Literature Review
1. WHY IS CHILDHOOD IMMUNISATION IMPORTANT?
The human body has the ability to resist almost all types of organisms or toxins that tend to damage the tissues and organs. This capability is called immunity. Much of immunity is acquired immunity that does not develop until after the body is first attacked by a bacterial disease or a toxin, often requiring weeks or months to develop. An additional portion of immunity results from general processes, rather than from processes directed at specific disease organisms (2000).
For this topic, the article by will be used for discussion. His article entitled ‘Addressing Parent’ Concerns: Do Vaccines Cause Allergic or Autoimmune Diseases?’ talks about anecdotal case reports and uncontrolled observational studies in the medical literature which claim that vaccines cause chronic diseases such as asthma, multiple sclerosis, chronic arthritis, and diabetes. This article was published on March 1, 2003 in the journal called Pediatrics.
According to the study, autoimmune diseases might occur after immunization because proteins on microbial pathogens are similar to human proteins (“molecular mimicry”) and could induce immune responses that damage human cells. However, wild-type viruses and bacteria are much better adapted to growth in humans than vaccines and much more likely to stimulate potentially damaging self-reactive lymphocytes. Consistent with critical differences between natural infection and immunization, well-controlled epidemiologic studies do not support the hypothesis that vaccines cause autoimmunity.
Remaining without immunization for childhood diseases is a risk no child should face. Chronic illness of children has become a global concern. Although the etiology and types of chronic illness may differ from developing countries to developed countries, some aspects are universal.
With the advent of public health programs and a decrease in childhood mortality, large populations of children all across the globe are experiencing chronic disease states. Although accurate data from developing countries is sometimes questionable, there has been a steady decline in infant and child mortality and a concomitant increase in chronic disease in children across the world.1,2 Statistical predictions point to an accelerated transition from acute to chronic disease in the next 50 years (2004). Without immunization, children are in danger of getting chronic diseases.
Immunity can be active or passive. In active immunization, antibody production is stimulated by administration or antigen or by exposure to naturally occurring antigens such as bacteria, viruses or fungi. In passive immunization, preformed antibodies actively produced in another person or animal are given to the recipient in the form of serum γ-globulin. Childhood immunization comes in the form of active immunization.
Immunization programs against infectious disease need to be developed on a global basis and administered to all children on the planet. Communication and education are imperative and culturally sensitive, community-based programs that convey information on how to recognize, treat, and seek appropriate health care are required. This is particularly important for potentially devastating communicable diseases such as diarrhea and malaria. Frequently, persons from westernized societies expect cultures other than their own to embrace treatment approaches fostered by Western medicine. These approaches are often used by these cultures as a last resort after traditional healing practices have failed (2004).
Global chronic illness in children has multifactorial etiologies. Poverty, malnutrition, inadequate immunization programs for preventable infectious diseases, and environmental hazards play a significant role as causal factors of chronic illness in children (2004).
The organisms that cause a disease (or materials produced from those organisms) are weakened or killed and then made into vaccines. These vaccines are injected into the body or are taken by mouth. The body reacts by making disease-fighting substances – antibodies – that build up in the system and guard against these diseases for a long time, often for a lifetime. Thus, immunization helps the body to defend itself against a particular disease.
Because they have received antibodies from their mother’s blood system, babies are immune to many diseases when they are born. But this immunity wears off during the first year of life ( 2004). That’s why immunization programs, which help young bodies of the children build their own defenses against disease, should be started early and carried out faithfully. Immunizations are very important.
The eight childhood diseases (measles, mumps, rubella, diphtheria, tetanus, pertussis, Haemophilus influenzae type b, and polio) which are preventable by immunization, can, and do, cause crippling and, sometimes, death. These illnesses are serious and their complications can be terrible. With the exception of tetanus, these diseases are contagious. They can spread rapidly from child to child and from community to community. As long as children remain unprotected against them, serious outbreaks of disease – even epidemics – can occur.
All children should receive active immunization with diphtheria toxoid, the type of toxoid or combination used depending on the age of the child. Schick tests generally are unnecessary; instead of a follow-up Schick test, a booster dose of toxoid is given at the recommended time. For those over 12, the best procedure is to immunize or boost with tetanus-diphtheria toxoid, adult type.
Active immunization may be started at age 1 to 3 months, either with separate injections of pertussis vaccine or through the use of DTP (Diphtheria and Tetanus toxoids and acellular pertussis vaccine) vaccine. In either case, the manufacturer’s recommendations should be followed, since the dose may vary from preparation to preparation. For those over 6 years old, routine use of pertussis vaccine, either separately or in combination, is not recommended.
The initial DTP immunization series is followed by a DTP booster at age 18 months and another of 0.5 ml given when a child reaches school age. Subsequent routine tetanus boosters every 10 years should maintain protection. More frequent boosters are unwarranted since untoward reactions to toxoid may occur. At any interval after basic immunization, immunity can be reestablished by a single 0.5 ml s.c. booster dose; however, after an interval of more than 10 year since the last injection of toxoid, the rate of the booster response may be somewhat slower.
The fourth dose of DTP may be administered as early as age 12 months, provided 6 months have elapsed since the third dose and the child is unlikely to return at age 15-18 months. Tetanus and Diphtheria toxoid is recommended at age 11-12 years if at least 5 years have elapsed since the last dose of tetanus and diphtheria toxoid-containing vaccine. Subsequent routine Tetanus and Diphtheria toxoid boosters are recommended every 10 years (2004).
Usually, the parents of children who are with chronic and infectious diseases preventable by immunization support the immunization recommendations to help ensure that more people are immunized against the many chronic diseases like pertussis, or whooping cough, which is a highly contagious disease.
Pertussis immunity from early childhood vaccinations wears off, leaving adolescents and adults susceptible to the disease. Adults and adolescents may suffer from a severe and prolonged cough, vomiting and complications, as well as disrupted home and school routines. While some have relatively minor symptoms, anyone with pertussis can spread the infection to others, particularly infants who are too young to have been fully immunized. Infants are at higher risk for severe illness, complications and death, and 90 percent of unvaccinated children living with someone with pertussis will contract pertussis.
Primary immunization of infants with trivalent vaccine should begin at about age 2 months, integrating the schedule with other routine immunization procedures. For primary immunization of children up to 6 years old, three doses are given at approximately 8-week interval. Inactivated poliovirus is recommended for children with immunodeficiency diseases.
Measles immunization is recommended as a routine procedure for all susceptible infants or children. Live attenuated vaccine is the agent of choice in healthy children and is given at about 15 months of age, when about 95% of children have an antibody response. If exposure to measles is likely before that age, the vaccine should not be withheld; reimmunization at an older age may be necessary. Vaccine may be given to at any later age to those not vaccinated earlier.
Measles, mumps and rubella vaccine for second dose is recommended routinely at age 4-6 years but may be administered during any visit, provided at least 4 weeks have elapsed since the first dose and that both doses are administered beginning at or after age 12 months. Those who have not previously received the second dose should complete the schedule by the 11-12 year old visit ( 2004).
While mumps infection is a largely benign disease when contracted during childhood, it becomes more dangerous in older children and adults, who are more susceptible to severe neurological, testicular, and ovarian complications from the infection. It is alarming to see that vaccination is clearly shifting the occurrence of this disease from young children toward those who are older (2003).
Three types of polio vaccines have been used throughout the world: 1) the OPV, or oral polio vaccine (Sabin vaccine), consisting of live, attenuated poliovirus; 2) the IPV, or inactivated polio vaccine (Salk vaccine), consisting of killed poliovirus and given by injection; and 3) the eIPV, an enhanced potency inactivated polio vaccine, consisting of killed poliovirus with high viral antigen content ( 2003).
Do vaccines protect us from the disease for which they are given? This question might seem absurd on the face of it, given the near disappearance of many infectious diseases for which vaccines are given credit.
Vaccines have been called potential allergens because they introduce foreign proteins directly into the blood without digestion or “censoring by the liver.” When we remember that one of the chief causes of allergies is the presence of undigested proteins in the blood, the connection between vaccinations and allergies becomes apparent (1995).
Vaccines have also been called drugs because, like drugs, they are inherently toxic and work on the principle of suppression rather than expression, as do natural therapies. This suppression of symptoms prevents the body-mind from discharging what needs to come out and only compounds the problem. Also, the expression of symptoms is part of the full immunological response which is necessary for the development of true immunity (1995).
Perhaps the only real difference between vaccines and drugs is that drugs work to suppress present symptoms and vaccines work to suppress possible future symptoms. Orthodoxy regards this latter as immunity, but evidence suggests it is immune suppression (1995).
One theory used to explain the increased incidence of allergic diseases in children according to the article is the “hygiene hypothesis,” which states that better hygiene is associated with an increased risk of developing allergies. Several epidemiologic findings support the hygiene hypothesis. For example, children are less likely to have allergies if they are part of a large family, attend child care, experience a large number of infections early in childhood, or come in contact with animals. On the other hand, children are more likely to have allergies if they live in areas of better sanitation, are not infected with helminths or worms, or live a “Western” lifestyle.
Over the years, vaccine-preventable diseases have been responsible for the illnesses and deaths of many infants, children and adults. Since the development and increased usage of vaccines, many diseases such as polio and measles have become very rare ( 2001).
An important way that parents and caregivers can help combat
vaccine-preventable diseases is to keep copies of updated shot records of the child so that they can not miss an immunization. This could help the child a lot, even save his or her life, as there are instances that vaccine-preventable diseases can take lives.
2. IS FREQUENT BREAST EXAMINATION A MEANS TO DETECT EARLY ONSET OF BREAST CANCER?
Hope that regular self-examination of the breasts might protect women against dying from breast cancer was finally extinguished by a huge study that demonstrated it was useless, an article titled “Self-examination ‘useless’, breast cancer study finds” said.
The source of this article is the London paper The Independent. The author of the article is Jeremy Laurance. This article was published on October 3, 2002. Although this was written in 2002, this topic is still relevant at present. The topic of breast cancer is one which has been around for years and will surely be around in the next few years.
The article summarized talks about mammography as a useful tool to try to detect breast cancer early in women over the age of 50 and to reduce a woman’s chance of dying from breast cancer whereas for general public health policy it does not appear that breast self-exams are very helpful.
Cancer of the breast is the most common malignant condition among women and carries with it the highest fatality rate of all cancers affecting this sex. Breast cancer is rare in men, but when it does occur, it is usually not recognized, until late, and thus the results of treatment are poor.
Breast cancer appears to have reached epidemic levels. Talk to any group of people anywhere in the UK and they all seem to have some experience of it–someone in their family, a friend, a neighbor or work colleague. And it is not just a vague impression that this is the case, there are hard statistics to back it up. Every year around 39 000 women and between 200 and 300 men are diagnosed with breast cancer in the UK. Government figures show that the number of people who develop breast cancer every year has increased by 70 per cent since 1971, and by 15 per cent in the ten years to 2000. It is by far the most common form of cancer in women and the most common cause of cancer death in women ( 2004).
While history, physical examination, and mammography or thermography may strongly suggest breast cancer, the diagnosis can be made only by microscopic examination of tissue removed by open or aspiration biopsy.
Human breast cancer appears long after the organ finishes its development. Age is associated with the location of the tumors. The area of the breast where breast cancer originated was more central in the older patient population we studied. Breast tissue involutes first in the lobular parts and then in the larger central ductal structures.
Declining ovarian function in the premenopause leads to regression of epithelial structures and stroma. The central duct system remains but the lobules shrink and collapse. The last structures to appear with sexual maturity are the first ones to regress. This is reflected in the location of breast cancers in younger as opposed to older women. The cancers originate first in lobular ducts and later in the larger ductal structures (1999).
Breast cancer probably originates in an involuting target organ with a time relationship between the histogenesis, histoapoptosis, and development of breast cancer. It is surprising that breast cancer does not originate in the developing organ, as is the case for nearly all other epithelial and stromal cancers, which usually initiate and grow in regenerating or rapidly developing tissues. It is rare for breast cancer to develop before the age of 24. This is exactly the time when normal involution starts in most women. Involution of human breast tissue is well known to clinicians through mammography or magnetic resonance imaging and is a normal aging process. The development of breast cancer in involuting tissue argues that susceptibility to breast cancer is probably created much earlier in life (1999).
Many, if not most, ailments of the body cause pain and this includes breast cancer. Cancer pain syndromes can result from the progression of the disease or from efforts to cure or control the disease (2004). The sense organs for pain are the naked nerve endings found in almost every tissue of the body. Pain has been classified into two major types: fast pain and slow pain. Fast pain is felt within about 0.1 second after a pain stimulus is applied, whereas slow pain begins only after 1 second or more and then increases slowly over many seconds and sometimes even minutes (2000).
Fast pain is also described in many alternative names, such as sharp pain, pricking pain, electric pain and acute pain. Acute pain is generally the result of a specific injury and can be clearly explained in terms of where we feel it in the body. This type of pain is felt when a needle is stuck into the skin, when the skin is cut with a knife, or when the skin is acutely burned. It is also felt when the pain is subjected to electric shock. Fast, sharp pain is not felt in most deeper tissues of the body.
Slow pain also goes by multiple additional names, such as slow burning pain, aching pain, throbbing pain, nauseous pain, and chronic pain. This type of pain is usually associated with tissue destruction. It can lead to prolonged, unbearable suffering. It can occur both in skin and in almost any deep tissue or organ. Chronic pain is the other type of pain which is so called because it can continue for months or years and even trigger additional health problems such as depression and lead to lifestyle changes in attempts to remedy the situation.
Breast cancer presents a type of slow or chronic pain. This pain largely results from overstimulation of nerve endings. The nerve endings may be stimulated by inflammatory substances that are produced by damaged cells from the cancer and released from the surrounding capillary network.
The evidence that endogenous sex hormones influence risk of breast cancer has been reviewed extensively elsewhere; for pubertal girls, however, the modulation of endogenous estrogens is much more important. The main difference between high and low risk women for breast cancer is the persistent difference in serum estrogens secondary to early and late menarche. In addition, the serum levels might be further modulated to a great extent by nutrition, body fat, and exercise during puberty. Adipose tissue converts androgens to estrogen by aromatization. Bodies weight (fatness) influences additionally the direction to potent and less potent forms of estrogens (catecholestrogens). Late pubertal development and late menstrual patterns are thought to result in part to smaller amounts of body fat (1999).
Breast Cancer Campaign funds independent research into breast cancer at centers of excellence throughout the UK. The Charity aims to find a cure for breast cancer by funding research which looks at improving diagnosis of breast cancer, better understanding how it develops and ultimately either curing the disease or preventing it.
Friends and relatives can be a major source of support, but face their own difficulties. They have to provide emotional support, physical care and help in making decisions about treatment. Many of the observations about the impact of cancer are as true for them as for the patient. Their response to the illness depends on things such as their relationship to the patient, the stage of the disease and their own personalities.
It is important that healthcare professionals, especially the nurses, examine the breasts of male and female clients. A small amount of glandular tissue, a potential site for the growth of cancer cells, is located in the male breast. In contrast, the majority of the female breast is glandular tissue.
Early detection is the key cure to breast cancer. It is therefore a major responsibility for nurses to teach clients health behavior such as breast self examination. Studies suggest that only a minority of women perform breast self-exams ( 2004).
Surgery, radiotherapy, and chemotherapeutic agents are the major modalities used to treat patients with cancer, though various biologic therapies are beginning to have a significant impact. The basic problem is to make available drugs (natural products or synthetics) that kill cancer cells effectively but are not excessively toxic to normal cells.
Current cancer treatments – “cut, burn, poison” – are recognized as crude and painful. Promising new methods focus on delivering anticancer drugs precisely to the cancer (via monoclonal antibodies that respond to one type of protein on a cancer cell) and on increasing the immune system’s ability to fend off cancer (2004).
In all these, the nurses are responsible for co-ordinating care following any operations and/or treatment for breast cancer. As well as supporting the patients and his/her family through the operation and treatment, the nurses can provide the patient and his/her caregivers with clear written and verbal information; and can also examine the patient and arrange any tests that might be needed.
The NHS Cancer Plan, published in September 2000, sets out the first ever comprehensive strategy to tackle the disease. It is the first time any government has drawn up a major program of action linking prevention, diagnosis, treatment, care and research. The NHS Cancer Plan contains a wide range of targets and commitments. The NHS Cancer Plan Progress Report released in March 2005 substantial progress has been made in meeting the Plan’s targets. The thirty-four cancer networks which have been established have achieved important improvements in delivering cancer services across England (2005).
The progress report also mentioned that cancer networks have helped improve cancer services and have achieved some particular successes. These include planning for the introduction of new cancer drugs and developing plans for funding specialist palliative care. In addition to the NHS Cancer Plan, the Department has launched other initiatives to improve cancer services, including a tobacco advertising ban and a strengthening of the partnership between the NHS and the voluntary sector (2005).
There have been many largely anecdotal descriptions of the extreme psychological distress, social, and sexual difficulties associated with breast cancer treatment (1991). Numerous descriptions in the scientific literature and lurid accounts in the popular press continue to chart the psychosocial havoc wreaked by the diagnosis of breast cancer and its treatment, especially if that treatment involves breast amputation.
It is also important to remember that denial is a common and important coping strategy for many women with breast cancer. This is just a normal psychological process and what the nurse can do is to provide support.
For a woman who has already undergone many emotional and physical assaults, the news that she must now go through several courses of chemotherapy or other therapeutic procedures over a period of several months after being diagnosed of cancer is often regarded with a mixture of fear and suspicion. Just as the diagnosis of breast cancer has created denial and anxieties, the need for chemotherapy or other therapeutic procedure may create similar anxieties.
Women with breast cancer also has counselling needs which has to be taken cared of. The primary aim in counseling patients with breast cancer is to help women find their own means of coping with the emotional stresses of having a life-threatening illness. Coping is referred to as ‘constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person’ (1991). The outcome of good coping in this sense means successfully adapting to the difficult and changing physical and emotional demands placed on a woman with breast cancer.
Tremendous emotional upheaval is common after being diagnosed with cancer. Many cancer patients experience feelings disbelief, shock, fear, and anger. They may also feel overwhelmed by the girth of information about their cancer and their treatment options, by the decisions they are required to make, and by the sudden changes in their lives. It takes time to accept and understand the diagnosis. As overwhelming and painful as a diagnosis of cancer is initially, many cancer survivors say that their struggle against cancer gave them an opportunity to re-evaluate their lives and to find strengths and abilities that they hadn’t known they possessed (2004).
The UK Department of Health abandoned the policy of advising women to examine their breasts in 1991 and the current advice to women is to be “breast aware”. Lesley Walker, director of cancer information at Cancer Research UK, said being “breast aware” meant looking out for changes such as a new lump or thickening in one breast or armpit, any puckering, dimpling or redness of skin, changes in the position or condition of the nipple and any new pain or discomfort felt on one side. In light of this, it is understandable that even if self-breast examination cannot really be effective, other means of breast examination can still be helpful.
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