Test patch



:

[10, 19]

A test patch is performed by many physicians before performing the actual fist sitting of the procedure. A test patch is usually done on two or three different spots using different parameters. This helps in physician’s evaluation of the ideal treatment parameters and pain threshold for an individual case and also gives an idea to the patient about the procedure and the associated discomfort. This helps in reassuring the patient about the procedure. The patient is called after 72-96 hrs to assess the development of any delayed adverse effects and if there is no adverse sequel, the procedure can be started immediately. The energy density that is required in the first sitting is the one that caused a perifollicuar erythema and edema in the test spot.[ 30] However, a test patch may not always be feasible and is as such not recommended in all cases. It may be considered important in difficult to treat areas and in patients who are apprehensive.

Laser safety

It is paramount to observe safety precautions in all cases. This includes laser safety precautions and personnel safety precautions. These have been listed in

box 3

Box3: Laser Safety Guidelines

[19]

Treatment Protocol


[19,21]

Pat should be asked to wash the treatment area with soap and water to remove any grease, dust or make up. Pre treatment photograph should be taken. The area to be lased should be marked with a white skin marking pencil. [Figure 38.8] Topical anaesthesia or ice cubes can be used to make the patient more comfortable during the procedure especially, if the patient is apprehensive or experienced pain during the test patch. The hair on the treatment area should be trimmed to the skin with the help of an electric trimmer or shaved with a disposable laser just prior to the procedure. The residual hair growth should not be more than 1mm -3mm. If the hair is stuck on the skin surface after shaving, these can be removed with the help of a micropore tape. The exact parameters to be used should be determined based on the test patch result or on basis of the skin and hair type of the patient. Prior to starting the procedure, it is important to recheck the parameters fed in to the system. Make a final check on the safety measures prior to starting the procedure as mentioned in box 3. It is especially important to confirm that all personnel in the treatment zone are wearing safety goggles. The patient should be informed before firing the laser. The hand piece should be kept perpendicular to the skin surface with firm but gentle pressure and there should be complete contact of the hand piece with skin. In case of areas such the mandibular edge, where complete contact in not possible the skin should be pulled towards the flat surface, e.g. cheek, to effect a complete contact. The pressure should be enough to reduce the capillary blood flow and push the hair follicles towards the skin surface. All areas should be treated in a single sitting. The complete area should be covered by proper placing of the handpeice with not more than 10% overlap of the treatment area. Care should be taken that the same area is not lased more than once which can lead to development of adverse effects. Care should also be taken to lase the entire treatment area and not leave behind untreated spots . This can lead to development of patchy hair growth. A treatment grid may be used to prevent these errors. Adequate cooling during the procedures can be achieved by using cool air sources or immediate application of ice packs on the treated area by an assistant. The recent equipments come equipped with cryosprays or precooled sapphire tips for intraprocedure cooling. Development of dusky discolouration or blister formation indicates incorrect parameters and these should be immediately rectified or the procedure should be stopped. Certain difficult to treat areas require special care. These are mentioned in

box 4

. After completing the procedure the patient should be asked to apply ice packs to reduce pain and edema. At the end of procedure a sunblock cream is applied on the treated area. The procedure details should be immediately noted and this should include the patient details and skin and hair type, procedure details including date/ time, photograph record, fluence, pulse width and cooling method used and lastly the record of any untoward incident should be noted.

Post procedure care at home should be explained and this should include avoidance of heat or hot water bags on the area for at least 24-48 hours, using mild soap and pat drying the treated area and in case if there is a blister formation or any other adverse effect, patient should be advised to apply an antibiotic ointment and inform the treating physician.

Box 4: Laser hair removal in difficult to treat areas

Adverse effects with Laser hair removal [

30]

Most complications are mild and transient such as pain erythema and edema. Sometimes superficial thermal burns may be seen. [Figure 38.9 and 38.10] These are generally caused due to wrong parameter settings, physician error during procedures, lack of adequate safety measures and inadequate sun protection by the patient.

Table 6

lists the complications during a laser hair removal procedure and its management. Apart from these certain uncommon adverse effects are possible which the clinician should be aware of. Paradoxical hair growth is seen in 0.6% to 10% of patients treated as per data available from different studies. [30]. The possible etiology is the stimulation of vellus hair to form terminal hairs by the low fluences in the areas near to the treatment zones. Another theory is the synchronisation of the hair growth cycle to form terminal anagen hair from the dormant hair follicles. [ 57] Darker skin types [III-VI skin types] and patients with Hirsutism seem to be more prone to develop paradoxical hair growth. Continued laser treatment of the affected area is the treatment for the paradoxical hair growth. Persistent severe urticaria has been reported in a number of patients after laser epilation. Some authors believe it to be due to the delayed hypersensitivity reaction to the ruptured hair follicular antigen. [58]. Nd: YAG Laser treatment of axillary hair has been reported to cause persistent hyperhidrosis. This is possibly due to the stimulatory effect of laser on the hair follicle. [59]. Premature hair greying and ingrowing hair are some other complications reported. [30]

Table 6: complications and its management during laser removal

What’s New in Laser Hair removal?

Newer devices are focussing on faster treatments with better patient experience. Devices with pneumatic skin flattening (PSF) help in reducing pain by working on the ‘gate theory’ of pain reduction. This theory states that on stimulation of the non-nociceptive nerves, signal transmission of pain is reduced. The device suction in the skin that has to be treated and this suction pressure on the skin stimulates the tactile nerve endings that reduces pain sensation transmission. This also helps in bringing the target chromophore closer to the laser window and reduces capillary flow which helps in optimising the treatment as has been explained above [illustration 38.4]. [30] SHR™ technology is another improvement that uses low fluence with rapidly delivered pulses (5-10Hz) and higher average energy. This necessitates the use of multiple passes to build the necessary energy but is faster and has a better patient experience. Another development for performing rapid treatments is computer controlled laser scanner mirrors. These help in automatically placing the laser beam in a perfect non-sequential pattern over a larger skin area. [60]. The technology helps in treating larger areas of various sizes by automatically addressing the issues of correct beam placement.

Miscellaneous pearls in laser hair removal procedure

The procedure of laser hair removal can be optimised by matching the patient and his correct parameters.

Table 7

describes the ideal parameters for various skin and hair types

Table 7


: Laser parameters based on skin and hair characteristics

As the hair structure changes from thick terminal hair to thin vellus hair, the laser parameters need to be changed to a smaller spot size. Hence a different laser may be needed as the therapy proceeds. Concurrent use of multiple laser wavelengths could have a synergistic effect and this needs to be probed further. Treatment grids are very helpful to prevent skip areas especially when a large area needs to be lased. Some patients may not respond to the therapy. In these cases, changing the wavelength may be helpful.

Conclusion

Laser hair removal remains one of the most commonly availed laser populations. The results post therapy are very gratifying. The learning curve with lasers for hair removal is not as steep as with some other indications. It is important not to be very aggressive, since that can lead to adverse effects. Newer technologies minimize pain and the treatment duration time. Home hair removal systems may prove to be a an essential aid in every house hold in the near future especially since the price are reducing and the newer technologies have made these equipments significantly effective. It is important to keep a standard operating protocol and following it diligently to reduce iatrogenic complications.

Summary

Hair has a lot of aesthetic value irrespective of age and gender. There is a decreased quality of life in hirsute patients. The laser equipments work in the wavelength range of 600-1100nm. Lasers act through the principle of selective photothermolysis and target the melanin but hair reduction occurs by the transfer of heat to the stem cells which are located in the bulge and the hair papillae. This works on the extended theory of selective photothermolysis. The parameters that have to be monitored for optimal therapy are the wavelength, fluence and the pulse width. Multiple equipments are available for hair reduction such as diode, alexandrite, Long pulse Nd YAG and IPL Home use laser hair removal devices are now available but are expensive at present. The commonest indication for hair removal is hypertrichosis in a female, however multiple other indications can be corrected by laser hair removal. Patient assessment includes detailed history and examination. An informed consent should be taken prior to the procedure. The actual procedure is nearly the same with all machines with few subtle differences. Most adverse effects are iatrogenic and following a strict protocol helps in ameliorating these complications. Newer technologies are making the procedure faster and pain free.

One of the many programs that is available for the population are the several programs outfitted to help curve and lower the number of obese people in the United States. With the way that society is going, there is a huge problem with society and obesity. Obesity is defined as, “Obesity is a complex disease involving an excessive amount of body fat. Obesity isn’t just a cosmetic concern. It is a medical problem that increases your risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.” (Mayo Clinic, 2019) Understanding this helps us determine what programs are available to the population and how-to better market them for availability and use.  One of the major reasons that we need to focus on programs that are able to help curve obesity is focusing on Early Care and Education and Weight-loss.

There are several reasons that Early Care and Education is important in helping prevent obesity is because if we create habits at a early age, we have a lower risk of adult obesity. “A comprehensive approach that improves the food and physical activity policies, practices and environments in ECE programs has potential to impact childhood obesity in the United States.” (Center for Disease Control, 2019) There are several programs that are available to children but that also leaves a opening for us to improve. When looking into childhood obesity there are several programs that cater to making sure that children are given proper meals while they are at school, promote exercise, and build good habits to make sure that children are spending less time on screen time. Some of the major programs offered to children are the Early Childcare and Educational (ECE) Obesity Prevention program, The Racial and Ethnic Approaches to Community Health ( REACH) Program, and the Action for Healthy Kids. Each of these programs offers a benefit that the other might not.

• Early Childcare and Educational (ECE) Obesity Prevention Program – This is a program that works closely with the state and federal government to be able to put into effect some of the prevention plans that have been proven. This program also provides training and technical assistance for supporting obesity prevention efforts. (
  
  https://www.cdc.gov/obesity/downloads/acting-early-to-prevent-obesity.pdf
  
  )
• The Racial and Ethnic Approaches to Community Health (REACH) – This program works to better assist in bridging the gaps that there are in multi-cultural areas. For example, there has been a higher rate of Hispanic to non-hispanic individuals who are obese. REACH provides funds to states and local health through the CDC to help implement and create programs that are both cultural appropriate but also help curve obesity within the community.
• Action for Healthy Kids – This program is not federally funded but offers a alternative to some of the programs available through the CDC and other organizations. They implement strategies that get kids the hands-on experience of what it means to eat healthy but also allows them the ability to be able to get kids working outside. These programs are available to schools and parents through grants that just need to be applied for on their website.

Obesity has played a major role in society today. Understanding the role that obesity plays in children means that we should be looking at how to educate parents on how to make better food. According to the CDC, the number of children that were considered obese was lower when the child had more education. “Approximately 17 percent of U.S. youth have obesity, and nearly one in three children and adolescents are either overweight or have obesity.” (Partnership for a healthier America, 2019) Not only is lowering adolescent obesity a major priority but we also need to make sure that we are looking at the fact that unfortunately there are so many options available that do not have healthy alternatives. So much of our food in local grocery stores are processed and therefore don’t have the nutrients that are required for a healthy meal. Not only are the foods generally processed but usually the ones that are at a more affordable cost are also the ones that are processed the most. Understanding this also helps us see that obesity can be directly linked to economic standings in community. The children that grow up in a under privileged area often are the ones that come from families who cannot afford to pay for healthier alternatives.

As previously stated, there are several strategies in place to help combat childhood obesity. The ones that will be the most effective are the ones that not only educate children but also give them the options that they need to continue to learn and make better choices as they get older. With obesity comes other health problems, such as diabetes and cardiovascular issues. Understanding childhood obesity will help us prevent and lower the costs of healthcare all around because people will be seeing providers for day to day reasons rather than chronic health conditions.

One of the major reasons that I believe in A Healthier America is because their goal is to transform the way that the marketplace works, cultivate and create healthier environments for children and young adults, as well as showcase ways to improve food within households and increase the physical activities that children do. Each point in their mission statement is a valid reason for why children are the future of our country and without changing healthy lifestyles now there is no way to guarantee that they are given the ability to live long healthy lives.

Some of the strategies that are in place to help incorporate and make sure that families are given the opportunity to continue to eat healthier foods and increase activity are programs like the Woman, Infant and Children (WIC) program where food packages are provided to children to help curb unhealthy eating and lower the financial burden that parents face when trying to be able to afford healthier alternatives to over processed foods. Other major programs that are available are the opportunity to give children healthier lunch meals at their schools while also increasing the number of outdoor programs that are available to children through after school programs.

As with any major epidemic there are challenges that have to be overcome in order for society to take on the full benefit of the programs available to them. Some of the major challenges that are faced are the high cost of organic or healthier foods, matched with the failing economy deny majority of the population the right to cleaner foods. Of course, there are health complications that children face when dealing with obesity, some of those complications are: sleep disorders, eating disorders, as well as psychological difficulties. Not only do these factors play a role in the overall health of the child at a young age but they are cause habits to form that will carry into adulthood.

Personally, some of the strategies that I believe would allow us the best opportunity to curb the problems that we face with childhood obesity are going to be finding way to educate families that might not be able to get the education that they need. Not only do I believe that education is a huge part of making sure that children are not facing obesity but at the same time we have to make sure that we are giving children the opportunities without strings attached. For example, we should be making sure that we are giving children the opportunity to get healthy alternatives to food.

• Education – Incorporating local health classes as well as the making sure there are opportunities for fun when it comes to education will make a huge impact on the way that children learn. Some of the programs that I would implement would be monthly cooking classes and programs that allow for better alternatives to foods that are allowed on EBT. Unfortunately because there is a huge correlation between poverty and obesity, we should make sure that we are lobbying for federal programs that put stricter regulations on what can and cannot be purchased with food stamps. I believe that this would give families that guidance that they need to make healthier choices when choosing foods.
• Education is extremely important when looking at families. Understanding that gives us the freedom to incorporate realistic education into the public education system. We should give children the ability to feel like it’s something fun rather than a chore. Children should be given cooking classes that count for electives that utilize healthy cooking to make sure that children are equipped with the tools to make healthy choices before they even leave the education system.

Ultimately there are always going to be ways to prevent chronic diseases, but it will it will fall on the parents to help instill and educate their children so that they are making healthy choices from a young age. Children follow by example and therefore when parents are making choices for their own food habits children are going to be choosing those same foods. As a parent myself, understanding these choices helps to put a ease in my mind on why I make the choices I do.

References

• Childhood Obesity Causes & Consequences. (2016, December 15). Retrieved from
  
  https://www.cdc.gov/obesity/childhood/causes.html
  
  .
• 
  https://www.cdc.gov/obesity/downloads/Early-Care-and-Education-Policy-Review-FINAL_web508.pdf
  
• What Are The Complications of Childhood Obesity? (n.d.). Retrieved from
  

  What Are The Complications of Childhood Obesity?

  .

• Obesity. (2019, August 22). Retrieved from
  
  https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742
  
  .
• Early Care and Education (ECE). (2019, October 2). Retrieved from
  
  https://www.cdc.gov/obesity/strategies/childcareece.html
  
  .
• What We Do. (n.d.). Retrieved from
  

  What We Do

  .

• Early Childcare and Education Obesity Prevention Program. (2018, August 20). Retrieved from
  
  https://www.cdc.gov/obesity/strategies/ece-obesity-prevention-program.html
  
  .
• 
  https://www.cdc.gov/obesity/downloads/acting-early-to-prevent-obesity.pdf
  
• Racial and Ethnic Approaches to Community Health. (2019, September 17). Retrieved from
  
  https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/index.htm
  
  .
• About Us. (n.d.). Retrieved from
  
  https://www.ahealthieramerica.org/articles/about-us-5
  
  .

A policy is typically defined as a principle or rule to guide decisions and achieve rational outcomes. It is not used normally what is actually done, it is normally referred to as either procedure or protocol. A policy will contain what and the why procedures. A policy can be considered as a statement of intent. Policy may apply to generalized private sector organization and groups and individuals. In another way policy can be defined as a collection of different ideas and methods which is used for the improvement in any field including health care and the other hand, health policy is a practical device or advantageous procedure and positive course of action.

Social Policy is a subject area, not a discipline; it borrows from other social science disciplines in order to develop study in the area. The contributory disciplines include sociology, social work, psychology, economics, political science, management, history, philosophy and law. The name social policy is used to apply 1) that policies which are used by the government use for welfare and social protection, 2) to the ways in which welfare is developed in a society and to the academic study of the subject. In the first sense, social policy is particularly concerned with social services and the welfare state. Improvements to social policy are a key element of development and the achievement of human rights. Many social policies are addressed by the third committee of the UN general assembly.

Health policy can be defined as the decision, plans and action that are undertaken to achieve specific health care goals within the society. According to the World Health Organization, health policy can achieve several things. It defines the vision of the future. We can define the different categories of the health policies, eg pharmaceutical policy, public health and personal health care policy, tobacco control policy. Before 1990 there was a good collaboration of health and social care policy.

Contemporary issues on NHS

National Health Services is the United Kingdom health services organization. The short form of National Health Services is NHS. It was stabilised in 1948. It was grown the world’s largest publicly funded services. It is also known as a most efficient, most comprehensive and egalitarian. In the Second World War and difficult scenario NHS was established. The principle of NHS always remains in the core. It was born for good health care and should be available to all. The NHS is the free services for anyone who is resident of the United Kingdom. The NHS only charges some prescription and optical and dental services. NHS is giving the free services more than 60 million people. It covers everything such as antenatal screening routine treatment for coughs and colds to open heart surgery, accident and emergency treatment and it also covers the end of life care.

Mainly it is funded from taxation. In United Kingdom they have separate management in England, Wales, Scotland and Northern Ireland; in many respects they are similar. Despite their separate management and funding there is no any discrimination when a resident of one country of the United Kingdom requires treatment in another although a patient will often be returned to their home area when they are fit to be removed?

It is the huge organization. In this organization have more than 1.7 million employees and half of them are clinically qualified, including 120000 hospitals doctors 400000 nurses 40000 GP’s practises and 25000 ambulance staff. The NHS of the England is the biggest part of the system It is caring more than 51 million people and employing 1.3 million people. The number of patients using the NHS is large. Every 36 hours it is dealing a million in the England, in Scotland 463 in minute and more than 700000 people will visit on NHS dentist and 3000 heart operation, here are 10000 GPs in nationwide. Each GPs look more than 140 patient in a week.

NHS is spending big amount of money. When the NHS established the starting budget of the NHS is 9 billion and now the budget of the NHS is 100 billion in year which is increasing by 4% every year. It is spending 60% of the budget to pay the staff, and 20% for the drug suppliers and remaining 20% is spending for the equipment and training costs. 80% of the total cost is distributed by the local trusts.

HEALTH AND SOCIAL CARE BILL: TO REFORM THE NHS FROM WHITE PAPER “LIBERATING THE NHS”

We know that the “health is wealth”. In any country of the world health is the backbone of the country and the main important is government funded health organization. If any policy is taken related to the health it affects the outcomes of the services. In the United Kingdom NHS is only one and which cover the almost 100% of the services. Now the government took a new policy for NHS Which is liberating the NHS. The Health and Social Care Bill was introduced into Parliament on 19 January 2011. The Bill is a crucial part of the Government’s vision to modernise the NHS so that it is built around patients, led by health professionals and focused on delivering world-class healthcare outcomes.

The Bill takes forward the areas of Equity and Excellence: Liberating the NHS (July 2010) and the subsequent Government response Liberating the NHS: legislative framework and next steps (December 2010), which require primary legislation. It also includes provision to strengthen public health services and reform the Department’s arm’s length bodies.

The Bill on health and social care 2011 contains provisions covering five themes:

It is strengthening commissioning of NHS services

It is increasing public voice and democratic accountability.

liberating provision of NHS services

strengthening public health services

Reforming health and care arm’s-length bodies.

Structure of NHS

Department of health

Strategic health authorities

Primary care trusts

GPs Dentists Hospitals

Patients

The Department of Health (DH) is in overall charge of the NHS with cabinet minister reporting as secretary of state for health to the minister. The 10 Strategic Health Authorities (SHA’s) are under the department of health which oversee all activities of NHS IN England. The strategic supervision of NHS is controlled by each SHA in its area. The NHS services of Scotland, Wales and Northern Ireland runs separately by the developed administrations. Primary care trusts are divided into primary care and secondary care. Primary care is the front line services. GPs, Dentists are primary care where people contacts first time. Secondary care can be defined as a acute health care and can be either elective or emergency care. Primary care is the centre of the NHS and they cover and control 80% of the NHS budget. These are the local organizations so they know the needs of community and they can make sure the organizations providing health and social care services are working effectively. The PCTs oversee 1800 NHS dentist and 29000 GP. Here are 175 acute NHS trusts and 60 mental health trusts which control the 1600 NHS hospitals and specialists care centres.NHS ambulance trusts provides the emergency ambulance services, in UK there are 11 ambulance trusts.

The NHS structure shown below which will be happened after reforming,

Independent board

250 + GP consortiums GPs Dentist specialist service

Hospitals, community services, mental unit intensive core

Patients

After reforming the NHS structure there would be the change in the management not in the whole system of the NHS, but changing the management system it directly affect the top to bottom shake of the NHS. which will directly affect the model of care of the NHS.

Reasons of reforming the NHS

NHS is the great national institution. The main principle of the NHS when it was founded is free at the point of use and available to every one based on need and it is not focused for ability to pay. Most of us believe it can be so much better for both the patient and professionals. So that the government took the bold vision for the NHS future, which is ‘equity and excellence’. According to the different surveys and analysis NHS of the United Kingdom is world class. It is giving the facility without cost and it is also employing more than 1.6 million people which mean it is giving a good services. According to the Health secretary Andrew Lansley says that NHS is the world class in some respects but it is not good enough in some areas eg ; rate of mortality, United Kingdom is the 2nd largest mortality rate among the 24 richest country in the world and rates of mortality for some respiratory diseases and the stroke has been the worst in the developed world. Now the NHS has too much bureaucracy, after reforming NHS would be more accountable to the patients and all the staff will free from excessive bureaucracy. In the structure of the NHS there are 10 strategic health authorities, 175 NHS trusts and 60 mental health trusts. After reforming It will increases spending on real terms of the health not in managing. Department of the health says NHS has further to go on managing care more effectively and international evidence prove it.

The changes of NHS are

The main changes are fundamental changes to structure and the operation which changes the social economic and managerial changes. The main structure of changes is a England’s 175 or so primary care trusts will be wound up in 2013 and their work, commissioning healthcare will pass to groups of GPs called general practise commissioning consortiums (GPCCs). Every GPCCs which will have existing practises will have own budget. The constriums will collect the £ 80 billion from the total budget of NHS and GPCCs are agreed to contacts with hospital and other. More than 200 GPCCs have been set up. The outcomes or changes will be taken by keeping the patient on the heart of the NHS. The patients will have more choices and control by the easy access of the GPs and hospitals. Patient will have the right of decision making about their treatment and care. It will be focused in clinical outcomes. Success will be measured by the bureaucratic process targets, but the against results that really matter to patients such as improving cancer and stroke survival rates. The capacity will be increases or will empower the professionals. Doctor and nurse will have right of professional judgement about the patient treatment. This thing will be supported by controlling the front line staff. If patient want they will have the access information, they can make choices. Patient will have the right of choosing the GP practise, consultant led-team and any provider. Hospitals will require to open their mistake, if something wrong patient must know it. The patient voice will strengthen by local authorities. The targets will be removed with no clinical justification. The quality standard of NICE will inform the commissioning of all NHS care and payment system. The drug companies will be paid by the value of their new medicines, follow of money will be transparent, comprehensive and stable payment system across the NHS to promote high quality care, drive efficiency and support patient choices. The service provider will get the money according to their services performance, payment should reflect outcome not just activity and provider an incentive for better quality. The NHS fundamental structure is controlled by the department of health, after reforming there would be one independent and accountable NHS commissioning board, and NHS will be the under control of this commissioning board. This board will allocate the NHS resources lead on the achievement of health outcomes. This board will promote and improves the patient involvement and choices. Another duty of this board will promotes equality and tackle inequalities. Day by day the minister power will be limited for the decision of NHS. The changes will be shaking top to bottom of NHS structure.

Benefits of NHS reforms

It is the big institution of health. After reforming there should be some changes with the facility of the NHS. GPs could more than double their income to £ 300000 per year this is the direct impact of the NHS reforms. It also cuts the bureaucracy. NHS foundation trusts are given significantly greater financial freedom and power. It increases the quality of primary medical services. Now the NHS budget is increasing 4% per year after reforming it will increase just 0.1% per year.

Model of care

Model of care is directly impact to the patients and it affects the whole output of the organization. I have already described the model of care in changes of NHS. when the people born in the world at first he is known only male and female at that time there is no any discrimination like that way United Kingdom National Health Service believes in the universality. In NHS there is no any discrimination for the treatment of the patient, it is only believe for the medical requirement, it doesn’t separate the richest and poorest of the people. It gives the treatment free of the cost. If the people of the different country which have more than 1 year resident permit he is also can take the benefit of the NHS. While starting the NHS at that time people have no right of choices, but now a days they have right of taking decision of their care. Day by day patients are increasing and also the NHS also increasing employee’s which gives the good services for the patient which is the positive point of the model of care. We know that NHS is employing the large number of employees.

Now a day United Kingdom government is focusing the reforms of the NHS, many arguments were taken about the patient of care; I thought it’s better to describe the different arguments here. British Medical Association is the leading association of the medical staff in the UK, but the British Medical Association said against the reforms of the NHS. According to the BMA: more than 150 organizations and 80 percent budget of the NHS will go to the GPs hand. Financially and managerial power is given to GPs which increases the bureaucracy. This proposal is unmanaged damaging and unjustified. This damages the patients care. There are different surveys says after reforming its affect a patient care. According to the Unison after the cutting of the staff its directly increase the workload for the nurses and doctor and other staff. The survey said that 88% think that during first year of the coalition government their workload has increased, and 65% said that rise of hitting patient care and safety. Around 67% of nurses said that increasing the workload direct impact on their health, and 69% said their job is not suitable or bad for family life. This will direct affect the model of care. Beside these arguments I thought that after reforming the NHS the model of care would be better. Equality and excellence liberating of the NHS Says patient are always in the core and after reforming patient will have many choices, they will have their decision for owns care, and they can tell no decision without me, which is not in the today’s model of care. Managerial cost will be saved which will be used to empower the technical and professional things, these things increases the model of care better.

Conclusion

Health is the backbone of the any country without healthy people country cannot be developed. Health and social care policy is directly related to the health of the people. So that government should think about how to take the policy, policy should not be taken without justification. I have already mentioned that policy is the key role of the development. Now the Government took the new policy about the National Health Services (NHS). in the history of the NHS government took many policies related to the health but this policy would be the biggest policy which will change the fundamental or it will shake the top to bottom of the NHS. in my opinion government should take the policy step by step not like big shake up. The implementation of this policy is very costly. British Medical Association already rejects this policy and many people are against of this. Health and social care policy and model of care are interrelated; this means how the patient will be treated, if the policy is failed then what would be the condition of the country. This policy cuts the thousands of jobs which will increase the unemployment, this policy increase the price competition allowing hospitals to undercut one another to attract patients, poses a risk to standard of care. some surveys said doctor will be the account after implementing this policy. ‘Health is wealth’ This is the universal truth so that government should not play the life of the people. According to health secretary Andrew lansley this policy “equity and excellence liberating NHS” will make the NHS bright future.

Exercise as an Effective Intervention for Symptoms of Anorexia
Nervosa

Introduction

Eating disorders (ED) are serious and dilapidating psychiatric conditions that affect individuals through adverse physiological, behavioral, and cognitive manifestations. Anorexia Nervosa (AN), characterized by an

obsessive desire to lose weight

through self-starvation, is the most common ED and the deadliest mental health disorder (Fisher et al., 2008). An estimated 1%-4.2 % of all women have experienced AN in their lifetime, with the disorder having the highest standardized mortality ratio of 5.86 among mental health disorders (Noetal et al., 2016). Individuals with AN experience pathologies of extreme food restriction and excessive exercise, which cause symptoms that include extreme weight loss, low blood pressure, heart arrhythmias, muscle wasting and weakness, myopathy, and cycles of binging and purging. Current treatment options for AN patients include a mixture of medical treatment, nutritional counseling, and behavioral and psycho therapy that emphasize weight gain through re-feeding and behavioral modifications away from self-starvation. The positive physiological and psychological benefits that exercise and physical activity has can provide a treatment method for symptoms of AN to reinforce or even replace current treatment options. In terms of physiological benefits, exercise provides positive influences on muscle composition, muscle strength, and body mass index (BMI), while allowing for reductions in obesity and chronic pain. Psychologically, exercise can positively influence self-esteem, depression, anxiety, and body image (Hausenblas et al., 2008). Based on these frameworks, improving physical fitness through healthy exercise can theoretically show improvements in the many detrimental factors of AN. So, can a controlled, dosed exercise program be an effective intervention against the physiological and behavioral symptoms of Anorexia Nervosa?

Studies conducted by Touyz et al. and Thien et al. provide data that
suggest exercise can be implemented alongside weight restoration and re-feeding
programs without compromising further weight reductions. Chantler et al. and
Vancamfort et al., through their research, show the effects resistance training
has on improving functional abilities and the management of myopathy symptoms. Furthermore,
experimentation done by Calogero et al. and Sauchelli et al. suggests that
exercise interventions can positively affect both behavioral and depressive
effects of AN. Overall, when paired with re-feeding programs, exercise
interventions can be effective in improving functional abilities and can
provide improved psychological states for individuals suffering from Anorexia
Nervosa.

Is Exercise Counterproductive to Treatment?

The implementation of exercise interventions may seem
counterintuitive to the treatment of AN that emphasizes weight gain; however,
literature suggests there are no statistically significant adverse effects. Due
to the clinical feature of extreme weight loss in AN patients, re-feeding and
weight restoration is an important component to treatment programs. To combat
the restrictive food intake behavior and excessive exercise, current treatment
plans follow strict re-feeding guidelines that enable patients to alleviate the
effects of malnutrition. Physical activity and exercise are minimized in order
to decrease the likelihood of further weight reduction. This limitation of
exercise and physical activity has contributed to the current lack of any
established exercise treatments for ED (Zunker et al., 2011). A study conducted
by Touyz et al. entitled, “Anaerobic Exercise as an Adjunct to Refeeding
Patients with Anorexia Nervosa: Does it Compromise Weight Gain”, aimed to explore
the effects exercise had with weight regain during re-feeding treatment of AN
patients. The researchers followed 39 AN patients, divided into two exercise
and non-exercise groups, during a six week treatment program. There was no significant
difference in the rate of weight gain found between the two groups during the
re-feeding period, with patients participating in the exercise program gaining
.94 kg per week compared to the 1.01 kg gained in patients not participating.
These findings introduce the idea that implemented exercise does not compromise
the main goal of re-establishing a healthy weight, but rather has the same
effects as no exercise at all.

Similar findings to Touyz et
al. were seen in Thien et al.’s research, “Pilot study of a graded exercise
program for the treatment of Anorexia Nervosa,” that exhibited the lack of
deleterious effects of exercise during AN re-feeding. These researchers conducted
a randomized control trial of 16 AN patients and divided them up into an
exercise prescribed group and a non-exercise prescribed control. After being
followed every 2-3 weeks for 3 months, results showed that there was no
significant difference in body fat or BMI change between the control and the
experimental group, with significant improvements in quality adjusted life year
(QUALY) scores favoring the experimental group. As with Touyz et al.’s data, the
lack of significant difference in the level of change of weight gain suggests
that exercise does not promote adverse effects during re-feeding programs. These
results challenge the notion that AN patients should not experience exercise or
an increase in physical activity when recovering, which is founded through the
belief that exercise is solely used for weight reduction. Clinical implications
of this positive exercise data can allow for the implementation of exercise
interventions that can introduce other physiological and psychological benefits
for patients. Exercise and physical activity, rather than being counter
productive to treatment, can thus have important roles in the reduction of AN
symptoms.

Physiological Effects of Exercise Interventions

As a role within treatment programs, exercise interventions can provide improvements in both functional abilities and biomarkers of exercise performance. Aside from weight restoration, AN treatment programs should also work to allow affected individuals to regain functional abilities that may have been lost during stages of severe starvation and malnourishment. Type 2 muscle fiber atrophy and slowed motor nerve conduction velocities cause neuromuscular deficits in starved and muscle depleted AN patients- including proximal limb weakness, decreased maximal force generation, and an increased rate of muscular fatigue (Fisher et al., 2012). These symptoms can be addressed through resistance exercise interventions to improve overall muscle composition and the resulting improvements in functional abilities. Chantler et al. explored these potential benefits of resistance training on AN patients in their study entitled, “Muscular strength changes in hospitalized anorexia patients after an eight week resistance training program.” These researchers followed fourteen female AN in-patients, randomized into 2 groups (one exercise, one non-exercise), through 8 weeks of treatment. The non-exercise group experienced a normal re-feeding treatment without an exercise intervention, while the exercise group experienced a twice a week, hour-long resistance training program that incorporated both upper and lower body exercises. At the end of the study, researchers found statistical improvements in the peak torque of knee extensors, knee flexors, and elbow flexors of the exercise group, compared to no improvements in the non-exercisers. Additionally, the exercise group had statistically improved body composition as a result of the increased proximal limb strength. This data suggests that an added resistance training intervention can provide the necessary physiological benefits to aid in the recovery of AN patients. With proximal limb strength improvements, both body composition and functional abilities can be altered towards more healthy levels. These improvements can resolve the neuromuscular deficits that disable AN patients from properly functioning on a muscular level and from completing activities of daily living.

The study conducted by Vancampfort et al. entitled, “A systematic review of physical therapy interventions for patients with anorexia and bulimia nervosa,” echoes similar findings to Chantler et al.’s research on positive effects of resistance exercise interventions. 8 randomized control trials were reviewed that met selection criteria of utilizing a comparison between physical therapy and a placebo condition and having a control intervention of standard care for AN. The methodological qualities of each trial were also assessed, with 3 of the studies exhibiting strong methodological qualities. Analysis of these studies concluded that both resistance and aerobic training interventions had statistical improvements on body mass index, muscle strength, and body fat percentages. In addition, aerobic exercise was found to significantly decrease depressive symptoms and lower scores of eating pathology in individuals with AN. These physiological improvements of resistance training on AN patients, without any adverse effects on weight gain, suggest that this type of intervention has utilization within current therapy and recovery programs. The incorporation of a resistance-exercise component to re-feeding programs can inhibit the myopathy symptoms seen in AN by strengthening the coordination and activation of muscle synergists and the performance of motor skills. Targeting improvements in muscular strength can induce increased functional abilities and allow AN patients to return to the levels of functioning before their pathology. The results of this study also present evidence that exercise intervention can positively affect the emotional well being and behavior of individuals with AN.

Psychological Effects of Exercise Interventions

Exercise interventions can also provide positive psychological effects on the behaviors and emotional well being of individuals with AN. With AN being the deadliest mental health disorder in the world, the emotional well-being of affected individuals is a crucial component to the behavioral eating pathology that leads to self-starvation and malnutrition. AN treatment programs can offer both psycho and behavioral therapy alongside medical re-feeding techniques to normalize eating patterns and support feelings of weight gain (Zunker et al., 2011). An exercise program can have similar effects to these contemporary therapy approaches and can introduce added behavioral and psychological benefits. The study conducted by Calogero et al. entitled, “The Practice and Process of Healthy Exercise: An Investigation of the Treatment of Exercise Abuse in Women with Eating Disorders,” investigated the behavioral and emotional states of ED patients after exercise interventions and its relationship to decreased pathology and weight restoration. Researchers followed 254 women with ED, with the two groups divided into an experimental group exposed to an exercise intervention and a control group that was not exposed, over the course of 6 months. The exercise intervention group followed an hour long, 4-day a week exercise program that incorporated both aerobic and strength training, with both groups receiving several self-report assessments on a weekly basis. The results of the study showed that women with AN who participated in the exercise program actually gained 40% more weight than their non-exercise exposed counterparts. Findings from the questionnaires also showed that the exercise intervention group statistically decreased their involvement, rigidity, and emotional commitment towards exercise, while the control group had no statistically significant difference in these dimensions. This exercise intervention data supports the idea that general re-feeding alone can not resolve some of the emotional and behavioral manifestations that causes self-starvation and excessive exercise. Exercise can provide outlets for AN patients to alleviate anxiety and increase their comfort levels and feelings towards gaining weight. By experiencing a strict exercise program, patients can be exposed to the same types of fundamental approaches and principles of healthy exercise on a regular basis. This level of repetition can help to internalize the benefits of healthy exercise and change attitudes and behaviors away from excessive exercise.

In addition to the effects of an exercise intervention on the mental and behavioral attitudes towards excessive exercise, the study conducted by Sauchelli et al. entitled, “Physical activity in anorexia nervosa: How relevant is it to therapy response,” explores how exercise affects the psychological well-being of AN patients. Sauchelli et al. followed 88 AN patients exposed to an exercise intervention as part of their treatment plan and 116 healthy-weight controls through a 12 week period. Measures in time spent in physical activity, BMI and body composition changes, depressive symptoms, and eating disorder psychopathology were recorded. This study found that there was no difference between the healthy control or exercise group in the time spent in moderate to vigorous physical activity (MVPA). The increased level of eating disorder severity and low levels of MVPA showed associations with poor treatment outcomes, while low MVPA and depressive symptoms also showed significant associations. The similar time spent in physical activity between the healthy control and exercise group shows the ability of AN patients to respond well towards exercise. By implementing, rather than restricting, exercise and physical activity within treatment programs, treatment outcomes can see improvements. The comorbidity between depression and AN can also be addressed through exercise as less time in MVPA is linked to depressive symptoms. This relationship also suggests that exercise can present a mood-regulatory effect on AN patients along side its ability to improve functional strength. Exercise can thus provide AN patients with psychological benefits in terms of emotional well being when integrated within a treatment plan.

Conclusion

Exercise, as an intervention for AN, can provide the necessary physiological and psychological benefits to manage the

self-restriction and excessive exercise

pathologies when incorporated with re-feeding plans. The studies conducted by Toyuz et al. and Thien et al. showed the ability of exercise to provide improvements without jeopardizing any re-feeding and weight restoration efforts. This idea allows for more clinical implications of exercise interventions, in terms of its physiological and psychological benefits, to be addressed. The studies done by Chantler et al. and Vancampfort et al. provide evidence that shows exercise interventions improve muscular strength, BMI, and body composition – effects that positively influence the functional abilities of patients. Additionally, the research conducted by Calogero et al. and Sauchelli et al. demonstrated that exercise positively affected the attitudes and behaviors against excessive exercise and had an association with decreased depressive symptoms. A limitation of such studies includes their cross-sectional nature, which makes it difficult to draw causational conclusions regarding exercise and its effects. However, all these studies implemented exercise along side of re-feeding and weight restoration programs and all concluded that exercise does not have detrimental effects on weight regain. For future studies, it is necessary to explore the mechanistic features of exercise as it relates to AN to determine causational effects. Furthermore, it is important to provide exact specifications of experimental exercise interventions. Not only will this specification provide a standard to which future studies can utilize, but it also allows for mechanistic research to be focused. No standardized exercise intervention is currently used to help treat the symptoms of AN, but these promising research data on the beneficial effects of exercise on physiology and behavior can perhaps change this fact.

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