Water fluoridation

Water fluoridation ABSTRACT The safety and efficacy of water fluoridation has been a topic of great controversy throughout Americas communities. Scientific evidence has shown that ingesting low to moderate levels of fluoride can benefit the dental health of a community, especially those populations in a community that may be classified as having low socioeconomic status. Children in all areas, but especially those with low SES, are at greatest risk for developing dental caries and having a community water fluoridation program (CWFP) will help them reduce their dental caries. Moderation of fluoride ingestion for individuals is the key. Low to moderate daily ingestion of fluoride, averaging 1.0 mg/liter per day is optimum. Dental and skeletal fluorosis can occur if ingestion levels are greater than 3.0 mg/liter per day for long periods of time. This is a discussion on the safety and efficacy of water fluoridation. INTRODUCTION This commentary presents the on-going controversy on community water fluoridation in the United States, and I will attempt to analyze science-based evidence in support of water fluoridation. There have always been questions on the safety and efficacy of fluoride in drinking water, some school of thought believes that fluoridation has some adverse effects to exposed human populations, especially in infants and children. Another school of thought believes that water fluoridation is essential in preventing tooth decay, and therefore the practice should be sustained. According to the Center for Disease Control and prevention (CDC) water fluoridation is one of the 10 great public health achievements of the 20th century in the United States (CDC, 1999), which is attributable for increased lifespan of Americans by 25 years ( Bunker et al., 1994). This paper will discuss science-based evidence that proves the efficacy and safety of water fluoridation among children as well as offer some reco mmendations to the various stakeholders. POSITION STATEMENT Water fluoridation is the adjustment of the concentration level to the optimally regulated level of which the naturally occurring fluoride presents in public or community drinking water supplies. In most cases, deflouridation is needed when the naturally occurring fluoride level exceeds recommended limits. The recommended fluoride concentration in drinking water by the U.S. Public Health Service (PHS) is 0.7-1.2mg/L, to effectively prevent dental caries and minimize the occurrence of dental fluorosis (NRC, 2006). Low decay rates were found to be associated with continuous use of water with fluoride content of 1ppm (Meskin, 1995). There has been serious questions as to the efficacy of fluoride intervention in preventing both tooth decay, as it benefit is said to be merely cosmetic or topical (CDC, 1999). Such topical effect of fluoride can be achieved by the use tooth without the risking the overexposure from ingested fluoride (NRC, 2006). However, it has also been reported that fluor ide exposure provides both systemic and topical protection. Ingested fluoride deposited on tooth surface during tooth formation, and fluoride contained in saliva provides long-lasting systemic protection against booth tooth decay than topical application using tooth paste or fluoride foams (CDC, 2001). WHAT IS FLUORIDE Fluoride is a naturally occurring element. It is found in rocks and soil everywhere. Fluoride can be found in fresh water and ocean water. Naturally occurring fluoride levels ranges from 0.1ppm to over 12ppm (NRC, 2006).Fluoride is present in the customary diets of people and in most portable water sources. The average dietary intake of fluoride is approximately 0.5mg daily from either naturally occurring fluoride in the water or the fluoride found in produce. It is also a normal component of tooth enamel and bone studies have shown that the calcified tissues of both enamel and bone are made up of a combination of hydroxyl- and fluor-apatites of varying composition depending on the abundance of fluoride at the site of formation. These tissues are the principal sites of deposition of fluoride (NRC, 2006). HOW FLUORIDE PREVENTS AND CONTROLS DENTAL CARIES Dental caries is an infectious, transmissible disease in which bacterial by-products (i.e., acids) dissolve the hard surfaces of teeth. Unchecked, the bacteria can penetrate the dissolved surface, attack the underlying dentin, and reach the soft pulp tissue. Dental caries can result in loss of tooth structure, pain, and tooth loss and can progress to acute systemic infection. Cryogenic bacteria (i.e., bacteria that cause dental caries) reside in dental plaque, a sticky organic matrix of bacteria, food debris, dead mucosal cells, and salivary components that adheres to tooth enamel. Plaque also contains minerals, primarily calcium and phosphorus, as well as proteins, polysaccharides, carbohydrates, and lipids. Cryogenic bacteria colonize on tooth surfaces and produce polysaccharides that enhance adherence of the plaque to enamel. Left undisturbed, plaque will grow and harbor increasing numbers of cryogenic bacteria. An initial step in the formation of a carious lesion takes place when cryogenic bacteria in dental plaque metabolize a substrate from the diet (e.g., sugars and other fermentable carbohydrates) and the acid produced as a metabolic by-product demineralizes (i.e., begins to dissolve) the adjacent enamel crystal surface (CDC,2009). Demineralization involves the loss of calcium, phosphate, and carbonate. These minerals can be captured by surrounding plaque and be available for reuptake by the enamel surface. Fluoride, when present in the mouth, is also retained and concentrated in plaque. Fluoride works to control early dental caries in several ways. Fluoride concentrated in plaque and saliva inhibits the demineralization of sound enamel and enhances the remineralization (i.e., recovery) of demineralized enamel (Featherstone, 1999 Koulourides, 1990). As cryogenic bacteria metabolize carbohydrates and produce acid, fluoride is released from dental plaque in response to lowered pH at the tooth-plaque interface. The released fluoride and the fluoride present in saliva are then taken up, along with calcium and phosphate, by de-mineralized enamel to establish an improved enamel crystal structure. This improved structure is more acid resistant and contains more fluoride and less carbonate (Featherstone, 1999). Fluoride is more readily taken up by demineralized enamel than by sound enamel. Cycles of demineralization and remineralization continue throughout the lifetime of the tooth. Fluoride also inhibits dental caries by affecting the activity of cryogenic bacteria. As fluoride concentrates in dental plaque, it inhibits the process by which cryogenic bacteria metabolize carbohydrates to produce acid and affects bacterial production of adhesive polysaccharides. In laboratory studies, when a low concentration of fluoride is constantly present, one type of cryogenic bacteria, Streptococcus mutans, produces less acid. Whether this reduced acid production reduces the carcinogenicity of these bacteria in humans is unclear (Van Loveren, 1990). Saliva is a major carrier of topical fluoride. The concentration of fluoride in ductal saliva, as it is secreted from salivary glands, is low approximately 0.016 parts per million (ppm) in areas where drinking water is fluoridated and 0.006ppm in non fluoridated areas. This concentration of fluoride is not likely to affect cryogenic activity. However, drinking fluoridated water, brushing with fluoride toothpaste, or using other fluoride dental products can raise the concentration of fluoride in saliva present in the mouth 100- to 1,000-fold. The concentration returns to previous levels within 12 hours but, during this time, saliva serves as an important source of fluoride for concentration in plaque and for tooth remineralization (Murray,1993). Applying fluoride gel or other products containing a high concentration of fluoride to the teeth leaves a temporary layer of calcium fluoride-like material on the enamel surface. The fluoride in this material is released when the pH drops in the mouth in response to acid production and is available to remineralize enamel. In the earliest days of fluoride research, investigators hypothesized that fluoride affects enamel and inhibits dental caries only when incorporated into developing dental enamel (i.e., preeruptively, before the tooth erupts into the mouth) (Murray,1993). Evidence supports this hypothesis, but distinguishing a true preeruptive effect after teeth erupt into a mouth where topical fluoride exposure occurs regularly is difficult. However, a high fluoride concentration in sound enamel cannot alone explain the marked reduction in dental caries that fluoride produces . The prevalence of dental caries in a population is not inversely related to the concentration of fluoride in enamel, and a higher concentration of enamel fluoride is not necessarily more efficacious in preventing dental caries (Mcdonagh etal.,2000). The laboratory and epidemiologic research that has led to the better understanding of how fluoride prevents dental caries indicates that fluorides predominant effect is post eruptive and topical and that the effect depends on fluoride being in the right amount in the right place at the right time. Fluoride works primarily after teeth have erupted, especially when small amounts are maintained constantly in the mouth, specifically in dental plaque and saliva (Mcdonagh etal., 2000). Thus, adults also benefit from fluoride, rather than only children, as was previously assumed. RISK FOR DENTAL CARIES The prevalence and severity of dental caries in the United States have decreased substantially during the preceding 3 decades. National surveys have reported that the prevalence of any dental caries among children aged 1217 years declined from 90.4% in 19711974 to 67% in 19881991; severity (measured as the mean number of decayed, missing, or filled teeth) declined from 6.2 to 2.8 during this period (Burt, 1989). These decreases in caries prevalence and severity have been uneven across the general population; the burden of disease now is concentrated among certain groups and persons. For example, 80% of the dental caries in permanent teeth of U.S. children aged 517 years occurs among 25% of those children. Populations believed to be at increased risk for dental caries are those with low socioeconomic status (SES) or low levels of parental education, those who do not seek regular dental care, and those without dental insurance or access to dental services (Meskin,1995). Persons can be at high risk for dental caries even if they do not have these recognized factors. Children and adults who are at low risk for dental caries can maintain that status through frequent exposure to small amounts of fluoride (e.g., drinking fluoridated water and using fluoride toothpaste). Children and adults at high risk for dental caries might benefit from additional exposure to fluoride (e.g., mouth rinse, dietary supplements, and professionally applied products). All available information on risk factors should be considered before a group or person is identified as being at low or high risk for dental caries. However, when classification is uncertain, treating a person as high risk is prudent until further information or experience allows a more accurate assessment. This assumption increases the immediate cost of caries prevention or treatment and might increase the risk for enamel fluorosis for children aged NATIONAL GUIDELINES FOR FLUORIDE USE PHS recommendations for fluoride use include an optimally adjusted concentration of fluoride in community drinking water to maximize caries prevention and limit enamel fluorosis. This concentration ranges from 0.7ppm to 1.2ppm depending on the average maximum daily air temperature of the area (PHS, 1991). In 1991, PHS also issued policy and research recommendations for fluoride use. The U.S. Environmental Protection Agency (EPA), which is responsible for the safety and quality of drinking water in the United States, sets a maximum allowable limit for fluoride in community drinking water at 4ppm and a secondary limit (i.e., non-enforceable guideline) at 2ppm (EPA,1998). The U.S. Food and Drug Administration (FDA) is responsible for approving prescription and over-the-counter fluoride products marketed in the United States and for setting standards for labeling bottled water and over-the-counter fluoride products (e.g., toothpaste and mouth rinse) (ADA,2007). Nonfederal agencies also have published guidelines on fluoride use. The American Dental Association (ADA) reviews fluoride products for caries prevention through its voluntary Seal of Acceptance program; accepted products are listed in the ADA Guide to Dental Therapeutics (ADA, 2007). A dosage schedule for fluoride supplements for infants and children aged 16 years, which is scaled to the fluoride concentration in the community drinking water, has been jointly recommended by ADA, the American Academy of Pediatric Dentistry (AAPD), and the American Academy of Pediatrics (AAP) (Meskin,1995). In 1997, the Institute of Medicine published age-specific recommendations for total dietary intake of fluoride. These recommendations list adequate intake to prevent dental caries and tolerable upper intake, defined as a level unlikely to pose risk for adverse effects in almost all persons. COST-EFFECTIVENESS OF FLUORIDE MODALITIES Documented effectiveness is the most basic requirement for providing a health-care service and an important prerequisite for preventive services (e.g., caries-preventive modalities). However, effectiveness alone is not a sufficient reason to initiate a service. Other factors, including cost, must be considered. A modality is more cost-effective when deemed a less expensive way, from among competing alternatives, of meeting a stated objective (Garcia,1989). In public health planning, determination of the most cost-effective alternative for prevention is essential to using scarce resources efficiently. Dental-insurance carriers are also interested in cost-effectiveness so they can help purchasers use funds efficiently. Because half of dental expenditures are out of pocket (Garcia, 1989), this topic interests patients and their dentists as well. Potential improvement to quality of life is also a consideration. The contribution of a healthy dentition to quality of life at any age has not been quantified, but is probably valued by most persons. Although solid data on the cost-effectiveness of fluoride modalities alone and in combination are needed, this information is scarce. In 1989, the Cost Effectiveness of Caries Prevention in Dental Public Health workshop, which was attended by health economists, epidemiologists, and dental public health professionals, attempted to assess the cost-effectiveness of caries-preventive approaches available in the United States (Downer et al., 1981). Community Water Fluoridation Health economists at the 1989 workshop on cost-effectiveness of caries prevention calculated that the average annual cost of water fluoridation in the United States was $0.51 per person (range: $0.12$5.41) (Burt, 1989). In 1999 dollars, this cost would be $0.72 per person (range: $0.17$7.62). Factors reported to influence the per capita cost included: size of the community (the larger the population reached, the lower the per capita cost); number of fluoride injection points in the water supply system; amount and type of system feeder and monitoring equipment used; amount and type of fluoride chemical used, its price, and its costs of transportation and storage; and expertise of personnel at the water plant. When the effects of caries are repaired, the price of the restoration is based on the number of tooth surfaces affected. A tooth can have caries at >1 location (i.e., surface), so the number of surfaces saved is a more appropriate measure in calculating cost-effectiveness than the number of teeth with caries. The 1989 workshop participants concluded that water fluoridation is one of the few public health measures that results in true cost savings (i.e., the measure saves more money than it costs to operate); in the United States, water fluoridation cost an estimated average of $3.35 per carious surface saved ($4.71 in 1999 dollars). Even under the least favorable assumptions in 1989 (i.e., cities with populations A Scottish study conducted in 1980 reported that community water fluoridation resulted in a 49% saving in dental treatment costs for children aged 45 years and a 54% saving for children aged 1112 years (Downer et al., 1981). These savings were maintained even after the secular decline in the prevalence of dental caries was recognized. The effect of community water fluoridation on the costs of dental care for adults is less clear. This topic cannot be fully explored until the generations who grew up drinking optimally fluoridated water are older. School Water Fluoridation Costs for school water fluoridation are similar to those of any public water supply system serving a small population (i.e., Assessment of the Adverse Health Effects of fluoride Evidence of the adverse health effects of prolonged exposure to high concentrations of fluoride are well documented by several peer reviewed studies, which are examined in this paper. Higher concentrations of total ingested fluoride from potential sources like drinking water, food and beverages, dental-hygiene products such as toothpaste, and pesticide residues can have adverse health effects on humans (NRC, 2006). Some of the adverse health effects of fluoride in drinking water are enamel fluorosis, skeletal fluorosis, bone cancer and bone fracture. (NRC, 2006, PHS, 1991). Fluorosis is caused mainly by the ingestion of fluoride in drinking water (Viswanathan et al., 2009). Fluoride has high binding affinity for developing enamel and as such high concentration of cumulative fluoride during tooth formation can lead to enamel fluorosis, a dental condition from mild to severe form characterized by brown stains, enamel loss and surface pitting (DenBesten Thariani, 1992). These dental ef fects are believed to be caused by the effects of fluoride on the breakdown rates of early-secreted matrix proteins, and on the rates at which the degraded by-products are withdrawn from the maturing enamel (Aoba Fejerskov, 2002). Children are much more at risk of enamel fluorosis, especially in their critical period from 6 to 8 years of age, than adults. Fluoride uptake into enamel is possible only as a result of concomitant enamel dissolution, such as caries development (Fejerskov, Larsen, Richards, Baelum, 1994). There is a 10% prevalence of enamel fluorosis among U.S. children in communities with water fluoride concentrations at or near the EPAs MCLG of 4 mg/L (NRC, 2006). The CDC estimates that 32% of U.S. children are diagnosed with dental fluorosis (CDC, 2005). Today, there are convincing evidence that enamel fluorosis is a toxic effect of fluoride intake, and that its severe forms can produce adverse dental effects, and not just adverse cosmetic effects in humans (NRC, 200 6). Burt and Eklund (1999) states: â€Å"The most severe forms of fluorosis manifest as heavily stained, pitted, and friable enamel that can result in loss of dental function†. Epidemiological data from both observational and clinical studies have been examined. Sowers, Whitford, Clark Jannausch (2005) investigated prospectively for four years bone fracture in relation to fluoride concentrations in drinking water in a cohort study, by measuring serum fluoride concentrations and bone density of the hip, radius, and spine. The authors reported higher serum fluoride concentrations in the communities with fluoride concentrations at 4 mg/L in drinking water; and higher osteoporotic fracture rates in the high fluoride areas that were similar to those in their previous studies in 1986 and 1991. It is unclear in their recent study whether existing factors in the population like smoking rates, hormone replacement and physical activity were examined as potential cofounders for fractures. Fasting serum fluoride concentrations are considered a good measure of long-term exposure and of bone fluoride concentrations (Whitford, 1994; Clarkson et al., 2000). Findings by t he Sowers studies were complemented in several ways by Li et al. (2001) in a retrospective cohort ecologic study. The combined findings of Sowers et al. (2005) and Li et al., (2001) lend support to the biological gradients of exposures and fracture risk between 1 and 4 mg/L of fluoride concentration. Evidently, the physiological effect of fluoride on â€Å"bone quality† and the fractures observed in the referenced animal studies are consistent with the effects found in the observational studies. RECOMMENDATIONS Before promoting a fluoride modality or combination of modalities, the dental-care or other health-care provider must consider a persons or groups risk for dental caries, current use of other fluoride sources, and potential for enamel fluorosis. Although these recommendations are based on assessments of caries risk as low or high, the health-care provider might also differentiate among patients at high risk and provide more intensive interventions as needed. Also, a risk category can change over time; the type and frequency of preventive interventions should be adjusted accordingly. Continue and Extend Fluoridation of Community Drinking Water Community water fluoridation is a safe, effective, and inexpensive way to prevent dental caries. This modality benefits persons in all age groups and of all SES, including those difficult to reach through other public health programs and private dental care (CDC, 2001a). Community water fluoridation also is the most cost-effective way to prevent tooth decay among populations living in areas with adequate community water supply systems. Continuation of community water fluoridation for these populations and its adoption in additional U.S. communities are the foundation for sound caries-prevention programs. In contrast, the appropriateness of fluoridating stand-alone water systems that supply individual schools is limited. Widespread use of fluoride toothpaste, availability of other fluoride modalities that can be delivered in the school setting, and the current environment of low caries prevalence limit the appropriateness of fluoridating school drinking water at 4.5 times the optimal concentration for community drinking water. Decisions to initiate or continue school fluoridation programs should be based on an assessment of present caries risk in the target school(s), alternative preventive modalities that might be available, and periodic evaluation of program effectiveness (CDC, 2001a). Frequently Use Small Amounts of Fluoride All persons should receive frequent exposure to small amounts of fluoride, which minimizes dental caries by inhibiting demineralization of tooth enamel and facilitating tooth remineralization. This exposure can be readily accomplished by drinking water with an optimal fluoride concentration and brushing with fluoride toothpaste twice daily(CDC, 2001a). Supervise Use of Fluoride Toothpaste among Children Aged Childrens teeth should be cleaned daily from the time the teeth erupt in the mouth. Parents and caregivers should consult a dentist or other health-care provider before introducing a child aged Use an Alternative Source of Water for Children Aged 8 Years Whose Primary Drinking Water Contains >2 ppm Fluoride In some regions in the United States, community water supply systems and home wells contain a natural concentration of fluoride >2ppm. At this concentration, children aged 8 years are at increased risk for developing enamel fluorosis, including the moderate and severe forms, and should have an alternative source of drinking water, preferably one containing fluoride at an optimal concentration. In areas where community water supply systems contain >2ppm but 8 years. For families receiving water from home wells, testing is necessary to determine the natural fluoride concentration (CDC, 2001a). Label the Fluoride Concentration of Bottled Water Producers of bottled water should label the fluoride concentration of their products. Such labeling will allow consumers to make informed decisions and dentists, dental hygienists, and other health-care professionals to appropriately advise patients regarding fluoride intake and use of fluoride products (CDC, 2001). CONCLUDING POSITION STATEMENT When used appropriately, fluoride is a safe and effective agent that can be used to prevent and control dental caries. Fluoride has contributed profoundly to the improved dental health of persons in the United States and other countries. Fluoride is needed regularly throughout life to protect teeth against tooth decay. To ensure additional gains in oral health, water fluoridation should be extended to additional communities, and fluoride toothpaste should be used widely. Adoption of these and other recommendations in this paper could lead to considerable savings in public and private resources without compromising fluorides substantial benefit of improved dental health. What is consistent from the literature review is the fact that infants and children are much more at risk of overexposure and the development of adverse health effects. A community water fluoridation program (CWFP) is very safe and efficient, not only in terms of reducing dental caries, but also on the communitys budg et (CDC, 2001a). A CWFP can especially help those communities who have populations in the low SES category. These populations have children whose parents or guardians dont always have access to dental insurance and so regular dental checkups to curb the dental caries is not always an option. Reducing dental caries before they lead into more extreme oral morbidity can be very beneficial to these children. Implementing a fluoridated water program can also be beneficial to a whole community in terms of saving communities thousands and millions of dollars. Implementing a water program would follow strict guidelines set by the EPA, so the optimum level of fluoride would be followed, staying in the range of 0.7 to 1.2, where people would ingest no more than an average of 1 mg/liter of fluoride per day. Moderation is the key. There are studies confirming that ingestion of fluoride greater than the optimum level could produce dental fluorosis. Though unconfirmed by studies, individual reports have even suggested that ingestion of fluoride >8 mg/liter per day over a long period of time could produce skeletal fluorosis. However, with proper surveillance and reporting of fluoride in water systems, the greater population could be served, increasing the dental health of all individuals, especially the youth and saving dollars from excessive health care costs (ADA, 2009). Remember, a little prevention now can go a long way later. REFERENCES ADA (2005).Fluoridation Facts: ADA statement commemorating the 60th anniversary of community water fluoridation. Retrieved October 19, 2009 from www.ada.org/public/topics/fluoride/facts/fluoridation_facts.pdf ADA.(2007). ADA Guidelines to Dental Therapeutics. Retrieved October 23, 2009 from http://www.ada.org/prof/resources/pubs/advocacy.asp ADA (2009). Fluoride: Natures tooth decay fighter. J of the Am. Dental Ass., 140(1), 126-126. Alphajoh, C.(2009). (PhD Student). Service Learning Activity: Environmental Health. Walden University. Assessed November 13, 2009 from http://environmentalhealthtoday.wordpress.com/2009/05/13/commentary-and-position-statement-on-the-safety-and-efficacy-of-water-fluoridation/ Aoba, T., Fejerskov, O. (2002). Dental fluorosis: Chemistry and biology. Crit. Rev. Oral. Biol. Med., 13(2), 155-170. Bowden, G.(1990). Effects of fluoride on the microbial ecology of dental plaque. J Dent Res 1990; 69(special issue):653—9 Brunelle, J.(1987. The prevalence of dental fluorosis in U.S. children. J Dent Res.(Special issue) 68:995. Bunker, J.P., Frazier, H.S., Mosteller, F. (1994). Improving health: measuring effects of medical care. Milbank Quarterly,72, 225-58. Burt, B. (1989).(Ed.). Proceedings for the workshop: Cost-effectiveness of caries prevention in dental public health, Ann Arbor, Michigan, May 1719, 1989. J Public Health Dent 1989; 49(special issue):3317. Burt, B.A., Eklund, S.A. (1999). Dentistry, dental practice, and the community. Philadelphia, Pennsylvania: WB Saunders Company, 204-20. CDC (1999). Ten great public health achievements United States, 1900 1999. MMWR,48(12), 214-243. CDC (2001a). Promoting oral health: intervention for preventing dental caries, oral and pharyngeal cancers and sport-related craniofacial injuries a report on recommendations of the Task Force on Community Preventive Services. MMWR 2001, 50(21), 1-12. CDC. (2001). Recommendations for using fluorideto prevent and control dental

Amalgam Model

Counseling Theory: An Amalgam Model, 2008, Name, affirms that science proves what the Bible has long understood and says about man or human nature; that Scripture alone has the correct diagnosis of the sickness and potential outcomes of his endeavors and challenges as well as the results especially, of a fallen nature. The author uses the scientific researches that show how the truths of Scripture are explained and made manifest in the lives of men and women.Practitioners who make use of this model that there is neither competition nor confusion as to the pre-eminence of Scripture; rather, it presupposes that science complements what the Biblical writers as revealed, have long known the real and lasting solutions to the â€Å"sicknesses† that man ahs encountered. I. Introduction Psychology has made great strides in the development of principles and methods and the discovery of facts which find useful application in various aspects of everyday life.The objectives of psychology are : (1) to understand human behavior; (2) to predict human behavior by means of observation and experiment; (3) to influence or alter the behavior of he individual or group in desirable ways so that he can achieve the goal he desires. Behavior is described and analyzed. On this basis, an attempt to predict behavior is possible, and although this may not thoroughly and completely be accomplished in some endeavors, the basic understanding then is that there are certain expectations concerning how any person would act or decide upon things that are within his conscious awareness.Psychology is of great importance to man since psychological problems are common to group relations, in whatever framework a person or group of individuals come from. The thrust of this paper is to develop my own theory of behavior and putting these in the context of the helping relationship. It starts with a basic understanding of human behavior coming from various viewpoints or perspectives. Then it discuss es the reasons why an individual becomes mentally sick or develops unhealthy patterns of behaving towards anything that affect him.This includes the maladjustments that are usually prevalent in a person’s day-to-day functioning especially if and when he has not learned or developed the skills of rightly apprehending the tests of life, so to speak. The work of a counselor is a privilege since the counselee or client will be unfolding his life and makes himself vulnerable to a stranger. It is not an easy choice to make hence, all the training and knowledge would be indispensable to help the client reveal and trust himself to another. Counseling is not a very easy job.But it can be facilitated well when there is a clear vision of what and how it unfolds in the relationship that is established with the client. II. Discussion The paper is divided into different parts and meant to answer to the requirements stated as follows. A. Summary of my overall approach Psychology is the scie ntific of human behavior and mental processes; a study which is of considerable interest to almost all people. In the pursuit of this study is the important feature of understanding the goals or objectives.To describe, explain and predict behavior and if possible control or modify it, are the main objectives of this scientific discipline. These objectives confine as well as broaden student’s approach towards a deeper perspective of the field in the sense that he/she will have a grasp on the variety of subject matters that psychology provides, the advances or breakthroughs it has attained, its inadequacies and shortcomings, as well as forthcoming challenges the discipline faces. Since human individuals are complex and changing, the study is fascinating yet possesses a certain degree of difficulty.Fascinating because it explores all the facets of being human and possessing a certain degree of difficulty because of its multifarious sub-disciplines. Sigmund Freud offered a psycho analytic viewpoint on the diagnosis and understanding of a person’s mental health. Other perspectives, the behavioristic paradigm offers to see this in a different light. The psychoanalytic perspective emphasizes childhood experiences and the role of the unconscious mind in determining future behavior and in explaining and understanding current based on past behavior.Basing on his personality constructs of the Id, Ego and the Superego, Freud sees a mentally healthy person as possessing what he calls Ego strength. On the other hand, the behavior therapist sees a person as a â€Å"learner† in his environment, with the brain as his primary organ of survival and vehicle for acquiring his social functioning. With this paradigm, mental health is a result of the environment’s impact on the person; he learns to fear or to be happy and therein lies the important key in understanding a person’s mental state.Considering that the achievement and maintenance of mental health is one of the pursuits of psychology, the following is a brief outline of what psychologists would endorse a healthy lifestyle. The individual must consider each of the following and incorporate these in his/her day to day affairs: 1. The Medical doctor’s viewpoint – well-being emphasis than the illness model 2. The Spiritual viewpoint- a vital spiritual growth must be on check. 3. The Psychologist’s viewpoint- emotional and relationship factors in balance.4. The Nutritionist’s viewpoint – putting nutrition and health as top priority. 5. The Fitness Expert’s viewpoint- Exercise as part of a daily regimen. The theory I have in mind then is an amalgamation of several approaches, primarily the integration of the Christian worldview and the theories set forth by Cognitive-behaviorists and psychoanalytic models, and biological/physical continuum. There are other good models but a lot of reasons exist why they cannot be â€Å"good enough; † a lot depends on my own personality.Being authentic to who you are, your passion, is effectively communicated across an audience whether it is a negative or positive one. The basic way of doing the â€Å"amalgamation† or integration is that the Christian worldview takes precedence over the rest of the approaches. Although many of the concepts and premises of each theory mentioned are sound and at times efficacious, when it clashes with the faith-based theory, the former must give way to the latter.It is understood then, that I thoroughly examined each of the theory and set them against the backdrop of spirituality. Interpreting a problem that a client suffers for instance, entails that the theoretical viewpoint that I am convinced with, has better chances of properly understanding the maladjustments that the client had been suffering. To come up with the balanced worldview (an integration in other words), the balance between the realms mentioned, including the true fr ame of human individuals and the true nature of God (or theology) are properly considered.Thoroughly accepting the fact that there is no contest between the natural and the spiritual; only that troubles arise when one realm is overemphasized at the expense of another. This thin line or slight tension between the two levels is best expressed in the personhood of Jesus Christ, who was a perfect man as well as God. If we start to equate ourselves with that notion (which is usually happening) and we start to think that we are balanced, then we surely lack understanding or real self-awareness of the fact that we are deeply and seriously out of balance and this is one reason why we need help.B. Philosophy and Basic Assumptions ~What does a mentally healthy person look like and how are his traits different from those who are mentally ill or are developing a certain form of illness. Personality is more than poise, charm, or physical appearance. It includes habits, attitudes, and all the phy sical, emotional, social, religious and moral aspects that a person possesses. However, to be more precise, the explicit behavioral styles covered in the course, perhaps, best captivate an individual’s personality and how he/she is understood.With the different behavioral styles, an overall pattern of various characteristics is seen. Like a â€Å"psychograph,† a person’s profile is pulled together and at a glance, the individual can be compared with other people in terms of relative strengths and weaknesses. The term mentally ill is frightening to many people. Movies, books, and magazines often depict mental illness in frightening ways. In some cases, adolescents suffering from a mental illness do act unpredictably or even dangerously. With proper diagnosis and treatment, most of the symptoms of mental illnesses can be controlled.It is tempting to distinguish healthy adolescents from adolescents with mental illness problems. However, there is often a fine line b etween mental health and mental illness. It is important to understand that mental illnesses vary in their severity. For example, many adolescents suffered from various levels of anxiety or depression. Others have suffered from serious mental disorders with biological origins. Education about the adolescents` mental illness is vital for those with mental health problems as well as for the adolescents` friends and family.Many of the disorders or mental illnesses recognized today without a doubt have their psychodynamic explanation aside from other viewpoints like that of the behaviourist, or the cognitivists. From simple childhood developmental diseases to Schizophrenia, there is a rationale that from Freud’s camp is able to explain (Kaplan et al, 1994). ~ What constitutes a mentally/emotionally healthy person and what causes a person to become dysfunctional? The Christian point of view argues that man is not necessarily or inherently good and that starts him off to a bad star t.The environment further either encourages that innate evil or tones it down. However, the basic idea is that there is a spiritual aspect and this is addressed in what the Christian Scriptures declare as the â€Å"renewing of the mind. † Because this is an integrated approach, it recognizes the work of science with the concept or understanding that it only confirms what Scripture recognizes or identifies all along. Psychology reminds us of the differing opinions of experts in this field. It talks about personality which represents all that the mind, or the mental and affective aspects of a person.People talk a lot about personality or behavior as if it’s such an uncomplicated and unfussy concept, but they end up having difficulty defining it when asked. They are apt to say that it (behavior or personality in general) is something a person â€Å"has. † They describe the behavioral components of particular people in words like â€Å"friendly,† â€Å"nice, † â€Å"forceful,† or â€Å"aggressive,† to paint a picture of what they mean by the term and as a result end, instead, in vague descriptions of how a person usually behaves with other people.On the other hand, when we base our descriptions on concrete and observable actions that people commonly do or adapt, we come up with what experts call as â€Å"behavioral profile. † There are different styles of behavior as well as there are no right and wrong profile. When we come up with correct profiling, the expected result is that we develop ways of getting to know a more concise and accurate picture of ourselves, or people in general. Personality is more than poise, charm, or physical appearance. It includes habits, attitudes, and all the physical, emotional, social, religious and moral aspects that a person possesses.However, to be more precise, the explicit behavioral styles covered in the course, perhaps, best captivate an individual’s personality and how he/she is understood. With the different behavioral styles, an overall pattern of various characteristics is seen. Like a â€Å"psychograph,† a person’s profile is pulled together and at a glance, the individual can be compared with other people in terms of relative strengths and weaknesses. A healthy personality does not mean it does not have any difficulties at all. It means that a person has the capabilities to withstand any turmoil or stress that come his way.He has learned the skills to make him adjust to the internal and external stresses; minimizing conflicts from within and without but in a healthy and normal functioning way. ~ How does personal growth occur in the context of your therapy? Personal growth occurs in the context of self-insights; insights concerning the workings of one’s mind in relation to the structures and stimuli around the person. He self-insight is very significant and crucial to the client for him to be able to work well with t hose who are there to assist in his recovery and eventual personal growth. †¢ What makes your theory work?Christian counselors are prepared to help their clients sort the distinctions and similarities between psychology and the Christian faith? This is important because basic to therapy success is that when therapist and client share similar worldviews, the therapy may then advance. Moreover, do Christian counselors and those in this kind of profession really pursue real interest and deep thirst for a systematic and regular study of the Bible? If they do not do so, they will be deficient of the overall grasp of the Bible’s structure and content and lack a working knowledge of basic biblical doctrines.A deep and thriving relationship and commitment to an equally gifted Bible – believing church will also benefit the counselor in his/her personal life and practice, thus a necessary requirement,. C. Key Concepts ~ Explain the primary points of your theory as if you we re to summarize it quickly for someone The Psychodynamic perspective is based on the work of Sigmund Freud. He created both a theory to explain personality and mental disorders, and the form of therapy known as psychoanalysis.The psychodynamic approach assumes that all behavior and mental processes reflect constant and often unconscious struggles within the person. These usually involved conflicts between our need to satisfy basic biological instincts, for example, for food, sex or aggression, and the restrictions imposed by society. Not all of those who take a psychodynamic approach accept all of Freud’s original ideas, but most would view abnormal or problematic behavior as the result of a failure to resolve conflicts adequately.Many of the disorders or mental illnesses recognized today without a doubt have their psychodynamic explanation aside from other viewpoints like that of the behaviourist, or the cognitivists. From simple childhood developmental diseases to Schizophr enia, there is a rationale that from Freud’s camp is able to explain (Kaplan et al, 1994). In the psychodynamic theory, the following three assumptions help guide a student of human behavior or an expert in this field determine the underlying factors that explain the overt manifestations of specific behaviors.These assumptions therefore, help guide the diagnosis of the presence or absence of mental illness. They are the same assumptions that guide the therapist in choosing what treatment that will better help heal, cure or alleviate the symptoms. These assumptions are: – â€Å"There are instinctive urges that drive personality formation. † – â€Å"Personality growth is driven by conflict and resolving anxieties. † – â€Å"Unresolved anxieties produce neurotic symptoms† (Source: Kaplan et al, 1994). The goals of treatment here include alleviating patient of the symptoms which specifically works to uncover and work through unconscious c onflict.The task of psychodynamic therapy is â€Å"to make the unconscious conscious to the patient† (â€Å"Models of abnormality†, National Extension College Trust, Ltd). Employing the psychodynamic viewpoint, the therapist or social scientist believes that emotional conflicts, or neurosis, and/or disturbances in the mind are caused by unresolved conflicts which originated during childhood years. In the psychodynamic approach the treatment modality frequently used includes dreams and free association, at times hypnosis (as preferred by either the therapist or by the client).The therapist actively communicates with the client in the on-going sessions. The scenario appears that a given patient may have up to five times a week session and runs up to five years in length (Rubinstein et al. , 2007). Cognitive-Behavioral Therapy postulated primarily by Ellis and Beck â€Å"facilitates a collaborative relationship between the patient and therapist. † With the idea tha t the counselor and patient together cooperate to attain a trusting relationship and agree which problems or issues need to come first in the course of the therapy.For the Cognitive Behaviorist Therapist, the immediate and presenting problem that the client is suffering and complaining from takes precedence and must be addressed and focused in the treatment. There is instantaneous relief from the symptoms, and may be encouraged or spurred on to pursue in-depth treatment and reduction of the ailments where possible. The relief from the symptoms from the primary problem or issue will inspire the client to imagine or think that change is not impossible after all.In this model, issues are dealt directly in a practical way. In the cognitive approach alone, the therapist understands that a client or patient comes into the healing relationship and the former’s role is to change or modify the latter’s maladjusted or error-filled thinking patterns. These patterns may include wi shful thinking, unrealistic expectations, constant reliving and living in the past or even beyond the present and into the future, and overgeneralizing. These habits lead to confusion, frustration and eventual constant disappointment.This therapeutic approach stresses or accentuates the rational or logical and positive worldview: a viewpoint that takes into consideration that we are problem-solvers, have options in life and not that we are always left with no choice as many people think. It also looks into the fact that because we do have options then there are many things that await someone who have had bad choices in the past, and therefore can look positively into the future. Just as the cognitive-behavioral model also recognizes the concept of insight as well, this is only a matter of emphasis or focus.In behavioral/cognitive-behavioral therapies the focus is on the modification or control of behavior and insight usually becomes a tangential advantage. Techniques include CBT thr ough such strategy as cognitive restructuring and the current frequently used REBT for Rational Emotive-Behavior Therapy where irrational beliefs are eliminated by examining them in a rational manner (Corey, 2004; Davison and Neale, 2001). Whereas in insight therapies the focus or emphasis is on the patient’s ability in understanding his/her issues basing on his inner conflicts, motives and fears.Coaching the patient on the step by step procedure of CBT is a basic and fundamental ingredient. Here the client is enlightened as to the patterns of his thinking and the errors of these thoughts which bore fruit in his attitudes and behavior. His/her thoughts and beliefs have connections on his/her behavior and must therefore be â€Å"reorganized. † For instance, the ways that a client looks at an issue of his/her life will direct the path of his reactivity to the issue. When corrected at this level, the behavior follows automatically (Rubinstein et al. , 2007; Corey, 2004). D. Therapeutic Goals~ What are your general goals in therapy? Christian counseling admittedly embraces in reality, a basic integration of the biblical precepts on the view of man and psychology’s scientific breakthroughs in addressing the dilemmas that beset human individuals. Depending on the persuasion of the practitioner, especially whether he or she comes from either the purely theological or â€Å"secular† preparation, Christian counseling can either lean to certain degrees of theology or psychology. According to Larry Crabb, â€Å"If psychology offers insights which will sharpen our counseling skills and increase our effectiveness, we want to know them.If all problems are at core spiritual matters we don’t want to neglect the critically necessary resources available through the Lord by a wrong emphasis on psychological theory† (Crabb in Anderson et al, 2000). Dr. Crabb’s position certainly ensures that science in particular, has its place in counseling in as much as theology does. He made sure that all means are addressed as the counselor approaches his profession, especially in the actual conduction of both the diagnostic and therapeutic or intervention phases (Crabb in Anderson et al. , 2000).Trauma inducing and crisis triggering situations have spiraled its occurrence and in its primacy in the US and in many other countries in recent years. Its broad spectrum ranges from the national disaster category such as that of Hurricane Katrina or the 911 terrorist strikes in New York, Spain and England, to private instances such as a loved one’s attempt at suicide, the murder of a spouse or child, the beginning of mental illness, and the worsening situation of domestic violence (Teller et al, 2006).The acute crisis episode is a consequence of people who experience life-threatening events and feel overwhelmed with difficulty resolving the inner conflicts or anxiety that threaten their lives. They seek the help of counse lors, paramedics and other health workers in crisis intervention centers to tide them over the acute episodes they are encountering. These are defining moments for people and must be adequately addressed else they lead lives with dysfunctional conduct patterns or disorders (Roberts et al, 2006).

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Sunchips multigrain snacks Lay's potato chips Smiths potato chips Quavers potato snacks Natural Lay's Ruffles potato chips Brands Our products can be found in more than 200 countries around the globe. PepsiCo is a global food and beverage leader with a diverse product portfolio that includes 22 brands that each generate more than $1 billion each in annual retail sales. Take a closer look at the brands and products that make up the PepsiCo portfolio. PepsiCo Inc. NYSE:PEP) is a global manufacturer, distributor, and marketer of food and beverages, owning many well-known brands including Pepsi, Frito-Lay, Tropicana, Gatorade, and Quaker Oats. [1] PepsiCo operates in over 200 countries, with its largest markets in North America and the United Kingdom. [2] Unlike its major competitor, the Coca-Cola Company (KO), the majority of PepsiCo's revenues do not come from carbonated soft drinks. [3] In fact, beverages account for less than 50% of total revenue. [3] Additionally, over 60% of PepsiC o's beverage sales come from its key noncarbonated brands like Gatorade and Tropicana. 4] PepsiCo's diverse portfolio can mitigate the impact of poor conditions in any one of its markets. Strong demand growth in international markets — the company serves 86% of the world's population and international sales account for 48% of revenue — is helping to offset a sluggish domestic market and provided the company with opportunities for continued expansion. [5] [6] PepsiCo is highly exposed to raw materials costs. Prices for the most important input materials, aluminum, PET plastic, corn, sugar, and juice concentrates fluctuate widely. aid fourth-quarter profit rose 17 percent, helped by higher prices, and authorized a new plan to repurchase as much as $10 billion in stock as the world’s largest snack-food maker returns cash to investors. Net income increased to $1. 66 billion, or $1. 06 a share, from $1. 42 billion, or 89 cents, a year earlier, the Purchase, New York- based company said today in a statement. Profit excluding some items totaled $1. 09 a share. Analysts had projected $1. 05, the average of estimates compiled by Bloomberg. Enlarge image PepsiCo Quarterly Profit Exceeds Estimates Amid Marketing DriveDaniel Acker/Bloomberg A customer picks up a two liter bottle of PepsiCo Inc. soda from a supermarket shelf in Princeton, Illinois. A customer picks up a two liter bottle of PepsiCo Inc. soda from a supermarket shelf in Princeton, Illinois. Photographer: Daniel Acker/Bloomberg 4:10 Feb. 14 (Bloomberg) — Hugh Johnston, chief financial officer at PepsiCo Inc. , talks about fourth-quarter results and the outlook for the company. Johnston speaks with Betty Liu on Bloomberg Television's â€Å"In the Loop. † (Source: Bloomberg) Sponsored Links | Buy a link |Samsung Distribution ChannelChief Executive Officer Indra Nooyi has increased prices and worked to boost sales with new products, such as Gatorade Energy Chews and Pepsi Next. PepsiCo has spent more to market brands including Lay’s and put a renewed focus on U. S. soft drinks to revive lagging beverage sales and regain market share from Coca-Cola Co. PepsiCo, the world’s second-largest soft drink maker, rose1. 1 percent to $72. 28 at the close in New York. The shares have advanced 5. 6 percent this year, compared with a 1. 6 percent increase for Coca-Cola. The company’s $10 billion share-repurchase will be from July 1, 2013, through June 2016.PepsiCo will also boost its annualized dividend by 5. 6 percent to $2. 27 a share starting in June. In 2013, PepsiCo intends to pay dividends of $3. 4 billion and buy back $3 billion of its shares. Annual Forecast Earnings per share in 2013 will increase 7 percent from the $4. 10 in 2012, implying profit of $4. 39. Analysts projected $4. 41, the average of estimates compiled by Bloomberg. Chief Financial Officer Hugh Johnston said on a conference call today that the company sees no need for large -scale acquisitions. PepsiCo has also asked for approval from the U. S. Food and Drug Administration for new sweeteners, Nooyi also said on the call.Any restructuring of the company’s beverage bottling business in North America won’t be addressed until early 2014, Nooyi said on the call. That extends a timeline Johnston laid out one year ago, when he said PepsiCo would evaluate its beverage distribution operations in North America through this fall and consider whether to make changes, including divestiture. â€Å"We certainly wouldn’t want to make a change in the business structure while there’s still opportunities to unlock value that might be better unlocked while PepsiCo still owns the business,† Johnston said in a conference call with journalists, declining to elaborate.Fourth-quarter revenue fell 1 percent to $20 billion. Analysts projected $19. 7 billion, on average. PepsiCo Americas Foods volume grew 6 percent in the quarter, helped by acqu isitions and higher sales of Frito-Lay products in North America. Coca-Cola, based in Atlanta, said Feb. 12 that net incomerose 13 percent to $1. 87 billion as sales of non-carbonated drinks in North America such as Powerade helped counter lower demand in Europe. Revenue advanced 3. 8 percent to $11. 5 billion, less than analysts estimated.

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