Case Management for Breast Cancer Patients

Table of Contents Breast cancer as a chronic disease Supportive care contrasted to preventive measures Conclusion Reference List Tumours are diseases that can be characterized with little percentage of preventive measures taken to forecast the condition of a patient or analyze the possibility of inherited genomes to provoke development of cancer tumours. In this respect, preventive measures should be taken in order to decrease the mortality rates all over the world in terms of cancer illness and breast cancer in particular. Advertising We will write a custom essay sample on Case Management for Breast Cancer Patients specifically for you for only $16.05 $11/page Learn More The changes should be made in the area of preventive approaching the breast cancer as a chronic illness in institutions addressing the healthcare providers’ professional competencies and the way patients, families, and communities perceive this illness and prevent its appeara nce. Breast cancer as a chronic disease Breast cancer is a chronic illness because it is a recurring one and, as a rule, it progresses slowly. Mammary neoplasms are treated as a chronic illness if neoplasms occur constantly even after the use of invasive method and chemotherapy sessions and demonstrate a low progress. In this respect, it needs a completely different approach than a single instance of breast cancer tumour that can be extracted and a tumour can happen to occur no more. Another case that can be considered in breast cancer treatment is the fast or inoperative instance of mammal neoplasm. Inherited propensity and different external factors (smoking, eating carcinogenic products, and others) can accelerate the risk of cancer occurrence. However, sometimes, people live with cancer tumours all life long and undergo a number of chemotherapy sessions that slow down the development and spreading of infected cells. So, a patient should be screened for a breast cancer and appr opriate measures should be taken if a patient has an inherited propensity of breast cancer. As reported by Perry et al. (2007), in June 2003, the European Parliament called for establishment of a programme by 2008 which should lead to a future 25% reduction in breast cancer mortality rates in the EU and also a reduction to 5% in the disparity in the survival rates between member states† (p.615). So, this can be considered the first set of measures to be taken for improving the treatment incorporation of preventive measures into practice as an alternative for supportive measures. Though supportive measures are necessary for patents that have been diagnosed advanced breast cancer tumour, it is necessary to think about alternative ways to decrease the rate of mortality caused by breast cancer and various complications. Advertising Looking for essay on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More Thus, Blamey et al. (20 07) have studied the survival of invasive breast cancer which presupposes supportive taken for patients that were diagnosed advanced breast cancer tumour and have to perceive some treatment in the form of surgical invasion followed by chemotherapy sessions. In this respect, breast cancer can be characterised as a chronic illness that needs preventive measures to be introduced for healthcare providers and for patients and their families as an alternative to supportive measures. Supportive care contrasted to preventive measures As supportive measures were taken for breast cancer patients in the late 20th century, it is necessary to implement some preventive measures. Perry et al. (2007) suggests that even the supportive invasive measures were well-coordinated in case of advanced tumours diagnosis (p.619). In other words, supportive measures are contrasted to timely screening of breast cancer and preventive measures taken for breast cancer patients. When preventive treatment does not work, it is necessary to implement healthcare education for patients and their families. In addition, all types of health care institutions should incorporate preventive measures for patients that have inherited predisposition to breast cancer. Counselling sessions and other ways to inform people that may potentially be diagnosed breast cancer would be primary steps to prevent breast cancer and reduce the mortality rate. As a rule, the reports inform about increase in the spreading rates and the mortality rates. However, the study by Ravdin et al. (2007) offers some evidence of the decrease in breast cancer incidence in breast cancer in the United States in 2003. Perhaps, it is necessary to analyze the measures taken by healthcare providers that year to achieve this result and continue in the same manner. One of the possible ways to increase the awareness of patents in their possible illnesses is to inform the population of the measures to be taken to decrease the effect of various factors on their organism and undergo a set of procedures. Thus, Robson, Offit (2007) report of certain risk assessment and genetic testing to be taken in case a patient can potentially be diagnosed breast cancer. Besides, there are measures that can be taken to inform the patient and her family members about the risk and risk that exists in this case. A set of preventive measures can be taken if a person is of definite age and can be potentially diagnosed breast cancer due to certain external factors. Advertising We will write a custom essay sample on Case Management for Breast Cancer Patients specifically for you for only $16.05 $11/page Learn More In addition, it is necessary to take some measures such as mammography to prevent the slightest possible percent of being diagnosed breast cancer. However, even if you are diagnosed breast cancer, it woud be more productive to remove the tumour and take non-invasive measures while fighting against the di sease. Another study that analyzes management measures that should be taken to prevent occurrence of a disease is the one by Narod Offit (2005). Hereditary illnesses should be opposed to chronic ones. In addition, there should be definite measures taken for patients that have already been diagnosed breast cancer and those who may potentially have it in future. As a rule, it is a matter of time if all female relatives of a patient were diagnosed breast cancer. In this case, preventive therapy is the most appropriate measure that consist in risk assessment, genetic testing, counseling sessions, and other steps including breast examination, mammography, magnetic resonance imaging, ultrasonography, and screening for other cancers, as well as chemoprevention and surgery as parts of strategies for reducing risks. Moreover, the preventive measures for breast cancer include prophylactic mastectomy, analysis of reproductive factors, and oophorectomy for breast cancer risk reduction. As you can see, there are many steps that can be taken but the most appropriate way to fight against the cancer in the earliest stages is to take a combination of those steps and prevent the occurrence of the disease before the patient is diagnosed breast cancer. Conclusion It appears to be more productive to take preventive measures instead f taking invasive measures while dealing with such problem as breast cancer and inherited breast cancer. Advertising Looking for essay on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More When women face such problem, they should receive constructive counselling. Moreover, most women with a possibility to have breast cancer can undergo a set of preventive measures including mammography that would help to screen the tumour when non-invasive measures would be enough. The patents as well as health care providers should be aware of the alternative measures to be taken in every separate case and certain complications and individual peculiarities that should be taken into account while considering preventive measures and certain complications, age, family health history, and other numerous factors. Preventive measures can be introduced on the regular basis to help women with different stages of breast cancer to fight their disease int he most productive way. Reference List Blamey, R.W., Ellisa, I.O., Pindera, S.E., Leea, A.H.S., Macmillana, R.D., Morgana, D.A.L.,†¦ Elstona, C.W. (2007). Survival of invasive breast cancer according to the Nottingham Prognostic Index in cases diagnosed in 1990–1999. European Journal Of Cancer, 4 3, 1548-1555. Narod, S. A., Offit, K. (2005) Prevention and management of hereditary breast cancer. Journal of Clinical Oncology, 23 (8), 1656-1663. Perry, N., Broeders, M., de Wolf, C., Tà ¶rnberg, S., Holland, R., von Karsa, L. (2007). European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition – summary document. Annals of Oncology, 19 (4), 614-622. Ravdin, P. M., Cronin, K. A., Howlader, N., Berg, C. D., Chlebowski, R. T., Feuer, E. J., †¦ Berry, D. A. (2007) The decrease in breast-cancer incidence in 2003 in the United States. The New England Journal of Medicine, 356 (16), 1670-1674. Robson, M., Offit, K. (2007). Management of an inherited predisposition to breast cancer. The New England Journal of Medicine, 357 (2), 154-162. This essay on Case Management for Breast Cancer Patients was written and submitted by user Leigha Beck to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Comparison of Douglass and Jacobs Narratives

Comparison of Douglass and Jacobs Narratives Introduction Forced labor played an important role in the American history. It affected the lives of many Blacks living in the country during that time. Some slaves managed to escapethatenabled them to write some stories based on their lives. Fredrick Douglass, for example, wrote a narrative referred to as Narrative of the Life of Fredrick Douglass: An America Slave. Advertising We will write a custom research paper sample on Comparison of Douglass and Jacobs Narratives specifically for you for only $16.05 $11/page Learn More Douglass gave an account of his social, Douglass authored his works on Narrative of the Life of Douglass after Blacks had started demanding for their rights and freedoms. In contrast, the works of Jacob was affected by the political and historical events that went on during publication of her works.Advertising Looking for research paper on african american? Let's see if we can help you! Get your first paper with 15% OFF Learn More She published her works at a time that Americans rose against each other in the Civil War. She had to convey compelling argument to gain the attention of women about suffrage. Douglass had a major influence in society because he was both a leader and a writer. His works was met with criticism from owners of the slaves, which forced him to run for his safety. Fredrick Douglass based his ideas on the sermon. He could influence church members to reject any form of slavery because it was against God’s will. He was hired to lecture at Massachusetts Antislavery organization, whereby he developed some of styles that could enable him to attack slave owners. He came up with rhetorical devices that were similar to sermons and proclamations and used them in formulating his narrative. Such strategies included reverberation, contrast and many classical credible tactics. His findings were based on compilation of various speeches given in church. This means that he used b iblical quotes to condemn slavery because he cited some of the famous writings from the Holy book to prove that slavery was indeed inhuman (Pyne 71). Furthermore, Douglass borrowed the ideas of Emerson, which were popular in 1840s. He combined various views to encourage his supporters to fight against slavery, which caused anguish to people. He gave a narration in which he likened slavery to the life of a man who undergoes initiation from childhood to adulthood. Initiation signifies transformation from boyhood to maturity. In the same way, fight for freedom is like transformation from human chattel to a free citizen. According to Douglass, he analyzes his displeasure against slavery, by stating: Slaves sing most when they are most unhappy. The songs of the slaves represent the sorrows of his hear, and are relieved of them, only as its tears relieved an aching heart (Douglass 20)†. Because of his personal view to slavery, he was able to relate to the vile moments of slavery to his sermons. In return, he had an opportunity to attack slavery. The sermons provided Douglass with a good opportunity to attack slavery. He used quotations from the Bible, which contradicted with the activities of slave owners, to challenge slavery.Advertising We will write a custom research paper sample on Comparison of Douglass and Jacobs Narratives specifically for you for only $16.05 $11/page Learn More This enlightened Christian slave owners to neglect the provisions of the slavery laws. In addition, he used the sermons in church to remind slave owners that it was against God’s Will to use or humiliate another human being by treating them as objects. It is noted that Christianity played a bigger role in abolishing slavery in the US. Contrary to Douglass’ observation, Jacob gave her reasons against the slavery at around 1854. Such views and ideas made the author live as a renegade for about ten years. She authored her works after Cornelia Grinnell had given her a decent job. In other words, her findings could be termed as sentimental meaning a domestic novel. The author targeted women in families, home, matrimony and womanly reticence. She had borrowed much from the previous women writers. Her works encouraged women to rise up and fight slavery as well as male patriarchy. The issue of gender makes a big difference between the two scholars. Jacob focused on the problems encountered by women under slavery. She argued that slave owners could demand for sexual relationships with their subjects. In this case, women were the first casualties because they could not resist. Jacob showed how society used physical qualities to discriminate some members.She claimed that no social structure was maintained by oppressing some of its members. Conversely, the two scholars had different focuses because Douglass emphasized on struggle to achieve manhood and freedom while Jacob was much disturbed by the issue of sexual exploitation. A s Jacob observed, slavery was much terrible for women as compared to men. Women were affected most because there were no jobs for them (Shlaes 45). In society, women existed at the mercy of men. They were infringed economical and socially. They were only supposed to handle minor activities, but not to participate in major debates.Advertising Looking for research paper on african american? Let's see if we can help you! Get your first paper with 15% OFF Learn More The major problem for women was male domination and societal structure, which was rigid and unbiased. Douglass did not talk much about women (Pyne 83), but was more focused on liberating the entire society from slavery. On the other hand, Jacob’s concerns were clear. She longed for liberating women from male patriarchy and domination. She cited societal structure as one of the impediments to women liberation. Culture did not allow women to participate in active politics, neither did it encourage women to rise up and fight for their rights. Even pressure groups focused only on setting men free from slavery, not women. This implies that women were supposed to stand up and fight for their rights independently. This is reflected perfectly in the following text: When he told me that I was made for his use, made to obey his command in everything; that I was nothing but a slave who will must and should surrender to his, never before had my puny arm felt half-strong (Jacob 29). From Jacob’s narrative, it is established that she was not learned meaning that her works did not have any scholastic foundation. She could not be compared to Douglass who was educated (Shlaes 45), though very poor. Family backgrounds affected the writings of the two authors. Jacob claimed that her adventures seemed incredible because of the life she went through. She also admitted that her descriptions fell short of acts because she was not much enlightened, unlike Douglass who was well off academically since he was offered employment as a tutor. He worked in one of the colleges that supported liberation. Educational backgrounds affected the narratives of the narrators since more education affects an individual’s orientation to the world. In other words, learned narrators use tact in presenting his or her ideas. Douglass understood the importance of the importance of liberty hence encouraging slaves and other members of society to fight for their rights (McPherson 14). On the other hand, Jacob urged women to raise their concerns through societal institutions, such as government, which proved to be futile. Douglass used his influence and position in the society to inform the public of the evils of slavery. Conclusion Overall, Douglass and Jacobs aimed at eliminating slavery by condemning it through written texts. They focused on the awful experiences and nature of slavery. Each of the narrators had different viewpoints as regards to slavery. In addition, the scholars exposed injustices that infringed upon peoples rights to equality and equal opportunities. Comparison of works of the two writers reveal that differences endured by male and female slaves related to gender roles, political aspects, and societal structure. Douglass, Fredrick. Narrative of the life of Fredrick Douglass, an American slave. Oxford: Oxford University Press, 2009. Print. Jacob, Harriet. Incidents in the life of a slave girl. Harvard: Harvard University Press, 2007.Print. McPhe rson, James. Battle Cry of Freedom: The Civil War Era. Oxford: Pulitzer Prize, 2003.Print. Oatis, Steven. A Colonial Complex: South Carolinas Frontiers in the Era of the Yamasee War, 1680-1730. New York: University of Nebraska Press, 2004.Print. Pyne, Stephen. How the Canyon Became Grand. New York, NY: Penguin Books, 1998.Print. Shlaes, Amity. The Forgotten Man: A New History of the Great Depression. New York, NY: Harper Perennial, 2008.Print.

Causes and effect of stress Essay Example | Topics and Well Written Essays - 250 words

Causes and effect of stress - Essay Example The feelings of loss can turn to stress if nothing is done to remedy the situation. Phobias also stress people because one has little control over what happens when they experience these stressors. Another cause of internal stress levels includes those issues related to health. If an individual has depression-related ailments or heart diseases, the stress levels increase (Renner 294-5). External issues also affect the way an individual reacts to stress. Pressure from work due to too much work with few or no vacations could have a negative toll on the body. Having to meet deadlines everyday also affects the daily reactions amongst employees. Finances also affect the way people react because they are unemployed, have low wages or have to plan for the future and are yet to get substantial amounts of money to accomplish their goals (Renner 296). People undergo different transitions in life, which define who they are. When they experience stressful situations, some may cave in to pressure. Others result to depression or solve their issues appropriately. Whichever way one looks at it, stress is part of life, but people need appropriate coping

Pulmonary Hypertension Essay Example | Topics and Well Written Essays - 5000 words

Pulmonary Hypertension - Essay Example Genetic factors may account for mutations in the blood vessels which may manifest in the increased prevalence of smooth muscle cells and fibroblasts in the walls of the blood vessels (Ali, Summer, and Levitzky, 2005). Pulmonary hypertension may also be caused by congenital heart defects like atrial septal defect, ventricular septal defect, patent ductus arteriosus, and congenital heart problems which have left to right shunts (Ali, Summer & Levitzky, 2005). In instances when the pulmonary hypertension would worsen, the right-side pressure may overwhelm systemic pressure and â€Å"poorly oxygenated mixed venous blood bypasses the lungs and enters the systemic circulation, causing severe shunt-related hypoxemia† (Ali, Summer & Levitzky, p.129, 2005). Non-specific symptoms like dyspnea on exertion, fatigue, angina pectoris, and syncope (Ali, Summer & Levitzky, 2005). These are however symptoms which also apply to other cardiopulmonary disorders like ischemic and valvular heart disorder. Hoarseness is a symptom more specific to pulmonary hypertension because it is caused by compression of the recurrent laryngeal nerve due to the enlarged main pulmonary artery (Ali, Summer & Levitzky, 2005). In cases of cardiac overload, sodium and water retention increases under the influence of the aldosterone hormone. Sodium and water retention consequently manifests as volume overload causing distended neck veins (jugular vein distention), ascites, and leg edema. Other symptoms may include tachypnea, dizziness, apprehension, fear, persistent hypoxemia, excessive fatigue, and cyanosis (Canobbio, 2006). Dizziness, fatigue and syncope are largely due to insufficient cardiac output (Newman, 2008). Initial diagnostic tests may include chest x-ray, spirometry, ECG, and echocardiography, and CBC following a complaint of significant exertional dyspnea in patients who seem relatively

Modified Radical Mastectomy for Contralateral Breast Cancer

Modified Radical Mastectomy for Contralateral Breast Cancer Abstract Breast cancer is the most common malignancy in women worldwide. With improving survival figures and early breast cancer detection, treatment related long term adverse effects of radiotherapy have become a concern. Contralateral breast cancer due to scatter radiation from during radiotherapy of diseased breast is one of them. This prospective clinical study was conducted to measure the dose received by the contralateral breast and compare the different techniques which influence this dose. It was found that in post mastectomy patients, treatment with telecobalt medial tangential field contribute more dose to contralateral breast compared to supraclavicular field and lateral tangential fields. The mean dose received by contralateral breast during irradiation of chest wall was 168.29 cGy which 3.36 percentage of the prescribed dose. Key Words; contralateral breast dose, breast malignancy, thermoluminescent disc, scattered radiation Introduction Breast cancer is the most common malignancy among the women worldwide. [1] With improved survival figures due to early breast cancer detection and multimodality treatment, long term adverse effects in the form of second malignancy of contralateral breast (CLB) has become a concern. In patients getting radiotherapy to the affected breast, CLB also receives radiation in the form of scattered radiation due to scattered from primary. Second malignancy is a late sequel of radiation appearing at an interval of 10-15 years. [2, 3, 4, 5, 6, 7] Since breast is highly radiosensitive structure this dose to CLB is a major concern especially in younger women and patients with longer life expectancy. Although radiation induced malignancy is a stochastic effect but the intensity increases linearly with increase in dose. [8] Studies have measured CLB dose on phantom and patients and have observed that the dose to CLB is more for medial tangential (MT) than supraclavicular field (SCL) field and later al tangential (LT) field. In our centre 22% of female patients are suffering from breast cancer and majority of them belong to low socio economic status and presented with advanced disease. In the present study we measure the dose to CLB in patients receiving radiotherapy following modified radical mastectomy (MRM). The radiation dose to CLB were measured with the help of CaSO4: Dy thermoluminescent discs (TLD). The TLD are highly sensitivity and can measure even very small doses. Materials and methods Measurement of CLB was done in 25 patients undergoing for EBRT by cobalt teletherapy machine (THERATRON 780 C and E) following MRM. Precalibrated TLD (9mmÃâ€"13mm) were placed on the surface of CLB. Total three discs were placed one at the nipple and other vertically on either side of nipple 3 cm apart. We tried our best to place the TLD on the same position each time. Skin tattooing was done to demarcate the exact position at the first sitting and this was used subsequently to replicate the position. After delivery of radiation dose for a particular field the discs were removed and another set of three discs were placed for next reading. In this way total six discs were used daily, three for SCL field and three for MT or LT field as MT and LT fields were treated on alternate days and SCL field was treated daily. For MT and LT fields breast cone was used for half beam block. Total dose delivered was 50 Gy in 25 fractions, 2 Gy per fraction, 5 fractions per week in 5 weeks. The expos ed TLD were stored in radiation free zone and the readings were taken after 24 hours and within 7 days after exposure because after seven days the TLD start to loose electrons. The scattered dose received by TLD were measured on NUCLEONIX TL 10091 TLD reader. After one set of measurement, the discs were annealed by heating 400 degree celcius and then used for next measurement. For each patient, measurements were carried out at first week, third week and last week, total three times during the course of treatment. Statistical Analysis Mean dose calculation received by CLB. Total dose received by CLB, this was calculated by multiplication of mean dose to number of fractions. The percentage of radiation dose received by CLB with respect to the prescribed dose to diseased breast (Total doseÃâ€" 100 / prescribed dose to diseased breast). We also stratified data based on gantry angle at which EBRT was delivered (≠¤50 degree and > 50 degree). The statistical software SPSS version 20.0 was used for the data analysis. Results The age wise distribution of patients and the mean dose received by CLB is shown in table 1. 19 out of 25 patients in our study were 50 years or younger. 52% patients had left sided breast cancer. Table 2 shows the contribution of SCL, MT and LT field dose with the gantry angle at which the radiation dose was delivered. Total dose received by CLB varies from 1.22% to 5.82% of the prescribed dose of 50 Gy to the affected breast. Mean total dose received by CLB was 105.55 cGy with MT field followed by SCL field, (33.96 cGy) and LT field {(28.97 cGy) as shown in table 2. This data shows that the maximum contribution of dose to CLB was with MT field followed by SCL field and LT field. Mean dose with all three fields received by CLB was 168.48 cGy with SD  ±62.23 which corresponds to 3.36% of prescribed dose to affected breast. 11 patients were treated on cobalt unit with gantry angle ≠¤ 50 degree having 3.00% contribution of CLB dose (table 3). 14 patients treated with gantry angl e > 50 degree had 3.79% contribution of CLB dose (p=0.199). The mean, median and range were 3.66, 3.34 and 4.60 respectively. Discussion It is well known that exposure to ionizing radiation causes carcinogenesis in healthy tissues. Although it is a stochastic effect having no threshold dose but the intensity increases with increase in radiation dose. CLB must be considered as an organ at risk during radiotherapy planning for treatment of cancer breast. Many previous studies conducted to calculate the dose received by CLB, were based on patients, phantom or treatment planning system. Boice et al analyzed the record of 41109 patients of cancer breast and they found the mean CLB dose was 2.82 Gy. [9] They also hypothesized that there was increased relative risk of CLB malignancy due to exposure to ionization given to diseased breast. The relative risk was 1.19 for all patients, however the relative risk was more (1.49) for younger patients who were less than 45 years old. In our study, the maximum dose received by CLB in women below 40 years which was 3.93 percentage (196.437 cGy) of prescribed dose. The minimal dose was received in patients who were above 60 years of age {(1.96 %) (97.875 cGy)}. The possible reason could be the increased laxity of breast tissues in older women cause more lateral shifting of CLB away from the radiation at the time of exposure. Half beam block technique is routinely used while irradiating the breast with tangential beams. [10, 11] Kelly et al measured CLB dose on Alderson Rando phantom using TLD with four different techniques of breast cancer treatment using 6 MV photon beam on linear accelerator. [12] The used half beam block with asymmetrical jaws, custom blocks and symmetrical collimator jaw. Another technique used was isocentric method with non divergent posterior border. They observed highest dose to CLB in MT field with wedge. In our study radiation was delivered using half beam block with breast cone. The dose to CLB was maximum with MT field because in half block beam, the breast cone is placed near to surface of breast which cause increased dose due to secondary collimator scattering. Bhatnagar et al compared dose to CLB during EBRT to chest wall irradiation using conventional tangential technique and intensity modulated radiotherapy (IMRT). [13] They observed 20 percentage reduction of dose to CLB using IMRT. According to a study by Chougule, the average contralateral nipple dose was 152.5-254.75 cGy and the percentage was 3.05-6.05% for a dose of 5000 cGy in 25 fractions for post mastectomy breast cancer. [14] In our study, the measured mean contralateral nipple dose on was 171.88 cGy (55.5-303.80 cGy) which accounts to 3.47% (1.11%-6.07%) of prescribed dose (table 2). Dose to CLB were higher for dose calculated at the level of nipple as compared to dose received by whole CLB. This may be due to TLD at level of nipple being closest to the radiation source. According to Rankel et al with high gantry angle the beam will be closer to the surface leading higher dose to the CLB. [15] In this study, it was found that with gantry angle >50 °, more dose was delivered to the CLB though the difference is not statistically significant (p=0.199). Conclusion In our patient cohort, higher inadvertent CLB dose was delivered in younger patients with MT field; overall, dose being 3.36 percentage of prescribed dose.

THE NATIONAL TOBACCO STRATEGY

Facts about harm associated with tobacco and contact information for quit programs provide access to information and support School education programs that focus on assertiveness skills, academic success and developing a negative attitude to smoking all help young people to modify personal behaviors and enhance skills that will be protective against smoking in future Quitting service Creating Supportive environments: Promotion of smoke free messages and regulation of place creates a variety of physical and social support structures accessible to individuals Frightening media campaigns â€Å"every cigarette is doing you damage† maintained powerful antismog attitude in the with advertising of pharmaceutical products, such as nicotine patches, the urgency to quit is implemented by the sense of having a solution readily available. Most indoor and public places are smoke free, providing safe physical and social environments for people to work and interact socially.Non-health initia tives like housing, counseling and anti-violence strategies reduce stress and anxiety that might lead to smoking. Employment and training programs to reduce boredom associated with unemployment-?address socio-cultural and socioeconomic determinants which influence tobacco use. Regulation of place of sale aims to eliminate the sale of tobacco products to minors and aka them less visible: hidden behind counters Strengthening Community action Local educational strategies such as peer support and mentoring programs improve self-esteem and the sense of worth among students which can be protective factors against harm from tobacco use.Families and parents provided with safe places for children to avoid tobacco smoke-?parks Reorienting Health services: ‘Lifestyles' prescription pads are tools used by Gaps to initiate discussions with patients about lifestyle behaviors-?help doctors introduce preventative assuages and recommendations for improving lifestyle behaviors. Building Healthy Public Policy. High levels of taxation on tobacco ensure cigarettes are less affordable, reducing access for younger people in particular Imposition of laws that prevent smoking in most public and indoor environments I. E. No smoking in pubs and clubs Place of drug education in all Australian schools an important cornerstone of public policy. Delivery of anti-smoking messages and development of anti-smoking attitudes as young as possible is critical.

Catholic Sacraments

The Sacraments of the Catholic Church are, the Church teaches, efficacious signs of grace, instituted by Christ and entrusted to the Church, by which divine life is dispensed to us. The visible rites by which the sacraments are celebrated signify and make present the graces proper to each sacrament. They bear fruit in those who receive them with the required dispositions. † Though not every individual has to receive every sacrament[->0], the Church affirms that, for believers as a whole, the sacraments are necessary for salvation, as the modes of grace divinely instituted by Christ[->1] Himself.Through each of them Christ bestows that sacrament's particular grace, such as incorporation into Christ and the Church, forgiveness of sins, or consecration for a particular service. The Church teaches that the effect of a sacrament comes by the very fact of being administered, regardless of the personal holiness of the minister administering it. However, a recipient's own lack of prope r disposition to receive the grace conveyed can block the effectiveness of the sacrament in that person.The sacraments presuppose faith and through their words and ritual elements, nourish, strengthen and give expression to faith. The Catechism of the Catholic Church[->2] lists the sacraments as follows: â€Å"The whole liturgical life of the Church revolves around the Eucharistic sacrifice and the sacraments. There are seven sacraments in the Church: Baptism[->3], Confirmation[->4], Eucharist[->5], Penance[->6], Anointing of the Sick[->7], Holy Orders[->8], and Matrimony[->9]. † Baptism[->10] is the first and basic sacrament of Christian initiation.Baptism is usually conferred today by pouring water three times on the recipient's head, while reciting the baptismal formula: â€Å"I baptize you in the name of the Father and of the Son and of the Holy Spirit[->11]. † The ordinary minister of the sacrament is a bishop or priest, or a deacon. In case of necessity[->12], an yone intending to do what the Church does, even if that person is not a Christian, can baptize. The sacrament frees from original sin[->13] and all personal sins, and from the punishment ue to them. Baptism makes the person share in the Trinitarian life of God through â€Å"sanctifying grace[-;14]†, the grace of justification that incorporates the person into the body of Christ and his Church, also making the person a sharer in the priesthood of Christ. It imparts the theological virtues[->15]: faith[->16], hope[->17], and charity[->18] and the gifts of the Holy Spirit, and marks the baptized person with a spiritual seal or character that indicates permanent belonging to Christ.Baptism is the foundation of communion between all Christians. The many symbols of baptism include a white garment, symbolizing innocence and purity, a candle, symbolizing the Light of Christ, the Oil of Chrism, which is used to anoint the baby or candidate being baptized, and the water, which symboliz es cleansing and the washing away of sin. Confirmation is the second sacrament of Christian initiation. It is called Confirmation because it confirms and strengthens baptismal grace.It is conferred by â€Å"the anointing[-;19] with Sacred Chrism[-;20], which is oil mixed with balsam and consecrated by the bishop, which is done by the laying on of the hand of the minister who pronounces the sacramental words proper to the rite. These words refer to a gift of the Holy Spirit[-;21] that marks the recipient as with a seal. Through the sacrament the grace given in baptism is strengthened and deepened.Like baptism, confirmation may be received only once, and the recipient must be in a state of grace meaning free from any known unconfessed mortal sin[-;22] in order to receive its effects. The originating minister of the sacrament is a validly consecrated bishop[-;23]; if a priest confers the sacrament and in special cases, the link with the higher order is indicated by the use of oil bles sed[-;24] by the bishop on Holy Thursday[-;25] itself or on a day close to it. In the East, which retains the ancient practice, the sacrament is administered by the parish priest immediately after baptism.In the West, where administration is normally reserved for those who can understand its significance, it came to be postponed until the recipient's early adulthood; but in view of the earlier age at which children are now admitted to reception of the Eucharist, it is more and more restored to the traditional order and administered before giving the third sacrament of Christian initiation. The Eucharist is the sacrament, the third of Christian initiation, completes Christian initiation by which Catholics partake of the Body and Blood of Jesus[->26] Christ and participate in his one sacrifice.The first of these two aspects of the sacrament is also called Holy Communion. The bread which must be wheaten and wine which must be from grapes used in the Eucharistic rite are, in Catholic fa ith, transformed in all but appearance into the Body and Blood of Christ, a change that is called transubstantiation[->27]. That is, Catholics believe they are sacramentally, though not physically, eating and drinking the human flesh and blood of Jesus Christ. Only a bishop[->28] or priest[->29] is enabled to be a minister of the Eucharist, acting in the person of Christ himself.Deacons[->30] as well as priests are ordinary ministers of Holy Communion, and lay people may be authorized in limited circumstances to act as extraordinary ministers of Holy Communion. The Eucharist is seen as â€Å"the source and summit† of Christian living, the high point of God's sanctifying action on the faithful and of their worship of God, the point of contact between them and the liturgy of heaven. So important is it that participation in the Eucharistic celebration is seen as obligatory on every Sunday and holy day of obligation[-;31] and is recommended on other days.Also recommended for thos e who participate in the Mass is reception, with the proper dispositions, of Holy Communion. This is seen as obligatory at least once a year, during Eastertide. The Sacrament of Penance is the first of two sacraments of healing. The Catechism of the Catholic Church mentions in the following orders different names of the sacrament, calling it the sacrament of conversion, Penance, confession, forgiveness and Reconciliation. It is the sacrament of spiritual healing for a baptized person from the distancing from God resulting from sins committed.If a man sins after baptism, he cannot have baptism as a remedy; Baptism, which is a spiritual regeneration, cannot be given a second time. Reconciliation involves four elements: Contrition the Penitent's sincere remorse for wrongdoing or sin, repentance, without which the rite has no effect; Confession to a Priest with the faculty to hear confessions while it may be spiritually helpful to confess to another, only a Priest has the power to admin ister the sacrament, Absolution by the Priest, and, Satisfaction or Penance.Many sins wrong our neighbor. One must do what is possible in order to repair the harm. Simple justice requires as much. But sin also injures and weakens the sinner himself, as well as his relationships with God and neighbor. Absolution takes away sin, but it does not remedy all the disorders sin has caused. Raised up from sin, the sinner must still recover his full spiritual health by doing something more to make amends for the sin: he must make satisfaction for or expiate his sins. This satisfaction is also called penance.In early Christian centuries, this element of satisfaction was quite onerous and generally preceded absolution, but now it usually involves a simple task for the penitent to perform, to make some reparation and as a medicinal means of strengthening against further temptation. The priest is bound by the seal of confession[->32], which is inviolable. Accordingly, it is absolutely wrong for a confessor in any way to betray the penitent, for any reason whatsoever, whether by word or in any other fashion.A confessor who directly violates the sacramental seal incurs an automatic excommunication whose lifting is reserved to the Holy See[->33]. In some dioceses, certain sins are reserved which means only certain confessors can absolve them. Some sins, such as violation of the sacramental seal, consecration of bishops without authorization by the Holy See, direct physical attacks on the Pope[->34], and intentional desecration of the Eucharist are reserved to the Holy See.A special case-by-case faculty from the Sacred Penitentiary[->35] is normally required to absolve these sins. Anointing of the Sick[->36] is the second sacrament of healing. In this sacrament a priest anoints the sick with oil blessed specifically for that purpose. The anointing of the sick can be administered to any member of the faithful who, having reached the use of reason, begins to be in danger by reas on of illness or old age. A new illness or a worsening of health enables a person to receive the sacrament a further time.When, in the Western Church, the sacrament was conferred only on those in immediate danger of death, it came to be known as Extreme Unction[->37], Final Anointing, administered as one of the Last Rites. The other Last Rites are Confession if the dying person is physically unable to confess, at least absolution, conditional on the existence of contrition, is given, and the Eucharist, which when administered to the dying is known as Viaticum[->38], a word whose original meaning in Latin[->39] was provision for a journey.Holy Orders[->40] is the sacrament by which a man is made a bishop[->41], a priest[->42], or a deacon[->43], and thus dedicated to be an image of Christ[->44]. A bishop is the minister of this sacrament. Ordination as a bishop confers the fullness of the sacrament, making the bishop a member of the body of successors of the Apostles, and giving him the mission to teach, sanctify, and govern, along with the care of all the Churches.Ordination as a priest configures the priest to Christ the Head of the Church and the one essential High Priest, and conferring on him the power, as the bishops' assistant, to celebrate the sacraments and other liturgical acts, especially the Eucharist. Ordination as a deacon configures the deacon to Christ the Servant of All, placing him at the service of the bishop, especially in the Church's exercising of Christian charity towards the poor and preaching of the word of God.Aspirants to the priesthood are required by canon law[->45] to go through a seminary[->46] program that includes, as well as graduate level philosophical and theological studies, a formation program that includes spiritual direction[->47], retreats[->48], apostolate experience, etc. The course of studies in preparation for ordination as a permanent deacon is decided by the Episcopal conference[->49] concerned. Matrimony[->50], or Marriage, like Holy Orders, is a sacrament that consecrates for a particular mission in building up the Church, and that provides grace for accomplishing that mission.This sacrament, seen as a sign of the love uniting Christ and the Church, establishes between the spouses a permanent and exclusive bond, sealed by God. Accordingly, a marriage between baptized[->51] people, validly entered into and consummated, cannot be dissolved. The sacrament confers on them the grace they need for attaining holiness in their married life and for responsible acceptance and upbringing of their children.As a condition for validity, the sacrament is celebrated in the presence of the local Ordinary[->52] or Parish Priest[->53] or of a cleric delegated by them or in certain limited circumstances a lay person delegated by the diocesan Bishop with the approval of the Episcopal Conference[->54] and the permission of the Holy See[->55] and at least two other witnesses, though in the theological tradition o f the Latin Church the ministers of the sacrament are the couple themselves.For a valid marriage, a man and a woman must express their conscious and free consent to a definitive self-giving to the other, excluding none of the essential properties and aims of marriage. If one of the two is a non-Catholic Christian, their marriage is licit only if the permission of the competent authority of the Catholic Church is obtained. If one of the two is not a Christian, the competent authority's dispensation is necessary for validity.