Evaluation of Public Health Agenda in Community: Obesity

Evaluation of Public Health Agenda in Community: Obesity Module Title: Promoting the Public Health of Populations in Specialist Community Public Health Nursing Module Code: SHN3048 Critical evaluation of the current public health agenda in relation to a health need identified within a community profile. The purpose of this assignment is to critically analyse the current public health agenda in relation to a health need identified through use of community profiling. This paper will aim to provide recommendations as to how a Specialist Community Public Health Nurse (SCPHN) can proactively address high levels of obesity identified within the Cwmbwrla ward (Appendix 1). For the benefit of the reader Cwmbwrla is a suburban area of Swansea, with good transport links to the city centre. In considering the level of deprivation Cwmbwrla is ranked 181 0f 1,909 (LSOA) in Wales (Welsh Government, 2014a). Public health in the 21st century is defined by Riegelman (2010 p4) as the totality of all evidence-based public and private efforts that preserve and prolong health and prevent disease, disability and death thus, recognising public health as a varied approach which should be viewed holistically. Health visitors are a group of specialist community public health nurses (SCPHN), skilled in delivering a proactive Public health service which relies on evidence base research to enhance health and reduce inequalities for all families with children 0-5 (Royal College of Nursing, 2011; The National Institute for Health and Care Excellence (NICE) 2014). The current Public Health strategy in Wales aims to achieve a healthier, happier and fairer Wales, through improving health, reducing inequalities and supporting a good start in life (Public Health Wales (PHW), 2015; Welsh Assembly Government (WAG), 2010; WAG, 2011a; Welsh Government (WG), 2016). There is consistent evidence which suggests investment in the early years significantly improves the health of the child and has a positive impact on long term outcomes (Acheson,1998; Black,1980; Marmot, 2010). As a result of the reaffirmation of the public health role of the SCPHN in recent policy, it is believed that the health visitor is st rategically placed to empower individuals and positively influence the health outcomes of young children and their families (Department of Health (DoH), 2011; WG, 2012a). The four domains of SCPHN practice begin with Search for health needs (Cowley Frost, 2006), thus requiring health visitors to undertake an assessment of the populations health and well-being. A key part of this process is health needs assessment (HNA) (Nursing and midwifery Council, 2010).ÂÂ   In defining HNA, Stewart et al, (2009) suggests the purpose is to identify the health assets and need of a population in order to inform decisions regarding service delivery to improve health and reduce inequalities. Through use of HNA policies are developed and needs are prioritized across services, with the aim of targeting those in greatest need (Williams, 2013). Statistics from the profiled area of the Cwmbwrla ward (Appendix 1), identify high levels of obesity in adulthood as being a significant problem. Despite there being no local data to highlight the levels of childhood obesity specifically within the ward, research suggests a strong link between childhood obesity and obesity in later life (NHS, 2015). Findings from the child measurement program 2014-2015, recorded that 11.8% of 4-5 year olds in Swansea were obese (Public Health Wales Observatory, 2016), a trend mirrored throughout Wales, with findings from the Welsh health Survey (2011) identifying that 35% of children living in Wales were classed as overweight or obese. Obesity has fast become a global epidemic (World Health Organisation (WHO), 2003; 2016), with research suggesting that obesity is the worlds most common nutritional disorder (NICE, 2014). The 2007 Foresight report emphasized the need to tackle the problem of obesity in the United Kingdom, particularly in childhood. The prevalence of obesity in infants, children and adolescents is increasing rapidly both nationally, and internationally, which has a significant impact on both short and long term health (Hall et al, 2009; WHO, 2016 ). Exploration of the literature suggests that there are many risk factors associated with becoming overweight, with the key principles leading to obesity being laid down in childhood (WAG, 2010). Wanless (2004) and Jones et al (2005) identified that during the period of 1986-2002 weight gain in children translated to a doubling in the proportion of those classified obese.ÂÂ   Childhood obesity is becoming evident in younger ages, with studies documentin g a sizable increase in the percentage of overweight children between the ages of two and three years (Hall et al, 2009; Nelson, 2004). Studies linking overweight to psychological consequences show that obese children tend to have low self-esteem, increased rates of sadness, loneliness and are often bullied and socially excluded outside the home (Strauss,2000). Promoting healthy weight and preventing and managing obesity have become pressing public health priorities over recent years (Phillips et al 2011). The effects of addressing obesity in early childhood are not solely limited to its health benefits; improvements in the rates of obesity could potentially save the NHS millions. In Wales alone it is estimated that between 1.65 million a week is spent treating conditions linked to Obesity (PHW, 2016). Despite obesity being at the forefront of the Public health agenda within the UK, progress in tackling childhood obesity has been slow and inconsistent, with a clear lack of provision identified as a problem within Wales (WAG, 2010; WHO, 2016). It has long been recognized that socioeconomic class has a significant impact on health inequalities, with those living in the most deprived areas more at risk of becoming overweight or obese (Acheson, 1998; Black, 1980). This is of particular relevance to the Cwmbwrla ward (APPENDIX 1), which falls within the 20% most deprived areas within Wales (WG, 2014). NICE (2014) supports this, with statistics indicating that 29% of children living in the most deprived areas of Wales being overweight or obese compared to 21% in the least deprived areas. More recent findings have suggested that, despite improvements in the overall health of the general population, there continues to be significant gaps between the social classes (Dahlgren and Whitehead, 1991; Marmot, 2010). These differences have been tackled within Welsh Government policy, which aimed to target the most deprived areas of Wales, through the delivery of the Flying Start program, which promotes health and delivers intensive servi ces in areas of greatest need (WAG, 2005, 2011a; WG, 2016). While such services must be applauded for their proactive approach, it must also be considered that as a consequence of this, the availability services relies heavily on postcode (WG, 2013), resulting in many families in need being unable to access necessary support. However, more recent WG policy has identified the need to tackle inequality, and improve health outcomes for all children, delivering support in key areas to all families with children under 7, underpinned by the principle of progressive universalism (HCWP, 2016). As previously identified, the determinants of obesity are complex and varied, it is important to recognise than no single intervention is likely to prevent or improve childhood obesity alone (WHO, 2012). Availability of data is important in planning services at a local level. Collaboration, leadership and quality improvement play a leading role within WG policy (PHW, 2013; WG, 2011, 2016). These policies emphasize the importance of adopting a muti-agency approach in addressing health needs, thus, identifying the need for SCPHN to support existing programs when planning health interventions to address obesity, with the aim of strengthening current initiatives and reducing the need for later more expensive treatments (NICE, 2013). The all wales obesity pathway supports this, and sets out a multi-agency approach in targeting obesity, allowing the identification of gaps in provision and the determination of where to best focus efforts (WAG, 2010). Over recent years, the WG have invested millions on strategies targeting obesity; for example, Free swimming programme (2003), Health Challenge Wales (2005), Creating an active Wales (2009), Mend (2009), and Our healthy future (2009), despite this the number of overweight children and adults continues to rise (Mc Pherson Marsh, 2007). Research suggests it Is highly likely that obese children will have obese parents, thus indicating the possible detrimental effects of learnt behaviours in childhood such as poor eating habits (NICE,2015). The literature emphasises the need for family involvement in interventions to ensure improvements in outcomes (Public Health England, 2014). There is emerging evidence that programmes that aim to enhance parenting skills can have a positive impact on childhood obesity (Berge Everts, 2011). Therefore, within the Cwmbwrla area, a recommendation would be to build community capacity for healthy eating by setting up a 4 week weaning programme. The programme would be available to families between the 16 week clinic contact and 24 week health review as per the HCWP (2016), and will deliver education and advice within a group setting. The programme will cover topics such as, delayed weaning, healthy eating in childhood, controlling portion size and how to quickly create cheap but nutritio us meals, with the aim of encouraging behaviour change using an educational approach (Naidoo Wills, 2016). The programme would aim to build upon existing initiatives such as Change 4 Life, which has previously been judged for not fulfilling its full potential (WAG, 2014). However,ÂÂ   it is important to consider that in the past, group programmes have been criticised for failing to involve individuals and communities who are hard to reach resulting in poor engagement (PHW, 2013). A further recommendation for the Cwmbwrla ward would be the provision of Increased/intensive home visits to specific families identified during the antenatal or birth visit as being at risk of overweight or obesity. Research has indicated a correlation between parenting lifestyle and that of their children in terms of diet and physical activity (Rhee, 2008). Arguably, the most effective strategy we can employ in tackling obesity in childhood is to work with parents (Golan, Kaufman Shahar, 2006).The aim is to focus on parents and support them to making positive choices that facilitate a healthy start in life. The additional visits will enable SCPHN to facilitate behaviour change by addressing key influences such as; positive parenting, feeding behaviour and food and activities accessible within the home, while also allowing the SCPHN the flexibility toÂÂ   tailor the program specifically to the needs of the individual family. It is imperative that SCPHN are mindful that there is no one correct parenting style, it is therefore important when delivering the program not to stereotype, but to encourage a generally more authoritative approach. Delivering the program within the home will aim to address the possible barriers families experience in accessing services (PHW, 2013). To conclude, this paper has evaluated the current public health agenda in relation to high levels of obesity identified within the Cwmbwla ward, a trend mirrored throughout the UK. Findings suggest that effort needs to be invested in preventing obesity, particularly in children; targeting early intervention and encouraging and educating families to adopt a healthy varied diet and active lifestyle (NICE, 2006, 2014). Through raising awareness, and by influencing local and national policies, SCPHN can facilitate ways to combat the problem of childhood obesity and seek to change the patterns which lead to obesity and poor health in later life (Cowley Frost, 2006; WG, 2014). As a result, recommendations for practice were identified for implementation within the profiled area of Cwmbwrla. The overall aim is for SCPHN to identify, address and facilitating families to overcome the current obesity epidemic, which could potentially result in a huge gain in terms of both cost to the NHS and more importantly the health of children and the adults they become (WG, 2015). Congestive Heart Failure: Causes, Types and Symptons Congestive Heart Failure: Causes, Types and Symptons Heart failure is caused by the heart not pumping as much blood as it should and the body does not get as much blood and oxygen that it needs. The malfunctioning of the heart chambers are due to damage caused by narrowed or blocked arteries leading to the muscle of your heart. This Heart failure can also be described based on which area of the heart isnt operating properly.2 types of heart failure. 1) Diastolic dysfunction: The contraction function is normal but theres impaired relaxation of the heart, impairing its ability to fill with blood causing the blood returning to the heart to accumulate in the lungs or veins. 2) Systolic dysfunction: The relaxing function is normal but theres impaired contraction of the heart causing the heart to pump pump out as much blood that is returned to it as normally does. As a result of more blood remaining in lower chambers of the heart Causes Any disorder that directly affects the heart can lead to heart failure, as can some disorders that indirectly affect the heart. Some disorders cause heart failure quickly; others do so only after many years. Some disorders cause systolic dysfunction, others cause diastolic dysfunction, and some disorders, such as high blood pressure and some heart valve disorders, can cause both types of dysfunction. Systolic Dysfunction: In many cases, a combination of factors results in heart failure. Coronary artery disease is a common cause of systolic dysfunction. It can impair large areas of heart muscle because it reduces the flow of oxygenirich blood to the heart muscle, which needs oxygen for normal contraction. Blockage of a coronary artery can cause a heart attack, which destroys an area of heart muscle. As a result, that area can no longer contract normally. Myocarditis (inflammation of heart muscle) caused by a bacterial, viral, or other infection can damage all or part of the heart muscle, impairing its pumping ability. Some drugs used to treat cancer and some toxins (such as alcohol) may also damage heart muscle. Some drugs, such as nonsteroidal antiiinflammatory drugs, may cause the body to retain fluid, which increases the workload of the heart and may precipitate heart failure. Heart valve disordersinarrowing (stenosis) of a valve, which hinders blood flow through the heart, or leakage of blood backward (regurgitation) through a valveican cause heart failure. Both stenosis and regurgitation of a valve can severely stress the heart, so that over time, the heart enlarges and cannot pump adequately. An abnormal connection (septal defectsi(see Birth Defects: Atrial and Ventricular Septal Defects and Patent Ductus Arteriosus: Failure to CloseFigures) between the heart chambers can allow blood to recirculate within the heart, increasing the workload of the heart, and thus can cause heart failure. Disorders that affect the hearts electrical conduction system and produce prolonged changes in heart rhythms (especially if these are fast or irregular) can cause heart failure. When the heart beats abnormally, it cannot pump blood efficiently. Some lung disorders, such as pulmonary hypertension (see Pulmonary Hypertension), may alter or damage blood vessels in the lungs (pulmonary arteries). As a result, the right side of the heart has to work harder to pump blood into the lungs. The person may then develop cor pulmonale (see Cor Pulmonale: A Disorder Stemming From Pulmonary HypertensionSidebar), in which the right ventricle is enlarged and there is rightisided heart failure. Sudden, usually complete blockage of a pulmonary artery by several small blood clots or one very large clot (pulmonary embolism) also makes pumping blood into the pulmonary arteries difficult. A very large clot can be immediately life threatening. The increased effort required to pump blood into the blocked pulmonary arteries can cause the right side of the heart to enlarge and may cause the walls of the right ventricle to thicken, resulting in right sided heart failure. Disorders that indirectly affect the hearts pumping ability include a severe deficiency of red blood cells or hemoglobin (anemia), an overactive thyroid gland (hyperthyroidism), an underactive thyroid gland (hypothyroidism), and kidney failure. Red blood cells contain hemoglobin, which enables them to carry oxygen from the lungs and deliver it to body tissues. Anemia reduces the amount of oxygen the blood carries, so that the heart must work harder to provide the same amount of oxygen to tissues. (Anemia has many causes, including chronic bleeding due to a stomach ulcer.) An overactive thyroid gland overstimulates the heart, so that it pumps too rapidly and does not empty normally during each heartbeat. When the thyroid gland is underactive, levels of thyroid hormones are low. As a result, all muscles, including the heart, become weak because muscles depend on thyroid hormones to function normally. Kidney failure strains the heart because the kidneys cannot remove excess fluid from t he bloodstream, so the heart has a larger volume of blood to pump. Eventually, the heart cannot keep up, and heart failure develops Diastolic Dysfunction: Inadequately treated high blood pressure is the most common cause of diastolic dysfunction. High blood pressure stresses the heart because the heart must pump blood more forcefully than normal to eject blood into the arteries against the higher pressure. Eventually, the hearts walls thicken (hypertrophy), then stiffen. The stiff heart does not fill quickly or adequately, so that with each contraction, the heart pumps less blood than it normally does. Diabetes causes other changes that stiffen the walls of the ventricle. As people age, the hearts walls also tend to stiffen. The combination of high blood pressure and diabetes, which are common among older people, and ageirelated stiffening makes heart failure particularly common among older people. Heart failure may result from other disorders that cause the hearts walls to stiffen, such as infiltrations and infections. For example, in amyloidosis, amyloid, an unusual protein not normally present in the body, infiltrates many tissues in the body. If amyloid infiltrates the hearts walls, they stiffen, and heart failure results. In tropical countries, infiltration by certain parasites into heart muscle can cause heart failure, even in young people. Some heart valve disorders, such as aortic valve stenosis, hinder blood flow out of the heart. As a result, the heart muscle thickens and has to work harder, and diastolic dysfunction develops. Eventually, systolic dysfunction also develops. In constrictive pericarditis, the sac that envelops the heart (pericardium) stiffens, preventing even a healthy heart from pumping and filling normally. Types of Heart diseases affect the heart chambers include These are the heart diseases which leads to heart failures A) Pulmonary heart diseases B) Heart Disease affecting heart muscles C) Heart disease affecting heart valves D) Heart disease affecting coronary arteries and coronary veins E) Heart disease affecting heart lining F) Heart disease affecting electrical system G) Congenital heart disease A) Pulmonary heart disease Pulmonary heart disease is caused by an enlarged right ventricle. It is known as heart disease resulting from a lung disorder where the blood flowing into the lungs is slowed or blocked causing increased lung pressure. The right side of the heart has to pump harder to push against the increased pressure and this can lead to enlargement of the right ventricle In the case of heart diseases affecting heart muscles, the heart muscles are stiff, increasing the amount of pressure required to expand for blood to flow into the heart or the narrowing of the passage as a result of obstructing blood flow out of the heart. B) Heart diseases affecting heart muscles Cardiomyopathy Heart muscle becomes inflamed and doesnt work as well as it should. There may be multiple causes such as high blood pressure, heart valve disease, artery diseases or congenital heart defects. a) Dilated cardiomyopathy The heart cavity is enlarged and stretched. Blood flows more slowly through an enlarged heart, causing formation of blood clots as a result of clots sticking to the inner lining of the heart, breaking off the right ventricle into the pulmonary circulation in the lung or being dislodged and carried into the bodys circulation to form emboli . b) Hypertrophic cardiomyopathy The wall between two ventricles becomes enlarged, obstructing blood flow from the left ventricle. Sometimes the thickened wall distorts one leaflet of the mitral valve, causing it to leak. The symptoms of hypertrophic cardiomyopathy include shortness of breath, dizziness, fainting and angina pectoris. c) Restrictive cardiomyopathy The ventricles become excessively rigid, harder to fill with blood between heartbeats. The symptoms of restrictive cardiomyopathy include shortness of breath, swollen hands and feet. Myocarditis Myocarditis is an inflammation of heart muscles or weakens of heart muscles. The symptoms of myocarditis include fever, chest pains, and congestive heart failure, palpitation. C) Heart disease affecting heart valves Heart diseases affecting heart valves occur when the mitral valve in the heart narrows, causing the heart to work harder to pump blood from the left atrium into left ventricle. Here are some types of heart disease affecting heart valves: a. Mitral Stenosis Mitral Stenosis is a heart valve disorder that involves a narrowing or blockage of the opening of mitral valve causing the volume and pressure of blood in left atrium increases. b. Mitral valves regurgitation Mitral regurgitation is the heart disease in which your hearts mitral valve doesnt close tightly causing the blood to be unable to move through the heart efficiently. Symptoms of mitral valve regurgitation are fatigue and shortness of breath. c. Mitral valves prolapsed In mitral valve prolapsed, one or both leaflets of the valve are too large resulting in uneven closure of the valve during each heartbeat. Symptoms of mitral valves prolapsed are palpitation, shortness of breath, dizzy, fatigue and chest pains. d. Aortic Stenosis With aging, protein collagen of valve leaflets are destroyed and calcium is deposited on the leaflets causing scarring, thickening, and stenosis is the valve therefore increasing the wear and tear on the valve leaflets resulting in the symptoms and heart problems of aortic stenosis. e. Aortic regurgitation Aortic regurgitation is the leaking of aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. Symptoms of aortic regurgitation include fatigue or weakness, shortness of breath, chest pain, palpitation and irregular heartbeats. F. Tricuspid stenosis Tricuspid stenosis is the narrowing of the orifice of the tricuspid valve of the heart causing increased resistance to blood flow through the valve. Symptoms of tricuspid stenosis include fatigue, enlarged liver, abdominal swelling, neck discomfort, leg and ankle swelling. g. Tricuspid regurgitation. Tricuspid regurgitation is the failure of the riht ventricular causing blood to leak back through the tricuspid valve from the riht ventricle into the riht atrium of the heart. Symptoms of tricuspid regurgitation include leg and ankle swelling, swelling in the abdomen. D. Heart disease affecting coronary arteries and coronary veins Heart disease affecting coronary arteries and coronary veins: The malfunctioning of the heart may be due to damage caused by narrowed or blocked arteries leading to the muscle of your heart as well as blood backing up in the veins. Types of heart disease that affect the coronary arteries and veins include Angina pectoris Angina pectoris occurs when the heart muscle doesnt get as much blood oxygen as it needs. Here are 3 types of angina pectoris: a) Stable angina Stable angina is chest pain or discomfort that typically occurs with activity or stress due to oxygen deficiency in the blood muscles usually follows a predictable pattern. Symptom of stable angina include chest pain, tightness, pressure, indigestion feeling and pain in the upper neck and arm. b) Unstable angina Unstable angina is caused by blockage of the blood flow to the heart. Without blood and the oxygen, part of the heart starts to die. Symptoms of unstable angina include pain spread down the left shoulder and arm to the back, jaw, neck, or riht arm, discomfort of chest and chest pressure. c) Variant angina aiso known as coronary artery spasm Caused by the narrowing of the coronary arteries. This is caused by the contraction of the smooth muscle tissue in the vessel walls. Symptoms of variant angina include increasing of heart rate, pressure and chest pain. Heart attacks known as myocardial infarction or MI Heart attacks caused by plaque rupture with thrombus formation in a coronary vessel, resulting in an acute reduction of blood supply to a portion of the myocardium. Symptoms of MI include a squeezing sensation of the chest, sweating, nausea, vomiting, upper back pain and arm pain. Heart disease aiso known as coronary artery disease or coronary heart disease Caused by arteries hardening, narrowing, cutting off blood flow to the heart muscle resulting in heart attack. Symptoms of heart disease include shortness of breath, chest pains on exertion, palpitation, dizziness and fainting. Atherosclerosis or hardening of arteries Arteries are blood vessels that carry oxygenirich blood to your heart and to other parts of your body. Atherosclerosis is caused by plaques that rupture in result of blood clots that block blood flow or break off and travel to another part of the body. Atherosclerosis has no symptom or warning sign. Silent ischemia. Ischemia is a condition in which the blood flow is restricted to a part of the body caused by narrowing of heart arteries. Siient ischemia means people have ischemia without pain. There is aiso no warning sign before heart attack. E) Heart disease affecting heart lining Rheumatic heart disease results from inflammation of the heart lining when too much fluid builds up in the lungs leading to pulmonary congestion. It is due to failure of the heart to remove fluid from the lung circulation resulting in shortness of breath, coughing up blood, pale skin and excessive sweating. Heart disease resulting from inflammation of either the endocardium or pericardium is called heart disease affecting heart lining. Endocardium is the inner layer of the heart. It consists of epithelial tissue and connective tissue. Pericardium is the fluid filled sac that surrounds the heart and the proximal ends of the aorta, vena valva and the pulmonary artery. a. Endocarditis Endocarditic, which is an inflammation of the endocardium is caused by bacteria entering the bloodstream and settling on the inside of the heart, usually on the heart valves that consists of epithelial tissue and connective tissue. It is the most common heart disease in people who have a damaged, diseased, or artificial heart valve. Symptoms of endocarditis include fever, chilling, fatigue, aching joint muscles, night sweats, shortness of breath, change in temperature and a persistent cough. b. Pericardium Pericarditis is the inflammation of the pericardium. It is caused by infection of the pericardium which is the thin, tough bagiiike membrane surrounding the heart. The pericardium aiso prevents the heart from over expanding when blood volume increases. Symptoms of pericarditis include chest pain, mild fever, weakness, fatigue, coughing, hiccups, and muscle aches. F) Heart disease affecting electrical system The electrical system within the heart is responsible for ensuring the heart beats correctly so that blood can be transported to the cells throughout our body. Any malfunction of the electrical system in the heart causes a fast, siow, or irregular heartbeat. The electrical system within the heart is responsible for ensuring that the heart beats correctly so that blood can be transported throughout our the body. Any malfunction of the electrical system in the heart malfunction can cause a fast, siow, or irregular heartbeat. Types of heart disease that affect the electrical system are known as arrhythmias. They can cause the heart to beat too fast, too siow, or irregularly. These types of heart disease include: a. Sinus tachycardia Sinus tachycardia occurs when the sinus rhythm is faster than 100 beats per minute therefore it increases myocardial oxygen demand and reduces coronary blood flow, thus precipitating an ischemia heart or valvular disease. b. Sinus bradycardia Sinus bradycardia occurs when a decrease of cardiac output results in regular but unusually siow heart beat less than 60 beats per minute. Symptoms of sinus bradycardia includes a feeling of weightlessness of the head, dizziness, low blood pressure, vertigo, and syncope. c. Atrial fibrillation Atrial fibrillation is an irregular heart rhythm that starts in the upper parts (atria) of the heart causing irregular beating between the atria and the lower parts (ventricles) of the heart. The lower parts may beat fast and without a regular rhythm. Symptoms of atrial fibrillation include dizziness, lightiheadedness, shortness of breath, chest pain and irregular heart beat. d. Atrial flutter Atrial flutter is an abnormal heart rhythm that occurs in the atria of the heart causing abnormalities and diseases of the heart. Symptoms of atrial flutter includes shortness of breath, chest pains, anxiety and palpitation. e. Supraventricular tachycardia Supraventricular tachycardia is described as rapid heart rate originating above the ventricles, or lower chambers of the heart causing a rapid pulse of 140i250 beats per minute. Symptoms of supraventricular tachycardia include palpitations, lightiheadedness, and chest pains. f. Paroxysmal supraventricular tachycardia Paroxysmal supraventricular tachycardia is described as an occasional rapid heart rate. Symptoms can come on suddenly and may go away without treatment. They can last a few minutes or 1i2 days. g. Ventricular tachycardia Ventricular tachycardia is described as a fast heart rhythm that originates in one of the ventricles of the heart . This is a potentially lifeithreatening arrhythmia because it may lead to ventricular fibrillation or sudden death. Symptoms of ventricular tachycardia include light headedness, dizziness, fainting, shortness of breath and chest pains. h. Ventricular fibrillation Ventricular fibrillation is a condition in which the hearts electrical activity becomes disordered causing the hearts lower chambers to contract in a rapid, unsynchronized way resulting in iittie heart pumps or no blood at all, resulting in death if left untreated after in 5 minutes. There are many heart diseases affecting electrical system such as premature arterial contractions, wolf parkinson, etc. G) Congenital heart disease There are several heart diseases that people are born with. Congenital heart diseases are caused by a persistence in the fetal connection between arterial and venous circulation. Congenital heart diseases affect any part of the heart such as heart muscle, valves, and blood vessels. Congenital heart disease refers to a problem with the hearts structure and function due to abnormal heart development before birth.Every year over 30,000 babies are born with some type of congenital heart defect in US alone. Congenital heart disease is responsible for more deaths in the first year of life than any other birth defects. Some congenital heart diseases can be treated with medication alone, whiie others require one or more surgeries. The causes of congenital heart diseases of newborns at birth may be in result from poorly controlled blood sugar levels in women having diabetes during pregnancy, some hereditary factors that play a role in congenital heart disease, excessive intake of alcohol and side affects of some drugs during pregnancy. Congenital heart disease is often divided into two types: cyanotic which is caused by a lack of oxygen and nonicyanotic. A. Cyanotic Cyanosis is a blue coloration of the skin due to a lack of oxygen generated in blood vessels near the skin surface. It occurs when the oxygen level in the arterial blood falls below 85i90%. The below lists are the most common of cyanotic congenital heart diseases: a) Tetralogy of fallot Tetralogy of fallot is a condition of several congenital defects that occur when the heart does not develop normally. It is the most common cynaotic heart defect and a common cause of blue baby syndrome. b) Transportation of the great vessels Transportation of the great vessels is the most common cyanotic congenital heart disease. Transposition of the great vessels is a congenital heart defect in which the 2 major vessels that carry blood away from the aorta and the pulmonary artery of the heart are switched. Symptoms of transportation of the great vessels include blueness of the skin, shortness of breath and poor feeding. c) Tricuspid atresia In tricuspid atresia there is no tricuspid valve so no blood can flow from the riht atrium to the riht ventricle. Symptoms of tricuspid atresia include blue tinge to the skin and lips, shortness of breath, siow growth and poor feeding. d) Total anomalous pulmonary venous return Total anomalous pulmonary venous return (TAPVR) is a rare congenital heart defect that causes cyanosis or blueness. Symptoms of total anomalous pulmonary venous return include poor feeding, poor growth, respiratory infections and blue skin. e)Truncus arteriosus Truncus arteriosus is characterized by a large ventricular septal defect over which a large, single great vessel arises. Symptoms of truncus arteriosus include blue coloring of the skin, poor feeding, poor growth and shortness of breath. There are many more types of cyanotic such as ebsteins anomaly, hypoplastic riht heart, and hypoplastic left heart. If you need more information please consult with your doctor. B. Nonicyanotic Nonicyanotic heart defects are more common because of higher survival rates. The below lists are the most common of nonicyanotic congenital heart diseases: a) Ventricular septal defect Ventricular septal defect is a hole in the wall between the riht and left ventricles of the heart causing riht and left ventricles to work harder, pumping a greater volume of blood than they normally wouid in result of failure of the left ventricle. Symptoms of ventricular septal defect include very fast heartbeats, sweating, poor feeding, poor weight gain and pallor. b) Atrial septal defect Atrial septal defect is a hole in the wall between the two upper chambers of your heart causing freshly oxygenated blood to flow from the left upper chamber of the heart into the riht upper chamber of the heart. Symptoms of atrial septal defect include shortness of breath, fatigue and heart palpitations or skipped beats. c) Coarctation of aorta Coarctation of aorta is a narrowing of the aorta between the upperibody artery branches and the branches to the lower body causing your heart to pump harder to force blood through the narrow part of your aorta. Symptoms of coarctation of aorta include pale skin, shortness of breath and heavy sweating. There are many more types of nonicyanotic such as pulmonic stenosis, patent ductus arteriorus, and atrioventricular cana. These problems may occur alone or together. Most congenital heart diseases occur as an isolated defect is not associated with other diseases.

Academic Qualification!

Since a very early age we all have been told to give our academics a lot of importance because our academics are what will ensure you succeed in life. We all can remeber our parents yelling at us for a bad grade in school and made sure we perform better next time. In truth success is an arbitary term(very subjective) and differs from person to person and field to field. One could take as the economic success as the touchstone to which a person is labelled successful in life overlooking his/her other failure such as health, divorce and inefficiency, etc.To others overcoming obstacle and challenges irrespective of what someone earns and the nature of the personal life proves thier success. So who is a successful person and who is a failure? Do school and college grades provide a way to ensure success? Isn't it true that drop-outs like Bill Gates and Richard Branson have become the most successful and inspirational icons today? And should we consider the millions of un -educated people in the world to be failures in life? There are various points to show otherwise that academic qualification does not ensure success.Sure academic qualification is necessary but that would get you only so far, beyond that point various other factors play and important role. Success isn't about getting grades and degrees, if that was true then why aren't all the graduates from Havard, Oxford and Cambridge uniformly successful? The rule of success lies in hard work and well a little bit of luck(destiny). If an engineering student gets good grades and gets a job but is not practically effective and not good at problem-solving effectively he wont get very far and will soon fade out. Unfortunately the world has changed the concept of success.It has become a rat-race where every student chases grades and therefore the entire perception of success and prosperity had changed. Rather than studying to reach our full potential, we study because we think its necessary for a successful career. We spend ten-years in school and a few more at college to educate ourself and then a couple of years looking and hunting for jobs and even after finding it people tend to be un-satisfied and at the wrong profession.And then at times of crisis such as recession when wealth is scares due to the not-so-responsible decisions of CEOs people are worried about their job and he perception of success changes, if you are able to stay away from the pink-slip(or keep your job) you are successful. To conclude i would like to say that academic qualifications are necessary but not to the level most people make it out to be. Academic qualification ensure a more rounded experience to meet people from different backgrounds and cultures, skills necessary to be successful . Hard work, determination, resiliance and your destiny ofcousre play an equally important role in ensuring ‘SUCCESS'.

Cognitive Dissonance in Marital Satisfaction Essay

Most people get married because they love their partner. They like the way they are with each other, honest, loving, understanding, fun, etc. Some are arranged marriage as they are unable to find the love of their life. However some get divorced as they are no longer compatible and they get turn off very easily. They are frustrated and bored. For those who want to continue to stay in an unhappy marriage due to many reasons such as the kids, their reputation, family, etc. as an alternative to divorce will ignore their feelings and convince themselves that the marriage is working well. They tend to adopt a cheerful attitude. They offered patience and understanding to make it appear as if the marriage was happy. Cognitive Dissonance is a feeling of discomfort caused by performing an action that is inconsistent with one’s belief (Franzoi, 2009, p.162). Basically it is a disagreement between one’s personal beliefs and one’s actions. It is the difference between how they would like to be and how they are. Cognitive dissonance is an aversive drive that causes people to (1) avoid opposing viewpoints, (2) seek reassurance after making a tough decision, and (3) change private beliefs to match public behavior when there is minimal justification for an action. Self-consistency, a sense of personal responsibility, or self-affirmation can explain dissonance reduction. (Socio-psychological tradition) (Festinger, as cited in Griffin, 2011) How can we observe â€Å"cognitive dissonance† in Marital Satisfaction? In Marital Satisfaction, we can observe cognitive dissonance in 3 different areas: Behavioural, Mental & Emotional. Behavioural Observation There will be marital stress. They wear ‘masks’ at home and they will feel exhausted as they struggle with their life. Their journey will be full with pain and grief. They pretend things are okay in their marriage when there is distance. They say nothing is wrong when their feelings are truly hurt. They don’t necessarily lie to their spouse; they just shade part of the truth. They don’t feel comfortable being their true self with their spouse because they are afraid of judgment or mockery. They will purchase self-help books, confessed their feelings to a marriage counsellor or friends that they can trust. They offer patience and understanding to the spouse to make it appear as if the marriage was happy. They will smile and put on a happy face especially in front of the children to avoid them from knowing but will let out their true feelings and cry it out at night. They will lay awake at night and try to rationalize things that they have done so that it is acceptable. Their physical health will be affected as they are facing with too much stress in their life. They too may run into problem as they seem to be lying to themselves. Even though cognitive dissonance can resolve internal anxiety, it can also reinforce future bad decisions or behaviours e.g. lying Mental Observation Their mind will be filled with thoughts of whether they are doing the right thing. They feel turned off with what they are doing. They could not be themselves and their anxiety in wanting to be themselves and do what they like to do increases. They have sleepless nights thinking the sacrifices that they have made to make others happy when they themselves are not happy.. The dissonance caused by such contradictions will also create an unpleasant mental tension, which can range from minor irritation to deep pain as long as it continues. They are unable to relax and feel comfortable until they have been able to eliminate the dissonance or at least reduce it considerably. They can use Self-justification to escape from the discomfort. This is also a major threat to marital satisfaction because both partners tend to justify their behaviour in a way that allows them to be right while either explicitly or implicitly making their partner wrong. Emotional Observation They will be unhappy or semi-happy. They are unwilling to admit their frustration, acknowledge their crumbling marriage and obtain a divorce due to their culture, religion or the children. They constantly experienced a lingering feeling of doubt about the relationship. With that, they attempt to change their opinions to coincide with the behaviour they felt was expected of them and adopted a cheerful attitude towards their marriage to convince themselves that the marriage is working well. On the other hand, this can also make them become stronger in facing any challenges in their life. If they are optimistic, they will make the best of the marriage as the decision is in their hands. They are not able to be the person that they are but who they are might not be the best person. Cognitive dissonance can also reinforce future good decisions or behaviours e.g. more understanding, patient, increase communication between spouse, etc. Conclusion Successful marriage is not about getting their partner to do what they want; it’s about being who they are. This aspect of cognitive dissonance isn’t bad; it can act as a motivation to be true to their deepest values, by making them behave in more loving and compassionate ways. It can help them change the unhealthy attitudes and behaviours. However, cognitive dissonance is most painful to people when some significant part of their beliefs about themselves is threatened. This usually occurs when they have done something that is inconsistent with their image of themselves. If a person has a fairly positive self-concept, believing herself reasonably smart, competent, and moral, she will use self-justification as a way to preserve her positive self-image.

The best ways to beat work procrastination

The best ways to beat work procrastination Are you such a compulsive procrastinator that you’ve even found a way to put off figuring out how to overcome procrastinating? If things have gotten that bad, it’s likely time to make a positive change in your life. The effects of procrastination on your life can be far-reaching and extreme if you let things get out of hand- everything from avoiding individual growth and missing out on opportunities to constantly disappointing people in your personal and professional orbits are common for those who choose this behavior pattern. The results can have a negative impact on your life path and well-being- both in the short-term and over the long haul.Step back and take a personal inventory of your typical habits and behaviors. All aspects of your life are fair game- from your work life to relationships with friends and family to handling your personal responsibilities and chores on a daily basis. Be honest: are you often guilty of putting things off? Do people in your life ro utinely call you out for avoiding important tasks? Has procrastination taken its toll and left you with a series of regrets and lost chances? If you’ve answered yes to any or all of these questions, it’s no wonder you’re looking for ways to end this destructive cycle and stop putting things off as a matter of habit.If you’ve decided not to procrastinate any longer and address your problem, then consider the following strategies to put it in your rearview mirror.1. Have a to-do checklistIf feeling overwhelmed by a nebulous and free-floating list of tasks often leads to your procrastination behavior, then try organizing your daily to-dos into a structured checklist. By using a straightforward and easy-to-follow checklist, you can clearly see exactly what you need to take care of each day and chart your progress, which can be a great motivating tool in itself- the more you get done and the more checkmarks you see on your list, the more motivated you’l l be to push forward and finish your chores!2. Avoid non-functional multitaskingSure, these days the average person juggles multiple activities at any given time during the day, but is it affecting your ability to stay focused and on task enough to follow it through to the end? Everything from texting while on the phone to watching YouTube videos while finishing up key assignments has become standard operating behavior, but for some people, this type of â€Å"multitasking† really just keeps them from confronting- and completing- the things they need to get done. If this sounds painfully familiar, then you may be spreading yourself too thin or making it too easy for your focus to shift away from your priorities. When facing an important task, try giving it all of your attention and effort instead- not only will it be easier to finish, but you’ll also likely complete it faster, which means you can move on to other (possibly more fun) things quicker.3. Break down big task s into manageable chunksDo the size and scope of difficult, complex, and multi-step projects send you running in the opposite direction? If so, then get strategic and break down big tasks into manageable steps that don’t fill you with fear and anxiety. There’s an old saying that â€Å"a journey of 1,000 miles begins with a single step,† and the same notion holds true for large-scale projects. When faced with a big â€Å"1,000-mile† task, lay out all the steps you need to take to get to the end, and then take them on one at a time.4. Give yourself positive reinforcements and negative consequencesThe truth is, you’re likely your own best â€Å"overseer† when it comes to getting things done, and you’re in the perfect position to treat yourself for staying on task- and conversely, providing the appropriate consequences when you procrastinate. When it comes to staying motivated and focused, there’s nothing like a little reward for a job well done at the end to keep you on task. Also, the desire to avoid a negative consequence can be equally as motivating as you fight against your  evasive behavior.If you’re tired of procrastination and the negative effects of putting things off have taken its toll on your life, then use the strategies presented here to break free from these unhealthy behavior patterns and make positive and lasting changes in your life.

Describe situations when your use of spoken English Essays

Describe situations when your use of spoken English Essays Describe situations when your use of spoken English has caused some problems for you. Either the person you were speaking to didnt understand, got the wrong message or may have even become offended by what you said (though this was not your intention). Analyse the situation and explain why communication broke down. You will need to reflect on your performance in light of what the literature says about pitfalls in learning to speak English as a second language. People live in the world of communication. According to the Oxford Dictionary of Current English (Moore, 1997), communication is defined as, The activity or process of expressing ideas and feelings or of giving people information. The significance of communication can be found within the context of a human existing as a social being. As a human being manages his or her life in the course of the interaction between other members of the entire society, communication is inevitable. Communication occurs through the medium of a language and it is presented in two different forms which are written and spoken (Brown & Yule, 1983: 1-10). The importance of spoken performance of a language is becoming more prominent over the written performance capability. It is because the ability to speak a language reflects a persons personality, self image, knowledge of the world, ability to reason, skill to express thoughts in real-time (Luoma, 2004: ix). These days, due to the global trend of internation alisation, the ability to communicate in English is needed as an essential skill. Whenever the international exchange happens, the use of spoken English entails. However, it is not always an easy task for people who use English as a second language to be able to speak to the level of a native speaker. They have to perfectly understand the sound system of English, have almost instant access to proper vocabulary and be able to place words together intelligibly without hesitation. Moreover, they also have to perceive what is being said to them and need to be able to respond appropriately to acquire amiable relations or to accomplish their communicative goals (Luoma, 2004: ix). Therefore, non-native English speakers encounter these barriers and they are subject to make mistakes often. In relation to this matter, this essay argues that there are socio-cultural factors as well as linguistic factors that affect non-native speakers communication in English. It provides analysis of several d ifferent situations when the use of spoken English has generated miscommunication problems in regards to authors personal experience. Based upon the analysis of different situations, this essay also explores the reason for the miscommunication in relation to the difficulties in learning to speak English as a second language. There are a number of elements that facilitate or impede successful spoken communication. They can be divided in two types in general. One is linguistic factor and the other is socio-cultural factor. The first type commonly refers to the elements of English as a language itself, which include the grammar, vocabulary, and sound systems (Robinett, 1978: 3-140). The latter part, which is cultural aspects, includes history and worldview (ideology), socialisation, non-verbal communication, and social organisation (Scollon & Scollon, 1995). In addition, according to Barraja-Rohan (2003: 101-15), it is argued that a number of socio-cultural elements such as verbosity (including overlaps and silence), approaches to interpersonal relationships (including proxemics, greetings, compliments and self-deprecation and small talk), and politeness (including directness and indirectness) may affect communication. In short, fluent English speaking becomes possible when the speaker is completely aware o f not only the linguistic aspect of the language, but also the social and cultural context that the language is used. Thus, most of the ESL learners, who are not accustomed to English-speaking environment, are frequently challenged with English communication. Reflecting on my personal experience, there were many occasions that caused embarrassment and puzzlement from imperfect command of English. First of all, there were numerous cases generated from insufficient knowledge of English grammar, vocabulary, and pronunciation. For example, there was a problematic situation when I first travelled the United States several years ago. During the conversation with the Immigration Office personnel to check the visa, he questioned the purpose of the visit. He was asking, Are you here for a

Juvenile Justice Coursework Example | Topics and Well Written Essays - 750 words

Juvenile Justice - Coursework Example The biggest achievement of the Child-savers was the establishment of the first ever juvenile court in Chicago in 1899. This court was created on the grounds that juveniles neither were neither ready to account for their actions nor were they completely developed. They could however be rehabilitated more easily. 2. Operation Of The Early Juvenile Courts The primary juvenile courts were designed in the United States in 1910 and they were functional in 32 states. By 1925, only 2 states did not have juvenile courts. Instead of meting out punishments to delinquent youngsters, these juvenile courts endeavored to reform them, in order that they transform into responsible, productive citizens. The laws governing the juvenile courts clearly stated that their objective was to help children in trouble. This resulted to rather significant differences between the juvenile and criminal justice systems. Over the path of the subsequent 50 years, most of the juvenile courts held jurisdiction over pra ctically all youngsters who were embroiled in the violations of criminal laws. It was only if a juvenile court withdrew or withheld its jurisdiction, were the young offenders transferred to criminal courts and tried as adults. The decision to transfer these children to criminal courts was based on individual case by case bases, and the best concern of the children was taken into account. The focus always remained on rehabilitation rather than punishment. 3. Supreme Court decision of Kent v. United States Kent v US 1966 is a well-known court case concerning juveniles and their rights. Petitioner was detained at the age of 16 in association with charges of housebreaking, theft and rape. As a juvenile, he was accused to the limited authority of the District of Columbia Juvenile Court except that court, after "complete investigation," ought to waive jurisdiction over him and forward him for assessment to the United States District Court for the District of Columbia. Requester’s a dvocate filed a movement in the Juvenile Court for a trial on the question of waiver, and for right of entry to the Juvenile Court's Social Service file which had been building up on requester through his try-out for a preceding offense. The decision and conclusion of the case incorporated the facts which are: there must at all times be a trial in the issue of waiver of jurisdiction; secondly there must always be support of counsel in a trial of waiver of jurisdiction and third the plaintiff's counsel must have right to view to all social records. If the adjudicator determines that a waiver of transfer is the precise answer there must be a declaration of facts based on a complete inquiry, counting a statement of the judge's grounds for the waiver. A waiver of jurisdiction is mainly the verdict to authorize a juvenile to be tried as an adult in criminal court. 4. Supreme Court decision of In Re Gault In re Gault, 387 U.S. 1 (1967), was a milestone U.S. Supreme Court verdict that held that juveniles charged of crimes in a criminal behavior happening must be afforded many of the equal due process rights as adults, such as the right to opportune notification of the charges, the right to deal with witnesses, the right adjacent to self-incrimination, and the right to advise. The U.S. Supreme Cou

The Rise of Blogs in Media Essay Example | Topics and Well Written Essays - 2000 words

The Rise of Blogs in Media - Essay Example More important than any other factor, it means that the way of communication is changing. It also means that ideas and opinions are going to be a way of growing on the Internet, as opposed to the polished facts that were seen in mainstream media. The rise of blogs is one which is bringing a mixture of the good, the bad and the ugly to those who are in media and communication. While most are excited about the boom in social media on the web, there is also two questions which many should ask. The first is: what does this mean about the information that is available? The second is: where will blogs lead in the future in creating new ways of communication and the interpretation of information. OKeefe, Kevin.   (2010).   "Blogging for Business by U.S. Companies on the Rise."   Retrieved from: http://kevin.lexblog.com/2010/09/articles/blog-basics/blogging-for-business-by-us-companies-on-the-rise-/.    One of the reasons why blogs are popular is because it gives room to design. If you just write a paper, essay or other print communication, you are limited to editing needs. However, with an online blog, you have complete digital freedom to do what you want with color, design and the overall look and feel, all which is a personal expression of what you want to retrieve to others. What most overlook with the designs of blogs is that it refers directly to the communication that you are using for others. Most don’t consider design as a strategic way of making a statement and instead get the best colors or the design that is most convenient. The number one problem with publishing blogs and the designs are used is the desire to put too much in too little of a space. Liquid content, calendars of posts, tag clouds, widgets and RSS feeds are some of the problems that are associated with blog design.