health and human services

 The term "Health and Human Services" (HHS) refers to a U.S. government department and the broader field of services related to health and well-being. Here is an overview of both:

**1. U.S. Department of Health and Human Services (HHS):**

- **Role:** HHS is a federal executive department in the United States government. Its primary role is to enhance and protect the health and well-being of all Americans. It oversees a wide range of programs and agencies related to public health, social services, and human welfare.

- **Agencies:** HHS includes numerous agencies and offices, some of which include the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Centers for Medicare & Medicaid Services (CMS), and the Administration for Children and Families (ACF), among others.

- **Responsibilities:** HHS is responsible for developing and implementing health and human services policies, regulations, and programs. It administers and funds healthcare services, public health initiatives, medical research, social services, child welfare programs, and more.

- **Leadership:** The head of HHS is the Secretary of Health and Human Services, who is a member of the President's Cabinet. The department plays a crucial role in responding to public health emergencies, such as the COVID-19 pandemic.

**2. Health and Human Services (Field):**

- **Definition:** In a broader sense, "health and human services" refers to a field encompassing a wide range of programs and services aimed at promoting the well-being and quality of life of individuals and communities. This field includes services related to healthcare, mental health, social services, public health, and more.

- **Programs and Services:** Health and human services encompass a variety of programs and services, including healthcare delivery, mental health counseling, substance abuse treatment, child welfare services, elderly care, housing assistance, nutrition programs, and vocational rehabilitation, among others.

- **Professionals:** The field employs a diverse range of professionals, including doctors, nurses, psychologists, social workers, counselors, public health experts, and many others who work to provide care, support, and resources to individuals and communities in need.

- **Goals:** The overarching goals of health and human services are to improve health outcomes, enhance social well-being, address disparities, and ensure access to essential services for all members of society, especially vulnerable populations.

In summary, "Health and Human Services" refers to both a U.S. government department responsible for overseeing health and social service programs and a broader field encompassing a wide range of programs and services dedicated to promoting the health and well-being of individuals and communities.

world mental health day

 World Mental Health Day is observed annually on October 10th to raise awareness about mental health issues, promote mental well-being, and advocate for improved access to mental health care and support worldwide. This day provides an opportunity to initiate important conversations about mental health, reduce stigma, and encourage individuals to seek help when needed. Here are some key aspects of World Mental Health Day:

**1. Awareness:** World Mental Health Day aims to increase public awareness and understanding of mental health and mental illnesses. It serves as a platform for discussing mental health-related topics, challenges, and solutions.

**2. Stigma Reduction:** One of the primary goals is to reduce the stigma associated with mental health conditions. Stigma often prevents individuals from seeking help and support when they need it.

**3. Advocacy:** Organizations, mental health professionals, and advocates use this day to call for improved mental health policies, increased funding for mental health services, and better access to mental health care.

**4. Education:** World Mental Health Day provides an opportunity to educate the public about common mental health disorders, their symptoms, and the importance of early intervention and treatment.

**5. Support:** It encourages individuals to reach out to those who may be struggling with their mental health, offering support, empathy, and a listening ear.

**6. Initiatives and Campaigns:** Various organizations and mental health institutions organize events, seminars, workshops, and campaigns to mark the day. These initiatives aim to promote mental well-being and provide resources for individuals and communities.

**7. Global Focus:** World Mental Health Day is observed internationally, highlighting the global nature of mental health issues and the need for collective efforts to address them.

**8. Theme:** Each year, World Mental Health Day has a specific theme to focus on. Themes have included "Mental Health for All," "Mental Health in the Workplace," "Young People and Mental Health in a Changing World," and others, with the goal of addressing specific aspects of mental health.

**9. Personal Well-Being:** On a personal level, World Mental Health Day encourages individuals to prioritize their mental well-being by practicing self-care, seeking help when needed, and maintaining open and supportive relationships.

**10. Resources:** Many mental health organizations and institutions provide resources and information on mental health conditions, treatment options, and where to seek help.

Participating in World Mental Health Day can involve a range of activities, from attending events and webinars to sharing information and resources on social media. Individuals, schools, workplaces, and communities can all contribute to the mission of raising awareness and promoting mental well-being.

It's important to recognize that mental health is an essential aspect of overall health, and taking care of one's mental well-being is just as important as physical health. If you or someone you know is struggling with mental health issues, reaching out to a mental health professional or a support network can make a significant difference.

Stress management for hipertensi

 Various definitions of stress that can be understood. That stress itself according to (Kaplan, 2006 in Hawari 2012), is a condition or the body's response to any pressures and demands generated by it changes in the environment, whether from favorable conditions or not pleasant. Stress is a reality of everyday life that cannot be avoid by all people, stress or emotional tension can affect the cardiovascular system (Marliani, 2007). 

Unbelievable stress as a psychological factor that can increase blood pressure

The etiology of stress itself is a factor causing deep trauma development of post-traumatic stress disorder in developmental disorders post traumatic stress. But not everyone experiences stress disorder post-traumatic after a traumatic event. Sources of stress quoted by (Sarwono, 1988 in Syam, 2014) distinguishes the sources of stress, namely within the individual, family, community and society.

The sources of stress in a person can sometimes come from

in a person. For example, through pain (Budi Keliat, 2002).

The level of stress that arises in a person through an assessment of multifacial forces that fight when someone experiences conflict. Furthermore, the sources of stress in the family; stress here can sourced from interactions among family members such as; dispute in family matters of finances, feelings of mutual indifference.

Furthermore, the sources of stress in the community and environment;

Enter the stress approaches according to several authors.

(Sytherland & Cooper, 1990) stress among others can be conceptualized from various points/views including: Stress as a stimulus, ie

The first approach focuses on the environment and describe stress as a stimulus. Hippocrates believed that The health characteristics of these diseases are coordinated by the environment external (Sutherland & Cooper, 1990). Furthermore, stress as a response,

What is meant in this approach focuses on a person's reaction to the stressor as a response (or the stress of a variable depending) the response referred to here is the response that contains two components, namely psychological and physiological components. Then stress

as the individual's interaction with the individual's environment will provide

different stress reactions to the same stressor for example we can

Observe the behavior of people in traffic. People trapped in the past

Continuous traffic will look at the clock while there is also a quiet one

just. In fact, it is not uncommon to still be able to enjoy music (Budi Keliat, 2002).

The stress response can be divided into two, namely the components

psychology as well as physiology.

Signs and symptoms each person has a different response

to stress experienced, so the symptoms are also different.

As expressed by (Munajat, 2000 in Syam 2014), namely;

physical symptoms which include rapid breathing, dry lips, clammy hands, feeling

hot and hot, tense muscles, diarrhea or constipation, tired easily,

Symptoms and food for diabetes

The symptoms of diabetes mellitus may include:

1. Frequent thirst.

2. Persistent hunger.

3. Increased urination, particularly during the night.

4. Unexplained weight loss.

5. Loss of muscle mass.

6. Frequent fatigue.

7. Blurred vision.

8. Slow-healing wounds.

9. Recurrent infections, such as those affecting the gums, skin, vagina, or urinary tract.

Individuals with diabetes can still include sweet foods in their diet, but it should be done with specific guidelines, such as:

1. Consume sweet treats infrequently and in small portions.

2. Offset sweet food intake with other nutritional elements like vegetables, nuts, and lean proteins such as fish.

3. Opt for fiber-rich foods, such as soybeans, which are not only high in protein but also fiber, promoting prolonged feelings of fullness.

4. Reduce the consumption of high-carbohydrate sources like white rice, refined pasta, white bread, potatoes, and corn.

5. Examine nutrition labels on food packaging to determine the sugar and carbohydrate content.

Living alone with a blood cancer

Living alone with a blood cancer. Living as an independent person is important for many young people, but it may be very challenging to keep the spirits up and continue to be positive, if you are living alone with a blood cancer. You may be someone who normally appreciates your independence; however being unwell may make you feel lonely and isolated.

The possibility of having to sacrifice your current living situation on top of the diagnosis of a blood cancer is all very overwhelming.  There are aspects of living with a blood cancer that can make it difficult to manage everyday life, such as grocery shopping and cleaning.

Some young adults may feel comfortable with temporarily moving home with family or whanau whilst they undergo treatment for their blood cancer. For many young adults this is simply not an option, and for those individuals there is support available to help them through this time and remain living independently.

Ask to speak to your social worker who will be able to help you to remain as independent as possible.

If you are living alone it is important that you:

•  • Put together a list of emergency contacts in case you do unexpectedly become unwell. 
•  • Let friends, family, whanau and neighbours know about what could happen so if you call them in an emergency, they will know what to do and who to call. Your doctors and nurses will also give you a list of 24 hour emergency contact numbers to use in such circumstances.

It is okay to accept help. Family and friends who care about you may want to help in any way they can, and it is sometimes difficult to accept this help when you have previously lived so independently.  Some family, whanau and friends may find it difficult to talk openly about your blood cancer, but would be happy to help in more practical ways, such as doing your shopping or helping with your house cleaning and transporting you to doctors’ appointments.

Accepting support offered may make living alone easier, and therefore enable you to retain your independence. Although you may want to stay independent for as long as possible, remember that it is okay to ask for help when you need it. Being independent is about finding the right balance between acknowledging when you need support and looking after yourself.

Breast cancer molecular alteration

Molecular alterations The most frequently mutated and/or amplified genes in the tumour cells are TP53 (41% of tumours), PIK3CA (30%), MYC (20%), PTEN (16%), CCND1 (16%), ERBB2 (13%), FGFR1 (11%) and GATA3 (10%), as reported in a series of early breast cancers. These genes encode cell-cycle modulators that are either repressed (for example, p53) or activated (for example, cyclin D1), sustaining proliferation and/or inhibiting apoptosis, inhibiting oncogenic pathways that are activated (MYC, HER2 and FGFR1) or inhibiting elements that are no longer repressed (PTEN).

The majority of the mutations affecting 100 putative breast cancer drivers are extremely rare, therefore, most breast cancers are caused by multiple, low-penetrant mutations that act cumulatively. Luminal A tumours have a high prevalence of PIK3CA mutations (49%), whereas a high prevalence of TP53 mutations is a hallmark of basal-like tumours (84%).

For TNBC, different molecular drivers under- line its subtypes. At the metastatic stage, specific predictive alterations, such as PIK3CA mutations, can be easily detected non-invasively in the plasma in circulat- ing tumour DNA rather than on tumour biopsy; never- theless, depending on the technology used, the level of sensitivity may vary. 

Epigenetic alterations are involved in breast carcinogenesis and progression. In breast cancer, genes can be either globally hypomethylated (leading to gene activation, upregulation of oncogenes and chromosomal instability) or, less frequently, focally (locus-specific) hypermethylated (leading to gene repression and genetic instability due to the silencing of DNA repair genes).

Other epigenetic mechanisms involve histone tail modifications by DNA methylation, inducing chromatin structure changes to silence gene expression and nucleosomal remodelling. These changes are reversible, enzyme-mediated and potentially targetable. For example, in luminal-like breast cancer cell lines, inhibition of histone deacetylase with specific inhibitors such as vorinostat or chidamide can reverse resistance to endocrine therapy via inhibition of the resistance pathway driven by epidermal growth factor receptor signalling.

Recently, a phase III trial in metastatic luminal breast cancer showed the superiority of a treatment combining chidamide with endocrine therapy (namely, the aromatase inhibitor exemestane) to exemestane alone.

Immune crosstalk in breast cancer

Immune crosstalk in breast cancer. The immune reaction to breast cancer is initiated by the neoantigens expressed by tumour cells, encoded by altered genes and presented by antigen-presenting cells (APCs) on major histocompatibility complex class I (MHC I) or MHC II molecules. Neoantigen presentation results in activation of CD8+ (cytotoxic) and CD4+ (helper) T cells. CD8+ T cells are the main effector cell of the anti-tumour immune response; their activation (principally through the T cell receptor (TCR)) results in release of the cytolytic molecules perforin and granzyme B, which directly induce tumour cell lysis.

The anti-tumour action of CD8+ T cells is amplified by cytokines secreted from CD4+ T cells, namely IFNγ, IL-2 and tumour necrosis factor (TNF). Activated CD8+ T cells also upregulate expression of Fas ligand (FasL) and TNF-related apoptosis-inducing ligand (TRAIL; also known as TNFSF10) on their membrane, which induce apoptotic pathways to kill tumour cells.

Cancer cells elicit an innate immune response, comprising natural killer (NK) and NK T cells that are capable of direct tumour cell killing. Malignant cells can suppress the immune response by expressing immune checkpoint regulators (for example, cytotoxic T lymphocyte-associated protein 4 (CTLA-4) and programmed cell death 1 ligand 1 (PD-L1)), which are upregulated by effector T cells as a consequence of chronic exposure to tumour antigens (T cell exhaustion).

The reduced anti-tumour immune response by upregulated immune checkpoint molecules establishes a pro-tumour microenvironment, which is further enriched by recruitment of immunosuppressive cells, T regulatory (Treg) cells and myeloid-derived stromal cells (MDSCs). Treg cells, which inhibit activation of CD4+ and CD8+ T cells, are induced by tumour-associated macrophages (TAMs) and by tumour-secreted and cancer-associated fibroblast (CAF)-secreted factors, such as transforming growth factor-β (TGFβ).

 In addition, TAMs and Treg cells inhibit APCs via IL-10 secretion, inducing a tolerogenic state of APCs. MDSCs are recruited to the tumour bed by tumour-secreted factors, inhibit trafficking of T cells to the tumour bed and inhibit effector T cell activation by upregulating 2,3-indoleamine- dioxygenase (IDO) and arginase expression, enzymes involved in the T cell nutrient depletion.

The secretome of the pro-tumour microenvironment, containing factors that stimulate angiogenesis and invasion (such as vascular-endothelial growth factor (VEGF) and matrix metalloproteinases (MMPs)) also contribute to tumour immune escape and propagation. CCL22, CC-chemokine ligand 22; CXCL16, CXC-chemokine ligand 16; NOS, nitric oxide synthase; PD-1, programmed cell death 1; RANKL, receptor activator of nuclear factor-κB (RANK) ligand; TH1 cell, type 1 T helper cell. Adapted from ref. 75, CC-BY-4.0 https://creativecommons.org/licenses/by/4.0/