Introduction

The article highlights the association between adversarial youthful experiences during early childhood and interactive challenges witnessed in kindergarten from the perspective of a teacher. The study is relevant and necessary because initial childhood experiences influences childhood decisions which go on to impact or shape the adulthood life (Jimenez et.al, 2016). More so, the swift gradual process of a child’s growth and brain development from birth all through the first five years makes it vital period for examination and study of susceptibility and chance.

Previous researches associated adversarial early childhood experiences with poor medical results (Jimenez et.al, 2016). However, current researches on the same subject matter revealed more than meets the eye, which is, early childhood experiences associated with poor school commitment during their middle childhood and adolescence stages.

 In order to generate a workable hypothesis and fulfill or cover issues others studies failed to cover in the past, the research centered on kindergarten cohorts as through them, it is easy to observe and examine the association between ACE and academic skills inclusive of learning, and traits within a kindergarten environ (Jimenez et.al, 2016).

 Secondary analysis of data method

The researchers carry out the research through a secondary analysis of data, gathered from delicate families and children reports. The children reports contain birth cohorts’ information from more than 5000 children born between 1998 and 2000 across 20 states in America. Somehow, most children were born out of wedlock (Jimenez et.al, 2016). The longitudinal data groups was made up of postnatal interviews from both mother and father, successive interviews with the same parents one, three or  nine years later after the  infant’s birth and staying at home with the parents for a certain period of time.

 A more comprehensive description entails utilization of data about ACEs on mothers’ 5-year follow up interviews as well as information from teacher’s reports on the final academic kindergarten performance (Jimenez et.al, 2016). Since mothers have the sole responsibility of taking care of their children’s every need, the study required them to provide information on previous exposures as well as past teacher comments on their children in order to give a clear picture of the child and the entire situation.

In terms of sampled study population, the research only considered kids who had teacher remarks and their personal information was in caregiver reports hence making it easy to track their ACE exposures while depending detailed on relevant information that was able to give accurate simplified information (Jimenez et.al, 2016). Simply put, the research depended on highly secondary data form, which was made, and conclusions drawn. Given that, an estimated 98% of the sampled caregivers turned out to be biological mothers, the researchers’ reports labelled them as generic mothers.

 Findings

The children‘s educators or tutors were to rate each youngster’s educational abilities during last term of the kid’s kindergarten year based on a 5 point Likert scale (Jimenez et.al, 2016). Likert scale categorized the results based on literacy, science, and socialization areas of their lives. Only one child ranked below average level, which was a good sign. While looking into literacy in detail, the researchers unveiled teacher reports and the ranks of students based on the teacher perspectives and tests during the last kindergarten month

 Teachers asked to elaborate on children’s behavior throughout the last kindergarten term via the behavior checklist claimed that children comments or testimonials were false. After summing up results from the three subscales, number one stood for not true, two stood for partly true, and three absolute truth with high scores signifying absolute truth. In the end, 85% of the caregivers or mothers sampled in the research after a five year follow up interviews and 1007 children from the accessible data exposed most the mothers lived with their children. 26% reported that mothers had a romantic relationship with newfound lovers. Half of the sampled children who took part in the interview were Black Americans and only a quarter of the sampled people were of Latinos origin (Jimenez et.al, 2016). However only 27% of the mothers were in marriages before the birth of their children. It is vital to note that socioeconomic features were similar across the board hence not a discussion under the sample collected.

 Discussion of the outcomes

In a countrywide urban model, going through ACE commonly related to poor academic performance and interactive results in kindergarten school. In regards to youngsters the absence of ACE, kids with a poor school performance such as learning skills, inadequate attention challenges, social issues, and hostility are more likely to develop ACE, which in turn leads to poor health practices. Based on the vast literature on the issue and the findings from the research unveiled that ACE was linked to poor basic skills for example, language and learning hence leaving a child vulnerable to low academic achievement consequently leading to unhealthy practices (Jimenez et.al, 2016). Attention deficit, societal challenges, and hostility are some of the common aspects related to ACE. Therefore, there are two sides of the same coin. On one side, ACE can directly affect a child’s educational life hence triggering the disruption of social and health aspects of their lives. On the other side, the child can state certain educational aspects can force a child to experience ACE.

 Implications

Based on the findings from the research, counsellor would outline their questions based on observed school performance, social and level of attention of the pupil (Jimenez et.al, 2016). Counsellors would also consider the family background and whether the mother of the child has a partner or not. All of above will form a structural guideline that gives a counsellor the actual picture.

 Recommendation

  While responding to poor performance immediate is a good gesture, assuming and relating it to ACE is out rightly wrong and may lead to a misdiagnosis. Therefore, the right thing to do is observation, then giving the youngster a distance. If the situation persists, then one can go right ahead, initiate an open discussion about the situation at hand, and find a sustainable solution.

References

Jimenez, M. E., Wade, R., Lin, Y., Morrow, L. M., & Reichman, N. E. (2016). Adverse experiences in early childhood and kindergarten outcomes. Pediatrics, 137(2), e20151839.

The Potential Uses of Cinnamon as a Part of Anti-inflammatory Treatments

Ekram Rakib, Student ID – U1703251, Programme: Pharmacology, Module Name: BS5001 Biology of Disease, Supervisor: Dr Samir Ayoub

Layman Abstract:

Cinnamon is a spice that is made from the inner back of the cinnamon tree. There are two types that are mainly consumed and it has been found to have different health benefits. It has been used in the traditional medicine and most of the researches that have been done on it has come out with positive results of having medicinal value. Cinnamon spice has a compound that gives it the therapeutic value and it is called cinnamaldehyde.

Coumarin is a substance found in cinnamon spice and causes damage to the liver and the lungs but it is found in very low quantities in Ceylon, which has then been most preferred. The difference between the Ceylon and cassia cinnamon is that, Ceylon is sweeter and it has more delicate flavour while the cassia type is slightly darker in colour and has a stronger flavour.

 Tyrosine is a compound found in the cinnamon spice and it is the one that contain the antioxidant properties (Shan et al., 2005, p.7750) Cinnamaldehyde compound is also found in the cinnamon tree and is the one that contain the anti-inflammatory properties. Different test that have done in the labs have also confirmed that it reduces inflammation both externally and internally.

Aims and Justification:

The purpose of this research is to find out if the cinnamon tree or the spice that come from it has that capability to reduce inflammation and thus its possibility to be used in treatment of condition that has inflammation in the clinical set up. Inflammation is generally the process in which the white blood cells and other substance that it produces protect the body from infection from foreign organisms such as bacteria and viruses. Its function is to eliminate the initial causes of injury and also clear out the necrotic cells or the original insult to the damaged tissue.

Inflammation has five classical signs such as heat, pain, redness, swelling and loss of function and therefore it has different consequences. Different condition result to inflammation and therefore it presence with the classical signs with inflammation on the site (Lawrence, 2009, p.32). Cinnamon spices contains cinnamaldehyde which has been linked by different studies to reduce inflammation.

A studies that have been published shows that cinnamon spices which are the cassia and Ceylon are among the spices that reduce inflammation. There are different studies that have done and they all have a proof that the cinnamon spices reduce inflammation which is thus beneficial. Different lab test have also been known to reduce the inflammation markers in blood and therefore it reduces the side effects of the process that result.

A study that was done on paw edema where cinnamic aldehyde was used, the edema reduced the activities of catalase, superoxide dismutase and glutathione peroxidase in the paw tissue. All the studies thus clearly shows that cinnamon spices cause reduction in the inflammation and thus it is a proof that it has a good effect in the reduction of inflammation in individuals with inflammatory conditions. The food or the tea made from the spice have been found to reduce inflammation.

Background Information:

Cinnamon is one of the tasty spices that have been found to have numerous medicinal value that can help in reduction of the severity of illnesses. It has different properties such as antioxidant, anti-microbial and an anti-inflammatory effect. The cinnamon spice comes from the inner bark of the trees that belong to the cinnamon genus. Most of the researchers state that, the spice is most commonly in use today. It has been used in the traditional medicine and this has been backed up by the current medicine.

            There are two most commonly used types which are Ceylon cinnamon and cassia cinnamon. They can be grounded into powder then added to food or even used to make tea. Reports from the journal BMC Complimentary &Alternative Medicine states that Ceylon cinnamon (Sri Lankan cinnamon) is the best type to use (Ranasinghe et al., 2013, p.235) It is native to Sri Lanka and it is more expensive than the cassia cinnamon.

            Coumarin is a substance that naturally occurs in the cinnamon and it has been associated with damaging of the liver and also the lungs if taken in high quantities. A study done on 2012 found that the level of concentration of coumarin is lower in Ceylon cinnamon at 0.004% than in cassia cinnamon at 1% (Blahová and Svobodová, 2012, p.7) Thus Ceylon the best choice.

            Cinnamon has also been found to have antioxidants activity due to the tyrosine compound that is found in its extracts. It also affect the immune strengthens the immune system and thus improve the body to fight against disease pathogens. A study that was done on Indian, Ceylon cinnamon found that the bark has a powerful immune boosting capability. The extracts from the cinnamon tree increased the antibodies in the blood and helped to stimulate the immune system.

            The compound that has been found to be more beneficial to reduce inflammation in cinnamon is cinnamaldehyde (Gunawardena et al., 2015, p.912). A study that was published on the journal Food & Function discovered that, the cinnamon tree contained the anti-inflammatory substance (cinnamaldehyde) which was closely related to help treat age related inflammatory conditions. Other studies in the laboratories have also shown that the compound that are found in the cassia cinnamon helps in reduction of the inflammatory markers in blood and therefore the scientist have concluded that cinnamon have naturally occurring substance that has good anti-inflammatory properties.

            The cinnamon powder has been greatly linked with reducing the inflammation when it has been consumed, a study that was done in 2017 found that the cinnamon bark has essential oil that have a potential to reduce inflammation on the human skin. The oil helped in boosting the number of cells thus promoting the skin to recover from the injury.

            It has also been found to have both anti-inflammatory and anti-microbial activity which means that consumption of the spiced tea with cinnamon is likely to boost good digestive health.  A study that was done in 2017 found out the phenolic compound I the cinnamon tea to help kill microorganism and reduce gastrointestinal tract inflammation.

Methods and Experimental Design:

The cinnamon water extract preparation: Raw cinnamon bark is put into a tank then purified water is added into it at a ratio of 8:1 and then the mixture is heated to boil for one hour. The water extract is then remove and filtered via a 100-mwsh screen. This is to remove any solid debris and then the filtrates is collected into intermediate containers which were then left standing static. The supernatants are then carefully removed and placed in concentration tank for vacuum evaporation to make it more concentrated.it is then heated and later centrifuged and dried. The powder is then added to water to make the cinnamon water extract.

Animal: male BALB/c two months old bought from Taconic a branch of Korea and they were fed with  water together with rodent chow  in a facility with a well controlled humidity and temperature and no microorganisms causing diseases performed at the university. The sample were kept according to the Care and Use of Laboratory Animals Guide provided by the National Research Council in US

The cinnamon water extracted was then administered to each mouse orally for six days prior administration of intraperitoneal injection of LPS at a dosage of twenty, hundred or five hundred mg/kg of body weight. The control sample were given the same amount of normal saline at the time of experiment and each of the groups were made up of twelve mice. On the 7^th day, LPS 1.3mg/kg was administered one hour prior to blood sampling taken which was then obtained through cardiac puncture. Dexamethasone was administered eighteen hours prior to the LPS injection to act as a reference. The samples of blood that were then collected were centrifuged at 800g for 20 minutes and then they were kept at negative 20°C as serum samples up to the time they were used

Statistical Analysis: The data for in vivo is mean ± SEM. The non-similarity in the statistics among many groups means were evaluated using one-way method called ANOVA which then Schaffer test was done.

Expected Results and Impact:

LPS originates from gram-negative bacteria cell wall and they are endotoxins that facilitates TNF alpha expression and IL-6 among microphages and monocytes. The cytokines protect the body by stimulating processes. The test on cinnamon water extract (CWE) effect on the inflammation response to stimulation of LPS. Based on the study the dosage of 20,100 and 500 mg/kg were used and it was found that serum level of TNF alpha was majorly decreased in the20 and 100 mg/kg doses and they were high in the 500mg/kg dosage. On the other hand, the levels of IL-6 decreased on 20 and 100 mg/kg group administered dose but the 100 mg/kg dosage group reached a great level. The group that was administered with 500 mg/kg indicated a higher IL-6 levels than in the control group. It is therefore likely that some of compounds which are not known are beyond a critical level may cause interference with nature of CWE in reducing inflammation..

Appendix 1:

Cost:

Appendix 2:

It is necessary to endure that the equipment used at work is used for the purpose it is intended for. Instruction and training are all necessary. Use gloves, goggles and coat always. There is no drinking or eating and chemicals are properly handled.

Risk Assessment Form                            School of health, sport and Bioscience  

                                                                                                           university of East London

Key

Likelihood                                                              Severity                                                                     Residual Risk (likelihood x severity)

1. Low (1 point) L. slight less (3 days off) (1 point)                            1-2 no action required
2. medium (2 point) M serious (more than 3 days off) (2 point) 3-4 medium

H high risk (3 points)                                           H major issues (injury) (3 points)                                6-9 high risk/ priority

References:

Blahová, J. and Svobodová, Z., 2012. Assessment of coumarin levels in ground cinnamon available in the Czech retail market. The Scientific World Journal, 2012.

Gunawardena, D., Karunaweera, N., Lee, S., van Der Kooy, F., Harman, D.G., Raju, R., Bennett, L., Gyengesi, E., Sucher, N.J. and Münch, G., 2015. Anti-inflammatory activity of cinnamon (C. zeylanicum and C. cassia) extracts–identification of E-cinnamaldehyde and o-methoxy cinnamaldehyde as the most potent bioactive compounds. Food & function, 6(3), pp.910-919.

Hong, J.W., Yang, G.E., Kim, Y.B., Eom, S.H., Lew, J.H. and Kang, H., 2012. Anti-inflammatory activity of cinnamon water extract in vivo and in vitro LPS-induced models. BMC complementary and alternative medicine, 12(1), p.237.

Iqbal, M. (1993). International trade in non-wood forest products: An overview - IV. Spices and condiments. [online] Fao.org. Available at: http://www.fao.org/3/x5326e/x5326e07.htm#2.%20cinnamon%20and%20cassia [Accessed 10 Feb. 2019].

Lawrence, T. (2009). The Nuclear Factor NF- B Pathway in Inflammation. Cold Spring Harbor Perspectives in Biology, [online] 1(6), pp.a001651-a001651. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882124/ [Accessed 10 Feb. 2019].

Liao, J.C., Deng, J.S., Chiu, C.S., Hou, W.C., Huang, S.S., Shie, P.H. and Huang, G.J., 2012. Anti-inflammatory activities of Cinnamomum cassia constituents in vitro and in vivo. Evidence-Based Complementary and Alternative Medicine, 2012.

Mskcc.org. (2018). Cinnamon | Memorial Sloan Kettering Cancer Center. [online] Available at: https://www.mskcc.org/cancer-care/integrative-medicine/herbs/cinnamon [Accessed 10 Feb. 2019].

Ranasinghe, P., Pigera, S., Premakumara, G.S., Galappaththy, P., Constantine, G.R. and Katulanda, P., 2013. Medicinal properties of ‘true’cinnamon (Cinnamomum zeylanicum): a systematic review. BMC complementary and alternative medicine, 13(1), p.275.

Shan, B., Cai, Y.Z., Sun, M. and Corke, H., 2005. Antioxidant capacity of 26 spice extracts and characterization of their phenolic constituents. Journal of agricultural and food chemistry, 53(20), pp.7749-7759.

Breastfeeding and Depression

Introduction

            Breastfeeding results to changes that occur both physically and biologically to both mother and the baby. Several studies have linked it with reduction in postpartum depression because of its effect in inhibiting release of stress hormones.  Other hormonal changes include release of prolactin hormone in which helps in promoting release of breast milk. There is also stimulation of the nipples by hormone oxytocin which thus promotes breastfeeding.

            Furthermore, it results in changes in body size of the baby because it is there source of nutrients and it has been linked with different benefits, both to the mother and the baby. For the mother it is thought to reduce the amount of blood loss after delivery, it also promotes uterus involution and also associated with decreased postpartum depression (Victora et al., 2016). The changes that occur therefore, have positive results as found by most studies that have been done thus it improves the mood of a mother and reduce the risk for developing postpartum depression

 Breastfeeding therefore, results to changes that will lower postpartum depression, enables mothers deal with issues that may arise as they take care of the baby, reduce the level of anxiety and fear, and also results in changes in the brain that improves readiness for breastfeeding the “next” baby. The benefits that it has to the baby promotes good health and this might reduce postpartum depression that might arise to the mother when the baby is unwell.

            Most of the studies that have been carried out have suggested that breastfeeding lowers the level of depression of women who are in their postpartum period; this thus promotes good health and improves the experience of being a mother.

Breastfeeding and depression

Initially, it was thought that the relationship between postpartum depression and breastfeeding was unidirectional; the postpartum depression was also considered to delay breastfeeding initiation and also cause early cessation of breastfeeding. In more recent studies, it has been shown that the relationship could be bidirectional. This thus indicates that, although postpartum depression may result in reduced rates of breastfeeding, women who do not engage in breastfeeding are at higher risk of developing postpartum depression. Furthermore, evidence suggests that breastfeeding may protect a woman from postpartum depression, and also it hastens recovery from the symptoms after birth.

            Besides, various investigations have been done concerning the relationship between breastfeeding and postpartum depression, but it is not yet clear. However, most of them have come out to support the claim that it lowers depression in their conclusions. This might be due to the interaction between the psychological, physiological and sociocultural mechanisms which significantly affect the relationship.  In the most recent studies, there is connections that have shown that mothers who use formula feed for their babies are at a higher risk of depression than those who breastfeed.

            Studies also on breastfeeding intention and initiation and their relationship with postpartum depression. Breastfeeding intention is the decision to breastfeed upon delivery of the baby while initiation is the actual breastfeeding itself after the birth of the baby. Unfortunately, initiation of breastfeeding has been operationalized differently in various investigations that have been done to include, those women who try to breastfeed and stop immediately after, those who practice exclusive breastfeeding for long periods. It also includes those women supplement formula feed with breastfeeding together with those who used expressed breast milk. This can complicate the interpretation.

            Some of the studies have shown no relationship between intention to breastfeed, and prenatal depressive symptoms but others found that women who had prenatal depression are less likely to have the intention to breastfeed. However, some of the follow-ups that were done revealed that some of the women who had intended not breast initiated breastfeeding (Borra, Iacovou & Sevilla, 2015). This thus shows that, women who did not previously intend to breastfeed changed their minds maybe due to encouragement or even education during their prenatal period.

            In other studies that were done on associations between intention to breastfeed and initiation with postpartum depression, it was found that women who were not depressed before the childbirth, and intended to initiate breastfeeding had decreased risk of developing postpartum depression (Borra, Iacovou & Sevilla, 2015). On the other hand, women who had no intention to breastfeed but changed their mind and started breastfeeding had higher risk for developing postpartum depression. It therefore links depression with actions on breastfeeding not breastfeeding itself. Interestingly, when a mother had tried to breastfeed but failed, it was associated with depressive symptoms (Pope et al., 2016). The mothers who did not initiate breastfeeding had a higher chance of developing depression when compared to those who breastfeed.

            A majority of studies have reported that women who do not breastfeed are at higher risk of developing depressive symptoms than those who breastfeed. An example is a longitudinal study that was done Nishioka and colleagues that revealed that at five months after delivery, higher risk for development of postpartum was associated with women who did not breastfeed and lower for those who breastfeed (Nishioka et al., 2011). This was found to persist even if education, income, age and history of previous depression was controlled.

             Early cessation of breastfeeding has been associated with postpartum depression, but the initial experience that mothers go through during breastfeeding could also cause. Breastfeeding also had protective benefits against postpartum depression, in that those women who had low levels of depressive symptoms reported no symptoms when on exclusive breastfeeding (Dias & Figueiredo, 2015). Besides, the duration of breastfeeding has also been related to decreased depressive symptoms from childbirth to three months. It has also been found that women who breastfeed report a decrease in a negative mood. Breastfeeding, therefore, may provide both acute and long-term improved effects on postpartum depression.

             Other studies also report that postpartum depression results after a mother stops breastfeeding at twelve weeks after delivery. However, most mothers who are at higher levels of depression were likely to stop breastfeeding, but they will also report no satisfaction in the feeding of the infants and others such as breastfeeding difficulties and low levels of breastfeeding self-efficacy (Chaput et al., 2016). Levels of depression are more moderate in those who practice exclusive breastfeeding as compared to those who did partial breastfeeding. There was also a relationship between higher risk for depression in the mothers who practiced partial breastfeeding and those who did an exclusive bottle feeding.

            The way in which breastfeeding affects postpartum depression has been studied in different investigations. Negative breastfeeding symptoms and also self-efficacy of breastfeeding on the women have been linked to playing a key role postpartum depression (Chaput et al., 2016). This is because there are a lot of difficult experiences that the woman goes through during there early weeks after delivery, it is also linked with lack of satisfaction of breastfeeding. Besides, in other studies that never found a relation between breastfeeding and postpartum depression, depression was linked with fear of the mothers to breastfeed. This was because the woman who never feared to breastfeed had a lower possibility to get depressed.

            The difficulties in breastfeeding and lack of confidence to breastfed are the most common concern for women who have postpartum depression (Chaput et al., 2016). The relationship between duration of breastfeeding and postpartum depression has been related to other factors. These factors include negative symptoms of the mother, impaired interaction between the mother and the infant, and physiological processes, these factors are also associated with maternal postpartum depression. In addition, depressive symptoms that come in the early postpartum period increased the feelings of low self-esteem and self-efficacy.

             Breastfeeding has also been suggested to weaken the body neuroendocrine response to stress and thus can enhance the mood of the mother. Hormones which are involved in lactation, oxytocin and prolactin are also suggested to have mood improving effects. Oxytocin act by facilitating the feeling of relation and nurturance during breastfeeding (Dias & Figueiredo, 2015). Lactation even is thought to attenuate a cortisol stress response through the reduction of the stress hormone levels.

Midwifery application

             Midwifery is a health profession that takes part in pregnancy, the act of assisting in the delivery of the baby and even in the postpartum period which includes the care of the newborn. Breastfeeding, which is feeding a child with breast milk has been associated with numerous benefits which are both for the baby and the child. The studies that have been done concerning the effects of breastfeeding on postpartum depression is essential in aiding in the management of the condition in mothers who just gave birth to their babies (Wambach & Riordan, 2016). This is because of a better understanding of the effects that the breast milk will help in coming up with the best intervention that will promote better delivery of care.

             Postpartum depression has been associated with other factors such as the breastfeeding difficulties and low self-efficacy to mothers. Midwifery deals with postpartum care of the mothers, understanding these factors will enable midwives to see the gap that may be there concerning dealing with the difficulties in breastfeeding. This will thus foster a better education to the woman, for example, teaching the women on the ways of attaching the child to the breast, will enable the infant suck well and thus reduce depression that may result from the experiences.

             Furthermore, women who have a fear of breastfeeding as found by some studies need to be well explained and taught. It is essential to remove the fear they have to improve their experience during breastfeeding. The women should be instructed on how to breastfeed the baby, for example, the attachment of the baby to the breast, duration on each breast and the frequency of breastfeeding (Wambach & Riordan, 2016). They should also be taught on the benefits of breastfeeding to them and their child; this might help them understand and have more knowledge and thus reduce the fear which in the long run will decrease the risk of postpartum depression.

            Breastfeeding is a natural process, and it has more benefits both to mother and child. It is, therefore, appropriate to advice mothers who attend an antenatal clinic and after delivery to breastfeeding their children if it is not contraindicated. The benefits for the mother such as reduction in the blood flow and hastening recovery of symptoms promotes good health and also reduces the effects that may have on meeting the daily needs (Wambach & Riordan, 2016). It is thus important for the midwives to provide the necessary information for the mothers to make informed decisions.

            The midwives should also help the mothers prepare well before birth. Assisting mothers to make an informed decision on intention to breastfeed and initiation of breastfeeding early will reduce confusion that may result after delivery (Wambach & Riordan, 2016). This will reduce the risk of developing postpartum depression which may arise when women who did not want to breastfeed, finally breastfeeds unintentionally.it is also necessary for the midwives to address issues that are likely to make the women stop breastfeeding.

Conclusion

             Breastfeeding has been linked to lower postpartum depression which is a benefit to a mother while feeding her baby. The benefits that a woman gets through breastfeeding are numerous, and it includes reducing flow after delivery and promotion of the recovery from the symptoms (Victora et al., 2016). The researches that have been done concerning the relationship between breastfeeding and postpartum depression has come out with various reports. There studies that had been done and those recently done have found that breastfeeding lowers postpartum depression. Breastfeeding has been linked with a reduction in postpartum depression in most of the studies, and this thus shows that breastfeeding plays a role in the reduction of depression in mothers in their postpartum period.

References

Borra, C., Iacovou, M., & Sevilla, A. (2015). New evidence on breastfeeding and postpartum depression: the importance of understanding women’s intentions. Maternal and child health journal, 19(4), 897-907.

Chaput, K. H., Nettel-Aguirre, A., Musto, R., Adair, C. E., & Tough, S. C. (2016). Breastfeeding difficulties and supports and risk of postpartum depression in a cohort of womenwho have given birth in Calgary: a prospective cohort study. CMAJ open, 4(1), E103.

Dias, C. C., & Figueiredo, B. (2015). Breastfeeding and depression: a systematic review of the literature. Journal of affective disorders, 171, 142-154.

Nishioka, E., Haruna, M., Ota, E., Matsuzaki, M., Murayama, R., Yoshimura, K., & Murashima, S. (2011). A prospective study of the relationship between breastfeeding and postpartum depressive symptoms appearing at 1–5 months after delivery. Journal of affective disorders, 133(3), 553-559.

Pope, C. J., Mazmanian, D., Bédard, M., & Sharma, V. (2016). Breastfeeding and postpartum depression: Assessing the influence of breastfeeding intention and other risk factors. Journal of Affective Disorders, 200, 45-50.

Victora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton, S., Krasevec, J., ... & Group, T. L. B. S. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475-490.

Wambach, K., & Riordan, J. (Eds.). (2016). Breastfeeding and human lactation. Jones & Bartlett Learning.

 Obesity in West Virginia

Abstract

            Obesity is an issue that is caused by presence of excess body fats than normal. This is a major crisis in many areas of the world and West Virginia is one of the areas that are greatly affected. There are several steps that need to be taken in order to handle this issue like educating the caregivers on proper diet and also exercise in order to keep fit. This problem is affecting anyone including one’s own children hence there is the need to see steps of education to people an diet and exercise needs to be done. Good health and reduced cases of chronic illness like heart associated problems are some of the measures that will enable to tell that the actions done have really worked.

Introduction

            Obesity is a medical illness that results from a situation where a person has excess body fats that might affect their health. Obesity has been a major crisis in many areas globally and mostly in West Virginia. There is the need to know the causes, effects and how to curb the issue among the people who are mostly affected, that is; the children and adults.

            Kent Leonhardt is the head of department of agriculture in West Virginia.  He views the issue of obesity as a major concern that is affecting most adults and children. It is being associated with increased rate of high blood pressure cases among children as well as adults (Co, Jeffrey, Emmett, Modak & Sondike, 2015). The children who have the issue of obesity are usually at high risk of being victims of obesity. Obesity in early life of a child is viewed as a chronic medical illness. Early diagnosis and treatment of the children and adults who are affected by obesity are some of the steps that can be administered in order to fight this issue of obesity. Kent has the ability to solve this issue of obesity by introducing education sessions concerning proper diet that will protect the people from getting obese. This problem affects many people including the family members therefore it is a great concern. The children can be victims of the same. There is the need to see actions of changes in the diet that people are eating nowadays.

            Catherine C. Slemp is the head of health department in West Virginia. He is another stakeholder who addresses this issue of obesity as major crisis. Obesity is mostly contributed by lack of sufficient knowledge concerning the child-hood diet by the caregivers. Lack of physical activities is yet another issue (Kaphingst & Story, 2009). Children and also adults are supposed to engage in activities that enhance good body fitness and avoid foods that are highly contributing to increased cases of this issue. Physical activity also improves the health status. These steps will enable energy balance in the body of the baby. This issue is affecting many people in the families and also friends hence it is calling for immediate interventions. Good advice given to the caretakers of the children is something that needs to be implemented in order to fight this issue of obesity.

            Sistersville is the head of recreation in West Virginia who views obesity as a major crisis that is affecting the people. When people carry out recreational activities, they are usually in the position to keep safe from obesity crisis (McLean, Hurd, McLean & Hurd, 2014). Even children and close people in the family are at high risk of obesity. There is therefore the need for taking steps of participating in recreational activities. Having a future that has minimal cases of obesity and cardiovascular diseases is one of the measures that will tell that the steps were adhered to.

            Stephen T Williams is the mayor of Huntington, West Virginia who also views the issue obesity as a great threat to the people. He feels that this is something that needs to addressed because it is affecting many people especially children who are later affected by the condition in life. Offering education among learners in schools is a step that can contribute to effective control of the issue (bb, J & Kes, 2013). Obesity is an alarming issue as it affecting any person regardless of age or sex hence a lot of money is incurred during care of the clients. There is the need to see that the learners have been impacted with the knowledge even those who want to have higher education and having a future with less cases of this condition is an implication of effectiveness of this step.

            David McKinley is House Representative in West Virginia who feels that obesity is a major crisis. There is the need to take step on changing food preferences for the children in order to eradicate the issue of obesity among them (McGee, 2012). This include establishment of small gardens in school and kitchens so that the children can stop buying junk foods which are contributing to obesity. This policy needs to be implemented in order to save children who are close associates in our families hence the issue affects us directly if it is not addressed. Future life without cases of obesity is a measure that will show the step had been well implemented.

Conclusion

            Obesity is a major crisis in West Virginia and is directly affecting many people. There is therefore the need to take actions that will enable curb the cases and ensure that the steps have been implemented so that in future there will no or less cases of obesity.

Reference

Co, J., Jeffrey, J., Emmett, M., Modak, A., & Sondike, S. B. (2015). Obesity, hypertension and    metabolic syndrome in children in West Virginia. The West Virginia medical journal,            111(4), 20.

Kaphingst, K. M., & Story, M. (2009). Child care as an untapped setting for obesity prevention: state child care licensing regulations related to nutrition, physical activity, and media            use for preschool-aged children in the United States. Preventing chronic disease,    6(1),    A11-A11.

Gibb, J., & Kes, T. (2013). The Parthenon, February 19, 2013

McLean, D., Hurd, A., McLean, U. N. L. V. D., & Hurd, D. A. (2014). Kraus' Recreation and Leisure in Modern Society. Burlington: Jones & Bartlett Learning, LLC.

McGee, J. (2012). A Model for School Food Policy: How Schools Can Fight Childhood Obesity   by Changing Children's Food Preferences.

            From the clinical perspective, health care professionals are always susceptible to work-related stresses as a result of some of the emotional and psychological demands of their work and other aspects that are associated to the organization that they work at (Pérula et al., 2019). It is, therefore, vital for medical profession to be in the position of addressing prevailing reasons that make physicians, especially nurses to lack the potential of handing their work related stresses. Regardless of the fact that there exists a considerable absence of proper therapeutic training, it is vital for nurses to ensure that that they have utilized the importance of mindfulness-based stress reduction (MBSR) to the extent of understanding the potential it has in handling the existing the stresses and the burnout that nurses undergoes.   

            In the process of answering the EBP questions, it means that becomes possible for the psychosocial and physical work-related stress nurses experience have been chronologically addressed. The reason for that is because EBP has the ability of providing nurses with various tools that enables them to fatigue or burnout while at work. This is to imply that the main intervention entails training nurses about the primary care (PC) means that are required for the purpose of taking care of the patients who engages in training without straining. Conversely, in order to be in the position of applying JHNEBP appraisal tool, it is important to ensure that the mechanisms used have the potential of reducing resources that the nurses uses in offering treatment without straining. This is because burnout and work stress amongst nurses who participates in MBSR program have been perceived as being one of the main problems that the majority of the health personnel have been experiencing.

            According to Pérula et al., (2019), it has been realized that the majority of the nurses who participates in such a program have the ability of reducing extra work-related stresses and burnout. Nevertheless, some of the programs that are used for the purpose of improving patients’ health status with sickness such as headache are still in their formative years. Therefore, for the nurses who are at risk of experiencing fatigue, it takes into account the manner in which MBSR program has the ability of improving their psychosocial functioning. MBSR (mindfulness-based stress reduction) is one of the modern psychotherapy means that appears to be more effective in taking care of pain and stresses that they experience (Pérula et al., 2019). Comparing it with other methods that were traditionally used, it is important to scrutinize its effectiveness in treating the mental and physical health problems in nurses experiencing tension headaches for the majority of the clinicians.

            Ideally, this is because it has the ability of making the nurse to understand the general effect of fatigue that they encounters when handling the patient’s feelings, thoughts, and body sensations, especially pain. Another mechanism that can be used in comparing the prevailing the JHNEBP Appraisal Tool ultimately has the ability of ensuring that the MBSR have had the ability of enabling nurses to handle their work-related stresses and burnout. This implies that it will be easier for them to come up with various means that cope up with reality via approved emotional self-regulation mechanisms. When it comes to the need of participating in acute care nurses who are ultimately at the risk of developing compassion fatigue, it is important to take into consideration the general importance of engaging in the MBSR program as compared to other programs that handles physical and mental health.      

            In the process of participating in the MBSR, it means that it will assist them in developing burnout persistence in the process of taking steps that improves their working conditions. The reason for that is because nurses always desire to live a life that is stress free (Pérula et al., 2019). Therefore, with this mechanism, it means that it is possible for nurses to have the potential of altering the functioning of their brain and govern the manner in which they react to stressful impulses. In the short run, it is possible to reduce their pain related anxieties that ultimately interferes with nurses daily nursing activities.

                                                            Reference

Pérula-de Torres, L., Atalaya, J., García-Campayo, J., Roldán-Villalobos, A., Magallón-Botaya, R., Bartolomé-Moreno, C., Moreno-Martos, H., Melús-Palazón, E., Liétor-Villajos, N., Valverde-Bolívar, F., Hachem-Salas, N., Rodríguez, L., Navarro-Gil, M., Epstein, R., Cabezón-Crespo, A. and Moreno, C. (2019). Controlled clinical trial comparing the effectiveness of a mindfulness and self-compassion 4-session programme versus an 8-session programme to reduce work stress and burnout in family and community medicine physicians and nurses: MINDUUDD study protocol. BMC Family Practice, 20(1).

                                                Patient therapeutic analysis            

According to medical research, head, eye, ear, nose, and throat (HEENT) are some of the examinations that are perceived as being the initial means of understanding its vital signs. As far as the conditions of the patient are concerned, the physical examination to be given will have to commence with general inspection of the causing factors before proceeding to palpation (Seidel et al., 2011). This is to imply that the same medical examination will ultimately require the extensive utilization of various special instruments so as to assist in inspecting ear, eyes, and the associated techniques used that are used in assessing their sensory functioning.

            Ideally, such symptoms have been noted to be having the ability of escalating into some life-threatening condition that ultimately demands prompt examination and treatment. The reason for that is because the majority of the physicians who are responsible for conducting the same assessment need to have the potential of identifying some of the minute differences that exist. During the general assessment of head, neck, eyes, ears, nose, and throat, it is important for the nurses to consider analyzing the patient’s health history. In so doing, it implies that it will be easier for them to understand the underlying causing factors that can aid in reviving her condition (Seidel et al., 2011). In return, it becomes possible for the physician or physicians to perform simple tests that will aid in improving the therapeutic health care needs required.

            As a physician, it is, therefore, important to ensure that some of the anatomic landmarks leading to such discomfort have been identified.   With such an assessment, it implies that is becomes easier for the concerned nurses or nurse to have the ability of describing the some of the physical assessment techniques to be used in enhancing routinely assessment of such a clinical problem. In order to be able to describe and distinguish some of the hearing loss, the findings obtained are crucial in the therapeutic means required (Seidel et al., 2011).

                                                            References

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Head, face, and neck. In Mosby's guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.           

‘at-will’ doctrine

From the class discussion, the side that seems more logical is to avoid the use of ‘at-will' doctrine.  I agree with the post that the Regional Hospital should not adopt ‘at-will' doctrine since  employees  will not focus on  work  but rather, they will develop the fear that anytime they can be fired. Thus, they will change their behaviors, they will not take risks, they will lack job security, they will increase financial stress, and they increase conflict with co-workers. As a result, employers will be hurt by the failure of employees to improve performance (Hudson & Ferguson, 2013). The at-will doctrine allow both employees and employers to terminate employment at will. In most cases, employers can terminate employment for good reason or for no legal reason.  This means that there is a power disparity in that employer has more power to dismiss and replace an employee (Hudson & Ferguson, 2013). The Regional Hospital should consider issues such as uncertainty that may occur when an employer terminates job without notice and when an employee leaves the organization without notice. Note that when an employer notice that a certain employee is under-performing, the manager can terminate the employment immediately. Similarly, if employees notice that the working environment is not friendly, they can quit immediately and find new positions.  Rather than adopting at-will doctrine, the Regional Hospital should adopt employment contracts and involve other parties such as the labor union and form an agreement concerning employment issues. The Regional Hospital should create a culture that connects employers and employees, a culture that motivates the employees to focus on their passion and increase performance, and a culture that encourages the organizational members to focus on mission and vision for the organization to succeed and enjoy a competitive advantage (Hudson & Ferguson, 2013).

Reference

Hudson, D. L., & Ferguson, R. N. (2013). The handy history answer book. Canton, MI: Visible

Ink Press.

  Effects of United Kingdom (UK) Exit from European Union (EU) on Pharmaceutical Sector

Introduction

The vote by the United Kingdom to exit from European Union is one that greatly surprised the world and it has left the policy makers, business frontrunners and pharmacy corporations with the work of looking for a technique to ensure that things do not fall apart (Grubert, 2017). This includes ensuring that there are reasonably priced medications, research and expansion financing and also a supervisory endorsement pathway. The business dealings between the UK and the EU corporations and the position of the EU citizens that are occupied in the UK are some of the top matters that are being focused on. However, the pharmaceutical industry is facing major issues which include matters if relocation from London founded European Medicines Agency (EMA). The other contests that are still being faced include the creating treaties between the UK and the EU on matters of certification and the endorsement of first-hand medications, the movements of the medicines and the active elements amid nations (Grubert, 2017). Matters of sustained involvement by the UK in the advanced medicines inventiveness and the amalgamated apparent law court, subsidy for the theoretical research of the medications and also admittance to assets for the venture in drug growth schemes are also some of the challenges being faced by the industry.

Industry overview

The pharmacological segment is one of the most industrious commerce in UK, it generates about 41.8 billions of dollars turnovers and it also contributes about one percent of the UK’s output. This sector has employed about 62,600 people across all the 543 companies that are reinforced by 1,314 facility and source corporations that include about 51,000 individuals (Swanick et al., 2016). Most of the pharmaceutical companies are SMEs which have about 90% of the manufactures and they have fewer employees that range from 250 employees and below. 43% of these are normally micro companies which tend to have less than five personnel. The pharmacological products denote 8.2% of the properties that are distributed from the UK and 5.3% of these merchandises are traded in to the UK (United Kingdom Pharmaceuticals, 2019).

 The UK pharmacological segment is basically a portion of the international business which has great output and development, in which the UK forms an international collection and also remains a prominent European nation. The worldwide segment is categorized by the local industrialized sites serving continent extensive markets. The UK presently formulae part of the European advertises and as a result profoundly united with European Economic Area (EEA) states for source chains and the directive of the manufacturing and delivery (United Kingdom Pharmaceuticals, 2019). The verdicts on where to assemble medicines within a region are reliant on a array of features, but there are precise worrying supervisory necessities on growth, analysis and issue of medicines that limit the possibilities for the productions wanting the right of entry to the EU market.

The UK dependable lawful system and sturdy defence of intellectual property has assisted to found the nation as a main midpoint for the production of therapeutic expedients and prescriptions. The local market for pharmacological produces is presently valued at 30 billion euros and the petition for these goods is anticipated to remain growing because of the burdens of an aging populace (Swanick et al., 2016). Weak monetary development can significantly reduce the development forecasts for the subdivision but in over-all the petition for the pharmacological merchandises has been uncontrollable to monetary recessions with the segment’s development lingering optimistic even throughout the 2009 catastrophe (Park et al., 2017). The EU remains to be the leading single export advertise for UK pharmacological corporations. The imports to the EU have developed by about 30% in the last ten years and there is still advance growth that is projected.

Germany is a vital market because of its huge and well-off yet speedily ageing populace. All the same, EU now indicates fewer than partial of the entire UK pharmacological exports. The dispenses to outside of EU have currently more doubled over over the preceding ten years with the crucial progress advertises being Asia most precisely china and also the US (O’Donnell, 2016). Drug pricing and compensation is a selected capability of the EU affiliate countries, subsequently, third parties can acquisition trademarked medications in EEA affiliate states with lesser charges and later on resell them to the EU associate countries a procedure that is commonly known as ingress (O’Donnell, 2016).

The effects of Brexit on the pharmacological manufacturing

1. Invention

As earlier illustrated, this is the industry that can be defined to be UK’s motor for innovation. This is the sector that capitalizes more in research and development (R&D) than any other division, the existence science segments stimulates the formation of greatly capable jobs and the development of corporations and associations with academic world as well as other areas that help in creating value for UK. The UK is a position in the intercontinental location in matters of science having learned and essentially advanced over 25 of the top most prescription medications in the domain (O’Donnell, 2016). In order to ensure that they withstand this status, UK has to guarantee that there is definite long term subsidy which takes account of ensuring that the optimistic aptitudes and capabilities are cherished and work in partnership at balance. This commercialization of the exploration will always necessitate backing of the small and average enterprises (SMEs), from the commencement to auction. The commercialization and the development of SMEs fundamentally depend profoundly on UK’s venture capital (VC) firms, but at the same time also contingent greatly on the European Investment Fund (EIF) and European Investment Bank (EIB) subsidy. This founds 25-40% of the VC reserves and entices supplementary sequestered reserves. If the European Investment Bank (EIB) subsidy channels break, then the UK SMEs will agonize and scarcer start-ups will be formed (Collins, 2016).

2. Loss of international exploration leader standing

Although 19% of the domain’s most quoted life sciences are formed in the UK, 60% of all the globally co-authored researches are generally steered with EU associates. The cross boundary associations between EU state associates are becoming progressively supreme in attaining the balances that are obligatory to make the innovation encounters (Grubert, 2017). The forfeiture of the EU affiliation presents a substantial hindrance in upholding the UK at the outlook of international study. Additionally, if countries not in EU see European gauge as indispensable to conventioning their goals, it is probable that they motivation to object partnerships out of the UK. Furthermore, forfeiture of orientation with the EU on records defence might jeopardise the UK’s foremost point mainly because the existing UK Data Protection Act is inadequate to permit European records allotment (Grubert, 2017).

3. Regulation

It is not easy to categorically tell the degree that the UK pharmacological production is willing to endure the control by the EU decrees once it gets off the EU. A great portion of this is extremely reliant on whether the UK will remain to be a portion of the European solitary markets and provision unrestricted effort of pharmaceutical merchandises (Kazzazi et al., 2017). This is a verdict for both of the UK and the outstanding EU associates have to scope. The most probable result is that the corporations that are in quest of debuting new yields will be forced to disjointedly apply for supervisory endorsement in the UK and also in the EU. It will central to postponements in the structure and it could be harmful to the drug unveilings within UK, because corporations could highlight relating for supervisory endorsement in the significantly greater EU advertise as equated to UK (Collins, 2016).

Not constraining to the complete operation of the European Fabricated Medicine Directive (FMD) is likely to deny the UK of the EU’s exertions to avert the fabricated prescriptions that enter EU nations and consequently getting to the patients in UK. In spite of UK’s trail in statuses of market in EU admission, there is likely to be an augmented approval affliction for the UK as medications previously centrally accepted by European Medicine Agency (EMA) would requisite supplementary approval in the UK (Kazzazi et al., 2017). EMA has already conjectured the hypothetically noteworthy disturbances to its processes following departure of UK from EU but it remains uncertain as to whether transfer will take place or what additional fluctuations are likely to arise in esteems to the association between UK and EMA. These difficulties could nevertheless be avoided by the numerous managerial rationalization measures for example the ones that are used by European Free States Association (EFTA) states.

4. Directive of medicinal devices

Therapeutic expedients are controlled by the EMA and Medicine and Healthcare Products Regulatory Agency (MHRA). The Medical Devices Directive (MDD) correspondingly tries to apply the EU extensive ethics to the therapeutic expedients. What this means is that at the contemporary day, the devices that are certified in solitary EU state can be wholesaled all over the EU states (Park et al., 2017).  This lowermost joint denominator structure consents the manufacturers to intentionally catalogue their merchandises in states that have inferior criterions.

With UK leaving EU, the MHRA is expected to execute more robust criterions on the therapeutic devices. Setting guidelines that EMA unsuccessfully installed as a result of the opposition from the member countries, by doing this, it will advantage bigger pharmacological firms that have more erudite research and development and industrial set-up for safeguarding that the produces are of high eminence in order to meet the more strict guidelines (Collins, 2016). At the end of the collaboration with the EU on issues of European pharmacovigilance (PV) and the imminent therapeutic expedient catalogues will lessen the aptitude of UK to perceive the lateral effects and also retort to the well-being subjects (Park et al., 2017). Additionally, forfeiture of admission to the European centre for Disease Prevention and Control (ECDC) may possibly deter the aptitude of UK to yield prescriptions that battle plagues and could also suspension the creation and stock of imperative vaccines.

5. Confidence and gauge Loss for UK

The connotation of the British Pharmaceutical Industry (ABPI) backs the existing controlling scheme, which is considered as exceedingly operative, but devours voiced apprehension about the latent supplementary administration that an innovative sovereign UK supervisory structure would generate (Collins, 2016). If distinct supervisory structures are there for the UK, the corporations looking to unveil new yields will have to request for monitoring consent in UK and the EU counties, which could principal to adjournments. This could be harmful to unveilings in the UK because the corporations will probably consider applying for the supervisory endorsements in the EU market that is superior as equated to UK which institutes of only 3% of the market for new medications (Grubert, 2017).

6. Talent

It is projected that 17% of the researchers in STEM (science, technology engineering and mathematics) in the UK research institutes are frequently EU nationals that are not from UK. This means that enabling the undertaking across boundaries is indispensable to safeguarding the resource of ability required in existing and emergent ability gap zones such as bioinformatics, genomics or progressive psychoanalysis pharmaceutical products development. The international fondness of UK status is hence reliant on on elimination of obstacles to appealing, emerging and retentive talent (Kazzazi et al., 2017). This comprises the existing state of indecision concerning UK’s prospect settlement plan and the hostile image that is presented on the foreign workforces. The government rests devoted to warranting scholar flexibility is always sheltered. The congress settled that scientist flexibility is of major prominence to the science community in UK and hence must always be secured if the UK science and exploration is to endure global leadership (Kazzazi et al., 2017).

Considerations for post Brexit models

In regard to the analysis conducted in this study, the exit of UK from EU has negative effects on the pharmaceutical sector and this is all in relation to the funding and benefits that EU offers this sector. There is one model that can offer a way out which would permit UK to go on getting the subsidy as well as the welfares from the EU driven scientific research engagements even after its withdrawal.

• European Economic Area (EEA)

It was created in the year 1994 and it presently comprises Norway, Iceland and Liechtenstein. These nations instrument EU regulation for example unrestricted trade, recognize EU managerial verdicts, and back to EU to aid the social and economic inequalities through the member countries and unrestricted movement (Grubert, 2017). They nevertheless cannot ballot in the European assembly and have no give or take in its decrees. A good case sample is with Norway which is an affiliate of EEA which has been capable of preserving its self-sufficiency over its pharmacological sector (Collins, 2016). It has its identifiable Medicines Agency which is subordinate to its state health care institute. This is not something that is so dissimilar to UK which has NHS and the MHRA that is accountable for advertising of medications. Even though being a member of EEA mean that Norway has to observe the EU guidelines in respect to market approvals, its specific medication organization can sway the work of EMA as EU affiliate state can (Grubert, 2017). Norway is capable of controlling its charges and compensation which is dissimilar for in and out patients disparate for the rest of the EU states.

EEA classical would be the informal choice for UK pharmacological manufacturing consenting for development to a lawful context only faintly dissimilar to the existing model while incentivising pharmacological firms to stay in the UK. As with the situation of Norway, EEA model can prosper in upholding and even enticing key performers in the pharmacological industry (O’Donnell, 2016). The acceptance of the EEA model for UK would safeguard safety of the standing quo thus permitting for constant organization and also competence amid the UK and also the other section of the EU in relations of research and development, scientific tribunals, trade, marketing, supply among many others (O’Donnell, 2016). This model is definite since it would also permit the pharmacological firms that are only founded in the UK to profit from the innovative restructuring. This is because this reorganization will present single EU gateway for scientific trials. This will guarantee that there is consistent procedure for the endorsement of scientific tribunals across EU and it will allow partaking nations to admission and also share scientific trials data on an EU catalogue.

If the UK manages to get affiliation to EEA, it successfully holds its rank with the EU. This motivates those pharmacological corporations in EU with disclosed headquarters or with industrial positions in the UK and also the ones that conduct scientific trials in the UK to endure their actions in the same style (Peters, 2017). Devoid of this refuge net, these firms will be forced to validate that their determination conforms to the EU morals which could substantiate to be time consuming and also affluent, probably contributing to the firms moving away from the UK. This is particularly pertinent to those EU pharmacological firms that do not have headquarters or industrial plants that are not in UK. If the UK does not join the EEA, these corporations will most likely transfer to EU or other EEA countries all in chase of effective affluence and occupational safety (O’Donnell, 2016). This will happen because it will be unruly and it will take too much time to found new governmental practices contained by a shifting commercial setting. Linking with the EEA should consequently defend the UK pharmacological manufacturing from the administrative commotion and financial disadvantage of pharmacological firms departing from the UK (O’Donnell, 2016).

Recommendations for UK to ensure that the pharmaceutical sector continue to grow

Guarantee unrestricted movement of the high expert specialists between the UK and EU borders. This will guarantee that UK still preserves the high level of expert work power in the production and the UK academies while at the same time offering the British residents with the liberty to get employment, study and attain skill across the EU states (Peters, 2017). This selection will petition to transnational pharmacological firms that desire to rapidly and effortlessly reposition employees across the globe. The unrestricted measure of specialists will consequently inspire foreign pharmacological corporations to reservation their UK centred amenities. This will also lessen anxieties in respect to their EU staff associates and their aptitude to entice as well as apprentice the finest in the arena (Grubert, 2017). This contract is also helpful for UK since it will inspire more overseas investments in the UK.

Consensually constructive trade arrangements for both drugs therapeutic strategies with EU. The EU is perceptibly an indispensable advertise for the pharmacological firms in the UK, in order to aid avert the withdrawal of medicine corporations that are grounded in the UK, the management should safeguard that it renegotiate the trade circumstances with the EU that are analogous to those that were there before the exit. What this calls for is for a new well-organized custom scheme for the UK-EU craft with minor charge and managerial liability (Collins, 2016). This will correspondingly be significant in aiding to avert a sharp increase in the charges of the drugs that are smuggled from the EU.

Conclusion

The departure of UK from EU has very great effects on the pharmaceutical sector most of which are negative. The exit results in the UK becoming the third party country to the EU and it closes the access to the single market. This greatly affects the pharmaceutical industry given that UK is deeply integrated to the global pharmaceutical trade. UK will lose a large number of professionals who are mostly from the EU states meaning that its reputation as one of the greatest manufacturer of medicines will be tarnished because the production rates will go down. UK will not continue to enjoy the funding from the EU states not to mention the large market for the drugs that EU provides. The solution to this issue will be for UK to join European Economic Area (EEA), where it will be able to still enjoy a certain percentage of the benefits that will enable the UK pharmaceutical sector to prevail.

References

Collins, A. (2016). Making a break. Chemist & Druggist, 284(6972), 18–20. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=116431735&site=ehost-live

Grubert, N. (2017). Interpreting UK’s Post-Brexit Life Sciences Strategy: Examining the

access outlook and implications from the UK’s recently unveiled blueprint as it prepares for secession. Pharmaceutical Executive, 37(11), 34–39. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=126221428&site=ehost-live

Kazzazi, Fawz & Pollard, Cleo & Tern, Paul & Ayuso-Garcia, Alejandro & Gillespie, Jack &

Thomsen, Inesa. (2017). Evaluating the impact of Brexit on the pharmaceutical industry. Journal of Pharmaceutical Policy and Practice. 10. 32. 10.1186/s40545-017-0120-z.

O’Donnell, P. (2016). Europe’s Drug Regulators Eye a Post-Brexit Prize. Applied Clinical

Trials, 25(12), 10–11. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=120468419&site=ehost-live

Park, J. J., McKee, M., & Atun, R. (2017). Brexit: Severe Risks to Britain’s National Health

Service. American Journal of Public Health, 107(10), 1594–1596. https://doi.org/10.2105/AJPH.2017.304010

Peters, R. C. (2017). Solving Pharma’s Post-Brexit Puzzle. Pharmaceutical Technology

Europe, 29(1), 24–26. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=120924475&site=ehost-live

Swanick, M., Pisani, J., Saunders, T., & Comer, B. (2016). After Brexit. Pharmaceutical

Executive, 36(9), 43–58. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=118209157&site=ehost-live

United Kingdom Pharmaceuticals. (2019). Acquisdata Industry SnapShots: United Kingdom

Pharmaceuticals, (15061), 1–159. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=134708973&site=ehost-live

Differential Diagnosis of Skin Conditions             

Chief complain

            Red patches on the skin which are itchy and burning with no control over scratching them all the time

History of presenting illness

James is a 28-year-old male client who attended the health care facility with itchy red bumps in his skin that does not allow him control over scratching. He explains that the rushes started three weeks ago and he hoped it would go away but it had become bigger and the skin has started peeling off. He also states that the rashes are painful and if scratches for a long time it becomes more painful, itchy and sometimes bleed. He also reports that his joints have also become stiff and he cannot do things comfortably. On physical examination the skin is dry and cracked and there are presence of silvery scales on the bumps. The client has also thickened nails on observation.

Differential diagnosis

Eczema causes itchiness, dryness of the skin, occurs mostly on the face, neck, hands, ankles and even eyelid. It causes small raised bumps which may leak fluid (Agha et al., 2016). It may also affect pigmentation and thus might make the affected part lighter and darker

Psoriasis presents with itchy skin, red bumps which painful. The skin becomes dried and cracked and might bleed at times on scratching. There are also signs of thick, pitted and cracks on the nails (Limaye, 2015). This are the main presentations.

Pityriasis rubra pilaris causes pink, red scaly patches on the skin which are usually itchy and it might cause development of the patches on one side of the body and most often on elbows, knees, hand and feet (Brown & Badri, 2019). The skin may be thickened and the scaly patches may spread to the whole body.

Actual diagnosis

The correct diagnosis for the condition is psoriasis due to the fact that, the client reported some form of bleeding from the cracked parts of the skin on scratching. Presence also of the pitted nails suggest psoriasis. There also the presence of the stiff joints which is not present in the above condition as they do not present with it.

References

Agha, H. M., Asim, S. A., Alam, M. Z., & Wahid, Z. (2016). ECZEMA. The Professional Medical Journal, 23(01), 060-064.

Brown, F., & Badri, T. (2019). Pityriasis rubra pilaris. In StatPearls [Internet]. StatPearls Publishing.

Limaye, K. (2015). Psoriasis: an overview and update. The Nurse Practitioner, 40(3), 23-26.

Managing asthma

            Asthma is a chronic disease whose symptoms vary over time depending on the individual as well as the environment and circumstances one is in. since the effects that the disease has on the individual may be different depending on what the individual is experiencing, it requires people with asthma to constantly keep track of the disease so as to know what measures to take in order to effectively manage the condition. Patients should therefore use long and short term treatment methods to help manage the disease and lead a normal life if well managed. Although the treatment and control methods have significant results when it comes to controlling the disease, they also have side effects that patients must consider before determining the correct control and treatment method to use.

Long term treatments are ideal for people with asthma symptoms occurring more than twice a week. The long term treatments function by reducing swelling and also relaxing the muscle bands around the airways. They are classified into two groups namely, anti-inflammatory drugs and bronchodilators (AAAAI, 2019. The anti-inflammatory drugs make it easier to breath by reducing the swelling and mucus in the airways and they consist of inhaled corticosteroids and cromolyn sodium to mention a few. Corticosteroids, like Mometasone and Flunisolide, work by preventing the symptoms of asthma before they start rather than relieving them (AIM, 2019). Cromolyn sodium on the other hand works by reducing the amount of swelling in the airways when the individual is exposed to asthma triggers and therefore aids in breathing.

Quick relief medication consists of Ipratropium which aids in breathing by relaxing airways and Corticosteroids which reduce swelling in the airways. While corticosteroids are highly effective for severe asthma attacks, they have serious side effects and should therefore be taken for short periods and only to treat severe attacks (NAEPP, 2007). Another treatment option is immunotherapy which targets allergies that trigger the asthma. The medication is given in the form of tablets or injections that make the body less sensitive to allergies and therefore reduces the number of things that act as triggers. It is however important to consider the effects that the treatment methods have on the patient when managing the condition so as to avoid some side effects such as slowed growth rate in children who use corticosteroids.

The harmful side effects of asthma treatments can be regulated using the stepwise approach. The method works by regulating the frequency in which treatments are administered. Since the ailment may vary in severity depending on the triggers present and the patient, stepwise enables caregivers or the patient to either increase or lower the treatments according to the severity of the asthma (AIM, 2019). Stepping up the dosage and treatments helps the patient to regain control of the disease while stepping down prevents unnecessary treatments and their side effects. Patients must therefore come up with ways to assess the severity of the disease on different occasions so as to use the appropriate dosage when seeking treatment.

The stepwise management approach helps patients and health care providers to better manage the condition as it adds more clarity on the patient’s medical condition. Patients are required to keep record of the symptoms, triggers and other relevant factors that make it easier to determine whether to increase or lower the medication. In doing so, both the patient and the caregiver learn more about the asthma and what the patient can do to overcome triggers and also how to better manage the condition. Reducing the medication needed also cuts down on the side effects brought about by certain medical treatments and therefore makes it easy to manage the condition. The stepwise method is therefore ideal and should be used to not only manage asthma but also help patients lead normal, healthier, lives.

References

American Academy of Allergy Asthma and Immunology, (2019) “The Stepwise approach for Asthma control” retrieved from, https://www.aaaai.org/conditions-and-treatments/library/asthma-library/follow-stepwise-approach-for-asthma-control

Asthma Institute of Michigan, (2019) “Long term control medications used to treat asthma”         retrieved from, https://getasthmahelp.org/ltc-medications.aspx

National Asthma Education and Prevention Program, (2007) “Stepwise approach in managing     asthma in youths 12 years of age and adults” NCBI, retrieved from, https://www.ncbi.nlm.nih.gov/books/NBK7222/

Thread Lift

            Thread lift involves major changes in treatment which are effective and leave no scars on the skin. They lift, tighten and give it a younger appearance. There is no break in the skin. It is therefore recommendable for any person with sagging of neck and facial skin or someone having wrinkle lines to use this procedure. There are two types of the procedure which are performed depending on the site of the skin. PDO Mono Thread technology is a procedure which usually involves bringing back the normal looks of one’s face and bringing back the youthful facial appearance. The other type of procedure involves use of instant lifting COG threads. These are important Mono threads which are designed with barbs. The barbs are usually the ones that hook to the bottom side of the skin. The tissues which are considered to be sagging are supported by a support structure formed by the barbs. Anchoring points are not important with the use of COG threads. Usage of these threads is best for the middle and lower facial regions. There can be formation of collagen around the barbs of the threads and the threads themselves. There is a doctor who has undergone through implementation of the best and quality techniques training whose name is Dr. Andreas Skarparis. Minimally invasive techniques use COG threads and CE-certified PDO threads for the outpatient. These threads have been medically proven as safe.

ZO Skin Health

            Dr. Zein Obagi created ZO Skin Health peels. This doctor had worked as a dermatologist for a period more than 20years. He was working as a doctor who had been certified by the board. He has made better change in the skin industry through his treatment practice of skin peel and usage of medical products that makes the skin appear younger and the practice has been preferred by many people across world.

Medik8

            Medik8 have a feeling of intense enthusiasm for better health of the skin, aiming for every person to have a feeling of being beautiful and confident in their personal skin. They are working very hard to give good results with their strong skincare. They believe in combination of research and innovation. They have a mission of ensuring that everyone believes in achieving real results and beautiful skincare.

Candela Alexandrite Laser Hair Removal

Before treatment   

            The therapist scans the whole area where the hair is to be removed using the laser and it a basic requirement that the length of the hair to be removed to be 2-3mm. The treatment is easy and not painful which has been enabled by the use two cooling systems. Effective completion of hair sessions requires 5-6 sessions which must be done monthly. A temporary redness appears after the session but disappears in some hours or days. There should be application of moisturizer creams after the session as recommended by the working team and application of sunscreen to be done by the patient some days after the procedure. More variable pulse periods and options have been offered by the new Candela Gentlelase Pro hair removal. The procedure is much safe even for the skins which are slightly tanned and also is also safe during summer.

            Laser hair removal and repeat sessions

            There are no repeat sessions with Candela alexandrite laser hair removal but if someone happens to have hair in the area of treatment, it is possible to book the session in ten days time to be examined and treated on the areas of concern.

Rabies

Introduction

Rabies is defined as a disease resulting from animal bites have the rabies virus. This virus damages the brain cells, and paralyses the spinal cord (Jackson, Alan and William, 2). This disease can be found anywhere in the world and has been in existence for many centuries. After the virus has been transmitted into the human body, it can take up to 12 weeks for symptoms to start showing, and it was not until the 19^th century that people realize that there is no accurate diagnosis of this disease. The Rabies virus is commonly spread by domestic dogs, even though wild animal such as bats and wolves can also spread it. These animals spread rabies virus through wound inflicting bite and scratching. Rabies is a disease that mostly affect the poor that live in rural remote areas. There are post bite vaccines to prevent the rabies virus from affecting someone after a bite or a scratch.

Rabies virus is transmitted through a bite by an infected animal. This virus finds its way through the skin. After the virus is introduced in the body it starts to affect the nervous tissues and the amount of the virus continues to increase at the inflicted wound for about a week. This virus might alternatively be transported to the base of the spinal cord where it continues to increase, and then the virus is transported back to the infected wound and the brain. The transportation of this virus is facilitated by motor neurons. When this virus enters the brain, it affects all the neutrons in the brain cells (Jackson, Alan and William, 29). This virus cannot be tested through blood since it is never present in blood. Death from rabies is as a result of neutron alteration that is cause by the competition between the rabies RNA and the RNA present in the host.

Rabies has five stages the first stage; incubation, prodromal, acute neurological stage, coma stage and lastly the death stage. After exposure to the rabies virus the symptoms can begin after a few days or weeks, or even one or two years. At the beginning of the first stage incubation, the symptoms are mostly similar to those of flu, this stage mostly takes place from 30 days after infection till 90 days of the infection. Serious symptoms begin showing in the seconds stage prodromal, at this stage one feels a certain discomfort that they cannot identify, the victim experiences nausea, vomiting and indigestion and other gastrointestinal symptom. The victim also experiences mild fever in this stage. In this stage, the victim is likely to go through psychiatric disturbances such as insomnia, agitation and lastly depression (Baer, 209).

When the victim approaches the third stage the virus starts affecting the brain, the victim starts oozing foam from the mouth. In other case where the virus affects the spinal cord, it paralyses it, causing the victim to be weak, this stage lasts for about 2-7 days. After this period the respiratory system of the victim begins to fail, and this marks the beginning of the coma stage which lasts for a maximum of 7 days before the victim reaches the final stage, death which might be delayed by putting the victim on life support, but eventually the victim will die (Baer, 209). There is close to none chance of surviving rabies after it has passes its second stage.

Today Asia and Africa attributes to 95%victims of rabies. In today’s world rabies is well controlled even in developed countries. the World Health Organization declared rabies as a neglected tropical disease that mostly affects the poor. WHO embarked on a rabies eradication campaign in the south east part of Asia and is targeting to have completely eradicated rabies by the end of 2020. An example of this campaign was launched in Bangladesh in 2010, WHO is eliminating rabies by carrying out mass dog vaccination and availing vaccines for those who come in contact with the rabies virus (World Health Organization, 13). This reduced death caused by rabies by 50% in 2010-2013. Bill & Melinda Gates is another foundation that is working with WHO towards eradication of rabies.

To prevent this deadly disease, precautions must be taken. Domestic animals such as dogs and cats should be vaccinated against this disease regularly. People must be educated on preventive measures. These preventive measures include; avoiding contact with and reporting any stray animals to relevant authorities, when a domestic animal bites or scratches a person it should be examined immediately to know if the animal has rabies or not, the person should also allow the wound inflicted to bleed then later was it with water and seek medical assistance from a doctor (World Health Organization, 13). It is only by educating the general public on measures to control rabies that it can be fully eradicated.

Mostly, the rabies vaccine is given to a person after the person has been exposed to the virus, people such as forest rangers, veterinarians and people who are vaccinating animals against this disease are allowed to take the vaccines before exposure, since they are dealing with animals that might be having this disease without their knowledge. Currently, there are only three vaccines in the market. Before one is exposed to any field with rabies, they receive a pre-exposure shot three days in advance. The vaccine is injected in the muscles instead of fatty tissues (Jackson, Alan and William, 3). There is a treatment, Milwaukee Protocol, which is offering hope for a rabies cure.

Conclusion

Rabies is a disease caused by a virus. This disease is mostly found in animals which later transmit it to humans through bites and scratches. The virus increases in the body and later it affects the brain and the spinal cord. It has five stages; incubation, prodromal, acute neurological, coma stage and death. Today WHO is working with foundations such as Bill &Melinda Gates to eradicate rabies completely, by availing drugs at a considerable price and carrying mass vaccination of dogs.  It is advisable that preventive measures should be taught to people in order they can be aware of how to deal with this disease. There are three vaccines for this virus and the hopes for a cure lies in a treatment by the name Milwaukee Protocol.

 Work cited

Jackson, Alan C, and William H. Wunner. Rabies. Amsterdam: Elsevier/Academic, 2007. Internet resource.

Who Expert Consultation on Rabies: First Report. Geneva: World Health Organization, 2005. Internet resource.
Baer, George M. The Natural History of Rabies, Volume 1. Saint Louis: Elsevier Science, 2014. Internet resource.