Osteoarthritis
Osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease), is a group of diseases and mechanical abnormalities involving degradation of joints,

[1] including articular cartilage and the subchondral bone next to it. Clinical manifestations of OA may include joint pain, tenderness, stiffness, creaking, locking of joints, and sometimes local inflammation.

In OA, a variety of potential forces—hereditary, developmental, metabolic, and mechanical—may initiate processes leading to loss of cartilage -- a strong protein matrix that lubricates and cushions the joints.

As the body struggles to contain ongoing damage, immune and regrowth processes can accelerate damage.

[2] When bone surfaces become less well protected by cartilage, subchondral bone may be exposed and damaged, with regrowth leading to a proliferation of ivory-like, dense, reactive bone in central areas of cartilage loss, a process called eburnation.

[3] The patient increasingly experiences pain upon weight bearing, including walking and standing. Due to decreased movement because of the pain, regional muscles may atrophy, and ligaments may become more lax.OA is the most common form of arthritis,

[4] and the leading cause of chronic disability in the United States.
"Osteoarthritis" is derived from the Greek word "osteo", meaning "of the bone", "arthro", meaning "joint", and "itis", meaning inflammation, although the "itis" of osteo arthritis is somewhat of a misnomer -- inflammation is not a conspicuous feature of the disease.

Osteoarthritis is not to be confused with rheumatoid arthritis, an autoimmune disease with joint inflammation as a main feature.

A common misconception is that OA is due solely to wear and tear, since OA typically is not present in younger people. However, while age is correlated with OA incidence, this correlation may illustrate that OA is a process that takes time to develop -- or that repair and regeneration that may keep pace with damage in the joints of younger people do slow with age.

There is usually an underlying cause for OA, in which case it is described as secondary OA. If no underlying cause can be identified it is described as primary OA. "Degenerative arthritis" is often used as a synonym for OA, but the latter involves both degenerative and regenerative changes.

OA affects about 8 million people in the United Kingdom and nearly 27 million people in the United States, where it accounts for 25% of visits to primary care physicians and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions.

It is estimated that 80% of the US population will have radiographic evidence of OA by age 65, although only 60% of those will show symptoms.[6] In the United States, hospitalizations for osteoarthritis soared from about 322,000 in 1993 to 735,000 in 2006.

Signs and symptoms
The main symptom is acute pain, causing loss of ability and often stiffness. "Pain" is generally described as a sharp ache, or a burning sensation in the associate muscles and tendons. OA can cause a crackling noise (called "crepitus"

when the affected joint is moved or touched, and patients may experience muscle spasm and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Humid and cold weather increases the pain in many patients.

OA commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected.


As OA progresses, the affected joints appear larger, are stiff and painful, and usually feel worse, the more they are used throughout the day, thus distinguishing it from rheumatoid arthritis.

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes (on the distal interphalangeal joints) and/or Bouchard's nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly.

OA at the toes leads to the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they experience any pain.[10]

OA is the most common cause of joint effusion, sometimes called water on the knee in lay terms, an accumulation of excess fluid in or around the knee joint.
[edit] Causes

Although it commonly arises from trauma, osteoarthritis often affects multiple members of the same family, suggesting that there is hereditary susceptibility to this condition.

A number of studies have shown that there is a greater prevalence of the disease between siblings and especially identical twins, indicating a hereditary basis .

Up to 60% of OA cases are thought to result from genetic factors. Researchers are also investigating the possibility of allergies, infections, or fungi as a cause.
[edit] Types

OA affects about eight million people in the United Kingdom, and about 27 million people in the United States, where it accounts for 25% of visits to primary care physicians and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions.

It is estimated that 80% of the US population will have radiographic evidence of OA by age 65, although only 60% of those will be symptomatic.

Some investigators believe that mechanical stress on joints underlies all osteoarthritis, with many and varied sources of mechanical stress, including misalignments of bones due to congenital or pathogenic causes;

mechanical injury; being overweight; loss of strength in muscles supporting joints; and impairment of peripheral nerves, leading to sudden or uncoordinated movements that overstress joints.
Primary

Primary OA in the left knee of an elderly female.
This type of OA is a chronic degenerative disorder related to but not caused by aging, as there are people well into their nineties who have no clinical or functional signs of the disease.

As a person ages, the water content of the cartilage decreases due to a reduced proteoglycan content, thus causing the cartilage to be less resilient.

Without the protective effects of the proteoglycans, the collagen fibers of the cartilage can become susceptible to degradation and thus exacerbate the degeneration. Inflammation of the surrounding joint capsule can also occur, though often mild (compared to that which occurs in rheumatoid arthritis).

This can happen as breakdown products from the cartilage are released into the synovial space, and the cells lining the joint attempt to remove them. New bone outgrowths, called "spurs" or osteophytes, can form on the margins of the joints, possibly in an attempt to improve the congruence of the articular cartilage surfaces.
These bone changes, together with the inflammation, can be both painful and debilitating.
Secondary

This type of OA is caused by other factors but the resulting pathology is the same as for primary OA:
* Congenital disorders, such as:
o Congenital hip luxation
o People with abnormally-formed joints (e.g. hip dysplasia (human)) are more vulnerable to OA, as added stress is specifically placed on the joints whenever they move. [However, recent studies have shown that double-jointedness may actually protect the fingers and hand from osteoarthritis.]
* Diabetes.
* Inflammatory diseases (such as Perthes' disease), (Lyme disease), and all chronic forms of arthritis (e.g. costochondritis, gout, and rheumatoid arthritis). In gout, uric acid crystals cause the cartilage to degenerate at a faster pace.
* Injury to joints, as a result of an accident.
* A joint infection, e.g. from an injury.
* Hormonal disorders.
* Ligamentous deterioration or instability may be a factor.
* Marfan syndrome
* Obesity. Obesity puts added weight on the joints, especially the knees.
* Sports injuries, or similar injuries from exercise or work. Certain sports, such as running or football, put undue pressure on the knee joints. Injuries resulting in broken ligaments can lead to instability of the joint and over time to wear on the cartilage and eventually osteoarthritis.
* Pregnancy
* Alkaptonuria
* Hemochromatosis and Wilson's disease
* Childhood physical abuse[15]

Diagnosis
There is no laboratory or pathological definition of osteoarthritis, and therefore no accepted laboratory tests to diagnose in

Diagnosis can often be made with reasonable certainty by clinical examination[16][17]. Confirmation can be done through x-rays.

This is possible because loss of cartilage, subchondral ("below cartilage") sclerosis, subchondral cysts from synovial fluid entering small microfractures under pressure, narrowing of the joint space between the articulating bones, and bone spur formation (osteophytes)

- from increased bone turnover in this condition, show up clearly on x-rays. Plain films, however, often do not correlate well with the findings of physical examination of the affected joints.

Usually other imaging techniques are not necessary to clinically diagnose osteoarthritis.

In 1990, the American College of Rheumatology, using data from a multi-center study, developed a set of criteria for the diagnosis of hand osteoarthritis based on hard tissue enlargement and swelling of certain joints.

These criteria were found to be 92% sensitive and 98% specific for hand osteoarthritis versus other entities such as rheumatoid arthritis and spondyloarthropities .

Related pathologies whose names may be confused with osteoarthritis include pseudo-arthrosis.

This is derived from the Greek words pseudo, meaning "false", and arthrosis, meaning "joint." Radiographic diagnosis results in diagnosis of a fracture within a joint, which is not to be confused with osteoarthritis which is a degenerative pathology affecting a high incidence of distal phalangeal joints of female patients.
[edit] Treatment

Treatment of OA consists of exercise, manual therapy, lifestyle modification, medication and other interventions to alleviate pain.

Lifestyle modification
No matter the severity or location of OA, conservative measures such as weight control, appropriate rest, exercise, and the use of mechanical support devices can be beneficial. In OA of the knees, knee braces can be helpful.

A cane, or a walker can reduce pressure on involved leg joints which can be helpful for walking and support. Regular exercise such as walking or swimming, or other low impact activities are encouraged.

Applying local heat before, and/or cold packs after exercise, can help relieve pain, as can relaxation techniques. Weight loss can relieve joint stress and may delay progression although research supporting this is equivocal.
[edit] Physical measures

Proper advice and guidance by health care providers such as chiropractors, physical therapists, occupational therapists, and medical doctors is important in OA management, enabling people with this condition to improve their quality of life.

Functional, gait, and balance training has been recommended to address impairments of proprioception, balance, and strength in individuals with lower extremity arthritis.

These deficits can contribute to higher fall risk in older individuals.

Patient education
Patient education has been shown to be helpful in the self-management of patients with arthritis in decreasing pain, improving function, reducing stiffness and fatigue, and reducing medical usage.

A meta-analysis has shown patient education can provide on average 20% more pain relief when compared to NSAIDs alone in patients with hip OA or rheumatoid arthritis.

Exercise
Moderate exercise leads to improved functioning and decreased pain in people with osteoarthritis of the knee.

Adequate joint motion and elasticity of periarticular tissues are necessary for cartilage nutrition and health, protection of joint structures from damaging impact loads, function, and comfort in daily activities.

Exercise to regain or maintain motion and flexibility by low-intensity, controlled movements that do not cause increased pain.

Muscle weakness around an osteoarthritic joint is a common finding. Progressive resistive/strengthening exercises load muscles in a graduated manner to allow for strengthening while limiting tissue injury.[23]

Splinting of the thumb for OA of the base of the thumb leads to improvements after one year.

In 2002, a randomized, blinded assessor trial was published showing a positive effect on hand function with patients who practiced home joint protection exercises (JPE).

Grip strength, the primary outcome parameter, increased by 25% in the exercise group versus no improvement in the control group. Global hand function improved by 65% for those undertaking JPE.
Medication
Paracetamol

Paracetamol (Tylenol/acetaminophen), is commonly used to treat the pain from OA, and was recommended in 16 of 16 guidelines evaluated in a 2007 review of existing guidelines.

A randomized controlled trial comparing paracetamol with ibuprofen in x-ray-proven mild to moderate osteoarthritis of the hip or knee found equal benefit.

However, paracetamol at a dose of 4 grams per day can increase liver function tests.In 2006, however, a Cochrane review[29] found a small benefit (effect size of 0.13) from paracetamol, suggesting questionable clinical significance.

There is equivocal evidence for gastrointestinal bleeding or renal (kidney) damage with long-term use of 4 g/day.[30] NSAIDs appear to be more potent, but pose greater risk of side-effects.

Non-steroidal anti-inflammatory drugs
In more severe cases, non-steroidal anti-inflammatory drugs (NSAID) may reduce both the pain and inflammation; they all act by inhibiting the formation of prostaglandins, which play a central role in inflammation and pain.

However, it should be noted that this class of drugs is not without risk for adverse events including increased gastrointestinal bleeding. Most prominent drugs in the class include diclofenac, ibuprofen, naproxen and ketoprofen.

High oral drug doses are often required. However, diclofenac has been found to cause damage to the articular cartilage. Even more importantly all systemic NSAIDs are rather taxing on the gastrointestinal tract, and may cause stomach upset, cramping, diarrhea, and peptic ulcer.

Such systemic adverse side effects are normally not observed when using NSAIDs topically, that is, on the skin around the target area.

The typically weak and/or short-lived therapeutic effect of such topical treatments may be improved by using the drug in more modern formulations, including or ketoprofen associated with the Transfersome carriers or diclofenac in DMSO solution.

Another type of NSAID, COX-2 selective inhibitors (such as celecoxib, and the withdrawn rofecoxib and valdecoxib) are often used but are no more effective than the other NSAIDs.

These latter NSAIDs carry an elevated risk for cardiovascular disease, and some have now been withdrawn from the market.

Corticosteroids
Oral steroids are not recommended in the treatment of OA due to their modest benefit and high rate of adverse effects. However intra - articular corticosteroid temporarily improve symptoms as discussed below.
[edit] Narcotics

For moderate to severe pain a narcotic such as morphine may be necessary.

Topical
There are several NSAIDs available for topical use (e.g. diclofenac, ibuprofen, and ketoprofen) with little, if any, systemic side-effects and at least some therapeutic effect.

The more modern NSAID formulations for direct use, containing the drugs in an organic solution or the Transfersome carrier based gel, reportedly, are as effective as oral NSAIDs.

Creams and lotions, containing capsaicin, are effective in treating pain associated with OA if they are applied with sufficient frequency.

Injectable
A 2005 review of injections of hyaluronic acid, known as vicosupplementation, did not find that it led to clinical improvement in OA.

A subsequent 2009 study found similar results.[33] Injection of glucocorticoids (such as hydrocortisone) leads to short term pain relief that may last between a few weeks and a few months.

Surgery
If the above management is ineffective, joint replacement surgery may be required. Individuals with very painful OA joints may require surgery such as fragment removal, repositioning bones, or fusing bone to increase stability and reduce pain.


Arthroscopic surgical intervention for osteoarthritis of the knee has been found to be no better than placebo at relieving symptoms.

Alternative treatments
The majority of patients with arthritis have tried alternative treatments for their pain. Various studies have reported some benefit for many of these approaches, including acupuncture and some herbal supplements. However, the response rates tend to be low and there is concern about bias in many studies.

Acupuncture
Though findings are tentative and preliminary, there is evidence that acupuncture can be useful in the symptomatic treatment of osteoarthritis. All studies suggested that the results were equivocal and more high-quality evidence was needed.

* A 2007 review suggested that acupuncture is superior to sham treatment for both pain and function in the short- and long-term treatment of chronic knee pain, of which osteoarthritis was one element.

* A 2007 review suggested acupuncture was an effective treatment for the pain and dysfunction associated with osteoarthritis of the knee

* A 2007 review suggested acupuncture was useful for older patients with osteoarthritis of the knee and superior to waiting list or usual care groups but results were not clinically relevant for sham and actual acupuncture and were ascribed to a placebo effect.

* A 2007 review found that electroacupuncture was associated with short-term relief of osteoarthritic knee pain better than placebo, but manual acupuncture was not, and the quality of the articles reviewed with small sample sizes may undermine the validity of conclusions.

* A 2008 review suggested there was moderate quality evidence that acupuncture reduces pain for patients with osteoarthritis of the knee; the evidence for exercise and weight reduction was higher, and also improved physical function and self-reported disability respectively

* A 2008 set of consensus recommendations produced by the Osteoarthritis Research Society International concluded that acupuncture may offer symptomatic benefits for osteoarthritis of the knee or hip

* A 2008 review suggested that acupuncture provides short-term management of osteoarthritis-related knee pain. However, short-term treatment with acupuncture did not have long-term benefits.

Glucosamine/Chondroitin
There is controversy about glucosamine's effectiveness for OA of the knee.

A 2005 review concluded that glucosamine may improve symptoms of OA and delay its progression.

However, a subsequent large study suggests that glucosamine is not effective in treating OA of the knee, and a 2007 meta-analysis that included this trial states that glucosamine hydrochloride is not effective.In addition, in vitro analysis of glucosamine has revealed that glucosamine inhibits cartilage cell characteristics .

There is a "striking" difference between the results reported from trials involving glucosamine sulfate as compared to glucosamine hydrochloride, with glucosamine sulfate reporting an effect size of 0.44 compared to a 0.06 effect size from glucosamine hydrochloride; Osteoarthritis Research Society International recommends discontinuing glucosamine if no effect is observed after six months.

There is concern that industry bias has affected the earlier trials, although a 2008 OARSI consensus review stated that this was "unsubstantiated". No adverse effects have been observed. The European League Against Rheumatism practice guidelines recommend glucosamine.

Chondroitin sulfate has also become a widely used dietary supplement for treatment of osteoarthritis, both in combination with glucosamine and by itself.

A meta-analysis of randomized controlled trials found no benefit from chondroitin, although this meta-analysis included only 3 trials, one which had "an exceptionally high placebo response" and one which was published as only an abstract.[30]

Other supplements
* S-Adenosyl methionine (SAMe) has been tested; a review of 10 studies found that it has an effect on pain relief similar to nonsteroidal anti-inflammatory drugs.

A 2004 trial comparing SAMe and celecoxib found that during the first month the SAMe group reported more pain, but thereafter there was no significant difference between SAMe and celecoxib on reducing pain. The SAMe group reported somewhat fewer side-effects, consistent with a prior review.

* Frankincense resin from Boswellia serrata trees—Indian frankincense is a traditional treatment for arthritis in Ayurvedic medicine.[52]

* Bromelain, protease enzymes extracted from the plant family Bromeliaceae (pineapple), blocks some proinflammatory metabolites.[53]

* Antioxidants, including vitamins C and E in both foods and supplements, provide pain relief from OA.

* Ginger (rhizome) extract - has improved knee symptoms moderately.

* Selenium deficiency has been correlated with a higher risk and severity of OA.

* Vitamin B9 (folate) and B12 (cobalamin) taken in large doses has been thought to reduce OA hand pain in one very small, non-quantitative study of 25 people, the results of which are extremely vague at best.

* Vitamin D deficiency has been reported in patients with OA, and supplementation with Vitamin D3 is recommended for pain relief.


OA affects nearly 27 million people in the United States, accounting for 25% of visits to primary care physicians, and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions.

It is estimated that 80% of the population will have radiographic evidence of OA by age 65, although only 60% of those will show symptoms. In the United States, hospitalizations for osteoarthritis soared from about 322,000 in 1993 to 735,000 in 2006.

Arthur W. Page
Following in the foot steps of his father as a journalist, Arthur W. Page would pave the way for the field of public relations. Walter Hines Page, Arthur's father, was an excellent journalist, editor and business man.

He was a founder of Doubleday Page publishing company, advisor to Woodrow Wilson and the U.S. Ambassador to Great Britain during WWI.

In 1905, at the age of 22, Arthur Page started to work at Doubleday Page and would end up working for the company for 22 years.

He was promoted to vice president of the company's magazine department, where he found a special interest for a magazine called The World's Work.

He wrote strong editorial articles about the responsibilities and duties of U.S. corporations to its consumers.

In 1927 Walter Gifford, CEO of the AT&T company, inquired whether Page would like to put his ideas into practice for AT&T and he accepted.

This would lead to be corporate America's first public relations position and create a framwork for the field, still being used today.

He spent 19 years as a vice-president for AT&T and unknowingly established a public relations protocol.

Through his speeches, presentations, letters and advice Page formed the model of the public relations specialist.

He stressed, to his public relations staff, that survey research must be an integral part of their profession.

He also emphasized that anticipating problems that their clients might face is critical.

His accomplishments include writing President Trumans announcement of the use of the atom bomb at Hiroshima, was a consultant to U.S.

Presidents from Theodore Roosevelt to Dwight Eisenhower and served as a member of the boards of directors of the Chase Bank, Westinghouse, Kennecott Copper and Continential Oil.

Ivy Lee
While attending Princeton University, Ivy Lee participated in the school newspaper. Using these skills as a journalist he found his way into newspaper writing, as most public relations specialists first do.

He worked for the New York American, the New York Times and the New York World writing mostly about financial and business issues.

In 1903 he took his first step toward public relations by landing a job as publicity manager for the Citizens' Union.

He authored a textbook entitled The Best Administration New York City Ever Had and then accepted a press job with the Democratic National Committee.

In 1905 partnering with a collegue from the DNC, George Parker, they agreed to form their own public relations firm, Parker and Lee.

He then published his "Declaration of Principles," which focused on giving factual information to the public.

Then in 1906 he came to work for the Pennsylvania Railroad company, which at that time was under public scrutiny for denying information and interviews to reporters.

At once, Lee decided to update reporters on business matters and take them to the accident sites. Later he became the executive assistant to the president of Pennsylvania Railroad, which gave him notoriety.

From this exposure John D. Rockefeller, Jr. asked for Lee's help in controlling the media during the strikes at the Colorado Fuel and Oil Company. Shortly there after he accepted a position on the personal advisory staff of John D. Rockefeller, Sr in 1915.

With a longtime interest in Russia, Lee decided to use his skills to campaign for the Soviet Union. He thought that if he could establish a commercial trade link between the U.S. and Soviet Union that it would open the lines of communication and squash its turmoil.

This only created accusations of Lee being a Russian propagandaist, which never proved to be true. Other controversy stirred when he did consulting work for I.G. Farben Industries of Germany and was accused of being a Nazi advocate.

Lee started a revolution to inform the public on private interests by providing facts so the public could better understand the policies and routines of American corporations.

"You suddenly find you are not running a private business, but you are running a business of which the public itself is taking complete supervision," said Lee.
Home E mail me Back to Top The Greats by age

Do we live in an era of change or in a changing era?
How can one characterize the deep transformations that come with the accelerated insertion of artificial intelligence and new Information and Communication Technologies (ICTs) in our present society?

Is it a question of a new stage in the industrial society or are we entering into a new era? “Global village”, “technotronic era”, “post-industrial society”, “information society” or “information age”, and “knowledge society” are just a few of the terms that have been coined in an attempt to identify and understand the extent of these changes.
But while the debate proceeds in the theoretical sphere, reality races ahead and communication media select the terms that we are to use.

The bottom line is: whichever term we use, it will be a shortcut that allows us to reference a phenomenon - be that present or future -, without having to repeatedly describe it; however, the selected term in itself does not define content.

Content emerges from usage within a specific social context, which in turn influences perceptions and expectations, since each term brings with it a past and a meaning (or meanings), with its respective ideological baggage.

It was therefore to be expected that any term used to designate the society in which we live, or to which we aspire, be the focal point of a dispute over meanings, backed by the varied opposing projects of society.

Within the benchmark of the World Summit on the Information Society (WSIS) there are two terms that have occupied the scenario: information society and knowledge society, with their respective variants. But, although the benchmark imposed usage of the former, from the beginning it caused disagreement and no single term has achieved a consensus
Information society

In this past decade, the expression “information society” has without a doubt been confirmed as the hegemonic term, not because it necessarily expresses a theoretical clarity, but rather due to its “baptism” by the official policies of the more developed countries and the “crowning” that meant having a World Summit dedicated in its honor.

The term’s antecedents, however, date back from previous decades. In 1973, United States sociologist Daniel Bell introduced the notion “information society” in his book The Coming of Post-Industrial Society [1],

where he formulates that the main axis of this society will be theoretical knowledge and warns that knowledge-based services will be transformed into the central structure of the new economy and of an information-led society, where ideologies will end up being superfluous.

This expression reappears strongly in the 90s, within the context of the development of the World Wide Web and ICTs.

As of 1995, it was included in the agenda of the G7 meetings (followed by G8, which joins heads of State and governments from the most powerful nations on the planet). It has been addressed in forums of the European Community and the OECD - Organization for Economic Cooperation and Development (the thirty most developed countries in the World), and has been adopted by the United States government, as well as various UN agencies and the World Bank Group.

All with great repercussions in the communication media. As of 1998, the term was first selected by the International Telecommunication Union (ITU) and then by the UN, as the name for the World Summit to be held in 2003 and 2005.

Within this context, the concept “information society” as a political and ideological construct has developed under the direction of neo-liberal globalization, whose main goal has been to accelerate the establishment of an open and “self-regulated” world market.

This policy has counted on the close collaboration of multilateral organizations such as the World Trade Organization (WTO), the International Monetary Fund (IMF), and the World Bank, in order for the weak countries to abandon national regulations or protectionist measures that “would discourage” the inversion; all with the known result of a scandalous widening of the gaps between the rich and the poor in the World.

In fact, at the end of the century, when the majority of the developed countries had already adopted ICT infrastructure development policies, there is a spectacular peak in the share market of the communications industry. But the markets in the North begin to become saturated.

Then, increased pressure is placed on the developing countries to leave the way free for investments by telecommunications and informatics companies, in search of new markets to maintain growth of earnings.

It is within this context that the WSIS is convoked; a panorama that changes, however, when the stock bubble burst as of the year 2000.

Regardless of this reality and the key role that communication technologies have played in the acceleration of economic globalization, information society’s public image is more associated with the “friendlier” aspects of globalization, such as the World Wide Web, mobile and international phoning, TV via satellite, etc.

Thus, the information society has assumed the role of the “good will ambassador” for globalization, whose “benefits” could be within the reach of all, if only the “digital divide” could be bridged. [2]

Knowledge society
The notion “knowledge society” (“sociedad del conocimiento”) emerged toward the end of the 90s and is particularly used as an alternative by some in academic circles to the “information society”.

UNESCO, in particular, has adopted the term “knowledge society”, or its variant, “knowledge societies”, within its institutional policies.

There has been a great deal of reflection on the issue, which strives to incorporate a more integral conception that is not only related to the economic dimension. For example, Abdul Waheed Khan (general sub-director of UNESCO for ¬Communication and Information) writes [3]:

“Information society is the building block for knowledge societies. Whereas I see the concept of ‘information society’ as linked to the idea of ‘technological innovation’, the concept of ‘knowledge societies’ includes a dimension of social, cultural, economical, political and institutional transformation, and a more pluralistic and developmental perspective.

In my view, the concept of ‘knowledge societies’ is preferable to that of the ‘information society’ because it better captures the complexity and dynamism of the changes taking place. (...) the knowledge in question is important not only for economic growth but also for empowering and developing all sectors of society.”

A nuance in this debate, which only concerns the Roman languages, is the distinction between “sociedad del conocimiento” and “sociedad del saber” (which both translate as “knowledge society” in English).

The notion “saberes” implies more precise or practical certainties, while “conocimiento” encompasses a more global or analytical comprehensiveness. André Gorz considers that “conocimientos” refer to “formalized targeted contents, which cannot, by definition, belong to people...“Saber” consists of experiences and practices that have become intuitive evidence and customs.”

[4] For Gorz, “intelligence” covers the whole range of capacities that allow combining “saberes” with “conocimientos”. He then suggests that “knowledge society” be translated as the “intelligence society”.

In any case, in general, within this context the terms “sociedad del conocimiento” and “sociedad del saber” are used interchangeably, although, at least in Spanish, “conocimiento” seems to be more common than “saber”.

Current definitions: state-of-the-art

It is necessary to differentiate here between those definitions that aim to characterize an existing or emerging reality from those that express a vision-a longing or desire- for a potential society.

Both are relevant: the former for their contribution to analysis, and the latter because they guide policies and actions.

In the first category, we will refer to Manuel Castells, for being one of the researchers to have most developed this theme, in addition to being a renowned authority on the subject.

Castells prefers the term “informational society” to “information society” (making the comparison with the difference between industry and industrial).

He points out that while knowledge and information are decisive elements in all modes of development, “the term informational indicates the attribute of a specific form of social organization in which information generation, processing, and transmission are transformed into the fundamental sources of productivity and power, due to the new technological conditions that arise during this historic period.” [5]

Further on, he states: “What characterizes the current technological revolution is not the central personage of knowledge and information, but rather the application of this knowledge and information to knowledge generation andinformation/communication processing devices, in a cumulative feedback loop between innovation and the uses of innovation.” And he vouches:


“The diffusion of technology infinitively amplifies its power when its users appropriate it and redefine it. The new information technologies are not merely tools to be applied, but rather processes to be developed.(...) For the first time in history, the human mind is a direct productive force, not only a decisive element of the production system.” [6]

As for the knowledge society, in a later publication he points out: “it has to do with a society in which the conditions for generating knowledge and processing information have been substantially changed by a technological revolution focused on information processing, knowledge generation, and information technologies.” [7]

Yves Courrier, when referring to Castells, differentiates the two terms in this manner: “information society” places the emphasis on the content of the work (the process of collecting, processing, and communicating the necessary information), and “knowledge society” emphasizes economic agents, who should be superiorly qualified to exercise their work. [8]

With respect to visions, the documents resulting from the WSIS stand out, for having emerged from a world process. The Geneva Declaration of Principles [9] adopted by governments, -with significant contributions from civil society-, expresses in its first article:

“We... declare our common desire and commitment to build a people-centered, inclusive, and development-¬oriented Information Society, where everyone can create, access, utilize, and share information and knowledge, enabling individuals, communities and peoples to achieve their full potential in promoting their sustainable development and improving their quality of life, premised on the purposes and principles of the Charter of the United Nations and respecting fully and upholding the Universal Declaration of Human Rights.”

On the other hand, the Civil Society Declaration [10] extends its vision in several paragraphs, but essentially says:
“We are committed to building information and communication societies that are people-centered, inclusive, and equitable.

Societies in which everyone can freely create, access, utilize, share and disseminate information and knowledge, so that individuals, communities, and peoples are empowered to improve their quality of life and to achieve their full potential.” Subsequently, this Declaration adds the principles of social, political, and economic justice, as well as full participation and capacity-building of the peoples;

it highlights the objectives of sustainable development, democracy, and gender equality; and it evokes societies where development acts as a setting for fundamental human rights and is oriented to attain a more equitable distribution of resources.

Debates in progress
One of the goals of the first phase of the WSIS convocation was precisely to develop a common vision of the information society.

Although a large part of the governmental delegations and the private sector attributed little importance to this aspect, for many organizations in civil society, it was dealing with a key issue, for it was there that the controversy regarding its meaning took place, evidencing the clash among projects of society.

In fact, the entire process had been crossed by (at least) two separate approaches, which can be briefly summarized as follows:

In the first approach, to talk about the information society refers to a new development paradigm that assigns technology to a causal role in the social order, designating it as the drive of economic development.

For the developing countries, this discourse implies that the transition towards the information society is essentially a matter of time and of political decision to create adequate “empowering conditions”.

[12] Something similar occurred with regard to the social sectors affected by the digital gap, which would have to be included via universal access programs.

By placing technology at the core of this model, the telecommunications industry is convoked to lead this development; while the industry that produces services and digital content assumes a hitherto unheard of ¬influence. [13]

The second approach, which contested the first in the Summit process, sustains that the new phase of human development that we are entering into is characterized by the predominance of information, communication, and knowledge in the economy as well as human activities.

According to this standpoint, technology is the support that has unleashed the acceleration of this process; but it is not a neutral factor, nor is its course inexorable, since technological development is guided by games of interest.

Following this perspective, policies for information society development should focus on human beings and should be conceived in terms of their needs and within a benchmark of human rights and social justice.

[14] The developing countries and the social actors should play a key role in the orientation of that process and the decisions.

In other words, for this second approach, what is fundamental is not “information” but rather “society”.

While the first approach refers to data, transmission channels, and storage space, the second talks about human beings, cultures, forms of organization and communication. The information is determined in terms of society and not the inverse.

That is why the campaign for Communication Rights in the Information Society -CRIS- points out in the document on the WSIS, “The Question for Civil Society” [15]:

“If civil society is going to adopt and recover the notion of an information society, it should return to these basic notions, posing the correct questions:

- Who generates and possesses information and knowledge? How is it valued?

- How is knowledge spread and distributed? Who are the custodians?

- What restricts and facilitates the use of knowledge on the part of people to attain their goals? Who is best and least positioned to take advantage of this knowledge?”

Alternative formulations under debate

Given the predominance acquired by the term “information society”, alternative formulations tend to use this term as a demarcation reference.

An initial objection has to do with the word “society” in the singular, as if it was dealing with a uniform world society. The proposed alternative is to speak about information or knowledge “societies” (using plural). Several UNESCO documents refer to “knowledge societies”.

This idea was taken up by civil society actors who participated in the Summit and who adopted the term “societies” in their consensus documents.

As for “information”, the argument brought forward by Antonio Pasquali (2002) [16] had repercussions on civil society at the Summit:

“To Inform essentially connotes causative and ordering unidirectional messages with a tendency to modify the behavior of a passive receiver; to Communicate, the interrelation of relational, dialogical, and socializing messages between speakers equally qualified for free and simultaneous reception/emission.

If Information tends to dissociate and create hierarchies between the poles of the relation, Communication tends to associate them; only Communication can give birth to social structures.” (emphasis by the author.)

And in fact, civil society consensus documents adopted the formula “information and communication societies” in order to be set apart from the technocentric vision present in the official discourse, without losing their referentiality to the Summit theme.

One could consider that this option was an important gesture within the context of the WSIS; but it does not escape from being a weighty formulation for current usage.

As for the debate on the “knowledge society”, those who uphold it consider that it evokes precisely a more integral vision and an essentially human process. Others, however, object to it for its association with the dominant concept that reduces knowledge to its economic function (the notion, for example, of “knowledge management” in companies, which emphasizes essentially how to assert one’s claim to and take advantage of employees’ knowledge); which values only the type of knowledge that is supposedly objective, scientific, and digitizable, disparaging that which is not.

An interesting variant, which emerged within the framework of the WSIS debates, even if there were very little repercussions in the process, is “shared knowledge society (ies)” (“sociedad(es) del saber compartido” or ... “de los saberes compartidos”).

Among others, Adama Samassékou (at that time president of the WSIS bureau) proposed regarding the information society:

“It is important to understand what this concept covers: it does not have to do with information that is disseminated and shared, but rather with a society in which there is a wish to communicate in another manner and share knowledge. It has to do then with a shared knowledge society and a knowledge society.” [17]

Alternate definitions
The concept “information society”, born under the precepts of neo-liberal globalization, infers that henceforth it will be the “technological revolutions” that will determine the course of development; social conflicts would be things of the past.

For the same reason, this concept is no longer the most appropriate to qualify the new trends in societies, nor much less to describe a counter-hegemonic project of society.

Our position is that, beyond debating the appropriateness of one term or another, what is fundamental is to contest and delegitimize any term or definition that reinforces this technocentric conception of society.

We do not intend to propose an alternative formula herein, but rather present criteria to foment the debate.

First, we welcome the notion that any reference to “societies” should be in the plural, recognizing the heterogeneity and diversity of human societies. This also implies reaffirming the interest of each society appropriating technologies for their specific development priorities, and not simply adapting to them in order to be part of a supposed predefined information society.

Second, we affirm that any definition that uses the term “society” cannot describe a reality circumscribed to the World Wide Web or ICTs. The Web may be a new social interaction scenario, but this interaction is strictly integrated to the physical world, and the two spheres are mutually transformed.

Lastly, we are backing a project of society where information is a public good, not a commodity; communication, a participative and interactive process; knowledge, a shared social construction, not private property; and technologies, a support for it all, without becoming an end in itself.
29 May 2006

couverture du livre enjeux de mots This text is an extract from the book Word Matters: multicultural perspectives on information societies. This book, which has been coordinated by Alain Ambrosi, Valérie Peugeot and Daniel Pimienta was released on November 5, 2005 by C & F Éditions.

The text is under the Creative Commons licence, by, non commercial.

Knowledge should be shared in free access... But authors and editors need an economy to keep on creating and working. If you can afford it, please buy the book on line (39 €)
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This text is an extract of the book: couverture - cover

* Word Matters
* Towards Knowledge-SharingSocieties
* Words Matters : Story of a Project
* The Information Society / the Knowledge SocietyNetworked and e-Governance
* Internet Governance
* Cultural Diversity
* Infrastructure and Universal Access
* Digital Divide
* Public Access to the Internet
* Gender
* Accessibility
* Open Source Intelligence
* Citizen Expression
* Innovation by Usage
* Virtual Communities
* Digital Libraries
* Knowledge Management
* Education in the information society
* Human Rights
* Cybercrime
* Communication Rights
* Media
* Piracy
* Free Software
* Intellectual Property Rights
* Information Economy
* Multilingualism Matters

From where do our policy-makers get their wacky ideas?

From where do our policymakers get their ideas, inspirations and aspirations and why are they sleeping behind the Wheel?
What and who influences their thinking and creative minds?

Not to be nitpicky, but shouldn’t our policymakers and community leaders be up in arms with Agribusiness companies from China and the western world? They are very busy exporting disease-induced GM food and chemically –saturated foods to Ghanaian consumers so as to increase chronic diseases like obesity, diabetes and cardiovascular ailments. Where is the outcry and who is educating the public against the consumption of unhealthy food from our food chain?

Can our fragile National Health Insurance scheme be able to confront a rising tide of chronic diseases that are linked to unhealthy diet like the food we consume every day in the west? It’s a fact; the chronic diseases we experience in the western world are undoubtedly linked to poor diet that we consume wantonly. Ironically, it’s the same food we are embracing wholeheartedly in Ghana under the watchful eyes of our sleepy policymakers whilst they’re trying to fund a stable and economically viable national health Insurance care for the citizenry.

Where is the national uproar from our policymakers , leaders and parents when two-hundred thousand of our JSS graduates who took the BECE are left to fend for themselves and perhaps are sentenced to a life of mediocrity? Who is going to mine our impending, infant oil industries when our future work force is forced to end its education abruptly?

Few weeks ago, it was in the news that our security agencies were “urged to identify the emerging threats to the nation for the government to deal with expeditiously”. I beg your pardon? What is more threatening to a nation than its two-hundred thousand students---with potential to lift the country up to its glory ----being left on the way side of education and a bright future? What is more threatening to a nation than a country with fertile land embracing GM food, and without the medical strength to withstand its fallout? Hello!

When are our leaders and policymakers going to search for ideas and solutions to develop proper directions to take our nation and society forward?

Jim Rohn, an American renowned motivational speaker once said: “If you can tell me the books you read and how many times you read, friends you hang around with and what they do for a living, how many hours you spend in front of a television and what you watch, I can pretty much tell you how your bank account looks.” He goes on to say he can tell a person’s bank account by the size of one’s personal library and how one manages his time. He added, “People with small bank account tend to have big television sets and spend their time unprofitably”. In our case it will be the ownership of DVDs and the amount of time we spend on the cellphones and at funeral celebrations that are our Achilles heels.

In a layman’s term what he was trying to say is that we end up pretty much where we expect to be—what we think of the most is what we become. Therefore if we continue doing what we have been doing, we will continue to get exactly the same results. To get stimulated and stretched our minds we need to associate with people and things that can help us think of new ideas and new ways of doing things. How we think determines how we act and tackle issues. I wonder what our policymakers are thinking of when it comes to lifting up those in need.

My inquiring mind wants to know.

Question: With no disrespect, what are the titles of the last five books our leaders read this year? What kind of books and how many books do our politicians, policy makers, community leaderships, chiefs, Assembly men and women and head of institutions read? Who wants to take me up on this one? And, if they don’t read where do they get their inspirations and aspirations from? What is the source of their ideas or inspirations, apart what they get from churches and other religious institutions---which always go out of the window? Or do they just go with the flow, so to speak? My inquiring mind wants to know!

Speaking of leaders, what about the role of heads of our traditional kingdoms? Since they still retain some amount of economic and social influence within the country, they need to sharpen their creativity skills to meet our modern day needs.

How often do our policymakers, teachers, community- leaders and politicians try to be in solitude, mentally or physically? Do they go to bed wondering how best to improve the lives of the ordinary folks under their care or in their constituencies or communities? I wonder what kinds of books they read and how often and what influences their thinking. Finding answers to these and other questions will help us to understand why things are what they are in our part of the world. These questions will also help us to lower our expectations, so as not to be disappointed.

This is not to question one’s leadership prowess and policymaking process. Neither am I trying to belittle our leaders’ competency and ability to do their job---yeah, right! I’m trying to put it very diplomatically and delicately. However, the unnatural decision -making process does not meet our expectations and future goals. The inability of some of our leaders in our communities and districts to solve our basic human problems has forced me to question their sources of ideas and inspirations. Their inability to be creative and think- outside- the- box makes me wonder as to what they do with their spare time and if they see the need to hone their “creative skills”.

This has nothing to do with traditional education because traditional academia only value things that can be quantified and measured. How can we quantify or measure one’s ability to understand or encourage others to live up to their expectations or potential? How do we measure one’s courage to tell the voters the truth they don’t want to hear? How do we measure one’s ability to seek out innovative ways to bring new methods to inspire people and see opportunities where others see obstacles?

How could traditional education alone help one to recognize that every change cracks open the door for opportunity? Or accept full responsibility for his results, rather than expect to be compensated for time alone? How can we encourage others to see the future with optimism, hope, boldness, enthusiasm, and the confidence that can come only from having faith in what may not yet be reality?

How can we measure one’s ability to go against the conventional wisdom, just by showing an academic degree? The Ghanaian traditional education can not do all that. So we need other sources for ideas and inspiration through mental or physical confinement and training.

Being able to have time to confer with oneself helps one to learn a simple technique for seeing things in new ways and stretching one’s thinking. It helps one to approach the usual in an unusual way, which can ultimately lead to new solutions.

Could it be that our leaders don’t easily come up with earth-shaking ideas because they don’t create the right ecology where ideas can be germinated? Or it could be that they‘re afraid to be “Alone”, figuratively? Many of our leaders and policymakers fail to tap their creative leadership power because they confer with everybody and everything else but themselves. Yes, we all know a few individuals who fit into this mode. You know one, don’t you? He’s the fellow who goes to great lengths not to be alone. He feels a compelling need to talk with others every waking moment. He also has an unusual appetite for a huge diet of small talk and gossip.

But, for us to solve our emerging problems our leaders and policymakers and ordinary folks need to have time out to confer with them in order to come up with uplifting ideas and solutions. It will unleash their creativity because what they would encounter each day they confer with themselves without distractions and interruptions may present opportunities for a solution that would be the seed for an idea.

If water shortage is a problem in our communities what are our solutions? If our children are failing academically, what are our solutions? If our towns lack after-schools programs for our kids what are our solutions?

Being in a managed solitude is a leadership tool that every great leader needs and uses in order to map out his or her vision and implement goals. Check the lives of the world’s great religious, social and political leaders. In the past and present, each one of them spent a great amount of time alone—in a managed solitude; voluntarily or coercively.

In managed mental solitude moments our subconscious minds tap our memory bank, which in turn feeds our conscious minds. Great thinkers use solitude to put the pieces of a problem together, to work out solutions, to plan, and, in the “super-thinking”.

From Moses to Buddha to Martin Luther King Jr to Mahatma Gandhi, from Mohammed to Mandela to Kwame Nkrumah and many others, they spent time in jail or in some form of physical or mental confinement where they ironically planned their future moves without any distraction. Lech Walesa, former President of Poland and Solidarity leader was imprisoned before he became a President.

In fact ordinary writers and artists like the late Fela Kuti and Bob Marley were once in self-induced mental or physical confinement in order to hone their mental skills. As a result, these people developed unique skills from being in “solitude confinement”: They used these skills in every endeavor they embarked on.

The people who change history are not the people who do safe things, take the easy route, follow the status quo, say what everyone else says, or try to make everyone happy. They are also not afraid to be “alone”. Do you remember Gandhi, Mandela, Martin Luther Kings Jr and even Jesus? They were all on the “edge.” They could not have lived in the middle of the storm without developing mental solitude.

When I say a “solitary confinement” I mean being mentally or physically alone—without TV, cellphones, friends and anything that will take away your thinking process. By being solitude means to take a week off and confer with you: E.g. spend an hour in the park, turn off the television, cellphone and computer—carve out time for mental restoration. Does that mean one has to be imprisoned or isolated to have impact on the society and history?

Absolutely not. No one claims that being locked up and tortured is great training for being a great leader, or making one more in tune with the needs of one’s community or constituency. But, it’s believed that being in managed seclusion is highly relevant to building leadership skills and strong mental faculties because it allows one to be creative.

The I-can’t-stand- being -alone syndrome shuns independent thought and clouds visions. Decisions and mental observations made alone in managed solitude have an uncanny way of being right most of the time.

Let’s face it, the main job of a good leader is “thinking” and the best preparation for an effective leader is thinking. That is why there is a need for our leaders to be in a managed solitude. Leaders need “quiet places” to generate creative ideas. The spaces between minutes one spends allow solutions and ideas to incubate and grow. That is why great geniuses sometimes accomplish more when they are alone.

Being in a managed confinement mentally or physically allows people to confer with themselves. It also allows people to read good, creativity generating books or brain- storm and develops a positive insight that will reveal a pathway for fairness, integrity, service and humane principles that give them security to adapt to change and take advantage of the opportunities that changes created.

Being in a solitude helps to purge one’s thoughts of pride and superficiality and to expand one’s horizons. The purpose of being in solitude or managed confinement is to repair all that which is faulty in one’s personality and thoughts. It’s a way of learning a lesson and making one more thoughtful and sensitive to others’ needs.

But, what lesson could compensate a person like Mandela for a life spent behind bars? Well, without a doubt Mandela’s imprisonment deepened and enlarged his soul and thought by teaching him to be more compassionate and less privileged. He came out of prison totally different---a person with a lot of power before he went in. The power of ideas comes through thinking and thinking comes alive and powerful from being in solitude.

How many hours do our leaders, policymakers and community leaderships spend on researching and reading about issues and the jobs they were hired or elected for? How much time do our politicians spend attending the needs of their constituencies?

As a chief of your town how much time do you actually spend on one –on-one with your subjects or the ordinary people in your town? How many DVDs do you have as compared to the number of books? As a District Chief Executive or an MP how often do you change your car when you visit your district? After only seven months in office you probably weigh more than when you were elected. Be honest, don’t cheat on this one. What is your source of ideas, if any?

In a country like ours where one’s family or where one is born dictates one’s life outcome, the government needs to play a meaningful role not only in shaping one’s future but in equalizing the playing field. That is why our policymakers should be very creative and sensitive to the needs of the people.

In a broader sense we need a visionary and inclusive leadership at the helm of our institutions –from chieftaincy to presidency. Our leaders should be alone to challenge the status quo and focus less on what Ghana is and more on how it ought to be. Trust me, a good many things are not as they ought to be in our part of the world. Yes, there is a tendency to become overwhelmed by the challenge of trying to fix things. But, we should focus on the possibilities—the endless possibilities within us.

With that I’m proposing the institutionalization of ”Think Week”: This is a time set aside for our policy makers, especially MPs and District Executives , to spend time alone to do their serious, creative thinking. Why not? Microsoft and other Fortune 500 companies do it, as well as every CEO. Perhaps if our leaders learn how to be in mental confinement and be creative, maybe, one day we can address the huge disparity and egregious inequality that exists between our living standards and the developed world.

By the way, leadership is not just the possession of vision and ability to think. It’s has more to do with putting a “system” in place that works for the benefit of the people it’s intended for. A remarkable leader creates not necessarily an earth-shaking idea, but a system which can out live him.

Take our energy situation. We always have electricity interruption in the dry season, when the rainfall doesn’t empty into the barrels of Akosombo Dam. We have been living with such inconveniences but no comprehensive solution has been given other than building more dams that depend on rainfall---instead of pursuing vigorously other alternative energy like natural gas, wind and solar stations across the land. We can even revitalize the rural Ghana with solar panels .What about harvesting our water resources?

On an individual level, there is enough blame to go around. Ghana didn’t get to this juncture by accident. It’s like all the social and economic problems, along with lack of integrity and laziness just sneaked into the country at night when everyone was asleep. Surprise! We can blame our plights on colonization and other forces all we want until the Kingdom come. But, it should be remembered that our plight is more internal than external. Everything that happens to us is largely of our own making. It’s a choice we make!!

These choices, of course, are not single monumental ones. No nation decides, for example, to become poor so that it could go panhandle for money around the globe, or sleep in darkness or scramble for water in the dry season.

Do we try something new, or stick to the tried –and-true? Do we take risk as a nation? Do we indulge our hearts or cater to our fears? Do we do what‘s comfortable? For the most part, we often tend to choose comfortable and familiar, the well-worn but well-known.

Yes, there are some conditions we have no control of like climate. However, whining about uncontrollable conditions won’t get us any where. Is our creativity just to design a way to cheat the system, government or our fellowmen or women all that we can do?

This reminds me of a story about a New Year’s Eve village party. You may have heard it. It’s about a village that was planning a grand New Year’s Eve celebration. Every member of the village was required to bring a bottle of wine and pour it into a huge plastic container, in the middle of the village.

At New Year’s Eve, everyone would share a drink from the container—to celebrate the New Year. To make a long story short, a lot of people came from afar and near to empty their personal bottles into the container and were instructed to wait for mid- night to drink. As their culture dictates, the chief opened the valves and invited the people to join him for celebration. Whoops. Not too fast!

Something unusual happened. Every glass they raised contained water instead of wine. Another Whoop! One thing was obvious .Apparently, everyone in the village had the same wacky idea: “If all my neighbors bring great wine, no one will notice if I just slip in a bottle of water.” “Oh, heck my little bit of deception won’t be too bad to spoil the New Year’s fun” .So they thought. Does that ring a bell?

Unfortunately that behavior plays out in our work situation and everyday life in Ghana. We believe “cheating” the system a little won’t make a big difference. It has a dignified name.

The good old Stealing or duping which is euphemistically called “connection” is practiced with impunity by almost every Ghanaian. But, what if as a mechanic your slacking off to fix the government buses’ brakes resulted in an accident, which unfortunately and coincidentally cost the lives of a lot of people? What if, your own daughter who happened to take the bus free that fateful day among the dead?

What about the road contractor who thought a little cheat is not going to do any harm? He used one hundred bags of cement, instead of the official requirement of three hundred bags? Because of his lousy workmanship and work ethics the bridge he built didn’t last more than a year. It collapsed and claimed the lives of his two colleagues and their loved ones when they were attending a wedding.

As a teacher the student you failed to teach five years ago is the same person who just robbed the bank and killed two innocent customers. He has no education and no marketable skills, so he turned into robbery for his survival.

What about the police officer who refused to arrest the driver who drives around with a faulty brake ? The driver got into an accident and killed fifteen people after giving you GH5.00 bribe (all in coins).


As a chief and a community leader of your town you’re also jointly responsible for the poor academic performance of the students (the main “assets” of the town) because you failed to support them with much needed resources.

You can’t do much because you’re spending the resources on unnecessary litigation instead of funding after-school tutoring programs to help the students on their school assignments. All it takes is to hire a teacher to help the kids to study after school, instead of them congregating at Video centers; to watch video shows and” Agya Koo”.

You’re a District Executive Officer and have engulfed yourself in party business so that the welfare of the people in your locality is secondary to your agenda. You think no one will notice the damage your poor stewardship is causing the district. How do you feel when you go to bed at night? What is the most significant action you took during your tenure? Did the ordinary folks benefit from your stewardship? It’s you and your conscience!!

Speaking of conscience, do we have any? I was in Ghana six months ago, and I inquired about the closure of a citrus -juice factory at Asamankese in the eastern region. I was told that some few greedy citrus farmers decided to invent their own “connection” by beating the system and increasing their fortune by harvesting and supplying immature oranges that subsequently made the company incur a huge financial loss.

As an obvious result, the factory closed its doors, and the credible farmers had no reliable market for their produce. The orange season will soon come and the poor, greedy farmers don’t bother to harvest the oranges any more. The oranges have become waste .A classic example of a “little cheating” and “connection” at work. Look! Who are the losers?

I believe each one of us is equipped with unique skills to accomplish our goals with creativity .So all we need is the right inspiration from books--- by authors like Zig Ziegler, Napoleon Hill, Dale Carnegie and Covey R. Stephen, just to name a few --- and environment to unleash creativity to flourish.

Once we do that, we can engage in work that is an authentic fit and improve our lives and subsequently, this will improve our communities, and ultimately the entire nation. So don’t be afraid to spend some quiet time with yourself to incubate ideas and find solutions to our emerging problems.

It always takes an unexpected, unusual force or event to redirect our thoughts, courage, goals and ideas. So change, even if unwelcome, forces us to reevaluate what our best options are. Those times of mental transitions (“confinements”) are great opportunities to look for ways to build on the good and ignore the bad. “A mind that feeds only on itself soon is undernourished, becoming weak and incapable of creative progressive thought.”

Credit: Kwaku Adu-Gyamfi
NJ, USA
[The author is a social commentator and a founder of Adu-Gyamfi Youth Empowerment Foundation for the youths of Asuom.]

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Rheumatoid arthritis can also cause inflammation of the tissue around the joints, as well as in other organs in the body. Autoimmune diseases are illnesses that occur when the body's tissues are mistakenly attacked by their own immune system. The immune system is a complex organization of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections. Patients with autoimmune diseases have antibodies in their blood that target their own body tissues, where they can be associated with inflammation. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.

While rheumatoid arthritis is a chronic illness, meaning it can last for years, patients may experience long periods without symptoms. However, rheumatoid arthritis is typically a progressive illness that has the potential to cause joint destruction and functional disability.
Pictures of Normal and Arthritic Joints - Rheumatoid Arthritis

A joint is where two bones meet to allow movement of body parts. Arthritis means joint inflammation. The joint inflammation of rheumatoid arthritis causes swelling, pain, stiffness, and redness in the joints. The inflammation of rheumatoid disease can also occur in tissues around the joints, such as the tendons, ligaments, and muscles.

In some patients with rheumatoid arthritis, chronic inflammation leads to the destruction of the cartilage, bone, and ligaments, causing deformity of the joints. Damage to the joints can occur early in the disease and be progressive. Moreover, studies have shown that the progressive damage to the joints does not necessarily correlate with the degree of pain, stiffness, or swelling present in the joints.

Rheumatoid arthritis is a common rheumatic disease, affecting approximately 1.3 million people in the United States, according to current census data. The disease is three times more common in women as in men. It afflicts people of all races equally. The disease can begin at any age, but it most often starts after age 40 and before 60. In some families, multiple members can be affected, suggesting a genetic basis for the disorder.

*

What causes rheumatoid arthritis?

The cause of rheumatoid arthritis is unknown. Even though infectious agents such as viruses, bacteria, and fungi have long been suspected, none has been proven as the cause. The cause of rheumatoid arthritis is a very active area of worldwide research. It is believed that the tendency to develop rheumatoid arthritis may be genetically inherited. It is also suspected that certain infections or factors in the environment might trigger the activation of the immune system in susceptible individuals. This misdirected immune system then attacks the body's own tissues. This leads to inflammation in the joints and sometimes in various organs of the body, such as the lungs or eyes.

Regardless of the exact trigger, the result is an immune system that is geared up to promote inflammation in the joints and occasionally other tissues of the body. Immune cells, called lymphocytes, are activated and chemical messengers (cytokines, such as tumor necrosis factor/TNF, interleukin-1/IL-1, and interleukin-6/IL-6) are expressed in the inflamed areas.

Environmental factors also seem to play some role in causing rheumatoid arthritis. For example, scientists have reported that smoking tobacco increases the risk of developing rheumatoid arthritis.

What are the symptoms and signs of rheumatoid arthritis?

The symptoms of rheumatoid arthritis come and go, depending on the degree of tissue inflammation. When body tissues are inflamed, the disease is active. When tissue inflammation subsides, the disease is inactive (in remission). Remissions can occur spontaneously or with treatment and can last weeks, months, or years. During remissions, symptoms of the disease disappear, and patients generally feel well. When the disease becomes active again (relapse), symptoms return. The return of disease activity and symptoms is called a flare. The course of rheumatoid arthritis varies from patient to patient, and periods of flares and remissions are typical.

When the disease is active, symptoms can include fatigue, loss of energy, lack of appetite, low-grade fever, muscle and joint aches, and stiffness. Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity. Arthritis is common during disease flares. Also during flares, joints frequently become red, swollen, painful, and tender. This occurs because the lining tissue of the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovial fluid). The synovium also thickens with inflammation (synovitis).

In rheumatoid arthritis, multiple joints are usually inflamed in a symmetrical pattern (both sides of the body affected). The small joints of both the hands and wrists are often involved. Simple tasks of daily living, such as turning door knobs and opening jars, can become difficult during flares. The small joints of the feet are also commonly involved. Occasionally, only one joint is inflamed. When only one joint is involved, the arthritis can mimic the joint inflammation caused by other forms of arthritis, such as gout or joint infection. Chronic inflammation can cause damage to body tissues, including cartilage and bone. This leads to a loss of cartilage and erosion and weakness of the bones as well as the muscles, resulting in joint deformity, destruction, and loss of function. Rarely, rheumatoid arthritis can even affect the joint that is responsible for the tightening of our vocal cords to change the tone of our voice, the cricoarytenoid joint. When this joint is inflamed, it can cause hoarseness of the voice.

Since rheumatoid arthritis is a systemic disease, its inflammation can affect organs and areas of the body other than the joints. Inflammation of the glands of the eyes and mouth can cause dryness of these areas and is referred to as Sjogren's syndrome. Rheumatoid inflammation of the lung lining (pleuritis) causes chest pain with deep breathing, shortness of breath, or coughing. The lung tissue itself can also become inflamed, scarred, and sometimes nodules of inflammation (rheumatoid nodules) develop within the lungs. Inflammation of the tissue (pericardium) surrounding the heart, called pericarditis, can cause a chest pain that typically changes in intensity when lying down or leaning forward. The rheumatoid disease can reduce the number of red blood cells (anemia) and white blood cells. Decreased white cells can be associated with an enlarged spleen (referred to as Felty's syndrome) and can increase the risk of infections. Firm lumps under the skin (rheumatoid nodules) can occur around the elbows and fingers where there is frequent pressure. Even though these nodules usually do not cause symptoms, occasionally they can become infected. Nerves can become pinched in the wrists to cause carpal tunnel syndrome. A rare, serious complication, usually with long-standing rheumatoid disease, is blood vessel inflammation (vasculitis). Vasculitis can impair blood supply to tissues and lead to tissue death (necrosis). This is most often initially visible as tiny black areas around the nail beds or as leg ulcers.

How is rheumatoid arthritis diagnosed?

The first step in the diagnosis of rheumatoid arthritis is a meeting between the doctor and the patient. The doctor reviews the history of symptoms, examines the joints for inflammation and deformity, the skin for rheumatoid nodules, and other parts of the body for inflammation. Certain blood and X-ray tests are often obtained. The diagnosis will be based on the pattern of symptoms, the distribution of the inflamed joints, and the blood and X-ray findings. Several visits may be necessary before the doctor can be certain of the diagnosis. A doctor with special training in arthritis and related diseases is called a rheumatologist.

The distribution of joint inflammation is important to the doctor in making a diagnosis. In rheumatoid arthritis, the small joints of the hands, wrists, feet, and knees are typically inflamed in a symmetrical distribution (affecting both sides of the body). When only one or two joints are inflamed, the diagnosis of rheumatoid arthritis becomes more difficult. The doctor may then perform other tests to exclude arthritis due to infection or gout. The detection of rheumatoid nodules (described above), most often around the elbows and fingers, can suggest the diagnosis.

Abnormal antibodies can be found in the blood of patients with rheumatoid arthritis. An antibody called "rheumatoid factor" can be found in 80% of patients. Citrulline antibody (also referred to as anti-citrulline antibody, anti-cyclic citrullinated peptide antibody, and anti-CCP) is present in most patients with rheumatoid arthritis. It is useful in the diagnosis of rheumatoid arthritis when evaluating patients with unexplained joint inflammation. A test for citrulline antibodies is most helpful in looking for the cause of previously undiagnosed inflammatory arthritis when the traditional blood test for rheumatoid arthritis, rheumatoid factor, is not present. Citrulline antibodies have been felt to represent the earlier stages of rheumatoid arthritis in this setting. Another antibody called the "antinuclear antibody" (ANA) is also frequently found in patients with rheumatoid arthritis.

A blood test called the sedimentation rate (sed rate) is a measure of how fast red blood cells fall to the bottom of a test tube. The sed rate is used as a crude measure of the inflammation of the joints. The sed rate is usually faster during disease flares and slower during remissions. Another blood test that is used to measure the degree of inflammation present in the body is the C-reactive protein. Blood testing may also reveal anemia, since anemia is common in rheumatoid arthritis, particularly because of the chronic inflammation.

The rheumatoid factor, ANA, sed rate, and C-reactive protein tests can also be abnormal in other systemic autoimmune and inflammatory conditions. Therefore, abnormalities in these blood tests alone are not sufficient for a firm diagnosis of rheumatoid arthritis.

Joint X-rays may be normal or only show swelling of soft tissues early in the disease. As the disease progresses, X-rays can show bony erosions typical of rheumatoid arthritis in the joints. Joint X-rays can also be helpful in monitoring the progression of disease and joint damage over time. Bone scanning, a radioactive test procedure, can demonstrate the inflamed joints. Bone scanning, a radioactive procedure, can also be used to demonstrate the inflamed joints. MRI scanning can also be used to demonstrate joint damage.

The American College of Rheumatology has developed a system for classifying rheumatoid arthritis that is primarily based upon the X-ray appearance of the joints. This system helps medical professionals classify the severity of your rheumatoid arthritis.
Stage I
* no damage seen on X-rays, although there may be signs of bone thinning
Stage II
*on X-ray,evidence of bone thinning around a joint with or without slight bone damage
* slight cartilage damage possible
* joint mobility may be limited; no joint deformities observed * atrophy of adjacent muscle
* abnormalities of soft tissue around joint possible
Stage III
* on X-ray, evidence of cartilage and bone damage and bone thinning around the joint
* joint deformity without permanent stiffening or fixation of the joint
* extensive muscle atrophy
* abnormalities of soft tissue around joint possible
Stage IV
* on X-ray, evidence of cartilage and bone damage and osteoporosis around joint
* joint deformity with permanent fixation of the joint (referred to as ankylosis)
* extensive muscle atrophy
* abnormalities of soft tissue around joint possible
Rheumatologists also classify the functional status of people with rheumatoid arthritis as follows:
Class I: completely able to perform usual activities of daily living
Class II: able to perform usual self-care and work activities but limited in activities outside of work (such as playing sports, household chores)
Class III: able to perform usual self-care activities but limited in work and other activities
Class IV: limited in ability to perform usual self-care, work, and other activities
The doctor may elect to perform an office procedure called arthrocentesis. In this procedure, a sterile needle and syringe are used to drain joint fluid out of the joint for study in the laboratory. Analysis of the joint fluid in the laboratory can help to exclude other causes of arthritis, such as infection and gout. Arthrocentesis can also be helpful in relieving joint swelling and pain. Occasionally, cortisone medications are injected into the joint during the arthrocentesis in order to rapidly relieve joint inflammation and further reduce symptoms.

How is rheumatoid arthritis treated?

There is no known cure for rheumatoid arthritis. To date, the goal of treatment in rheumatoid arthritis is to reduce joint inflammation and pain, maximize joint function, and prevent joint destruction and deformity. Early medical intervention has been shown to be important in improving outcomes. Aggressive management can improve function, stop damage to joints as monitored on X-rays, and prevent work disability. Optimal treatment for the disease involves a combination of medications, rest, joint-strengthening exercises, joint protection, and patient (and family) education. Treatment is customized according to many factors such as disease activity, types of joints involved, general health, age, and patient occupation. Treatment is most successful when there is close cooperation between the doctor, patient, and family members.

Two classes of medications are used in treating rheumatoid arthritis: fast-acting "first-line drugs" and slow-acting "second-line drugs" (also referred to as disease-modifying antirheumatic drugs or DMARDs). The first-line drugs, such as aspirin and cortisone (corticosteroids), are used to reduce pain and inflammation. The slow-acting second-line drugs, such as gold, methotrexate, and hydroxychloroquine (Plaquenil), promote disease remission and prevent progressive joint destruction, but they are not antiinflammatory agents.

The degree of destructiveness of rheumatoid arthritis varies from patient to patient. Patients with uncommon, less destructive forms of the disease or disease that has quieted after years of activity ("burned out" rheumatoid arthritis) can be managed with rest, pain and antiinflammatory medications alone. In general, however, patients improve function and minimize disability and joint destruction when treated earlier with second-line drugs (disease-modifying antirheumatic drugs), even within months of the diagnosis. Most patients require more aggressive second-line drugs, such as methotrexate, in addition to antiinflammatory agents. Sometimes these second-line drugs are used in combination. In some patients with severe joint deformity, surgery may be necessary.

"First-line" medications

Acetylsalicylate (aspirin), naproxen (Naprosyn), ibuprofen (Advil, Medipren, Motrin), and etodolac (Lodine) are examples of nonsteroidal antiinflammatory drugs (NSAIDs). NSAIDs are medications that can reduce tissue inflammation, pain, and swelling. NSAIDs are not cortisone. Aspirin, in doses higher than that used in treating headaches and fever, is an effective antiinflammatory medication for rheumatoid arthritis. Aspirin has been used for joint problems since the ancient Egyptian era. The newer NSAIDs are just as effective as aspirin in reducing inflammation and pain and require fewer dosages per day. Patients' responses to different NSAID medications vary. Therefore, it is not unusual for a doctor to try several NSAID drugs in order to identify the most effective agent with the fewest side effects. The most common side effects of aspirin and other NSAIDs include stomach upset, abdominal pain, ulcers, and even gastrointestinal bleeding. In order to reduce stomach side effects, NSAIDs are usually taken with food. Additional medications are frequently recommended to protect the stomach from the ulcer effects of NSAIDs. These medications include antacids, sucralfate (Carafate), proton-pump inhibitors (Prevacid and others), and misoprostol (Cytotec). Newer NSAIDs include selective Cox-2 inhibitors, such as celecoxib (Celebrex), which offer antiinflammatory effects with less risk of stomach irritation and bleeding risk.

Corticosteroid medications can be given orally or injected directly into tissues and joints. They are more potent than NSAIDs in reducing inflammation and in restoring joint mobility and function. Corticosteroids are useful for short periods during severe flares of disease activity or when the disease is not responding to NSAIDs. However, corticosteroids can have serious side effects, especially when given in high doses for long periods of time. These side effects include weight gain, facial puffiness, thinning of the skin and bone, easy bruising, cataracts, risk of infection, muscle wasting, and destruction of large joints, such as the hips. Corticosteroids also carry some increased risk of contracting infections. These side effects can be partially avoided by gradually tapering the doses of corticosteroids as the patient achieves improvement of the disease. Abruptly discontinuing corticosteroids can lead to flares of the disease or other symptoms of corticosteroid withdrawal and is discouraged. Thinning of the bones due to osteoporosis may be prevented by calcium and vitamin D supplements. For further information on corticosteroids, please read the article on prednisone.

Newer treatments

Newer "second-line" drugs for the treatment of rheumatoid arthritis include leflunomide (Arava) and the "biologic" medications etanercept (Enbrel), infliximab (Remicade), anakinra (Kineret), adalimumab (Humira), rituximab (Rituxan), and abatacept (Orencia).

Leflunomide (Arava) is available to relieve the symptoms and halt the progression of the disease. It seems to work by blocking the action of an important enzyme that has a role in immune activation. Arava can cause liver disease, diarrhea, hair loss, and/or rash in some patients. It should not be taken just before or during pregnancy because of possible birth defects and is generally avoided in women who might become pregnant.

Newer medications that represent a novel approach to the treatment of rheumatoid arthritis are products of modern biotechnology. These are referred to as the biologic medications or biological response modifiers. In comparison with traditional DMARDs, the biologic medications have a much more rapid onset of action and can have powerful effects on stopping progressive joint damage. In general, their methods of action are also more directed, defined, and targeted.

Etanercept, infliximab, and adalimumab are biologic medications that intercept a messenger protein in the joints (tumor necrosis factor or TNF) that promotes inflammation of the joints in rheumatoid arthritis. These TNF-blockers intercept TNF before it can act on its natural receptor to "switch on" inflammation. This effectively blocks the TNF inflammation messenger from recruiting the cells of inflammation. Symptoms can be significantly, and often rapidly, improved in patients using these drugs. Etanercept must be injected subcutaneously once or twice a week. Infliximab is given by infusion directly into a vein (intravenously). Adalimumab is injected subcutaneously either every other week or weekly. Each of these medications is being evaluated by doctors in practice to determine what role they may have in treating patients in various stages of rheumatoid arthritis. Research has shown that biological response modifiers also prevent the progressive joint destruction of rheumatoid arthritis. They are currently recommended for use after other second-line medications have not been effective. The biological response modifiers (TNF-inhibitors) are expensive treatments. They are also frequently used in combination with methotrexate and other DMARDs. Furthermore, it should be noted that the TNF-blocking biologics all are more effective when combined with methotrexate.

Anakinra is another biologic treatment that is used to treat moderate to severe rheumatoid arthritis. Anakinra works by binding to a cell messenger protein (IL-1, a proinflammation cytokine). Anakinra is injected under the skin daily. Anakinra can be used alone or with other DMARDs. The response rate of anakinra does not seem to be as high as with other biologic medications.

Rituxan is an antibody that was first used to treat lymphoma, a cancer of the lymph nodes. Rituxan can be effective in treating autoimmune diseases like rheumatoid arthritis because it depletes B-cells, which are important cells of inflammation and in producing abnormal antibodies that are common in these conditions. Rituxan is now available to treat moderate to severely active rheumatoid arthritis in patients who have failed treatment with the TNF-blocking biologics. Preliminary studies have shown that Rituxan was also found to be beneficial in treating severe rheumatoid arthritis complicated by blood vessel inflammation (vasculitis) and cryoglobulinemia.

Orencia is a recently developed biologic medication that blocks T-cell activation. Orencia is now available to treat adult patients who have failed treatment with a traditional DMARD or TNF-blocking biologic medication.
While biologic medications are often combined with traditional DMARDs in the treatment of rheumatoid arthritis, they are generally not used with other biologic medications because of the unacceptable risk for serious infections.

The Prosorba column therapy involves pumping blood drawn from a vein in the arm into an apheresis machine, or cell separator. This machine separates the liquid part of the blood (the plasma) from the blood cells. The Prosorba column is a plastic cylinder about the size of a coffee mug that contains a sand-like substance coated with a special material called Protein A. Protein A is unique in that it binds unwanted antibodies from the blood that promote the arthritis. The Prosorba column works to counter the effect of these harmful antibodies. The Prosorba column is indicated to reduce the signs and symptoms of moderate to severe rheumatoid arthritis in adult patients with long-standing disease who have failed or are intolerant to disease-modifying antirheumatic drugs (DMARDs). The exact role of this treatment is being evaluated by doctors, and it is not commonly used currently.

Other treatments

There is no special diet for rheumatoid arthritis. One hundred years ago, it was touted that "night-shade" foods, such as tomatoes, would aggravate rheumatoid arthritis. This is no longer accepted as true. Fish oil may have antiinflammatory beneficial effects, but so far this has only been shown in laboratory experiments studying inflammatory cells. Likewise, the benefits of cartilage preparations remain unproven. Symptomatic pain relief can often be achieved with oral acetaminophen (Tylenol) or over-the-counter topical preparations, which are rubbed into the skin. Antibiotics, in particular the tetracycline drug minocycline (Minocin), have been tried for rheumatoid arthritis recently in clinical trials. Early results have demonstrated mild to moderate improvement in the symptoms of arthritis. Minocycline has been shown to impede important mediator enzymes of tissue destruction, called metalloproteinases, in the laboratory as well as in humans.

The areas of the body other than the joints that are affected by rheumatoid inflammation are treated individually. Sjogren's syndrome (described above, see symptoms) can be helped by artificial tears and humidifying rooms of the home or office. Medicated eyedrops, cortisporine ophthalmic drops (Restasis), are also available to help the dry eyes in those affected. Regular eye checkups and early antibiotic treatment for infection of the eyes are important. Inflammation of the tendons (tendinitis), bursae (bursitis), and rheumatoid nodules can be injected with cortisone. Inflammation of the lining of the heart and/or lungs may require high doses of oral cortisone.

Proper, regular exercise is important in maintaining joint mobility and in strengthening the muscles around the joints. Swimming is particularly helpful because it allows exercise with minimal stress on the joints. Physical and occupational therapists are trained to provide specific exercise instructions and can offer splinting supports. For example, wrist and finger splints can be helpful in reducing inflammation and maintaining joint alignment. Devices such as canes, toilet seat raisers, and jar grippers can assist in the activities of daily living. Heat and cold applications are modalities that can ease symptoms before and after exercise.

Surgery may be recommended to restore joint mobility or repair damaged joints. Doctors who specialize in joint surgery are orthopedic surgeons. The types of joint surgery range from arthroscopy to partial and complete replacement of the joint. Arthroscopy is a surgical technique whereby a doctor inserts a tube-like instrument into the joint to see and repair abnormal tissues.

Total joint replacement is a surgical procedure whereby a destroyed joint is replaced with artificial materials. For example, the small joints of the hand can be replaced with plastic material. Large joints, such as the hips or knees, are replaced with metals.

Finally, minimizing emotional stress can help improve the overall health in patients with rheumatoid arthritis. Support and extracurricular groups afford patients time to discuss their problems with others and learn more about their illness.