When termination of pregnancy is permissible Free Essays

The debate about termination of pregnancies has been raging for a long time and it has been pitting the pro abortionists who believe that abortion is permissible under certain circumstances and the anti abortionists who believe that abortion is not permissible under any circumstance. From a logical perspective, the pro abortionists seem to be sensible because there are certain situations where abortion must be carried out. There are some situations where abortion is moral and ethical meaning that it is permissible. We will write a custom essay sample on When termination of pregnancy is permissible or any similar topic only for you Order Now One of the situations where abortion is permissible is when abortion is permissible is when the life of the mother is in danger. When the life of the mother is in danger, do you save the mother or the child?. This situation can be supported by the ethical theory of utilitarianism. This theory states that any act is ethical and moral if it is done to benefit the larger percentage of the society and an act is unethical if it is done to the detriment of a larger percentage of the society. It this theory is brought into the issue of pregnancy it is easy to understand why termination of pregnancy is permissible in case the life of the mother is at risk. The question that one needs to ask is; who between the child and the mother is more beneficial to the society? The mother could be a woman who has some other children who need to be taken care of. The mother could be a breadwinner in her family. This mother could be a public servant and her demise would affect the services she used to render to the nation. The mother is a relative and a friend to many people and her demise would affect them emotionally. However, this child does not have as much value to the society as the mother meaning that the life of the child is not as important as that of the mother (Sedgh 2007). Therefore , saving the life of the mother, from a utilitarian point of view is more beneficial to the society more than saving the life of the child. Saving the life of the child while letting the mother to die is not ethical because this will present a problem for the child who will have to grow without motherly care and love while the society will place an extra burden to the society which will have to bring up a child in the absence of the mother. Therefore, in case the life of the mother is threatened by a pregnancy, then termination of such a pregnancy is permissible and supported by the ethical theory of utilitarianism. Another instance under which abortion is permissible is when a woman becomes pregnant after an incident of rape. Though pregnancies arising from rape are rare it is important to note that some pregnancies occur after incidences of rape. Why is pregnancy that arises after an incidence of rape permissible? To start with, rape is a tragic act that violates the body of a woman and also affects her mental health a great deal. Psychiatrist s argue that the mental health of the woman can be safeguarded if a pregnancy arising from such tragic acts such as rape is terminated. From a legal point of view, it is argued that rape is an act of violation, a grave injustice meaning that it is unjust to force such a woman to carry a pregnancy arising from rape to viability. The pregnancy will keep reminding the woman of the violence committed against her and this would last for nine months of the pregnancy and whenever she sees the child. This would make the woman live with a lot of mental anguish. From a utilitarian perspective, it is quite ethical and moral to terminate this pregnancy because the mental health of the woman is of a higher value than the life of the fetus. From a humanitarian perspective, the fetus is also considered an aggressor against the integrity and the personal life of the woman and it is defensible and permissible to terminate the pregnancy as a way of defending the personal and human values of the woman because these values are robbed of her by the violent act of rape. Those opposed to abortion argue that termination of a pregnancy arising after an incident of rape is not permissible because that pregnancy can avoided according to these anti abortion activists, conception does not occur immediately after sexual intercourse meaning that pregnancy can be avoided in all instances of rape especially if the victim receives medical treatment immediately after the attack to remove the male semen from the uterus to ensure that fertilization does not take place. However these people fail to realize that rape is a traumatizing act that destabilizes the mental state of a victim meaning that making decisions such as visiting a medical center for immediate treatment may not be easy for the victims. It is good to avoid the pregnancy by seeking instant medical help but in case the pregnancy occurs then it is very permissible to terminate it to safeguard the mental health of the mother. There are other anti abortionists who argue that the unborn children resulting from rape have the right to live because they are as innocent as the mother. They claim that the rapist is the aggressor and not the unborn, but it is important to note that the child will always remind the woman of the violent action during the entire pregnancy and even after the birth of the child. The mother may not be able to give utmost love and care to the child because the child is unwanted and brings traumatic memories to the mother. This means that relieving the mental suffering of the mother is more important than the right to live of the fetus meaning that is ethically permissible to terminate a pregnancy arising from an incident of rape (Finer, 2000). The third instance where termination of a pregnancy is permissible is a situation where a woman gets pregnant as a result of incest. However, this situation depends with the nature of incest because if the woman willingly participates in an incestuous intercourse, then termination of such a pregnancy is not permissible. However, if the woman was forced by the second party to participate in an incestuous intercourse against her will, then a pregnancy arising out of such a situation can be terminated without moral and ethical questions being raised. This is because there are very few differences between a forced incestuous intercourse and rape. Both of them violate the dignity and the mental stability of the woman and a child arising out of such an intercourse is usually an aggressor towards the woman. The child will forever be a reminder to the woman of that degrading incident that violated her dignity and self worth and this will affect the mental health of the woman for a long time. Just like in rape where the pregnancy is terminated to safeguard the mental health of the woman, a pregnancy arising out of a forced incestuous intercourse can be terminated because the mental health of the woman is more important than the value of life of an unborn fetus, who in the first place is an unwanted child who will never get enough motherly love, care and attention from the mother. The fourth circumstance may appear controversial but a deeper look into the argument will expose the logic. According to some pro abortionists, women can be forced to carry a pregnancy to viability just because it is unethical to terminate that pregnancy but the question that arises is; is that woman ready to bring up the child. The woman may have engaged in a sexual activity with a man after mutual consent but gets pregnant accidentally, meaning that she wasn’t ready for the pregnancy. This kind of a pregnancy is called an unwanted pregnancy. In most cases, when women give birth after carrying an unwanted pregnancy to viability, they are never able to give their children the relevant motherly love, care and attention and they usually neglect these children meaning that they are never able to enjoy quality life. Some of these women especially in the third world countries throw the children away after birth or when they are very young and these children usually become street children. The big question that arises is; which is more ethical between giving birth to an unwanted child then let the child to suffer for their entire life or terminating an unwanted pregnancy before the fetus becomes a human being. The later seems to be more ethical because it prevents the lifetime suffering of an innocent child. This means that if a woman feels that she cannot really take care of the child she is carrying despite her being responsible for its conception, then the termination of such a pregnancy is morally and ethically permissible. Moreover, women have an ethical claim to their body meaning that thy have bodily autonomy which should be regarded as integral to the conception of an ethical and free society that embraces democracy. This autonomy is an ethical necessity meaning that no one should force a woman under any circumstance to carry a pregnancy to viability (Bankole,1998). There are some cases where women are forced to terminate pregnancies because of their careers. Is this termination of pregnancy defensible and permissible? When a woman really knows that she cannot be a good mother and abort the child they are carrying, they are making the most ethical decision ever because it would be quite unethical to give birth to a child one cannot care for. This means that in such a situation, abortion is permissible. Some of the instances described above may appear controversial especially to those who approach the debate with a closed mind. While religious doctrines and values are not inferior to the secular approach, it is important to note that religious values cannot be a background for tenets that apply to all citizens. List of references Bankole, A. 1998, Reasons Why Women Have Induced Abortions: Evidence from 27 Countries. International Family Planning Perspectives, 24 (3), 117–127 and 152. Retrieved 2006-01-18. Finer, L. 2005, Reasons U. S. women have abortions: quantative and qualitative perspectives. Perspectives on Sexual and Reproductive Health, 37 (3), 110–118. Retrieved 2006-01-18. Sedgh, G, 2007, â€Å"Legal abortion worldwide: incidence and recent trends†. Int Fam Plan Perspect 33 (3): 106–16. World Health Organization. 2004, â€Å"Unsafe abortion: global and regional estimates of unsafe abortion and associated mortality in 2000†. Retrieved 2009-03-22. How to cite When termination of pregnancy is permissible, Papers

Like Water for Chocolate free essay sample

The movie and book Like Water for Chocolate have a lot of comparisons but also dramatized scenes. Even though both movie and book give the same theme they also have different styles to approaching the theme. With different approaches to the moral of the story they differentiate in how they get it across to the viewer. Food in this story shows how Tita deals with her happiness and sadness. She makes people depressed with a wedding cake and makes people hot and love when she makes quail with rose pedals. Food is something that people can express emotion no matter what they make. In the movie Like Water for Chocolate the beginning of the movie it starts out being told by a narrator. Then it goes into it being told as it happens by Tita. I enjoyed the movie just as much as the book but I did like the dramatic scenes of the movie because it gave the viewers an idea of how things were in this time era more then it does in the book. We will write a custom essay sample on Like Water for Chocolate or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Sometimes a good dramatic movie is worth seeing because you get intricate with it. In the book, the scenes that are dramatized in the movie are not dramatized in the book because it is harder to make something seem bigger than it is while reading it. The book however put things in perspective of when it took place, by naming the chapters after the months that everything was happening unlike the movie where everything clashed together as a whole time line of events. The things you see or think about in a book are not the images that the author wants to you see in perspective but the way you read the words is how you see it. Putting both movie and book in perspective and after reading the book and watching movie I can say I enjoyed both. I do like the movie better however because it did give more dramatic scenes and story line then the book. I like how in the movie Tita was portrayed as this much lovelier woman then her sister who married her boyfriend when she was younger. With this controversy you see much more in the movie then the book in my eyes. In retrospect both show the roles of women and men and how they are supposed to act in the society and family household. Women in the family were to cook, clean and take care of the family while the men were out working, bringing home money for the family. It is hard to see this in both however because Tita’s father died and Pedro you don’t see doing this as much as he probably should in both movie and book. In the book, I can argue that when Tita was little she was in the kitchen with Nacha learning how to cook and prep the food for different occasions. She wanted her sister in there and have fun. â€Å"Tita managed to convince them to join her in watching the dazzling display made by dancing water drops dibbled on a red hot griddle†¦Rosaura was cowering in the corner, stunned by the display. Gertudis, on the other hand, found this game enticing†¦threw herself and showed her rhythm. Rosaura tried to join then†¦Rosaura resisted Tita trying to move her hands closer to the griddle†¦. Tita got spanked for that and was forbidden to let her sisters come in to her world of the kitchen† (Esquirel pg. 8). This whole scene in the book was in the first chapter, where as the scene in the movie was a short intricate of what happened in the kitchen. The scene in the movie was just when they were younger and Tita and Gertudis were throwing water onto the griddle, laughing and having fun. Another scene in the movie and book that are very separate and different is when Tita and Nacha were getting the ingredients for the cake they had to make for her sisters wedding. In the book in the month of February it talks about how Tita and Nacha were making marmalade for the filling of the cake. In this chapter it is talked about how to prepare it, cook it and put it in the cake. â€Å"Nacha and Tita had made several jars of preserves apricot, fig, and camote with pineapple- the month before the wedding†¦ Spared the task of making the marmalade the same day as the cake† (pg. 31). The book then goes on to talk about how to cook the marmalade and then also what Tita and Nacha have to do in order to cook it perfectly and not get burned by the fire. They also talk about how the smell of the aroma fills the kitchen and the smell of the apricots is sweet and revising. In the movie, they show nothing about the marmalade being made or cooked. The only scene in the movie about the preparation of the wedding cake is when Tita and Nacha are prepping the batter for the cake. Tita cries into the cake because she is sad about the wedding, it should have been her being married not making the cake for it. These are only two differences that the movie and book have in comparison to the story. There are many other differences that could be talked about that are major to the story but I like this two the best because they represent Tita’s life and what she did for her family. Many other sections of the book are not portrayed in the movie and in reality we cant get the entire aspect of the life of this family in the movie, like we can get while reading the book. After reading the book and after watching the movie we can kind of get an understanding of how family traditions were really important to these families during this time era especially in other countries. In the Tita’s family the family tradition was that the youngest daughter was to never get married because she would have to take care of her mother until the day she died. That is why Pedro had to marry Rosaura and not Tita; even though he didn’t love her he loved Tita. Sometimes we depict the life of those in other countries as wanting us to be like us because we don’t want to see people in poverty or as being stricter then how they should be. After reading the book and watching this movie the similarities and differences that are depicted throughout the story line. This story line is very dramatic and I like dramatic scenes because it shows more about it then it would if it sometimes it wasn’t over dramatic. I enjoyed the end of the movie better because it showed that Pedro and Tita still loved each other until the end of the movie. They proved that no matter what happens in their life they will wind up being together at the end. They die because of their love affair.

Comprehensive Guide on How to Prepare a Speech

â€Å"To speech or not to speech?†: Your Guide on How to Create a Speech There is nothing worse than staring at an empty screen and its painful to think how you can begin this speech. Especially if the deadline hangs over you dangerously.But try to approach the matter strategically. This guide could help many busy people prepare for the performances and bring out three simple steps that allow you to quickly move from making up speech to its utterance.Step 1. Its important to spend a few minutes thinking about what you want to achieve with your speech or presentation. As the one great man once remarked, If you do not know where you are going, you will be somewhere else. So for a few minutes, think about the following:What is this speech? Common types are informational (teaching, instructing), persuasive (your goal is to change peoples beliefs and behavior), emotional (aimed at emotional reaction).Who are your audience? What do they already know about this topic? What do they think is true and what is not? What do they want? What are they hoping for? What a re they afraid of?What should the audience feel? What do you want them to do? Choose 1-3 things that you want to convey to them (based on what they already know or believe in, what they hope for, what they want, what they fear, and what you want them to understand), which will then motivate them to do what you want from them? If possible, follow the three main points.Step 2. Organize the information. Psychology studies show that when you give people too much choice and too much information, attention is dissipated, and they eventually do not â€Å"buy† anything. When you expect from the audience that it will buy what you are saying, it is necessary that the ideas are as simple and uncomplicated as they could be. Here is an easy scheme that can be followed and that will keep the attention of the audience.Smart and attractive introduction. Make your audience be interested in you from the first minutes. Use a quote, story, question, statistical indicator something that will hoo k people as soon as possible.Briefly mention the main things. Let the audience understand what will be discussed.Summary of speech. Tell people what you just told them. (This is serious our memory is short, and our attention disappears quickly.)The audience will remember the best part is that they heard last. Complete unfinished thoughts, state the last inspiring conclusion that will encourage people to think and act differently, and end up with a spectacular and memorable statement. What is even better is that these last words should be sent to the beginning of the speech, then it will be perceived as fully completed.Step 3. Speak enthusiastically. Your task is not just to survive your speech, but to show empathy, humor, your style. Meet the listeners with your eyes, use gestures to generate energy, walk around the room (not too much), and let your voice and your face be alive: you must show that you are really worried about your theme and your audience. Do not stand still do som ething.

Critial Investigation of the etiology of juvenile idiopathic arthritis The WritePass Journal

Critial Investigation of the etiology of juvenile idiopathic arthritis Introduction Critial Investigation of the etiology of juvenile idiopathic arthritis IntroductionReferencesRelated Introduction Juvenile idiopathic arthritis is an umbrella term which includes all forms of arthritis that begin before the age of sixteen, of over six week’s duration, and of unknown cause. (Petty el al 2004)   With various contributing environmental and genetic factors, arthritis is an autoimmune disease. Ongoing research, into the etiology of juvenile idiopathic arthritis, has identified the most common risk factor as infection in combination with genetic susceptibility.   An autoimmune reaction occurs as a result of an infection or trauma, this causes synovial hypertrophy and chronic joint inflammation in genetically susceptible individuals.   (Rabinovich 2010). Juvenile idiopathic arthritis is a genetically complicated characteristic in which many genes are important as indications at the onset of the disease. Both the IL2RA/CD25 and the VTCN1 genes have recently been identified as juvenile idiopathic arthritis susceptibility loci (Hinks et al 2009) .Pathogenesis has many other contributing factors such as stress and maternal smoking. (Prince et al 2010) The International League of Associations for Rheumatology (2004) classification of Juvenile idiopathic arthritis, JIA, includes seven subtypes: Systemic onset JIA, oligoarticular, polyarticular RF-positive and RF-negative, Enthesitis-related arthritis, Juvenile ankylosing spondylitis, and ‘‘other.’’ The most common type of JIA is Oligoarticular.     60% of children, mainly girls under 5, with JIA have this type. During the first 6 months Oligoarticular affects between one and four joints.   The knees, ankles and wrists are the most affected. After 6 months it can spread to more than four joints and is known as ‘Extended oligoarthritis’ affecting 2 in 5 children. Affected children are moody and difficult as a result of their symptoms, which include joint stiffness in the morning and joint pain.   Walking may be delayed in very young children. 1 in 5 children also have inflammation of the eye, Uveitis.   Children who carry antinuclear antibodies in their blood are most at risk of uveitis. (Arthristis Research UK, 2010) Polyarticular arthritis, which again is more common in girls, affects 20% of children with JIA.   (Arthristis Research UK, 2010) Polyarthritis mainly affects the joints of the hands and feet, which become painful, swollen and stiff. This type can often affect more than one joint, usually over 4, at a time. The child can often become unwell and pain may be accompanied by a fever. About 10% of children will have the rheumatoid factor (RF), meaning that their blood contains an antibody similar to that often found in adult rheumatoid arthritis. Most RF-positive children are girls, typically aged 10 or over. RF-positive children can have a more severe form of the disease which, without early intervention, can result in long-term joint damage. It is unlikely that RF-positive children will be free from Polyarthritis with symptoms continuing into adult life. Permanent remission is more often seen in children who are RF-negative.   (David and Lloyd 1999, pg 207) About 10% of cases of arthritis in children are systemic. This type of arthritis affects girls and boys equally but is more often seen in under fives. (Arthritis Research UK, 2010). This severe and potentially fatal form of JIA includes children who have arthritis associated with marked systemic features. Systemic   arthritis can be identified by a fever   which persists daily for at least two weeks either at the onset or prior to the arthritis. One or more of the subsequent systemic features must also occur,   these are a rash, generalised lymphadenopathy, liver or spleen enlargement and   serositis (inflammation of the serous tissue, which lines the major organs including the heart and lungs.)   Every child is different. Some children will fully recover after one bout of systemic arthritis. Others could have symptoms that come and go for several years and a number of children go on to develop polyarthritis but have no further fever attacks.   (Arthritis Research UK, 201 0) Psoriatic arthritis affects less than 10% and is most commonly found in girls aged 8 to 9 years. Psoriasis, a skin condition causing   a widespread flaky skin rash is prevalent.   Ã‚  The rarer form, Enthesitis-related arthritis usually affects boys aged eight and over. The main symptoms are arthritis in several joints at once, often located at the sacroiliac joint. Enthesitis-related arthritis has a genetic risk factor with children carrying, the HLA-B27 gene. This gene is an indicator common with some adult forms of arthritis. However affected children don’t always go on to suffer in adult hood. (Arthritis Research UK 2010) Although Munro et al (2009)   reported that there are no specific tests for the diagnosis of JIA. Diagnosis is made on both clinical findings and investigations. A literature review, by Munro et al (2009), reports that past research recommends documenting the range of motion in all joints, the extent of joint swelling, the presence of bony overgrowth and whether affected joints are affected by muscle atrophy and weakness. Significant trauma, fever, in particular if it is persistent for 10 days or without clear cause or coupled with a rash also need to be evident..   Rheumatoid factor and antinuclear antigen screening tests should be conducted although children with an infection or current pathology may have positive findings, and the tests should not be used as a definite diagnosis of JIA. Inflammation, identified with a raised white cell or platelet count,  Ã‚   may also be identified   by during a full blood screening. T-lymphocytes play an essential role in the pathophysiology of JIA. They release pro-inflammatory cytokines and favour a type-1 helper T-lymphocyte response. An abnormal interaction between type 1 and type 2 T-helper cells has been hypothesized. Research into T-cell receptor expression; confirm recruitment of T-lymphocytes specific for synovial antigens. Evidence of a disorder in the humoral immune system is identified by the increased presence of autoantibodies, increased serum immunoglobulins, existence of circulating immune complexes   or complement activation. Chronic inflammation of the synovium is characterized by B-lymphocyte infiltration and expansion. Macrophages and T-cell invasion are linked with the release of cytokines, which induce synoviocyte proliferation. (Rabinovich 2010) JIA, if badly managed, can have a number of consequences   such as growth failure, leg length discrepancy, contractures, scoliosis, blindness (secondary to untreated chronic anterior uveitis), Macrophage activation syndrome, disability and many more. Psychosocial problems are also evident. JIA sufferers are predominantly affected by pain.   When   treating   children in pain, doctors and parents must first understand the physiology of pain and why children have different reactions. The International Association for the Study of Pain (2007) defines pain as â€Å"An unpleasant sensory and emotional experience which we primarily associate with tissue damage or describe in terms of such damage, or both.† This definition recognises that pain is a perception and not a sensation as many believe.   Pain can be categorised into nociceptive, or neuropathic. Sustained activation of the nociceptive system caused by   tissue injury   results in pain described as nociceptive . While neuroplastic changes are evidently involved, nociceptive pain is alleged to arise as a result of the normal activation of the sensory system by noxious stimuli, a process that utilises transduction, transmission, modulation and perception. Direct injury or dysfunction of the peripheral or central nervous system results in   Neuropathic pain. The injury could be to either neural or non-neural tissues. (American Medical Association, 2010) There has been several pain mechanism theories proposed over the last 50 years.   The specificity theory, described in 1664 by Rene Descartes, proposes that pain impulses travelled along a dedicated pathway from receptors in the periphery to a specialised pain centre in the brain, resulting in a mechanical behavioural response. Descartes described each nerve as having a specific function, with free nerve endings being called pain receptors. (Thomas 1998, pg 6) It suggests that the greater the damage or injury then the more sever the pain. (Brannon and Feist , 2000) This theory can be supported to the extent that there are some specialised nerves in the human body however others can have numerous functions or detect several types of stimuli. On the other hand this theory does not explain the variable nature of pain. Furthermore no pain centre has ever been identified; current research suggest multiple areas of the brain detect and respond to the   pain stimuli. (David and Waterfie ld 1999) In 1962, Weddel (cited by Thomas 1998) states that there is no separate system for perceiving pain, rather that pain is due to intense peripheral stimulation of non-specific receptors. This in turn produces a pattern of nerve impulses, which is interpreted centrally as pain. The pattern theory proposed that strong and mild stimuli produced different patterns of impulses. (Thomas 1998, pg 6) This theory ignores the specialism of some receptors and does not account for conditions in which a gentle touch can trigger episodes of neuralgia (David and Waterfeild 1999) The best explanation to date is the pain gate theory, proposed by Mezack and Wall in 1965. (David and Lloyd 1999, pg28)   The theory suggests that stimulation of nerve endings evokes nervous impulses that are transmitted by three systems located in the spinal cord. The substania gelatinosa in the dorsal horn of the spinal cord, the dorsal column fibres and the central transmission cells act to stimulate or inhibit nocioceptive impulses. The transmission of impulses from the afferent fibres to the spinal cord transmission cells is modulated by the spinal gating mechanism in the dorsal horn. The gating mechanism is influenced by the amount of activity in the larger-diameter fibres. Larger diameter fibres are thought to be inhibiter, thus closing the pain gate, the opposite occurs when smaller fibres are stimulated: pain is transmitted and the gate opens.(Melzack and Wall, 1996) In addition descending control from various structures in the brain can also inhibit the relay and close th e gate. On reaching the brain,   the impulses are further modified and integrated with other sensory input. On arrival at   the brain   the impulses are felt as pain. It is important to understand that those afferent fibres do not have a fixed response but are subject to modification even before they reach the pain gate and after they reach the brain. (David and Lloyd 1999, pg 28) The pain gate theory was the first to appreciate that pain can be affected by  Ã‚   psychological factors.   A person may be able to control pain be altering their state of mind. For example if a person is able to distract themselves from the pain then less impulses are sent to the brain therefore not enough stimuli are present to open the gate. (Salvano and Willems 1996, pg 15) In summary experiences of pain are influenced by many physical and psychological factors such as beliefs, prior experience, motivation, emotional aspects, anxiety and depression can increase pain by affecting the central control system in the brain. The specificity theory and the pattern theory suggests that pain occurs only due to damage to body tissue while the gate control theory claims that pain may be experienced without any physical injury and individuals interpret pain differently even though the extent of injury is the same. The gate control   theory also suggests that pain can be controlled by the mind. The author’s understanding is that Juvenile idiopathic arthritis produces nociceptive pain, through recurrent inflammation of the joints. Inflammation releases chemicals such as histamine and bradykanin, which are detected by nociceptors which then activate noxious impulses to the dorsal horn. Once enough impulses are generated to â€Å"open the gate† neural areas responsible for perception and response activate. The perception and level of response is influenced by the state of mind. Pain impacts on the lives of children, with arthritis, by limiting activities, disrupting school attendance, and contributing to psychosocial distress (Kimura and Walco 2006). A study by Schanberg et al (2003)   investigated levels of pain in 41 children with arthritis by the daily completion of pain diaries. They found that 70% of the children had significant amounts of pain, on 60% of the days, with 38% having pain daily. Children often describe the pain associated with JIA as â€Å"aching,† â€Å"sharp,† â€Å"burning,† and â€Å"uncomfortable† (Antony and Schanberg 2003). Research also suggests that children with JIA have a lower pain threshold than their healthy counterparts. (Hogeweg et al 1995) This could be due to the children’s brains, were pain is processed, changing due to long exposure to noxious impulses. The perception of pain in children with JIA could also be influence by the cognitive capabilities and age. Beales et al (1987, cite d in Antony and Schanberg 2003) suggest that cognitive development impacts pain perception due to the association and understanding of the child’s condition. For example all the children , despite their age, described the pain as â€Å"aching† but younger children did not associate it with anything unpleasant , older children, however,are more likely to relate their joint   feeling   to their arthritis-related disability. Therefore with cognitive maturation, children become capable of connecting internal sensations with internal pathology and the potentially serious consequences. Hence, older children with arthritis may become more distressed by the sensation, resulting in increased reported pain intensities as the childs age increases. (Antony and Schanberg 2003). There is a mounting body of research indicating to the importance of psychosocial variables in the pain incidence of children with JIA, consisting of emotional distress, stress, and mood. Also significant is the child’s perception and coping strategy with their pain. Moreover, a number of studies have described the role of parental and familial factors in child pain, specifically parental psychological health, parental pain history, and the nature of the way in which family members interact with one another. Addressing these issues while managing the condition may help to reduce pain, elevate mood, and improve overall quality of life for children with arthritis. (Antony and Schanberg 2003). A child’s pain needs to be assessed at each appointment, whether by a doctor or physiotherapist. Pain can be assessed both subjectively and objectively. It is important to gain a good description of areas affected, the intensity, type and severity of the pain. A more objective measurement is a Visual analogue scale, completed by the child and a VAS global assessment of disease and function completed by the parents. (Pounty 2007) A multidisciplinary approach, to the management of Juvenile idiopathic arthritis, is considered best practice. Treatment is aimed at controlling inflammation and minimising its effects on the joints. For the best outcome, awareness of complications of both disease and therapy and the psychosocial effects of the illness on both the child and family is essential. (Davidson 2000) Treating the pain can sometimes be the only intervention during a physiotherapy session. Both pharmalogical and non-pharmalogical methods are used to treat pain in JIA.Guidelines for the management of childhood arthritis,   Ã‚  The British Paediatric Rheumatology Group (2001), are available and new research is continuing to improve treatments. Most JIA children are Initial treatments include intra-articular long-acting corticosteroid injections and NSAIDs. NSAIDs control pain and inflammation and are usually given for 4 to 8 weeks before starting treatment with a second-line agent. Naproxen, tolmentin, diclofenac, and ibuprofen are commonly used and are usually well tolerated with little gastrointestinal discomfort. The choice of NSAID may be based on the taste of the medication and the convenience of the dosing regimen. Naproxen is prescribed most frequently. Indomethacin is a potent anti-inflammatory medication commonly used to treat ERA and SOJIA, however side effects include headaches, difficulty in concentrating, and gastrointestinal upset. These can be counter acted with other medications. (Weiss and Ilowite 2005) A literature review (Hashkes and Laxer 2005, Cited by Munro et al 2009) looked at the affects of NSAIDS on JIA. These were inconclusive as the participants receiving all forms and doses of NSAIDs achieved significant improvements in the outcome measures and no individual NSAID was shown to have a clear advantage over others. The immune system can be suppressed and the progress of arthritis   slowed down, as well reducing the inflammation, by the use of   diseases modifying anti-rheumatic drugs (DMARDs) (National Rheumatology Society 2008) Methotrexate is most commonly used for JIA.   Random controlled placebo trials and dose finding trials have shown that DMARDs can be effective in polyarticular and oligoarticular arthritis although not in systemic arthritis. (Prince et al 2010) Both physiotherapy and occupational therapy can reduce the impact of JIA, on the daily lives of children. Physiotherapy has a number of treatments that can be utilised to reduce pain. Physical therapy and exercise programs have been shown to be helpful in reducing pain in children with arthritis and should therefore be encouraged, especially since children with arthritis tend to be less physically active and may have become de-conditioned (Kimuru and Walco 2006). Exercise can have an analgesic effect.   If using the Pain gate theory, movement can help to close the gate by providing a distraction. Exercise is also good for the healing process. Satallite cells, which can only be activated through exercise, are important for muscle growth and repair. They can be stimulared to either replace damaged muscle cells or add muscle cells.   (Poutney 2007, pg 234) A literature review, by Long and Rouster-Stevens (2010), highlighted the importance of exercise in the treatment of JIA. Current studies show that inactivity can lead to deconditioning, disability, decreased bone mass, and reduced quality of life. While progress in pharmacology has improved the lives of patients with JIA, management should also consist of a moderate, regular exercise program or more active lifestyle. The literature suggests physical activity may improve exercise capacity, reduce disability in adulthood, improve quality of life and, in some patients, lessen disease restrictions.   . There is however limited evidence of the effect of strength training in children with JIA. Fisher et al (2001) monitored the effects of resistance exercise, via isokinetic equipment, in 19 children with JIA. Children were given an 8 week, personalised progressive programme.  Ã‚   Participants demonstrated significant improvement in quadriceps and hamstring strength and endurance, contraction speed of the hamstrings, functional status, disability and performance of timed tasks.   Despite the limited evidence, it is recommended that a programme of strength training may be beneficial with JIA. Recommendations for healthy children can be used as a guide.  The American Academy of Paediatrics (2001, cited by Maillard 2010) recommends that to increase strength and fitness, low resistance for 15 repetitions is ideal for children. They suggest twenty to thirty minute sessions, two to three times weekly. There is evidence that there is no benefit to increasing the amount of sessions. (Ma illard 2010) Hydrotherapy is also advocated for JIA. The effects of hydrotherapy are gained with the combined effect of the warmth, the buoyancy and the fun element of the treatment. Hydrotherapy aims to reduce pain and muscle spasms, increase joint range of movement, and increase muscle strength. Epps et al (2005) found that following two months of hydrotherapy combined with land based exercise there was an increased quality of life and reductions in the impact of the disease in 47% of children with active juvenile arthritis. Pain relief from the heat generated from the pool could be replicated using heat pads or a hot bath. Heat relaxes your muscles and stimulates blood circulation. In relation to the pain gate theory thermal receptors may detect a raise in temperature, impulses are generated which help to close the gate in the dorsal horn, reducing the amount of noxious impulse to the perception area therefore providing relief   Conversely cold packs could be used to reduce inflammation and therefore reduce the amount of impulses generated by chemorecepters.   (Arthritis Foundation 2011) Alternative therapies are often used to aid pain relief (Feldman et al 2004). Massage is found to be effective on depression, anxiety, mood, and pain (Walach et al 2003).   Field et al (1997) investigated the use of massage on children with JIA. Parents massaged their child for 15 minutes per day, for 30 days. They found that the self assessed pain scales decreased as well as cortisol levels lowering, reducing their stress and anxiety. It is possible that the touch from massage helps to reduce pain by closing the gate in the dorsal horn. In conclusion, juvenile arthritis is a painful condition that affects a child’s social, educational and physical life. Pain is a major contributor to the lowered quality of life experienced by these children. Relief can be found in many interventions. A multidisciplinary approach is best practice. The evidence suggests that a combined programme of physiotherapy and medication can help to reduce pain and improve function in these children References American Medical Association.(2010) ‘Pathophysiology of Pain and Pain Assessment.’ Chicago [online]. Available at:http://jhuleah.files.wordpress.com/2010/08/dr-moore-reading-1-ama_painmgmt.pdf (Accessed on 10th March 2011) Anthony.K,  Schanberg. L, (2003) ‘Pain in children with arthritis: A review of the current literature’ Arthritis Care Research, 49(2),  pages 272–279[online] available at: http://onlinelibrary.wiley.com(Accessed on 14th March 2011) Arthritis Foundation (2011) ‘using heat and cold’ [online] Available at: arthritis.org/use-heat-cold.php (Accessed on 14th March 2011) Arthritis Research UK (2010) ‘Juvenile idiopathic arthritis (JIA, arthritis in childhood)’ . Available at: arthritisresearchuk.org(Accessed on 14th March 2011) British Paediatric Rheumatology Group (2001) ‘Guidelines for the Management of Childhood Arthritis’. Rheumatology, 40(11), pp1309-1312, [Online]. Available at: http://rheumatology.oxfordjournals.org (accessed on: 16th March 2011) Brannon, L. Feist, J.(2000), Health Psychology: An Introduction to Behaviour and Health ,4th ed , USA: Brooks/Cole, David.C, Lloyd.J (1999) ‘Rheumatology Physiotherapy’. London: Mosby International limited Davidson.J.(2000) ’Juvenile Idiopathic Arthritis: a clinical overview European Journal of Radiology, 33( 2), pp 128-134,[Online]. Available at: www. Sciencedirect.com (Accessed on 12th March 2011) Epps.H,  Ginnelly.L,  Utley.M,  Southwood.T,  Gallivan.S,  Sculpher.M,  Woo P.(2005) ‘Is hydrotherapy cost-effective? A randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis.’ Health Technol Assess. 9(39), pp1-59, [Online]. Available at: ncbi.nlm.nih.gov (Accessed on 12th March 2011) Feldman.D, Duffy.C, De Civita.M, Malleson.P, Philibert.L, Gibbon.M, Ortiz-Alvarez.O, Dobkin.P (2004) ‘factors associated with the use of complementary and alternative medicine in juvenile idiopathic arthritis’ Arthritis Care Research, 51(4),  pages 527–532,[online]. Available at: (Accessed on 10th March 2011) Fisher NM, Venkatraman JT, ONeil KM, (2001) ‘The effects of resistance exercises on muscle and immune function in juvenile arthritis.’  Arthritis Rheum,  44(9), pp276, [Online]. Available at:www.medscape.com(Accessed on 12th March 2011) Hinks A, Ke X, Barton A, et al.  (2009) ‘Association of the IL2RA/CD25 gene with juvenile idiopathic arthritis’.  Arthritis Rheum, 60(1), pp251-7, [Online]. Available at: http://onlinelibrary.wiley.com(Accessed on 10th March 2011)   Hogeweg.J, Kuis.W, Oostendorp.A, Helder.R, (1995) ‘General and segmental reduced pain thresholds in juvenile chronic arthritis’ Pain, 62(1), pp11-17, [Online]. Available at: www.sciencedirect.com (accessed on 10th March 2011) Hull.RG, (2001). ‘Management guidelines for arthritis in children.’  Rheumatology, 40, pg1308, [online]. Available at: http://rheumatology.oxfordjournals.org (Accessed on 12th March 2011) International Association for the Study of Pain (2007) ‘IASP Pain Terminology’[Online]. Available at: iasp-pain.org(Accessed on 12th March 2011) International League of Associations for Rheumatology, Petty RE,  Southwood TR,   Manners P,   Baum J,   Glass DN,  Goldenberg J,  He X,  Maldonado-Cocco J,  Orozco-Alcala J,  Prieur AM,  Suarez-Almazor ME,  Woo P. (2004) ‘International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001.’Rheumatology,31(2), pp390-2, [Online]. Available at: jrheum.org (Accessed on 12th March 2011) Kimura.Y, Walco.G, (2006) ‘Pain in children with rheumatic diseases’ Current Rheumatology Reports , 8(6), pg480-488, [online] Available at: www.springerlink.com. (Accessed on 11th march 2011). Long,.A, Rouster-Stevens.R, Kelly. A (2010) ‘The role of exercise therapy in the management of juvenile idiopathic arthritis’ Current Opinion in Rheumatology , 22( 2), p 213–217, [Online]. Available at: http://journals.lww.com/co-rheumatology (Accessed on 12th March 2011) Maillard.S(2010) ‘Physiotherapy for Juvenile Idiopathic Arthritis’ [lecture] Great Ormond Street Hospital, London [online] available at:www.vadlo.com (accessed on: 12th March 2011) Melzack.R, Wall.D (1996) ‘The challenge of pain’ 2nd ed.London: Penguin, Munro.J, Haesler.K, Rada.J, Jasper.A, (2009) ‘Juvenile idiopathic arthritis: a literature review of recent evidence’ NHMRC,[online] available at: racgp.org.au (Accessed on 10th March 2011) National Rheumatology Society (2008) ‘Methotrexate in Rheumatoid Arthritis’ [Online] available at:nras.org.uk (Accessed on 10th March 2011) Petty.R, Cheang.M, Malleson.P, Oen.K, Cabrel..N, Rosenberg.A (2004) ‘Predictors of pain in children with established juvenile rheumatoid’. Arthritis Care Research, 51(2), pp222-227, [Online]. Available at: : http://onlinelibrary.wiley.com (Accessed on 14th March 2011) Poutney.T (2007) ’Physiotherapy for Children’. Philadelphia: Elvieser Prince.F, Otten.M, van Suijlekom-Smit.L, (2010) ‘Diagnosis and management of juvenile idiopathic arthritis.’ BMJ,341,c6434, [Online]. Availbel at: www.bmj.com (accessed on: 16th march 2011) Rabinovich (2010) ‘Juvenile Rheumatoid Arthritis’ Available at: http://emedicine.medscape.com/article/1007276-overview(Accessed on 14th March 2011) Schanberg L, Anthony KK, Gil KM, Maurin EC(2003) ‘Daily pain and symptoms in children with polyarticular arthritis.’ Arthritis Rheum, 48, pp1390–1397, [Online]. Available at: http://onlinelibrary.wiley.com( Accessed on 14th March 2011) Thomas.V, (1998) ‘Pain : its nature and management  Ã¢â‚¬Ëœ London : Baillià ¨re Tindall Walach H, Guthlin C, Konig M. 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