Category: Disease

A chronic disease may be defined as a sickness that is continual in nature and the path of the disease runs into a few months. The chronic diseases include diabetes, cardiovascular disorders, cancer, asthma, stroke, chronic respiratory diseases, etc. These diseases are distinctive of very slow development and patient suffering goes on for a longer duration (NCBI MeSH, 2012).These are generally non-communicable in nature, but in some cases viruses have been implicated like cancer and HIV/AIDS. It is reported that around 63% of the deaths result due to chronic conditions (World Health Organization, 2012). In the United States too, chronic diseases account for nearly 70% of the deaths, which is around 1.7 million per year (Statistics and Tracking, 2012). The common causes of chronic diseases identified are physical inactivity, poor diet, alcohol abuse and excessive tobacco use. The emphasis of research has shifted from communicable to chronic diseases due to high mortality and long standing patient suffering. The chronic conditions demand a high level of consistent patient and health care. This paper aims to analyze a preventing chronic disease research article. The article has been selected from CDC website and the title of the paper is Preventing Chronic Illness in Young Veterans by Promoting Healthful Behaviors (Preventing Chronic Illness in Young Veterans by Promoting Healthful Behaviors, 2012).

Analysis of the selected research article

The article Preventing Chronic Illness in Young Veterans by Promoting Healthful Behaviors is a recent article, last updated on 15 December 2011. The paper deals with the discussion of the chronic illness suffering and increased risk among war veterans who have returned from Iraq and Afghanistan, and opportunities to develop strategies to promote healthful behaviors among them. The causes being tobacco use, weight linked behaviors, physical apathy and deprived nutrition. Though continuous smokers, these war veterans were 50% more prone to tobacco use, attributed to their socio-cultural conditions and military vocation course. The entry to adulthood leads to weight gain leading to chronic conditions. These war veterans are more prone to hypertension too. They also have more access to physical training against their other peers, and are also entitled to VA healthcare system, focusing more on chronic illness prevention. The age related analysis has found that the best time for change in behavior is after initial deployment, when young soldiers can be encouraged to quit smoking. The strategies to be adopted are to define and establish a well defined data collection system (Chronic Disease Prevention and Health Promotion, 2012), and for this participants need to be recruited through organizations (National Institutes of Health, 2012; National Heart Lung and Blood Institute, 2012). The data could be collected through the social websites, online surveys, and also the data need to fully self-explanatory in nature. Another approach is to develop and design innovative policies to encourage young veterans quit smoking, alcohol, etc. More efficient partners are required apart from VA health care (Department of Veterans Affairs, 2012). There should be an integration of Military health care with VA healthcare system, with the participating research centers and universities. This would increase the interaction of war veterans with these institutions on their return, and hence would be helpful in controlling chronic illness.

Economic justification of Preventing Chronic Disease

Chronic diseases cannot just be measured as the disease of the rich and the elderly in the light of the fresh research evidences. The cost of chronic illness, micro- and macro-economic data imply upsetting economic cost for the family and the nation having a deep impact on the saving and spending patterns, labor-market output, and human-capital buildup. Governments need to intrude in the private globe of the individual as markets fail to attain publicly best outcomes. There are evidences that interventions such as tobacco termination programmes, tobacco taxes, educational, and pharmacological programmes are cost-effective. Research investments by public sector assume magnitude with the detection that chronic diseases are on the rise with aging populations across the globe. The cost of illness studies have suggested that it ranges between 0.02% and 6.77% of a countrys GDP. According to one research by Sturm in 2002, to review the additional per-person annual healthcare costs associated with obesity, overweight, smoking and heavy alcohol drinking among the age group 18-65 years in USA; it was found that increased costs due to obesity, smoking and heavy drinking were $395, $230, and $150 respectively. When the advanced research by Finkelstein in 2003 were extrapolated, it was established that the expenditures for overweight and obesity collectively amounted to 9.1% of total annual US medical expenditures in 1998. Given existing health finance patterns in many developing and under-developed nations, the costs associated with treating chronic disease are more likely to be felt by those who are affordably poor, mounting the risk of economic loss and impoverishing medical expenditures of the families concerned (The Oxford Health Alliance, 2012; OECD, 2012).

To conclude, the increased risk factors for chronic illness among war veterans could be controlled through more engagement between the patients, healthcare systems, and the research and academic organizations, leading to formulation of effective health policies keeping in view of the future economic burden of the rising chronic disease cases.

Explanation: The graphical representation shows the effects of obesity by getting to middle ages above 35 years, on the probability of surviving to dissimilar ages. Clearly, reaching an over-weight (BMI=32) than a healthy weight (BMI=24) cuts life expectancy by nearly 3 years.

References

Chronic Disease Prevention and Health Promotion. (2012). Center for Disease Control and Prevention. Web.

Preventing Chronic Illness in Young Veterans by Promoting Healthful Behaviors. (2012). Center for Disease Control and Prevention. Web. 

Statistics and Tracking. (2012). Center for Disease Control and Prevention. Web. 

Department of Veterans Affairs. (2012). Health Care. Web.

National Heart Lung and Blood Institute. (2012). NHLBI- Supported Research. Web.

National Institutes of Health. (2012). Research Portfolio Online Reporting Tool (RePORT). Web.

NCBI MeSH. (2012). Chronic Disease. Web.

Prospective studies collaboration. (2009). Body-mass index and Cause-specific mortality in 900 000 adults: collaborative analyses of 57 Prospective studies. Web.

The Oxford Health Alliance. (2012). Chronic disease: an economic Perspective. Web.

OECD. (2012). The prevention of life style related chronic diseases: An economic framework. Web.

World Health Organization. (2012). Chronic diseases. Web.

Introduction

Chronic Kidney Disease occurs as a result of a breakdown in the functioning of the renal due to kidney damage. Subsequently, the kidney may retain excessive quantities of harmful nitrogenous and non-nitrogenous wastes associated with the renal failure. This analytical treatise attempts to explicitly present an outline for evaluating the nursing intervention plan for prevention and treatment of the Chronic Kidney Disease.

Intervention Plan Summary

Through the application of the Health Promotion Plan, the proposed intervention plan involved completed behavioral change in the form of healthy eating habits. The plan is appropriate for the identified role given that self-driven actions are easily rooted in the behaviors of the target population. From this approach, the highlighted numbers of new cases of CKD are likely to go down tremendously (Winnick, Lucas, Hartman, & Toll, 2005).

Formative and Summative approaches to evaluation of the intervention plan

Nursing intervention to minimize blood loss evaluation

It is important to have knowledge on the type of the Chronic Kidney Disease a patient is suffering from. It is imperative to maintain the patients on rest and increase the periods of complete rest periods to minimize the metabolic rate which increases the activities in the kidney. The nurse should then make frequent observations for metabolic acidosis in order to be in a position to notice any complication on an hourly basis. Regulate the fluid intake to avoid occurrence of edema (Arvin, 2011).

It is important to provide oral hygiene to the patient to minimize the occurrence of ulcers and irritation of the tissues as a result of excessive acidic wastes excreted through mucous membranes. Moreover, this practice should go hand in hand with the peritoneal dialysis and hemo-dialysis to minimize blood loss. In addition, the nursing intervention should incorporate counseling and guiding the patients to minimize anxiety. Excessive anxiety may increase the blood loss since the renal function will be more rapid than the kidney of the patient can handle. Increased activities or excessive pressure as a result of stress or anxiety may increase the retention of the harmful wastes in the kidney of the Chronic Kidney Disease patient (Arvin, 2011). The success will be measured by the degree of positive response exhibited by each patient. When the results are satisfactory by 60%, the intervention will be declared successful.

Evaluation of the intervention and diet plan

The nurse should ensure that the diet of the patient has high carbohydrate content, relatively low protein, and adequate fats since high fat and carbohydrate calories from metabolism does not support the creation of energy from proteins. This ensures that any available protein is reserved for repair of damaged tissues. Besides, it is important to reduce quantities of food rich in potassium to reduce the high levels of potassium in the ART patient. High level of potassium is the renal system is very harmful since it may result in electrolyte imbalances (Wang, Gamboa, Warnock, & Muntner, 2011). Proper dieting will be evaluated on the basis of changes in the condition of the patient after three months of the dieting program.

Evaluation plan for a patient with Chronic Kidney Disease

The evaluation plan for the Chronic Kidney Disease intervention will be carried out through a direct nurse-patient contact to boost acceptance and effectiveness. The main inputs in the intervention will include appropriate venue, allocating interaction hours and days, hiring appropriate healthcare personnel, and creating progress tracking module. The evaluation process will commence from the beginning of the program through to its completion for each patient. The main outputs will be categorized within the parameters of self improvement in terms of physical functioning and augmented kidney performance (Arvin, 2011).

References

Arvin, A. (2011). Nursing care plan for acute renal failure. Web.

Winnick, S., Lucas, D.O., Hartman, A.L., Toll, D. (2005). How do you improve compliance? Pediatrics, 115 (6), 718-724.

Wang, H. E., Gamboa, C., Warnock, D. G., & Muntner, P. (2011). Chronic Kidney Disease and Risk of Death from Infection. American Journal of Nephrology, 34(4), 330-336.

Peritonitis is an acute peritoneum inflammation, which is a thin membrane covering the surface of the abdominal wall and the organs located in the abdominal cavity. A slit-like hole is formed between the peritoneum sheets, containing a small amount of fluid, which facilitates the sliding movements of the abdomens internal organs relative to each other.

Symptoms of Peritonitis

• Abdominal pain
• Diarrhea
• Fever
• Nausea and vomiting
• Loss of appetite
• Low urine output
• Thirst
• Inability to pass stool
• Fatigue
• Confusion

Causes of Peritonitis

Peritonitis occurs due to infection that can develop from the foci of inflammation in the abdominal cavity. The most common cause of peritonitis is appendicitis, less often are acute cholecystitis, perforation of the stomach, and duodenal ulcers, intense pancreatitis, entering abdomen wounds. Thus, peritonitis is mainly a complication of the abdominal organs inflammatory diseases and has three stages of its development:

• Compensation stage. The body struggles with the problem at the limit of its capabilities, but there is no significant disruption in the work of internal organs. This stage lasts from several hours to 1 day.
• Subcompensation stage. There is a failure of many organs and systems. In this case, treatment is required in the conditions of the intensive care unit.
• Decompensation stage. The organ dysfunctions are arising in the body in most cases (60-100%).

Treatment

The volume and tactics of treatment depend on the severity of peritonitis course and its cause. In the vast majority of cases, treatment should only be surgical. Whether it can be performed laparoscopically through small incisions or traditional surgery is necessary is decided after the diagnosis is made. In surgical treatment, doctors begin with the disinfection of the principal infectious focus and the abdominal cavity. Then the abdominal cavity is drained, form pathways for the outflow of inflammatory exudate using silicone rubber drainages. The drainage can remain at the site of inflammation for up to 2 weeks.

Introduction

It is apparent that heart diseases have been rampant and hence posing a challenge to the obese and overweight people in the United States of America (Franklin et al, 2001, p. 1245). However, epidemiological studies have already been employed to diminish health menace caused by cardiovascular diseases (CVD) in United States. According to Franklin et al (2001, p.1245), Framingham study examined factors and evolution of heart diseases over several decades.Generally, the study targeted to examine both men and women in order to obtain valuable insight on the prevalence of cardiovascular diseases. Moreover, the study has enhanced the scrutiny of predisposing factors as well as diagnosis of such ailments in both men and women. Empirically, it is evident that more than 65% of adult who are overweight are susceptible to heart diseases (Ford, Giles & Mokdad, 2004, p.1791). In this case, cardiovascular ailments have been ranked the highest among those maladies that contribute to high mortality rates in United States. This paper explores why CVD has become an epidemiological problem in United States. Besides, the impacts of Framingham study have also been prioritized in this essay.

Framingham Heart Study: Results

This study was carried out to investigate health status of men and women who aged from 30-60 years and did not have signs and symptoms of heart diseases (Franklin et al, 2001 p1248). Consecutively, they would be examined after two years and their medical details recorded. Moreover, their lifestyles and eating habits were observed and over several decades, a qualitative analysis was made in regard to the data recorded. Basing on the analyses made from the results, scientists were able to establish the concept of risk factors (Ford, Giles & Mokdad, 2004, p.1793). In this case, they aimed at elaborating various aspects in peoples health and lifestyles that accelerated their suffering from cardiovascular diseases. A report was released in 1961 that gave a conclusion on how to decimate limit factors which caused heart disorders (Linton & Fazio, 2003, p.10).

As part of the findings from the study, smoking was identified as one of the major predisposing factors of cardiovascular infirmities. Besides this, it was revealed that filters in cigarettes do not decimate the risks in anyway (Franklin et al., 2001, p.1249). Predictably, it was discovered that regardless of differences in age and pulse pressure, men were more prevalence to heart diseases due to smocking as opposed to women. However, women were more susceptible to diabetes mellitus than men (Franklin et al, 2001, p.1247). It is clear that, some of the notable heart complications are painless. However, they silently delimit the heart function and eventually cause deaths. Another predictable factor is on consumption of food that is highly rich in cholesterol. It is vivid that fatty foods have high levels of lipoproteins which have adverse effects on arteries and blood capillaries of the heart (Linton & Fazio, 2003, p.13). Gradual hardening of arteries due to fatty deposits in the arteries limits blood flow in the body. Eventually, the heart gets fatigued and fails to function. Certainly, it is clear from the research done that lack of exercise accelerates weight gain resulting into obesity.

From the statistical records obtained during the study, it is revealed that ailments which result to heart failure are triggered due to poor metabolism (Franklin et al., 2001 p1247). In this case, poor diet increases risks of ailing from diabetes, hypertension and obesity. It is estimated that 17% of children in United States are obese hence likely to succumb to cardiovascular infirmities (Ford, Giles & Mokdad, 2004, p.1791). In line with this, it is vivid that the poor minority are more prevalent to heart diseases due to malnourishment, stress and lack of recreational facilities for exercising. It is also a commonly observed experience in the United States that the population is highly prone to predisposing factors like smoking, alcoholism and poverty among the minor races (Linton & Fazio, 2003, p. 22). However, the study has also confirmed that cardiovascular epidemics can be decimated by weight control through physical exercises (Linton & Fazio, 2003, p. 25). In line with this, addiction to media programs accelerated inactivity among youths, children and older adults. Besides, people are different in the way they respond to metabolic syndrome. It is also factual that heart related problems invade people depending on their genes.

Framingham Heart Study: Impact

Qualitatively, the Framingham study has been appraised by health practitioners and clinicians in US in helping them understand features of CVDs (Ford, Giles & Mokdad, 2004, p.1799). In this context, this has enabled them to predict and monitor the predisposing factors that might occur in future. Models laid by this study are effective for lay people to desist from the baseline of CVD. Notably, Framingham study has highly resulted into decline in mortality rate in United States. It is evident from statistical records that, there has been a drop rate of 50% for people who die from cardiovascular illnesses (Burt et al, 1995, p. 307).

Moreover, empirical research studies indicate that the study has eventually diminished the number of smokers in U.S from 70% to 30% (Burt et al, 1995 p312). In this essence, smocking was perceived to be one of the predisposing factors that made people in US to become vulnerable to heart diseases (Franklin et al, 2001, p.1249). Decline in smocking rate has consequentially reduced risk of suffering from CVDs. In addition to this, and with the help of Framingham study, citizens in U.S have been enlightened that certain types of food contain cholesterol. This substance block the heart vessels like arteries causing heart attacks (Ford, Giles & Mokdad, 2004, p.1797). This has led to documentation of programs that help the state to reverse rate at which poor eating habit is actively increasing prevalence of CVDs.

It is evident that new drugs have been made available to control and decimate heart ailments like hypertension (Franklin et al., 2001, p.1247). Earlier on, heart specialists did not know that heart attacks caused no pain to patients. In this case, they diagnosed them for other infirmities. Contemporarily, they can now understand that painless attacks ruin heart functions. It is definite that there has been rise in survival rate of people with CVDs due to development of new form of therapies. These include thrombolysis and angioplasty to enhance the patients to recover from the illness (Burt et al., 1995, p. 309). Though the impacts remain unsatisfactory, it is predicted that the morbidity and mortality rate will decline with time. Frequently, several recommendations have been made through the study to impact changes in peoples lifestyles (Linton & Fazio, 2003, p. 27). Doctors have been equipped with knowledge from the study on how to advise patients on proper diet, exercise and treatment thus reversing the impacts of heart diseases. For instance, active exercise has helped old adults to reduce weight thus living healthy lifestyles. Consequentially, the data provided by Framingham study has fueled US specialists and the government to take stern measures on predisposing factors like smocking, drug abuse amid others (Franklin et al, 2001, p.1247). Coincidentally, this has improved the life span of citizens in US thus decimating mortality rates.

Conclusion

In summing up, it is imperative to note that cardiovascular diseases (CVDs) have been ranked highly among those illnesses that cause deaths in United States. Recently, it has been ranked as one of the most chronic ailments in developed countries. It is also apparent that one fifth of mortality cases are related to heart diseases. Nonetheless, there have been establishment of new tools to annihilate these risk factors associated with cardiovascular diseases. Better strategies have helped to underscore the risks thus making the public to improve their lifestyles. This has been accomplished by improving on diet, active physical activities and pre-diagnosis for early detection of CVDs. Through the Framingham study, clinicians and health specialists have documented on measures of freeing patients from CVDs. Subsequently, use of sophisticated methodologies to limit CVDs has enhanced a predictable trend.

References

Burt, L. et al. (1995). Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 19881991. Hypertension. 25, 305313.

Ford, E., Giles,H & Mokdad A. (2004).The distribution of 10-Year risk for coronary heart disease among US adults: findings from the National Health and Nutrition Examination Survey III. J Am Coll Cardiol. 43(10), 1791-1796.

Franklin, S. et al. (2001). Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation.103, 1245 1249.

Linton, M. & Fazio, S. (2003). A practical approach to risk assessment to prevent coronary artery disease and its complications. Am J Cardiol. 92(1), 9-26.

Sexually transmitted diseases (STDs) have become a significant issue in the twenty-first century. Studies show that most of the infections can be traced to drug addicts and sex workers (Abad et al. 1705-1706). The high prevalence of STDs is often a result of sharing syringes to insert drugs and an increased number of sexual partners (Arasteh et al. 3320). While there are effective methods of controlling the spread amongst non-addicts, the treatment of the addicted proves to be difficult. This paper claims that preventive techniques need to specifically target drug addicts and sex workers to combat the STD epidemic and offer interventions to reduce risky sexual behaviors and drug use.

Human immunodeficiency virus (HIV) has caused a pandemic that has stimulated an increased focus on developing new antiretroviral (ARV) drugs to treat the disease. The period between 1994 and 1998 marked the rise of another new class of non-nucleoside reverse transcriptase inhibitors (NNRTIs) to address and slow the spread of HIV (Crepaz et al. 334). Since they were easier and cheaper to produce than protease inhibitors, they aided in scaling up the ARV therapy in resource-limited settings (Crepaz et al. 335). Identifying novel drug targets has been significant in the discovery as well as the development of other ARV drug classes. For instance, since the 80s, researchers have believed that a molecule named CD4 is the primary receptor for HIV in immune cells (Crepaz et al. 335). Later, they reported the finding of a co-receptor called CXCR4, which was needed to enter particular HIV strains into immune cells (Crepaz et al. 335). The discovery motivated scientists and researchers to search for other co-receptors.

Numerous groups, such as NIAID scientists, believed that another receptor named CCR5 is the actual primary co-receptor utilized by the disease to infect immune cells (Crepaz et al. 336). This discovery established the basis for developing the CCR5-blocking drug maraviroc, which was approved by the FDA in 2007 (Parra et al. 529). Another significant ARV drug class that arose in 2007 was called integrase inhibitor raltegravir. It became a valued part of combination antiretroviral treatment (Crepaz et al. 336). However, HIV can seek numerous pathways to develop resistance to the medicine. Its variants that are resistant to raltegravir may as well be resilient to elvitegravir, which is another integrase inhibitor of the first generation.

Dolutegravir, which was approved by the FDA in 2013, is a second-generation integrase inhibitor that had a high barrier to the development of drug resistance (Wainberg and Han). In clinical experiments, raltegravir proved effective for individuals infected with HIV who had not previously undergone therapy (Wagner et al. 988). The drug proved to be effective even when the first-generation drugs were ineffective. Other benefits of the raltegravir include convenience in terms of once-a-day dosing, relatively low production cost, and a good safety profile (Crepaz et al. 337). It is now included in two of the initial line regimens that the United States Department of Health and Human Services medical practice guidelines suggest for infected adults. Recently, it was added to the WHO policies as an optional first-line agent for grown people (Wainberg and Han).

Medical trials suggest that treatment with ARV therapy slows the progression of AIDS, improves the patients quality of life, and increases survival rates (Crepaz et al. 338). However, the viral suppression therapy effect was lower among drug addicts compared with other groups because repetitive transmission prior to the therapy has had a positive impact (Crepaz et al. 338). Drug addicts and sex workers have low access to viral suppression therapy since most lack insurance, food, and accommodation due to poverty (Abad et al.,1710). Identifying and sustaining treatment has to be a prerogative in handling the STD situation (Crepaz et al. 338). The utilization of one or several medications for drug addicts is related to a high rate of disease progression and the emergence of virus resistance. Nowadays, three or more ARV drugs are used at the same time for the purpose of treating HIV infection. Trials to induce virus suppression with multiple ARV drugs and then maintain the accomplished impact with only two drugs resulted in an unacceptably high frequency of disease return (Crepaz et al. 338).

There are various risks of STD development among sex workers and drug-addict groups associated with their lifestyle. These factors can be divided into individual risks, such as the relationship between the addicted and non-addicts and environmental risks (Abad et al. 1710). The combination of factors from these two groups determines the high level of infections in a particular population. The first group consists of the structure of drug-dealing networks where all new members are actively encouraged to abuse drugs. This is usually done on the level of personal relationships, such as attachment or love. Creating relationships with personal network members can lead to dangerous patterns of behavior, such as sharing syringes or having unprotected sex may. Childhood abuse and violent relations often lead to trauma that pushes people into prostitution or drugs and thus greatly increases individual-level risk factors (Crepaz et al. 338).

Environmental factors consist of the availability of needles, poverty, and inefficient law enforcement practices. Syringes are practically available at all drugstores and can be acquired without the need for a prescription. Food shortage and lack of accommodation contribute to feeling hopeless, which may result in people abusing drugs or prostitution (Wagner et al. 989). It is important to note that when it comes to drug abusers, even substances such as alcohol, methamphetamine, crack cocaine, and inhalants are associated with high rates of infections (Kamyar et al. 3319).

Excessive consumption of alcohol can be an essential risk factor for HIV since it is connected to dangerous sexual behaviors and, among those already infected, can negatively impact the treatment outcomes (Abad et al. 1711). Abuse of opioids, which is a drug class that aims to minimize pain, has also been linked with the growth of the number of infections. Research shows that the majority of sex workers prefer using this group of substances since they are readily available on the streets (Abad et al. 1712). Due to the restrictions and regulations guiding prescription in hospitals, individuals have opted for cheaper, more dangerous forms.

Meth, which is also called methamphetamine, is associated with unhealthy sexual behaviors that put individuals in greater danger of contracting HIV. Meth can be either injected or smoked (Lansky et al. 1). If a person decides to inject methamphetamine, the syringes or needles utilized in such occurrences can transmit diseases from one infected person to a non-infected. Crack cocaine and inhalants are the other drugs that rank high in the list of substances that can lead to unsafe decisions (Arasteh et al. 3318). The former refers to a stimulant that has the ability to create a cycle whereby people quickly exhaust their resources and turn to other ways to obtain the drug. This includes having sex to get the money they can use to buy what they need (Lansky et al. 2). Lastly, for a long time, amyl nitrite, which is an inhalant, has been connected to careless behaviors when it comes to sex (Lansky et al. 2).

The two primary ways of spreading STDs include repetitive utilization of syringes by several individuals and s unprotected sex with numerous partners. To prevent such practices, measures need to be taken to monitor distributive syringe sharing and syringe services programs among addicted individuals (Adams et al. 3306). Furthermore, more governmental measures must be adopted to avoid issues such as prostitution, for instance, minimizing factors that lead to it, for example, poverty, childhood abuse, violence in families, and criminal activities.

Distributive syringe sharing (DSS) and syringe services programs (SSP) are aimed at controlling the use of syringes by drug addicts (Adams et al. 3307). These initiatives proved to be effective in curbing the spread of HIV and hepatitis C since they allow the exchange of used needles for clean ones (Adams et al. 3307). The programs are financed by states and non-profit organizations and provide guidelines for drug addicts on how to avoid STD infections.

The problem of poverty in the United States can be addressed with the help of state governments and non-profit organizations. The assistance from these actors is not always monetary, as, at times, states provide free access to laundry services, movies, and educational programs (Abad et al. 1709). Employment services play a significant role in providing citizens with an opportunity to find a job or some employment (Abad et al. 1709). Some programs may include providing the poor with medical insurance to improve their access to healthcare.

Sex education plays a significant role in the prevention of STDs. Sex education programs targeting children and adolescents can promote an understanding of the essence of the relationship between the sexes and norms of behavior in sexual life. Addressing the spread of STDs requires a versatile social approach to the problem, the promotion of moral values, and comprehensive education of the younger generation (Sieving 208). Teenagers must be aware of the diseases that can be transferred through unprotected sex and assume responsibility for their own health and the health of their partners.

The United States government promoted sexual education with the help of various agencies to help adolescents receive comprehensive sexual education. Without systematic education, younger peoples knowledge about sex and STDs is fragmented, which may lead to significant risks of unhealthy sexual behavior. Providing children with adequate knowledge concerning sex and STDs can help reduce risky behavior among adolescents and young adults, which will reduce the risks of STDs.

The paper has drawn claimed that prevention interventions need to target drug addicts and sex workers to combat the STD epidemic. HIV is the cause of a pandemic, which spurred the search for antiretroviral drugs for the treatment of the disease. In the mid-90s, there emerged a new class of NNRTIs that were cheaper to produce than protease inhibitors. This boosted the effectiveness and access to ARV therapy. The paper demonstrates that recognizing novel drug targets has been critical development of new ARV drug classes. For instance, the discovery that the central receptor of the HIV virus was not a molecule named CD4 but the CXCR4 cells spurred the development of a new type of ARV medication. ARV treatment slows the emergence of AIDS while improving patients quality of life and survival rates. Nevertheless, in the drug-addict populace, the viral suppression therapy effect was greatly lower than in other groups as a result of repetitive transmission prior to the therapy having had a positive impact.

Drug addicts and sex workers have low access to viral suppression therapy since most lack insurance, food, and accommodation due to poverty. Identifying and sustaining treatment must be a prerogative in handling an STD situation. The utilization of a single or more medication for drug addicts is related to a high rate of disease progression as well as the emergence of virus resistance. Nowadays, three or more ART drugs are used at the same time for the purpose of treating HIV infection. The two primary ways of spreading STDs include repeated use of syringes by several people as well as unprotected sex with numerous partners. To prevent such practices, measures need to be taken to monitor distributive syringe sharing and syringe services programs among addicted individuals. Furthermore, more governmental interventions are required to reduce prostitution by addressing the factors that lead to it, such as poverty, childhood abuse, violence in families, and criminal activities.

Works Cited

Abad, Neetu et al. A Systematic Review of HIV and STI Behavior Change Interventions for Female Sex Workers in the United States. AIDS and Behavior, vol. 5, 2015, pp. 17011719.

Adams, Monica, et al. Distributive Syringe Sharing and Use of Syringe Services Programs (SSPs) Among Persons Who Inject Drugs. AIDS and Behavior, vol. 23, 2019, pp. 33063314.

Arasteh, Kamyar, et al. Injection and Heterosexual Risk Behaviors for HIV Infection among Non-Gay Identifying Men Who Have Sex with Men and Women. AIDS and Behavior, vol. 23, 2019, 33153323.

Crepaz, Nicole, et al. Brief Report: Racial and Ethnic Disparities in Sustained Viral Suppression and Transmission Risk Potential Among Persons Aged 1329 Years Living with Diagnosed HIV Infection, United States, 2016. AIDS Journal of Acquired Immune Deficiency Syndromes, vol. 83, no. 4, 2020, pp. 334-339.

Lansky, Amy, et al. Estimating the Number of Persons Who Inject Drugs in the United States by Meta-Analysis to Calculate National Rates of HIV and Hepatitis C Virus Infections. PLOS ONE, vol. 9, no. 5, 2014, e97596.

Parra, Jorge, et al. Clinical utility of maraviroc. Clinical drug investigation, vol. 31, no. 8, 2011, pp. 527-542.

Sieving, Renee E., et al. Sexually transmitted diseases among us adolescents and young adults: Patterns, clinical considerations, and prevention, Nursing Clinics, vol. 54, no. 2, 2019, pp. 207-225.

Wagner, Karla. Place of Residence Moderates the Relationship Between Emotional Closeness and Syringe Sharing Among Injection Drug Using Clients of Sex Workers in the US-Mexico Border Region. AIDS and Behavior, vol. 9, 2015, pp. 987995.

Wainberg, Mark A., and Ying-Shan Han. Will drug resistance against dolutegravir in initial therapy ever occur? Frontiers in Pharmacology, vol. 6, no 90, 2015.

Introduction

Gastroesophageal reflux disease (GERD) is a concerning chronic disorder of the digestive system with worldwide prevalence and a tendency to affect a growing population. Although GERD rates vary among different countries, it is currently one of the most common health conditions within the clinical practice (Diniz et al., 2014). This health condition is accompanied by a wide range of symptoms that substantively deteriorate the health-related quality of life. Conventional treatment of GERD consists of medication therapy and, in severe cases, surgical intervention. Nonetheless, medication and surgical procedures may result in insufficient efficiency, drug resistance or side and adverse effects (Bjørnæs et al., 2019). Mentioned risks and disadvantages emphasise the necessity of alternative or supplementary therapy methods, and osteopathic manipulative treatment (OMT) is considered a reasonable and valuable approach to improving GERD-associated symptoms and patients quality of life.

To date, few investigations have been conducted in order to explore the efficiency of OMT in patients with GERD. However, several variously designed studies were carried out and reported statistically significant positive effects of osteopathic therapy in treating GERD symptoms and enhancing the lifes quality of patients (Bjørnæs et al., 2019; Bjørnæs et al., 2017; Bjørnæs et al., 2016; Diniz et al., 2014; Eguaras et al., 2019; Goyal et al., 2019; Lynen et al., 2022). Research has shown that osteopathic interventions appear to be beneficial in decreasing GERD symptoms in the long term; therefore, OMT may be an additional or alternative treatment in patients suffering from this health disorder.

Overview of GERD

GERD is a multisymptom disorder conditioned by stomach contents with acidic juices frequently flowing from the stomach back into the oesophagus. The disease can be categorized into erosive or non-erosive GERD and manifests in a wide range of symptoms divided into three groups: typical, atypical, and extraesophageal (Goyal et al., 2019). The most predominant typical symptoms include heartburn, the taste of acid in the mouth, and painful feelings in the chest, epigastric and thoracic areas (Bjørnæs et al., 2019). Extraesophageal and atypical symptoms that may accompany GERD are epigastric fullness, dental erosion, burping, wheezing, cough, asthma, laryngitis and sinusitis (Eguaras et al., 2019; Goyal et al., 2019). Secondary symptoms may include indigestion, vomiting and sleeping problems (Bjørnæs et al., 2019). Consequently, GERD interferes with and compromises patients well-being and lifes quality since it requires modification of eating habits and sleeping patterns due to the lasting recurrent symptoms that may limit patients daily activities (Diniz et al., 2014; Goyal et al., 2019). The diseases chronic nature presupposes that GERDs adverse effects can persist for the long term.

There is no primary determined cause of the GERD occurrence, but several factors contribute to this disorder. The possible key factor for the GERD development is a failure or excessive relaxation of the lower esophageal sphincter (LES) (Bjørnæs et al., 2016; Eguaras et al., 2019). For instance, in normal conditions, LES allows the passing of food and fluids into the stomach and prevents stomach contents from rising up back into the oesophagus. Nevertheless, when the functioning of LES is disordered, stomach acids and contents move backwards and at high frequency resulting in GERD. Besides concerning symptoms, GERD may be accompanied by various comorbidities: the increasing influence of stomach acid potentially results in the destruction of mucosal defence mechanisms. The mucosa damage leads to erosions, inflammations and ulcerations (Bjørnæs et al., 2016). Thus, it is crucial to identify GERD in the early stages and select the appropriate treatment accordingly to the severity of the disorder.

Treatment Options

The treatment methods for GERD have significantly developed over the past several decades, yet considerable disadvantages are still prevalent. Back in the time, the common medication therapy included antacids frequently supplemented with anticholinergic agents in order to reduce the output of gastric acid (Bjørnæs et al., 2016, p. 1). The following improvement implied the pharmacological treatment consisted of histamine H2-receptor antagonists (Bjørnæs et al., 2016). Most of the reviewed literature emphasises a modern medication approach to treating GERD that occurs with proton pump inhibitors (PPI) (Bjørnæs et al., 2019; c., 2017; Bjørnæs et al., 2016; Eguaras et al., 2019; Goyal et al., 2019; Larsen et al., 2019; Lynen et al., 2022). The purpose of PPI medication is to increase the pH of stomach juice and thus cure the esophagitis (Larsen et al., 2019, p. 76). Research has shown that PPI is the most prevalent and standard treatment of GERD.

Nonetheless, several weaknesses of this pharmaceutical approach were identified throughout various studies. Bjørnæs et al. (2017) claim that PPI treatment is not curative and requires continuous medication and demands lifestyle changes (p. 1). Moreover, long-term PPI therapy does not cure GERD but may only contribute to symptoms relief and is associated with the risk of adverse events and low response rates (Larsen et al., 2019; Lynen et al., 2022; Malfertheiner et al., 2017). Thus, modern medication in treating GERD appears insufficient and related to substantial disadvantages.

Another option implies surgical intervention and appears to be the only approved efficient and curative treatment of GERD. This surgery is called fundoplication, performed laparoscopically and involves that the gastric fundus of the stomach is wrapped or plicate around the lower end of the oesophagus (Bjørnæs et al., 2017, p. 1). The purpose of the surgical procedure is to reinforce the LESs closing function (Bjørnæs et al., 2017). However, the literature review has shown that this intervention is associated with several crucial flaws: irreversibility, failure to achieve expected outcomes and the risk of severe adverse effects (Bjørnæs et al., 2019; Bjørnæs et al., 2017; Bjørnæs et al., 2016; Diniz et al., 2014; Larsen et al., 2019). Thereby, the potential mentioned disadvantages of medication and surgical treatment emphasise the necessity to apply other treatment strategies. Literature review reveals that OMT has shown its efficacy and may be used as an alternative or additional therapy to traditional approaches.

Osteopathic Techniques in GERD Treatment

In the osteopathic treatment of GERD, a wide range of techniques may be applied, though most of them should imply diaphragm and visceral manipulative interventions. Considering that one of the probable key reasons contributing to the development of GERD is insufficient closing of LES, the primary goal of OMT is to promote the complete closing of this sphincter (Bjørnæs et al., 2016, p. 1). Recent research has shown that the osteopathic manipulative intervention on the diaphragm produces a positive increment in the LES region soon after its performance (da Silva et al., 2013, p. 451). However, the study of da Silva et al. (2013) included the OMT consisted merely of a diaphragm stretching technique accompanied by breathing exercises. In regard to GERD causes and symptoms, visceral techniques supported by diaphragm techniques should be applied.

Current research has shown that most of the studies were carried out with a combination of different techniques. Several studies are based on the same OMT, including techniques that might influence LES and increasing the effect on the sphincter (Bjørnæs et al., 2016, p. 2). Mentioned OMT consists of four visceral techniques that are expected to stimulate the LES closing mechanism ((Bjørnæs et al., 2019; Bjørnæs et al., 2017; Bjørnæs et al., 2016). The osteopathic treatment consisted of the following techniques: traction of the cardia, mobilization of the diaphragm and thoracic spine and posture correction (Bjørnæs et al., 2016, p. 2). They all presupposed the patients lying position, the operators intervention in the patients epigastric area and appropriate breathing techniques.

Another general osteopathic approach in managing GERB is a visceral osteopathic technique. The techniques performance involves a patient in a sitting position, an osteopath behind the patient, and the operators hands placed on an epigastric area of the patient. When the patient is breathing in and flexing, the practitioner is deepening hands on the area; when the patient is exhaling and straightening, the spine operator pushes their hands caudally (Diniz et al., 2014; Eguaras et al., 2019; Goyal et al., 2019). A technique called sphincter normalization by recoil was applied in two studies (Diniz et al., 2014; Goyal et al., 2019). The purpose of this technique is to relax the smooth muscle of the sphincters of areas considered as such (Diniz et al., 2014, p. 184). The balancing of the diaphragms technique is designed to restore the harmonic and fluidic function between the diaphragms. This technique was also used at least in two research (Diniz et al., 2014; Goyal et al., 2019). Thus, a number of different visceral and diaphragm osteopathic interventions and their combinations were used to treat GERD.

Patient Response to OMT

Osteopathic therapy in GERD treatment appears to be a natural, sparing and restoring treatment option that promotes significant improvement and positive effects. Several differently designed studies were examined, and the results were compared. Two reports exploring the individual cases of OMT utilization with techniques directed at the oesophagus and diaphragm in a patient suffering from GERD showed that osteopathic treatment improved symptoms (Diniz et al., 2014; Goyal et al., 2019). Interestingly. that the same results were obtained in the studies with larger samples (Bjørnæs et al., 2019; Bjørnæs et al., 2017; Bjørnæs et al., 2016; da Silva et al., 2013; Eguaras et al., 2019; vzc; Lynen et al., 2022). However, further research is required to conduct a more specified study and reinforce the findings through additional investigations.

The number of interventions among the studies ranged from three to twelve, with a diverse follow-up system. However, Larsen et al. (2019) investigated the minimum efficacy dose (MED) of OMT in the treatment of GERD and concluded that the estimated MED was three sessions with 48 hours between treatments. The study of Bjørnæs et al. (2019) was shaped accordingly to MED findings. The osteopathic intervention was carried out within three sessions with two-days intervals in between, and a follow-up period was one year. This study achieved outstanding results since almost 47% of the patients had no related GERD symptoms one year after the intervention (Bjørnæs et al., 2019). Such duration of lasting benefits underscores the effectiveness of this treatment approach.

Considering the efficacy of OMT and the positive patient response, it may be concluded that anti-reflux OMT significantly decreases the GERD symptoms and the need and use of PPI. Another outstanding finding related to the efficiency of OMT is that in a recent study no differences in GERD symptoms were identified between the OMT group and those who additionally continued medication intake (Bjørnæs et al., 2016). According to Lynen et al. (2022), besides positive improvement in GERD symptoms, secondary outcomes of the OMT in treating GERD include improved life quality and patients well-being. Thereby, existent literature reinforces the effectiveness of osteopathic treatment in patients with GERD and provides satisfactory results, evidencing the improved health outcomes.

Conclusion

Literature research on the topic of the effectiveness of OMT in patients suffering from GERD has shown that such a treatment approach is appropriate as a supplementary or alternative treatment. Patients with GERD are forced to modify their lifestyle and experience lower life quality, poor health conditions and a lack of overall well-being. Thus, the topic is highly concerning, and beneficial treatment approaches should be developed. Traditional pharmaceutical therapy is associated with several disadvantages that include a low response rate to the prescribed medication, resistance to the drugs and severe side effects. PPI use does not cure the disease itself but only decreases the manifestation of symptoms. Moreover, since GERD is a chronic disorder, medication treatment is expected to be long-term. In the case of discontinuation of therapy, there is a severe risk of recurrence of all symptoms. Fundoplication also has several drawbacks involving adverse events, irreversibility and failure to achieve the expected outcomes.

On the other hand, OMT is a favouring approach with no adverse effects registered and identified as potentially positively affecting GERD-associated symptoms. Current literature research has revealed several studies that reinforce the effectiveness of osteopathic treatment in patients with GERD. Compared to continuous medication treatment and the complexity of the surgical intervention, OMT has shown beneficial health outcomes in the long term and after a low number of sessions.

References

Bjørnæs, K. E., Elvbakken, G., Dalhøi, B., Garberg, T. H., Kaufmann, J., Glomsrød, E., Reiertsen, O., & Larsen, S. (2019). Osteopathic manual therapy (OMT) in treatment of gastroesophageal reflux disease (GERD). Clinical Practice, 16(3), 1109-1115. Web.

Bjørnæs, K. E., Larsen, S., Fosse, E., Myklebust, Ø., Skauvik, T., & Reiertsen, O. (2017). The effect of osteopathic manipulation therapy (OMT) in patients suffering from gastroesophageal reflux disease (GERD). International Journal of Clinical Pharmacology & Pharmacotherapy, 2(132), 1-7. Web.

Bjørnæs, K. E., Reiertsen, O., & Larsen, S. (2016). Does osteopathic manipulative treatment (OMT) have an effect in the treatment of patients suffering from gastro esophageal reflux disease (GERD). International Journal of Clinical Pharmacology & Pharmacotherapy, 1(116), 1-6. Web.

da Silva, R. C. V., de Sá, C. C., Pascual-Vaca, Á. O., de Souza Fontes, L. H., Herbella Fernandes, F. A. M., Dib, R. A., Blanco, C. R., Quiroz, R. A., & Navarro-Rodriguez, T. (2013). Increase of lower esophageal sphincter pressure after osteopathic intervention on the diaphragm in patients with gastroesophageal reflux. Diseases of the Esophagus, 26(5), 451-456. Web.

Diniz, L. R., Nesi, J., Curi, A. C., & Martins, W. (2014). Qualitative evaluation of osteopathic manipulative therapy in a patient with gastroesophageal reflux disease: A brief report. Journal of Osteopathic Medicine, 114(3), 180-188. Web.

Eguaras, N., Rodríguez-López, E. S., Lopez-Dicastillo, O., Franco-Sierra, M. Á., Ricard, F., & Oliva-Pascual-Vaca, Á. (2019). Effects of osteopathic visceral treatment in patients with gastroesophageal reflux: A randomized controlled trial. Journal of Clinical Medicine, 8(1738), 1-14. Web.

Goyal, M., Narang, U., & Sehgal, S. (2021). Osteopathic manipulative treatment in improving health related quality of life in a patient with gastroesophageal reflux disease: A case report. JK Science: Journal of Medical Education & Research, 23(1), 55-57. Web.

Larsen, S., Holand, T., Bjørnæs, K., Glomsrød, E., Kaufmann, J., Garberg, T. H., Elvbakken, G., Dalhøi, B., Reiersten, O., & Dewi, S. (2019). Randomized two dimensional between patient response surface pathway design with two interventional and one response variable in estimating minimum efficacy dose. International Journal of Clinical Trials, 6(3), 75-83. Web.

Lynen, A., Schömitz, M., Vahle, M., Jäkel, A., Rütz, M., & Schwerla, F. (2022). Osteopathic treatment in addition to standard care in patients with gastroesophageal reflux disease (GERD)A pragmatic randomized controlled trial. Journal of Bodywork and Movement Therapies, 29, 223-231. Web.

Malfertheiner, P., Kandulski, A., & Venerito, M. (2017). Proton-pump inhibitors: understanding the complications and risks. Nature Reviews Gastroenterology & Hepatology, 14(12), 697-710. Web.

Introduction

Influenza has been cited to cause considerable morbidity and mortality in the United States. The Center for Disease Control and prevention (CDC) launched a program intended to create awareness about the Flu and thus reduce the morbidity and mortality associated with it. Seasonal influenza is a program run by the CDC to create awareness about influenza and curb its spread in the United States. This paper seeks to use the guide to community preventive services to determine the effectiveness of the CDC seasonal influenza program in preventing and providing timely information to the country in accurate and reliable ways.

Background summery

The CDC program on Seasonal Influenza creates awareness about the flu by: informing people through the media and internet on how the flu is identified, the symptoms, how it spreads, the periods when its contagious, the complications it can cause, those at high risk and how it can be prevented, specifically through vaccination. The CDC program also promotes vaccination efforts to curb the flu. To prevent the seasonal influenza the CDC has recommended that everyone aged six months and above to be vaccinated during the 2011 influenza season. Vaccination is the universally favored method that is used to reduce the incidence, morbidity and mortality associated with influenza.

Program Evaluation

Program effectiveness

The Seasonal influenza program was evaluated basically in regard to its ability to reduce morbidity and mortality of influenza, its ability to promote health behaviors its ability to increase awareness of the influenza immunization nationally, its ability to address the concerns surrounding vaccine safety and efficacy, and the programs ability to engage primary care providers and public health officials in developing local initiatives to encourage and increase influenza vaccine uptake (Briss, Brownson, Fielding, & Zaza, 2004).

The CDC seasonal influenza program has been generally successful partly due to the widespread flu awareness that was created by the H1N1 pandemic in 2009. In that year the vaccines nearly ran out though the overall vaccination among different age groups remained low. Survey results indicate that approximately 35% of schools going children were vaccinated against the H1N1 virus while fewer than 10% received the vaccine for seasonal influenza. The coverage for the influenza vaccination program was determined using the data from surveys carried out by National Health Interview Surveys (NHIS), National Immunization Survey (NIS), Behavioral Risk Factor Surveillance System (BRFSS) and the National 2009 H1N1 Flu Survey (NHFS) (Centers for Disease Control and Prevention, 2011). The most recent survey was conducted by BRFSS in which the respondents were asked whether they had undertaken any flu vaccination in the past 12 months. The response rate was 54% for adults for the survey conducted between September 2010 and March 2011 (Centers for Disease Control and Prevention, 2011).

Cost effectiveness of seasonal influenza vaccination

The CDC seasonal influenza program recommends vaccination for influenza, especially during the high contagious seasons. This analysis indicates that the single or two dose strategies that is recommended for different risk groups is cost effective (Community Preventive Services, 2011). This is due to the fact that the severity of the seasonal influenza increases during the high contagious seasons. Survey results indicate at elevated prevalence rates for influenza (30%) the single dose approach leads to cost savings while the two dose strategy remains cost effective (Centers for Disease Control and Prevention, 2011).

Challenges and recommendations

The following challenges impede the CDC seasonal influenza program: The coverage among older children and those in the adolescent stage remains low. This implies that morbidity and mortality due to seasonal influenza remains high in this groups. This challenge can be tackled through the continued implementation of the existing strategies and formulation of new ones to increase the coverage among these age groups; the influenza causing virus also mutates every now and then and thus the vaccines need to be reproduced for every new strain. This problem can be tackled through regular surveillance to identify the new strains (Briss, Brownson, Fielding, & Zaza, 2004).

Conclusion

This paper sought to evaluate the effectiveness of the CDC seasonal influenza program. It has been established that the program has resulted in a marginal increase in the number of individuals being vaccinated against the flu and thus it has been effective in reducing morbidity and mobility associated with seasonal influenza in the United States.

References

Briss, P., Brownson, R., Fielding, J., & Zaza, S. (2004). Developing and using the Guide to community Preventive Services: Lessons learned about evidence based public health. Annual Review Public Health , 25,281-302.

Centers for Disease Control and Prevention. (2011). Seasonal Flu. Web.

Community Preventive Services. (2011). The Community Guide: What works to promote health. Web.

Chronic Obstructive Pulmonary Disease (COPD) is nowadays, spreading widely across the globe. COPD is increasingly becoming a natural burden and anticipated to as the rank third cause of mortality by 2020. There is a need to establish an early diagnosis for the disease. Similarly, clinical context and risk factors that accompany COPD are essential for positive diagnosis, but pulmonary function tests are imperative for confirmation purposes. COPD is commonly associated with smocking. Cigarette smoking ranks as the main cause of COPD. However, water-pipe smocking is becoming prevalent behavior in most Middle Eastern countries and thus, becoming a significant causal factor for COPD. A systematic study conducted by medical practitioner in April 2011 in Easter countries to determine the link of water-pipe-smoking and COPD indicated that water-pipe smocking is a significant casual factor of COPD. The study revealed that water-pipe smoking negatively affects lung function and is equally dangerous as cigarette smoking.

Water-pipe smoking is featuring as the emerging second major cause of COPD. There exist a long-term casual association between cigarette smoking and COPD, with cigarette smoking ranking as the leading single most important risk factor for COPD. A current study about the trend of water-pipe smoking, which is a tobacco consumption method, indicates that it is increasing globally at an alarming rate. A recent study of the same has linked water-pipe smoking with lung and esophageal cancer, periodontal diseases as well as low birth weight. Various studies about the relationship between water-pipe smoking and COPD indicate that symptoms of chronic bronchitis are high (11.7% of water-pipe smokers) as compared to 9.5% for cigarette smokers and 0% for non-smokers respectively. Smoking ranks as the main cause of emphysema and therefore, the increase global adoption of water-pipe smoking is likely to aggravate the situation (Strauss, 1999).

COPD are those diseases that affect the lungs. They include diseases such as emphysema, chronic bronchitis that make patients to have trouble while breathing. The disease mainly affects people aged above 35 years. In the UK, over 2 million people suffer from COPD. The disease is not easily diagnosable and thus, majority of people live with it untreated, mistaking it for smoke cough. The main cause of COPD is smoking, with men ranking as the leading victims. The likelihood of suffering the disease increases with how often one smokes, and the longer one smokes. When, individuals suffer from COPD, they experience trouble while breathing in and out because of obstruction of the airways. In addition, COPD causes the destruction of the lungs through inflammation. When persons persist using water-pipe smoking, smoking damages the lungs further. The continuous inflammation of the lungs results to permanent changes in the lungs. Therefore, the lungs produce more mucus and the airways become thicker in response to the inflammation. The overproduction of mucus obstructs airflow, which makes breathing difficult. Similarly, over smoking leads to the destruction of the air sac, this makes the lungs lose their standard elasticity. The loss of elasticity then makes the breathing process difficult, phlegm and cough that accompany COPD (Davidson, 2000).

The diagnosis of COPD entails a thorough exercise. The process involves the doctor gathering a patients medical and family history, as well as carrying appropriate tests. The patients history will entail requesting the patient whether he/she smokes, had contact with lung irritants such as secondary smoking, air pollutants, dust and chemical fumes. The doctor also tries to learn whether the patient experiences any cough and if so, how often and the amount of mucus that comes out when coughing. When examining the patient, the doctor uses a stethoscope to listen for any whistling or abnormal chest sounds. Other tests that doctors use to determine COPD are spirometry or lung diffusion capacity test. Doing diagnosis using a Spirometry entails requesting a patient taking a deep breath and puffing the air into a tube that that links to a spirometer. Spirometer calculates the air a patient breathes out, as well as how fast the patient breathes out. The doctor may then give the patient some medicine to open the airways and then request the patient to repeat the process in order to compare the two results.

The spirometer is important because it can test COPD before symptoms develop. In addition, doctors can use it to determine the extent of COPD of a patient. This is important in assisting the doctor to set the treatment goals depending on the seriousness of COPD detected. The Forced Vital Capacity (FVC) is the maximum air that one can exhale forcibly. It shows flexibility and capacity of the lung, as well as how easily the airways allow air to pass through. The Forced Expiratory Volume is the maximum quantity of air one can exhale per second. For moderate COPD patients the FEV should range between 50-80%, for severe COPD the FEV should be 30-50%, while the ratio for FVC (FEV)/FVC ought to be less 70% of normal despite the COPD patient has FEV less than 50% or greater than 80%. Chest X-ray is another important test that doctors can use to test COPD. A Chest CT scan as often referred is important as it shows a picture of all the structures inside the chest, which can indicate signs of COPD. The scan is important because it may determine whether the patients condition is because of impending heart failure or COPD (Bowler, 2009). Finally, doctors may opt to use an arterial blood gas test that measures the amount of oxygen in the blood. This test is imperative in determining the seriousness of the COPD and whether, the patient requires oxygen therapy. Doctors prescribe oxygen therapy for COPD Patients who have PaO2 d 55mmHg or SaO2 d 88% (Murphy, 2001).

In determining the causal relationship between water-pipe smoking and COPD, the researcher will get a sample of people identified with symptoms of COPD who consume water-pipe smoking and non-smokers. The researcher will measure the level of oxygen in the patients blood sample when starting and ending the investigation using the arterial diffusion process. The researcher will also determine the amount of air the patients can breathe out, as well as how fast they can breathe out during the initiation and termination of the investigation. The researcher will make sure that the non-smokers get expose to other COPD causing agents such as dust, smoke and chemical fumes. The researcher will then determine the appropriate changes after a time span of three months in the sampled individuals, which will be imperative in determining how water-pipe smoking contributes to COPD as compared to other agents such as dust, chemical fumes and other air pollutants associated with COPD.

Reference List

Bowler. (2009). COPD Diagnosis. Web.

Davidson, P. (2000).Chronic Obstructive Pulmonary Disease. New York: Prentice Hall.

Murphy, R. (2001).Emergency oxygen therapy for the COPD patient. Emergency Medicine Journal, 8, 5, 333-339.

Strauss, N. (1999). COPD, Cigarette and Water-Pipe Smoking. Emergency Medical Journal. 3, 2, 123-135.

Introduction

Sarcoidosis is a disease that is characterized by abnormal development and the gathering of chronic inflammatory cells. These cells develop into nodules that collect in a variety of organs. The syndrome is also referred to as sarcoid or Basnier-Boeck-Schaumann. The disease is common in various parts of the world. However, it mainly affects young people between the age of 20 and 29.

The syndrome is also very prevalent in women above the age of 50. The disease has been spotted in various places across the world with a 16.5 average prevalence in every 100,000 men. It is also in the record that, in every 100,000 women in the world, 19 women have the syndrome. However, the prevalence of the disease is higher in Northern Europe, which has a rating of 60 patients in every 100,000, for example in Iceland and Sweden. Out of all the diagnosed patients, only 50% have relapses while 10% of them are likely to have disabilities. Baughman, Culver, and Judson (2011, p.573) assert that the syndrome may cause serious scars on the lungs, which may eventually lead to death that results from a failure of the respiratory system. Although the symptoms of sarcoidosis may vary over the years, the disease has been attributed to the immune reaction of the body, especially after an infection.

Signs and symptoms of the disease and its occurrence

Sarcoidosis disease is mainly characterized by inflammation of various parts of the body. Askari (2009, p. 567) affirms that the major symptoms of the diseases include fatigue that is not even relieved by sleeping, arthritis, swollen knees, loss of weight, skin lesion, blurred vision, and dry cough. All these symptoms are likely to be vague. The most visible symptoms are those that affect the cuticle such as rashes, nodules, erythema nodosum, lupus pernio, and granuloma annulare. Sometimes, it becomes difficult to diagnose cancer and Sarcoids since the two diseases may have almost similar symptoms. Doughan and Williams (2006, p.282) reveal how the symptoms may be manifested through the infection of the liver, heart, or brain. In some incidences, the patient may develop Lofgren syndrome, which results from a combination of various symptoms such as hilar lymphadenopathy, erythema nodosum, and arthralgia. Infection of the lungs is characterized by localization of the pulmonary tissues with 50% of the patients having permanent damage of the tissues while 5-15 % of them develop lung fibrosis. The infection is physically manifested by dry rales. Askari (2009, p. 567) affirms that liver infection has been associated with sarcoids at a 60-90% rate. Patients develop hepatomegaly due to liver infection. The patients also indicate increased alkaline phosphates. The skin of the patient is also affected in about 25% of the cases. Skin infection is manifested through erythema nodosum, maculopapular eruptions, lupus pernio, and plaques. However, Rossman and Kreider (2007, p.453) observe that skin lesions last for a few weeks and that they may not necessarily require treatment. Infection of the eyes is indicated by uveoparotitis, swelling of the retina, and uveitis. The patient experiences blurred vision in acute cases. He or she may lose sight. Sarcoids also affect the blood of the patient. There is an abnormal diagnosis of the blood such as anemia, which occurs in 4-20%, leukopenia in about 40%, and hypercalcemia in less than 10% of the patients. Infection of the lymph nodes is prevalent in sarcoids. The disease is manifested on the head and neck through cervical lymphadenopathy. Sarcoids can affect all parts of the nervous system. Rossman and Kreider (2007, p.453) assert that, when the brain nerves are affected, the condition is regarded as neurosarcoidosis. It occurs in about 5% of cases. The patient may also show hearing loss and optic nerve dysfunction. In serious cases, the infection results in meningitis. Sarcoids can also be manifested in the exocrine glands. This condition is manifested through enlargement of the parotid gland in 10% of the patients. Sarcoidosis also affects the scalp. The symptoms are manifested on the scalp through loss of hair.

There is no known precise cause of sarcoidosis disease. However, the most followed hypothesis is that sarcoidosis is caused by an alteration in the immune system especially after there has been exposure to pathogens.

Moreover, there is no clear genetic predisposition to sarcoidosis disease. However, although no genetic marker has been confirmed, various genes have been associated with sarcoids. For example, BTNL2 and HLA-DR alleles are associated with sarcoids. In addition, when sarcoid is very persistent, there is a likelihood that HLA and B7-DR15 work together. On the other hand, if the disease is not persistent, HLADR3-DQ2 is in control. The siblings of sarcoidosis patients have a 5-6 danger ratio of inheriting the disease. It is therefore argued that the role of genes in spreading the sarcoids is very low. Heredity of the syndrome can be linked to the fact that members of the same family are likely to be brought up in the same environment.

Relationship of sarcoidosis with the immune system and the components of the immune system

Sarcoidosis is mainly manifested through inflammation or granulomatous. The infection invades the bodys defense mechanism making the body unable to defend itself. Inflammation of various body parts results from the gathering of monocytes, active T-lymphocytes, and macrophages. These cells have very high inflammatory mediators. The IFN-gamma, IL-12, and TNF-alpha cells are also affected. Sarcoidosis suppresses the immunity of the body against tuberculin and suchlike infections. Contrary to the norm of many infections, sarcoidosis does not negatively affect defense cells but rather increases their production rate. Baughman, Culver, and Judson (2011, p.573) assert that sarcoidosis increases the number of macrophages and activation of CD4 aiding T-cell. This increase results in increased inflammation of various organs of the body. The infection develops a condition where the body is in dire need of energy since there is both hyper-reactivity and hypo-reactivity of the body. Perhaps these increased energy levels result in body infections and cancer. The body experiences challenges in regulating the antigens. The secretion of IL-2 is suppressed by the T-lymphocytes, which regulate the secretion along with the granulomas of sarcoid. The suppressed IL-2 cells are responsible for controlling and regulating the memory of antigens in ensuring that it is very specific. The granuloma contains Langhans cells that contain calcium and proteins. In-patients of sarcoid glanulomas are mainly found in schaumann bodies. The TNF-alpha cells aid the creation of granulomas. Lymphocytes and leucocytes are therefore affected. The production of these defense cells, therefore, becomes uncontrolled. The cells are produced in very huge quantities, thus making the body unable to control them. Out of the increased and uncontrolled production of these cells, body inflammations are witnessed.

Treatments and vaccines available for the disease

Diagnosis of sarcoidosis is made through the exclusion method. Doughan and Williams (2006, p.282) observe that medics use X-ray, PET scan, CT scan, lung biopsy, endobronchial ultrasound, mediastinoscopy, and endoscopic ultrasound in diagnosing sarcoidosis using exclusion. The collected tissue from the lymph nodes is screened for cancer, fungi, and other strains of microorganisms. Physicians also use angiotensin enzymes converters. These enzymes control the blood levels in sarcoidosis patients. Angiotensin-converters are also used in monitoring the progress of sarcoidosis patients. The process of diagnosis may involve all body organs since doctors carry out the elimination method to arrive at the symptoms of the disease. The doctor has to differentiate sarcoidosis from lymphoma, rheumatoid nodules, varicella infection, metastatic, and other related infections. For instance, Grunewald, Eklund, and Olerup (2004, p.696) observe that sarcoidosis can easily be confused with diseases such as lymphoma among others, which have almost similar characteristics. Such characteristics include a single-nucleated cell that causes inflammation of the granulomatous. It is also recommended that doctors closely examine the thyroid gland in female patients because sarcoidosis in female patients manifests itself in thyroid diseases such as hyperthyroidism and hypothyroidism. The infundibulum is also enveloped in sarcoid patients. It is also advisable to check whether the disease wraps the small lobes on the front parts. Rossman and Kreider (2007, p.457) assert that sarcoidosis is also manifested by clear lesions from vermin and from the ventricles.

In treating sarcoidosis, not every patient will need therapy. For example, about 30-70% of patients with this disease do not require immediate therapy. Treatment becomes very necessary and urgent in cases where patients lungs are impaired. It is only when symptoms refuse to decrease in severity that the patient is put on therapy. Sarcoidosis is normally treated using corticosteroids. In modern-day medicine, doctors prefer prednisolone corticosteroids in the treatment of sarcoidosis. Treatment of sarcoidosis has been very effective with the use of corticosteroids. However, Grunewald, Eklund, and Olerup (2004, p.696) argue that some sarcoidosis patients are resistant to any steroids and steroid medicine. It may be difficult to use corticosteroids in sarcoidosis patients with mild symptoms since the disease is manifested spontaneously. Medics also recommend that corticosteroids be used only in cases where the case is very progressive to the level of threatening the existence of an organ. Steroids have many side effects that can negatively influence the patients health.

In case the disease has reached a severe point, physicians treat it with azathioprine and/or methotrexate. However, some doctors also use cyclophosphamide in treating the disease. Various immunosuppressants have been used in treating sarcoidosis. This kind of treatment is informed by the fact that the granulomas that result in the gathering of various cells of the immunity system, for example, the T-cells, have been associated with causing the disease. Such immunosuppressants include antitumor necrosis factor-alpha and interleukin-2. However, the use of immunosuppressants has not proved to be effective in treating sarcoids. On the contrary, its side effects can be devastating since it can result in the reactivation of tuberculosis. The impact of latent tuberculosis in sarcoidosis patients may be fatal. According to Antonelli et al. (2006, p 526), since sarcoidosis affects various body organs, patient follow-up should be done using an electrocardiogram, liver tests, eye examinations, and blood tests. There is also the constant need for serum calcium tests and urine calcium tests. Such tests will act as indicators of whether these organs are functioning properly. If the organs have been affected by the infection, the physician should treat the specific organ as the patient continues with therapy.

Reference List

Antonelli, A., Fazzi, P., Fallahi, P., Ferrari, M., & Ferrannini, E. (2006). Prevalence of hypothyroidism and Graves disease in sarcoidosis. Chest, 130(2), 52632.

Askari, A. (2009). A middle-aged man with progressive fatigue. Cleveland Clinic journal of medicine, 76(10): 564574.

Baughman, P., Culver, A., & Judson, A. (2011). A concise review of pulmonary sarcoidosis. American journal of respiratory and critical care medicine, 183(5), 57381.

Doughan, A., & Williams, B. (2006). Cardiac sarcoidosis. Heart British Cardiac Society, 92(2), 282288.

Grunewald, J., Eklund, A., & Olerup, O. (2004). Human leukocyte antigen class I alleles and the disease course in sarcoidosis patients. Am. J. Respir. Crit. Care Med., 169(6), 696702.

Rossman, D., & Kreider, E. (2007). Lesson learned from ACCESS (A Case Controlled Etiologic Study of Sarcoidosis). Proc Am Thorac Soc, 4(5), 45360303.

Health research includes marketing as a tool to connect with potential audiences. The uniqueness of this area is that the results of experiments can save numerous patients lives. Consequently, marketing operations to advance research on Parkinsons disease cover the specific conditions people experience. Conducting focus groups and wide-ranging surveys on stem cells financial and cultural feasibility as therapeutic manipulation are some of the options available.

Parkinsons disease is a degenerative syndrome, the particular danger of which is the lack of adequate treatment. Besides, the condition progresses rapidly and significantly affects the quality of life. Numerous studies are moving closer to discovering innovative intervention methods and prevention in the early stages of the disorder. Stem cells are a promising technique that affects symptomatology and gene balance. In this case, marketing is an integral part of these experiments, as it provides a sample for research. For example, modern online surveys and technologies to achieve group diversification are gained by using classic techniques such as interviews and focus groups (Dobkin et al., 2020). Another essential part of scientific activity is client orientation and identification of their needs. It is no secret that stem cell treatment is a costly procedure and is inaccessible to all patients with Parkinsons disease. The goal of marketing efforts is to gather information about this treatments acceptability for various communities and the likelihood of using a specific strategy based on demographics (Purcarea, 2019). Thus, advancing research covers learning about the perception of particular findings in the audience.

Parkinsons disease is a severe condition that requires an innovative approach to treatment. Scientists task is a laboratory and clinical testing of hypotheses regarding the effectiveness of specific intervention techniques, including stem cells. Marketers are responsible for optimizing the sample and collecting information about patients needs, perceptions, and financial ability to undergo therapy. Thus, this interdisciplinary field is an ally of healthcare agents and provides theoretical and practical materials for further experimentation.

References

Dobkin, R., Amondikar, N., Kopil, C., Caspell-Garcia, C., Brown, E., Chahine, L., Marras C., Dahodwala N., Mantri S., Standaert D., Dean M., Shoulson I., Marek K., Katz A., Korell M., Riley L. & Tanner C. (2020). Innovative recruitment strategies to increase diversity of participation in Parkinsons disease research: The Fox Insight cohort experience. Journal of Parkinsons Disease, 10(2), 665-675. Web.

Purcarea, V. (2019). The impact of marketing strategies in healthcare systems. Journal of Medicine and Life, 12(2), 9396.