Category: public health

Determinants of health and ways they impact persons health

Determinants of health
Determinants of health

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Determinants of health and ways they impact persons health

Introduction

  To improve the health status of the community, there is need to reduce the health inequalities. This is only achieved by understanding factors that promote as well as protect health of the community, which are commonly referred to as determinants of health (Fane & Ward, 2014). These determinants are categorised into social, cultural and economic factors.

This is important because despite the fact that the USA government is spending fortune in medical care, the health outcomes still remains low than most of the developed countries. In fact, the USA IS ranked the 34th in infant mortality in the world (Potter, Trussell, & Moreau, 2009).

 However, it is possible to envision the more promising end of this medical story if number of strategies are employed to understand as well as promoting the health of the community. This is achieved through analysis of health determinants as outlined by logic models (Blanchard  et al., 2013).

These models are important because they are oversimplified and approximate, thus helping  the identification of complex interplay, which would be important in taking action  to improve the health  of the population, which are developed by the new framework of health goals  for USA, commonly referred to as “ Healthy People 2020 (Fane & Ward, 2014).”

 This paper summarizes the main sociocultural and economic determinants of health and ways they impact the health of a person, leading to inequalities. Understanding these determinants is important because it helps improve the health of the community, thereby reducing healthcare inequalities. This aid in the identification of the specific areas for actions, which also facilitates the identification of the most feasible interventions that could aid promote quality care.

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 Determinants of health

Evidence based study indicates that certain healthcare behaviours affects   personal and community health. These includes behaviours such as smoking, poor nutrition, physical inactiveness, and excessive alcohol consumptions. Similarly, the amount of household income, educational achievement, ethnic background, employment and neighbourhoods also associated with profound effects of health (Perrin, 2013).

 To start with, income and wealth determinants impact the health of a person. Research indicates that increased income improves the health outcomes.  However, the relationship between health and income is not linear (Potter, Trussell, & Moreau, 2009). This is because money itself does not translate into good health. Instead, wealth is generally considered to give someone position within the society, which makes them, have better access to better economic opportunities (Salt, 2014).

This makes them live in healthy and safe communities, with better equipped facilities. Additionally, they are able to afford health insurance, and thus can access health more easily. Most have great amount of wealth and assets such as savings, low debt and high amount of savings that can be disposed to meet the health demands of the person where necessary (Blanchard  et al., 2013).

 Conversely, poor people are restricted to these amenities and are often exposed to environments that are health damaging. They lack sufficient amenities such as recreational facilities, grocery stores or even health care facilities (Fane & Ward, 2014).  These people will lack social supports or relationships, have poor self-esteem, lack sense of control and are more likely to suffer from chronic diseases and acute stress. This impact is particularly vital in children and infants.  Low income is associated with increased infant and childhood mortality.

It is also suggested that the hardship and economic deprivation in childhood significantly affect the adult health (Fane & Ward, 2014).  Thus, children in low income households are more likely to suffer from poor nutrition, which results to health complications in their adult life including obesity, cancer, mental health, and cardiovascular diseases. This forms a vicious cycle of poverty and health (Potter, Trussell, & Moreau, 2009).

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 The link between socioeconomic factors and health is clearer. However, the communities in which people live also influences their health. Literature indicates that people living in poor neighbourhoods report higher mortality rates, high incidences of chronic diseases and poorer health standards as compared with people living in safer neighbourhoods (Potter, Trussell, & Moreau, 2009).  One study conducted in Wake County, North Carolina indicated that people living in poorer neighbourhoods reported higher incidences of pre-term birth, greater levels of depression, high level of teen pregnancy and increased resistance and disorders among the adolescents (Fane & Ward, 2014).  

Additionally, different neighbourhoods makes it difficult to access healthy food, availability of parks and sidewalks and open spaces where people can exercise. The proximity of the people to environmental hazards also influences the quality of care (Diaz de León-Castañeda, Ramírez-Fernández, & Pinzon Florez, 2013).

Housing also influences the health being of an individual. Living in houses that are poorly ventilated, damp, overcrowded or with poor waste disposal strategies are associated with increased diseases, communicable infections and other preventive diseases (Salt, 2014). Housing structures are very important as people spend approximately 90% of their time within  their home, and thus  poor housing  can put people at risk of developing  health complications due  exposure to environmental hazards (Fane & Ward, 2014).

Additionally, overcrowding increases the risks of transmitting infectious diseases such as tuberculosis as well as other respiratory diseases (Blanchard  et al., 2013). It could lead to more healthcare complication in events of pandemics such as virulent influenza. Research estimated that low income households live in overcrowded conditions, where more than 70,000 housing units in USA are overcrowded (Potter, Trussell, & Moreau, 2009). The issue is more complicated with most people facing foreclosures which is associated with the downturn of the economy. This accelerates the risk of sharing housing, and doubling up of people with their families and friends (Cai & McAdam-Marx, 2013).

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 Academic achievement is strongly correlated with increased lifespan. Generally, people with less education are associated with more chronic complications and their life expectancies are shorter as compared with people with higher level of education (Blanchard et al., 2013).  This is indicated by the healthcare study, where adults who have finished high school are more likely to have better health outcomes as compared with dropouts (Salt, 2014). In the USA, the ager adjusted mortality of people who dropped out of high school is two folds higher than those who completed their education.

These people are more likely to suffer from chronic and acute healthcare complications such as hypertension, stroke, diabetes, asthma, ulcers and emphysema. On average, it is estimated that the college graduates live five years longer as compared to those who failed to complete high school education (Diaz de León-Castañeda, Ramírez-Fernández, & Pinzon Florez, 2013).

 Research indicates that education achievement and health are not only correlated at personal level but also in their future generation. For example, maternal education is associated with better health for the children. Similarly, children born by high school dropout’s parents are two folds likely to suffer from premature death. Educated mothers’ infant mortality rates are considerably lower than uneducated parents. This is because educational achievements, wealth and health are interrelated, and have significant impacts on person’s health.

 Another important health determinant is social exclusion, which is often associated with poverty. Social exclusion is associated with huge impacts in health such as premature deaths. Absolute poverty results to lack of basic materials, and is still rampant in developed countries (Salt, 2014).  Most of the unemployed people, ethnic groups, refugees, homeless and the disabled are often socially excluded. This denies them the opportunity to access decent living opportunities such as education, housing, transport or even the ability to participate in various activities of the lives that makes them participate fully. This exclusion and being treated as lesser beings leads to health complications (Cai & McAdam-Marx, 2013).

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The social exclusions occurs inform of racism, discrimination, hostility, stigmatization as well as unemployment. These denies people their ability to participate in educative training, prevention programs or even accessing potential beneficial healthcare capacities. These issues are socially as well as psychologically damaging, and can have detrimental effects to these discriminated people (Pegram & Bloomfield, 2013). 

The longer these people live in prisons, psychiatric facilities and children’s homes, and the more likelihood of them to suffer from a wide range of disorders. These incidences are also associated with increased risk of divorce, addictions and disabilities. Research indicates that people with strong family relations have better health outcomes. For instance, the highest incidences of mental illness are from single parent families (Pegram & Bloomfield, 2013).

Addiction is a public health issue of concern as it is associated with social breakdown, which worsens the issue of healthcare disparities. Addiction in this context refers to overreliance of drug use such as alcohol and cigarrette smoking. This is associated with increased mortality associated with suicides, injuries and poisoning. Although unclear, cultural values and beliefs tend to influence the quality of care (Salt, 2014).

This includes activities such as religious values that prohibits people from seeking medical assistance. Other determinants includes population based healthcare facilities as well as services. These includes activities such as sewerage and water to ensure that people’s health is maintained. The extent of funding of these activities dictates the level of the maintenance of this infrastructure, their developments and also usages.

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Ways the determinants of health impact people’s health

 Most of the social factors mentioned above are described to have both interactive and independent effects. For instance, people with high level of incomes are more likely to have achieved higher education. They are also more likely to have more opportunities to live in safe, standard and healthy environments. Their neighbourhoods are more likely to be secure, thus promoting physical activeness. They are also able to purchase organic food as compared to those with low income households. These people are also more likely to have medical cover, which facilitates access to quality care (Cai & McAdam-Marx, 2013).

 Conversely, people living with poverty are more likely to have lower education achievement, indicating that they are most likely unemployed. They will often live in substandard housing, putting them at risk of communicable diseases due to overcrowding effects and poor sanitation (Cai & McAdam-Marx, 2013). These people lack enough resources to purchase quality foods, hence depends mainly with fast food, increasing the risk of obesity. These people are more likely to engage in risky behaviours such as drug abuse and prostitutions, putting them at greater risk.  This makes them experience higher levels of stress as compared with their counterparts (Pegram & Bloomfield, 2013).

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 Whereas most of these factors are interconnected as described above, there is growing evidence that these factors independently determine the health of the people. For instance, in the USA, the health status of all ethnic communities decreases as income level decreases. It is reported that people with 100% federal poverty guidelines (FPG) reports the worse health as compared to people in other income level (Pegram & Bloomfield, 2013). However, within each income levels, specific communities have worse health outcome as compared with others.

For instance, the African American normally reports poor healthcare outcomes as compares to the Hispanics and non-Hispanics white (Cai & McAdam-Marx, 2013). These marked differences across the ethnic communities are observed in other determinants of health. Therefore, to effectively reduce the increased   healthcare disparities, issues such as accessibility of educations, standard housing, safe living as well as working environments, healthcare facilities and all other opportunities that facilitate the healthy living of the community must be addressed (Diaz de León-Castañeda, Ramírez-Fernández, & Pinzon Florez, 2013).

Conclusion

 As indicated, it is evident that there is strong correlation between the health and people’s incomes and way of life including community environment, educational achievement, and ethnicity and housing conditions. It is indicated that those people with higher incomes, higher education achievement and those living in a health as well as safe environments have been associated with longer life expectancies and are associated with better health outcomes. Conversely, people with lower education levels, living below poverty line, substandard housing and those in poor neighbourhoods have poor health outcomes. This is attributable to the fact that these lack sufficient resources to treat   even the preventable diseases. This translates to increased health disparities among the various ethnic groups.

References

Blanchard, C., Gibbs, M., Narle, G., & Brookes, C. (2013). Learning from communities in the USA and England to promote equity and address the social determinants of health. Global Health Promotion, 20(4 Suppl), 104-112. http://dx.doi.org/10.1177/1757975913501006

Cai, B., & McAdam-Marx, C. (2013). The determinants of antihypertensive use and expenditure in patients with hypertension in the USA. Journal Of Pharmaceutical Health Services Research, 5(1), 11-18. http://dx.doi.org/10.1111/jphs.12041

Diaz de León-Castañeda, C., Ramírez-Fernández, D., & Pinzon Florez, C. (2013). Compared Analysis of Inequalities in Health and Influence of Social Determinants of Health in Cuba and USA. Value In Health, 16(7), A711. http://dx.doi.org/10.1016/j.jval.2013.08.2189

Fane, J., & Ward, P. (2014). How can we increase children’s understanding of the social determinants of health? Why charitable drives in schools reinforce individualism, responsibilisation and inequity. Critical Public Health, 1-9. http://dx.doi.org/10.1080/09581596.2014.935703

Pegram, A., & Bloomfield, J. (2013). The importance of measuring blood pressure in mental health care. Mental Health Practice, 16(6), 33-36. http://dx.doi.org/10.7748/mhp2013.03.16.6.33.e849

Perrin, V. (2013). Social Determinants Of Health. Health Affairs, 32(11), 2060-2060. http://dx.doi.org/10.1377/hlthaff.2013.1102

Potter, J., Trussell, J., & Moreau, C. (2009). Trends and determinants of reproductive health service use among young women in the USA. Human Reproduction, 24(12), 3010-3018. http://dx.doi.org/10.1093/humrep/dep333

Salt, R. (2011). Microcredit and the Social Determinants of Health: A Conceptual Approach. Public Health Nursing, 28(3), 281-290. http://dx.doi.org/10.1111/j.1525-1446.2010.00927.x

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Intellectual Property in Electronic Health Records

intellectual property
Intellectual Property

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Intellectual Property in Electronic Health Records

Introduction

As a nurse, one comes into contact continually with issues of electronic health records. The Health Insurance Portability and Accountability Act is one of the Acts of the Federal Government that attempt to speak to the question of e-health records and classification of it as intellectual property. In this case, it is required that in the provision of cover for Americans, there is need to have a catalog of information kept by the health care providers which can be used in the offer of health covers (Hiller et al, 2011).

The HIPPA provides for mechanisms of protection of such information that is intellectual property by the privacy rule which demands that Personally Identifiable information ought not to be disclosed unless within the framework provided for under the Act (Bates, 2005).

Background

It is the case that such information may be used in the carrying out of research. However, there is no clear methodology of addressing intellectual property concerns in the information that is stored therein. Most certainly, the IP in the coming up with software that can store such information is squarely an entitlement of the software developer.

Where does this leave the information and the collector of information? This is a question that must be determined to inform agreements that organizations which offer IT services to the health care providers may have to craft in their Service Level Agreements. (Garde, 2007)

It cannot be avoided that this is an issue that deserves adequate attention because often, the patient will not know whether they have any rights regarding the information they give herein. This actually gives them impetus to lie about the information they give.

Even if they do not lie about the information they give, they may end up being a bit economical about the truth in the information they give.  The growing need for enhancement and embrace technology in every area and the growing relevance of cloud storage means that the traditional ways of record keeping by health care providers is an idea of a bygone age. (Garde, 2007).

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It is a mundane principle of IP law that information gathering cannot amount to a situation where the gatherer is granted IP rights. This is because IP rights involve the exertion of mental capacities and the sweat of the brow cannot suffice for the abrogation of such rights by one such person. Ultimately, there is then a question that arises. Who then is entitled to such rights?

These information rights will inform how we handle such information and the procedures to be followed in the use or transfer of such information. The seriousness of the question of confidentiality and security of information is at the centre of electronic health records. In the event that this is not properly addressed, there is a real possibility that the policy on the creation of such records crumbles and the efficiency envisioned in such an instance fails in the main.

Findings

A priority, I perceive need to have a brief legislation on the IP rights regarding such scenarios. In such a case, there is need to properly brainstorm and see whether a law can be crafted to even sanction properly the actions of such persons who may handle such information, for instance nurses as they go about with their ordinary dealings.

It may then appear as though there shall be an overlap with the question of Confidentiality as already provided for in other pieces of legislation including HIPAA. However, this will be more specific and will spell out clearly the IP rights and offer a more comfortable pillow for the patient and users of such information will be under a more elaborate set of duties. (Zittrain, 2000)

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Procedure

There is an elaborate procedure for the making of laws. In this my case, I have already encountered the need by observation and from experience that there is no clear policy directive on such. There is also an alarming dearth of scholarly attention to such an area which has far reaching implications for research. A focus group discussion with members of the profession reveals that information may be abused without the knowledge of the proper owners of the said property which is actually a virtual violation of the fundamental right to dignity.

It is the case that information that is de-identified may be used for research with few qualms. However, this does not completely take away the need to have the proper owners of the information at the centre of such a procedure.

This procedure is made easier by the fact that a citizen like me may institute the procedure without being found to have lacked the requisite locus. As the law progresses, the question of locus is slowly being found to be merely procedural and cannot be allowed to supersede substantive societal needs and justice. As a matter of conjecture, this will need a bit of education of the stakeholders on the issues to which this law will speak to.

Only then will a critical mass be achieved because this is a fairly technical area that may not be fully appreciated by many. However, IP Law is an issue of concern to all policy makers because the traditional forms of property are slowly being phased out.

The presentation of such laws to both houses of congress, both of whom must ruminate over the proposals and determine whether or not they deserve parliamentary attention. (Mason, 2015) It is hoped that the idea shall not die at the committee stage, but shall sail through to help protect the rights of patients.

References

Bates, D., 2005. Physicians and ambulatory electronic health records.”. Health Affairs, 24(5), pp. 1180-1189..

Garde, S., 2007. “Towards Semantic Interoperability for Electronic Health Records–Domain Knowledge Governance for open EHR Archetypes.”. Methods of information in medicine, 36(3), pp. 332-343..

Hiller, J., McMullen, M. S., Chumney, W. M., & Baumer, D. L. (2011). Privacy and security in the implementation of health information technology (electronic health records): US and EU compared. BUJ Sci. & Tech. L., 17, 1.

Mason, A. T. a. G. S., 2015. . American constitutional law: introductory essays and selected cases.. 1 ed. New York: Routledge.

Zittrain, J., 2000. “What the publisher can teach the patient: intellectual property and privacy in an era of trusted privication.. Stanford Law Review, pp. 1201-1250.

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Teenage Sexual Education Project Paper

Teenage Sexual Education
Teenage Sexual Education

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Teenage Sexual Education

My project is on the provision of sexual education to teenagers. Teenagers that are sexually active are a matter of serious public concern.  In the past years, several school-based programs have been designed for sole aim of holding up the initiation of sexual activity.  Schools can play a central role in offering teenagers with a wide knowledge base that can aid them in molding their healthy lifestyle and coming up with informed decisions about their behavior (Shindel& Parish, 2013).

Detailed sexual education provides accurate information about gender identity, human sexuality, sexual health, reproduction and develops skills for communicating and relating to others in meaningful and satisfying ways. Additionally, it supports one’s ability to make sexual decisions with integrity and respect to other people.

Noddings (2015) reports that equal access to sexual education for teenagers of all cultures, races, gender identities, economic circumstances, and ethnicities are a matter of social justice. Young people who learn how to make respectful and intentional sexual decisions manage leading a healthy and safe lifestyle free from early teenage pregnancies, STIs such as HIV/AIDS, syphilis and gonorrhea as well as lost opportunities and barriers of economy that often follow.  Parents, schools, religious institutions, and community based organizations have a crucial role of providing detailed sex education to young people (Wight & Fullerton, 2013).

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How it relates to the Field

As a health care practitioner, this project of sexual education is central to my practice. We are charged with the responsibility of ensuring that the public engages in activities that do not predispose them to health risks. We have a mandate of ascertaining that high health standards are maintained in the community. It is our duty to enlighten the public on the consequences of certain activities that impair the quality of life of the people and may lead to high mortality rates.

Therefore, provision of sexual education is one way of ensuring that people lead a healthy lifestyle by avoiding STIs and teenage pregnancies. The school is the appropriate environment of offering sexual education since it is often in regular contact with a large percentage of young people, with virtual all teenagers attending it before they engage in risky sexual behavior.

PICOT Question

Population: Teenagers attending public schools in the US. Students that were cognitively handicapped, school dropouts, delinquent, institutionalized, or emotionally disturbed were not considered for this project since they address different needs and characteristics.

Intervention: Sexual education on the importance of abstinence behavior.

Comparison:  The results of this study were compared to those of studies that focused of a group of students in public schools who had not received sexual education

Outcome: The results that were determined include; delay in onset of intercourse, decease in intercourse frequency, and decrease in the number of sexual partners.

Timing:  Evidence was gathered from studies where by the intervention was implemented for a period of one year and results obtained.

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IOWA Model

According to Schaffer et al., 2013, health care providers are encouraged to use updated research evidence to promote better patient outcomes and inform actions, decisions, and patient interactions to deliver quality care to patients. Different models have been developed by scholars to promote the use of EBP in healthcare.

One of these models is the IOWA model. This model is quite crucial in my project since it will serve as a guide on the steps I should follow for successful completion of this project. For instance, it has seven steps that each researcher should follow when conduct a study. These steps are;

  •  Selection of a topic
  • Forming a team
  • Retrieval of evidence
  • Evidence grading
  • Developing an EBP standard
  • Implementing EPB
  • Evaluation

With this model, I will be in a better position to actively read, critique, and grade evidence that will aid in promoting my project of sexual education among young people.

Feedback

A well designed PICOT question is an essential guide in retrieval of evidence in literature research. The question provides information on the type of population to be considered in the study, the implemented interventions, the control parameter, the outcome as well as the timing of the research.

Adhering to these steps makes a literature research simple even for novice researchers. The formulation of the PICOT question also supports an EBP project since one can select literature on the research topic and use the steps to gather evidence, implement it, and determine the outcomes of the project.

References

Noddings, N. (2015). The Challenge to Care in Schools, 2nd Editon. Teachers College Press.

Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidence‐based practice models for organizational change: overview and practical applications. Journal of advanced nursing, 69(5), 1197-1209.

Shindel, A. W., & Parish, S. J. (2013). Sexuality education in North American medical schools: Current status and future directions (CME). The journal of sexual medicine, 10(1), 3-18.

Wight, D., & Fullerton, D. (2013). A review of interventions with parents to promote the sexual health of their children. Journal of Adolescent Health, 52(1), 4-27.

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A Social Issue or Governmental Concern

A Social Issue or Governmental Concern
A Social Issue or Governmental Concern

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A Social Issue or Governmental Concern

Introduction

            Obesity is currently a serious social issue that is increasing rapidly. Whoever considered both woman and children to have different perceptions about their body index, the knowledge in surgical and medical issues that are connected to this disease (Li, et.al.2015). It is important to establish that the US is considerably experiencing a larger growth of obese generation, a factor that needs address.

Thesis:

            Obesity is a fast growing epidemic due to several factors such as poor diet, lack of physical activity and stress and has become a serious social issue requiring greater government involvement through nutritional content regulation and increased physical education in schools.

Obesity as a Governmental Concern

It is essential to determine that obesity as a health problem has had a considerable amount of economic impact within the health care system of the United States of America. This can be attributed to the increasing prevalence of overweight individuals that are directly associated with costs for a nations. These costs are incurred by the government in the development of preventive, diagnostic and treatment approaches that are connected to this disease (Li, et.al.2015).

On the other hand, the indirect costs that nations are bound to experience includes the wages that are lost by individuals who do not have the capacity to work since they are diagnosed with this ailment including the value of the future costs that a state is bound to encounter as a result of this ailment, a factor that makes it more of a governments concern as well. Additionally, it is imperative to determine that nations divert resources with the aim of dealing with the challenges that these issues present in a nation thus affecting the economic state of a nation.

Governments are additionally pushed in the acquisition of healthy foods that are more available, with the aim of reducing the supply chain and the promotion of other foods. The government is also obligated to develop awareness programs that encourage the population of healthy feeding in order to mitigate the effects of this disease, encourage physical activity and make the changing of policies easier for individuals who preset such illnesses. In other words, the government is forced to use its potentials in changing the social causatives of obesity

Obesity has been found to affect the health, economy, and social status of different individuals including the economic nation. This can be depicted as individuals who present this illness spend on medication including the government’s efforts aimed at managing this disease. The government in handling this situation is forced to pool several resources aimed at training the healthcare professionals on how to help in managing obesity (Li, et.al.2015).

The health professionals help patients on decreasing their weight stigma and encouraging patients on the need of being sensitive through an approach that involves education. The healthcare professionals are then trained and equipped with appropriate skills in managing this disease. This has seen the development of an obesity management approach that teaches the patients on how to diet and manage the disease. These approaches remain effective in managing obesity in a nation, a factor that requires a joint effort of both the health and government sectors. This determines the fact that obesity remains a health concern in a state.

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Obesity as a Social Issue

            Obesity is characterized as a condition that allows the accumulation of excess fats in the body. However, when people accumulate unnecessary weight as a result of this disease, it results into a social factor since it develops several implications within the society, legal, economic, religious and political elements (Li, et.al.2015). In determining the social aspects of obesity in Americans, it is essential to consider that Americans have turned out to be conscious about obesity currently than they did in the past, with many considering it as a societal issue that is viewed to be serious as compared to smoking or drinking.

The rates of Obesity has immensely grown, thus resulting in other nutritional related chronic diseases including the significant burdens that families, healthcare systems and the community encounter in caring for patients with this disease.

It is additionally important to consider the fact that individuals who are obese are viewed differently in the society. The society is more likely to consider them as suffering from unwanted illnesses, a factor that depicts the fact that these individuals are prone to suffer from discrimination and prejudice in different societies (Li, et.al.2015). On the other hand, obese people are considered to also have few friends, lower employment and education opportunities.

Following sources, we considered the perceptions of women especially those who suffer from obesity and their levels of knowledge on the medical and surgical elements as related to this disease as social (Li, et.al.2015). This has seen many of overweight women grow in large numbers, a factor that has caused them to underrate their body mass index (BMI). Since a majority of women that are obese are faced with the challenge of underrating their body mass index.

This can be depicted in the less educated women who we considered whom as having issues that result in the underestimation of their BMI. As depicted in the research, several of these women do not consider knowing their BMI status (Li, et.al.2015).Women are more likely to suffer from obesity without considering to it. It is now essential to call for support systems among the medical fraternity in administering advice to this population.

It is essential to consider that there are some misconceptions that have been developed and that have dominated policy initiatives directed towards combating and managing obesity. Several schools of thought believe that diet restrictions and the element of weight stigmatization may be ineffective in the fight against obesity (Li, et.al.2015).

However, it is important to consider applying psychological science in enacting new regulative approaches that aid in weight management in the local and national level. This essentially discourages individual’s willpower that is in strategies developed to fight obesity and encourage the initiation of policies that support environmental changes that nurture health for the populace.

In managing diabetes, it is vital to consider that there have been misconceptions dominating the policy initiatives in mitigating this disease. This determines the fact that the misconceptions dwelt on diet restrictions and weight stigmatization as not effective in mitigating this disease. In addressing this health concern, there is a need of inclusively incorporating psychological science in helping patients with weight management.

Studies have discovered that there is a need of employing scientific policies in improving the health of patients who suffer from this disease (Li, et.al.2015). This encourages the patients to develop a willpower approach in fighting obesity, whereas there is a need of encouraging policies that support environmental changes in nurturing a healthy society for all. Working conditions require that employees develop a healthy lifestyle that entails eating healthy foods, exercise and inclusion of education.

As determined in this paper, Obesity has turned out to be a health concern since it affects the economic, health, and social lives of individuals in a nation. In a nut shell, obesity is a social concern that has grown rapidly over the years. This a major cause for concern in the long list of issues that obesity can lead to.

Many people do not realize just how damaging obesity can be to their body and their overall health. It is in our hands to put an end to obesity and the extra toll that it is taking on the lives of US citizens conclusively. Let’s change the trend of obesity by making the initiative to live better lifestyles so that we can build towards a healthier America.

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  • Conclusion

As determined in this study, Obesity remains a fast growing epidemic due to several factors such as poor diet, lack of physical activity and stress and has become a serious social issue requiring greater government involvement through nutritional content regulation and increased physical education in schools. Obesity has been found to affect the health, economy, and social status of different individuals including the economic nation (Li, et.al.2015).

This can be depicted as individuals who present this illness spend on medication including the government’s efforts aimed at managing this disease. However, it is important to consider applying psychological science in enacting new regulative approaches that aid in weight management in the local and national level.

This essentially discourages individual’s willpower that is in strategies developed to fight obesity and encourage the initiation of policies that support environmental changes that nurture health for the populace. This therefore determines the rationale behind this ailment being a social issue and a governmental concern that is widely affecting several nations both socially, economically, religiously and politically.

References

Li, W., Buszkiewicz, J. H., Leibowitz, R. B., Gapinski, M. A., Nasuti, L. J., & Land, T. G. (2015). Declining Trends and Widening Disparities in Overweight and Obesity Prevalence among Massachusetts Public School Districts, Retrieved from http://www.medscape.com/medline/abstract/26270317

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Children and Teens Obesity

Children and Teens Obesity
Children and Teens Obesity

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Children and Teens Obesity 

Recently, the idea of taking body mass index (BMI) measurements within the school premise for surveillance purposes has gained much attention from school officials, researchers, the media, and legislators. While a considerable number of children across the United States are underweight, a huge number of them are overweight or obese.

According to a survey done by the Center for Disease Prevention and Control, there were about 13.7 million children between 2 and 19 years suffering from obesity in the US (Sliwa, Brener, Lundeen, & Lee, 2019). While some policy makers support the idea of school-based BMI measurement, others do not. 

One of the biggest reasons for supporting school-based BMI measurement is because many children are suffering from chronic diseases such as diabetes and cardiovascular disease due to overweight and obesity. According to Nihiser et al. (2017), the implementation of school-based BMI measurement will help policy makers to identify the number of children that are underweight, healthy, overweigh, and obese in various schools and apply the necessary measures.

These measures can include ensuring that children that have unhealthy weight have access to specialized diets and exercise while at school. School administrators can also use the generate information to help parents take care of their through proper diets at home. 

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Children and Teens Obesity 

According to Madsen et al. (2020) some institutions and policy makers feel that schools may not provide the necessary environment to ensure privacy and confidentiality while taking the measurements. Many students are very sensitive about their bodies due to the increase of bullying cases among overweight and obese children.

Policy makers therefore feel that children with unhealthy weights will be subjected to an unhealthy environment. Most parents also feel that they also have the right to be consulted before their child’ body mass index is measured and they also have the right to decline or accept the initiative. 

The available data is not conclusive as to whether school-based BMI measurement is effective or not. However, it is recommendable that every school have a supportive and safe environment for children of all body weights. 

Children and Teens Obesity 

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References

Madsen, K. A., Thompson, H. R., Linchey, J., Ritchie, L. D., Gupta, S., Neumark-Sztainer, D., … & Ibarra-Castro, A. (2020). Effect of school-based body mass index reporting in California public schools: a randomized clinical trial. JAMA pediatrics.

Nihiser, A. J., Lee, S. M., Wechsler, H., McKenna, M., Odom, E., Reinold, C., … & Grummer‐Strawn, L. (2017). Body mass index measurement in schools. Journal of School Health, 77(10), 651-671.

Sliwa, S. A., Brener, N. D., Lundeen, E. A., & Lee, S. M. (2019). Do schools that screen for body mass index have recommended safeguards in place?. The Journal of School Nursing, 35(4), 299-308.

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Obesity in Woodbury Iowa

Obesity in Woodbury Iowa
Obesity in Woodbury Iowa

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Obesity in Woodbury Iowa

Obesity in Woodbury Iowa is a significant public health concern. The prevalence of obesity in in Woodbury County Iowa is 38.3 % among the females. In Iowa State, the prevalence of obesity among the females is 35.9% while the prevalence of obesity among the females at the federal level is 36.1%.

Therefore, the prevalence of obesity among the females in Woodbury County exceeds the Iowa state and the national statistics. 37.5 % of the men in Woodbury County, Iowa, are obese. At the state and the national levels, 36.3% and 33.8% of men are obese respectively (Centre for Disease Pprevention and Control, 2015). Similarly, the prevalence of obesity among the men in Woodbury County, Iowa, supersedes both the state and the national prevalence rates.

Obesity in Woodbury Iowa

Contributing Factors

Obesity is affected by both the race and age. In Iowa, the prevalence of obesity is highest among the Hispanics and Non-Hispanic blacks and lowest among the Non-Hispanic whites. Obesity increases with age and is mostly affects adults aged 60 years and above and is lowest among the adults aged 20 to 39 years of age. The level of education impacts on obesity as well (Office Of Disease Prevention and Promotion , 2018 ).

Obesity reduces with the increase in the level of education. Education increases the level of awareness on the factors associated with obesity as the preventive measures. Obese patients who have a diploma or a degree have shown increased life expectancy.  The positive impact of education on obesity is uniform across all age groups. 

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The level of income impacts obesity as well. Higher levels of income are associated with reduction in the prevalence, the severity and the effects of obesity. Higher levels income impact on the access to healthcare services. Families that can afford insurance policies or out of pocket payments access healthcare services for managing obesity. Therefore, the prevalence of obesity among such individuals is reduced, as compared to individuals in lower socio-economic class.

Individuals with low income cannot afford the foods that are nutrient intensive. Generally, the foods that are sugar and fat intensive are cheap in the United States markets. Sugar and fats are predisposing factors to obesity.   Culture affects obesity. Culture dictates the type of foods that the members of the particular culture dependent on as food. Culture also affects health seeking behavior (ODPP, 2018).

Culture impacts on the perception of the specific cultural group on the engagement in physical activities that significantly affect obesity. Healthcare policies determine the impact of obesity to any community.  Healthcare policies determine the access by the respective members of the community to healthcare services regarding the management of obesity.

Healthcare politicizes on financing healthcare determine the access to care for obese to the individuals who cannot afford the care. Healthcare policies also affect the availability of resources and facilities for managing obesity. The county’s and the national policies in managing healthcare community services such facilities for physical exercises and educational resources and personnel are key to implement obesity management strategies (Galloway-Gilliam, 2013).  

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Obesity in Woodbury Iowa

Interventions  

One of the programs that have been undertaken in my state to prevent obesity is early childhood care. Statistics indicate that on average, children spend most of their time per week under non-parental care.

The State of Iowa in partnerships with the Center for Disease Control and Prevention (CDC)  have drawn up programs on adequate diet, performance of  physical activities and reduction in care time. The state government supports the programs in schools and children care centers through funding, provisions of evidence based recommendation for early child care to prevent obesity (Benson at al., 2013).

The programs support the breastfeeding mothers and the availability of nutrient rich diet to the children that prevents obesity.  The hospitals within my community have initiated hospital strategies aimed at reducing obesity. The initiative targets the hospital employees and the patient under the care. The initiatives encourage healthy food and beverage choices, physical activities within the hospitals environment and support for lactating mothers.  

The hospitals also partner with the community to increase healthy living behaviors for the community members. The hospitals provide education on obesity prevention and management using the locally available resources.

Obesity in Woodbury Iowa

Scope and Role of Nursing and Public Health Nursing on Obesity in Woodbury Iowa

Nurses have a role in encouraging patients to maintain healthy diet. Nurses possess the knowledge on the foods that contribute towards obesity and that prevent the occurrence of obesity. Nurses spend a significant amount of time with admitted patients. Additionally, nurses interact with patient at the community level in offering primary healthcare services.  Nurses educate patients on physical activities as part of the measures to prevent obesity as a public health issue.

Physical exercises reduce the amount of fats that accumulate in the body. Nurses educate on the type, the duration and the intensity of the physical exercises that are appropriate for each of the patients presenting with or at risk of obesity. Nurses conduct assessments of patients who present with obesity. Nurses provide care to a patient in clinical setting. Assessment is the initial step of the nursing process (Schofield et al., 2011).

Assessment, as part of the nursing process, involves collection of data about the patient thorough history taking, physical examination, and clinical tests. Nurses take history of patients on their diet, performance of physical activities, and the impact of obesity on every individual patient during the clinical visits. The nurse also conduct laboratory tests including lipid profile tests in order to assess the risks of development of cardiovascular disease as a complication of obesity.  Part of the nurses’ assessment focuses on vital signs such as blood pressure measurements.

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Expansion of the Scope of Obesity in Woodbury Iowa

One of the ways to increase the scope of community health nursing interventions in addressing obesity is through partnerships.  Community partnerships involve creation of community based networks. The collaboration with the population level partners allows the nurses and public health professionals to gauge the factors that contribute to obesity the community level.

The aim of the partnerships should be to do community specific assessments on the prevalence, causes, and impacts of obesity on the local community (Betancourt, Green, Carrillo, & Firempong, 2016). Further, the aims of the local community partnerships should be to recommend, initiate and implement strategies that are suitable for the local community , based on the population specific needs identified during the assessment.

Policy development is another way of increasing the scope of the nurses’ and public health professionals’ roles in combating obesity.  Nurses and public health professionals are key stakeholders in managing obesity, as a public health issue. The professional input is critical in developing policies that are specific to the local community population.

The professionals collaborate with the department of health, which is responsible for drafting policies for public healthcare such as obesity ((Betancourt et al., 2016). The public health issues should be alignments with the national statistics on obesity, ways of preventing obesity and the federal government’s regulation in combating public health problems.

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References

Benson, G. A., Sidebottom, A., VanWormer, J. J., Boucher, J. L., Stephens, C., & Krikava, J. (2013). HeartBeat connections: A rural community of solution for cardiovascular health. Journal of the American Board of Family Medicine, 26(3), 299–310.

Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports.

CDC. www.cdc.gov. (19 August 2015). 13 December 2018 https://www.cdc.gov/ dnpao/division-information/policy/obesity.htm>.

Galloway-Gilliam, L. (2013). Racial and ethnic approaches to community health. National Civic Review, 102(4), 46–48.Course Library Guide.

Office of Disease Prevention and Health. (12 December 2018 ). 12 Decembe 2018 <https://www.healthypeople.gov/>.

Schofield, R., Ganann, R., Brooks, S., McGugan, J., Bona, K. D., Betker, C., Dilworth, K., … Watson, C. (2011). Community health nursing vision for 2020: Shaping the future. Western Journal of Nursing Research, 33(8),1047–1068.

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Positive Health Behaviors Essay

Positive Health Behaviors
Positive Health Behaviors

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Positive Health Behaviors

One of the most basic instruments of modern public health and preventive medicine is disease screening and positive health behaviors. Screening programs have a long and illustrious history in efforts to prevent infectious disease outbreaks and focus chronic illness therapy. Pregnant women are frequently tested for a complete blood count, blood type, diabetes, syphilis, and other diseases. The approach of disease screening has been demonstrated to save lives, save health-care expenditures, and alleviate suffering.

Breast and cervical cancer screening has been particularly effective in decreasing the disease burden in women (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005). Health screenings should be a top priority for everyone to promote good health. some of the most important advantages of health screening Early diagnosis of illnesses can lead to improved treatment and management, lowering the risk of complications and improving the odds of a positive health outcome.

Positive Health Behaviors

Health screening determines if a patient is at risk for, or already has, a disease or condition (Farrington & Mikkelsen, 2020). Furthermore, health screening can aid in the prevention of cardiovascular disease, stroke, and diabetes in those who have a family history of these conditions, as well as offer prompt treatment (Farrington & Mikkelsen, 2020). Age is a key risk factor for a wide range of life-altering illnesses. Early identification and treatment, on the other hand, might provide the body with the strongest resistance against these disorders (Farrington & Mikkelsen, 2020).

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Positive Health Behaviors

Screening, however, can be harmful. When three characteristics of screening programs work in concert, the impact is greater than often recognized. As an example due to the fact that the majority of people who are checked do not have the illness, screening can potentially damage more people than it can help (Farrington & Mikkelsen, 2020). There will always be false positives and negatives since screening tests are not 100 percent sensitive or specific.

Early identification of diseases can lead to overdiagnosis, which is when a person is diagnosed with a condition that will never damage them in their lifetime (Farrington & Mikkelsen, 2020). Also, the ability to reach the desired audience, load on the government, and how everyone involved approaches the problem. Every Woman Counts initiative, which aimed to provide women with preventative health care, proved ineffectual.

In looking at the enrollees in the Nebraska Every Woman Matters program who were getting checked for breast and cervical cancer, it was discovered that there was a link between socio-demographic factors and obtaining cancer screening. As a result, getting cancer screening services is hampered by people’s social position, income, and knowledge.

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Because the advantages and risks of screening are diverse in nature and are assessed and valued differently, it’s impossible to compare them. Valuing benefits and harm is affected by such things as the economic capability of individuals. That is why organizations such as Every Woman Matters (EWM) which is a state-run federally funded program were formed to reduce financial and public awareness barriers to preventative breast and cervical cancer screening by improving public knowledge of the danger and making screening more affordable for low-income women (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005).

A clinical breast examination, mammography, and Papanicolaou smear test are provided at a reduced or free cost to eligible women. Practices can use the EWM program’s services to help them implement the program. With the aim to reduce the number and impact of risks as well as improving their service delivery in hospitals and clinics, the EWM program conducted an analysis using the GAPS method (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005).

They included office employees at each phase of the GAPS model to improve preventive care and alter office operations: goal-setting, analyzing existing routines, planning routine modification, and giving support for these improvements (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005). The findings of the analysis showed that the main reasons why program was not effective in meeting its preset goals include lack of enthusiasm from some physicians and staff, lack of leadership skills of individuals who are in charge of the facilities and also organizational problems hence some internal instability (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005).

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Despite the obstacles that prevented large improvements in screening in some of the practices, we feel the GAPS model’s ideas are valid and propose it as a realistic structure for bringing desired change to a complex organizational system like a clinical practice (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005). In addition, additional process factors like as leadership, cohesion, resources, and shared vision were emphasized in our research (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005).

Positive Health Behaviors

There are a good number of successful advocacy programs for early cancer screening and evaluate the characteristics that are deemed effective and are given credit for the work they do. A good example is the American Cancer Society who promote a healthy lifestyle to help prevent cancer for all people. By supporting cancer advocacy in nations with growing cancer societies, the ACS has taken a leadership position in global cancer advocacy (ACS, n.d.).

The centerpiece of the ACS global effort is training international cancer control leaders through the American Cancer Society University (ACSU) in all aspects of running a community-based cancer control organization or program (ACS, n.d.). The ACSU program begins with a week-long course, which is held a few times each year in different parts of the world, followed by support of participants in home countries (ACS, n.d.).

This society donates millions of dollars annually to cancer clinics and hospitals, all of which is utilized in cancer research, cancer prevention, cancer screening and many other services (ACS, n.d.). Another such organization is The International Union Against Cancer, also known as UICC, which is the most prominent and inclusive international body dedicated to cancer control. It is a membership organization with a small administrative head office, with controlling committees made up of volunteers (Mortara, 2011).

The World Cancer Congress, conducted every two years in a large city, most recently in Washington, DC in 2006, is the most conspicuous UICC activity (Mortara, 2011). Thousands of people from all walks of life attend these conferences, the vast majority of whom are from high-income nations, but with a growing focus on establishing efficient cancer management in those countries (Mortara, 2011).

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Positive Health Behaviors

Those involved in the health care system, nurses, physicians, patients, and others play increasingly interdependent roles. Problems arise every day that do not have easy or singular solutions. Leaders who merely give directions and expect them to be followed will not succeed in this environment.

What is needed is a style of leadership that involves working with others as full partners in a context of mutual respect and collaboration. To accomplish the objective of a reformed health-care system, strong leadership will be necessary. Strong leadership is critical if the vision of a transformed health care system is to be realized.

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References

Backer, E. L., Gesk, J. A., McIlvain, H. E., Dodendorf, D. M., & Minier, W. C. (2005). Improving Female Preventive Health Care Delivery Through Practice Change: An Every Woman Matters Study. The Journal of the American Board of Family Medicine.

Farrington, J., & Mikkelsen, B. (2020). Screening programmes: a short guide. Copenhagen: World Health Organization.

Mortara, I. (2011, July 18). The International Union Against Cancer. From touch oncology: https://touchoncology.com/immunotherapy/journal-articles/the-international-union-against-cancer/

ACS. (n.d.). Facts About the American Cancer Society. From American Cancer Society: https://www.cancer.org/about-us/who-we-are/fact-sheet.html

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Neonatal Resuscitation Research Paper

Neonatal Resuscitation
Neonatal Resuscitation

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Neonatal Resuscitation

Introduction

Is there a thing that is as defenseless and precious as a baby who is newly born? I agree with the fact that thousands of babies in the United States are premature before their small bodies can sustain life.  The normal time needed for a fetus to be fully developed in to a normal baby is usually thirty six to forty weeks. Premature infants therefore, are those born before the thirty sixth week.

Infants born before the twenty sixth gestation week have anatomically underdeveloped lungs and, they cannot physiologically support ventilation. I appreciate that there has been giant leaps forward within the last decades which has enabled us all but the most premature and smallest infants.

Currently, analyzing the Millennium Development Goals on Neonatal resuscitation in the developing world indicates that there is an impressive progress in child health. However, there is barely any notable achievement as far as neonatal health is concerned. Neonatal deaths’ proportion (death within the initial twenty eight days) is anticipated to increase as a result of the reduction in postneonatal deaths burden.  

The World Health Statistics shows that the health-related MDGs indicate that approximately thirty seven percent of the under-five mortality is usually within the neonatal period. Most deaths occur during the first week (early neonatal period). More than one million neonates lose their life within the first twenty four hours as a result of poor quality care, globally and annually.

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Continuum of Care

The key principle in developing strategies aimed at addressing (NHC) Neonatal Health Care revolves within the continuum of care. Throughout the lifecycle, including childhood, childbirth, pregnancy and adolescence, the care need to be offered as a seamless continuum spanning the health center, community and home, globally and locally (Atkins and Murphy, 1994, 50).  Therefore, decreasing child mortality depends entirely on managing neonatal mortality or otherwise, tackling Neonatal Health Care.

Personal Experience

I am a RRT (Registered Respiratory Therapist) and have worked in NICU (Neonatal Intensive Care Unit). Additionally, I have visited many other units as part of the duties as a Respiratory Care nurse. I have experienced the procedures and tests, the angst and waiting as well as the sensitive roller coaster of emotions that both parents and child endure. In case the infant is developed adequately and is strong enough for survival, there is anxiety concerning the quality of life for the child and the family that has to cater for the child’s specific needs.

Is the cost measurable in terms of real dollars and emotionally? Mezirow (1990) argues the mortality and morbidity rates in particularly low birth weight children is remarkably high; it is in fact, so high that the sole ethical choice is to leave them die a painless and natural death. Infants that are born before the twenty fourth gestation week need not be resuscitated for financial, medical and ethical reasons.

Medical ethic principles are justice, beneficence, non-maleficence and respect for autonomy. These principles act as the guideline for health care professionals when dealing with all their patients. There is no exception. Respect for autonomy recognizes “the patient has the capacity to act intentionally, with understanding, and without controlling influences that would mitigate against a free and voluntary act” (Lim et al, 2000, 492).

In the case of neonates, the biological parents have the responsibility of making the child’s health care decisions, as far as ethics in medicine is concerned. The non-maleficence principle implies that healthcare professionals should not create needless injury or harm intentionally to the patient, either with omission or commission acts. All procedures ad tests should have their benefits weighed. Beneficence can be defined as “the duty of health care providers to be of a benefit to the patient, as well as to take positive steps to prevent and to remove harm from the patient”.

In respect to the justice principle, each patient should be given what is rightfully theirs. Equal persons should be given equal treatment (Speck, 1985, 93).  Moreover, patients need to be treated with honesty and dignity, and together with their families, the healthcare community’s total disclosure is necessary so that they are able to make informed decisions. Even if, a health care professional does not agree with the decision made, it is necessary to treat the patient with dignity; the choice should be respected.

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My Critical Experience

From my many years of practice as a nurse, I choose this critical experience since it was tremendously emotional and had a profound impact on me until today. Douglas was delivered at twenty five weeks of gestation with a weight of five hundred and fifty grams. He was born spontaneously preterm in vertex presentation. His primigravida single mother, Annette, had pre-eclampsia which led to the preterm birth.

Annette was given a dose of steroids thereby delivering Douglas within the next hour. Using antenatal steroids is considered as critical intervention in anticipation of prematurity which improves preterm babies outcome (Teasdale, 2000, 581).

At birth, Douglas’ condition was critical and therefore, the need for resuscitation. As mentioned earlier, surfactant treatment is administered to preterm infants having respiratory distress since they lack a protein referred to as surfactant which prevents the lung’s small air sacs from collapsing. Douglas was therefore given surfactant treatment together with a breathing mechanical ventilator aid so that his lungs could remain expanded.

The boy’s condition improved, and he was successfully transferred to CPAP (Continuous Positive Airway Pressure).  This was aimed at delivering pressurized air to his lings via small tubes in the nose to help in breathing. Douglas developed bleeding in the brain (intracranial bleed) of grade III on the second day. Intracranial bleed is prevalent during the first 3 days of life and an ultrasound examination diagnoses it. Mild intracranial bleeds resolve themselves and no of few lasting problems (Miles, 1989, 71).

More severe bleeds cause the brain ventricles to expand rapidly, causing brain pressure which brings about permanent brain damage. The results are neuro developmental delay or cerebral palsy. Douglas also had PDA (Patent Ductus Arteriosus), a common heart problem in premature babies. This however did not need treatment as it was small.

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Irrespective of the boy’s critical condition during the first week in life, there was an improvement in his general condition. Naso-gastric tube feeds started being used, and intravenous fluids stopped (Shields-Poe and Pinelli, 1997, 32).  While still an inpatient at the hospital, Annette visited Douglas for 2 days during which she was updated of his critical condition. Annette did not bond with her son comfortably, although the nurses encouraged her to.

She gave excuses so that she could not express milk and therefore Douglas was fed with donor breast milk. On the 3rd day, she was discharged, and she visited only once every week. However, she called nurses most of the times to enquire about his progress. Annette’s behavior was brought to the attention of a social worker, and it was reviewed. When I was delegated to look after Douglas, I met the mother once during which I spoke with her and encouraged her to hold and touch the baby which she did.

On the 22nd day after birth, the CPAP was working for Douglas; he could tolerate the feeds and was adding weight. For the six days I took care of him, his general condition was satisfactory. Annette called at nights to check on Douglas’ condition. I informed her he was stable with a 30 grams weight gain. She was enthralled and promised to come the following day.

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On my seventh night duty, on the twenty eight days after birth, I was surprised to meet Douglas re-intubated and on Nitric oxide high frequency mode ventilator. Douglas has developed PPHN (Persistent Pulmonary Hypertension), stopped breathing and was cyanotic. According to Wood (2009), preterm PPHN is linked to high risk adverse neurodevelopmental and health outcomes. To date, it is among the most complicated conditions experienced in NICU.

His critical condition made him be supported using various intravenous infusions, among them morphine to manage pain. Annette had visited at day time and cuddled her baby. She also has a social talk with the in-charge nurse and she was to come during the evening and stay overnight with her son. Unfortunately, Douglas succumbed to cyanotic attack after she left. She was updated of this on her way back to the hospital. On arrival, Annette and the friend she had come with were confused to see the extreme technical situation surrounding the boy.

I offered a drink and a chair to Annette. The serving consultant counseled her and recommended the life support to be withdrawn since Douglas IVH was at grade IV. Annette was unable to decide on the care withdrawal. She begged to leave and come back with her mother the following morning to discuss the situation further and come up with a decision. She immediately left.

At NICU, 4 nurses are delegated with the responsibility of receiving admissions from the theatre and labor ward and taking care of sick babies. We were 3 three nurses that night as a result of staff shortage. An emergency came from the clinical nurse manager from the labor room. One of the nurses rushed to the labor room and brought back twenty eight weeks preterm Mark who was intubated. He required medications and infusions and since his condition was grave, attention was focused to him.

After Mark settled, I was beside Douglas when I realized that his heart rate had gone down to 120 per minute from the usual 160 per minute. The consultant agreed with me that nothing more could be done. The morphine infusion had to be increased to manage pain (Reid, 1993, 307). I called Annette as they were driving home with the friend to inform her of the development. She confirmed that she would come back the following with her mother as earlier agreed.

I touched Douglas’s hand soothingly and wished Annette was there to console and hold him. Suddenly, the nurse attending to Mark called out for drugs as Mark had developed cardiac arrest. We worked to resuscitate Mark but I could see that Douglas was also going in to an arrest since there was continuous drop in the heart rate. Mark was the priority at the moment but I wished I could go over to Douglas and console him.

His monitor stopped indicating vital signs. Mark died shortly after Douglas. We did all we could have done to save the two lives but as with hundreds of other babies, we were unsuccessful.  The social worker had to follow Annette to provide further care.

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The Care of Premature Newborns

“Good ethics begin with compelling facts” is a guiding principle when dealing with ethical care for premature newborns. So as to make a profound decision, the first thing is the qualified obstetrician to assess and gather all the necessary information utilizing all the available resources. Consequently, the parents need to be informed in a way that they can understand (respect for autonomy).

“It should be emphasized that there is some uncertainty with any predictive process, because every infant is unique. The prognosis for the fetus may change after birth, when a more accurate assessment of the gestational age and actual condition can be made” (Daly et al, 2004, 2).After the fetal weight and gestational age are determined; the parents should be presented with the facts and counseled on the child’s possible outcomes.

It is imperative that the health care team and physician address the process of decision making as a team, together with the parents. Moreover, the parent’s belief system and desires as well as the child’s needs should be kept at the forefront. The Journal Pediatrics have categorized the treatment decisions and summarized them on prognosis basis as:

1.         In case there is a high likelihood of early death and survival would encompass high risk of morbidity that is unacceptably severe: intensive care not indicated.

2.         In case there is a likelihood of survival and the risk of inadmissibly severe morbidity is small: indicate intensive care.

3.         In cases that fall within the mentioned categories and there is uncertain prognosis and likely extraordinarily poor, and survival encompasses diminished child’s quality of life, parental desires determine the approach for treatment. (Carkhuff, 1996, 211).

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During the last few decades, there has been an improvement in the prognosis for tremendously premature infants. However, many of the exceptionally small and extremely premature infants die or possess a morbidity rate that is unacceptably high. In this population, the medical complications are usually profound and complicated. Some complications result from the birth event and others are congenital defects. Majority of the morbidities are linked to immature lung development.

Fetuses produce surfactant, an essential proper lung function protein, at the age of thirty two weeks. Surfactant deficiency is treated by medical science by refining and producing porcine and bovine surfactant. However, this is usually not as effective compared to native surfactant.  There is the instantaneous complication of reduced delivery of oxygen to the brain, organs and blood. Besides this, the long term complication is anoxia, brain injury as a result of inadequate oxygen supply to the brain. High morbidity rates attract the greatest categories of complications.

Majority of the morbidities bring about profound and severe disabilities, and cause early demise (Murphy et al, 2003, 227). The mortality rate of neonates in this group is relatively high, and the severe to moderate morbidity rate is more than fifty percent. It is worth noting that the statistics for very small and very premature neonates indicate a one hundred percent mortality rate. These children possess physical limitations and abnormalities that they have to bear with for their entire lives and which their families need to provide care. The outstanding care is extremely expensive and emotionally exhausting.

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Reflect on the cost of offering care to late preterm vs a term infant. Late preterm have far much less complications as well as complicated medical needs as opposed to Extremely Low Birth Weight (ELBW) neonates, and yet the cost of caring for them during their 1st year of life is astoundingly vast. The cost for taking care of a premature infant who is late term is three times more the cost for term infants.

Extremely Low Birth Weight neonates’ cost is six times a term infant’s cost, if the infant survives. At a national level, the cost for ELBW’s care is staggering. United States spends 5.8 billion dollars annually (Raeside, 2000, 98).  This represents forty seven percent of all infant hospitalization costs and twenty seven of all pediatric stays. 65, 600 dollars is the average cost, where the least viable consume most of the resources.

The figures refer to the initial hospital stay costs. This is the first care as far as caring for children with profound or severe disabilities are concerned. Is this burden fair to the society? These are some of the prevailing questions in the light of the discussion on medicine socialization and healthcare coverage. What is the belief of the society on the value of life? Can a baby’s existence be replaced with the dollar value?

Considering that resources are infinite, should they be used on the few neonates and leave the majority to share the smaller percentage? (Schmieding, 1999, 636). What if it is my child is among those that require disproportionate resources and care to survive? What if my child is among those being given a normal care level since there are few providers as majority of the providers are focused on ELBW who need the highest care level? The answer to these questions will vary depending on the role of a person; a parent, health care consumer or a provider.

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Figure 1: Grave Neonatal Morbidities in < 750 g Birth Weight Infants in the National Institute of Child Health and Human Development Neonatal Centers, 1995-1996

ConditionFrequency of Morbidities (%)Range 
Respiratory Distress Syndrome78        54-97 
Oxygen required at twenty eight days after birth                    8164-92
Chronic Lung Disease             528-86
Necrotizing Enterocolitis                     149-38
Septicemia                   4830-64
Grade 3 intraventricular hemorrhage              136-29
Grade 4 intraventricular hemorrhage              133-26
Periventricular Leukomalacia             72-30
Growth failure             10092-100

This data is for infants who are alive at twenty days (Cotton, 2001, 515).

Conclusion

Preterm neonates require extensive care to ensure their survival. Major challenges that make this goal ineffective include inadequate nurses and medication. More than often, care has to shift to neonates who require immediate attention. It is sue to these reasons that neonate mortality is still high although there has been an improvement in child care as per the MDGs. It takes a lot of courage to work as a nurse and especially when emphatic with the mother to the neonate infant.

Bibliography

Atkins, S. and Murphy, K. (1994) “Reflective Practice.” Journal of Nursing Standard, Vol. 8, iss. 39, 49-56.

Carkhuff, M. H. (1996) “Reflective learning: work groups as learning groups.” Journal of Continuing Education in Nursing, Vol. 27, iss. 5, 209–214.

Cotton, A. H. (2001) “Private thoughts in public spheres: issues in reflection and reflective practices in nursing.” Journal of Advanced Nursing, Vol. 364, iss. 4, 512-519.

Daly, J. Chang, E. and Jackson, D. (2004) “Quality of work life in nursing: Some issues and challenges.” Journal of the Royal College of Nursing, Vol. 13, iss. 4, 2.

Lim, J. J., Childs. J. and Gonsalves, K. (2000) “Critical incident stress management.” The Journal of American association of occupational health nursing, Vol. 48, iss. 10, 487–497.

Mezirow, J. (1990) Fostering critical reflection in adulthood: a guide to transformative and emancipatory learning. Jossey-Bass.

Miles, M. S. (1989) “Parents of chronically ill premature infants: sources of stress.”Journal of Critical Care Nursing Quarterly, Vol. 12, iss. 3, 69-74.

Murphy, F. C., Smith, I. N. and Lawrence, A. D. (2003) “Functional neuroanatomy of emotions: A meta-analysis.” The journal of Cognitive, Affective, & Behavioral Neuroscience, Vol. 3, iss.  3, 207-233.

Raeside, L (2000) “Caring for dying babies: perceptions of neonatal nurses.” Journal of Neonatal Nursing,Vol. 6, iss. 93-99.

Reid, B. (1993) “But we’re doing it already”, Exploring a response to the concept of reflective practice in order to improve its facilitation.” Journal of Nurse Education Today, Vol. 13, iss. 4, 305-309.

Schmieding, N. J. (1999) “Reflective inquiry framework for nurse administrators.” Journal of Advanced Nursing, Vol. 30, iss. 3, 631–639.

Shields-Poe, D. and Pinelli, J. (1997) “Variables associated with parental stress in neonatal intensive care units.”Journal of Neonatal Network, Vol. 16, iss. 1, 29-37.

Speck, P. (1985) “Counselling on death and dying.”British Journal of Guidance and Counselling, Vol. 13, iss. 1, 89-97.

Teasdale, K. (2000) “Practical approaches to clinical supervision.”The journal of Professional Nurse,Vol. 15, iss. 9, 579–582.

Wood, J. T. (2009) Interpersonal Communication: Everyday Encounters. Cengage learning.

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1959 Tobacco Campaign Essay Paper

1959 Tobacco Campaign
1959 Tobacco Campaign

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1959 Tobacco Campaign 

Literature and Critique on the 1959 Tobacco Campaign in the United States

Introduction 

Tobacco advertising campaign used the Marlboro man as a figure to represent the Marlboro cigarettes. This icon figure was used in the United States from 1954 to 1999. In 1954 Leo Burnett Worldwide was the first advertising firm to conceive the Marlboro man. The Marlboro man was an image which comprised of rugged cowboys with a cigarette. Such advertisements were initially introduced to make the filtered cigarettes more popular which were originally considered to be feminine in nature (Amos and Haglund, 2000).

This advert was considered to be one of the most successful and brilliant promotional campaigns of all times. The feminine campaign was transformed using the slogan “Mild as May” in a very short time into a masculine advert. The cowboys proved to be more popular when used as Marlboro men despite there being a variety of other men who could be used as Marlboro men. The popularity of the advert led into the origin of ‘Marlboro country’ and ‘Marlboro cowboy’. This essay will offer a critique of the Marlboro advertisement campaign; both the positive and negative effects of the promotion in United States.

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1959 Tobacco Campaign 

Origin of the Campaign

The Marlboro brand was first initiated as cigarettes for women in 1924 by Philip Morris & Co. owing to the harmful effects of smoking established by scientific in 1950 the cigarette industry shifted their attention to filtered cigarettes. Nevertheless, Marlboro filtered cigarettes was presumed to be women’s brands and therefore Leo Burnett the advertising executive had to look for a different image  have an appeal to a larger market.

Consequentially, the firm noticed that there were some emerging trends among the teenagers who wanted to declare their autonomy from their parents through smoking. As a result of this discovery the firm had had to focus their attention to this group of consumers. 

Though scientific questions were posed concerning the contents of the filters the advertising executive reasoned that it was meant to reduce the harmful effects. With this stand he completely refused to respond to health claims of smoking Marlboro brand of cigarettes. Burnett continued to be inspired into creating an icon figure of Marlboro man and as a result the icon came in 1949 to represent masculine icon (Buckley, 1982).

The Texas cowboy- Clarence Hailey Long story came to his attention in an issue of life magazine where the new Marlboro now represented images of other masculine occupations such as gunsmiths, sea captains and athletes tough more attention was placed on the cowboy image as the Marlboro man (Thomas, 1991).

1959 Tobacco Campaign

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Marlboro man icon 

Owing to the failure of the paid models of Marlboro men who lacked authenticity, Burnett came across a cowboy actor Darrell Winfield working as a cowboy on a ranch. Darrell Winfield represented Marlboro man for a period of 20 years until 1980 when he retired (Sanz and Johnson, 1990). So much was spent looking for another icon of Marlboro where another figure came up by the name Brad Johnson in 1987 (Marken and Anzeigen, 1975).

Success or Failure of the advert

Quite a substantial amount of sales were recorded due to the immediate effect of the Marlboro man Campaign (Moellinger and Craig, 1972). The sales skyrocketed from $5 billion in 1955 when the Marlboro man campaign was conceived to $ 20 billion by 1957 which was quite significant representing 300% increase in a span of two years only!

The rising health concerns were overcome through the Marlboro Man campaign as the advertising campaign focused more on the success (Barry, 1997). Eventually heavy imitation was observed with use of Marlboro Man where other executives invented new taglines such as “independent thinkers”, “Men of America” in relation to smoking Marlboro brands (Schudson, 1984).

It is however discerning to notice that all the three men who made appearances in the Marlboro promotions succumbed to lung cancer. These were; David McLean, Wayne McLaren, and Dick Hammer.  The Marlboro Brands of cigarettes were branded as ‘cowboy Killers’. As a matter of fact McLaren had to testify in support of anti-smoking legislation, nevertheless, Philip Morris refuted the claims that McLaren ever appeared in the Marlboro Man campaign. Before his 52nd birthday in 1992 McLaren succumbed to lung cancer. 

1959 Tobacco Campaign

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Various concerns raised in America on Marlboro Man campaign

Various activists came up to oppose the use of Marlboro Man campaign and launched anti-smoking. The World Health organization claims if unchecked there will be a death rise due to cigarette smoking to 10 million people per year from 4 million reported yearly cases. Though the consumers were fully aware of the harmful effects of cigarette smoking they continue to smoke owing to the effects of the Marlboro Man campaign (Rollin, 1997)).

It was and it is still quite alarming that the number of lawsuits and damages claimed are in billions of dollars including numerous files opened of Philip Morris owing to the advertisement especially in Florida and Minnesota’s States (Henry, 2007).

Eventually, the sales in Marlboro brands recorded a huge drop due to imposition of government restrictions on cigarette advertisement. The marketing approach for the brands had to shift their strategies. Hence Philip Morris changed to negotiations strategies with the relevant authorities into reducing the smoking habits (Michael, 2000)

1959 Tobacco Campaign

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Conclusion    

Despite the change of tactics for the Marlboro Man campaign, much is needed to be done concerning tobacco adverts by Marlboro brands. The campaigns have changed into making smokers to have a lifelong of smoking. In spite of the growing health concerns in relation to smoking, many people have continued to use the Marlboro brands because they want to be seen like real men. The ladies want to feel a sense of independence; the teenagers want to show a sign of rebellion to their parents by smoking Marlboro brands.

The menace of smoking cannot be put to a stop if the anti-smoking campaign does not begin at the grassroots level through sensitizing of youth and other smoking against smoking. The government has a big role to play as observed through exercising of strict anti-smoking campaigns in the United States and completely banning any form of promotion for Marlboro brands and other brands as they have proved to more influential.

References 

Amos, A. & Haglund, M. (2000), from social taboo to torch of freedom: the marketing of  Cigarettes to women, Tobacco Control, 9, 3-8

Barry, A. M. (1997). Visual Intelligence: Perception, Image and Manipulation in Visual Communications, Albany: State University of New York Press.

Bernard E. Rollin, (1997), Harley-Davidson and philosophy: full-throttle Aristotle, Open Court Publishing

Buckley, K. W. (1982). The selling of a psychologist: John Broadus Watson and the application Of behavioral techniques to advertising, Journal of the History of the Behavioral Sciences, 18(3), 207-221

Cynthia Sanz, Kristina Johnson, (1990), an Ex-Marlboro Man Who Can Really Ride, Brad Johnson Adds Sigh Appeal to Always, People’s Magazine, vol. 33 no 7

Heiße Marken, Coole Anzeigen, (1975), Come to Marlboro Country”1975 US ad campaign, Brand Hot

Kevin Thomas, (1991), MOVIE REVIEW: ‘Harley Davidson, Marlboro’ . . . Lively but Ludicrous, Los Angeles Times

Michael Schudson (1984), Advertising, the Uneasy Persuasion: It’s Dubious Impact on American Society, New York: Basic Books, p. xiii and p 45.

Moellinger, T., & Craig, S. (n.d.). (1972) “So Rich, So Mild, So Fresh“: A Critical Look at TV Cigarette Commercials: 1948-1971.

Neil Henry, (2007) American Carnival: Journalism under Siege in an Age of New Media University of California Press

Schudson, Michael. (2000). Advertising as capitalist realism. Advertising & Society Review 1(1), 

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