Philosophy Essay Example | Topics and Well Written Essays - 1250 words - 13

Philosophy - Essay Example Happiness can have no other purpose than its own sake. Logically, we can’t desire happiness because we want to be intelligent, smart, successful, or any number of other things. These are things are not as valuable as happiness themselves, because these are the sorts of things that people strive for because they think they can achieve happiness through them. In this way people are using these as a means to an end, and even though this end is happiness, these sorts of things still are not as valuable. For instance, fame and money do not always bring people happiness. Often the case seems to be that the pursuit of these things gets in the way of the pursuit of happiness. People are able to be happy without large amounts of money or being famous, but these don’t make people happy in and of themselves. These things might lead a person to happiness, but happiness will not lead to these things. People also need to seem to have some function. Without a purpose to one’s life, there is no reason to attempt to accomplish anything. People need to feel like they are doing something, because if they feel that they are doing nothing, then there is no real purpose in being. By deliberately attempting to accomplish something, we are able to strive towards happiness. Aristotle felt that people needed to live a life of reason in order to have a purpose. By living a life a reason, it is possible to contribute to one’s own growth as a person, and this is enough to give people purpose. Aristotle was also concerned with virtue. As he saw it, virtue was not simply a matter of having a list of things that could and should be done and a list of things that shouldn’t be done. We must know the reason behind doing things. Take for instance religion. Religion gives people a list of things that should and shouldn’t be done. But religion does not offer reasons for why things

Human Development Essay Example for Free

Human Development Essay Taking a look at the Human Development Index map of Africa, which can be seen on (http://en.wikipedia.org/wiki/Human_Development_Index) on the web; it shows that many of Africas countries are very underdeveloped.7 One of the obvious reasons for why countries is Africa are underachieving is because of how poor is the strength of their economy compared to others. As it is well known, Africa is very rich in mineral resources as many other states rely upon their, possessing most of the known minerals types of the world. Africas economy is more reliant on agriculture than that of any other continent, with around 60% of Africans working in the agricultural sector. Secondly, the economic development of virtually all African nations has been hindered by inadequate transportation systems. Most countries rely on road networks that are composed largely of dirt roads, which become impassable during the rainy seasons. Road networks tend to link the interior of a country to the coast; few road systems link adjacent countries.9 To show how poor and how bad economy crisis is in Africa, one ought to take a look at their food crisis and the growing volume of food imports. Whereas Africa imported an average volume of 1.96 million metric tons of agricultural products in the years 1961-63, by 1980-82 this figure had risen to 11.2 million metric tons at an annual value of over $6.8 billion (over one-seventh of the total value of Africas imports in 1982).Owing to foreign exchange constraints, most African countries have had to rely increasingly on food aid to meet their imported food requirements.10 The commercial sectors of most African states rely heavily on one or a few export commodities. The bulk of trade occurs with industrialized nations, which require raw materials and sell industrial and consumer goods. Trade between African states is limited by the competitive, rather than complementary, nature of their products and by trade barriers, such as tariffs, and the diversity of currencies. Looking at the economy of Europe, a sharp contrast in strength and influence can visibly be seen. Europe has long been a world leader in economic activities. As the birthplace of modern science and of the Industrial Revolution, Europe acquired technological superiority over the rest of the world, which gave it unquestioned dominance in the 19th Century. An important impetus for growth since the mid-20th Century has been the formation of supranational organisations such as the European Union, the European Free Trade Association, and the Organisation for Economic Cooperation and Development. Unlike Africa, Europe has highly developed transport systems, which are densest in the central part of the continent. Many countries in Europe use well maintained transportation systems to transport important goods such as water transport which plays a major role in the European economy. Almost all European countries maintain national airlines, and several, such as Air France, British Airways, Swissair, Germany, and Netherlands are major worldwide carriers.13 Looking at both economies and trade, it is unquestionably obvious that Europe conducts substantial international trade compared to Africa. For Europe, much of its trade is intra-continental, especially among members of the European Union, but also engages in large-scale trade with countries of other continents. Germany, France, Great Britain, Italy and the Netherlands are among the worlds greatest trading nations. A large portion of European inter-continental trade involves the exporting of manufactured goods and the importing o f raw materials. Europes agricultural sector is generally highly developed, especially in Western Europe. The agricultural sector in Europe is helped by the Common Agricultural Policy, which provides farmers with a minimal price for their products and subsidized their exports, which increases competitiveness for their products. This policy is highly controversial as it hampers free trade worldwide (protectionism sparks protectionism from other countries and trade blocs: the concept of trade wars) and is violating the concept of fair trade.15 Africas economy is more reliant on primary products (i.e, agricultural and mineral) than that of any other continent, with around 60% of Africans working in the agricultural sector. About three fifths of African farmers are subsistence farmers tilling small pots of land to feed their families, with only a minimal surplus that can be sold for other goods.16 However, there are significant number of large farms that grow cash crop such as coffee, cotton, cocoa, and rubber; these farms, normally operated by large corporations, cover tens of square kilometres and employ large number of labourers. Africas geography is unsuited to trade and thus hampers its economy. The centre of the continent, at least on the western side, is an almost impenetrable rainforest that greatly impedes the transit of people of goods. Some of the wealthiest parts of South Africa are blocked from the rest of Africa by the Kalahari Desert, while the Sahara creates an obvious barrier to trade. While Africa has a number of great river systems such as those of the Nile, Niger, Congo, and Zambezi, it is not nearly as well-linked rivers as are other areas such as Europe. Moreover, many of the rivers are blocked by rapids and cataracts that require vast development projects if they are to be bypassed. The wetness of the roads and tracks makes transport difficult and hazardous. In addition Africa is cut off from the sea to a greater extent than any other continent. To enforce even more problems to Africa; there is an increasing amount of desertification occurring in Africa where the deserts, especially the Sahara are becoming larger, enveloping area around them, leaving less space for land. This process is partly due to the deforestation of areas of forest; with no roots to hold soil in place, it blows away leaving an infertile desert. Europe has a well developed financial sector. Many European cities are financial centres with the City of London being the largest.19 The European financial sector is helped by the introduction of the euro as common currency. This has made it easier for European households and firms to invest in companies and deposit on banks in other European countries as exchange rate fluctuations are now non-existent in Europe. As mentioned above, Europes economy is superior to that of Africa, so what can Africa do to improve its economy or perhaps what can it take from the Europe economy as a model. Professor J A. van Ginkel held a conference on the Knowledge and Development in Africa; here he talked about ways to improve Africas economy however not only by getting the economic policies right.20 Prof van Ginkel mentions that there is now substantial evidence that institutional weakness in many African countries is a critical obstacle to economic performance.21 From the surveys he conducted on the obstacles to business in Africa it highlights the damage caused by: the unpredictability of changes in laws and policies, the unreliability of law enforcement, and the impact of corrupt bureaucracies.22 Unless governments eliminate these kinds of obstacles then it is unlikely that the economy whether it is just locally in certain parts of Africa or on a national front will flourish. An aspect of the Europe model that Africa can learn from is the aspect of knowledge. No commodity is more expensive than knowledge. An Africa without a sustainable, strong knowledge sector of its own will always remain in a dangerously dependent position. Research and training institutions on the continent can make a critical contribution in at least three ways: by making the most of existing indigenous knowledge; by accessing the vast reservoir of existing global knowledge, as well as the ongoing advances in understanding, and adapting them to suit specific local conditions; and by helping to find innovative solutions to seemingly intractable problems.23 In terms of human resources, it was highlighted in the Seminars of Anticipation that African developments suffers from a tragic paradox: on the one hand, elites trained in Western world are too many (and most of them stay in the US or in the EU because they cannot find well-paid qualified positions in Africa, or because their skills do not correspond to African needs); while on the other hand the well-trained intermediate executives required to manage a modern economy are cruelly missing in Africa (higher technical experts, management executives, civil administrators). To conclude, this essay has looked the economies of both Europe and Africa and compared and contrast both of them. It has also provided information about both economies in terms of trade and finance. A brief history was provided which looked at the relationship between Europe and Africa and to the days of colonisation. Reasons as to why both regions are on different levels economically were provided to show how dominant and rich Europe was and how poor and underdeveloped Africa was. The Africa food crisis was mentioned to give an account of how poor Africa was against other regions. In addition ways that Africa can improve their economy thus bringing it more power and strength so that it can compete with other regions was provided, for example making sure Africa had the aqeduate education so that it learn. Many Africans move to the west so that they can have higher education which is not available in Africa and tend to stay there once they have completed their studies. This is detrimental to Africas development and thus a solution to the problem would be to support the creation of a complete curriculum. This would lead to a massive contribution to the development of vocational and technical education in Africa thus improving Africas economy. So as it can seen, the economies for both Europe and Africa are at this present time in contrast to each other but there is hope for Africa to become more dominant and influential in world affairs if the correct adjustments and policies are introduced to improve them. References Fawcett, L., Hurrell, A., Regionalism in World Politics, Oxford, Oxford University Press, 1995, pg 43Â  Ravenhill. J, Africa in economic crisis, Basingstoke, Macmillan, 1986, pg 9Â  www.ciaonet.org/isa/rajo

Nurse-led Respiratory Syncytial Virus Immunisation

Nurse-led Respiratory Syncytial Virus Immunisation Respiratory syncyital virus in pre-term babies. Setting up a nurse led clinic to give Synagis (immunisation) with implications for nursing practice. From the neonatal nurses view point. Introduction The respiratory syncytial virus is identified as a labile paramyxovirus which produces a histologically characteristic effect of causing fusion of human cells in tissue culture – hence the term â€Å"syncytial†. It is commonly sub-classified into types A and B. The B strain is generally asymptomatic in the majority of the population whereas the A subtype tends to produce the more severe illnesses which tend to predominate in the majority of clinically significant outbreaks (Bar-on ME et al 1996). It has an incubation period of 4-6 days and the infection typically lasts from 7-14 days, but does occasionally last up to three weeks. If it becomes necessary to hospitalise a child with respiratory syncytial virus infection, the admission period is typically 5-7 days.(Hentschel J et al 2005) Contagion in the form of virus shedding is its highest levels during days 2-4 of the illness but the active viral particles will continue to be shed for up to 14 days after the clinical onset of symptoms. The respiratory syncytial virus is known to affect both upper and lower respiratory tracts although the most clinically significant manifestations arise in lower respiratory tract infections, bronchiolitis and pneumonia being perhaps the most significant. Bronchiolitis is a particularly severe illness in the pre-term infant by virtue of the fact that it causes very significant small airways obstruction. (Sigurs N et al 1995) The respiratory syncytial virus is currently the commonest identified cause of lower respiratory tract infections in children under the age of three world-wide. Serological studies have identified that, at least in the UK, that virtually all children will have had at least one episode of infection by the age of three. In the infant and neonate age groups, it is currently the numerically largest cause of both pneumonia and bronchiolitis (Krilov L R et al 1997), and is also thought to play a role (as yet not fully understood), in the aetiology of both asthma and chronic obstructive airways disease.(Pullan C R et al 1998) For those patients who have concurrent immunodeficiency states it is a very significant cause of both morbidity and mortality (Long C E et al 1995) Clinical presentation In our considerations here we shall confine our discussion to those clinical manifestations common in the neonatal group and accept that the comments made do not necessarily apply to those older children and adults who may also contract the virus. The respiratory syncytial virus is currently the commonest cause of pneumonia in young children with the greatest preponderance in the under three age range. (Jeng M-J et al 1997) The initial phases of an infection are generally characterised by symptoms of a transient upper respiratory tract infection such as runny nose, watery eyes and mild pyrexia. This typically progresses to produce symptoms of cough, wheeze (although this may be absent in the neonate), high pyrexia, dyspnoea, central cyanosis – characterised by a bluish tinge to the skin, lips and fingernails, increased respiratory rate and occasionally visible utilisation of the accessory muscles of respiration and sub-costal retraction, all of which indicate lower respiratory tract involvement. (Brunell P A 1997). In severe cases it can progress to the point of respiratory failure. In the context of our discussion here, these developments can be extremely dangerous in the pre-term infant who has significantly smaller airways than older children or adults, and also less in the way of respiratory reserve, so that any embarrassment of the respiratory function is of proportionally greater clinical significance. (Graham S M et al 2002) Particular risk factors for a severe bout of the disease are: Prematurity Young age (especially those less than six weeks old) Pre-existing heart conditions (congenital malformations) Pre-existing lung conditions (bronchopulmonary dysplasia and cystic fibrosis ) Immune system malfunction Low socio-economic status and especially those who live in Overcrowded housing conditions Passive exposure to cigarette smoke Day care or childcare attendance Presence of older children in the same household Lack of innate immunity from failure to breast feed. (after Thompson et al. 2003) Mode of infection After each bout of infection the body develops a degree of immunity to the virus. This is less of a factor in the neonate, whose immune system has not developed to the same degree as in the older child. In the pre-term infant , the immune response is (in practical terms) almost non-existent. In any event the immunity is never complete as the virus is capable of subtle mutations of its protein coat which allows it to partially evade the immune system. Re-infections are common but they do tend to be less severe than the original attack. (Panicar J, et al 2004) The mode of spread is through droplet spread and from direct contact with infected nasal or oral fluids. It can enter the body most easily through the epithelial surfaces of the eyes and nose. Epidimiology The respiratory syncytial virus produces characteristic patterns of infection which are epidemics of up to five months duration. They typically occur in the winter months and records show (since 1990) that they typically begin in the time span between October to mid-December with a marked peak in January and February. In the UK, the respiratory syncytial virus is responsible for about 125,000 episodes of hospitalisation (Leader S et al 2002).and about 2,500 deaths (NCHS 2002). These factors are of particular importance in our considerations when we are considering the timing of any protection programme. These figures translate into the fact that 20% of all hospital admissions for lower respiratory tract infections are due to respiratory syncytial virus infections, and if looked at as an annual incidence rate, admission for respiratory syncytial virus infection is currently 28.3 per 1,000 infants and 1.3 per 1,000 for children under the age of 4 years. (Muller-Pebody B et al 2002) The highest rate of clinically significant infection occurs at ages between 2 and 6 months with a significant peak in the 2-3 month age range. Respiratory syncytial virus is typically brought into the home by an older (school age) child who then passes it onto the younger child in the family. In child care and crà ¨che facilities it is quite common to observe 100% infection rates in both children and staff. On a practical note, respiratory syncytial virus infection has also been seen to spread throughout a hospital environment infecting patients and staff alike. (Shay, D K et al 2001), We shall specifically consider the implications of vaccination later in this essay, but there are other issues of prevention that require examination. We have already discussed the mode of common infection through the respiratory and ocular epithelial surfaces. It follows that there are certain measures which, while not eradicating the possibility of spread, will certainly help to reduce it. In the home environment, it is sensible to frequently wash hands after coming into contact with nasal or oral secretions and before handling a young child. Frequent handwashing will reduce the risk of contamination by direct spread. School age children should be kept as separate as practically possible from a neonate if they have symptoms of a â€Å"cold†. Sneezing into a handkerchief will also help to reduce the possibility of droplet transmission. In its droplet form, the virus will live on household surfaces for many hours and is therefore still capable of transmission. In terms of the work of the neonatal community nurse, such patient education should be seen both as part of an empowerment and education programme every bit as much as a prophylactic measure for the neonate. (Hogston, R et al 2002). In the more controlled environment of a hospital, it is possible to institute barrier measures if there is significant risk such as the immuno-compromised patient or the child at risk with congenital heart disease. Frequent pre-touching hand washing is essential to help prevent cross transmission (Ng D K et al 2000). Specific preventative treatments Palivizumab ( or Synagis – Trade name) is a medication that is commonly given to infants at highest risk of complications of respiratory syncytial virus infection, for example those who were born prematurely or those with chronic heart and lung disease. It is given by monthly injection through the at-risk winter months and provides significant levels of protection. This protection however, is comparatively short lived and has to be repeated on a yearly basis until the child is judged to be no longer at high risk of significant sequelae of infection. (PPTI 2005). It is also extremely expensive. (see on). Palivizumab is the first of what may become a series, of monoclonal antibodies, which have been developed to specifically target and combat one specific infection. Its current indications include prevention of serious lower respiratory tract disease caused specifically by the respiratory syncytial virus. There are currently a number of papers that have studied its safety and efficacy in a number of situations such as bronchopulmonary dysplasia (BPD), infants with a history of premature birth (≠¤35 weeks gestational age), and children with hemodynamically significant CHD. (Meissner H C et al 1999), Technically it is a humanised monoclonal antibody of IgG1k type which is produced by recombinant DNA methods. It targets an A antigenic site of the F-protein covering of the virus. It is primarily derived from human antibody sequences and has two light and two heavy chains with a molecular weight of about 148,000 Daltons. The viability of nurse-led respiratory syncytial virus immunisation programme. >From the literature and the evidence that we have presented so far we can point to the fact that the respiratory syncytial virus is a significant risk to neonates, especially those who have significant risk factors for the development of lower respiratory tract complications. (Berwick D 2005) Although we specifically have not considered treatment in this essay, we should note that, in the context of a discussion on the role of prophylaxis, that the treatments available for neonate infection with respiratory syncytial virus are severely limited. In the words of Jon Friedland, an eminent professor of infectious diseases in London: Treating respiratory syncytial virus bronchiolitis remains a good example of therapeutic nihilism — nothing works except oxygen. Adrenaline, bronchodilators, steroids, and ribavirin all confer no real benefit. (quoted in Handforth J et al 2004) If we accept that this is the case and we also accept the significant morbidity and mortality rates quoted earlier in this essay, then it clearly makes sense to consider the role of prophylaxis in respiratory syncytial virus infections. It clearly therefore also makes sense to consider what active measures can be taken in order to try to reduce the possibility of infection or prevent the damaging and serious sequelae of infection. Sadly, this is far from straightforward. One could reasonably hope that a immunologically based vaccine would have been developed to help with this problem. Despite the fact that the first formalin inactivated respiratory syncytial virus vaccine was developed over forty years ago, progress in this field appears to have been painfully slow. Recently published literature on the subject of the effect of vaccines against respiratory syncytial virus found that there was no significant benefit conferred in terms of preventing either the infection or the complications. (Simoes E A et al 2001). We should note that this was not a small study but a meta-analysis of five major studies on the subject and therefore has considerable weight if we are considering an evidence base for our findings. (Green J et al 1998). If we accept the premise that a successful respiratory syncytial virus vaccine should be able to prevent severe lower respiratory tract disease and the morbidity consequent upon it, and should also ideally protect against both A and B strains of the virus, we would also have to postulate that it would have to be given directly after birth in order to prevent immediate primary infection form the environment. In general terms, this presents the nub of the problem as neonates have very poorly developed immune response mechanisms and the bulk of their immunity is passively derived form the trans-placental maternal antibody production and the immunoglobulins present in the maternal milk. (Kim H W et al 1969). Active immunisation in very early life proves to be fruitless, as the immature neonatal immune system cannot generally produce either an adequate T-cell response or effective antibody levels. It is also the case that the maternal antibodies themselves, also interfere with the infant’s ability to mount an antibody response of its own. (Clements M L et al 1996) In order to combat these problems there are a number of immunological strategies currently under investigation. One strategy is to vaccinate the mother during the third trimester in order to try to boost the naturally occurring antibodies and thereby increase the natural passive immunity. This is unlikely to give significant immunity beyond the first six weeks of birth unless the child is breast fed, in which case the immunity would last for longer (see below). It would however, have the advantage of protecting the most vulnerable individuals at a critical time. Initial trials of this method using a purified F protein subunit vaccine was found to be safe in a trial of 35 third trimester vaccinations. (Munoz FM et al 2003). The trial showed a disappointing, but detectable, response and the infants had increased IgG against respiratory syncytial virus up until 9 months of age. Clearly this strategy would be ineffective against children born with a significant degree of prematurity and who therefore, are at greatest risk A second approach was tried with live attenuated genetically modified vaccine. This approach was found to work in adults and older children but could not be sufficiently attenuated to produce a safe and sufficient response in neonates. (Piedra P A 2003). The third approach was to try live recombinant viral vectors which expressed respiratory syncytial virus proteins. Thus far, the results have been disappointing both in terms of immunogenicity and there are also safety concerns with iatrogenic oncogene activation. (Haller A A et al 2003) In terms of our potential nurse run clinic, all of these options have very significant drawbacks and none are therefore likely to represent a realistic immunisation option. Clarke (S J et al 2000) suggest that although huge strides have been taken with a number of vaccine products – especially the live attenuated vaccines, it will probably be a minimum of another decade before routine effective vaccination becomes widely available. It is perhaps because of this failure to present a solution of a vaccine that has caused researchers to examine other avenues of investigation for workable prophylactics. A line of investigation into passive immunity with IV hyperimmune globulins against respiratory syncytial virus has shown positive results in initial trials against preventing severe forms of respiratory complications in high risk children (Groothuis J R et al 1999). This particular formulation can only be given intravenously and therefore is of limited use outside of a hospital environment. It is clearly of no use in a community setting. The other line of passive immunity has developed into the intramuscular form of IgG humanised monoclonal antibody described above (palivizumab). Clinical trials already published have already shown that monthly injections of palivizumab in high risk infants have been able to reduce the hospital admissions for respiratory syncytial virus-related disease by more than 50% (IRSVSG 1998). This was a well designed double-blind placebo controlled randomised study and, in addition to apparently demonstrating its efficacy, it also showed an impressive safety record. This particular formulation appears to have a very good side-effect profile and clinical experience appears to confirm the initial trial results. Given the fact that respiratory syncytial virus places a heavy financial and economic burden on the NHS, a 50 % reduction in these levels is quite substantial. Cost-effectiveness is clearly a major question in any consideration of a national vaccination programme and studies elsewhere in Europe, (Roeckl-Wiedmann I et al 2003) have called into question the costings and have therefore also called into question the need for further evaluation. These considerations are given further credence if we consider the fact that if we take as a marker the number of hospital laboratory reports of respiratory syncytial virus, there appears to be a marked downward trend in the UK between 1990 and 2003. (Fleming D M et al 2003). It may be that there are other active factors here such as changes in clinical or laboratory practice, but it would appear to reflect a definite downward trend. This comment is actually given further credence when one considers the epidemiological data from the primary health care sources which also show a fall in acute respiratory infections over the same period. (Neuzil K M et al 2000) Passive immunisation is currently considered to be the best option in terms of providing immunity in the community although many authorities consider that it is currently only an option for the high risk infant. In the terms of our consideration here for a nurse run immunisation clinic, we should consider a set of guidelines, (that were actually produced in the USA), which could be adopted as they are based on the current best evidence available. (AAP 2003) The guidelines suggest that passive immunisation (palivizumab ) should be currently considered for premature infants born at less than 32-35 weeks gestation or for infants younger than 2 years with chronic lung disease. Although this is clearly a rational view, we have to note that it is based upon American statistics and American costings and is applicable primarily to American culture. It does not imply that the recommendations are necessarily transferable to the UK situation. The NHS has been more cautious. The current NHS guidelines were considered and formulated by the joint committee on vaccination and immunisation of the Department of Health. (JCVI 2002). Their report notes that: Palivizumab seems safe, well tolerated, and effective in reducing admissions to hospital, but it remains very expensive, at a cost of around  £2500 for five doses over the season for respiratory syncytial virus. In the UK, the statistics seem to suggest that readmission rates associated with respiratory syncytial virus infection-related bronchioliitis show that palivizumab is only cost effective if it is used in infants born prematurely with chronic lung disease and receiving oxygen at home (which is actually a very expensive undertaking in any event). (Feltes T F et al 2003). If this opinion is taken in conjunction with the suspicion that the rates of respiratory syncytial virus infection are actually falling, this will actually weight the cost-effectiveness argument further against the use of palivizumab. It is noted that a more recent study of palivizumab in infants who have congenital heart disease has been completed, but the information collected is insufficient in terms of readmission rates, morbidity and cost-benefit analysis, to allow a confident recommendation for use in this population. (Feltes T F et al 2003) The neonatal nurse’s viewpoint. In this essay we have considered much of the current literature on the subject of community immunisation for respiratory syncytial virus. There is little doubt that the virus represents a significant threat to a small proportion of neonates and a minor threat to the rest. (Crowe JE Jr 1995). It is also clear from the evidence that the prospect of active immunisation of the at risk groups has been aggressively pursued over a time scale of about four decades with very little in the way of positive practical results. In essence, this means that the only realistic prospect of giving the at-risk neonate a degree of protection against the respiratory syncytial virus, is by means of increasing the levels of passive immunity. We have considered the role of the only viable therapeutic agent in this area (palivizumab), and have come to the conclusion that the evidence base for its use is sound if it is given on a monthly basis through the winter months when the at risk populations are at greatest risk of significant morbidity, and indeed mortality. Against this statement we have to weight the cost-effectiveness of what is a very expensive agent. (Handforth J et al 2000). The neonatal community nurse therefore finds herself ideally placed to act as the gatekeeper in this role. By virtue of her position of having direct contact with each of the neonates in her community, she is probably the most optimally places member of the primary healthcare team to assess and oversee the administration of palivizumab to those at greatest risk. (Scally G et al 1998) The mechanics of the enterprise will inevitably vary from practice to practice, but the elements of any recall system will be an up to date age/sex register, a forward planning facility and good communications with the antenatal services so that prospective candidates can be assessed at the earliest opportunity. The multidisciplinary nature of the modern primary healthcare team is ideal for communication of this nature and the neonatal nurse should be able to optimally utilise the recall facilities of the practice in order to ensure maximal compliance once the decision to treat has been made. (Yura H et al 1998) On the positive side there is the fact that Nurse led clinics, in general terms, have been proven to work both effectively and efficiently in many other areas. On the negative side we have the practical situation that the current recommendations from the Joint Committee on Vaccination and Immunisation that the current evidence base supports the view that palivizumab should only be offered to babies in the Group I classification, which currently includes babies under the age of two years with severe chronic lung disease, on home oxygen during the RSV season. This represents about 500 babies a year nationally. Common sense would indicate that there is absolutely no practical rationale for setting up any form of clinic in primary care for this number of babies on a national basis. Even if this recommendation was extended to include those babies in Group II (those with chronic lung disease but not on home oxygen), this would only add another 1000 to the national total and again, clearly there would be absolutely no rationale for setting up a local clinic base for this type of work load. (Netten A et al. 2000) The Committee’s reasoning for offering palivizumab to the Group I babies was on the evidence that it would be likely to reduce hospitalisation by a factor of 40% and thereby be cost effective. The Committee also suggested that these guidelines should be reviewed if a more effective and cheaper vaccine became available. If we consider, for the sake of argument, that such a vaccine has become available and that it is both practical and National policy to set up such vaccination clinics, we can consider the leads given by papers that report experiences in other areas of childhood vaccination. Nesbitt (A et al. 1997) give a very informative overview of the practical difficulties involved in setting up a Hepatitis B vaccination clinic. They point to the problems of trying to reach the most vulnerable and potentially isolated individuals in the community and highlight the need for specific nurse initiated home visits to the persistent absentees to the clinic. (Nesbitt A et al. 1995) They also highlight the difficulties in trying to get a level of immunity in a population that is constantly turning over. It requires a very high degree of vigilance on the part of the nurse running the clinic to ensure that all new arrivals are incorporated into the recall system with complete efficiency and without delay. On a slightly tangential subject, the whole issue of the nurse-led clinic was reviewed and assessed for overall effectiveness and cost effectiveness by Raftery (J et al. 2005). This paper demonstrated, beyond doubt that nurse led clinics could be both effective and very cost effective. This particular paper looked at the role of the clinic in the prevention of heart disease in the adult population, which is clearly not directly applicable to our considerations here, but the important relevant considerations are that the autonomous nurse led clinic can work very effectively with auditable results that can demonstrate both positive health benefits and an efficient and cost-effective use of a nurse’s time. (Polsky D et al. 1997) One of the interesting points raised in this paper which was also directly transferable to a nurse led immunisation clinic was that the increased costs noted also included an element for increased prescribing for intercurrent morbidity that was discovered at the time of the assessment. This is a factor that is likely to be translated into increased costings for the vaccination clinic, as many mothers are likely to save up questions and minor degrees of pathology if they know that they are having an appointment with the practice nurse. (Lancaster T 2003). This may well be translated into increased prescribing costs. Taking a holistic view however, one would hope that these costs would not be incurred without good reason and therefore one could conclude that it would be for the greater good of the patient in the long run and therefore presumably justified. (Benger J R et al. 2005) Considering all of these issues one can see that the viability of the nurse led clinic, certainly in the areas of RSV vaccination, is totally dependant on the development of an effective and cheaper vaccine. At this point in time, the recommendations do not support the logistics of a nurse led clinic for palivizumab although it is clear that the neonatal nurse should be the prime source of the palivizumab vaccination, the numbers involved support the specific identification and targeting of the Group I babies. References AAP 2003 American Academy of Pediatrics. Respiratory syncytial virus. In: Pickering LK, ed. Red Book: 2003 Report of the committee on infectious diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003: 523-8. Bar-on ME, Zanga JR. 1996 Bronchiolitis. Prim Care. 1996;23:805-819. Benger J R, Hoskins R 2005 Nurse led care: Nurses are autonomous professionals delivering expert care BMJ 2005 330: 1084. Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005; 14: 315 316. Brunell PA. 1997 The respiratory season is upon us. Infectious Diseases in Children. Thorofare, NJ: Slack Inc; 1997;10(1):5. Clark SJ, Beresford MW, Subhedar NV, Shaw NJ. 2000 Respiratory syncytial virus infection in high risk infants and the potential impact of prophylaxis in a United Kingdom cohort. Arch Dis Child 2000;83: 313-6 Clements ML, Makhene MK, Karron RA, Murphy BR, Steinhoff MC, Subbarao K, et al. 1996 Effective immunisation with live attenuated influenza A virus can be achieved in early infancy. J Infect Dis 1996;173: 44-51. Crowe JE Jr. 1995 Current approaches to the development of vaccines against disease caused by respiratory syncytial virus (RSV) and parainfluenza virus (PIV): a meeting report of the WHO Programme for Vaccine Development. Vaccine 1995;13: 415-21. Feltes TF, Cabalka AK, Meissner HC, Piazza FM, Carlin DA, Top FH, et al for the Cardiac Synagis Study Group.2003 Palivizumab reduces hospitalisation due to respiratory syncytial virus in young children with haemodynamically significant congenital heart disease. J Pediatrics 2003;143: 532-40 Fleming DM, Ross AM, Cross KW, Kendall H. 2003 The reducing influence of respiratory tract infection and its relation to antibiotic prescribing. Br J Gen Pract 2003;53: 778-83. Graham SM, Gibb DM. 002 HIV disease and respiratory infection in children. Br Med Bull 2002;61: 133-50 Green J, Britten N. 1998 Qualitative research and evidence based medicine. BMJ 1998; 316: 1230-1233 Groothuis JR, Simoes EAE, Levin MJ, Hall CB, Long CE, Rodriguez WJ. 1999 Prophylactic administration of respiratory syncytial virus immune globulin to high-risk infants and young children. N Engl J Med 1999;329: 1524-30 Haller AA, Mitiku M, Macphail M. 2003 Bovine parainfluenza virus type 3 (PIV3) expressing the respiratory syncytial virus (RSV) attachment and fusion proteins protects hamsters from challenge with human PIV3 and RSV. J Gen Virol 2003;84(Pt 8): 2153-62 Handforth J, Friedland JS, Sharland M. 2000 Basic epidemiology and immunopathology of RSV in children. Paediatr Respir Rev 2000;1: 210-4 Handforth J, Mike Sharland, and Jon S Friedland 2004 Prevention of respiratory syncytial virus infection in infants BMJ, May 2004; 328: 1026 – 1027 Hentschel J Berger T M Tschopp A et al 2005 Population-based study of bronchopulmonary dysplasia in very low birth weight infants in Switzerland. Eur J Pediatr 2005 May;164(5):292-7. Hogston, R. Simpson, P. M. (2002) Foundations in nursing practice 2nd Edition, London: Palgrave Macmillian. 2002 IRSVSG 1998 The Impact-RSV Study Group. Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. Pediatrics 1998;102: 531-7 Jeng M-J, Lemen RJ. 1997 Respiratory syncytial virus bronciolitis. Am Fam Physician. 1997;55:1139-1146. JCVI 2002 Joint Committee on Vaccination and Immunisation. Minutes of the meeting held on 1 November 2002. www.doh.gov.uk/jcvimins01nov02.htm (accessed 31.3.06) Kim HW, Canchola JG, Brandt CD, Pyles G, Chanock RM, Jensen K, et al. 1969 Respiratory syncytial virus disease in infants despite prior administration of antigenic inactivated vaccine. Am J Epidemiol 1969;89: 422-34 Krilov LR, Mandel FS, Barone SR, Fagin JC and The Bronchiolitis Study Group. 1997 Follow-up of the children with respiratory syncytial virus bronchiolitis in 1986 and 1987: potential effect of ribavirin on long term pulmonary function. Pediatr Infect Dis J. 1997;16:273-6. Lancaster T. 2003 The benefits of nurse led secondary prevention clinics continued after 4 years. Evid Based Med 2003;8: 158 Leader S. Kohlhase K. 2002 Respiratory syncytial virus-coded pediatric h

Man + Woman = Family :: same sex marriage, argument

Man + Woman = Family   Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"The Catholic bishops of Alaska have urged their people to approve a state  Ã‚  Ã‚  Ã‚  Ã‚   constitutional amendment declaring that a valid marriage may exist between one man and one woman.† A decision made last February by Supreme Court Judge Peter Michalski opened the door to change the nature of marriage. It dismisses male and female sexuality as an important role in marriage. It eliminates the possibility of the procreation of children. It changes also the meaning of family (National Catholic Reporter, 1998). If same-sex marriages are legalized, we will soon forget what a real family should consist of†¦.   Ã‚  Ã‚  Ã‚  Ã‚  It is very important to realize the importance of a man and a woman’s sexuality when in wedlock. When God created man and woman, he made a special contour of the two bodies to come together and interlock in a comfortable position. When the opposites do come together a child is soon after born. This is not possible with two of the same sex.   Ã‚  Ã‚  Ã‚  Ã‚  To have a child come into the world is one of the greatest things in life. When two people share equally, this phenomenon of childbirth, it naturally bonds a husband and wife together forever. If you married the same sex and adopted a child you would never experience that type of a bond.   Ã‚  Ã‚  Ã‚  Ã‚  Since the beginning of time a family tree has had a man and a woman resting at the peak. Sexual relations between a man and a woman will keep the tree full of branches for many years to come. When the same sex get married it will eliminate the growth of new branches. Eventually, the roots will be gone and the tree will die. Fortunately for me, my family tree is full of strong branches, and it gets bigger and bigger each year.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  In my short time on this Earth, I have found out why it is important for a man and a woman to be united as one. There are a lot of differences between the two sexes. In a same-sex marriage, the opportunity to enjoy those differences will cease to exist. I know this because I am married to the opposite sex myself. Together we have found out just how different a man and a woman really are.

Factors Motivating Variation

The section â€Å"Factors motivating variation† of Chapter 2 of Introducing Sociolinguistics (Meyerhoff 2006) introduces four social factors that motivated people how to use language. Meyerhoff provides a rough introduction on these factors that would be discussed deeply in latter chapters. The first factor is speakers desire to show how to join in a group and separate from others. That means people use language to identify which group they belong to. Meyerhoff uses the Martha’s vineyard study to explain that vineyarder used different pronunciation to distinguish themselves from summer visitor.The specific linguistic variant is an identification to separate local group and visitor group. The second factor is speakers desire to be valuable in their group. Meyerhoff explains speaker use specific variant to raise their self image in the community, then to establish a positive image in their community. On the other hand, speakers desire to eliminate the negative by avoiding using a variant which their image would be downgraded. These three factors motivate speakers determine how to use language to achieve a â€Å"good† identity in the society.Compare to the other three factors, the final one is focused on the interaction between the speaker and group members. Meyerhoff states the speakers desire to test how in-group members are orienting themselves to those three factors. Communication accommodation theory is introduced to explain this factor in generally. It presents that the speakers depend on audience behaviors to choose the variant. Besides that the speakers will use language to test their hypotheses are workable or not. Therefore, variation is a result after these testing.

An Analysis of the Social Gradient of Health Essay

â€Å"The demonstration of a social gradient of health predicts that reducing inequality itself has health benefits for all, not simply for the impoverished or deprived minorities within populations. † (Devitt, Hall & Tsey 2001) The above quote from Devitt, Hall and Tsey’s paper is a relatively well grounded and well researched statement which draws on contemporary theoretical sociological concepts to support the assertion that reducing inequality is the key to improving health for all. However the assertion that the demonstration of a social gradient of health predicts that a reduction in inequality will lead to health benefits for all is a rather broad statement and requires closer examination. The intention of this essay is to examine the social gradient of health, whose existence has been well established by the Whitehall Studies (Marmot 1991), and, by focusing on those groups at the lower end of the social gradient, determine whether initiatives to address inequalities between social classes will lead to health benefits for those classes at the lower end of the social scale. The effectiveness of past initiatives to address these social and health inequalities will be examined and recommendations made as to how these initiatives might be more effective. The social gradient described by Marmot and others is interrelated with a variety of environmental, sociopolitical and socioeconomic factors which have been identified as key determinants of health. These determinants interact with each other at a very complex level to impact directly and indirectly on the health status of individuals and groups at all levels of society; â€Å"Poor social and economic circumstances affect health throughout life. People further down the social ladder usually run at least twice the risk of serious illness and premature death of those near the top. Between the top and bottom health standards show a continual social gradient. † (Wilkinson & Marmot 1998) In Australian society it is readily apparent that the lower social classes are at greater disadvantage than those in the upper echelons of society; this has been discussed at length in several separate papers on the social gradient of health and its effects on disadvantaged Australian groups (Devitt, Hall & Tsey 2001, Robinson 2002, Caldwell & Caldwell 1995). Within the context of the social gradient of health it can be inferred that Indigenous groups, for example, are particularly susceptible to ill health and poor health outcomes as they suffer inordinately from the negative effects of the key determinants of health. A simple example of this is the inequality in distribution of economic resources: â€Å"Average Indigenous household income is 38% less than that of non-Indigenous households. † (AHREOC 2004). The stress and anxiety caused by insufficient economic resources leads to increased risk of depression, hypertension and heart disease (Brunner 1997 cited in Henry 2001). Higher social status and greater access to economic resources is concomitant with a reduction in stress and anxiety levels, as individuals in these groups have more control over economic pressures which create this stress. This simple comparison proves that the social gradient of health accurately reflects how socioeconomic determinants affect the health of specific social classes at the physiological level. An extension of the research into the social gradient and the determinants of health is the examination of the pathways through which specific social groups experience and respond to these determinants. These ‘psychosocial pathways’ incorporate psychological, behavioural and environmental constraints and are closely linked to the determinants of health; â€Å"Many of the socio-economic determinants of health have their effects through psychosocial pathways. † (Wilkinson 2001 cited in Robinson 2002). These pathways have been demonstrated by Henry (2001) in the conceptual model of resource influences (Appendix A), a model which illustrates the interaction between the constraints mentioned above and their impact on health outcomes. Henry states that a central differentiator between classes is the amount of control an individual feels they have over their environment. Whereas an individual from a lower class group holds a limited sense of control over their well being and consequently adopts a fatalistic approach to health, those in higher classes with a stronger sense of control over their health are more likely to take proactive steps in ensuring their future wellbeing. This means that both individuals will cope differently with the same health problem. This is partly as a result of socioeconomic or environmental determinants relative to their situation, but it is also a result of behavioural/physical constraints and, most importantly, the modes of thought employed in rationalising their situation and actions. In essence these psychosocial pathways occupy an intermediate role between the social determinants of health and class related health behaviours. This suggests that, while the social gradient of health is a good predictor of predisposition to ill health among specific classes, it cannot predict how reducing inequality in itself will affect health outcomes or how a specific social class will respond to these changes. An examination of some initiatives aimed at reducing inequality in the indicators of health outcomes reveals this problem; â€Å"In 1996 only between 5% and 6% of NT Aboriginal adults had any kind of post secondary school qualification compared with 40% of non-Aboriginal Territorians. † (ABS 1998). Within the context of the social gradient of health, education is an important indicator of health outcomes. It is evident from the quote above that there exists huge inequality within the Northern Territory education system; this suggests an increased likelihood of ill health for Aboriginal people in later life. Even though there have been initiatives to address this inequality in one of the indicators of health outcomes (Colman 1997, Lawnham 2001, Colman & Colman 2003), they have had only a minimal impact on Indigenous second level education rates (ABS 2003). This is partly due to the inappropriateness of these initiatives (Valadian 1999), but it is also due to the disempowerment and psychosocial malaise (Flick & Nelson 1994 cited in Devitt, Hall & Tsey 2001) which are a feature of Indigenous interaction and responses to the social determinants of health. Research has also been carried out into how effecting change in the inequalities in other indicators of health might affect health outcomes. Mayer (1997) cited in Henry (2001) examined the effects of doubling the income of low income families and concluded it would produce only modest effects. Henry believes that this points to the strong influence of the psychological domain in influencing health behaviours. This suggests that the key to better health for all lies not just in reducing inequality between the classes but also in changing those elements of the psychological domain which influence health behaviour. Another example of the gap between initiatives to reduce inequality and their impact on those inequalities is evident in an examination of economic constraints experienced by Indigenous Australians on social welfare. Price and McComb (1998) found that those in Indigenous communities would spend 35% of their weekly income on a basket of food, compared to just 23% of weekly income for those living in a capital city for the same basket of food. To combat this inequality it would seem logical to reduce the price of food in Indigenous communities or else increase the amount of money available to those living in remote communities, i. e. a socioeconomic approach. It has already been established that increasing income has only modest effects and in combination with the fact that smoking, gambling and alcohol account for up to 25% of expenditure in remote communities (Robinson 2002), how can it be guaranteed that the extra funds made available through either of the two suggestions above would be employed in achieving a desirable level of health? One possible suggestion is that a socioeconomic approach must be complemented by a psychosocial approach which addresses those abstract modes of thought, cultural norms and habits and health related behavioural intentions which dictate healthful behaviours. â€Å"Culture and culture conflict are factors in Aboriginal health. But instead of the emphasis being placed on Aboriginal failure to assimilate to our norms, it should rather be put on our failure to devise strategies that accommodate to their folkways. † (Tatz 1972 cited in Humphrey & Japanangka 1998) Any initiative which hopes to resolve inequality in health must incorporate a sound understanding of the influence of the psychosocial pathways relative to the class level and cultural orientation of that group, otherwise its success will be modest at best. Using Henry’s model of resource influences provides a framework for understanding how addressing these psychosocial pathways can lead to greater uptake of initiatives designed to address these inequalities. An analysis of the National Tobacco Campaign (NTC 1999) reveals how this initiative failed to impact significantly on Indigenous smoking rates. This was a purely educational initiative which aimed to raise awareness of the effects of smoking on health. One of the primary flaws of its design was its failure to even acknowledge those Indigenous groups at the lower end of the social scale; it also failed to communicate the relevance of its message to Indigenous people; â€Å"The only thing is that when it comes to Aboriginal people, they will not relate to Quit television advertisements because they don’t see a black face†¦. I’ve heard the kids say ‘Oh yeah, but that’s only white fellas’. They do. † (NTC 1999) Not only did this initiative fail to connect with Indigenous people, it also failed to influence the elements of the psychological domain which legitimate such high rates of smoking. Within Indigenous culture smoking has become somewhat of a social practice, with the emphasis on sharing and borrowing of cigarettes (Gilchrist 1998). It is ineffectual to put across messages about the ill effects of smoking if the underlying motivation of relating to others is not addressed. In a report conducted on Indigenous smoking (AMA & APMA 2000 cited in Ivers 2001), it was suggested that one of the key themes of an initiative aimed at reducing indigenous smoking rates should be that smoking is not a part of Indigenous culture. The ‘Jabby Don’t Smoke’ (Dale 1999) is an example of an initiative whose design attempted to influence accepted social norms. Its focus was primarily on children, thereby acknowledging the importance of socialization and the instillation of cultural norms at an early age. Unfortunately no data is available detailing its impact on smoking rates. As mentioned earlier in this essay, another feature of the psychological domain which has an effect through the psychosocial pathways is the modes of thought employed in rationalising actions and responses to various determinants and constraints. Self efficacy or the amount of perceived control over one’s situation is an important contributor to health status; â€Å"Empowered individuals are more likely to take proactive steps in terms of personal health, whilst disempowered individuals are more likely to take a fatalistic approach† (Henry 2001) Examples of initiatives which have strived to empower Indigenous people in being responsible for their own health include ‘The Lung Story’ (Gill 1999) and various health promotion messages conveyed through song in traditional language ( Castro 2000 cited in Ivers 2001, Nganampa Health Council 2005). By encouraging Indigenous people to address these issues in their own way, the amount of perceived control over their own health is increased thereby facilitating a greater degree of self efficacy. The intention of this essay has not been to deny that the social gradient of health does not exist or that it is not an effective tool in creating understanding of where social and health inequalities lie. Unfortunately programs and initiatives which have been guided by the social gradient of health and have been purely socioeconomic in their approach have failed to have a significant, sustainable effect on health inequalities. In the US, despite socioeconomic initiatives to resolve inequality, the gap between upper and lower class groups has actually widened in recent times (Pamuk et al 1998 cited in Henry 2001). The scale of the intervention required to ensure a sustained impact on health inequalities has been discussed by Henry (2001), he also highlights the need to garner substantial political will in order for these changes to happen and makes the point that those in the upper classes are relatively content with the present status quo. This essay has attempted to demonstrate that in an environment where well grounded, evidence based socioeconomic initiatives are failing to have the desired out comes, it is perhaps time to focus more on altering those strongly held health beliefs which not only dictate responses to social determinants of health but also dictate responses to initiatives designed to address these inequalities; â€Å"Healthful behaviours are due to more than just an inability to pay. A mix of psychological characteristics combines to form distinctive behavioural intentions†. (Henry 2001) In the current environment of insufficient political will and finite resources it would be prudent to use every tool available to ensure initiatives aimed at reducing inequality between the classes will have the maximum amount of benefit. This approach is not a long term solution, but until it is possible to achieve the large scale social remodelling necessary to truly remove social inequality, and consequently health inequality, it is the most viable solution available. REFERENCES. ABS, 2003. ‘Indigenous Education and Training’, Version 1301. 0, A Statistical Overview, Australian Bureau of Statistics, Canberra, viewed 22nd August 2005, http://www. abs. gov. au/Ausstats/abs@. nsf/Lookup/FC7C3062F9C55495CA256CAE000FF0D6 A statistical overview of Aboriginal and Torres Strait Islander peoples in Australia 2004, Australian Human Rights and Equal Opportunities Commission (AHREOC), Sydney, viewed 20th August 2005, http://www. hreoc. gov. au/social_justice/statistics/. Brunner, E. 1997. ‘Stress and the Biology of Inequality’. British Medical Journal. No. 314, pp 1472-1476. Castro, A. 2000. ‘Personal Communication’. No other details available. Caldwell, J. & Caldwell, P. 1995. ‘The cultural, social and behavioural component of health improvement: the evidence from health transition studies’, Aboriginal Health: Social and Cultural transitions: Proceedings of a Conference at the Northern Territory University, Darwin 28-30th September. Colman, A. 1997. ‘Anti-racism Course’, Youth Studies Australia, Vol. 16, Issue 3, p. 9, viewed 22nd August 2005, EBSCOhost Database Academic Search Premier, item: AN 12878155. Colman, A. & Colman, R. 2003. ‘Education Agreement’, Youth Studies Australia, Vol. 22, Issue 1, p. 9, viewed 22nd August 2005, EBSCOhost Database Academic Search Premier, item: AN 9398334. Dale, G. 1999. ‘Jabby Don’t Smoke, Developing Resources to Address Tobacco Consumption in Remote Aboriginal Communities’, Paper presented to the Eleventh National Health Promotion Conference, Perth. 23-26th May. Devitt, J. , Hall, G. , Tsey, K. 2001. ‘An Introduction to the Social Determinants of Health in Relation to the Northern Territory Indigenous Population’, Occasional Paper. Co-operative Research Centre for Aboriginal and Tropical Health. Darwin. Flick, B. , Nelson, B. 1994. ‘Land and Indigenous Health’, Paper No. 3, Native Titles Research Unit, Australian Institute of Aboriginal and Torres Strait Islander Studies, Canberra. Gilchrist, D. 1998. ‘Smoking Prevalence among Aboriginal Women’, Aboriginal and Islander Health Worker Journal, Vol. 22, No. 4, pp. 4-6. Henry, P. 2001. ‘An Examination of the Pathways through Which Social Class Impacts Health Outcomes’. Academy of Marketing Science Review, vol. 3, pp 1-26. Humphery, K. , Japanangka, M. D. , Marrawal, J. 1998. â€Å"From the Bush to the Store: Diabetes, Everyday Life and the Critique of Health Service in Two Remote Northern Territory Aboriginal Communities. † Diabetes Australia Research Trust and Territory Health Services, Darwin. Ivers, R. 2001. ‘Indigenous Australians and Tobacco; A Literature Review’, Menzies School of Health Research and the Cooperative Research Centre for Aboriginal and Tropical Health, Darwin. pp. 67-80, 93-107. Lawnham, P. 2001. ‘Indigenous Push at UWS’, The Australian, 27th June, 2001. p. 34, viewed 22nd August 2005, EBSCOhost Database Academic Search Premier, item: AN 200106061025662941. Marmot, M. G. , Davey Smith, G. , Stansfield, S. , Patel, C. , North, F. , Head, J. , White, I. , Brunner, E. and Feeney, A. 1991. ‘Health Inequalities among British Civil Servants: the Whitehall II Study’, Lancet, 337, 1387. reading 1. 5. Mayer, S. 2001. What Money Can’t Buy: Family Income and Children’s Life Chances. Harvard University Press, Cambridge, Massachusetts. National Tobacco Campaign. 1999. ‘Australia’s National Tobacco Campaign: Evaluation report Volume 1’. Commonwealth Department of Health and Aged Care, Canberra. Nganampa Health Council. 2005. Nganampa Health Council, Alice Springs. Viewed 23rd August 2005, http://www. nganampahealth. com. au/products. php Pamuk, E. , Makuc, D. , Heck, K. , Reubin, C. , Lochner, K. 1998. ‘Socioeconomic Status and Health Chartbook’. Health, United States. National Centre for Health Statistics, Maryland. Price, R. , & McComb, J. 1998. ‘NT and Australian Capital Cities Market Basket Survey 1998’. Food and Nutrition Update, THS, Vol. 6, pp. 4-5. Robinson, G. 2002. ‘Social Determinants of Indigenous Health’, Seminar Series, Menzies School of Health Research. Co-operative Centre for Aboriginal Health. Valadian, M. 1999. ‘Distance Education for Indigenous Minorities in Developing Communities’, Higher Education in Europe, Vol. 24, Issue 2, p. 233, viewed 22nd August 2005, EBSCOhost Database Academic Search Premier, item: AN 6693114. APPENDIX A. CCONCEPTUAL MODEL OF RESOURCE INFLUENCES. [pic] Henry, 2001. .

buy custom Work Place Change essay

buy custom Work Place Change essay 1.0 Work Place Change 1.1 Introduction Organizations apply numerous changes in their structures of operation from time to facilitate sustainability and development. These organizations are work places for many people and individuals are affected either negatively or positively when a change occurs. In all work places, the environment comprises of coordination between workers at all levels with the aim of meeting the organizations set goals. The effort to facilitate these changes brings about mixed reactions among the workers and the after effects are apparent. Organizations normally allow the people involved to participate in implementing these work place changes. 1.2 Understanding Work Place Change Work place changes are of many forms. They include new appointments, transfers, promotions, organizational changes, employment of new technology and many more. People resist changes because the fear of the unknown and past experiences that have been unpleasant. The good side of change is that it promotes growth and gives access to new opportunities that could not be realized without it. Either way, the changes have the fear effect on workers but the effect can be reduced if there is proper involvement of all parties in implementation of the change is observed. Organizations have different strategies of ensuring that they maintain a high level of production. These strategies involve employing changes in different times and so, organizations plan for changes early before they implement them. Work places consist of different workers with different responsibilities. Workers who have been working in one work place understand the capabilities of their work mates and coordinate better. This coordination results to increased production and organizations growth is observed. In other words, change is meant to improve an organization although it has some negative effects during implementation. Change in a work place has many effects on the organization. These effects range from uncoordinated activities to slower performance of activities. An organization will experience low output during and immediately after a change is implemented. Organizations normally inform their clients of any new changes so that they can expect irregularity during such a time. Fear of the unknown among the employees creates a lot of fear and their production lowers greatly if they are not well informed of the change. Other than negative effects, change also has numerous positive effects. Organizations introduce these changes with a vision of improving growth and development. The proposed changes to be introduced are normally well researched and proven to be worth it. This is because the changes are aimed at improving productivity while sustaining the growth of the organization. An organization experiences positive effects like access to new opportunities after implementing changes. The workers can experience effects like better working conditions and terms of service. Frequently, work place changes have more advantages than disadvantages to the organizations and thats why the organization pushes for their implementation. 1.3 Causes of Work Place Change Development and growth strategies formulated by an organization will always stimulate change because they involve employment of new ideas and projects. Organizations operate under a management team that is employed to oversee growth and development. The management develops a growth strategy that all other workers use as a guide. Work place changes have many causes which can be internal or external. Internal factors that cause work place changes can be planned or unplanned. When an organization plans to expand, downsize, relocate or restructure, the change is internal and planned. Unplanned changes are caused by numerous factors. They occur when workers move out of the organization, new workers are appointed into the organization, workers re promoted and demoted, new technology is employed, new working tools are employed and many more. External factors that cause work place changes range from infrastructure to environment, government policies among others. Every organization has a management team and a working team, and they all have different roles and responsibilities. If a member of the management team or a leader of an organization leaves office with or without notice, a big change will be observed in the organization. This kind of change creates anxiety among the workers because they normally execute their duties with an aim of succeeding, and acquiring a leadership role in the future. A leader who leaves office without a solid reason will create fear of the unknown among the workers in an organization. When an organization makes changes to the management team, it observes irregularities in production which often affect the clientele but if well managed, such irregularities can be controlled quickly. The working team in an organization requires the management to be stable so that execution of the activities goes as planned. Effects of a managerial change should be well communicated in good time so that they are retained within the organization. 1.4 Problems Observed After a Change Changes in work places cause problems to the workers, the organization and their clientele. These problems are caused by poor implementation of the change. The biggest problem is loss of production. All organizations have their primary objective of sustainability. The workers also have their primary objective of job security in an organization. When an organization implements changes without prior notice, the workers are threatened by unknown fears about the security of their jobs. These fears drive workers to look for other jobs in better established organizations that offer secure jobs. Another big problem is lack of proper coordination. If the change is a new appointment into a senior position, the change will affect the chain of command in the organization. If such a change is implemented without proper communication between the workers and the management, confusion might happen because the workers are not conversant with the appointee and the appointee too, is not conversant wit h fellow workers. Workers in an organization perform their duties according to the responsibilities allocated and the goals set. Every employee in an organization aims for a promotion into a higher level after sometime. This expectation turns into fear when a foreign candidate is appointed into such a position with or without notice. Workers fears are great observed when they observe an organizations growth after their hard work and a retarded growth of their job ranks. Introduction of new changes to an organization is important especially when the organization wants to expand into new projects. These new projects interfere with the normal activities thus increase the responsibilities of individual workers. The increase in responsibilities in a work place brings about decreased production and work related stress. These effects are negative to the development of an organization although majority of changes require to be implemented by the current workers before new appointments for the extra responsibi lities are put in place. This ensures that the new project has been proved to be worth it before a full implementation. 1.5 Response to Changes Changes have numerous positive and negative effects and the affected parties respond differently to these changes. Work places that employ many people experience more problems during a change than smaller organizations. Since most workers are filled with fear of a change, they develop a revolting behavior towards the change which can be termed as negativity. Negativity is a behavior witnessed among workers when they come across a problem, and they are afraid to speak out loud. This behavior is harmful to an organization and its consequences are decreased production. Negativity is easily spread to other workmates in search of support against a change. This effect becomes obvious if the larger percentage of the workers does not want the change. If such negativity behaviors are noticed by the management team, they are easily resolved if the revolting team is involved in deciding which changes are necessary. Efforts to get rid of negativity among people in an organization are made possible if the persons affected give out their opinions freely. This helps resolve any issues arising from an implemented change. The persons with the negative feeling against a change should also offer possible solutions and lead in implementing the resolved changes. Increased communication among the work mates improves understanding and easier efforts towards resolving issues brought about by a change. Changes implemented in an organization are meant to improve growth. Some of the positive effects of change are increased production and notable growth. These positive effects are possible if the organization researches about the topic first, from the organizations that have implemented the same changes before. This ensures that they will have prior knowledge on how to exactly implement the change and produce great results. Inevitably, growth, development, and sustainability are the key objectives of any organization, workers will put more effort in any new projects and changes that aim towards the objectives. The process starts from notifying workers about the change, managing fear of the unknown and a swift implementation so that results can show immediately and promote confidence among the workers. Work place change effects spread from where the organization to the clientele receiving products and services from the organization. For example, employment of new technology improves production, reduces work related stress but threatens the existence workers. The implementation requires appointment of qualified personnel to operate and support the new technology. The change may require the organization to get rid of the workers replaced by the new technology while reducing the chances of developing the careers of the existing workers. The effects of employing new technology will definitely be felt by the clientele receiving products and services from the organization and the organization will definitely record higher production leaving the workers in great fear of losing their jobs. This fear also affects the newly appointed workers because they are venturing into the unknown. An organization that is planning to implement such a change as a new project can manage to sustain the exis ting workers and hire new ones as an expansion strategy, allowing the existing staff overcome the fear of the unknown. This way, the expansion adds confident to workers and ensures them of sustained and better employment while increasing production. 1.6 Process of Implementing a Change A change can be implemented effectively, if a strategic process of implementation is employed. Upon reaching a decision to change, an organization needs to come up with a process which consists of planning what to change, communicating the plan to the workers and clientele, implementing the change and supporting the change. The planning stage of the change starts from the initial idea. The idea has to be in line with the organizations objectives. The idea is researched to find out whether it will bring benefits to the organization. This is done by checking the performance of similar changes in other organizations and by researching the benefits of such a change in the organization. The next stage involves communicating the information about the planned idea with the workers inside the organization and the clientele so that they can prepare for any irregular activities. This move is aimed at eliminating the workers fear of the unknown and maintaiing the clienteles confidence. During this stage, workers are allowed to participate in formulating the implementation plan, and that helps the workers absorb the idea and participate in implementation. When an organization inputs the workers ideas into the initial idea include their opinion in the change, the workers are more confident with that feeling of ownership into the change. This move is highly advised as it encourages the existing workers and clientele to give their opinion and stop fearing the unknown. Production continues as usual because all parties are prepared for change. The implementation stage involves the roll out of the plan. When implementing the change, workers experience numerous adjustments and production level may be affected. An organization has to involve its clientele in implementing the change because an irregularity can hurt the customers confidence. In this stage, all activities are well monitored and any development is recorded so that evaluation of the project is accurate. During implementation, workers may experience increase of responsibilities and commitment. The changes are welcomed by the workers only if they were involved in planning and their opinions are included in the final change. The supporting or managing stage comes after the change is implemented. The organization does a thorough evaluation of the implemented change to check whether it has reached the set goals. The workers will generally have mixed reactions to the change and it is extremely important to provide guidance and support to facilitate the change. This is done by giving timelines and expected outputs so that the organization can evaluate the success of the change. The organization need to provide training on the new requirements and regularly review the advancement of the change. The review of advancement of the change allows the organization to evaluate the change and maintain the workers and customers confidence. An organization that has successfully implemented a change has the responsibility of ensuring its sustainability. The organization needs to collect the views of the workers who are directly involved with the change. By keeping an open communication channel, an organization will receive more accurate feedback and respond swiftly. The process of implementation requires full participation of parties involved so that production is either maintained or increased and the workers are part and parcel of the change. Production is not the only consideration when evaluating success but also the workers welfare so that an organization can avoid work related stress, which reduces production greatly if not observed. By ensuring that workers in an organization are involved in implementation of a change, the organization is assured of full commitment by workers. The workers also feel more secure when communicating back to the implementation team about the outcome of the change. Methods of Eliminating Fear Fears that are accompanied by work place change are real and a threat to the sustainability of an organization. These fears should be addressed seriously to avoid the downfall of an organization. An organization that has planned to implement a change should therefore employ strategic fear elimination methods. When an organization ignores to address the possible effects of a change, it risks losing its workers and clients. Methods of eliminating the fear of the unknown are many but the most effective one is the inclusion of all the involved parties, in all stages of implementing a change. As discussed above, an organization that invites the workers to participate in planning and implementing a change normally eliminates this fear completely. The most effective method is, when an organization invites its workers to participate and convinces them that the change is a progress that is in line with the organizations set goals, rather than telling them its a change. This method is very effective because it increases the confidence of the workers and gives them a feeling of success. The move builds courage among workers and drives them to working harder with an aim to succeed again. Introduction of training about a planned change before its implemented is another effective method of eliminating fear. This training prepares the people involved with the knowledge of the exact change that will happen. Workers in an organization who undergo the training know exactly the challenges they may face and the commitment they would require in order to succeed. After the organization trains all workers about the new change, the workers are able to participate fully in the planning stage and the fear of the unknown wears out before the change is implemented. Work place change is inevitable in all organizations. The workers in an organization have an ability to eliminate fear if they decide to embrace the change and treat it as a progress that will drive the organization towards achieving their objectives. This method of eliminating fear if very effective but it is applicable to workers who understand the need of a change. The management team is the organ of an organization that is responsible for advising the workers about the benefits of a change. Workers who are engaged in development planning adapt easily because they understand the benefits of implementing changes in an organization. An organization that has plans for development and growth expects its workers to be ready for any changes. Workers in an organization who experience fear after a change are normally terrified of facing the change because they feel that they knowledge and skills might be shallow. Organizations that succeed in eliminating fear of change care more about the skills of individuals in the organization. When organizations treat all workers as professionals and respect their opinion, the workers continue to execute their duties with more confidence and also feel well appreciated for their contribution. Such organizations invest in the knowledge of their workers and increase effort in improving their skills. This method drives out fear and makes workers feel like they are part of the organization. Once an organization invests in improving the skills of the workers, the workers consequently pump in quality ideas that are used to propel the organization towards reaching their objectives. Trust between the workers and an organization is achievable when there is a direct communication channel between the two. Communication allows all organs of an organization relate to each other in a more open manner. An organization that has clear and open communication channel has the advantage of eliminating fear of change from the workers because they are well informed of the consequences of such a change in good time. The communication channels allow for swift response to feedback and enable the workers to overcome fear quickly. Open communication gives freedom of expression to all persons in an organization and enables the management team to communicate more freely with the working team and vice versa. 1.7 Controlling effects of Work Place Change Effects of work placer change can be positive or negative. An organization that minds its sustainability will always have strategic measures for controlling such effects. For example, an organization can decide to employ new technology and use of robotics in its activities. Such a change will cause a lot of fear to the workers because the technology might take their place. In business, new technology and use of robotics for production reduced the number of human resource required and increases production, thus causing fear to the people working in such a business. There are numerous methods of controlling such effects in an organization. If the effects are positive to either the organization or the working team, an organization needs to ensure that the effects will be sustainable so that they benefit from the positive effects. If the effects are negative to either the organization or the working team, the organization needs to have a contingency plan to eliminate anxiety among the workers and retain the sustainability of the organization. Workers in an organization are the largest organ that is supposed to drive an organization towards reaching their set goals. A good strategy that can be employed by an organization to control the effects of a change is by inviting contribution of ideas from the workers so that their solutions can be implemented, thus reducing anxiety. Since workers might hold back their ideas, they can easily control the effects of a change if they are given the responsibility of seeking solutions other than assigning the responsibility with the management team. A working environment that encourages open information sharing gives confidence to the workers and freedom to express their concerns. An organization that promotes interaction between the management team and the working team by sharing ideas in an open and honest manager creates an environment filled with trust. This trust allows the workers to feel safer and participate better in developing the organization thus increasing production. This way, an organization is able to control many effects of a work place change. Equal treatment of workers and recognition of their participation in growth of an organization is an excellent method of controlling their emotions. When an organization implements change, the effects of the change are better controlled if there is trust and confidence built in the workers. An organization that has open communication channels will listen to concerns of all workers and give honest feedback in good time. This working environment gives the workers the courage to face the effects of a change. Workers develop a self esteem that eliminates their fear of being singled out. 1.8 Management Role in Helping Staff Deal with Change The management team is the organ responsible for developing a working strategy and creating solutions to problems in an organization. The management works as a team. It includes managers of different departments who operate as leaders of the working team. Both the management team and the working team work coherently to ensure that the organization reaches its set goals. When a change is implemented, the effects of the change affect all organs of an organization. The management team comprises of highly skilled professionals who have the ability to drive the organization into meeting its objectives. This team has the ability to formulate contingency plans incase of any problem. It is the responsibility of the management to help other managers and workers deal with change. The management team responds to change by identifying its effects and then formulating a sustainable solution. Members of the management team may be affected by change and so, the team starts by helping the affected managers. Managers who are affected by change require support from the other team members and assurance that the change is controllable. This is only possible if they are given a chance to speak their mind and if their opinions are taken into account when formulating solutions. This method eliminates all fears that the managers. Another method of helping staff deal with change is by informing them about the good side of an implemented change. The information provided to the workers should include assurances of job growth so that workers morale can increase. Employment of new technology in an organization should be coupled with improvement of workers skills through education regarding the introduced technology. The management should empower the existing workers more effectively by investing in improving their knowledge and skills. Skill improvement training should be conducted before new technology is implemented so that the change will be embraced by the workers. Workers who fear that their skills might be inadequate are worse affected by a change, and the management has the ability to buuild their confidence by improving their skills. Since such workers have worked with the organization, their production is higher than any new workers. The management in an organization can create a work place culture that anticipates change whenever its implemented or whenever it happens. Since not all changes are planned, the management can include all the workers in creation of a work place culture that prepares all workers to retain their confidence in case of a change. Organizations plan their activities according to the goals they want to reach. A good plan should be recorder according to order of priority, and communicated openly to the workers. Such a plan will always include changes and new projects to be implemented in the future. If such a list of current and future plans is communicated with the rest of the staff, the management and workers find ample time to research about the possible advantages and disadvantages of proposed changes and projects. The workers will then have the chance to give feedback regarding their findings, and their opinions will be included in the final planning before the proposed changes are impl emented. In work places, the management can develop a culture that can help workers deal with change. The culture includes guides to workers attitudes, working ethics, behaviors and other systems that are necessary in the functioning of an organization. A work place culture that is developed to help workers deal with change means that change will be highly anticipated and production of an organization will increase. A work place culture is developed with consideration to the workers past responses and possible occurrence of change within a given time. Such a culture provides for awareness and preparedness to workers towards embracing growth and development in an organization. Organizations aim development and growth. These two factors initiate a changing environment from time to time. Growth consequently invites new appointments and employment of new ideas, turning the environment into an ever changing setting. In such a changing environment, a work place culture that embraces change helps wo rkers deal with change more effectively. Culture which helps workers deal with changing environment can only be designed by combining solutions of past experiences and inclusion of workers opinions while training workers about the importance of embracing change rather than rejecting it. As discussed above, open communication about proposed changes should be included such a work place culture, to allow for new appointees adapt swiftly to the operations of an organization. Organizations with a specific working place culture help new entrants adapt to the new environment easily. A working culture that emphasize on importance of embracing change creates room for courage among the workers and they sequentially work harder in a changing environment to propel an organization towards success. A wining work culture makes workers have confidence with what they have to offer in an organization. The culture should be supportive, friendly, open, relaxing and inclusive. Management in an organization should encourage enthusiasm. Workers who are passionate and have the will to succeed produce better. A work place culture that includes fun helps kills boredom and encourages sharing of ideas. A healthy working culture guides workers on methods to follow when they are face with effects of a change. An organization that faces change effectively succeeds because it has developed an inclusive culture that ensures equal treatment of workers. Work place culture can also be the work place change. An organization that restructures tries to eliminate past mistakes in an effort to succeed. This move results to changes in the management team and most often, new appointments into the management team. Such appointments accompany new leaders and new ideas. Most managers who have been appointed into a new organization start by changing the work place culture to suite their ideal idea. A change in work place culture receives resistance from the existing workers because they are accustomed to it. The management whether existing or new, has to include the views of all persons in an organization before changing culture of a particular workplace. Such inclusion helps workers deal with any new change without affecting production because their views are considered during the change. 1.8 Culture of Negativity in a Work Place In all organizations, workers have different production rates. Negativity has been observed in many organizations and if not well addressed, the negativity influence embeds itself into the existing work culture. Workers who produce more and are very active might face ridicule from fellow workmates who are less active, and, in an effort to escape the ridicule, production decreases. A culture of negativity develops where communication channels are not open and the management team doesnt realize that production has been affected. This culture mostly affects production and the morale of hardworking employees. Negativity culture in a work place is controllable and can be eliminated in many ways. The management can eliminate this behavior by recognizing individual efforts and giving incentives in an effort to increase workers motivation, while discouraging negativity. 2.0 Safety Management Systems in the Canadian Aviation Industry 2.1 Safety Management Culture Change in Canadian Aviation Industry The Canadian Aviation Industry is seriously regulated and it has created a new safety culture in the aviation industry. The safety management system has been enforced in the industry and it manages and health and occupational safety in the work place. This change of culture has been developed to prevent any work related accidents and its implementation was a success. The aviation industry has since struggled to fully implement a culture of safety management in the industry with an aim of succeeding in maintaining safety in workplaces. Implementation of a safety management culture in all organs of the aviation industry in Canada has been emphasized greatly and all parties are well informed of the importance of developing such a culture. The introduction of the safety management system was encouraged and organizations in the industries responded by implementing the laid down procedures. The safety management System is responsible for identifying possible hazards and taking charge of controlling the risks involved. 2.2 Safety Management Culture A safety culture is a way in which the people in a workplace act in relation to attitudes, perceptions, beliefs, and values shared in regard to safety awareness. The Canadian aviation industry safety culture was created to encourage total safety awareness and it has so far been a success. The culture encourages management of safety using well tested methods and organizations understand that there are reduced work related risks and increased production upon implementation. Developing this culture involves embedding the safety management system into the operations of an organization and making it part of the organizations culture. Workers who perform their duties while observing a strict safety culture are assured of occupational safety and feel the urge to spread the culture to their workmates. Introduction of a safety management system is a change that can interrupt normal operations during implementation. This change has more advantages to the organization, workers and their clientele and so, the change is worth implementing. Upon implementation, existing workers are liable to extra responsibilities of observing safety while performing their other allocated duties. The implementation of a new safety system slightly lowers production during at first although workers get used to such a change quickly and get back to normal production. This is because the extra responsibility of ensuring that safety is observed require some extra attention that eats into production time. In the Canadian aviation industry, workers have the moral responsibility of ensuring their activities and the work places are safeguarded. When implementing the safety systems in Canada, there are governing requirements found in every jurisdiction on how safety is achievable and complementary researched data that clearly displays the effectiveness of a successful safety management system. The data that is provided to show effectiveness of implementing a safety management system clearly shows evidence of reduced occupational risk in organizations that have already implemented the system. The safety management system clearly reduces costs associated with accidents and incidents in organizations. The safety management systems that are implemented by players in the Canadian aviation industry address the importance of implementing the change and pushes for implementation with an aim of reducing work place risk. The system has clear instructions on how to manage risk, how to identify possible risks and implement appropriate controls, how to ensure open communication across all organs of an organization, the process of how to rectify non- conformities and how to apply a continual enhancement process. The systems design is user friendly and has so far improved occupational safety thus ensuring safety of the workers. The Canadian aviation industry has scheduled to fully implement the change in the whole industry and focus on enhancing for more safety by the year 2015. According to the Canadian Transport Authority, the safety system is effective if the workers and their management commit to overseeing safety in work places. The implementation of safety management system in work places is tested and has no negative effects on workers or organization although its execution interferes with production slightly during the early stages. 2.3 Safety Management as a Work Place Change In the world, there are many organizations that have evaluated and realized the benefits associated with implementing a safety management system. This is a change that that has beneficial effects to the organization and the workers. Regulatory authorities in charge of these organizations have over time developed safety management systems that are specific to their activities. Safety management systems are developed to benefit the organization as a whole and increase workers confidence while increasing production. Safety management systems reassure workers of their safety and encourage their participation in implementation. An organization that plans to implement a safety management system has the responsibility of introducing the idea to the workers and training them on how the system benefits the organization. The introduction eliminates any fear and the training offered prepares the workers with the necessary knowledge about the proposed change. Work places that are safer are also comfortable. When occupational hazards are minimized, an organization records reduced misfortune costs and production increases because the workers are assured of safety. 2.4 Conclusion Work places experience changes when they are developing and when external factors interfere with activities of the organization. These changes affect the organization in different ways and they can be beneficial of non- beneficial. The obvious effect of a change affects the workers in an organization. Workers develop fear of the unknown and initiate resistance against the change if an organization implements it without prior communication. In an effort to eliminate fear, organizations inform worker of their proposed changes and invite their participation so that they embrace the change as a progress towards success. When workers are involved in planning of a change, they embrace the change when its implemented the fear of the unknown fades out. Buy custom Work Place Change essay