pp. 391-400. Elseiver Ltd. [online] Available at: http://sciencedirect.com/ (Accessed: 15 December 2007). Jane Z.; Olle M.D.; Varni W.; James PhD; Fairclough L.; Dianne. Dr. P.H; Butler W.; Robert PhD; Noll B.; Phipps Sean PhD; Copeland R.; Donna PhD; Katz R.; Ernest PhD; Mulhern K.; Raymond PhD. (2002) ‘Problem-Solving Skills Training for Methods of Children with Newly Diagnosed Cancer: A Randomized Trial’, Journal of Developmental and Behavioural Paediatrics, 23, (2), pp. 77-86 [online] http://jrndbp.com/ (Accessed: 14 December 2007). Neff J.M.; Anderson G. (1995) ‘Protecting Children with Chronic Illness in a Competitive Marketplace’, 274, (23). USA [online] Available at: http://jama.ama-assn.org/ (Accessed: 15 December 2007). PA Voute et al. (2005) 5th edn. Cancer in Children: Clinical Management. Oxford University Press. Rivera Juan A, PhD; Sotres-Alvarez, MS; Habicht Jean-Pierre, PhD; Shamah Teresa, MS; Villalpando Salvador, MD (2004) ‘Impact of the Mexican Program for Education, Health, and Nutrition (Progresa) on rates of Growth and Anemia in Infants and young children’, A Randomized Effectiveness Study, 291, (21), pp. 2563-2570, Jama [online]. Available at: http://jama.ama-assn.org/ (Accessed: 17 December 2007). Additional Resources: http://www.everychildmatters.gov.uk/ (Accessed: 16 December 2007). http://www.dh.gov.uk/ (Accessed: 17 December 2007). http://www.cancerbackup.org.uk/ (Accessed: 17 December 2007). http://www.statistics.gov.uk/ (Accessed: 17 December 2007).