Importance and factors involved in marital adjustment

Importance and factors involved in marital adjustment According to Alfred Adler (1978), marriage is part of the three tasks (i.e., work, friendship, and love) that the human community sets for every individual. Relationship importance Over the course of life, people learn to establish different relationships, with different values, expectations and commitments. One of those relationships is the marital relationship. For A good marital relationship marital adjustment is essential. Sinha Mukerjee (1990) defines marital adjustment as The state in which there is an overall feeling in husband and wife of happiness and satisfaction with their marriage and with each other. Locke Wallace (1959) defines marital adjustment as: accommodation of husband and wife to each other at a given time According to Spanier and Cole (1976), marital adjustment is a process, the outcome of which is determined by the degree of: a) troublesome marital differences, b) interpersonal tensions and personal anxiety, c) marital satisfaction d) dyadic cohesion, e) consensus on matters of importance to marital functioning. There are a number of factors that define a healthy marital adjustment. Some of these factors are Factors involved in Marital Adjustment: Wife employment and Marital Adjustment: Blumstein and Schwartz (1983) had earlier found that individuals, particularly wives, reported increased levels of self-esteem, self-concept, and self-worth were positively correlated with employment. Previous research on the relationship be- tween wife employment and marital adjust- ment has produced conflicting results: some investigations report a positive relationship between wife employment and marital adjust- ment (Burke Weir, 1976; Hartley, 1978); others suggest a negative relationship (Bean, Curtis, Marcum, 1977; Gover, 1963); other studies show no relationship (Bahr Day, 1978; Blood Wolfe, 1960). Nathawat and Mathur (1993) did a study in India about marital adjustment and subjective well-being in Indian-educated housewives and working women. Their results indicated that working women had better marital adjustment and subjective well-being. Working women reported high scores on general health, life satisfaction and self-esteem measures lower scores on hopelessness, insecurity and anxiety whereas the housewives had lower scores on negative affect than the working women. Trust and marital adjustment: Relationships are composed of trust, and sharing of intimate thoughts and feelings. They are built upon trust and sharing and they get stronger from these things (Finkenauer, Kerkhof, Righetti, Branje, 2009). According to Regan, Kocan, and Whitlock (1998) Trust is one of the most important component of a loving relationship. Also international studies have found trust to be a critical factor in the success of long-term marriages (Roizblatt et al. 1999; Sharlin 1996). In a longitudinal study, Kristina Moeller and Hakan Stattin (2001) report that adolescents with trustful parental relationships experienced greater satisfaction with their partner relationships in midlife. Quality of life and marital adjustment Psychological Factors: Depression stress (psychological well being) Lower psychological well-being is a major risk factor for relationship distress. Higher rates of relationship problems have been consistently linked to persons suffering from severe psychiatric disorders, including depression, substance abuse, and anxiety disorders (Bradbury, 1998). Many studies link marital conflict to depression (Beach, Arias, OLeary, 1987; OLeary and Beach, 1990). Although the authors propose a bidirectional causal relationship between marital conflict and depression, they suggest that marital conflict is typically a more powerful contributing factor to depression. Marital satisfaction appears to be an important factor of psychological well being. Marital distress has been linked with many psychological difficulties especially depression. (KAUSAR ANSARI.. thesis) . Belongingness and Marital Adjustment: According to Baumeister Leary (1995) Belongingness might have multiple and strong effects on emotional patterns and on cognitive processes. Lack of belongingness or attachments is linked to a variety of ill effects on health, adjustment, and well-being. In a close relationship there is a need to belong and if that need isnt fulfilled then problems may occur. One of the universal institutions is marriage which is accepted to satisfy the need for belongingness. Economics and Marital Adjustment Education and income have also been linked to marital satisfaction and marital conflict, with greater levels of education and income predicting greater marital satisfaction and less conflict. Economic stress has a negative effect on marital satisfaction and a positive influence on relationship dissolution (Johnson Booth, 1990). Economic strain is directly linked to increased couple disagreements and has direct impact on marital adjustment (Kinnunen and Feldt, 2004). Many researches haves been conducted on economic factor in relation to marital adjustment e.g Zedlewski (2002) studied economic factor in relation to family well-being , he found that low family income and limited benefits have negative influences on child and family well-being. Voyandoff (1990) studied economic distress and family relations.   Ross Mirowsky (1992) and Yadollahi (2009) studied that employment of spouses  and the sense of control in various types of stressors of marital life. Diener and Diener (2001) investigated that wealth is related to many positive outcomes in life. Gudmunson, Beutler, Israelsen, McCoy Hill (2007) found that financial problems significantly contributed to lower reported marital satisfaction among married couples. In a study in Finland conducted by Kinnunen and Feldt (2004) concluded that husbands unempl oyment is strongly associated with his marital adjustment. Couples with better economic resources are martially adjusted as compared to those who have limited economic resources. Economic hard times increased rate of martial distress.   (Blekesaunes   2008)   Personality and Marital Adjustment In a study by Bouchard, Sabourin, Lussier, Y. (1999) the relationship of various personality traits with marital adjustment was studied. Personality traits studied were neuroticism, extraversion, openness, agreeableness and conscientiousness. The scale used to measure marital adjustment was dyadic adjustment scale. The results showed that women high in agreeableness and openness were more adjusted. Also males that were high on openness and agreeableness were more martially adjusted. Husbands openness was positively related to their wives marital adjustment. Open individuals may tolerate and respect differences in behavior and thought of partner which would reduce the number of conflicts and increase the consensus between spouses. Kim, Martin, and Martin (1989) and Levine and Henessy (1990) found that personality factors differentiated stable from unstable marriages. Stable marriages were more similar in intelligence, protension, radicalism, tender-mindedness, mutual trust, acceptance, enthusiasm, and genuineness. Personality factors that reduce the likelihood of stability and satisfaction have included the lack of warmth and extraversion (Levine Henessy); passive-aggression (Slavik, Carlson, Sperry, 1998); borderline pathologies (Paris Braverman, 1995); bipolar disorders (Peven Schulman, 1998); feelings of insecurity, unfairness, depreciation, and powerlessness (Begin, Sabourin, Lussier, Wright, 1997); disagreeableness, emotional instability, inconsiderateness, and physical abuse (Botwin et al., 1997; Kosek, 1996; Shackelford Buss, 1997); depression (Cohan Bradbury, 1997; Davila Bradbury, 1997; Fals-Stewart, Birchler, Schafer, Lucente, 1994); neuroticism (Karney Bradbury, 1997; Russell Wells, 1994a ; Russell Wells, 1994b); tension, anxiety, worry, and suspicion (Craig Olson, 1995); hostility, defensiveness, and aggression (Heyman, OLeary, Jouriles, 1995; OLeary, Malone, Tyree, 1994; Newton, Kiecolt-Glaser, Glaser, Malarkey, 1995); and negative affectivity leading to negative attributions (Huston Vangelistic, 1991; Karney, Bradbury, Fincham, OSullivan, 1994). Individual personality traits have also been linked to couples relationship functioning for both men and women. Personality traits of neuroticism, anxiety, and emotional instability have been shown to impair relationship functioning and reduce relationship satisfaction (Watson Clark, 1984). Additionally, personality characteristics of agreeableness and expressiveness have been referred to as individual protective factors, which may enhance marital satisfaction (Bradbury, Campbell, Fincham, 1995). Communication and Marital Adjustment: Communication is necessary for human growth and development also it serves as the essential foundation for marital success and is the facilitating process for an enduring marriage that is satisfying (Robinson Blanton, 1993). Communication within relationships is an important factor, if there isnt communication the relationship suffers. The relationship between marital communication and adjustment is a strong one (Murphy Mendelson 2004). Gottman (1995) in his book indicated that communication could be both productive and destructive to relationships as unhappy couples tend to criticize, disagree, complain, put down, and use excuses and sarcasm. Unrewarding communication patterns lead to the development of relationship distress (Markman, 1979). In contrast, happy couples with marital stability and satisfaction are more likely to use active listening skills, agree, approve, assent, use laughter and humor (Fisher, Giblin, Hoopes, 1982) and possess character virtues of self-restraint, courage, and friendship (Fowers Olson, 1986). Gottman (1995) has suggested that satisfied couples maintain a five-to-one ratio of positive to negative exchanges in interactions Gender also plays an important role in couple communication as there are gender differences in verbal and nonverbal communication with men tending to be more dominant in their interactions and women being more submissive (Tannen, 1990). Emmers-Sommer (2004) studied the effect of communication quality and quantity indicators on satisfaction in relationships. A key term in the study was quality time; this refers to focused, uninterrupted time spent with children, partners, friends, and significant others. Another key term used in the study was quantity time; this refers to frequency of communication or contact. For individuals to reach relationship satisfaction they have to examine the quantity and quality of their disclosures with their partners. Emmers-Sommer (2004) found that quality of communication predicts both relationship satisfaction and intimacy. The quantity of communication, however, was not a predictor for relationship satisfaction. Concealment/Non- disclosure and marital adjustment: Disclosure  as a phenomenon was first investigated by Sidney Jourard (1971). The process was originally defined as telling others about the self. Rosenfeld (1979) explained self-disclosure as the personal information of self that is only available from himself and is not available from other sources. Jorgensen Gaudy (1980) defines self disclosure as: A process by which a marriage partner ex- presses feelings, perceptions, fears, and doubts of the inner self to the other partner, allowing relatively private and personal information to surface in the relationship that normally would not be revealed in the course of day-to-day interaction. The word conceal has been originated from the Latin work Concelare , celare means to hide. Merriam Webster defines concealment as  to prevent disclosure or recognition. Concealment is the activity of hiding information and keeping secrets from other people. Larson and Chastain (1990) explained self concealed personal information as firstly, a subset of private personal information, secondly, it is accessible only to the individual and thirdly it is actively kept from the awareness of others. Thus, self-concealment involves the conscious concealment of private information like feelings, thoughts, actions or events that one perceives as highly intimate, distressing or negative. Even though concealment and disclosure seem the same, there is some difference between self-disclosure and self-concealment. According to Larson and Chastain 1990 the act of revealing personal information is self- disclosure whereas the act of concealing personal information is self-concealment. They argued that self-concealment and self-disclosure are two separate and distinct constructs even though they are related. Effects of concealment/non-disclosure on marital adjustment Feelings of Exclusion People usually resent it when they perceive that another person is keeping secrets from them. The general reaction towards concealment is that of exclusion since in that persons view his right to know is being violated. This level or degree of exclusion felt by a person is higher when these persons are in a close and intimate relationship (Finkenauer, Kerkhof, Righetti, Branje, 2009). Marital relationships are composed of trust, and sharing of intimate thoughts and feelings. They are built upon trust and sharing and they get stronger from these things. Therefore the quality of relationship is influenced adversely when there is a perception of concealment from partner. The perception of concealment effects on relationship quality, the person feels rejected or excluded (Finkenauer, Kerkhof, Righetti, Branje, 2009). The exclusion that is communicated by concealment can be assumed to violate almost all features and values commonly associated with close relationships, including trust, caring, honesty, friendship, companionship, unconditional acceptance, and respect (Finkenauer, Kerkhof, Righetti, Branje, 2009). Psychological effects To keep secrets or deliberately conceal information from others seems to be part of normal development. Even though every person has secrets they can sometimes be a burden. There are different types of secrets people keep like having cheated on an exam, having a disease, sexual orientation or having been sexually molested as a child. Most of these secrets involve stigmatizing or negative information that usually involves the secret keepers themselves. People who conceal negative or distressing information of self from others as compared to the ones who do not, are more depressed, anxious, shy and have low self-esteem.(Kelly, Klusas, Weiss Kenny, 2001) Effects of Disclosure on marital adjustment Self-disclosure and liking The earliest work done on the relationship between disclosure and liking was by Jourard (1959) who found a positive association between liking the other person and disclosing to that person in a sample of nursing students and faculty. A number of studies have been done on this relationship and confirmed that we disclose more to people whom we like. (e.g., Certner,1973, Fitzgerald, 1963; Worthy, Gary, Kahn, 1969) and also we tend to like the people who disclose personal information to us (e.g., Archer, Berg, Runge, 1980; Daher Banikiotes, 1976;Taylor, Gould, Brounstein, 1981). Self-Disclosure and psychological well-being Most of the studies done on the relationship between concealment and psychological well-being have shown the same results which are that higher levels of disclosure are associated with psychological wellbeing and lower levels of disclosure are associated with poorer mental health. Disclosing distressing information helps with the psychological well-being and not disclosing leads to poorer mental health. It is thought that disclosing distressing information helps psychological well-being by reducing the stress of keeping the information to oneself (Ichiyama et al 1993; Cramer, 1999; Barry and Mizrahi, 2005; Hook and Andrews, 2005; Kahn et al 2002). Gender differences and concealment: Concealment is behavior that is more common in males. On the other hand previous studies indicate that females are usually more willing to disclose distressing or personal information. Traditionally, discussing personal problems is a behavior that is considered more appropriate for females than for males (Kahn and Hessling, 2001). Among men, asking for help when faced with psychological problems is often perceived as a weakness (Jourard and Lasakow, 1958; West, 1970; Jourard, 1971; Cozby, 1973; Kelly and Achter, 1995; Kahn and Hessling, 2001). Moreover, traditional sex-role stereotypes suggest that females are more skillful in communicating and also are more concerned with issues of intimacy than are men. So an intimate disclosure by a man may be seen as less appropriate than a similar disclosure by a woman (Collins Miller 1994). All in all men who disclose are generally viewed as maladjusted whereas women who do not disclose may be viewed as maladjusted. (Collins Miller 1994). Age and tendencies towards disclosure/ non-concealment and in terms of age it has been found that young people are more likely to disclose than older people. (Jourard, 1971; Hook and Andrews, 2005). Literature Review: Labels such as satisfaction, adjustment, success, happiness, and quality have all been used in describing the quality of marriage (Fincham, Beach, Kemp-Fincham, 1997) Theories on marital adjustment and disclosure Social penetration theory: Many studies have dealt with self disclosure. One main theory that was a framework for the study is Social Penetration Theory (Altman Taylor, 1987). This theory was a model for the study because it looks at self disclosure as both the depth and the breadth. In this study the depth of self disclosure is an important factor when reaching satisfaction in relationships. Altman and Taylor use an onion as a metaphor for relationship development. They suggest that the onion represents the breadth and depth of self disclosures. On the outer layer of the onion individuals have the breadth of disclosures: a broad aspect of a person such as their tastes, worldview, and studies. As individuals go deeper into the onion, they get to the depth of disclosures meaning they get more detail on aspects of an individual. This represents the degree of a persons disclosure. The main route to deep social penetration is through individuals disclosures. The depth of penetration would represent the degree of personal disclosure. Altman and Taylor (1987) suggest the depth of penetration into the onion model is the degree of intimacy. This study examines the depth of penetration, breadth is equally important in relationships. This theory supports the idea that people who have a high level of depth in their disclosure will be more satisfied in romantic relationships. This theory does not examine the amount of self disclosure as it does the depth of self disclosure. Three competing models of marital disclosure and satisfaction Jorgensen Gaudy (1980) gave models for marital disclosure and satisfaction and according to Spanier (1976) marital satisfaction is a sub category of marital adjustment. According to the linear model of marital relationship, there exists a positive, linear relationship between marital disclosure and marital satisfaction. Marital relationship is characterized by factors like intimacy, trust and caring. Marital disclosure positively impacts these factors and therefore presence of these factors in a marital relationship systematically increase the level of marital satisfaction. Therefore, this model suggests that higher the level of marital disclosure greater will be the marital satisfaction and vice versa. The curvilinear model as opposed to the linear model suggests that a satisfying marital relationship exists only with medium levels of self disclosure. When self disclosure falls on the high or low end of the continuum of self disclosure, marital satisfaction will decrease. This means that too lack of self disclosure is not the only factor that results in low marital satisfaction. Extensive self disclosure might be perceived as nagging or too much complaining which might raise negative feelings of hostility in the spouse which in turn will decrease the marital satisfaction. Hence, according to this model moderate levels of self disclosure are characterized as a key factor in achieving high marital satisfaction. John Gottmans (1999) scientifically validated theory of marriage, based on 25 years of longitudinal research, is one of the leading theories in the study of marital satisfaction. Gottmans theory (1999) states that positive interaction and friendship is the key to marital satisfaction and the prediction of marital stability over time. According to Gottman (1999), a ratio of 5:1 positive to negative interactions is necessary for marital stability. Gottman defines marital stability as a satisfying marital relationship that is not disrupted by separation or divorce. He states, The most important finding was that more positive affect was the only variable that predicted both marital stability and happiness (p. 21). In Gottmans theory (1999), there is a process of what he calls sentiment override in couples. He states, Sentiment override can be either positive or negative. Negative sentiment override means that people have a chip on their shoulder. These types of partners are hypervigilant, looking for slights or attacks by their partner. Positive sentiment override means that even negativity by the partner is interpreted as informative rather than as a personal attack (p. 164). Positive sentiment override creates a milieu in which the partners are more tolerant and accepting of each other, while negative sentiment override creates a set of expectations that ones spouse will behave negatively. Similarly, OLeary and Smith (1991) refer to this phenomenon as cognitive attributional correlates of marital satisfaction. These authors state that distressed couples are less likely to objectively interpret positive behaviors from their spouses as positive and more likely to interpret the intent of their spouses statements more negatively than they were meant to be. Compared to non-distressed couples, dissatisfied spouses make attributions that cast their partners behavior in a negative light and these attributions in turn negatively influence marital satisfaction (Bradbury Fincham, 1990). In summary, according to Gottman (1999) as well as OLeary and Smith (1991) it is not what happens in the marriage, but how the partners perceive and define what has happened that is critical. Gottman posits that 69% of couples problems will be what he calls, perpetual problems, meaning largely unresolvable. He has found that in the case of the perpetual problems, it is important for couples to establish a dialogue, as opposed to a solution in these instances. When couples cannot dialogue about these issues, they often become gridlocked, where each partner becomes frustrated and eventually emotionally disengaged. The role of communication therefore plays an important role in marital satisfaction. Studies examining marital satisfaction vary in design, measurement, and outcomes, leading to a number of explanations accounting for marital satisfaction (Gottman, 1999). Perception of concealment has an adverse effect on marital relationships. Some researches have been carried out related to this issue. In a longitudinal study it was studied how perceiving concealment in close relationships influences marital well-being. The research showed that people in marital relationships who perceive their partner to be concealing information from them had poor relationships, mistrust and conflict between them. In the study it was also discussed that people who conceal information also perceive that the other person is concealing information from them. Perceiving concealment may give the other partner the impression that he/she is not desirable or cannot be trusted; it gives the other person the feelings of being excluded. And the feeling of exclusion may result in feelings of separation or estrangement which may result in marital conflict (Finkenauer et al., 2009). Another study conducted in Belgium has investigated disclosure and secrecy in close, long-term relationships. It showed in the study that secrecy contributed a lot to marital dissatisfaction. The study explains how a person who has a secret avoids a difficult topic rather than facing it to avoid conflict, while the other partner perceives the secrecy as a sign of suspicion, which contributes negatively to marital satisfaction. Another point in the study was that people trying to hide something on the way feel that they have to put on a mask for the other person so he/she doesnt get to know their secret; they have to pretend which may lead to less intimacy and closeness. People who felt comfortable with sharing their emotions and were able to talk about matters were more satisfied with their relationship. One of the questionnaires used to test their study was the Larson and Chastains (1990) Self- Concealment Scale (Finkenauer Hazam, 2000). Low expressiveness leads to dissatisfaction in a marital relationship. Miller et al. (2003) argued that expressive people are less likely to suffer decline in marital satisfaction. They found that spouses expressiveness was positively related to their own and partners affectionate behaviors and this affectionate behavior was in turn related with marital satisfaction. Expressiveness is positively associated with peoples perception of their partners responsiveness. Davidson, Balswick Halverson (1983) did a study on the Affective Self-Disclosure and Marital Adjustment. It was based upon 162 married couples. The study explains that the greater is the discrepancy in partners affective self-disclosure, the lesser is the individuals marital adjustment. READ WHOLE PAPER AND WRITE. Sprecher and Hendrick (2004) examined the relationship between self-disclosure and relationship quality and found a positive relationship between disclosure and relationship quality. Self-disclosure is an indicator of satisfaction in romantic relationships. Levesque, Steciuk, and Ledley (2002) studied how self-disclosure relates to the development of personal relationships, relational intimacy, and relationship dissolution. The results showed that perceived intimacy was strongly associated with level of self-disclosure. Self-disclosure was found to be strongly reciprocal. Levesque et al. 2002 found that the level of self-disclosure strongly influences individual differences between disclosers. HANSEN E.J SCHULDT J.W (1984) did a study on marital self-disclosure and marital satisfaction. The sample for the study was on a sample of 50 married couples of mean age 25 years and mean length of marriage was 3.18 years and mean education was 15 years. Scales used for measuring the variables were Jourards self disclosure questionnaire( jourard and Lasakow, 1958) and Spaniers (1976) Dyadic Adjustment Scale. the results of the study showed that wifes disclosure to husband was positively related to husbands marital satisfaction and husbands disclosure to wife was also positively related to husbands marital satisfaction. One predictor that may have particular importance to marital satisfaction is gender roles. According to Kurdek (2005) there are two classes of theories that explain the position about how men and women experience close relationships in different ways. the first class, that is the biological, posits that males and females in a relationship process events differently at the cardiovascular, endocrinological, immunological, neurosensory, and neurophysiological levels. For example Kiecolt-Glaser Newton (2001) in their research reviewed evidence showing that men are more physiologically sensitive to acute stressors than women and women showed stronger and more durable physiological changes than men in marital conflict. The other class that is the class of social psychological theories posits that both genders differ in ways that are directly relevant to relationship functioning like the structure and content of how the self is constructed, personality traits and socialized roles. The other class that is the class of social psychological theories posits that both genders differ in ways that are directly relevant to relationship functioning like the structure and content of how the self is constructed, personality traits and socialized roles. Other research has also substantiated that marriage disproportionately benefits men, with husbands reporting higher levels of marital satisfaction and well-being than their wives (Bird Fremont, 1991; McRae Brody, 1989; Schumm, Webb, Bollman, 1998). Gender is defined as the socially determined role of an individual that is ascribed as a result of his or her sex (Juni Grimm, 1994). Gender roles influence men and women in every aspect of their lives and relationships (Knox Schacht, 2000). Demographic characteristics including age, race, income, education, length of marriage, and religiosity, have been linked to marital satisfaction and marital conflict (Knox Schacht, 2000). Based on Gottmans (1999) research, length of marriage is also a significant predictor for marital satisfaction and marital conflict. He identifies two critical time periods of vulnerability in the marital trajectory, with the majority of couples divorcing within the first seven years of marriage. Couples who divorce within the first seven years of marriage have relationships characterized by having high levels of marital conflict. Conversely, a second vulnerable time period for the marital trajectory is 16 to 24 years of marriage. This is the next most likely time frame for couples to divorce. These relationships are characterized by spending little time together, lack of communication, and a lack of conflict expression. Gottman (1999) refers to these couples as two ships passing in the night.

Full Kinetic Chain Manipulative Therapy on the Knee

Full Kinetic Chain Manipulative Therapy on the Knee The relative effectiveness of full kinetic chain manipulative therapy and full kinetic chain rehabilitation in the treatment of osteoarthritis of the knee. Brief Synopsis of the Research Therefore in this study we aim to establish the effect of the KFC manipulative therapy alone, FKC rehabilitation alone and the combination of the two interventions on osteoarthritis of the knee. This will be done by means of a quantitative randomised comparative clinical trial. 60 patients will have been diagnosed with osteoarthritis of the knee according to the inclusion and exclusion criteria, and will be randomly divided into 3 groups. The first group will receive 6 treatments using FKC manipulative therapy alone, the second will receive 6 treatments using FKC rehabilitation alone, and the third group will receive 6 treatments using FKC manipulative therapy combined with FKC rehabilitation. Subjective (Beck Depression Inventory, McMaster Overall Therapy Effectiveness Tool, Western Ontario and McMaster Universities Osteoarthritis Index and Berg Balance Scale) and objective (Inclinometer) measures will be taken at baseline, 1 week and 1 month follow up. These results will be recorded and the data analysed using SPSS statistical package at a 95% confidence interval. Section B: To be typed in Arial 12-point font in one and half line spacing (expand sections to fit contents, but keep within the specified maximum lengths) 1. Field of Research and Provisional Title The relative effectiveness of full kinetic chain manipulative therapy and rehabilitation in the treatment of osteoarthritis of the knee. 2. Context of the Research 1. Osteoarthritis is a very common condition, affects 9.6% of men and 18% of women aged >60 years worldwide (Woolf and Pfleger, 2003). 2. Although multi-factorial, falls cause nearly two-thirds of all non-intentional injury related deaths in older adults (Hawk et al., 2006). One of the causative factors is loss of hip and knee proprioception secondary to increased joint degeneration, thus by addressing these problems with the rehabilitation and/or adjustment there may be a decreased risk of fall. 3. There is research to suggest that applying manipulative therapy and rehabilitation to the full kinetic chain yields greater benefits for KOA patients than at home rehabilitation alone (Deyle et al., 2005), however this combination of treatments has never been compared against full kinetic chain manipulative therapy alone. 4. KOA stiffness, pain and dysfunction was shown by Deyle et al., (2000) and Deyle et al., (2005) to improve better when adding manipulative therapy to a rehabilitation program as compared to placebo and exercise alone, respectively. 3. Research Problem and Aims Aim: The relative effectiveness of full kinetic chain manipulative therapy and rehabilitation in the treatment of osteoarthritis of the knee. Objectives: i) To determine whether manipulative therapy alone is effective in the short term treatment of KOA in terms of subjective and objective measurements. ii) To determine whether manipulative therapy alone is effective in the intermediate term treatment of KOA in terms of subjective and objective measurements. iii) To determine whether rehabilitation alone is effective in the short term treatment of KOA in terms of subjective and objective measurements. iv) To determine whether rehabilitation alone is effective in the intermediate term treatment of KOA in terms of subjective and objective measurements. v) To determine whether manipulative therapy combined with rehabilitation is effective in the short term treatment of KOA in terms of subjective and objective measurements. vi) To determine whether manipulative therapy combined with rehabilitation is effective in the intermediate term treatment of KOA in terms of subjective and objective measurements. vii) To compare short term results and intermediate results, respectively. viii) To determine whether manipulative therapy combined with rehabilitation is effective in decreasing the risk of fall according to the Berg Balance Scale. ix) To determine whether rehabilitation alone is effective in decreasing the risk of fall according to the Berg Balance Scale. x) To determine which treatment method is more effective in decreasing the risk of fall according to the Berg Balance Scale. 4. Literature review Osteoarthritis is a chronic degenerative disorder with a complex aetiology (Felson, 2000). It is characterized by focal loss of articular cartilage within synovial joints, associated with hypertrophy of bone (osteophytes and subchondral bone sclerosis) and thickening of the capsule, resulting in alterations in biomechanical properties (Woolf and Pfleger, 2003). It is a very common joint disorder, affecting mostly those above the age of 60 and can occur in any joint but is most common in the hip; knee; and the joints of the hand, foot, and spine (Symmons, Mathers and Pfleger, 2003). As many as 40% of people over the age of 65 suffering symptoms associated with knee or hip OA (Zhang et al., 2008), resulting in OA becoming the fourth leading cause of disability in the years 2000 (Symmons, Mathers and Pfleger, 2003). Although no cure exists, a number of treatment options exist to provide symptomatic relief as well as improvement of joint function. Amongst these are non-pharmacological in terventions, such as rehabilitation, manual therapies, acupuncture and electromodalities, as well as pharmacological measures such as oral medication and intra-articular injections. In severe cases, where nonsurgical interventions have failed, more invasive approaches may be needed (Scher and Pillinger, 2007). McCarthy (2004) compared the effectiveness of an at home exercise program on its own or when supplemented with a class-based exercise program. There was found to be a greater improvement in WOMAC score in the class-based exercise group (20.6%) than the at home group (8.8%). These relatively modest effects may be owed to inability of exercise to address a number of factors that prevent patients from maximising results from their exercise program. Fitzgerald (2005) identified quadriceps inhibition or activation failure, obesity, passive knee laxity, knee misalignment, fear or physical activity and self-efficacy as examples of such factors. The necessity for additional interventions to address these factors therefore becomes apparent. Tucker et al. (2003) compared the relative effectiveness of knee joint manipulation versus a non-steroidal anti-inflammatory drug (NSAID), and found manipulation to be just as effective as NSAIDs in the treatment on KOA. Fish et al., (2008) had similar results when comparing the effectiveness of knee joint mobilisation against Topical Capsaicin Cream. Capsaicin has been previously demonstrated superior to placebo in many painful disorders including knee and general osteoarthritis. Pollard, Ward, Hoskins and Hardy (2008) applied a manipulative therapy protocol, consisting of soft tissue mobilisation and an impulse thrust to the symptomatic knee joint complex. This was found to have a statistically significant improvement in knee pain, mobility, crepitus and function when compared to the control group (interferential current set at zero). Pollard et al. (2008) also noted that knee treatment had a significant improvement in hip movement of those in the intervention group compared to the control group. This may be owing to the effect that treatment to a single joint may have on the full kinetic chain (hereafter FKC). A number of studies have been conducted on various joints of the full kinetic chain of the lower extremity to determine their effect on the knee. Cliborne et al., (2004) aimed to determine the short-term effect of hip mobilization on pain and range of motion (ROM) measurement in patient with knee osteoarthritis (OA). It was demonstrated that the presence of hip pain and pain on squatting, restricted hip flexion and/or a positive scouring test predicts a better knee OA outcome. Currier et al., (2007) suggest that pain over the hip, groin or anterior thigh; limitations in passive knee flexion and internal rotation of the hip; as well as pain with hip distraction predicts a favourable short-term response to hip mobilizations. In fact it was found that, based on the presence of one variable, the probability of a successful response was 92% at 48-hour follow-up, which increased to 97% if 2 variables were present. Iverson et al., (2008) suggest that the strongest predictor of whether adjus ting the lumbopelvic spine will decrease knee pain (in patellofemoral pain syndrome) is if there is a side-to-side difference in hip internal rotation greater than 14 °. The presence of this variable increased the likelihood of a successful outcome from 45% to 80%. These studies collectively show that correcting the various dysfunctions within the kinetic chain will have a favourable effect on knee joint dysfunction. However, there has yet to be a study that seeks to improve knee osteoarthritis by treating all indicated joints in the full kinetic chain. Few studies have looked at what effect combining manipulation and rehabilitation would have in the treatment of KOA. Deyle et al., (2000) applied manual therapy to the knee as well as to the lumber spine, hip and ankle as required. Additionally patients where given to knee exercise program to perform in the clinic on treatment days and at home. WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scores are used to detect changes in the patients perception of function and quality of life, specifically related to the disease process. In this study, there was a 55.8% improvement in the treatment group as compared to a 14.6% improvement in those patients receiving placebo (subtherapeutic ultrasound), thus proving the effectiveness of combining manipulation and rehabilitation. Using similar methodologies, Deyle et al., (2005) compared an at home versus in clinic physical therapy program. Those being treated in clinic received supervised exercise, manual therapy to the F KC and a home exercise program, while a second group received at home exercise only. Significant improvements where seen in both groups, however the clinic treatment group had an improvement in WOMAC scores of 52% and only a 26% improvement was seen in the home exercise group. The author attributed this difference between groups to the application of manual therapy to the full kinetic chain. However, the clinic group performed the exercises under supervision and where corrected where necessary while the home group were largely unsupervised and may have performed the exercises incorrectly as a result, thus decreasing the benefit such exercises would have. One should therefore not consider the difference in group performance to be solely due to the addition of manual therapy. To date there is no study which compares the effect of manual therapy alone versus the above mentioned treatment combinations. Therefore there is a need for a study to determine whether FKC manual therapy combined with a standardised rehabilitation program is more effective than either intervention alone in the treatment of osteoarthritis of the knee. 5. Research Methodology Design type: Quantitative comparative clinical trial conducted at the Durban University of Technology Chiropractic Day Clinic (hereafter DUT CDC). Advertising: [Appendix A] Old age homes and retirement villages throughout the greater Durban region will be approached, as well as advertisements placed on notice boards of DUT, community halls, shopping centres and places of worship. Sampling procedure: A sample size of 60 (n=60) will be selected by means of convenience sampling (Brink, 2006). Those individuals responding to the advertisements will be screened and accepted based on the inclusion and exclusion criteria. Telephonic interview: Patients are required to contact the DUT CDC telephonically to determine whether they meet the requirements of the study. This will be determined by asking the patient the following questions; * Are you between the ages of 38 and 80? * Have you had knee pain for longer than 1 year? * Do you have a history of trauma or surgery to the lumbar spine or lower limb? * Are you able to stand and walk on your own, with minimal need and/or without significant dependence on canes and walkers? * Do you suffer from a chronic medical condition that would require you to take regular medication? * Would you be prepared to have radiographs taken of your lower limb? If the patient meets the criteria for the study, a consultation will be made, at which they will be presented with a letter of information and informed consent form [Appendix B], which they will be required to sign. The following inclusion and exclusion criteria will be assess using a case history [Appendix C]; physical exam [Appendix D]; lumbar and pelvis [Appendix E]; hip [Appendix F]; knee[Appendix G] and; ankle and foot [Appendix H] regional examinations. Inclusion Criteria: A. Criteria, as developed by Altman (1991), requires a minimum of one of the first three clinical criteria below (#1, 2 or 3) for diagnosis of KOA (sensitivity 89 % and specificity 88%). 1. Knee pain and crepitus with active motion and morning stiffness ≠¤ 30 min (with age 38 ≠¤ 80 years of age). 2. Knee pain and crepitus with active motion and morning stiffness >30 minutes and bony enlargement (with age 38 ≠¤ 80 years of age). 3. Knee pain and no crepitus and bony enlargement (with age 38 ≠¤ 80 years of age). B. The following 4 criteria are all required: 4. Knee pain of ≠¥ 1 year duration and able to stand and walk without severe varus/valgus deformity and/or severe instability (Kellgren and Lawrence, 1957). 5. Diagnosis of concurrent subluxation/or joint dysfunction (S/JD) complex: a. Diagnosis of S/JD will be supported throughout using the PART(S) system. 6. A patient must have a score of ≠¥720 mm (≠¥30%) on the WOMAC scale to be included (Tubach et al., 2005). 7. No history of meniscal or other knee surgery in the past 6 months (Pollard et al., 2008). 8. A diary will be kept to monitor whether medication consumption is increased, decreased or stays the same. Exclusion Criteria: 1. Significant visual disorders, severe vestibular disorders, neurological and peripheral sensory disorders which may be a contra-indication to exercise 2. History of knee or hip joint replacement, severe varus or valgus deformity, instability, fracture and severe osteoporosis, Rheumatoid arthritis, or frank avascular necrosis with or without moderate or severe deformity, 3. History of significant lumbar herniated disc injury with sequela, 4. Severe balance and proprioception problems (i.e. inability to stand with and/or without marked spinal or hip deformity) 5. Symptoms of moderate to severe osteoarthritis in both knees and/or hips: Note: both knees can be treated if there is KOA or joint dysfunction in the opposite knee and otherwise no other severe complications as noted above. However, only data collected from the worst knee will be used for the purpose of the study. 6. Long term chronicity combined with multiple treatment failure especially multiple failure with previous physical treatment (≠¥ 3), with and/or long term severe pain, and/or a severely complicated or complex disorder (such as multiple co-morbidities combined with KOA such as a mix of: knee, hip and lumbosacral OA, and/or cardiovascular and/or auto-immune disease), or a severely disabled and/or a patient with severe and decreased functional ability and/or a severe clinical depression, may lead on a case by case basis, to exclusion. A basic guide for #6 to be used on a case by case basis: I. Pain: The patient gives a history that can be interpreted as having stayed constantly or chronically at a high level of an estimated verbal analogue score (VAS) of ≠¥ 7 or WOMAC score of 1680-1920mm (70-80%) (out of a maximum worst score of 2400mm) for 3 to 5 years or longer. II. Complicated or complex: 3 or more disorders at one time in the same patient (with KOA) as listed from #1-5 above. III. Severely disabled: dependent on a cane, brace or walker 75 to 100% of the time when ambulating; severe cardiovascular disease; severe instability in the knee or other joints or possibly less than, or markedly less than half the normal ROM. IV. Clinically depressed: determined by history and use the Beck Depression Inventory (BDI). The BDI has been validated for measuring depression in clinical and nonclinical settings (Beck et al., 1961). Radiological analysis: Although diagnosis of KOA will be made primarily through clinical examination, knee x-rays will be taken on patients who qualify and consent to participate in the clinical trial. The purpose is to determine the grade of osteoarthritic change (according to the Kellgren-Lawrence scale (reference)), to confirm suspicions of contra-indications to treatment, or to rule out a pathology outside of OA. Additionally, the subjects history and physical examination may indicate the need for lumbosacral/pelvic, hip, ankle and/or foot x-rays (see exclusion criteria below). Procedure: Time Baseline 2 weeks 4 weeks 6 weeks 1 week F/U 1 month F/U # Rx 2 2 2 Outcome measurement WOMAC ROM BBS BDI WOMAC OTE ROM BBS BDI WOMAC OTE ROM BBS BDI Once accepted into the study, patients will be randomly allocated into 3 (three) groups using a randomised allocation chart (reference). Interventions: Group A will be treated with only manipulative therapy of the FKC. Group B will be treated with only rehabilitation of the FKC. Group C will be treated with manipulative therapy combined with rehabilitation of the FKC. Manipulative therapy: [Appendix I] FKC manipulative therapy (manipulative therapy to the knee, and any indicated axial or appendicular joint dysfunction, such as to the spine, hip, ankle, and foot) for KOA has been hypothesized as superior to localised manipulative therapy (Deyle et al., 2005). Treatment will focus on carefully restoring knee flexion and extension by lesser grades of mobilization as recommended by Deyle et al., (2005) and Fish et al., (2008), and patellar mobilization as per Pollard et al., (2008), along with careful high velocity low amplitude axial elongation of the knee joint as per Fish et al., (2008). Additionally, manipulative therapy will be applied where needed to the full kinetic chain using other diversified techniques, such as HVLA manipulation or mobilization as outlined in Shafer and Faye (1990), and/or Peterson and Bergman (2002). Also, the hip technique, as outlined by Hoeksma et al., (2004) and the use of HVLA knee manipulation methods from Tucker et al., (2005) will also be utilized when indicated. The particular joint dysfunction also known as the subluxation complex or manipulable lesion will be chosen based upon findings in the regional examinations. Rehabilitation: [Appendix J] Rehabilitative therapy will include exercises, focused soft tissue treatment and stretch to the knee and elsewhere along the full kinetic chain where needed based upon functional assessment (Deyle et al., 2005). Also included in rehabilitation will be patient advice, education and home exercise recommendations for managing their KOA. The rehabilitation protocol will be standardised across groups B and C, with minor case by case variations. Intervention frequency: All patient will receive: 6 treatments in the first three (3) weeks (2x treatments/week). Training in a rehabilitation program, to be completed daily. Regular telephonic communication (every 1-2 weeks) following the completion of the 6th treatment. All groups will be required to return to the clinic no more than one (1) week after the 6th treatment and at the one (1) month follow up to have readings taken. Measurement Tools: All data will be collected previsit 1, no more than 1 week after 6th treatment and at 1 month follow up, with the exception of OTE which will not be collected at previsit 1. Subjective data will b obtained by means of; Beck Depression Inventory [Appendix K] The McMaster Overall Therapy Effectiveness (OTE) Tool [Appendix L] will be used to assess patient satisfaction and general improvement. o The OTE is a valid and reliable questionnaire that allows the patient to classify the change in their health status: whether their KOA symptoms, or overall quality of life has improved, remained the same, or worsened since the last visit (Chan et al., 2006) The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [Appendix M] detects change in function and quality of life in patients suffering from KOA using multiple questions with the visual analogy scale (VAS). o The WOMAC is valid and reliable for KOA, and has a long history of being broadly and frequently utilized to assess knee and hip OA, thus allowing comparison to a large number of studies and trials (Bellamy et al., 1988). Berg Balance Scale (BBS) questionnaire [Appendix N] is a predictor of fall risk and will be delivered if the one legged standing test is failed (Hawk et al., 2006)). KOA patients who are +ve for the Berg Balance Scale (BBS) will be monitored as a subgroup (with a + OLST and BBS) at all clinic assessments Objective data will be obtained by means of: Inclinometer [Appendix O] readings for knee flexion and extension only to evaluate the patients range of motion (ROM) (reference). Statistics: The latest version of SPSS will be used to analyse the data. 6. Plan of Research Activities Provide a summarised work plan for each year of the project giving information for each research activity per year, under the following headings: Activity Timeframes (target dates for the duration of the project) 7. Structure of Dissertation / Thesis Chapters 1. Introduction 2. Review of the related literature 3. Subjects and methods 4. Results 5. Discussion 6. Recommendations and conclusions 7. References 8. Potential Outputs  § Provide details on envisaged measurable outputs (e.g. publications, patents, students, etc.);  § Expected national and/or international acclaim for the research and contribution of research outputs to building the knowledge base;  § Exploitability of outputs, e.g. applicability to community development, improved products, processes, services in SA, region and/or continent;  § Expected effects of research results. 9. Key References Brink, H. 2006. Fundamentals of research methodologies for health care professional. 2nd edition. Juta and co. Cape Town. Cliborne, A., Wainner, R., Rhon, D., Judd, C., Fee, T., Matekel, R., and Whiteman, J. 2004. Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test findings, and short-term response to hip mobilization. Journal of Orthopaedic Sports Physical Therapy, November; 34(11): 676-685. Currier, L., Froehlich, P., Carow, S., McAndrew, R., Cliborne, A, Boyles, R., Mansfield, L., and Wainner, R. 2007. Development of a clinical prediction rule to identify patients with knee pain and clinical evidence of knee osteoarthritis who demonstrate a favourable short-term response to hip mobilization. Physical Therapy, September; 87(9): 1106-1119. Deyle, G., Allison, S., Matekel, R., Ryder, M., Stang, J., Gohdes,D., Hutton, J., Henderson, N., and Garber, M. 2005. Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomised Comparison of Supervised Clinical Exercise and Manual Therapy Procedures versus a Home Exercise Program. Physical Therapy, 85(12): 1301-1317. Deyle, G., Henderson, N., Matekel, R., Ryder, M., Garber, M., and Allison, S. 2000. Effectiveness of Manual Physical Therapies and Exercise in Osteoarthritis of the Knee. Annals of Internal Medicine, 132(3): 173-181. Felson, D. 2000.Osteoarthritis: New Insights Part 2: Treatment Approaches. In: National Iinstitute of Health Conference, Annals of Internal Medicine; 133: 726-737. Hawk, C., Hyland, J.K., Rupert, R., Colonvega, M. and Hall, S. 2006. Assessment of balance and risk for falls in a sample of community-dwelling adults aged 65 and older. Chiropractic and Osteopathy, 14(3). Haynes, S. and Gemmell, H. 2007. Topical treatments for osteoarthritis of the knee. Clinical Chiropractic; 10: 126-138. Iverson. C., Sutlive, T., Crowell, M., Morrell, R., Perkins, M., Garber, M., Moore, J., and Wainner, R. 2008. Lumbopelvic manipulation for the treatment of patients with patellofemoral pain syndrome: development of a clinical prediction rule. Journal of Orthopaedic Sports Physical Therapy, June; 38(6): 297-312. McCarthy, C., Mills, P., Pullen, R., Roberts, C., Silman, A., and Oldman, J. 2004. Supplementing a home exercise programme with a class-based exercise programme is more effective than home exercise alone in the treatment of knee osteoarthritis. Rheumatology; 43: 880-886. Pollard, H., Ward, G., Hoskins, W. and Hardy, K. 2008. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. Journal of the Canadian Chiropractic Association, December; 52(4): 229-242. Symmons D, Mathers C, Pfleger B. 2003. Global burden of osteoarthritis in the year 2000 [online]. Geneva: World Health Organization. Available at: URL: http://www3.who.int/whosis/menu.cfm?path=evidence,burden,burden_gbd2000docslanguage=english Tucker, M., Brantingham, J., Myburg, C. 2003. Relative effectiveness of a non-steroidal anti-inflammatory medication (Meloxicam) versus manipulation in the treatment of osteo-arthritis of the knee. European Journal of Chiropractic, 50: 163-183. Woolf, A.D. and Pfleger, B. 2003. Burden of major musculoskeletal conditions. Bulletin of the World Health Organization, 81 (9). Zhang, W., Moskowitz, R. W., Nuki, G., Abramson, S., Altman, R. D., Arden, N., Bierma-Zeinstra, S., Brandt, K. D., Croft, P., Doherty, M., Dougados, M., Hochberg, M., Hunter, D. J., Kwoh, K., Lohmander, L. S. and Tugwell, P. 2008. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage, 16:137-162. Appendix L The McMaster Overall Therapy Effectiveness (OTE) Tool (for general improvement and patient satisfaction) Patient No.â‚ ¬Ã…’â‚ ¬Ã…’â‚ ¬Ã…’â‚ ¬Ã…’ Visit No. Page No. . Overall Treatment Evaluation KOA We would like to find out if there are any changes in the way you have been feeling since treatment started: after 6 treatments, and also at the 1st week and 1st month follow ups. Since treatment started, has there been any change in your ACTIVITY LIMITATION, SYMPTOMS AND/OR FEELINGS related to your knee osteoarthritis? Please indicate if there has been any change by checking ONE of the three boxes below (Better/About the same/Worse): Better About the Same Worse ⇓ ⇓ If you have checked ABOUT THE SAME, ⇓ Please stop here. ⇓ If you have checked the box If you have checked the box BETTER: WORSE: How much BETTER would you say How much WORSE would you say your ACTIVITY LIMITATION, your ACTIVITY LIMITATION, SYMPTOMS AND/OR FEELINGS SYMPTOMS AND/OR FEELINGS have been since treatment started? Have been since treatment started? Please choose ONE of the options Please choose ONE of the options below: below: Almost the same, hardly better at all Almost the same, hardly worse at all A little better A little worse Somewhat better Somewhat worse Moderately better Moderately worse A good deal better A good deal worse A great deal better A great deal worse A very great deal better A very great deal worse Patient No.â‚ ¬Ã…’â‚ ¬Ã…’â‚ ¬Ã…’â‚ ¬Ã…’ Visit No. Page No. . Overall Treatment Effect CHF, continued Answer the following question whether or not you answered BETTER or WORSE and what your response was. Note if you have improved, the change will be important since you likely will be able to carry out your responsibilities with greater ease and comfort compared to before the study. If on the other hand you are worse, then you will have more difficulty carrying out your responsibilities; this will also be important for you as you have more difficulty with your activities. Is this change (BETTER/WORSE) important to you in carrying out your daily activities? Not important Slightly important Somewhat important Moderately important Important Very important Extremely important THANKS FOR YOUR COOPERATION! Description of scales and how they will be assessed: * Pages one and two are graded separately. * Page one is graded on a 15 point scale. Scored from +7 to -7 * If the answer to the first question is Better then you have a + integer * If the answer to the first question is About the Same the score is 0 * If the answer to the first question is Worse then you have a integer * With a + or integer, the answers below the better or worse response are numbered sequentially from top to bottom. Almost the same, hardly better is a 1 and A very great deal better is a 7. * Page two is graded on a 7 point scale. Scored from 1 to 7 * The answers are numbered sequentially from top to bottom. Not important is a 1 and Extremely important is a 7 Later we will dichotomize the scores on page one between scores > 1 (improved) and Appendix M The WOMAC Western Ontario and McMaster Universities osteoarthritis index KNEE OSTEOARTHRITIS Name:_________________________________________________ Date:___/___/______DOB:___/___/_____ In Sections A, B and C questions will be asked in the following format and you should give your answers by putting a straight vertical (up-and-down) mark on the horizontal line. Note: 1. If make a straight vertical (up-and-down) mark on the line, at the left-hand end of the line, i.e. NO PAIN EXTREME PAIN Then you are indicating that you have no pain. Note: 2. If make a straight vertical (up-and-down) mark on the line, at the Right-hand end of the line, i.e. NO PAIN EXTREME PAIN Then you are indicating that you have extreme pain. 3. Please Note: a) that the further to the right-hand end you place your straight vertical (up-and-down) mark on the line, the more pain you are experiencing b) that the further to the left-hand end you place your straight vertical (up-and-down) mark on the line, the less pain you are experiencing c) Please do not place your straight vertical (up-and-down) mark on the line outside the markers. You will be asked to indicate on this type of scale the amount of pain, s

Abortion :: essays research papers

Abortion, which has been legal for over 23 years, is against the Constitution and the Supreme Court case that legalized, it should be overturned. In 1971 a pregnant single woman (Roe) brought a class action suit challenging the constitutionality of the Texas criminal abortion laws, which prohibited having or attempting an abortion except on medical advice for the purpose of saving the mother's life. This lawsuit was labeled Roe v. Wade. The Wade of Roe v. Wade was Henry Wade, one of the attorneys who argued the case for Texas. Roe v. Wade was first argued in the Supreme Court on December 13, 1971. Roe v. Wade was reargued October 11, 1972 and on January 22, 1973 Justice Blackmun delivered the opinion of the Court: "The [Supreme] Court declares the statutes void as vague and overbroadly infringing [the] plaintiff's ninth and fourteenth amendment rights." From then on an average of 4,100 abortions have been legally performed in this country daily. Abortion is defined by a decidedly objective source (the dictionary) as "a fatally premature expulsion of a fetus from the womb" (Webster 2). Abortions are performed in a variety of ways. The procedure depends on how long the woman has been pregnant and where she decides to have the abortion. The most common methods of abortion in the United States are: menstrual extraction, suction curettage, D&E, saline, prostaglandin, and hysterotomy. Menstrual extraction is a form of a suction curettage that doesn't use a curette and is sometimes performed even before a pregnancy test has confirmed pregnancy. A suction curettage is performed from six to 14 weeks after the "mother's" last period. A blunt suction tube is inserted into the uterus, which extracts the baby and the uterus lining. Then a narrow metal loop called a curette is used to scrape the walls of the uterus to make sure that it has been completely emptied. The saline method is used after the sixteenth week. It is an abortion where the baby is poisoned by a salt solution that is injected through the woman's abdomen into the amniotic sac. The baby is delivered, usually with an anesthetic that lessens the woman's pain to that of natural childbirth. Prostaglandin is used during the same timeframe as a saline abortion. Prostaglandin is a hormone that induces labor. In a prostaglandin abortion a synthetic version of the hormone is either injected into the amniotic sac or introduced as a vaginal suppository that causes violent labor and delivery of the baby, which is usually born alive because the drug doesn't kill it in the womb.

Acting and Identity in Sizwe Banzi is Dead and in Death and the Kings

Both "Sizwe Bansi is Dead", (written by Athol Fugard in collaboration with John Kani and Winston Ntshona) and "Death and the King's Horseman" (written by Wole Soyinka) are both set in South Africa, in two important and significant cultural moment for the country. "Swize Bansi is Dead" tells the difficult reality of Africa under apartheid (1950s), analysing the complex issue of identity in that time. The rules of Apartheid meant that people were legally classified into a racial group, mainly Black and White, and separated from each others. This division restricted black people from being able to vote, having medical care, education, or other public services, and if when, in rare cases these were possible, they still were of a lot inferior compared to what white people were entitled to. Not only Black people were thus deprived of their write as human beings, as persons, but what most suggested that they'd lost their identities is that all of them had to have an "identity book". This item, insert them into a system of figures, where each one of them wasn't identified by a name anymore, they were recognised and registered by a number. This is a very important issue of the play, in fact the focal point is to show us how irrelevant the name and the "identity" had become for those people. Is your name your identity? And if not, is it possible to maintain a stable and truthful inside identity when deprived of all signs of uniqueness such as your own name? This theme is very much confronted in Sizwe Bansi is Dead. The main character, Sizwe Bansi is forced into talking a terrible decision. Taking a dead man's identity book, therefore stealing his "official" identity, to be able to get on with his life and keep in contact with his f... ...the characters show how loosing their write to vote and therefore express their opinion, and especially having to carry an identity booklet all the time (just because of the colour of their skin) can generate an inside crisis on one's identity. Is our identity determined by our name? Can we change name and be able to keep a stable identity? This play also raises the issue of being actors, just to survive in the society they lived in. Not being able to show their feelings and their disappointment at any time, obliged them to smile, sing, and fake. These issues are also raised in "Death and the King's Horseman", but more with showing how important and determinant our culture is for our personal identity. Thus, living in an era where this one is changing, because of the rough imposition of a new one, can torn one's personality, making them doubt all of their beliefs.

Mommy why u so young? :: Social Issues, Adolescent Mothers

Adolescent mothers have unique heaths needs compared to older mothers and other female adolescents (Aujoulat et al, 2010; Chablani & Spinney, 2011; Crittenden et al.2009,). Therefore,it is important for community development nurses to consider their specific needs when designing programs. This paper will identify the prevalence of adolescent motherhood in Saint John, New Brunswick and Canada. The challenges and problems that adolescent mothers face, along with the relevant health determinants, will be examined. Finally, local interventions and strategies the literature has identified as successful in improving the health status of adolescent mothers will be examined and critiqued. Target population and epidemiology The target population for this assessment is adolescent mothers aged 15 to 19. For this essay, adolescent mothers are considered to be between the ages of 15 to 19, unless otherwise stated. There were 15,570 live births to adolescent mothers in Canada in 2008. In New Brunswick, there were 488 live births in 2008 (Statistics Canada, 2008). Less than 5% of adolescents who become pregnant opt for adoption in New Brunswick (L.Smith, personal communication, September 21, 2011). The Health Indicators report showed that 28% of New Brunswick teenage pregnancies occurred in the Saint John area in 2009 (Office of the Chief Medical Officer of Health{OCMOH}, 2011). The report also identified the teenage fertility rate in New Brunswick. This rate refers to the number of live births that occur to females aged 15 to 19 per 1,000. In Saint John, the fertility rate for adolescents is 43.7. This number is significantly higher than the national teenage fertility rate of 14 and the provincial fertility rate of 20 (OCMOH). Although Canada’s national fertility rate is less than half of the United States of America’s rate of 41, it is still higher than most European countries including France, which has a rate of eight, and the Netherlands’s rate of four (OCMOH). These statistics show a significant number of adolescent mothers in Saint John, New Brunswick and Canada, proving the need for health care interventions for this target population. Determinants of health To conduct a throughout assessment on the needs of adolescent mothers, it is essential to consider the determinants of health. Common problems this population faces include high drop out rates, depression, social isolation, repeat pregnancies, and less effective parenting skills(source). The determinants of health most likely to impact adolescent mothers include income and education, social support, personal health practices, healthy childhood development, and gender.Unfortunately, the literature mainly focuses on the negative health determinants for this group and neglects to concentrate on positive health determinants or assets.

Lessons Learned and to be learned

Background: Managing Total Technology was the first simulation course I have ever enrolled for. From the very beginning of the course, I knew that it will a very interesting course and indeed, I find it to be a successful, memorable and exciting way of education. Part 1: Honestly speaking I took the simulation very easy in the beginning. But as we move in to week 3, I started to realize that we really need to imply ourselves if we need to do better in the simulation. There are several key learnings that I take from this simulation course, such as; 1. Fundamental Knowledge: First of all, I would say, to do a business or to make a decision, one should seek knowledge regarding that business or position. One should do homework before thinking about playing any role in the business scenario. Seeking fundamental knowledge is the first step. 2. Do not Limit yourself: It is pivotal to know your business environment well and remember, business understanding it is not limited to the area you are responsible for. One should know the overall strategy of the company and the circumstances in which the company is working. The manager, regardless of his/her role in the company should be aware of the challenges company is currently facing in achieving its goals and objectives. 3. Be a Guru: When you are responsible for making decision in one of the area of the company, it is of utmost important that you acquire all the technical and non-technical expertise in that area. Ideally, nobody should be more aware than you in that particular field so that you can make the decision confidently and that people respect your decision and don’t challenge it without knowing the depth of it. 4. Competitve Intelligence is Key Always make well informed decisions. Look for the weaknesses of the competition. Consistently track their performance and their financial situation so that you are well aware in advance if they are in a situation where you can take advantage and consolidate your position in the market place. 5. Be a Visionary You cannot be a successful manager or CEO if you are unable to look in to the futu re and make decision according to the future challenges. You have to keep one eye at the long term objectives of the organization and plan accordingly. Learn from the mistakes and make tactical changes but never alter your long term strategy because you fail in achieving one or two of your short term goals. Part 2: Key Take Aways: A. Strategic Thinking: One of the top learnings from the simulation is the importance of strategic thinking. When we started the simulation, we thought that only one segment, High-Tech, will be good enough to become leader in the overall simulation and it proved wrong. We knew in the middle of the simulation but stuck to our initial strategy which I guess was the right thing to do because eventually High-Tech market is the future. B. Leadership Qualities It sounds like an extension of the first point Strategic Thinking, but it is actually not. I have learned from this simulation that a company is defined by the definition of its CEO. Leadership plays an important role in driving all the areas of business and it requires special capabilities to perform as a leader. Leadership is not about making final decisions it is about making the right decision at the right time. I want to learn how I can be a successful leader in the field of marketing and sales, which is my passion.

Meaning of Life and Thanksgiving Essay

As the first pilgrims arrived at Plymouth Rock and had a feast with the Indians, they shared a moment of thanks together. They gave thanks for all their blessings, thus, creating our lovely day of Thanksgiving. When Thanksgiving is thought of, the first thing that comes to mind is turkey and a plentiful amount of food. Thanksgiving to me, is the time to be together with the ones you care about. Coming together for a day to just be with each other and to catch up is what Thanksgiving means to me. Family should be with each other to share memories and to realize the plentiful amount of blessings they have been given. Thanksgiving is not only a day for gorging on food or falling into a food coma, but talking with each other and just being glad to be with one another. Having family during Thanksgiving is a crucial part in my life. Having all of my relatives in one place for one day to talk and have fun with them makes Thanksgiving extra special for me. It is one of the few days of the year that I get to see everybody. The turkey, yams, cranberry sauce, mashed potatoes is just the icing on the cake. Everybody in my family loves the food. We eat and eat until we can’t eat anymore. My family has a tradition of playing soccer afterwards but that goes only so far due to our full stomachs. My cousins and I play a friendly game of poker, afterwards our failed attempts for soccer, for first dibs on dessert. After a good game of poker, my cousins and I look for ways to entertain ourselves meanwhile the adults talk about their lives and brag about their kids. Society today makes Thanksgiving look like a day just to eat. As society advances the meaning of Thanksgiving deteriorates into a secular holiday. The meaning of Thanksgiving seems obsolete. I truly believe that Thanksgiving should be refreshed in its meaning and should be celebrated with family and love. As people come together to share a special day in our history, this should be a day which people will not take for granted.