Category: Disease

Introduction

A disease is described as a condition/disorder that interferes with the normal functioning of the body. Communicable diseases are those diseases that are easily spread from person to person by way of contact, food, water, contaminated objects or even through the air. They are also referred to as infectious diseases. This relatively easy mode of transmission makes the control and containment of these diseases fairly hard. (Anderson & May 1991) Some communicable have a high morbidity and sometimes a high mortality rate. That is to say they are likely to infect lots of people in a very short time and may also result in their deaths also after a very short time.

Measles is a communicable disease caused by a virus, paramyxovirus from the genus Morbillivirus. The disease is spread through respiration; for example, contact with fluid from an infected persons mouth or nasal organs. It can also be spread directly in the environment through aerosol transmission. Its salient characteristics on the infected victims include total body skin rash and flu-like symptoms that include running nose, fever and cough. Since the causative agent of measles is a virus, its symptoms usually disappear on their own even without proper medication once the virus has completed its life cycle. Perhaps this is the reason why the disease is persistent in many developing countries where medication is usually provided piecemeal and is terminated when the symptoms seem to disappear.

Measles is very rare in developed countries such as USA and Australia. In the USA, the occurrence of measles is almost nil due to widespread immunizations. Hence, the number of measles cases has declined rapidly in the last 50 years. For example, there were thousands of cases of patients suffering from the disease in the 1950s, but in 2002, only 44 cases were reported. The majority of patients affected by the disease are children (Cronan 2005).

A stark contrast exists in the developing countries where immunization programs are in many cases moribund. The disease poses serious challenges in countries in regions such as sub-Saharan Africa and South East Asia where most of the developing countries lie. Among the challenges to eradication of measles is the desire to achieve and certify global eradication or to reduce measles in countries where it is commonplace. In addition, improving coverage of surveillance and strengthening management are key issues that need to be reviewed in order to eradicate the scourge. Since the World Health Organization, WHO, set goal to eradicate measles, the measures that it put in place to meet this objective were campaign strategies such as Catch-up, Keep-up, Follow-up. Active surveillance is an important component of implementing these measures. The strategies used by WHO and its affiliate bodies to eradicate measles are steadily evolving and therefore require a high level of flexibility in the equipment, staff and measures used. Quality surveillance and implementation of the key findings is therefore the key to eradicating measles (Anderson & May 1991).

Surveillance System

Measles has some key aspects that need to be out into consideration when designing a system of surveillance to control it. To begin with, human beings are the only hosts for the disease. This means that the disease is not zoonotic and therefore not likely to be transmitted by animals. In addition, despite the effort to eradicate it, measles is still a threat to humanity, being one of the top ten most important causes of death and one of the most common vaccine-preventable diseases in children. Several factors make measles harder to tackle than other diseases such as smallpox. The factors include its higher rate of infection, the difficulty in administering a vaccine for it and in carrying out surveillance and detecting infected individuals (Griffin & Moss 2006).

The main importance of disease surveillance is to identify the prevalence of an infectious disease such as measles and to draw a plan to prevent it from becoming a threat to the public. Surveillance results should contain information on morbidity and mortality among people in a community or state. They should also show possible impacts of immunization strategies and the disease trends in the society. The following are some of the useful surveillance systems. Their applicability varies from place to place due to their attributes such as financial implications and availability of proper surveillance equipment (Griffin & Moss 2006).

Prevention

The most important step in surveillance is to find methods that would prevent the occurrence of measles. For effective surveillance towards prevention, anti-measles campaigns should start at the community level. At this level, the communities should be enlightened on the threat of measles, its implication and the need to eradicate the disease. In most of the countries where measles is still a threat, the affected populations are usually concentrated in highly populated areas such as outskirts of town centers or busy rural areas (Oxford 1985). These areas need public awareness in order to facilitate efficient collection of information. The information collected, such as samples, should be analyzed at district or state hospitals or other health facilities in order to obtain conclusive findings on the possible occurrence of measles and the measures that should be enforced to control the situation. The national authorities should act on the findings in order to educate the communities on the need for eradicating the scourge. In the process, individuals found to be carriers of the disease can be isolated and subjected to medication before the disease shows full impact. Vaccination programs for children 6 to 8 months after birth could serve as a sufficient preventive measure (Anderson & May 1991).

Treatment

Where the disease has already taken course the best solution is to provide appropriate medication and ensure that the full dose is taken to avoid recurrence of the disease. During surveillance, cases of measles identified should be treated in isolation since the disease could spread to others within the same household, as they may have not been vaccinated. Most vaccines achieve only 90 per cent immunity and therefore leave a chance for infection (Griffin & Moss 2006).

Routine monitoring

Apart from prevention and treatment, surveillance should also entail routine monitoring in order to successfully seal the possibilities of outbreaks. This involves regular collection of samples and figures concerning the measles cases. Perhaps the reason why the occurrence of measles is rare in Australia is its health departments routine monitoring and survey. The Department of Communicable Diseases in Victoria within the Department of Health Services (DHS) has a core function of managing surveillance programs through routine monitoring. Routine monitoring of measles is resource intensive, both in terms of time consumption and staff. Therefore, to carry out the process effectively, public health resources need to be more effectively directed towards this strategy.

Using the Australian case, physicians and laboratories are required to notify the DHS upon any diagnosis of presumptive measles. Other specimens too are collected for analysis. For example, blood serum is collected from people for analysis in case they are carriers of measles. The serum is specifically tested for measles specific immunoglobin. Other specimens collected are nose and throat swabs, which are tested for measles though ribonucleic acid (RNA) by a polymerase chain reaction method (WHO 2006).

Electronic disease surveillance system

This system of surveillance is advanced and more appropriate for the regions that are prone to measles outbreaks. It is a method that promotes the use of data and information standards to integrate the surveillance systems in all regions or states in a country. The USA has been active in using this type of surveillance to monitor disease conditions, particularly measles, through its health body- Centers for Disease Control (CDC). The system detects outbreaks rapidly and monitors the general health of the nation. It also collects and monitors disease trends in order to facilitate preparedness for outbreaks or control (CDC 2007).

Sensitivity and Specificity of Measles

The measles pathogen has characteristics that make it easy to eliminate. As earlier mentioned, the virus has specificity only to human beings. Therefore, once it is eliminated from the human population, it has no chance to survive elsewhere. In addition, its transmission occurs only when illness is apparent. Isolation of patients is therefore the key to curbing its spread. Another advantage of this is that the disease can easily be spotted and hence eliminated. Furthermore, its transmission in remote areas usually stops spontaneously (maybe be due to sparse population) and a vaccine once injected against it, provides protection for a long period of time.

There are variations in the specificity of measles to antibodies. During monitoring, the variations should be considered so as to avail proper medication. For example, measles specific IgM antibodies appear at the time of the beginning of rash and may persist for 28 days. Furthermore, measles specific IgG antibodies appear around the same time as IgM antibodies. The specificity of the measles virus to antibody material is vital in administering medication or vaccination (Nelson & Williams 2006).

Possibly, measles is still widespread in some Asian and African countries because of the deficiency of some vital food components. Vitamin A, to which the measles virus and vaccine are sensitive, is deficient in these countries. Its availability is in the range of 0.3-1 percent. Yet it is recommended that the vitamin should be available for effective functioning of the measles vaccine. WHO therefore advises health experts to provide Vitamin A supplements when the measles vaccine is availed to a patient (WHO 1999).

Some vaccination programs have been blamed for their adverse effects on children when they are applied. The latest edition of the book produced by the National Heath and Medical Research Council of Australia, called Australian immunization hand book, gives succinct guidelines about the side effects that arise with vaccination for measles. In Australia, many children have been denied vaccination due to reactions at the site of injection, fever or irritability after vaccination or having a history of egg allergy. Sensitivity of children to the measles vaccine should therefore be given priority when implementing the measles surveillance program. For example, it is evident that children who are allergic to eggs are sensitive to the measles vaccine and an alternative vaccine should therefore be sought which would suit them (Anderson & May 1991).

Pertussis

A case definition of pertussis is regarded as situation where a person develops a cough that prolongs for more than two weeks. This cough is characterized by the following conditions:

• Inspiratory whooping.
• Vomiting after coughing.
• Paroxysm of coughing.

Surveillances of pertussis entail routine surveillances for cases where DTPS is less than 90%. This routine surveillance involves reporting all the aggregate clinical data each month. This is done both at the peripheral and intermediate levels. The information reported includes the venerable age which is between one to four years. The immunization status should also be incorporated. Where the DTPS is greater than 90%

The routine surveillance should cover the venerable age, immunization and mortality rate. In case of an outbreak of Peturssis the WHO should be informed and appropriate information given such information comprise of date of outbreak, immunization and the mortality. Pertussis surveillances in some situation also encompass sentinel surveillances where microbiology studies are conducted.

Contrast of measles with pertussis

Pertussis has not been given equal treatment of surveillance like measles despite its major causes of thousands of deaths yearly. This is attributed the difficulties associated with its monitoring process. In some cases pertussis surveillances goes as far as conducting some studies to establish the pertussis epidemiology in a given area. This is in contrast with measles that is easier to monitor as the measles pathogen has characteristics that makes it easier to monitor as it is only transmissible to human beings only (WHO 1999).

Conclusion

Measles is still prevalent in sub-Saharan Africa and South East Asia countries. Surveillance for the disease requires concerted effort in prevention, treatment, education and routine monitoring. Vaccination programs in countries that experience food shortages are supposed to go hand in hand with provision of vitamin A supplements, to which the measles virus is sensitive. Sensitivity of children to the measles vaccine should be given priority. Some vaccines cause rashes at the sites of injection; others cause stress and irritability in the children involved. Children who are allergic to eggs should be considered for special vaccines, as there may be contraindications due to ordinary vaccines.

Pertussis, as opposed to measles, requires more frequent monitoring since it occurs more frequently than measles. Pertussis requires specialized surveillance such as sentinel surveillance in hospitals to determine the trend of the disease.

References

Anderson, RM & May RM 1991, Infectious diseases of humans: dynamics and control Oxford University Press, Oxford CDC 2007,National electronic disease surveillance system, Web.

Cronan, K 2005, Infections: measles, 2008. Web.

Griffin, DE & Moss WJ 2006, Can we eradicate measles? Microbe, Vol.1, No.9.

Needham, C & Canning R 2003, Global disease eradication: the race for the last Child, ASM Press, Victoria.

Nelson, K E & Williams CM 2006, Infectious disease epidemiology: theory and practice, Jones & Bartlett Publishers, New York.

Oxford, JS 1985, Conquest of viral diseases: a topical review of drugs and vaccines, Elsevier, New York.

WHO 2006, Measles surveillance in Victoria, Bulletin of the World Health Organization, 2008. Web. 

WHO 2000,Pertussis surveillance, A global meeting, Geneva, 2008. Web.

WHO 1999, Strategies for control of measles in SEAR countries, Report of an inter-agency consultation, New Delhi.

Crohns disease is an inflammatory disease that affects different parts of the gastrointestinal tract. Crohns disease ruins the small intestines, but it can occur anywhere from the larynx to the anus. It is considered an immune disease and produces inflammation of the tract. The usual age of patients is 20-30 years old. Thus, this disease can occur in any age, but prevails among people of Jewish origin. The disease affects both white and black population. The main symptoms are pain in gastrointestinal track, diarrhea, weight loss and arthritis. It is particularly insidious in that the pain and distress from the Crohns disease often cause the person to have phases of depression and problems with performance of usual work functions (Warner and Barto, 2007). In spite of great changes in science, the course of the disease is unknown. There is a prediction that strains of mycobacterium (bacteria) can be a cause of the Crohns disease. The disease has a great impact on quality of life, and the task of a nurse professional is to help a patient overcome possible problems and reduce negative feelings related to disease. The takes of the nurse is to explain to the patient that the medicines used to treat the Crohns disease produce serious side effects and can be addictive. In some case, colectomy is necessary, but living with the ileostomy can be emotionally and socially devastating (Roscher, 2008). There are several subtypes of the disease which includes Crohns colitis (pain and bloody diarrhea), Crohns enteritis (abdominal pain and diarrhea), Crohns terminal ileitis(abdominal pain and diarrhea), Crohns entero-colitis and ileo-colitis( pain and bloody diarrhea) (Warner and Barto, 2007).

The fist stage of education plan is to prepare the patient to live with this condition (with Crohns disease) for a long time. It is important to understand that strict diet, limited physical activity and regular treatment are the only measures which would help the patient to live longer. It is important to underline that there millions of people with this disease who experience any problem after surgical treatment or drug treatment (Gulanick and Myers, 2007). The second stage is to explain possible problems and difficulties the patient can experience. A patient with this disease usually has excessive absenteeism and decreased job performance when the employee has attacks or is on drug therapy. It is important to help the patient to overcome depression and anxiety caused by the pain. The Crohns disease is not linked to the work environment, so the company will not be required to create special work settings in job content. Anxiety occurs when the person is upset about having performance judged and are frightened by the process. One form of control is test anxiety, which has undesirable effects on health. For patients with Crohns disease, test distress can be evident in both written examinations and evaluations. Instead of focusing on positive moments, patients with high anxiety worry about their performance and health conditions. In Crohns disease, stress is associated with intrusion of such thoughts as preoccupation with feelings of inadequacy, expectation of punishment, and loss of status and self-esteem (Sklar and Sklar, 2007).

The main challenges of the patient are sudden pain and blockage of the intestine. These are the extreme conditions required immediate hospitalization. It is important to recognize that treatment only controls symptoms and slows the inflammatory process, but it has not been extremely effectual in preventing flare-ups of the disease when the person is under unexpected stressful situations. So, the main task of the patient is to avoid stressful and traumatic situations in all aspects of life (Lewis et al, 2007).

Crohns disease needs an effective schedule created by a patient for personal needs. This panning should involve regular treatment, diet and avoidance of stressful situations. The nature of Crohns disease and its symptoms do not influence ability of a person to work. When the health plan comes up for renewal, the task of the patient is to modify it in accordance with new conditions and changes in his life style.

References

1. Gulanick, M., Myers, J. L. (2007). Nursing Care Plans: Nursing Diagnosis and Intervention. Mosby; 6 edition.
2. Lewis, S. L. et al. (2007) Medical-Surgical Nursing (Single Volume): Assessment and Management of Clinical Problems (MEDICAL SURGICAL NURSING) Mosby; 7 edition.
3. Roscher, B. (2008). How to Cook for Crohns and Colitis: More Than 200 Healthy, Delicious Recipes the Whole Family Will Love. Cumberland House Publishing.
4. Sklar, J., Sklar, M. D. M. (2007). The First Year: Crohns Disease and Ulcerative Colitis: An Essential Guide for the Newly Diagnosed. Da Capo Press; Revised edition.
5. Warner, A. S, Barto, A. E. (2007). 100 Questions & Answers About Crohns Disease and Ulcerative Colitis: A Lahey Clinic Guide. Jones and Bartlett Publishers, Inc.; 1 edition.

Assessment

The client is a 57-year-old over-weight Caucasian male. Assessment of the clinical history of the patient shows that the patient had demonstrated an elevated blood pressure level five years back, which is under control with medication. In addition, the patient suffers from hyperuricemia, which is again under control with medication. Lipid profile and blood sugar is normal, but triglycerides are above normal.

The patient smokes about 20 cigarettes a day and leads a sedentary life. The family history shows that father died at the age of 73 years from coronary heart disease, the mother at 69 years from coronary heart disease, one brother at age 37 years from coronary heart disease, and one brother at age 59 years from coronary heart disease. Medications in use are indapamide 1.5mg sustained release tablets once a day and allopurinol 100 mg tablets once a day.

The life style of the patient and familial history put the patient at high risk for coronary heart disease and prevention of coronary heart disease is the topic chosen. The reason for choosing coronary heart disease is that it is the leading cause of mortality in the United States of America, extending over eighty years, and is a heavy drain on health-care expenditures estimated at approximately $151.6 billion in terms of direct and indirect costs (Neyer et al, 2007).

In addition to family history of coronary heart disease, tobacco smoking, hypertension, abnormal blood lipids and lipoproteins, physical inactivity, obesity, and diabetes are risk factors for coronary heart disease. The presence of two or more factors heightens the risk for coronary heart disease (Wilmore, Costill & Kenney, 2008). The patient lives with his wife and is from the middle income group. The children are gainfully employed and live separately.

Though there is no apparent cause for psychosocial stress, Ericksons theory of psychosocial development of an individual posits that an individual goes through different crisis stages in the various stages of life, and unless the individual masters the crisis, psychosocial stress results. In mid-life the crisis that is faced relates to generativity or stagnation, and failure to master this could lead to psycho-social stress in the individual (Roper-Coleman & Keckhausen, 2006).

At the clinical assessment stage it is possible to evaluate the coping styles of the patient through observing the statements made by the patient. In essence there are two coping styles internalizing and externalizing. Patients using internalizing coping styles are likely to use self-deprecating statements, as they look upon the cause of their problems and not their resolution within themselves. On the other hand, patients using externalizing coping styles get angry and blame everyone else but themselves, as they use externalizing behaviours as a means to reduce their stress (Mohr & Beutler, 2005). In the case of this patient externalizing coping style was observed.

Expected Outcome/ Planning & Goal Settings

The expected outcomes for the patient are smoking cessation and weight reduction by twelve kilos to achieve optimum body mass index (BMI)& These two outcomes are to be achieved over a planned time span, and are realistic for the patient and measurable. Through smoking cessation and weight reduction, the environmental risk factors are eliminated reducing the risk for coronary heart disease.

The plan for smoking cessation is to encourage the patient to enrol in group therapy to understand smoking cessation behaviour and remove stress. At this stage the life partner is also encouraged to become a partner in the smoking cessation activity. The next stage involves the actual stopping of smoking cessation supported by nicotine replacement therapy. The goals set in this plan is for a definite commitment by the patient to quit smoking within one month of the group therapy, and the actual cessation of smoking to happen immediate to this commitment (Belleudi et al, 2007)

The plan for weight reduction is to consume more foods that are liked that are low in carbohydrates and incorporate fruits and vegetables that are liked in the diet. At the same time an exercise program through walking is started. To start with this program looks at an exercise of brisk walking for 30 minutes 5 days a week that increases fortnightly by ten minutes till a brisk walking time of sixty minutes is reached. Again, the life partner is encouraged to be a part of this program. The weight reduction of twelve kilos is over a span of six months and the targeted weight loss is two kilos a month.

Nursing Interventions

The planned nursing interventions for smoking cessation are first to motivate the individual to quit smoking. This is done in two ways. The first is to demonstrate the lowered pulmonary functioning through spirometry and carbon monoxide tests feedback and presenting graphic representation of the degradation of the cardiovascular system through smoking. The second intervention is to enhance the coping ability of the individual to the crisis in the stage life. The final nursing intervention is in the form of frequent monitoring and counselling to evaluate progress of the program and take it forward (Rice & Stead, 2004).

The first nursing intervention in the weight reduction program is to give clarity to the goals and objectives of the programs and clarify the exercise and nutrition program in it. The second intervention is to provide weight loss counselling. The third intervention is to monitor the weight loss on a constant basis to take the weight production program forward (Briscoe & Berry, 2009).

Conclusion

The patient is at high risk for coronary heart disease due to the presence of more than one risk factor, in the form of smoking, excess weight and a sedentary life style. The smoking cessation program coupled with the weight reduction program will help to prevent the early onset of coronary heart disease in this patient.

Literary References

Belleudi , V., Bargagi, M., Davoli, M., Di Pucchio, A., Pacifici, R., Pizzi, E., Zuccaro, P. & Perucci, C. A. (2007). Characteristics and effectiveness of smoking cessation programs in Italy. Results of a multicentric longitudinal study. Epidemiologia e prevenzione, 31(2-3), pp. 148-157.

Briscoe, J. S. & Berry, J. A. (2009). Barriers to Weight Loss Counseling. Journal for Nurse Practitioners, 5(3), 161-167.

Mohr, D. & Beutler, L.E. (2005). The Integrative Clinical Interview. In Larry. E. Beutler & Gary Groth-Marnat (Eds.), The Integrative Assessment of Adult Personality, Second Edition (pp. 82-121). New York: Guilford Publications.

Neyer, J. R., Greenlund, K. J., Denny, C. H., Keenan, N. L., Labarthe, D. L. and Croft, J. B. (2007). Prevalence of Heart Disease  United States, 2005. MMWR Weekly, 56(6), 113-118.

Rice, V. H. & Stead, L. F. (2004). Nursing interventions for smoking cessation. Cochrane Database of Systematic Reviews, Issue 1, Art No. CD001188.

Roper-Coleman, S. F. & Heckhausen, J. (2006). Adult Development. In Richard Schulz, Linda, S. Noelker, Kenneth Rockwood & Richard, L. Sprott (Eds.), The Encyclopedia of Ageing, Fourth Edition (pp. 21-25). New York: Springer Publishing Company.

Wilmore, J. H., Costill, D. L., & Kenney, W. L. (2008). Physiology of Sport and Exercise, Fourth Edition. Champaign, IL: Human Kinetics.

Chronic obstructive pulmonary disease (COPD) is a spectrum of diseases related to long-term breathing problems and airflow blockage. It appears to be quite widespread: as Centers for Disease Control and Prevention estimates (2017), 16 million Americans suffer from this spectrum of diseases. Moreover, there is a problem of undiagnosed patients, the number of which frequently includes the ones speaking other languages and belonging to other cultures.

To begin with, discussion of the possible limitations and solutions is vital in this context. In such a lesson, it would be appropriate to speak of the disease itself, its treatment and prevention, its barriers, and solutions. Signs and symptoms are to be analyzed as well as causes of diseases (Lopez-Campos et al., 2016). As for prevention, there are multiple ways like smoking cessation and air quality improvement. Sometimes, surgery is needed, though management usually includes exercises and bronchodilators. Speaking of the possible barriers to mention, one could point out that patients may use unconventional medicine, and its effect cannot be ignored in treatment (Ali & Watson, 2017). Moreover, there is the possibility of a language barrier between a patient and medical personnel. Hence, it is also recommended to allow sufficient time for the interview in order to collect comprehensive anamnesis and to address health literacy in such cases (Wittenberg et al., 2018). As for the learning evaluation methods in COPD treatment when patients belong to other cultures, they do not differ from the regular ones. Though, they must include assessment of abilities to work in a multicultural environment.

To conclude, a lesson on COPD should include information on treatment, prevention, and management. Moreover, the possible limitations of treatment of patients belonging to other cultures are to be discussed as well as the possible solutions like carrying out more comprehensive interviews or preventive activities. Finally, speaking of the learning evaluation methods, they do not have to differ from the ordinary ones; however, specialized knowledge of other cultures could be useful.

References

Ali, P., & Watson, R. (2017). Language barriers and their impact on provision of care to patients with limited English proficiency: Nurses perspectives. Journal of Clinical Nursing, 27(5  6), 1152  1160.

Centers for Disease Control and Prevention. (2011). Introduction to program evaluation for public health programs: A self-study guide. CDC.

Centers for Disease Control and Prevention. (2017). Chronic obstructive pulmonary disease. CDC. Web.

Lopez-Campos, J., Tan, W., & Soriano, J. (2016). Global burden of COPD. Respirology, 21(1), 14  23.

Wittenberg, E., Farrel, B., Kanter, E., & Buller, H. (2018). Health literacy: Exploring nursing challenges to providing support and understanding. Clinical Journal of Oncology Nursing, 22(1), 53  61.

Research Question

The development of waterborne illnesses is a serious global dilemma because of millions of cases related to infecting people by contaminated fresh water. This is of particular concern to such widespread diseases as botulism caused by the bacteria living in contaminated water. Because water is considered the main resource for drinking, healthcare, industry, and recreation, many infections can be transmitted by parasites and microbes, public health is under the threat. Although 70 % of the Earth is covered with water, not all resources can be used for drinking, sanitation, and hygiene owing to constantly emerging waterborne infectious diseases. Therefore, the given disease poses a serious challenge to maintaining the welfare of the community.

Problem Statement

Clean, safe, and healthy water is indispensable for sanitation, drinking, hygiene and recreation because it allows to sustain human health and to reduce the likelihood of waterborne illnesses. At the global level, however, more than 900 people have limited access to healthy water and, as a result, the spread of infectious diseases transmitted by water is inevitable. Aside from personal hygiene, there are a number of public recreational centers, such as swimming pools, which face a serious dilemma. In particular, Hlavsa et al. (2011) have found out that local governments are responsible only for regulating, establishing, and enhancing sanitation standards in swimming pools.

Due to the absence of federal control, there are substantial variations in terms of compliance, regulation, and enforcement. As a result, the researchers indicate that there was a significant increase in water-associated outbreaks in 2007-2008 (134 cases) as compared to 78 cases of waterborne infections (Hlavsa et al., 2011).

Kun et al. (2012) have provided an analysis of waterborne infectious diseases at a global level and have correlated those with socio-environmental factors. The study has demonstrated a direct connection between serious public health problems and the spread of water-associated outbreaks (Kun et al., 2012). As a result, the negligence of simple rules and ignorance of environmental problems can lead to the development of serious waterborne diseases like botulism. According to Zhang et al. (2010), the history of the disease is quite long, but there are no specific strategies that would reduce the development of bacterial infections. What is more important, the disease has spread over almost all regions in the United States, including Mississippi and Alaska.

To understand the seriousness of the problem, specific attention should be paid to the analysis of sources and reasons of microbe and parasite exposures to water, as well as how quickly these pathogens spread. At this point, Leclerc et al. (2002) consider microbial explore to waters a result of neglected attitude to sustaining public sanitation, as well as inappropriate regulations established in various countries.

As a result, water-associated outbreaks have a close relation to public health policies and strategies that should be taken into consideration. More importantly, the lack of relevant norms and standards can become a trigger of re-emerging and emerging diseases all over the world.

In their studies, Leclerc et al. (2002) have outlined a number of serious diseases caused by water microbes. These classes of pathogens include enteric and aquatic bacteria, enteric viruses, and enteric protozoa (p. 392). All these microorganisms constitute a major threat to the health of individuals because of the epidemic spread of bacterial diseases.

References

Hlavsa, M., Roberts, V., Anderson, A., Hill, V., Kahler, A., Orr, M., && Yoder, J. (2011). Surveillance for waterborne disease outbreaks and other health events associated with recreational water  United States, 20072008. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 60(12), 1-32.

Kun, Y., LeJeune, J., Alsdorf, D., Bo, L., Shum, C. K., & Song, L. (2012). Global Distribution of Outbreaks of Water-Associated Infectious Diseases. Plos Neglected Tropical Diseases, 6(2), 1-9.

Leclerc, H. H., Schwartzbrod, L. L., & Dei-Cas, E. E. (2002). Microbial Agents Associated with Waterborne Diseases. Critical Reviews In Microbiology, 28(4), 371.

Zhang, J., Sun, L., & Nie, Q. (2010). Botulism, where are we now?. Clinical Toxicology (Philadelphia, Pa.), 48(9), 867-879.

Chest pain can be caused by a variety of physical conditions, including heart disease or nervous disorders. A 52-year-old male patient has several physiological abnormalities that are triggered by hyperlipidemia and first-degree obesity. In addition to necessary laboratory tests, the man needs additional blood and urine tests, such as creatinine and proteinuria. The patient is burdened with family and professional responsibilities, which should be regulated by long-term health education. Thus, this case requires more detailed laboratory research to study post-interventional practice and monitor potential heart disease.

The results of the preliminary examination provided are the basis for diagnosis, but it can be detailed. The nature of the pain can characterize several critical illnesses, including heart attack. It has been noted that individuals at risk should have a detailed physical examination and questioning about chest discomfort (Inamdar & Inamdar, 2016). For example, pain that spreads to the left arm could be the first stage of a heart attack. Further examination should include questions about a feeling of heaviness in the stomach, weakness, burning in the ribs, and dizziness. These markers indicate coronary heart disease and oxygen deficiency, which have been partially confirmed by laboratory tests. The missing tests are cholesterol, creatinine, and triglyceride levels, which complement the picture of arterial health (Hung et al., 2020). Thus, additional questioning about physical pain perception and laboratory tests are needed to make a definitive diagnosis.

Diagnosis of cardiovascular diseases is a diversified process, as they are associated with disorders of the nervous system, digestive tract, or accidental infections. A laboratory test of biological material is essential to rule out multiple irrelevant diagnoses. It has been noted that increased C-reactive protein (CRP) is associated with infections and inflammation, but it is also correlated with the first stages of heart disease (Sproston & Ashworth, 2018). This acute-phase protein responds to damage to blood vessels and arteries and may indicate plaque on the way to the heart. Differential diagnoses for the patient are atherosclerosis, aortic and vascular aneurysms, and thrombosis since laboratory tests may show blockage. Thus, further study of the patients biophysical parameters will help make a more accurate diagnosis and prescribe preventive measures.

Patient education is one type of prevention, as clinicians indirectly influence a persons everyday behavior. The patient should receive dietary advice, exercise plan, and conditions in which an immediate visit to the doctor should be made. For example, sharp pain in the left arm and shoulder is a symptom of a heart attack. Consequently, these conditions should be discussed, and the patient should confirm their understanding and willingness to use the advice in everyday life. A statement about not having enough time for illness and the need for an immediate solution to the problem are incompatible with these symptoms. The clinician should express an understanding of family and professional duties and communicate the need for ongoing health monitoring. Besides, responsibilities can be combined with diet and exercise without affecting the routine. Thus, the lack of free time will not become an obstacle to better quality of health care in the framework of prevention.

A 52-year-old male patient has laboratory abnormalities in addition to physical pain. High blood pressure, hyperlipidemia, and excess weight are sufficient reasons for further diagnosis of heart disease. A heart attack is a threat due to pain in the left arm, as are atherosclerosis and thrombosis in several differentiated cases. Patient education plays a key role, as the man must be aware of physical conditions characterized by negative dynamics. Thus, this case requires long-term monitoring and frequent visits to the clinic for laboratory tests and interviews with the clinician.

References

Hung, M., Kounis, N., Lu, M., & Hu, P. (2020). Myocardial ischemic syndromes, heart failure syndromes, electrocardiographic abnormalities, arrhythmic syndromes and angiographic diagnosis of coronary artery spasm: Literature review. International Journal of Medical Sciences, 17(8), 1071-1082. Web.

Inamdar, A., & Inamdar, A. (2016). Heart failure: Diagnosis, management and utilization. Journal of Clinical Medicine, 5(7), 62. Web.

Sproston, N., & Ashworth, J. (2018). Role of C-reactive protein at sites of inflammation and infection. Frontiers in Immunology, 9, 754. Web.

Introduction

Studies indicate that high blood pressure is a frequent occurrence among the patients with both acute and chronic kidney disease (Hilgers & Mann, 2014; Mann, 2014; Tedla et al., 2011). Such studies also indicate that hypertensions have been found to occur mostly among patients with glomerular or vascular disorders (Tedla et al., 2011). The therapies of the disorders vary depending on the condition of the patients and the level of the blood pressure (Mann, 2014). The management and treatment of the hypertension remain critical determinant of the survivability and final treatment of the patients suffering from chronic kidney disease (Tedla et al., 2011). The evidences presented in such studies provide a direct correlation between hypertension and the chronic kidney disease. Besides, the evidence of such studies has been used to develop therapies and preventive measures among the medical practitioners.

How Research have linked Hypertension and Chronic Kidney Disease

Studies indicate that patients with hypertension are likely to develop chronic kidney disease (Tedla et al., 2011; Hilgers & Mann, 2014; Mann, 2014). In fact, hypertension is both the source and result from the chronic kidney disease (Tedla et al., 2011). Evidence suggests that the management and prevention of chronic kidney disease benefit from the high blood pressure control (Kauric-Klein, 2012). On the other hand, clinical trials demonstrate that CKD is more likely to cause high blood pressure given the importance of kidneys in the control of glucose levels in the blood (Scheffers, Kroon, Schmidli, 2010). Even though the studies have linked the CKD and hypertension, the results are limited to clinical group of disorders. In fact, whether the results can be extrapolated to include other chronic kidney disorders remains a matter of clinical trials. Chronic kidney diseases include a large number of clinical disorders characterized by their heterogeneous causative agents and natural history (Scheffers et al., 2010; Tedla et al., 2011). In fact, most of the studies on the relationship between hypertension and chronic kidney disease have not taken into consideration patients with kidney failure (Scheffers et al., 2010).

While results from clinical trials indicate that appropriate treatment of CKD has increased probability of reducing uncontrolled high blood pressure, the prevalence rate of hypertension is still increasingly high among patients with CKD. Further, the findings indicate that the control and treatment of the disease are far from being attained despite the mounting evidence. Studies indicate that in the United States, the prevalence rate of adults with hypertension is about 23% of non-CKD patients (Mann, 2014). Based on the results of the national survey of non-institutional adults in the United States, about 35% of stage 1, 48% of stage 2, 60% of stage 3 and 84% of stage 4 and 5 of the CKD patients are suffering from hypertension (Mann, 2014). Besides, the results indicate that the prevalence of hypertension also depends on the cause of CKD. Hypertension is strongly correlated to patients with the Renal Artery Stenosis (RAS), Diabetic Nephropathy (DN) and the Polycystic Kidney Disease (PKD) represented by about 93%, 87% and 74% respectively (Mann, 2014). Hypertension is common among patients on both peritoneal dialysis and hemodialysis as well as among the patients who have experienced renal transplant (Mann, 2014). However, the technical understanding and definition of hypertension influences the manner in which hypertension has been correlated with peritoneal dialysis and hemodialysis (Kauric-Klein, 2012b).

In spite of the increased prevalence of hypertension among patients with CKD as well as the availability of medication, only a few patients attain the goals of the prescribed therapy (Hilgers & Mann, 2014). However, evidence suggests that the prevailing circumstances are changing in the general population (Jones, 2014; Kauric-Klein, 2012b). The evaluations of the current studies and those of earlier decades indicate that increased awareness of the control of hypertension has caused the improvement of the patient outcomes (Jones, 2014; Kauric-Klein, 2012a; Samranbua, 2011). Besides, the current studies indicate that the evidence-based treatments of other cardiovascular treatments among the patients with CKD have also caused the improvement of the patient outcomes (Jones, 2014; Kauric-Klein, 2012a). However, the reduced rates compared with the earlier decades indicate that increased awareness among the CKD patients have yielded positive results (Jones, 2014; Kauric-Klein, 2012a; Scheffers et al., 2010). Critical analysis of the results of the current studies also indicates that the increased awareness have also resulted in reduced non-adherences to the prescribed therapies (Scheffers et al., 2010). Even though such studies are not clear on the type of hypertension among the CKD patients, the results highlight the significant roles of the nurses in monitoring and reliably diagnose hypertension as well as assess the achievement of high blood pressure goals (Scheffers et al., 2010).

Conclusion

While most studies on the relationship between hypertension and the CKD have focused on the treatment, the researches on how hypertension can be managed to reduce the chances of mortalities among the CKD patients are lacking. Besides, researchers have not accurately determined whether high blood pressure results in the CKD. Moreover, despite the prevalence rate of hypertension among patients with CKD as well as the availability of effective medication, only a few patients attain the goals of the prescribed therapy. However, the current studies indicate improved patient outcomes due to the increased awareness on the prevention and management of hypertension among the patients with CKD.

References

Hilgers, K. F. & Mann, J. F. (2014). Effect of antihypertensive treatment on renal function in primary (essential) hypertension. American Journal of Nephrology, 36(3), 456-498.

Jones, L. (2014). Reducing disparities in hypertension among African-American women through understanding information seeking and information use (Doctoral dissertation). Web.

Kauric-Klein, Z. (2012a). Blood pressure knowledge in hypertensive hemodialysis patients. Canadian Association of Nephrology Nurses and Technologists Journal, 22(4), 18-25.

Kauric-Klein, Z. (2012b). Improving blood pressure control in end stage renal disease through a supportive educative nursing intervention. Nephrology Nursing Journal, 39(3), 217-228.

Mann, J. F. (2014). Pathogenesis of hypertension in kidney disease. American Journal of Nephrology, 36(2), 398-427.

Samranbua, A. (2011). The Lived Experience of Rural Thai Older Adults with Poorly Controlled hypertension (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses.

Scheffers, I. J.M. Kroon, A. A. Schmidli, J. (2010). Novel baroreflex activation therapy in resistant hypertension: results of a European multi-center feasibility study. Journal of the American College of Cardiology, 56(15), 12541258.

Tedla, F. M., Brar, A., Browne, R. & Brown, C. (2011). Hypertension in chronic kidney disease: navigating the evidence. International Journal of Hypertension, 1(1), 332-405.

Introduction

The Centers for Disease Control and Prevention (CDC) is a federal agency that works to improve the overall health of the general population by promoting healthy behaviors, preventing disease, and being better prepared for emergencies. The Centers for Disease Control and Prevention (CDC) concentrates its efforts on promoting health around the globe, reducing leading causes of death, strengthening surveillance and epidemiology, improving global health, and reforming health policy. As a result, the CDC can contribute to the enhancement of public health and safety, the promotion of equal opportunities, and the improvement of the quality of life within the community through its key areas of focus.

How the Organizations Mission and Vision enable it to Contribute to Public Health and Safety Improvements

The Centers for Disease Control and Prevention (CDC) has a broader duty to the people of the United States than only their health, as evidenced by the agencys mission and vision statements. The Centers for Disease Control and Prevention has proven time and again that it has what it takes to keep Americans safe from infectious diseases and other risks to public health. The mission of the Centers for Disease Control and Prevention is to ensure that CDC personnel are appreciated, respected, and supported in their efforts to fulfill the Agencys public health mission. The vision of the organization is to realize its goal of creating a working environment that exemplifies diversity, inclusiveness, and equality. The overarching goal is to protect American citizens from harm both locally and abroad.

All of CDCs infrastructure and personnel must be set for the organization to fulfill its objective, as underscored by the vision. The CDCs vision positions it as a model agency that puts its mission first, allowing it to make significant strides in improving public health and safety (CDC, 2019). The mission statement emphasizes its responsibilities to the American people and directs its activities in this regard. Generally, the fundamental principles of responsibility, respect, integrity, and honesty underpin the work of the CDC and are vital to the realization of its goal and vision.

Ways a Local and or Global Initiative Supports Organizational Mission and Vision

To help achieve the goals of the Centers for Disease Control and Prevention (CDC), the Vision Health Initiative (VHI) has established a multi-tiered network to improve eye health and prevent blindness. The Vision Health Initiative (VHI) was established by the CDC to strengthen the nations vision health via a coordinated public health strategy to enhance monitoring, applied public health research, and preventative and control measures for eye illness, eye injury, and vision loss. Through this initiative, it is possible to better manage and prevent injuries, diseases, and vision loss that lead to impairment.

Organizations Ability to Promote Equal Opportunity and Improve the Quality of Life in the Community

The CDC places high importance on achieving health equity, reducing gaps, and promoting the health of all populations. As part of its efforts to prevent and reduce the prevalence of chronic diseases, the Centers for Disease Control and Preventions Healthy Communities Program advocates for closing socioeconomic and racial/ethnic health gaps (Petersen et al., 2019). To accomplish this goal, the CDC focuses on health equality and can reach people who have the greatest need through implementing worldwide programs, developing research tools and resources, and providing leadership. The organization can become more efficient via the promotion of diversity and inclusion to better represent the people it serves. Inclusion and diversity are key factors in driving innovation, greater performance, and creative output. Diversity in terms of color, gender, ethnicity, and any number of other qualities guarantees a fair opportunity for all individuals, hence enhancing public health promotion in areas that are composed of minority populations.

Effects of Social, Cultural, Economic, and Physical Barriers

Social, cultural, economic, and physical barriers often hamper individuals access to health care. In the United States, for instance, people of varying socioeconomic statuses have varying degrees of difficulty obtaining medical treatment. Children from low-income homes are more likely to die as they grow up than those from higher-income families because of the lack of access to the healthcare they face. Therefore, for the CDCs health promotion efforts to be most successful, they must focus on modifying each persons unique social and environmental context.

Impact of funding sources, policy, and legislation on the organizations provision of services

The budgetary power, which consists of yearly appropriations decided by the United States Congress, is the primary source through which the CDC obtains funds for its discretionary spending. The Centers for Disease Control and Prevention can fulfill its purpose and carry out a variety of disease prevention strategies due to the financing they get. The CDC, in its role as the nations public health protection agency, is vested with the authority to enact rules pertaining to the prevention of health and safety hazards to the United States of America from both foreign and domestic sources. Through the use of federal regulations, the CDC and other agencies carry out the implementation of legislation enacted by Congress about public health.

By working together, the CDC and Public Health Laws aim to make the public health system more equipped to deal with emerging threats, chronic diseases, and other national public health concerns. Federal and state constitutions, legislation, ordinances, regulations, rules, case law, and public body policies provide the foundations for these structures (Fischer et al., 2017). The goal of public health regulations is maintaining and improving communities, which aim to stop disease outbreaks and transmission, promote healthy lifestyles among children and their families, and protect people from potential threats in their homes, workplaces, and communities.

The Organizations Impact on a Community

The goal of the Centers for Disease Control and Preventions (CDC) Health Impact in 5 Years (HI-5) effort is to increase the availability of healthy food and other lifestyle choices by identifying and addressing the determining social and economic factors. The policy provides resources for community-wide health promotion initiatives, including interventions, strategies, and preventative measures (CDC, 2022). Every member of the community, from newborns to the elderly, needs these services since they address a broad variety of health concerns and threats. These conditions include abuse and neglect of children, obesity, infant mortality, excessive weight gain, and unplanned pregnancies among teenagers.

How Nurses Can Be Involved in the CDC

Because of the scope of the HI-5 initiative, nurses have exciting new opportunities to improve the health of their communities. A nurses expertise in disease prevention opens up several opportunities for collaboration between the CDC and the nursing profession. Nurses play a crucial role in promoting wellness via preventive care by providing information and guidance. Nurses may also play a role in health promotion, which is a kind of preventive health care. Nurses may also provide nutritional education as a part of health promotion.

Conclusion

The Centers for Disease Control and Prevention (CDC) conducts several programs and initiatives that contribute to the health and safety of the American people. By increasing peoples awareness of health issues and their ability to get treatment, the initiatives, policies, and funding shown below help people individually and collectively. The CDC also monitors for and identifies potential new health threats to the public. Awareness of the CDC and the aid it provides is thus crucial for societies.

References

CDC. (2022). Health Impact in 5 Years. Office of the Associate Director for Policy and Strategy. Web.

Fischer, L. S., Santibanez, S., Jones, G., Anderson, B., & Merlin, T. (2017). How Is CDC Funded to respond to public health emergencies? Federal appropriations and budget execution process for nonfinancial experts. Health Security, 15(3), 307-311. Web.

Petersen, R., Pan, L., & Blanck, H. M. (2019). Peer reviewed: Racial and ethnic disparities in adult obesity in the United States: CDCs tracking to inform state and local action. Preventing Chronic Disease, 16. Web.

Malnutrition

Nutrition performs a critical role in an individuals overall health. Not maintaining proper or sufficient amounts of the required nutrients over a prolonged or short period can contribute to malnutrition which often leads to illness and disease. Malnutrition refers to a lack of sufficient nutrition that is induced by not getting enough to eat, consuming less of the right diet, and the body not being able to utilize the food which is consumed. The condition occurs when an individuals diet does not have a sufficient nutritional balance that the body requires for optimum health (Whitney & Rolfes, 2019). The condition can lead to short-term and long-term health issues, slow healing of wounds and illnesses, increased risk of infection, exhaustion and loss of appetite, and other severe physical and mental health complications (Whitney & Rolfes, 2019). The condition can also be caused by a wide range of problems, such as patients who have trouble absorbing nutrients or individuals with chronic disordered eating like bulimia or anorexia nervosa (Lenters et al., 2020). Malnutrition management or treatment can rely on the nature and extent, as well as the prevalence of other underlying disorders or conditions.

Physiological Effects of Anemia on a Human Body

Malnutrition can contribute to many health complications, ailments, and diseases. One of them is anemia which occurs due to a lack of the required amount of iron levels in the blood. Nutritional anemia is a hazardous health issue that is usually more common in women and girls attributed to menstrual losses and increased pregnancy requirements (Altaf et al., 2018). Iron deficiency anemia or nutritional anemia causes red blood cells in the human body to start slimming and become thin, oval-shaped, and very pale due to low hemoglobin levels in the blood (Altaf et al., 2018). The deficiency may result from inadequate iron, lack of vitamin C, and underlying factors that can inhibit nutrients from being properly absorbed by the body.

The explanation as to why females are more likely to experience this condition is due to blood loss that usually happens during the reproductive period and also during pregnancy since both the unborn baby and the pregnant mother need iron. In that case, if the quantity of iron intake is not sufficient during this period, anemia may result. According to the World Health Organization (WHO), approximately 30% of the global population is affected by this disease (as cited in Altaf et al., 2018). Therefore, proper prevention measures have to be implemented by relevant bodies to help prevent or reduce anemia among society.

The most accessible type of iron for the body to digest is heme iron, which is usually contained in meat. If an individual is unable to consume meat, other foods rich in vitamin B, vitamin C, and iron supplements, may be used to provide the necessary amounts that the body requires (Whitney & Rolfes, 2019). Besides consuming a diet that is rich in iron, the body should also get other types of food supplements in form of vitamins. These vitamins play an essential role in helping the body to absorb iron and lack of or too little of them can raise the risk levels of iron deficiency anemia (Whitney & Rolfes, 2019). The symptoms and signs of an individual who has nutritional anemia are pale skin, hair loss, tinnitus, fingernails, deformed toenails, ulcers that are found in the mouth, and the urge of eating ice. Women also experience skipped menstruation more often during the reproductive period.

Relationship Between Specific Foods/Nutrients and the Anemia

A well-balanced diet alongside high protein, iron, vitamin B, and C will manage nutritional anemia. Dried nuts and fruits such as raisins, mangoes, watermelons, prunes, avocados, leafy greens, dates, soybeans, and figs are good sources of these essential nutrients (Altaf et al., 2018). Others include very high iron and protein sources, which help counter nutritional anemia, like eggs and salmon (Whitney & Rolfes, 2019). The foods which contain iron, protein, and vitamins B and C, aid in establishing an appropriate iron supply in the body and boost its requirements with the needed iron. Constant monitoring of hemoglobin or blood iron levels, particularly for menstruating girls and women and during the pregnancy period, may be needed to balance and ensure correct iron levels are maintained (Altaf et al., 2018). It helps in preventing, managing, and monitoring this disease.

On the other hand, some foods, like tea, coffee, milk, whole grain cereals, and any food containing tannins, must be avoided as they impede iron absorption in the body. It is also essential to not eat foods that contain gluten, phytate, and oxalic acid. Patients can focus on eating only high iron and other vitamins since they help generate red blood cells and hemoglobin more quickly. Monitoring measures will also depend on the nature of these iron deficiency disorders, other underlying conditions, along with a healthy diet and the necessary intake of crucial food products which contain adequate iron.

Nutritional Recommendations to Help Combat Anemia

The following dietary guidelines should be observed to help in combating nutritional anemia. First, a healthy diet with a high protein and iron composition. Second, eggs are widely known to be a rich source of protein and iron, and therefore an individual should include them in the diet. Third, vitamin C and B complex must be presented in the daily diet as well. Fourth, other food guidelines include raisins, dates, figs, soya beans, and green leafy vegetables, all of which are essential for combating nutritional anemia.

References

Altaf, B., Khan, M. B., Aftaab, R. K., Jawed, S., Salam, R. M. T., & Amir, F. (2018). Nutritional deficiency anemia. The Professional Medical Journal, 25(7), 10181023. Web.

Lenters, L., Wazny, K., & Bhutta, Z. A. (2020). Management of severe and moderate acute malnutrition in children. In R. E. Black, R. Laxminarayan, M. Temmerman & N. Walker (Eds.), Reproductive, maternal, newborn, and child health: Disease control priorities (vol. 2, 3^rd ed., pp. 205223). World Bank Publications.

Whitney, E. N., & Rolfes, S. R. (2019). Understanding nutrition (15^th ed.). Cengage Learning.

Recognizing both health and disease is an integral part of the care process. Health pertains to the condition in which the body can normally perform its vital functions while the disease is the opposite of such a state. The knowledge obtained regarding such important healthcare concepts is vital for professionals to be reliable providers of care and help patients overcome the burden of disease that reduces their quality of life, which includes both physical and emotional well-being.

For a nursing student, the information obtained during the Human Disease course provides a framework on top of which one may build further knowledge, skills, and competencies that are essential in their future career. For example, by understanding how to gather data regarding how, when, and where diseases occur, nurses have an idea of how severe a disease is and which resources are necessary to put toward prevention and treatment (Zelman et al., 2015). In addition, the course provided valuable information regarding the epidemiology of the disease, which is highly relevant in the modern context. Nurses are now required to know COVD-19 epidemiology to make recommendations regarding the prevention, control, and treatment of the virus.

Health promotion and disease prevention are highly important functions of healthcare professionals as the latter is required to educate the public regarding the ways they can avoid chronic diseases and live healthy and happy life. The knowledge about the disease is not about fearmongering patients but rather providing them with support and qualified advice on how they can overcome the challenge of poor health. While treatment, either medical or holistic, is highly important, understanding disease helps to prevent it more successfully.

Reference

Zelman, M., Tompary, E., Raymond, J., Holdaway, P., & Lou, M. (2015). Human diseases: A systemic approach (8th ed.). Pearson Education.