Central Giant Cell Granuloma in Eight Year Old Patient

Central Giant Cell Granuloma in Eight Year Old Patient INTRODUCTION Central giant cell granuloma (CGCG) is a benign aggressive destructive osteolytic lesion of osteoclastic origin1 that ocur in the mandible and maxilla and accounts for approximately 7% of all benign tumours of jaws2. The world health organization (WHO) has defined CGCG as an intraosseous non-neoplastic lesion, consisting of cellular fibrous tissues that contain multiple haemorrhage multinucleated giant cells, and, occasionally trabeculae of woven bone3. The nature of CGCG is still controversial. Jaffe was hypothesized that this is a reactive and self curing lesion and included the terminology giant cell reperative granuloma. Later, the neoplastic hypothesis was raised to explain the aggressive subtype4. Recently, both reperative and neoplastic assumptions are true, so that CGCG lesions are patially reactive and partially neoplastic4. CGCG is an uncommon lesion that occurs in young adults before the age of 30 years with a female preponderance5. There was a peak incidence for males between the age of 10-14 years and for females between 15-19 years of age6. It is more common in the anterior mandible than in the maxilla. Histological characteristics are highly cellular, fibroblastic stroma with plump, spindle- shaped cells with a high mitotic rate; the vascular density is high. The multinucleated giant cells are prominent throughout the fibroblastic stroma but are not necessarily abundant. They are often located most numerously around of haemorrahge6. Clinically, CGCG shows a wide variety behavior that is ranging from a non-aggressive, asymptomatic (indolent) and slow growing lesions to an aggressive, large, expansive lesion with rapid growth and aggressive sign and symptoms. Choung et al.7were the first described between the differences aggressive and non- aggressive lesions based on signs and symptoms and histological features. Aggressive lesions are characterized by one or more of the following features: pain, paresthesia, root resorption, rapid growth, cortical perforation, and a high recurrence rate after surgical curretage. Radiogically, the lesion appears as a radiolucent area and it can be unilocular or multilocular with either well-defined or can be ill-defined margins8. Multiple lesions are rare and are often associated with a syndrome (i.e. Noonansyndorme, neurofibromatosistype I ) or with cherubism6. The radiological and histological apperances of CGCG are not pathognomatic, and therefore further examination such as blood tests, including calcitonin, phosphate, parathyroid hormone and alkaline phosphate levels must be performed to confirm the diagnosis and to exclude hyperparathyroidism8. One of the treatment choice for CGCG is curratege with or without adjuvant therapy, i.e. liquid nitrogen, cryosurgery, peripheral ostectomy and Carnoy’s solution and another treatment modality is aggressive en- bloc resection, resulting in varying degrees of deformity5. It results in serious mutilation of the jaw and face. Loss of teeth and of dental germs in young patients is also often unavoidable9. In growing patients, to preserve both aesthetic and functional necessity non-surgical methods such as intralesional injections with corticosteroids, IFN-ÃŽ ± 2a and systemic dose of calcitonin are increasingly used by clinicans. These alternative therapeutic strategies come in useful for large aggressive lesions to cure or reduce the size and thus minimize the need for extensive surgical resection that can result in functional and aesthetic deficits in young patients. Calcitonin therapy for CGCG was first announced by Harris in 1993 and since then several case reports have been published of successful treatment of this lesion using different types of calcitonin and different strategies of administration5. In this report a patient is presented with massive aggressive CGCG who were treated with salmon calcitonin, as a single treatment modality, after initial treatment with intralesional steroid had failed. CASE REPORT An 8- year- old male patient complaining of a tender/ non-tender swelling on the left mandibular molar area was referred to the oral and maxillofacial surgery service at the Selcuk University, Faculty of Dentistry, in 2010. There was neither medical history nor trauma. Physical examination †¦Ã¢â‚¬ ¦.cm, lymphadenopathy, Radiographically, in the left mandibular molar area a diffuse radiolucency†¦Ã¢â‚¬ ¦ Based on clinical and radiological findings pre-diagnosis of CGCG was made and laboratory investigations were required to eliminate hyperparathyroidism (brown tumors) before treatment. Parathyroid hormone levels were found in normal reference ranges. Additionally low level of haemoglobin and high level of creatinin and phosphate were examined. An incisional biopsy was performed under local anesthesia. Histologically diagnosis of the lesion was proved as CGCG. Because of the patient’s age and dental development conservative therapy was preferred. Intralesional steroid injections of a solution of Kenacort-A (10 mg/ml triamcinolone aqueous suspension, Bristol-Myers Squibb S.p.A, Loc.ta Fontana del Ceraso, Angani, Italy) were performed during 1 year but there was no resolution in the lesion. After initial steroid treatment was failed authors decided using intranasal (systemic) calcitonin treatment. Miacalcic ® 200 IU/day nasal spray (Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA) (calcitonin-salmon) was preferred and performed 2 yearlong. Luckily any side effect was seen and the patient was showed exceptionally good cooperation to treatment and. During systemic calcitonin therapy clinicians must be on the alert about some side effect such as bloating or swelling of the face, arms, hands, lower legs, or feet, chills, cough, difficulty with breathing, difficulty with swallowing, dizziness, fever, itching, joint pain, muscle aches and pains, nausea or vomiting, nervousness, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue, skin rash, sweating, tightness in the chest, tingling of the hands or feet, trembling or shaking of the legs, arms, hands or feet, trouble sleeping, unusual weight gain or loss. Following calcitonin therapy there was a decrease in tumor size that was observed clinically. Preserving the teeth and growing jaw bone for natural mastication and facial aesthetic the tumor was not decided to operate. The patient has a three- year follow up and has any clinical or radiological sign or symptoms. DISCUSSION CGCG is an uncommon lesion that occurs more frequently in females. In most cases it appears before the age of 30 years. Mandibular lesion is more often than the maxillary lesion with a ratio 2:1. In the mandible the anterior and posterior regions are equally affected while in the maxilla, the anterior region is usually affected.(ant. Mu post. Mu) The clinical behavior of CGCG ranges from a slow growing asymptomatic swelling to an aggressive lesion that presents pain, local bone destruction, root resorption or tooth displacement. Some authors have classified CGCG into two types, based on clinical and radiographic features. The first is non-aggressive CGCG, which is characterized by slow, almost asymptomatic growth that does not perforate the cortical bone or induce root resorption and has a low tendency to recur. The second is aggressive CGCG, which is characterized by pain, rapid growth, expansion, and perforation of the cortical bone, radicular resorption and high tendency to recur. Histologically, CGCG is characterized by the presence of multinucleated giant cells (MGC) in background composed of mononucleated stromal cells (MSC) with ovoid or spindle-shaped mesenchymal nuclei. The giant cells are typically seen in a hemorrhagic field containing numerous poorly defined vascular channels, which may be quite prominent. A patchy distribution of cellular elements is one feature that helps differentiate CGCG fromtrue giant cell tumors. In aggressive lesions, Ficarra et al. reported more numerous giant cells in CGCG and Nougeria et al. showed that in aggressive lesions MGCs are usually more numerous, larger and uniformly scattered throughout the lesion. Flanagan et al. were the first to demonstrate that giant cells in CGCGs are osteoclasts through osteoclast- specific monoclonal antibodies staining. This report was provide in vitro reaction of giant cells to calcitonin and showed the behavior of giant cells in cortical bone excavation typical of osteoclasts. It has been demonstrated that giant cells express calcitonin receptors. Calcitonin therapy is based on these findings. It is though those giant cells are directly inhibited in their function by calcitonin. Others, however, debate that CGCGs develop from mononuclear precursor cells and, as such, are part of the granulocyte/macrophage lineage or are primarily of fibrotic origin. Although giant cells are the most prominent histopathological feature of CGCGs, the focus of interest has shifted to the role of the mononuclear cells. Recent studies have shown that mononuclear cells, rather than the giant cells are proliferating compartment responsible for the biological activity of the lesion. de Lange et al. reported that the giant cells of CGCG are derived from subset of mononuclear phagocytes. These mononuclear precursor cells differentiate into mature giant- cells under the influence of RANKL expressing, proliferating, spindle shaped (osteoblastlike) stromal cells. Nougeria et al. designed a study to determine receptors of MGCs and find out their origin. This study showed, positive immunohistochemical expression of receptor activator of nuclear factor –kB (RANK), tartrate- resistant acid phosphatase (TRAP), vitronectin receptor (VNR) and calcitonin receptor and these findings have suggested on osteoclastic phenotype for MGCs. The presence of CD68 glycoprotein and alpha-1-antichymotrypsin has suggested that MGCs have a macrophage/hystiocyte origin. In the light of these findings aim of the treatment of CGCGs should include both inhibit osteoclastic activity of the lesion and inhibit the differentiation of macrophage/ hystiocyte precursors into osteoblast like cells. Traditional treatment for CGCGs is surgical curettage. Some authors proposed excision via curettage for treatment of CGCGs and the overall recurrence rate has been reported to range from 16 % to 49 %. A higher incidence of recurrence was found in aggressive CGCG and younger patients, especially males. In growing patients, aggressive surgical approaches may result in facial deformities and patients may lose some of tooth germs. Eisenbud et al. indicate that surgical curettage with peripheral osteotomy is still not the safest treatment for CGCGs especially in aggressive lesions. The functional and aesthetic alterations as well as the psychological consequences caused by the surgical treatment of CGCG have encouraged researchers to look for effective alternative therapeutic strategies. Alternative therapeutic options for CGCGs are systemic calcitonin intralesional injection of corticosteroids and IFN-ÃŽ ±. Calcitonin has been administered as a nosespray and as subcutaneous daily injections. Recently only nosespray form is available. This hormone increases the influx of calcium into the bones, functions as an antagonist to parathyroid hormone, and inhibits osteoclastic bone resorption. Calcitonin has also been hypothesized to directly inhibit giant cells. In 1993 Harris was first reported total remission of CGCGs in 4 patients. On the contrary Kaban et al (1999) observed a significant growth following calcitonin therapy. Response of patients to calcitonin therapy is variable. Many factors can contribute to the various responses to calcitonin which have been reported in the literature. The different types of calcitonin (human, salmon) and the different types of administration (subcutaneous injections, nasal spray) are some of these factors. With regard to the efficacy of calcitonin therapy, 3 phenomena have been recognized: Primary resistance or primary non-response is noted. There is the so-called plateau phenomenon, denoting that the alkaline phosphates serum levels cannot be lowered beyond a certain point, irrespective of the calcitonin dose. The third potential problem is secondary resistance, also called the escape phenomenon. Patients who initially react well to calcitonin show a diminished reaction after some time. Increased activity of osteoclasts through loss of calcitonin receptors is the more likely explanation for this phenomenon. Intralesional corticosteroids injection for CGCGs treatment was first reported by Jacoway et al. (1988). This method hypothesized that the extracellular production of bone- resorption- mediating lysosomal proteases by giant cells in inhibited by steroids which also induce apoptosis of the osteoclast- like cells. In English literature, complete remission results from intralesional administration of corticosteroids in insufficient and the number of patients is very small. Especially, in large cases intralesional corticosteroid therapy may not be effective and may not provide of reduction in size. No reports in which the effectiveness of intralesional corticosteroid injection for CGCG is described separately for the aggressive type and non- aggressive type are available. Nougeria et al. indicated that MGCs may be similar to osteoclasts and macrophages/hystiocytes and that CGCG can be prompted to respond to calcitonin or intralesional glucocorticoid as shown in the literature. They reported the expression of glucocorticoid and calcitonin receptors in CGCG before and after treatment with intralesional injection of steroids. They concluded that glucocorticoid receptor expression in the MGCs was higher in patients with a good response. The difference in calcitonin reseptor expression was not statistically significant between the aggressive and non- aggressive lesions and between the patients with a good response and with a modatare/negative response to treatment. Although aggressive CGCG had higher calcitonin receptor expression no significant difference in calcitonin receptor expression in different clinical forms of CGCG was found in this study. The treatment response was determined using previously described scores. In which four criteria were conside red: stabilization or regression of the lesion size evaluated clinically and in follow-up radiographs; the absence of sumptoms; increased radio-opacity in radiographs, representing peripheral and/or central calcification of the lesion, increased difficulty in solution infiltrating the lesion during the sequence of applications. If a case provided all of these, the response was determined to be good; providing two or three criteria was determined to be moderate; and providing one criteria or no criteria implied a negative response to treatment. Another alternative therapeutic agent is IFN-ÃŽ ±, it has angiogenic potential and it is a mediator in differentiation from mesenchymall cells to osteoblasts thus leading to an increase in bone apposition. Similar to corticosteroids IFN-ÃŽ ± is also capable of stopping rapid growth of their lesions and reducing their size, but it still necessary to use additional surgery to eliminate the lesion. In the literature only one case report was showed complete remission with IFN-ÃŽ ± therapy. Several reports suggest that IFN-ÃŽ ± administered as a monotherapy for aggressive CGCGs is useful for inhibiting the rapid growth of lesions and for reducing their size. Total remission of lesion cannot be achieved, because IFN-ÃŽ ± has no direct inhibiting effect on proliferating tumor cells and additional surgery is probably still required to eliminate lesions. Therefore, the effectiveness of monotherapy with IFN-ÃŽ ± is still questionable. CGCG is found predominantly in young adults. Surgical treatment of these patients might have resulted in physical and psychological disorders, such as developmental disorder of the mandible, dysfunction of mastication, and facial deformities, non- surgical treatment with systemic calcitonin administration which is a minimally invasive procedure and less costly and should be considered the first choice for treatment of CGCG in young patients.

CIPD Ass Member Criteria Essay

What it means to be an Associate Member of CIPD The Associate Member applies their specialist skills and knowledge in the context of the organisation’s structure, culture and direction, by: providing support for human resources (HR) leaders and managers as they work to deliver a range of HR processes in one or more professional areas delivering some HR functions, such as administrative, information and processing activities. Whatever the nature or size of the organisation, the Associate Member gives vital support in one or more of the key component areas of human resources. So they may work within the central HR team, or in learning and development, or another of the professional areas within the HR remit. They may be someone setting out on an HR career, aiming for progression to Chartered Membership as they develop their skills, knowledge and experience. Or they could be someone who wishes to continue supporting fellow professionals without moving to Chartered Membership, but would like formal recognition for their existing role and contribution. Whichever it is, the Associate Member completes tasks and addresses problems that are well-defined but still have a degree of complexity. Operating within clearly defined limits they exercise some autonomy and judgement, taking and implementing appropriate decisions. The basis for their discretion is their knowledge and understanding of the organisation, and the established range of HR policies, processes, procedures and practices that they help deliver. Associate Membership signifies that this is someone who has been assessed against clear professional criteria – someone who demonstrates that they have the skill, knowledge and approach to make a significant supporting contribution, and deliver excellent results. It also confirms that they have signed up to the CIPD CPD Policy and Code of Professional Conduct, and work to its standards and criteria. Meeting the criteria To achieve Associate Membership the individual has to show that they have delivered against the criteria in a work environment. There are three elements in the criteria. 1. Activities – what the Associate Member does 2. Knowledge – what the Associate Member understands in order to carry out he activities 3. Behaviours – how the Associate Member carries out the activities. Activities: what the Associate Member does The Associate Member uses their specialist HR skills and knowledge to support HR leaders and managers, delivering information and services as and when required: consistently, on time and to standard. To do this the Associate Member: Maintains and produces management information collects and collates financial and non-financial data and statistics on the HR activities and processes within their work role converts raw data into meaningful HR and management information, and passes it on to managers and HR specialists, to inform plans, decisions, budgets produces clear and meaningful reports and updates, regularly and/or on request maintains HR record systems and individual records, with full, accurate and appropriate information and in line with data protection laws and regulations. Supports HR colleagues and line managers provides line managers/others with accurate and timely information/advice on HR policies, procedures and practices, in line with the organisation values and relevant regulations helps ensure that all HR processes provide equal opportunity, promote diversity, are based on merit and are applied equitably, fairly, reasonably and without bias manages the administration of continuing or one-off HR programmes, workshops, or meetings, and helps in their delivery. Supports improvement in processes and policieslooks for continuous improvement opportunities in HR processes, and feeds messages, ideas and observations to senior HR colleagues or managers supports change initiatives and programme implementation, maintaining service during the process and at the same time testing new approaches helps staff and managers outside HR to understand the need for and benefit of change, their role in the process, the next steps and the expected results. Maintains th eir Continuing Professional Development (CPD) enhances their professional skills, knowledge and behaviours through reflective and planned CPD. Knowledge: what the Associate Member understands To carry out the Activities the Associate Member has to know about and understand three contexts: 1. the organisation they work in or with 2. their specific work role (such as: generalist or specialist role) 3. the wider HR context. 1 The organisation and its context, including: the organisation’s structure, culture and operations its goals, targets and financial structure its HR policies, procedures, programmes, processes and practices its range of products and services and who its customers are how its teams work together to optimise performance. 2 The specific work role and the HR area(s) that are the focus for it, including: the relevant and appropriate legal and regulatory framework, and the external bodies and agencies that legislate and/or give advice and support how to contribute to the effective implementation of the organisation’s HR processes, procedures, practices, tools, techniques and approaches. 3 The wider HR context, including: how the different HR activities form an integrated whole, and the way that an action in their own professional area can affect other areas and impact on colleagues how to:plan and prioritise activities and their own work effectively, efficiently, on time and within budget -communicate effectively with employees at all levels -deliver service excellence, handle and resolve complaints and deal with difficult customers -use IT effectively and efficiently (specifically HR information systems). Behaviours: how the Associate Member carries out activities In delivering the Activities the Associate Member has to demonstrate how they meet the Behaviour criteria, organised in three clusters: Insights and influence, Operational excellence, Stewardship. Insights and influences 1. Curious keeps up to date with developments, ideas and trends in HR, the organisation and its sector. Uses information to inform personal CPD plans accepts and acts on feedback on their performance, taking action to broaden their experience, knowledge and skills uses information to inform personal CPD plans. 2. Decisive thinker uses knowledge and judgement to identify options and make day to day decisions makes sure information is accurate, consistent and relevant, before using it to carry out a task or make a decision. 3. Skilled influencerworks with other people to help gain commitment and support for changes or policies, using the appropriate communication channel or method puts forward logical and evidenced suggestions. Operational excellence 4. Driven to deliver identifies the steps needed to achieve agreed objectives, focusing on priorities keeps track of progress, to deliver on time and meet or exceed expectations. 5. Collaborative builds and maintains a network of useful contacts and relationships to support colleagues shows sensitivity and respect for other people’s feelings, cultures and beliefs. 6. Personally credible provides sound, realistic and impartial adviceconsistently delivers their promises and commitments and accepts responsibility for their actions, even when facing opposition. Stewardship 7. Courage to challenge shows courage to speak up, asks questions or for information, help or advice from other people when faced with unfamiliar issues or circumstances. 8. Role model demonstrates sound personal values and ethics, and operates within the organisation’s values, processes and expected behaviour supports colleagues in times of high workload or pressure deals with confidential and sensitive HR matters and data in line with professional good practice and the legal requirements.

Mod2 Week 1 Hand in Assignment Review of Oviatt and...

MOD2 WEEK 1 HAND IN ASSIGNMENT REVIEW OF OVIATT AND McDOUGALS Toward a Theory of International New Ventures Oviatt and Mcdougall in their paper, Toward a Theory of International New Ventures, tried to identify and define International New Ventures in the context of the global marketplace. Their work gained global acclaim in its bid to pose questions about the validity of existing theory on internalization. A decade later, Zahra’s work titled â€Å"A theory of international new ventures: A decade of research† attempts to build on prominent aspects of the work of Oviatt and McDougall with the hope of highlighting their important contributions to the field of international new ventures. I will attempt to highlight the areas where Zahra’s work†¦show more content†¦FACTORS GIVING COMPETITIVE ADVANTAGE Age, entrepreneurial activities and actions undertaken by INVs have all been mooted by various authors to bring about competitive advantage. However, according to Zahra, what matters is how these firms compete when they enter the market. Furthermore, companies who choose to see things differently are able to create superior value from their business in relation to their competitors. Basically, these INVs identify hidden opportunities in the international markets and they usually tap new potentials identified with new methods. Again, significant value can be tapped from within an organization if the founders are able look inwards and innovate. This might be in the form of a new product totally different from those in the market or by changing the internal processes that creates old products thereby making them more efficient. In this case, the organizational form might be the factor conferring competitive advantage. According to Zahra, Oviatt and McDougall overlooked a critical aspect that confers competitive advantage. He posits that the institutional environment and economic geography can not only build, but can sustain competitive advantage for an INV. He identified the subtleties such as culture, history and geography which can have a profound effect when you are dealing with opportunities in a new country or territory. They also go a

Analytical Paper Explicating Emily Brontes Wuthering...

Analytical paper explicating the novel-Wuthering Heights by Emily Bronte Introduction Emily Bronte really does do good job bringing in love, passion, longing, and death and also the afterlife, which has a way of linking them all rolled up into one, and creates the excellent novel that we all refer to in this current time as Wuthering Heights. Even though Catherine and Heathcliffs desire for each other did appear to be the attraction of Wuthering Heights, provided that it is greater and more lasting than any other sentiment that had really put on display throughout the entire novel, Bronte also does a great job with showing the provocative theme of demise and the afterlife in her novel, conferring to the disapproval of Robert M. Polhemus. Polhemus composes a criticism that goes all the way back to the early 1990s era and it was titled, Love and Death in Wuthering Heights, and in this he makes a huge discussion of death, love, and the afterlife, and then clarifies how all three are connected. It appears to be very clear that Polhemus give a mention in his w ork, †¦it is a text that is very much decisive of all the mystical sensual profession, forcing and raising a lot of the serious matters that twirl about love that is thought to be very romantic in the post-Renaissance time. I agree with his statement, given that in my opinion, it is tremendously accurate. Brontes novel shows the central subject of love and its influence on ones movements, in adding to its

Is Underage Drinking Not Only Effect Their Live - 1650 Words

Actually underage drinking not only effect their live, but also affect teenager’s health. Research has shown that about 40% of teens drinking of 14-19 degree is achieved the level of short-term risk of harm. So what harm does alcohol do to your body? First of all, alcohol can poison the liver, cause the liver function damage. Excessive drinking consumption increased the burden on the liver. Mainly depends on the oxidative decomposition, damaged liver cell degeneration. Eventually lead to cirrhosis, medicine called â€Å"Alcoholic Liver Disease† (ALD). According to the senior scientist Robert Mann, Ph.D. â€Å"Cirrhosis of the liver is the most serious form of ALD and a cause of many deaths and serious illnesses. In cirrhosis, scar tissue replaces normal liver tissue, disrupting blood flow through the liver and preventing it from working properly. Clinical signs of cirrhosis include redness of the palms caused by capillary dilation (palmar erythema); shortening of musc les in the fingers (contractures) caused by toxic effects or fibrous changes; white nails; thickening and widening of the fingers and nails (clubbing); liver enlargement or inflammation; and abnormal accumulation of fat in normal liver cells (fatty infiltration)†. Those are describing about cirrhosis. Except affects alcohol for the liver, Alcohol also can effect Brain, Heart, pressure and Cancer etc. For the brain, there are two important areas of the brain that are effect by alcohol. These are the prefrontal areaShow MoreRelatedUnderage Drinking And The Central Nervous System1446 Words   |  6 PagesThere are so many people who have drank underage. Norah Piehl quotes, â€Å"According to a 1991 University of Michigan study 81% of students had had at least one alcoholic drink in their lives (13 Piehl).† Wow, that is scary. 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Primary Healthcare Services Rural Seniors Health And Social Care Essay Free Essays

string(41) " into the alone demands of rural Canada\." One of the most dramatic demographic tendencies in the universe today is the ripening of the population: an addition in the proportion of senior citizens relative to the young person and working age population. The grounds for this tendency are frequently complex. Some of the grounds could be the enormous impact of the babe boomer coevals, additions in life anticipation, alterations in birthrate forms and for many geographical locations, emigration of the younger members of society. We will write a custom essay sample on Primary Healthcare Services Rural Seniors Health And Social Care Essay or any similar topic only for you Order Now This population alteration is apparent in rural Canada where there is a higher ratio of seniors to youth. With this alteration in composing of the rural population, the demands for services are increasing ; in peculiar, primary wellness attention services are particularly of import for senior citizens in rural countries. This includes more focal point on bar and intervention of common diseases and hurts, basic exigency services and wellness publicity. In this essay, I will be analysing Canada ‘s aging population, primary wellness attention services, enterprises taken by LHIN ‘s in Ontario to undertake the issue and besides European schemes. Canada ‘s Aging Population Canada faces important ripening of its population as the proportion of seniors increases more quickly than all other age groups. Seniors can be defined as those above the age of 65. In 2001, one in eight Canadians were aged 65 old ages or over. By 2026, one Canadian in five will hold reached age 65 ( Natural Resources Canada, 2009 ) . The challenges of an aging Canadian society will necessitate: continued attempts to better wellness, wellbeing and independency in ulterior life ; ease the engagement of older Canadians in economic and societal life ; strengthen the supportive environments within communities ; and, prolong authorities plans profiting Canadians of all ages ( Natural Resources Canada, 2009 ) . Canada ‘s seniors are a diverse population. Issues related to their overall wellness and wellbeing may change depending on their topographic point of abode ( urban, rural, or northern countries ) , their gender, and their ethno-cultural background every bit good as if they are among Canada ‘s Aboriginal people. Primary Health Care Services Primary wellness attention refers to an attack to wellness and a spectrum of services beyond the traditional wellness attention system. It includes all services that play a portion in wellness, such as income, lodging, instruction, and environment. Primary attention is the component within primary wellness attention that focuses on wellness attention services, including wellness publicity, unwellness and hurt bar, and the diagnosing and intervention of unwellness and hurt ( Health Canada, 2006 ) . Primary Health Care is besides relevant to secondary and third attention. The Primary Health Care attack focuses on advancing wellness and forestalling unwellness. The Primary Health Care attack means being attentive to and turn toing the many factors in the societal, economic and physical environments that affect heath – from diet, income and schooling, to relationships, lodging, workplaces, civilization and environmental quality ( Health Canada, 2006 ) . In add-on, the Primary Heal th Care attack topographic points citizens and patients on the same degree with wellness professionals when it comes to doing determinations about wellness issues that concern them. The five rules normally associated with the Primary Health Care attack are handiness, public engagement, wellness publicity, appropriate engineering and inter-sectoral cooperation ( Health Canada, 2006 ) . Accessibility refers to a go oning and organized supply of indispensable wellness services available to all people with no unreasonable geographic or fiscal barriers. Public engagement means persons and communities have the right and duty to be active spouses in doing determinations about their wellness attention and the wellness of their communities. Health Promotion is the procedure of enabling people to increase control over and to better their wellness. Appropriate engineering includes methods of attention, service bringing, processs and equipment that are socially acceptable and low-cost. Inter se ctoral cooperation is the committedness from all sectors ( authorities, community and wellness ) is indispensable for meaningful action on wellness determiners ( Canadian Nurses Association, 2005 ) . Health Care in Rural Canada The challenge of supplying good quality wellness attention close to place in a state as huge and sparsely populated as Canada is non new. In malice of major scientific promotions and a wellness attention system that is rated amongst the top in the universe, the challenge remains. A figure of factors play a function in the handiness of, and entree to, good quality attention for rural occupants. Distribution of Doctors The uneven rural-urban distribution of doctors has been at the Centre of treatment for a figure of old ages. Less than 10 % of all doctors are known to be practising in rural Canada where about 20 % of the Canadian population resides ( Government of Canada, 2002 ) . When the information is broken down between household doctors general practicians and specializers, it is clear that specializers are even more under-represented in rural parts. Rural parts encounter troubles in recruiting and retaining doctors. Many factors play a function in a doctor ‘s determination to come in rural pattern, including both personal and professional dimensions. Physicians most interested in working in rural countries frequently come from rural backgrounds and are committed to working in this environment. Physicians ‘ determinations to go forth rural pattern are normally influenced by non-monetary factors, such as a deficit of professional back-up, long hours of work, limited chances for farther medical preparation, deficient occupation chances for spouses, and concerns over kids ‘s educational chances ( Government of Canada, 2002 ) . Levels of satisfaction with rural work appear to lift with propinquity to big urban centres. Several inducements are being implemented to promote and retain doctors in rural parts by most states and new schemes are ever being discussed. Another suggestion for covering with the deficit of rural doctors is to do rural wellness a more of import portion of the course of study in medical schools across Canada. The Canadian Medical Association has put forth recommendations that the instruction of doctors for rural pattern deserves particular attending to guarantee adequateness and rightness of larning experiences to run into the alone demands of rural Canada. You read "Primary Healthcare Services Rural Seniors Health And Social Care Essay" in category "Essay examples" Medical specializers are besides under-represented in rural countries with, harmonizing to the Canadian Medical Association, merely 5 % of the entire figure of Canadian specializers practising in rural countries. In Ontario, merely 4 % of specializers pattern in rural communities ( Government of Canada, 2002 ) . This state of affairs is expected to go worse in the following 20 old ages, when two-thirds of retiring doctors will be specializers and one-third household physicians/general practicians. This deficit of specializers will doubtless hold an impact on the rural community. It is of import to observe that there are grounds that one can reason with to apologize the uneven distribution of doctors. With Canada ‘s rural population being sparsely distributed in little Numberss, it is non executable to hold many doctors in rural and distant countries where the population is merely a few hundred. Having doctors for such a little figure of people is non economically executable and can take away from other countries that have a greater population. Sing the fact that many to a great extent populated countries are already missing doctors, increasing the figure of doctors for smaller populations may non be the best determination. Distribution of other Health Care Professionals The distribution of doctors is one of the biggest jobs in rural Canada and it is besides the most widely discussed ; nevertheless, it is of import to observe that the handiness of and entree to, other wellness attention professionals is besides of concern. The Canadian Medical Association has found that there is a deficiency of psychiatric nurses, physical healers, occupational healers, address diagnosticians and linguistic communication diagnosticians in rural countries ( Romanow, 2002 ) . Attempts are being made to counterbalance for this job by implementing household wellness squads. A Family Health Team is an attack to primary wellness attention that brings together different wellness attention suppliers to give the best possible quality of attention for the patient. Family Health Teams consist of physicians, nurses, nurse practicians and other wellness attention professionals who work together and convey their ain alone experiences and accomplishments so that the patient receives the really best attention when it is needed ( Ministry of Health and Long-Term Care, 2009 ) . This attack is designed to convey wellness attention as stopping point to place as possible for people populating in rural and distant countries every bit good as urban countries. This attack is besides meant to give physicians support from other wellness attention professionals so doctors and general practicians do non hold to bear the load of covering with patients entirely. Distribution of Health Care installations There is an uneven distribution of infirmary services and wellness attention installations and this reflects the uneven distribution of medical professionals every bit good. The sum of clip and distance it takes for people populating in rural countries to acquire to wellness attention installations is a major job. Traveling for a long clip for a long distance requires clip and money and besides adds to the uncomfortableness of the individual that is badly. There are no infirmaries in many little rural communities. The nearby urban centres may hold infirmaries with basic medical installations. However, patients need to be taken to big urban centres when specialized intervention is needed. For illustration, in Ontario, larger rural communities have infirmaries that provide indispensable services such as 24-hour exigency attention, OBs, anaesthesia, and general surgery. Smaller infirmaries may besides supply these installations ; nevertheless, these medical installations can be dependen t on specializers who may necessitate to be brought in from different infirmaries located in urban centres ( Romanow, 2002 ) . Rural countries have a limited figure of infirmaries which provide a limited figure of services, unlike their urban opposite numbers. When infirmaries do non supply certain services, which can be an issue for people populating in those countries, who already have such limited picks on their wellness attention. For illustration, if the lone infirmary available in a distant country is operated by spiritual leaders and followings, so installations such as abortion can non be available to the people. Although the option of abortion is available in several urban countries, many rural countries do non hold the option and if person is seeking abortion, so they would hold to go long distances to entree such a installation. It is of import to observe that similar to doctors, it may non be economically executable to hold a infirmary for every distant country where the population is much smaller than many of the urban countries. Hence, alternate options such as household wellness squads can be a good option for many of the rural countries. Rural Seniors Large populations of seniors in Canada live in rural countries. Approximately, one tierce of Canada ‘s seniors live in rural countries and little towns ( Minister of Public Works and Services Canada, 2002 ) . Seniors are besides the largest consumers of wellness attention. A figure of wellness jobs are peculiarly prevailing among aged Canadians, including depression, dementedness ( including Alzheimer ‘s Disease ) , osteoporosis, malnutrition, and loss of bodily maps ( sight, hearing, mobility, continency ) . All of these may necessitate specialised medical attention and support services. Traveling long distances to make needed services is peculiarly disputing for seniors with mobility jobs. The bulk of seniors in Canada live independently and it has repeatedly been proven through surveies that independency is a critical influence in seniors ‘ lodging picks. The capacity to populate independently, nevertheless, depends upon a figure of factors, including wellness, fiscal position, and the handiness of support services, which include professional services, such as medical or personal attention ( Minister of Public Works and Services Canada, 2002 ) . Over the old ages, a figure of support services have been developed to assist seniors. These services include repasts for seniors, particular transit, homecare, sing housewifes, societal and recreational plans, and reding and information. Although these services are effectual, they are for the big portion available merely in urban countries. In rural and distant countries there are jobs with entree to primary wellness attention. The deficiency of after hr ‘s services can take to the usage of exigency suites in the infirmary for instances that are non so terrible such as minor hurts or unwellness. Besides, if primary attention suppliers such as household physicians are non available at all, so patients have no pick but to travel to exigency suites in infirmaries for minor hurts and unwellnesss ( Minister of Public Works and Services Canada, 2002 ) . These patients who lack the primary attention supplier and therefore hold to see infirmaries are known as orphan patients. A bulk of the orphan patients are seniors. Besides, due to miss of appropriate attention, many of the patients that need specialized attention have to wait in infirmary beds, and occupy a bed, until they can be transported to other medical installations that offer such attention. The patients that occupy hospital beds in such manner are known as pati ents who need Alternative degree of Care ( ALC ) ( Ministry of Health and Long-Term Care, 2009 ) . It is of import to cover with the deficiency of primary wellness services in rural countries in efficient ways because seniors are more concentrated in rural parts and seniors are the largest consumers of wellness attention. An effectual manner to undertake this would be to use household wellness squads as you can hold a assortment of professionals working together and this can be good to patients every bit good as the medical professionals. Another effectual manner to turn to this issue, particularly the issue of ALC, is to utilize telemedicine. Ontario has one of the largest telemedicine webs in the universe and it is known as the Ontario Telemedicine Network. Telemedicine is the bringing of health-related services and information utilizing telecommunications engineerings. Through videoconferencing, digital instruments like stethoscopes and patient scrutiny cameras, telemedicine can present wellness attention straight to the places of the patients alternatively of patients holding to go ( Ontario Telemedicine Network, 2010 ) . This is particularly effectual in rural countries as the distance required to go can take a batch of clip and money. Cuting down on the traveling can besides be really good to seniors as they would salvage clip, money and they would non hold to go while ill. Telemedicine can assist with Alternative degree of Care patients as the patients now would non hold to go to urban centres and travel to specializers as the specializers can now come to them via videoconferencing. North East LHIN Enterprises The Ministry of Health and Long-Term Care ( MOHLTC ) has started the Aging at Home Strategy with an purpose to reenforce the ability of community support services to let seniors to populate healthy, independent lives in their ain places. The enterprise is being led by the Local Health Integration Networks ( LHINs ) , with each LHIN having a specific support allotment to run into the demands of their local communities. Programs being funded include: enhanced place attention and community support services such as repasts, transit, shopping, snow shoveling and attention giving supports ( Northeast LHIN, 2010 ) . The North East LHIN ‘s enterprise can be peculiarly helpful with primary wellness attention. Their inaugural includes heightening the scope of place attention services for seniors to avoid unneeded ER admittances and support seasonably discharge from ER and infirmary. The North East LHIN besides looks to make intensive community based instance direction, in-home primary attention, enhanced community supports and enhanced mental wellness services ( Northeast LHIN, 2010 ) . European Primary Health Services Initiatives States in Europe besides experience similar issues in primary wellness attention services as Canada does. Looking at the enterprises taken by European states and comparing it to initiatives taken in Canada can be an effectual manner to compare and contrast the different wellness systems and besides to look for farther betterments in the Canadian wellness attention system. In Greece, the authorities has put forth the thought of community centres for the business and protection of older people. There are many of these centres, called KAPI, throughout the state. These centres combine the socialising facet with primary wellness attention installations every bit good as other societal services ( Oxford Institute of Aging, 2003 ) . These centres have societal nines and activities every bit good as primary wellness attention suppliers including doctors and physical therapists. Baseball clubs such as these can besides possibly be effectual in Canada. The nines do non needfully hold to be extras like those in Greece, but utilizing a similar thought can be helpful in footings of primary wellness attention services for seniors. Decision With the uninterrupted rise of the aging population in Canada, the demand for primary wellness attention services are increasing. This includes more focal point on bar and intervention of common diseases and hurts, basic exigency services and wellness publicity. It is of import to implement primary wellness attention services in rural Canada as the bulk of Canada ‘s seniors live in rural countries and besides because seniors are the biggest consumers of wellness attention. Current enterprises such as household wellness squads, telemedicine and the Aging at Home Strategy are taking good paces in footings of presenting primary wellness attention services. A combination of such plans along with larning from several plan applied around the universe can take to better primary wellness attention services for seniors, every bit good as the population as a whole. How to cite Primary Healthcare Services Rural Seniors Health And Social Care Essay, Essay examples

Wealth distribution, a social injustice free essay sample

In current times we often observe that many members of our society receive less than other members regardless of whether they are no less deserving. In contrast, there are some who have ownership over assets and earn income that they may not be deserving of. The distributive balance is upset and wealth distribution today can thus be seen as a social injustice. This injustice that is becoming more noticeable as people start to become aware of the facts, as we can see through the start of the occupy wall street movements that, first started on wall street in America, have spread to other countries (one of which being Australia). As a consequence of how wealth is habitually distributed and the way in which governments are run, the wealthy continue to become wealthier while the poor in fact experience a reduction in their wealth, or at best maintain their low status. A number of different governmental and social structures exist in different countries respectively to ensure a just community, and people have many different views on what the best approach to distributing wealth is; however it seems that in all forms of idealisms that countries are run on a fair wealth distribution model is still yet to be truly attained. A social democratic view enacted by the Australian government strives, like other forms of idealism, to promote equality. The Australian government, advocating social justice in light of human, civil and social rights, attempts to reduce economic disparity between what is known as the ruling class (the bourgeoisie) and the working class (the proletariat) first and foremost through a high tax rate. This allows the government to create and provide a welfare state, where the state plays a key role in the protection and promotion of the economic and social well-being of its citizens. In this way the government can give welfare checks to the unemployed and poverty stricken individuals and pay for vital social services such as health care. Additionally under the heading of human rights, social rights, civil rights, and ultimately the advocacy of social justice, there are in place government bodies to ensure labor rights and encourage a mixed economy, along with an extensive system of social security to ensure citizens against loss of income following illness, unemployment, or retirement. However, despite the multitude of measures taken to ensure the equitable distribution of wealth and opportunity, wealth distribution in Australia today is still seen as unjust as a large proportion of the country’s wealth is still tied up in a small percentage of people at the top end of the social spectrum. The general dissatisfaction arising from this situation is palpable in the occupy Wall Street movements, that are concerned with the injustice currently taking place with respect to wealth distribution. These occupy movements that began in America but have since hit other capitalist societies, are directed at economic and social inequity. More specifically, however, the people are indignant that the top 1% of the social spectrum continues to grow richer while everybody else becomes poorer, and for this reason the movement commonly chants the slogan â€Å"we are the 99%. † In America the movement has drawn attention to the fact that the richest 1% of Americans now own more wealth than the poorest 90% of Americans combined, and the richest 400 Americans now have more wealth than the bottom 155 million Americans combined. It is therefore not hard to see reason for their protest. A similar situation currently exists in Australia, with large discrepancies in numbers in 2009-10 between the wealthiest 20% of households and the poorest 20% of households. According to the Australian Bureau of Statistics, the wealthiest 20% account for 62% of total household net worth, with an average net worth of $2. 2 million per household while the poorest 20% of households account for only 1% of total household net worth, with an average net worth of $31,829 per household. This can be at least partly attributed to a decrease in tax rate increments. The statistics draw on the selected income distribution indicators, which specify disposable household income (money that can be kept and spent for recreational purposes), show that those individuals in the high income bracket receive 40% of their total income while those in the low income bracket only receive 10%. Consequently, the net worth across households becomes even less matched as the rich not only have a considerably higher income, but are also able to save up much more. The discrepancies between the net worth in households are therefore exponentially larger than the discrepancies that exist in income, which reflects the previously mentioned pattern of people accumulating wealth through their working lives. The indignant attitudes posited by the movement can therefore be seen as justified. However, thought it may be justified, the movement seems to lack a focused goal –they demand that some change is needed so that the situation regarding inequality can be rectified, but their demands fail to offer articulated strategy as to how this can be done. Although economic and social distributions are still lopsided in Australia, exemplified by the movements that have recently hit, certain institutions are in place that attempt to minimize this inequality and give hope that equality may be some day attainable. In the spirit of much desired social justice, our government advocates the principles of both equality of opportunity and equitable distribution of wealth, as well as public responsibility for those unable to avail themselves if the minimal provisions for a good life. As a result, welfare is available to whoever needs it, every citizen automatically benefits from health cover for serious illnesses, student loans from the government are not subject to interest and can be paid off in manageable amounts, our government is not in recession, and, ultimately we are for the most part well looked after. Such institutions and benefits that represent a positive step in the direction of equality are not always found in other countries. Statistics on wealth distribution in the United States of America for example, in theory a neo-liberalist country, portray an even more radical divergence between the bourgeoisie and the proletariat. Furthermore, the minimum wage in Australia is the equivalent of $14 USD, which far exceeds America’s $7. 25. The Australian unemployment rate of 5. 2%, too, is more favorable to the rate of 8. 6% here. So, while the Australian wealth scheme is far from perfect, it is favorable to the current American model. Of interest is North Korea’s, communist approach to wealth distribution. Their government restricts personal freedom, advocating that everybody must be of comparable status in all aspects in order to achieve social justice. The system’s scheme for economic equality is therefore simple; however it too inevitably fails as it works against human nature. The result of such idealism is that a few end up taking power and all the wealth, as we can see when we consider Kim Jong IL’s position. So, irrespective of the way in which governments try to disperse wealth, a large proportion of the country’s wealth will be held by a small percentage at the top. Some might argue that the current distribution of wealth is, on the contrary, a reflection of justice because those that are rich are in fact rich because they work harder and are more deserving. This, while occasionally being accurate, is not always the case. Frequently those individuals in the top 1% are overpaid while people in the ‘low-income’ bracket who are working harder for many more hours are fighting to support themselves. Here, we can appreciate a frustration that can arise, which supports one of Freud’s suggestions as to how discontent with civilization can develop. The constraining effects of living in a civilized community, here manifested in an inability to achieve due to order and status, can fuel disgruntlement which can naturally lead to pandemonium, which is mildly observed in the occupy movements. Whether the existing economic inequality can be seen as a social injustice can be considered in light of Socrates assertions. Socrates believes in distributive justice where things such as wealth are properly allocated; that is, wealth would be disseminated equally to all deserving, contributing members of a society. Indeed this seems to be a sound philosophy when we consider the consequences of the improper allocation of wealth in our society today, being ubiquitous turmoil and the indignant protests of occupy movements to which inequality gave rise. This prompts a consideration of an egalitarian attitude; perhaps justice can only exist within the coordinates of equality. Moreover, Socrates believed that the best way for people to live was to focus on self-development rather than on the pursuit of material wealth, which seems to be precisely where the wealthy have focused their efforts. It can be safely concluded that at present wealth distribution does not reflect social justice. However, with incremental progressions like those that have been recently made in Australia, along with contemplation of such philosophical principles, we will come ever closer to reaching equity. References