Category: Health

Introduction

The definition of quality remains contested and multifaceted. Barbara and Goodstadt advance that quality is inherent with efficiency, effectiveness, and consumer satisfaction (Barbara & Goodstadt 1999). When focusing on quality, it depends on whether goods are the center of an intervention or a service. Ovretveits notion of quality is based on a three-tier model which examines and evaluates quality based on consumer satisfaction, efficient policies or set benchmarks, and professional assessment (Ovretveit 1996, p.55-62). When incorporating quality into management, continuous quality improvement dwells on an exhaustive management philosophy that focuses on an ongoing improvement by applying scientific procedures to gain knowledge and have a grip over varying work processes (Barbara and Goodstadt 1999 p. 83-91).

Historical background to CQI

Using U.S history as an example, CQI according to American Medical Association (APA) study in 1910, found the need to improve hospital conditions and follow up on patients to assess service delivery. By 1977, the American College Surgeons association had developed a criterion for measuring standards. It focused on the general hospital management structure. It further broadened the scope to include the external non-hospital environment as the community (Luce, Bindman & Lee 1994). By 1952, American Medical Association (AMA) and Canadian Medical Association (CMA) had joined to form a joint hospital accreditation forum. By 1966, the focus had shifted to the achievement of set benchmarks, rigorous and obligatory schedules, and more advanced techniques (Luce, Bindman & Lee 1994).

Currently, new methods of practice have broadened quality assessment and improvement programs. AMA and CMA standards have guided quality based on setting up clinical investigations and consensus conferences and recommending the way forward. Through physician profiling practice and data evaluation on clients, the progress is assessed. Besides, rogue physicians are induced to change their habits. The trend had improved recently to focusing on group improvement rather than individual physicians. It has also broadened settings to include ambulatory care and community mental health (Luce, Bindman & Lee 1994 p. 263-268).

In this criterion, hospitals aspiring for accreditation apply and upon assessment are given conditions of operation, or those which fail to meet standards may appeal. The professional standard organizations stress efficiency and quality. Peer review organizations review re-admissions, hospital admissions, operations, deaths, and complication rates. They identify problems and suggest remedies, alert practitioner institutions, new data, and accreditation bodies about malpractices or challenges experienced (Luce, Bindman & Lee 1994 p. 263-268).

Evaluating Quality Care

Various approaches have been identified that guide health management. Levin proposes the Deming Cycle (Plan-to-study-act). He outlines steps to be followed while managing a health issue. You begin by planning change, followed by implementing the change process and observing either positive or negative outcomes. Finally, the change is adopted or rejected (Levin 1994). Baker adds that identifying an outcome, focusing on an individual or community interest, and identifying how to recognize an improvement is followed. While conducting the process you open your mind to new ideas, options, or tests.

Barbara and Goodstadt (1999 p.83-91), argue that customers are a critical component in the health management process. The customers encompass patients, colleagues, the broader community, or even funders (Al Assaf 1993 p. 3-12). Assaf adds that customer satisfaction, which is a major force behind CQI, needs deep examination in the context of health promotion. Murray stresses the need for data to assist in decision-making while engaging in CQI (Barbara and Goodstadt 1999 p. 83-91). CQI is also conceptualized as a system where health promotion relies on the interconnectedness of parts.

To add on, CQI utilizes benchmarking to identify best practice processes (Buccini 1993 p. 455-463). As managers, it is important to note that variability of circumstances is and requires reduced rigidity in response. Besides, CQI promotes teamwork. When adapting CQI as health promotion, change interventions should promote goals, values, and tackle challenges (Barbara and Goodstadt 1999 p.83-91).

Designing an Outcome Measurement Strategy

A CQI strategy for improved health promotion requires a focused approach guided by desired change. While designing a workable strategy one should embrace an open mind to issues as they emerge.

The strategy

1. An identified change intervention that eyes health promotion will re-align with set goals, objectives, and missions of the health institution. This will be imperative in guiding through set benchmarks.
2. As a health-promoting institution, joining accreditation bodies that work towards CQI will be a priority. This has the benefit of sharing experiences among groups of colleagues from various institutions and peer-reviewing each other for improvement. Peer reviews instill quality and standards through checks and balances.
3. Setting up a repository center for epidemiological data is necessary for monitoring trends in practice, identifying new knowledge and challenges that inform decision-making in the health sector.
4. Continuous research identifies new knowledge, practices, and initiatives that can be shared among peer review organizations for the improvement of service delivery as a whole.
5. Lastly, a successful health promotion change initiative will focus on re-engineering the structure of management that embraces non-rigid styles. It will be a synergy of both vertical and horizontal chain of command. This will enhance community involvement and open decision-making.

Reference List

Al Assaf, A. F. (1994). Introduction to Historical Background. The textbook of Total Quality Healthcare, 4, 3-12.

Barbara, K. &. Goodstadt, M. (1999). Continuous Quality Improvement and Health Promotion: Can CQI lead to Better Outcomes? Health Promotion International, 14, 1, 83-91.

Buccini, E. (1993). Total Quality Management in Critical Care Environment: A Primer. Critical Care Clinics, 9, 455-463.

Levin, W. (1994). Using Theory to Improve Population Health: What healthcare can teach management, Canadian Journal of Quality in Healthcare, 11, 4-15.

Luce, J., Bindman, A., & Lee P. (1994). A Brief History of Healthcare Quality Assessment and Improvement in the U.S. West J Med, 160, 263-268.

Ovretveit, J. (1996). Quality in Healthcare Promotion. Healthcare promotion International, 11, 55-62.

Study Design

For this qualitative study, the study design was to establish the impacts of cultural factors on Saudi students approach to managing stress during their study in Australia. The researcher should consider and understand the unique features of the research subject, its setting and develop response methodologies to encounter the problems (Creswell 2009, p. 39). Therefore, the researcher used ethnography as the design in conducting the study.

Participants and Sampling

Participants

In this research, five Saudi students at the University will be interviewed for the study to represent the population being studied. In addition, the study will ensure anonymity and confidentiality of the participants for their input in the research. The participants will also be assured of the freedom to withdraw from the study whenever they feel to pull out. Moreover, the participants would be accessed at the University through a written request to take part in the study.

Convenience and purposive sampling were used to make the qualitative research objective in nature, and its outcome dependable (Grbich 2007, p. 17). The researcher has contacted the prospective respondents, and five have been selected for interview. They will be interviewed on the impacts of cultural factors on Saudi students approach to managing stress during their study in Australia.

Data Collection

Proper and accurate data collection is central to the success of qualitative research (Patton 2002, p. 27). The data collection methods, which were used in determining the impacts of cultural factors on Saudi students approach to managing stress during their study in Australia was through conducting four qualitative interviews. Here, the interviews were structured in such a way that they give detailed protocol.

In conducting the interviews, open-ended questions would be used so that the respondent may give a detailed account of their concern about the problem (Grbich 2007, p. 26). Sometimes, the researcher may be forced to use video and audiotapes in capturing the raw information to enhance accuracy and reliability. For the participants who might not accept video-taping, the researcher will take notes while interviewing.

Data Analysis

Once the raw data are collected, the researcher commences the task of analysis. Preferably, thematic data analysis would be applied in this research (Grbich 2007, p. 29). For this study, the right methods as Grbich (2007, p. 40) identified will be used in the analysis of the data collected, and these include using constant comparative analysis, phenomenological, ethnographic, Narrative, and disclosure analysis. Therefore, analytical reasoning will be used to interpret the peoples feelings and the circumstances under which the opinion originates, other than basing the analysis on validating the thought (Minichiello, Aroni & Hays 2008, p. 64).

Questions

1. Tell me something about your life here in Australia.
2. How different is your life here compared to your home country?
3. Are there any similarities between the two cultures, Saudi and Australian?
4. If you were to change something about your life here in the Australian culture, what would you choose?
5. How does stress impact your family life?
6. Which part of Australian society makes you stressed?

References

Creswell, J., 2009, Qualitative, Quantitative and Mixed Methods Approaches (3^rd Ed), Thousand Oaks, Sage.

Grbich, C., 2007. Qualitative Research in Health, London, Sage.

Minichiello, V., Aroni, R., & Hays, T., 2008, In-Depth Interviewing (3^rd Ed.), Pearson Education Australia, Sydney.

Patton, M., 2002, Qualitative Evaluation and Research Methods, (2^nd Ed), Thousand Oaks, Sage.

The evaluation of the Arlington community has shown high regard for the alleviation of tobacco use and alcohol consumption. The population has been highly concerned to abolish the use of tobacco and alcohol among the youth. There is overwhelming evidence of declining cases of tobacco and alcohol use among the youth. This is in line with the national goals of reducing tobacco and alcohol use among the youth.

Nevertheless, the analysis of the Arlington community has shown that a small number of young people are still engaged in alcohol and tobacco use. Despite the efforts and strategies which have been set to ensure make sure that the population is free from tobacco and alcohol use, the crisis is still prevailing in the community. An assessment of the community has offered overwhelming results on health concerns. An assessment of middle school children in Arlington has demonstrated the threat to the community as far as alcohol and tobacco use was concerned. As it has been observed, the community has overwhelming goals for the reduction of alcohol and tobacco use.

As far as tobacco and alcohol use is concerned, the Arlington community has set admirable goals for the populations health. Notably, the community is focusing on increasing the percentage of youths who are tobacco and alcohol-free. In the light of the ideas of Stanhope and Lancaster (2011) no community can succeed in the war on drugs without setting specific goals and objectives. The case of the Arlington community is hereby appealing in the sense that realistic goals on alcohol and tobacco use termination have been set (Stanhope and Lancaster, 2011).

Due to the high vulnerability of youths to alcohol and tobacco use, the young people in the Arlington community are under strict parental and teacher supervision. As it is provided in this study, the youths between 12-17 years old have little time to spend out of school or beyond the supervision of adults. This is very beneficial in countering the use of alcohol and tobacco. As noted by Nies and McEwen (2010), one of the best ways to keep children out of tobacco and alcohol consumption is to ensure supervision as much as it is possible.

This has been considered in the community whereby the majority of the children spent much of their time with adults both in school and at home. Notably, a small percentage of around 10% are engaged in the habit. With these statistics, it is evident that the vulnerability of the user in using the substance is limited (Nies and McEwen, 2010).

The involvement of the youths in extra curriculum activities is also a great achievement in the war against alcohol and tobacco use (Kayser-Jones, 2009). Despite that majority of the youths spent little time on extracurricular activities, great efforts have been put to engage them. It is appealing to note that a high percentage of youth are active in extracurricular activities. This has a significant effect in preventing them from bad behaviors and more specifically, alcohol and tobacco use.

It is commendable that the schools in the community have been at the forefront to ensure that the youths are fully engaged, thus limiting their vulnerability to tobacco and alcohol use. The engagement of the youths in physical activity is also commendable in addressing the issues of alcohol and tobacco use. As observed in the assessment, all young people spend some hours a week doing sports or some other physical activity which in this case has a good influence on their health (Stanhope and Lancaster, 2011).

As far as cigarette smoking is concerned, a majority of the youths have demonstrated overwhelming results. A high percentage of youth of around 90% have never smoked cigarettes. Its only around 4% of young people who have smoked a cigarette in their time. The current engagement in smoking is only represented by 1-2% of the youth who smoke on average 4 cigarettes a day. With this in mind, the community has succeeded in countering the evil of alcohol use among a larger population of its youth. However, a lot needs to be done to address the smaller proportion of the youths who are still entangled in the behavior (Nies and McEwen, 2010).

The case of alcohol use among the youths in the Arlington community has also demonstrated appealing results. Over 75% have never sipped alcohol. Only 6% of youth in the Arlington community have tasted it at the ages of 10 and 8 respectively. The evaluation of the Arlington community has demonstrated that around 7% and 6% of the youth have also tasted alcohol at the age of 12 and 14 respectively. Based on these statistics, it is evident that much has been done in eliminating alcohol and tobacco from the community (Anderson and McFarlane, 2010).

The overall assessment of the Arlington community has demonstrated appealing results as far as health was concerned. The issue of alcohol and tobacco use in the Arlington community has been adequately addressed. The goal of an increasing number of youths who are alcohol and tobacco-free has been prioritized. This is evident through the commitment of parents and teachers in engaging students in extracurricular activities, physical activity, and supervision. The current prevalence of alcohol and tobacco use among the youth in the Arlington community is the lowest: 90% and 75% is the number of youths who have never smoked and taken alcohol respectively. Nevertheless, there is a need to be cautious in addressing the small percentage of youth who are still overwhelmed by alcohol and tobacco consumption.

References

Anderson, E. and McFarlane, J. (2010). Community as partner: Theory and practice in Nursing. New Jersey: Lippincott Williams & Wilkins.

Kayser-Jones, J. (2009). Nursing homes: A health-promoting or dependency-promoting Environment? Journal of Health Promotion Maintenance, Vol. 32, No. 1, pp. S66- S74.

Nies, M. and McEwen, M. (2010). Community/public health nursing: Promoting the Health of populations (5th Ed.). Washington, DC: Saunders.

Stanhope, M. and Lancaster, J. (2011). Public health nursing. Populations-centered Health care in the community (8th Ed.). New York: Mosby.

Introduction

The study compared anthropometric methods among individuals from industrialized countries and developing countries. It assessed body size in terms of weight, height, and waist girth. It attempted to determine trends in body fat distribution among the two groups from Industrialized and developing countries. It undertook tests on lipid profiles guided by increasing risk to blood pressure. It assessed nutritional implications by gender and socio-economic groups. An increase in body fat over time was associated with decreased physical activity and fitness.

On the other hand, an examination of waist cycling is associated with cardiovascular risk than muscle gain. The investigation has used standardized anthropometric methods to provide data on how physical size and structure were connected to the risk of developing coronary heart disease and hypertension diseases. Commonly used standard measurements methods focus on indices connecting to risks of coronary heart disease or systemic arterial hypertension (Australian Bureau of Statistics, 74-128).

Terminologies

• Weight: encompasses total height, frame size, muscle proportions, fat, and bone without shoes (Ebomoyi, Wickremansighe, and Cherry, 33-38).
• Height: includes individuals sum of four components (legs, pelvis, spine, and skull) (Lohman et al.).
• BMI: is the relative weight measured in weight/height squared and has become widely used to assess underweight, overweight, and acceptable weight (Lohman et al).
• Waist-Hip Ratio (WHR): The fat around the waist indicates intra-abdominal fat deposits in an index of risk for cardiovascular disease (Hill et all.; Birmingham and all).
• Muscle: mid-muscle arm circumference, mid-arm circumference, and triceps skin hold of an individual (Lohman).

Materials and Methods

Methods used in the study have been internationally proven for better and more reliable results. Height and weight are internationally accepted as primary body size indices. BMI has been used to correlate with risk factors for cardiovascular diseases. Waist girth targeting the central and upper body has been associated with obesity (Wang, 47). Other methods such as Muscle mass Circumference (MAMC), Muscle arm circumference (MAC), and Triceps skin fold have been associated with diabetes and heart diseases. The methods have been utilized in this study.

Results

Classification of Weight using BMIa

Table 1.1: The tables build illustrate methods used in the anthropometric exercise.

Table 1.2: Reference levels for triceps skin-fold, adults, sexes separate

Comparisons between two populations in developed and developing countries indicated the following results

Female comparison and contrast

Female BMI from industrialized countries averaged at 22 for those aged 19-24 and 21 for those aged 25-44. Those aged 19-24 and 24-44 had BMI index (22), (21) within acceptable weight respectively. The triceps skinfold (TSF) for this category of women was low (1.5 & 1.7) for both 19-24 and 25-44 age categories respectively. The height for this category of women averaged 1.67 for those aged 19-24 and 25-44. Their weight averaged at 60.9 kg for those aged 19-24 and 57.9 for those aged 25-44. Hip circumference for 19-24 was 97 and 95.9 for those aged 25-44. The waist hip ratio was 0.74 for 19-24 categories and 0.72 for the 25-44 categories. Mid arm muscle circumference was 20 for 19-24 was 19.9 and 22.9 for 25-44 age categories. The mid-arm circumference was 27.3 for 19-24 and 27.9 for 25-44 age categories.

Females from developing countries aged 19-24 had BMI index of 20.9 and 20 for those aged 25-44. The BMI indices indicated both age groups were within acceptable weight. Their triceps skinfold (TSF) was low. 19-24 had low (TSF) at 1.8 while 24-44 1.7. The height for this category averaged at 1.62 for the two age categories. For those in developing countries, their weight averaged at 54.5 kg for those aged 19-24 and 52.6 kg for those aged 25-44. Hip circumference was 93.6 and 94.8 for those aged 24-44. The waist hip ratio was 0.74 for 19-24 categories and 0.73 for the 25-44 category.mid arm muscle circumference was 20 for 19-24 and 19.6 for 25-44 age categories. The mid-arm circumference was 25.7 for 19-24 and 24.9 for 25-44 age categories.

Male comparison and contrast

Male BMI from industrialized countries averaged at 24 for those aged 19-24 and 32 for those aged 25-44. Those aged 19-24 who had BMI index (24) were within acceptable weight while those aged 25-44 had an overweight BMI index (32). The triceps skinfold (TSF) for this category of men was low at (0.9) for both 19-24 and 25-44(1.73) categories. The height for this category of men averaged at 1.76 for 19-24 and 1.71 for 25-44 age groups. Their weight averaged 75 kg for those aged 19-24 and 100 for those aged 25-44. Hip circumference for 19-24 was 97.7 and 110 for those aged 25-44. The waist hip ratio was 0.82 for 19-24 categories and 0.88 for the 25-44 categories. Mid arm muscle circumference was for 19-24 was 29 and 30.1 for 25-44 age categories. The mid-arm circumference was 32 for 19-24 and 35.6 for 25-44 age categories.

For males in developing countries, BMI averaged at 22 for those aged 19-24 and 26 for those aged 25-44. Those aged 19-24 had a BMI index (22) within acceptable weight while those aged 25-44 had a BMI index (26) were overweight. The triceps skinfold (TSF) for this category of men was low for both 19-24(1.7) and 25-44 (1.73). The height for this category of men averaged at 1.77 for 19-24 and 1.71 for 25-44 age groups. Their weight averaged 69 kg for those aged 19-24 and 76kg for those aged 25-44. Hip circumference for 19-24 was 89 and 103.6 for those aged 25-44. The waist hip ratio was 0.83 for 19-24 categories and 0.88 for the 25-44 categories. Mid arm muscle circumference for 19-24 was 25.2 and 25.6 for 25-44 age categories. The mid-arm circumference was 29.5 for 19-24 and 30.9 for 25-44 age categories.

Table 1.3: Average Body Mass Indexes (BMI) of women and Men by age and sex classified as underweight, acceptable weight and overweight from both industrialized and developing countries.

Discussion

According to Jellffe (1989), BMI showing underweight, acceptable weight, and overweight could be based on a standardized index scale. BMI less than 20 indicated being underweight, a weight within 20- 25 BMI indicated acceptable weight while greater than 25 up to 30 indicated overweight. Obesity was measured by over 30 BMI. From this investigation, the two categories of groups of males and females from industrialized and developing countries indicated noticeable trends.

Males and females from industrialized countries had BMI as follows; 19-24 (24, 22), 24-34 (32, 21) respectively. This showed that those aged 19-24 from both categories of males and females were within normal acceptable weight. However, men aged 24-34, were or were susceptible to being overweight. The females aged 25-34 (22 BMI) had their BMI within the standard and acceptable scale (National Center for Health Statistics 60).

For males and females from the developing world, males aged 19-24 (26 BMI) were slightly overweight, while females in the same age category were within acceptable weight. Those males aged 25-34 (BMI 22) and females (BMI 20) were both within the acceptable weight according to standard scales. The emerging trend shows that males aged 25-34 in industrialized countries were likely to turn on overweight as compared to those from developing countries. Other age categories were normal in both situations.

According to surveys done in the U.S arm circumference levels for normal individual males and females ranged as follows; 19-24 (MAC:30.8, 26.5), 25-34 (MAC: 31.9,27.7) respectively (NHS, 1970). From the survey findings, males from industrialized countries had a muscle arm circumference (MAC) of 32 and 35.6 for 19-24 and 25-34 age groups respectively. Females had muscle arm circumference (MAC) of 27.3 and 27.9 respectively (National Center for Health Statistics 62). This indicates that both males and females from industrialized countries had access to enough proteins. It also showed that muscles were overdeveloped, going by the standards in the national survey scales, which indicated a lack of physical activities (Gay, 189).

For individuals from developing countries, MAC for males and females were as follows: those males aged 19-24, and 25-34, (29.5, 30.9). Females aged 19-24 and 25-34 had MAC of (27.3, 27.9) respectively. According to laid scale standards, males in such categories should fall within 30.8 and 31.9, and for females, it should fall within 26.5 and 27.7. According to findings, it shows that women and men from developing countries were within the normal muscle arm circumference ratios and that they were more involved in physical fitness than their industrialized counterparts.

The data also indicates that Waist to Hip Ratio (W/H R) could be applied to the two categories of groups. According to Lohman, (1988), fat distribution around the waist and abdominal fat deposits were important indexes for diabetes, hypertension, and cardiovascular disease. Normal fat distribution with upper cut-off was standardized at 0.8:1 for females and 0.90:1 for males. From the emerging findings, it was noticeable that men and women from industrialized had (W/H) ratio as follows; 19-24 and 25-34 (W/H: 0.74:1, 0.82:1for 19-24, 0.72:1, 0.82:1 for 25-34) respectively. Those from developing countries had (W/H: 0.72:1, 0.88:1 for 19-24 and 0.73:1, 0.85:1 for 25-34) respectively.

Anthropometric Data for Author, Student aged 40 years

The student had a BMI of 34. The MAC measured 32 while the weight in kilograms was 82.4 kgs. The height was 1.68 ft while the hip circumference was 98. The student originated from industrialized countries.

Interpretation

It is important to focus on weight and height monitoring embedded in the aging process for growth and development. It becomes easier to understand dietary and exercise patterns. Height and weight have implications for health problems, therefore, monitoring increases consciousness on the need for healthy activities (Jelliffe and Jelliffe). The waist girth if understood may guide understanding of subcutaneous fat distribution. Studies have shown that waist circumference is correlated with visceral fat, 0.44 for black men and women and 0.66 for white men and women (Ebomoyi, Wickremansighe, and Cherry, 33-38).

Fat distribution around the waist and abdomen was an important index for diabetes or heart-related diseases. Going by set standards, normal fat distribution with upper cut-off was 0.85:1 for females and 0.90:1 for males. From the foregoing data, the student had 0.96:1 (Wang 49). The student was likely to be prone to diabetes and heart diseases. Besides, his BMI was 34, above normal scales, and was classified as overweight.

Table 1.4: Anthropometric Data for Author, Student aged 40 years.

Table 1.5: Obesity Standards.

Table 1.6: Reference levels for arm circumference, adults, sexes separate and ages 18-54.

Observation

Obesity standards according to Jelliffe (1989) had been set by practitioners in America. The student was aged 40 years. The student was male and had a minimum triceps skin fold of (MAMC: 31.5) and (MAC: 32). The triceps skin fold measurements depicted by MAMC and MAC showed that the student had MAMC of 31.5 and MAC of 32. The waist was 98 cm. Besides, waist to hip ratio was 0.96. The hip circumference was 107 cm.

Students Examination

The students skin fold measurements indicated that the arm circumference thickness was beyond normal. He had MAMC of 31.5 and MAC of 32. Fat distribution indicated that the student experienced over nutrition. The student was in danger of turning obese. There was a likelihood of hypertension due to over nutrition of forms of protein energy. The muscle mass showed that the student was physically inactive and could lead a physically strenuous life. The waist girth indicated that the student had a hip circumference of 107 and hip waist ratio of 0.96. Adipose and subcutaneous fat distribution around the waist was more prone for heart related diseases.

Limitations of Anthropometric Methods used

Universal methods used to check body size in relation to health implications have been criticized by various scholars. Body fat derived from TSF scales has been unreliable in predicting abnormal fat distribution in obese children. The skin fold measures have been noted to be inaccurate by +6 or -6 error chance BMI scale over-concentrates on height and weight limiting its ability to accurately determine fat mass. Besides, current scales on height and weight do not show obesity on individual basis making it hard to predict individualized health risks (Wang 50).

Student, males and females anthropometric comparison

A common pattern emerged among students and males from industrialized countries. The BMI was slightly higher than normal scales. A common pattern was evident among males from developing countries where 19-24 were had normal BMI. The 25-44 age categories from industrialized countries were abnormal in BMI, WHR, and MAC.

Conclusion

The study concludes that the two groups were healthy. A smaller percentage of males from the industrialized countries were overweight or likely to turn overweight. Obesity-associated with insulin resistance, intra-abdominal adipose tissue among the studied groups showed that there were low risks for cardiovascular disease (Gay, 189). The correlation of W/H ratio to cardiovascular disease among the groups was minimal (Hill, et. all 381-7).

Furthermore, an examination of the student showed that the student was in danger of potential cardiovascular diseases. Triceps skinfold circumference was above normal measurements. The student resided in industrialized countries and was more likely to turn obese. The correlation between obesity and cardiovascular diseases was real. The findings substantiated other findings from industrialized countries where physical fitness for men and women was poor.

An emerging trend indicated that males and females from industrialized countries were more likely to suffer from hypertension, stroke, and obesity than those from developing countries. It implied that those males and females from developing countries were more active physical and took nutritional food with low-fat content. The trends in heart-related diseases among the two groups observed in the study corroborated scientific findings that show that the frequency of heart diseases was more common among industrialized countries than developing countries.

Works Cited

Australian Bureau of Statistics. National Nutrition Survey User Guide 1995, Canberra: ABS. 1998. Print.

Australian Bureau of Statistics. National Nutrition Survey: Selected Highlights, Canbera: ABS, 1995. Print.

Birmingham, B., A.R. Dyer, R.B. Shekelle and J.Stamler Subscapular and Triceps Skinfold Thickness, Body Mass Index and Cardiovascular Risk Factors in a Cohort of Middle-age Employed Men. Journal of Epidemiol. 46.3 (1993): 289-302. Print.

Ebomoyi, E.W., A.R. Wickremansighe, and Flora F. Cherry Anthropometric Indicators of childrens nutrition in two Communities. Journal of Biosocial Science, 23.1 (2008): 33-38. Print.

Gay, G. In Obesity Perspective. DHEW Public, 75 (1973): 189-203. Print.

Hill, J. S. Sidney, C.E. Lewis, K. Tolan, A.L. Scherzinger, E.R. Stamm. Racial Differences in a Mounts of Visceral Adipose Tissue in Young adults. Am J Clin Nutr. 69.3 (1999): 381-7. Print.

Jellffe, Derrick Brian and E. F. Patrice Jellffe. Community Nutrition Assessment, with Special Reference to Technically Developed Countries. Oxford: Oxford Publications. 1989. Print.

Lohman, Timothy G, Alex F. Roche, and Reynaldo Martorell. Anthropometric Standardization Reference Manua. Champaign:IL Human Kinetics Books, 1988. Print.

National Center for Health Statistics. Skinfolds, body girths, biacromial diameter, and selected anthropometric indices of adults. United States, 1960-1962. Vital Health Stat 11.35 (1970): 1-63. Print.

Wang, Ru, Peijie Chen and Wenhe Chen. Effect of Diet and Exercise-Induced Weight Reduction Proteins CD55 and CD59 in Overweight Chinese Adolescents. J. Exerc. Sci. Fit. 9.1 (1994): 46-51. Print.

Introduction

Public health refers to a science aimed at improving the health of people in the community. This is through the provision of health education and conducting research for upcoming diseases and ailments and seeking ways in which they can be prevented. Public health professionals conduct an analysis of the effect of genetics on health and the environment (Friedman, Furberg and Demets, 1998).

This enables them to come up with programs that protect the health of the community and solve the existing health issues. In line with public health and education, biostatistics, which involves the use of statistical methods in scientific research in public health helps in the identification of the causes of diseases and injuries. It involves studies on the environment and genetics as well as clinical trials and observational studies.

Resistance of Drug-Defying germs in India

Drug-Defying germs from India may be reported to speed the post-antibiotic era. This is according to the World Health news published on 1^st June 2012 by Jason Gale Narayan. According to the article, $12.4 billion which represents a third of the worlds antibiotics get manufactured by the pharmaceutical industry.

These become liberally used to the extent that the bacteria develop immunity to the drugs. Some of these resistant bacteria have entered the water and sanitation systems, while the super bacteria have taken up in hospitals. Here, they pose a threat to patients as their care and attendance become compromised a fact that has put Indias image at risk as it gets known to be one of the best medical tourist destinations. The drug-resistant bacteria spread wildly and cause about 25,000 deaths in Europe.

The bacteria also tend to be multiplying rapidly due to a gene NDM-1, which stands for New Delhi metallo-beta-lectamase-1, which gets carried on mobile loops of DNA referred to as plasmids. These spread easily and fast across many types of bacteria and infiltrate most of the species of bacteria. Germs empowered by NDM-1 also muster a number of ways of destroying the worlds most potent antibiotics.

Use of Biostatistics in Drug Resistance

Biostatistics is essential in this case as it offers knowledge to clinicians and other medical staff about medical services before they get into the market. This helps in demonstrating the effectiveness as well as safety of products on human health before they can be released for use by humans.

Biostatistics is an essential aspect of the clinical research process as it assists in the designing of protocol and its development, recruitment of patients, allocation of treatment, measuring differences in treatment and analyzing the rate of treatment response (Wang, & Bakhai, 2006). This helps an immense deal as the doctors, researchers and clinicians are able to monitor the cause of an illness and hence devise ways of handling it.

Researchers are also able to discover ways of dealing with resistant drugs and bacteria in order to provide a cure for given diseases. This saves the community and population at large from suffering from diseases that have no cure at all, leading to massive deaths across the world.

Use of Biostatistics in educating people on Public Health matters

To educate the public about this issue, I would use biostatistics to explain to the public how treatment can be allocated. This is in reference to recorded statistics on the spread of the disease, how it gets transmitted and ways that may be used to control and eradicate it (Kirkwood and Sterne, 2003). It also helps in measuring the difference in treatment which enables the audience to know the effectiveness of certain drugs on given diseases.

Conclusion

Public health is vital as it provides information to people about upcoming health issues. This helps them to protect themselves from exposure to certain diseases. This can be made possible and easy by biostatistics which provides details concerning diseases and ailments and how they can be prevented and cured. As a result, people should be concerned about public health matters and implement the use of biostatistics in public health education.

References

Friedman, L. M., Furberg, C. D. & Demets, D. (1998). Fundamentals of clinical trials, (3^rd ed.). New York: Springer Verlag.

Kirkwood, B & Sterne, J. (2003). Essential medical statistics, (2^nd ed.). Oxford: Blackwell Publishing.

Wang, D. & Bakhai, A. (2006). Randomization. In: D Wang & Bakhai, (Ed.), Clinical Trials: A Practical guide to design, analysis and reporting. London: Remedica. 81.

Fragile states refer to those states with an unstable political system. This means that these countries have a history of civil strife or war with neighboring autonomous political entities. Political instability has serious implications on the state of government and the provision of social amenities in the areas that are affected (Levy 2008, p.51). The greatest effect of political instability is that the countries have poor economies. The fragile states have a myriad of problems arising from poor coordination of their activities (Brock 2011, p.78).

The United Nations has initiated programs to develop these countries social amenities up to an international level. These goals are scheduled to be achieved by 2015 and are known as Millennium Development Goals. These targets require an appropriate environment for them to be achieved (Sharp 2011, p.73).

This means that any country with an unstable economy is likely to have trouble in achieving these goals (Brinkerhoff 2007, p.62). Furthermore, these millennium development goals require foreign funding to a considerable extent. The willingness of the donor countries to cooperate with the United Nations in the funding of the projects determines the fate of the MDGs.

Millennium Development Goals have many objectives within their scope. Quality health for all the citizens of the fragile states is one of the major aims of the programs by the United Nations. Since the majority of the population in these countries consists of poor people, the United Nations has to work closely with the governments of these countries to achieve its objectives (Manor 2007, p.37).

Some governments in the fragile states, which are uncooperative, and too preoccupied with political issues to attend the development issues, compound the difficulties experienced by the United Nations. Illiteracy in these countries is still high, and this makes it difficult to get the citizenry to cooperate over the issue of development. Since health requires a considerable degree of funding and a high level of awareness, quality is low in these countries.

Background

The concept of fragile states revolves around political and economic stability. Any country with the tendency to experience a sharply changing political or economic status is considered a fragile state. Political stability and economic prosperity are directly related to each other. This means that a poor economy is likely to have an unpredictable political atmosphere. Likewise, an unstable political atmosphere results in a continuously changing rate of economic progress.

These countries are not necessarily poor, but they have a continuously deteriorating economic status. Some countries have had such a situation for a long time. Health has been one of the greatest losers due to political and economic instability. The basic criterion of determining fragile states is the level of efficiency and the legitimacy of the authority in charge. Effectiveness refers to the efficiency of the authority, and the willingness of the government in a state to respond to a problem. On the other hand, legitimacy refers to the ability of the government to assert authority in the major aspects of governance. The aspects of governance include the provision of health care services.

Fragile states have the worst conditions in almost every sector compared to other countries in the world. Consequently, these states have a greater proportion of poor people than any other country. It is estimated that the fragile states have a third of the worlds poor population. These countries also have a third of the worlds unhealthy population.

Although the majority of the fragile states are developing countries, not all developing countries are fragile states. Long periods of instability in these countries have led to the deterioration of health facilities, and neglect of the necessary funding required in achieving equitable health status around the world. In general, the state must be able to provide a legitimate and rigid framework for the establishment of an effective health system.

Introduction

In a fragile state, the government is not in a position to provide a basic framework for the provision of quality health care. This has often resulted in a humanitarian crisis with a high rate of spread of diseases and rising mortality rates. The unhealthy population that results from such a state is not as productive as it is expected of a population with a reasonably stable healthcare system (Walker & Maxwell 2009, p.45). In particular, fragile states do not have a rigidly set framework for developing health policies.

Implementation of policies in the government agencies is also slow, and sometimes it is not implemented at all. Even the averagely endowed countries such as Pakistan remain with an ailing health system due to the relative instability of the country (Manning 2009, p.65).

Several international development agencies have taken the initiative to establish an aid system to help these countries establish an effective health care system. The common goal is to provide functional and effective health care within the community. This effort by the international agencies to strive to meet the requirements of the MDGs has several factors affecting it (Link 2007, p.57).

The first problem in the fragile states is the control of the health facilities and the healthcare system for proper development of the countries healthcare system. For the development agencies and the state to establish a functional healthcare system, there must be a grip on the resources necessary to set up an efficient health system.

The government should have control of the health sector for the millennium development goals to be achieved. Fragile states lack this permanent control of the health sector and resources. This makes the goal of achieving health for all people in the world by 2015 an unrealistic feat.

Analysis

For an effective health system to be realized, the government has to be transparent and accountable. This will help the country to attract donors for the health sector. It is important for the government to facilitate accountability for the available resources, and any fund intended for development in the health sector (Higginbotham & Leo
n 2001, p.45). Lack of transparency and accountability in the health sector is the major cause for the stagnation of the health sector in fragile states.

The health system lacks transparency often due to policies and the control that the government exerts on the usage of any funds intended for health care. The realization of MDGs pertaining to health care in these countries requires an administration that keeps an elaborate track of the spending of donor funds and the observation of policies in the developing countries (Carment 2001, p.152).

A fragile state may not be able to provide a constant and stable funding for the health sector. Other sources of income for the sector are then necessary. The government has to instil confidence in the donors and the people who are responsible for the health services provision at the grassroots level. The most important factor that facilitates this is the ability of the state to provide protection for the health services institutions and the public. The security provided for the health services institutions refers to the financial security of the healthcare system (Skolnik 2008, p.56).

In many countries that are considered fragile, physical violence is rampart, and the public is prone to this violence. The level of violence varies among the various states that are considered fragile. In this kind of an environment, the health institutions find it difficult to operate. In a country where the security systems have collapsed, it is difficult for the public to access quality health care due to the insecurity that health workers face.

This influences the specialised health services that can only be provided by specialised personnel. Fragile states may not be able to provide basic health facilities such as conventional basic health care. All these problems are caused by the instability of the country in terms of resources or political leadership. Failure of political leadership has more implications on the health sector of the country. Medical personnel may refuse to work in the country if the condition in the country is extremely dangerous.

This is particularly common in the failed states, where the rule of law is absent. The extensive destruction of the healthcare system by the violence often sets back the development of the health sector in such countries. A combination of factors contributes to this. The anarchy and disorder that prevails in such a state prevents the government from performing duties such as provision of basic health care.

On the other hand, economic instability in the countries results in a situation where the health provision agencies cannot set a standard for financing the provision of health care. Sometimes, the responsible financiers of the health system may fund it adequately. However, due to the frequent and unpredictable economic situation, the government and the health agencies are unable to provide quality health care to the public.

It is difficult to structure a program to help fragile states prosper in any sector. In such states, government policies change too frequently for the health agencies to establish a secure programme to improve healthcare in the country. The health care system is disrupted by the fluctuating financial situation in the country. The donors for the health sector are discouraged by the nature of financial and security systems in the health sector (Washer 2010, p.59).

Programmes established to promote health in fragile state are also prone to the effects of the fragile economy and healthcare structure. Preventive measures cannot be implemented to avert the occurrence of serious and widespread health conditions in the country. In the warring countries, humanitarian crises may claim lives for years and go unattended since the state of security is too poor for any willing volunteer or government to offer any health services to the public.

Fragile States and the International Community

Fragile states are a concern to the international community. These states cause a political risk to the rest of the world. The anarchy and instability that prevails in these countries may spread to other countries when problems such as terrorism, infectious diseases, and insurgency prevail in these countries. It is important for the international community to implement plans to stabilise the economic and the political structure of such countries.

To achieve full stability of these countries, it is necessary to provide goals for health care improvement. Recently, the United Nations initiated a program to counter the current state of poor health in most parts of the world by ensuring that people lead healthy lives. These goals are necessary to realise full productivity of the world population. In addition, health is necessary to promote the campaign to eradicate poverty in the world (Annan 2005, p.12).

The United Nations, which is in a position to oversee such a project for all countries in the world, is leading in the initiative to establish functional and efficient health care systems around the world by 2015. This is a millennium development goal for the world powers to achieve before the set time. This feat is supposed to be achieved by cooperation between the countries with poorly performing health sector and those with relatively plenty of resources (WHO 2011,p.45). Other health provision agencies other than the state machinery are also involved in the quest for a better health care by the set date.

While some countries with inefficient health systems are taking up the challenge and addressing the health issues, other states are not cooperative, or are not in a position to respond to the distress in the health sector. A third of the states around the world are fragile by definition (Rechel et al 2004, p.75).

These countries are also mostly populous countries, which are prone to humanitarian crisis and disease outbreaks. If these countries do not establish a good healthcare system soon, they might brew disaster for the whole of the world. Recent outbreak of lethal diseases is an example of the possible crises that could occur if the condition in these countries continues unabated (Picazo 2009, p.251). Examples of diseases that have plagued the world due to lack of mechanisms to control them is the bird flu and the viral disease Ebola. Ebola is a lethal disease from the swamps of Congo.

When the disease first broke out, it was detected in a population living in a swampy area in Congo (Garrett 1994, p.155). The country was in a state of war, and could not control the spread of the disease. The only factor that deterred the disease from becoming a lethal epidemic on a global scale is the speed with which it killed its victims. There was not enough time between infection and death of the victims to allow the disease to spread in a large population.

This is an example of a lethal disease that could plague the world due to the poor health provision systems in the use. Another example of a disease that could have brought a disaster to the world is the avian flu that affected humans. The disease began spreading from the Far East in an area with a poor population in a fragile economy (Wagstaff & Claeson 2004, p.37). The epidemic went on for several months unabated by the country of origin due to the poor alertness of the healthcare system.

The disease was stopped by its obvious symptoms that facilitated isolation of the affected individuals. This shows the effect that an infectious disease with mild symptoms could have on the world population in case such an epidemic emerged in the near future (Sama & Nguyen 2008, p.25). The current global healthcare system is too weak to defend against such an occurrence. This clearly brings out the importance of the Millennium Development Goals.

The current situation in the world does not support the United Nations aim of realising the MDGs. This is because the concerned countries are not cooperative in the endeavour (UNO 2003, p.12). For political reasons, the countries with the capability of giving aid to the poor countries are not willing to give the aid to the affected areas. This has led to lack of enough financial resources to deal with the health situation around the world (Liebowitz et al 2010, p.48).

Studies show that although developed countries continue to give aid, the funds are not directed at the most affected areas of the economy. Most of the funds are directed to agencies that misappropriate them. This trend has continued for decades since it is powered by the world politics (WHO 2005, p.62). The powerful countries are interested in spreading their influence in the world economy rather that funding plans to establish a system for global health.

On the other hand, the fragile states, which are mostly the developing economies, are keen to protect their sovereignty (Ottaway & Carothers 2000, p.95). Thus, they avoid funds with string attached from the developed nations. In some of the countries affected by the health problems, the government is not legitimate, and is interested at asserting its authority rather than ensuring global health by playing their parts in the international effort to achieve MDGs pertaining health.

In Africa, governments that are keen to maintain their authority have ignored the guidelines that govern the states that aim to attain the MDGs (United Nations 2003, p.64). In this continent, very few governments are on track towards achieving the said goals. The most probable result is that the countries in this continent are unlikely to achieve these MDGs by the set dates (Jensen 2010, p.82).

The current trend around the world shows that the direction that the world powers have taken in the quest to achieve health for all people according to the millennium development goals guidelines is not realistic. It is necessary to separate the political issues in the world from the health care system (Addison & Odedokun 2003, p.25).

A close analysis of the events around the world indicates that the world politics and the health issues cannot be handled on the same platform. While the world politics affect the individual countries in which they are active, health affects the whole world (Burnell 1997, p.125). This means that a health problem in one part of the worlds is likely to pose danger to the other parts of the world, irrespective of the economic status of the countries.

The solution can be found if the world economies succeed in separating their political issues from the policies that are meant to guide the efforts to realisation of the Millennium Development Goals (Rashid 2008, p.154). Experts estimate that the world has enough resources to deal with the disparities that it surfers in provision of social amenities and health care (Boyd 2008, p.52). The policies that govern the distribution of wealth around the world determine the course of the efforts to establish uniform health among the worlds countries and societies.

The worlds donors should focus more on the root causes of poverty in the quest to establish a uniform world economy. Funding development projects directly may not be the best solution for the words poor population. However, focussing on provision of social amenities such as health, and provision of quality education could be more productive (UN 2008, p.24).

Enhancement of these base factors is likely to result in a healthier population, which is more capable of production. Since the current approach to eradication of poverty and disease has failed to meet the expected results, the concerned authorities and organisations should adopt a different approach to the issue.

References

Addison, T., & Odedokun, M. O 2003, Donor funding of multilateral aid agencies: determining factors and revealed burden sharing, United Nations University, World Institute for Development Economics Research, Helsinki.

Annan, K. A 2005, The Millennium development goals, United Nations, New York.

Boyd, J. A 2008, An introduction to sustainable development, Earthscan, London.

Brinkerhoff, D. W 2007, Governance in post-conflict societies rebuilding fragile states, Routledge, London.

Brock, L 2011, Fragile states, Polity, Cambridge.

Burnell, P. J 1997, Foreign aid in a changing world, Open University Press, Buckingham, England.

Carment, D 2001, The Millennium Development Goals and Fragile States: Focusing on What Really Matters. Flethcher Forum, 12-45.

Garrett, L 1994, The coming plague: newly emerging diseases in a world out of balance, Farrar, Straus and Giroux, New York.

Higginbotham, H. N., & Leo
n 2001, Applying health social science: best practice in the developing world, Zed Books in association with International Forum for Social Sciences in Health, London.

Jensen, L 2010, Millenium Development Goals Report 2010, United Nations Dept. of Economic and Social Affairs, New York.

Levy, B. S 2008, War and public health (2nd ed.), Oxford University Press, New York.

Liebowitz, J., Schieber, R. A., & Andreadis, J. D 2010, Knowledge management in public health. CRC Press, Boca Raton, FL.

Link, K 2007, Understanding new, resurgent, and resistant diseases: how man and globalization create and spread illness, Praeger Publishers, Westport, Conn.

Manning, R. C 2009, Using indicators to encourage development: lessons from the Millenium Development Goals, DIIS. Copenhagen.

Manor, J 2007, Aid that works: successful development in fragile states, World Bank,Washington, DC.

WHO, W. H 2011, World Health Statistics 2011, World Health Organization, Geneva.

Ottaway, M., & Carothers, T 2000, Funding virtue: civil society aid and democracy promotion, Carnegie Endowment for International Peace, Washington, D.C.

Picazo, O. F 2009, Zambia health sector public expenditure review accounting for resources to improve effective service coverage, World Bank, Washington, D.C.

Rashid, A 2008, Descent into chaos: the United States and the failure of nation building in Pakistan, Afghanistan, and Central Asia, Viking, New York.

Rechel, B., Shapo, L., & McKee, M 2004, Millennium development goals for health in Europe and Central Asia relevance and policy implications, World Bank, Washington, D.C.

Sama, M., & Nguyen, V 2008 ,Governing health systems in Africa, Dakar: Council for the Development of Social Science Research in Africa, Washington, D.C.

Sharp, M 2011, Health, nutrition, and population in Madagascar, International Bank for Reconstruction and Development/World Bank, Washington D.C.

Skolnik, R. L 2008, Essentials of global health, Jones and Bartlett Publishers, Sudbury, Mass.

UN, U 2008, End poverty 2015: millenium development goals, United Nations Dept. of Public Information, New York.

UNO U. N 2003, Millenium development goals progress report 2003: Zambia, United Nations, Zambia.

United Nations, U. U 2003, Millennium development goals: country report, Swaziland, United Nations Country Team , Mbabane, Swaziland.

WHO, W 2005, Health and the millennium development goals, World Health Organization, Geneva, Switzerland.

Wagstaff, A., & Claeson, M 2004, The Millennium Development Goals for Health Rising to the Challenges, World Bank, Washington, DC.

Walker, P., & Maxwell, D. G 2009, Shaping the humanitarian world, Routledge, Milton Park, Abingdon, Oxon.

Washer, P 2010, Emerging infectious diseases and society, Palgrave Macmillan, New York.

It is axiomatic to argue that sometimes scientific researchers get carried away when identifying random variables where more than two groups especially in health outcomes are involved. They tend to misuse various statistical tools which might compromise the study when dealing with multiple comparisons. This has caused a great dilemma for many observers and the world at large. Public health for instance requires a lot of accuracy and any level of data fishing should be discouraged. (Sullivan, 2012)

The study of low back pain in the Ullensaker is one of the public health examples. The purpose of this study was to show whether musculoskeletal pain sites correlate with low back pain. The study identified the respondents with low back pain from adults who were enrolled in an epidemiological surgery for musculoskeletal pain within Ullensaker municipality in Norway in 1990. 4050 participants were sent questionnaires to participate in the study and of these 67% responded.

Individuals who registered low back pain were excluded leaving a total sample population of 1283 in 1990. A similar study was carried out 14 years later (2004) and 763 which was 59% of the population responded and formed part of the sample. After a 14 year follows up the results demonstrated that musculoskeletal pain sites significantly predict a low back pain. (Dahl, Grotle, Benth, and Natvig, 2008).

There are a number of problems that are involved in multiple comparisons; the main problem is that, as one adds each additional test, the probability that the researcher will conclude that there is a statistically significant effect across tests even when there are no such effect increases.

In Sullivan, L. M. (2012) the use of multiple comparisons brings a statistical problem, because there is the likelihood of an uncontrolled rate of rejecting null hypothesis or failing to reject a false null hypothesis; even in scenarios when it should not or should be rejected if the subsequent hypothesis is performed on the outcome of the same data. This raises the biggest dilemma of reducing the risk or rejecting or accepting the null hypothesis and maintaining the likelihood that there is, or there is, no correlation. ANOVA which is one of the Multiple Comparison Procedures can be used to correct this.

Finally, researchers using multiple comparisons may erroneously identify additional statistically significant effects in scenarios where there is the existence of nonzero true effects. When there is complex data, there is a high likelihood of, overinterpretation of patterns.

Rouse, (2010), data fishing which is also referred to as data dredging is a practice whereby large volumes of data are analyzed at once to get any correlation between the data. Data fishing can also be described as seeking to get more information than the data can really provide. Data fishing on many occasions results in relationships between variables which might be deduced as significant when in real situations it is not because many variables may be related by chance while others may be related by some unknown factors.

In the study low back pain in the Ullensaker the conclusion that musculoskeletal pain sites significantly predicts a low back pain could be misleading and is insignificant when factors like age, types of meals and gene inheritance could be the immediate direct cause of back pain. Although there has been constant misuse of data fishing, it can be useful when finding unexpected relationships that might have not been discovered. This will require further analysis because the concurrence of data might be coincidental.

References

Dahl, F.A., Grotle, M., Benth, J. S & Natvig,B. (2008). Data splitting as a counter measure against hypothesis fishing: with a case study of predictors for low back pain. European Journal of Epidemiology, 23(4): 237242. Web.

Rouse M. (2010). Data dredging (data fishing) Data Management. Web.

Sullivan, L. M. (2012). Essentials of biostatistics in public health (2nd Ed.)Sudbury, MA: Jones & Bartlett Learning.

Introduction

• Community health promotion is critical to improving population health.
• Nurses can help to improve access to services and health literacy.
• Developing an intervention requires assessing the population and its needs.
• Relevant theories can be used to design the intervention and target a population group.
• The presentation will describe the community, health needs, and the educational proposal.

Community health promotion plays a crucial role in improving population help. In particular, community-based interventions led by nurses are effective, as nurses have knowledge and skills to improve access to services and health literacy of the chosen population. Developing a practical community-based intervention requires assessing the population and its needs. Relevant theories can be used to design the intervention and ensure that it targets a specific population group. This presentation will describe the chosen community, its health needs, and the educational proposal.

Community

• The chosen community is Queens Village.
• Racially diverse: African American  60.9%, Asian  13.09%, Caucasian  8.78%, Hispanic-12% (Queens Village, 2018).
• Good infrastructure, including schools, hospitals, libraries, banks, and other resources (Community District Profiles, 2015).
• Different age groups present: children 0-17 (18%), young adults 18-24 (10%), adults 25-54 (43%), older adults (28%) (Niche, 2018).

The chosen community is Queens Village, NY. The population of Queens Village is racially diverse, with 60.9% African Americans, 13.09% Asians, 8.78% Caucasians, and 12% Hispanics. Queens Village has a well-developed infrastructure, with enough schools, hospitals, libraries, banks, shops, clinics, and other important resources. The population is also diverse in terms of age. 18% of residents are children aged 0 to 17, 10% are young adults aged 18-24, 43% are adults aged 25-54, and 28% are older adults. The diversity of the chosen population provides opportunities for various targeted health promotion efforts.

Target Population and Community

• The target population is adults 35-55.
• Have risk factors for heart disease, such as (Department of Health and Human Services, 2017):
  • alcohol or drug use;
  • smoking;
  • diabetes and prediabetes;
  • high body weight or obesity;
  • unhealthy diet;
  • having a family history of heart disease;
  • sedentary lifestyle;
• Target group can be located in local churches.

As the main health problem identified as part of the survey is heart disease, the target population are adults aged 35-55 years who have risk factors for heart disease. The risk factors include substance use, smoking, diabetes and prediabetes, obesity, unhealthy lifestyle, and family history of heart disease. The target group can be located and recruited in local churches, as the population of Queens Village has an abundance of religious resources.

Health Needs and Problem

• The primary health problem identified is heart disease.
• Heart disease is the leading cause of death in Queens Village  1581 deaths, death rate 133.4 (Community Health Profiles 2015, 2015).
• In New York City, heart disease death rate is 202.8 (Community Health Profiles 2015, 2015).
• Many adults in the area have lifestyle risks for heart disease, such as:
  • diabetes;
  • substance use;
  • obesity;
  • sedentary lifestyle, and more.

According to Community Health Profiles 2015 (2015), the most critical health problem in the area is heart disease. It is the leading cause of death in Queens Village, with 1581 deaths and a death rate of 133.4. Although the death rate for heart disease is higher in New York City (202.8), it is still important to address this health problem, as many adults in the area have lifestyle risks for heart disease. During the windshield survey, it was identified that many adults have obesity and lead a sedentary lifestyle, while population health statistics confirm that they also suffer from diabetes and substance use disorders.

Goals

• Healthy People 2020 goal is to improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke (ODPHP, 2014, para. 1).
• Healthy People 2020 objective is HDS-1, Increase overall cardiovascular health in the U.S. population (ODPHP, 2014, para. 14).
• Measurable goal: to improve peoples knowledge of cardiovascular disease prevention.
• Results: over 70% of participants agree on improved awareness of heart disease prevention.

As stated by the Office of Disease Prevention and Health Promotion (ODPHP, 2014), one of the crucial Healthy People 2020 goals is to improve cardiovascular health and quality of life through prevention, detection, and treatment of risk factors for heart attack and stroke (para. 1). The related Healthy People 2020 objective is HDS-1, which is to increase overall cardiovascular health in the U.S. population (para. 14). A measurable goal of the project is to improve peoples knowledge of cardiovascular disease prevention. Upon completion of the program, over 70% of participants should agree that their awareness of cardiovascular disease prevention strategies has improved.

Educational Topic

• Education will address cardiovascular disease prevention in adults.
• Research supports that education can be used to improve awareness of risk factors (Altman, Nunez de Ybarra, & Villablanca, 2014).
• Increased awareness can motivate people to engage in self-care (Feigin, Norrving, & Mensah, 2017).
• Self-care behaviors help to prevent cardiovascular disease (Riegel et al., 2017).
• Risk factor theory forms the basis of this program (Edelman & Kudzma, 2018).
• The majority of Queens Village adults have a medium level of education: high school degree  32%, college degree  31%, bachelors degree  15% (Niche, 2018).
• Good level of education would allow them to apprehend basic health information and make informed health decisions.

The proposed education project will address cardiovascular disease prevention in adults using lifestyle modifications. The project is largely based on the risk factor theory (Edelman & Kudzma, 2018). The effectiveness of this project is supported by research. First of all, research supports that education can be used to improve awareness of risk factors (Altman, Nunez de Ybarra, & Villablanca, 2014). Secondly, increased awareness can motivate people to engage in self-care (Feigin, Norrving, & Mensah, 2017). Thirdly, appropriate self-care behaviors, such as diet and exercise, help to prevent cardiovascular disease (Riegel et al., 2017). Thus, the project will help to prevent heart disease by educating participants on lifestyle health promotion. The majority of Queens Village adults have a medium level of education. For instance, 32% of people have a high school degree, and 31% have a college degree (Niche, 2018). Thus, a good level of education shows that they will be able to apprehend basic health information and make informed health decisions.

Educational Proposal  Teaching Content

• Teaching content will focus on risk factors for heart disease and lifestyle prevention.
• Promoting physical activity and a healthy diet.
• Encouraging people to avoid substance use and smoking.
• Providing information about health services.

The teaching content will focus on risk factors and prevention methods. It will promote physical activity and healthy eating, encourage people to avoid substance use and cease smoking, and provide information about health services available in the community to improve access to care.

Educational Proposal  Teaching Methods

• Teaching methods are determined based on (Eldredge, Markham, Ruiter, Kok, & Parcel, 2016):
  • group size;
  • facility;
  • length of intervention;
  • goals of education.
• Teaching methods used should give meaningful information.
• Presentations are often used to encourage lifestyle modifications (Sink et al., 2015).
• Chosen methods are weekly interactive presentations carried out in 60 to 90-minute classes.

According to Eldredge, Markham, Ruiter, Kok, and Parcel (2016), teaching methods depend on the group size, the facility, the length of an intervention, and the goals of education. To fulfill the goals of this project, teaching methods should provide meaningful information. For instance, presentations are often used to encourage lifestyle modifications (Sink et al., 2015). Thus the chosen methods are weekly interactive presentations carried out in 60 to 90-minute classes.

Educational Proposal  Expected Outcomes

• Knowledge of risk factors for heart disease.
• Motivation to improve lifestyle.
• Awareness of community resources.
• Inspiration to promote lifestyle change.

As a result of the project, participants will be able to name and explain risk factors for heart disease. They will also be able to assess their risk of heart disease. Participants will also obtain information about community resources available to them. Finally, they will be motivated to improve their lifestyle and promote lifestyle change in their families, workplaces, and other groups.

Educational Proposal  Evaluation Method

• Evaluation methods depend on the goal of the intervention (Eldredge et al., 2016).
• The goal is to improve peoples knowledge.
• Surveys are quick and can be expanded to provide more meaningful information.
• Surveys with statements rated on Likert Scale should be used to evaluate the intervention.

The choice of a particular evaluation method depends on the intervention. As the goal is to improve peoples knowledge, surveys can be used for self-evaluation. Surveys will contain statements that can be rated on a Likert scale.

Conclusion

• The proposed educational program is based on risk factor theory.
• Research supports the use of education for health promotion.
• The project will promote autonomy and self-care behaviors.
• Enhanced motivation and awareness will have a positive effect on heart disease prevention.

Overall, the proposed educational program is based on risk factor theory and is supported by research. The project will promote autonomy and self-care behaviors, while also providing enhanced motivation and awareness. It is likely that education will have a positive long-term effect on heart disease prevention in the area.

References

• Altman, R., Nunez de Ybarra, J., & Villablanca, A. C. (2014). Community-based cardiovascular disease prevention to reduce cardiometabolic risk in Latina women: A pilot program. Journal of Womens Health, 23(4), 350-357.
• Community District Profiles. (2015). Queens community district 13. Web.
• Community Health Profiles 2015. (2015). Queens community district 13: Queens Village. Web.
• Department of Health and Human Services (DHHS). (2017). What are the risk factors for heart disease? Web.
• Edelman, C. L., Kudzma, E. C. (2018). Health promotion throughout the lifespan (9th ed.). St. Louis, MO: Elsevier.
• Eldredge, L. K. B., Markham, C. M., Ruiter, R. A., Kok, G., & Parcel, G. S. (2016). Planning health promotion programs: An intervention mapping approach (4th ed.). John Wiley & Sons.
• Feigin, V. L., Norrving, B., & Mensah, G. A. (2017). Primary prevention of cardiovascular disease through population-wide motivational strategies: Insights from using smartphones in stroke prevention. BMJ Global Health, 2(2), e000306.
• Niche. (2018). Queens Village. Web.
• Office of Disease Prevention and Health Promotion (ODPHP). (2014). Heart disease and stroke. Web.
• Queens Village, New York, NY demographics. (2018). Web.
• Riegel, B., Moser, D. K., Buck, H. G., Dickson, V. V., Dunbar, S. B., Lee, C. S., & Webber, D. E. (2017). Selfcare for the prevention and management of cardiovascular disease and stroke: A scientific statement for healthcare professionals from the American Heart Association. Journal of the American Heart Association, 6(9), e006997.
• Sink, K. M., Espeland, M. A., Castro, C. M., Church, T., Cohen, R., Dodson, J. A., & Williamson, J. D. (2015). Effect of a 24-month physical activity intervention vs health education on cognitive outcomes in sedentary older adults: The LIFE randomized trial. Journal of the American Medical Association, 314(8), 781-790.

Amy is looking forward to starting a new chapter and wants to meet many new people. However, several red flags in her statements singled out that the girl might experience difficulties in unknown circumstances and the environment. As Amy has been visiting me for six years, we have built a trusting relationship. She knows that I respect her confidentiality, thus she will probably share more information about her college expectations and listen to my recommendations.

The first red flag necessary to clarify with Amy is her prioritization to meet new people and attend parties, not gaining knowledge. I will start asking her about the college, its faculties, the number of students, and if Amy tells more about her desire to make new friends at the parties, the necessity to educate her about the balance between studying and socializing will appear. I will also check Amys stress tolerance and ask how she deals with difficult situations. The inability to cope with such experiences combined with a lack of parental control might lead adolescents to develop addictions like alcohol or drugs (Truong et al., 2017). Moreover, these poor health habits are on the list of the leading causes of adolescent mortality, therefore, it is vital to discuss such attitudes as a preventative health measure.

Another red flag in Amys statements is that she has never lived far away from home. To gain more information about her readiness to put herself in a different environment, I will ask her to tell more about the place she is going to live. After listening to her, I will ask if she wants to receive some recommendations to maintain a good mood, motivation to study, and thriving health even in entirely new conditions. Amy is the representative of late adolescence, and she understands that her everyday choices and habits affect her health and are necessary to be managed consciously. Kim and Kim (2020) state that improving adolescents future orientations about their life chances may improve adult health (p. 6). I will clarify if Amy has expectations about her plans after college and plans to do anything particular. Her response will help me assess in which aspects she might meet mental or physical health obstacles and share preventative practices with her.

The last red flag is Amys concerns about the parents worrying about her leaving for the first time and for such an extended period. She states that they also studied away from home, and it might mean they feel that their daughter is not ready for such an experience. Another reason for their worries might be family relationships as factors like a lack of trust, inadequate expectations, and general misunderstanding can severely affect an adolescents grades and future (Kapali et al., 2019). I will ask Amy if she wants to tell me anything about how her parents talk to her to find out if there are any particular threats they are afraid she might face.

Adolescents can treat counseling about health as an unnecessary activity due to their perception of youth and their bodies endless abilities. However, such conversation can help students like Amy develop habits to maintain prosperous physical and mental conditions through their college years and later in life. Addressing these red flags during the visit is necessary to discover weak points and provide an adolescent with preventative practices she will probably need in her new life.

References

Kapali, G. D., Neupane, S., & Panta, G. (2019). A study on academic stress, parent-adolescent relationship with parents, and academic achievement of adolescent students. Journal of Health and Allied Sciences, 9(2), 70-74. Web.

Kim, T., & Kim, J. (2020). Linking adolescent future expectations to health in adulthood: Evidence and mechanisms.Social Science & Medicine, 263, 113282. Web.

Truong, A., Moukaddam, N., Toledo, A., & Onigu-Otite, E. (2017). Addictive disorders in adolescents.Psychiatric Clinics, 40(3), 475-486. Web.

Introduction

When selecting a health IT (HIT) system, several stakeholders should be involved to work collaboratively for the success of the exercise. According to Nelson and Staggers (2018), any form of HIT initiative requires the close coordination of various players to ensure that all health-related data are managed well and patient privacy is protected to enhance service delivery. The following are the stakeholders that are involved in the selection of a HIT system  Board members, chief executive officer, chief financial officer, chief medical officer, medical department leaders, clinicians, office managers, billing department, and front office staff members.

Goals and Interests

Clinical Goals (Chief Medical Officer, Medical Department Leaders, and Clinicians)

Chief medical officer and medical department leaders have shared clinical goals and interests. They are important to this selection process because they offer useful clinical advice and insights concerning how the HIT system should be operated. They give their input and feedback from a leadership perspective by raising all pertinent issues upfront. Specifically, these stakeholders are concerned with the hospitals needs together with how the proposed system would affect the overall organizational mission and vision. On their part, clinicians play a central role in the selection of a HIT system because they are involved in its day-to-day usage to facilitate decision-making for quality and timely service delivery to patients (Van de Wetering, 2018). Therefore, they know which system would be most suitable to address the underlying needs to ensure that patient needs are addressed comprehensively for improved care provision. Given that clinicians are mainly the end-users of HIT systems, their feedback and input are invaluable.

Operational Goals (Office Managers, Front Office Staff, and Billing Department)

For any HIT system to work effectively, office managers, front office staff, and those working in the billing department should be involved. Office managers and front office staff are the first individuals to engage patients when they visit a healthcare setup. Therefore, the input of these stakeholders is important, as they know the nature of problems that should be addressed by the HIT system. Their goal is to ensure that the system facilitates quick and easy customer service, especially when taking the initial patient information and entering it into the system. Similarly, the billing department is involved to ensure that the proposed system integrates functions that support the billing process. For instance, the HIT should be robust enough to link with the various health insurance companies and different payer systems available in the market.

Financial Goals (Board Members, Chief Executive Officer, and Chief Financial Officer)

The selection and implementation of any HIT system require a substantial amount of resources, and thus the management plays a central role in the process. The main goal of this group of stakeholders is to gauge the ability of the facility to finance the implementation of the selected system. Additionally, these stakeholders are focused on how the system would improve service delivery and affect the overall financial well-being of the hospital. Overall, this team ensures that the HIT system has a good return on investment and improved performance of all sectors in the organization.

Conclusion

The selection of a HIT system should involve all key stakeholders working as a team to make the right decisions for the improvement of service delivery, patient satisfaction, and safety. The different stakeholders pursue clinical, operational, and financial goals for the overall performance of the healthcare facility. The key stakeholders include medical officers, the chief executive officer, front office staff members, and clinicians among others as highlighted in this paper.

References

Nelson, R., & Staggers, N. (2018). Health informatics: An interprofessional approach (2^nd ed.). Elsevier.

Van de Wetering, R. (2018). IT-enabled clinical decision support: An empirical study on antecedents and mechanisms. Journal of Healthcare Engineering, 110. Web.