Role of Arts in Health and Well-being

What role can the arts have in making someone feel better?

Respond to and critique this idea, exploring notions of “well-being”, illness and health and using 2 or three examples of practice.


CONTENTS

  1. P.1  Title
  2. P.2  Contents
  3. P3-15  Main Text
  4. P.16-7  Bibliography




I will respond to this question by first examining the language and definition of well-being and health.  I will then explore the question further with specific regard to the way applied arts can benefit community health, those at risk of social exclusion and intergenerational social harmony.  I will also reflect upon arts funding within a community well-being context, particularly; the difficulty of evaluating arts-based health projects, the decrease in core funding for education and social services and how the lack of “diversity” or depravation within a community can actually in itself lead to deprivation.

Using two examples of applied theatre in the Scottish Borders I will argue that the arts can help make participants feel better in a personal, non-medical sense. Through my analysis, I will conclude that the arts can be greatly beneficial to users but only within a strong, vibrant and holistic health service that properly funds and values the impact of artistic service providers.  I will argue that the Arts, when applied in the correct context with trained professionals, have the power to make people feel better in many complex and subtle ways.  Through my work as a youth theatre director and media tutor I see, first-hand, the benefit to, for example, participant’s self-confidence and self-esteem that can be achieved through ensemble drama and community arts projects.  I am also aware that the effect is not universal.  Therefore, whilst I will contend that Applied Theatre cannot be used to halt the effect of medical diagnoses, it can be used to shape the individual’s response to their symptoms, their feelings about it and how society can build more resilient and empowered communities.

As John Ashton, former president of the Faculty of Public health wrote in

Let’s Invest in Real Health:

“To make the best of our health and well-being, we need to make it intrinsic to the way we think and live. Our understanding of what good health means should run through our lives like the writing on a stick of Blackpool rock.” Ashton, 2014.

Like the letters in the rock Ashton refers to, I believe that all aspects of understanding how people can be “healthier” must be delicately woven into everyday life.  A holistic approach, empowering individuals to better understand their own “well-being”.  Societies that are educated from an early age about physical. mental, emotional, social and spiritual well-being.

Defining what “well-being” is however, can be elusive.  As Dr Katharine Low suggests:

“the notion of “well-being “is controversial.  Politicians and policy makers frequently refer to notions of well-being, but the goals and understandings of the term are quite different, as are their uses of the concept. “Low, 2017,

Performing Arts and Well-being

Much like the language used to describe an individual’s response to their own feelings of personal well-being, the concept of “well-being” is a personal response and varies between individuals, As Dr Low suggests, sometimes no common language exists to define a word that means different things to everyone.

Clarifying what “good health” means has long been difficult to define.  In Scotland the Getting it Right for Every Child (GIRFEC) approach is modelled on the United Nations Conventions on the Rights of the Child (UNCRC) and aims to provide support for all children and young people in Scotland.

The GIRFEC model “supports children and young people so that they can grow up feeling loved, safe and respected and can realise their full potential. At home, in school or the wider community, every child and young person should be: Safe, healthy, achieving, nurtured, active, respected, responsible and included (SHANARRI)” https://www.gov.scot/policies/girfec/principles-and-values/

The GIRFEC approach is reflected in all government policies which directly involve children, young people and their families and is cascaded down through government services, education and is adopted by all those who work with children and families.  In my view, by embedding the GIRFEC concept within all aspects of Scottish children’s lives the government have created a framework that both; allows partners to more clearly understand the objectives of the government and sets a very prescriptive and narrow set of restrictions on organisations working within the arts education sector.  As a practitioner I find it useful to have guidelines on working with young people but as a working professional it can sometimes be frustrating having to justify artistic decisions against targeted outcomes to receive funding.

Using the GIRFEC model, agencies that work within the arts and health field are more easily

able to align outcomes and objectives from projects as everyone is using the same language

around the “well-being” of the child.

Understanding how health, illness and “well-being” are different yet intrinsically connected is important when discussing how the arts can be used to help make someone feel better.   I don’t infer that applied arts can be used as “medicine” to treat ill health but rather to inform, to educate and to engage.

“Health” is another slippery concept. The World Health Organisation defines health as:

“A state of complete physical, mental and social well-being and not merely an absence of disease or infirmity” WHO constitution, 1948)

Yet, this definition does not really consider the individual’s response to their symptoms and general feeling of health and has not been amended since 1948. Individuals with the same symptoms may react and “feel” differently about their diagnoses.

“Whether or not someone is ill, is something the person concerned ultimately must decide for him- or her-self. But whether that person has a disease or is sick is something doctors and others may dispute.” Kenneth Boyd, 2000.

Boyd is distinguishing between “well-being”, the self determination of illness and the “medical” description of health. For example; a doctor may ask an individual to describe the pain they are experiencing on a scale of 1-10 to help diagnose, this self-diagnosis can only be applied to the individual and cannot be used in any forensic way.  My wife has given birth, her 10 and mine on the scale would be different and couldn’t really be compared.

In an arts and health environment, it is possible to alleviate physical and emotional symptoms of disease through the delivery of the ‘art’ itself; individuals recovering from a disease could for example regain greater mobility and motor skills as result of participating in circus skills and clowning workshops.  Simple exercises such as pretending to walk a tight rope can help improve someone’s balance and coordination and can help increase the distance and time someone can walk unaided., learning to juggle can help an individual’s motor skills and reflexes and clowning can help an individual greater understand how others are feeling. The combination of having fun, learning new skills and engaging in an activity not normally associated with older people, in addition to cardiovascular and physical exercise, is a small example of how increasing resilience within an individual be helped by the arts and that in turn can have a wider impact on the community through lowering reliance on services.

“a general definition of good health is impossible since health is always experienced and the value of each of us sets on different aspects will vary”

Matarsso, 2010.

Rather or in conclusion, to truly or better understand health, we must acknowledge that every individual is the keeper of their own interpretation of symptoms, feelings and “well-being”.  It is therefore my contention that applied arts must be bespoke, targeted and user-led if it is to have any impact on health.

Accordingly, I will now examine two examples of Applied Theatre whose practice I believe achieves these aims and also begin to explore the funding of Applied Arts projects.

“I Mind o’ that” is an intergenerational reminiscence project run by Borders Youth Theatre (BYT).  Working with rurally isolated communities in south east Scotland, BYT, supported by local windfarm goodwill funds, partners with a primary school and a local older people’s group to produce a piece of theatre based on the young people’s interpretation of the older people’s childhood memories.  The project, which runs for twelve weeks, sees the young people interview the older folk, record their memories and stories and produce a booklet of reminiscences that will be used to devise and produce a performance for the school and wider community.  The project compliments the Curriculum, is GIRFEC compliant, by covering aspects such as communication, comprehension and community as well as drama, music, media and technology.  The project, which is led by a youth drama worker and a retired head teacher, is now in its sixth year and has reached 12 primary schools and nearly 300 rurally isolated people.  Those living in rural areas often experience social isolation and poverty due to issues relating to lower population density, the disparate nature of rural settlements and geographical isolation.  In addition, issues such as low wages, higher fuel cost and infrequent local transport services can impact higher on groups such as older and younger people.

For many of the participants this is the first time they have interacted with the other constituency.

“I never talked to older people about their life in the past” (Pupil, Liliesleaf Primary School)

“I enjoyed reminiscing with young people” (Resident, Liliesleaf)

Over the weeks bonds emerge and both groups arrive early and are very excited to see the other.  Often these are tiny communities and older individuals can experience feelings of isolation and loneliness.  Simply knowing someone’s name and having spoken to them breaks down a barrier.  Being able to say hello, by name, to people who pass in the street is a tiny but very important way in which a community can feel safer and more together.  The benefits to the young people in terms of boosting self-esteem and confidence as well as learning new skills can be seen, and the older people also reported feeling more active and more prepared to try new things, but the main benefit is to the wider community; Both constituents of the reminisces projects view themselves as helping the other although the project is never pitched to them as that. So, by participating, both constituents get the sense of civic networking and belonging without feeling they are doing “worthwhile and worthy” work.  Both groups are equal participants, but both groups feel they are participating for the benefit of the other.  In seeing their childhood memories restaged by children, the older people feel better about themselves and their place in the community.

A similar project saw the Voice of My Own (VOMO) video project work with young people at risk of offending and exclusion in high schools in the Scottish Borders. The project had a restorative justice approach; allowing the young people to understand the effect of their offending behaviour upon the community and individuals and also helping the partners to reduce the anti-social and risk-taking behaviour of the service users.   The participants visited the local police station and met with police officers who had been arresting them, by simply having a conversation the participants come to realise that the individual police officers are helpful and friendly and want the best for them and their community.

Using film as a means of social engagement the project brought together local businesses, social services and the police to help create positive community links with young people.  A small moment, such as a young person at risk of offending behaviour playing a game of pool with an officer who has previously arrested them can create a positive link; both the officer and the young person are more able to see the other’s perspective, a dialogue can be opened in a non-threatening manner to discuss the causes of the young person’s offending behaviour and thus signpost them to additional services from which they may benefit.  The final work was filmed on location in a local shop that had been experiencing issues with shop lifting and anti-social behaviour.

The community benefits from better cohesion because the project helps to create more resilient individuals who feel valued and part of a stronger community and the funders and partners achieve their outcomes in line with national strategy.  In a wider health context by helping create more resilient and empowered individuals the overall burden to overly subscribed services, such as befriending or additional learning support, and to NHS and police services can be reduced.

By using the arts, in this instance film making, informal learning, such as learning how all the members of the team need to cooperate to achieve the objective, is able to take place in non-traditional settings.  Using applied arts can engage those disadvantaged and at risk who would otherwise not have the opportunity with an activity that is of interest to them and empower them to have a voice of their own.

Through improving the individual’s sense of “feeling good” and by raising aspiration and reducing future potential support requirements, such as youth offending services and social services, I argue that the wider community can benefit in many ways including: lower offending rates, reduction in anti-social behaviour, improved life style choices and an overall reduction in state and third sector dependence and expenditure.  I will later argue that funding for such projects is difficult to obtain and often bound by targets and directed too specifically.

By engaging participants in positive, user led activities designed to boost self-esteem, confidence and coping strategies the arts can help transform people’s feeling of “well-being”.  By offering a creative voice to those often unable or unwilling to express their feelings and opinions or in isolated circumstances the arts can help people feel better and to alleviate feelings associated with illness.

Those working in the field of Applied Theatre have an acute awareness that whilst the benefits to the way people feel about themselves are provable and worthwhile we must remain realistic about the impact our work can have in areas of medical health and curing disease.  Rather our work can benefit users towards leading a healthier lifestyle, helping individuals make informed and appropriate decisions and ultimately helping to create a more joined up and cohesive community.

Only by understanding that we need to treat people holistically, as John Ashton purports, within a wider National setting, such as GIRFEC aims to achieve and using a wide range of methods that complement existing services rather than seeking to replace them, like the “I Mind of That” project and the VOMO film club, will we truly be able to say that we are healthy.

Having investigated the examples above, I surmise that they illustrate the potential benefits and limitations of Applied Arts to Health and “Well-being” in as much as those words can mean following my earlier conclusions that the work must be bespoke, targeted and user-led. I will now reflect upon the area of arts funding.

In a period of enforced and political austerity, it is even more incumbent on those working within the field of applied arts and health to maximise the potential benefit to individuals.  However, this must not be at the expense of the quality and purpose of the work; local authorities and funding bodies are increasingly forced to work towards the governments strategic aims.  In order to qualify for just £7200 from the local council Arts project, LIVE Borders, BYT, a volunteer run charity must now, in addition to reporting quarterly to LIVE Borders Board about all their activities, complete comprehensive reports on how their work impacts and actively seeks to engage with young people transitioning from school, disadvantaged or non-engaging young people and looked after children. Not only does this place additional burden on already dedicated volunteers, it risks BYT adapting the way they work to meet the requirements sufficient to receive funding.  Using, for example, the GIRFEC model, to help determine need has real benefits however it also excludes companies and charities that don’t align with the SHANARRI targets.

Target based outcomes are difficult to evaluate within the arts as “change” can be difficult to evaluate and very “personal”.

Another example of this is funding bodies relying on traditional methods to determine need; the Scottish Index of Multiple Depravation 2016 is an extremely useful tool with which to determine areas requiring additional support, the interactive map allows the user to see at a glance which areas and categories funders are likely to use to determine need; crime, housing and health.  This also means, at a glance, one can see the areas that are disadvantaged in other ways that are not priorities on the index such as those I mentioned in the section above about the “I Mind o That” project.   In rurally isolated areas there may not be the base poverty experienced in cities, no area of Rural Scotland is within the bottom 10% of the most deprived decile on SIMD, but other disadvantages are in play such as lack of arts opportunities, lack of transport, lack of further education opportunities and low wages.

All young people who live in the Scottish Borders for example are disadvantaged according to the geographical access domain rating on the SIMD, but this ranks very low on funders priorities. In the 2011 Census, the Scottish Borders has a population that is 98.7% white.  This fact alone excludes charities working within the region from accessing key UK Government, Creative Scotland and Lotto funding as they are seen as “non-inclusive”.   The only SIMD funding organisations can properly access in the Scottish Borders is via the three areas in the region that rank below the 5

th

decile.  This leads to the absurd situation where a very small number of people are targeted for all the resources allocated.  During one period last year in one of the three small areas on the SIMD lower decile in the Borders, there were applied arts practice in dance, drama, film, graffiti, poetry, music and art all running simultaneously.  Those identified as potentially benefiting from services are often “frequent flyers”, individuals who have complex and long-standing issues within their lives that cannot be solved by the arts alone.  Too often the only service these individuals in need of support receive is from arts workers which falls woefully short of helping to fix the individual and rather creates resentment and a non-productive work atmosphere. The organisations delivering the projects are forced, if they want to stay afloat, to tailor their work and effectively manipulate their bid to secure the funding.

These absurd situations are a hinderance to arts workers and perpetuate the “victim” mentality within the service users who are on a continuous carousel of intervention service which creates dependency and ultimately does nothing to empower the individual or benefit the community.

I argue that if funders, such as LIVE Borders are doing to BYT as noted above, continually focus their resources and time upon “disadvantaged” people they are disadvantaging the majority.  Rather than continuing to be channelled towards government outcomes with projects that target reluctant users I advocate a wider approach to public arts designed to integrate creativity and fun into every aspect of society; mass participation, cross generation projects that bring together different groups of the community.

In closing, having firstly attempted to define the terms health, illness and “well-being, I have argued that the arts cannot heal the symptoms of disease and should not be used instead of essential health services, but that the Applied Arts can make someone “feel better”, can improve their own sense of well-being, can augment and complement existing services and can educate in a more holistic way.

Finally, I argue that it is imperative upon those who work in the area of Applied Theatre to maintain belief in the value of their work and to not yield to the pressures of compromising its integrity in order to secure funding.

BIBLIOGRAPHY

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    Let’s Invest in Real Health. In Arts Council England’s Create: A Journal of Perspectives on the Value of Art & Culture

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    Performing Arts and Wellbeing

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    the Geese Theatre Handbook.

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    Games for Actors and Non-Actors

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    The rainbow of desire

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    Performance and the medical body

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    Standing at the Crossroads – What future for Youth Work?

    The Journal of Contemporary Community Education Practise Theory.
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    Towards a new ‘we’: Applied theatre as integration

    .  Applied Theatre Research.  Volume 5, number 3.  Intellect Ltd
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    Applied theatre evaluations as technologies of government: a critical exploration of key logics in the field.

    Applied Theatre Research. Volume 5 Number 1.  Intellect Ltd
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    Evaluating drama in education through the capability approach.

    Applied Theatre Research.  Volume 3, number 2. Intellect Ltd.
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    But was it artistically vibrant?




    An analysis of the audience response to a community performance.

    Applied Theatre Research, Volume 3, number 3. Intellect Ltd
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    The Gift of Theatre

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    Theatre in education: More than just a health message

    .  Journal of Applied Arts and Health.  Volume 1, number 3.  Intellect Ltd

  • http://www.artshealthandwell-being.org.uk/sites/default/files/APPGAHW%20submission%20to%20DCMS.pdf

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Osteoporosis in Women and Current Research

Osteoporosis in Women

Osteoporosis is a disease of the bones, and the most common worldwide. It causes decreased bone mass, the bones become more porous increasingly over time, plus the spaces or cavities inside become fragile, this withstanding less of the blows and easily fracturing. This disease has been defined as the widespread skeletal disorder, characterized by low bone mass and deterioration of bone microarchitecture.

Osteoporosis can be classified as primary (occurs in both sexes and in all ages, although it is more represented in women who have gone through menopause and in older men) and secondary (it is a product of drug treatments, or some intercurrent disease, or alcoholism). Causes of secondary osteoporosis can aggravate and accelerate bone loss. Unfortunately, these fractures mostly occur at an already advanced stage of the disease, because it is a silent disease. When it is quite advanced, bones become brittle, and even with a simple fall or a simple tension, such as bending or coughing, fracture. The most common fractures are those of wrists, vertebral, and hips and the latter are of great importance because of the consequences that it brings with it. The patient has to be hospitalized, surgically intervened, and pass a period of recovery that causes a loss of quality of life for the patient and family members. Even if the recovery is short, not to mention that there are patients who do not fully recover.

Osteoporosis can develop in two ways. You may lose too much bone, or your body may not form enough bone, some people have both problems. This disease affects all races and sexes, although the highest incidences are from the female Caucasians and Asians ethnicity, (women have less bone mass than men, tend to live longer than men, and when estrogen levels fall it accelerates bone mass erosion). Although there may be patients occur off other races, male and female sexes who have not passed the menopause stage, but they a smaller amount.

Hence, a great deal of attention is paid to habits related to raising the quality of life of the bone system, such as calcium intake either by absorbing dairy products, physical exercises, and the elimination of smoking. Proper calcium intake varies by age and gender, for this, medical monitoring is necessary for the proper amounts. Vitamin D is also essential for bone conservation, most people need about 800 international units (IU) of vitamin D every day. This vitamin allows the body to absorb calcium. Vitamin D can be obtained from the sun, food, and supplements and is formed primarily through the skin when it receives sun radiation appropriately.

When the disease is at an advanced stage, you may have several symptoms. The most common being: back pain, which in most cases can cause one or more compressed or fractured vertebrae, gradual loss of height, unexpected bone fracture and hunched posture.  Patients who have taken corticosteroids for several months or who have suffered hip fractures should go to the doctor for checkups. Bone density can be measured with advanced technology called dual-energy radioabsorciometry (DEXA). A scan is performed on the patient’s body, analyzing some bones, usually those of the hip and spine. They test the mineral levels in the bones.

Early interventions, medical treatments, and lifestyle conditions are very important, but there are higher risk factors that are unalterable and you can’t control them; such as:  sex, race, age, family history, (genetic factor, especially if they have suffered hip fractures from the mother or father) and height (small people being shorter their bones have less bone mass to cope with old age).

Treatment of Osteoporosis depends on the results of the bone density test, if the risk of fractures is not high it is not necessary to medical to the patient, but if the risk of bone fractures is high, the treatment focuses on modifying bone loss and avoiding fractures; the most common medicines are Biophosphonate, (Zoledronic Acid, Alendronate, Ibandronate, Risedronate). These medication’s side effects include heartburn-like symptoms, nausea, and abdominal pains, hence the importance of strictly following the dosage recommended by your doctor. If these medicines are incorporated intravenously, the patient does not suffer stomach damage, but the first three days, they can cause headache pains, muscle aches, and fever. Intravenous treatment is scheduled for a quarterly or annual injection as the disease progresses. While orally it is recommended to take a weekly or monthly tablet and may be more expensive. There are other bone-strengthening medicines that are mainly used if there is intolerance to the treatment or if it is not effective, such as Teriparatide (Forteo). This powerful drug is like parathyroid hormone and stimulates bone growth. A daily injection is used under the skin. After two years of treatment with teriparatide, another medicine is indicated to maintain bone growth. Abaloparatide (Tymlos) is another parathyroid hormone-like medicine. You can take it for only two years, after which your doctor will guide you, to other medications, such as, Calcitonin. This is a hormone that slows down bone loss. It is available as an injection or nasal spray. Side effects of the injection may be diarrhea, stomach pain, nausea, and vomiting. Side effects of nasal spray may include headache and irritation of the nasal mucosa. Other option is Raloxifene, helps prevent and treat osteoporosis in women. It also increases bone density. Side effects include suffocations and the risk of blood clotting. Another drug is Teriparatide, which contributes to bone formation. It is a synthetic form of parathyroid hormone, and both men and women can use it. It can be given by injections. It is injected into the thigh or stomach once a day. Common side effects are nausea, stomach pain, headache, muscle weakness, tiredness and loss of appetite. Another option is Romosozumab (Evenity), this medicine is newer. It is given by injection and only in the doctor’s office and it is limited to one year of treatment, and as in the previous cases the results are indicated in another medicine.  All medications to treat osteoporosis have the ability to slow down or even reverse the progression of the disease and help prevent bone fractures.  There is no absolute cure for the disease, but if you can change lifestyle habits especially from the age of 25, consult with your doctor if you have any genetic records, modify your, exercise periodically and avoid falls


Current Studies

“Reasons for not treating women with postmenopausal osteoporosis with prescription medications: physicians’ and patients’ perspectives.” Written by Weaver JP, Olsson K, Sadasivan R, Modi A, Sen S. (2017) is important in the study of osteoporosis.

The background of the study includes: In the United States of America, between one-third and two-thirds of postmenopausal women diagnosed with osteoporosis do not begin treatment with a prescription drug for the disease. The objective of the study was to understand the reasons why they refuse to do so.

In the study, researchers looked at: Online physician and patient surveys were conducted in 2013. The survey included a list of recently diagnosed postmenopausal women who did not have treatment for osteoporosis and data from physicians for the subject in question

The results show: the medical survey was completed by 224 Physicians and 811 patient letters were reviewed, a total of 165 patients completed the patient survey. Among the most common reasons for Physicians not recommending treatment were: Low calcium and/or vitamin D levels, pre-existing gastrointestinal problems, polypharmacy and patients potentially at risk from drug side effects. Patients’ reasons for refusing treatment for this disease after diagnosis were concerns about side effects, considering other over-the-counter options, behavioral modifications, and questioning the potential benefit of receiving medications

The conclusions of the study showed that: patients decided not to receive drug treatment for newly diagnosed osteoporosis in at least 50% of cases, the most common reasons given by Physicians and patients were that they had other alternatives and concern about the risks of consuming prescription drugs.

Another study important to the field is “Physical activity-does it really increase bone density in postmenopausal women? A Review of Articles Published Between 2001-2016.” written by Segev D,Hellersteint D, Dunsky A (2018).

The background of the study includes: Physical activity has many health benefits including the positive effect on bone health over the life cycle. In the first stage of life during childhood the physical stress stimulates bone remodeling and increases density, but due to hormonal changes during adulthood and mainly postmenopause the rate of bone remodeling slows down and is less efficient.

The objective of the study was: Examine the effectiveness of physical activity to improve bone mineral density (BMD) in women after menopause based on literature review

The methods include articles from three databases (PubMed, SPORT Discus with full text, and Science Direct) were reviewed. Only publications with bone mineral density studies clearly affected by the physical activity of women of menopause age were used. Twelve articles met these above criteria.

The results showed that: Physical activity had a positive effect on bone mineral density. Exercise prevented bone loss and, in some cases, contributed to the increase in bone loss.

The conclusions of the study showed that: Physical activity can significantly improve bone mineral density in postmenopausal women, but the exact type of activity, as well as intensity, duration, and frequency are not yet clear. More studies are needed to know which type of training is right for postmenopausal women.


Patient Experience

Family member A, who is currently 76-years-old, and diagnosed at age 56-years-old, had an early menopause at age 38-years-old. From the age of 45 years old approximately, started with back pain. At first doctors told her they were occurring due to age. The pains deepened until it began to increase, at that time not much was known about the disease, one day while having a conversation with a relative she went to rest her hands on the table, and felt a very severe pain; her wrists fractured. She went to the hospital immediately and doctors ordered a densymmetry where the results were low and an X-ray that indicated that. She had suffered a fractured vertebra and was corrected only because the shape of the vertebrae indicated that. Treatment began and the doctors’ first recommendations were to remove all the obstacles from the house that she could trip and fall from. Unfortunately, 10-years-ago she suffered a fall and had a hip fracture.they used prosthetics and rehabilitation for her to be able to walk again. It has been 1 year and currently she can walk only on crutches. She never smokes, she never took drugs, or alcohol, but she used many medications of cortisone for asthma when she was very young.

The other case is a friend of family member, she is a woman, she only has 27 years old , anorexic during adolescence and smoker, was hospitalized twice because of this disease and one of the times she was in the hospital when she was only 17 years old, she had the densymmetry and X-rays and osteoporosis (low bone mass with high probability of fracture), as it was hunched into the back and the mouth began to deform, many cavities and teeth loose. The medications you were prescribed for life are calcium and Vitamin D supplements and the diet with lots of dairy and the meat has to grind it because it causes you to chew it, all your daily activities make them walking because she noticed that they decrease the pain


Reference

Family nursing – definition of family

Discuss the major sociocultural changes that have contributed to the changing demographics of Canadian families. Include the theoretical foundation

Select 3 photos and attach them as appendices. Explain how the photos selected represent the definition of family in general and based on my own experience of family in comparison to the statistical representations of family forms in Canada. Discuss the major sociocultural changes that have contributed to the changing demographics of Canadian families. Include the theoretical foundation I found most helpful to explain my definition and my experience of family and why.
I attach full assignment. However, I am requesting editing service from page 2 to page 9.

Why the current Universal Healthcare system in the US is lacking, inefficient, bad.

Why the current Universal Healthcare system in the US is lacking, inefficient, bad.

Why the current Universal Healthcare system in the US is lacking, inefficient, bad, etc,. and why we should adopt the Universal Healthcare System.?Why the current Universal Healthcare system in the US is lacking, inefficient, bad, etc,. and why we should adopt the Universal Healthcare System.?

Why the current Universal Healthcare system in the US is lacking, inefficient, bad, etc,. and why we should adopt the Universal Healthcare System.?Why the current Universal Healthcare system in the US is lacking, inefficient, bad, etc,. and why we should adopt the Universal Healthcare System.?

Metformin (Glucophage) Reactions

Metformin (Glucophage) is available in the Pakistan since 1998. It falls in the same drug class as phenformin. Metformin is considered a first line agent and is significantly useful in people with known insulin resistance

GLUCOPHAGE® (metformin hydrochloride tablets) and GLUCOPHAGE® XR (metformin hydrochloride extended-release tablets) are oral antihyperglycemic drugs used in the management of type 2 diabetes. Metformin hydrochloride (N,N-dimethylimidodicarbonimidic diamide hydrochloride) is not chemically or pharmacologically related to any other classes of oral antihyperglycemic agents. The structural formula is as shown:

Glucophage (metformin hydrochloride tablets) Structural Formula Illustration

Metformin hydrochloride is a white to off-white crystalline compound with a molecular formula of C4H11N5 • HCl and a molecular weight of 165.63.

Metformin improves hyperglycemia primarily through its suppression of hepatic glucose production, especially hepatic gluconeogenesis[1]. The “average” person with type 2 diabetes has three times the normal rate of gluconeogenesis; metformin treatment reduces this by over one third.[2] Metformin activates AMP-activated protein kinase (AMPK), a liver enzyme that plays an important role in insulin signaling, whole body energy balance, and the metabolism of glucose and fats;[3] activation of AMPK is required for metformin’s inhibitory effect on the production of glucose by liver cells.[4] Research published in 2008 further elucidated metformin’s mechanism of action, showing that activation of AMPK is required for an increase in the expression of SHP (Small heterodimer partner), which in turn inhibits the expression of the hepatic gluconeogenic genes PEPCK and Glc-6-Pase.[5] Metformin is frequently used in research along with AICAR as an AMPK agonist. The mechanism by which biguanides increase the activity of AMPK remains uncertain; however, research suggests that metformin increases the amount of cytosolic AMP (as opposed to a change in total AMP or total AMP/ATP).[6]

In addition to suppressing hepatic glucose production, metformin increases insulin sensitivity, enhances peripheral glucose uptake, decreases fatty acid oxidation, and decreases absorption of glucose from the gastrointestinal tract.[8] Increased peripheral utilization of glucose may be due to improved insulin binding to insulin receptors.[9] AMPK probably also plays a role, as metformin administration increases AMPK activity in skeletal muscle.[10] AMPK is known to cause GLUT4 translocation, resulting in insulin-independent glucose uptake. Some metabolic actions of metformin do appear to occur by AMPK-independent mechanisms; a recent study found that “the metabolic actions of metformin in the heart muscle can occur independent of changes in AMPK activity and may be mediated by p38 MAPK- and PKC-dependent mechanisms.”[11]

Metformin causes a few gastrointestinal side effects including nausea, metallic taste, diarrhea and abdominal discomfort[7] . These can be avoided if the dose is increased slowly, and taking the drug with meals. A small amount of weight loss, possibly due to drop in net caloric intake due to appetite repression and/or a reduction in hyperinsulinemia is suggested. Falling in the same drug class as phenformin, the reported incidence of lactic acidosis is surprisingly low, 0.03 per 1000.

In a US double-blind clinical study of GLUCOPHAGE in patients with type 2 diabetes, a total of 141 patients received GLUCOPHAGE therapy (up to 2550 mg per day) and 145 patients received placebo.

Most Common Adverse Reactions (>5.0 Percent) in a Placebo-Controlled Clinical Study of GLUCOPHAGE Monotherapy

The occurrence can further be avoided if contraindications are followed. It is contraindicated in people with a high risk of lactic acidosis: renal serum creatinine levels over 150 μmol/l[14}or hepatic impairment, respiratory insufficiency, severe infection and alcohol abuse. Any pharmacological therapy that alters either of the factors mentioned before is also considered. It should also be used cautiously in elderly especially those above 80 years of age. It is recommended to monitor renal function upon initiation and at least once a year thereafter.

It should be withheld immediately before a person has a procedure with a radiocontrast dye, as the dye increases the risk of renal failure and therefore lactic acidosis [15] [16]. It should also be discontinued before and surgery and can be started immediately after if the renal function is normal and the patient is stable. It is also recommended to monitor hematological parameters as it alters vitamin B12 absorption [12] [13] and therefore cause anemia (7% in clinical trials). The mechanism of action is unknown but can be reversed by discontinuation of the drug.

Daily dosage should be 500 mg orally twice daily with meals. The dose can be increased every 2 weeks to 2000 mg daily.

References

  1. Kirpichnikov D, McFarlane SI, Sowers JR (2002). “Metformin: an update”. Ann Intern Med 137 (1): 25-33. PMID 12093242.
  2. Hundal R, Krssak M, Dufour S, Laurent D, Lebon V, Chandramouli V, Inzucchi S, Schumann W, Petersen K, Landau B, Shulman G (2000). “Mechanism by which metformin reduces glucose production in type 2 diabetes” (PDF). Diabetes 49 (12): 2063-9. doi:10.2337/diabetes.49.12.2063. PMID 11118008.
  3. Towler MC, Hardie DG (2007). “AMP-activated protein kinase in metabolic control and insulin signaling”. Circ Res 100 (3): 328-41. doi:10.1161/01.RES.0000256090.42690.05. PMID 17307971.
  4. Zhou G, Myers R, Li Y, Chen Y, Shen X, Fenyk-Melody J, Wu M, Ventre J, Doebber T, Fujii N, Musi N, Hirshman M, Goodyear L, Moller D (2001). “Role of AMP-activated protein kinase in mechanism of metformin action”. J Clin Invest 108 (8): 1167-74. doi:10.1172/JCI13505. PMID 11602624.
  5. Kim YD, Park KG, Lee YS, et al. (2008). “Metformin inhibits hepatic gluconeogenesis through AMP-activated protein kinase-dependent regulation of the orphan nuclear receptor SHP”. Diabetes 57 (2): 306-14. doi:10.2337/db07-0381. PMID 17909097.
  6. Zhang L, He H, Balschi JA (2007). “Metformin and phenformin activate AMP-activated protein kinase in the heart by increasing cytosolic AMP concentration”. Am J Physiol Heart Circ Physiol 293 (1): H457-66. doi:10.1152/ajpheart.00002.2007. PMID 17369473.
  7. Bolen S, Feldman L, Vassy J, et al (2007). “Systematic review: comparative effectiveness and safety of oral medications for type 2 diabetes mellitus”. Ann Intern Med 147 (6): 386-99. PMID 17638715.
  8. Royal Pharmaceutical Society of Great Britain and the British Medical Association. “Chapter 6:Endocrine system—6.1.2.2 Biguanides”, British National Formulary, 54.
  9. Bailey CJ, Turner RC (1996). “Metformin”. N Engl J Med 334 (9): 574-9. doi:10.1056/NEJM199602293340906. PMID 8569826.
  10. Musi N, Hirshman MF, Nygren J, et al. (2002). “Metformin increases AMP-activated protein kinase activity in skeletal muscle of subjects with type 2 diabetes”. Diabetes 51 (7): 2074-81. PMID 12086935.
  11. Saeedi R, Parsons HL, Wambolt RB, et al. (2008). “Metabolic actions of metformin in the heart can occur by AMPK-independent mechanisms”. Am J Physiol Heart Circ Physiol 294 (6): H2497-506. doi:10.1152/ajpheart.00873.2007. PMID 18375721
  12. Andrès E, Noel E, Goichot B (2002). “Metformin-associated vitamin B12 deficiency”. Arch Intern Med 162 (19): 2251-2. doi:10.1001/archinte.162.19.2251-a. PMID 12390080.
  13. Gilligan M (2002). “Metformin and vitamin B12 deficiency”. Arch Intern Med 162 (4): 484-5. doi:10.1001/archinte.162.4.484. PMID 11863489
  14. Jones G, Macklin J, Alexander W (2003). “Contraindications to the use of metformin”. BMJ 326 (7379): 4-5. doi:10.1136/bmj.326.7379.4. PMID 12511434
  15. Weir J (March 19, 1999). Guidelines with Regard to Metformin-Induced Lactic Acidosis and X-ray Contrast Medium Agents. Royal College of Radiologists. Retrieved on 2007-10-26 through the Internet Archive.
  16. a b Thomsen HS, Morcos SK (2003). “Contrast media and the kidney: European Society of Urogenital Radiology (ESUR) guidelines”. Br J Radiol 76 (908): 513-8. doi:10.1259/bjr/26964464. PMID 12893691.

Purpose of Evidence Based Research

Evidence Based Research

In today’s healthcare environment, practicing nurses are in high demand to utilize current evidence in making clinical decisions relative to patient care (Schaffer, Sandau, & Diedrick 2013). This is best achieved through thoughtful incorporation of the current research in the care of the patient along with nurses’ expertise, patient preferences and values, and local context. Evidenced based practice is defines as a problem-solving approach in making clinical decisions with the healthcare organization and is attributed to improved clinical outcomes, functional outcomes, quality of life outcomes, and economic outcomes (Schaffer et al. 2013).  EBP also focuses on safer nursing practices while enhancing patients’ access to healthcare information regarding the best treatments and it provides more opportunities for highly personalized treatment.

Research, EBP, and Quality Improvement

The purpose of conducting research is to generate new knowledge or to validate existing knowledge based on a theory. Unlike research, EBP isn’t about developing new knowledge or validating existing knowledge. It’s about translating the evidence and applying it to clinical decision-making (Schaffer et al. 2013). The purpose of EBP is to use the best evidence available to make patient-care decisions. The purpose of QI is to use a systematic, data-guided approach to improve processes or outcomes. While the concept of quality can be subjective, QI in healthcare typically focuses on improving patient outcomes. So, the key is to clearly define the outcome that needs to be improved, identify how the outcome will be measured, and develop a plan for implementing an intervention and collecting data before and after the intervention. Unlike research and EBP, QI typically doesn’t require extensive literature reviews and rigorous critical appraisal. Therefore, nurses may be much more involved in QI projects than EBP or research. Also, QI projects normally are site specific and results aren’t intended to provide generalizable knowledge or best evidence.

APNs Role in Research, EBP, and QI

Nurses can no longer rely solely on their clinical experience to deliver quality care. Nurses should ask and evaluate themselves frequently for best practices and improvement in all practices. Clinical practice is the primary focus of advanced practice nursing (APN) roles. However, with unprecedented needs for health care reform and quality improvement (QI), health care administrators are seeking new ways to utilize all dimensions of APN expertise, especially related to research and evidence‐based practice. International studies reveal research as the most underdeveloped and underutilized aspect of these roles. (Melnyk, Gallagher-Ford, & Long, 2014). I believe this will improve patient care by strengthening the capacity of advanced practice nurses to integrate research and evidence-based practice activities into their day-to-day practice. The question arises as to how we have been practicing nursing without EBP!

Implementation.

Once a topic has been identified there are several steps that can guide one through the research process in an efficient manner (Polit & Beck, 2017). The first step is to ask a question. In this step we must convert the need for information into an answerable question. The second step is to find the information or evidence required to answer the question. Basically, we must track down the best information looking in all different directions to answer this question. Step three involves critically appraising the evidence found. This step is very important because it checks the validity, impact, and usefulness in clinical practice of the question asked. In step four, integrating the critical appraisal with clinical expertise and with the patient’s situation is most important. In this step we include the value and circumstances of the question and situation. Last, but not least evaluation step or step five. Evaluating what was researched, the effectiveness and efficiency in the execution of steps one through four. This step allows us to seek out ways to improve the both for the next time a question is ask.

Topic Search.

Evidenced based practice in nursing was easy to search for in all databases available.  Science Direct is an oddball for most people but I love it. The articles are easy to find, always peer reviewed, and straight from nursing journals. This detail narrows the search on the front in. CINAHL has everything anyone would need and many more articles than most sites. Limiting the key phrases of what one would be looking for is key in these searches.

EBP Models.

A number of EBP models have been developed; many appear very different from each other. Some of these models are more useful in some contexts than others, and each has advantages and disadvantages. The Iowa model of EBP was developed as a model to promote quality care. It has been used in multiple academic and clinical settings (Murphy, Staffileno, & Foreman, 2018). This model blends quality improvement with research utilization in a setting that nurses find understandable. The Iowa model uses “triggers” of EBP, which makes the model unique to the others. The Johnson Hopkins model was developed to ensure that current research findings were incorporated into patient care. This model reflects upon using three domains: nursing practice, education, and research. The core component for decision making must reflect in these three domains (Murphy et al., 2018). The process for choosing a model for a facility is almost the same as following and researching EBP. It is chosen through research and evidence.

Conclusion.

The profession of nursing traditionally has considered direct, hands-on patient care to be its priority. Hands-on care may be becoming secondary, however, to the increasingly cumbersome, time-consuming demands for documentation of nursing care. The study process highlighted the urgent need for a new culture that values EBP. Without this culture shift, direct patient care tasks cannot be best practice. The EBP process must become the standard for “thinking at the bedside.” This involves identifying patient problems when they arise; asking searchable, answerable questions; discovering valid evidence to answer the questions; and working with other members of the healthcare team, including the EBP mentor, to develop, implement and evaluate innovative practices based on the best available evidence (Melnyk et al., 2014).


References

  • Melnyk, B. M., Gallagher- Ford, L., Long, L, E., & Fineout Overholt, E. (2014). The establishment of evidenced-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldview on Evidence- Based Nursing, 11, 5-15.

    https://doi.org/10.1111/wvn.12021
  • Murphy, M. P., Staffileno, B. A., & Foreman, M. D. (2018).

    Research for advanced practice nurses: from evidence to practice

    . New York, NY: Springer Publishing Company, LLC.
  • Polit, D. F., & Beck, C. T. (2017).

    Nursing research: Generating and assessing evidence for nursing practice

    (10th ed.). Philadelphia, PA: Wolters Kluwer.
  • Schaffer M.A., Sandau K. E. & Deidrick L. (2013) Evidence- based practice models for organizational change: overview and practical applications.

    Journal of Advanced Nursing



    69


    (5), 1197-1209. doi: 10.1111/j.1365-2648.2012.06122.x

Tables

Topic Search


Data Base


Search Terms


Hits-Results


MeSH, Filters,


Phrases, and


limits


New Results

CINAHL

Evidenced Based Practice in Nursing

7,127

Full Text

Year 2014 to 2019

EBP and Peer

Review

3653

1557

426

ScienceDirect

Evidenced

Based Practice

576

Research articles

Year 2018 and 2019

107

56

Impact of Air Pollution on the Human Respiratory System

Impact of Air Pollution on the Human Respiratory System

Outline

I. Introduction

Thesis statement: We cannot ignore the air polluted issue because it is the main reason for damaging the human respiratory system.

II. Adults’ Respiratory System

  1. Switzerland Residents
  2. Rome Residents

III. Children’s Respiratory system

  1. Embryos
  2. The Growth of Respiratory System
  3. Respiratory Disease
  4. Acute Respiratory Infections

IV. Lung Cancer

  1. Example
  2. A Kind of Carcinogen

V. Conclusion

Air Pollution Affects Respiratory System

We usually hear the news about air pollution. The news suggests that people will wear the mask in the next few days because the quality of the air will become worse. The quality of the air affects the human respiratory system. The outdoor air includes not only oxygen we need but also many pollutants that damage human health. Although many natural phenomena, such as volcanoes, fire, and so on, emit the pollutants into the atmosphere, human activities are the main cause of air pollution. Since the industrial revolution, the environment has become different from before. The quality of the air has become worse and worse. There are some pollutants in the atmosphere, such as particulate matter, nitrogen dioxide, sulfur dioxide, heavy metal, and ozone, which can damage human health. According to the World Health Organization(WHO) study, it is the air pollution that results in the major reason of death and disease for people with respiratory system problems. Over Nine of ten people breathe in air pollution. Every year, 7 million people die because of air pollution. The respiratory system is highly irritated by these pollutants. Plenty of studies prove that air pollution can harm the human respiratory systems. Lungs play important roles in the respiratory system. They are used to absorb air and promote air delivery. Some professionals analyzed short-term exposure in air pollution on mortality. They found the daily mortality has a connection with the level of air pollution. The WHO pointed out that there are about 4.2 million premature deaths. The WHO survey shows 29% of those die from lung cancer, 17% of those die from acute lower respiratory infection, 24% of those die from stroke, 25% of those die from ischemic heart disease and 43% of those die from chronic obstructive pulmonary disease. (Data from WHO) According to this information, we can conclude that air pollution is not only damaging the environment but also harming human health. We cannot ignore the air polluted issue because it is the main reason for damaging the human respiratory system.

On Adults’ Respiratory System

At the past time, people thought smoking cigarettes can affect respiratory systems. However, plenty of the adults still are infected the respiratory diseases even if they do not smoke. Many studies point out that air pollution is the main cause of respiratory diseases, rather than smoking.

Switzerland Residents

In 1991, the Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) indicated long-term exposure in air polluted areas has a strong connection with the adults’ respiratory symptoms. This study focused on 18 to 60-year-old adults at eight study sites in Switzerland. This study considered testers for never, past, and current smokers. Tester’s age, weight, gender, genetic asthma, genetic atopy, level of education, and nationality were controlled by the researchers. In 2002, they did further study. This study wanted to know the effects on the human respiratory system when people exposed to traffic pollution. The researchers controlled testers for socioeconomic status, exposure to pollution and health-related factors. They also controlled testers living in different distances from the main streets. This study wanted to know the effects on the human respiratory systems when people lived in traffic polluted areas. Traffic pollution is the reason of air pollution. Although the development of traffic makes our lives become more convenient, air pollution is becoming worse and worse. This study indicated that it increased the rate of breathlessness and regular phlegm because of living near the main streets with traffic pollution. (SAPALDIA Team, 2006) Therefore, according to the SAPALDIA study, we get the conclusion that living near air polluted areas affects certain respiratory symptoms.

Rome Residents

In 2008, there was a research surveying 9488 Rome residents. This research analyzed 25 to 59-year-old Rome residents who lived near air polluted areas. The researchers found the residents easily suffered from chronic bronchitis, asthma, and rhinitis because they lived closer to high air polluted areas. This research pointed out that respiratory diseases especially rhinitis have a high connection with air pollution. Non-smokers are the deeper effects than smokers. (Cesaroni, Badaloni, Porta, Forastiere, & Perucci, 2008)

To sum up, we know even though people do not smoke, they are still infected with respiratory diseases because of exposure to air pollution.

On children’s respiratory system

More and more children suffer congenital respiratory disease. Some reports point out air pollution can result in congenital respiratory disease through their mothers. When mothers are exposed to air pollution during their pregnancies, the embryos are also affected. It results that many children suffer congenital respiratory disease. Therefore, not only adults but also children are affected by air pollution.

Embryos

Air pollution can affect children before they are born. When their mothers are exposed to high levels of pollutants, these pollutants can enter the embryos’ circulation through the placentas and umbilical cord blood. The researchers, in the Environmental Working Group, who collaborated with Commonweal in New York, USA, claimed that the pollutants could enter embryo bodies through their mothers. After these pollutants enter embryos’ bodies, it will increase the rate of intrauterine growth retardation, low birth weight, pre-term birth, and perinatal morbidity. “Pregnant mothers from China exposed to high levels of ambient sulfur dioxide and particulate matter pollution have been shown to have the increased risk of preterm delivery and low infant birth weights.” (Salvi, 2007, p. 276)

The Growth of Respiratory System

When children inhale the same amount of the pollutants as adults, it causes more serious effects because children’s respiratory systems do not completely develop. In addition, because children have many activities than adults, they inhale a greater amount of pollutants. Therefore, air pollution causes more serious effects on children. Most of the ambient air pollutants are chemicals. Several oxidant air pollutants are the main causes of the respiratory system. They obstruct the signals of pathways. They also have been proved to enlarge allergens, enlarge the risk of worsening asthma and reduce lung function. They also affect the growth of children’s respiratory systems. (Salvi, 2007)

Respiratory Disease

Many people suffer respiratory diseases, such as rhinitis, nose allergies, asthma, and so on, because they were exposed to the air polluted area during their childhood. According to a book called Effect of Air Pollution on Children’s Health and Development, particulate matter, nitrogen dioxide, and ozone in air pollution affect children’s respiratory systems. This book collected a variety of studies about the effects of air pollution on children’s respiratory system. Particulate matter causes more serious effects on asthmatics. A part of this research further showed it causes significant disadvantage effects on lung function. Long-term exposure to nitrogen dioxide affects prevalence, the incidence of asthma, allergic rhinitis or atopic eczema. “Three out of four studies showed an association with bronchitis and cough while two out of three showed significant reductions in lung function.” (Krzyżanowski, Kuna-Dibbert, & Schneider, 2005, p. 77) Ozone affects the functions of the lungs. One large study showed when asthmatic children who live in high ozone concentration areas and increase the rate of incidence. Traffic-related air pollutants affect the prevalence and incidence of asthma and hay fever. (Krzyżanowski, Kuna-Dibbert, & Schneider,2005) Therefore, according to this book, we get a conclusion that many pollutants such as particulate matter, nitrogen dioxide, ozone, and so on cause respiratory infection. Furthermore, many children suffer respiratory disease because of air pollution.

Acute Respiratory Infections

Air pollution affects acute respiratory infections. Air pollution has a connection with asthma-related morbidity and mortality. Much evidence proves that the morbidity and mortality related to air pollution have a positive connection with the respiratory infection. In Europe, there were a quarter of children who were killed by acute respiratory infections in 2001. Chauhan, Chatterjee Johnston made a study that wanted to know the relationship between air pollution and the risk and severity of acute respiratory infections in children. Their study pointed out PM10, PM2.5, nitrogen dioxide, sulfur dioxide and ozone in air pollution increased upper and lower respiratory symptoms in children. According to the survey, the researcher claimed children’s respiratory health can be improved when the pollutants decrease. (Krzyżanowski, Kuna-Dibbert, & Schneider, 2005)

Therefore, we can conclude air pollution results effects not only on children but also on infants through inheritance. Once the pollutants enter embryo bodies, it will keep in their bodies forever. It will affect the growth of children.

Lung cancer

Lung cancer is the number one cancer of death. Although smoking cigarettes causes lung cancer, numerous studies prove outdoor air pollution such as emission from the vehicle and industrial sources, can cause lung cancer. Every year, there are above 200,000 people deaths because of lung cancer in air pollution. The pollutants can be divided into large size and small size. The Large size of particle pollutants affects human health, but the small size of particle pollutants is more harmful. The Larger one is defended by our natural defenses such as tears, sneeze, and cough. However, the small one cannot be defended by these natural defenses. These harmful particle pollutants enter our body and damage our health. These small particles are called particle pollution that make up of acids, organic chemicals, metals, soil and dust particles.

They are from vehicles, factories, burning, and so on. In 2013, WHO said the particle pollution is the main cause of lung cancer. (American Lung Association, 2016)

A kind of Carcinogen

Outdoor air pollution is classified as a cancer-causing agent by the International Agency for Research on Cancer(IARC) that is a part of WHO. The IARC is a major organization that studied the causes of cancer in America. The IARC got a conclusion that outdoor air pollution has a connection with lung cancer. It also has a connection with other cancers. According to the IARC evaluation, the risk of lung cancer is increasing while the level of particulate matter is increasing. According to the Global Burden of Disease Project, air pollution killed 3.2 million people in 2010, including 223,000 people from lung cancer. (Simon, 2013) A Fred Hutchinson Cancer Research Center’s Dr. Parveen Bhatti, an expert on environmental factors, claimed that when particulates enter into the air, it increases residents’ risk of cancer. The Environmental Protection Agency proved that particulate matter is the most effect on lung cancer. Bhatti said these matters with certain chemicals toxic to human DNA cause cell mutations and then induce lung cancer. (Tompa, 2017)

Example

In China, there was an 8-year-old girl who was diagnosed with lung cancer in 2013. She was the youngest patient with lung cancer. Her doctor claimed she suffered from lung cancer because of air pollution. In the same year, the International Agency for Research on Cancer identified air pollution is the cause of lung cancer. This agency found tiny dust-like particles called particulate matter are the key to air pollution. The tiniest particulate matter is less than 2.5 millionths of a meter across, called PM2.5. It causes lung cancer. It increases the risk of suffering lung cancer when people were exposed to the high level of PM2.5. (American Lung Association, 2016)

Therefore, according to the above of the information, we can conclude that air pollution is the main cause of lung cancer.

Conclusion

To sum up, we must face up to the air polluted issue. More and more studies can prove that air pollution damages human health. Air pollution is produced by transportation, factory, agriculture, power generation, home with cooking and heating. As the technologies are developed, more and more pollutants, such as particulate matter, nitrogen dioxide, sulfur dioxide, and so on, are emitted into the atmosphere. These pollutants damage the environment such as acid rain, global warming, holes in the ozone layer, and so on. They also affect human health. Although the development of technology improves human lives, human health has been damaged. When people inhale the pollutants, they may be infected a chain of respiratory diseases such as breathless, asthma, bronchitis, and so on. It even causes premature deaths. These pollutants affect not only individuals but also embryos. When mothers are exposed to air pollution during their pregnancies, they also inhale the pollutants that enter into embryo bodies. It even makes embryo death. These pollutants keep in embryo bodied. It affects the growth of children. (Salvi, 2007) The CNN report pointed out that over 95% of people are breathing unhealthy air. Health Effects Institute pointed out that there were about 6.1 million killed by air pollution in 2016. (Masters, 2018) It is an amazing statistic. Therefore, we cannot ignore the environmental issue. Air pollution is a more and more serious problem. Once human bodies are damaged by air pollution, they do not fully recover. Let us start to deal with the air polluted issue.

References

  • Ambient air pollution: Health impacts. (n.d.). Retrieved from https://www.who.int/airpollution/ambient/health-impacts/en/
  • The Connection between Lung Cancer and Outdoor Air Pollution. (2016, June 21). Retrieved from https://www.lung.org/about-us/blog/2016/06/lung-cancer-and-pollution.html
  • Cesaroni, G. (2008). Comparison between various indices of exposure to traffic-related air pollution and their impact on respiratory health in adults.

    Occupational and Environmental Medicine

    ,

    65

    (10), 683-690. doi:10.1136/oem.2007.037846
  • Gerbase, M. W. (2006). Respiratory Effects of Environmental Tobacco Exposure Are Enhanced by Bronchial Hyperreactivity.

    American Journal of Respiratory and Critical Care Medicine

    ,

    174

    (10), 1125-1131. doi:10.1164/rccm.200512-1890oc
  • Krzyżanowski, M., Kuna-Dibbert, B., & Schneider, J. (2005).

    Effect Of Air Pollution On Children’s Health And Development

    .
  • Masters, J. (2018, April 17). More than 95% of world’s population breathing unhealthy air, says new report. Retrieved from https://www.cnn.com/2018/04/17/health/world-dangerous-air-report-intl/index.html
  • Salvi, S. (2007). Health effects of ambient air pollution in children.

    Paediatric Respiratory Reviews

    ,

    8

    (4), 275-280. doi:10.1016/j.prrv.2007.08.008
  • Simon, S. (2013, October 17). World Health Organization: Outdoor Air Pollution Causes Cancer. Retrieved from https://www.cancer.org/latest-news/world-health-organization-outdoor-air-pollution-causes-cancer.html
  • Tompa, R. (2017, August 18). Links between air pollution and cancer risk.

    Hutch Magazine

    . Retrieved from https://www.fredhutch.org/en/news/center-news/2017/08/air-pollution-boosts-cancer-risk.html

After reading Joan Magretta’s article, comment on how numbers are used in your work setting or other part of your life in achieving financial goals.3. Only in recent years have hospitals begun to develop meaningful systems of cost accounting. Why did they not begin such development sooner?

After reading Joan Magretta’s article, comment on how numbers are used in your work setting or other part of your life in achieving financial goals.3. Only in recent years have hospitals begun to develop meaningful systems of cost accounting. Why did they not begin such development sooner?

4. Teaching hospitals receive an additional payment to recognize the indirect costs of medical education. What rationale might be used to justify this extra payment?

SAMPLE ANSWERS (DO NOT COPY)
2. After reading Joan Magretta’s article, comment on how numbers are used in your work setting or other part of your life in achieving financial goals.

I really enjoyed this article and how it explained the balance between the interpretation of what numbers mean and how to use them to affect change. In MU we track a physicians success by comparing their achieved numbers to those established by the gov to make a given measure. What is frustrating is that the docs and staff lose focus of the value of what we are doing, trying to make an interoprative system of sharing medical information, with are we making the numbers? In this respect numbers are good and bad, good that we can get them and monitor progress and bad because they are blinding those looking at them on how we can improve care and make the numbers at the same time. The purpose and value of the program gets lost in the focus on the numbers. As a result we changed the order of the MU meeting. We talk process first, what’s best for the patients then we fit that into MU, or try to. The numbers are no longer posted at the start of the meetings but are saved for brief viewing in the final 2 minutes of the meeting. That and serving chocolate during the meeting seem to work fairly well – for now.

3. Only in recent years have hospitals begun to develop meaningful systems of cost accounting. Why did they not begin such development sooner?

In 1983 and before hospitals were paid actual costs for delivering service. In about 1983 Medicare introduced the perspective payment system for care. This payment system was based on a set amount of money the hospital would receive based on patient diagnosis not cost. If the hospital managed the care of the patient efficiently the hospital would break even and/or exceed expense (profit). if the hospital did not manage the patients well the hospital would lose money on that patients stay. A mechanism to forecast and determine best care practices was necessary for the hospital to survive financially. the hospital actually became accountable for efficient operations. Introduction of HMO payers, fixed rates for fixed service business added to the need for meaningful cost accounting.

4. Teaching hospitals receive an additional payment to recognize the indirect costs of medical education. What rationale might be used to justify this extra payment?

Teaching hospitals are established to support university based medical and dental training for advanced students. In most cases teaching hospitals are located cities where the indigent population is generally more concentrated than in suburban and rural settings. Thus the patient population in teaching hospitals is expected to of higher acuity than other hospitals, patients are sicker. The current DRG payment system does not adjust for this making it necessary for teaching hospitals to receive more than their suburban and rural counterparts.

Care Plan and Interventions for Suicidal Patient

CARE DELIVERY

This essay will explore the effectiveness of the care delivered to one of the author’s service users whilst on clinical placement. This essay will demonstrate how the author developed therapeutic relationships through the use of appropriate communication and interpersonal skills in order to achieve this. Furthermore this essay will look at the formulation and documentation of the service user’s care plan involving the service user’s family and carers within a framework of informed consent. This essay will also evaluate and document the outcomes of nursing and other interventions. This essay will finally discuss the opportunities utilised and created to promote the health and well-being patients.

In line with the codes of conduct for the Nursing and Midwifery Council (NMC, 2010), the author has sought and received voluntary and informed consent from the client whom the author will, for the purpose of confidentiality, be referred to under the pseudonym Alice Azonto. Further to this, all names and locations will be referred to under pseudonyms for the same purpose. The author will refer to Alice Azonto by her first name ‘Alice’ as is her preference.

Alice is a 47 year old woman who attempted to commit suicide having taken an overdose of paracetamol following the death of her husband. She was rushed to a local hospital for medical attention when found by her neighbour and a good friend Dona in a semi-conscious state. Alice collapsed in her kitchen floor with empty sachets of tablets beside her and a suicide note addressed to her only son John who lives in a nearby city.

It appeared that Alice has not been eating and drinking well. This resulted in weight lost and a chronic lung condition because of excessive smoking. It also appeared that Alice has been neglecting herself and there were signs she had made superficial cuts to her wrists.

Alice was diagnosed of depression and was detained under section 2 of the Mental Health Act (MHA, 2007) when she refused to be admitted voluntarily following an assessment. Hospital environment can be very stressful for clients when they first arrive on the ward. Nurses need to engage positively with clients to develop therapeutic relationship. Barker (2009, p.36) argues that, therapeutic relationship empower clients to learn or cope more effectively with their environment.

The nurse commenced a therapeutic relationship with Alice by initially introducing himself and addressed her by her preferred name. Alice was listened to and reassured by the nurse without any immediate advice or diminishing his feelings. NMC (2010) recommends that patients must be treated as individuals and respect their dignity. Alice was offered a daily 1:1 sessions with the nursing team which enabled staff identified his goals and wishes which were incorporated into his plan of care. Department of Health (DOH, 2006) asserts that 1:1 sessions are therapeutic; they enable the service user to engage well with staff as it empowers them to express their feelings and thoughts.

A person-centred plan of care was devised in other to deliver effective care to promote Alice recovery. NICE (2009) recommends that treatment and care should take into account patients’ needs and preferences. It further suggests that people with depression should be given the opportunity to make informed decisions about their treatment and care together with their healthcare professional involved in their care. Different allied health professionals such as the psychiatrists, psychologists, GP, nurses, social workers, OT and other community care providers were involved Alice care because of the severity his complex mental and physical health needs.

DOH (2004) the ten essential shared capabilities recommend that professionals, patients, families and carers should work in partnership to provide quality care. Consent was sought from Alice whether she wanted his son John to be involved in her care. Gaining consent is a legal aspect of mental health nursing and it shows that patients are treated with respect (Diamond, 2008 p. 234). Alice and her son were fully involved in every aspect of the plan of care. CPA (2008) recommends that patients, families and carers should be involved in decision making in regard to their care plans. The author and the nursing team provided Alice with vital information to promote her choice and to enable Alice to make informed decisions. To make sure Alice’s needs were still being met, the MTD reviewed her mental and physical health regularly and amended her plan of care accordingly with any significant changes. No Health without Mental Health (2011) affirmed that meeting service users other needs improves their quality of life and provides good well-being.

Alice was initially nursed within eyesight observation which was later reviewed to general observation due to the nature of her illness and presentation per (NICE, 2005) recommendation. Alice had prompts, reassurance and full support from the nursing team in maintaining her personal hygiene needs. Alice had regular appointments with her GP to monitor her chronic lung condition and was also provided with bereavement support and counselling. NHS (2012) recommends that bereavement support should be offered to patients, carers, and families if they lose a dear one as it has impact on their mental health and well-being. Alice was made aware of options of treatment available to her as guided by (NICE, 2009). Food and fluid intake chart was also put in place to monitor her dietary. Alice was provided with the available social support networks and with the support of an OT Alice engaged in purposeful activities to help lift her mood up and promote her independence.

New Horizons (2011, p. 136) suggests that occupational activities are therapeutic and they help patients to engage with staff and other patients on the ward and builds self-worth and confidence towards discharge. In addition to the antidepressant treatment, Alice also had the team psychologist inputs to help promote her prompt recovery. NICE (2009) recommends that, people with moderate or severe depression should be provided with a high-intensity psychological intervention i.e. Cognitive Behavioural Therapy (CBT) or Individual Personal Therapy (IPT) with a combination of antidepressant medication. Papageorgiou, C. et al. (2011) affirms that, one of the most widely known types of psychological therapy for depression is CBT, which combines both cognitive and behavioural techniques into an integrated whole. The nurse and the MDT have educated Alice on how to promote healthier lifestyles choices and provided Alice with information in the form of leaflets about her condition and range of information on smoking cessation so that she can make her own informed choice. Wrycraft (2009) argues that, mental health promotion is an activity healthcare professionals carryout as part of their everyday practice in their roles and do not realise they are engaging in such activity. However at other times they actively seek information about health promotion activities

Staff facilitated these health promotions by strengthening the patients on the ward, they increased emotional resilience through 1:1sessions and negotiating with the patients to promote her self-esteem and coping skills.

The MDT should review her plan of care depending of her progress.

CASE STUDY #1: You are working with an amateur bodybuilder who is 12 months out from a bodybuilding competition. Design a year-long periodized training program for the athlete with the objective of op 2

CASE STUDY #1:

You are working with an amateur bodybuilder who is 12 months out from a bodybuilding competition. Design a year-long periodized training program for the athlete with the objective of optimizing the client’s physique at the time of the competition. The training program should include the following:

  • A list of assessments to be performed at the onset of the training program
  • A warm up and cool down for each training day
  • A detailed year-long periodized training program including specific exercises, sets, repetitions, suggested rest times, etc. The program should include a Foundational Training phase, a Hypertrophy phase, and a Cutting phase.
  • An explanation as to why you made your recommendations for each phase of training.
  • Nutrition and supplement recommendations to support the bodybuilder during each phase of training.