Freakonomics Crime and Abortion Essay

Mohammed 2 egalized abortion would have been 50% more likely than average to live in poverty. † This statistic that researchers discovered reinforced the belief that if a woman did not want to have a child because of personal reasons or because she was not ready and if there was an abortion ban, the child would most likely grow up in a poor household and have a higher risk of engaging in criminal activity once they reached adulthood. It is reasoned that because abortion was legalized twenty years before, an entire generation of children with a higher risk of becoming criminals were not born and that’s why the crime rate dropped. The fallacy that is apparent when attempting to explain a crime drop with an abortion increase is that the two are simply correlated and not necessarily causal. The authors refute that claim by providing evidence that there is a link between abortion and crime. â€Å"Sure enough, the states with the highest abortion rates in the 1970s experienced the greatest crime drops in the 1990s, while states with lower abortion rates experienced smaller crime drops† (4). The evidence regarding state data is pretty compelling especially when put in the framework of post-Roe v. Wade and the generational gap that follows the Supreme Court decision. Although there seems to be a link between abortion and the crime rate, it all comes down to how a person’s own beliefs will influence them to interpret the data. Conclusions can be drawn to support different viewpoints and once the moral implications of abortion are taken into consideration, then it no longer becomes a logical argument. Works Cited Levitt, Steven D. Stephen J. Dubner. Freakonomics. New York, Harper Collins, 2005.

Information About the Magic Mineral Shungite

Information About the Magic Mineral Shungite Shungite is a hard, lightweight, deep black stone with a magic reputation that is well exploited by crystal therapists and the mineral dealers who supply them. Geologists know it as a peculiar form of carbon produced by metamorphism of crude oil. Because it has no detectable molecular structure, shungite belongs among the mineraloids. It represents one of Earths very first oil deposits, from deep in Precambrian time. Where Shungite Comes From The lands around Lake Onega, in the western Russian republic of Karelia, are underlain by rocks of Paleoproterozoic age, approximately 2 billion years old. These include the metamorphosed remains of a great petroleum province, including both the oil shale source rocks and bodies of crude oil that migrated out of the shales. Evidently, once upon a time, there had been a large area of brackish-water lagoons near a chain of volcanoes: the lagoons bred enormous numbers of one-celled algae and the volcanoes produced fresh nutrients for the algae and sediment that quickly buried their remains. (A similar setting is what produced the abundant oil and gas deposits of California during Neogene time.) Later in time, these rocks were subjected to mild heat and pressure that rendered the oil into almost pure carbon- shungite. Properties of Shungite Shungite looks like especially hard asphalt (bitumen), but its classified as a pyrobitumen because it does not melt. It also resembles anthracite coal. My shungite sample has a semimetallic luster, a Mohs hardness of 4, and a well-developed conchoidal fracture. Roasted over a butane lighter, it bursts into splinters and emits a faint tarry odor, but it does not easily burn. There is a lot of misinformation circulating about shungite. It is true that the first natural occurrence of fullerenes was documented in shungite in 1992; however, this material is absent in most shungite and amounts to a few percent in the richest specimens. Shungite has been examined at the highest magnification and found to have only vague and rudimentary molecular structure. It has none of the crystallization of graphite (or, for that matter, of diamond). Uses for Shungite Shungite has long been considered a healthful substance in Russia, where since the 1700s its been used as a water purifier and disinfectant just as we use activated carbon today. This has given rise over the years to a host of overstated and poorly supported claims by mineral and crystal therapists; for a sample just do a search on the word shungite. Its electrical conductivity, typical of graphite and other forms of pure carbon, has led to a popular belief that shungite can counteract the supposed harmful effects of electromagnetic radiation from things like cell phones. A producer of bulk shungite, Carbon-Shungite Ltd., supplies industrial users for more prosaic purposes: steelmaking, water treatment, paint pigments and fillers in plastic and rubber. All of these purposes are substitutes for coke (metallurgical coal) and carbon black. The company also claims benefits in agriculture, which may be related to the intriguing properties of biochar. And it describes the use of shungite in electrically conductive concrete. Where Shungite Gets Its Name Shungite gets its name from the village of Shunga, on the shore of Lake Onega.

The Antacid Rocket Experiment

The Antacid Rocket Experiment If your child has tried the Naked Egg Experiment, he has seen how the chemical reaction between calcium carbonate and vinegar can remove an eggshell. If he’s tried The Exploding Sandwich Bag Experiment, then he knows a little bit about acid-base reactions. Now he can harness that reaction create a flying object in this Antacid Rocket Experiment. With some open space outdoors and a little caution your child can send a homemade rocket into the air by the power of a fizzy reaction. Note: The Antacid Rocket Experiment used to be called the Film Canister Rockets, but with digital cameras taking over the market, it’s become harder and harder to find empty film canisters. If you can film canisters, that’s great, but this experiment recommends you use mini MM tubular containers or clean, empty glue stick containers instead. What Your Child Will Learn (or Practice): Scientific inquiryObserving chemical reactionsThe Scientific Method Materials Needed: Mini MMs tube, a clean used-up glue stick container or a film canisterHeavy paper/card stockTapeMarkersScissorsBaking sodaVinegarTissuesAntacid tablets (Alka-Seltzer or a generic brand)Soda (optional) Tissues are not a necessity for this experiment, but using tissue can help to delay the chemical reaction long enough to give your child some time to get out of the way. Make Baking Soda and Vinegar Rockets Have your child sketch out and decorate a small rocket on a piece of heavy paper. Ask her to cut out the rocket and set it to the side.Help your child cut the â€Å"hinge† holding the cover to the MMs tube so it comes on and off. This will be the bottom of the rocket.Give her another piece of heavy paper and have her roll it around the tube, making sure the bottom of the rocket is easily accessible. Then, have her tape it tightly in place. (She may need to cut the paper to make it fit better).Glue the rocket she drew and cut out to the front of the tube to make the whole thing look more like a real rocket.Move outside to a clear, open area and open the containerFill it one-quarter full with vinegar.Wrap 1 teaspoon of baking soda in small piece of tissue.Warning: You must act quickly in this step! Stuff the folded tissue in the tube, snap it shut and stand it up (with the lid down) on the ground. Move away!Watch the rocket pop right up into the air after the tissue dissolves in the vinegar. Make an Antacid Rocket Use the same rocket from the baking soda and vinegar experiment, making sure to clean it thoroughly first.Take off the cover and put an antacid tablet into the tube. You may have to break it into pieces to get it all to fit. You can use generic antacid tablets but Alka-Seltzer works better than generic brands.Add a teaspoon of water to the tube, snap on the cover and put the rocket - lid down - on the ground.Watch what happens once the water dissolves the antacid tablet. What’s Going On Both rockets are working under the same principle. A baking soda and vinegar mixture and the water and antacid combination create an acid-base chemical reaction that releases carbon dioxide gas. The gas fills the tube and the the air pressure builds to a point where it is too great to be contained. That’s when the lid pops off and the rocket flies up into the air. Extend the Learning Experiment with different types of paper and how much baking soda and vinegar you use. It may help make the rocket fly higher, faster, or even be coordinated to a countdown.Ask your child compare how the different rockets worked. Which worked better?Substitute soda for water in the antacid rocket and see if it works differently.

Urban Politics Research Paper Example | Topics and Well Written Essays - 2750 words

Urban Politics - Research Paper Example Poverty in the United States is seen to vary to a great degree depending on a number of factors; some of these factors include an individual’s education level, age, family living arrangements, area of residence and labor force attachment. Poverty is noted to generally be more highly concentrated in some areas as compared to others. This aspect is clearly demonstrated by the fact that poverty levels are found to be considerably higher in the center of cities as compared to a city’s suburban areas. In addition to this, poverty rates are also found to be about three times as high in the poorest states as compared to the least poor states. Of note is that it is normal for some neighborhoods to be characterized as having a higher concentration of poverty as compared to others. According to Gabe (2015), the incidence of poverty in central city areas is generally found to be considerably higher at 19.1% than that in suburban areas 11.1% within metropolitan areas. As at 2013, nonmetropolitan areas were recorded as having poverty rates averaging about 16.1%. A typical pattern in poverty rates in metropolitan areas is for the poverty rates to generally be highest in the center city areas. These high rates of poverty then proceed to gradually drop off as one moves towards the suburban areas before experiencing a subsequent increase with increasing distance from the core of the metropolitan area. Ever since President Lyndon Johnson first moved to declare a War on Poverty in the United States and the subsequent passage of the 1964 Economic Opportunity Act, the optimism that first surrounded these measures is noted to have rapidly faded over the years. Both the Federal and the State governments have over the years designed and implemented a number of policies designed to help to reducing poverty rates but these have been met with moderate success. The rather unwelcome corollary that has resulted from rural-urban

Why Offenders Abuse Children Assignment Example | Topics and Well Written Essays - 250 words

Why Offenders Abuse Children - Assignment Example Incest abuse should be punished more severely than stranger abuse. This is in part because of the effects of incest on the victim and the biological facts behind incest. Since the offender is usually close to the victim, the victim might experience frequent and greater trauma since the reminder is always close. Incest also leads to lack of trust on family members causing a rift in the family. Incestuous abuse usually last for a long period causing more stress and damage than a stranger case would have done. In most cases, the perpetrators use threats to prevent the victims from disclosing the abuse. This usually adds to the trauma since the victim keeps the traumatic experiences to themselves, which according to therapists does not help a traumatic situation but makes it worse.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Child sexual abuse is a complex issue especially when attempting to determine why adults engage in sexual activities with young children. Although there does not exist a clear or a distinct answer to this question, such acts may be committed under two major grounds that include psychological forces and social structure. With regard to psychological forces, the attacker may be motivated by emotional congruence, blockage or sexual arousal. Emotional congruence incorporates satisfying an emotional need by relating sexually to the child. Sexual arousal takes place when the subject child becomes the source of sexual satisfaction. Additionally, blockage may take place when other alternative sources of sexual gratification are unavailable.

I will tell you later Essay Example | Topics and Well Written Essays - 2500 words

I will tell you later - Essay Example Secondly, the paper will focus on the relationship between food and water security and possible solutions to the security of the two. In the conclusion, there will be focus on the solution to safeguard food and water security in both developed countries and developing countries. Food-Water nexus Water and food are extremely connected; the impact of the quality and proper usage of the two is made necessary by the utilization of water resources and practice of good agricultural methods. Water is very essential in the food industry. In the primary production stage, it is used in irrigation, livestock watering and aquaculture. According to Krittasudthacheewa 3, agriculture consumes about 70% of all surface water supplies whereas domestic and industrial usage takes up the remaining percentage. It also performs a main role in the preparation and processing stage where it is used as a means of transport, as an ingredient for washing, pasteurizing, cooling and steam production. In order to p roduce, process and prepare food, a lot of energy is required. Energy is used in the transportation, treatment and production of food. Water enables the production for hydroelectric power which aids in the food production process by provision of energy. ... Poor agricultural practices have resulted to loss of soil due to run off water and had also caused water logging because of hard pans. The pollution of animal waste and water used in irrigation leads to the pollution of surface and ground water. Irrigation flows carry salts, nutrients and pesticides which contaminate the water sources and alter the eminence of the water. The pollution has negative impact on food production especially since the polluted water is to be reused in future. Utilization of polluted water in the food production chain results in low quality and insufficient agriculture produce. It also impacts on the cost of production that rises due to increased costs in the purchase of the necessary curatives needed for maximum production and protection of the impact of the infected produce. It is therefore necessary to practice good agricultural methods while at the same time regulating water usage. Protection of water sources from pollution and unnecessary use normally re sults in increased productivity. The relationship between water and food production should be well balanced to ensure the continued supply for food and likewise existence of suitable and non-polluted water. The disturbance of one has tremendous impacts on the other. The two depend on each other for maximum productivity which is essential to cater for the ever increasing human needs and wants. Impact of food production and water security Water security is the access to safe water for consumption and sanitation. Food security on the other hand is the availability of safe, sufficient and nutritious food to live a healthy life. Interdependence between water and food is the reason why agriculture is responsible for much water exploitation. During food production,

Self-management of patients with continuing care needs

Self-management of patients with continuing care needs In essence, patient self-management in relation to their health, encompasses a patients ability to handle an illness experience, to cope with undergoing treatment or make suitable lifestyle changes (Mulligan 2009). The concept was introduced to the health field by Kate Lorig who reached conclusions patients health and subsequently health service costs connected to them being an inpatient can be reduced by encouraging self-management (Lorig 2001). These ideas are utilized in the generic long-term conditions model which emphasizes patients are not happy to be in hospital unless it is completely essential (DOH 2010), (Appendix 1). Effective self-management is also widely thought to reduce the likelihood of hospital admission, and many argue patients prefer to be given access to the information necessary to facilitate a respected voice in decision making processes (Gibson et al 2004, Newman et al 2004). Linked to self-management is also the concept of self care described as a requirement for success in controlling many chronic illnesses including diabetes (Berg 2007), and asthma (Cortes 2004). Self care is also described holistically as essential to the well-being of those with chronic illnesses with continuing care needs in nursing homes (Bickerstaff et al 2003), in the community, (Sharkey 2005), in hospital, intermediate, or rehabilitative settings (Singleton 2000, Coleman 2004). Conversely, low self-esteem, low health literacy, and/or deprivation are barriers to utilization of self-management strategies (Williams et al 2011). Those most likely to participate in self-management are young, middle-class females (Coben 2005). Whilst those lacking literacy skills may not manage as well and family care-giving actions differ between ethnic and socio-economic groups (Larsen 2009). People who suffer a disproportionally high prevalence rate for chronic conditions are those with learning disabilities (Presho 2009) and ability to comprehend and enact management regimes might affect the efficacy of education initiatives with this population. The Expert Patient Program, a 6 week, lay-led course teaching self-care, is a prominent initiative expected to be more cost effective than usual care (NSF 2010, Richardson 2007). Although the EPPs effectiveness to enable improvements in patients self management ability regarding physical symptoms has been disputed (Gately 2007). Perhaps this is due to complex combinations of assorted medications, lifestyle adaptations, and bothersome side effects which are implicated as adversely affecting patients perseverance with management plans (Barlow 2002, Touchette 2008). GP business care plans developed in the UK propose introducing courses using self-management handbooks could reduce expenditure on asthma management (Appendix 4). Yet Cortes argues such asthma education programs neglect specific needs of older people identified as price of medication, problems undertaking management plans, poor quality of life, and troubles accessing health care (Cortes 2004). These opinions contradict the development of Lorigs ideas that self-management enables the best quality of life, but since healthcare information has the greatest effects on outcomes when it is goal orientated (Bodenheimer 2002, Barlow 2002, Kralik et al 2004), maybe older peoples self management goals need more attention. Concurrent with increased longevity and lifestyle factors like poor diet, obesity and related chronic disease is predicted to increase greatly in prevalence (Wang 2010, Mulligan 2009, Armstrong 2005, and Keen 2010). Diabetes has well recognized links between weight and illness progression (Patel 2003), and has also recently been blamed for advancing cognitive deterioration through vascular dementia (Luchsinger 2001). Therefore tightening diabetes control in early stages may vastly improve future health as illness limits mobility, and dementia/retinopathy hamper potential to access self-care resources (Sinclair 2000). Notably due to widespread sensitivity over weight, healthcare professionals should be non-judgmental towards patients with chronic conditions, especially considering psychological and psychosocial implications connected to adjustment to an illness, including guilt, fear, stigma, confidence loss, and isolation (Presho 2008). It was observed during a TIDE (Type 1 Diabetes Education) diabetes specialist nurse led session that those with busy manual working lives find it difficult to take time to self-manage by adjusting insulin to activity levels or establishing a routine of carbohydrate counting and insulin adjustment. Others find calculations following the DAFNE (Dose Adjustment for Normal Eating) structure, hard to understand. Several patients who had suffered previous traumatic hypoglycemic episodes felt anxious about reducing insulin intake, and reported differences in advice from GPs, and nurses as well as confusion over new insulin analogues and devices. This indicates understanding patients as unique individuals, timing and convenience of interventions are important. Furthermore providing clear, consistent advice appeared allied to development of positive attitudes towards nurses education interventions. Studies suggest structured education in type 1 diabetes has improved patients maintenance of glucose targets and a reduction in occurrences of hypoglycemia changed peoples attitudes to education (Heller 2009). Also those with greater understanding of and confidence in adjusting insulin appropriate to activity, with less anxiety over following a fixed regime to avoid hypoglycemia achieve top self-management in type 1 diabetes (Whitehead 2008). On a stroke rehabilitation unit, patients with multiple conditions, particularly diabetes, asthma, and Parkinsons had restricted motor function. Yet nurses could provide encouragement for patients to express concerns, to relieve some psychological distress or help empower patients with the required self-confidence to make decisions (Costello 2009). Patients expressed difficulty with waiting for physios to engage in movement improving circulation, but self-administered some medication and carers views and choices underpinned care planning as recommended in Essence of Care benchmarks, via regular carers group meetings (DOH 2010). Chronic disease is the leading cause of death worldwide (Larsen 2005) and literature establishes dependent peoples needs are equality, rehabilitation, and independence. Furthermore security and dignity are important to older peoples mental health (Presho 2008). On a local scale Manchesters operational plan illustrates emergency admissions for asthma is greatest in the North East and prevention is being addressed with annual health checks provision improving recently. Whilst the national continuing care framework commenced in 2007 promises to ensure national equity of access to NHS funding for continuing care (NHS 2010). Significantly Our Health and Wellbeing Today (DOH 2010) suggests national morbidity is greatest from circulatory disease, which is particularly high in lower socioeconomic groups. These groups also have the greatest prevalence of anxiety and depression and have increased likelihood of having chronic conditions such as diabetes, which has led enquiring researchers to suggest depression as a factor that precipitates and perpetuates chronic conditions (Chapman 2005). Socioeconomics is also reported to determine medication adherence in asthmatics (Kaptain 2009). Victim blame might occur if expectations patients follow structured management programs ignore social contexts of illnesses, (Lindsay 2009) so emphasis should be on developing realistic goals. The kings fund review of self-management highlights that patients perceptions of self management differ according to how they receive a diagnosis, and these attitudes can change over time. Differentiation was noted between diagnosis of asthma or diabetes, where it was felt greater clarity existed, than of Parkinsons disease for which diagnosis takes longer (Coben 2005). Disclosing a medical condition could also have implications for patients quality of life, and a study of anecdotes from Parkinsons patients demonstrated those with confidence to disclose their illness subsequently achieved greater measured anxiety reduction (Presho 2008). Notably research shows patients fret significantly about psychological consequences of physical disability (Miller 2006). Concealment could be due to perceived stigma and misconceptions about the disease or depression about associated decline, physical disability and being a burden (Moore Knowles 2006). Alternatively challenges of symptom management such as sleeping problems and fatigue, sexual dysfunction and cognitive impairment might lead to depression (Schrag, Jahanshahi, Quinn, 2001; Schreurs, De Ridder, Bensing, 2000). Similarly emotional responses to asthma can impact upon attitudes towards taking prevention medication which enables control, and alongside non-adherence patient stress increases leading to depression, anxiety or inability to cope (Kaptain 2009). Interventions aimed at managing pre-diabetes and mild asthma, that miss-managed, could contribute to the development of diabetes mellitus and chronic airway disease (Murphy 2007), are well developed and promoted by the charities Diabetes and Asthma UK (Appendix 3). It is especially important to promote good control since poor control negatively impacts on the affected persons quality of life and also their families (NICE 2008). Also individuals reportedly favor self-management because controlling their health affords greater sense of autonomy (Corben 2005). The EPP has incentives of providing greater knowledge about treatment decisions with the underlying expectancy patients have authentic understanding of their own conditions, and greater recognition of patients roles should give them self-confidence to protect future health (DOH 2001). Illness progression might be reduced by lifestyle changes, therefore nurses have a role in promoting patients independence, well-being, and in encouraging active ageing (NMC 2009). In 2005 the Kings fund report highlighted that major challenges to promoting self management were; developing professionals supportive skills, improving services and information available to facilitate patients self-management, and becoming more flexible to fit compatibly around patients other commitments (Rosen 2005). Dorothea Orem created a comprehensive model of nursing which can be applied to individuals to assess level of self-care ability (Appendix 2). Orem conceptualizes nursing as doing for a disabled person with a self-care deficit, or assisting them/family to do for their selves (Orem 2003). Further to this Orem formulated three systems of nursing to apply, of which partially compensatory nursing seems appropriate for stroke patients, whilst a supportive-educative role suits structured education sessions (i.e. TIDE). The effects of an education intervention delivering the DESMOND program (Appendix 5) for patients with type 2 diabetes to newly diagnosed patients over a period of 6 hours measuring cost effectiveness and quality adjusted years are reported by a randomized trial to have positive effects particularly on reducing patients weight and the amount they smoke (Gillett 2010). Issues of self-efficacy and self-management prominent features of the DESMOND that have been found to build patients confidence (Davies 2008, Skinner 2006) are key to developing a sense of well being in rehabilitation (Presho 2008). Nevertheless, concerns nurses might have include doubts about the patients being experts after what is actually a relatively short training period (Lindsay 2009). Moreover, there could be internal conflicts for nurses between applying structural protocols (i.e.) or professional ethics, and accepting a patients wish to continue a harmful behavior or health neglect. Farrell argued in 2004, active teaching on conditions and problem-solving to address medical issues better promotes self-efficacy than passivity (Farrell 2004). Yet it is important patients are equipped with enough knowledge to act as concordant partners and are supported with taking medications (Murphy 2007) (Appendix 7). Involving relatives in demonstrations of using metered dose inhalers is helpful with dependent asthmatic elders because direct patient observation by nurses supervising medication is often impossible once they have returned from hospital, (Schlenk 2004). Ability to encourage self-management requires nurses to listen, and respond to the concerns and preferences of people in their care (NMC Code), as well as sharing in a way people can understand, the information they want or need to know about their health (NMC code). This may include providing written supplementation to verbal information such as education leaflets or management diaries, and allowing adequate time for adjustment and decision making. Patients whose physical function has deteriorated significantly and continues to decline may be in a too highly dependent illness phase to benefit from strategies to return to normal function (Larsen 2009). Cochrane authors conclude evidence showing contracts improve patient adherence to health-promotion in adult asthma studies is limited (Bosch-Capblanch et al 2007), which suggests patients intentions when agreeing to follow advice is unreliable for predicting management outcomes. Patient self-reports are a simpler method of gleaning non-adherence information, are inexpensive, and possible in most settings (Schlenk 2004 cited by Ruppar 2008). Research observes patients with Parkinsons disease using Alexander Technique had a reduction in depression and improved capacity to manage their disability (Clark 2003). The essence of care is about getting to know and value people as individuals, (NMC Guidance for the care of Older People 2009) and nurses can recognize and respect peoples role in their own care. Evidence also suggests motivational interviewing can reduce depressive attitudes towards illness situations and to encourage positive action to improve health outcomes, therefore perhaps GPs and practice nurses should increase these services (Home and Carr 2009). Nurses can arrange social workers to speak to the patient, to engage with their family, find out their needs, compile appropriate packages of care and request doctors provide explanations of the mechanisms causing a stroke in dedicated wards which usually provide speech and language therapy, occupational, and physiotherapy. Dedicated stroke wards are shown by studies to improve outcomes after two years of patients who were independent prior to their stroke vis-à  -vis ADLs without lengthening stay (Glader 2001 and Cochrane Stroke Unit Trialists Collaboration 2007). It can be a stressful time for patients and family having to make continuing care decisions; therefore patients might seek support from others who have been in their situation (Help the Aged 2009). Gathering information allows patients to manage their illness alongside doctors, and sharing plans with friends and family, explaining their importance, can help them to follow them, there are purportedly around 6 million carers in the UK combining caring with paid employment, saving  £57 billion a year in care costs (Campling 2006, Costello 2009). Not every patient has supportive family members so professionals and expert patients, and charities can be significant. Especially interventions tailored to marginalized patients needs such as X-PERT education for type 2 diabetics undertaken in Urdu (Diabetes UK 2009). In critical phases of illness, which may be the point where a patients continuing care needs begin, patients relatives main needs are for information, support and proximity (Henneman 2002). In the case of Parkinsons disease conveying to patients families the hope that there are strategies for managing the condition, particularly in early stages, might reduce fear, negative impact and sense of stigma (Moore Knowles 2006). Managing pain and discomfort is often considered a challenging aspect of caring, and psychological aspects also cause pain. Total illness effects make it important for patients to have supportive family members to listen to them to find out potential causes/remedies (Costello 2009). Practitioners should be sensitive to needs of carers as well as patients, and evidence suggests nurse-led stroke carer sessions, responding to individuals concerns would be helpful (Smith 2004). A study using the stress and coping model (Lazarus and Folkman) to identify a relationship between sleep deprivation and depression in family care-givers found that individuals self-reports underestimated their problems (Carter 2003). People may feel that because they know their relative they are capable of best comprehending and providing for them, and this could lead to guilt about accepting assistance with care (Nolan 2000). Research into respite care suggests family carers expressed needs for information, skills training or education and emotional support (Hanson 2001). To decrease feelings of powerlessness and support independence for those with chronic conditions Larsen proposes five interventions to recommend to carers (Appendix 6) (Larsen 2009). Peak-flow monitoring, allergen avoidance, and the Buteyko method of symptoms control for mild asthma, based on correctly dosing steroids to maintain safe asthma control are found to be effective (McKeown 2003), as are diet, exercise, supplements and anti-diabetic medication as preventative strategies for type 2 diabetes, reducing heart attacks, microvascular disease, and death (Patel 2003). Though some studies suggest effectiveness reduces 1-3 months post intervention (Siminerio 2007). Subsequently insight into self-management adherence remains complex and under-researched, but supports identifying barriers to adherence and taking action to remove these (Touchette 2008). In liberating the NHS the symbiosis of adult social care, carers, and the NHS is recognized and promises are made to improve the convenience of services to patients (DOH 2010). To reiterate, according to the UK governments policy overall evidence suggests self-care results in beneficial outcomes and better service utilization, but this is largely based on primary studies as systematic reviews are reportedly too time consuming (DOH 2005-7). Systematic reviews also indicate clinical benefits for diabetic and hypertensive patients (Jordon and Osborne 2007). Although psychological benefits to patients appear widely well recognized (Lindsay 2009), patient self-determination requires more than medical management, (Greenhalgh 2009). Contrary to commissioners intentions studies show attendance at health services does not necessarily decrease following education sessions, although this may not indicate poor management as it could reflect success of techniques teaching patients confidence to converse with clinicians (Griffiths 2007). Since GPs are also accused of stalling EPP progress, dubious about its efficacy and under referring patients (Jordon Osborne 2007) it follows that nurses might take a key role in involving patients. The basis behind the EPP being best practice are aims to increase patient beliefs in health services efficacy, personal confidence, and ability to self manage (DOH 2010), therefore nurses are following policy implementing programs RCTs suggest achieve these outcomes (DOH 2005-7). Finally research highlights the importance of having clearer, comprehensive, shared definitions of self-management between health disciplines to reduce patient confusion and so professionals collaborate better (Godfrey 2011). References Armstrong, D. (2005) Chronic Illness: Epidemiological or social explosion, Chronic Illness, 1: 26-7 Barlow, J. H., Sturt, J., and Henshaw, H. (2002) Self-management interventions for people with chronic conditions in primary care: arthritis, asthma diabetes: Health Education Journal; Vol 61, issue 4, p 365-78 Barlow, J., Wright, C., Sheasby, J., Turner, A. and Hainsworth, J. (2002) Self-management approaches for people with chronic conditions: a review, Patient Education and Counseling, Vol 48, p 177-87 Berg, G.D., Wadhwa, S. (2007) Health Services outcomes for diabetes disease management program for the elderly: Disease Management; Volume 10, p 226-234 Bickerstaff, K. A., Grasser, C. M., McCabe, B. (2003) How elderly nursing home residents transcend losses of later life: Holistic Nursing Practice; Vol 17; Issue 3, p 159-165 Bodenheimer, T., Lorig, K., Holman, H., Grumbach, K. (2002) Patient Self-management of Chronic Disease in Primary Care: The Journal of the American Medical Association; Vol 288, Issue 19, p 2469-2475 Bosch Capblanch X, Abba K, Prictor M, Garner P (2007) Contracts between patients and healthcare practitioners for improving patients adherence to treatment, prevention and health promotion activities. Cochrane Database of Systematic Reviews (2): Art. No.: CD004808 BTS/SIGN (2008) British Guideline on the Management of Asthma: British Thoracic Society (21.02.11) http://www.britthoracic.org.uk/Portals/0/Clinical%20Information/Asthma/Guidelines/sign101%20revised%20June%2009.pdf Carter, P. (2003) Family Caregivers Sleep Loss and Depression Over Time: Cancer Nursing; Volume 26 Issue 4 p 253-259 Campling, F., and Sharpe, M. (2006) Living with a long-term illness: Oxford University Press Chapman, D. P., Perry, G. S, Strine, T. A., (2005) The Vital Link Between Chronic Disease Depressive Disorders: Preventing Chronic Disease, Public Health research, practice and policy; Volume 2, No 1 Clark, Chambers, C. (2003) Parkinsons disease: Self-Care Measures You Can Take: American Holistic Nurses Guide to Common Chronic Conditions: John Wiley Sons; New Jersey Cochrane (2011) Organised inpatient (stroke unit) care for stroke: Stroke Unit Trialists Collaboration; The Cochrane Database of Systematic Reviews, Issue 3 http://www2.cochrane.org/reviews/en/ab000197.html Corben, S., and Rosen, R. (2005) Self-management for Long-term Conditions, Patients perspectives of the way ahead; The Kings Fund: UK Cortes, T., Lee, A., Boal, J., Mion, L., Butler, A. (2004) Using focus groups to identify asthma self care and education issues for elderly urban-dwelling minority individuals: Journal of Applied Nursing Research; Volume 17, Issue 3, p 207-212 Costello, J. 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(2010) Generic Long Term Conditions Model; (Accessed online 14/02/2011) http://www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_120915 DOH (2005-7) RESEARCH EVIDENCE ON THE EFFECTIVENESS OF SELF CARE SUPPORT http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_081251.pdf DOH. (2010) Self Care Local Business Case Tool User Guide http://selfmanagement.co.uk/self-care-resources (Accessed Online 14/02/2011) DOH. (2010) Making the case for self care education: http://selfmanagement.co.uk/self-care-resources DOH (2001) The expert patient: a new approach to chronic disease management 21st century Gately, A., Rodgers, C., Sanders, A. (2007) Re-thinking the relationship between long term condition self-management education and the utilization of health services: Social science and Medicine; Volume 65, p 934-945 Farrell, K., Wicks, M, Martin, J. C. 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