Category: Population

Affordable Care Act (ACA) is associated with the recent reformation of the U.S. health care system. To conclude about the role and effectiveness of Affordable Care Act, it is necessary to focus on such a research question as the possibilities for improving the patient health outcomes (Chang & Davis, 2013, p. 407). Thus, the main question which should be asked in this context is the following one: Will Affordable Care Act contribute to improving the patient health outcomes in the United States? To answer this question in detail, it is necessary to focus on the researches conducted in the field and on the primary data presented in the form of opinions which are provided by the Americans. From this point, the target population used for collecting the data should include potential patients or users of the new insurance system and physicians and nurses who work within the new environments. To discuss the process of the target population selection, it is necessary to focus on the selection procedures, sample size, the data collection methods, and on the statistics used to analyze the data in the research.

Rationale for the Identified Target Population

The target population selection process includes several stages which are associated with determining the research question and the purpose of the study. The target population as the general population to be addressed in the research includes patients and physicians as the main stakeholders of the health care industry (Jacobsen, 2012, p. 106-107). To select the population, it is necessary to focus on potential patients who used, use, or plan to use the specific health care programs and insurances associated with Affordable Care Act. From this point, the sample population is selected to provide the data on the Americans’ vision of the policies, plans, and insurance strategies associated with Affordable Care Act. The rationale for the target population is based on the necessity to receive the primary data on the observed and expected patient health outcomes while referring to the sample population’s personal background, professional practice, and personal experience (Furrow, 2011, p. 1727). To focus on the complete picture, it is relevant to select the sample population from healthcare practitioners and potential or current patients as users of the ACA plans.

Method for Determining the Appropriate Sample Size

The size of the studied sample depends on the character of the research. The use of the data referred to the sample population in the current research plays the supportive role in order to provide more evidence and support the conclusions drawn with the focus on the systematic review. That is why, there are such criteria to determine the appropriate sample size as accessibility and the possibility to use convenience sampling (Jacobsen, 2012, p. 117-119). As a result, the appropriate sample size is 15 persons who can be easily accessed and interviewed. The focus on convenience sampling provides the researcher with the opportunity to collect the individual data which is referred to the experience and opinions of patients, full-time nurses, and practicing physicians.

Rationale for Selecting the Data Collection Methodology

The proposed data collection method is the use of questionnaires for the primary analysis part of the research. The researcher intends to use the questionnaire in order to conduct the face-to-face and online interviews. The process of preparing the working questionnaire includes such stages as the development of the questionnaire in relation to set topics, the choice of close-ended and open-ended questions and answer types, formatting layout, and the use of the questionnaire during the interview (Jacobsen, 2012, p. 126; Johnson, Hassin, Baker, Bajger, & Treuer, 2013, p. e81521). The use of questionnaires to conduct the interview and to collect the qualitative data can be discussed as one of the most effective methods used for working with rather small sample populations.

The use of questionnaires to conduct the interview is also appropriate while referring to the principles of the convenience sampling because of the necessity to receive the individual qualitative data. The questions developed for the interview should discuss such topics and aspects as the presence of the real experience in using plans and insurance programs associated with Affordable Care Act and the assessment of the patient health outcomes. To work with the research literature, it is necessary to screen the articles and examine the studies’ data (Hofer, Abraham, & Moscovice, 2011, p. 69; Neutens & Rubinson, 2010, p. 24; Sommers, Long, & Baicker, 2014, p. 585).

Descriptive Statistics Appropriate for the Research

The proposed research is based on collecting and analyzing the qualitative data. However, the use of descriptive statistics is also necessary for drawing inferences, and it can be used in order to discuss the qualitative data as really descriptive in relation to the studied population. Thus, it is important to describe the sample population and to discuss the percentage in relation to the improvement of the health outcomes for the patients, while focusing on strengths and weaknesses of Affordable Care Act. In this research, it is desirable to use the principles of the qualitative study combined with the principles of using descriptive statistics in order to present the adequate description of the situation associated with patients’ health outcomes in the form of numbers (Jacobsen, 2012, p. 189). However, the use of numerical summaries about the tendencies and description of the sample population is not the only way to present the descriptive statistics results. It is also possible to use graphs in order to reflect the conclusions made during the statistical analysis.

Statistical Tests Appropriate to Be Used to Analyze the Data

Statistical tests are usually used in comparative statistics. While referring to the descriptive statistics used in the research, it is necessary to focus on the measures of central tendency (Jacobsen, 2012, p. 190). While analyzing the participants’ answers to the questions in the interview, it is necessary to focus on the average response related to positive and negative experiences associated with using programs associated Affordable Care Act. The measures of central tendency are also important to be referred to while discussing the potential health outcomes for patients who use Affordable Care Act.

Conclusion

The selection of the target population and the selection of the data collection methods are the important stages in the research which influence the reliability and validity of the study. That is why, it is important to focus on effective criteria to use the sample population and data collection methods. To conduct the research, it is reasonable to select the sample population according to the principle of accessibility. The focus on questionnaires and interviews is appropriate because of the approach’s easiness. To analyze the collected data, it is significant to use the descriptive statistics in order to conclude about the potential patient health outcomes.

References

Chang, T., & Davis, M. (2013). Potential adult Medicaid beneficiaries under the Patient Protection and Affordable Care Act compared with current adult Medicaid beneficiaries. Annals of Family Medicine, 11(5), 407-411.

Furrow, B. (2011). Regulating patient safety: The Patient Protection and Affordable Care Act. University of Pennsylvania Law Review, 159(1), 1727-1775.

Hofer, A., Abraham, J., & Moscovice, I. (2011). Expansion of coverage under the Patient Protection and Affordable Care Act and primary care utilization. The Milbank Quarterly, 89(1), 69–89.

Jacobsen, K. (2012). Introduction to health research methods: A practical guide. Sudbury, MA: Jones and Bartlett Publishers.

Johnson, E., Hassin, R., Baker, T., Bajger, A., & Treuer, G. (2013). Can consumers make Affordable Care Affordable? The value of choice architecture. Plos One, 8(12), e81521- e81527.

Neutens, J., & Rubinson, L. (2010). Research techniques for the health sciences. San Francisco, CA: Pearson Education.

Sommers, B., Long, S., & Baicker, K. (2014). Changes in mortality after Massachusetts Health Care Reform: A quasi-experimental study. Annals of Internal Medicine, 160(1), 585-593.

Introduction

Russia is a country located in northern part of Eurasia. This country is the largest country on earth considering the land area. Formerly known as USSR, Russia is made up of 83 federal subjects. The country is one of the richest in the world. According to DaVanzo and Grammich (2001), Russia has the largest mineral reserves in the world. The country also has the largest forest cover in the world, and the largest fresh water lake.

This makes the country very significant in the world history. Given this big size of the country, it has had a number of issues in regard to health of its population. Although the government has made great effort to look into health issues, reports indicate that the country stiff has a number of issues of health to address. This research focuses on these health concerns that this country faces.

Analysis of the Country

Historical Issues

This country has a rich history that spans several years back. East Slavic state, which was the first state to be established in this country, was developed in the 9^th century. The state developed, but did not manage to rise over other existing nations in the regions. In 1721, Russia became an empire under the leadership of Peter the Great. Following the Russian revolution in the early 19^th century, the Union of Soviet Socialist Republic (USSR) was formed in December 30, 1922. The Union of Soviet Socialist Republic was a very strong nation that emerged as one of the superpowers following the Second World War. Unfortunately, USSR broke, leaving Russia as the strongest and largest country in 1991.

Economic Issues

The economy of this country is very strong. The country’s economy is considered eighth largest in the world by GDP. As stated above, this country has the largest mineral deposits in the world. Generally, the Russians are living above the poverty line, with their infrastructure well developed. The growth of the economy and the living standards has both been on the rise. This country is a member of various economic organizations in the world and in Europe.

Social Issues

From the social perspective, Russia is one of the countries with unique national heritage which is rare in Europe. There are communities in this country that have maintained their national heritage such as beliefs towards given environmental factors and religion. Although the country was the force behind communism, the country has since embraced capitalism that it once opposed vehemently. The country has semi-presidential system, with the president being elected through democratic elections. The country respects human rights and freedom as entrenched in the international human rights commission.

Technological Issues

Russia is one of the leading states in terms of technology. Technological developments of this country emerged after the Second World War, during the cold war. There was a massive competition between the USSR and the United States over supremacy in technology. While the United States focused on technological development in various sectors, USSR focused on technological development in the field of weaponry. Russia currently has the largest stockpile of weapons of mass destruction. It also has advanced technologies in other sectors of economy including the health sector.

Geographical and Climate Issues of the Russia

Russia has a large land mass with almost eight different time zones. This makes the country experience different climatic condition in different cities. The country generally experiences humid continental climate, except the tundra region and the extreme Southeast. However, a section of the country bordering the Indian Ocean experiences warm air from the ocean. The Northern region experiences extremely cold temperatures, especially at the poles which have below 71.2 degrees centigrade. The regions around Arctic Islands experience polar climate.

Health Status and Healthcare System in Russia

According to Rivkin-Fish (2005), Russia was once ranked as a country with the highest number of hospitals, physicians, and health workers than any country in the world. This figure has been dropping within the last two decades, especially following the fall of the Union. There are a number of diseases that have claimed lives of many Russians in the last one decade. The leading killer disease in this country is cardiovascular disease which accounts for about 60 percent of deaths in this country. Other diseases include cancer, tuberculosis, digestive and respiratory diseases. HIV/AIDs are fast becoming one of the greatest health concerns in this country. Almost unheard of in this country when the country was part of the union, almost one million Russians are currently living with HIV/AIDs.

Relationship between Russia and the World

Abstract

Russia has had both cordial and tensed relationship with its neighbors. This is partially so due to the policy it adopted of communism that divided the world into two main blocks. The stockpile of arms at its disposal has also caused a lot of tension between it and various nations around the world. The need to be seen as a world power is also creating tensions between Russia other world powers.

Russia and its Neighbors

Russia has had conflicts with its neighbors for a long time. The relationship between Russia and Georgia, which was seen as the country that led the revolution resulting into the fall of USSR, has been tense. Although the two have not engaged in war, Russia has considered Georgia as a state that was used by the United States to bring down the powerful USSR. It has however, had a relatively warm relationship with countries like Poland among other neighbors.

Russia and the World

On the international scale, Russia has been considered as either a friend or foe depending on the inclination that the country has towards the idealisms taken by the USSR. The United States remains the country which has had a tense relationship with this country. The cold war era saw the two countries amass weapons of mass destruction ready to attack each other at the slightest provocation. However, it has had a very cordial relationship with other states that adopted communism such as Cuba and China.

Demographic Data

Ethnic Composition

According to Hardt (2003), Russian federation is a home for many ethnic groups. The country hosts about 160 different ethnic groups. The Russians constitutes about 81% of the total population. This ethnic group is believed to have its origin from the east Slavic tribes. Russians are generally light Skinned with light eyes and hair. The other ethnic groups include the Tatars with 3.9% 0f the total population who are believed to have its origin from the Gobi regions in the 5^th century, the Ukrainians with 2.0%, Bashkirs 1.1%, Chuvash 1.0%, and other ethnic groups constituting about 12% of the total population.

Religious Groupings

The most common and widespread religion that carries the largest population of Russia is the Eastern Orthodox Christianity.73% of Russian entire population is believed to be Orthodoxy, 6% 0f the population is Muslim, 1% of the population falls in other faiths and the remaining population comprise the non-religious group. Because of the culture of this society, all the non-religious groupings are associated with the orthodox faith.

It is believed out of the whole population of Russia, close to 16% practice fasting in the period of lent. Christianity branches in Russia include the Roman Catholicism, Baptist, Lutherans, Pentecostals and other protestant organizations. In Russia, there is Judaism, Buddhism, and Krishnaism among others (Rivkin-Fish, 2005). According to Lovett-Scott and Prather (2014), 9.9% of the population of Russia, comprise the ethnic groups that traditionally observed Islamic religion.

Cultural Characteristics

According to Manning and Tikhonova (2009), Russian culture historically is rich. Their culture is demonstrated in various aspects of life including their feeding habits, arts, traditions, attitudes and many others. A large part of the Russian population uses the Russian language as the official and only language. The Russians observe their traditional folk music including the traditional dances and have a unified formal way of greeting different people depending on the level of their relationship.

Researches show that most of the Russian families are small with one or two children. Their favorite foods of Russians include potatoes, carrots, cabbages, meat, and beets among others, although during lent period, Russians observe fasting forbidding consumption of foods like meat, eggs, and butter. Worldwide, the Russian’s literature is among the best in the world. Their literature is well known for its developed and influential nature. Russians believe in collective spirit and working in groups an aspect is observed to date. Russians also have a way in which they do name their children, and they so much value gift giving and dining, business and dressing etiquettes. Russians also practice architecture. Due to its rich culture, Russia attracts many tourists across the world.

Education Levels

Education system in Russia is comprehensively developed. In Russia, education is regulated and controlled by the ministry of education and science. This state has more than 50 universities and over 700 institutions of higher learning. Almost everyone in Russia is educated. Currently, the literacy level in Russia is 99.4% with 99.7% of being men and 99.2% women. The World Bank 2008 statistics should that over 54% of the workers in Russia at least a college or tertiary level of education. Russia has the highest number of population attaining education to college level.47.7% of Russians have completed secondary education.

Health Statistics

The status of health in this country has been on a decline since 1991 when the Soviet Union officially brought to an end (Rivkin-Fish, 2005). Many cases have since then been reported concerning the rise of diseases like cancer, HIV/AIDs, tuberculosis, heart attack and many alcoholic related diseases. According to Manning and Tikhonova (2009), over the last decade, Russian’s life expectancy has reduced from 70 years to about 65 years.

Men form the largest part of the population that is at risk. They live 13 years less compared to their female counterparts. Infant mortality is also considerably to be much higher than most of the other industrialized countries around the world. In 2006 cases, 15.1 per every 1,000 of Russian population were reported. Towards the close of 2005, the number of registered cases of HIV/AIDs was about 350,000 in Russia, with the highest level experienced in the year 2001 (Rivkin-Fish, 2005). In spite of its poor health status, Russia has shined in the fields of medicine including heart and laser eye surgery.

Population Affected

Generally poor health status in Russia affects almost every one and especially the poor and women in the society.Depending on the disease, the vulnerability of the any given population vary, for example, the Russian men are more susceptible to Tuberculosis compared to their female counterparts. However, statistics has it that more women than men are infected with HIV/AIDs. The table below presents this.

The above statistics shows that prostitutes have the highest risk of getting infected by HIV. This is because of the nature of their profession. The second most affected population is those who abuse alcohol the then prisoners.

Problem Identification

Major Health Concern

Globally health is a major issue. In Russia as mentioned earlier, health status is highly on decline.Alcoholism and drug abuse in Russia is high. These drugs are mainly taken into the body through injections. The major health concern in Russia is HIV/AIDs. This is tragedy among the Russians has greatly contributed to the low status of health in Russia. It is believed that about 1.2 million people in Russia are HIV-positive.

In 2008 alone, according to Russian Federal AIDS Centre, 471,676 cases were reported. By November the year 2012 the figure had raised to 703,781.This condition has stigmatized many in this nation. The rationale for choosing this particular health concern is because of its effect in the social welfare of the infected person and the family. HIV/AIDS is not one of the leading causes of death. However, to those who get infected of HIV in this country, the effect is always big and devastating. It is for this reason that the researcher focused on this issue.

Economic and Social Impact of HIV/AIDs

According to Hardt (2003), Russia is the fastest growing state in HIV/AIDs with its new cases doubling after every twelve months. The devastating impacts of this health problem in Russia have greatly been felt. HIV/AIDs have led to many suffering and deaths in Russia. Since the prevalence of the disease is common among the youngsters, upon their death the country is rendered poor economically by losing the human resource and economic potential in these youths. Their deaths also reduce the taxable population in Russia lowering the economic power of the nation. The world health organization reports that there is a link between a reduced life expectancy and the decrease of gross national product. This health issue has directly slowed down the economic growth rate of Russia reducing the Gross Domestic Product (GDP) per capita.

Scope of the Problem

Of the 143 million Russians, about one million people are infected with HIV. This means that the population affected is less than one percent. This may be seen as a negligible percentage, but the impact it has on the infected, his or her family and friends, and medical officers expands the scope of this problem significantly.

Historical Development of HIV/AIDs

Historically, HIV found its way to Russia from the discovery of man in Africa who was infected. This man transmitted the virus to 15 soviet soldiers who later spread the disease to the rest of the world. In Russia, no privacy laws existed before and therefore the list of these 15 men was published and the infection was made open to the public. In the 1980’s, mandatory tests were instituted within the Soviet Union, where positive results were seriously dealt with. This time safe sex did not exist and drug abuse rate was high. There was also poor networking of nations and poor information flow after the Soviet Union broke. These Factors provided a fertile ground for HIV transmission in Russia and worldwide. Today HIV/AIDs remain a growing problem in Russia.

World Wide Disparity of the Problem

HIV/AIDS is a global problem. The issue of this disease is a major health concern in many nations today. Cases in many nations on HIV have been on rise since the discovery of the virus. Most of the developing countries have greatly been affected. This is due to social economic impacts that come along with the infection of the HIV virus. Nations are crying due to the daily increased mortality rate reported. Solutions to this tragedy are sourced aggressively by many nations worldwide. No matter the combined efforts by nations to find the cure to problem, their efforts are in vain because the disease has no cure. HIV/AIDs remain a global monster.

Effects of Globalization and Technology on HIV/AIDs

Globalization and technology has had impacts on HIV/AIDs. The travelers who come to visit Russia due to globalization have been reported to be part of those who infect commercial sex workers in this country. However, technological inventions have helped come up with various drugs such as antiretroviral drugs to help minimize growth of the virus in the body.

Effects of HIV/AIDs if Left Unchecked

There is a serious need for the Russian government to address this HIV/AIDs problem urgently and systematically. This is because the pandemic is claiming the deaths of many people each day. The economy status of Russia is of concern and its growth can only be realized by addressing the HIV/AIDs issue in the state. If not checked, the state of Russia will continue facing the serious social and economic crisis that come because of HIV/AIDs infection within the country. If the problem is not confronted, the transmission rate of the disease will continue increasing and the Russian economy will continue to deteriorate.

International Healthcare Organization Involved in the Delivery of Healthcare in Russia

The fight against HIV/AIDs in Russia calls for international aid. The Russian government has spent billions on finding a solution to this crisis but their efforts alone is not enough. The HIV/AIDs condition in Russia has drawn attention from many international organizations. Among these international organizations includes the world health organization and World Bank is also making great efforts in helping this nation overcome this crisis. The country through donations and other relevant assistance from these international healthcare organizations has been able to hold and offer trainings on HIV/AIDs, offer counselling to the affected people and also provide some medical care to the victims.

Summary and Conclusion

Russia has one of the fastest developing economies in the world. With vast mineral resources and a wide population, this country can experience massive economic development. However, various health issues have affected this growth. HIV/AIDs infection has massively affected this nation. The impact of HIV/AIDs to the victim and the family and friends is massive. The country is also forced to increase its expenditure trying to take care of the victims impeding its development.

References

DaVanzo, J., & Grammich, C. (2001). Dire demographics: Population trends in the Russian Federation. Santa Monica: Rand.

Hardt, J. P. (2003). Russia’s uncertain economic future. Armonk: M.E. Sharpe.

Lovett-Scott, M., & Prather, F. (2014). Global health systems: Comparing strategies for delivering health services. Burlington: Jones & Bartlett Learning.

Manning, N. P., & Tikhonova, N. E. (2009). Health and health care in the new Russia. Farnham: Ashgate.

Rivkin-Fish, M. R. (2005). Women’s health in post-Soviet Russia: The politics of intervention. Bloomington: Indiana University Press.

Developmental origins of health and Disease

The developmental origins of health and diseases are the environmental influences on health that start before one’s birth, however, affecting the life of an individual throughout his or her life. These factors affect the tissue homeostasis and physiology of a human being. Other issues influence the life of an individual; they are mainly nutrition and metabolic aspects (Mercy & Saul, 2009).

The impact of childhood policies and programs on lifelong health

Due to the influence of the environment on the wellbeing of people, the need for devising policies for a sustainable future helps in supporting the vitality and productivity of society. The early years of one’s life are essential for lifelong healthy development, which starts for a child from the maintenance of a healthy mother during her pregnancy. “Early experiences strengthen biological systems for children and allow them to thrive into healthy adults” (Guyer, Ma, Grason, Frick, Perry, Sharkey & McIntosh, 2009). Strong and focused policies for the promotion of the health of children is similar to laying the foundation for the construction of a brain with full capacity for the achievement of skills necessary for productive adulthood. Policies are necessary for the promotion of responsive and stable relationships. They also provide a safe environment for chemical and physical development in individuals, promote nutritional support and develop the concept of maintenance of a multi-sectored perspective to provide strong early childhood foundations for lifelong health (Guyer, Ma, Grason, Frick, Perry, Sharkey & McIntosh, 2009).

“We are all born equal” constrains how society thinks about the early life

The concept of ‘we are all born equal’ limits the society to thinking that the needs in early development stages remain standard for all individuals. Childhood is an important part of the life of an individual and requires high priority for the achievement of equity in its reinforcement for healthy adulthood. The assumption that people are equal leads to the overlooking of environmental influences that create some differences in people.

Influences of the concept

The concept of ‘we are all equal’ masks the physiological differences in people resulting from environmental influences. There is a difference in early childhood care and development support for children; the assumption of people being equal aggravates that factor by not looking for means of helping the children in diverse communities for them to develop normally and healthily (Joyce, Racine & Yunzal-Butler, 2008).

Developmental origins of life and health influence on adult morbidity.

Using developmental origins of life and health concepts have a positive influence on adult morbidity through the restoration of health statuses and provision of resources. Firstly, the poor health of a mother before birth influences the kind of disease or diseases the person has in their childhood and adulthood. Maintenance of good health during the pregnancy through such means as proper nutrition leads to delivery of healthy children with possible avoidance of diseases in their adulthood. Secondly, low incomes lead to a lack of resources and can prevent insuring of parents. However, the availability of insurance resources ensures the good health of families and helps in the control of diseases throughout the developmental stages of a child into adulthood.

Challenges to addressing upstream risks

Social and income determinants on health care challenges in the addressing of the upstream risk and protective determinants of health in current health policies and programs in the U.S. or other countries. These are challenges because there are some cultural societies, which constrain policy changes while in some countries, income constraints reduce the capacities for maintenance of sustainable health programs.

Suggestions for improving asthma conditions

There need to be policies on equitable healthcare provision. Secondly, healthcare should be accessible to uninsured and underinsured people to reduce cases of onset of chronic conditions, for example, asthma (Joyce, Racine & Yunzal-Butler, 2008).

References

Guyer, B., Ma, S., Grason, H., Frick, K., Perry, D., Sharkey, A., & McIntosh, J. (2009). Early childhood health promotion and its life-course health consequences. Academic Pediatrics, 9, 142-149

Joyce, T., Racine, A., & Yunzal-Butler, C. (2008). Reassessing the WIC effect: Evidence from the preg­nancy nutrition surveillance system. Journal of Policy Analysis and Management, 27, 277-303.

Mercy, J. A., & Saul, J. (2009). Creating a healthier fu­ture through early interventions for children. JAMA, 301(21), 2262-2264.

The number of falls and subsequent injuries is increasing as the population is aged 65 years and overgrows. Balance issues and falls are very frequent in the elderly, and they significantly contribute to the increased rates of institutionalization. It is approximated that more than 28 percent of the elderly people above 65 years of age experience falls every year. The rate of falls rises tremendously to more than 40 percent for those who are aged 75 years and above (Hicks et al., 2008). The risks of falls have been established to be strong predictors of morbidity in the geriatric population. Balance issues in elderly individuals are attributed to a number of factors. These factors include weaknesses in muscles that render stability, impaired muscle stimulation patterns, loss of proprioception, and loss of the ability to control normal posture. Further, a reduction in physiological reserves due to advanced age also inhibits the potential to respond to rapid disturbance (Hicks et al., 2008).

Although most falls among older adults (90%) do not cause injury or death, research shows that many are medically and personally serious. Older adults who suffer a fall injury become heavy users of medical resources. Fractures are a common result of falls among older adults, and hip fractures produce the greatest morbidity and mortality. “These lead to loss of independence through disability, as well as fear of falling. The reduction in mobility and independence is often serious enough to result in admission to a hospital or a nursing home, or even in premature death” (Chang 2004). It is critical, therefore, to implement an effective prevention or treatment program.

Old adults have reduced capacity in different body systems—such as skeleton and musculature, proprioception, balance, and vision—which have vital roles in maintaining body balance and strength. When for various reasons these systems are compromised, functional capacity will be reduced, increasing the chance of falls. In addition, people who have previously had a fall are at a higher risk of further falls. Among current randomized clinical trials, a multifactorial fall risk assessment and management program is the most effective component of a fall prevention program (Chang 2004). Exercise is an intervention used in the largest number of studies, and it too has had a statistically significant beneficial effect on the preventing risk of falls (Chang 2004).

Therefore this essay will discuss the effect of exercise in preventing falls, specifically as it improves the musculoskeletal condition, proprioception, and balance in the elderly population.

There is a direct relationship between aging and musculoskeletal system deterioration. With time, skeletal muscle losses its strength because we do less heavy physical work so the muscles tend to detrain. In addition to that, there is also loses contractile component of muscle which controls power. Decreased contractility and strength are due to pathophysiological changes in the body specifically in a number of nerves supplying the muscles. Decrease nerve supplies to muscles which contribute to muscle atrophy. Sarcopenia in old age is associated with impaired functional performance, increased physical disability, and increased risk for falls (Evans 1993). Therefore an exercise program specific to elders, involving strengthening and balance-retraining, is a primary fall prevention strategy. A systemic review by Gillespie et al. shows that an individually tailored program of progressive muscle-strengthening, balance-retraining exercises, and walking has significantly reduced falls over a one-year period. With evidence, sarcopenia can be reversed and prevented through physical exercise and training, especially resistance training. Using an exercise program of sufficient frequency, intensity, and duration, it is quite possible to increase muscle strength and endurance at any age furthermore decrease the incidence of falls in the elder population.

Balance and neuromuscular foundations deteriorate with age. Aptitude to keep up balance is a difficult process that is dependent on three major elements of sensory systems, the brain’s ability to process this information; and muscles and joints for coordinating the movements required to maintain balance. Unfortunately, due to lack of activity and wear and tear mechanism, muscles deteriorate and atrophies and joints become lose responsiveness to balance. Some studies have successfully lowered falls and have used balance-retraining, endurance training, and Tai Chi.

Various studies focusing on FICSIT exercises trials have demonstrated that balance effectively reduces the risk of falling compared to other aspects of exercising. In a study by Tinetti et al. on how various intervention measures decrease the propensity for falls, the researchers demonstrated that in a score range between 0 and 12, a shift of one score considerably reduced the risk of falls by 11 percent. This assertion is supported by Lord (2005), who argues that customized exercise intervention, balance, and muscle strengthening are effective interventions for decreasing the risk of falls among the elderly population. In addition, Cummings-Vaughn and Gammack postulated similarly in their review, indicating that focused balance exercises are effective intervention strategies in minimizing the risk of falls. Moreland et al. also share this assertion and suggest that focused balance exercises are important interventions even in a community setting.

Tai Chi has become an important aspect of exercising focused on reducing the risk of falls in the geriatric population since Tai Chi is a multifactorial intervention that helps in strengthening the body by reengineering the mind. This subsequently makes Tai Chi an appropriate intervention measure for a wide range of physical and mental health aspects, such as maintaining bone density, the flexibility of joints, decreasing the risk of cardiovascular conditions, enhancing the body’s immune status, and promoting emotional health. This makes Tai Chi an important intervention in enhancing balance and reducing the risk of falls in the elderly. It has been demonstrated that Tai Chi is very effective in decreasing the risk of falls for the geriatric population in community settings. It enhances balance since it focuses on various physical health aspects that are essential in maintaining upright posture; for example, leg strength, reflexes, and flexibility.

A study of 256 people aged between 70 and 92 who have gone through a one-hour class three times per week for a six-month Tai Chi program has shown Tai Chi to be effective in reducing the frequency of falls and the risk of falling by 55% (Li et al. 2005). This study has also found that Tai Chi reduces fear of falling. Tai Chi, it is claimed, improves flexibility and functional balance, lower-extremity strength, and postural stability. This claim is further supported by a study conducted by Wolf et al., which has found a decreased risk of multiple falls among older adults after 15 weeks of Tai Chi.

Therefore, Tai Chi exercise is an evidence-based intervention that should be highly recommended to the elderly population to diminish the risk of falls. Another benefit of Tai Chi is its adaptability to every age and fitness level. It doesn’t put too much strain on aging bones and joints which is another concern of frailness in many elders.

Exercises are also an effective intervention measure in reducing the risk of developing osteoporosis. Osteoporosis is a strong predictor of falls in the elderly population. Osteoporosis is the thinning of bones that usually occurs in the population as people advance in age. The condition causes bones to become fragile and prone to fracture. Annually, it is estimated that osteoporosis accounts for over 1.2 million bone fractures (Hicks et al., 2008). Osteoporosis is mainly caused by a lack of enough vitamin D, as well as calcium. In addition, the risk of developing the condition is heightened by failure to engage in exercises that involve bearing weight. Exercises have been shown to help in building and maintaining bone mass effectively. According to Chang et al. (2004), regular exercises induce bone-building processes and retention of calcium, muscle strength, coordination, and balance, thereby strengthening bones and reducing the risk of osteoporosis and falls in the elderly.

Arthritis is also another musculoskeletal condition that is a significant cause of morbidity and joint pain in the elderly. Joint mobilization and muscle strengthening exercises are effective physiotherapeutic interventions for patients suffering from arthritis. The benefits of exercises are that they reduce joint pains and stiffness, enhance muscle tone, and increase flexibility and endurance (Barnett et al., 2003).

To conclude, health care providers need risk assessment tools, so that reliably identify and guide intervention by highlighting remediable risk factors for falls and fall-related injuries, to help prevent falling in the elderly population (Scott #). Improving physiological deterioration by strength exercise, and balance exercise will decrease the incidence of disease. The significant impact on the functional capacity of the elder population, and in the way in which health professionals deal with aging clients, is an important factor for healthy aging.

References

Barnett, A., Smith, B., Lord, S., Williams, M., & Baumand, A. (2003). Community-based group exercise improves balance and reduces falls in at-risk older people: a randomized controlled trial. Age Ageing, 32, 407-414.

Chang, J. T., Morton, S. C., Rubenstein, L. Z., Mojica, W. A., Maglione, M., & Suttorp, M. (2004). Interventions for the prevention of falls in older adults: a systematic review and analysis of randomized clinical trials. BMJ, 328, 680-688.

Hicks, G. E., Gaines, J. M., Shardell, M., & Simonsick, E. M. (2008). Associations of back and leg pain with health status and functional capacity of older adults: findings from the retirement community back pain study. Arthritis Rheum, 59(9), 1306-13.

Statement of the Problem

High morbidity rates among the elderly population are largely attributed to falls. Thirty four percent of the seniors aged over 60 years fall at least once in a year with a higher percentage of falls being experienced among frail elderly individuals living in aged residential homes. Falls not only cause injury leading to hospitalization but also lead to anxiety, depression and physical immobility. Moreover, the U.S., reports of fall-related injuries and other complications in aged care homes are on rise. In financial terms, providers incur huge costs due to injuries sustained by elderly persons within the nursing home settings. As such, studies that investigate the fall risk factors are important as they give insights on the causes of falls and how the fall risks can be avoided.

Psychotropic medications including commonly used drugs have been found to contribute greatly to falls in elderly individuals. However, differentiating the specific medications that cause falls from those that do not is a challenge in clinical practice. Several studies have examined the relationship between specific psychotropic drugs and the likelihood of experiencing falls during the study period; but, differences in methodology, definitions of the falls and setting make it difficult to make conclusions about the impact of psychotropic drugs on falling in seniors. Althogh the use of psychotropic medications has continued to rise, research evidence indicate that certain classes of these medications cause falls among seniors.

Using articles from various databases, this paper will analyze the association between use of psychotropic medications and falling in seniors. A meta-analysis of study data including drug classes, age of participants and fall frequency from recently published studies will help determine whether or not psychotropic medications increase falling in elderly individuals. Conclusions will be made based on the findings of critical appraisal of relevant literature.

Research Question

Over the past few years, there has been increasing recognition that some psychotropic medications cause falling in elderly people. This paper will explore the research question that: Does the Use of Psychotropic Medications Increase the Risk of Falls Compared to the Non Use of Psychotropic Medications in the Elderly Population?

Literature Review: The Search

A computerized literature search of articles published between 1999 and 2012 was conducted on CINAHL, MEDLINE and EBM to identify relevant studies for inclusion. The search was conducted based on the methodology described by Garrard. In the search, several MeSH terms were used including ‘therapeutic uses’ that was combined with terms like ‘home accident’ or ‘accidental falls’. Advanced searches were done using subheadings derived from the Mesh terms. Moreover, another search using the terms, ‘pharmacoepidemiology’ and ‘epidemiology’ combined with ‘home accident’ or ‘accidental falls’ was conducted on all the databases. Studies related to the topic were included in the final assessment.

The inclusion/exclusion criteria was based on whether the researchers collected original data or they relied on secondary sources of data and the study design employed Six met the inclusion criteria and were included in the final appraisal.

Literature Review: The Matrix

Passaroet al., 2000 Dec. Benzodiazepines with different half-life and falling in a hospitalized population: The GIFA study. GruppoItaliano di Farmacovigilanzanell’Anziano.J ClinEpidemiol.

Level 2 evidence; a prospective study. The use of benzodiazepines is not a risk factor for falls in elderly people. Benzodiazepines, Falls. Recent evidence indicates that the use of benzodiazepines is a major risk factor for falling in seniors. Based on this observation, this study aimed to evaluate the role of various benzodiazepines in falls in elderly care facilities. Non-randomized controlled clinical trial. Sample size was 7908 patients; 58 clinical centers. Survey forms. Of the 7980 patients followed in this study, 2.2% experienced falls during the study period. 3.2 % of patients who took benzodiazepine experienced falls compared to 1.9% for the control group.

The findings indicate that the use of benzodiazepines that have a short half-life increase the risk of falls among elderly patients. Thus, elderly patients must be evaluated properly before being put under psychotropic medication.

Frels, Willia, Narayanan &,Gariball; 2002 Aug. Causes of hospital falls among elderly patients. Postgrad Med. J.

Level 3; A case-control study. Understanding the fall risk factors does not help in formulation of strategies to prevent falls among the elderly people. Temazepam medication. Falls. There is an urgent need for evidence to support the strategies employed to prevent falls among the elderly. Alternative medications should be sought to replace benzodiazepines. A Case-control research design. 181 elderly bpatients. Survey forms. In this study, 46% of the fallers were under benzodiazepines compared to 27% of fallers in control group.

There an urgent is need for an alternative to benzodiazepines for elderly patients Landiet al., 2005 May; Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study. J Gerontol A BiolSci Med Sci.

Level 3; observational study. The use of psychotropic medications from different classes enhance the fall risk among elderly people. Benzodiazepines, antidepressants, Nonbenzodiazepine, antipsychotic drugs and sedative-hypnotics, falls. Injuries resulting from falls raise much concern especially for elderly people. Most of these falls have more than one cause and often involve an interaction between internal and external factors. Observational study. The sample size was (n = 2854, of elderly people admitted to nursing homes under the Italian Silver Network Home Care project. Survey forms.

Psychotropic drugs of any class caused an increase in the risk of fall by 47% (OR, 1.47); Also, users of atypical antipsychotic medications experienced an in increasing fall risk (OR, 1.45). Prescribing short-acting benzodiazepines for sedating the elderly instead of long-acting agents may substantially lower the fall risk.

Lawlor, Patel &,Ebrahim. 2003 Sep. Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ

Level 3; Cross-sectional study. There is no connection between falling, drug use and chronic diseases and drug among elderly women. Chronic diseases; circulatory disease, COPD, depression, and arthritis, falls. Although psychotic drugs play a role in determining falling in elderly people, chronic conditions also contribute to falls

Cross-sectional study. 4050 elderly women (aged 60-79 years). Surveys.The risk of falling increasing by 32.2%with the rise in the number of chronic illnesses affecting the patient. Chronic disease is a major predictor of falling among elderly women, compared to psychotropic drugs.

Rozenfield, Camacho&,Veras, 2003 Jun; Medication as a risk factor for falls in older women in Brazil. Rev PanamSaludPublica.

Level 3. There is no association between falls use of medications by elderly people living in residential care homes. Psychotic medications, Non psychotic medications,

Falls. Non-psychotic drugs including OTC beta-blockers and diuretics used by elderly people increase the risk of falling for people living in the community settings. Cross-sectional. 634 elderly women. Questionnaires, Interviewing. In the study, 23.3%of participants reported to have fallen once in the previous year, while 14% reported falling more than twice in the previous year. There is an connection between recurrent falls and drug use; most falls can be avoided through better drug use

Hienet al., 2005 Aug; Atypical antipsychotic medications and risk of falls in residents of aged care facilities. J Am Geriatr Soc..

Level 4. There is no association between the use of atypical antipsychotics and the reduced fall risk. Atypical antipsychotics (Olanzapine, Risperidone) and typical antipsychotics, falls. There has been some evidence suggesting that the use of atypical antipsychotics could have a reduced risk of falls compared to typical antipsychotics

Prospective cohort study. 1,107 subjects. Survey forms. 11% of subjects(n=226) experienced at least one fall during the study period. Atypical antipsychotic medications do not result to lower fall-related incidences compared to psychotropic medications

Literature Review: Critically Appraise the Evidence

The six studies varied in outcomes, research design, level of evidence, study setting (long-term care facility or community), the age of the participants and time and method of ascertaining the falls. Two studies involved a cross-sectional study design, others were a prospective cohort study, a case control study, cross-sectional and non-randomized controlled clinical trial with varied levels of evidence. Other differences relate to mean age of the participants (more than 60 years) and the method of ascertaining the medications. All these studies except one (Lawlor, Patel,&Ebrahim, 2003) examined the role of antipsychotic and psychotropic medications in patient falls.

The studies confirm that there is an association between use of psychotic medications and falls in elderly individuals across all settings. Five of these studies (Hienet al., 2005; Rozenfield, Camacho, &Veras, 2003; Landiet al., 2005; Frels, Willia, Narayanan &Gariball, 2002; and Passaroet al., 2000) supported the finding that psychotropic medications increase the fall risk among elderly people. On the other hand, (Lawlor, Patel &Ebrahim, 2003)finding was compelling; it compared the effect of chronic diseases and psychotropic medications on falling among elderly patients.

Of the six studies, five had a significant treatment effect of between 11% and 46%, one had a treatment effect of 2.2%. These results indicate that psychotropic medications or antipsychotics have side effects on elderly individuals and their use substantially increases the risk of falling. The probability of falling was high for medication classes of benzodiazepines, antipsychotics, sedatives and antidepressants. The studies assessed the different classes of psychotropic medications, mode of administration and the associated risks but fail to examine the underlying mechanism of action. As such, further research is needed to examine the effect of psychotropic medications on cognitive functioning of elderly persons.

Conclusion

Psychotropic medications have been identified as a risk factor for patient falling. Nevertheless, not many randomized controlled trials have been done to assess the effect of specific psychotropic medication classes on falling among elderly people. The results of this analysis establish that psychotropic medications should be prescribed to seniors with great caution. There is sufficient evidence from observational studies that psychotropic medications contribute to falls in elderly persons. Future research should focus on long-term care and community care settings to provide quality data on fall risks for use by pharmacists and physicians when they are prescribing psychotropic medications to seniors.

References

Hien, T., Cumming, R.G., & Cameron, D.et al., (2005). Atypical antipsychotic medicationsand risk of falls in residents of aged care facilities. Journal of the American Geriatrics Society, 53(8), 1290- 1295.

Frels, C., Williams, P., Narayanan, S., & Gariballa, S. (2002). Latrogenic causes of falls in hospitalized elderly patients: a case control study. Postgraduate Medical Journal, 78(922), 487-489.

Landi, F., Onder, G., Cesari, M., Barillaro, C., Russo, A., & Bernabei, R. (2005). Silver Network Home Care Study Group, Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study. Journal of gerontology. Series A: Biological sciences and medical sciences, 60(5), 622- 626.

Lawlor, D. A., Patel, R., & Ebrahim, S. (2003). Association between falls in elderly women and chronic disease and drug use: cross sectional study. British Medical Journal, 327(7417), 712-717.

Passaro, A., Volpato,S., Romagnoni, F., Manzoli,N., Zuliani, G., & Fellin, R. (2000). Benzodiazepines with different half-life and falling in a hospitalized population: the GIFA study. Journal of Clinical Epidemiology, 53(12), 1222-1229.

Rozenfeld, S., Camacho, A., & Veras, P. (2003). Medication as a risk factor for falls in older women in Brazil. Revista Panamericana Salud Publica 13(6), 369- 375.

Introduction

Human Papilloma Virus (HPV) has been termed as the highest sexually transmitted infection in America. The HPV virus has an asymptomatic nature which makes it easy to go undetected. The virus has a high potential of causing cancer specifically cervical and genital warts. The teenage population is of concern because it is a sexually active group, has multiple sexual partners and engages in unsafe sexual practices which increase the risks of infection. The high prevalence rates and the mortality rates associated with HPV have increased concerns for early detection, treatment and prevention with vaccination. This and the fact that some of the vaccines have raised concern about their effects on health among the teenagers warrant more research and evaluation. The focus thus is more geared on the actual process of HPV, that is, the diagnosis, detection, treatment, vaccination and treatment of the virus. It is worth noting that since the diagnosis, detection, treatment, vaccination and treatment of the HPV virus affects the government, it is necessary to evaluate its efforts and ethical concerns together with the proposed strategies and solutions as well as the objectives of Healthy People 2010.

Diagnosis, Detection and Prevention

The asymptomatic nature of HPV has made it difficult to diagnose and detect it. This is worsened by the unlikelihood of teenagers coming out to express the problems they could be experiencing since it is usually sexually related (Krishnan, 2008). The common method of diagnosing HPV is the Pap test which is done on young teenage girls after three years of being sexually active. The HPV testing normally follows the Pap test and is usually done on the DNA to ascertain the type of HPV (Garland & Tabrizi, 2006).

The diagnosis and detection of HPV have been made easier by advancements in technology. Initially, the methods used for detecting HPV were direct probe hybridization with examples of southern blot and dot blot which were less sensitive, time consuming and labor intensive and required great amounts of DNA for detection (Garland & Tabrizi, 2006). The main methods for detection of HPV are Hybrid capture 2 and Polymerase chain reaction (PCR). The PCR has the amplification assay capability of increasing the HPV sequences that are present in biological specimens. Although the reagents for the HPV are not standardized, the micro array systems and linear array assay are used due to their ability to allow the detection of multiple types of HPV. The types of HPV range from the low risks of HPV 6 to 11 to high risk of HPV 16 at which cancer risks are usually very high.

The diagnosis and detection of HPV among teenagers elicits different opinions. Some argue that there is no need of testing for HPV among teenagers. The American College of Obstetricians and Gynecologists (2010) asserts that “most adolescent girls should wait until they turn 21 to have their first Pap test, but those who have HIV and others with weakened immune systems should begin routine cervical cancer screening right away” (p. 3). On the other hand, some experts assert that teenagers are sexually active and should be tested since their risks of HPV infection are very high. It is worth noting that HPV testing is common for young girls unlike boys since no standardized test has been agreed upon for men. However, the manifestation of HPV among men is most commonly recognized through warts.

Vaccination and Prevention of HPV and Cervical Cancer

The main vaccines are Gardasil and Cervarix which are suited for females aged between 9 and 26 and males aged between 9 and 18 years. The Gardasil vaccine has the ability of protecting against HPV types 6, 11, 16 and 18, while Cervarix protects against HPV types 16 and 18. The wide scope of Gardasil makes it more common than Cervarix. The Food and Drug Administration has had developments for approving preventive vaccines against HPV among teenagers and young adults (Rodriguez, 2010). Deresinski (2007) asserts that this vaccine should be given more to young girls aged between 11 and 12 years who have not received the first vaccination. He however argues that the vaccine benefits the sexually active teenagers who are not already infected as compared to those infected while the administration of the vaccine does not require HPV testing.

Vaccination against HPV is faced with different challenges that limit its effectiveness. These challenges include the lack of knowledge, nature of the disease, societal myths, socio-economic status, religious factors and beliefs as well as parental attitudes and beliefs and the awareness of the health care provider (Rodriguez, 2010). These challenges do influence the different opinions surrounding the virus. Some controversies surround the vaccination and nature of HPV infection. For instance, the American College of Obstetricians and Gynecologists (2010) argues that “there is no point in testing for HPV because it is so common among teens and 90% of HPV infections are naturally resolved by the immune system within two years,” (p. 4). The ACOG has this opinion since to them; the immune system of teenagers develops to be able to overcome the virus. They assert the vaccine has some negative impacts especially on young girls while making the vaccination mandatory would breed more rebellion. However, Rodriguez (2010) differs in this and asserts that “the establishment of mandatory school-based vaccination programs is one solution to the problem of compliance, however, time for implementation will be required and the success of the program will depend on public acceptance” (p. 6). Overall, the lack of mandatory vaccination would be effective as compared to mandatory vaccination due to the nature of the virus, societal perceptions, and negative effects on the teenagers as well as the psychological impact. However, necessary medication has to be encouraged to the teenagers including vaccination.

Government Concern and Ethical Concerns

The concern of the government is evident in the recommendation of the FDA for the vaccines for HPV while ensuring that the burden of HPV infection is reduced (Mayeaux, 2008). Further, this concern is made possible through enhanced health delivery systems and insurance while some states have adopted mandatory vaccine programs to ensure prevention of HPV (Rodriguez, 2010). The concerns of the government on the HPV virus, is influenced by the ethical issues surrounding the virus which limit the willingness of society to address it. Since the prevalence rates are high and its negative effects due to the relation with cancer related infections, the government then comes in to provide necessary measures for dealing with the HPV virus. The ethical issues in the HPV infection especially as affecting adolescents are evident in their myths surrounding it, the sexual nature of the infection and the religious beliefs (Rodriguez, 2010). The concerns are on the safety of the vaccine as well as the fact that it would make the adolescents be more sexually promiscuous.

Healthy People 2010 Objectives in Relation to HPV and Cervical Cancer

The Healthy People 2010 objective regarding the HPV infection is related to the aspect of vaccination of teenagers especially girls. This is also related to the objective of increasing the awareness of the virus among the teenagers. The objective targets at increasing the vaccination percentage coverage to 90% of the adolescent girls. The other objective is the developing of a vaccine that can prevent against all the types of HPV to ensure maximum protection to the teenagers. The Healthy people also have an objective of increasing the screening of cervical cancer and HPV especially among the teenage population (Hitt, 2010). The other objective is also on encouraging positive sexual behavior among the teenage population focusing on those who have never had a sexual intercourse to 56%, to those who were sexually experienced but not sexually active to 30% and to the sexually active to 65% with specific focus on grades 9 to 12 teenagers (Hitt, 2010). The other objective on the prevention of HPV is the encouragement of the increase in the use of condoms among the teenage population. Further, the Healthy People 2010 has an objective to increase the numbers of women and teenage girls that undergo a pap test. The other objective is reducing the proportion of the teenage population with HPV infection through minimizing the number of cases reported especially the risky types of HPV that are linked to causing cancer related infections specifically cervical cancer.

Strategies and Solutions to HPV and Cervical Cancer

The strategies on HPV infection are more focused on increasing the rates of vaccination and awareness and knowledge on the infection. Vaccination has to be encouraged to the teenagers with concerns for improving their health. Further, as Saslow (2007) argues, there is need for more research to ensure standardization of vaccines and diagnosis and detection. This is because the lack of standardized vaccines, diagnosis and detection increases the fears for safety as well as makes the understanding of the HPV virus difficult. He further points to the need for more education on HPV to be given to the adolescents, their parents, policy makers and providers of health regarding prevention, early detection and regular screening of HPV infection (Saslow, 2007). This education is necessary to ensure that they are aware of the virus. It is also necessary to address the controversies surrounding the HPV vaccination. This is because when medical practitioners differ on the necessity of vaccination, the implementation is quite limited. Further more strategies are on enhancing the support of the government in dealing with the HPV virus. This can be done through funding of research and set of effective measures of dealing with the virus. It is also important to encourage openness in addressing sexual behavior and myths surrounding it and also encouraging teenagers to be responsible in their sexual behaviors.

Conclusion

HPV infection has a high prevalence rate. There is a need for action to be taken for the protection of adolescents who are at high risk of infection. It is necessary to have effective measures for ensuring that the myths surrounding the infection are replaced with knowledge and awareness while the controversies are handled.

Reference List

American College of Obstetricians and Gynecologists (2010). Exceptions for Pap Screening in Adolescents: HPV Testing not recommended. Web.

Deresinski, S. (2007). Advisory Committee on Immunization Practices issues guidelines for Gardasil, HPV Vaccine. Infectious Disease Alert, 26(7), 75-78.

Garland, S., & Tabrizi, S. (2006). Methods of HPV Detection: Polymerase Chain Reaction Assays. Basel: Karger Publishing Company.

Hitt, E. (2009). CDC: Adolescent Vaccinations Increased Substantially From 2008 to 2009, Reaching Several Healthy People 2010 Immunization Goals. Web.

Krishnan, S. (2008). The HPV Vaccine Controversy: Sex, Cancer, God, and Politics: A Guide for Parents, Women, Men, and Teenagers. New York: Praeger Publications.

Mayeaux, E. (2008). Reducing the Economic Burden of HPV related Diseases. Journal of American Osteopathic Association, 108(4), 2-7.

Rodriguez, M. (2010). Is Increasing HPV Infection Awareness Promoting Increased Vaccine Compliance? The Internet Journal of Advanced Nursing Practice, 11(1), 1-24.

Saslow, D. (2007). American Cancer Society Guideline for Human Papillomavirus (HPV) Vaccine Use to Prevent Cervical Cancer and Its Precursors. Cancer Journal of Clinicians, 57(1), 7-28.

Introduction

Health is a crucial aspect of a community. It affects the economic, social and political aspect of that community. Therefore, a community must maintain a healthy population that could enable them to prosper in the three fields. On this light, the health departments put efforts to understand the state of health in a given population (Doyal & Pennell, 1979). As a result, they carry out community assessment which acts as a partner model. Community assessment seeks to identify the health needs and challenges that exist within the population living in that community. Based on the assessment, they make the necessary diagnosis for the population. In this paper, we will consider the veterans living in Jeffersontown.

History

In 1700s, veterans and colonialist started settling in the area referred as Jeffersontown today. The settling took place amidst threats of attack by the Indians. Many people settled to the northern parts of Ohio River in search of arable land. Bruner bought 122 acres of land that was under a forest. He aimed at bringing up a city at the junction of two roads. The other settlers obtained land from him where they built shops and markets. Consequently, a town was established gradually. Settlers established various businesses making the town active and busy. Gradually, they established settlements that eliminated the tiresome journeys from Louisville town. As a result, most of the people inhabiting Jeffersontown are veterans (Johnston & Jeffersontown, 1997). In fact, the town has a veteran’s memorial park which occupies 25 acres. In this paper, we shall analyze and focus on the veterans found in this town.

Demography

According to the census that was carried out in the 2010, the town had about 26595 people. Based on this census, the households were approximately 10653 and the numbers of families were 7275. The population had a density of 1033 per square kilometer. The city has a mixture of races. It comprised of 87 percent white Americans, 9 percent black American, 0.2 percent Native Americans, 1.8 percent Asians, 0.03 percent from the island of pacific, and 1.14 percent from other races. The remaining population originated from racial combinations (Farley & Haaga, 2011).

The households within the city were ten thousand, six hundred and fifty three. 32 percent of the household had dependent children. 54 percent of the households were in marriage and living together with their couples. Eleven percent were single females, 32 percent were non-families and 26 percent living individually. In addition, 6 percent of the households had individuals with at least 65 years. From statistics, it was clear that the population reduced from 26633 since 2000. This is a reduction of about 0.1 %.

Most of the population ranged from the age of 25 to 44 years. In fact, the median age was thirty six years. The number of people under the age of eighteen was approximately twice the number of those past the age of sixty five years. The population, thus, portrayed gender imbalance. In this case, 93 percent of the population comprised the males. This gender imbalance is a crucial factor in health. Four percent of the families were below the poverty line. Although the poor population is low, it raises health concerns that should be addressed.

Morbidity and Mortality

In general, Jeffersontown (in Kentucky) experiences a state of good health. However, the population is affected by some diseases which cause mortality and ill health. The diseases include cancer, cardiovascular and respiratory diseases. These diseases are caused by risk factors that can be controlled. The risk factors include smoking, poor dieting and inactivity. The most challenging risk factor is tobacco smoking. From statistics, 29 percent of adults smoke tobacco (Erhardt & Berlin, 1974). In fact, fifty percent of the deaths are attributed to smoking. In addition, insufficient physical activities have increased the cases of obesity and cardiovascular diseases. Other risk factors that lead to illnesses and deaths include motor accidents and criminal violence. This implies that the morbidity and mortality can be controlled easily in Jeffersontown. Moreover, health care officers should determine the causes of gender imbalance and address them appropriately. This will ensure that the roles of females related to health are not neglected in the society.

Health Strengths and Needs

The health status of Jefferson town has various strengths that make the population to stabilize its economy. Firstly, the population is affected by very few endemic diseases. Most of the diseases arise due to poor lifestyle behaviors. This implies that the population suffers from diseases that can be controlled and eliminated. For example, the population can control the cancerous diseases by reducing tobacco smoking. They can, also, control the cardiovascular diseases by carrying out physical practices. In addition, the city does not experience a lot of pollution from industries. Consequently, the population is less prone to diseases that are brought about by pollution. However, there are various healthcare needs within the city. First, the population should abandon the risk activities that expose them to diseases. These activities include smoking tobacco, inactivity and taking poor diets. They should, also, adhere to rules that ensure road safety and transport to reduce the motor vehicle accidents.

Education

Education is a crucial pillar in maintaining health. It provides people with necessary information which enable them to keep good health. Educated people consider preventive measure and engage in behaviors which benefit their health. In Jeffersontown the level of graduation from high school is low. From statistics, only a few schools meet the national level of graduation. Consequently, the population with bachelor degrees is low. This has adverse effects on the health of the population.

Safety and Transport

Motor vehicle accidents pose challenges to the health of Jefferson town. Safe transport is, therefore, an issue of crucial concern. The government has put a safety belt law. This law ensures that the passengers are safe during transport. It asserts that the officials can arrest the motorists who do not use seat belt. In addition, the authority has put up a law that governs licensing operations. In this law, a driver must graduate in driving before getting a license. Also, it puts restriction on teenage driving. It denies the teenagers a freedom to drive between midnight and 6 a.m. This law helps to reduce cases of teenage crashing in accidents. The two laws are considered primary rather than secondary laws.

Politics and Government

Governance of a community is a major player in maintaining good health. It determines the availability of health resources. It, also, enforces the laws which aim at preventing deaths and promoting health. Jefferson runs under governance of the mayor. The mayors hold the position for four years. After four years, the mayor vacates the office allowing for an election. This mayor is the administrative body which enforces the law, controls finances, advises the county council, and appoints the members of various boards. They, also, monitor the tax payment system. This tax determines the amount of fund that is available to the health care facilities in the town. In this case, the maintenance of good health relies on the nature of mayor’s governance. A reluctant and corrupt mayor decreases the effectiveness of the health care system.

Health and Social services

Mainly, health depends on the availability of facilities and services. Hospitals and other health care facilities are fairly distributed in the city. Most of them have enough health care personnel. However, the town suffers from insufficient primary care officers. The deficiency of primary care personnel brings about negative health status.

For social services, the city has various social facilities. These social facilities include parks and city halls. For example, the veterans enjoy the services that are offered by the Veterans Memorial Park. The park has six pavilions and two playgrounds. The pavilions are used for holding events and resting. On the other hand, the playgrounds are used for the purpose of recreation. To the veterans, recreation is very crucial because it helps them to fight lifestyle diseases and promote health.

Economy

Jefferson is a large source of job opportunities and employments. It has the Bluegrass Park that occupies 1800 acres. This holds many businesses that enable the veterans to earn income. Recently, it holds more than eight hundred and fifty businesses. In relation to health, the increased income helps the veterans to afford health care services. It, also, enable them to take balanced diet which curb the lifestyle diseases and promote good health. However, some veterans are unable to afford employment in the town. Consequently, they are below the poverty level leading to poor dieting and lack of health care facilities. This poses an important health care challenge to the community of Jefferson Town.

Conclusive Analysis

From the data above, we conclude that the community of Jefferson Town does not have extreme health challenges. The area portrays economic stability and satisfactory governance. The area enjoys recreational and social facilities which form the basic tools of making a healthy community. From the demographics, we understand that the largest population is independent. Consequently, the population can afford health services and other facilities that maintain health. Therefore, the population is elevated above basic health challenges which affect most areas of the developing countries.

However, it is challenged by crucial risk factors that expose the population to illnesses and death. However, the community can realize better health condition if they chose the right lifestyle behaviors. This implies that the population has the power to control their health conditions. We, also, conclude that the governance of the city should employ more primary care physicians than the number employed today. The additional primary care physicians would capitalize on prevention of diseases and reduce the cases of curing diseases.

Community Nursing Diagnosis

Based on the research, it is evident that the main health challenges arise from poor lifestyle behaviors that expose the population to ill health. Consequently, the main diagnosis is creation of awareness against those risk factors. The healthcare officers and other stakeholders should establish programs to campaign against tobacco smoking, poor dieting and reckless driving. They should organize for public health education to teach people about proper dietary behaviors in institutions and hospitals. Principally, the public awareness against behavioral risk factors is the surest way towards good health. This will ensure that the level of terminal illnesses and rate of mortality are reduced.

References

Doyal, L., & Pennell, I. (1979). The political economy of health. London: Pluto Press.

Erhardt, C. L., & Berlin, J. E. (1974). Mortality and morbidity in the United States. Cambridge, Mass.: Harvard University Press.

Farley, R., & Haaga, J. (2011). The American people: Census 2000. New York: Russell Sage Foundation.

Johnston, J. T., & Jeffersontown, K. (1997). Jeffersontown, Kentucky, the first 200 years: a pictorial history of Jeffersontown, Kentucky, and surrounding community. Jeffersontown, KY: City of Jeffersontown.

According to Ullmann (2008), at least one in every adult aged 65 and above falls frequently. The consequence of this can be early death or lifelong complications. According to Boltz (2012), these falls can also be life threatening. In 2010, about 2.3 million falls were nonfatal and they were treated in various hospital emergency departments. During the same period, more than 600,000 patients were hospitalized. As noted by Boltz (2012), men have a higher chances of falling as compared to women.

In order to foster fall prevention, it is advisable for adults to exercise regularly in order to improve leg strength and consequently body balance. Secondly, it is advisable to seek medical advice regarding drugs that cause side effects such as drowsiness or dizziness. Thirdly, adults aged 60 and above should ensure that they undergo frequent eye checkup and update of eyeglasses in order to improve their vision.

Fourthly, it is imperative to make homes safer by taking more action to minimize or eliminate hazards that can lead to tripping by installing grab bars in frequently visited locations such as washrooms. Lastly, adults should improve their intake of calcium and vitamin D. Supplements of these minerals are also highly recommended. Treatment of bone related diseases such as osteoporosis will help in mitigating this problem. This consideration will help in lowering hip fracture risks among adults.

New research and technology solution related to the topic

New research on this topic has been focused on fall prevention. The rationale for this was developed based on the causes of falls among adults, which are well known due to the researches conducted in this field over time. According to Ullmann (2008), U.S. Preventive Service Task Force (USPSTF) reported to the congress on the need to address the existing gaps in key areas of knowledge concerning fall preventing means for older people.

It urged Congress to take an initiative in order to fill these gaps. The USPSTF proposed to initiate and validate practical techniques that can be employed to identify and deal with risks related to adult falls. Other non-governmental bodies are also working on preventing and curative measures of dealing with this adult problem.

There are several new programs such as HUR iBalance Testing Systems which help in improving strength and power of exercise programs for adults. New technologies such as hip replacement and bone replacement are also fostering new ways of dealing with these common adult falls. Walking gear that supports disabled people are also being developed. A good example of this technology is the exoskeleton which assist the body by adding strength to disabled areas like legs or arms. Robotic technologies are also being improved in order to offer humans more power in areas where they are limited. With improvement of robotic related technologies, more research on human enhancing computer aided devices will be conducted in the next few decades.

References

Boltz, M. (2012). Evidence-based Geriatric Nursing Protocols for Best Practice. New York, NY: Springer Publishing Company.

Ullmann, G. (2008). The Efficacy of Feldenkrais in Improving Balance, Mobility and Health Related Factors in an Older Adult Population. New Jersey, NJ: ProQuest.

Vaccination is the use of synthesized drugs that trigger the body, to react to infections and thereby averting potential attacks by dangerous diseases. Vaccines build immunity, which is the response of the body, particularlythe white blood cells to disease causing microorganisms. In this case, the disease causing agent is the avian virus. Without vaccination, the population is at a greater risk of Infection (Goldsby, 2003).

It is not a requirement that everyone gets vaccinated, but a large number of the population should be vaccinated. The vaccinated population will act as a shield of the other section of the population that is not vaccinated. This provides a ‘herd immunity’ type of protection. Herd immunity, is protection provided by vaccinatinga large number of the population. Infection, which has a greater rate of spread, will require that a huge number of people be vaccinated, reducing the number of newavailable hosts to the infectious virus. Through reduction of potential hosts, the infection rate can be easily controlled. Herd immunity is attained through everyone knowing that survival of those around them highly depends on them. (Madigan, 2006).

Vaccinating a small population is disadvantageous in that the disease can spreadrapidly. There is a need to know about the extreme effects of a disease. Diseases can cause damage to a population, if measures are not taken, to ensure that the lives of people in the affected area are protected by vaccination. Viral diseases, like in this case, are spread at high rates and there is need to come up with urgent preventive measures. Making the vaccine compulsory may not be favorable to some groups of people such as the pregnant women, people with pre-existing conditions and infants (Tortora, 2010).

There are groups of people, who out rightly oppose the use vaccines, because they believe that the drugs used are a danger to their health. Groups of these nature tend to think that the government is ‘out to get them’. Vaccination, in some cases, like that of pregnant women, may cause damaging effects to the fetus, leading to loss of pregnancies through spontaneous abortions and maternal mortalities (Ray, 2004).

If other disease control measures are put in place, other than vaccination, the spread can be easily controlled. Most diseasesare greatly influenced by the standards of hygiene. Good hygiene practices can go along way in countering outbreaks. Simple measures include washing of hands, isolation of the sick, avoiding contact with infected people in public places. These hygiene measures are vital in countering the spread of infection. Isolation and destruction of the infected cases are important.

Generally, vaccination is important in the control of diseases, but making it compulsory creates a major injustice to groups that may be rendered ineligible, by their physiological predisposition. A better way towards prevention of the virus lies in the liberty to choose whether to undergo the vaccination process, or to choose other measures of prevention. This makes my case that the American citizens can be protected without vaccinating everyone.

References

Goldsby, R. A. (2003). Immunology. San Francisco: W.H. Freeman& Sons Ltd.

Madigan, M. (2006).Brock Biology of Microorganisms. New York: Pearson Education.

Ray, C. G. (2004). Sherri’s Medical Microbiology. New York: McGraw Hill.

Tortora, G. J. (2010).Microbiology: An Introduction.New York: W. W. Wiley & Sons Company.

Introduction

Respiratory distress was the main reason for why patient John Doe (J.D.) was presented in the ER. As soon as the patient was observed by the doctor for the first time, an IM injection of epinephrine and an inhalation machine with albuterol were given to the patient. It was necessary to continue observations and investigations such as the chest X-ray, blood tests to provide a proper diagnosis and identify the causes of distress. During a certain period of time, it was concluded that the patient had sepsis that is a defined as a clinical syndrome (Schmidt and Mandel par.1). It is usually characterized by systemic inflammation due to infection and a severe development that can result in a septic shock (Schmidt and Mandel par.1). This laboratory report aims at discussing the peculiarities of the diagnosed disease management and the ways of how sepsis can be developed in the patient’s organism using the results of X-rays and blood tests.

Results

The patient’s hospitalization was characterized by a number of interventions and an overnight observation. One of the first steps in addition to the injection of epinephrine and an inhalation machine was a chest X-rays. The results of this test proved lung inflammation (Fig. 1). It was a cloudy white spot on the patient’s x-ray image. Besides, a portion of blood tests was taken to identify the reasons for the patient’s distress (Table 1: Results from Initial Laboratory Tests). The increased number of white blood cells (17.3) proved the fact that there is an infection in an organism. Other reasons for such WBC number may be the stress or inflammation. Therefore, it is necessary to consider other aspects of the blood test. For example, the levels of hemoglobin, platelets, creatinine, glucose, urea, GGT, ALP, and bilirubin were normal. Some changes were observed in ALT (alanine transaminase). This test measures the amount of the required enzyme in the patient’s blood. The results were twice higher than normal and indicated the elevated liver enzymes that were observed in patients with bacterial sepsis (Shah et al. 261). Finally, slight changes were observed in the international normalized ratio (INR) that indicated the correctness and appropriateness of the chosen blood-thinning medication warfarin.

A high amount of INR identifies the necessity of more time for the blood to clot and the possibility of sudden bleeding without a possibility to stop it. In general, the results of the blood tests helped to identify the infection in the body, and it was necessary to continue investigations to clarify if sepsis is the reason for respiratory distress. A lung biopsy helped to clarify the situation. An abnormal condition close to the surface of the lung proved the possibility of bacterial lung infection. The patient’s H&E stain, CD4+ stain, and B220 stain were marked in the lung biopsy. Unfortunately, the condition of the patient worsened in a short period of time. Fever was the reason for why the patient had a positive result for microbial products and the increased amount of IL-10 and IFN-Y (Fig. 3). With time, the Multiple Organ Dysfunction score showed the abnormal results in almost all organ systems. Besides, the chemical and blood gases composition turned out to be abnormal as well (Table 2: Multiple Organ Dysfunction). Such results usually indicate the complete organ dysfunction or even death. Despite all treatment and doctors’ interventions to increase fluids and antibiotics, it was impossible to stop the blood pressure falling. The patient did not manage to recover and passed away soon after his immediate hospitalization.

Discussion

In fact, the results of the blood tests and X-rays should help to understand the possibility of sepsis on the initial stages of the hospitalization process. The point is that sepsis may be of different levels, and it becomes harder to control in case one stage is missed. As a rule, difficulties in breathing and respiratory distress are not the initial stages of the disease. It means that the patient was already closed to a septic shock when he was hospitalized. Eggimann et al. explain that sepsis remains to be one of the most crucial causes of morbidity and mortality among the hospitalized patients, and the rates can be changed if the patients have acute respiratory distress syndrome at the same time (1210). The worth of the blood tests is all about the possibility to identify if the organism has an infection or undergoes some inflammation process. It helps to identify the main following steps and manage the disease treatment in the required way. At the same time, a white spot on the X-rays image informs about the problems with lungs and the necessity to continue diagnosing the patient with the help of the lung biopsy. The results of the biopsy and the fibrotic tissues that could be observed in the H&E stain could be identified as the main possible causes of the respiratory distress that bothered the patient at the beginning of the hospitalization process. Fever and the inabilities to reduce the pain during breathing were the additional symptoms that proved a fast sepsis development in the organism.

Conclusion

In general, the evaluation of the case study and the test results help to comprehend that sepsis is hard to predict and treat. Despite all tests and interventions, it was hard to help the patient and decrease the level of pain experienced. The situation under analysis proved that sepsis could be developed gradually; still, if it was identified at the late stages, it was hard and even impossible even for sufficient doctors to treat a patient and save their life.

Works Cited

Eggimann, Philippe, Stephan Harbarth, Bara Ricou, Stephane Hugonnet, Karin Ferriere, Peter Suter, and Didier Pittet. “Acute Respiratory Distress Syndrome after Bacteremic Sepsis Does not Increase Mortality.” American Journal of Respiratory and Critical Care Medicine 167.9 (2003): 1210-1214.

Schmidt, Gregory, A. and Jess Mandel. “Evaluation and management of severe sepsis and septic shock in adults.” Uptodate.com 2013. Web.

Shah, Amir, A., Michael Patton, Wajahat H. Chishty, and Amir Hussain. “Analysis of Elevated Liver Enzymes in an Acute Medical Setting: Jaundice May Indicate Increased Survival in Elderly Patients with Bacterial Sepsis.” The Saudi Journal or Gastroenterology 16.4 (2010): 260-263.