Category: Disease

Introduction

Improved and advanced health care services have led to a longer life expectancy and better life over the past decades. However, factors like aging, obesity, and changing trends have affected the provision of these services. Demographic changes and the increasing number of new types of bacteria and viruses have made the delivery of healthcare services difficult. This has led to the need for advancement both in technology and scientific research. In this paper, these challenges to healthcare delivery are discussed, and the coming ones in the future are anticipated to help determine how these services can be improved and the challenges overcome.

Aging

This is a significant influence on healthcare delivery since this group consists of elderly people who do not work and, therefore, are not able to pay for the services. This group is also prone to illnesses and, therefore, requires more attention than any other group. With the efforts centered on increasing life expectancy this group is bound to grow in size; therefore, more attention will be required in the future. According to the results given by the U.S census bureau in 2010, the aged population was the minority with the majority being the middle age. This trend implies that in the future middle age will enter the age group thus increasing the size, and this will automatically lead to increased demand for medical services (Anderson, 2010). The following is an illustration of the nature of the population in the US as of 2010 and the prospected changes by the year 2050.

From the above illustration, the elderly will increase progressively by the year 2050. This increase in the aged population is due to the efforts that have been put into making the environment a better place to live. Pollution has been the main factor that has been improved through the centralization of emission-causing activities in places where human habitation is low. Care for the aged has also promoted life expectancy because this helps them stay free from infections for longer periods.

This care has also been enhanced by the provision of hygiene and sanitation services to the aged. Other habits like smoking and excessive alcohol indulgence are on the minimal, and this promotes long healthy life. Crime has been on the decrease, and things like nuclear attacks have seized to be common occurrences, and people live their full lives without such accidents (Guah, 2009).

Demographic factors like improved knowledge and education on healthy eating habits are crucial to increased life expectancy, people are now eating nutritious food that does not harm the body as well as avoiding foods that add toxins to the body and cause disease. People have learned the importance of exercise, and this has been encouraged through the introduction of gyms and sports clubs to provide avenues for exercise to improve the quality of life. Technology has also improved life expectancy because people easily retrieve information from the net to learn their conditions and help improve them. Getting attention from health care has also improved because emergencies can easily be attended to with ease in communication provided by technology (Guah, 2009).

Some health issues are common in the elderly population, and this has affected the health care provision in that with the increased aged population these cases have increased. An example of these issues is the Arthritis condition which can render a patient immobile thus forcing those around them to take twenty-four-hour attention to them. Another common occurrence in the elderly is stroke which is an extremely serious condition that also makes a patient helpless and requires that full attention be given. This calls for attention from health care providers and this is particularly challenging if such cases increase (Guah, 2009).

To help improve such complications among the old, it is necessary to learn about these conditions and practice healthy habits that help prevent diseases. For the aged, it is also beneficial to shower them with love and attention to reduce stress levels and avoid stoke which is mostly caused by depression. For cases like Arthritis, early diagnosis is necessary to help keep excessive effects at bay; this can be done through frequent health checkups and care (Guah, 2009).

Obesity

The prevalence rate of obesity in the U.S has been increasing over the years; by 2010 the rate was 25% in most of the states with others going as high as 30%. Half of the total population can be regarded as overweight, and this is a serious health issue because this means they are prone to health complications. Further still, its steady increase is seriously alarming given the health complications that come with obesity. It is estimated that with the current trend in the established cases of obesity, in the next ten years 60% of the U.S population might be overweight with 40% being obese, and this is a cause for concern (Segrave, 2008).

According to Segrave (2008), the principal causes of obesity in the U.S are

1. The increased availability and consumption of processed and packed foods due to the busy lifestyles that they lead. These foods in most cases contain lots of sugar, condensed fats and oils, preservatives, and additions that do not have any nutritional value but only add junk to the system. Most of these chemicals cannot be digested by the body hence they are stored as fats while others translate into toxins which often bring health problems to the body.
2. Consumption of foods that lack nutrients in large quantities, these are mostly fried foods and soft drinks that go with them. These foods are easily absorbed into the body making the person hungry and forcing him to take more portions than necessary, and this of course leads to obesity.
3. Fast foods are all over America and this encourages people to grab something while working, driving, or even when bored. Taking such snacks between meals is risky especially because they contain a lot of fats and preservatives. They can be termed as empty calories that only contribute to gaining weight with no added value to the body.
4. The ease of movement provided by vehicles has made Americans lazy and this coupled with many hours of sitting in the office leads to decreased metabolism, therefore, most of what is ingested in the body are stored as fats (Census scope, 2011).

Increased cases of obesity have led to increased weight-related health problems and this further frustrates the efforts of health care providers to overcome diseases. The more people who are obese the larger the demand for these services which makes it hard for them to deliver effectively (Segrave, 2008).

Examples of illnesses caused by obesity are diabetes and hypertension. Diabetes is likely to occur because increased intake of processed and refined foods leads to a fast absorption in the body signaling the need for more food which will lead to excess production of insulin. This demand for insulin soon exceeds what the body can provide leading to diabetes. This condition is dangerous because the body is not able to regulate blood sugar levels; therefore, requiring constant medical attention and can cause death if not corrected. Hypertension is attributed to overworking the heart and the tendency to cause failure. This is because for obese people the pulmonary artery has to pump blood with a lot of pressure to cater for the big mass as well as outdo the thick deposits of fat surrounding the blood vessel (Segrave, 2008).

However, these complications related to obesity can easily be solved by observing what is taken into the body. The empty calorie diets can be substituted with whole-grain foods such as grains and legumes which the body takes time to break down, and are not easily absorbed into the body. These foods also keep the stomach full for longer periods thus frequent eating sessions are avoided (Holroyd, 2008).

Fruits and vegetables nourish the body with disease-fighting agents as well as supply the body with vitamins and minerals which are acutely essential to the body. Processed and canned foods can be replaced with natural and organic foods such as chemical-free vegetables with no organic modifications, foods that are free of additives and artificial flavors, and preserving agents. In general, foods prepared in the lab are not ideal; naturally grown foods are the best (Holroyd, 2008).

With the majority of the people working for long hours in the office, exercise is ideal, and this can be encouraged by opting to walk to the offices rather than driving there. Attending fitness programs is also advisable to keep the body active and increase metabolism. This helps fight complications like breath shortness or even heart failure caused by excess weight (Holroyd, 2008).

Future adaptations of healthcare delivery to help prevent age and obesity-related health issues

Investing in healthcare facilities and medical technology will help conquer the growing numbers of people with aging complications. This, of course, will lead to increased costs on medical care and therefore be more expensive, however, the benefits outdo the costs therefore it is worth spending, the more the resources spend on health, the better the progress towards achieving better health care (Oleske, 2012).

Educating the society on the various ways to manage congenital and chronic diseases such that these diseases remain at their lowest level and chances of advancing into serious states are kept at minimal. This education is especially useful in fighting the diseases caused by aging because it provides knowledge on what to expect in later stages of life and what measures to take to avoid some health issues or what lifestyle to adopt so as not to suffer some illnesses. For instance, enough exercise and taking whole meals can help keep diabetes away during old age (Oleske, 2012).

Some conditions like obesity are preventable, and this can be done by empowering patients through sharing knowledge and information and basing research on real-life situations. This can also be achieved by engaging those affected in continuous monitoring and evaluation to form a network of information sharing that will see the whole society involved in healthcare (Oleske, 2012).

Conclusion

Prevention is better than cure; therefore attention should be shifted from providing quality health care to practicing healthy eating habits and leading lifestyles that promote excellent health. Practicing these healthy habits helps reduce the cost of medical services and products.

References

Anderson, T. (2010). An unofficial guide to the 2010 U.S. Census. Campbell, CA: FastPencil, Inc.

Census scope. (2011). Unites States Age distribution: Social Science Data Analysis Network. Web.

Guah, M. W. (2009). An Official Publication of the Information Resources Management Association, International Journal of Healthcare Delivery Reform Initiatives, 1(3): 43-58.

Holroyd, H. J. (2008). Stop obesity: An answer to the problem of obesity and its complications. Bloomington, IN: AuthorHouse.

Oleske, D.M. (2012). Goal-Oriented Patient Care-An Alternative Health Outcomes Paradigm. New york. Kluwer Academic/Plenum Publishers.

Segrave, K. (2008). Obesity in America, 1850-1939: A history of social attitudes and treatment. Jefferson, N.C: McFarland & Co.

Drug Prescription

For the patients treatment, the author would prescribe esomeprazole, taken daily via the oral route in full 40mg dosages, for four weeks. Zhang et al. (2017) find that this medication in the suggested dosage is the most effective of a number of proton pump inhibitors and histamine-2-receptor antagonists. Antacids are also an option for treating mild cases of gastroesophageal reflux disease (GERD), but the patients condition is too severe to resort to them. The severity of the patients state is also the reason for the four-week treatment period, as this length is recommended by Farthing and Ballinger (2019). The medication will be distributed orally via capsules, as this is the typical route of its administration, and the patient is capable of swallowing, which precludes the use of a nasogastric tube. No other drugs will be prescribed, as GERD therapy is typically limited to the usage of this medication alone.

Monitoring and Efficacy Evaluation

The monitoring measure employed for the patient will be esophageal pH-impedance monitoring. It is standard practice in the management of GERD, used to evaluate the severity of the condition based on the acid that comes up to the esophagus. Patel et al. (2015) recommend phenotyping the severity of the symptoms and the disease as a whole based on the strength of reflux evidence. Treatment should continue as usual in the case that the patients symptoms start declining over time, as this would demonstrate the effectiveness of the treatment. However, in the case that no change is observed, Farthing and Ballinger (2019) recommend performing upper gastrointestinal endoscopy before determining the next course of action. If symptoms start manifesting more heavily than before, the same consideration applies, and the usage of higher dosages of the drug should be considered.

Long-Term Treatment

Long-term treatment should begin after the disappearance of the symptoms and can vary substantially depending on the outcomes of the initial therapy. Farthing and Ballinger (2019) recommend continuing drug therapy in the case that the patients GERD is severe or if there are frequent recurrences, both of which may apply to the person in the case study. Due to the nature of GERD monitoring, regular returns to the clinic are likely unnecessary, as esophageal pH-impedance monitoring takes too long, often taking place 24 hours a day. Hence, the patient should self-monitor his symptoms, noting the recurrence of episodes and referring to medical professionals should incidents resume. Regular conversations on the phone regarding the matter will likely be adequate for confirming the patients state.

The risks of the condition can be mitigated in the long term by lifestyle changes, about which the patient should be educated. Park et al. (2017) find a reduction in the severity of GERD symptoms in patients with obesity once they lose weight, and the change is recommended for the situation. Abandoning smoking and lowering the fat content in the persons diet are also two changes that they should make, as they can affect the esophagus and stomach, respectively, contributing to GERD incidents. With regard to episodes when the patient is lying down, they should be educated to arrange their bed in a manner that elevates the head, protecting the esophagus from reflux via gravity. The patient should also try not to lie down for some time after eating to avoid combining the two contributing factors. Through the combination of all these changes, the severity of the condition can be mitigated substantially.

References

Farthing, M. J. G., & Ballinger, A. B. (Eds.). (2019). Drug therapy for gastrointestinal disease. CRC Press.

Park, S. K., Lee, T., Yang, H. J., Park, J. H., Sohn, C. I., Ryu, S., & Park, D. I. (2017). Weight loss and waist reduction is associated with improvement in gastroesophageal disease reflux symptoms: A longitudinal study of 15 295 subjects undergoing health checkups.Neurogastroenterology & Motility, 29(5). Web.

Patel, A., Sayuk, G. S., Kushnir, V. M., Chan, W. W., & Gyawali, C. P. (2016). GERD phenotypes from pHimpedance monitoring predict symptomatic outcomes on prospective evaluation. Neurogastroenterology & Motility, 28(4), 513-521. Web.

Zhang, C., Kwong, J. S., Yuan, R. X., Chen, H., Xu, C., Wang, Y. P., Yang, G. L., Yan, J. Z., Peng, L., Zeng, X. T., Weng, H., Luo, J., & Niu, Y. M. (2017). Effectiveness and tolerability of different recommended doses of PPIs and H 2 RAs in GERD: Network meta-analysis and GRADE system.Scientific Reports, 7(1). Web.

Introduction

Ischaemic heart disease is characterized by in adequate blood supply to the heart. The disease does not have a single dominant cause but has strong relations to several aspects of lifestyle, and a significant link to genetic inheritance (Fox, 1987). Types of diet and drug use or abuse are some of the causative agents of heart disorder. Ischaemic heart disease targets people in developed countries according to some studies. A high mortality rate is associated with the disease making it one of the leading causes of death in modernized countries. This makes it a subject of interest for many medical researchers (Corbin & Strauss, 2008).

The causes of ischaemic heart disease indicate that there is a significant influence of the social-cultural factors in the starting and the course of development of the disease in those people who are already affected. In the following interview, I sought to examine the influence of lifestyle and social-cultural factors on the health of people suffering from ischaemic heart disease.

An in-depth interview can be conducted to facilitate qualitative research of the facts and theories regarding the disease. Through this kind of research, one can make an objective conclusion on the situation regarding the disease (Schiffrin, 2001).

Use of In-depth Interview

In the following account of research on ischaemic heart disease, the researcher conducts qualitative research and qualitative analysis of the data obtained to determine the cause of the disease. An interview with an expert gives a brief but deep insight into the risk factors affecting the health of people suffering from ischaemic heart disease (Kvale & Brinkmann, 2009).

As a researcher, I chose to interview an experienced cardiologist to obtain an objective opinion pertaining to ischaemic heart disease. The responses from the cardiologist constituted the data for my interview transcript (Denzin & Lincoln, 2005).

In my research, the cardiologist first mentioned that the disease is one of the leading causes of death in western countries. In this case, most western countries are developed countries. The disease is one of the many cardiac ailments that result in fatal cardiac action complications. About sixty percent of males who succumb from cardiac ailments suffer from ischaemic heart disease. The expert further explains that the occurrence of death due to this disease in the female population is slightly lesser but still high at forty eight percent. He says that according to this high rate of mortality, there is a reason to consider risk factors that people suffering from the disease face (Anderson, 1973).

The Use of Qualitative Research

Qualitative research examines what certain practice or behavior results to. The qualitative approach gives the researchers a deep understanding of what is likely to happen is a certain procedure or practice is embraced by an individual or a group of individuals. When conducting a qualitative research, data is obtained from a specific preferred source particularly due to the suitability of the particular source as a source of data (Patton, 2002). In case of a study regarding a disease, the study is likely to involve either a patient or an expert in the particular branch of medicine in which the disease lies. In this particular study, the research involves a cardiac ailment.

The researcher seeks to understand the cause of a disease which does not have any one particular cause (Flick, 1998). Since the development of the disease involves many factors, which together contribute to the development of the disease, a qualitative research may be necessary ascertain the degree of influence of the disease on the health of the affected people. Since the research to be done on the disease is a qualitative research , it is then necessary to seek information from a qualified source so as to be able to obtain relevant information rather than get too much of irrelevant information from random sources.

Qualitative research may use several methods to obtain data. Methods such as field studies, observation of the phenomena in question and ethnography may be used to obtain the relevant data. This particular study involves the opinion of a particular expert in the field. Although the data is examined objectively, the study involves a single source due to the position of authority of the source regarding the particular disease.

In-depth interview was used for this particular study. This involved direct questions to the interviewee seeking a brief answer which deeply examines the risk factors behind the disease. Due to the selection of a single interviewee prior to the study, the research lacks randomisation, a phenomenon found in many other methods of research. In the inquiry regarding this disease, the researcher will focus on the phenomenology regarding the development of the disease. The data collected from the correspondent in the interview will be closely examined to determine the degree of influence of various factors on the course of development of the cardiac condition.

Thematic Analysis

Thematic analysis of data collected in a research project is used to categorically analyse data in the various contexts. This method is used to determine if any patterns can be discerned in the data collected. The researcher does not have to have a prior knowledge of the field in he or she is working in (Wolcott, 2009). This is a major difference compared to the positivist approach that requires one to have a predetermined expectation of the experiment or research project.

While thematic analysis is an idealistic approach where the outcome of the research is largely unknown, the experimental approach is a realist method that seeks to affirm a known possibility. This is an advantage to the researcher using qualitative analysis since no prior knowledge of the field is required. Thematic analysis is an important approach in qualitative research (Brown & Yule, 1983).

Examination of the Data

In this analysis the researcher has to examine the data collected carefully and identify the patterns that can be used to classify the data into categories. These categories can also be referred to as the themes that have been discerned in the data by the user. The themes are then used to make a conclusion at the end of the research. It is these themes that are used to make a purposeful documentation of the conclusion. Moreover, the themes validate the conclusion of the researcher adding to the existing body of knowledge in the particular field. The conclusion of the thematic analysis is the part where the themes are validated using the data collected by the researcher (Boyatzis, 1998).

In the particular research regarding the ischaemic heart disease the researcher examines the possibility of a pattern existing in the risk factors that lead to the development of the disease. These patterns were then used to determine the general behaviour that would present most of the patterns to a significant degree. This can then be used to identify the general behaviour that leads to the worsening or improvement of the condition people suffering from the particular disease.

Final Deduction

In the analysis of the data collected from the respondent, the content of the data collected from the interview will be analysed objectively to yield an independent conclusion on the risk factors that affect the development of the heart ailment, and the conditions that may worsen the situation (Khan, 2006).

Interview Transcript

According to my interview with the cardiologist, ischaemic heart disease presents obvious symptoms that indicate the presence of a defect of the cardiac system. An otherwise healthy person starts to show signs of physical stress on being subjected to mild physical strain. The strain considered in this case is physical exhaustion of the patient (Bourgeault et al, 2010). Chest pains particularly to the left of the chest cavity may indicate a developing heart condition. The symptoms may present in a mild manner initially, but may progress into serious and uncomfortable cardiac condition (Gillinov & Nissen, 2012).

This is can be evidenced by the perspective of my correspondent, Ischaemic heart disease presents itself in a manner that suggest that there is an obvious defect of the heart. Many heart diseases result to chest pain in their advanced stages. The patient will normally experience abnormal exhaustion after a mild physical strain. Although this may not prompt a certain diagnosis with the disease, it indicates that there are high chances that the symptoms are a result of the ischaemic heart disease.

The doctor pointed out that the physical condition behind the symptoms of the disease is primarily the obstruction of the coronary artery such that the blood supply to the cardiac tissue is impaired. Progressively, this leads to weakening of the heart muscles and may result to permanent damage to the heart if a corrective measure is not undertaken, A cardiac arrest is the final stage of the disease if the condition is left unattended or the patient is poorly monitored.

Themes Developed

Effect of Dietary patterns

In some people, fatty diets result in excess cholesterol in the blood. Some proteins also result to high blood cholesterol in some individuals. Blood cholesterol is linked to the genome of a particular person. This is because the enzymes that break down this substance are produced in different levels depending on each individuals gene composition. A person who ingests high cholesterol food products risks the development of atherosclerosis (Khan, 2006).

This is a condition where fat deposits on the walls of blood vessels over a long period of time The doctor notes that the deposit of fat in the vessels takes time, so one may not notice the changing composition of diet in ones life, Eventual blockage of the coronary artery results in a heart failure or an acute impairment of the hearts activities. This situation worsens the condition of people suffering from ischaemic heart disease (Naff, 2008).

Smoking

Smoking is widespread among majority of cultures around the world. Although it seems harmless due to its slow action, smoking severely affects the heart muscles and the arteries supplying blood to the heart. This is due to the presence of the substance nicotine in the inhaled contents of the smoke (Fox, 1987). A small amount of nicotine has the effect of hardening the blood vessels. Significant narrowing of the vessels is also seen in the individuals who smoke regularly. This habit, combined with other factors, may result in a worsening heart condition in people suffering from ischaemic heart disease. The condition worsens with stress build up and high blood pressure. People who do not smoke have a better chance of fighting against the ailment.

Lack of Enough Exercise

This is another risk that affects people with ischaemic heart disease Exercise plays an important role in ensuring that the composition of blood stays balanced. People who lack exercise have high fat and cholesterol levels in their blood. In western cultures where daily strain at work takes all time, it is usually difficult for the working class to develop an exercising habit. A person with ischaemic heart disease, who keeps on working without any exercise, is likely to worsen the condition. Chances of survival of such people are also slim. Accumulation of fat and cholesterol in the bloodstream could easily initiate a cardiac arrest in a patient suffering from ischaemic heart disease.

Cultural Behaviours

Health behaviours of people suffering from ischaemic heart disease Different cultures may influence people in a manner that affects their health. In some cultures, women suffering from ischaemic heart disease may act in a way as to control the disease even without their consciousness of their actions. Lower stress levels among the female population put women at an advantage in the control of the disease (Falk et al, 2010). In other societies, the role of certain people or age group may put pressure on an ischaemic heart disease patient, Since the disease is worsened by an adverse psychological situation, more responsibilities an individual has in a community, the more serious the condition of the person suffering from ischaemic heart disease becomes. This is due to increased blood pressure. If the blood pressure goes beyond the normal then the results may be fatal.

Thematic Analysis of the Interview Transcript

The quotations above constitute the answers given by the doctor regarding the risk factors that lead to development of ischaemic heart disease. It is clear that the disease does not have a definite cause. In addition, the disease is affected by several behavioural factors in its development.

A single phenomenon is supported by most of the themes regarding the disease. Factors that lead to accumulation of fat deposits in the blood vessels lead to worse conditions in people suffering from ischaemic heart disease. Particularly, inadequate exercise and poor diet have a similar effect of allowing cholesterol and fat to accumulate in the vessels. Both practices lead to development of antheroma. This suggests that any behaviour or diet that results in a high cholesterol and fat content in the blood affects people suffering from ischaemic.

Another pattern seen in the evidence from the doctors speech is the high blood pressure. Smoking, which results in narrowing of the vessels and eventually an abnormally high blood pressure, worsens the condition of the patient with the ischaemic heart disease. On the other hand, cultural roles of a member of a community are also another factor affecting the course of development of the disease in a person who is already living with the disease. High stress levels lead to increase in blood pressure in any human being. In turn, the high blood pressure puts strain on the heart. A person with ischaemic heart disease is likely to have more complications due to high blood pressure. Any factor that increases blood pressure of an individual with ischaemic heart disease results in a worsening condition (Creswell & Creswell, 2009).

Conclusion

The themes analysed indicate that the risk factors that are featured in the doctors speech have an underlying common effect. The two distinctive common effects of the risk factors are increased blood pressure beyond normal range, and change in composition of the blood to include a high fat and cholesterol content.

Although the risk factors are distinctive, they seem to converge to a single conclusion. Any behaviour or cultural factor that leads to abnormal rise in blood pressure or causes high blood cholesterol levels affects people with ischaemic heart disease negatively.

However, some factors have a significantly higher effect on the possibility of the disease developing in a particular patient The explanations of the doctor point out to the practices that are necessary to avoid advancement of the disease. Some of the factors affecting the development of the disease have been given special attention by the cardiologist (Smith, 1992).

It is evident that the lifestyle of an individual is the major determinant of the presence of risk factors. Smoking and hypertension are all closely associated with the lifestyle of an individual (Shneidman, 1951). Although age is a risk factor, it is not controllable at the moment. This is supported by the fact that the doctor does not mention anything to do with a solution to the age factor (Johnstone, 2002). All the other three factors are controllable through a change of life style.

References

Anderson, C. R. (1973). Heart attack. Nashville, Tenn.: Southern Pub. Association.

Bourgeault, I. L., Dingwall, R., & Vries, R. G. (2010). The SAGE handbook of qualitative methods in health research. Los Angeles: SAGE.

Boyatzis, R. E. (1998). Transforming qualitative information: thematic analysis and code development. Thousand Oaks, CA: Sage Publications.

Brown, G., & Yule, G. (1983). Thematic analysis. Cambridge: Cambridge University Press.

Corbin, J. M., & Strauss, A. L. (2008). Basics of qualitative research: techniques and procedures for developing grounded theory (3rd ed.). Los Angeles, Calif.: Sage Publications.

Creswell, J. W., & Creswell, J. W. (2009). Research design: qualitative, quantitative, and mixed methods approaches (3rd ed.). Los Angeles: Sage.

Denzin, N. K., & Lincoln, Y. S. (2005). The SAGE handbook of qualitative research (3rd ed.). Thousand Oaks: Sage Publications.

Falk, E., Shah, P. K., & Feyter, P. (2010). Ischaemic Heart Disease. London: Manson Pub.

Flick, U. (1998). An introduction to qualitative research. London: Sage.

Fox, K. M. (1987). Ischaemic heart disease. Lancaster, England: MTP Press.

Gillinov, M., & Nissen, S. E. (2012). Heart 411: the only guide to heart health youll ever need. New York: Three Rivers Press.

Johnstone, B. (2002). Thematic analysis. Malden, Mass.: Blackwell.

Khan, M. I. (2006). Encyclopedia of heart diseases. Burlington, MA: Elsevier Academic.

Kvale, S., & Brinkmann, S. (2009). InterViews: learning the craft of qualitative research interviewing (2nd ed.). Los Angeles: Sage Publications.

Naff, C. F. (2008). Heart disease. Detroit: Gale Cengage Learning.

Patton, M. Q. (2002). Qualitative research and evaluation methods (3 ed.). Thousand Oaks, Calif.: Sage Publications.

Schiffrin, D., Tannen, D., & Hamilton, H. E. (2001). The handbook of discourse analysis. Malden, Mass.: Blackwell Publishers.

Shneidman, E. S. (1951). Thematic test analysis,. New York: Grune & Stratton.

Smith, C. P. (1992). Motivation and personality: handbook of thematic content analysis. Cambridge [England: Cambridge University Press.

Wolcott, H. F. (2009). Writing up qualitative research (3. ed.). Thousand Oaks, Calif.: SAGE Publications.

Introduction

• Hispanics and Latinos have the highest propensity for heart related diseases in the society.
• They are at a very high risk of developing diabetes, obesity, and hypertension.
• A communal intervention is necessary to alleviate the issue.
• There is a need to create awareness among the Hispanic and Latinos about the high risk they face with reference to the development of heart related diseases.

Demographics

• Data collected from Westminster, CO reveals that 75% of Hispanics and Latinos are overweight.
• 21.3% of the Hispanic and Latinos do not engage in any physical exercises.
• 30% of the Hispanic and Latinos in the city have already been diagnosed with diabetes.
• 20.5% are smokers, and this increases the risk of developing heart related illnesses (Westminster (city), Colorado, 2015).

State level statistics

• 25% of Hispanic and Latinos in Colorado are obese.
• Diabetes is one of the common diseases among the Hispanics and Latinos in the state.
• Only 55.8% of the population are adequately educated (Graham, 2013).

Proposed intervention

• An inclusive community-based intervention program.
• The program will involve the members of the community, physicians dealing with heart related diseases, and the authorities in the State.
• A multifaceted approach to ensure there is a comprehensive awareness program to fight against hypertension.

Objectives of the intervention plan

• To create awareness about the risk of developing heart related diseases to the Hispanic and Latinos.
• To involve hypertensive, obese, and diabetic members of the society to educate Hispanics and Latinos about the management of these illnesses.
• To involve health care physicians in the community in educating the Hispanics and Latinos about preventing heart related diseases.
• To compel the authorities to provide affordable, preventive health care for Hispanics and Latinos in the society.

Targeting the community

• The proposed intervention plan will be applied in the Westminster, CO. With the help of the authorities, the plan will be adopted in the entire state.
• The intervention will take place over 2 years to ensure the entire population is covered.
• The member of the community will be reached through a mobile campaign to recruit volunteers for the program.
• The program will involve local institutions like churches, physicians offices, and other local resources that can help in harnessing a large following for the program.
• The program will particularly target the members of the community that are living with heart related diseases.

Role of the CHN

• The role of the CHN in this program will be the development of an educational platform to help the Hispanics and Latinos come to terms with the factors that enhance their risk for developing heart related diseases.
• The CHN will also be in charge of developing a plan for the ambulatory clinics that will be used to diagnose people from different parts of the city.
• The CHN will be charged with the collection of demographics on the number of people in the city that have heart related diseases, and those that are at a high risk of developing the diseases.

Primary level of intervention

• The program will aim at reducing some of the causal factors of heart relate diseases.
• The CHN will provide information about some of the causal factors like smoking and involve the community in compelling its members to stop smoking.
• The CHN and other physicians in the program will also educate the members of the community about healthy lifestyles, including healthy diets and regular exercising.

Secondary level of prevention

• Mobile clinics will be availed to provide free health care services to the high-risk population. The clinics will drive around the neighborhoods of the Hispanics and Latinos.
• Hispanics and Latinos will be urged to visit the clinics for tests and diagnosis of heart related diseases.
• Nurse educators will be provided to help the diagnosed members of the community to manage their respective illnesses.
• The CHN will visit the diagnosed members of the community to follow up on their health management processes.
• The community will be provided with lists of symptoms that indicate the presence of certain heart related diseases to ensure the illnesses are detected in time.

Tertiary level of prevention

• Heart surgeries for patients with serious heart conditions will be provided at an affordable price to alleviate their conditions.
• Any other necessary surgical procedures to prevent heart related diseases from threatening the lives of the members of the target population will be provided by experts in the same field.
• The authorities will be compelled to finance the development of public health care facilities with a specially equipped unit to deal with different heart related diseases.

Intervention justification

• Based on the check it, Change it intervention program proposed by Shah et al. (2013), this program is bound to provide a comprehensive prevention plan.
• The plan involves the identification of the causal factors, establishing the affected population, and developing a plan to help them get better (Shah et al., 2013).
• It covers the primary, secondary, and tertiary levels of prevention; hence, it has a high probability of reducing the risk of developing heart related illnesses among the Hispanics and Latinos.
• The intervention program also focuses on alleviating specific heart related diseases as proposed by Jafar et al. (2010). It will particularly focus on reducing the number of cases of Hispanics and Latinos diagnosed with hypertension (Jafar, 2010).

Why the intervention should be a priority

• According to Jafar et al. (2010), hypertension and other cardiovascular illnesses are the leading cause of death across the world.
• Hispanics and Latinos in Colorado are facing a very high risk of developing cardiovascular diseases that may lead to high numbers of premature deaths.
• The authorities in the state should be compelled to finance the intervention plan at different levels of the prevention program.
• There is a need for the health care system to facilitate accessible and affordable preventive health care services to this population.

Proposed Short-term and long-term qualitative evaluation

• The short-term effect of the program will be evaluated through a survey to establish the response of the members of the community with reference to the ability of the target community to use the education provided to enhance their lifestyles.
• The long-term effect of the program will be evaluated by reviewing data on the disease management knowledge possessed by the people diagnosed with different heart related diseases.
• The ability of the members of the community to effectively identify symptoms associated with heart related diseases will also reveal the qualitative evaluation of the intervention program.
• The CHN and nurse educators will conduct regular formative and summative assessments on the target population, which will cumulatively reveal the efficiency of the program.

Proposed Short-term and long-term quantitative evaluation

• The number of the members of the community that will enroll for voluntary work in the intervention program will highlight its support from the community.
• Quantitative data on demographics from the mobile clinics will reveal the response of the community in voluntary access to preventive health care services for heart related diseases.
• The number of public health care facilities that will be constructed by the authorities in the state will also reveal short-term and long-term effects of the program.
• Statistical analysis of the number of Hispanics and Latinos that will be diagnosed with heart related illnesses will also reveal a trend that will be used to determine whether the intervention program will yield positive effects.

Summary

• An intervention program is required to reduce the risk level of developing heart related diseases for Hispanics and Latinos in Winchester, CO, and the entire state.
• The proposed intervention plan will require the integration of communal efforts, which will include health care experts, members of the community, and the authorities.
• Mobile clinics will be used to provide free preventive health care services.
• Nurse educators and the CHN will provide health education to the target population.
• The authorities will be compelled to develop health care facilities to provide affordable services to the Hispanics and Latinos.

References

Graham, S. (2013). Bridging the Hispanic Health Divide. Web.

Jafar, T. H., Islam, M., Hatcher, J., Hashmi, S., Bux, R., Khan, A., & Chaturvedi, N. (2010). Community based lifestyle intervention for blood pressure reduction in children and young adults in developing country: cluster randomised controlled trial. BMJ, 340.

Shah, B. R., Thomas, K. L., Elliot-Bynum, S., Thomas, K., Damon, K., LaPointe, N. A., & & Peterson, E. D. (2013). Check It, Change It A Community-Based Intervention to Improve Blood Pressure Control. Circulation: Cardiovascular Quality and Outcomes, 6(6), 741-748.

Westminster (city), Colorado. (2015). Web.

Introduction

Blood is vital for life, and excessive losses are associated with high mortality rates. Transfusions revolutionized the management of serious hematological illnesses by increasing the chances of survival. It is vital to note that the procedure is commonly practiced in most hospitals around the world. The management of illnesses like autoimmune hemolytic anemia in childhood has improved courtesy of new and innovative techniques. Transfusions are essential in the treatment of hematologic illnesses because they improve clinical outcomes.

Autoimmune Hemolytic Anemia

A variety of illnesses lead to a decrease in the circulatory systems effectiveness in both adults and children. Autoimmune hemolytic anemia in childhood is often caused by the production of antibodies that target antigens on red cells, which are then prematurely destroyed (Ladogana et al., 2017). The disease is diagnosed by conducting an exhaustive history and clinical exam. The clinical tests involved include a white blood cell count, a reticulocyte count, the assessment of hemolysis indices, a urinalysis, red cell morphology on a peripheral smear, and the evaluation of the patients blood group (Ladogana et al., 2017). It is vital to note that affected individuals usually have high reticulocyte counts because of increased erythropoiesis.

The direct antiglobulin test is conducted to identify the antibodies attached to red cells. The test is first conducted on polyspecific sera to identify IgG and C3 (Ladogana et al., 2017). If the result is positive, a monospecific antiserum is used to identify the collected samples individual antibodies.

The treatment of autoimmune hemolytic anemia involves the use of steroids and transfusion therapy. In the U.S., approximately 11.3 million units of platelets, red cells, and plasma are transfused every year (Scharman et al., 2017). However, it is worth noting that the administration of packed red cells to affected individuals is relatively uncommon because of difficulties associated with matching recipients to donated blood samples.

The procedure is reserved for patients with severe anemia, and only 3-5ml/kg is administered during therapy (Ladogana et al., 2017). Some patients benefit from plasma exchange processes where circulating immune complexes are removed. It is estimated that each cycle is capable of eliminating approximately 65% of antibodies, which means that the procedure must be repeated in serious cases of the illness (Ladogana et al., 2017). Transfusions increase the chances of survival in people suffering from a variety of hematological illnesses.

Patients diagnosed with the illness must be tested to identify specific red cell phenotypes and the presence of alloantibodies whose existence is obscured by auto-antibodies. Therefore, laboratories are often required to conduct extensive red cell antigen typing to facilitate effective transfusion. It is recommended that molecular methods should be applied to limit the chances of adverse reactions during treatment. It must be pointed out that the blood products used in affected patients must be leucodepleted before storage. The administration of blood must be done slowly, with a maximum of four hours allocated for the procedure (Ladogana et al., 2017). This ensures that the patients immune system adjusts to the introduction of foreign antigens, thus reducing the possibility of an adverse reaction.

Sickle Cell Disease

Sickle cell disease is a common genetic disorder that mostly affects children. The affected individuals have defective red blood cells with limited blood carrying capacity. The illness is diagnosed by conducting hemoglobin electrophoresis and a baseline blood study. The disease is primarily managed through transfusions, which restore the bloods ability to transport oxygen (Akaba et al., 2019). A simple transfusion is conducted when patients experience acutely lowered hemoglobin levels. This is common when affected individuals experience aplastic or sequestration crises. For long-term management of the illness, patients receive between 2-3pints of blood every four weeks to maintain a hemoglobin level of above 10g/dl (Akaba et al., 2019). Transfusions help reduce the incidence of complications associated with reduced oxygen flow to vital tissues in people diagnosed with the ailment.

New Instrumentation

The current practices in transfusion medicine place emphasis on precision and safety. Testing for infectious disease markers is an essential step that involves several intricate measures. For instance, complex donor questionnaires are used to gather vital clinical information. In addition, comprehensive skin disinfection techniques have been introduced to eliminate sin bacteria, and leucodepletion is applied to eliminate intracellular organisms. Contemporary test technologies like pathogen reduction and nucleic acid testing are used to increase efficiency (Prudent et al., 2019). Improved instrumentation is necessary for the delivery of effective transfusion services in health institutions.

Technological advancements play a critical role in improving patient safety during the transfusion process. For instance, using hand-held devices capable of identifying bar codes on patients wrist bands coupled with the utilization of miniature printers to produce patient labels helps reduce errors during sample collection (Alli, 2021). In addition, statistical process control charts are vital when tracking performance. They allow laboratories to assess the frequency of mislabeled specimens and make the changes necessary to facilitate efficiency (Suman & Prajapati, 2018). Oxygen sensing probes are also currently used to detect vital parameters prior to the administration of blood products (Papkovsky & Dmitriev, 2018). Finally, the use of computer programs to store important patient information, laboratory results, and physician communications has facilitated the reduction of errors in various clinical settings.

Ethical Issues

The ethical code of conduct on transfusions was designed to ensure that patients access safe blood products in good time. In the management of hematological illnesses, several issues must be taken into consideration. For instance, motives for personal gain, coercion by the patients relatives, or monetary incentives should be the basis of prescribing the procedure (Obeta et al., 2020). It is also crucial to inform the patient of the potential risks associated with receiving donated blood as well as potentially effective alternative therapies. It is critical that donors give informed consent and that blood is collected voluntarily.

Compelling individuals to give blood is unethical. A rigid set of rules must be followed when choosing individuals capable of making donations. It is essential that any form of discrimination on the basis of gender, religion, or nationality is avoided (Obeta et al., 2020). Confidentiality must be maintained at all stages of the process, and access to blood products must not be restricted. Adhering to these principles ensures that patients and donors receive the best possible care in healthcare institutions.

Conclusion

Blood transfusion has revolutionized medical practice by providing an effective means of managing illnesses that previously had high mortality rates. Diseases like sickle cell anemia and autoimmune hemolytic anemia are treatable through the administration of specific blood products. Technological advances like leucodepletion, pathogen reduction, and nucleic antigen testing ensure that donated blood is safe. Ethical issues like the administration of transfusions for monetary gains or the coercion of individuals to donate must be addressed. The quality of life among individuals afflicted with hematological maladies has improved thanks in part to revolutionary transfusion techniques.

References

Akaba, K., Bassey, O. B., Akpan, I., & Essien, O. (2019). Transfusion therapy in sickle cell disease. Journal of Blood and Lymph, 9(2), 14. Web.

Alli, S. K. A. (2021). Barcoding an automatic identification and data capture system in healthcare settings. The Pharma Innovation Journal, 10(1), 187200. Web.

Ladogana, S., Maruzzi, M., Samperi, P., Perrotta, S., Del Vecchio, G. C., Notarangelo, L. D., Farruggia, P., Verzegnassi, F., Masera, N., Saracco, P., Fasoli, S., Miano, M., Girelli, G., Barcellini, W., Zanella, A., & Russo, G. (2017). Diagnosis & management of newly diagnosed childhood autoimmune haemolytic anaemia. Recommendations from the red cell study group of the paediatric haemato-oncology Italian association. Blood Transfusion, 15(3), 259267. Web.

Obeta, K. O., Obeta, M. U., & Lugos, M. D. (2020). Current trend in blood transfusion science: Where are we ?Haematology International Journal, 4(2), 19. Web.

Papkovsky, D. B., & Dmitriev, R. I. (2018). Imaging of oxygen and hypoxia in cell and tissue samples. Cellular and Molecular Life Sciences, 75(16), 29632980. Web.

Prudent, M., Tissot, J. D., Fontana, S., & Niederhauser, C. (2019). Editorial: Transfusion medicine and blood. Frontiers in Medicine, 6, 14. Web.

Scharman, C. D., Burger, D., Shatzel, J. J., Kim, E., & DeLoughery, T. G. (2017). Treatment of individuals who cannot receive blood products for religious or other reasons. American Journal of Hematology, 92(12), 13701381. Web.

Suman, G., & Prajapati, D. R. (2018). Control chart applications in healthcare: A literature review. International Journal of Metrology and Quality Engineering, 9(5), 122. Web.

Epithelial tissues of the body represent the tissues lining the surfaces of skin, digestive organs, and respiratory organs. They can be found anywhere in the body where a barrier is needed to be formed, with things being able to pass across the created barrier. Because of the wide coverage of epithelial tissues in the body, there are many types of diseases affecting the tissue, and it is essential to know them to understand how the disease affects epithelial tissues. At this time, lets focus on eczema as one of the widespread concerns of epithelial tissue.

Put simply, eczema also referred to as atopic dermatitis, is a condition that affects the skin, which is made of epithelial tissue1. It makes the skin red and itchy and can first manifest in people as early as childhood. It is important to note that eczema tends to transform into a chronic condition for many people and can disappear and flare up periodically, often depending on environmental factors. Unfortunately, there is no cure that can help clear eczema entirely and make it never reappear. Although, there are several treatments and self-care activities that can help relieve the itching and redness and prevent new flare-ups on a short-term basis. Examples of good practices for eczema include avoiding harsh soaps, moisturizing the skin on a regular basis, as well as applying medicated creams and different types of ointments.

Getting to know the symptoms of atopic dermatitis can help identify the signs early to engage in preventive and management efforts, according to a doctors recommendations. While the signs and symptoms of atopic dermatitis can vary from one person to another, they typically include dry skin, itching of different extents, especially during the night, the appearance of red to darker-colored patches, usually on the hands, feet, neck, ankles, wrists, as well as inside the knees and elbows bends. The skin affected by eczema usually appears thickened, scaly, and cracked, and due to scratching, it can often be raw, swollen, and highly sensitive to different external factors. Also, one may check for signs of small bumps that can leak fluid and crust over when being scratched.

When it comes to the age differentiation of eczema, the onset of the disease is often at five years old, with the highest incidence taking place between three and six months, but it can take place at any age. Around 60% of patients develop eczema in the first year of their life, while 90% get it within the first five years1. However, it is notable that atopic dermatitis can happen to people of different ages, although the percentage is much lower than those mentioned for children.

The burden of disease can be different depending on its severity as well as the ways of management. However, pain and itchiness of the skin can be quite cumbersome, preventing a person affected by eczema from doing everyday things2. Also, because eczema can often have an unpleasant appearance, some people can be self-conscious about it and get embarrassed, which is quite unfortunate3. Therefore, the problem with eczema is that it can significantly reduce the quality of life and health. Not only is sore and itchy skin annoying, but it also does not perform its protective function effectively, which causes a problem for the overall health of the body.

Reference List

1. Kurn H, Daly DT. Histology, Epithelial cell. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. Web.
2. Avena-Woods C. Overview of atopic dermatitis. Am J Manag Care. 2017;23(8 Suppl):S115-S123.
3. Mayo Clinic Staff. Atopic dermatitis (eczema). Mayo Clinic. 2020. Web.

Medicare is a program designed to support those who cannot afford health insurance and who are over sixty-five years old. However, there is one exception to this rule. People who have end-stage renal disease are eligible for Medicare notwithstanding the age (End-stage renal disease, 2013). I find this fact rather strange. Firstly, I do not understand why Medicare program contradicts its basic rule, which is providing aid for the people pertaining to a certain age group.

If the government sets this age barrier, it should take care of keeping up with their own regulations. There is no explanation of why Medicare has an age limit for all illnesses with the only exception of end-stage renal disease. Secondly, there are other illnesses which require a lot of care and expenses, but they are not included in Medicare coverage. In the meantime, people with end-stage renal disease receive a long-term support which can be resumed after the period when it is not needed without any additional requests or waiting periods.

I do not intend to say that people with end-stage renal disease do not deserve support. They indeed might need it more than other people. The disease is life-threatening, and those who suffer from it do require additional aid. However, there should be a separate regulation for the assistance which such people can expect to receive. There are many serious illnesses apart from end-stage renal disease which require a special status. However, they are not included in the Medicare program, which makes the situation look rather unfair. I think the government should create a separate program for people with end-stage renal disease not to make others confused by Medicare regulations and exceptions from them.

The EPSDT Program and Access to Dentistry Services

I agree with the authors opinion that Medicaid is a beneficial program for children from low-income families which allows them to receive the necessary healthcare support. I, too, am of the opinion that there are some limitations to the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program designed for children and young people under the age of twenty-one (Peters, 2006). The EPSDT was implemented as a subdivision of Medicaid with the aim of the enhancement of childrens access to quality healthcare services (Peters, 2006). However, the programs functioning is not as optimistic as its prospects were in the initiation phase.

For instance, there are huge difficulties concerned with the EPSDT participants access to dentistry care. The states are supposed to provide dental screenings for children, but they frequently fail to fulfill this requirement. It is often the case that a state may have its own schedule for such screenings, and not all children manage to receive timely assistance. Moreover, research shows that the majority of children eligible for Medicaid do not get any EPSDT services (Peters, 2006).

EPSDT was intended to pursue a noble aim of providing healthcare support for Medicare children, but its actual implementation met some serious obstacles. On the part of dentists, these limitations are caused by the uncertainty of which services are actually covered by the program. In general, the program presents challenges not only to dentists but all healthcare specialists. The core disadvantage is in EPSDT being rather complicated. Other limitations are concerned with the insufficient data about the program participants, restricted family understanding, unclear care organization, and state administrative confrontations.

References

End-stage renal disease (ESRD). (2013). Web.

Peters, C. (2006). EPSDT: Medicaids critical but controversial benefits program for children. Issue Brief (George Washington University. National Health Policy Forum, 819, 1-24.

Kidneys are instrumental in eliminating toxins and waste substances, including uric acid, creatinine, and urea, extracellular fluid volume regulation, electrolyte concentrations, serum osmolality, and hormone production. This paper provides a comprehensive analysis of the chemical procedures used to diagnose kidney disorders and advancements in kidney testing methodologies. I will also present my thoughts regarding the elements a novel examination may target.

Chemical Methods Used to Diagnose Kidney Disease

Glomerular Filtration Rate (GFR)

The GFR is the most effective glomerular function indicator; it relates to the millilitres per minute filtration rate of compounds contained in plasma via the glomerulus.

Currently, there is no endogenous marker with the recommended features, and therefore, exogenous GFR markers are commonly utilized for assessing GFR. GFR analysis using a polysaccharide identified as inulin is regarded as the reference procedure for GFR estimation. Other common exogenous markers used for GFR assessment include radioisotopes such as 99 Tc-DTPA and 51 Cr-EDTA.

Creatinine

Creatinine is the most conventional endogenous marker used to assess glomerular function. It incorporates urine collection over a twenty-four-hour period, or ideally over a precisely scheduled time (five to eight hours) and, according to Chwala and Ronco (2016), twenty-four-hour collections are notably capricious or unreliable. Incomplete or inappropriate urine sampling is among the primary factors impacting this tests accuracy; therefore, a scheduled collection is crucial. Serum creatinine is an advanced renal impairment indicator  according to Chwala and Ronco (2016), renal function is reduced by fifty percent before a serum creatinine surge is observed. GFR is categorized in various phases depending on ones kidney disorder. Since eGFR uses serum creatinine, the effects of issues related to serum creatinine computations are typical; this, therefore, demands corrections for factors, including age, gender, and race.

Blood Urea Nitrogen (BUN)

BUN relates to a nitrogen-comprising substance produced within the liver as a urea cycle and protein metabolisms end product. Approximately eighty-five percent of urea is excreted by kidneys. Serum creatinine represents a more effective renal function evaluation test compared to urea; nonetheless, urea levels are usually elevated earlier in kidney disorders. The proportion of BUN-to-creatinine (BUN: creatinine) may be instrumental in differentiating prerenal conditions from renal triggers, particularly if BUN rates are high. Cystatin C

This is a protein with low-molecular-weight that works by inhibiting protease secreted by the bodys nucleated cells. This compound is produced continually and is freely cleared by the kidney. This component is usually measured in urine and serum, and it is not impacted by diet, muscle bulk, or age. It is also been included in the eGFR equations, including the creatinine-cystatin KDIGO CKD-EPI equation.

Proteinuria and Albuminuria

Albuminuria relates to the unusual albumin present in the urine. It is utilized as a marker for detecting incipient nephropathy in individuals diagnosed with diabetes. Urine protein measurement can be performed using random urine protein: creatinine proportion or a twenty-four-hour urine collection.

Tubular Function Tests

Renal tubules are instrumental in water and electrolyte reabsorption and in sustaining the acid-base balance. Electrolytes, including glucose, phosphate, magnesium, chloride, potassium, and sodium, can be computed in urine. Urine osmolality measurements facilitate the evaluation of tubules concentrating capacity.

Urine Analysis

Urine Analysis Urine analysis incorporates urine characteristics assessment to help in disease diagnosis. It involves microscopic and chemical examination as well as physical observation. Physical inspection is concerned with analyzing clarity and color. It utilizes dry chemical procedures to determine the presence of leukocyte esterase, nitrite, urobilinogen, bilirubin, ketones, blood, glucose, and protein presence. Microscopic analysis entails a wet-prep urine evaluation to examine micro-organisms, casts, and crystals presence. The most appropriate specimen for this function test is freshly voided urine  midstream; this is because midstream urines contamination by compounds including epithelial cells as well as commensal bacteria is less likely.

New Methods

Kidney Tubular Distress Assessment

Organ systems within the human body have developed the ability to expand their functioning in distressful conditions. The reserve capacity assessment represents an effective tool for uncovering subclinical disorders. Kidneys stress testing appears to provide significant cognizance of the absence or presence of kidney disorder (KD) and parenchymal loss ascribed to fibrosis and injury. The renal reserve capacity is ground on two primary features: tubular and glomerular (Figure 1). Figure 1: Renal reserve capacity testing.

Glomerular Reserve Testing (GRT)

GRT has been elucidated comprehensively; however, its use in daily clinical practice is limited. GFR, a test utilized as a kidney function surrogate, relies on diet, weight, sex, or age, and, therefore, it presents significant fluctuations among patients. The variation amid baseline and maximal GFR is regarded as the renal glomerular function reserve. It is directly linked with distress-correlated nephron recruitment and elevated renal flow of blood. Nonetheless, the deficiency of large cohort surveys crucial in delineating the renal glomerular function reserves populace variability serves as a significant shortcoming for this assessment.

Tubular Reserve Capacity

Tubular reserve capacitys application in clinical practice bears significant potential. Tubular reserve (TR) may be examined by testing the kidney tubules secretion capacity, and it can be informative in various situations. The primary tool for assessing tubular function is to evaluate an exogenous or endogenous substances tubular secretion, including furosemide and creatinine. Acid or salt loading can be utilized to assess the tubules efficiency in eliminating acid or sodium.

Furosemide Stress Evaluation (FST)

FST is ground on furosemides pharmacokinetic attributes, and it aims to evaluate the renal tubules functional capacity. Furosemide generates minimal urine levels in CKD patients irrespective of its extended plasma half-life. This phenomenon is attributed to the renal blood flow decline and decreased tubular secretion. Urinary outpost is posited as a renal tubular function capacity surrogate marker; it could assist clinicians in distinguishing individuals with tubular injury and those at significant CKD or AKI progression risks.

Thoughts on What a Novel Test May Target

From the extensive research on kidney diseases and the relevant renal function tests, I believe a novel test for this condition should be capable of detecting early kidney damage signs and prognosis by measuring or computing even low protein marker levels in blood and urine samples. A novel test should consist of non-invasive markers and target a specific site and organ to facilitate the detection of early injury and differentiation amid extrarenal, prerenal, and intrarenal kidney injury causes. It should integrate the use of highly sensitive markers with minimal biological variability to better longitudinal changes evaluation.

Bibliography

Chawla, L. S. and Ronco, C., Renal Stress Testing in the Assessment of Kidney Disease, Kidney International Reports, vol. 1, no. 1, 2016, pp. 57-63. Web.

Coca, A. et. al., Role of the Furosemide Stress Test in Renal Injury Prognosis, International Journal Molecular Science, vol. 21, no. 9, 2020, pp. 112. Web.

Rivero, J. et al., Furosemide Stress Test and Interstitial Fibrosis in Kidney Biopsies in Chronic Kidney Disease, BMC Nephrology, vol. 21, 2020, pp. 1-9. Web.

Ronco, C.and Chwala, L. S., Glomerular and Tubular Kidney Stress Test: New Tools for a Deeper Evaluation of Kidney Function, Nephron Clinical Practice, vol. 134, 2016, pp. 191-194. Web.

Rysz, J., Novel Biomarkers in the Diagnosis of Chronic Kidney Disease and the Prediction of Its Outcome, International Journal Molecular Sciences, vol. 18, no. 8, 2017, pp. 1-17. Web.

Introduction

The coronavirus disease (COVID-19) is an unprecedented global health issue confronting the world today. From Asia, where it was first reported, the virus has spread to almost all corners of the world, causing death, human suffering, and devastating socioeconomic crises universally. The pandemic has affected the health of people and nations, exposing weaknesses in healthcare systems and responses. Families have suffered unparalleled grief, anxiety, and distress from the increasing fatality, massive job losses, lockdowns, and movement restrictions to curb the spread of the virus. This paper describes the COVID-19 condition, its transmission, progression, signs and symptoms, diagnosis, and treatment. A comparison is made between the United States and Germany.

Description of the Global Health Issue

COVID-19 is an ongoing global health crisis that has overstretched health care systems, as the number of infections keeps rising each day. According to the Centers for Disease Control and Prevention [CDC] (2021), to date, over 122 million positive cases have been confirmed globally, including more than 2.7 million deaths, as of March 2021. The pandemics economic and social impacts on many economies due to travel restrictions, lockdowns, and job losses are significant. It has disproportionately affected vulnerable populations all over the world, highlighting the need for global structural responses to end health inequities.

Condition

COVID-19 is a contagious viral respiratory disease that presents with pneumonia-like symptoms. The causative agent is the novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is classified as a betacoronavirus related to SARS and MERS that account for more severe outbreaks reported previously (Cascella, Rajnik, Cuomo, Dulebohn, & Napoli, 2021). This family of viruses contains single-stranded RNA and can spread between species, causing respiratory illnesses of varying severity  from flu to SARS. Similarly, COVID-19 is thought to have a zoonotic origin before infecting people. It is suggested that the first transmission to humans occurred through infected wild meat in a wet market in Wuhan, China (Cascella et al., 2021). Soon, the human-to-human spread accelerated across the globe, mainly through contact with asymptomatic patients.

Coronavirus has high transmissibility and pathogenicity, causing severe disease, especially in individuals with poor immune function, such as the elderly and those with underlying comorbid conditions. The average post-exposure incubation period is 5-6 days, but a longer period of 14 days before symptom onset is experienced in some cases (CDC, 2021). Therefore, a two-week quarantine period is mandated to confirm infected cases. The virus triggers an excessive immune reaction or a cytokine storm in the lungs, causing tissue inflammation and damage (Cascella et al., 2021). The autoimmune response account for the clinical presentation of this disease, including fever and breathing difficulties.

Transmission

COVID-19 is believed to have a zoonotic source, but the animal host is unknown. The most probable host of this virus before it infected humans includes bats or pangolins (Cascella et al., 2021). The mechanism of human-to-human transmission involves respiratory droplets or contact with infected surfaces. Coughing or sneezing releases respiratory droplets containing the virus into the immediate environment. Transmission is possible if these infectious particles land on the mouth, eyes, or nose of an individual nearby, usually within one meter (CDC, 2021). Thus, close contact with symptomatic or asymptomatic cases increases the risk of exposure to the virus.

Another mode of transmission includes fomites around an infected person. This indirect route involves contact with infected hands, surfaces, or objects followed by touching ones mouth, nose, or eye. Aerosol transmission of this disease is possible in certain environments or conditions. Aerosol-generating procedures or treatments, including intubation, nebulizers, or cardiopulmonary resuscitation, increase the risk of infection (Cascella et al., 2021). However, the viral load in air samples is usually too low to be transmissible.

Progression

COVID-19 progression involves three phases of increasing symptom severity in patients. The first stage is the early infection or pre-symptomatic point that manifests as mild upper respiratory tract (URT) infection 1-2 days before symptom onset (Cascella et al., 2021). At this point, the individual is highly infectious, as the virus invades the nasal receptors (angiotensin-converting enzyme 2 or ACE-2), replicates, and infects more cells. In some cases, the infection reaches the lungs by attacking ACE2 receptors in alveoli after about 5-14 days of incubation (Cascella et al., 2021). The body responds by secreting chemokines to destroy infected cells. Pus collected in the alveoli inhibits gaseous exchange in the lungs and at this point, the patient exhibits a persistent cough, fever, and breathlessness.

The second stage is the pulmonary phase which is characterized by full-blown pneumonia. It comprises two parts: stage IIA which manifests as pneumonia-like symptoms and IIB which includes hypoxia (Cascella et al., 2021). The latter phase necessitates admission and supplemental oxygen to keep the patient life. The pulmonary phase develops about a week after symptom onset. The third stage is the hyper-inflammation period during which the patient deteriorates rapidly. Acute respiratory distress syndrome (ARDS) develops, showing as highly inflamed lungs and fluid buildup in the alveoli 14 days after symptom onset (Cascella et al., 2021). As a result, a gaseous exchange is inhibited and the oxygen level in the blood drops. At this point, the patient needs ventilatory support to help with breathing. Systemic complications, such as dyspnea, renal failure, and septic shock are common at this stage, increasing the mortality risk.

Signs and Symptoms

The clinical presentations and symptom severity depend on the stage of the disease. For mild (uncomplicated) illness, URT symptoms are observed, including slight fever, dry cough, sore throat, nasal blockage, myalgia, fatigue, and migraines (CDC, 2021). Some asymptomatic patients report a loss of taste and smell due to the infection. Moderate pneumonia manifests with respiratory symptoms, including coughing and breathlessness, but acute dyspnea is absent. Severe cases present with serious and prolonged dyspnea, fever, and respiratory distress (CDC, 2021). Hypoxia is another complication that may be present in severe COVID-19, which often degenerate into ARDS. Digestive symptoms, including diarrhea, are also experienced in a few cases. Chest CT scans usually reveal lung abnormalities and septic shock that is linked to high mortality if vasopressors are not used.

Diagnosis

Suspected cases or patients presenting with fever of URT symptoms are eligible for COVID-19 testing. Epidemiological factors, including contact with an infected person, are other criteria for doing a test. The recommended diagnostic methods are molecular and serological tests and imaging. A sample or sputum collected from the URT region (nose or oropharynx) is amplified in a reverse polymerase chain reaction (RT-PCR) and specific probes are used to confirm COVID-19 viral genetic material (Cascella et al., 2021). The process is repeated after treatment to ascertain viral clearance before discharge.

A serological diagnosis tests serum samples for antibodies released as an immune response to COVID-19 infection. However, its level of specificity and sensitivity is presently low (Cascella et al., 2021). Further research is required to develop this diagnostic method for use in broad-based surveillance. Imaging techniques, such as Chest X-ray examination and computed tomography can reveal lung changes, including alveolar opacities, due to COVID-19 infection (Cascella et al., 2021). The results indicate the stage of infection and response to treatment and care.

Treatment

No specific pharmacological agents are recommended for the disease, but symptomatic treatments and supplementary oxygen are indicated for dyspnea or ARDS. As suggested by Cascella et al. (2021), mechanical ventilators can be used in intensive care settings to help patients with severe lung damage breathe. Other procedures that can improve outcomes include non-invasive ventilation and intubation to manage the alveolar fluid buildup. Pharmacological agents, including corticosteroids (dexamethasone) and antiviral agents (remdesivir) can be effective for managing ARDS to reduce mortality (Cascella et al., 2021). Antibodies purified from recovered individuals are another treatment option that is under clinical trials. In recent weeks, COVID-19 vaccines with varying levels of efficacy have been released for mass inoculation to create heard immunity and curb transmission.

A Comparison to another Country

The United States is one of the most affected countries, regarding the incidence rate and death toll. Further, the statistics and responses differ from those of European countries, such as Germany. The number of confirmed cases in the US is over 30.5 million, with a death toll of about 550,000, compared to 2.6 million and 75,000 in Germany, respectively (CDC, 2021). The difference can be attributed to dissimilar responses by the governments to the pandemic. While Germany was quick to impose restrictions, lockdowns, and wearing of facemasks, the US was slow to adopt these measures, allowing the disease to spread.

Conclusion

COVID-19 is a major health crisis facing the world today, and its impact on public health, social, and economic spheres is significant across the globe. This novel viral disease is caused by SARS-CoV-2 that is thought to have a zoonotic origin. Human-to-human transmission occurs through respiratory droplets or contact with infected surfaces. The disease presents with URT symptoms, such as fever, coughs, and shortness of breath. Molecular and serological tests are used to test COVID-19, while supplemental oxygen, ventilators, and antiviral agents are indicated for symptom management.

References

Cascella, M., Rajnik, M., Cuomo, A., Dulebohn, S. C., & Napoli, R. D. (2021). Features, evaluation, and treatment of coronavirus (COVID-19). Treasure Island, FL: StatPearls.

Centers for Disease Control and Prevention. (2021). Cases, data, and surveillance. Web.

Introduction

Parkinsons disease is a complex disease that includes a whole system of symptoms and predictors, each of which must be investigated individually. The biological pathways leading to such disease dysfunctions are under study, and therefore the dependence and correlation with many characteristics may not be apparent. In this regard, this study is being conducted to clarify the existence of sex differences in the development of ultrasonic vocalization and anxious behavior, which in turn portend motor deficits, which are a direct symptom of Parkinsons. The authors drew on previous studies where a similar relationship had already been established and made differences in the long term of the experiment, taking young rats as a basis and tracking the dynamics over a long distance.

Accordingly, the leading independent variable is the sex and genotype of rats, which is divided into WT (wild) and Pink1, while the dependent variable is a whole set: rat weight, cylinder forelimb, cylinder hindlimb, rears and lands, ultrasonic sound total calls, open field time /movements and number of entries in the central zone. In simpler terms, vocalization, the anxiety of rats, weight, and their motor activity were assessed, which were just calculated thanks to the listed technologies and approaches. Accordingly, the null hypothesis, which was rejected with a statistical significance of p=0.05, stated: differences in the genotype and gender of rats do not affect the predicates of motor deficits as a symptom of Parkinsons disease, namely, anxiety and ultrasonic vocalization.

The hypothesis was: differences in the genotype and gender of rats affect the predicates of motor activity deficit as a symptom of Parkinsons disease, namely anxiety and ultrasonic vocalization.

The independent variables were: genotype and sex.

The dependent variables were: rat weight, cylinder forelimb, cylinder hindlimb, rears and lands, ultrasonic sound total calls, open field time/movements, and the number of entries in the central zone.

Experimental Design

For the experiments adequacy, the participants were rats of two species and different sexes in equal proportions: 24 per species, 12 males and 12 females among them. A group of stimulated rats was also allocated to create a controlled amount during testing the effect of USV; however, they were not included in the main experiment. Another critical factor in selecting rats was the age of 2 months or 4 to 6 weeks. The study was conducted according to exceptional standards for the maintenance of participants in the experiment.

First, the rats were put on a 12-hour light cycle. This fact means they spent 12 hours in the light and the next 12 hours in the dark. A red glow was used to assess rats behavior in this cycle. Food and water were supplied on time and without restrictions. It is crucial to obtain experimental design approval from all relevant authorities by the Animal Care and Use Committee of the University of Wisconsin-Madison School of Medicine and Public Health and in accordance with the NIH Guidelines for the Care and Use of Laboratory Animals.

The weight of the rats was assessed using appropriate equipment with a digital scale. A literature review conducted by the authors showed that ultrasonic vocalization is activated during the estrous cycle of females. Consequently, female behavioral tests were performed during this period, accompanied by more significant anxiety. The cycle itself was detected both by behavioral signs and by cytodiagnostics. Moreover, this cycle consists of four stages, and the females were evaluated only during one of them; smears assessed the transitions.

The anxiety of rats is assessed by movement in an open field: the number of entrances to the central zone and the total distance traveled have been proven to be indicators of this behavior. For this assessment, video cameras were used and calculating these variables. A transparent cylinder, also equipped with cameras, was used to count the motor activity of the rats for 1 second. To do this, the evaluators were deprived of information about the genotype and sex of rats in terms of the number of dynamics of movement of the fore and hind limbs through the glass.

Ultrasonic vocalization was considered more complex and was differentiated into many other variables: duration, bandwidth, intensity, and peak frequency. At the same time, the number of calls was also taken into account; rats that issued less than 30 were not taken into account in the statistics at all. The obtained data were used to compile a Custom CodeSet consisting of mRNA of breed-differentiable genes. It singled out five types of central genes responsible for most of the dependent variables. These data were evaluated using special software for a variety of specific characteristics. This action is applied and is not directly related to the activities for testing the hypothesis.

Finally, statistical analysis was performed using special SigmaPlot software, according to the two-way ANOVA method. At the same time, variables that did not correspond to the normality distribution were transformed using the square root or the rank; in this case, the Shapiro-Wilk and Levene tests were used. The critical level of significance was constantly maintained at the level of 0.05 for each assessment.

Results

As a result of evaluating the results, many conclusions were drawn: Pink1 females turned out to be more anxious than males due to the more significant number of entries into the central zone, in the absence of statistically significant differences in the distance traveled, either by genotype or by sex. Again, Pink1 females had more significant motor activity in the cylinder score, and USV scores were higher for males, regardless of genotype. Then, using the NanoString approach, heat maps with genes and genotype differentiation were developed with further identification of the genes necessary for this work. Experimental rats were deeply anesthetized with isoflurane and subsequently euthanized. Samples of the brain and other body parts were frozen, placed in appropriate solutions, and isolated. Subsequently, a procession of RNA was carried out to analyze the necessary genes.

Conclusions

The initial hypothesis was supported by the fact that both gender and genotype have a statistically significant effect on the manifestation of specific symptoms of Parkinsons disease. To varying degrees, it manifested itself with greater force in females, for example, anxiety, during ultrasonic vocalization in males. It is essential that the differences turned out to be significant and made it possible to identify the corresponding genes that are directly or indirectly responsible for these symptoms. The findings of this study made it possible to determine the future vector of work, confirmed earlier studies on the presence of a correlation between the sexes, and made it possible to apply NanoString technology to differentiate differences by genotype.

Personal Opinion

In my opinion, a sufficiently small sample for this experiment is leveled by the use of non-parametric comparison methods, such as the Mann-Whitney U-test. In this work, the competence of the evaluators was also assessed, and an integrated approach was applied to the consideration of statistical significance. In general, the results of the work were supplemented by further analysis of genes and genotypes, which not only increased the scientific significance of the work but also more accurately determined the vector of further research. It seems that this study meets all scientific requirements and is carried out in the best possible way.

Real World Application

Studying Parkinsons disease is very important not only for the scientific community but for the world as a whole. Specifically, this study makes adjustments to the daily lives of those suffering from this disease and medical professionals who have to deal with it. For the rest of the population, the research may be educational about warning signs of anxiety and motor deficits as signals for medical evaluation and potential treatment.

Naturally, it should be taken into account that between experiments on rats and real studies on humans, there are several more scientific and applied work stages. However, already at this stage, there are revealed correlations, which are confirmed by more than the first experiment, judging by the literature review of this work. However, in the case of such studies, their impact on everyday life and professional activities is achieved only with the accumulation of knowledge and, as a rule, over a long distance, respectively, has a delayed effect.