Literature Review: Smoking And Coronary Artery Disease

Literature Review: Smoking And Coronary Artery Disease Cigarette smoking highly boosts the risk of coronary artery disease (CAD), and the associated risk is particularly high in subjects with diabetes mellitus (DM) (Mà ¼hlhauser, 1994). The prevalence of smoking worldwide is one and quarter billion adult smokers, 10% of them reside within South East Asian countries. Smoking prevalence in these countries is a range from 12.6% to 40% in Singapore and Laos, respectively. Malaysia is recording 21% adult current smokers (Southeast Asia Tobacco Control Alliance (SEATCA), 2008). Cigarette smoking is estimated to cause more than five million deaths, making it the leading cause of preventable mortality worldwide (Peto et al., 1996). Atherosclerotic cardiovascular disease, chronic obstructive pulmonary disease (COPD) and lung cancer consider the three relevant causes of smoking related mortality (Centers for Disease Control Prevention, 2008). It has well known that cigarette smoking increases the risk of microvascular complications in DM (ie, nep hropathy, retinopathy, and neuropathy) probably by its metabolic effects (worsening diabetes control and insulin resistance) in combination with increased inflammation and endothelial dysfunction. It appears to be stronger in type 1 diabetic patients, while the enhanced risk for macrovascular complications, coronary heart disease (CHD), stroke, and peripheral vascular disease, is most pronounced in type 2 diabetic patients (Eliasson, 2003, Haire-Joshu et al., 1999, Solberg et al., 2004). Smoking cessation can safely and cost effectively be recommended for all patients, and it is a gold standard against which other preventive behaviors should be evaluated. Stopping smoking at any age has a considerable impact on improving life expectancy, reducing morbidity and reducing health care costs associated with treating smoking related conditions (Asaria et al., 2007, Ward, 2008), but effective strategies are lacking cessation support (Everett and Kessler, 1997). There are several treatment interventions have been identified as essential to achieve cessation. These interventions include brief counseling by multiple health care providers, use of individual or group counseling strategies, and use of pharmacotherapy (Haire-Joshu et al., 1999). Smoking cessation medicines are among the most cost-effective disease prevention interventions available (Fiore, 2000). There are several types of them assist in smoking cessation are available. (Wu et al., 2006). The 2008 update to Treating Tobacco Use and Dependence, a Public Health Service-sponsored Clinical Practice Guideline Panel identified seven first-line (FDA-approved) medications (bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, and varenicline) and two second-line (non-FDA-approved for tobacco use treatment) medications (clonidine and nortriptyline) as being effective for treating smokers (Fiore et al., 2008). The most commonly used formulation is nicotine replacement therapy (NRT). It reduces motivation to smoke and many of physiological and psychomotor withdrawal symptoms usually experienced during an attempt to quit smoking, and therefore, may increase the likelihood of remaining abstinent (Gourlay and McNeil, 1990, W est and Shiffman, 2001). NRT is currently recommended as a safe intervention to general populations and higher-risk groups, including pregnant and breastfeeding women, adolescents, and smokers with cardiovascular disease (National Institute for Health and Clinical Excellence (NICE), 2008). Systematic reviews show that all forms of NRT have been proven to be effective (Fiore et al., 2008) and it increase quit rate one and a half to two fold in comparison with placebo. There are many studies provide good evidence that smoking cessation pharmacotherapy enhance the success of quit smoking attempt (Cahill et al., 2008, Fiore et al., 2008, Hughes et al., 2007, Stead et al., 2008). Unfortunately, there are insufficient evidences to recommend one delivery system over another. Literature review This review will cover the aims of this research. Globally, it was estimated that there are about 1.3 billion smokers, half of whom will die from smoking-related diseases (Shafey et al., 2009). While in Malaysia, the Third National Health and Morbidity Survey has reported some decline in smoking statistics among general population (18 years and above) in Malaysia with an overall smoking rate of 21.5%; male and female smoking rates of 46.4% and 1.6%, respectively (Ministry of Health, 2006). To our knowledge, there is limited information about the prevalence of smoking among diabetes mellitus patients, but it seems to be mirror to general population, at least for young adults. Findings from the national Behavioral Risk Factor Surveillance System show that the prevalence of smoking in young adults with diabetes mellitus is similar to the prevalence in the general population (Ford et al., 2004). Other study in the United States found the age-adjusted prevalence of smoking was 27.3% and 2 5.9% among people with and without diabetes, respectively. The prevalence of smoking did not differ significantly between participants in both groups when they were stratified by age, sex, race, or education (Ford et al., 1994). Few studies examined the prevalence of tobacco use with diabetic patients, information that is critical for targeting prevention efforts. There is no estimated prevalence for smoking in diabetes mellitus patients in Malaysia. Few studies was conducted about the knowledge and awareness of diabetic patients towards smoking cessation and its pharmacotherapies. There is a survey done in the United Kingdom to investigate awareness of pharmacotherapeutic aids to smoking cessation in diabetic cigarette smokers. A structured questionnaire-based interview was held by research nurse individually with current smokers in a private room. Of 597 diabetic patients attending a routine clinic, one hundred diabetic patients were current smokers. The majority of them were type 2 diabetic patients (96%). There were 66% and 54% had heard about NRT and bupropion, respectively. Those who had heard about NRT, only 49% considered it safe with diabetes, while who knew of bupropion 39% thought it unsafe in diabetic patients. Approximately 84% were aware of the UK National Health Service (NHS) quit line, but only 8% had used it. The authors conclude that this subpopulation has poor knowledge and awareness of NRT and bupropion as aid s to quit smoking (Gill et al., 2005). A qualitative study done in the United States, aimed to investigate beliefs about cigarette smoking and smoking cessation among Urban African Americans with Type 2 Diabetes. Focus groups and a short survey were used to assess cigarette use patterns, perceived smoking health effects, preferences for treatment, and attitudes toward smoking cessation among this subpopulation. Twenty five participants were included in this study. The mean age was (SD) 48.5 years ( ±10.23), 60% female, smoked 20.9( ±12.54) cigarettes per day. Regarding the beliefs and knowledge about smoking and diabetes, Participants believed that smoking increased their risk for all health outcomes, though there was not a clear understanding of how. Furthermore, they believed smoking decreased their appetite and quitting smoking makes you gain weight, and that it would negatively affect diabetes. Regarding beliefs and opinions about stopping most participants desired to quit and believed it was important t o quit, but were not motivated to quit or confident they could achieve cessation (Janet L. Thomas et al., 2009). Another study established in the United States, aimed to assess what smokers believe about the health risks of smoking and the effects of smoking filtered and low-tar cigarettes, as well as their awareness of and interest in trying so-called reduced risk tobacco products and nicotine medications. It was conducted between May and September 2001. They gathered data on demographic characteristics, tobacco use behaviors, awareness and use of nicotine medications, beliefs about the health risks of smoking, content of smoke and design features of cigarettes, and the safety and efficacy of nicotine medications. The findings of this study showed a substantial percentage of respondents either answered incorrectly or responded dont know to questions about health risks of smoking (39%), content of cigarette smoke (53%), safety of nicotine (52%), low-tar cigarettes and filtered cigarettes (65%), additives in cigarettes (56%), and nicotine medications (56%). The smokers characteristics most commo nly associated with misleading information when all six indices were combined into a summary index were as follows: those aged 45 years or older, smokers of ultra-light cigarettes, smokers who believe they will stop smoking before they experience a serious health problem caused by smoking, smokers who have never used a stop-smoking medication, and smokers with a lower education level. Those who believed they would stop smoking in the next year were more knowledgeable about smoking. The authors conclude that smokers are misinformed about many aspects of the cigarettes they smoke and stop smoking medications (Cummings et al., 2004). Unfortunately, there is a dearth of information on the efficacy of smoking cessation pharmacotherapies in diabetic patients because large-scale studies involving this group do not report results separately for them. Additionally, there are few direct head to head comparison studies among them in this subgroup population. In an open-label, randomized trial conducted in Belgium, France, the Netherlands, the United Kingdom, and the United States, compared varenicline with transdermal NRT for smoking cessation. Participants were randomized to receive either 12 weeks of varenicline or 10 weeks of transdermal NRT (Aubin et al., 2008). The primary end point was continuous abstinence rate (CAR) during the last 4 weeks of each treatment. Secondary end points were CARs from the last 4 weeks of treatment through weeks 24 and 52 and the 7-day point prevalence of abstinence assessed at the end of treatment, week 24, and week 52. The Minnesota Nicotine Withdrawal Scale (MNWS) and The modified Cigarette Evaluation Questionnaire (mCEQ) measures of craving, withdrawal, and smoking satisfaction were assessed at baseline and at each weekly visit through week 7 (or at early termination). Data were analyzed in both the prespecified primary analysis population (all randomized participants who received at least 1 dose of study drug: 376 varenicline, 370 NRT) and the all-randomized population (378 varenicline, 379 NRT). CARs were significantly higher in the last 4 weeks of treatment of varenicline group compared with NRT group (55.6% vs 42.2%, respectively; Odds ratio (OR) = 1.76; 95% CI, 1.31-2.36; P < 0.001). At week 24, there was no significant difference in CARs (32.2% and 26.6%; OR = 1.33; 95% CI, 0.97- 1.82). At week 52, CARs were not significantly higher for varenicline over to NRT in the primary analysis population, although the difference in CARs remain significant through week 52 in all-randomized population analysis (25.9% vs. 19.8%; OR = 1.44; 95% CI, 1.02-2.03; P = 0.04). The 7-day point prevalence of abstinence at week 12 was significantly higher for varenicline compared with NRT (62.0% vs 47.0%, respectively; OR = 1.71; 95% CI, 1.27-2.30; P < 0.001). The d ifferences in 7-day point prevalence of abstinence were not significant at week 24 or week 52. For weeks 1 through 7, the average scores of MNWS and mCEQ for cravings, withdrawal symptoms, and the reinforcing effects of smoking were significantly lower with varenicline compared with NRT (all population analysis, P à ¢Ã¢â‚¬ °Ã‚ ¤ 0.001). Varenicline group had significantly lower MNWS subscale scores for negative affect and restlessness compared with NRT (both, P < 0.001); there was no difference between varenicline and NRT in the subscale scores for increased appetite or insomnia. A guideline Treating Tobacco Use and Dependence: 2008 Update is a product of the Tobacco Use and Dependence Guideline Panel. This guideline contains strategies and recommendations designed to assist clinicians; tobacco dependence treatment specialists; and health care administrators, insurers, and purchasers in delivering and supporting effective treatments for tobacco use and dependence (Fiore et al., 2008). A meta-analysis displayed the effectiveness of the first-line smoking cessation medications compared with placebo at 6 months post-quit. They determined the estimated abstinence rate and odds ratio at 6 months post-quit (95% CI) compared with placebo estimated abstinence rate of 13.8% and estimated odds ratio of 1.0. Varenicline had the highest estimated abstinence rate and odds ratio (33.2% and 3.1), while nicotine gum had the lowest estimated abstinence rate and odds ratio (19.0% and 1.5). Another multicenter, randomized, double-blind, placebo-controlled trial compared the efficacy and safety of varenicline with placebo for smoking cessation in 714 smokers with stable cardiovascular disease that had been diagnosed for > 2 months. Participants received either varenicline (1 mg twice daily) or placebo at ratio 1:1, along with smoking-cessation counseling, for 12 weeks. Follow-up lasted 52 weeks. The primary end point was carbon monoxide-confirmed CAR for last 4 weeks of treatment. The secondary outcomes were the CAR from week 9 through 52; CAR for weeks 9 to 24 and 7-day point prevalence of tobacco abstinence at weeks 12 (end of drug treatment), 24, and 52. The CAR was higher for varenicline than placebo during weeks 9 through 12 (47.0% versus 13.9%; odds ratio, 6.11; 95% CI, 4.18 to 8.93) and weeks 9 through 52 (19.2% versus 7.2%; odds ratio, 3.14; 95% CI, 1.93 to 5.11). The varenicline and placebo groups did not differ significantly in cardiovascular mortality (0.3% ve rsus 0.6%; difference, _0.3%; 95% CI, _1.3 to 0.7), all-cause mortality (0.6% versus 1.4%; difference, _0.8%; 95% CI, _2.3 to 0.6), cardiovascular events (7.1% versus 5.7%; difference, 1.4%; 95% CI, _2.3 to 5.0) (Rigotti et al., 2010). Nides and his colleagues conducted a multicenter, double-blind, placebo-controlled, trial to evaluate the efficacy and tolerability of three varenicline doses in adult smokers. Bupropion hydrochloride was included as an active control. Participants were randomized to receive varenicline 0.3 mg once daily, varenicline 1 mg once daily, varenicline 1 mg BID, bupropion SR 150 mg BID, or placebo for 7 weeks, with the option of participation in follow-up through week 52. The varenicline groups received active drug for 6 weeks, followed by placebo for 1 week. The primary efficacy outcome in this study was CAR for any 4-week period from baseline through week 7. Secondary efficacy outcomes involved the 4-week CAR for weeks 4 through 7, 4 through 12, 4 through 24, and 4 through 52; cravings and withdrawal symptoms, assessed using the MNWS and the brief Questionnaire of Smoking Urges (QSU-brief); reinforcing effects of smoking, assessed using the mCEQ; and changes in body weight (Nides et al., 2006). The findings of this study presented that the patients treated with varenicline (except of those who received varenicline 0.3 mg once daily) or bupropion SR had significantly higher CARs for any 4 weeks compared with placebo (P < 0.001 and P = 0.002, respectively). The CARs for any 4 weeks were 48.0% for varenicline 1 mg BID (OR = 4.71; P < 0.001), 37.3% for varenicline 1 mg once daily (OR = 2.97; P < 0.001), 33.3% for bupropion SR (OR = 2.53; P=.002), and 17.1% for placebo. No statistical comparison was performed between the varenicline and bupropion SR groups. Only varenicline 1 mg BID was significantly more efficacious than placebo throughout the entire follow-up period (P à ¢Ã¢â‚¬ °Ã‚ ¤ 0.01). Varenicline 0.3 mg once daily and varenicline 1 mg once daily were significantly more efficacious than placebo through week 7 (P à ¢Ã¢â‚¬ °Ã‚ ¤ 0.05), and bupropion SR was significantly more efficacious than placebo through week 12 (P à ¢Ã¢â‚¬ °Ã‚ ¤ 0.05). Scores on the MNWS and QSU-brief indicated reductions from baseline in cravings with varenicline 1 mg BID compared with placebo at each weekly time point during active treatment (week 2: P < 0.01; weeks 1 and 3-6: P < 0.001). Varenicline 1 mg BID was also associated with consistent improvements from baseline (the day before the TQD) to week 1 in scores on several subscales of the mCEQ compared with placebo, including satisfaction (mean change, -4.82; P < 0.05), enjoyment of respiratory tract sensations (mean change, -0.84; P < 0.05), and aversion (mean change, 0.82; P < 0.05). (The mCEQ was not used beyond week 1 of the active-treatment period.) There were no significant differences on any of the mCEQ measures between the lower doses of varenicline and placebo (Nides et al., 2006). Rationale/Justification Few studies examined the prevalence of tobacco use with diabetic patients, information that is critical for targeting prevention efforts. To our knowledge, there is no estimated prevalence for smoking in diabetes mellitus patients in Malaysia. Most people today recognize major health risks from smoking, but this general knowledge does not necessarily translate into a belief that one is personally at high risk of becoming seriously ill as a consequence of smoking. Furthermore, general awareness of health risks does not mean that people are adequately informed about smoking in ways that might influence their smoking behavior. Because the knowledge, beliefs, and preferences of smokers facilitate maximum receptivity to programs, these are important considerations when developing effective cessation interventions. Therefore, we will investigate smokers knowledge about the health risks of smoking and their awareness of nicotine medications. Unfortunately, there is a dearth of information on the efficacy of smoking cessation pharmacotherapies in diabetic patients because large-scale studies involving this group do not report results separately for them. Additionally, there are few direct head to head comparison studies among them in this subgroup population. Objectives General objectives Determine the prevalence of smoking among diabetic patients in outpatient clinic at General Hospital Penang. To investigate diabetic smokers knowledge about the health risks of smoking and their awareness of nicotine medications. To estimate direct head-to-head comparison between varnicline and nicotine patch regarding to their efficacy in smoking cessation. Specific objectives Determine the prevalence of smoking among diabetic patients. To assess the knowledge of diabetic smokers about the health risks of smoking and their awareness of nicotine medications. To compare between varenicline and NRT in the abstinence rate of smoking. To compare between varenicline and NRT in the cravings and withdrawal symptoms, assessed using the MNWS and QSU-brief. To compare between varenicline and NRT in the reinforcing effects of smoking, assessed using the mCEQ. To compare between varenciline and NRT in changes in body weight. Research Methodology Study design This study comprises different types of study design according to the different objectives. For estimating the prevalence of the smoking among DM patients, it will be achieved by review the medical records for all diabetic patients who attend the diabetic outpatient clinic during 2010. Besides assessing the smoking status, we will collect also specific demographic and diabetic-related data. Any medical records does not contain information about smoking status will be excluded. The second objective in investigating knowledge and awareness of diabetic smokers about the health risks of smoking, smoking cessation and smoking cessation pharmacotherapies, the study design it will be cross-sectional survey. All the diabetic smoker patients who attend the outpatient diabetic clinic at General Penang Hospital in 2011 will be invited to participate in the survey. The questionnaire will be either distributed or interviewed by the clinical staff. The questionnaire will be based on another study. More detailed information on how the survey was conducted can be found elsewhere (Cummings et al., 2004). The questionnaire will be divided to two sections involving: socio-demographic, tobacco-related and diabetes-specific health information; knowledge and awareness towards the health risks of smoking and their knowledge of smoking cessation and smoking cessation pharmacotherapies. The sociodemographic information will include (age, sex, race à ¢Ã¢â€š ¬Ã‚ ¦ etc); diabetic-related information, it will contain: type of diabetes, type of diabetic treatment, duration of diabetes; while for smoking related information will involve: number of cigarettes smoking per day, age started smoking, duration of smoking, are there any attempt to stop smoking for any period of time, Are there other smokers in the household. To compare treatment effect of varenicline and nicotine patch in abstinence rate of smoking cessation for diabetic smoker patients and to investigate the impact of the smoking cessation on the diabetic control. The study design will be randomised, open-label, parallel group study. The participants will be randomized in a 1:1 ratio either to varenicline or nicotine patch treatments. Subject who will receive varenicline will administer 0.5 mg/day for 3 days, 0.5 mg twice daily for 4 days, then 1 mg twice daily thereafter. Full dosing was achieved by the target quit date (TQD) and continues up to 12 weeks. Participant who will receive nicotine patch applied transdermal patches each morning starting on the TQD for 10 weeks. Doses of NRT were 21 mg/day for the first 6 weeks, 14 mg/day for 3 weeks, then 7 mg/day for 3 weeks. We choose these two treatments (nicotine patch and varenicline) for several reasons. Nicotine patch is the most commonly used pharmacotherapy for smoking cessation (Burton et al., 2000, Pierce et al., 1995, West et al., 2001). Given that many smokers in general population use this treatment to quit smoking, it is important to determine treatment effect of other agents relative to the patch. Furthermore, recent data suggest that there is decline in the efficacy of nicotine patch over the previous 10 years (Irvin et al., 2003, Jorenby et al., 1999, Pierce and Gilpin, 2002). Varnecline is selected in this study because yet there is limited studies publish about the effectiveness of this treatment in the diabetic smoker population. Also, varnecline was found to be the highest efficacy in the 2008 PHS Guideline meta-analysis (odds ratio 3.1) comparing to placebo (Fiore et al., 2008). Finally, smokers could be encouraged to seek out this prescribed agent, and insurers and health care syste ms could be encouraged to make this treatment more widely available, if it could be demonstrated that varnecline is more efficacious than over-the-counter medication (such as nicotine patch). In this study we will collect three types of end points: efficacy, measuring of craving and withdrawal symptoms, and investigating the impact of smoking cessation on diabetic outcome. The primary outcome for efficacy in the study it will be self-reported CAR, confirm by exhaled CO levels of 6 ppm or below, during the last 4 weeks of treatment (varenicline and NRT, weeks 9-12 after TQD) The secondary is the CAR from the last 4 weeks of each treatment until 6 months. Other secondary outcomes are 7-day point prevalence of tobacco abstinence at weeks end of drug treatment and at 6 months. Continuous abstinence define as self-reported abstinence from any tobacco- or nicotine-containing product during the specific period and it will be verified by carbon monoxide (CO) level à ¢Ã¢â‚¬ °Ã‚ ¤ 10 ppm. If the CO level is more than 10 ppm will be classified as a smoker regardless of self-reported abstinence. Point prevalence abstinence define as self-reported abstinence from any tobacco- or nicotine-containing product in the past 7 days that was not contradicted by expired air CO > 10 ppm. These are traditional standards for assessing efficacy of smoking cessation interventions (Fiore et al., 2008, Hughes et al., 2003). The Minnesota Nicotine Withdrawal Scale (MNWS) (Cappelleri et al., 2005) will be used to assess urge to smoke, depressed mood, irritability, anxiety, poor concentration, restlessness, increased appetite and insomnia. The modified Cigarette Evaluation Questionnaire (mCEQ) (Cappelleri et al., 2007) will be used to assess smoking satisfaction, psychological reward, aversion, enjoyment of respiratory tract sensations and craving reduction. The two previous questionnaires will be administered baseline visit and at each weekly visit through week 6 (after TQD) and at the end of treatment or at termination for participants who discontinued the study before week 6 (TQD). While the MNWS will be administered to all participants, the mCEQ will be administered only to participants who report smoking since their last completed questionnaire. Furthermore, we will assess the level of the nicotine dependence by using the Modified Fagerstrà ¶m Test for Nicotine Dependence (Heatherton et al., 1991) that range to three score ranges: (0-3) score indicate to low dependent, (4-6) score indicate to moderate dependent and (7-10) score indicate highly dependent. It will be administered at the baseline of the study. Schematic presentation of study design: Screening all diabetic patients medical records to estimate prevalence of smoking among them Interviewed structured questionnaire for all diabetic smoker to: To know characteristics of diabetic smoker (sociodemographic, diabetic history and tobacco use history) Investigate the knowledge towards smoking cessation and its pharmacotherapies Patients who attend quit smoking clinic Assessed for eligibility Excluded: Did not meet entry criteria Withdrew consent Randomized at ratio 1:1 Allocated to Varnicline (2mg or 1mg) (For 12 weeks) and arrange for quit date Allocated to nicotine Patch (For 12 weeks) and arrange for quit date Follow up at the end of treatment (12 weeks) and at 6 months to assess: Abstinence rate of smoking cessation the cravings and withdrawal symptoms the reinforcing effects of smoking changes in body weight Analysis Inclusion criteria The inclusion criteria it will be varying among the different objectives: For investigating the knowledge and awareness towards smoking cessation and its pharmacotherapies, smoker and ex-smoker diabetic patients (either type I or II) of both sexes aged à ¢Ã¢â‚¬ °Ã‚ ¥18 years will be included. For the direct comparison between nicotine patch and varenicline, Diabetic smokers of both sexes aged à ¢Ã¢â‚¬ °Ã‚ ¥18 years who smoke à ¢Ã¢â‚¬ °Ã‚ ¥10 cigarettes/day and willing to quit smoking. Exclusion criteria Patient is currently using any form of tobacco other than cigarettes; any form of NRT or other smoking cessation therapy. Significant depression requiring behavioral counseling and those using medications with psychoactive effects (e.g., antidepressants, antianxiety agents). other active psychiatric diseases because of previously identified limitations with delivery of the specific counseling intervention in such subjects. History of skin allergies or evidence of chronic dermatosis. Patient has medical contraindications for any of the study medications. Pregnant, breastfeeding women or at risk of becoming pregnant. Drug abuse or HIV infected patient. Recent (à ¢Ã¢â‚¬ °Ã‚ ¤3 months) history of myocardial infarction, angina pectoris, serious cardiac arrhythmia, or other medical conditions that the healthcare provider deemed incompatible with study participation. Participation within the last 12 months in a formal smoking cessation program.

Marriage and Family

The definition of family is a problematic issue for many scholars because of the complexity of the phenomenon and diversity of various family forms. With the continuing discussion of the possibility of gay families, the family is going to undergo an even more drastic redefinition. However, most families, irrespective of their form, will share some common features that allow researchers to group them together.The definition of the US Census Bureau states that the family is a â€Å"a group of two people or more related by birth, marriage, or adoption and residing together† (Flora & Segrin, p. 5). Therefore, to qualify for a family people need to be connected with ties of blood or law and live together; otherwise, people living together will be considered non-family households. Since the definition is structural, it resides on the inner structure of the unit and is therefore more straightforward than other attempts to define family.Family forms are also most frequently determined by structural ties. Thus, scholars distinguish the family of origin that â€Å"refers to relatives who are connected by blood or traditional sociolegal contracts such as marriage or adoption† (Flora & Segrin, p. 6). This form usually describes the family into which one is born.There is also a nuclear family that includes â€Å"two heterosexual parents and one or more children† (Flora & Segrin, p. 7). Nuclear families are distinguished first of all by the presence of two or one-parent, thus falling into two- or single-parent households. The latter type has spread with increase in the divorce rates from 11% of all families to 16% in the period from 1970 to 2000 (Flora & Segrin, p. 7). Two-parent families may not necessarily include children’s biological parents; at times, they will be remarriage, or step-families. Families can also be child-free, which includes â€Å"a married couple who voluntarily decides not to have children† (Flora & Segrin, p. 7).The above definition of the nuclear family refers to monogamous families that are typically considered the norm in the West. In a monogamous family, each partner will have only one spouse. In a polygamous family, a man can have more than one wife or vice versa. This is the case, for instance, in Muslim families where a man will often take more than one wife.A nuclear family contrast with multigenerational family households where representatives of many generations live together under one roof, and families include grandchildren and grandparents living together, or even great-grandchildren and great-grandparents. The nuclear family became more widespread in the industrial epoch and reached its height in the 1950s when more and more young families began to live apart from their parents. Most will nevertheless keep the contact between their nuclear unit and extended family – a group of all other relatives in addition to parents and children, most notably aunts, uncles, cousins, gran dparents, in-laws etc.Depending on the form of legal relationship between the people of the opposite or same sex living together, a couple can be classified as a cohabitating family. In this family, partners are not bound to each other by any form of legal contract. This form has proliferated of late as people have begun to see marriage bonds as less and less compulsory. Gay or lesbian families are couples including individuals of the same sex that live together, sometimes also with children. In most cases, such families will be based on the sexual intercourse and emotional commitment.Another family form on the rise today is the adoptive family in which a couple will adopt one or more children, sometimes in addition to the children they already have. Adoptions can also be biracial and international, meaning that kids are from a different race and country than their adoptive parents (Walsh, p. 17).The abundance of various family types testifies to the important role of the family in the life of people. Today’s reality has seen increasing acceptance of diverse family forms. These forms have come to replace the traditional nuclear family structure with different patterns.2. .The traditional American family in the past decades has undergone profound transformation. Due to the rising divorce rates, more and more children will live in single-family households as well as those where parents will re-marry. Blended families where children of both remarried parents live together are also becoming more common. The proliferation of new family types replacing the traditional nuclear family requires of family members more aptitude for adjustment.At present, America has the highest divorce rate on the globe. This change has translated into rise of single-family households that in 1990 â€Å"accounted for 23 percent of all Caucasian families, 33 percent of all Hispanic families, and 61 percent of all African American families† (Faruque 1999). Single-parent house holds headed by working mothers are still more likely to have incomes below poverty level than two-parent households; this additional factor pushes more women toward remarriage.On average, an American child will spend five years in a single-parent household. The divorce of biological parents is often followed by the re-marriage of one or both parents, which leads to an increase in step-parenting. As of 1999, â€Å"slightly over 40 percent of all current marriages in the United States [were] 2nd and 3rd marriages† (Faruque 1999). Quite often, remarriage will result in the formation of the blended family involving not only the two spouses, but also their children and perhaps aging relatives to care for.Partners how have formed such a family will often find themselves stressed to cope with the increased burden and have less time to devote to their children. As a result, remarried and blended families have many things to cope with that are not a problem to traditional families: t he need to find contact with children of the new spouse, need to blend children in if there are children in custody on both sides, coping with new relatives and so on.Remarriage will often result in households where children live with their mother and her new husband, although father-stepmother arrangements are also possible. Stepfamily Association estimates that about 30% of American children live in stepfamilies (Rainbows). According to data from the US Census Bureau, â€Å"20% of the children in two-parent households living with one natural parent and one step parent† (Rainbows). Another statistical fact is that â€Å"slightly more than 40% of all current marriages are second or third marriages† (Rainbows).Step-parenting is a challenge to many who find the child an additional complication to an otherwise happy new relationship. For children, living in a new household with a step parent may also be problematic because they are â€Å"trapped by their feelings of love and identification with the absent biological parent and the growing attachment to the stepparent† (Faruque 1999).All these data demonstrate that divorce and remarriage are a powerful trend in the development of the American family, and quite soon the traditional family with two parents and their biological children may recede into the past or remain a minority. Today’s parenting is associated with many complex issues such as handling children who demonstrate an adverse reaction to the new parent or stepsiblings. On the other hand, the changing family patterns increasingly cause emotional disturbance among children that are likely to experience emotional, learning or other behavioural problems because of divorce and/or remarriage in their families. The changing family situation requires a greater variety of skills on the part of parents and children in order to cope with shifts and new family structures less painfully. BibliographyFaruque, Cathleen Jo. The Changing Of America's Families. 26 May 2006 ;http://www.selfhelpmagazine.com/articles/parenting/families.html;.Flora, Jeanne, and Chris Segrin. Family Communication. Mahwah, NJ: Lawrence Erlbaum Associates, 2005.Rainbows. A Generation at Risk. 26 May 2006Walsh, Froma. Normal Family Processes: Growing Diversity and Complexity. New York: Guilford Press, 2003.

I can remember rare occasions as a child when I would wake...

I can remember rare occasions as a child when I would wake up for school and there would be pancakes, eggs and bacon on the table and orange juice or Sunny Delight to drink. These exciting occasions, however, were just that: rare. Most days I would bound down the stairs to the toaster loaded with Pop-Tarts. I would usually be disappointed that I couldnt devour a wholesome breakfast, but I later came to understand the convenience of the Pop-Tart. My parents could put pastries in the toaster and continue to get ready for their day without having to worry about too much clean-up. It was during these early days of my education that I really found a love for the sugary, fruit-filled pastries. Post Cereals was the first company to come†¦show more content†¦Along with their release to stores across the country, store managers were instructed to put the Pop-Tarts in the cookie and cake aisle, opposed to the cereal aisle where the Post Country Squares were faltering in sales. Kellogg started out with only four flavors of Pop-Tarts: apple currant, blueberry, cinnamon and strawberry. Over the years they have come out with a variety of different flavors including chocolate, French toast and a very popular smores version. The company decided not to frost the original version because the creators thought that the frosting might melt in the toaster. The developers later came to realize that the frosting would not melt in the toaster, however, and the first Pop-Tarts with frosting were released for sale in 1967. In 1971, Kellogg decided to introduce Milton the Toaster, a cartoon character that would be used to help promote the product. The character was a hit with the sample audiences and was launched nationwide, but the campaign was terminated after a commercial showing Milton the Toaster being hugged by a child fostered a fear that children may try to copy the commercial and burn themselves. 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Accounting And Finance Division Ms Finance Finance Essay - Free Essay Example

Sample details Pages: 9 Words: 2586 Downloads: 2 Date added: 2017/06/26 Category Finance Essay Type Argumentative essay Did you like this example? 2. Introduction and background: In todays modern business world, every company wants to get prosperous with their current market condition, where it is facing competition against its rivals within local market and international market. The question always has been arise whether the company performance is related to the pay or incentives of executives, so in order to find if there is any relationship between them, hence I have opted to choose the topic. Don’t waste time! Our writers will create an original "Accounting And Finance Division Ms Finance Finance Essay" essay for you Create order Top management drives the company, plays a vital role in leading the company for growth and development. The executive purpose is making profit and taking corrective decisions for the firm. Gray, SR., Benson and PG states that a small part of non-profit organisation ie executives but amazingly set the importance of non-profit organizations and in general factor community observation regarding their levels of pay of executive. MC Jensen, WH Meckling narrates that generally shareholder shows very less interest on the size of the firm but it prefers measuring efforts of executive in economic performance. It also states that shareholders basic objective is to maximize the return on investments. One of the main point arises is high salary for top executive are worth paid for their performance. For example, in one of the articles publish in Zimbio (https://www.zimbio.com/CEO+Richard+Fuld/articles/182/Lehman+Brothers+CEO+Defends+Nearly+500+Million) in term of 8 years with Lehman Brothers, R ichard Fuld made $484 million in form of bonuses, salary and stock options as he eventually drove his company out of existence. McKnight, PJ in his articles highlighted that salaries are always pre-determined during the beginning of the financial year and bonuses are decided at the end of the financial year with taking into consideration of companies economic performance and, then there should not be any relationship between compensation and performance of the individuals. The main objectives of this study are to focus on key elements of executive compensation is related to company performance. Conyon, MJ (2007) reveal in UK there are two or more executive compensation consultants such as Monk, UK PricewaterhouseCoopers and also Deloitte is main consultants. In an organisation, of the total work force only few percentage of the total workforce works in top management and they enjoys good sum of compensation. During the boom period of financial market, companies tend to pay enormo us fees to their workers which includes top executive of the company. This rise in bonuses was severely lop-sided on the way to cash rather than stock. There has been many discussions on performance of an individual should be relate to their compensation and benefits. Performance based incentives brings out more of growth opportunities within the company, it also involves more of risk taking and promotes long term orientation. 3. Theory and prior research: In the past few decades there have been many literature review by researcher on the rise in executive compensation, hence this rise in incentive, has shown interest researcher to work on this topic. Bebchuk and Grinstein (2005) narrates that there has been significant rise in executive compensation and growth are mostly based on equity which does not due to reducing cash based compensation These are established on two factors arm`s length model of bargaining and managerial power model influencing the pay and incentives of executive compensation. Conyon Sadler (2001) described that the compensation of the company has been increased drastically in the recent decades. It also held on tournament theory which predicts that the CEO may put on effort to promote a well-paid place job. Also observed relationship between performance of the company and incentives received to executive, by measuring the return on company with management financial incentives and firm performance. According Tro janowski Renneboog (2002) evaluates that if the ownership of the company is given to the executive then the company will show positive performance. It also states that cumulative use of agency theory results to company performance in the market (stock performance), increase in compensation and stock dependent. It also analyse two managerial of labour market executive disciplinary costs and executive compensation schemes. Voulgaris, Stathopoulos Walker (2010) showed a new evidence of executive pay relates with executive compensation. It states that the managerial power approach has aggregate outcome on the compensation which influence the equity based compensation pay level to rise. It also showed executive compensation is more relates to power of top level executive than that of economic causes. Pay and compensation structure are related to the managerial power approach. Ozkan (2007) with the data set of 390 UK non-financial firm periods from 1999 2005 shows constructive and s ignificant link between level of executive compensation and performance of firms. The author also showed the level of compensation for large UK companies includes both cash and equity based components. This paper used GMM system method which controls the presence of unobserved firm-specific effects and for the growth within the explanatory variables. The CEO cash compensation does not get impacted with the proportion of non-executive directors of the firm, but ownership can provide incentives to non-executives directors. Espenlaub, Stathopoulos, Walker (2007) by collating data from 3307 executives observed that there is a relationship between managerial incentives and firm risk reveals a nonlinear relationship with the size of the firm to medium size quoted companies. The article also explains that small size company shows there is a negative relationship between pay by performance and risk consistent with standard agency model but for large company relationship becomes unstabl e with different models. Hence it concludes that neither of any models can full explain the relationship of performance by pay and the risk. Goh Gupta (2010) narrates that there is a wide range of equity based pay structure in firm and an extensive of compensation consultant of high level of pay. This paper use the samples of 350 FTSE firms from 2002 2008 it states that the CEO and top executive of the firm enjoy high salary incremental in the year and less uncertain payment package. And greater bonus in terms of cash and less in term of equity based compensation in the form of stock. It also finds no evidence that the increase in number of consultant results to increase in compensation than that of non-increasing consultant for the firm. Therefore it concludes that in some companys consultant are successful in constructive compensation of pay of top executive of the firm. Camara (2008) states that ever since 1995 not less than 50% of the FTSE companies have decided to raise an d grant bonuses to senior executives, as the payoffs which are dependent of the firm stock return relative to a given period of time. Hence the results suggests that the firm in UK practice when relative performance incentives standby with absolute performance incentives tends to decline in cost of cost of incentives package, they also take undertake high risky capital investment projects and to increase the wealth of shareholders they reduce the incentives of the executives. Conyon, Peck Sadler (2000) observed 100 UK companies which are listed in stock market and covering more than 500 executives all over from UK at the end of 1990s. It has been observed that there is a convex relationship between executive pay at a managerial level and a break between CEO executive pay and board structural level. It also showed the executive have small role in forming the company performance. Conyon (2007) highlighted three main findings from his studies; CEO compensation are paid very high an d they are greater than firm using consultant compensation, the amount of equity based incentives is higher than the consultant of the firm and found less evidence with the possible within the conflicts of interest which tends to high pay or package to CEO. Murphy (1998) this paper examines the pay structure of executive compensation by equipping potential researcher by summarizing the empirical and theoretical research. Also it has been analyse that higher pay and performance are less in huge firms, the pay level and performance is less in regulating utilities than that of industry firm and the pay performance is high in US than any other countries. Labour economist usually focused on market performance but now they are more interested in pay of executives as inside data of the firm is very messy and unavailable. Hence the study of executive compensation states that there is a comprehensive and perspective significant influencial of top management of the firm in compensation pai d to them also. Conyon Murphy (2000) states that they found a difference in incentives and pay of executives in United States and United Kingdom in 1997, US CEO earns 45% higher cash compensation and total compensation by 190%. The median CEO of US gets 1.48% of any shareholders wealth increase whereas UK gets 0.25%. The main differences between these countries are US feature greater share option award from institutional and there is a culture difference. Conyon (2007) observed that a letter from Warren Buffet in February 07 to the stakeholders of Berkshire Hathaway CEO perks at one company are quickly copied elsewhere. All the other kids have one may seem a thought too juvenile to use as a rationale in the boardroom. But consultants employ precisely this argument, phrased more elegantly of course, when they make recommendations to comp committees Therefore it is not so much academically proven that executive compensation is related to equity compensation to executives. 4. Research objectives: The plans of the research is based on the prior working reports and evidence of article or journal in which researchers tried to explain and reviewing their point of view toward the topic and looking out for evidence obtained by the researcher deriving their best possible outcomes; whether it is directly or indirectly relates to executive compensation. Also in terms of agency theory whether it is applicable in stock price to grow gradually during this period as top management of the firm are agents of stock holder. It will be based on top executive incentives earned when they were in the power to drive the company during the term and check if the benefits received from the firm are up to their marks of their contribution made toward the company. To identify performance of executive in UK market with regards to their pay compensation. To examine the exemption and the factors associates behind the executive compensation It will focus on the relationship between the executive performance pay and size of the firm by two equations The basic motivation for study in this topic is to understand the policies of company regarding their pay and package structure and to understand the structure of compensation paid to executive and to have a close review on their decision making and its outcome. 5. Methods and data: Based on the model applied by McKnight (1996) showed the relationship between the executive performance and incentives pay and size of the firm by two equations The basic hypotheses to determine the executive compensation are used by two hypotheses equation: Determining company performance with the compensation paid to the executives. And the empirical relationship between sizes of the firm with the compensation paid to their executives. It predicts compensation which is dependent variables . (1) ÃÆ' ¢Ãƒâ€¹Ã¢â‚¬  Ãƒ ¢Ã¢â€š ¬Ã‚  Compit = ÃÆ'Ã… ½Ãƒâ€šÃ‚ ±t +ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²ÃƒÆ' ¢Ãƒâ€¹Ã¢â‚¬  Ãƒ ¢Ã¢â€š ¬Ã‚  (Perf)it-1 Where, ÃÆ' ¢Ãƒâ€¹Ã¢â‚¬  Ãƒ ¢Ã¢â€š ¬Ã‚  Compit is percentage change in executive compensation and percentage change in annual bonus and sum of salary. ÃÆ' ¢Ãƒâ€¹Ã¢â‚¬  Ãƒ ¢Ã¢â€š ¬Ã‚  (Perf) = Performance of the company over the period of time i = aggregate salary of executive t = time (year) The percentange change in companys perf ormance ÃÆ' ¢Ãƒâ€¹Ã¢â‚¬  Ãƒ ¢Ã¢â€š ¬Ã‚  Perfi = [(ÃÆ' ¢Ãƒâ€¹Ã¢â‚¬  Ãƒ ¢Ã¢â€š ¬Ã‚  Perft (ÃÆ' ¢Ãƒâ€¹Ã¢â‚¬  Ãƒ ¢Ã¢â€š ¬Ã‚  Perfit 1))/ (ÃÆ' ¢Ãƒâ€¹Ã¢â‚¬  Ãƒ ¢Ã¢â€š ¬Ã‚  Perfit 1)] Where the performance of the company can be represented by ÃÆ' ¢Ãƒâ€¹Ã¢â‚¬  Ãƒ ¢Ã¢â€š ¬Ã‚  Perfi in year subtracted by performance in the previous year t-1 divided by the performance variable in the year t-1. The following equation shows relationship between size of the firm and executive pay compensation. This equation forecasts compensation which is dependent by and ÃÆ' ¢Ãƒâ€¹Ã¢â‚¬  Ãƒ ¢Ã¢â€š ¬Ã‚  Compit will be influenced by size of the firm as independent (2) ÃÆ' ¢Ãƒâ€¹Ã¢â‚¬  Ãƒ ¢Ã¢â€š ¬Ã‚  Compit = ÃÆ'Ã… ½Ãƒâ€šÃ‚ ±t +ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²ln(Size)it-1 + eit Where ÃÆ' ¢Ãƒâ€¹Ã¢â‚¬  Ãƒ ¢Ã¢â€š ¬Ã‚  Compit = the salary and bonus over a period of time. i = aggregate salary of executive t = time (year) ln(Size)it-1= Log of the size of the firm ie sales turnover and total asset of the firm The nature of the research will be to desire the goals of the topic chosen and meeting their objectives. The basic objective of research would be collecting data, eliminating irrelevant data which are not useful for the research. The study period for this would range from 1997 to 2007 of 60 medium to large UK companies. Review of applied research theory, interpreting them with wide range of different reports and working on the similar issue. As the research is based on the performance of the company, it becomes very crucial to find the performance relationship of the company with respect to compensation drawn by the executives. For research on executive compensation the data sets use would be annual reports, secondary data and if required from the Data Stream. If in case any additional information or data set is required for the topic then Data Stream or from companies annual report websites will play an important role in analysing the data contents and p resenting. The annual statement reports includes following detail remuneration policy statement, details of compensation committee members and advisors, performance graph, details of the directors if it is internal or external, the details of the director remuneration and the term spent etc. 6. Research ethics: Vrakatseli (2006) ethical considerations were taken into account; therefore the name of the project as well as the names of the firm that participated in it was reformed in this study to ensure confidentiality. The study for topic does not involve any direct contact with human nature. It is an explanatory theory based on the performance of the executive pay and compensation. This study of executive compensation involves the past study by practitioners and data from the Datastream. It is a case study where I need to find the correct, needful and relevant data, as per regulation act, it is a compliance issue to deal with human behaviour. According to Willig (2001), investigators should always respect the thoughts and protect their applicants from any harm or loss or damage, and they should aim to preserve their emotional well-being and self-respect their privacy at all times. 7. Time scale and resources: If deadline for a dissertation is given, planning and fixing of a project before deadline makes one feel good for project. Flexibly or alternate planning of the projects should be there during stumble. The proposed dissertation timeline can be slightly different but most of them follow a general process of flowchart. Dissertation plans and time consuming for work (each section) to get completed on time so that there is no possible delay for it. Time schedule grid motivates encourage that the particular task needs to be performed. Some of the examples of planning and managing the work are brainstorming about the topic, random flow of fishbone diagrams, analysing critical path with help of flow chart and a very common use to planning the project is Gantt chart. According to Taylor, S.J. Bogdan, R. (1998) showed different methods of collecting data and techniques which needs to be applied, when applying to actual study and practice. A research design must be planned in order to get w ork completed on time. It is mapping out the method for the best answering the research questions. Weeks 1 2 3 4 5 6 7 8 9 10 11 12 Steps             Creating and developing research questions             Planning, collecting and managing general information to start             Company annual reports collecting data and other information             Reading and evaluating information             Taking notes of main findings             Organizing information             Planning and developing the dissertation             Reviewing and revising my 1st draft             Editing, revising and designing draft             Adding additional information and Finalizing the report             Completion and submition of report             Gantt chart