It has been a tiresome process for patients visiting a hospital or a clinic whether for the first time or for more consultations. In most cases, nurse often asks the patients for personal details which involve submission of hospital cards. It is through these cards that nurses are able to fish for one’s file which may be a process that may consume so much time for the patient. This is the hard reality in most of our hospitals across the world. However, there are a few hospitals which have embraced other advanced healthcare data systems such as the digital electronic data systems. Contrary to other sectors, the healthcare sector still lags behind in adopting the new information technology. Therefore, the transformation process from a traditional approach of paper record keeping into seamless digital recording has been a challenging subject in healthcare systems. As the world is entering into another era of technological advancement, most of the federal governments and other stakeholders in the healthcare systems across the states have offered their support towards pushing for a motion to make electronic medical records a worldwide standard. The importance of adopting these electronic data systems is far-reaching. Computerization would, therefore, allow nurses to get patients’ health information with ease, improved care and cutting on cost. This paper seeks to contribute to the overall understanding of healthcare record systems at large hospitals in relation to the adoption of the EMR systems. Finally, the paper will seek to inform of the recommended methods of improving the adoption of electronic data systems in hospitals.
According to Rizer, (2015), Ohio State University Wexner Medical Center is one of the large medical centers often crowded with patients as they offer a wide-range of services. The center has six hospitals with forty-six outpatient sites. Each day these hospitals are expected to serve approximately 1200 patients with more than 100 surgeries. These hospitals are often sub-divided into so many departments and sub-specialties. On a normal day, these hospitals within the Ohio State University Wexner Medical Center often receive patients directly at outpatient clinics and at times there are referral cases from other smaller hospitals. Therefore each sub-specialty has its own wards where they admit their patients, treat them and also discharge them. Organizational structure at Ohio State University Wexner hospital is hierarchical and managers are regarded to hold a substantial amount of power (Jha et al, 2009). Clinical staffs are always focused on a day to day engagement on how they can improve their hospital operations and services to their patients. Ohio State University Wexner hospital is located in an area that covers a wide area hence serving a relatively larger population. As a result, these hospitals are often dominated by long lines of patients in the waiting room. At the end of the day, the hospital staffs are often overwhelmed by the tiresome task of registering their patients. This has, in turn, led to poor service provision in hospitals thus raising concerns in the healthcare sector. Ohio State University Wexner hospitals have therefore adopted the electronic version where patients’ medical history is maintained by the health providers. This includes the administrative clinical data of a patient once they visit the hospital for treatment. The medical superintendent of these hospitals, therefore, has developed a wide selection of nonclinical tasks and expressed importance in the electronic health data system for various reasons (Jha et al, 2009).
Billing is an important aspect of Ohio State University Wexner hospital and has been greatly improved through EHR systems. This has led to the improvement of transparency and workflow within the hospital settings. Through this system, a patient is able to visit a consultant, pay for the prescribed tests and laboratory examinations. After this, the patients can get back to the doctor for diagnosis where they are finally given a prescription at the pharmacy (Menachemi & Collum, 2011). All this enhanced by the use of the electronic system without having to carry along any doctor’s notes as the system enhances communication online.
Registration at Ohio State University Wexner hospital is made easier through EHR. This has led to a reduction of waiting time for patients especially while awaiting manual record keeping and movement of papers. Once a patient visits the hospital, the health staff in charge is only required to key in the patient’s details into the system. This has been of great importance as it has enhanced quick retrieval of information from the system thus reducing the time used to physically search for the records.
Another major reason as to why Ohio State University Wexner hospital has adopted the electronic data system of record keeping is due to the administrative support offered by these systems. The systems have been widely used in the hospital to assist in carrying an account of the surgeries performed each day and the number of patients seen by the health staffs within the hospital (Burton et al, 2004). Data collection is thus made easier especially when making returns to the ministry of health on statistics of illnesses highly treated within the hospitals (Menachemi & Collum, 2011). The systems have also raised the interest of medical practitioners in Ohio State University Wexner hospital as they have tools such as decision-making tools. The systems also have the ability to help clinical staff in practicing Evidence Based Medicine. Through the use of electronic health management system, the accuracy of diagnosis in hospitals is improved. This has greatly reduced the cost of healthcare as records are kept in place hence the repetition of tests is avoided. Picture archiving system, on the other hand, is widely used in hospitals and they are involved in keeping records of patients’ x-rays, MRI, and Ultrasounds.
However, Ohio State University Wexner hospital is not yet at a point where they can fully confirm the use of EHR systems only. It is for this reason that there is a need for an integrated use of health record systems. Thus doctors are recommended to use the two systems, the manual, and the electronic health data system. This will act as evidence in case litigation as the manual papers contain doctor’s signatures (Menachemi & Collum, 2011).
Privacy concerns are one of the emerging issues facing these electronic health records. Americans are worried that availing patients’ health records online will make it easily accessible to other people other than the patients themselves. Many people fear that increasing patients’ information online will increase identity theft and increase in dangers of ransomware. There have been reasonable concerns from consumers about privacy and safety. According to a study carried out in 2012, it was revealed that medical providers often disclose some of the patient’s information at a fee to all those who are willing to pay. Among all those who may be interested in a patient’s information includes, employers, drugs, and insurance companies. As a result of this justified concern about information security, the slow adoption rate has been experienced across all U.S hospitals due to fear of exploitation (Zuniga, 2015).
Jha et al, (2009), asserts that IT departments in collaboration with the hospital administration are working towards improving their use of data in order to keep their patient’s health. This will also improve their shift into value-based payment contracts. They are also seeking to build a strong interoperability with the various hospital systems and software, investing more in the enhanced decision support. IT departments at Ohio State University Wexner hospital are thus responsible for reinstating exceptionally modified and costly legacy systems that offer EHR solutions to the next generation. These solutions will thus increase security, mobility and cloud-based solutions that will offer physicians and hospital staffs. This will offer them with immediate access to the information, resources as well as specialists needed to provide best quality services to patient care. The system is also expected to incorporate other new technologies so as to advance patient engagement and treatment.
In conclusion, EHR systems in hospitals are reforming the healthcare system and more so in terms of patient care delivery. Allowing patients access to their health records through the electronic system authorize patients, reduces physical error and cuts the cost of patient’s insurance providers and hospital bills. However, there still exist so many hindrances to efficient electronic health records access. Information technology skills are lacking in hospitals, a resource that is desperately required so as to support and adapt to the desired changes. Future research should, therefore, focus on inducing the adoption of electronic health records for general practitioners, patients, and hospital staff. Although the benefits of these electronic health records are apparent from those who have already implemented, these are long-term benefits that will take time for users to observe. More immediate rewards are therefore highly needed for a universal acceptance and adoption of these health records.
References
Burton, L. C., Anderson, G. F., & Kues, I. W. (2004). Using electronic health records to help coordinate care. The Milbank Quarterly, 82(3), 457-481.
Menachemi, N., & Collum, T. H. (2011). Benefits and drawbacks of electronic health record systems. Risk management and healthcare policy, 4, 47.
Zuniga, A. V. (2015). Patient Access to Electronic Health Records: Strengths, weaknesses and what’s needed to move forward. School of Information Student Research Journal, 5(1), 3.
Jha, A. K., DesRoches, C. M., Campbell, E. G., Donelan, K., Rao, S. R., Ferris, T. G., ... & Blumenthal, D. (2009). Use of electronic health records in US hospitals. New England Journal of Medicine, 360(16), 1628-1638.
Rizer, M. K., Kaufman, B., Sieck, C. J., Hefner, J. L., & McAlearney, A. S. (2015). Top 10 lessons learned from electronic medical record implementation in a large academic medical center. Perspectives in health information management, 12(Summer).
Low Back Pain (LBP) and obesity have emerged among the very common health problems particularly in patients who are attending health care at primary levels in the United Arab Emirates. As such, the causal connection between obesity and LBP have for the past few years have piqued the interest of many researchers. It is noteworthy, though, that there is still a wide range of controversy concerning the association between the two, in addition to the presence of various conflicting observations. A significant challenge in the process of trying to ascertain the primary cause and the implication of LBP in association with obesity is the nature of the condition. Fundamentally, LBP is a condition that cannot be easily determined. This is mainly attributed to the fact that it is heterogeneous, comes in many dimensions in nature, and very little information is known concerning the etiology of the disease. This research proposes a clinically-driven collaborative research effort to investigate the spinal biomechanics of obesity and LBP in the UAE, a country where both obesity and LBP are more than double the global averages.
The proposed study will investigate the spinal biomechanics of obesity and LBP in the UAE and come up with new strategy to determine whether the BMI of the patient is the cause of LBP or not. A musculoskeletal simulation model will be developed to identify the volume of mechanical load that can affect the spine thus the low back pain. Moreover, this research will study 3 different hypotheses for reasons leading to increase mechanical load on the musculoskeletal system.
This research was supported by the Government of Abu Dhabi to help fulfill the
vision of the late President Sheikh Zayed Bin Sultan Al Nahyan for sustainable
development and empowerment of the UAE and humankind.
The term obesity can be defined as the excess accumulation and storage of fat in the human body. This definition creates a separation in context of the body weight, which is a measure of the general mass, from obesity, which is based on the approximation of the amount of fat present in the body. The main tool currently used worldwide for estimating overweight and obesity is the body mass index or BMI. Defined as the ratio of the weight of an individual (kg) divided by the square of their height (m2), a BMI ratio of >25 indicates overweight, while that of >30 defines obesity. Obesity is a global public health challenge of severe proportions. Increasing at an alarming rate, worldwide, obesity has more than doubled in the last two decades, with more than 2.1 billion people (30% of the world’s population) overweight and obese. According to new research by the McKinsey Global Institute (MGI), a devastating $2.1 trillion or 2.8 percent of global GDP is currently spent on obesity annually, but less than 1% on prevention. Today, obesity comprises the 5th leading risk factor for mortality in the world (around 3.4 million annual deaths), as it significantly increases the risk for developing numerous chronic diseases including coronary heart disease (by over 50%), ischemic stroke (by 44%), type 2 diabetes (by 23%), as well as many cancers (up to 41%). The problem is expected to worsen, where almost half of the world’s adult population is expected to be overweight or obese by 2030 . The global trend of sustained growth in obesity prevalence indicates that the current measures in the prevention, treatment, and management of the condition are largely ineffective.
World Health Organization (WHO) 2014 data reveals that the UAE currently ranks fifth in the world in obesity, at a prevalence rate of 36% (33% males and 39% females). In other words, three in every ten Emirati males and almost 4 out of every 10 females are obese, with an economic burden amounting to $6 billion/year in associated disease cost. If we also include the percentage of overweight individuals, based on the most recent Global Burden of Disease report, more than 60% of men and 66% of women in the UAE are currently overweight or obese (average of 63% or more than double the global average of 30%). Furthermore, while the UAE slightly fares better than the US in adult obesity prevalence (US current rate is 38%), UAE children are 1.8 times more obese than American children, indicating a dangerous future trend and prognosis as well as ineffective prediction tools and preventive/intervention strategies, particularly considering the very young median age of the population (30.3 yrs.) (Badawood et al 2017).
Low Back Pain
With an immense prevalence rate of 70-80%, low back pain (LBP) is considered the single leading cause of disability throughout the world, plaguing the lives of millions of individuals and imposing huge health and socioeconomic challenges, worldwide. Although various factors have been associated with LBP prevalence, the causative and underlying mechanisms, key information for prevention and clinical management, remain largely elusive. The primary aspects that are used to predict LBP include physical stress, for example, lifting, driving, and frequent movements which involve the back. Some of the psychosocial aspects related to the problem comprise of high-perceived workload and also the time pressure. Other personal behavior, such as smoking, drinking and a sedentary lifestyle have also been associated with LBP. The visible attributes of the weight of the human body and also cases related to being obese are not easily comprehended.
Correlation between Obesity and Low Back Pain
Over the past few decades many studies found a positive correlation between weight and LBP. Despite the evidence that body weight has been associated with LBP, the causal link remains not well established. Most existing studies in literature conclude that body weight should be considered a possible weak risk indicator, but there is insufficient data to assess if it is a true cause of LBP. Longitudinal studies suggest overweight/obesity is a risk factor for low back pain, and the co-occurrence of pain and overweight/obesity negatively affects quality of life. The mechanism of relationship is unknown but is hypothesized to include mechanical and metabolic abnormalities, possibly secondary to lifestyle choices. Several studies demonstrate that treatments for obesity reduce pain secondary to weight loss. Researchers agree that it is important to focus on expanding knowledge about mechanisms of the relationship between LBP and obesity, testing explanatory models addressing their co-occurrence, towards improved and more effective therapeutic and rehabilitation modalities.
It is instrumental to note that the widely increased aspects of mechanical based requirements are often deemed as the main cause of Low Back Pain. Body metabolism based disorders, in addition, may also play a detrimental role. According to research, the postulated kind of obesity, mixed with other co-morbidities such as diabetes type II, heart disease and hypertension, may initiate pathophysiological alterations the musculoskeletal system (vertebral bone, discs, ligaments and tendons) , hereby adding to the additional mechanical load attributed to obesity .
Cross-sectional studies show support for a relationship between obesity and LBP. Similarly, longitudinal studies suggest overweight/obesity early in life may be a risk factor for developing LBP, and some evidence supports a dose-response relationship between BMI and pain. While research to date has explored possible relationships between weight and low back pain, future research needs to further clarify the relationships through specific examination of mechanisms and pathways, such as musculoskeletal models.
The issue of being overweight is fundamentally a routine livelihood element which deemed as the primary element which causes the Low Back Pain. There is various theoretical hypothesis which is connected between obesity and Low Back Pain.it has been subjected to the postulation that too much weight of the human body that fundamentally have dissenting implication on the human back which is instigated by excessively oversize of the body.
It is instrumental to note that the widely increased aspects of mechanical based requirements from the issue of obesity have instrumentally been deemed as the main cause of Low Back Pain. In essence, it is apparent that the body metabolism based disorders, in essence, may have a lot of detrimental. According to research, the postulated kind of obesity, mixed with other co-morbidities of the cases of diabetes and also the issue of hypertension may have pathophysiology alterations of the illness of ligaments and body tendons based on the process of growing old which in turn impacts on LBP.
Problem Definition, Significance, and Magnitude
World Health Organization statistics show that that low back pain (LBP) is the leading cause of disability in the world, interfering with an individual’s quality of life and as well as the quantity and quality of work performance. In industrialized countries, LBP has been cited as the second most frequent chronic condition that warrants visiting a doctor, the fifth most common reason for hospitalization, and the third most frequent cause for invasive spinal surgeries. The worldwide lifetime prevalence of low back pain is reported to be as high as 84%, and the prevalence of chronic low back pain is about 27%, with 11–15% of the population being disabled.
“Mechanical” low back pain, for which the underlying pathology remains elusive, by definition, excludes pain resulting from neoplasia, fracture or inflammatory arthropathy, as well as referred pain (anatomical sites outside the spine). Most epidemiological studies of mechanical LBP are based on reported symptoms, rather than quantitative objective diagnostic criteria. Although various risk factors have been established for mechanical LBP, including physical activities and psychosocial aspects, its pathogenesis is mostly unclear and its etiology is non-homogeneous.
With immense prevalence rates, both obesity (33%) and low back pain (LBP) (70-80%) are considered among the fastest rising 21st century epidemics, plaguing the lives of millions of individuals and imposing huge health and socioeconomic challenges worldwide. Although obesity has been associated with LBP prevalence, its causative role and underlying mechanisms, key data for prevention and clinical management, remain largely elusive. This is in part due to limitations in the measures used to define and assess obesity for a particular population, as well as the lack of noninvasive diagnostic tools that shed better light on the etiology of LBP. Spinal clinicians often struggle on two levels:
from a diagnostic perspective, in terms of the decision to use expensive imaging (MRI and CT scans) that are often incapable of revealing the impact of the excessive mechanical loads associated with overweight; and
From a treatment/clinical management perspective, in terms of prescribing adequate personalized therapeutic and rehabilitative modalities.
Regardless whether obesity is the instigator or otherwise the primary contributor to lower back pain, it is generally agreed that increased body weight disturbs the normal loading biomechanics of the spine. For example, when an individual is overweight/obese, the added weight within the midsection gradually shifts to the pelvic region forward and leads to curving the spine excessively inward deviating from the normal spinal curvature. This condition is known as hyperlordosis or the swayback. It is a situation which exerts added pressure on the muscles of the back which are then compelled to bear increased weight (Melissas,Volakakis, &Hadjipavlou, 2003). Another example is abdominal obesity where the added waist circumference has been shown to increase the moment arm and hence generated moments at the vertebrae. In general. The spine is designed to carry the body's weight and distribute the loads appropriately, whether encountered during rest or activity. When excess weight is carried, the spine is forced to assimilate the burden, which may lead to structural compromise and damage (eg, injury, degeneration). One region of the spine that is most vulnerable to the effects of obesity is the low back—the lumbar spine.
A significance challenge in the process of trying to ascertain the primary cause and the implication of LBP in association with obesity is the nature of the condition. Fundamentally, LBP is the kind of condition that cannot be easily determined. A particular examination, instead of general context of LBP may be critical in helping out the connection between LBP and obesity. Within a demographic-oriented setting of individuals, the presence of higher related BMI and waist-Hip ratio measures were connected to high-intensity low back pain, (Gasibat et al 2017). Regardless, there is still no substance to prove that back pain is closely associated with the existence of lean tissue mass. In addition, the relationship between the rates of metabolic obesity and back pain has not been established.
The causal connection between obesity and LBP have for the past few years piqued the interest of many researchers. It is noteworthy, though, that there is still a wide range of controversy concerning the association between the two, in addition, t the presence of various conflicting observations. For instance in spondylosis, there is a decline in body engagement as well as disc herniation. The research which attempts to show a positive connection between the two aspects indicates that increased BMI is associated with osteophytes; which are mainly in thoracic and lumbar spines. Osteophytes is an expression denoting to bone spurs, which take a shape on the spine through a long period of time. Figure 2.1you can see the different between the normal spine and Osteoarthritic spine.
Local challenge and relevance
A research was carried out in the nationals of the United Arab Emirate, which are between the age of 25 and also 65 years who went to visit the PHC centers, regardless of the kind of their complaints, apart from the very ill and also other related complaints apart from the people who apologize from taking part in the process. Based on the presence of high level of illiterate nurses who are qualified through their Arabic language on the questionnaires that were handed to the people and also on face to face interviews. A sampling design was developed through the employment of administrative divisions that were present in Al-Ain city. In the quest to secure a comprehensive sample of the study based population, the planning was made in such a way that it the location size was put into consideration (Rodriguez et al 2017).
In context, the low based socioeconomic status in UAE is closely related to the emergence of LBP. As a matter of fact, education is one of the critical indicators which shows the socio-economic status mainly because it is not likely to be affected by chronic illnesses which affect people at adulthood. Various studies across the UAE investigated the connection that exists between education and Low Back Pain. According to the research carried out, there is explicit close connection between education and Low Back Pain. In the contemporary research, it is visible to note that the contemporary study reveals that the majority of the male and the female with Low Back Pain were mainly illiterate. It is important to note that obesity itself may be instigated by LBP as a result of poor lifestyle behavior and lack of good education. In the population of the Arabian community, lack of germane aspect of body exercise or lack of lifestyle habits within the female population may be the primary factors which leads to the presence of increased cases of LBP among the people (De la Garza-Ramos et al 2015).
Moreover, as a matter of fact, trunk and also a severe loss of muscle mass and obesity gradually progresses as the people grow older but the implication of muscle loss in essence on severe low back pain has not been subjected to close examination and also assessment. In UAE, the prevalence of the issue of LBP was primarily found to be higher in the females as compared to the male. The females and also the housewives in essence are perceived to spend a lot of their time and work simply around the house (Zhang, et al 2018). This may compel them to sit or bend for a longer duration of time or to end up lifting objects which are heavy. The amount of work, in general, may be doubled in the event that they are compelled to work at some kind of professional tasks types. This can elucidate the presence of high based prevalence among the women who stay at home and also attempts to explain the presence of the same in the female population.
Motivation and contribution
The existing facts and information do not encourage offering patients advice that weight reduction is primarily crucial. Especially, in terms of minimizing of the amount of pain in the low back. However, this does not disapprove of the advantages of losing weight, particularly concerning co-morbidities. Based on the suggestions presented by various scholars, the reduction of body mass may be mitigated the pain of the back which can instigate the problems to the victim and also lead to the total reduction of their adherence for any form of exercise regimen (Budhrani-Shani et al 2016). The obese people mainly in UAE primarily limited kind of exercise capacity and endeavoring to lose weight through personal exercise may, in the long run, prove to be rather hard and stressful, which is more disadvantage to the patient in general.
Overall, it has been found that the cases of obesity are predominant among the female than the male in the UAE. Probably the reason in some of this cases is that, previously in UAE society, women do not go out from their homes unless necessary, and when they do, they must be accompanied by at least one man, so it was so difficult and not flexible for them to practice physical activities different than household Chores. Also, lack of proper education and increase in poverty levels are the primary factors which contribute to the presence of many people with this particular condition (Vismara et al 2010). It is essential that patients ought to attempt to keep and slowly improve their fitness levels by endeavoring to shun gaining excessive body mass (Prince, 2015). In a society which is perceived as being perfect, this could be a moderate or otherwise vigorous physical activity for around half an hour on weekly basis. This is fundamentally a good approach through the process of having a better pattern and also a recommended kind of program of minimal-significance when it comes to training to be fit.
This kind of findings does lead to the possibility that despite the biomechanical elements which are connected to the spinal loading are connected to the back pain. It is the primary issue that majority of the people in UAE suffer from and the issues of high level of illiteracy and also poor education aggravates the matter further (Dario et al 2017). As noted for the research, it is common knowledge that being obese and having LBP are typical health- related issues mainly in people suffering from this condition who visit medical institutions United Arab Emirates. Despite the fact that some research established a weak connection that exists between LBP and being obese, it is worthwhile to mention that there is insufficient amount of evidence to clearly find the direct based causal relationship between the two aspects. This may be as a result of the quality of research work used to draft the general quality of the research work, the sampling process, data variations in collecting and also measuring the same. It is apparent that the scope of experiencing LBP and being obese are the primary determinants of disability and ill health of the patients (Smuck et al 2014).
A connection between the two could possibly be noted since the prevalence of such conditions does share a lot of covariates: which comprises of low based occupational status, the type of sedentary livelihood and also the scope of psychological distress. According to research, there is a notable connection between the body mass and also the LBP, despite the fact that there is no substantive causal connection. This as such shows that perhaps there the aspect of obesity, in essence, does lead to the presence of elements of LBP. (Ewald, Hurwitz, &Kizhakkeveettil, 2016). Therefore, it is essential that in the future, studies will be required to focus on confirming or otherwise refuting any kind of potential relationship which exists between the two typical issues.
The pathological increase in body weight adversely affects the condition of bones, joints, ligamentous apparatus and the performance of their functions. This influence is due to several factors. In the foreground - increased body weight leads to increased mechanical load on the musculoskeletal system. The main impact is taken by the spine, more precisely - its lumbosacral department, which accounts for the lion's share of the body weight load. Because of the increased load, the intervertebral discs suffer. This part of bones consist of cartilaginous tissue, which are responsible of shock absorbers; also it consist of pads which reduce the force of external influences on the spine during movement. Moreover it protect the bone tissue of the vertebrae from deterioration (Ibrahimikacuri et al., 2015). However they often prematurely wear out, this kind of cases called osteochondrosis; and one of the reasons for this pathological process is obesity. The increased mechanical pressure on the spine due to obesity, leads to a decrease in the elasticity of the intervertebral discs, which lead to reduction discs thickness, correspondingly, minimize the height of the intervertebral spaces. In addition, the disc which has affected by the previous conditions and lost its elasticity, it is more likely to experience a lumbar herniated disc. These factors cause the infringement of the sensory and motor roots of the spinal nerves between the vertebrae. As a result, the lumbosacral radiculitis is formed, and the external symptoms of it are pain and limitation of movements in the lumbar area (Ibrahimikacuri et al., 2015). With the passage of time, sensitive and motor disorders spread to the lower limbs. The muscles of the shins and thighs are subjected to atrophy. The finale of the pathological changes - is cauda equina syndrome. It is a figurative name for a bundle of nerve fibers passing through the spinal canal. Displacement of vertebrae and disc herniation with osteochondrosis lead to infringement of the cauda equina in the spinal canal. Which cause intense pain in the lower back, in the groin and the lower extremities. Thus, obviously obesity is undoubtedly the most risk factor associated with low back pain, as overweight leads to overloads of all joints and backs especially. Besides, extra pounds contribute to the fact that these people become lazier to do physical activities, which increases pain.
The effect of obesity on the course of osteochondrosis is poorly understood. Although there is evidence of a relationship between obesity and the progression of degenerative-dystrophic changes in the spine, caused by biomechanical and systemic metabolic factors. Under the pain syndrome in the lower back (LBP) is understood the pain localized between the XII pair of ribs and the gluteal folds. Recently, the opinion was formed that the LBP is a multidisciplinary problem in which neurological, rheumatological, traumatological and orthopedic aspects are intertwined. LBP most often develops between the ages of 20 and 50, with the most severe pain observed at the age of 50-64 years. In the age of 20 to 64 years, 24% of men and 32% of women suffer from back pain (Ibrahimikacuri et al., 2015). Anxiety is caused by the fact that 12-26% of children and adolescents also complain of back pain. Among women, according to different authors, the prevalence of BNS reaches 19-67% of the total population; with a peak, pain is at the age of 35-45 years (Harms, Peers, Chase, 2010; Breen, Carr, Langworthy et al., 2011).
Overweight often causes back pain, because the back muscles exposed to more stress, in this case people with higher weight are more at risk of painful sensations in the lumbar region. Doctors are sure: overweight signals about violations in the endocrine system, and two dozen extra fatty deposits can adversely affect the functioning of the cardiovascular system and the health of the back. A high body mass index causes a significant risk of degeneration of the intervertebral discs in the lumbar region. Scientists at the University of Hong Kong have studied how weight affects the spine (Samartzis et al., 2012). The study involved 2,599 patients aged 21 years and above. 73% of participants suffered from degeneration of intervertebral discs. 36% of them were overweight, and 9% - obesity. Participants were examined with the help of MRI, and the researchers traced the direct relationship between the number of extra pounds and the degree of degeneration, as well as the narrowing of disk space.
Back pain is a consequence of uprightness, as the greatest burden is placed on the lumbar spine. Also, the detrimental effect on the spine has the presence of hypodynamia, along with malnutrition, stress, and obesity. For most people, pain in the lumbar region is a fairly common phenomenon, which gradually becomes a part of everyday life of a person. Back pain may appear and disappear suddenly and not appear anymore (Ibrahimikacuri et al., 2015). Low Back Pain (LBP) is a widespread phenomenon in modern society. Injuries, infections, diseases of the abdominal cavity organs, inflammatory processes, psychological factors and sedentary lifestyle; all these new things on the community, are great affects and strong reasons leading to LBP. The results of the study show that, overweight and obesity play a significant role in that too. Moreover, the results of a cross-sectional study of scientists from the University of Hong Kong, Pokfulam, involving 2,599 volunteers from South Korea (mean age 41.9 years) indicate a reliable relationship between the presence, severity and prevalence of degenerative changes in the intervertebral disc and overweight in adults (Samartzis et al., 2012). In this study, degenerative changes in the intervertebral discs were present in 1890 (72.7%) participants. The body mass index (BMI) was significantly higher in comparison with persons without changes (23.3 and 21.7 kg / m2, respectively, p <0.001). It should be emphasized that for the Mongoloid race, a BMI above 23 kg / m2 is considered excess, and obesity is diagnosed with a BMI above 25 kg / m2. The study used radiographic and clinical data. The study also included the measurements of body height and body weight, magnetic resonance imaging of the lumbar spine, a risk ratio (RR) and a 95% confidence interval (CI) were calculated (Samartzis et al., 2012). A significant increase in the degree of degenerative changes in the intervertebral discs (p <0.001), their severe damage (p <0.001), the extreme degree of changes with the narrowing of the joint gap (p <0.001) was accompanied by excessive body weight and obesity. In the corrected multidimensional logistic regression model, there was a positive linear trend (r (2) = 0.99) between BMI and the presence of degenerative changes in intervertebral discs with an overweight (RR 1.30, 95% CI 1.03-1.62) and obesity (RR 1.79, 95% CI 1.17-2.74) (Samartzis et al., 2012). The final stage of degenerative changes of the intervertebral discs with narrowing of the lumen was expressed in people with excessive body weight (adjusted RR 1.72, 95% CI 1.23-2.41) compared to those with normal body weight (Samartzis et al., 2012).
The goal of another prospective study conducted in a population of Norwegians aged 30-69 years (8,733 men and 10,149 women without chronic LBP and 2,669 men and 3,899 women with its presence at the initial stage of the study) was to determine the effect of overweight and obesity on the increased probability of occurrence of chronic LBP during the 11-year period (Heuch et al., 2012). At the end of the study, a survey of patients from both groups showed a chronic pain syndrome, which was defined as pain that persisted continuously for three months over the past year. As a result, a positive relationship was found between BMI and the risk of LBP among people without it at the beginning of the study (Heuch et al., 2012). After adjustment for age, education, place and type of work, physical activity, smoking, blood pressure and serum lipids, the RR for a BMI ≥30 kg / m2 compared with a BMI <25 kg / m2 was 1.34 (95% CI 1.08-1.67) for men and 1.22 (95% CI 1.03-1.46) for women. A significant positive relationship is established between BMI and repeated LBP in women (Heuch et al., 2012). Thus, elevated BMI is associated with the development of chronic LBP, both in patients with and without it at the beginning of the study (Heuch et al., 2012). However, it remains unclear whether the initial presence of low back pain affects the increase in BMI in the future. After all, it is believed that the pain syndrome limits the motor activity, which, in turn, is one of the risk factors for the development of obesity.
Excess weight affects the back condition in the most negative way. The spine and sacroiliac joints bear the full weight of the body and maintain a normal posture. Excess weight leads to chronic pain in the low back (Allardyce, 2012). Many full people feel good and do not complain about health. However, this does not mean that everything is in order in their bodies: when the disease will make itself felt, it is difficult to say, but it must be remembered that every extra kilogram will sooner or later appear in the form of acute pain. That is why every six months it is necessary to conduct a spine examination and be sure to follow the rules for preserving its health (Allardyce, 2012). Any load on the back and lower limbs lead to uneven stretching of the pelvic muscles, as a result of which the pelvis changes its axis, which is bad for the spine.
There were a lot of investigations conducted to prove that lowering in body weight reduces the low back pain of the patients. The nowadays medicine has lots of ways how to reduce the body weight. One of such methods is the method of reducing the volume of the stomach. Recent investigation has shown that people who are overweight who have undergone an operation to resect the stomach (reducing the volume of the stomach) to reduce the amount of food consumed, eventually get rid of not only excess weight, but also from pain in the lower back (Phend, 2008). The scientists from the University of Southern California in the US has come to such conclusions, after studying the consequences of surgery for gastrectomy in 38 patients who were obese and had pain in the lower back. Six months after the operation, back pain decreased in the subjects by 44%. During this time, 30 women and eight men who took part in the study lost an average of 38 kg (Jones, 2015). "The study suggests that a significant weight loss, which is a consequence of surgery for gastrectomy, leads to a significant reduction in pain in the lower back if it worried the patient before the operation. Since our study has produced encouraging results, larger clinical trials are needed that will prove the effectiveness of such operations for the treatment of back pain, "says Dr. Paul Khoueir. (Phend, 2008) Currently, in the US, to undergo a gastric resection for medical reasons, the patient should have a body mass index (BMI) of 40 or 35 (measured in pounds and inches) with the presence of obesity-related diseases such as diabetes, heart disease, hypertension, as well as sleep apnea (respiratory arrest) (Jones, 2015). It is known that obese people have an increased risk of developing arthritis of the knee and hip joint, although there is no information about the effect of excess weight on the lumbar spine. And although overweight people with back pain are often advised to lose weight, the relationship between these two phenomena remains unproven.
According to Miller et al (2017), pain in lower body parts is in most cases associated with many issues, the most recent but common one is associated with is overweight and obesity. On their research to determine effects of weights, Miller et al. (2017), argue that obese individuals experience different types of pain. Furthermore, they argue that that the pain depends entirely on the gender of the individual. It is worthwhile to highlight that; their research focused on both genders whereby it indicated that the obese females feel more pain as compared to their male counterparts. In this case, as per the research, the pain is associated with the societal with the body structure that female has. Of importance, a lot of fact in their body as well as a structure to allow for reproduction is a major contributor (Miller et al., 2017). Another argument that these researchers pose it the report that overweight and average weight women have more of the same view as obese male.
Most of the studies show the direct dependence between the obesity or overweight and the lower back pain. Rahman Shiri et al. (2010) in their meta-analysis have shown that both overweight and obesity increase the risk of low back pain. “Overweight and obesity have the strongest association with seeking care for low back pain and chronic low back pain.” (Shiri et al., 2010). They also proved that the female patients suffer from the lower back pain more frequently than male patients. This conclusion was obtained in the mentioned above investigation of Heuch et al. (2012) and Miller et al. (2017). “Our findings suggest that the association between overweight or obesity and the prevalence of low back pain is stronger for women than for men.” (Shiri et al., 2010) The variations connected with gender in the connection of overweight or obesity with LBP could be due to hormone-related obesity and correlated differences in pain sensibility. In male patients, high BMI may indicate upper muscle mass; in the female patients, it can show the amount of adipose tissue (Shiri et al., 2010). The current study suggested that obesity or overweight are the potentially changeable risk factor for low back pain. Thus, the reduction of the BMI can reduce the overload on the spine and especially on the lower back. Although, well-conducted prospective investigations, including intervention studies, are required to confirm all these findings. *
The low back pain is also associated with the structure and state of the bones. The state of hip bones also determines the presence or absence of the LBP. Another negative consequence of obesity is osteoporosis (Allardyce, 2012). By this term is meant a decrease in bone density. Previously, it was believed that weight gain automatically leads to an increase in strength and densification of bones. This compensatory mechanism is supposedly designed to increase the stability of the musculoskeletal system to an increased load. But recently it has been established that in fact, everything is not so, and the density of bones does not increase, but, on the contrary, decreases (Allardyce, 2012). Partly this is due to a deficiency of vitamins A, E, D and minerals - calcium, magnesium, zinc, the balance of which is disturbed in obesity. But there is another reason - hormonal. Obesity is accompanied by a change in the ratio of hormones of the pancreas, adrenal glands, pituitary gland, thyroid gland. Hormonal imbalance leads to a disruption of the digestion of minerals by bone tissue. The fat cells (adipocytes) themselves are also hormone-producing (Allardyce, 2012). They are isolated biologically active substances, among them - cytokines, adiponectin, and others activate osteoclasts. The action of these cells is aimed at washing away minerals from the bones, and the destruction of collagen, a protein that provides bone strength. Moreover, collagen is beneficial for the health condition of joints. Intervertebral discs are not an exception to the rule. Thus, obesity affects the state of lower back causing its pain. Clinically, osteoporosis is manifested by fragility and pathological brittle bones. Patients suffering from osteoporosis, a small enough impact (push, fall in place) to get a fracture. Sometimes fractures arise spontaneously - so-called spontaneous fractures (Allardyce, 2012). In addition, osteoporosis serves as an additional factor in the development of osteochondrosis, arthrosis, the curvature of the spine. All these changes in the musculoskeletal system are inherently irreversible. However, weight loss slows their progression and facilitates flow.
Hashimoto et al. (2017) argue that the amount of fat in one’s body is relative to the amount of back pain they are likely to experience. This is according to their research among a Japanese population. In this case, the parameter that is used is the mass and height index (BMI) and also the percentage of fat in the body. Obese individuals have a high BMI and even a relatively high quantity of body fat. The two parameters are low for average weight individuals, and they do increase with an increase in weight. In a study conducted it was realized that individuals with a high BMI experience intense pain in the lower parts of the body. It was also realized that individuals with a high-fat percentage experience intense pain. In this way, it was found out that the two parameters: BMI and Fat percentage are directly related to the amount of pain that is experienced by a patient (Hashimoto et al., 2017). If patients want to reduce their pain, they should keep the two parameters as low as possible.
On the spine and joints, a huge load falls every day, which, with excess weight, increases even more. Excess body weight leads to the development of many diseases, including changes in the articular apparatus - arthrosis and arthritis, and spine, provoking the development of osteochondrosis and intervertebral hernias (Allardyce, 2012). Thus, excess weight is not just harmful to the spine - it is he who directly causes many of its diseases. Excess weight is a predisposing factor for the development of all known pathologies of the musculoskeletal system, the most important part of which is the spine. Also, excess weight affects many other body systems, primarily cardiovascular and is a risk factor for the development of many other diseases, such as atherosclerosis, hypertension, diabetes (Allardyce, 2012). Excess weight is formed when we eat much more calories (as energy units) than burn them during physical work. And our body begins to spend its internal reserves - when we spend more energy, but less gets inside. Thus, it is possible to lose weight by increasing physical activity and reducing the number of calories and following the rules of nutrition (Allardyce, 2012). But very often a person suffering from these or other diseases of the musculoskeletal system, sometimes can not afford to exercise intensively because of the limitation of mobility. In this case, proper nutrition is often the only way to reduce weight.
A longitudinal and cross-sectional study provided by Frilander et al. (2015) paid their attention to the low back disorders connected with obesity in the male patients only. As it was proven before, the low back pain is associated mostly with female gender because of the body constitution and hormone consistency of the organs. This study decided to investigate men aged 30–50 years (n=1385) who participated in a national health examination survey (Frilander et al., 2015). Body mass index was measured at baseline and follow-up, and waist margin at follow-up. Weight at the ages of 20, 30, 40 and 50 years was determined, when relevant. Several measures of weight were used to calculate age-standardized average body mass index (BMI) across the life course (Frilander et al., 2015). The clinically established result measures included chronic low back syndrome and sciatica. (Frilander et al., 2015) “Baseline BMI (20 years) predicted radiating LBP in adulthood, with the prevalence ratio (PR) being 1.26 (95% CI 1.08 to 1.46) for one SD (3.0 kg/m2) increase in BMI. Life course BMI was associated with radiating LBP (PR=1.23; 95% CI 1.03 to 1.48 per 1 unit increment in Z score, corresponding to 2.9 kg/m2). The development of obesity during follow-up increased the risk of radiating LBP (PR=1.91, 95% CI 1.03 to 3.53). Both general and abdominal obesity (defined as the waist-to-height ratio) were associated with radiating LBP (OR=1.64, 95% CI 1.02 to 2.65 and 1.44, 95% CI 1.02 to 2.04). No associations were seen for non-specific LBP.” (Frilander et al., 2015). Conclusions indicate that in case of overweight or obesity in early adulthood, as well as during life, the risk of radiation, but not nonspecific LBP among men, increases. Taking into account the current global epidemic of obesity, special attention should be paid to preventive measures, starting with youth, and measures should be taken to prevent further weight gain during life (Frilander et al., 2015). Although, there are some gaps in the research. Most of the respondents were former servicemen. That is why it is difficult to indicate whether the low back pain was caused by the gained weight or because of the excessive physical activity experienced during the military service (Frilander et al., 2015). They could get protrusion and hernia earlier when they had normal body mass index. Some of the weight-related measures were self-reported by the respondents. That is why it is difficult to know exactly whether their evidence was with or without any biases which could affect the observed associations. Moreover, military records did not pay attention to the abdominal adiposity at baseline. Thus, it is impossible to provide the associations of abdominal obesity during the life.
For some researchers, the interdependence between the obesity and overweight still remains unproven nowadays. That is why they need to conduct more and more additional researches. Thus, Ting-Ting et al. (2016) in the journal Clinical Spine Surgery provided a meta-analysis in order to update the current knowledge about the association between overweight, obesity, and low back pain (LBP) risk (Ting-Ting et al., 2016). The authors argue that despite there were lots of studies conducted during the past several decades, “available data from studies on the association between obesity and LBP remains debatable.” (Ting-Ting et al., 2016). The scientists searched through the PubMed and EMBASE databases to find the previous investigations related to the topic of obesity and low back pain correlation. Also, the subgroup and sensitivity analyses were conducted to test the possible candidate-effect factors. The “subgroup analysis proved that increased body mass index was associated with an increased incidence of LBP in both men (overweight: pooled OR=1.16, 95% CI, 1.04–1.31; obesity: pooled OR=1.36, 95% CI, 1.15–1.61) and women (overweight: pooled OR=1.24, 95% CI, 1.04–1.50; obesity: pooled OR=1.40, 95% CI, 1.08–1.82).” (Ting-Ting et al., 2016) Moreover, there was no evidence of publication bias. (Ting-Ting et al., 2016) Thus, the findings of the study proved that overweight and obesity are the risk factors for the lower back pain among both men and women. Thus the advantages of the research were that the targeted population was taken despite the gender. In such a way, the authors did not declare any conflicts of interests.
The lower back pain is often associated with the presence of hernias or protrusions. It is no secret that sometimes-extra pounds do not go to good health. This rule applies to some diseases (cardiovascular, digestive organs, etc.), but in the case of a hernia becomes particularly important (Obesity and Back Pain Treatment, 2016). The fact is that overweight is the cause of spinal congestion. Even if a person does not suffer from an intervertebral hernia, excess kilograms are a classic provoking factor (Obesity and Back Pain Treatment, 2016). In some cases, alone or in combination with others, it can lead to the development of pathology in the lower back and other departments. It is all the more important to control weight when a hernia has already arisen. Problems of weight loss excite many people, especially women. Usually, this is due to the desire to stay in good physical shape and look attractive. However, with an intervertebral hernia, weight loss is not only aesthetic value. Doctors recommend adhering to a diet and performing exercises for slimming with a herniated spine (Obesity and Back Pain Treatment, 2016). This will not allow the development of the disease and even help to recover.
Literatures review in UAE
In observation of the research conducted by Bener et al. (2003), low back pain (LP) is a common problem that is reported by patients that attend primary health care in the United Arab Emirates. The researchers at the same time found a close link between obesity and back pain in these number of patients who are mostly aged between 25 to 65 years. The region at the same time is highly comprised of obese individuals who have adopted poor feeding and eating habits at the same time. Males, as considered to females in the research, reported a higher complain of back pain and are the population that is more obese than the females. In another research conducted to determine the epidemiology of low back pain in the United Arab Emirates, (Bener et al., 2004), the researchers also identified that the lifestyle of the people in the region of United Arab Emirates is comprised of many risk factors. Lifting heavy weights, long-standing hours and smoking were the major factors that affected men than women. On the same note, men experienced low back pain concerns more than the female counterparts. However, it was also identified that those individuals that engaged in constant exercises were less associated with lower back pain. Feeding habits and other lifestyles and the prevalence was higher in women than men.
Chou et al. (2016) explain that obesity and lower back pain are a major public problem not only in the United Arab Emirates but in the entire globe. Since other studies on the same issue have not covered the relationship between low back pain and men, this research was determined to identify this problem. It was identified that older men reported high low back pain incidences than younger men in the study. At the same time, obese individuals reported the same problems and fat men versus thin men did not show any difference. The conclusion, therefore, was that men of a heavyweight than were obese at the same time were considered to experience back pain this linking obese and back pain and no link between heavyweight and back pain. Dafeeah et al. (2014) carried a research to determine the link between low back pain and lifestyle of the individuals in the region. The research identified that low back pain is prevalent among all genders and it is more prevalent in the older people than in the young individuals. Some of the major factors that the researchers in the study by Dafeeah et al. (2014) were weakness in the legs, smoking and prolonged standing hours of the individuals. Despite this, there was a global problem as defined in the above-named research relating to back pain among the old and those that adopted the bad lifestyle.
Mirtz & Greene, (2005) explained in their research that obesity is one of the highest causal factors of low back pain. Although there have been debates all along over this issue, the research, therefore, was aimed at identifying the link between the two variables. The conclusion of the research at the same time stated that there was a close link between obesity and back pain due to many factors that were identified. The body mass index is the major identified challenge in the obese individuals. In this case, an obese individual has a higher BMI, which means that the weight is more than the body can support. In this case, they must strain the body more so the back borne which is central in balancing the body weight. Therefore, indicates that high BMI results to the low capability of the body to handle the weight, which leads to low back pain. There are instances that back pain persists and becomes chronic in same individuals. This is accelerated by the risk factors, which in most of the times the individuals are not aware of. Some of these risk factors are smoking, low socio-economic background, lack of physical exercises, and bad posture (Lionel, 2014).
The researchers also identified that there are no such efforts by the medical institutions and other relevant stakeholders in managing the issue since it was identified. Identifying the problem and not providing a solution to it have surrounded most of the research.
Faghri & Momeni, (2014) carried out a research on how to solve the problem of back pain and obesity at the same time. From the research, it was identified that adopting a healthy lifestyle will solve all the problems that these individuals experience. A healthy lifestyle, therefore, means that eating the right portions of food each time, maintaining a life full of exercising and not involving in strenuous activities that might cause damage to the body skeletal formation. Physical activities are among the best suggestions that were put across by Faghri & Momeni, (2014) a solution to obesity and other lifestyle-related diseases. Workplace ethics and observation of the health standards also play a role in this case in that individuals need to adopt good sitting postures among other issues related to their well being physical. (Sumchai, 2015) also identified that exercising helps solve the problem of weak muscles, healthy body in terms of physique among others. Extensive exercises and strenuous activities also cause low back pain when not handled correctly. These individuals adopting a healthy life and managing to lose the same weight thus lowering the cases of low back pain can avoid obesity at the same time. Individuals that are younger in age are required to engage themselves in extensive physical activities and at the same time, not engage in activities that strain their muscles nor their back. Lifting heavy weights is one of the issues that face the young generation and the old in that they at times do not understand the limits they have to get to (Gasibat et al., 2017).
Low back pain patients exhibit some symptoms that complicate their health at the same time. Anxiety is one of them is anxiety which affects their daily activities. There are general body weaknesses, depression instances and somatization as indicated in the research by (Verjee et al., 2013). The psychological distress, therefore, forms the largest effect of this kind of patients in their entire life. Further, leading a life of not being unable to deliver on their abilities and capabilities at the same time. Much money is spent in treating such pains and effects that come with back pain and obesity. Thus, with the best systems in place like the observation of the lifestyle that is healthy and engaging in physical activities at the same time will be of benefit to the entire population in the UAE. Further research, however, must be conducted regarding the ways in which this challenge can be managed and how the population can engage in healthy lifestyles at the same time.
Gap in knowledge
As it can be seen, there are lots of investigations related to the problem of connection between obesity and lower back pain. All the researches have proven that overweight leads to the lower back pain. The obesity cannot be the direct cause of the pain, but it can be the reason for the other factors which lead to pain. Obesity causes the hormonal deterioration, the absorption of the useful minerals and vitamins by the body’s tissues. The lack of organic substances provokes the weakness of the muscular cord around the spine, which leads to the appearance of protrusions and hernias. The excess weight only aggravates the size of the protrusions and hernias. The larger they are - the stronger pain a person will suffer. The main limitation of almost all the studies is that it is impossible to take into account all the factors of the person’s lifestyle previously and at the moment. The back pain could appear before the person gains weight. In such a way it would be necessary to search the other side of the problem. The presence of protrusions and hernias can provoke the obesity because it severely influences the nervous system of the body. Thus, it is not good to take into account the present state of the body. The etiology of the disease should be investigated from the very beginning. This factor is the largest gap, which is observed in the mentioned investigations. Moreover, when the authors rely on the oral evidence of the respondents.
All research in the UAE about obesity and low back pain is very limited and has followed the previous research path. No new methods and modern techniques have been used to look at the relationship between LBP and obesity. In this research, we are going to use a modern simulation technique to simulate mechanical load on the spine and how it affected by different loads, taking into account other factors such as age, health status, job type and etc. In any case, the current literature review and research can prove that excessive weight and obesity are one of the most significant leading factors to the lower back pain and illnesses associated with this issue.
Just like in any other developing countries, transitional and dynamic social factors in UAE impede reliable epidemiology findings that are comparable to those found in developed nations. For instance, studies indicate that the condition of LBP is usually manifested at old age because the obesity scourge began later in developing nations (Shiri et al., 2008). Similarly, there is little data and research available for developing countries in regard to association of obesity and LBP, which poses challenges for comparative analysis. On this note, data that can act as benchmark for new research is limited. If the studies exist, it lacks multi-national perspective and it does not take in to account social, economic and perhaps nutritional conditions that each country undergoes during each stage in their development journey. These limitations indicate a significant research gap on relationship between LBP and obesity especially for comparative studies in developed and developing nations. Likewise, it has been observed that there are inconsistent findings on the correlation between obesity and LBP. While some studies hold that the relationships exist, others nullify it (Koyanagi et al., 2015) Lack of consistent findings in relation to this hypothesis further complicates the reliability and accuracy of new studies, as it is in this case.
1.2. Musculoskeletal Modeling and Simulation
This study focused on the Musculoskeletal Modeling and Simulation, which was used to measure body movement and forecast the possible outcomes of interventions on individual walking activity. Musculoskeletal Model is invasive instrument that is used to assess tension in muscles and measure forces generated when joints are in contact. These are conditions that are developed when human body is in motion, but unlike other cases such as muscle action, which are measured by noninvasive models, they require invasive measurements, and the musculoskeletal model is the appropriate tool. Establishing a correlation between muscle activity and human motion as well as knowing the usual movements of the body requires an empirical understanding. Nonetheless, it has been found that experimental observations, like gait examinations cannot lead to reliable understanding of complex neuromuscular activity that regulate human movement, thus, computerized simulations are necessary for finding the correlation of such complex matter. The simulations are meant to provide knowledge on muscle activity and kinematics of the joints, therefore, provide information on cases of pathological problems (Pandy & Berme, 1988).
Musculoskeletal model simulations are beneficial in many ways. These simulations provide understanding to clinical investigations for informed medical responses. It is a tool that incorporates and links divergent biomechanical data thus leading to reliable interpretations (Talaty, n.d). With Musculoskeletal Modeling simulations, it is possible to regulate and control the observed subject and conditions of the study, which is vital for assessing effects when changes are introduced. In this manner, researchers make specific systematic alterations and observe and identify vital elements of performance (Pandy, 2001). This perspective is supported by Komura,Shinagawa, and Kunii (2000), who claim that Musculoskeletal Modeling and simulations provides for formation and retargeting of body motions. As hinted above, establishing and understanding causal relationship in human motion is usually difficult because of presence of many possible interdependent causes. Strength of muscles, muscle action and orientation of human body are some of the factors that influence such performance. For example, muscle length can sometimes be attributed to shift in body direction or posture, which also impacts body’s ability to generate force. But, this condition can also result from multiple causes including pathological changes and injury. Capturing and examining such conditions, which happen simultaneously can be greatly challenging. As such, invasive procedures are needed to measure such variables; and Musculoskeletal Modeling and simulation is the suitable tool. With Musculoskeletal Modeling, it is easy to predict the impact of variables. According to Talaty (n.d), it allows the researcher to have control of the study. Parameters that are usually difficult to estimate can be measured with this tool. Complex associations evident in human motion can be untangled. Unlike other research models, Musculoskeletal Modeling and simulations is remotely vulnerable to ethical restrictions.
SIMM
Software for Interactive Musculoskeletal Modeling was applied as a tool for analyzing and modeling musculoskeletal structures of the participants. According to MAC (2016), this tool, particularly enables the understanding of force generated by joints at different body posture. In this way, the muscle movements and moments that develop at a particular body posture are established. Software for Interactive Musculoskeletal Modeling has different features. First, it has the capacity to import information and provide a real time analysis in 3D system. These activities happen concurrently when information is being recorded (Taga, 1995). Moreover, Software for Interactive Musculoskeletal Modeling has gait presentation tool. This tool records and presents information on different levels of motions. These reports are presented in statistical tools such as mean, standard deviation and graphical data. With these tools, one can easily establish gait movements. This feature is supported by scripting tool, which is helpful for creating active simulations and developing plots as well as reports. There are significant benefits that accompany the Software for Interactive Musculoskeletal Modeling. First, it leads to enhanced understanding of captured motion, which is aided by intuitive tendencies of kinematics and gait activities. Because many processes can be simulated at the same time, Software for Interactive Musculoskeletal Modeling usually results in enhanced surgical effects. Comprehensive presentations of gait activity are promoted through graphical reports. Biomechanics studies usually employ computerized models to develop musculoskeletal schemes and simulate body movements like running and walking. Software for Interactive Musculoskeletal Modeling is an instrumental tool for achieving this objective.
AnyBody Modeling System
In particular, Anybody Modeling System was applied in this study. In other words, this is was the chosen form of musculoskeletal system. According to Rasmussen, Damsgaard and Christensen (2000), Musculoskeletal Models are categorized in to two: forward and dynamic systems, inverse and dynamic systems. For forward systems, they predict motions that accompany certain muscular activity. Inverse systems perform the vice versa, which is they measure muscle activity resulting from certain motion. Anybody modeling system is an example of inverse and dynamics tools of musculoskeletal model, and it performs four significant purposes. Rasmussen, Damsgaard and Christensen (2000) indicates that with Anybody Modeling system, it is possible to develop a model right from scratch and manipulate it to any shape that fit and serve divergent purposes. It also provides for exchange of models and fosters corporation when creating models. It also enhances numerical competence thus leading to maximization of designs for use in less costly computers. Crowninshield (1978) asserts that anybody Modeling systems is a tool that leads to optimal measurement and estimation of muscle forces.
1.3. Study cases
Meanwhile, for the purpose of this study, a constant height of =1.75 m will be used to measure and calculate the BMI of various participants. Moreover, the study will be based on three cases:
Case A: Normal weight, where IBM is < 25
Case B: Overweight, where IBM is > 25 and < 30
Case C: Obesity, where IBM is > 30
In all these cases, two forms of postures are examined: standing and flexion forward, as you can see if figure below :
Participants that fall in different three cases were examined to measure the Proximo-Distal force and Antero-Posterior force. These measurements were done on both postures and captured in Anybody Modeling system.
1.4. Different Hypotheses
In this project, there are three Hypotheses were been studding:
Hypothesis 1:
There is a positive relationship between BMI and low back pain. Whenever BMI become higher, the higher risk of exposure of lower back pain. This relationship is based on the fact that, more load on the spine will causes damages on the vertebrae which will lead to low back pain.
Hypothesis 2:
When the fat around the waist increase, spinal load increase (not finish yet)
Hypothesis 3:
Comparing between all cases in both posture (Standing and flexion extension) (not finish yet)
Chapter 4
4.0 Results and Analysis
In this part the results from planned model are provided. The following section include of the basic case results from the current experiment. Moreover, its include analysis of results from different perspectives. By entering data as discussed above in AnyBody Modeling System, I select the measurements of proximo-distal and antero-posterior for both posture. Proximo-distal force refer to the vertical force, and antero-posterior force refer to the horizontal force as showing in the figure 4.1. I choose those measurements because they refer to the 4 main direction.
4.1. Model Basic input/ output data
Table A.1.4-1 : shows the main constant values for all measurements
Body Mass (kg)
BMI (kg/m2)
Body high (m)
Normal
67.375
22
1.75
Overweigh
82.6875
27
1.75
Obese
137
45
1.75
Table A.1.4-2 : shows the measurements of Proximo-Distal and Antero-Posterior force in the stand posture
Normal Standing
L1
L2
L3
L4
L5
Proximo-Distal
Normal
427.72
414.95
407.064
412.0658
456.85
Overweigh
523.889
508.139
498.52
504.3877
559.017
Obese
869.629
842.9351
826.954
835.8371
926.047
Antero-Posterior
Normal
-90.78
-40.8953
6.28
54.14899
69.683
Overweigh
-110.883
-49.999
7.685
66.458
85.313
Obese
-183.259
-82.1543
13.3964
110.2858
141.28
Table A.1.4-3 : shows the measurements of Proximo-Distal and Antero-Posterior force in the flex forward posture
Forward Flexion
L1
L2
L3
L4
L5
Proximo-Distal
Normal
1275.9
1238.2
1249.649
1197.6
1200.337
Overweigh
1566.356
1520.215
1536.12
1469.269
1473.106
Obese
2610.889
2532.861
2561.863
2445.248
2451.808
Antero-Posterior
Normal
-361.7
-206.199
44.8
246.76
327.49
Overweigh
-444.262
-25.328
53.49
304.913
400.7574
Obese
-739.779
-421.7049
86.9645
511.3954
665.6407
Tables above show that, in the posture of normal stand, the maximum proximo-distal force was on L5 for all 3 cases, while the minimum force was on L3. On the other hand, for the second posture which is forward flexion; the maximum proximo-distal force was on L1, while the minimum force was on L4. Changing amount of force through different postures have a huge effects on mechanism load on the spine.
Based on the tables above, it is evident that that posture is a major contributor to the rising cases of back pain. The body is normally developed in a manner that encourages movement. However, due to the increased modernization and the growth of technology, individuals in UAE similar to the rest of the world are living an inactive lifestyle dissimilar to the situation in the past 50 years as showed by the tables. In that in addition, to adopting an inactive posture that pressures the body to operate within a hyper tension the back is forced to remain in the posture for the longest period for instance in the office while operating a computer and in the car. In fact when one gains weight rather intensely, the situation is worsened.
4.2. Results in both posture
4.2.1. Results in normal stand posture:
Using (tables 4.1-4.4 and figures 4.2-4.9), a comparison was made between the forces on lumbar vertebrae in forward flexion posture. And the results showing below:
The ratio of increased the force between a vertebra and the vertebra which follow by, is relatively constant. Where the increase between the lumbar vertebrae in the normal weight is 23.75%; in overweight it is 29.25%, and in obese people it is 47%.
We can note that, the difference in force between normal and overweight is increasing slightly, on the other hand, the different between normal and obese is increasing sharply. This result supports the theory which said that, the higher BMI, lead to higher risk of LBP; and that is because, force in obesity case is greater than the force in normal case in about 23%, which is considering aa a high rate. The greater the force on the vertebrae, the more likely to hurt the spine.
Table 4.1: Proximo-Distal Force (N) in normal stand
Cases\
L1
L2
Increase in force
Normal
427.72
414.95
12.77
Overweigh
523.889
508.139
15.75
Obese
869.629
842.935
26.6939
Figure 4.3: Increase in force between L1 and L2, in normal stand posture
Table 4.2: Proximo-Distal Force (N) in normal stand
Cases\
L2
L3
Increase in force
Normal
414.95
407.064
7.886
Overweigh
508.139
498.52
9.619
Obese
842.935
826.954
15.9811
Figure 4.4: Proximo-Distal Force (N) on L2 and L3, in normal stand posture
Figure 4.5: Increase in force between L2 and L3, in normal stand posture
Table 4.3: Proximo-Distal Force (N) in normal stand
Cases\
L3
L4
Increase in force
Normal
407.064
412.0658
5.0018
Overweigh
498.52
504.3877
5.8677
Obese
826.954
835.8371
8.8831
Figure 4.6: Proximo-Distal Force (N) on L3 and L4, in normal stand posture
Figure 4.7: Increase in force between L3 and L4 in normal stand
Table 4.4: Proximo-Distal Force (N) in normal stand
Cases\
L4
L5
Increase in force
Normal
412.0658
456.85
44.7842
Overweigh
504.3877
559.017
54.6293
Obese
835.8371
926.047
90.2099
Figure 4.8: Proximo-Distal Force (N) on L4 and L5, in normal stand posture 2
Figure 4.9: Increase in force between L4 and L5 in normal stand
Without a doubt, the illustration of the charts and tables of the comparative analysis amid normal, overweight and obese clearly illustrates a major difference amid the three as well as the underlying factors. Normal weight can best be described as a balance in BMI or Body mass index. This means that the height and weight must be within the provided structure. However one can have the normal weight but still be categorized as obese if the fat contained in the body are excess that what the body requires. This situation is regarded as normal weight obesity which implies that an individual has the similar and severe health threats as an obese person. On the other hand, obesity refers to having intense fats amounts in the body which rejects the widely acknowledged perception of obesity as weighing much. BMI cannot be used to determine whether an individual is obese given that it does not determine the amount of fats but normally communicates if the weight is within the proper range.
Based on the figures it is evident that the populace of overweight and obese people in UAE is on the rise. In that normal weight is only owned by 24 percent of the populace followed by overweight with 29 percent and obese 47 percent. Overweight and obesity are the major contributor of the increasing cases of low back pain issues because such situations hinders an individual’s movement. In that those that are restrained by weight find it hard to engage in physical exercises such as movement and active participation in activities. In turn they opt for easier and digitized strategies such as the use of cars which leads to back pain. In addition the population of those with normal weight and exercises the right posture is decreasing relatively in the country.
4.2.2. Results in Forward Flexion posture:
Using (Tables 4.5-4.8 and Figures 4.10-4.17); a comparison was made between the forces on lumbar vertebrae in forward flexion posture. And the results showing below:
The ratio of increased the force between a vertebra and the vertebra which follow by, is relatively constant. Where the increase between the lumbar vertebrae in the normal weight is 21.5%; in overweight it is 28.25%, and in obese people it is 50%.
We can note that, the difference in force between normal and overweight is increasing slightly, on the other hand, the different between normal and obese is increasing sharply. This result supports the theory which said that, the higher BMI, lead to higher risk of LBP; and that is because, force in obesity case is greater than the force in normal case in about 28.5%, which is considering aa a high rate. The greater the force on the vertebrae, the more likely to hurt the spine.
Table 4.5: Proximo-Distal Force (N) in Forward Flexion posture
Cases\
L1
L2
Increase in force
Normal
1275.9
1238.2
37.7
Overweigh
1566.356
1520.215
46.141
Obese
2610.889
2532.861
78.028
Figure 4.10: Proximo-Distal Force (N) on L1 and L2, in Forward Flexion posture
Figure 4.11: Increase in force between L1 and L2, in Forward Flexion posture
Table 4.6: Proximo-Distal Force (N) in Forward Flexion posture
Cases\
L2
L3
Increase in force
Normal
1238.2
1249.649
11.449
Overweigh
1520.215
1536.12
15.905
Obese
2532.861
2561.863
29.002
Figure 4.12: Proximo-Distal Force (N) on L2 and L3, in Forward Flexion posture
Figure 4.13: Increase in force between L2 and L3, in Forward Flexion posture
Table 4.7: Proximo-Distal Force (N) in Forward Flexion
Cases\
L3
L4
Increase in force
Normal
1249.649
1197.6
52.049
Overweigh
1536.12
1469.269
66.851
Obese
2561.863
2445.248
116.615
Figure 4.14: Proximo-Distal Force (N) on L3 and L4, in Forward Flexion posture
Figure 4.15: Increase in force between L3 and L4 in Forward Flexion posture
Table 4.8: Proximo-Distal Force (N) in Forward Flexion posture
Cases\
L4
L5
Increase in force
Normal
1197.6
1200.337
2.737
Overweigh
1469.269
1473.106
3.837
Obese
2445.248
2451.808
6.56
Figure 4.16: Proximo-Distal Force (N) on L4 and L5, in Forward Flexion posture
Figure 4.17: Increase in force between L4 and L5 in Forward Flexion posture
L4 and L4 appears to be the most essential parts with respect to posture and spinal development. The muscles are responsible for movement or coordination and posture. If they contract then a tough and opposing external pressure is created and the movement of the spine, body and pelvis. In addition, it is the functioning of the muscles that offers a desirable approach for boosting the stiffness of the muscles which is usually a common thing during physical activities. Most of the functional activities usually need the contribution of these muscles in a general context. This normally leads to stabilized movement and so on. Based on the analysis it is evident that external force is usually higher among the obese and overweight individuals than those with normal weight. In that for instance pressure accounts to 50 percent and 29 percent among obese and overweight persons in respective. On the other hand the pressure only accounts for 21 percent among individuals with normal weight.
The increase in pressure between L4 and L5 normally leads to a forward posture due to the spinal strain that forces one to adopt the stand. On the other hand, it was established that the forward Flexion pressure increased with 2.37, 3.837 and 6.56 respectively among, normal, overweight and obese people. This is makes it apparent that the risk of pressure increases rises twice between an overweight and obese individual. It clearly illustrates that the different between the two is evident. While an overweight person will be referred to as obese, obesity magnifies the risk further. This does not however imply that an overweight person is safe since the difference of pressure increase is more than 1.5 which is high. The higher the pressure the higher the threat of the prevalence and dominance of LBP. Because the rate is high among the obese people this clearly illustrates that obesity is a major contributor to low back pain.
4.3. Analysis and discussion
However, the measurements of the two postures do not vary significantly for this group of participants. Nonetheless, there is striking difference in relation to the second and third cases. Overweight case, where IBM is >25 and <30, reported great increase in force in both postures, indicating increased spinal motion. While the third case recorded the highest levels of force intensity. In regard to specific posture positions, the difference remained constant, which indicates that high force is associated with standing posture relative to flexion extension posture. From these observations, it is apparent that force intensifies with increase in IBM. Further, it changes depending on posture applied.
We can conclude that different postures can also affect LBP. For people who work in that kind of job where it allows them to flex and have a continuous movement, they are less risk of LBP. On the other hand, people who have to stand for long hours, they are more susceptible to LBP, because the force is centered on L4 and L5 of lumber; as indicated by the results in this study. Additional to that, people whose work forces them to continually bend forward are suffering of pain in L1, as the concentration of force is on it. So for the normal people if the force are keeping effects the spine for long time can cause LBP, add to that the extra weight; logically the pain will increase and the situation will become worse. These findings indicate that there is correlation between increase in IBM and increase in spinal load.
These results are synonymous with the findings of other previous studies. In their study of the association of BMI and spinal pain, Baker and Giles (1999) observed that LBP increased with BMI levels. The participants of their study who were obese reported LBP condition. Leboef et al (1999) performed the same survey in Denmark and they established that there is positive link between LBP and BMI. However, the researchers indicate that the intensity of LBP depends on the duration of the condition with high levels being recorded on chronic cases of LBP. In similar study, Fanuee et al (2002) concluded that LBP prevalence and chronic cases of LBP are more pronounced on obese people. Mirtz and Greene (2005) examined the relationships between BMI and LBP. Using a comparative observation on different BMI measurements, they concluded that the risk of LBP was minimal at BMI <30. Moderate risk was associated with BMI > 30, and higher risk is linked to BMI>40. The results demonstrated that the responses of L4 nad L5 with regard to distinct postures leads to the exxagerated forces.
Chapter 5
5.0: Conclusion and Recommendations
In summing up, pain in the lower parts of the body has a real connection with obesity. If many people take measures aiming at reducing their weight, they will reduce the back pain a great deal. Such practices as regular exercise will help one reduce the back pain. MRI is a special parameter that can be depended on determining the existence of pain; it also helps us understand Modic changes. This can help in determinng the prevalence of the pain as well as determining the most appropriate medical and physical measure that is to be adopted to reduce the issue. Based on the analyisis above , it is evident athat LBP is highly prevalent among in close measures among both genders but higher among older persons. In addition, having weaker legs or bones that affects an individuals posture in addition to smoking and increated rates of standing and stting holds a substnatial effects with regard to LBP. This study supports the fact that LBP is currently an essentla clinical, socila and economic challenge in UAE and it representes a major health issue across the globe. The fact that obesity and overweight issues are the major contributors of the issue best illustrtaes the health urgency of the issue. It is claer that despite the fact that obesity is high in the country which accounts to 50 percent of the population with those with normal weight only representing 21 percent, this has become a major health problem in general. As long as the spread of obesity continues in the country, it means that the issue of LBP will still be high which is a threat to public health.
Recommendations
Low Back Pain (LBP) is a severe clinical and social economic issue in UAE, which is one of the most mutual source of disability and close to every individual particularly the agining ons suffers from the illness. Close to every individual suffers once during their life but adequate treatment is however, not so common. Obesity is a major contributor to the rise of LBP in the country. Obesity refers to being overweight as well as having high rates of fats in the body more than the body necesitates in general. It is thus, proposed that in order to address the LBP issue obesity must first be solved. It means that if individual focuses on reducing their weight, it is evident that the risks must be lowered. Being overweight hinders individuals from actively getting involved in physical activities. This means that awareness should be created among the public to allows them understand the issue of obesity and its association to LBP. It is evident that it is the absence of knowledge that contributes to obesity. Lifestyle chnage is also needed. The chnage entails getting actaively involved in physical activities and proper dieting in order to ensure that weight gain does not get an opportunity for obesity and weight gain. Lifestyle chnage will not only lower the risk of obesity and that of LBP and this will eliminate the health and socio-economic issue.
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To provide the path, direction and focus which Stevens District Hospital will take in the future
Gain updated knowledge and employ highly qualified professionals
Professional development
Design pay for performance programs
Design wellness program
Address the high-deductible problems in the Affordable Care Act
Increase recruitment of health care professionals
Update facility, establish a quality score system and, hospital renovation
Increase technological use and physician satisfaction to increase market share
Establish new financial model and expand the coverage capabilities
Implement care management model (Gulati et al. 2016).
Speaker notes
The purpose of the strategic plan in the Stevens District Hospital is to enable the facility to provide quality care to the patients. Given that the facility in a highly competitive market, the strategic plan will support the survival of the facility in the dynamic environment. The hospital should ensure that it meets the healthcare demand, it offers quality services in a cost-effective manner and equitable way. The facility has made a sound reasoning and developed a strategic plan in the areas such as financial stability, health insurance, innovation, recruitment, performance and well-ness programs and training (Gulati et al. 2016).
Strengths
Technology
Medicare eligibility
Commercial insurance coverage
The growth of automotive industry, the growth of employment and insurance benefits
Higher market share compared with competitors
Comprehensive medical care in three areas, that is, obstetrician, oncologist and non-invasive cardiologist
Higher operating revenue
Higher operating margin and higher patient satisfaction
Low malpractice cases
Aggressive management program
Financially strong (Gulati et al. 2016).
Speaker notes; through evaluating the company strength such as higher operating revenue, higher market share, higher patient satisfaction and technology, Stevens District Hospital will maintain its competitive edge and be able to explore more opportunities in meeting the healthcare demand (Gulati et al. 2016).
.
Weaknesses
Lack of highly qualified medical staff in orthopedics and oncology
Lack of patient scheduling
Poor primary care network
Lack of critical staff
Speaker note: the Stevens District Hospital should focus on these weaknesses and offer a solution to them in order to move on. However, lack of primary care network and qualified medical staff will make the facility lag behind and lack the power to operate in the competitive market.
Threat
The increase of population with chronic illnesses
The emergency of secondary and primary competitors
The shift of patients to the new emerging facilities
Lack of government reimbursement
No external funding
Speaker notes; There is a stumbling block that will hinder the Stevens District Hospital from providing quality services to the population. The health care facility is unable to control the above external components. However, using the strategic plan, the facility should rapidly address these issues such incorporating new technology to compete with the new facilities and recruiting qualifies medical staff to help patients manage their chronic conditions (Gulati et al. 2016).
.
Opportunities
Improving health care services
Serving a large population due to the remarkable community development in Jefferson City
Development of quality standard
Good economic condition
Expansion of automotive industry, a higher rate of employment and higher insurance coverage
Speaker notes; Stevens District Hospital has an opportunity to do better in the midst of other competitors. With the strategic plan of implementing innovation, the good economic environment, the higher rate of employment and insurance coverage, technological development and, community development will provide the facility with an opportunity to meet the demand of higher population and maintain its competitive edge (Gulati et al. 2016).
.
The roles of mission and vision statements in the strategic plan
communicate the mission and vision of creating a strategic plan
The facility should focus on the mission in order to gain a strategic direction
Mission and vision have a positive impact on employees
Strategic plan should focus on the organization image portrayed by mission and vision
The strategic plan should adhere to work ethics and cultures
The facility should consider the long-term future of the organization
Use the mission statement to evaluate the purpose of a strategic plan
Evaluate the position of the organization, the capabilities, the core values and models (Gulati et al. 2016).
Speaker note; the strategic plan should align with the mission and vision statements simply because these statements contains the values and expectations of the stakeholders. The statements hold achievable goals and objectives and, organization strategic plan should focus on fulfilling the mission and vision statements. Mission and vision are the cornerstones of any plan and the facility should consider the statements to shape behaviors, understand the current position, the reason for existence, and the future (Gulati et al. 2016).
.
The role of Radiology Department in increasing business for the hospital
Get professional training to accommodate the newly emerging role of radiologists
Implement the new technologies and adapt to the changes in order to provide the required medical progress (European Society of Radiology 2009, 2010).
Subspecialisation
Sub-specialist training to gain new knowledge, skills and develop practical experience
Rapid development and evolving technology demands specialized knowledge
Change the clinical condition by implementing new imaging machines
Professional collaboration
Conduct further research on radiology topic (European Society of Radiology 2009, 2010)
Speaker note; since there is a rapid change in the radiology field, radiologists should become competent and comprehensive providers. The radiology department has a big role to play in ensuring that patients receive high-quality services. They should achieve effectiveness and competency through sub-specialization where they will gain knowledge and skills that are demanded by the evolving radiology field (European Society of Radiology 2009, 2010).
Importance of multiple stakeholders in strategic planning 6
Brainstorming ideas and potential solutions
Prevents potential issues
Effective formulation and implementation of the strategy
Making decisions and develop guidelines
Forms a Strategic Control System where multiple stakeholders put the strategies into action, implements the necessary changes and sets strategic controls (Sadeghifar et al. 2015).
Speaker notes; in making a strategic plan, stakeholders play a significant role as they act as decision makers and more importantly, they raise ideas in different perspectives where the differing opinions are discussed to arrive to at a conclusion. Since the multiple stakeholders hold a different position in the facility, they present a unique perspective and valuable opinions based on how to run the business. Through communication, involvement and, understanding the purpose of the strategic plan, the organization is able to achieve the goals (Sadeghifar et al. 2015).
Stakeholders in strategic planning
Executive administrator
Implements goals of the strategic plan and objectives
Supervisors
Ensures the organizational members adhere to the established policies and procedures
Ensures the strategic plan aligns with patients’ care
Creates patient care policies
Ensures the strategic plan aligns with the admissions function (Sadeghifar et al. 2015)
Matron
Provides decision-based on quality care
Gives opinions on ways to reduce hospital admissions
Board of trustee
create key policy,
ensures an extensive planning
ensure the strategic plan aligns with mission and vision statements (Sadeghifar et al. 2015)
Hospital chief
Provides hospital-related issues
Gives recommended for areas that need improvement
Creates decision on insurance coverage
Uses his/her research skills and presents qualitative and quantitative analysis during the strategic planning
Operational staff
Ensures the strategic plan is implemented to support the day-to-day operations (Sadeghifar et al. 2015)
Speaker notes: Effective strategic plan requires stakeholders from managerial and operational levels. The above stakeholders play a significant role not only in making a strategic plan but also in ensuring that the plan is implemented to provide quality care to the patients. The interrelationship benefits the healthcare organization in that the executive administrator creates agendas and allocates resources to achieve the strategic plan. The other stakeholders in operational level ensure that the goals and objectives of the plan are achieved (Sadeghifar et al. 2015).
Purpose of a communication plan in the strategic planning process
Provide a message of the on-going development of a strategic plan
Provide the stakeholders with opportunities and key decision points
Communicate the purpose of the strategic planning process
Give the stakeholders an opportunity to give feedback
Engage all members in the strategic planning (Gulati et al. 2016).
Speaker notes: A communication plan is important as it ensures that all members receive the right information based on the strategic plan. The healthcare facility communicates the plan to all levels with a purpose of building awareness, encouraging participation, and ensuring that members are engaged and committed (Gulati et al. 2016).
.
References
Gulati, R., Mikhail, O., Morgan, R. O., & Sittig, D. F. (2016). Vision statement quality and organizational
performance in US Hospitals. Journal of Healthcare Management, 61(5), 335-350.
Sadeghifar, J., Jafari, M., Tofighi, S., Ravaghi, H., & Maleki, M. R. (2015). Strategic planning,
implementation, and evaluation processes in hospital systems: A survey from Iran. Global journal
of health science, 7(2), 56.
European Society of Radiology 2009. (2010). The future role of radiology in healthcare. Insights into
Humans have always changed their anatomy or physical appearance. Body modification exists everywhere in the world. Body adjustments in modern world can include, a tattoo, body paintings or minerals spread all over the bodies. Hair can be chopped or fashioned in a manner that modifies the body. Paints and haircuts are some of the temporary body modification methods. Piercings are semi-permanent modifications. Tattoos can be temporary or permanent, it all depends with one’s choice. Other kinds of permanent modification include burning badges and tattoos into a person’s skin. Removing one’s skin to form wounds. When the wounds heal, scars form. This method of body modification is known as scarification (DeMello, p301)
CRI1 explaining an issue
Ever since the dawn of time, humans have been altering their physical appearance, modifying it using paints, tattoo, piercings and scars for their own entertainment or pleasure. Although, over the course of history, in most areas of the earth, it is becoming less and less popular or unacceptable. Those who alter their bodies are termed as barbaric or uncivilized. Opponents of body modification fail to acknowledge that the practice was also carried out by their own ancestors in the past. Change is the only constant in life, the world is always changing and regenerating itself in various new ways. Most westerners perceive body alterations as a show of rebellion. However, the practice has an extensive history dating back to the cradle of mankind. This paper will discuss the types of body modification found in various cultures and reasons behind their existence (DeMello, p243).
Body alteration is a self-explanatory word. It defines itself. When an individual decides to change his or her outward appearance or anatomy, the adjustment is known as body modification. The reasons for body modification vary from one person to another. This is due to culture, religion, spiritual or cosmetic purposes. Body modification can be as basic as a young woman piercing her ears at a parlor; an individual getting Botox injection or an old man dying his hair black. The act of body modification is common in today’s society although the reason behind the change varies in each context (DeMello, p133)
CRIT2: Utilize context .Assumptions made on body modification
There are many assumptions associated with body modifications .Assumptions which group individuals into categories are common within the society and generate prejudice and discrimination .This can be exemplified when a parent or guardian cautions their children not to engage with people sporting body modifications .Most people assume modifications are evil or unethical (Sheumaker, Helen, and Shirley, p 119).
How far is too far in the context of body modification, such as piercings and tattoos. Some people have tattoos behind their tongues while others have altered the color of their skin. In some cases people over do their tattoos and piercing to an excessive level. This often brings stigma. The degree of body modification should be regulated. (Featherstone, p57).
DIVGL2
Most traditional cultures practice body modification, be it an African tribe donning a lip ring or Alaskan tribe wearing the labret cork, perspectives differ. In New Guinea, in Sepik area, the crocodile is held in high esteem. The community believes that the creature breathed life into them. As a tradition, young men usually take part in a christening ritual. In this ceremony, their skin is cut using bamboo sticks to look like the skin of a crocodile. Blisters, in this culture represented scales of crocodiles. Some people use tattoos for inspiration or to remember loved ones who may have passed away. Decisions are made at a personal level hence opinion vary from individual to another. (Featherstone, p155).
DIVGL3 addressing diversity
Body modification, tattoos and scarification are universal art forms used for various reasons. Research has revealed the utilization of cranial shaping in ancient Egypt. Cranial shaping starts the minute a child is born and the neck is still elastic. The head of the infant is wrapped tightly with bandages to force it into a conical shape .The head can also be flattened using a head board. This body modification is performed in tribes located in central Africa and some native tribes of America. Various cranial shapes act as identifiers between different groups and also differentiate social classes (Featherstone, p105).
Piercings can be traced back 5000 years ago. In ancient times, nose piercings were among the oldest recorded piercings. Nose piercings were very popular among the Aztec tribe. Ear piercings were used to repel evil spirits, magical purposes and to make a woman more beautiful. However ear piercings were a sign of dependence on parents .Foot binding was common practice in China until the late 1911 when the newly formed, Chinese republic abolished it. Binding begun at infancy stage. A girl’s feet was wrapped tightly in cloths, restricting growth hence deforming the feet. The wrappings and special shoes prevented the girls’ foot from advancing past 3.9 inches. Neck stretching begun at infancy. Beaded or metal rings were placed around the baby’s neck region. More rings were added to the neck as time passed by. The rings could push the collar bone and shoulders downwards, elongating the neck. After the neck has been elongated fully, the girl can go ahead and remove the rings without any challenge. The practice was popular in Asia and African tribes (Sheumaker, Helen, and Shirley, p345).
Scarification was first noticed among the Maori tribe who made self-inflicted deep cuts into their faces. This was meant to make tribesmen appear fiercer. Laceration was once a very popular act among Aboriginal tribe in Australia. Just like the tradition carried out by New Guinea people. Wounds would be inflicted on the stomach, breast region and other body parts of a man or woman. Scarification was performed on people who had attained the age of sixteen or seventeen years. This was such a vital ritual. Those who did not bear these scars were often not permitted to join the tribe’s ceremonies or represent .The tribeswomen belonging to these tribes would be subjected to lacerations as it was perceived as a symbol of beauty and men found it attractive (Sheumaker, Helen, and Shirley, p123).
Scarification, does not embrace its traditional roots within the contemporary society. It is often utilized as form of self-expression in the contemporary world. Sharp objects such as a scalpel or knives can be used to modify the body. These layouts can be easy such as ancestral arrangements or complicated (Featherstone, p126).
Stretching of earlobes is another common type of boy modification. Mesoamerican cultures such as Mayan and Canela tribes practiced it .In Mayan civilizations, a stretched earlobe was done for spiritual purposes .In Mayan tribes, the ear captured spiritual energy. Consequently body modifications made on the ear were important to the community. Obsidian and shells were worn on ear lobes to signify spirituality. Ear ornaments were made out of precious stones. Assisting in making a jadeite flare elevated the position of an individual. A Mayan flare had a very specific architecture. It has the shape of a flesh channel, a hollow tube worn in extended earlobes. The front of the flare is a bit bigger than the back of the channel. The architecture looks like a flower. Each component of the flare represent a different component of a flower. The major flare symbolizes a calyx and the beads symbolizes a pistol of a bloom of a plant and so on and so forth (Mitchell, Claudia, and Jacqueline, p 223)
In the Canela tribe, ear stretching is a ritual that marks the beginning of manhood for a boy child. After undergoing this ritual, a boy should be obedient and submissive to leaders and elders. So their ears are opened after they undergo the ritual. This ritual takes place when boys have attained the age of ten or fifteen years. The boy’s social identity is cemented by this sacrament. However, due to the influence of modern world. Canela tribe no longer carries out the act although the practice is common in the contemporary world. Stretched ear lobes are common in different communities around the world. It is a body adjustment that people find acceptable in the society. Although, individuals may ask questions why an individual decided to stretch their earlobes but it is not hated (Mitchell, Claudia, and Jacqueline, p 180)
Diversity in modern society
Youth and adolescence is one of the most important and impactful period in an individual’s life. It is a time when youth are seeking their identity. Tattoos and piercing are one of the various ways through which the youth may utilize for expression of their identity, for they are symbolic representations of how their inners self is understood .Individuals may want to alter themselves into people they are not. For example, someone may get a tattoo or piercing to look more tough or threatening. Body piercing is a self-imposed rite of passage among the youth. This actually means that people feel an instinctive drive or urge to undergo a passage (Mitchell, Claudia, and Jacqueline, p 103)
DIVGL1how ancient modification concise with modern day modifications
Most people tend to think that human bodies are as a result of nature. But in realty human bodies are also impacted by culture. That is, globally, all cultures around the world alter or change their body. Most of the body modification are similar. The reason may vary from one culture to another. Body modification was once associated with deviant social categories .But they have become more acceptable and main stream .The motives behind body modification are ever changing although the practice remain the same (Mitchell, Claudia, and Jacqueline, p 234)
Conclusion
Body modification is an ancient practice that has survived the test of time. There are various types of body adjustments .Tattoos, piercings, earlobe stretching and body painting are some of the most popular body modifications. People modify their bodies for various reasons. Youths find it as a way of self-expressing themselves. Nevertheless, body modification gives an individual a unique identity. Some societies are against the practice. They associate it with deviant or rebellious behavior.
References
DeMello, Margo. Encyclopedia of Body Adornment. Westport, Conn: Greenwood Press, 2007.
Sheumaker, Helen, and Shirley T. Wajda. Material Culture in America: Understanding Everyday Life. Santa Barbara, Calif: ABC-CLIO, 2008.
Featherstone, Mike. Body Modification. London: SAGE, 2000
Mitchell, Claudia, and Jacqueline Reid-Walsh. Girl Culture: An Encyclopedia. Westport, Conn: Greenwood Press, 2008
How the Criminal Justice System Handles Individuals with Mental Illness
Introduction
About 1.26 million inmates are mentally ill, standing for 45% of federal criminals, 56% of state offenders and 64% of jail inmates (Douglas & Lurigio, 2014). While mentally ill delinquents comprise of 5-7% of the general population, 30% of the convicts of crimes has some types of identifiable mental illness, and almost half of the evils of addiction are consigned by those with a psychological problem.
Studies reveal that people with severe mental illnesses have a depressing impact on the criminal justice system (Etter, Birzer, & Fields, 2008). Confinements, as well as prisons, have issues with congestion to some extent as a result of the number of people with relentless mental illness under custody. The workforce, as well as officers of the corrections, are not appropriately prepared or educated to deal with the demand and care that mentally ill inmates necessitate. Representatives of law enforcement habitually tend to be the first people to act in response to apprehensions regarding mental illness yet they are not mental health specialists and usually are not familiar with the best position of the way of handling the offenders, thus having them congested in jails as well as prisons. This paper aims to demonstrate that the mentally ill population in the criminal justice systems has been failed when it comes to the fortification of discrimination and receipt of proper care.
Before the 1960s, people who were mentally ill were placed in mental institutions as a means to defend the society and for them too (Brandt, 2012). Pharmaceutical firms started to build up new drug treatments in 1960 that left pledges of remedies or at least to assist people to deal with life with mental illnesses. Institutions gradually started becoming outdated, and outpatient care was the favored modern way of dealing with the mentally ill. However, two most essential restrictions were not anticipated. The limitations included lack of sufficient financial support for the social health processes and the rise of the mental patients association that permitted patients the right to prefer to acknowledge or snub treatment.
The reduction of operable mental institutions has led to the potential for a decline in unsafe experiences between police force agents with mentally ill persons. The patients have been freed into the community with no proper support, and some of them do not receive the appropriate outpatient care crucial for the management of their diseases. This fact limits the efficiency of community-based cure (Douglas & Lurigio, 2014).
Imprisoning people with mental illnesses draws on criminal justice assets, damaging the system and placing people in a background that were not intended to deal with mental health issues. As soon as a person with mental illness is positioned in a penitentiary or confinement, they are more likely to become victims of aggression given that they are more aggressive naturally and are considered easy targets by persons with no mental illnesses. People with mental illnesses are always labeled as abnormal or behaving in deceitful ways. Due to this label, it is hard for them to be regarded as victims. Imprisoned criminals with mental illnesses however become victims due to a lack of training of the correction institutions regarding the persons with mental illnesses. The mental ill persons time and again lack the basic resources to offer appropriate treatment or rehabilitation (Douglas & Lurigio, 2014). These people are also labeled as substance abusers, regularly dispossessed and victims of their own death. For instance, women who are mentally ill are time after time more likely to be aggressively and sexually persecuted and there is a large number who are imprisoned. People with mental illnesses are more likely to be wounded when fighting for the duration of incarceration as compared to those not mentally ill. In the case of men who are mentally ill, they are more likely to be beaten as victims of personal theft.
A study by Sims (2009) looked at the management of mental illness in the United States prisons and jails through a collection of peer-reviewed research. Sims emphasized that the criminal justice system is at present failing to achieve any of its swift objectives of reprimand when inmates suffer from harsh mental illness. One among the studies predicted that about 15% of the prisoners in the United States as of the year 2004 experienced from severe mental disorders like schizophrenia, schizo-affective mayhem, bipolar confusion and significant depression. Among the high figure of prisoners with mental health troubles and diseases, only 17% of neighboring jail prisoners, 24% of national prisoners and 34% of state prisoners received psychological health cure after admission (Gur, 2010). As a result of the little figures on mental health care issues, the justice system appears to be malfunctioning in dealing with mental health issues within the system.
Annually in the United States, about one and half million criminals with mental illnesses are placed on audition. There are conventional audition agencies. Habitually, people with mental illnesses will be set with an audition officer that specializes in working with probationers with mental illness. Individuals under audition are known to experience critical mental diseases and are compelled to take part in mental health management as a condition of their trial. Consequently, substantial differences between personally and traditional POs vary and timing strategies are available to observe and enforce treatment conformity (Reuland, 2010).
Middle schools as well as high schools have become besieged by the challenge of identifying and treating students with mental illness given that the managers of the schools have called upon law enforcement staff, principally school resources representatives to act in response to adolescents with mental illness conditions. Youths suffering mental illness recurrently interrelate with law enforcement officers as a result of the intimidating, maladaptive ad stressful character of their signs. Law enforcement officers are offered the authority to act and get involved in mental associated occurrences and help to establish where they ought to be sent. In this responsibility the police officers turn out to be most important caretakers for accessing mental health services in the society (Etter, Birzer, & Fields, 2008). In reality, the police are however to a great extent controlled in their preferences for care, given that mental health experts are frequently reluctant or powerless to acknowledge law enforcement set off mental health recommendations. Studies suggest that minorities might not experience a smaller amount mental of illness but their sign appearance, confidence as well as use of mental health services might be less as compared to the Caucasians and that these trends have persisted over time.
A Case Decided By the United States Supreme Court
On 19th June in 2017, the Supreme Court ruled in favor of Alabama death-row inmate James Edmond McWilliams after realizing that he was denied his legitimate privileges to the help of a mental-health specialist in assessment, organizing and presenting his security. The case was sent back to the Eleventh Circuit to make a decision whether the mistake had significant and harmful effects on his decree measures. The court evidently ascertained that a defendant has to obtain the help of a mental health specialist who is sufficiently accessible to the defense as well as sovereignty from the trial to assist efficiently in appraisal, preparation, and staging of protection.
The inmate had a history of brutal and numerous head wounds and was convicted of theft, rape, and assassination of a store clerk. Before the hearing of his case, his advocate had asked the court for specialist mental health support to carry out a neuropsychological as well as neurological assessment. The court gave advocates request but hired an expert who was a coworker to the two specialists presented by the state, and the justification counsel was given no chance to discuss with the expert. The expert prepared evidence and distributed it to the justification advocate only two days before the sentencing, with duplicates concurrently provided to the tribunal judge. Given that McWilliams advocate had no adequate opportunity to assess the expert's account and analysis, he asked for a continuation of the sentencing hearing but was deprived.
The above case is n accordance with the 1985 court’s decision that instituted that if mental health is a significant issue attest, a needy defendant has a legitimate right to a specialist to aid in assessment, arrangement, and presentation of the justification. The supplicant, in this case, alleged that he was deprived of his liberty to free specialist help in preparing for his capital verdict hearing. The U.S Court Of Appeals for Eleventh Circuit denied his assistance on this allege on the realization that Alabama provided the supplicant access to knowledgeable Psychiatrist (Reuland, 2010).
Most criminal justice system authorities have claimed that their organizations deal with the mentally ill criminal’s in different ways as compared to the means they deal with those who do not have mental issues. Mentally ill offenders are not supposed to request extraordinary regards in sentencing but require diverse ones in the case of management and administration. Correction branches can get the offenders associated with all the essential services only when their insurances are set up. For instance, they offer Behavioral Health service to the mentally ill. In case the mentally ill is very indicative, then they are located in the mental health divisions. Otherwise, if they have mental health issues, they make efforts to have the criminals occasionally scrutinized in appointments and prescription. However, nearly all units take them off expensive mental health drugs and injectable medicine and substitute them with a standard product that appears to be less successful (Reuland, 2010). Most of the mentally ill criminals who are imprisoned return to their homes with poorer health as compared to their time of admission.
As in the above case study, for petitioners to be entitled to mental health courts, they are required to plead accountable to a criminal offense after which they are placed on trial with a minimum if time. The petitioner is as well required to identify with reading and writing as well as having a capacity to understand the information given to them. Usually as soon as a criminal is released from jail or a detention center on a Friday, they do not meet with their probation officer until the following Monday (Sarteschi & Vaughn, 2013). Frequently the criminal is on the streets and has very minute property. It takes the experimentation officer extensive effort to get them linked with assets in the society like accommodation, provisions, clothes, mental health, and medical services, prescription and substance abuse cure. If they are lucky to be on Social Security Disability Insurance and have Medicaid or Medicare that procedure is regularly fairly fast.
In detention centers, mental health care is not offered by the units of corrections directly but through a considerable business service providers who apply to all health care for the state. The corporate service provider usually owes a responsibility to its stakeholders to keep its expenses down. This makes it a continuous effort to receive sufficient mental health care in prisons. Additionally, when a mentally ill person is in a secure unit, they most likely decline to take their medicines. At times this happens since they suffer side effects they don’t like with apprehension of how the institutions would judge them. They also think that by declining to continue with their medication, they might become symptomatic and the jail would not substitute them for treatment programs (Sarteschi & Vaughn, 2013). When the corrections caregivers are asked if they feel that the mentally ill are given the appropriate care and cure they require as a result of the illness, they assert that they do not think that there are sufficient resources to cover a suitable number offenders with mental illness. Treatment is possible for the majority criminal behavior but might not be recommendable for the community.
Conclusion
Jails and prisons are congested and lack the necessary finances to offer adequate treatment to inmates with mental illness. Treatment is possible for criminals suffering mental illness. However, the mentally ill require emotional, cognitive and conduct therapies and prescription as the desire to progress and become accountable and participatory members in the society. Mental health courts act as the most optimistic and effectual way of putting off recidivism when the curriculum is followed. All participants in mental health have the mental health issues dealt with under the mental health court. They are examined on their medication and thoughts which progressively facilitates appropriate adjustments to medicines in an essential way.
Knowledge is an authority in every feature of the individual life. The more criminal justice system becomes acquainted with and appreciates the mentally ill, the more they will be able to lend a hand and take care of them in a manner that is beneficial to both. Most mental illnesses never end, and people who live with this yoke have to agree to a lifespan of treat met and prescription if they want to stay out of the criminal justice system. To reduce the impact that the criminal justice systems and the mentally ill have on one another, it would be helpful to educate all experts involved and have state authorization mental illness awareness courses. Law enforcement, management providers, court detectives, and correctional experts all need to collaborate. This teamwork will optimistically benefit the communities.
References
Brandt, A. S. (2012). Treatment of Persons with Mental Illness in the Criminal Justice System: A Literature Review. Journal of Offender Rehabilitation, 51(8), 541-558. doi:10.1080/10509674.2012.693902
Douglas, A. V., & Lurigio, A. J. (2014). Juvenile Crisis Intervention Teams (CITs): A Qualitative Description of Current Programs. Police Journal, 87(2), 114-125. doi:10.1350/pojo.2014.87.1.534
Etter, G. W., Birzer, M. L., & Fields, J. (2008). The jail as a dumping ground: the incidental incarceration of mentally ill individuals. Criminal Justice Studies, 21(1), 79-89. doi:10.1080/14786010801972738
Gur, O. M. (2010). Persons with Mental Illness in the Criminal Justice System: Police Interventions to Prevent Violence and Criminalization. Journal of Police Crisis Negotiations, 10(1/2), 220-240. doi:10.1080/15332581003799752
Reuland, M. (2010). Tailoring the police response to people with mental illness to community characteristics in the USA. Police Practice & Research, 11(4), 315-329. doi: 10.1080/15614261003701723
Sarteschi, C. M., & Vaughn, M. G. (2013). Recent Developments In Mental Health Courts: What Have We Learned?Journal of Forensic Social Work, 3(1), 34-55. doi:10.1080/1936928X.2013.837416
The Medicare prescription Drug, Improvement and Modernization Act or the MMA is a public medical policy which was enacted in America in the year 2003.It generated the largest overhaul within Medicare history.
The problems that led to the introduction of the of the public health policy
Majority of the elderly Americans cannot afford to abide by a doctor’s advice when it comes to taking prescription drugs. The medication is normally expensive hence leaving their medical needs unmet. Doctors experience the same frustrations with the expensive cost of health medication as they have to take into consideration between what is practically good mediation and what their patients can afford. In a health system where medical personnel do not have the power to control the expenses incurred by their patients, the struggle is really painful.
The national argument on prescription medicine did not take majority of American by surprise. Spending on prescription medicine in the united states of America doubled as fast as the total national medical expenses between the year 1990 and 2000.In the year 2002, adults outpatients, aged 65 years spent a an estimated total of $87billion.This figure was estimated to rise in the coming years. The number of people under Medicare was projected to increase with each passing year as children became adults and became more eligible for the coverage from 41milion t in 2000 to 77million by the year 2030.While the elderly only make up 15% of the total population of America., they are responsible for 40% of the country’s prescription drug expenses.
In an attempt to relief the public from the financial load caused by purchasing prescription medicine, the government came up with the MMA of 2003.Under this medical policy, the public hoped to reduce the expenses they incurred while purchasing prescription drugs.
An In-Depth Critical Analysis of a Public Health Policy Implementation within the Last 15 Years
Tobacco Control Policy (Plan 2011)
Introduction
Public health entails the ability to sustain the health of a given populace by the application of appropriate measures by the national institution. The effectiveness of the public health system is usually equal to the general stability of a given nation. Thus, most governments consistently strive towards the decrease, monitoring, and prevention of the major forces that are established to be affecting the health of the public in an undesirable manner. Tobacco has remained as the country’s health epidemic for the longest time. Tobacco, unlike other legal drugs such as alcohol, is widely consumed by individuals of varying ages, which is accounted for addiction. Being the major cause of illnesses that can easily be prevented, the consumption has been part of controversial debates for the longest period. It is without a doubt that tobacco is not important for the country as it brings no health benefit despite being a major source of revenue for the government and stakeholders. This report will focus on conducting an in-depth analysis of the tobacco control policy plan in the United Kingdom. This will be achieved by analysing the achievements, failures as well as proposing some practical and viable solutions for the policy developers.
Background
The amount of tobacco that is consumed on a daily and annual basis in the United Kingdom and across the globe is overwhelming. In, fact tobacco is the most consumed legal drug which acts as the source of relief from the consumption of other substances for countless individuals. Modernity has widely been blamed as being the cause of early death and the rise of illnesses. However, human actions also count towards this negative trends since the regulation, consumption, and production of such substances is worrying. Since 2016 post the implementation of the policy plan in 2011 the prevalence rate with regard to smoking has decreased notably in UK (Parliament, 2017 p.1). Most people believe that cigarettes smoking has fewer health harms when equated to other drugs such as marijuana on the basis that it has been made legal. However, this is not the case since tobacco is the source of most chronic illnesses such as diabetes, lung diseases and so on.
Despite the achievements that have been achieved through the application of control mechanisms smoking is still the leading source of preventable illnesses and mortality. For instance in 2015 close to 16 percent of those that died from 35years and above in the UK which represent 79,000 people were established to have had heavy smoking reliance (Parliament, 2017 p.1). Smoking prevalence is more within the poor settings based on the convenience and low knowledge level. It is reported that tobacco smoking is responsible for close to 50 percent of the life expectancy rate that is amid the wealthy and poor people (Ciapponi and WHO, 2014 p.1). The UK’s government fresh policy plan referred as Tobacco Control Policy was implemented in 2011 and 2017 respectively with the aim of lowering the general smoking rate and targeting to strike the inequality smoking (Parliament, 2017 p.1). Since the original policy was implemented there has been a significant reduction but the smoking prevalence has been more dominant among youths which have become the source of increased health defects (ASH, 2016 p.1). The intention of implementing the plan was lowering smoking among young, elder and pregnant women while still creating an enabling setting for those with mental issues and offering support to innovative measures that seek to lower the consumption.
Smoking represents one of the major public health issues in the world. Smoking is related to toxic substances that lead to the destruction of the human body. The negative implication of tobacco on individual’s health works beyond the actual implication on the persona’s health but also contributes to environmental and socio-economic degradation. Smoking damages close to all the major organs from the lungs to the kidney thus creating opportunities for the dominance of various illnesses and lowering the general quality and expectancy of life. It has been projected that more than three hundred thousand people in the UK are admitted annually in hospitals due to smoking connected illnesses which accounts for about one thousand people daily. Some of the premature deaths that are driven by smoking are caused by illnesses such as heart failure, cancer, and lung failure. In fact, tobacco is known as the source of high risk for debilitating illness such as infertility, tooth decays, asthma and so on. Based on research it is not just the smokers that are exposed to such risks because even the non-users being passive smokers are affected.
It is without a doubt that smoking is high in the poor communities based on their socioeconomic status. Those that are engaged in the act do it for a number of reasons such as escapism from the actual issues that they experience socially, peer pressure, weight reduction, and stress liberation. The perception that smoking is less harmful has been the cause of increased smoking among young individual (Pirie, 2013 p.134). Several measures have been implemented in the past in tackling the issue such as changing the branding where warning labels have been included and marketing ban so that individuals might not be encouraged to partake in the act. However, it has been established that the awareness campaigns have proved to be less effective based on the fact that stricter measures that will force compliance are absent. As a result, the disparity amid the wealth, poor, young and older individuals have been on the rise (Pirie, 2013 p.134).
The intention of the policy is to lower the disparity and discourage the general consumption of tobacco within a wider range so that a healthier nation can be developed. The policy was proposed by the government based on the plan that was implemented in 2011 (Parliament, 2017 p.1). In this context, the proposal received much criticism from the manufacturers and forest organization (Forest, 2011 p.1). The organization argued that the government should not continue with the application of further measures above those that had been developed in 2011 without making consultation with the consumers. On the other hand, the investors held that the policy would generally discourage the buying of cigarettes which would affect them and the government economically. The practicality of the measure was tested through the success that the previous policy that was acquired by the original measure (Forest, 2011 p.1). The policy plan was implemented by the national government. Based on the implementation much success has been achieved. In that close to three million smokers have quit smoking and focused on E-smoking which is associated with no unnecessary health effects but leads to psychological stability (Hammond et al., 2006). The public has been the major beneficiary of this program with most individuals acknowledging it as a success based on the high reduction level that has been achieved.
Public Health Policy Evaluation
Policies play a major role in creating stability and promoting wellness in a country (SAPRU, 2004 p.173). The United Kingdom has been a major developer of Public health policies (PHP) with the aim of addressing health-related issues within the public domain. Due to several standards, some of these policies have not been successful in meeting the set objectives. Thus evaluation of the performance of each policy is essential in determining whether it has succeeded or failed. In this case for the Tobacco Control policy plan, a mixture of relevance, effectiveness and efficiency criteria was chosen. The rationale behind the section is based on the fact that performance cannot be established from a single dimension and the criteria offer a more reliable and accurate assessment that is not biased or based on assumptions. Also, the flexibility, convenience, and ease of use of the criteria played a role (SAPRU, 2004 p.173). This is because the criteria would seek to ensure that maximum information that supports the assessment needs is acquired.
With respect to the relevance criteria, it is worth establishing that the aim of the strategy is to establish the level in which the smoking control intervention has met the needs of the populace and the priorities of the nation (SAPRU, 2004 p.174). To begin with, it is certain that the implementation of the control measure was relevant in lowering the smoking rate and preventing the prevalence of smoking-related illnesses. The measure in this context was mainly serving a health-based agenda by preserving the wellness of the public. The country has always placed public health as a major priority an aspect that the policy has adhered to. The reduction of health illnesses among individuals across all adult ages is a positive and relevant matter. The issue is smoking is one that holds health-related implications in general which also affects the economy and social wellness. In short, relevance in the case revolves around the usefulness of the policy in handling the underlying public health problem. Based on the application of the policy it is evident that the policy should continue handling the underlying issues. The agreed aims and intentions of the policy plan are still valid and they depict an adequate reason for the continuity of the activities since the problem is one of the major health issues that is currently being experienced in the state. The policy fits well within the set health focuses by the government and the needs by the affected populace.
On the other hand, efficiency refers to the extent of the association between the resources, intervention, and output. In that, if the input and the services provided exceeds the output then the policy can be classified as inefficient. The output indicates the achieved results from the applied effort (SAPRU, 2004 p.174). This is the actual observable findings for the intervention procedure in which the policy implementers holds some degree of regulation. Any policy as an intervention measure to an existing issue is termed as efficient in the instance that it demands less expensive materials and resources that are easily accessible to the achievement of the desired results. In that, this can be measured with regard to superiority and amount. The result and input quality is also an essential aspect of achieving efficiency. In that, the use of the most affordable inputs is not a recommendation but in general, the performance should be appealing. In addition, the evaluation of a policy intervention necessitates conducting a comparative operation to establish the success. In the case of dealing with smoking issues, the efficiency of the intervention can best be measured by the associated cost and results. In that, the intervention must have resulted in smoking and illnesses spread reduction under minimal expenses for it to be efficient. This is similar to production where quality and productivity are the basis of the assessment. Also if the outcome of the measure is higher when equated with those of another program then the initiative is efficient.
Effectiveness is also a viable criterion for performance assessment of the policy in this case. Effectiveness refers to the level in which the anticipated results ranging from the set aims and outcomes have been obtained. Precisely, this is the association amid the results of the intervention and the ultimate results which means that the target beneficiaries have acquired certain benefits (SAPRU, 2004 p.175). In this case, the policy plan intervention was aimed at lowering smoking and the spread of illnesses. It means that for the plan to be categorized as effective the aims must have been achieved even though not comprehensively. A policy is termed as effective if it benefits the public in terms of guarding their wellness while its efficiency lies in quality, affordability, convenience, flexibility and so on. In other words, if an intervention is effectual it does not imply that it is effective. In that even though the plan may be implemented within an economic range it might lack the quality of lowering the smoking rate. The evaluation process through the criteria will, therefore, incorporate measuring the achieved change, the outcome as positive and assessing the acquired value through a comparative analysis of the previous policies.
Since the implementation of the policy plan in 2011, close to a five million usage reduction has been encounters in support of e-cigarettes and quitting (Forest, 2011 p.1). These reduction practices have been effective in changing the trend by offering the users with safe options to smoking. In my opinion, based on the achievement that the plan has achieved over the years it is evident that it has worked. In that, although the actual aims and objectives have not been met fully it has been a success. The original objectives included reducing the smoking rate to the lowest level amid all genders as well as preventing the spread of smoking-related illnesses that are associated with rampant individual’s death and health defects. This objective has been achieved since close to over fifty percent smoking amid adults has been achieved in the last five years. However, the problem has become more diverse as it has created a disparity among the wealthy and poor persons (Ciapponi and WHO, 2014 p.1). In that, the poor people tend to suffer more when compared to the rest of the populace. Based on statistics before the plan close to over one thousand persons were being hospitalized for tobacco connected defects but after the decrease has lowered significantly. This is a good thing given that some of these illnesses tend to affect individuals after individuals are over 40 years (Forest, 2011 p.1). In other words, stating that the policy has been effective is accurate because the original objectives have been met which has led to an expansion to cover the issue of disparity and the prevalence among young individuals.
Most critics argue that rather than lecturing to the consumption on what they should do, the government should focus on the development of policies that seek to create healthier and safer commodities. The implementation of the policy plan was developed after the original policy proved to be effective even though partially. The notion that the measures act a form of dictatorship to the public is inaccurate since this is only a measure to protect individuals from any form of harm that might result from the consulting. Tobacco contains some harmful substances such as nicotine which are the actual ingredients in the production of the substance. Thus, I do believe that the policy is relevant and well positioned within the health needs of the nation. Since there are regulations regarding the consumption of the products the obligation of the government with regard to the provision of protection is a necessity. The government has therefore acted within its mandates to creating wellness and ensuring that some of the tobacco-related illnesses are prevented (Scarborough et al., 2011 p. 526). The placement of the restrictive measures targets both the consumers and the producers which makes it effective.
Based on the evaluation criteria, the policy is relevance, effective and efficient. In that the policy plan is useful since it considers the needs of the populace and the health priorities of the country. So that stability in any given context can be achieved health stability must come first. Cigarettes smoking has remained to be one of the leading health epidemics in the country due to its ability to causing the rise of other illnesses (Scarborough et al., 2011). Several measures ranging from branding, to marketing have been implemented in the recent as the means of informing and discouraging the public from the extensive consumption of tobacco but less success has been achieved. Thus, targeting the whole populace is not only relevance but it is an approach that has decreased the use significantly. On the other hand, the policy is also efficient because it does not require the use of more resources and the outcome is as desired. With the reduction of the general consumption rate, which refers to quality performance then the policy is efficient. It is also effective based on its general capability to meeting the set objectives (Allender et al., 2009 p. 263). The set aims have been met even though in terms of efficiency the performance cannot be validated since even though the performance has been positive the services that the government offers are more demanding.
Discuss Evidence-Based Solutions for Its Better Achievement
According to, Scarborough et al., (2011) tobacco is a major cause of chronic illnesses. There is a risk of about 40 percent in developing diabetes among the active smokers when equated with those that do not smoke. Smoking leads to severe effects on an individual’s health. The plan acts as a form of measure that seeks to constrain individuals from the increased consumption. The major positive aspects are the fact that it seeks to lower the smoking rate in order for health wellness to be achieved. The process is a gradual one that will seek to create change over time rather than immediately. Since the program also incorporates an awareness program. This can mean that it seeks to inform and create familiarity to the public about the existence of the issue and how it can be solved (French, 2010 p.36). The effectiveness of the program depends on the participation of all the involved parties such as the stakeholders, consumers, and the government. The aspect is important as it does not only call for collaboration but also integrative working.
The Tobacco control policy intervention represents one of the most essential policies that seek to enhance the public health of the nation. Extent of smoking in the country is rampant and worrying despite the fact that a significant reduction among adults has been achieved. In fact smoking is the actual source of the rising health bills given that the chemicals destroy some of the major organs in the body thus leading to chronic defects. The undesirable nature of chronic illnesses such as diabetes that are fuelled by smoking is not that it leads to high financial burden but on the fact that it disorganizes the health of the country (French, 2010 p.34). Despite the reduction of tobacco consumption in the recent the average consumption by the active smokers is above the normal rate. This normally translates to early death in every year. It is estimated that the highest populace of those that smoke are also active alcohol consumers which further worsens the state. The intake is higher among young which is attributed to the perception that has been developed that the substances are less damaging when the consumption is regulated. The assertion and perception is misdirected as it does not matter how the substance is consumed since in the long run it will lead to the dominance of illnesses that cannot be cured.
The policy has also restrained the marketing and branding of cigarettes. This is a positive move since it is quite obvious that the commercial makes it quite clear that the general use of cigarettes despite the warning is good. By changing the branding the consumption is one that will be voluntary since the users are fully informed of the associated defects. The measures are not aimed at lowering the purchases but ensuring that awareness is achieved. Most young individuals tend to engage in the consumption on the ground that they lack the needed information for making informed choices. In addition, this justifies the disparity in mortality amid the wealthy and poor individuals in the community. In that, those from the poor setting are less educated in addition to being unemployed. Since their choices are not usually informed it, therefore, implies that the vulnerability in addition to the socio-economic stressors contributes to the dominance. Since cigarettes smoking is considered to be an effective mode of liberating from stress, individual’s will certainly turn to its use in relieving stress. The situation is not similar to those from the comfortable setting because the environment is enabling and the populace mainly comprises a health-conscious community that will not engage in such activities. Thus, the focus of the policy on addressing the underlying disparity in addition to lowering smoking and preventing illnesses is a positive and relevant approach (French, 2010 p.36).
The approach has been effective in minimizing the resulting effects in general terms which makes it effective. Reducing the consumption to a zero point is something that cannot be achieved in the short run based on the critic that the approach is receiving. In that, such a move will lead to a negative economic implication that is not favourable (Chaloupka, Straif and Leon, 2010). However, the fact that the approach is seeking to achieve health steadiness by lowering the extent of chronic illness. The intention of the initiative is to establish whether focusing on non-branded tobacco items would be an effective approach in discouraging the use among young individuals. The strategy seeks to offer support to the adult consumers who need to quit through some of the established health supporting measures. The best thing about the policy is that it does not affect the economic aspects of the matter but mainly centres on enhancing the health of the people.
However, several barriers and challenges to the effectiveness of this policy exist. To begin with, since the policy has been implemented on a national scale, it means that more funds and resources are required in fulfilling the objectives. In that, the number of users in the country is too many and the intervention requires more restrictive measures in general for the goals to be achieved. The participation of the government and that of the consumers and producers is a necessity. However, for the investors within the manufacturing industry, they have been consistently rejecting the measures by asserting that the government is only focusing on getting rid of their activities by discouraging consumption. The criticism is justified given that the lowering of the general consumption will also lead to a decreased buying which is unfavourable economically. In this context, the populace is constantly involved in protesting any move by the government as well as failing to comply with such measures. While the government seeks to safeguard the health of the populace this cannot be achieved without a number of economic implications (Chaloupka, Straif and Leon, 2010). The government acquires substantial revenue from the operation in general and thus if the business is affected its revenue will also decrease. However, the change is positive rather than what people see because it means that fewer funds will be used in supporting the individual’s health issues. The reduction of smoking will lead to a decreased health defects.
On the other hand, even though that most of the consumers understand that the intake of tobacco is not favourable, it is evident that quitting for them is not an option. Poverty dominates in different settings where the usage is high. In such an environment these people can only relief their worries and socio-economic pressures by smoking (French, 2010 p.38). This means that even though the need to create awareness plays part in changing perception for those within such environment achieving the objective is hard. In addition to poverty, the education level of these people is lower which best illustrates the existing disparity. Knowledge leads to consciousness. Among the wealthy, they are fully informed about the health implication of such intakes and thus most will prefer to take the safe choices (Ciapponi and WHO 2014 p.4). This is different to the lowly educated people since their decisions are based on needs rather than what is required. In other words, even though the policy has been a success in the achievement of the set aim there are several barriers that must be overcome. In that the issue of resources and resistance that the policy has been getting from those in the industry as well as socio-economic disparity. The measures have resulted in efficiency as the results have been positive in general. In other words since a notable decreased has been achieved the focus lies in creating more benefits for the beneficiaries. The policy appears to be benefiting the public part.
Conclusion
In summing up, it is evident that the policy has been effective in meeting the set aims. It is without a doubt that smoking is one of the most dominant health issues of the contemporary society. The measures that the government has implemented seek to reduce the consumption as well as prevent the spread of illnesses that are caused by tobacco use. The policy was developed after the prevalence of diabetes and other chronic illnesses that are triggered by smoking began to rise rather rapidly. Smoking had begun to rise in the past leading to a rather unstable surrounding. The promotion of this substance throughout the modern media is attributed to be the primary driver to the increased consumption among young individuals. In addition, the use is higher within the poor environment due to the lack of education and high rate of poverty. Despite the success that the policy has achieved over the years, it is evident that the existing challenges should be addressed. The government should focus on lowering the poverty rate along with the implementation of the program. Poverty creates intense pressure for individuals and they tend to acquire relief from the high consumption of nicotine. Also, the financial aspect of the investors should also be considered. Rather than forcing people to lower the consumption, more effective options in addition to e-cigarettes should be developed.
References
Allender, S., Balakrishnan, R., Scarborough, P., Webster, P. and Rayner, M., 2009. The burden of smoking-related ill health in the UK. Tobacco control, 18(4), pp.262-267.
ASH. 2016. Fall in smoking is positive but new tobacco control plan needed for trend to continue. Action on Smoking and Health. Retrieved from: http://ash.org.uk/media-and-news/press-releases-media-and-news/fall-in-smoking-is-positive-but-new-tobacco-control-plan-needed-for-trend-to-continue/
Chaloupka, F.J., Straif, K. and Leon, M.E., 2010. Effectiveness of tax and price policies in tobacco control. Tobacco Control, pp.tc-2010.
Ciapponi, A. and World Health Organization, 2014. Systematic review of the link between tobacco and poverty.
Forest, Org. (2011). Forest reacts to UK’s government’s new tobacco control plan. Forest online Org news. Retrieved from: http://www.forestonline.org/news-comment/headlines/forest-reacts-uk-governments-new-tobacco-control-plan/
French, D. 2010. Health psychology. Chichester, West Sussex, Wiley-Blackwell.
Hammond, D., Fong, G.T., McNeill, A., Borland, R. and Cummings, K.M., 2006. Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country Survey. Tobacco control, 15(suppl 3), pp.iii19-iii25.
Parliament U.K. 2017. Tobacco Control Policy Overview. Retrieved from: http://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-8116#fullreport
Pirie, K., Peto, R., Reeves, G.K., Green, J., Beral, V. and Million Women Study Collaborators, 2013. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. The Lancet, 381(9861), pp.133-141.
SAPRU, R. K. 2004. Public policy: formulation, implementation and evaluation. New Delhi, Sterling Publishers Private.
Scarborough, P., Bhatnagar, P., Wickramasinghe, K.K., Allender, S., Foster, C. and Rayner, M., 2011. The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006–07 NHS costs. Journal of public health, 33(4), pp.527-535.
Schulz et al (2017), asserts that neurodegenerative conditions such as Alzheimer and related diseases among the seniors are progressive. They result to decline in cognitive, social and physical functioning. Some of the symptoms of these conditions include behavioral and psychological symptoms. As these conditions progresses, the caregiving responsibilities increase. Some of these responsibilities include advocacy, emotional and social support and hand on assistance on most of the work. Other responsibilities include provision of safety, quality life, medical care and management of behavioral symptoms for the aged. Successful caregiving involves the use of servant leadership as the caregivers are expected to offer service to the aged during this stage of life. Caregivers tend to use multi-component interventions which tend to focus on the caregivers of the individuals at the disease stage with a combination of approaches that meets the unmet needs of the aged.
According to Sciubba, (2014), advocacy for the aged is one of the most important aspects of a more understanding of framing differences and power relations within the global civil society. The author claims that the aging process itself posses unique and varying challenges across all age cohorts and in various parts of the world. Therefore, different age cohorts and varying places have a differing social safety net. The degree to which these advocacy networks represent the aged is determined by the way these groups frame their issues. However, most of the advocating groups are currently suggesting that there is the emergence of the transitional advocacy network among the aging. Most of the advocacy of the aging is carried out by a group who campaign using collective action frames. These frames include diagnostic, motivational as well as prognostic frames. Through the use of these collective frames, the advocacy groups are able to increase their network’s reach. They also get the opportunity to resonance with various stakeholders.
References
Sciubba, J. D. (2014). Framing and power in aging advocacy. Social Movement Studies, 13(4), 465-481.
Schulz, R., Eden, J., & National Academies of Sciences, Engineering, and Medicine. (2016). Programs and Supports for Family Caregivers of Older Adults.
Physical activity is an important moderator of cognitive decline related to age. Depending on the mode of exercises and the intensity, the blood flow increases. This increases the ability of the blood vessels to respond normally hence reducing occurrences of vascular dysfunction. Interventions for increasing physical activity amongst the aged have yielded good results. This is because the aged are now able to improve their brain growth thus causing a decline in brain disorders and memory loss. As a result, this has contributed to the improvement of cognition n relatively older adults (Bherer & Liu-Ambrose, 2013). Continuous physical activities such as aerobics enable the aged to maintain their fitness. This also demonstrates an increased brain growth and functional plasticity among the aged patients who are diagnosed with early dementia and other health disorders. Physical exercises, therefore, have played a major role in cognitive development among the aged as it has helped in reducing some of the behavioral and psychological symptoms. Some of the psychological symptoms controlled by physical exercises include agitation, stress and wandering. As all of these symptoms are controlled, self-acceptance amongst the aged is increased hence resulting in an increase in self-esteem among them (Bherer & Liu-Ambrose, 2013).
It is therefore recommended that health education should be tailored to individuals needs. Older adults ought to be trained on both specific and general concepts and medical issues. This will ensure that the aged get information that will enable them to make right decisions basing on their circumstances (Reichstadt et al, 2010). Following this learning process, the aging will be able to adapt to the age-related changes hence allowing them to have a smooth transition. This understanding of the varying theories of aging will allow caregivers, family and the aged to understand the process of aging and the necessary transition to undertake. This transition and adaptation to changes with age will enhance the well being of the aging.
References
Bherer, L., Erickson, K. I., & Liu-Ambrose, T. (2013). A review of the effects of physical activity and exercise on cognitive and brain functions in older adults. Journal of aging research, 2013.
Reichstadt, J., Sengupta, G., Depp, C. A., Palinkas, L. A., & Jeste, D. V. (2010). Older adults' perspectives on successful aging: Qualitative interviews. The American Journal of Geriatric Psychiatry, 18(7), 567-575.
The Imclone case is a security fraud of stocks by Martha Stewards which occurred in December 2001 when Martha sold her shares of the ImClone system without the company’s knowledge. The Imclone Corporation is a company involved in production of medicine to fight cancer. The company’s stock price dropped very tremendously after its medicine Erbitux, an experimental antibody failed to be accepted by the Food and Drug Administration (FDA). This was as a result of secret selling of stocks by the stockholders including Martha whose stocks were worth $230,000. She sold her shares one day before the FDA’s approval of Erbitux after her broker, Peter Bacanovic, told her that Imclone was at the verge of failure. Her involvement was a not known until Doug Faneuil, Peter’s assistant, told investigators about it. She was taken to court and charged with security fraud, objection of justice and perjury. Stewards was found guilty and jailed for five months. She was late sentenced to house imprisonment for another five months and later a two years of probation in the year 2004. This paper will analyze how the Imclone case attracted the attention of the Security and Exchange Commission (SEC), the claims of the case, the right punishment for Stewards, and the factors to be considered when buying stock and why it is important to involve SEC during stock transactions.
The Security and Exchange Commission is a government agency that deal with stock transactions and crimes involved in stocks. Insider trading was the main reason that made the Imclone case to attract SEC’s attention. Stewart was involved in insider trading which is against the SEC’s policies. She possessed confidential information about the company’s chief executive officer, Waksal. The CEO had earlier sold his $5 million worth of stocks before the FDA’s decision (Brickey, 2005). This was done secretly but Stewart got the information from hers and Waksal’s mutual broker, Peter, through bribing, that Waksal was dumping his stock which meant that the company would fall. She sold her stock one day to the FDA’s decision to escape the loss. The agency requires insiders to disclose such information to the public and Stewart was not an insider. Several other stockholders were involved in the illegal transactions.
Several claims were made in Imclone case. First, according to SEC, Stewart’s transactions violated the duty to avoid trading on the information in question. She was not allowed to trade because she was not in the directors’ team and was not an insider. She traded the stock on a bribe. Secondly, the court claimed that Stewart needed to face the law for obligation of justice and perjury (Stabile, 2004). Before being exposed by Peter’s assistant, Stewart had claimed to be innocent in court. She said that she never had information about Waksal’s trade and that her sale was as a result of an agreement between her and her broker to sell the share if the value went below 60 dollars. She even went ahead to try and change the phone conversation between her and the broker, Peter.
Martha Stewarts deserved to be prosecuted. She is a billionaire who used leaked information to dump stocks she could have afforded to loss to a poor shareholder even though she knew that the company was crumbling down (Brickey, 2005). She was once a stockbroker and she understood what she was doing. Despite having lawyers who told her that what she did was illegal, she never pleaded guilty. Thus, no mercy should have been shown to her.
Martha Stewart’s fame made things smooth for her. Money enabled her to get the best lawyers for her case and she was able to pay the heavy fine imposed on her (Rawls, 2009). Also, in a world where fame and money talks, the rich can get away with anything. Stewart only received a five- month’s jail term and probation when she deserved to be jailed for a long time.
A company’s stock price is determined by several factors. One, economic and political factors. An act of terrorism in a country can negatively affect economic activities thus leading to fall in stock prices. Secondly, Investor sentiment can help increase or decrease stocks prices. According to Heins & Allison (1966), optimistic investors can cause a rise in the market thus raised stock while pessimistic investors can lead to failure of market thus low stock prices. Also, industrial performance can affect the stock price. Same industry companies often perform the same but a failure in one company is an advantage to another as this reduces competition thus increasing the stocks’ prices.
When buying shares, one should put some factors into consideration. One, the economic condition of the country and other condition, like diseases and climatic conditions, which may lead poor productivity thus low earnings. Second, a shareholder should consider the marketability of the shares and how fast they can sell (Rappaport, 1999). Also, one should know the company’s partners, both local and international, and their competitors.
Publicly-traded companies’ executives are advised to report their stock transactions to SCE. According to Rappaport (1999), this helps to prevent the influence of stock prices by scammers who buy shares at a low price and later sells them at exaggerated prices.
Being a shareholder may be the best idea to financials freedom, but a companies’ shareholders have to work together as a team built in trust in order to prosper. The company should also follow the laws governing stocks ownership and transactions in order to prevent insider trading which may lead to the fall of a company. All information about shares should be made clear to be public so that investors who intend to buy stocks can weigh options before investing in a corporation.
References
Brickey, K. F. (2005). In Enron's wake: corporate executives on trial. United States:
Northwestern University School of Law.
Heins, A & Allison, S (1966). Some factors affecting stock price variability. United States:
University of Chicago Press.
Rappaport, A. (1999). Creating shareholder value: a guide for managers and investors. United
States: Simon and Schuster, 1999.
Rawls, K. L. (2009). Martha Stewart and Insider Trading. United States: Faculty Publications
and Presentations.
Stabile, C. A. (2004). Getting what she deserved: the news media, Martha Stewart, and
masculine domination. United States: Feminist Media Studies.
Everyone has contemplations for the things they worry in regard. Unusually, in a smaller number of persons, rare thoughts and strong feelings can be an indication of a mental disorder that is popularly referred to Schizophrenia. Individuals diagnosed with the illness experience challenges when trying to differentiate amid the real and imagined things. Most individuals believe that Schizophrenia is the condition where an individual has two distinct personalities but this notion is inaccurate. Schizophrenia is a severe mental disease that restricts the ability of an individual to control thoughts, make decisions, feelings or maintain relationships. Contrary to most of the mental illness, Schizophrenia is slightly exceptional because it normally appears in young adults and not during the teenage years of after attaining thirty. Most of those found with the illness experience the preceding symptoms in their 20s. For men, the illness might appear in the early 20s while for women the occurrence might appear later. The aspect of attacking young adults is what makes it unique and a devastating disorder. In the period when most individuals are actively exploring the surrounding, personality and creating lasting relationships than the disorder attacks. Schizophrenia is, therefore, a severe disorder that mainly affects young adults although in rare cases.
According to Tillman & Weiss (2009), Schizophrenia symptoms are usually devastating and might not be understood easily among young adults given that they are closely related to the rebellious acts among young people. Schizophrenia is a constellation of deeds and symptoms that involves experiencing false impression, illusions, illogical speech, weakened expression of feelings and unsystematic behavior (Tillman & Weiss, 2009). Based on findings by the World Federation of Mental Health (WFMH), it has been established that more than 75 percent of those diagnosed with Schizophrenia experienced their first attacks before their 25 the birthday. The highest prevalence rate of the illness is mainly common amid individuals of between 18 and 24 years. The results, therefore, highlight the essence of mental awareness among young individuals to ensure that the spread of Schizophrenia and other mental health illnesses are established and treated early.
Diagnosing schizophrenia among young individuals in the adolescent and development stage is quite challenging because. It is because this is normally a period that is associated with terrific transformation in terms of personality and behaviors. Some severe effects of the mental issue can often be ignored which makes the diagnosis to be very challenging. In addition, some studies have illustrated that schizophrenia and depression can in most cases start with related symptoms which are dominated by stressful and undesirable implications which appear prior to the striking of the psychotic signs in Schizophrenics. Young adults mainly in their prodromal stage in relation to the illness will show distinct symptoms. Konarzewska et al., (2015) the signs might include appetite loss, sleep disorder, unorganized behaviors, blunted emotions which might seem to be abnormal to others and being unrealistic in terms of expression (Tsai et al., 2015). In other words, the illness does not only affect the rational behaviors but also the ability to decide and act as a normal person. The personality and behaviors are usually affected.
While in most cases depression is believed to be common among young people due to the challenges experienced during the transitioning period, Schizophrenia is evidently a devastating illness (Kiran & Chaudhury, 2016). This is based on the fact that the mental disorder is a serious and debilitating psychiatric illness that affects young people. Among young people, there are over 2.5 million people in the country. Unlike other disorder such as anxiety which only lasts for a short period, Schizophrenia is normally a long-term illness that has no cure and will affect the ability of a person to perform basic activities (Kiran & Chaudhury, 2016). Early Schizophrenia diagnosis is essential towards an efficient treatment of the illness. Thus, establishing the signs of the illness among young adults leads to improved care and mental stability. Unlike other mental illnesses, the disease affects both men and women respectively despite the fact that it first appears among men when compared to women.
The exact causes of the illness are not well known but specialists believe that a number of factors are mainly involved in influencing its development. Based on confirmation, genetics and environmental forces integrate to generate Schizophrenia. The illness holds an inherited component but environmental aspects have a significant influence on its growth. It is asserted that, if there is any history of the illness within the family then there is about one percent chance of developing the illness. In addition, the risk normally intensifies up to 10 percent in the instance that the parent was diagnosed with the illness. The presence of chemical inequities in the individual’s brain is also a trigger. Certain chemicals such as serotonin normally lead to the elevation of the illness. Most individuals believe as well as experiencing unsteady family relationships is also a cause of the illness. In that growing up, in a family that is dominated by tensions might trigger the deteriorations that cause a breakdown due to stress.
With respect to environmental forces as the cause of Schizophrenia, despite the absence of definite evidence, it is believed that trauma that is experienced before birth and severe infections might contribute to their evolvement of the illness. Stressful encounters normally commission the eruption of Schizophrenia (Viktor et al., 2010). This is because prior to the occurrence of any actual symptoms those that are affected tend to be short tempered, unsteady and disorderly. In most cases, such situations will lead to the rise of relationships issues and employment loss because it is not just the behaviors that are affected but also an individual’s personality. Such issues are blamed to be the major cause of the illness, while in actual nature it is the vice versa given that the diseases are responsible for the disaster. The disorder is also induced by drugs such as marijuana (Agrawal & Lynskey, 2014). Also, some studies have shown that the consistent use of prescribed drugs such as steroids can lead to the development of psychosis (Agrawal & Lynskey, 2014).
Health experts currently agree that Schizophrenia usually evolves due to the interaction amid biological inclination, for instance, the inheritance of specific genes and the type of environment that one lives in. the line of investigation is asserting that the disruption of the brain development is the source of genetic inclination and environmental stressors during the early period of an individual’s development which results in significant alterations in a person’s brain that might trigger suicidal incidents (Viktor et al., 2010). The occurrence, therefore, makes one susceptible to the growth of Schizophrenia. Environmental forces that are experienced in life can affect the further development of the brain which intensifies the risks of the illness by lowering the general ability of the biological composition to resist the defects which offers a viable chance for the disorder. Researchers now hold that schizophrenia is a result of the interaction amid, psychological, social and genetic forces. In the instance that during the early development an individual is exposed to isolation this leads to the development of anxiety disorder (Sreedhar, Poulose & Kumar, 2016).
Neither of the psycho-social factors, that incorporate the genetic and environmental forces is the actual cause and thus, there is no classified level of participation by each that seek to ensure that an individual is guarded against or will automatically be subjected to schizophrenia. Further, the risks forces for each individual might differ (Sreedhar, Poulose & Kumar, 2016). While an individual will develop the illness because of having an authoritative family history of the disease another individual with lower biological susceptibility might get the disorder because of the combination of different forces ranging from environmental and pregnancy stress that is encountered during the early adult life. The general procedure in which the surrounding forces and stress get accommodated in the brain is interrupted and schizophrenia is believed to be an ultimate outcome of epigenetics. Intense and continuous stress has the ability to trigger the evolvement of brain changes in a negative manner.
Teenagers and young adult’s brain are very fragile with regard to stress. In fact, their brain is about five to six times sensitive when equated with the adult's brain and can easily be affected by progressive stress. The state that appears to be average or manageable stress to adults normally turns to be particularly serious for young individuals. The stress that is associated with the destruction of the brain can highly intensify the risk occurrence for a number of mental and psychological illnesses such as depression. When such an altercation is experienced during the early teenage life it means that the consequences will be felt later as a young adult in the 20’s. The occurrence is caused by the fact that some parts of the brain have been destroyed by the continuous stress (Agrawal & Lynskey, 2014). However, despite the fact that the damages might not be controlled there are a number of ways through which the risks can be lowered. Based on a recent study most cases of schizophrenia can be prevented by taking affirmative actions during pregnancy to ensure that the individual is born with less vulnerability. Also in the development stages, the environment in which one is exposed too can be controlled. These prevention forces are specifically important for individuals with family history any given kind of mental disorder such as bipolar, anxiety, depression and so on.
It is without a doubt that there is a powerful biological element play might in the rise of the illness. Individuals with immediate family psychiatric history have a significant probability of getting the illness. However, twin research has proven otherwise by demonstrating that even though one of the twins might be affected by the illness the risk of the other is not as high. In other words, this illustrates the fact that both environmental and genetic forces must interact to produce the disorder. In that, it is not just a matter of just the multiplication of genes that lead to the rise of the illness (Sreedhar, Poulose & Kumar, 2016). Based on the scientific findings that nature and development are the main determinants of an individual’s character it is evident that the same features are needed in establishing an individual’s health status. It was previously believed that health defects are mainly caused by genetic composition but the notion has changed over the years. It is now more precise that this is not the case as some genes defects tend to remain dormant for the longest period until the moment that they are stirred when an individual is subjected to a given environment. Instead of nature which in this case represents genes while nurture is for the surrounding every component plays a fractional role in driving the development of the characteristics towards the negative health direction. Newer studies have demonstrated the general ability of nature only in the case when the environment is hostile. In that, a biological gene only contributes about zero percent regarding of what an individual becomes in terms of personality (Kiran & Chaudhury, 2016). In other words, if an individual has a genetic vulnerability but is raised in an environment where the defect is not aroused then it means that both the surrounding and the genetic composition have no role. The person will not, therefore, develop the mental illness since the interaction amid the two factors have turned to be without power. In this case, the defected gene will not act and its dormancy will continue. However, if the gene is present and the environment turns to be unfavorable but subjecting the individual to stress this means that the interaction will yield a hundred percent result by developing the illness (Viktor et al., 2010).
The phenomenon that an individual’s early encounters are responsible for shaping personality is true for Schizophrenia. The disorder only affects young adults because the unfavorable encounters that they acquired in the early life play part in the development. It is widely known that for instance children raised in a poor setting are at the highest threat of developing complication related to anxiety, drug abuse and depression when they transition to adulthood when compared to those from favorable settings. Those from comfortable environments and backgrounds are more advantaged even though those from the poor one's later transition to a more favorable socioeconomic status. The most crucial thing with regard to early experiences that affects individuals in early adult life is because negative or desirable life encounters are responsible for altering the DNA state. It is not apparently the organization of the DNA that is affected but its composition and structure that incorporates the substances that unites the elements and tightly holds the packs for every cell. It means that the changes which are described as epigenetic modifications normally simplifies the genes with regard to the composition of the proteins (Tsai et al., 2015). The experiences are the same for the individuals struggling with isolation or social acceptance. The pressuring stress implies that their inner stability is unfavorable and as the environmental discomfort continues it implies that the brain and the DNA are altered more leading to cognitive instability.
Schizophrenia is dominant among young adults due to the combination of genetic and environmental factors. In that, as teenagers people normally experience varying changes that changes not only their behavior but also personality. The period of transition is always stressful and the ability to cope is dependent on the support offered socially. Thus, if during the period one is subjected to isolation, it, therefore, means that their psychological and cognitive functions are affected. In other words, it is the past and ongoing encounters that wakes up the sleeping defects. It is without a doubt that mental stability does not only rely on the socio-economic wellness but also psychological stability (Tsai et al., 2015). The subjection to a stressful surrounding alters the biological and psychological steadiness thus creating the opportunity for the illness to rise. For young adults, the life transitioning means that they must not only create strong social relations but also focus on achieving stability both on the social, emotional and economic basis. The stage is one that has its own stressors and if the environment plays part in intensifying the condition the schizophrenia will arise.
Schizophrenia incorporates varying health issues with respect to thinking, emotions, and characters. One will be delusional by building their thoughts on unrealistic beliefs which are caused by schizophrenia because of the incapability to control thoughts and behavior (Grover et al., 2011). However, it does not imply that because the illness leads to the development of hallucinations that those that are involved do not have an actual experience of life. Life can be normal in different instances but the stability is lost in most cases due to the disorganization of the cognitive composition which not only leads to abnormal behavior but also unstable speech which means that communication is not fully composed or in context. Schizophrenia is mainly motivated by negative encounters which means that the affected persons begin to get isolated socially and lacks motivation for activities as they approach young adult life. Due to the difficulty of managing the pressure the situation intensifies leading to an unstable condition that reflects personality abnormality.
It is rather unfortunate that most individuals with schizophrenia have no knowledge of their illness. However, unlike for other illnesses, this act is not a coping approach that involves denial but it is part of the symptoms which makes the ability to assist the individual even more challenging. The general treatment of schizophrenia necessitates the combination of clinical, psychological and psychosocial contribution (Viktor et al., 2010). Since the illness is a psychiatric one the treatment will not lead to a cure but lowering the responsiveness of the illness. Certain medicines that are regarded as antipsychotics are essential in the treatment. Therefore they are usually taken in the long run so that the individual can sustain the cognitive stability. In addition, social support is a necessity as it helps individuals in coping more easily in addition to gaining acceptance of their condition which is an essential part of the management of the illness.
Conclusion
Schizophrenia is one of the leading serious illness that affects millions of young adults across America. With the lack of appropriate treatment, the illness might lead to the collapsing of most social relationships and intense stress. Schizophrenia among young people is caused by prior life encounters particularly from the environmental setting. However, genetic forces also play a crucial role in triggering the defect. Individuals with the disorder will usually isolate themselves from the social context with hallucinations and increased abnormality in behavior. It is worth noting that both the environmental and genetic nature is directly interrelated in determining the direction of one’s personality. With this in mind, the illness can be prevented by a practical intervention that seeks to guard those with the vulnerability by offering them social support. The treatment is effective when the illness is detected early when the signs have not intensified.
References
Agrawal, A., & Lynskey, M. T. (2014). Cannabis controversies: how genetics can inform the study of comorbidity. Addiction, 109(3), 360-370. doi:10.1111/add.12436
B., A., Sreedhar, S., Poulose, N., & Kumar, P. S. (2016). Schizophrenia care: an overview considering family burden, medication adherence, and pharmacoeconomics. Dysphrenia, 7(1), 6-10. doi:10.5958/2394-2061.2016.00002.1
Grover, S., Nehra, R., Bhateja, G., Kulhara, P., & Kumar, S. (2011). A comparative study of cognitive deficits in patients with delusional disorder and paranoid schizophrenia. Industrial Psychiatry Journal, 20(2), 107-114. doi:10.4103/0972-6748.102499
Kiran, C., & Chaudhury, S. (2016). Prevalence of comorbid anxiety disorders in schizophrenia. Industrial Psychiatry Journal, 25(1), 35-40. doi:10.4103/0972-6748.196045
Konarzewska, B., Stefańska, E., Wendołowicz, A., Cwalina, U., Golonko, A., Małus, A., & ... Ostrowska, L. (2014). Visceral obesity in normal-weight patients suffering from chronic schizophrenia. BMC Psychiatry, 14(1), 1-21. Doi: 10.1186/1471-244X-14-35
Tillman, K. H., & Weiss, U. K. (2009). Nativity Status and Depressive Symptoms among Hispanic Young Adults: The Role of Stress Exposure. Social Science Quarterly (Wiley-Blackwell), 90(5), 1228-1250.
Tsai, K. H., López, S., Marvin, S., Zinberg, J., Cannon, T. D., O'Brien, M., & Bearden, C. E. (2015). Perceptions of family criticism and warmth and their link to symptom expression in racially/ethnically diverse adolescents and young adults at clinical high risk for psychosis. Early Intervention in Psychiatry, 9(6), 476-486. doi:10.1111/eip.12131
Viktor, I., Vilma, V., Kadri, H., Vesna, P., & Marija, R. (2010). Some Characteristics of Patients with Schizophrenia Who Attempted Suicide. Contributions of Macedonian Academy of Sciences & Arts, 31(2), 183-193.
Recent Changes in the NHS and their usefulness in Local Communities Healthcare Improvement
Introduction
In Canada, for one to constructing a house, one needs to consider several factors as set by the national building authority. One is weather, the country experiences winter, autumn, spring and summer. Each season varies from each other in terms of weather; some have extreme temperatures up to -40 degree Celsius while others have favourable one. The other factor is cost of the equipment, one need to consider whether it’s economical healthy or not. The quality of equipment to furnish the house is also vital. This ensure that the house receive quality aeration through good ventilation processes. The house requires home appliances such as stove, refrigerator, stove ventilation fan, dish washer, cloth dryer among others. The house also needs heat ventilation air conditioning to regulate temperature within the house. Example of these ventilations is: forced air heating and central air conditioning systems, heat recovery ventilation system, duct work system and water heaters. One also needs to adhere with Canadian building codes. In this project, the main focus is on both home appliances and heat ventilation air conditioning. Home appliances are those accessories that are used at home to accomplish household chores. Heat and ventilation air conditioning are those fittings that regulate temperature within a house. Both home appliances and heat and ventilation air conditioning accessories requires energy to keep operating. There are two form energy that are available that is gas and electricity. Both are controlled by Natural Resource Canada. Energy is measured in term of kilowatt per hour (kW/hr). Energy is generated and distributed by private and public firms such as Hydro Ontario, Manitoba hydro, Toronto Hydro Electric system, Hydro Quebec among others. Since we have based our research in Ontario, we shall focus on power rates, prices and regulation of power by this state owned firm. The firm generate power through nuclear, hydro, gas, biomass and wind. All these aspect readily available in the province of Ontario thus the cost of energy becomes cheaper.
PART A: Home appliances
This ‘dream home’ is based on 2000 ft that comprises of four family members therefore the appliances required are not such big because family needs are also less. This means that power requirement will be less. We have ensured that each component has met international standards, ethical codes and therefore they are eco-friendly. We have also scrutinized the components from any green wash effect, thus we have the original equipment this allows compatibility and durability. This also saves us economically as there is less consumption of energy by the gadget. Some but not the least of the appliances required are:-
Dish washer
Purchase price : $ 699.99
Brand name : Kenmore elite
Model No : 14753
Expected yearly energy usage (kw/hr) : 270
Expected yearly operating cost : 42.82
Reason: It is built in a 360 degree power wash, occupies less space, has both gas and electricity power use, low noise with 45 decibels and stainless steel cover to prevent rusting, micro-clean that ensures less time is taken and little water and a removable rack ("Welcome to Kmart.com," n.d.)
Refrigerator
Purchase price : $ 1549
Brand name : Hoshizaki America
Model No : HR24A
Expected yearly energy usage (kw/hr) : 370
Expected yearly operating cost : 58.68
Reason: Thermostatic expansion valve that provide ensure all time favorable temperature are maintained, duct air distribution system, evaporator gas condenser, epoxy coated wire shelve, spacious racks, five year warrant compressor, stainless interior and exterior, low power consumption ("Portal - Personal: Residential | Canada's Office of Energy Efficiency," 2011)
Cloth washer and dryer
Purchase price : $ 379.99
Brand name : Kenmore elite
Model No : 62332
Expected yearly energy usage (kw/hr) : 199
Expected yearly operating cost : 31.56
Reason: wrinkle free dry technology which removes wrinkles, 4 levels of dryness temperature, 7.0 cu. ft. Capacity, has a Wrinkle Guard Option, a Smart Technology eliminate re-drying, temperature Control, 4 Drying Temperatures ("Welcome to Kmart.com," n.d.).
Cooking tops.
Purchase price : $ 1259
Brand name : Samsung
Model No : Na36k655tg
Expected yearly energy usage (kw/hr) : 256
Expected yearly operating cost : 40.60
Reason: smartphone compatibility through Samsung application, easy to clean, combined burners, support m multiple pot and pans, easy to clean ("Welcome to Kmart.com," n.d.).
Iron box
Purchase price : $ 26.59
Brand name : Brentwood
Model No : 97094461
Expected yearly energy usage (kw/hr) : 65
Expected yearly operating cost : 10.31
Reason: Stainless Steel soleplate steam Iron, Steam dry, burst and spray function, temperature control, vertical steam self-cleaning function,3 Way Auto Shut-Off, 30 seconds 8 Minutes ("Welcome to Kmart.com," n.d.) .
Microwave
Purchase price : $ 26.59
Brand name : kenmore
Model No : P110N30AP
Expected yearly energy usage (kw/hr) : 120
Expected yearly operating cost : 18.96
Reason: Conveniently cooking options with a bright LED clock, a spacious interior and easier accessibility ("Welcome to Kmart.com," n.d.) .
Toaster
Purchase price : $ 24.22
Brand name : Hamilton Beach
Model No : 22812
Expected yearly energy usage (kw/hr) : 100
Expected yearly operating cost : 15.8
Reason: crumb tray with 7 pin dial, a defrost man made material, single level with warm mode and toast boast ("Welcome to Kmart.com," n.d.).
Cooking ventilation fan.
Purchase price : $ 699.99
Brand name : Golden Vantage
Model No : Ak-r-h-0159
Expected yearly energy usage (kw/hr) : 125
Expected yearly operating cost : 19.83
Reason: It’s 30 inch, good dimension of 29.5" W x 29.5" L x 52.2" with a minimum drop down height of 36 inch, has a required ceiling height of 8.5’ to 9.5’ feet, a big duct Size of 6" that can allow Airflow up to 410 CFM, a 4 speed, touch pane size with Less Noise Level than 65db at 410 CFM, ETL compliance with US and Canada safety standards warranty 3 years warranty ("Welcome to Kmart.com," n.d.).
PART B Heating Cooling Equipment
This dream house has a cooling and heating system. During winter, when the temperature goes down as much as -40 degrees Celsius, the house requires warmth to raise it up to around 20 degrees Celsius. During summer, the temperatures are extremely hot up to around 30 degree Celsius, therefore the house need to be cooled down in order to maintain favourable conditions. This is done using heating and cooling system. Since our house is not big, it will require fewer coolants. We shall also incur an installation cost which will be embedded to the cost of the equipment. We shall also consider environmentally ecosystem in order to conserve our surroundings. They are as follows:-
Forced heating and Central air conditioner
Purchase price : $ 299.99
Brand name : Whirlpool
Model No : 50
Expected yearly energy usage (kw/hr) : 210
Expected yearly operating cost : 33.31
Reason: has energy star 2-speed dehumidifier removes up to 50 pints of moisture that operates at very low temperature, control panel, operate under low temp -41c degree, 3 fan wheel ("Acklands-Grainger: Industrial Supply, Safety Equipment and Fasteners - Acklands-Grainger, Canada," n.d.)
Water heater.
Purchase price : $ 257.33
Brand name : Eemax
Model No : Ha008240
Expected yearly energy usage (kw/hr) : 254
Expected yearly operating cost : 40.28
Reason: its durable, easily replaceable heating digital temperature display, an adjustable temperature in Increments of around 1ºF, its energy efficient with digital technology ("Welcome to Kmart.com," n.d.)
Ductwork system
Purchase price : $ 257.33
Brand name : Allegro
Model No : 9543-15
Expected yearly energy usage (kw/hr) : 180
Expected yearly operating cost : 28.55
Reason: flexibility, extra-long and no carbon formation, compatibility ("Welcome to Kmart.com," n.d.)
PART C Energy Usage
Electricity will be the main source of power. The estimated cost per year will be calculated using the energy cost calculator. The base is for Ontario rate $0.1586. The formula used to calculate cost per kilowatt is as follows; electoral cost per kilowatt/ hour equals the summation of average weighted cost kilowatt/hour for the month + global correction adjustment cost+ provider’s charges. Average weighted cost kilowatt/ hour is the total cost of all accumulated kilowatt for the year per hour. Global adjustment cost is the average cost of all resources from provinces in Canada and providers charges are prices set by the provider. Therefore:
42.82+58.68+31.56+40.60+19.83+33.31+40.28+28.55+10.31+18.96+15.8=340.75. The total cost per kw/hour is $ 295.68. Both average weighted cost and global adjustment costs varies from time to time while providers charges are static ("National Energy Use Database: Home Page | Natural Resources Canada," 2016). The provider will be Hydro one limited; they have favourable rates compared to other providers. They charges off peak; 6.5 c/kWh, mid-peak 9.5 c/kWh, on peak c/kWh. They are also located within the region thus consultations are quick and efficient ("Hydro One," n.d.)
It will be good if we purchase both appliances and equipment from local market and externally. By this, we shall save on cost and have a variety of products to select from the pool. We shall also enjoy different installation experts from all over the globe if we purchase externally. We shall also enjoy discounts if purchases are made externally. Another factor that we have considered is the warranty of both appliances and equipment system. We have tried to scrutinize the gadgets with the most number of years of warrant in the market. This makes us confident of the quality and durability of such. We shall also observed Canadian Building codes so that we met Canadian standards. This will also enable us have a firm house that will be able to hold the appliances and equipment. It also makes it easier for energy to be transmitted through line and pipes. Safety and precautions have also been observed when constructing the house to ensure that each obstacle had been taken care of and cost have been minimized drastically.
References
Acklands-Grainger: Industrial Supply, Safety Equipment and Fasteners - Acklands-Grainger, Canada. (n.d.). Retrieved from https://www.acklandsgrainger.com
Care Plan: Helping Client and Family Make Transition
TO: All Staff
FROM:
SUBJECT: Recommendations for Helping Client and Family Make a Transition
DATE:
As we can all understand, late life is a time of more than one transition. Transitioning is a hard task most especially for the patient and also to the family. Therefore we must all work towards making the transitioning process easier and a success. Ann is 82 years of age and her transition is undesired. This is the sole reason why we must all work together with her family in ensuring that she welcomes and takes her transition positively.
Ann’s case can be explained using the social reconstruction theory. This theory is founded on the concept that self-concepts heavily relies on the day to day interaction and the way other people react to them. However, in this theory, there are elements of social breakdown syndrome. This is the way an individual’s self-concept interact negatively with one’s social environment to produce a downward psychological functioning (Jin, 2010). This is the case with Ann who is quite vulnerable to psychological situations that require her to have a potential adjustment and coping approach.
Ann is vulnerable to breakdowns in a home and hence she has the greatest need for transitional care services. It is for this reason that we are all called upon to work together as a team in ensuring that Ann gets the best treatment during her time in the facility. We need to attend to Ann’s emotional needs during this transitional care. This will help in minimizing her negative experiences. It will also enhance her ability to support her loved ones most especially her daughter.
During this transition period, we ought to be proactive in our communication with each other, with the patient and her family. We should be able to explain the capabilities of the setting to which we shall place Ann during her caregiving. It is also important for us to be fully aware of the admission and the discharging process for Ann. We ought to work hand in hand with the facilities’ discharge planners. This will allow each and every one of us to have ready information for Ann and her family hence enabling them to be well informed. We ought to call the discharge planners regularly (Naylor & Keating, 2008). This will establish a relationship with them hence allowing for easier accessibility to Ann’s information update. However, it is important to note that communicating with Ann will be a challenge as she is angry at everyone. Therefore we should all try to build trust with her. This will allow her to open up hence creating a relationship with all of us with time.
Some of the most instrumental interventions for Ann’s case include the care transitional intervention and the transitional care model. Care transitions interventions will offer Ann and her family caregivers’ specific tools. This intervention will also allow Ann and her family caregivers to work with a transitional coach. Through this, they will be able to learn transition skills. Transitional care model, on the other hand, will be able to establish a multidisciplinary team (Naylor & Keating, 2008). This team will be able to work together in treating Ann’s chronological illness that is at high risk to self and to others. This team will give care to Ann during and after her discharge from the facility.
Yours sincerly,
References
Naylor, M., & Keating, S. A. (2008). Transitional care. Journal of Social Work Education, 44(sup3), 65-73.
Jin, K. (2010). Modern biological theories of aging. Aging and Disease, 1(2), 72–74. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995895/
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