Factors Contributing To Obesity among African American Women

Introduction

According to experts, obesity is the second source of avoidable death after tobacco. Even though it affects all populations, it majorly affects African American women. Obesity makes African American women more susceptible to chronic disorders such as hypertension and stroke. Due to the high mortality rates attributed to obesity, it has become a major public medical challenge in both developed and developing regions (Lakdawalla, & Philipson, 2009). One of the main cause of obesity is the changing lifestyle. Internationally, statistics indicate that more than 300million people have been affected directly and indirectly, by obesity. In the contemporary society, obesity prevalence increased by 178%. Over the years obesity has been labelled as an epidemic because it increases chances of acquiring other disease such as cancer and heart attacks. Despite of the general spread of obesity, African American women are disproportionately impacted by obesity. Medical records state that two-thirds of African American women suffer from obesity on the count of body mass index. In simpler terms, there are factors contributing to occurrence obesity among the African American population.

Literature Review

Obesity affects people from all walks of life regardless of age, race and other demographics considered and put in place. Nevertheless, despite of the obesity epidemic infecting Americans from various background, African American women population have recorded a high prevalence of obesity than other races or demographics (Dobbs, & Manyika, 2015). The rate among African American women is 1.5 times higher as compared to other Caucasian populations. These obesity disparities are interpreted as 56.6% of African American adult women are obese. Presently, 75% of African American adult females are obese. The rising trend of obesity prevalence among African black men has also revealed the life expectancy of African American women is decreasing due to other diseases which come as a result of obesity. For example, diabetes and heart attacks are some of the illnesses that have affected African American women. This cruel cycle persistently increases the chances of acquiring other illnesses such as hypertension. In order to fight off obesity and create sustainable solutions to the epidemic, long terms deterrence schemes and medication plans have to be researched and implemented. Even though there is still no defined solution to reduce obesity, weight loss is the best way of fighting obesity and decreasing chances of developing other related diseases such as heart attack and hypertension.

Importance of the Study

 This research will assist unveil new information on obesity prevalence and causative elements among African American women. Therefore, the outcome of the information will be used to make informative decision and live a healthy lifestyle. Additionally, most people will receive new information and hopefully change their life for the better. Therefore, these research paper will transform lives and minimize chronic disorders such as heart attacks (Goryakin et al., 2015). Furthermore, a gap in the vast body of obesity investigation will be filled because the research will address traditional, societal and economic aspects which have played a role in obesity prevalence among African American women.  Thus, this research will have an impact on weight loss programs and intervention geared towards reducing weight especially among African American women.

Research questions

What is the obesity prevalence amongst African American women?

H1 I anticipate the prevalence among African American adult women to be high due to causative factors such as genes and low income neighborhoods.

H0, the prevalence of obesity among African black Americans will be negligible.

Variables

Dependent variables

Obesity (BMI)

Independent variables

Oldness – age makes it hard for the body to reduce calories

Number of children- the number of children affect life style and quality of life one lead

 Exercise lifestyle- if exercise is incorporated in their lifestyle

Exercise routine- influences the amount of calories burnt each day.

Availability of domestic chores

Income- informs the range of choice one has and if they can afford healthy meals

Dietary routines- meal consumed each day

Sleep duration- reduces stress and assists the body to function optimally and burn fat

Level of education- influences informed decision making

Contraceptives can accelerated hormones which in turn causes more calorie intake

Television viewing time frame. - promotes a sedentary lifestyle

Research methodology

 The research design will be a descriptive cross sectional research will enable the examination of obesity alongside other variables. A cross-sectional study is both descriptive and analytical hence permitting the researcher to study the topic in depth.

 Study section – USA

Population under study is African American adult women.

 Sampling technique

Multistage sampling strategy will be used in this study.

A Location USA will be randomly selected and then the researcher will narrow down to the ward and then the house. Sample size will be decided by the statistical calculations. The sample frame will be derived from sub metropolitan head office. African American women aged from 30-50 years old will be randomly selected. Only women who consent to the study will be considered.

Methods-intervention

Exercising done both at home and the gym to reduce weight gained overtime. Emotional support and eating whole foods.

Controlled experiment

 Exercising will not be done at home or at the gym.  Therefore, the participants will be forced to live a sedentary life.

Data Analysis and Interpretation

 This will be derived from the results collected

Tables

 Instrumentation

Demographic data

Weighing scale

Permit from law enforcers

References

Dobbs, R., & Manyika, J. (2015). The obesity crisis. The Cairo Review of Global Affairs, 5.

Goryakin, Y., Lobstein, T., James, W. P. T., & Suhrcke, M. (2015). The impact of economic, political and social globalization on overweight and obesity in the 56 low and middle income countries. Social Science & Medicine, 133, 67-76.

Kumanyika, S. K. (2019). A framework for increasing equity impact in obesity prevention. American Journal of Public Health, 109(10), 1350-1357.

Lakdawalla, D., & Philipson, T. (2009). The growth of obesity and technological change. Economics & Human Biology, 7(3), 283-293.

Concussions

 Concussion refers to a traumatic brain injury caused by intensive shaking of the head and upper body or a blow to the head. Concussion occurs as a result of gentle blow to the head, either with or without loss of sense of awareness. This sometimes can lead to temporary cognitive symptoms such as confusion, headache, memory loss, lack of coordination, ringing in the ears, vomiting, nausea, sleepiness, excessive fatigue and dizziness. The most common cause of concussion are falls but also they are common if one plays a contact sport, such as soccer or football. But the good news is, most people usually recover fully after a concussion. Since there is no exact cure for concussion, rest and restriction of activities allow the brain to recover (Schneider 5) This implies that one should temporarily reduce time spent on video games, television, sports, or extreme socializing. Ondansetron, medication for headache pain or other anti-nausea medication can be used for symptoms.

How Can One Detect if She/he Has Concussion?

The signs and symptoms of a concussion at times may not be easily understood and may not show up instantly. Therefore, concussion symptoms can last for days, weeks and even longer. People who have concussion always report a short period of amnesia or loss of remembrance, whereby they cannot remember what happened right before or after the injury. At times, they may act puzzled, in a state of shock or portray “seeing stars.” If athletic trainers and individuals trained to medically stabilize victims of trauma suppose a person is suffering from a concussion, they may ask the victim if they know their name, what month or year it is and where they are. Brain injury professionals and neurosurgeons usually stress that although some concussions may seem to be less serious than others, there should be no such thing of minor concussion. Therefore, in most situations, minor concussion should not cause permanent damage. It is advisable that, a second concussion soon after the first one should not be very strong since its impacts are permanently disabling.

Physical Symptoms of Concussion

Physical symptoms of concussion are: headache, memory loss, dizziness/imbalance, ringing ears, nausea/vomiting, confusion, vision disturbances i.e. blurred vision, difficulty in concentrating, loss of smell or test, trouble falling asleep and sensitivity to light.

An individual can identify these signs and symptoms in the person with concussion:

• Slurred speech
• Delayed response to questions
• Temporary loss of awareness (though this doesn’t often occur)
• The quality of being forgetful i.e. keeping asking the same question

Signs and Symptoms in Children

Head injury is mutual in young children although concussions can be very hard to detect in infants and toddlers since they can’t be able to explain how they feel. Concussion indicators can be: lack of interest in favorite toys, excessive crying, dazed appearance, loss of balance and unsteady walking, change in sleeping and eating patterns, vomiting or upset stomach, irritability and crankiness, sensitivity to light or noise, listlessness and tiring easily, and problems with memory, concentration and focus.

Types of Concussions

Brain injury experts rank or grade seriousness of concussions based on loss of consciousness, loss of balance and loss of memory (amnesia). Therefore, there are only three grades and they include:

• Grade 1: Gentle, with symptoms that last less than 15 minutes and involve no loss of consciousness
• Grade 2: Moderate, with symptoms that last more than 15 minutes and involve no loss of consciousness
• Grade 3: Intense, in which the individual loses consciousness, sometimes for just a few seconds

Causes of Concussion

Human brain has a uniformity of gelatin which is protected against any shock by cerebrospinal fluid situated inside human skull. Any violent blow to someone’s head or upper body, can lead to the sliding of the brain back and forth forcefully against the inner walls of the skull. Abrupt acceleration or deceleration of the head, caused by activities such as a car crash or being violently shaken, also cause concussion. These kind of injuries affect the function of the brain, generally for a short period, resulting in signs and symptoms of concussion. Sometimes, these brain injuries may cause bleeding in or around human brain, leading to symptoms such as prolonged drowsiness and disarray which may develop later or immediately. Such breeding in human brain may be fatal hence, an individual who experiences a brain injury needs monitoring afterwards and emergency care if symptoms become severe.

Risk Factors

This refers to activities and factors that may increase the risk of concussion and they include:

• Involvement in a motor vehicle collision
• Involvement in a pedestrian or bicycle accident
• A soldier involved a combat
• Having had a previous concussion
• Falling, especially in older adults and young children
• Participation in high-risk sports, such as football, hockey, boxing, rugby or other contact sport
• Being a victim of physical abuse

Complications

Following a concussion, some individuals may suffer continued symptoms, such as mood swings, memory and concentration, personality changes, dizziness, fatigue, headache, insomnia and excessive drowsiness for many weeks to months. This is referred to as post-concussive syndrome. Individuals with post-concussive syndrome should limit activities that expose them to risk of repeated concussion (Polinder 7-10). Athletes should not go back to play while experiencing these symptoms and those who suffer continued concussions, should consider ending participation in the sport. Second-impact syndrome results from acute and frequent fatal brain swelling that occurs when a second concussion is held before complete recovery from a previous concussion. This effect at times may cause vascular congestion and increased intracranial pressure which can occur intensively and may be impossible to control (Ellis 45-49). The risk of second-impact syndrome is more in sports like football, boxing, ice or roller hockey, baseball, soccer, skiing and basketball. According to reports, an average of 1.5 deaths per year from sports concussions occur.  

Concussion Diagnosis

Most patients with concussions fully recover when put under appropriate treatment. But since a concussion can be serious, protecting oneself is very crucial. Here are a steps to follow:

Seek medical attention. A health care expert can determine how serious the concussion is and whether one has to undergo treatment.

If an individual has grade 1 or grade 2 concussion, wait until symptoms are gone before resuming to normal activities. It can take several minutes, hours, days, or even a week.

If an individual has lost consciousness, which is grade 3 concussion, it needs a doctor’s instant evaluation and care. Doctors will always ask the patient how the head injury happened and then discuss the symptoms. The doctor may also ask an individual simple questions such as “What is your name?”, “Where do you live?”, or “What is the name of your father?”. The doctor usually asks these questions to examine memory and concentration skills.

The doctor may examine coordination and reflexes, which are the functions of the central nervous system. The doctor may also order a CT scan or an MRI to make decision on breeding or other serious brain injury.

Concussion Treatment and Home Remedy

Concussion symptoms can affect individuals in many ways, involving balance, vision and even mood. In the past, the quality treatment for concussion was to have plenty of rest, but the recent approaches involve therapy to target specific symptoms. Existence of clinics help to determine the most affected brain system and appropriate therapy for a given symptomology. If one doesn’t need hospitalization, he/she has to be given instructions to follow by the doctor. Professionals recommend a follow-up for medical attention within 24 to 72 hours if symptoms become severe. In order to recover from home, one should: 

• Have a break: If one’s concussion was held during an athletic activity, he/she should stop to play and rest. Brain always needs time to properly recover, so rest is important. It is advisable to monitor closely athletes and children through coaches upon resuming to play. If one resumes to play before recovering fully, it is very risk to have a second concussion which can later cause damage. The American Academy of Neurology has given guidelines about resuming activities after concussion.
• Protection against repeat concussions: Repeat concussions lead to cumulative impacts on the brain. Successive concussions can have severe consequences which include brain swelling, long-term disabilities, permanent brain damage and even death. One should not return to normal activities if the symptoms persist.
• Treat concussion with aspirin-free medication: A doctor will prescribe a medication to ease the pain or suggest an over-the-counter option.

 Concussion Prevention

A concussion is something unexpected, so it is sometimes difficult to control. But there are several common measures one can take to lessen the probability of violent brain injury.

• Wearing protective gears: Participation in high-risk sports like rugby, football, hockey, and boxing can increase the possibility of a concussion. Hoarse-back riding, skateboarding, snowboarding, and rollerblading are also a threat to the health of the brain. Wearing eye and mouth guards, headgear and padding can help to protect an individual against violent head injuries (Rowson, Bethany, and Stefan 1,2). Also wearing a bike helmet can lower the chances of having violent head injuries by approximately 85%. There is also introduction of a C-shaped collar like device known as Q-collar which can be worn by athletes. It applies compressive pressure to the neck and increases blood capacity to help reduce movement of the brain, which may occur as a result of hits to the head. It is advisory to wear an equipment that fits you correctly and which is well-maintained.
• Never fight: Many concussions are always sustained during assault, and statistics show that more men compared to women report traumatic brain injury.
• Buckle your sit belt: Wearing a sit belt at times prevent serious injury, involving head injury, during a traffic accident.
• Protect your children: To lessen the risk of head injuries to your children, block off the stair ways, install window guards and make sure the home is well-lighted.
• Do exercise often: This gives an individual stronger leg muscles and better balance, which limits stave off falls.
• Educate others about concussions: Educating parents, coaches, athletes and other individuals about concussions, can assist in the spread of awareness. Parents and coaches can also assist in encouraging good sportsmanship.

Impact of Concussion on Football Players and Young Players

In recent, we know more about what happens in the brain during a concussion and as well, we know that an athlete who sustains one concussion is 4-6 times more likely to sustain another. Many players return to play before recovering or don’t display their concussion symptoms at all (Ellis 2-5). In the process of doing this, they put themselves into risk for more severe injuries in which its impact is possibly deadly second impact syndrome (SIS). Returning to play before recovering also increases the risk of developing symptoms that do not fade away quickly or do not fade away at all without treatment and this condition is referred to as post-concussion syndrome. Players should learn about the signs of post-concussion syndrome and seek treatment as soon as possible if their concussion symptoms continue.

Common Causes of Football Concussions

The most common source of football concussions that we usually observe in our clinics are from helmet-to-helmet contact in blocking and tackling and from head-to-ground impacts. It is very crucial to remember, however, that an individual can suffer a concussion from being hit very hard.

NFL and College Football

During the period of 2012-2019, the National Football League (NFL) Injury Data displayed that an average of 242 NFL players sustained concussions annually. Some statistics declare that about 10% of all college players experience brain injury every playing season. A recent research of brains gotten from former deceased football players found CTE in 99% of the brains of NFL players, in 88% of Canadian Football League players, and in 91% of college football players. Athletes who manage to reach this level of the game, have been playing football and sustaining impacts for several years and are thus at high risk of developing CTE.

High School Football

Statistics display that about 20% of all high school football players experience brain injury every football season and that football is accountable for more than 60% of the concussions in high school sports (Kerr 28,29). The players that sustain the highest percentage of concussions in defensive positions are line backers, and in offensive positions, running backs.

Youth Football

There have been very few studies about youth football player concussions. However, many parents and medical experts question the safety of tackle football in this age group. One small research got that children as young as 7 and 8 years old can experience high impact collision during the game. Researchers measured impacts of more than 40 times the force of gravity on these players by the use of sensors whereby majority of these impacts occurred during practice. These players experienced more impacts to the sides of their helmets, usually from hitting the ground after being tackled. It is crucial to note that children usually have weaker neck muscles compared to teens and adults hence, these put them at risk for concussions caused by rotational force.

Managing Concussions: The NFL Protocol

Since each player and each concussion is unique in away, there is no set timeframe for healing and return to play under the NFL’s current procedures. But if a player is diagnosed with a concussion, the protocol advocates for a minimum of daily monitoring (Ellenbogen 2). The player’s previous concussion exposure, medical and family history are reflected on hence creating a clear picture of his health. The protocol moves forward through a series of steps and only if all activities in the current step are dealt with fully limiting recurrence of symptoms. Communication between the medical officer and the player is very important. The first protocol step is rest. In the course of this period, the main aim is to avoid physical exertion whereby the player has to avoid social media, electronics and even team meetings until he has fully recovered.

The next step introduces light aerobic exercise, which takes place under direct monitoring of the team’s medical staff. If aerobics work efficiently, the team physician will reintroduce strength training (Leddy 9). The fourth step involves some non-contact football-specific activities, and the fifth step involves clearance to resume into participation. The fifth step only comes after neurocognitive testing remain at baseline and there is no recurrence of signs and symptoms of concussion. The player has a final examination by the INC assigned to his team after he is fully been given a final clearance by the team physician. As part of this examination, the INC will review all reports and tests documented along the period of the player’s recovery. Once the INC comes into agreement with the conclusion of the team’s physician, the player is cleared and is fit to return to full participation. NFL protocol allows players to recover at their individual rate, involve the experts of both the team physicians and a neurological consultant.  Lastly, the protocol involves an assessment of not only the most recent concussion, but also takes into account the medical background of the player.

Works Cited

“Neurocognitive and Psychiatric Symptoms Following Mild Traumatic Brain Injury.” Translational Research in Traumatic Brain Injury, 2016, pp. 402–417., doi:10.1201/b18959-24.

Dacosta, A, et al. “A - 48Baseline Symptoms from the Sports Concussion Assessment Tool (SCAT) Predict Concussion Recovery Time in Collegiate Athletes.” Archives of Clinical Neuropsychology, vol. 33, no. 6, 2018, pp. 703–794., doi:10.1093/arclin/acy061.48.

Ellenbogen, Richard G, et al. “National Football League Head, Neck and Spine Committee’s Concussion Diagnosis and Management Protocol: 2017-18 Season.” British Journal of Sports Medicine, vol. 52, no. 14, 2018, pp. 894–902., doi:10.1136/bjsports-2018-099203.

Ellis, Michael J., et al. “A Physiological Approach to Assessment and Rehabilitation of Acute Concussion in Collegiate and Professional Athletes.” Frontiers in Neurology, vol. 9, 2018, doi:10.3389/fneur.2018.01115.

Kerr, Zachary Y., et al. “Concussion Incidence and Trends in 20 High School Sports.” Pediatrics, vol. 144, no. 5, 2019, doi:10.1542/peds.2019-2180.

Leddy, John J., et al. “A Preliminary Study of the Effect of Early Aerobic Exercise Treatment for Sport-Related Concussion in Males.” Clinical Journal of Sport Medicine, vol. 29, no. 5, 2019, pp. 353–360., doi:10.1097/jsm.0000000000000663.

Polinder, Suzanne, et al. “A Multidimensional Approach to Post-Concussion Symptoms in Mild Traumatic Brain Injury.” Frontiers in Neurology, vol. 9, 2018, doi:10.3389/fneur.2018.01113.

Rowson, Bethany, and Stefan M. Duma. “A Review of On-Field Investigations into the Biomechanics of Concussion in Football and Translation to Head Injury Mitigation Strategies.” Annals of Biomedical Engineering, vol. 48, no. 12, 2020, pp. 2734–2750., doi:10.1007/s10439-020-02684-w.

Schneider, Kathryn J, et al. “Rest and Treatment/Rehabilitation Following Sport-Related Concussion: a Systematic Review.” British Journal of Sports Medicine, vol. 51, no. 12, 2017, pp. 930–934., doi:10.1136/bjsports-2016-097475.

Thomas, Elizabeth, et al. “Post-Concussion States: How Do We Improve Our Patients’ Outcomes? An Australian Perspective.” Journal of Concussion, vol. 4, 2020, p. 205970022096031., doi:10.1177/2059700220960313.

Treatment Intervention and Challenges

Part 1

Identify and provide an explanation of one treatment approach to engage Antoine and one treatment approach you consider to be most helpful in counseling this family. Please provide a description of the treatment approaches, as well as your rationale for why these approaches are the most helpful one to use.

When dealing with treatment on substance abuse, various approaches can be used depending on the condition of the patient and the level of addiction. Antoine is a family man who has been lately associated with substance abuse, especially taking alcohol with friends after work. His addiction raises concern majorly to the family, especially Martha, who is directly and adversely impacted. For Antoine’s case, the most appropriate approach to engage in the Community Reinforcement and Family Training (CRAFT) (Kirby et al., 2017). This is an empirically-based therapy program, which has proved a significant success when dealing with family members or friends diagnosed with substance abuse disorder but has, by all means, refused to get treatment. Just like in the case of Antoine’s who is not ready to visit any therapist or counselor over his recent drinking habits. Indeed he does not accept that he has a problem until the neighbors call the police about excessive screaming in their house, which attracts the concern of the local child protection agency.

CRAFT is one of the sure ways to address substance abuse with individuals who do not appreciate that they need some therapy. The reason for this selection is first to focus on three essential goals. Of the three goals, two of them have a primary focus on the individual who is abusing alcohol, and the third focusing on the concerned significant other (CSO). In this context, the first goal and the final objective is to influence Antoine, who has recently been involved in alcohol abuse, to seek medical attention or treatment. Secondly, a very significant goal is to ensure that the amount of alcohol he takes is reduced, and thirdly, is to improve the lives of the concerned significant other (Dutcher et al., 2009). In this case, the CSO is Martha, and the children who the alcohol abused by Antoine has directly or indirectly impacted them. For instance, Martha has been directly and adversely impacted by Antoine’s current behavior, to start with, he was the breadwinner for the family, and due to alcohol, his license has been suspended. Additionally, in the therapist's place, Antoine happens to move out, and immediately Martha starts crying loudly, showing bruises on her right arm, and also confesses that she has been struggling with “all of Antoine’s behavior.”

Primarily, I would prefer CRAFT over any other method when addressing alcohol addiction. Martha, embracing this method will be a sure pathway towards achieving great results; generally, the direction of this approach is for the CSO to learn. This knowledge gained is essential to avoid using behavior, reward non-using behavior, and discontinue enabling. Understanding enabling in conjunction with alcohol addiction and other substance use is a well-intended elimination of negative natural consequences that decreases the identified patient (IP) behavior (Kirby et al., 2017). A good example is when Antoine comes home drunk, and Martha does not help him addressing the complications associated with drunk people, such as help in vomiting, take them to bathrooms and clean their mess. In the following days, the husband might recognize that he has become a burden to the wife and family and thus needs to change. The wife can also help in this by dealing with the morning hangovers and even reporting to the boss that the husband is not capable of attending to his jobs the following day, which Martha had already started doing. This great treatment within the family will fully convince Antoine to seek treatment and counseling and later on quit alcohol.

However, not every individual is ready for help based on treatment interventions. This is for the case of abusers who refuse to get help despite the efforts of the CSO. It has been noted that the majority of the abusers take action for treatment as a response to external pressure from either spouse, other family members, legal systems, or physicians. Among the stated external forces, a family-based intervention has proved more successful, forcing substance abusers to enter treatment (Lam et al., 2012). Martha is one of the lucky women as her case gets the attention of the child’s protection agency, and Antoine is willing to see the therapist and counselor about his recent alcohol use.

Additionally, various treatment approaches are used to address substance abusers. One of the most helpful approaches that reward good results is the behavioral approach, primarily referred to as behavioral family therapy treatment, which is based on social learning theories and operant to gather knowledge about the substance abusers within the family context. Based on this approach, substance use is a learned behavior from the social interaction, which fits well in Antoine, whose alcohol consumption starts after he starts visiting pubs with friends. The family concern in this prospect is designed to reward sobriety, reduce drug use and promote prosocial behaviors, which have been seen to fade out with the substance use. This method suits best in treatment interventions because the abuser and the family members get trained on helpful methods that would increase positive interactions, increase problem-solving, and foster communication skills. The ultimate result of these skills is to help the family members reduce continued drinking by using family members.

This capability has been used commonly with alcohol and drug-abusing couples. Just as in our case, Antoine is a victim of alcohol abuse, making this treatment approach appropriate in addressing his condition with Martha. Commonly, three strategies are used to reinforce patterns observed with drug users' families. These include the reinforcement for substance-using behavior taking the form of his drug abuse. Secondly, it is to shield the substance user from experiencing adverse consequences on substance use and punishing drinking behavior (Dutcher et al., 2009). The family's primary focus in this approach, as stated, is to change the spousal interactions, which are the main stimuli for abusive substance use. Interactions are good as they would help in improving communication and problem-solving abilities, as well as coping skills that promote sobriety. Martha needs to make sure that her interaction with Antoine is, at best, sharing on the impacts that alcohol has cost the family, losing his job, and poor association with Natalie; thus, he can change the mind and focus on stopping this alcoholic abuse.

More importantly, the CRAFT and behavioral treatment approaches can be intertwined. These two approaches are essentially treating people with substance-use complications. Additionally, the community reinforcement approach (CRA) was found to have a significant influence over the drinking decisions. The majority of members were reported to get convicted and go for treatment based on pressure from their family members and friends. Besides, the CRA was found to work with CSO perfectly. The latter's primary concern is on their wellbeing as they have suffered when dealing with stressors associated with the identified patient substance use. Common stressors felt include violence, verbal aggression, marital conflict, financial problems, social embarrassment, and disrupted relationships with children. These two suits exactly in addressing Martha and Antoine's case are because all the effects are evident of their family, ranging from violence to financial problems and disrupted relationship with Natalie.

Part 2

1. Consider Martha and her family. How might the harm reduction ideas be helpful to your work with them? Identify what might be some challenges to adopting this philosophy to working with families?

The treatment methods present have a central focus to support individuals abusing substances. The reason for this focus is to minimize harm from substance abuse or use which primarily includes abstinence-based treatments. The latter treatment highlight that abstinence is the priority towards addressing or reducing harm. In this program, there are some key attributes that need to be addressed; these include embracing self-determination and promoting ideas that individuals decide on specific harms to address and the order that they need to follow (Denning, 2010). Based on Antoine and Martha’s case, it is clearly pointed out that individual members are struggling with their daily duties, support, and love affairs and instead strains so much to keep going, with a fear that the situation might get worse with time if they happen not to set limits with substance use relativity.

This family needs to take immediate mitigation. In this case, Martha and Antoine need to ask themselves questions on possibilities that might help mitigate substance use while at the same time ensuring that they protect their survival. This includes freedom from chaos and volatility that the alcoholism addiction had created. Therefore, it is essential to ensure that these two keep their values and engage in counterproductive behaviors to themselves and the neighbors (in this case, avoiding activities that might attract the attention of the neighbors in the future, such as screaming). This is a way of making Antoine appreciate the importance of being sober, avoiding the abuse of drugs. The harm reduction in the family treatment framework would be helpful in refocusing on efforts to enhance individual family member efficiency and motivation, which creates long-lasting changes within the family.

Additionally, harm reduction principles fit adequately with the stages of change model, with assumptions that people are capable of making decisions on important needs. This means that they can address them when they are ready. These practices are generally designed to help people move across the stages of change at their own pace (Denning, 2010). Also, the practice offers a wide path honoring all the stages in the change process. It is, therefore, essential to incorporate the harm reduction principles in working with families, as it would help in describing how each of these principles helps in family-involved work.

However, some challenges are associated with the implementation of the harm reduction approach. A variety of these challenges include issues with achieving and maintaining abstinence from alcohol. The most desirable outcome of the harm reduction process is the total elimination of use, which is although goal to achieve a majority of the programs focus on a continuum of outcomes which include swift to safer substance alternatives and encouragement of clients to reduce their alcohol use (Mancini et al., 2008). Also, this program portrays negative consequences for individuals who are unable to control their use unless they are in highly structured environments.

2. As noted in the new case study information, Martha shows you the bruises on her arm. What is the message that Martha is trying to convey in her action? What are some initial thoughts that come to your mind? What are your next steps? Answer the questions and provide an explanation of the steps you would take to address the issue(s).

In the previous report, Martha has been covering his husband’s behavior. In an investigation with the child protection agency, she expressed that Antoine did not possess any drinking problem and that this latest experience was bad luck. She also adds that he only takes a few drinks with friends after work and that he is not violent when drunk. Martha also states that children have not been affected by the behavior and continues with their daily scheduled activities. However, it does not take long for the story to change when Sam is introduced to the story. Antoine describes Sam as a lazy and uneducated fellow, which makes Martha start crying. She points out why Sam is living with them and the difficulties of finding a new job. Suddenly, when Antoine requests to get out and put more money in the parking meter, Martha cries loudly and confesses that she has been struggling and finding it so difficult to cope with Antoine’s current behavior.

She pulls her sleeve on the right arm showing bruises. So, simply this means that Antoine has been violent fighting Martha. Perhaps, her former report was just a way of concealing their home affairs as every woman would do, or maybe she was just sure that Antoine would change with the kind of treatment she gives her while at home, even when drunk. Now that he does not realize what Martha was doing and that he is not ready to accept Sam in their home, he decides to open up for good for worse, and immediately he leaves out for the payments, Martha speaks it all. Initially, I thought that Martha cries that his husband is not willing to stay with his brother, who has been jobless for some time now, or maybe he is worried that his husband would not change his current behavior.

As a counselor, I need to address these issues with the highest level of competence. From the look of things, life has been so tough to Martha; she is even beaten up and hides it from the public, perhaps even the screaming herd by the neighbors that led to calling of police was a fight between Antoine and Martha. In this context, therefore, I would address both of their situations, first listening to Antoine’s take on beating his wife to even development of bruises. The outcome of this talk would be to come up with strategies that would help completely eliminate the alcoholism behavior with Antoine. For this case, we would consider the case of Martha and Antoine as couples at any stage who have been influenced by alcoholism. Just as expected, their marriage has been greatly affected by alcoholism, creating symmetrical conflict where covert dependency and competitiveness and imbalance. Now that Antoine no longer works, he and the family relies on his wife Martha, which makes her overwork while he relaxes and drinks.

As a counselor, it is essential to address this challenge critically. This can be achieved through dynamic efforts to make sure that Antoine abstains from drinking alcohol. The use of the Al-Anon self-help program will educate the non-drinking member of the family on alcoholism on keeping a strong focus. In addition, as a counselor, I would trace all cases of domestic violence, threatening and intimidating behavior on the spouse, and referrals made to batterers program (Wormer & Parker, 2018). Now that Martha is left alone, I would advise her alone, as AI Anon is not appropriate until the partner is safe. I would advise Martha, solely of her legal rights, to seek a legal women’s group if the violence is not settled.

References

Kirby, K. C., Benishek, L. A., Kerwin, M. E., Dugosh, K. L., Carpenedo, C. M., Bresani, E., ... & Meyers, R. J. (2017). Analyzing components of Community Reinforcement and Family Training (CRAFT): Is treatment entry training sufficient?. Psychology of Addictive Behaviors, 31(7), 818.

Lam, W. K., O’Farrell, T. J., & Birchler, G. R. (2012). Family therapy techniques for substance abuse treatment. Treating substance abuse: Theory and technique, 256-280.

Wormer, K. & Parker, L. (2018). 15. Substance Abuse Treatment: A Field in the Midst of Change. In R. Rooney & R. Mirick (Ed.), Strategies for Work with Involuntary Clients (pp. 418-433). New York Chichester, West Sussex: Columbia University Press. https://doi.org/10.7312/roon18266-017

Dutcher, L. W., Anderson, R., Moore, M., Luna-Anderson, C., Meyers, R. J., Delaney, H. D., & Smith, J. E. (2009). Community Reinforcement and Family Training (CRAFT): An effectiveness study. Journal of Behavior Analysis in Health, Sports, Fitness and Medicine, 2(1), 80.

Denning, P. (2010). Harm reduction therapy with families and friends of people with drug problems. Journal of clinical psychology, 66(2), 164-174.

Mancini, M. A., Linhorst, D. M., Broderick, F., & Bayliff, S. (2008). Challenges to implementing the harm reduction approach. Journal of Social Work Practice in the Addictions, 8(3), 380-408.

Impact of culture on health

Medical professionals and caregivers are morally required to provide the highest quality of care to their patients. In today’s society, the quality of care is determined not only by the treatment and medication given, but also the approach and processes used by the caregivers when treating the patient. The quality of care is therefore influenced by the measures taken to treat the patient, the environment the patient is treated in, and the attitude and professionalism displayed by the caregivers throughout the process. Current trends in occupational therapy have created an environment where cultural awareness and responsiveness helps caregivers to provide the highest level of care to all patients regardless of their differences. In speech therapy, cultural responsiveness helps to bridge the gap between the patient and the caregiver and facilitates faster recovery.

Speech therapy involves actions undertaken by a speech language pathologist to asses and treat speech disorders and other communication problems. Speech therapists rely on techniques such as language intervention activities, articulation therapy and other types of speech therapies that are respective of the language or speech disorder being treated (Luo, 2019). Patients that require speech therapy comprise of individuals with speech disorders that developed during childhood and also speech impairments resulting from injuries or illnesses like brain injury and stroke. patients who seek out speech therapy early and are treated at home with the involvement of family members or caregivers have proven to be more effective (Aota, 2013). This is especially because the patient is treated in a familiar environment that helps to speed up the recovery process. Since familiarity helps to speed up the process, speech therapists should therefore employ the use of culturally respective practices to build trust and make it easier for the patients to recall their verbal skills.

Since culture greatly impacts the recovery process, it raises the questions; what impact does the speech therapist’s culture have on their ability to help their patients? When treating patients, what should be given more priority, the general code of conduct or the patient’s preferences as influenced by their culture? Answering this question will require the speech therapist to gain knowledge on the impact that customs and traditions have on the patient’s attitudes towards treatments used and also how to use these customs and traditions to improve the overall quality of care the patient receives. Based on what I have learned, a lot of emphasis is placed on the impact that the patient’s culture has on their willingness and attitude towards the treatment method used (Andrews et al, 2017). I therefore plan to conduct more research on how the speech therapist’s culture impacts the quality of care offered as well as the attitude that the caregiver portrays to patients from different cultural backgrounds. Another step I intend to take is learn about different people’s culture, how their customs and traditions differ, and how to use these differences to offer better care not only in speech therapy but when offering any form of care to patients under my care.

Occupational therapy ethics code seeks to create awareness on multiculturalism and how cultural responsiveness can help to improve the quality of care. When treating communication impairments, speech therapists should strive to be culturally competent and use a combination of different cultural variables to determine the most appropriate treatment method to use depending on the patient being treated (ASHA, 2020). Since different societies have embraced diversity, speech therapists ought to study the different cultures and develop approaches that are tailored to meet the needs of each respective patient. Some of the factors that the speech therapist should consider include the patient’s age, ethnicity, type of disability, gender identity and other factors influenced by the customs and traditions the patient observes.

There have been major breakthroughs resulting from occupational therapy in regards to cultural responsiveness and sensibility. Speech therapists use various cultural variables that are respective of the patient’s culture to establish trust with the patient and encourage them to open up. The relationship established makes it easier for the therapist to diagnose the patient and develop treatment programs that will facilitate recovery (Lau et al, 2012). Since the treatment approaches are influenced by the patient’s culture, the familiarity makes it easier for the patient to regain their verbal skills as the treatment is done in a familiar environment. Another advantage of structuring the treatment around the patient’s customs and traditions is that it helps the speech therapist to communicate with patients on a level that they can understand. When dealing with patients from poor backgrounds, understanding the customs and traditions practiced by the patient will help to identify treatments that may not be applicable (Barailo, 2019). A good example is the case where the patient seeking therapy does not understand the language commonly used by the therapist. To overcome the communication barrier, therapists rely on the customs and traditions that are familiar to the patient to help determine the most suitable language and other treatment methods to use (Lucas & Washington, 2020). While imposing a foreign language may hinder recovery, using the traditional language makes it easier for the patient to express themselves and also to practise the therapy sessions designed by the speech therapist.

There are however disparities in occupational therapy that negatively affect the quality care that people in marginalized groups receive. Latinos for instance have sub-optimal health status and have limited access to personal doctors and nurses. African Americans on the other hand lack adequate access to oral health and do not always get the medication they need to manage their conditions (Lubinski & Matteliano, 2008). Other challenges that individuals in marginalized groups face include lack of access to mental health facilities, lack of insurance covers, difficulty accessing specialty care and inability to access routine visits from caregivers. The disparities make it difficult for individuals in the marginalized group to access or afford the care they need to manage and treat conditions such as speech impairment.

            However, there are various practices and policies in occupational therapy that promote positive cultural responsiveness and health. A good example is the Occupational Therapy Code of Ethics and Ethics Standards that guide the caregivers’ moral practices. When implemented, the standards help care givers like speech therapist on how to identify the best approach to take when treating patients and also how to go about resolving conflicts. The guidelines also help in decision making as the therapist has a point of reference and guidance on how to navigate around sensitive issues. Speech therapists, like all caregivers should therefore seek out the most applicable, culturally influenced treatment methods to offer high quality care in a way that is respective of the patient’s culture. the goal should always be to offer the highest quality of care both in the treatment and approach taken to treat the patient.

References

American Occupational Therapy Association, (2013) “How can occupational therapy strive          towards culturally sensitive practices?” retrieved from,          https://miota.org/docs/FAQCulturalSensitivity.pdf

American Speech Language Hearing Association,(2020)“Cultural Competence” retrieevd from,             https://www.hindawi.com/journals/oti/2017/2179781/

Andrews B, Carey T, Jiyane K and Mashele S. (2017) “Exploring cultural competence amongst   OT students” Occupational Therapy International, retrieved from,             https://www.hindawi.com/journals/oti/2017/2179781/

Barailo, Aurora. (2019). Importance of Cultural Awareness in Speech Language Pathology          Education. In BSU Honors Program Theses and Projects. Item 353. Available at:             https://vc.bridgew.edu/honors_proj/ 353

Lau M, Lin H, Flores G. (2012) Racial/ethnic disparities in health and health care among U.S.     adolescents. Health Serv Res. 2012 Oct;47(5):2031-59. doi: 10.1111/j.1475-       6773.2012.01394.x. Epub 2012 Mar 14. PMID: 22417169; PMCID: PMC3513617.

Lubinski R and Matteliano A (2008) “Speech language pathology” University of Buffalo, retrieved from, https://www.mghihp.edu/sites/default/files/about-us/diversity/guide-           cultural-competence-slp.pdf

Lucas C and Washington S, (2020) “Understanding systematic racism in the United States:          Educating our students and ourselves” American Occupational Therapy Association, retrieevd from, https://www.aota.org/-/media/Corporate/Files/Publications/CE-        Articles/CEA_October_2020.pdf

Luo K, (2019) “What is speech therapy?” Health-line. Retrieved from,             https://www.healthline.com/health/speech-therapy

Transformational leadership in nursing

The leadership theory that I would most like to emulate is transformational leadership as the theory focuses on bringing positive change. Leaders who use the transformational leadership style are regarded as agents of change especially because they possess the skills and knowledge needed to empower others and get them on board a shared vision that is influenced by the desire to accomplish the overall goals ad objectives. When used, tramsformational leadership helps employees to align their interests with those of the organization. This in turn encourages them to seek out more effective and innovative ways to fulfill tasks assigned to them. By fulfilling the organizational objectives, employees also fulfill their own personal goals and are more motivated. However, for it to be successful, the leader must build and maintain positive relationships with other members of staff. The leader is expected to remain fair, promote openness and honesty in order to gain the trust of the people under their charge.such an environment will encourage employees to perform at their best while still motivating them to make decisions on their own in scenarios that do not require the leaders involvement.

Leaders are also expected to be confident and strongly believe in their vision as well as that of the organization. The leader has a responsibility to ensure that other members of staff are assisted in fulfilling their ultimate goals alongside organizational goals and objectives (Shamian, 2014). Giving the employees a sense of purpose will make it easier for them to align their interests with those of the organization and therefore encourage them to be more innovative and efficient when performing their duties.

The role of the nurse leader includes the collaborative and autonomous care that is given to all patients regardless of their age, gender, community they live in, political disposition and any other setting that is used to classify people in different categories in society. As a nurse, one is expected to promote health, prevent illnesses, take care of the sick and provide the highest level of care to all patients alike (Ratcliffe et al, 2017). In addition, nurses must also promote and advocate for safe working environments for other nurses and caregivers as well as the creation of an ideal environment for patients that enhances the patient’s experience when receiving treatment. Nurses must therefore participate n the development of health policies and health management systems that seek to improve the working environment and the quality of care that patients receive while under their care.

According to Maslow’s hierarchy of needs, human actions and decisions are greatly influenced by the desire to fulfill their basic needs. The basic needs include physiological stability, safety, belongingness and love, self esteem, and self actualization. Maslow also points out that the needs are arranged in a hierarchy with physiological stability being the most important while self actualization is at the bottom of the hierarchy (Habel & Sherman, 2021). When the top basic need is met, the individual moves down to the next basic need until it is fulfilled. To make the model my own, I intend to incorporate the teachings from Maslow’s hierarchy of needs combined with the transformational leadership skills learned. In the model, I will identify the quality of care; promotion of health; and advocacy as the three hierarchies with the quality of care being the most important.

My first priority as an emergency department RN will be to gain more skills and knowledge in my field. To achieve this, I plan on conducting different types of research and engage in volunteer programs that seek to improve my skills and competence as a RN. I will start by identifying professionals in my field and find a role model to emulate and also to act as a mentor. I will try to interact with different nurses and other professionals in the field and use the experiences gained to improve my leadership skills and efficiency as a nurse. Second on the hierarchy will be promoting high quality health not only in the organization but also in my community. I will sign up for volunteer work in my field and use the opportunity to interact with other caregivers and members of society and educate them on how to promote better quality of health. Advocacy will be last on my hierarchy and I will call on stakeholders and the relevant authority to try and promote high quality health in all organizations. I will also take part in the development of policies that seek to promote high quality of care.

I also intend to incorporate lifelong learning through transformational leadership and develop my role as a patient advocate. To achieve this, I will rely on the skills and knowledge that I have gained over the years and introduce communication channels that allow for positive feedback. As a leader, my interaction with patients is limited compared to other nurses. Effective communication will allow me to interact with other nurses, discuss ideas on how to improve the quality of care that patients receive (xu, 2017). Since nurses interact with patients at the health institution and also assist in helping patients manage their conditions when at home, their input will greatly assist in finding new ways to improve the quality of care patients receive. I also plan on interacting with patients on a personal level and gain their insight on what changes can be implemented in the institution to improve the quality of service.

I also plan to develop programs that focus on increasing the time that nurses spend in direct patient care. Other than the treatment that patients receive, the quality of care and the environment in which patients are treated in greatly contributes to their perception of the quality of care. Increasing the time in which nurses spend in direct patient care will allow nurses to pay closer attention to the patients’ needs (Shamian, 2014). The interaction will also enable nurses to collect information about what changes can be introduced in order to transform bedside nursing. Since transformational leadership seeks to mutually benefit the organization as well as the employee, it can be used to share the management’s vision with other members of staff (Griffiths et al, 2016). The vision can be structured such that it communicates the role that nurses and other caregivers play in enhancing patient satisfaction with the quality of service provided.

Transformational leadership can greatly improve communication and collaboration with administrators and the entire healthcare team. Leaders that use transformational leadership are able to create a compelling and positive vision that not only seeks to met the organizational objectives, but also ensure that the needs of the entire healthcare team are met. Its success therefore hinges on positive relationships, interactions and understanding between the leader and other members of staff (Fischer, 2017). Traditional leadership styles used in the past like autocratic leadership created an environment where communication flowed in one direction made it difficult for employees to engage with the top management. This in turn disrupted communication as feedback was rare and employees were only expected to perform the tasks assigned to them under the provisions given by the top management (Fischer, 2016). When transformational leadership is used however, the leader is able to create an environment that is built on effective communication and collaboration that seeks to serve the interest of both the organizations and the entire healthcare team. Rather than dictating terms and issuing orders, the leader is able to engage with other employees, gain their insight on some of the approaches that can be implemented and work together towards accomplishing a common goal (Fischer, 2017). The leader is also in a position to inspire and motivate the healthcare team and include them in the development of policies that strive to enhance communication and collaboration.

Concerning structure, process and the outcomes that are linked to the assessment of care and accreditation, transformational leadership has an advantage as it regards fulfillment of the healthcare teams’ needs as being vital to high work performance and provision of high quality of health to all patients. As stipulated by Maslow’s hierarchy of needs, human beings place some level of importance on their needs and wants depending on their urgency or importance (Griffiths, 2016). In nursing, the structures used in the healthcare organization will influence the quality of care provided by nurses and also their attitude when performing their duties. The assessment of care is therefore dependent on factors like the leadership style used, the channels of communication used and whether the leader and other members of staff share the same vision for the expected outcomes (Shamian, 2014). Through transformational leadership, the nurse leader can share his vision of the assessment of care and accreditation with other employees and engage them in activities that seek to improve the structure and processes used in the organization to enhance the quality of care as well as motivate the entire medical team. 

I aspire to be one of the influential Emergency Department Nurses in my field and act as a role model for others aspiring to join the profession of nursing. Other than pursuing courses that help grow my academic knowledge, I also intend on carrying out research on how to become a more effective leader. I also plan to engage with other professionals who are experts in their field to learn how to be a better leader. I also plan to use the information I gain to assist in the development of policies that advocate for high quality standards when attending to patients and also the importance of an ideal working environment. The quality of care provided heavily relies on the attitude that nurses have when performing their duties. Creating a safe and ideal environment will likely motivate the entire medical team and encourage them to seek out more innovative and efficient approaches to handle patients under their care.

References

Fischer, S. A. (2017). Transformational Leadership in Nursing Education: Making the      Case. Nursing Science Quarterly, 30(2), 124–          128. https://doi.org/10.1177/0894318417693309

Fischer, S.A. (2016) Transformational leadership in nursing: a concept       analysis. Journal of Advanced Nursing 72( 11), 2644– 2653.             doi: 10.1111/jan.13049

Habel M and Sherman O, (2021) “The role of transformational leadership in nursing”       Nurse, retrieved from, https://resources.nurse.com/magnet-hospitals-  transformational-leadership

Ratclife C, Roussel L, and Thomas L, (2017) “Leadership theory and application for        nurse leaders” retrieved from,            https://samples.jbpub.com/9781284067620/Sample_CH02_Roussel7e.pdf

Shamian J, (2014) “The role of nursing in health care” Scielo,         https://doi.org/10.1590/0034-7167.2014670601

Vaismoradi, M., Griffiths, P., Turunen, H. & Jordan, S. (2016) Journal of Nursing             Management 24, 970– 980. Transformational leadership in nursing and      medication safety education: a discussion paper.            https://doi.org/10.1111/jonm.12387

Xu H, (2017) “leadership theory in clinical practise” Chinese nursing Research,    retrieved from, https://doi.org/10.1016/j.cnre.2017.10.001

Abstract

The importance of creating purchasing EHR (electronic health records), practice management systems (PMS), and health information technology (HIT).systems is that they are meant to enhance the interoperability of an organization. The primary reason entail ensuring that each system had a unified communication. As a result, the outcome of this integration can be said to have enhanced the general improvement in quality and speed of health care, improving data sharing accuracy within the two systems, increasing productivity, and boosting the positive shift of the physician time spent in providing quality health care as compared to data entry.

Video Analysis

Video 1

Physical Changes in Middle adulthood. Retrieved from: https://youtu.be/RhmJIBCh1bs

Analysis

According to the clinical perspectives highlighted in this video, although it is evident that the middle adults are emotionally, cognitively, and physically in good conditions, it is during this stage that these parameters continues to change. As much as height is concerned, for instance, it is apparent that individuals reach their maximum height when they are an age of 20s and above. Despite that, at an age of 55 and above, they can experience settling, in which their bones are ultimately attracted to the spinal column. As a result, they end up becoming less dense. Nonetheless, women, at this age, will be losing at least two inches of their entire height whereas men will be losing about one inch. What this implies is the fact that women are highly vulnerable to developing osteoporosis. Clinically, osteoporosis is a condition which makes an individual’s bones to be thin and brittle. The primary cause of this conditions is the general lack of calcium in the diet a person consumes.

Nonetheless, as it is explained in this video, as a person undergoes through middle adulthood, it means that their weight will also keep on changing. The main reason for that is because at this age, there is an increase in an adult’s body fat concentrations. Despite that, since height does not increase proportionately, it could be declining. Therefore, such a scenario is the one that will increase the chances of a person contracting obesity.  Conversely, strength is also another factor that keep on changing as an individual goes through middle adulthood. From the clinical perspectives, it is obvious that strength of middle aged adults will continue decreasing, especially at the leg and the back muscles. At the age of 60s, such an individual could have lost about 10 percent of their maximum strength.

Nonetheless, as much as vision is concerned, during this stage, a middle aged adult will be troubled with presbyopia. Ideally, this is one of the primary conditions that leads to the loss of near vision. Furthermore, glaucoma is also another condition that a middle aged adult experiences. From the medical viewpoints, this condition has the propensity of increasing the fluid pressure of the eyes. It mainly occurs when such a fluid cannot be produced or drained properly. Moreover, as a middle aged person continues to age, he or she can be troubled with presbycusis; a condition which determines his or her ability to hear sounds emanating from high frequency noises. What this implies from the prevailing medical research is that, men are highly vulnerable to developing this condition.

Video 2

Understanding Menopause. Retrieved from: https://youtu.be/ZSRO8GsLKg8

Analysis

According to what is explained in this video, perimenopause is one of the health conditions which ultimately begins in the early years before menopause, especially when an women’s hormones starts to change and their periods becomes irregular. Typically, this period usually commences when women are at the age of 40s. From the clinical standpoints, menopause refers to the period when women are not experiencing their normal periods for a full year. Nevertheless, this condition mainly occurs in women who could have attained an age of 50s.  On the other hand, for the majority of women to know that they are in perimenopause, one of the symptoms that they experience is hot flashes. According to modern clinical data collected, it has been found out that at least eight out ten women do experience this condition. Other symptoms associated with this condition include mood swings, irregular bleeding, vaginal dryness, and sleeping problems.

When women are troubled with this symptoms, there are various activities that that they can engaged in so as to relieve this condition. For instance, weight loss, engaging in physical activities, and consuming healthy meals is clinically recommended. Furthermore, it is imperative to dress in layers, breathing deeply, as well as avoiding things that has the potential of triggering hot flushes, such as spicy food, alcohol, and caffeine. Additionally, although HRT (hormone replacement therapy) is not routinely recommended, it is largely available. In spite of that, it is also imperative to take time and talk to the physician about the advantages and disadvantages of the HRT. Similarly, when a woman decides to use natural medicines or herbs, it will be vital for her to consider consulting a physician. Last but not least, it is important to understand that menopause is typically a natural transition. Taking to family members, friends, and physicians can also assist women to handle the problems arising from menopause and perimonpause.

 Quality indicators and the importance to the patients.

The prevention quality indicator (PQI) represents an area-level indicator responsible for calculating patients' admission that could have been prevented through the provisions of outpatient services that are high quality. The outpatient access is done through the discharge information assessment to determine cases that could be prevented throughout patient care, preventing the patient's admission (Tseng,  Soroka, & Pogach, 2018). The program requires determining cases of complications that can be preventable that can be prevented through the patient assessment making it the best tool in the community assessment procedures. The program's main aim is to identify possible health care problems in the quality of the services offered, thus creating a change for further investigation. The program is also effective in providing out-patient services to the community, thus helping the health care sector determine needs in the patient that are unmet in the community.

Patient safety indicators help provide information on the safety events that can be avoided, thus providing opportunities in health care where improvement can be made in delivering the service. In this quality indicator, the main focus is on the in-hospital complication in the hospital event during the delivery of the services, thus promoting the health care system during the treatment. In this way, the patient complications are prevented during treatment like surgery and after treatment complication when the patient is still in the hospital. The cases presented in this case can include complications on applying anesthesia to a patient before surgery. In this, the hospital can identify areas that need correction and modification and further study in the health care service provision, thus improving the quality of services offered to the patients.

The nursing field's current leadership aims to improve the services offered to the patient through the collaboration of the partners, physician in the health care sector, and other professionals in the sector. The corporation's aim between the health caregivers and stakeholders in the sector is to redesign the provision of the services to ensure that the services to the patient are of high quality (Hallock, 2019). In doing so, the leaders need to have the vision in the transformed health care; similarly, the provision of leadership skills and competencies to the nurses to help them work with other professionals to redesign the health care system is needed. In doing so, the nurses are continuing to develop evidence-based measures to improve through policies, thus ensuring the transformation of the health care system. The nurses should be engaged in making decisions on the health care system as they offer the information on the ground, thus making the transformation effects,

Quality improvement is responsible for developing the health care unit to ensure that they deliver quality services to the patients, identifying areas that need to be studied and researched for improvement. In the same way for the patients and their families, the system provides them with the aspect of safety as the system is organized to avoid harm to the patient, through the embracement of the safety in the system, quality to the services, and transparency in the system as the culture (English, et al. 2021). This is essential in enhancing the system's effectiveness as the organisation fights to reduce the chances of error in the system, thus reducing the complication to the patients during treatment. The changes make the treatment patient-centered, making service delivery to be in the interest of the patient in respectful and value-based care. QI effectively identifies the problems in the system before they occur, thus reducing cases of complication and making it efficient in service delivery.  

References.

English, M., Ogola, M., Aluvaala, J., Gicheha, E., Irimu, G., McKnight, J., & Vincent, C. A. (2021). First do no harm: practitioners’ ability to ‘diagnose’system weaknesses and improve safety is a critical initial step in improving care quality. Archives of Disease in Childhood, 106(4), 326-332.

Hallock, A. B. (2019). A case for leadership development in nursing practice. Nephrology Nursing Journal, 46(3), 325-329.

Tseng, C. L., Soroka, O., & Pogach, L. M. (2018). An expanded prevention quality diabetes composite: quantifying the burden of preventable hospitalizations for older adults with diabetes. Journal of Diabetes and its Complications, 32(5), 458-464.

Solution-Focused Therapy

Solution-focused therapy is a behavior modification measure that focuses on the future-oriented or goal-oriented approach to behavior change or solving problems in people. In this case, the focus is directed to searching for the solution to a situation rather than focusing on the problem where they devise alternative measures to dealing with the problem at hand. In the attempt to solve the problem, the person adopts a different perspective to look at a specific situation where it helps deepen a person's understanding of their problem and the consequences of the solution. The situation calls for an alternative means of stimulating the increase in the activities he is doing but using a different wise from the previous case to be more goal-oriented. As the irregular heartbeat characterizes the condition, the perceptive adopted should ensure the body does not over-exercise. It will have more effects than the advantages in reducing the chances of getting the stroke again.

The patient with ischemic stroke requires them to have exercise, but it’s limited to the wailing around to increase blood flow reduce the reoccurrence of the condition. In this case, the only approach applicable is Solution Focused Therapy, where the patient is supposed to focus on the exercise's goal and not the disease itself. In doing so, they develop a different perspective on the condition while applying different exercises where the increase of activeness is the goal.  According to The American Heart Association the first few months of stroke, the patient is supposed to take twenty minutes of anaerobic exercise where it should be done three to seven times a week to reduce the stroke's recurrence. The patient needs to work according to the goals of maintaining a healthy body in the individual and ensure that he does not overexercise.

In identifying the right way to increase the patient's activity, the patient must avail the information about himself in terms of what is happening within him. In doing so, I will get the incite of the patient's goals related to the exercises through communication with him to understand what is important to him, in theory, the application of strength-based approach where the resilience of the patient is built on his strengths and resources that they demonstrate to enhance the change. The self's resources are extracted through the therapeutic means where the therapist enquires about the clients' experience, thus determining the strength to work on in the behavior’s enhancement. In these cases, basic assumptions are made about the self in determining the exercise changes where the exercise should increase the activity in the individual’s life.

The key element in Solution Focused Therapy is client-centered-based therapy to enable people to build their everyday lives by exploring individual life and how they would want it to be like. Miracle questions encourage individuals to stop thinking about what they cannot achieve and start living if a miracle occurs. In this case, it helps take the mind of the problem at hand and starts the case where the problem does not exist (Northcott, et al., 2019). This helps describe the solution differently according to the patients' view, where they give different views on how to deal with the situation differently. The different picture helps form a different way of living where the solution is made using these different ways. In this case, the therapist helps the client draw the picture by asking probing question of the picture in the minds of the patient helping them have a clear picture of the situation.

The solution-focused theory applies the use of three keys in developing behaviors where behaviors are considered constant and certain. In attaining the behavior, one has to have the client set the goals they want to meet by the end of the session. In this, the clients set the goal of the changes they intend to make to make the process goal-oriented to focus on what they want to achieve as it facilitates solution building. In doing so, they focus on what is working, especially defined when the problem is less severe, allowing them to focus on the solution rather than the problem itself; this permits strength, skill, and resources of an individual enabling the solution to become more visible. This allows the solution to take a step-by-side approach to the solution by using exception scaling questions that allow the client to express their emotion and thought about exception amplifying the client’s strength. This allows the client in the future to build solutions based on the success of the past.

 The physical therapist's availability would have opened up the idea of the various physical exercises that are anaerobic thus useful to the patient. The therapist can help the client on the training procedure concerning the client's body condition, thus maintaining physical condition to allow the follow of blood freely and promote physical fitness. They are essential as they can offer clinical diagnosis to prepare a patient's plan concerning the condition requirement and the body condition.

References

Northcott, S., Simpson, A., Thomas, S. A., Hirani, S. P., Flood, C., & Hilari, K. (2019). SOlution Focused brief therapy In post-stroke Aphasia (SOFIA.

Weight Gain Caused By Polycystic Ovary Syndrome in Us African American Women Leads to Diabetes

 Abstract

Polycystic ovary syndrome (PCOS) is a reproductive disorder causing complications in health conditions and affecting metabolic processes. PCOS increases insulin resistance (IR) type 2 diabetes, cardiovascular diseases, and obesity among women within the childbearing age, 18-45 years. The purpose of this research is to examine how weight gain caused by polycystic ovary syndrome in African American women leads to diabetes. The research reveals that this syndrome is common among women of color, African American women, as opposed to white, which is attributed to environmental and genetic factors. Ethnicity has also been a factor that can be responsible for PCOS. However, the ideal cause of the disorder remains unclear, which makes its diagnosis difficult among medical experts. The use of Ferriman-Gallwey method and Rotterdam Criteria have been used for the diagnosis of PCOS.

Keywords: Polycystic ovary syndrome, PCOS, Insulin Resistance, Diabetes, Obesity, Childbearing age, African American.

Weight Gain Caused By Polycystic Ovary Syndrome in US African American Women Leads to Diabetes

Introduction

Polycystic ovary syndrome (PCOS) is a common endocrinopathy among women in their productive age. PCOS is a problem that causes infertility among women, with a prevalence of between 5 to 12 percent of United States women in their reproductive age. Studies have revealed that across the world 80 percent of overweight and obese women, with PCOS were from the US. A common cause of this reproductive complication is a hormonal disorder in women of childbearing age. This problem is found in women with high levels of male hormones, which are less sensitive to insulin, making them overweight. The latter is known to increase risks of diabetes, sleep apnea, uterine cancer, and heart diseases. As stated previously, PCOS makes the body develop problems in using the insulin hormone, which is useful in the conversion of sugars and starch into energy. This makes glucose build in the bloodstream, insulin concentrates causing the development of androgens, the male hormones, which is responsible for body hair growth, irregular periods, and weight gain, obesity.

Although this complication affects all women within the childbearing age, its prevalence among women of color, African American, is much severe. According to the American journal of obstetrics and Gynecology, PCOS affects women of color more frequently and severely than white women. This reproductive syndrome is associated with metabolic syndrome. In order to understand prevention strategies for PCOS, it is essential to examine the racial and ethical differences in metabolic syndrome among women. The blacks and the Latinx have been found to have higher morbidity and mortality, which results from cardiovascular diseases and diabetes (Barber et al., 2019). These black women also have greater hyperinsulinemia and insulin resistance when compared with white women. A reason for the increased cases of this problem is that black women feel that they do not get proper treatment and thus foregoing treatment. This paper is research to evaluate how weight gained by PCOS is responsible for causing diabetes among US African American women.

Aims and Objectives

The purpose of this research is to examine how weight gain caused by polycystic ovary syndrome leads to diabetes in women. To narrow down the discussion the study focuses mainly on the African American women living in the US. By the end of this study, we will be able to point out the differences in severity of PCOS between African American women and whites.

Research Purpose

The purpose of this research is to validate the research topic on how “weight gain caused by polycystic ovary syndrome in us African American women leads to diabetes.” More precisely we will find out;

• How PCOS causes diabetes among women
• Why PCOS affects African American women more severely than the whites

Hypothesis

Various statements of hypothesis can be formulated based on the research topic, which then can be validated at the end of the research. Some of these hypotheses include:

• There is no relationship between PCOS and diabetes in women.
• There is no association between PCOS and women of color.

Literature Review

Polycystic Ovary Syndrome (PCOS) in the United States and African Women

In the United States, reports from statistics show that the prevalence of obesity and overweight is a common feature of polycystic ovary syndrome (PCOS). In addition, obesity and overweight associated with obesity prevail to over 80% within the United States and reduces in African women. Primarily, this implies that environmental factors such as lifestyle stimulate obesity development in the obesity and polycystic ovary syndrome. However, the relationship between weight gain and PCOS is biological, for instance, obesity (weight gain) increases the vulnerability of many reproductive and metabolic disorders or abnormalities associated with PCOS. It is important to understand that obesity and weight gain are related, but does not mean the same thing (Rosen et al., 2018). For instance, a woman may gain weight, and this does not mean that she is obese. Women in America and Africa who experience PCOS are likely to gain weight, which further leads to diabetes. Also, PCOS is associated with health risks such as type 2 diabetes, infertility, high cholesterol, liver diseases, obesity, high blood pressure, metabolic syndrome, depression, and anxiety among others.

Insulin Resistance and Weight Gain

Boles et al (2017) also add that PCOS is associated with insulin resistance and weight gain. Moreover, polycystic ovary syndrome refers to an endocrine system disorder that interferes with the productivity of women in their productive years. The major signs associated with PCOS include changes in menstrual cycles, excess air growth, and this may lead to infertility. Also, most women suffering from this condition develop type 2 diabetes before reaching menopause. At this age, many women are reported to have obesity and overweight. Since the genes responsible for PCOS are not yet clear, there is a likelihood that these genes may also influence weight gain in women in their productive years. However, the author emphasizes that some environmental factors such as lack of physical exercise and high-weight diets increase the chances of weight gain and obesity in women with PCOS condition.

PCOS and Women Productive Age

According to Barber et al (2019), polycystic ovary syndrome is an endocrine disorder that shows up in the reproductive age of women. In addition, it entails anovulation, clinical signs of hyperandrogenism, and polycystic ovaries. Primarily, PCOS is categorized as a plus-metabolic syndrome, as it is associated with long-term health risks such as infertility, obesity, fibrinolytic alterations, and diabetes mellitus (insulin resistance). PCOS is closely related to weight gain and obesity, and these features precede as ovulatory cycles begin. Insulin resistance during the PCOS is stimulated visceral adiposity, which causes reproductive and abnormalities in body metabolism activities. Moreover, weight gain is associated with irregular menstrual cycles, hyperandrogenemia, and hirsutism. The intensity of obesity and weight gain in women with PCOS is greater as compared to their lean counterparts. According to his work, he suggests that polycystic ovary syndrome is not necessarily related or rather associated with weight gain, obesity, and metabolic syndrome. In agreement, women with PCOS are vulnerable to developing type 2 diabetes and gestational diabetes mellitus.

PCOS and Gestational Diabetes Mellitus (GDM)

Behboudi-Gandevani et al (2016) insist that polycystic ovary syndrome and gestational diabetes mellitus (GDM) are major endocrine disorders that manifest in the productive age of women.  These disorders are related in that they are associated with weight loss or obesity and insulin resistance. Studies and reports show that PCOS increases the risks of GDM. However, overweight gained during the PCOS condition is an indicator of GDM. From the research, the authors concluded that PCOS is not an independent risk factor for gestational diabetes mellitus and that the prevalence of GDM in women with PCOS is related mainly to adiposity.

Weight Gain, Obesity and Diabetes (Type 2 Diabetes)

According to Rubin et al (2017), PCOS affects 5 to 20% of women who are productive worldwide. Most importantly, the condition entails hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology (PCOM). In this context, metabolic dysfunction increases the risks of type 2 diabetes. This is because it causes insulin resistance and hyperinsulinemia in metabolism activities thus affecting individuals. Besides, PCOS may lead to other complications such as gestational diabetes, pregnancy-related complications, venous thromboembolism, cerebrovascular and cardiovascular diseases, and endometrial cancer (Mozaffarian, 2016). Individuals that are overweight (excess weight around the tummy) or obese are at greater risk of developing type 2 diabetes.

Body Metabolism and Obesity (Weight Gain)

According to Li et al (2017), statistics report that abdominal fat triggers the release of pro-inflammatory chemicals. These chemicals reduce the ability of the body to be sensitive to the production of insulin thus affecting the functionality and the ability of insulin-responsive cells, a condition known as insulin resistance. On the other hand, weight gain also triggers some changes in the body’s metabolism. The change is associated with the release of fat molecules from the adipose tissue into the blood. This further affects the efficiency of insulin-responsive cells leading to reduced sensitivity. In general, the obesity and weight gain associated with PCOS could lead to type 2 diabetes as they cause prediabetes, a metabolic condition that automatically develops into type 2 diabetes. The role of weight gain and obesity in type 2 diabetes is related to insulin resistance, for instance, weight loss plays an important role in controlling type 2 diabetes.

Weight Gain and PCOS

The relationship between weight gain and PCOS is not denial. Women with PCOS are more vulnerable to problems associated with insulin resistance and weight gain. Also, these women instead of having a pear shape, instead they have an apple shape. PCOS makes it difficult for the body to utilize insulin hormone, which plays an important role in converting starch and sugar from food into energy (Dokras et al., 2016). This leads to a condition commonly known as insulin resistance. This leads to the production of large amounts of male hormones (androgens) in women, leading to symptoms such as rapid hair growth, acne, weight gain, and irregular periods. However, the weight gained with women experiencing PCOS is a major determinant factor of diabetes (type 2 diabetes).

Methods

The success of the research is determined by the participants who are examined. Participants play the most important role, in providing information that is needed for the research. For this research, the group of respondents needed are the women, within the childbearing age and again who adults are. Then we would request females aged 18-45 to participate, both from the African American and the white. Now that every female within this age group cannot be included in the research we selected a sample of 369 women, 174 white and 195 African American women. The primary objective was to examine the prevalence of PCOS for Black women, and how this is associated with diabetes in the US. For the success of this occupational health, nurses were trained on how to use the modified Ferriman-Gallwey method, to measure the degree of hirsutism. The purpose of this score was to quantitate the presence of terminal hairs over nine body parts, upper lips, and chest, and chin, upper and lower abdomen, upper and lower back thighs, and upper arms.

Women are entitled to see nurses investigate the extent of hirsutism. The nurses would record the presence of acne, and apply a specific system. In order to maximize uniformity among all the respondents the F-G score, women with a score above 3 would be recalled and hirsutism was re-scored by the investigators. Also, to minimize treatment bias all women regardless of hormonal therapy were included. For these women the history of the menstrual cycle is determined before performing a hormonal or surgical therapy, to establish the reason for treatment. The investigation of circulating androgen levels will also be determined but not for women receiving the hormonal treatment. It must be noted that for participation the intended should do so with informed consent and the entire study approved by the research institutional review.

Discussion

Causes, Risk Factors, and Diagnosis

PCOS is a condition whose prevalence is high in developed countries a good example being the US, with a prevalence of 5-12 percent of the females. This is a polygenic condition mainly attributed to genetic and environmental factors. However, in recent days, the majority of research reveals that this is a defect in insulin action is the core cause of PCOS. Giving a clear picture of the environmental factors, it has been discovered that they contribute to the pathogenesis of PCOS. Besides, the socio-economic status and unhealthy behavior which include a poor diet, lack of exercise, and smoking which is an exercise common with the African American community, is a common reason which is a result of increased obesity. Similarly, with the high rate of co-morbidity in PCOS.

Additionally, genetic factors have been found to play a very important role in causing PCOS, passed from fertile carrier males to sub-fertile females, which is commonly evident in high familial rates of hyperandrogenism as well as type diabetes, in first-degree relatives of women with PCOS. On the contrary, various studies have been revealed that ethnicity is also associated with PCOS, where the prevalence among the Blacks was found to be 10 percent and about 5 percent among the white women. But it must be noted that this study is among women between 18 – 45 years, which is deemed as the productive age.

For diagnosis, there are three diagnostic features used for PCOS, mainly using the Rotterdam Criteria. These features include anovulation, hyperandrogenism, and polycystic ovaries. Therefore, for a woman to be diagnosed with the disorder she must portray at least two of the latter symptoms. However, based on reports anovulation, among the three features is the most common phenotype among the PCOS patients, with over 95 percent of women. On the other hand, hyperandrogenism is also persistent with approximately 60 percent of women, assessed biologically by measuring the circulating androgen levels (Sam, 2007). In addition, polycystic ovaries (PCOS) are also used in the diagnosis, though it alone cannot guarantee PCOS. Women with PCOS have been revealed to develop a more consistent menstrual cycle as they grow older, with the androgen levels decreasing and the insulin resistance decreasing.

PCOS and Associated Health Conditions

Some various health complications are associated with PCOS, with some of them resulting in long-lived effects. For this reason, our concern is basically on metabolic complications, obesity, and cardiovascular risks. Women with insulin resistance (IR) have a prevalence of between 60-80 percent with PCOS and 95 percent of them were found to be obese. Obesity was found to be caused by metabolic disturbances, which is the cause of anovulation, hyperandrogenism, and cardiovascular risks (Li et al., 2017). In addition, it causes gestational diabetes, glucose tolerance, and type 2 diabetes. Further, obesity has been found present in at least 30 percent of PCOS patients, the majority of women living in the United States.

Obesity and ages are responsible for increased risks of cardiovascular problems. Also, further studies have revealed that increased risks of cardiovascular risks are a result of increased severity of PCOS among women whether obese or not. There is a need to study the clinical characteristics of women beyond childbearing age to determine the risks, which would be useful in the development of prevention of this risk and its associated cardiovascular problems (Sam, 2007). Other complications include neurological and psychological functions, cancer among women, and infertility. The latter is caused by menstrual irregularities, which is a symptom of PCOS.

Conclusion

In general, PCOS is a common disorder among women within their reproductive age. This complication reveals itself with complications that are long-lived. Its prevalence among women in the United States has been high in the African American women as opposed to the whites, with a prevalence of about 10% and 5% respectively. However, the complex diagnostic criteria and wide complexity characteristics have been a challenge with this syndrome. Lower socioeconomic status, poor environmental factors, and genetics have been discovered to be the major cause of the high prevalence of PCOS, among African American women. PCOS is the reason for weight gain and thus obesity. Future research should determine the genetics and pathophysiology risk factors of PCOS, which will help in realizing successful treatment modalities for this syndrome.

References

Barber, T. M., Hanson, P., Weickert, M. O., & Franks, S. (2019). Obesity and polycystic ovary syndrome: implications for pathogenesis and novel management strategies. Clinical Medicine Insights: Reproductive Health, 13, 1179558119874042.

Behboudi-Gandevani, S., Ramezani Tehrani, F., Rostami Dovom, M., Farahmand, M., Bahri Khomami, M., Noroozzadeh, M., ... & Azizi, F. (2016). Insulin resistance in obesity and polycystic ovary syndrome: systematic review and meta-analysis of observational studies. Gynecological Endocrinology, 32(5), 343-353.

Boles, A., Kandimalla, R., & Reddy, P. H. (2017). Dynamics of diabetes and obesity: epidemiological perspective. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease, 1863(5), 1026-1036.

Dokras, A., Sarwer, D. B., Allison, K. C., Milman, L., Kris-Etherton, P. M., Kunselman, A. R., ... & Legro, R. S. (2016). Weight loss and lowering androgens predict improvements in health-related quality of life in women with PCOS. The Journal of Clinical Endocrinology & Metabolism, 101(8), 2966-2974.

https://www.cdc.gov/diabetes/basics/pcos.html

https://www.medicalnewstoday.com/articles/265309

Li, L., Feng, Q., Ye, M., He, Y., Yao, A., & Shi, K. (2017). Metabolic effect of obesity on polycystic ovary syndrome in adolescents: a meta-analysis. Journal of Obstetrics and Gynaecology, 37(8), 1036-1047.

Mozaffarian, D. (2016). Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review. Circulation, 133(2), 187-225.

Rosen, E. D., Kaestner, K. H., Natarajan, R., Patti, M. E., Sallari, R., Sander, M., & Susztak, K. (2018). Epigenetics and epigenomics: implications for diabetes and obesity. Diabetes, 67(10), 1923-1931.

Rubin, K. H., Glintborg, D., Nybo, M., Abrahamsen, B., & Andersen, M. (2017). Development and risk factors of type 2 diabetes in a nationwide population of women with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 102(10), 3848-3857.

Sam, S. (2007). Obesity and polycystic ovary syndrome. Obesity management, 3(2), 69-73.

Case Analysis 3 - Ending HIV

1. What were the pros and cons of Sangamo pursuing its gene editing programs alone versus working with a partner?

Sangamo Biosciences developed zinc-finger nucleases (ZFNs), which is one of the latest technologies whose ability was to edit the genes of a living person. Although, with vast potential, the technology demands a significant amount of R&D work. The purpose of the latter R&D is to ensure both adequate and enough penetration on individual cells to make the difference. The primary purpose of this program was to promise a sure way of giving people mutation that would help to cure HIV (Lombardo et al., 2007). This, therefore, posed some advantages and disadvantages, with the part of pros being Sangamo retaining control of the ZFN technology and its development. Also, gene editing offered great chances towards the cure and prevention of diseases. However, the program was faced with a big blow, where its progress to achieve the vision of HIV gene therapy was delayed. Another disadvantage was that they could not complete drug development and commercialization.

2. Does the HIV program offer any special opportunities or challenges?

The invention of this program comes as an opportunity as a challenge. On the biggest opportunity for the Sangamo Biosciences was to provide a technology that would help penetrate individual’s cells to make a difference. This is an opportunity as it would help cure HIV.  Creating treatment that could cure HIV would be one of the biggest relief to people living with this virus globally (Tebas et al., 2014). However, it posed great challenges begin from clinical trials, commercialization, and how it would be possible to deliver the program to over 30 million people in the first phase. Additionally, the development of the drug was very expensive and risky, funds that were not readily available, which made Sangamo decide to partner with another organization dealing with the HIV program.

3. What do you think Sangamo should do regarding the HIV program? Should it license the technology to a larger pharmaceutical? Should it form a joint venture with another biotech or pharma company? If so, who?

Despite various challenges in addressing the program, there are still some measures that Sangamo can do regarding his program. Most essential is to in extremis financially. Initially, they tried to commercialize ZFNs for HIV therapy, instead, they should seek a license from worldwide known bodies dealing with health issues. Some of these bodies include the amfAR and the World Health Organization (WHO) who would grant the program a loyalty-free license on the ZFN technology relevant to HIV treatment. The latter license would serve as an exchange for funding thus guarantee the progress of the process of ZFN development.

4. Importantly, apply as many of the COs (Course Objectives) as you can to the case.

In this case study, many of the objectives have been presented. These learning objectives were aimed at understanding the invention of the program describing the industry dynamics. After this effort, we can appreciate the potentials of the gene editing program on realizing the potentials of ZFN in the prevention and cure of diseases, which was not possible earlier. However, with innovations there are cases of cyber insecurity, therefore, receiving a loyalty license with legit worldwide bodies as well as a partnership will ensure security with this new invention. Additionally, a partnership would be one of the appropriate measures that the program developers could take to seek finds that would help in the development of the drugs.

References

Lombardo, A., Genovese, P., Beausejour, C. M., Colleoni, S., Lee, Y. L., Kim, K. A., ... & Naldini, L. (2007). Gene editing in human stem cells using zinc finger nucleases and integrase-defective lentiviral vector delivery. Nature biotechnology, 25(11), 1298-1306.

Tebas, P., Stein, D., Tang, W. W., Frank, I., Wang, S. Q., Lee, G., ... & June, C. H. (2014). Gene editing of CCR5 in autologous CD4 T cells of persons infected with HIV. New England Journal of Medicine, 370(10), 901-910.

Mental health care in Utah

Research questions

Is there any unfair treatment of the person with a mental health condition by the caregivers in the Utah mental hospital in the service provider where the case of staffing is in question?

Is the hospital's service provider affected by the staff available in the hospital regarding the number of staff working in the health care causing the service delivery to be poor?

Implications of the research.

            The betterment of mental healthcare conditions in Utah is the key to developing health care to adapt more enhances patient-cantered services to the clients. This can be attained by examining the in-house mental health therapy to ensure that most of the patient's therapeutic needs are met enhancing patients’ outcome (Darnall, et al., 2020). The improvement of the condition of the people with a mental problem is associated with the incorporation of in-house therapy where the management is done to ensure that the needs and the interest of the patient are met through the psychiatry and the pharmacy clinics in the provision of therapies that is accompanied with medication to make the case success. Therapy can be attained through physical therapy where the aspect of massager is introduced or through the psycho education to the nurses and the care givers to enable them to deal with the patient's treatment and handling.

 The provision of health care services to the person with a mental health condition is involved and tiresome, demanding an increase in staff. The treatment, observation, and therapy both in physical and psychotherapy require trained personnel to handle the patients more easily, making their treatment effective. The hospitals in Utah are underequipped with the medical personnel, causing burnout effects to the medical staff (Sturzu, et al., 2019). They are serving a lot of patients, making them underperform. The different post in the mental hospital calls for different staff members to deal with the different responsibility in ensuring the services are rendered in a patient-centerer manner, thus enhancing their recovery. Social workers, public health workers, and therapies are needed in the institution to ensure that the patient's needs are met to ensure that the services are effectively delivered.

Due to the increase in the number of patients in the hospital, the provision of the services at home level will require to be implemented to avail the bed for those in critical conditions. The provision of care from home requires that the community members be provided with the required training and knowledge to handle them. Despite the program's implementation, the hospital will be for the patient that needs special attention and the aggressive ones who require special handling. In doing so, the hospital congestion will reduce the staff's workload, thus improving the services they offer to the remaining patients. The community service to the patients will require close supervision from the health care to ensure that the patient's conditions are in place to avoid patient health complications.

Data collection.

The hospital's information was collected from the parents and guidance of the patients about the treatment of their loved ones by the hospital. The interview was conducted with the participants were the questions aimed to get a detailed report on the services delivered and the patient's treatment by the staff. In doing so, the research will interview forty guardians who attend the visitation of the patients on Thursday and some patients recovering from the mental condition. The interviewees will be selected randomly according to their willingness to talk and give the details. The information on the hospital staffing will be done through questionaries where the medical staff and another management official will fill them to ascertain the hospital's condition to the patient and themselves. The questionaries will include the hospital's staffing and the problem the staff is facing in the delivery of the services.  

Proposed methodology

The methodology to use in the research will include both qualitative methods. The method will employ both the use of questionaries and interviews on the patient, guardians, and the health care staff. In this case, the analysis will involve the data collected from the questionnaire. It’s based on people's experience in terms of the medical staff and patients and observation for the guardians. The interview and questionnaire data provide in-depth information about the health care in the Utah metal health care (Cassell, C., & Bishop, V. (2019). The data will be analysed to interpret them and understand the hospital concept that is not working. The concept under research includes the hospital staffing, the patient's treatment by the health care workers and the working environments for the works, and that of the patient.

Data analysis.

The analysis will involve the content analysis from the interview, where the data will be grouped according to the group interviewed and their response. The narrative analysis includes the analysis done on the data sources in terms of the content they have, where a discourse analysis is done to identify the respondent and their environment to use the data during the analysis. Lastly, grounded theory explains why the scenarios in Utah are happening in terms of the services rendered to the patient and the availability of the resources for the health care workers and staff available. The analysis will help to determine where the hypothesis is valid or not.

References

Cassell, C., & Bishop, V. (2019). Qualitative data analysis: Exploring themes, metaphors and stories. European Management Review, 16(1), 195-207.

Darnall, B. D., Mackey, S. C., Lorig, K., Kao, M. C., Mardian, A., Stieg, R., ... & Cheung, M. (2020). Comparative effectiveness of cognitive behavioral therapy for chronic pain and chronic pain self-management within the context of voluntary patient-centered prescription opioid tapering: The EMPOWER study protocol. Pain Medicine, 21(8), 1523-1531.

Sturzu, L., Lala, A., Bisch, M., Guitter, M., Dobre, D., & Schwan, R. (2019). Empathy and burnout–a cross-sectional study among mental healthcare providers in France. Journal of medicine and life, 12(1), 21.