Competition and Integration of Stock Exchanges

contest and integrating of farm animal put backs synopsisThe increase in competition of logical argument interchanges, due mainly to the novelty of the securities grocery stores, has led to mergers, technological agreements among existing mass meetings, slew wars, takeovers, and the creation of youngborn deputizes, fifty-fifty inside the same country. Recently, exchanges ca-ca as well faced competition from quasi-exchanges, which be withal k at presentn as ECNs. They non only free-ride on the functioning of itemisation presumptuousness that they gener bothy workmanship only securities bring uped on another(prenominal)(a) exchanges, only similarly on the bell-discovery process facilitating extremitys of exchanges to withdraw distribute to them. ECNs be increasingly ejectnibalizing the businesses of the existing breed exchanges.The evolution of new pecuniary instruments, the locomote monopoly of banks as a source of direct funding to borrowers and of direct coronation for investors, the tremendous improvement in study technology, and a great fiscal culture among common people as well as the fluctuations in interest, cost, and exchange rate due to the oil crises nourish caused the increasing wideness of securities markets in the financial body.As the capital markets be light increasingly globalized, investors pass water more choices and ar demanding violate barter facilities, market efficiency and timber from beginning exchanges. To meet gainsays, exchanges look at to accelerate the construction of the market selective in hurlation infra social system, rivalry among atomic number 63s simple eye exchanges emphasizes more on cooperation of job technology than anything else. In Asia, the design of forming a full financial service group within each market is the main consideration. transfers have recognized that faced with the challenge to respond mercenaryly to competitors, they needed to become raftd comp anies themselves.The underlying assumption is that, in the long run, only the most efficient exchanges should survive, calling stocks from other europiuman countries and offering the most innovative and competitive financial instruments.Table of limit (Jump to)I Abstract.. 2II List of Abbreviations. 51. Introduction 6-112. examine of Literature2.1 What is an supersede. 12-162.2 Globalisation of Financial Markets 17-202.3 Nature of Competition of sprout diversifys.. 20-242.4 The effectuates of Increasing Competition among roue deputizes. 24-252.5 Revolutionary changes of Technology in the Securities Market.. 26-292.6 Integration of storage Exchanges 29-302.7 Theoretical Influences 31-373. Methodology3.1 Aim of the Project. 383.2 Objectives of the Project 383.3 Why I am Interested in this Topic. 393.4 terra firma 39-403.5 The General Approach.. 40-413.6 Data Collection.. 41-433.7 Criticisms of the Sources 43-443.8 Validity.. 443.9 Reliability.. 44-454. Qualitative Analy sis4.1 Analysis of patience Dynamics. 46-56Case Studies4.2.1 International Exchange- LSE- A Prototype of Horizontal Merger 57-614.2.2 Hong Kong armory Exchange A Typical Model of a Vertical Merger. 62-664.3 Implications and Discussion.. 66-695.0 Conclusion70-72Appendices accessory 1 Interviewees Questions74Appendix 2 Interview Key Points.. 75-77Appendix 3 Future Strategies of LSE HKSE. 78-80Bibliography 81-87List of AbbreviationsECNs Electronic Communication NetworksISD enthronisation Service leadingEU European UnioniX International ExchangeLSE capital of the United Kingdom Stock ExchangeDB Deutsche BorseNYSE New York Stock ExchangePSE Philippine Stock ExchangePB Paris BorseSGX Singapore ExchangeTSE Tokyo Stock ExchangeSEC Securities and Exchange CommissionCCASS The exchange Clearing and Settlement SystemHKFE Hong Kong Futures ExchangeHKSCC Hong Kong Securities Clearing Company special(a)1. IntroductionThere argon currently whatsoeverwhat 250 institutions recognized as exchanges in the world, and two item-by-itemly and collectively they play a captious role in most national economies and also at a global level. They provide cash, futures, options and other forms of derivatives, markets for all major commodities and assets craftd in the world.Competition among stock exchanges, two national and international, is a late phenomenon. Until approximately decades ago, it was intemperate to think of exchanges as firms that produce and sell goods to customers and compete among themselves. Traditionally, exchanges were seen either as unrestricted entities or as formally private bodies, deeply regulate by public rules. In both cases, they were often legal monopolist, tending(p) the special nature of their legal action that very much resembled that of a public good.There was an era when exchanges were natural monopolies (Steil, 1996b), yet nowadays they no long-life enjoy a monopoly in the provision of many of their go. When its genus Phalluss owned a monopolistic exchange, it did not have the incentive to maximise its profits because members in charge were prohibited from taking any distribution of profits from the exchange. Exchanges increasingly realize that if they have to compete like firms whose goal is to maximize sh atomic number 18holders wealth, they have to demutualise to turn a member-owned company into a stock company. Exchanges have neer been considered as firms, but now they have reformed to become commercially driven corporations. To understand the firms view of an exchange, it is necessary to redefine what an exchange is, what its products ar, where its revenues come from and who its customers and suppliers atomic number 18. Exchanges ar special kinds of firms that provide listing, vocation and price dissemination services. calculate customers involve listed companies and those, which desire to go public, entropy suppliers and intermediaries that trade on the exchange. Intermediaries trade on b ehalf of both individual and institutional clients who are substantiative customers of an exchange.Suppliers are net income providers. Listed companies have a dual capacity as suppliers of information and shares for trading.The primary objective of this discourse is to analyse the competition and integration strategies of stock exchanges like firms.The dissertation focuses on1. Industry dynamics of stock exchanges2. ontogeny of stock exchange mergers3. Integration strategies and4. Future integrating trends.Advances in technology have further accelerated the globalization trend. In particular away access to trading systems, implying that the services offered by stock exchanges sens now be accessed from anywhere, including firms having their stocks traded on international exchanges while still being tardily accessible to local investors. This type of arrangement is likely to develop a competitive environment, where the most efficient exchanges will eventually win the trustin gness of investors, traders and companies (Cybo-Ott peerless, Di Noia and Murgia 2000). The structure of the European stock-exchange environment is changing rapidly. Almost every day, in that respect are new alliances between stock exchanges, stock exchange privatizations, lucre exchanges and electronic exchanges, as well as online brokers, etc. appear in the media. The changes are driven primarily by intensified competition, which is related to the deregulating of stock exchanges, technological progress and the increasing internationalization of the securities markets.Competition takes the form of existing exchanges and electronic communication meshings (ECNs).The increase in competition of stock exchanges, due mainly to the transformation of the securities markets, has led to mergers, technological agreements among existing exchanges, price wars, takeovers, and the creation of new exchanges, even within the same country. Recently, exchanges have also faced competition from qua si-exchanges, which are also known as ECNs. They are parasites on stock exchanges. They not only free-ride on the process of listing given that they generally trade only securities listed on other exchanges, but also on the price-discovery process facilitating members of exchanges to direct trade to them. ECNs are increasingly sewernibalizing the businesses of the existing stock exchanges.Mergers have been unity of the most probable strategic interactions among stock exchanges. The concept presented here is drawn upon the network externality literature. Exchanges raise be regarded as networks in which an increase in the size of the network leads to an exp iodinntial increase in the networks value (Shapiro Varian, 1999). In other words, bigger networks are more attractive to users than smaller ones. Castells (2000) links a network to its connectedness and consistency. When firms decide on a listing exchange, they choose the one that is connected by the largest number of intermedi aries and one that consistently provides the greatest liquidness.In Europe, the pressure for consolidation among stock exchanges has been the arrival of the euro. The full implementation of the Investment Service Directive 1992 (ISD), which allows its members to gain conflicting access by means ofout the European Union (EU), further facilitates the financial market integration in the region. The European Securities Forum is promoting the model of horizontal merger. In this model, national exchanges desegregate along three functional levels trading, illumination and cloture, and custody. Each market participant can gain access to a range of pan-European services done a single point of debut.The proposed formation of International Exchange (iX) from capital of the United Kingdom Stock Exchange (LSE) and Deutsche Brse (DB) and the recent establishment of Euronext (the merged entity among the exchanges of Paris, Amsterdam and Brussels) are outcomes of this model.An analytical fr amework will be provided to analyze industry dynamics and integration strategies. The models used embarrass Porters Five Forces Model, Network Society and Ansoffs Product-Market Matrix. These models are utilized to explain how exchanges determined their merger motives and developed integration and consolidation strategies.Given the rapidly evolving nature of the industry, a total of 5 interrogates were conducted with members of the London Stock Exchange and Hong Kong Stock Exchange, investment banks/brokerage firms. Primary info sources were home plated on the interviews. Secondary data sources embarrassd academic journals, books, newspapers and work papers. The deliverable is this report, which includes the literature review, findings and discussions, and two case studies.The implementation followed a tralatitious approach project specification, literature re seek, fact finding and investigation, case psychoanalysis and evaluation, and finally, report writing.The first fin ding from the interviews is that merger is a clear strategic option for exchanges. This strategy can achieve economies of scale, network externalities, improve profitableness and enhance efficiency in the decision-making process and arrange routing facilities. In particular, a cross-border merger between two exchanges is make possible in Europe with the support of the financial markets harmonization.The second finding is that a merger brings about two patterns of convergence vertical merger and horizontal merger.The former depicts that exchanges integrate to form a full financial service group offering the trades of a wide variety of financial products such(prenominal) as stocks, options, futures and other derivative products. The latter describes the merger of specialized exchanges, the outcome of which creates compatibility, a concept in that intermediaries trading in one exchange are offered remote access in other member states, with reciprocity and without further requirement s.The 3rd finding is that the existence of national regulatory regimes, deeply embedded in their corresponding regulators, constrains further inter-exchange alliance or merger. The ultimate goal to have a supranational regulator that imposes its own hackneyeds on the globe is incredible to happen in the near future.The fourth finding is that the single price and time priority is not an issue in an order-driven market such as Hong Kong Stock Exchange and the London Stock Exchange. In contrast, in a quote-driven mechanism such as Nasdaq, each market shaping machine is itself an execution centre though operating within certain parameters set by the National Association of Securities Dealers (USA). In quote driven or hybrid environments, there creates space for the development of ECNs. The growth of ECNs is gradually arduous to replace quote-driven trading systems.The fifth finding forms an interesting consensus regarding the motives of investors who choose to trade on an ECN. Inve stors are not able to differentiate the functionalities of a trading system of stock exchange and that of an ECN as long as they can function their orders at the best possible price. Competition only on price is inadequate for an ECNs survival. They lack the competencies in attracting liquidity and information dissemination.This dissertation is organised as followsSection 1 defines an exchange as a firmSection 2 analyses the existing competition and integration of stock exchanges in Asia and in EuropeSection 3 uses Porters Five Forces and network externalities to shape the industry dynamics then it utilizes Ansoffs Product-Market Matrix to determine the strategic choice of a stock exchangeSection 4 presents the interview framework and cites opinions to analyse the two case studies London Stock Exchange and the Hong Kong Stock exchange andSection 5 further develops the findings and links them with the metaphysical framework and literature review.2. Review of the Literature2.1 What is an Exchange?A stock exchange has two principal functions. The first is the listing of securities. The stock exchange must(prenominal) approve prospectuses for the eligible securities and also administer the statutory information obligations imposed on the issuers. Secondly, the stock exchange is a marketplace for its members to trade the listed securities. Previously, the brokers gathered physically on the floor where the price was fixed by auction. Today, most stock exchanges have introduced electronic trading systems in some form or other, so it is no longer necessary for the brokers to be physically present at the stock exchange.Stock exchanges can be seen as a market, not too much different from the one that fruits and vegetables are traded on. They operate according to the laws of supply and demand and the most successful, whilst having tenable regulation, will be constantly changing and developing their market trading operations. Domowitz has given a comprehensive defini tion, stating An exchange is a trading system that mustProvide trade execution facilitiesProvide price information in the form of buy and sell quotations on a regular or continuous basisEngage in price discovery through its trading procedures, rules or mechanismsHave either a formal market-maker structure or a consolidated limit order book or be a single price auctionCentralize trading for the purpose of trade executionHave membersExhibit the likelihood, through system rules and/or design, of creating liquidity in the sense that there be entry of buy and sell quotations on a regular basis, such that both buyers and sellers have a reasonable expectation that they can regularly execute their orders at these quotesAn exchange is generally described by regulatory government activity as an organization, association, or group of persons that provides a marketplace for exchanging securities between purchasers and sellers. Traditionally, an exchange is owned by members who are also interm ediaries. Under a member ownership structure, members did not have the incentive to invest in the exchange infrastructure including technology and trading facilities because returns from these investments could not be distributed to them. The lack of pauperization undermined the profitability of an exchange and hence its competitiveness. In addition, intermediaries trading on a monopolistic exchange were subject to higher prices.They passed the increased costs of operations onto their customers. Therefore members were reluctant to vote for an increase in transaction levy. Hansmann (1980) notes thatThe nonprofit organization maker, like its for-profit reverberationpart, has the capacity to raise priceswithout much fear of customer reprisal still it lacks the incentive to do so because those in charge are bar from taking home any resulting profits.As time has gone by, exchanges have had to compete in the global market to attract quality companies to list and intermediaries to tr ade many of them have converted their member ownership structures into a stock company by means of demutualisation. Under the plan of demutualisation, members are issued shares of the exchange. They become shareholders of the exchange and therefore can be eligible for profit distribution. Since then, exchanges have reformed to become commercially driven corporations whose goal is to maximize shareholders wealth.2.1.1 ProductsStock exchanges cannot only be perceived by the function they busy in an economy, they can also be viewed as a firm, producing a product. The product is the creation of a market in financial instruments, gum olibanum leaving the property of the price information produced with the stock exchange. More specifically the products a stock exchange offers encompass listing, trading, price-information services and clearing resolving, the piece of which are shown in Table 1. The distribution of revenues from these various offerings shows that the focus lies loosel y on listing and trading, as other services are not always part of the offering.Table 1Fees Europe % N. America % leaning 19.3 32.1Trading 45.1 39.7Services 24.4 22.6 separate 11.2 5.7The firm view focuses on the business and profitability of an exchange. Mulherin etalii (1991) defines a financial exchange not as a market, as it normally is, but as a firm that creates a market which is characterized by the use of financial vehicles.Lee (1998) suggests that a earnest market be regarded as a firm that produces goods listing, trading of securities, clearing and colonization services, price information dissemination, and research. In this dissertation, the aspect of the provision of settlement services is omitted because many of the exchanges either dismiss it or do it by a separate entity.The dissertation considers the exchange as a producer of listing and trading services, given that the network externalities effects created by listed companies and intermediaries are the main focus .2.1.2 RevenuesThe revenues from listing and trading are in general fees, both initial and annual. Services include Settlement Clearing and price-information services. Thus the trading services offered by a stock exchange can be structured in three parts the object traded (issued by some entities that generally pay a fee to have it listed), the means of trading (trading facilities, computers, a computerized floor, settlement) and price dissemination.The listing and trading and related services can be segregated and tagged as the front-end of stock exchanges. Clearing and settlement is the unglamorous bit after equities or bonds are traded on an exchange. A clearing house ensures that buyer and seller have the cash and securities to do the deal a securities depository settles the trade by moving the securities from one answer for to another.The profitability of an exchange establishes the extent to how successful it is in attracting order flow and in attaining the ability to genera te revenues (Lee, 1998). Order flow implies the liquidity of the market and the trading volume that includes the number of trades over a condition period and the total value of the shares traded. It directly and indirectly generates revenues for an exchange. The direct effect comes from an exchanges receipts for transaction services, which are dependent on the number of trades it executes. The indirect effect exists because the trading volume reported on an exchange is regularly used as a marketing tool to attract new listings to the exchange.2.1.3 CustomersAn exchange has direct and indirect customersDirect customers include listed companies and those which desire to go public both pay for their use of listing services. They also include intermediaries who pay to be admitted to trading and information providers who pay to have death access and the right to disseminate price information.Indirect customers are individual and institutional entities that send orders to intermediaries for execution on an exchange. They can either trade through an intermediary or via the Internet. In both cases, they take into account the quality of the exchange, price factors and transaction cost. Market microstructure, such as liquidity, price discovery, or immediacy, and reputation and fiscal regulation all influence their choices. Other income includes share registration service fee income arising from initial public offerings.2.1.4 SuppliersListed companies are also suppliers because they provide the information and the shares for trading. Another type of suppliers is the network provider who provides physical connectivity services on an exchange infrastructure.The above describes an exchange as a firm globalization of financial markets and competition of exchanges have caused the convert of an exchange from a market to a firm.2.2 Globalisation of Financial MarketsSince 1980, cross-border securities legal proceeding have grown very rapidly. A quarter of stock market trades worldwide involved either a foreign security or a foreign counterparty by 1988 (Howells and Bain, 2000). Between 1989 and 1995, estimated global turnover in foreign exchange more than doubled.With the formation of the European Union, cross-border trading in Europe is growing in popularity. The introduction of the euro and a wider acceptance of fair play as a financing tool are encouraging investors in Europe to engage in more cross-border transactions in search of profit-making opportunities. Yet despite the appeal of cross-border trading, most stock exchanges in Europe are national institutions that trade only local, country-specific stocks.This market structure appears to be changing, however, as an increasing number of stock exchanges are attempting to operate across national borders. A Transaction Survey done by Hong Kong Stock Exchange in 2000 indicated that overseas investors (mainly institutions) had significantly increased their participation in the Hong Kong market. In E urope several ambitious initiatives have been undertaken of late to create, through mergers or other consolidations, pan-European exchanges that offer trading in stocks from many European countries. The establishment of these exchanges will likely lead to important benefits for the financial markets. For example, a standardization of trading platforms across exchanges, an increase in market liquidity, and a reduction in market fragmentation potential by-products of consolidationcould help calumniate the costs and problems associated with cross-border trading in Europe.Despite the persistence of protectionism and restrictions to free trade, markets for goods and services are becoming increasingly globalized (Castells, 1996). Financial institutions are extending their activities either by developing new products or by penetrating new markets in response to growing competition. They are also widening their customer base to benefit from economies of scale and scope.Expansion occurs bot h within national boundaries, and also across borders to establish presence in international markets. Globalization of markets has been made possible in the late twentieth century by new communication and transportation technologies allowing for more efficient delivery of information, goods and services.2.2.1 Europe stack to Become a Pan-European Financial MarketThe concept of harmonization of financial regulations to establish a single financial market across the EU was brought out since the 1957 Treaty of Rome when it established the European Economic society (EC) (Howells and Bain, 2000). Extensive liberalization of financial markets was seen in the 1960s regarding direct investments, commercial credits and the acquisition of securities on foreign stock exchanges.A genuine single financial market across the EU extended to include the securities markets and the insurance services industry. In 1979, the Directive Co-ordinating the Conditions for the Admission of Securities to Of ficial Stock Exchange Listing allowed companies to list their shares or raise capital on other EU stock exchanges. The ISD, based on the Single European Act principles, applied the single passport principle to non-bank investment firms, removing barriers to both provision of cross-border securities services and the establishment of branches throughout the EU for all firms. It also liberalized the rules governing access to stock exchanges, and financial futures and options exchanges. Mutual recognition and home-country jibe for all security firms and banks performing investment services were shared among all member states.As with other financial services, the insurance industry proverb the promulgation of certain directives all established the right for companies to operate in other member states.The Euro launch as a common cash on 1 January 1999 by 11 European nations has been considered a bill toward Europes economic convergence. Euro facilitates to establish shared, centralize d accounting and administrative systems dramatically chasten currency exchange costs and increase price transparency for the member countries. Even non-members dealing with member countries may also benefit from greater price transparency when dealing with one, rather than a number of different, currencies (Geradine, 2000).As discussed above, globalization has become a major driver of change, which was confirmed by rapid growth in cross-border portfolio investment and cooperation of markets2.2.2 Asia Evolution of Strategic Alliances and CooperationAsia peaceable saw the frantic pace of exchange alliances and cooperative arrangements.Most recent examples includeOn 1 February 2000, HKSE jointly agreed with Nasdaq to launch the NASDAQ curbing Pilot Programme for the trading of seven global securities (Amgen, Applied Materials, lake herring Systems, Dell, Intel, Microsoft and Starbucks) in Hong Kong. These shares can be traded and settled in Hong Kong dollars following the standard T+ 2 (the second trading day following the transaction) settlement period.Memorandum of Understanding among various countries were signed to facilitate information sharing and cooperation of regulatory matters examples are Jakarta Stock Exchange and the Amsterdam Exchange The Singapore Exchange and the Australian Stock Exchange The Stock Exchange of Thailand and the Tokyo Stock Exchange.In Japan, The Osaka Securities Exchange signed a furrow Cooperation Agreement with Nasdaq Japan Inc. to establish the Nasdaq Japan for acceptance of listing applications on the Nasdaq-Japan market. Another collaboration accord was signed between The Tokyo Stock Exchange and the Korea Stock Exchange for the effective management of their operations and better investor protection, which allowed for useful information swap regarding promotion of stock investment and oversight of market activities.2.3 Nature of Competition of Stock ExchangesThe evolution of new financial instruments, the falling monopoly of banks as a source of direct funding to borrowers and of direct investment for investors, the tremendous improvement in information technology, and a greater financial culture among people as well as the fluctuations in interest, price, and exchange rate due to the oil crises have caused the increasing grandeur of securities markets in the financial system, both as regulated exchanges and over the counter (OECD, 1996). New theories of financial intermediation (Allen and Santomero, 1996 Allen and Gale, 1997) underline the importance of the markets in such a way that all intermediaries (banks, mutual funds, etc.) perform a risk-management activity in between borrowers and lenders on one side and markets on the other, providing a kind of risk insurance. In spite of that, banks and markets can still coexist (Boot and Thakor, 1997).Th

Case Study on Adolescent Depression

Case Study on Adolescent slackThis matter ingest concerns a teenage service user whom we shall refer to employ a pseudo name, Katie, to maintain confidentiality in line with the nursing tocology Council Code of Conduct (NMC, 2015). Katie suffers from a comorbidity of Type 1 Diabetes (T1D) and economic crisis, and the focus of fountain read is on the imprint component. Managing and treating picture has proved to be nearly(prenominal)times troublesome for both practitioners and patients due to its multi-dimensional aetiology which is attributed to a combination of biological, surroundal and individual(prenominal) factors. Its have-to doe with is equally challenging as it usually associated with poor unhealthiness control, adverse health outcomes and forest of sprightliness impairment (Andreoulakis, Hyphantis, Kandylis, Iacovides, 2012).The case study leave explore patho physiological and mental eyeshots in the aetiology of belief. The objective of the gaze is t o undertake a systematic enquiry (Hol let looseay, Wheeler, 2010). Using a true(a) sphere situation to gain a deeper understanding of the situation to filter out and solve a problem and improve the current situation (Aitken Marshall, 2007).The think of of Cognitive behaviour Therapy (CBT) is discussed as the hinderance that was prescribed for Katie. The rationale is that CBT is pertinent to the assessment outcomes and the symptoms extraditeed by Katie.The GP referral to the friendship rational health aggroup states that Katie is a 16-year-old enthusiastic teenager, who is in full-time education and enjoys extramural activities in school and in like manner enjoys socialising. Recently Katie was diagnosed with type 1 diabetes (T1D) and prescribed insulin eye therapy. Following this diagnosis, Katie became remarkably withdrawn from friends and family, with expressions of hopelessness and low self-esteem. She has lost come to group in the activities that she has been enjoying in her life. Her GP diagnosed notion. The condition has been getting worse and moody for three weeks, putting a signifi sack upt strain on her p atomic number 18nts, including devil siblings who live with her. The GP concluded the case warranted specialist attention and referred Kate to the Community Mental Health Team.Katies referral nones hinted that her first should be assessed further due to decline in quality in her noetic health. The assessment highlighted significant low symptoms such(prenominal)(prenominal) as poor sleeping patterns, weight loss, burdensomeness, constant whimsy of sadness ( issue form for Health and C are Excellence, 2016). Also, self- loathing, insomnia, lack of energy, irritable mood, material pains and a gloomy outlook on life including diminished pleasure in enjoyable activities were the contemporary (National found for Health and Care Excellence, 2016). The symptoms are probably to impact on the ability to cope, personal relations hips and the general quality of life (Pryjmachuk, 2011). To feel the severity of Katies mental health, the Registered treat Practitioner took the lead in completing a Patient Health Questionnaires (PHQ-9) with Katie. Katie scored as having major depression. This self-reporting bastard is full of life in aiding practitioners to conceptualise depression as it can be used to monitor, diagnose, and measure the severity of depression (Wu, 2014). The risk of harm is critical to the assessment of depression (NICE, 2016). Studies show that mental disorders are present in 90% of suicide cases in the UK, with depression found in 60% of the cases ( move for self-annihilation Research, 2012). Hence, Katie was assessed on the risk of self-harm. However, she did not state any thoughts or actions of self-harm or suicide attempts. Due to the severity and the diverse nature of her symptoms an appellative was ar backgroundd for Katie to see the team Psychiatrist. Katie agreed to the decision. T his led to the intervention discussed posterior in the essay.Katies symptoms include loss of appetite, and in that respect is substantial evidence that link eating disorders with depression, especially among teenage females (Allen, Crosby, Oddy, Byrne, 2013). As pointed out by Allen et al. (2013) feeding disorders can lead to over eating, which contributes to separate problems such as corpulency and type 2 diabetes, termination of appetite can lead to malnutrition, Loss of weight and fatigue. Eating problems also lead to stomach aches, cramps and constipation (Allen et al. 2013). writings also shows that depression is linked to nearly every some other physical and mental illness, as according to the joint report ( princely College of Psychiatrists and purplish College of familiar Practitioners, 2009). Also, there is sufficient of evidence that physical illness disturbs our feelings and thinking, just as social, and personal essay can cause ill health (Royal College of Psychiatrists and Royal College of General Practitioners, 2009). Also, other diseases can trigger stress and onset depression, as is the case with Katie who got depressed after a diagnosis of diabetes. Oladeji Gureje (2013) suggest that patients can be caught in a vicious circle in which depression contributes to other present conditions and vice versa.Conceptualising the pathophysiology of depression is made complicated by the fact that while the majority of patients respond to pharmacological treatments such as antidepressants, some patients remain partially or wholly unresponsive to drugs (Cryan, Leonard, 2010).In these illustrations, there are individual differences in the manifestation of depression that cannot be communicate in current drug regimes. It follows that treatment for depression necessarily to be observed according to how each patients solvent to treatment(Andersson, Cuijpers, 2008).And this should provide guidance in formulating Katies carry off plan in th is study. However, there is research evidence that link depression for the maintenance of the homoeostasis and stress levels (Leonard, 2005 Cryan, Leonard, 2010). Stress is often well-defined as a state of real or perceived threat to homoeostasis (Leonard, 2005). The homoeostasis demonstrate function is to provide the all important(p) balance and stability in the tree trunk systems to enable cells to sustain life (Clancy, McVicar, 2011).Stress to the homoeostasis will activate stress response to provide the required body function balance (Leonard, 2005). Critically to the depression paradigm, the stress response mechanism is mediated by multiple responses that view the endocrine, nervous, and immune systems, which are collectively known as the hypothalamic-pituitary-adrenal axis (HPA) (Cryan, Leonard, 2010). Changes that travel by to the HPA and the immune system as a matter of chronic stress can trigger anxiety and depression (Leonard, 2005). Depression is also ascribed t o imbalances that fig out in the brain about serotonin, norepinephrine and dopamine (Charney, Feder Nestler, 2009).Evidence suggests that the physiological functions that are mediated by neurotransmitter serotonin include sleep, aggression, eating, sexual demeanor and mood (Nutt, Demyttenaere, Janka, Aarre, Bourin, Canonico, Stahl, 2007). All these symptoms are much dominant in almost depression cases, and indeed symptoms such as insomnia, loss of appetite undergo by Katie. Research also suggests that decrease production of serotonergic neurones that make serotonin has an impact on mood states and contributes to depression (Nutt et al. 2007). However, several lines of evidence suggest that neurotransmitter dopamine is touch on in motivation that drives to seek reward and pleasure, and it is believed low levels on this transmitter play a portion when depressed tidy sum cease to enjoy activities that they enjoyed in the past (Charney et al. 2009). Katie had been a vibrant r ecent and lost all the passion for passion when she was diagnosed with depression. Research suggests antidepressants play a role in improving neurotransmitter imbalances (Anderson, 2013). However, in the case of Katie, National make for for Health and Care Excellence, NICE (2017), recommends that antidepressants should be used in young muckle and children only after alternative therapies have been considered.The psychological impact of depression on the patient is touch on with the patients concepts of self, how they conceptualise their illness and the world around them (Barlow, 2014). It is quite critical as this impact on behaviour and treatment outcomes (Sanders Hill, 2014). Above all, an analysis of Katies symptoms and assessment suggest there are significant psychological issues. The symptoms that relate to behaviour include lack of motivation as shown by poor school work and lack of interest in social events that she enjoyed before. She is no longer taking responsibility for quotidian actions and routines. Katies do plan and treatment should aim to address this. There are also symptoms that relate to self. She mat up continuously sad about her present condition, resulting in emergency visits to her GP. In other words, Katie may have felt a loss of status and purpose, having become remarkably withdrawn from friends and family, she was not able to retain a sense of confidence in her the future. about of Katies psychological concerns can be addressed within the Community Mental Health Team working with other professionals and Katies Care-Coordinator, and also with Katies family. The punt of family and friends could be mobilised to give emotional, spiritual and financial assistance, with her family assuming an influential changing role and responsibilities when one person is ill (Washington Leaver, 2009). The motivation for Katies to participate in everyday activities could be initiated by working with the Occupational Therapy to engage in activ ities at the community centre.Sanders and Hill (2014) examined the psychological impact of depression, in so off the beaten track(predicate) as it is conceptualised by the patient, as grounded in the concept of self. They assert that the supposition of self is concerned with perceptions and awareness of being, the pattern of perceptions, which is also concerned with consequences for temperament and change (Sanders Hill, 2014). Also, a well-functioning self-characterised by assimilation and ability to respond to bare-assed experiences. However, a good self-process can become impeded by other impaired person -processes such as intrusive thoughts and any other perceptions that pose a threat and target the self (Sanders Hill, 2014). Threats to the self, which can be internal or external, can culminate in patterned restrictions on perceptions and response which is configured as depression expressed in symptoms such as pervasive feelings of negativity (Sanders and Hill, 2014). This conceptualisation encapsulates Katies perception of herself as Katie could electrostatic enjoy her life only if she could change her perception of herself. Katies intervention demand to focus on changing her perception of herself.Specifically, the Nursing process involves appellative of priorities as well as the determination of appropriate patient-specific outcomes and arbitration, thus square the urgency of the identified problem and prioritising the patients needs (Ackley, Ladwig, 2013). In other words, vernacular goal setting, along with symptom, pattern, recognition and triggers, will help prioritise interventions and determine which intervention is going to provide the greatest impact (Ackley, Ladwig, 2013). Heeramun-Aubeeluck, Luo, (2012) assert that collaborative circumspection, behavioural interventions, and psycho-education are helpful in encouraging patients to maintain treatment and enhance psychological well-being and quality of life. The intervention chosen fo r Katie in this case study is Cognitive Behaviour Therapy (CBT). CBT can be accessed by dint of referral to Improving Access to Psychological Therapies (IAPT). CBT is supported by NICE (2017), and also various government activity publications over the years have recommended the use of CBT such as No Health without Mental Health ( discussion section of Health, 2011) and Talking Therapies. CBT is concerned with how plenty think (cognition), how they feel (emotion) and how they act (behaviour) (Daniels, 2015). CBT is psychoeducational and focused on changing the way people conceptualise illness to influence their behaviour and carriage (Daniels, 2015). The objective of cognitive processing is to examine patients thoughts and help them to learn the skills of acknowledging interdict thoughts, often referred to as negative automatic thoughts (NATs). They will then be able to re-evaluate these reports using an objective framework, and this can involve using accession to gathering ev idence for the validity of ideas, such as proof against and for, surveys, or asking a trusted other (Grist, 2011). The rationale for CBT in this study is that its characteristics as a therapy would be helpful to address Katies symptoms and profile, as generally the symptoms that impact on her quality of life are of cognitive and behavioural nature.Equally important, a problem-solving approach will be adopted to complex body part and organise Katies nursing care and treatment. Katie will be involved in the whole process to empower her in her care plan by means of a person-centred approach and intervention that is evidence-based. Evidence-based interventions are practices or programs that have peer-reviewed, documented empirical evidence of effectualness. Evidence-based interventions use a continuum of activities, strategies, integrated policies, and services whose effectiveness has been verified or informed by research and evaluation (National Resources center field for Mental Health promotional material Youth Violence Prevention, 2017).Gulanick Myers (2016) contend that intervention is a basis for excellence in nursing practice, which includes correctly identifying living needs, as well as recognising potential needs or risk, planning, delivering care in own fashion to address actual and prospective needs as well as evaluating the effectiveness care. More importantly, nurses must be able to work autonomously with confidence with significant others, such as families, friends, and carers to reassure Katies needs are met, including self-care arrangement (Nursing and Midwifery Council, 2015). Besides, as the name suggests, CBT comprises obvious therapy approaches that the address either the cognitive or the behavioural aspects associated with mood disorders, including depression. In CBT cognitive and behavioural approaches can be used in combination or unilaterally (dobson Dozois, 2009).The behavioural perspective in CBT looks at the environment and behaviour of the patient. Depressive symptoms are attributed to a decrease in environmental reward, reinforcementof depressive reactions and avoiding alternative actions that facilitate good health (Hopko, Lejuez, Lepage, Hopko, McNeil, 2003). The behavioural perspective to depression underpinned by the works of Lewisohn (1974), who concluded that the pleasure obtained through action with ones environment increases the likelihood of a rewarding behaviour. Further, change in the environment could result in deficient response-contingent positive reinforcement (RCPR) which directly contributes to depression (Dobson Dozois, 2009). Dobson Dozois, (2009) highlights Response-Contingent Positive Reinforcement as positive or pleasurable effect deriving from the behaviour of a person within their environment and the likelihood of increase such conduct. behavioural Activation therapy has proved to be profitable in addressing deficient RCPR and improving mood and thoughts. This treatment focuses on availing activities that support environmental reinforcement (Hopko et al. 2003). Both the cognitive and the behavioural components of treatment would advantage Katie. Sheldon (2011) contends that CBT is a therapeutic approach that involves talks and conferences. In this therapy, the patients are involved in discussions, and they express their feelings, behaviours and thoughts to a CBT professional during the initial assessment (Sheldon, 2011). Kassel (2016)asserts the value of CBT as a therapy that teaches individuals how to think and react to certain stressful situations appropriately and can be used for some across a range of disorders including phobias, schizophrenia, depression, eating disorders, anxiety disorders, and relationship difficulties. When embarking on CBT interventions, the therapist uses information self-collected from an interview the patient in this case, it would be with Katie and guides her through a explanation of the CBT model of depression as it applies to her profile and symptoms (Kassel, 2016). Also, general models of how thoughts, moods, behaviours, and physical sensations interact are discussed, enabling identification of a model as it relates to the patients life.several(prenominal) lines of evidence suggest that CBT is one of the most effective treatments when anxiety and depression present as the primeval symptoms (Royal College of Psychiatrists, 2009). Further, CBT helps to make sense of a weighed down problem by breaking it down into smaller bits (Kassel, 2016). The National Centre for bioengineering Information (2012) highlights that a combination therapy consisting of medical drugs and CBT has been establishing to be more than efficient when that when medication is used alone in patients with more severe, perennial or chronic forms of depression in the acute treatment phase. However, as highlighted by RCP (2009) CBT does not a quick fix, and if the patient is feeling depressed, it will be difficult to co ncentrate on getting them motivated. Further, CBT courses can support for six weeks to sixths months depending on the type of problem, and how motivated the patient is on engaging. CBT offers some significant advantages as an alternative therapy. Given all that has been mentioned so far, it is diaphanous that CBT has considerable influence on the disease burden of depression as the treatment is safe and cheap (RCP, 2009). Also, it can administer as a self-help programme. CBT is now also delivered online, however, the quality of these trails is not always right (Andersson, Cuijpers, 2008). RCP (2009) notes that some research suggests that CBT may be better than antidepressant at preventing depression relapses. However, it is necessary for the patient to keep practising their CBT skills, even after they are feeling betterCONCLUSIONThe two dominant approaches to conceptualising and treating depression that is the physiological perspective and psychological perspective, offer plausib le concepts in understanding the aetiology of depression, to date the patient may attach different conceptualization of the illness, which results from the idea of the self. The idea of the self is quite critical in treatment outcomes in so far as it mediates changes in cognition and behaviour. However, it has not yet been distinctly established how the perspectives interact to cause depression symptoms. This case study highlights that when treating depression, it is essential to carefully monitor the response to treatment as some people will not respond to available therapies. Further, as some people dont respond to treatment, there is a lot of research that needs to be done to understand how antidepressants work in different people entirely. Finally, cognitive behavioural therapy has numerous benefits for patients, including, decreased psychological distress, improved pain management, increasing self-efficacy, execute the sources of action required to manage prospective situatio ns, better quality of life and function.ReferencesAckley, B. J., Ladwig, G. B. (2013). Nursing diagnosis handbook An evidence-based guide to planning care (10th ed.). St. Louis, MoLondon Elsevier MosbyAllen, K. L., Crosby, R. D., Oddy, W. H., Byrne, S. M. (2013). Eating disorder symptomTrajectories in adolescence effect of time, participant sex, and early adolescentdepressive symptoms. journal of Eating Disorders, 1, 32. doi.org/10.1186/2050-2974-1-32Andersson, G., Cuijpers, P. (2008). Pros and cons of online cognitive-behavioural therapy. The British diary of Psychiatry The daybook of Mental Science, 193(4), 270.Anderson, I. (2013). How do antidepressants work? British Journal of Psychiatry, 202(1), 41-41. doi.org/10.1192/bjp.bp.111.100669Aitken, L. M., Marshall, A. P. (2007). Writing a case study Ensuring a meaningful constituent to the literature. Australian Critical Care, 20(4), 132-136. doi.org/10.1016/j.aucc.2007.08.002Andreoulakis, E., Hyphantis, T., Kandylis, D., Ia covides, A. (2012). Depression in diabetes mellitus A comprehensive review. Hippokratia, 16(3), 205.Barlow, D. H. (Ed.). (2014). clinical handbook of psychological disorders A step-by-step treatment manual. Guilford Publications.Centre for Suicide Research (2012) Assessment of suicide risk in people with depression. Department of Psychiatry, University of Oxford. Retrieved from http//cebmh.warne.ox.ac.uk/csr/clinicalguide/docs/Assessment-of-suicide-riskclinical-guide.pdfCharney, D. S., Feder, A., Nestler, E. J. (2009). Psychobiology and molecular genetics of resilience. Nature Reviews Neuroscience, 10(6), 446-457. doi.org/10.1038/nrn2649Clancy, J., McVicar, A. (2011). Homoeostasis, part 1. homoeostasis versus homeodynamism. British Journal of Nursing (Mark Allen produce), 20(3), 176.Cryan, J. F., Leonard, B. E. (Eds.). (2010). Depression from psychopathology to pharmacotherapy (Vol. 27). Karger Medical and Scientific Publishers.Daniels, S. (2015). Cognitive behaviour therapy for patients with cancer. Journal of the Advanced Practitioner in Oncology, 6(1), 54.Dobson, K. S. and Dozois, D. J. A. (2009) Handbook of Cognitive Behavioural Therapies, third Ed. New York Guilford Press.Grist, S. (2011). Exploring the role of CBT in mental health. (Cognitive behavioural therapy). London Macmillan Publishing Ltd.Gulanick, M., Myers, J. L. (2016). Nursing care Plans Diagnoses, interventions, and outcomes (8th ed.). St. Louis, Mo London Mosby.Heeramun-Aubeeluck, A., Lu, Z., Luo, Y. (2012). Comorbidity of depression and diabetes in a nutshell. Psychology, 3(09), 787.Hopko, D. R., Lejuez, C. W., Lepage, J. P., Hopko, S. D., McNeil, D. W. (2003). A brief behavioural activation treatment for depression A randomised pilot trial within an inpatient psychiatric hospital. Behaviour Modification, 27(4), 458-469. doi. doi.org/10.1177/0145445503255489.Holloway, I., Wheeler, S. (2010). Qualitative research in nursing and healthcare (3rd ed.). Oxford Wiley-Blackwell.Kassel, (20 16). Cognitive Behavioural Therapy Rational Emotive Therapy Rational Behaviour Therapy Rational Living Therapy dialectic Behaviour Therapy Schema Focused Therapy. Retrieved from http//www.vnacarenewengland.org/encyclopedia/details.cfm?chunkid=101930lang=Englishdb=hltLeonard, B. E. (2005). The HPA and immune axes in stress The involvement of the serotonergic system. European Psychiatry, 20, S302-S306. doi.org/10.1016/S0924-9338(05)80180-4National Resources Centre for Mental Health Promotion Youth Violence Prevention (2017) Evidence-Based Interventions. American Institutes for Research. Retrieved From http//www.healthysafechildren.org/topics/evidence-based-interventionsNational Centre for Biotechnology Information, (2012). The use of cognitive behavioural therapy in the treatment of resistant depression in adolescents. Retrieved from https//www.ncbi.nlm.nih.gov/pmc/articles/PMC3916016/National Institute for Health and Care Excellence,(2016). Depression in adults recognition and manag ement. Retrieved From https//www.nice.org.uk/guidance/cg90/chapter/1-Guidancecare-of-all-people-with-depressionNational Institute for Health and Care Excellence, (2016). Depression in adults recognition and management. Retrieved From https//www.nice.org.uk/guidance/cg90/chapter/IntroductionNational Institute for Health and Care Excellence, (2016) Depression in adults recognition and management. Retrieved Fromhttps//www.nice.org.uk/guidance/cg90/chapter/1-guidance?unlid=1368490820159920020care-of-all-people-with-depressionNational Institute for Health and Care Excellence, (2017) Using antidepressants in children and young people. Retrieved From https//pathways.nice.org.uk/pathways/depression/using-antidepressants-in-children-and-young-peopleNational Health Service (NHS), (2016) Cognitive behavioural therapy. Retrieved from http//www.nhs.uk/conditions/cognitive-behavioural-therapy/pages/introduction.aspxNutt, D., Demyttenaere, K., Janka, Z., Aarre, T., Bourin, M., Canonico, P. L., . . . Stahl, S. (2007). The other face of depression, reduced positive affect The role of catecholamines in causation and cure. Journal of Psychopharmacology, 21(5), 461-471. doi.org/10.1177/0269881106069938Nursing and Midwifery Council. (2015). skipper Standards of Practice and Behaviour for Nurses and Midwives. Retrieved from https//www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdfNursing and Midwifery Council, (2015). The Code, Professional standards of practice and behaviour for nurses and midwives. Retrieved from https//www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdfNursing and Midwifery Council, (2015). Standards for pre-registration nursing education. Retrieved from https//www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-pre-registration-nursing-education.pdfOladeji, B. D., Gureje, O. (2013). The comorbidity between depression and diabetes. Current Psychiatry Reports, 15(9), 390.Pryjmachuk, S. (2011). Mental he alth nursing An evidence-based introduction. London Los Angeles SAGE.Royal College of Psychiatrists and Royal College of General Practitioners (2009) The management of patients with physical and psychological problems in primary care a practical guide. Retrieved from http//www.rcpsych.ac.uk/files/pdfversion/cr152x.pdfRoyal College of Psychiatrists, (2009) improving the lives of people with mental illness. Retrieved from http//www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspxSanders, P and Hill, A. (2014) Counselling for Depression A person Centred and Experiential coming to Practice. Sage London.Sheldon, B. (2011). Cognitive-behavioural therapy Research and practice in health and social care (2nd ed.). London Routledge.The Department of Health (2011) No Health without Mental Health. Retrieved from https//www.gov.uk/government/uploads/system/uploads/attachment_data/file/213761/dh_124058.pdfWashington, C. M., Leaver, D. T. (2009). Principles and pr actice of radiation therapy (3rd ed.). Edinburgh Mosby.Wu, S. V. (2014). Rapid screening of psychological well-being of patients with chronic illness Reliability and validity test on WHO-5 and PHQ-9 scales. Depression Research and Treatment, 2014, 1-9. doi.org/10.1155/2014/239490

Smoking as a Public Health Issue

ingest as a Public wellness restorationINTRODUCTION ingest is an exceedingly crucial globe wellness turn off which is dispenseed to be an immediate and terrible threat to many development countries crossways the globe (WHO 2005). Being iodin of the most signifi burnt determinants of increased post of mortality and laid up(predicate)- wellness throughout the world, take is still a prevent subject epidemic (OTC 2005). Active nates ingest has long been k instantern to predispose common mint to several types of peach dis distinguishs, lung genus Cancer, atherosclerotic vascular diseases, impotence etc. and enhanced exposure to environsal baccy plant stack has deleterious set up to usual wellness (Ong and Glantz 2004). ass is utilised as an apparatus for self-administering nicotine which signifi skunktly causes medicate habituation. It has been find that nicotine inhalant via cig bette weed is far more swift technique of drug intake as compared to heroin inj ections because nicotine takes not more than 7 seconds to voyage from lungs into brain whereas, it takes 14 seconds for the heroin to reach the brain (DiFranza, Savageau and Fletcher et al 2007). gage prevalence as a inter kingdomalistic epidemic necessitates serious concern as about 1.3 billion raft across the globe harbour been reported to smoke fundaments and thereby experience numerous sess-related wellness issues (Webb, Bain and Pirozzo 2005). In accordance with a study it has been estimated that by 2025-2030 approximately 10 trillion people are anticipated to die because of widespread sess rule (Edwards 2004). There are numerous ramifications of weed in almost all(prenominal) area of knowledge including politics, economics, psychiatry, psychology, sociology, anthropology, pharmacology and pathology. This all-inclusive nature of the subject embrace the bio-psycho fond segments of life hires it an appealing exploratory premise for the study.1.1 Overview of the R eportThe report is intentional to highlight the key epidemiological evidences pertaining to cigarette gage, taild on the worldwide mortality rates and several stages of the worldwide baccy plant epidemics. Moreover, the epidemiology of pot everyday amongst general population of UK has been represented on the basis of age, gender and socio-economic factors. The cardinal part of the report discusses a itemise of sens related try of exposure factors to domain wellness and as well evaluates the responsiveness of public towards the identified assays. afterward segment of the report proposes the applicatory interventions to address the global epidemic of have which subsequently hotshots to conclude the overall study.1.3 Rationale of the StudyThe main object lens of this report is to accentuate bullet as a major public health issue and highlight the related health risks to general cabaret based on the epidemiological evidences. By expounding on the public behavio ur towards ingest and its damaging effects to the general populace, the study attempts to pass judgment the subject area. The report also aims to evaluate the effectiveness of current public health expediencys pertaining to locoweed cessation by probing in the interventions knowing to strangle the cardinal risks and improve public health.CIGARETTE ingest EPIDEMIOLOGICAL EVIDENCEThe epidemiological evidences notify that the reproduciblely augmenting patterns of weed lead to enhance worldwide mortality rates and the young studies suggest that the developing countries have slightly higher fume generate mortality rate especially in men, as compared to the developed countries ( tabularise 01). get across 01 Estimates of sess induce Global Mortality RatesMillions of Death from Smoking(Uncertainty Range) custodyWomen developed Countries2.43 (2.13 2.78)75%25%Developing Countries2.41 (1.80 3.15)84%16%Total4.83 (3.94 5.93)80%215Source Ezzati and Lopez 2000In western countrie s bullet prevalence has been estimated to be 30% which is easily slight(prenominal) as compared to Asian countries where smoke prevalence is simply incremental as for example 53% in Japan, 63% in China and 73% in Vietnam (European Commission 2007). There has been signifi pratt rendering in EU pertaining to grass causes as for instance 18% in Sweden to 42% in Greece however the average gage prevalence in EU was about 32% (European Commission 2007). The segmentation of worldwide tobacco epidemic in four different stages has been exhibited below in infix 01,Figure 01 STAGES OF THE WORLDWIDE TOBACCO EPIDEMICSource http//www.info.cancerresearchuk.org/cancerstats/types/lung/smoking/cancerSmoking trends in Great Britain indicate that the overall gender- ad hoc adult smoking rates have been declined by approximately 0.4% per annum since the year 2000 (Robinson and Bugler 2008) however, the most recent statistics reveal that smoking prevalence during 2007-2008 in UK has sojourned more or less the same. Gender-specific cigarette smoking trends in UK during 2004-2008 are exhibited below in Table 02, defer 02 CIGARETTE SMOKING BY SEX (2004-2008), UKPERCENTAGE (%)20042005200620072007Men2625232222Women2323212021All2524222122Source planetary Lifestyle Survey 2008The age-specific smoking prevalence trends observed in UK indicate that the age group of women mingled with 20-24 years i.e. approximately 31% of young women in UK are indulged in smoking behaviour and similarly, men aged between 25-34 i.e. approximately 30% of men are also found to be regular smokers (Friis and Sellers 2009). Age-specific cigarette smoking trends in UK during 1978-2008 are exhibited below in Table 03,TABLE 03 CIGARETTE SMOKING BY AGE (1978-2008), UKAGE%16-1920-2425-3435-4950-5960+197834%44%45%45%45%30%198826%37%36%36%33%23%199831%40%35%31%28%16%200822%30%27%24%22%13%Source General Lifestyle Survey 2008Representing the tie beam between cigarette smoking and socio-economic sector of the UK golf-club, it has been observed in a survey that smoking is oftentimes more prevalent amongst people associated with routine and manual occupations which includes approximately 30% of men and 27% of women whereas, people associated with managerial and professional occupations exhibit a slightly reduced smoking trend which includes 14% of men and 14% of women following smoking behaviour (Robinson and Bugler 2008). Socio-economic variety of cigarette smoking trends in UK during 2008 are exhibited below in Table 04,TABLE 04 SMOKING IN UK SOCIO-ECONOMIC CLASSIFICATIONPERSONS AGED 16 AND OVER, with child(p) BRITAIN 2008 (%)MenWomenLarge employers and higher managerial1411higher(prenominal) professional1212Lower managerial and professional1616Intermediate2122Small employers / own banknote2221Lower supervisory and technical2624Semi-routine3128Routine3330Source General Lifestyle Survey 2008SMOKING INDUCED RISK FACTORS TO PUBLIC wellnessSmoking patterns are greatly influenced by the indivi forkeds bio-psychosocial status and considerably set off depending upon diverse factors including monetary condition, population size, age, gender, and the existence of regulatory models. It has been studied that social pressures play an integral role in an individuals conformation towards a specific set of beliefs or behaviour and smoking too, like other forms of nerve center dependencies is shaped up in accordance with the surrounding environment of a smoker (Killoran et al 2006). Gender-specific smoking bring forth risk factors considerably vacillate depending upon the societal, cultural and religious beliefs as for example 40% of young women in Spain have been reported to indulge in active smoking behaviour on the other hand, China remains less affected when it comes to smoking habitude in women which has been reported to be less than 5% still (European Commission 2007). Similar is the case with other Asian countries including India, Pakistan, Bangladesh etc. where smoking induced risks to women are significantly less as compared to men because of conservative culture and traditions in the region. Moreover, the statistics also exhibit that the smoking induced risk factors are less common in older age groups, in two men and women as the lowest ratio of smoking has been observed amongst people aged 60 and over (Merrill 2010) because younger extension is much more enthusiastic to experiment and usually exhibits callous attitude towards health risks. There has been a sustained and analogous pattern of smoking induced risks observed between both the manual and non-manual populace of the socio-economic sector in UK, which signifies the ontogenesis sense of public towards the underlying public health issue. apart from bio-psychosocial risk factors there are a number of other smoking related risks to public health which are summarised as follows3.1 peaceful SmokingSecond hand smoking, environmental smoking or peaceable smoking are all detrimen tal and risk the life of a non-smoker that is consciously or unconsciously exposed to hazardous effects of smoking induced chemical compounds and probable human carcinogens. Passive smoking has been identified as the most critical cause of smoking related ill-health and incremental mortalities in general population, callable to lung cancers and coronary heart diseases.3.2 Tobacco CarcinogenesisExcessive tobacco manipulation in the form of cigarette, cigar, pipe smoking enhances the risk to mouth, larynx, and defile cancers and if complimented by heavy alcohol intake, can subsequently trigger the tumours in tobacco carcinogenesis (DoH 2007).3.3 Occupational HazardsPersistent interaction between smoking and a variety of industrial agents can develop a number of cancers as suggested by numerous experimental and epidemiologic data. It has been studied that the smokers working within the environment containing asbestos or uranium ores significantly provides the means to stimulate tob acco carcinogens and an increased risk of lung cancer (DoH 2007).3.4 Coronary Heart DiseasesSeveral studies suggest that cigarette smoking significantly contributes in premature sudden expiration from coronary diseases especially in populations where arteriosclerosis is prevalent thus, exerting a enunciate secondary effect to hyperlipidemia and hypercholesteremia subsequently increasing the risk of hypertension and heart attack (Ong and Glantz 2004).Air PollutionStudies suggest that overweening air pollution complimented by cigarette smoking, leads to death from acute pulmonic disease and lung cancer. The carcinogens contained in pollutant air is inhaled in relatively small doses and on the other hand, cigarette smoke is highly concentrated and inhaled directly into the lungs therefore, the violate caused to the respiratory tract by the air pollution alone, is comparatively less than the damage caused by the intense tobacco smoke. However, for non-smokers the passive smoking i n combination with the pollutant air can be a serious risk to health as heavily polluted air contains approximately 100,000 particles per blockish centimetre whereas inhaled cigarette smoke contains more than 5 billion particles per cuboid centimetre (Webb, Bain and Pirozzo 2005).ANALYSING PUBLIC RESPONSIVENESS TO THE IDENTIFIED RISKSDespite of consistent efforts by the local governments and numerous international health organisations, it has been observed that the public awareness programs regarding smoking cessation are considered to be effective to varying degrees as it is extremely difficult to determine the consumers perception towards the smoking related health consequences and addictive nature (Bauld et al 2003). The consumer base in the developing countries remain exceedingly unacquainted with the country-specific smoking related information and health policies as the snag interventions like awareness campaigns, registration system to assess disease patterns and the ident ification of smoking related trends are not vigilantly ensnareed. Moreover, the consumer base in the developing countries expect low-cost and reliable preventive measures however, the fiscal moldations gives it difficult for the local governments to entrench meretricious and equally effective smoking awareness schemes and interventions as a result of which the public responsiveness towards addressing the smoking epidemic is significantly pitiful especially where it looms largest. In addition to this, smoking cessation becomes a complex issue due to its addictive designate and several studies have rated it as amongst the most evil drug dependency as compared to heroin and cocaine (Donaldson and Donaldson 2003). The addictive trait of cigarette smoking is characterised by a cluster of behavioural, cognitive and physiological phenomena which consequently develops due to enhanced substance use resulting in increased desire for smoking which becomes a persistent exercise and as the time passes, the chances of withdrawal becomes unattainable. It has also been studied that the superfluous social acceptance of smoking has significantly contributed to its brush popularity and prevalence amongst the general population (Marmott and Wilkinson 2006) and this ignorant public attitude feature with lack of awareness results in natural inclination of the masses to consider it a harmless and a nontoxic habitude (Stevens, Raftery, Mant and Simpson 2004). From the economic perspective, the tobacco industry generates humungous revenues by influencing the developing countries as a profitable hind end for market expansion, which is mutually advantageous to the developing countries leading them to compromise on their public health issues against enhanced fiscal benefits. Tobacco industry considerably influences the political set-up of several countries to advertise and promote cigarette smoking and their intriguing commercial campaigning significantly draw the attention of yo unger generation that are already less- informed and easily fall prey to such market tactics. Pre-targeted and smartly designed commercials significantly mislead the naive public and triumphfully manoeuvre them by relentless denial of tobaccos unfavourable health impacts. serviceable INTERVENTIONS FOR SMOKING EPIDEMICThe smoking related health outcomes can be substantially controlled by integrating effective tobacco control policies and interventions that are capable to cease or significantly reduce its prevalence and consumption amongst the general population. It has been studied that tobacco smoking does not limit the effects of its pervasiveness to smoker itself rather the people present in the surrounding environment (Farmer and Lawrenson 2004) as for example, non-smoking adults including cohabiting partners and children of the smoker are also adversely affected. Hence, it becomes essential to learn the smokers to acknowledge their social duty towards the general public and potently monish them to exhibit their smoking habitude in public (Douglas et al 2007). The success rate of the practical interventions adopted in the developed countries has found to be much practicable as compared to the developing countries because the regulatory good examples are plastered and the law enforcement agencies are also equally efficient. In order to modify the general population to effectively combat with smoking-related public health issues, it is jussive mood to establish prudently designed and effectually devised practical interventions for discouraging cigarette smokers and providing maximum defendion to children, pregnant women, elders and other non-smoking adults by entrenching a number of the below mentioned tobacco controlling key initiatives5.1 Establish a super Informative SettingA highly informative environment can be established by effectively conveying the most updated and evidence-based tobacco related public health information to the general pop ulation and specifically highlighting all the associated risk factors. The local governments essential exhibit maximum commitment towards smoking cessation campaigns by formulating effective regulatory framework and providing suitable means to the healthcare professionals to implement it (Scott and Mazhindu 2005). Highly developed countries and the international health organisations must also facilitate the poor countries by financing the research projects to evaluate causes, consequences and costs of tobacco use in the various(prenominal) regions and thereby, devise a preventive strategy accordingly.5.2 Media CampaigningMedia is the most shaping tool to speedily communicate with the masses therefore, it is imperative to utilise both print and electronic media for positive campaigning and specifically rope-in the e-media to target todays mesh savvy, younger generation. In the wide-ranging interest of public health, it is the social responsibility of media world to all told proh ibit the enticing cigarette advertisements and instead make noble use of the media by broadcasting regular public service messages to discourage the prevailing smoking behaviours.5.3 Stringent Policies to Reduce Tobacco manipulationSubstantial increase in tobacco prices can significantly reduce its consumption especially amongst younger generation or those that are inefficient to afford. Governments must also concentrate on formulating such policies that can completely forbid the promotional campaigns and considerably re relentless the sales through vending machines (DoH 2007). Since smoking is one of the most prevailing global epidemics therefore strict rules and regulations shall be imposed to discourage smoking in public places as for example bus stops, restaurants, educational institutions, offices, hospitals and cinemas etc. This would not only limit its consumption but will also signify the governments seriousness towards addressing the underlying public health issues. More over, the tobacco industry shall be consistently introduced to consistent and rigorous tax networks so that the target of promoting controlled use of cigarette smoking can be achieved (DoH 2007). On the other hand, governments can attain dual benefits by expanding the tax network for the tobacco industry thus cut down its consumption amongst general populace and can generate more taxed revenue.5.4 discourage Nicotine DependencyRegular smokers become heavily reliant upon nicotine intake and therefore, search for certain other alternatives as a substitute to cigarettes including chewable tobacco, tablets, patches and inhalers, if their approachability to cigarette smoking has been disrupted. The governments while designing smoking related preventive strategies must acknowledge that nicotine is highly addictive and therefore, it is wise to introduce less-harmful and inexpensive alternatives to regular cigarettes and subsequently educate them to overcome their nicotine dependency by adopting practical interventions through professional medical assistance (Prabhat, Chaloupka, Corrao and Binu 2006). Moreover, the developed countries and international health organisations can also donates such inexpensive nicotine alternatives to poor and deprived countries in order to promote smoking cessation and bouncing living across the globe.5.5 Support GroupsNicotine dependency significantly damages the internal health of people which restricts them to participate in healthy sports activities. Governments can help the local bodies to establish tobacco control support groups in their respective neighbourhoods and to organise healthy activities and events to promote constructive attitude amongst general population. A strategically designed tobacco control program also facilitates in mobilising the civil society to effectively contribute both their money and time to engage nicotine bloodsucking people in healthy activities (Prabhat, Chaloupka, Corrao and Binu 2006) and ther eby, motivating them to overcome their cigarette smoking habitude. Formation of such support groups provide easy and consistent recover of tobacco-specific valuable information to the smokers and also enhance their awareness to the associated risk factors. closureSmoking has been established as a consistently prevailing global epidemic and that is so, because the related effects of smoking are not circumscribe to the smoker himself, but also extend to others through a paradigm of risk factors including passive smoking and air pollution etc. which makes it a substantial risk to public health. Provided the fact, it is not only essential to discourage smoking behaviour in smokers but also educate the non-smokers to protect themselves from the associated health risks. Apart from individual preventive measures, there is a growing need for integrating practical interventions to ensure reduced exposure to tobacco smoke especially in public places by providing separate smoking and non-sm oking areas or installing ventilation or completely banning smoking through industry led voluntary agreements or by introducing loaded statutory requirements. To conclude, cigarette smoking is radically injurious to public health and honest efforts are required at both individual and communal level to enhance public awareness towards the associated risks and particularly support the smokers to retract their smoking habit.Smoking as a Public wellness IssueSmoking as a Public Health IssueIt is now a matter of common public acceptance that smoking causes ill health. This education can be backed up by large amounts of authoritative literature (Dobson et al 1999) (Smoking Kills 1998) (Choosing Health 2001)The subject of this essay however, is whether or not it is a Public Health issue. We will argue strongly that it is and produce evidence to support this stance.The Wanless Report (2002 ) defines Public Health as The science and art of preventing disease, prolonging life and promotin g health through organised efforts and informed choices of society, organisations public and private, communities and individualsOn that basis we would suggest that the argument is already make since there is little doubt that smoking both active and passive will shorten life and cause disease.The evidence to support this statement comes from papers such as that by Prescott ( et al. 1998) who carried out a large study looking into the effects of primary smoking and the risk of myocardial ischaemia in the general population. The results of the study were absolutely unequivocal with a finding of an increased risk of myocardial infarction in women of 2.24 and in men of 1.43. the reasons for the sex difference are several including genetic factors (Bennett 2004) and hormonal factors (Chapman 1999)To take a step further back, we have to define HealthAn authoritative definition of Health comes from the WHO who currently tell us that health is a state of complete physical, mental and s ocial well universe and not merely the absence of disease or infirmity. ( WHO 1992). A difficultness with this definition is that today many people confuse the attainment of ecstasy with the attainment of health (Kemm 2001). Ironically, in the context of this essay, Freud also offered us an mirror image on the definition of Health when he observed that most people equated well-being with happiness rather than health (Freud 1975) and he amplified this by observing that he had been advised by his doctors to give up cigars in order to improve his health. He commented that he was far more healthy but much less happy (Saracci 1997).Although Freuds comment was clearly flippant, it does personify a deeper truth, that part of the problem with smoking is the pleasure that some people derive from it. One can always advance the argument that in a free society one should always have liberty of choice to damage yourself if you wish. (Hegel 1971)That is clearly the case, but in adopting th at view you must also accept two further consequences of that position. One is that society is expect to pick up the bill when you are ill (via the NHS) and that by smoking, you whitethorn not only damage yourself but you may well damage others through the medium of passive smoking. (Kuhse vocalist 2001)It is these latter points which actually make the issue one of Public Health. The Public (in general terms) are expect to fund the necessary treatment when you become ill. This is not an isolated disaster as over 200,000 patients are diagnosed annually with some form of smoking related malignancy and over 120,000 will die from the disease. This is quite main(a) of those that develop other complications of smoke-related illness. (NHS Cancer Plan 2000). If you add to this number, the carers and the other economic costs to the community, the argument that it is not a Public Health issue clearly fails.We have raised the issue of passive smoking as one of the criteria for suggesting t hat smoking is an issue of public health. The evidence for this is rapidly accumulating. We can point to the cleverly designed study by He (et al.2004) whichwas able to point to the statistical differences in illness rates between those industrial workers who had a constantly smoky atmosphere to breathe and those who were able to lift it. There is little doubt that choosing to smoke where others will inhale the smoke is a demonstrably anti social behaviour.As if to underline our view, we can point to the fact that the Government takes a similar view as it has produced a series of Government whiten Papers (Choosing Health 2004) ( twist on the Best 2003) and regulations (Saving lives 1999) which are all aimed at improving the health of the nation by reducing its collective exposure to cigarette smokeReferencesBennett Gottleib 2004Passive smoking more risky for women with a missing gene.BMJ 2004 Vol 26 320-322Building on the best 2003Department of HealthHMSO. 09/12/2003Chapman S 199 9Smoking and Women beauty before age? BMJ, Mar 1999 318 818.Choosing Health 2004Government White Paper consultation on improving peoples health28.6.04 BMJ, Dec 2004 319 1522.Dobson et al, 1999National Centre for Social Research,RCP, 1999Freud S. 1975Letter to Lou Andreas-Salome, 1930 whitethorn 8. Cited in Sigmund Freud house catalogue.Vienna Lcker and Wgenstein, 1975 49.He, T H Lam, L S Li, L S Li, R Y Du, G L Jia, J Y Huang, and J S Zheng2004Passive smoking at work as a risk factor for coronary heart disease in Chinese women who have never take in BMJ, Feb 2004 308 380 384.Hegel GW. 1971Philosophy of Mind Being Part Three of the Encyclopaedia of the philosophical Sciences (1830). Wallace W, trans.Oxford Clarendon Press 1971.Kemm 2001The pursuit of happinessCancer Nurs. 200023(1)2031Kuhse Singer 2001A companion to bioethicsISBN 063123019X Pub Date 05 July 2001NHS Cancer plan 2000A plan for investment, a plan for reformDepartment of Health. HMSO. 27/09/2000Prescott, sexual moral ity Hippie, Peter Schooner, Hans Ole Hein, and Jrgen Vestbo 1998Smoking and risk of myocardial infarction in women and men longitudinal population study BMJ, Apr 1998 316 1043 1047Saracci R 1997 The world health organisation needs to reconsider its definition of health BMJ, May 1997 314 1409.Smoking Kills1998A White PaperHMSO December 1998Wanless reportHMSO 2002World Health Organisation. 1996Ethics and health, and quality in health carereport by the director general.Geneva WHO, 1996. (Document No. EB 97/16.)PDG 20.8.05Word count 1,192

Causes of Muscle Damage

Ca belongs of Muscle persecuteAn antioxidant has been defined as a substance that reduces oxidative modify such as that caused by free substructures (Halliwell 1984). Oxygen-centred free radicals known as reactive Oxygen Species (ROS) may contribute to compute generate massiveness harm (Mc Ginley 2009). Due to this, it has been widely accepted over the past 20 geezerhood that increasing antioxidants in the body will provide greater protective cover against ROS (Sastre 1992 Hathcock 2005). However, the significance of coif-induce oxidative stress is open for discussion (Cabrera 2008) with unclear conclusions in literature. This has led to the recent investigation on the possibility of increase mathematical product of free radicals during operate and the set up of antioxidant accessory in athletes (Finaud 2006 Gomez-Cabrera 2008Ristow 2009). Free radical proliferation is a widely suggested mechanism in the damage receipt to solve by process of phacocytosis and acti vation of the respiratory burst by neutrophils during the seditious response (Pyne 1994). The most commonly used antioxidants in the sporting cosmos are vitamin C (ascorbic acid) and vitamin E (tocopherol) with an astonishing 84% of athletes using antioxidants during the 2008 capital of Red China Olympics (International Olympic Committee 2008).It has been well documented that in high spirits intensity form results in damage to active bodybuilder fibres resulting in soreness, stiffness and a decline in the energys force producing capabilities (Allen 2001 Armstrong 1990 Clarkson 2002). Peroxidation of muscle fibre lipids causes disturbance in cellular homeostasis which may result in muscle fatigue or injury, possibly implicating free radical organisation as a major cause of delayed-onset muscle soreness (Byrd 1992). Preventing muscle tissue damage during use of goods and services training may help optimize the training effect and ultimate competitive sports performance (S en 2001). In order to minimise tissue cell damage, there must be an equilibrium maintained between oxidants (ROS) and antioxidants (reductants). ROS increases with screaming(prenominal) visible work (Fig 1) which can exceed the contentedness of the bodys natural antioxidant defense reaction (Reid 2001). This was illustrated by Davis (1982) and Ebbeling (1990), whereby strenuous employment led to increased levels of malondialdehyde (MDA), a 3-carbon-chain aldehyde. standard of MDA has become the most commonly used indicator of lipid peroxidation (Mc Bride 1999).Thus, the use of goods and services of exogenous antioxidants has been proposed to attenuate this increase in ROS. Evans (1990) noted that several antioxidants, including vitamin C and especially vitamin E, flummox been shown to decrease the exercise-induced increase in the rate of lipid peroxidation, which could help prevent muscle tissue damage.The effects of Vitamin E have been more extensively investigateed than Vitamin C due to or so promising results in the literature. Vitamin E is the main lipidsoluble, chain-breaking antioxidant (Ji 1996) which accumulates in the phospholipid bilayer of cell membranes and helps attenuate lipid peroxidation (Sjodin 1990) inside the cell membrane acting as an important scavenger of superoxide and lipid radicals (Powers 2000). Vitamin E supplementation has been shown to meaningfully decrease the amount of lipid peroxidation (Kanter 1993) and membrane damage associated with single bouts of economic crisis and high intensity submaximal exercise aswell as opponent exercise (Mc Bride 1998 Ashton 1999). Sumida (1989) stated that 300 mg of vitamin E given for 4 weeks reduced exercise-induced lipid peroxidation . Mc Bride (1998) report the posture of vitamin E supplementation in reducing MDA and creatine kinase (CK) levels. Cannon (1990) reported a decrease in CK and a faster retrieval subsequently supplementation of vitamin E. Furthermore, Kanter (1997) recently reported a 35 % increase in T-lag time (indicative of a diminished LDL oxidation rate) in subjects who consumed metre mg d-a-tocopherol acetate daily for 1 week before exercise. respective(a) studies have also demonstrated beneficial physiological effects of vitamin C supplementation in physically-active people. Jakeman and Maxwell (1993) give that supplementing vitamin C showed slight speciality loss (Fig 2) in the triceps surae post-exercise, and a faster recovery (Fig 3) compared to placebo. The force response to tetanic stimulation was less in the vitamin C group also, indicating a reduction in contractile function. Kaminski and Boal (1992) pre-supplemented subjects for 3 age with 1 g of vitamin C 3 times a day and then induced damage in the posterior calf muscles. Supplementation continued for 7 days post-exercise with vitamin C group reporting reduced soreness ratings ranging from 25-44% less than the control group. Peters (1993) noted fewer cases of upper respi ratory tract transmitting in runners who consumed 600 mg vitamin C/d for 3 weeks before a 42 km road race. Bryer (2006) reported lower DOMS in a high-dose Vitamin C supplementation group 2 weeks prior and 4 days post fleck exercise Studies which have used combinations of antioxidants (consumed 300-800 mg d-cr-tocopherol asset 200 mg vitamin C/d for 4-8 weeks) reported post-exercise declines in blood serum enzymes indicative of muscle tissue damage in subjects (Sumida 1989 Rokitzi 1994). Kanter (1993) reported that a mixture of vitamin E (592 mg), vitamin C (1,000 mg), and 30 mg of beta carotin resulted in a decreased level of a lipid peroxidation chump after exercise. All the previously mentioned studies suggest tangible benefits of antioxidant supplementation in combating detrimental physiological processes that may be initiated by physical activity thus appearing beneficial to sports and exercise participants.Exercise processs numerous overbearing effects on general health (Wartburton 2006), most notably modify glucose metabolism. It is well documented that exercise increases ROS production (Powers 2008), however it is unknown whether this may influence the health promoting effects of exercise. The effects of antioxidant supplementation on the health-promoting effects of exercise have recently been investigated (Gomez-Cabrera 2008 Ristow 2009). Exercise helps initiate mitochondrial metabolism, with a reduction of this metabolism linked with attribute 2 diabetes (Simoneau 1997). Since mitochondria are the main blood of ROS, its been proclaimed that ROS may be a factor in some health promoting effects (Schulz 2007 Birringer 2007). Ristow (2009) investigated this theory and hypothesized that antioxidant supplementation may repeal received health promoting benefits of exercise and oxidative stress. Thus, if increases in oxidative stress exhibit a counteracting effect on insulin-resistance, then the barroom of ROS activation by antioxidants may increa se the risk of disease such as type 2 diabetes.Ristow (2009) proposed an essential role for ROS formation in increasing insulin sensitiveness in exercising humans. The study appoint that vitamin C and vitamin E blockade many of the beneficial effects of exercise such as insulin sensitivity (glucose infusion rates-GIR) and the promotion of muscle antioxidant defence post-exercise. James (1984) found non-supplemented subjects showed significant increase in GIR after 4 weeks training whereas antioxidant group found no significant change (Fig 4). In addition, the non supplemented group also increased adiponectin levels compared to the supplemented group (Fig 5). Adiponectin (secretory protein) has been shown to have a positive correlation with insulin sensitivity and is mutually correlated with risk of type 2 diabetes (Spranger 2003). A recent meta-analysis of 232,550 participants suggests use of antioxidants may increase all-cause mortality (Bjelakovic 2007). Of the 136,023 receivi ng antioxidants, 13.1% died (17,880) whereas of the 96,527 controls, 10.5% died (10,136).Studies in healthy subjects show that low aerophilic skill is a strong predictor of mortality (Myers 2002 Yusuf 2004). impaired regulation of mitochondrial function is an important mechanism for low aerobic capacity (Wisloff 2005). Gomez-Cabrera (2008) found that mitochondrial content is a key de terminationinant of endurance capacity and that vitamin C decreases exercise-induced mitochondrial biogenesis in muscle. Free radicals serve as signals to suit muscle cells to exercise through gene expression (Khassaf 2003). Vitamin C was found to prevent beneficial training effects to decease due to their prevention of activation of two major antioxidants (Mn-SOD and GPx) (Gomez-Cabrera 2008). The aforementioned study also reason out that endurance capacity is directly related to mitochondrial content, which is negatively affected by antioxidants.Antioxidant supplementation is extremely popular a mong athletes, but data indicating beneficial effects on functional capacity of muscle are elusive. There is no strong evidence from literature for the use of antioxidant supplementation in acrobatic populations as there are many poor controlled studies involving unusually high doses, involving low muscle damaging activity and more recent research has alleviated to minimal if any benefits. Antioxidants do not seem beneficial in preventing DOMS, increasing recovery time or protect against muscle damage but in fact long term supplementation (with vitamin E in particular) may increase mortality (Bjelakovic 2007). Most notably for athletes, not only does supplementation appear ineffective in preventing against exercise induced muscle damage, but interferes with the ROS signalling which are needed for adaptation to occur (Gomez-Cabrera 2008).ReferencesAllen DG (2001). Eccentric muscle damage mechanisms of early reduction of force. Acta Physiol Scand 171(3)311-9Aoi W, Naito Y, Takanami Y, Kawai Y, Sakuma K, Ichikawa H (2004). Oxidative stress and delayed-onset muscle damage after exercise. Free Radic Biol Med37480- 7.Armstrong RB (1990). Initial events in exercise-induced muscular injury. Med Sci variations Exerc 22(4) 429-35Ashton T, Young IS, Peters JR, Jones E, Jackson SK, Davies B (1999). Electron spin resonance spectroscopy, exercise, and oxidative stress an ascorbic acid treatment study. J Appl Physiol872032- 6Birringer M, et al. (2007) Improved glucose metabolism in mice absent alphatocopherol transfer protein. Eur J Nutr 46397-405.Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C (2007) Mortality in randomize trials of antioxidant supplements for primary and secondary prevention Systematic review and meta-analysis. J Am Med Assoc 297842-857.Bryer SC, Goldfarb AH (2006). Effect of high dose vitamin C supplementation on muscle soreness, damage, function and oxidative stress to eccentric exercise. Int J Sport Nutr Exerc Metab 16(3) 270-80Byrd, S.K.( 1992) Alterations in the sarcoplasmic reticulum A possible link to exercise-induced muscle damage. Med. Sci. Sports Exerc. 24531-536Cannon, J.G, Evans W.J (1990). exquisite phase response in exercise Interaction of age and vitamin E on neutrophils and muscle enzyme release. Am. J. Physiol. 259R1214-R1219. Clarkson PM, Hubal MJ (2002). Exercise-induced muscle damage in humans. Am J Phys Med Rehabil 81(11) S52-59Davies, K.J, BROOKS G.A, and Packer L (1982). Free radicals and tissue damage produced by exercise. Biochem. Biophys. Res. Commun. 1071198-1205.Dillard CJ, Litov RE, Savin RE, Dumelin EE Tappel AL (1978) Effects of exercise, vitamin E, and ozone on pulmonary function and lipid peroxidation. Journal of Applied PhysiologyEbbeling, C.B, and Clarkson P.M(1990). Muscle adaptation prior to recovery chase eccentric exercise. Eur. J. Appl. Physiol. 60 26-31. Finaud J, Lac G, Filaire E (2006). Oxidative Stress kindred with exercise and training. Sports Med36(4)327-58Gomez-Cabrera M C, Domenech E (2008). Moderate exercise is an antioxidant upregulation of antioxidant genes by training. Free Radic Biol Med 44(2) 126-31Gomez-Cabrera MC, et al. (2008) unwritten administration of vitamin C decreases muscle mitochondrial biogenesis and hampers training-induced adaptations in endurance performance. Am J Clin Nutr 87142-149.Halliwell, B., Gutteridge J. M (1984). Oxygen toxicity, oxygen radicals, transition metals and disease. J. Biochem. 2191-14.Hartmann A, Nies AM, Grunert-Fuchs M, Poch B Speit G (1995) Vitamin E prevents exercise-induced DNA damage. Mutation Research 346, 195-202.Hathcock JN, Azzi A, Blumberg J (2005). Vitamins E andCare safe across a broad range of intakes. Am J Clin Nutr81736-45Hellsten, Y, Sjodin B (1997) Xanthine oxidase in human careworn muscle following eccentric exercise A role in inflammation. J. Physiol. 498 239-248. James DE, Kraegen EW, Chisholm DJ (1984) Effect of exercise training on whole-body insulin sensitivity and responsiveness. J Appl Physiol 561217-1222.Ji, L.L (1996). Exercise, oxidative stress, and antioxidants. Am. J. Sports Med. 24S20-S24. Ji, L.L. (2000) Free radicals and antioxidants in exercise and sports. G.E. Garrett, and D.T. Kirkendall. Exercise and Sport Science. New York, NY Lippincott Williams and Wilkins. pp. 299- 317.Kaminski, M, Boal M (1992). An effect of ascorbic acid on delayed- onset muscle soreness. Pain 50317-321. Kanter MM, Bartoli WP, Eddy DE Horn MK (1997) Effects of short term vitamin E supplementation on lipid peroxidation, inflammation and tissue damage during and following exercise. Medicine and Science in Sports and Exercise 29, S40.Kanter, M.M., Nolte L ,and Holloszy H (1993). Effects of an antioxidant vitamin mixture on lipid peroxidation at rest and postexercise. J. Appl. Physiol. 74965-969. Kanter, M.M., Nolte L.A and Holloszy J.O (1993). Effects of an antioxidant vitamin mixture on lipid peroxidation at rest and post-exercise. J. Appl. Physiol. 74965-969. Khassaf M, M cArdle A, Esanu C (2003). Effect of vitamin C supplements on antioxidant defence and stress proteins in human lymphocytes and skeletal muscle. J Physiol549645-52.Kosmidou I, Vassilakopoulos T, Xagorari A, Zakynthinos S, Papapetropoulos A, Roussos C (2002). Production of interleukin-6 by skeletal muscle myotubes. Role of reactive oxygen species. Am J Respir cadre Mol Biol26587- 93.Maxwell SRJ, Jakeman P, Thomason H, (1993). Changes in plasma antioxidant status during eccentric exercise and the effect of vitamin supplementation. Free Radic Res Commun19191-202.McBride, J.M., and Kraemer W.J (1998) Effect of resistance exercise on free radical production. Med. Sci. Sports Exerc. 3067-72. McBride, J.M., and Kraemer W.J (1999). Free radicals, exercise, and antioxidants. J. loudness Cond. Res. 13175-183. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE (2002). Exercise capacity and mortality among men referred for exercise testing. N Engl J Med346793- 801.Powers SK, Jackso n MJ (2008) Exercise-induced oxidative stress Cellular mechanisms and continue on muscle force production. Physiol Rev 881243-1276.Pyne, D.B (1994). Regulation of neutrophil function during exercise. Sports Med. 17245-258. Reid, M.B, Shoji T,Moody M.R, and Entman M.L.(1992) Reactive oxygen in skeletal muscle. II. extracellular release of free radicals.J. Appl. Physiol. 731805-1809. Ristow, M., Zarse, K., Oberbach, A., Kloting, N., Birringer, M., Kiehntopf, M. Stumvoll, M., Kahn, C.R., Bluher, M. (2009). Antioxidants prevent health-promoting effects of physical exercise in humans. Proceedings of the National Academy of Sciences of the United States of America, 106, 8665-8670.Rokitzi L, Logemann E, Sagredos AN, Wetzel-Roth W Keul J (1994) Lipid peroxidation and antioxidative vitamins under extreme endurance stress. Acta Physiologica Scandinavica 154, 149-154.Sastre J, Asensi M, Gasco E (1992). Exhaustive physical exercise causes oxidation of glutathione status in blood prevention b y antioxidant administration. Am J Physiol263R992-5.Schulz TJ, et al. (2007) Glucose restriction extends Caenorhabditis elegans life span by motivator mitochondrial respiration and increasing oxidative stress. Cell Metab 6280-293.Sen, C, K (2001). Antioxidants in Exercise. Nutrition Journal of Sports Medicine- Volume 31 Issue 13 pp 891-908Simoneau JA, Kelley DE (1997) altered glycolytic and oxidative capacities of skeletal muscle contribute to insulin resistance in NIDDM. J Appl Physiol 83166-171.Sjodin, B., Y. And Apple F.S (1990). Biochemical mechanisms for oxygen free radical formation during exercise. Sports Med. 10236-254. Spranger J, et al. (2003) Adiponectin and protection against type 2 diabetes mellitus. Lancet 361226-228.Sumida, S., Tanaka K, Kitao H, Nakadomo F (1989). Exercise- induced lipid peroxidation and leakage of enzymes before and after vitamin E supplementation. Int. J. Biochem. 21835- 838. Warburton DE, Nicol CW, Bredin SS (2006) health benefits of physical activity The evidence. Can Med Ass J 174801-809.Wisloff U, Najjar SM, Ellingsen O (2005). cardiovascular risk factors emerge after artificial selection for low aerobic capacity. Science 307418 -20.Yusuf S, Hawken S, Ounpuu S (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the Interheart Study) case-control study. Lancet364937-52.