The Services Directive Proposal

Of   course   the   fundamental   freedoms   set   out   in   the   Treaty   of   European   Union   are   central   to   the   success   and   functioning   of   the   EU   Internal   Market.Two   of   these   were   of   great   importance   for   the   Internal   Market:   freedom   of   establishment   (Article   43)   and   the   freedom   to   provide   cross   border   services   (Article   49).   While   the   former   provides   access   for   operators   to   practice   their   economical   activities   in   one   or   more   Member   States,   the   latter   enables   an   operator   providing   services   in   a   Member   State   to   do   the   same   in   another   Member   State   temporarily   without   being   obliged   to   get   established   there.[1]   Obviously   these   have   legal   implications.â€Å"This   means,   in   practice,   that   Member   States   must   modify   national   laws   that   restrict   freedom   of   establishment,   or   the   freedom   to   provide   services,   and   are   therefore   incompatible   with   these   principles.This   includes   not   only   discriminatory   national   rules,   but   also   any   national   rules   which   are   indistinctly   applicable   to   domestic   and   foreign   operators   but   which   hinder   or   render   less   attractive   the   exercise   of   these   â€Å"fundamental   freedoms†,   in   particular   if   they   result   in   delays   or   additional   costs.†Ã‚   [2]The   Internal   Market   has   effected   a   number   of   real   benefits   particularly   in   some   sectors   and   generally   in   providing   employment   and   freedom   of   movement   for   operators.â€Å"Overall,   the   Internal   Market   has   resulted   in   real   benefits.   For   instance,   in   the   10   years   since   the   completion   of   the   first   Single   Market   programme   in   1993,   at   least   2.5   million   extra   jobs   have   been   created   as   a   result   of   the   removal   of   barriers.The   increase   in   wealth   attributable   to   the   Internal   Market   in   those   10   years   is   nearly   â‚ ¬900   billion;   on   average   about   â‚ ¬6000   per   family   in   the   EU.   Competition   has   increased   as   companies   find   new   markets   abroad.   Prices   have   converged   (in   many   cased   downwards)   and   the   range   a nd   quality   of   products   available   to   consumers   have   increased.†Ã‚   [3]Later   in   1992   Jacque   Delor   proposed   and   implemented   a   programme   aimed   at   creating   a   single   market   by   eliminating   non-tariff   barriers   to   goods   trading.   Although   the   programme   has   been   beneficial   but   it   leaves   room   for   substantial   progress   in   order   that   services   can   be   offered   across   borders   smoothly.[4]In   2002   EU   commission   studied   the   numerous   barriers   that   affect   the   flow   of   services   across   the   borders   of   Europe.   It   was   found   that   these   barriers,   including   legal   restrictions,   difficulties   in   obtaining   the   required   authorisation   from   local   authorities,   an d   the   length   and   complexity   of   procedures,   made   it   almost   impossible   for   some   businesses   to   get   established   in   countries   other   than   their   origin.[5]However,   on   7   May   2003   the   European   Commission   implemented   its   Internal   Market   Strategy   for   the   period   of   2003-2006.â€Å"The   Strategy   concentrates   heavily   on   removing   many   of   the   barriers   that   prevent   businesses   in   the   services   sector   from   operating   across   Europe.   The   commission   views   improvements   in   this   sector   as   essential   to   meeting   the   targets   of   the   2000   Lisbon   package,   given   that   services   now   account   for   around   two-thirds   of   the   EU’s   GDP.†[6]The   Commission   als o   pointed   out   that   the   enforcement   of   EU   legislation   was   not   effective   in   a   way   that   it   itself   become   one   of   the   barriers.   Within   these   strategies   and   in   order   to   address   the   problem   of   removing   barriers   hindering   the   flow   of   services   within   the   Member   States,   the   Commission   proposed   a   Service   Directive   aimed   at   enabling   service   providers   of   the   Member   States   to   establish   themselves   and   provide   services   in   States   other   than   they   originally   come   from.In   January   2004   Frits   Bolkestein,   the   European   Commissioner   for   Internal   Market   at   the   time,   proposed   a   draft   of   the   Directive   on   services   in   the   Internalà ‚   Market;   today   commonly   referred   to   as   ‘Bolkestein   Directive’.[7]   The   Services   Directive   by   removing   all   the   barriers   hindering   the   movement   and   establishment   of   service   providers   with   the   EU   Member   States,   is   expected   to   â€Å"create   jobs,   boost   economic   growth   and   increase   quality   and   choice   for   consumers.†Ã¢â‚¬Å"The   consultants   Copenhagen   Economics   have   predicted   a   0.3%   rise   in   GDP   and   a   0.7%   increase   in   employment.   The   European   Commission's   estimates   point   to   a   1.8%   increase   in   GDP   and   2.5   million   new   jobs.†[8]Yet   the   Service   Directive   was   not   well   received.   Although   it   was   adopted   for   first   reading   in   February   2004,   opposition   in   different   countries   were   pronounced.   Countries   with   high   standard   of   social   protection   expressed   fear   from   the   consequences   of   cheaper   competition   from   the   foreign   market.â€Å"Some   countries   and   trade   unions   feared   this   would   lead   to   a   â€Å"race   to   the   bottom†,   with   firms   relocating   to   countries   with   lower   wages   and   the   weakest   consumer,   environmental   protection,   employment   and   health   and   safety   rules.†[9]Yet   the   most   disagreed   point   was   that   of   â€Å"country   of   origin   principle†Ã‚   which   allows   services   providers   to   operate   in   another   country   while   being   obliged   to   abide   only   by   the   laws   of   the   country   of   origin.[1]  Ã‚  Ã‚   EU   Single   Market:   General   Principles   available   at:   http://ec.europa.eu/internal_market/services/principles_en.htm   accessed   on   15   January   2007 [2]   EU   Single   Market:   General   Principles   available   at:   http://ec.europa.eu/internal_market/services/principles_en.htm   accessed   on   15   January   2007 [3]A   Single   Market   for   Services   available   at:   http://ec.europa.eu/internal_market/top_layer/index_19_en.htm   accessed   on   15   January   2007[4]   Can   Europe   Deliver   –   Research   by   Paul   Stephenson   –   Edited   by   Neil   O’Brien   (2006)   available   at:   http://www.openeurope.org.uk/research/services.pdf   accessed   on   15   January   2007 [5]   Can   Europe   Deliver   –   Research   by   Paul   Stephenson   –   Edited   by   Neil   O’Brien   (2006)   available   at:   http://www.openeurope.org.uk/research/services.pdf[6]   Services   Directive   background   available   at   :   http://www.smallbusinesseurope.org/en/basic_background319.htm   accessed   on   15   January   2007 [7]Directive   on   services   in   the   internal   market   –   From   Wikipedia,   the   free   encyclopedia   available   at:   http://en.wikipedia.org/wiki/Directive_on_Service_in_the_Internal_market#column-one   accessed   on   15   January   2007[8]   Q&A:   Services   Directive,   Available   at:   http://news.bbc.co.uk/1/hi/world/europe/4698524.stm   accessed   on   15   January   2007 [9]   Q&A:   Services   Directive,   Available   at:   http://news.bbc.co.uk/1/hi/world/europe/4698524.stm   accessed   on   15   January   2007

Purpose and Use of HRMS

Every organization has a set of employees working together to achieve the same goals known as the â€Å"human resource† of the organization. These people in turn are handled by another set of employees known as the â€Å"human resource management†. As the fast growing environment and the technology is becoming an active part of the daily exchanges in the business environment, companies are forced to implement latest tools to compete in the fast paced world. One of the tools utilized by the managers to counter the activities of the human resource management is to utilize the human resource management systems or they may also be called human resource information systems. These systems make a direct link with the human resource management and the information technology, enhancing the competence of the organization. Moreover, their main purpose is to automate the activities handled by the human resource management which in turn boosts the efficiency of the department. FINDINGS: Focusing on the purpose and uses of the human resource information systems, let’s look at the reason why managers want to implement these systems in the first place. There comes a time when your business is generating large profits and there is an immense amount of information that needs to be stored; be it about your employees or about the organization itself, there has to be a database securing this information. To ensure the security of this information along with reduction in paper work, organization of data, reorganization of processes, maintenance of profits and the employees an organization may require a human resource management system. These systems serve various purposes and hence, incorporate a lot of modules. Their main focus is on the employee information. First to mention is the Payroll module which takes a note of the attendance of the employees after which it automatically calculates various taxes that they are supposed to pay and also the deductions if any. This helps to reduce all the paper work and calculations; the only manual work done over here is to enter the attendance of the employees. The Work Time module takes care of the time along with the work efforts that the employees need to put in. This information is eminent in order to keep the costs of the organization low and efficiency high. Thirdly, there is the Benefit Administration module which basically focuses on making the employees involved in the benefit programs. These programs generally include compensation, insurance, retirement benefits and so on and so forth. The next module is known as the Human Resource management module. It helps managers to evaluate and analyze employees through their data provided and also takes care of the training and development of the employees and what skills do they encompass. There have been great advancements in technology and such systems have also been developed which tap relevant applicants and put them in the right database for further evaluation by the managers. Another similar module which focuses only on training is known as the Training module. It keeps a check of the skills, education and what type of learning the employee has and suggests books, CDs and other various platforms which may enhance their learning. A cost check is also kept by them, telling what training may cause what expenditures. The next module, known as the Employee Self-Service module enables the employees to check records of their attendance and also question the records if ever a problem is faced, without having to go directly to the HR personnel. It helps them to perform transactions related to the human resource department and ask questions related to the department. Basically this facilitates the employees to solve their own matter. All of these modules combine together to help the organization as a whole. The human resource unit is benefitted as it improves their decision making capability and aids them in providing their best to their customers/clients. It integrates all information into an Enterprise Resource Planning system which further enhances the capabilities of the organization. It promotes organizational and operational efficiency along with making the managers more intricate about their decisions and strategic planning. These systems can be used to achieve the objectives of the organization as well as establish a competitive advantage. As a lot of time of the HR activities is spent on activities which are transactional in nature, these modules may aid the purpose of those activities and help simplify the work. As mentioned above these modules activate the payroll and benefit activities serving the use of such modules. Also do they take into account the Equal Employment Opportunities by looking at various employees and their qualifications. Thirdly there comes the benefit that the employees gain due to an easy access of all the data. The self service provider module for instance aids the employees to get greater access to the human resource information which in turn reduces HR costs. These systems help to analyze the whole organization, looking at the absenteeism analysis, skills inventories, internal job matching, affirmative action plan, applicant tracking, workforce utilization, training needs assessment and so and so forth all give a clear picture to the HR managers of what the organization needs and what it should do to acquire its targets. HRMS facilitate employees by making data more accessible as no human contact is required which takes up most of the time in understanding the query of the employee. Another important factor is that bulletin boards again enhance the information spread throughout the organization as it is accessible to employees globally. They provide a platform through which data can be transferred electronically between vendors and the employees making the whole process swift and smooth. RECOMMENDATIONS: Looking at various uses and the purpose of the Human Resource Management Systems a few recommendations are as follows: * HRMS systems should also introduce a transparent mechanism through which employees are evaluated against their peers, to get a clear picture as to where they stand in the organization. This may enhance their motivation to do better and increase their ranking to become a more valued asset to the organization as it is visible to everybody. This can be included in the self sufficient module where employees can check each other’s ranking. These systems can also incorporate reports of the competitors; about their pay packages and benefits given so as to compare there’s with them; making the organization never lag behind in satisfying their employees. It should always remain up to date with the current scenarios of their competitors and look at the factors in which they need to improve themselves to motivate employees as compared to their c ompetitors. This information may only be available for the use of the human resource department. Another piece of information which may be generated from these systems is to generate productivity reports of each employee. Notice how much effort and time one employee is putting in and what the results are. The employee with the highest productivity may then be rewarded and based as a bench mark to evaluate other performances. * Certain surveys can be occasionally conducted to check the morale of the employees and seek what is there that is missing from the organizations point to satisfy them. Through online responses these systems can generate reports and infer what common problems employees face. * Also HRMS can hold information as to what other types of jobs would the employees like to do. This can come in handy for situations when managers want to utilize job rotation, job enlargement or job enrichment. This can make them aware that in what other activities a person is good in and how could that be put to use. CONCLUSION: HRMS, along with increasing the efficiency of the organization, also standardize the processes making employees utilize easier and quicker mechanisms. Their use and purpose for an organization is mostly administrative and they fulfill it ideally. It provides an effective framework to utilize and administer the human capital of a company. By the help of IT professionals these systems are generated and transformed from initially being the main frame â€Å"client server† architectures. Overall, as viewed through various insights it can be concluded that much of the work that is done manually is taken over by these systems for better management of processes and a well integrated company is a result of implementing these systems. They allow managers to employ them in such a way that it becomes an â€Å"effortless† job for the managers to keep a track of various activities: focusing on recruitment, employee turnover, problems and so and so forth. A company making use of these systems in the right way has a great chance to prosper.

SCI Case Study

1. Why did Allen’s heart rate and blood pressure fall in this time of emergency (i.e. at a time when you’d expect just the opposite homeostatic response)? Pg. 969 This occurred because Allen’s spinal cord has decreased perfusion due to damage, and a broken vertebral bone. Also, there has been a disruptions of the sympathetic fibers of his autonomic nervous system therefore it can no longer stimulate the heart. Allen likely has spinal shock.2. Upon admission to the hospital, Allen’s breathing was rapid and shallow, can you explain why? Pg. 969 Due to Allen’s fall he likely has an incompetent diaphragm due to injuring a cervical segment. This would alter effect the lower motor neurons and external intercostal muscles. This would cause his chest x-ray to show a decreased lung expansion. This may have caused Allen to have to take rapid shallow breaths to maintain oxygenation. Overall, interruption of spinal innervation to the respiratory muscles would a lso explain his acidotic state.3. Why did Allen lose some sensation to his arms and all sensation from the upper trunk down? This is because Allen’s C5 segment was injured. Therefore, the dorsal column tracts and spinothalamic tracts were altered. This would cause Allen to have lost and decreased sensations.4. Why did Allen have dry skin and a fever upon admission to the hospital? pg. 970 The rationale for the dry skin and fever is that Allen had lack of sympathetic and hypothalamic control. Therefore, his body adapted to the temperature of the environment as wells as attempting to increase extracellular fluid. Overall, spinal shock would result in these symptoms along with decreased sweat production resulting from decreased sympathetic motor neuron stimulation.5. Based on the physical exam findings, which vertebral bone do you think was fractured? Give reasons for your answers? Pg. 969 Based on the physical findings I would say Allen’s fracture occurred at C5. I belie ve this is  where the fracture occurred because Allen had minimal biceps brachial stretch reflex, was able to raise his shoulders and tighten them, and could tighten his biceps.In addition Allen could not raise his arms against gravity, had flaccid lower extremities, and was without triceps or wrist extensor reflexes, and other muscle stretch reflexes were absent. If the fracture was at C4-5 Allen would not be able to shrug his shoulders and if the fracture was at C7 he could extend his flexed arms. Top of FormBottom of Form6. What is the normal pH of blood? Why was Allen’s blood pH below normal? Pg. 970-971. The normal blood pH is between 7.35 and 7.45. Allen’s blood was acidotic due to a decrease in lung expansion and an alteration in the perfusion to his spinal cord. He also has an alteration in spinal innervation to the respiratory muscles including the phrenic nerve that controls the diaphragm. This would further cause Allen to not be able to adequately take in enough oxygen and blow off enough CO2 to adequately have gas exchange, within the alveoli. Respiratory failure.7. What is the primary muscle of respiration? What nerve initiates this muscle? The primary muscle of respiration is the diaphragm. The nerve that initiates this muscle is the phrenic nerve.8. Which spinal neurons to the nerve you named in question #7? Pg. 969. The cervical spinal nerve C3-5 innervate the phrenic nerve. These are the lower motor neurons.9. By four days after the injury, some of Allen’s signs and symptoms had changed. Allen’s arm muscles were still flaccid, yet his leg muscles had become spastic and exhibited exaggerated stretch reflexes. Use your knowledge of motor neural pathways to explain these findings. Pg. 969. Allen is experiencing these signs and symptoms because he is his spinal shock is now resolved. Therefore his lower motor neurons will then be able to fire impulses unlike the upper motor neurons due to the injury being at C5. There fore, due to his cervical injury muscle spasticity, bladder activity, and reflex activity will begin. This is called spastic paralysis.10. Why did Allen suffer from urinary incontinence? Pg. 970. Allen suffered from urinary incontinence because of autonomic dysfunction. Initially autonomic dysfunction causes an areflexic bladder, also known as a neurogenic bladder. This means his bladder had zero ability to contract. Autonomic dysfunction then leads to urinary retention.

Cardiovascular Diseases

Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature). Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses wh ich usually have a rapid onset of symptoms and may resolve within days with or without treatment. A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and cause a heart attack. When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke. Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber cap s which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing. We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovascular Diseases. Patient. co. uk. emis www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue. Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relations discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate d ifferent viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks. On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is presented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B. Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found. The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, blood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking. Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture. Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and their â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factors In this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customers’ groups should avoid practice them. b) Non-modifiable risk factors The factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels. On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing atheroma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high bl ood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor. Any kind of their complication probably will trigger more serious problems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors ev en more, in order to try to decrease the second group of factors (treatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity. And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health. That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and other risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones’ influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation. A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL). High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol reduces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women. But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD. UKLOPITI U ONO GORE Among estrogen’s positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack or stroke. Estrogen’s effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body’s natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can cha nge but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person. Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress. The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a day)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advis e them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-is-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD). CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Disease; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Thei r CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresents individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible. Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or approp riate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions , or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. php How to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of thi s measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids. All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, grain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activity The aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Eze timiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control. The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and Cardiovascular Diseases Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature). Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses wh ich usually have a rapid onset of symptoms and may resolve within days with or without treatment. A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and cause a heart attack. When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke. Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber cap s which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing. We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovascular Diseases. Patient. co. uk. emis www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue. Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relations discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate d ifferent viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks. On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is presented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B. Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found. The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, blood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking. Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture. Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and their â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factors In this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customers’ groups should avoid practice them. b) Non-modifiable risk factors The factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels. On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing atheroma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high bl ood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor. Any kind of their complication probably will trigger more serious problems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors ev en more, in order to try to decrease the second group of factors (treatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity. And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health. That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and other risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones’ influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation. A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL). High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol reduces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women. But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD. UKLOPITI U ONO GORE Among estrogen’s positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack or stroke. Estrogen’s effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body’s natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can cha nge but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person. Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress. The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a day)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advis e them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-is-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD). CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Disease; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Thei r CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresents individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible. Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or approp riate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions , or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. php How to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of thi s measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids. All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, grain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activity The aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Eze timiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control. The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and Cardiovascular Diseases

Intercultural Conflict Resolution in Schools Assignment

Intercultural Conflict Resolution in Schools - Assignment Example Note that for research purposes, the real names of respondents were replaced. Justine: These programs help to establish peace, remove vehemence and create healthy relationships among students. In schools where cultural conflict is low, programs such as the Resolving Conflict Creatively Program (RCCP) have been implemented to help bring an understanding between students of different cultures. Justine: The schools address cultural conflicts by making sure these programs are run and encouraging teachers and parents to respect the diverse cultures within each school system. This starts by learning of the practices in other people’s cultures in order to ensure awareness. For instance, one’s culture may permit interaction of both sexes both in classroom sitting arrangements and the playgrounds while another culture is against this. The awareness by the students will ensure that the activities conducted by the students do not bring conflicts among them. The school should implement policies that respect each culture. They should educate on the harms of intercultural conflicts and penalize those who are intolerant to coexistence. Justine: The beliefs of some cultures lead to intercultural conflicts. This is for instance, in cases where big Korean girls share the same school with smaller Korean girls. According to their beliefs, the bigger girls are allowed to assault the smaller ones in case they believe they do not receive enough respect from them. This leads to conflicts. Justine: Students experience different conflicts in relation to cultural difference. These include socio-economic status conflicts, for instance as seen between Iranians and Soviet Armenians who share same cultural views but the conflict in socio-economic status from back in their communities. Conflicts are also evident in the formation of cliques, the rise of fights, formation of gangs, and even in assigning homework.

Employment law Essay Example | Topics and Well Written Essays - 3000 words - 2

Employment law - Essay Example The emphasis is on the common law tests used to determine employee status. This is a particularly contentious area in the modern labour markets where the lines between the employed and self-employed are increasingly â€Å"blurred†.3 This paper demonstrates that the common law tests developed to determine the employee status is unsatisfactory and why. I. Significance of Determining Employee Status Initially, the courts treated the employee status as one defined around the concept of master and servant. As a result, during the 19th century, the employment relationship was primarily regarded as one of service in which the emphasis was on the servant’s (employee’s) duty to remain loyal and subservient rather than the master’s (employer’s) duty to â€Å"provide continuing employment.†4 In more recent times the word â€Å"worker† continues to gain currency in legislation and regulations suggesting the modernisation of employee status.5 For i nstance, Section 230(3) of the Employment Rights Act 1996 provides that: In this Act ‘worker’ (except in the phrases ‘shop worker’ and ‘betting worker’) means an individual who has entered into or works (or, where the employment has ceased, worked under) – (a) A contract of employment, or (b) Any other contract, whether express or implied and (if it is express) whether oral or in writing, whereby the individual undertakes to do or perform personally any work or services for another party to the contract whose status is not by virtue of the contract that or a client or customer of any profession or business undertaking carried on by the individual.6 In other words, the term worker is used interchangeably with the word employee, reflecting the varying forms of employment that can take place in modern times. For instance the individual who works from home may not be under the kind of control that the workplace employee is, but should not be denied employee status.7 The use of the word worker immediately draws attention to the changing nature of the employee status and carries with it the identification of the significance of the employee in today’s labour market. The employee is no longer a servant, but a source of human capital. In this regard, the common law tests for determining the master servant relationship which necessarily flow from the older notion of master and servant, is no longer compatible with modern notions of the employee/employer relationship. There are essentially four primary reasons justifying a more robust test for determining employee status in more recent times. To begin with, the predominance of the contract of employment as a basis for identifying the employee’s status does not take into account the relative inequality of bargaining power between the employee (the weaker party) and the employer.8 These inequities compromise the extent to which the employee may bargain for and ob tain specific benefits under the contract of employment. The fact is, a self-employed worker will obviously be responsible for its own salary and health and safety at work.9 Secondly, the

US. foreign policy Essay Example | Topics and Well Written Essays - 500 words - 2

US. foreign policy - Essay Example n expert, Gilles Dorronsoro states that the Afghan government is now operating independently and there is a good chance that it can withstand threats from the Taliban after the pullout of American troops. In spite of this optimistic position, it is doubtful that the US can destroy the military power of the Taliban in less than a year. Ex-Taliban leader, Abdul Salam Zaeef states that the Taliban machinery is strong in recruiting more militants and it will not be possible that the US can use military force to exterminate the power of the Taliban in the short run. Observers like Zaeef and NATO have urged the United States to negotiate with the Taliban. This option also comes with issues. It is widely feared that the Taliban might want a compromise that will cause problems for the Afghan government after a US pullout. This possibility is confirmed by Zaeef who goes further to opine that Afghanistan after a US withdrawal will fare better under a strong dictator who will wield enough power to disarm and punish the troublemakers amongst the Taliban. In any negotiation, the Taliban are likely to demand for more control and a more Islamized country. This is dangerous because it can potentially lead them to stir up further power struggles that might destabilize the country. This makes negotiation a less desirable option for the US. Obama however states that America might be prepared to negotiate with the Taliban if they break away from Al Qaeda, renounce violence and prepare to abide by the Afghan constitution. American officials state that some central authorities like the Taliban leadership of Quetta, Pakistan are prepared to abide by these conditions. However, it is doubtful that the radical and younger groups will accept such demands prior to negotiations. The US might need a strong compromise to protect its interest and this entails the elimination of the Al Qaeda threat and the prevention of a possible civil war. For these two ends, America is prepared to