Health

Twenty years ago osteoporosis was a word used mainly by researchers and physicians. Over the past few years, there has been an explosion of information about this condition that can cause severe pain and crippling. No cure is known yet, but ways to lessen your potential for osteoporosis have been identified. Today, one in three Americans are 50 or older. The baby boom generation will begin to enter their retirement shortly after the turn of the century that is rapidly approaching.

Thanks in part to medical advances and the emphasis on exercise and healthy diets, vast numbers of these baby boomers can expect to reach their eighties, nineties, and beyond. Yet, if present day trends unhealthy eating and lack of exercise continues, osteoporosis threatens to be one of the biggest public health dangers of modern times. Osteoporosis, literally meaning porous bone, is a disease of the skeleton in which the amount of calcium present slowly decreases to the point where the bones become extremely brittle and subject to fractures. The skeleton serves two functions.

It provides structural support for organs and muscles and also serves as a depository for the bodys calcium and other minerals, manly phosphorous and magnesium. The bone holds 99% of the bodys calcium. The other 1-% of remaining calcium is freed to circulate in the blood and is essential for crucial functions in the body such as blood clotting, muscle, contractions and nerve functions. Bones have two main sections. The outer section of the bone is the cortical bone. It is composed of a hard shell that serves to protect the other section of the bone, called the trabecular bone.

This part of the bone is an inner lacy, structural matrix of calcium that helps support the bone structure. Bone tissue is constantly being broken down and reformed to help the body cope with everyday stress and for maintaining a properly functioning body. The breakdown of the bones is called resorption and is performed by cells known as osteoclasts that did holes into the bone allowing calcium to be released into the body. Then, cells produced by the bone called osteoblasts help rebuild the bone.

The osteoblasts first fill in these holes left by the osteoclasts with collagen and then by laying down crystals of calcium and phosphorous. A complex mix of hormones and chemical factors controls this osteoclast-osteoblast balance. The trabecular and cortical parts of the bone both give off calcium to the body when it is needed, but as aging progresses the amount slowly declines. The rebuilding of bones makes them denser until about the age of 35 and peak period of bone mass building is somewhere between the ages of 25 to 35. After the age of 35, the body becomes slower and slower in replenishing bone as time goes on.

Osteoporosis develops when bone resorption occurs too quickly or if formation occurs too slowly. Because weakened bones, an increased susceptibility to fractures of the hip characterize osteoporosis, spine, and wrist are prevalent. Doctors have identified two types of osteoporosis that correlate with specific types of fractures. Type I osteoporosis, often referred to, as post enopausal osteoporosis, is most associated with wrist and spine fractures. Type II osteoporosis, also called senile osteoporosis, is generally attributed to reduced calcium by old age and causes mainly hip fractures.

There are more than 300,000 hip fractures, 300,000 wrist fractures, and over 700,000 spinal fractures in the US each year (Peck and Avioli 19). Osteoporosis causes more than 1. 5 million fractures each year and the cost to the healthcare system for these fractures is over 13. 8 billion dollars per year, greater than the cost for congestive heart failure and asthma. Of the individuals who fractured a hip, one-half will be permanently disabled, 20% will require long-term nursing care, and 20% of hip fracture victims die within a year, usually from complications caused by surgery.

Hip fractures are responsible for about 65,000 deaths per year in the United States. Hence, osteoporosis represents a major public health problem. There is no single cause of osteoporosis, and it seems that there are many factors that contribute to the disease. Some people are more prone to develop osteoporosis than others are. Factors that increase the likelihood of developing osteoporosis can be separated into controllable and uncontrollable factors. Uncontrollable factors include age, sex, body frame, and race.

The longer a person lives, the greater their chance is in developing osteoporosis. Osteoporosis is associated with age because bone mass begins to decline after it peaks at about the age of 35. The more years that passes the more loss of bone increases. Roughly estimating, people lose 10% of bone mass per year (24). As people grow older they also become less physically active, and this assist in bone loss. Also, other changes occur with age that can affect out ability to absorb calcium. The skin and kidney do not make Vitamin D with the same efficiency as they do in youth.

This affects the ability to absorb calcium from the diet or from supplements. A decline in stomach acid after the age of 60 may also affect the ability of the body to absorb calcium. Another risk factor for osteoporosis is sex. Women are four times as likely to develop osteoporosis than men are. One reason is that woman generally have thinner, lighter bones then men do. Also, the rapid loss of estrogen women experience after menopause can be contributed to osteoporosis. Estrogen protects the body against bone loss.

Women with regular menstrual periods are exposed to healthy levels of estrogen from puberty to menopause. Around the time of menopause though, the levels of estrogen sharply declines. Early menopause or surgically induced menopause, such as a hysterectomy, can increase a womans likelihood of developing osteoporosis because the protective effect of estrogen is lost. Another contribution of sex to osteoporosis is t women live longer then men do, which gives them more time to develop weaker bones. Race is also a risk factor of osteoporosis.

Caucasians and Asians have a higher risk of osteoporosis than African-Americans and Hispanics do. African-Americans in the US ave heavier and larger bones than Caucasians, although the reason for this is unknown. (33). Controllable risk factors for osteoporosis includes lack of calcium, lack of physical activity, cigarette smoking, and alcohol and caffeine intake. Lack of calcium is one of the great cause of osteoporisisCalcium is needed to build strong bones during childhood and early adult hood, and to prevent losses thereafter.

Studies have linked an inadequate amount of calcium intakes appear to be associated with low bone mass, rapid bone loss, and high fracture rates (Germano 99). Today, many people consume less than half of the amount of calcium recommended to build and maintain healthy bones. Calcium needs change during ones lifetime. The bodys demand for calcium is greater during childhood and adolescence when the skeleton is growing rapidly. Pregnant and lactating woman also need increased calcium, as do postmenoptusal woman and older men and women.

Good sources of calcium include low fat dairy products such as milk, cheese, and yogurt, dark green leafy vegetables like broccoli, collard greens, and spinach and other foods fortified with calcium like orange juice, cereals and bread. Lack of physical activity is another controllable factor. Bone is a living tissue that responds like muscles to exercise. Individuals who are inactive, immobilized, or bedridden for a long time are at higher risk. Weight bearing exercises such as walking, running, tennis, and other exercises that cause muscle to work against the force of gravity play an important role in preventing bone loss.

Therefore, resumption of physical activity is an important factor in building bone and preventing bone loss. Other risk factors are smoking, alcohol, and caffeine. A high intake of caffeine-containing foods, such as coffee, is thought to increase the amount of calcium eliminated in the urine (Bonnick 59). For individuals who have osteoporosis, a comprehensive treatment program includes a focus on nutrition, exercise, and safety issues to prevent falls that may result in fractures.

In addition, medications may be prescribed to slow or stop bone loss, or increase bone density. Currently the U. S. Food and Drug Administration for the treatment of postmenopausal osteoporosis approve estrogen, calcitonin, and alendronate. Estrogen, reloxifene and alendronate are approved for the prevention of the disease. While osteoporosis can be prevented and treated, there is, as of now, no cure. Prevention is the only way to avoid this disease and its debilitating consequences. Yet millions of Americans are not actively protecting themselves against osteoporosis.

Over the past decade, important information has slowly been uncovered about the causes of osteoporosis and the ways to prevent it. One of the most significant findings is that osteoporosis in not an inevitable part of growing older. One of the great myths associated with this disease is that as people age, they are all susceptible to suffering fractures or to becoming stooped over. This major misconception that causes individuals to overlook their risk and to avoid taking the necessary steps to prevent and treat osteoporosis.

Osteoporosis: a condition characterized by an absolute decrease in the amount of bone present to a level below which it is capable of maintaining the structural integrity of the skeleton. To state the obvious, Human beings have evolved under Earth’s gravity “1G”. Our musculoskeleton system have developed to help us navigate in this gravitational field, endowed with ability to adapt as needed under various stress, strains and available energy requirement.

The system consists of Bone a highly specialized and dynamic supporting tissue which provides the vertebrates its rigid infrastructure. It consists of pecialized connective tissue cells called osteocytes and a matrix consisting of organic fibers held together by an organic cement which gives bone its tenacity, elasticity and its resilience. It also has an inorganic component located in the cement between the fibers consisting of calcium phosphate [85%]; Calcium carbonate [10%] ; others [5%] which give it the hardness and rigidity.

Other than providing the rigid infrastructure, it protects vital organs like the brain], serves as a complex lever system, acts as a storage area for calcium which is vital for human metabolism, houses the bone marrow within its mid cavity and o top it all it is capable of changing its architecture and mass in response to outside and inner stress. It is this dynamic remodeling of bone which is of primary interest in microgravity.

To feel the impact of this dynamicity it should be noted that a bone remodeling unit [a coupled phenomena of bone reabsorption and bone formation] is initiated and another finished about every ten seconds in a healthy adult. This dynamic system responds to mechanical stress or lack of it by increasing the bone mass/density or decreasing it as per the demand on the system. eg; a person dealing with increased mechanical stress will respond with ncreased mass / density of the bone and a person who leads a sedentary life will have decreased mass/density of bone but the right amount to support his structure against the mechanical stresses she/she exists in. Hormones also play a major role as seen in postmenopausal females osteoporosis (lack of estrogens) in which the rate of bone reformation is usually normal with the rate of bone re-absorption increased.

In Skeletal system whose mass represent a dynamic homeostasis in 1g weight- bearing,when placed in microgravity for any extended period of time requiring practically no weight bearing, the regulatory system of bone/calcium reacts by ecreasing its mass. After all, why carry all that extra mass and use all that energy to maintain what is not needed? Logically the greatest loss -demineralization- occurs in the weight bearing bones of the leg [Os Calcis] and spine. Bone loss has been estimated by calcium-balance studies and excretion studies.

An increased urinary excretion of calcium , hydroxyproline & phosphorus has been noted in the first 8 to 10 days of microgravity suggestive of increased bone re-absorption. Rapid increase of urinary calcium has been noted after takeoff with a plateau reached by day 30. In contrast, there was a teady increase off mean fecal calcium throughout the stay in microgravity and was not reduced until day 20 of return to 1 G while urinary calcium content usually returned to preflight level by day 10 of return to 1G.

There is also significant evidence derived primarily from rodent studies that seem to suggest decreased bone formation as a factor in hypogravitational osteoporosis. Boy Frame,M. D a member of NASA’s LifeScience Advisory Committee [LSAC] postulated that “the initial pathologic event after the astronauts enter zero gravity occurs in the bone itself, and that changes in mineral homeostasis and the calcitropic ormones are secondary to this. It appears that zero gravity in some ways stimulate bone re-absorption, possibly through altered bioelectrical fields or altered distribution of tension and pressure on bone cells themselves.

It is possible that gravitational and muscular strains on the skeletal system cause friction between bone crystals which creates bioelectrical fields. This bioelectrical effect in some way may stimulate bone cells and affect bone remodeling. ” In the early missions, X-ray densitometry was used to measure the weight-bearing bones pre & post flight. In the later Apollo, Skylab and Spacelab issions Photon absorptiometry (a more sensitive indicator of bone mineral content) was utilized.

The results of these studies indicated that bone mass [mineral content] was in the range of 3. % to 8% on flight longer than two weeks and varying directly with the length of the stay in microgravity. The accuracy of these measurements have been questioned since the margin of error for these measurements is 3 to 7% a range being close to the estimated bone loss. Whatever the mechanism of Hypogravitational Osteoporosis, it is one of the more serious biomedical hazard of prolonged stay in microgravity. Many forms of weight loading xercises have been tried by the astronauts & cosmonauts to reduce the space related osteoporosis.

Although isometric exercises have not been effective, use of Bungee space suit have shown some results. However use of Bungee space suit [made in such a way that everybody motion is resisted by springs and elastic bands inducing stress and strain on muscles and skeletal system] for 6 to 8 hrs a day necessary to achieve the desired effect are cumbersome and require significant workload and reduces efficiency thereby impractical for long term use other than proving a theoretical principle in preventing hypogravitational osteoporosis.

Skylab experience has shown us that in spite of space related osteoporosis humans can function in microgravity for six to nine months and return to earth’s gravity. However since adults may rebuild only two-third of the skeletal mass lost, even 0. 3 % of calcium loss per month though small in relation to the total skeletal mass becomes significant when Mars mission of 18 months is contemplated. Since adults may rebuild only two-thirds of the skeletal mass lost in microgravity, even short durations can cause additive effects.

This problem becomes even greater in females who are already prone to hormonal osteoporosis on Earth. So far several tudies are under way with no significant results. Much study has yet to be done and multiple experiments were scheduled on the Spacelab Life Science [SLS] shuttle missions prior to the Challenger tragedy. Members of LSAC had recommended that bone biopsies need to be performed for essential studies of bone histomorphometric changes to understand hypogravitational osteoporosis.

In the past, astronauts with the Right Stuff had been resistant and distrustful of medical experiments but with scientific personnel with life science training we should be able to obtain valid hard data. [It is of interest that in the SLS mission, two of the mission pecialists were to have been physicians, one physiologist and one veterinarian. ] After all is said, the problem is easily resolved by creation of artificial gravity in rotating structures. However if the structure is not large enough the problem of Coriolis effect must be faced.

To put the problem of space related osteoporosis in perspective we should review our definition of Osteoporosis: a condition characterized by an absolute decrease in the amount of bone present to a level below which it is capable of maintaining the structural integrity of the skeleton. In microgravity where locomotion consists mostly of swimming actions with stress eing exerted on upper extremities than lower limbs resulting in reduction of weight bearing bones of lower extremities and spine which are NOT needed for maintaining the structural integrity of the skeleton.

So in microgravity the skeletal system adapts in a marvelous manner and problem arises only when this microgravity adapted person need to return to higher gravitational field. So the problem is really a problem of re-adaptation to Earth’s gravity. To the groups wanting to justify space related research: Medical expense due to osteoporosis in elderly women is close to 4 billion dollars a year and significant work in this field lone could justify all space life science work.

It is the opinion of many the problem of osteoporosis on earth and hypogravity will be solved or contained, and once large rotating structures are built the problem will become academic. For completeness sake: Dr. Graveline, at the School of Aerospace Medicine, raised a litter of mice on a animal centrifuge simulating 2G and compared them with a litter mates raised in 1G. “They were Herculean in their build, and unusually strong…. ” reported Dr. Graveline. Also X-ray studies showed the 2G mice to have a skeletal density to be far greater than their 1G litter mates.

The anthrax vaccination is the only known defense available for United States Troops against the deadly anthrax virus. Many experts have said it is not effective against inhalation anthrax. Studies have not been conclusive in their findings. The chance of living if you have received the anthrax vaccination seems better. More studies should be conducted outside the Department of Defense, with their cooperation, before the process to vaccinate troops continues. Anthrax is a disease normally associated with plant eating animals (sheep, goats, and cattle) caused by the bacterium Bacillius anthracis.

It is now controlled through vaccination programs throughout the world including the United States. Human infection with anthrax usually results from contact with infected animals or products. Anthrax was discovered by Robert Koch in 1876. An effective vaccine for animals was developed in 1881 by Louis Pasteur. In humans, the disease appears in both external and internal forms. The external form is contracted through cuts and breaks in the skin. The internal form is caught by inhaling anthrax spores, which invade the lungs and intestinal tract (Funk and Wagnalls New Encyclopedia, 1996).

Russian scientists have created a new form of the anthrax virus by genetic engineering. Col. Arthur Friedlander , chief of the bacteriology division at the U. S. Army Medical Research Institute states, The evidence that they presented suggested that it could be resistant to our vaccine (Riechman, Army Times 03-09-98). When anthrax is used as a biological weapon, people become infected by breathing the spores released in the air. Anthrax is 100,000 times deadlier than the deadliest chemical warfare agent. It is the preferred biological agent because it is easy to produce in bulk and the materials are low in cost.

B. D. Hawkins,Army Times) Dr. Jose Ramero Cruz, of the World Health Organization states,Because anthrax spores are resistant to dryness and heat, they are relatively easy to grind and store. U. S. officials say that as many as 12 countries including Russia, Iraq, and North Korea, have established capabilities to produce and load deadly anthrax spores into weapons (D. Funk, Army Times, 3-19-98). An anthrax loaded scud missile could kill 100,000 people in an urban area according to a 1993 study, Proliferation of Weapons of Mass Destruction: Assessing the Risks, (J. Erlich, Army Times, 9-8-97).

No country is known to have released the biological agent during wartime. Anthrax has the potential to cover large areas of the battlefield. It is not known what branch of service, front line, or rear area troops would be at greater risks. Defense Secretary William Cohen stated, Anthrax is the poor mans atomic bomb (D. Funk, Army Times,1-12-98). The anthrax vaccine is used to protect against anthrax. It contains only dead organisms. Human vaccination was developed in England and the United States in the 1950s and early 1960s.

The vaccination was licensed and approved by the United States Food and Drug Administration in 1970. The vaccination is produced by Michigan Biologic Products Institute located in Lansing, Michigan. It has been administered to veterinarians, laboratory workers, and livestock handlers safely for over twenty five years (D. Funk, Army Times, 8-31-98). The anthrax vaccination prevents illness by stimulating the bodys natural disease fighting abilities. It has not been proven whether the vaccination will work against inhaled anthrax. The informational insert that usually comes with the vaccine could not be obtained.

I did find that according to the Michigan Department of Public Health in Lansing, Michigan there are no references for using the vaccine for inhaled anthrax (Joyce, AGWVA). Chairman of the Joint Chiefs of Staff, General Henry H. Shelton says we have stockpiled a safe and effective vaccine to protect our forces against anthrax (DefenseLINK a. , 18June98). There are many views and arguments to this statement. One that may not be resolved until further research can be done or anthrax is used against roops who have received the vaccination.

Almost all cases of inhalation anthrax in which treatment was started after symptoms began, have resulted in death, regardless of treatment afterwards. Being vaccinated greatly increases your chances of surviving an exposure to anthrax. Without the vaccination or protection (MOPP gear) it has a ninety-nine percent death rate to unprotected persons (PROMED (03) PRO/AH). From this point of view, it would beneficial to receive the vaccination. Since 1970, there have been no known long term side effects associated with the anthrax vaccination.

Reported side effects to the vaccine are mostly limited to local reactions. They include, sore arm, redness, and slight swelling at the injection site in 30 percent of recipients. Severe local reactions such as swelling that may extend from the elbow to the forearm are rare (Arnot Ogden Medical Center, 1998). Minor adverse reactions can include, but are not limited to flu like symptoms. Out of 133,870 immunizations, only seven (. 005 percent) severe reaction cases have been reported. Six were found to be minor effects and all service members were returned to duty.

Only one service member had a more severe illness (Guillain-Barre Syndrome) that occurred after receiving his third dose of anthrax vaccination. He began recovery one month after onset of the illness (D. Funk, Army Times, 8-31-98). No studies have been conducted to determine if the anthrax vaccination causes cancer, induces genetic mutation, impairs fertility, or causes fetal harm ( Joyce, AGWVA). Service members have already begun the immunization process against anthrax. Phase I of the immunization process began with all service members expected to be going to a high threat area on August 16, 1998. Those already in Korea will begin September 9,1998.

Service members serving in the Persian Gulf began in early March of 1998. About 48,000 have begun the series. Phase II will be for units first to deploy (XVIII Airborne Corps and subordinate units) in the event of a military incident. It is scheduled to begin in fiscal year 2000. Phase III will include the remaining forces and new recruits by fiscal year 2003. All 2,400,000 active duty, reserve, and national guard members will be vaccinated (D. Funk, Army Times,8-31-98).

All service members will be required to take the vaccination as stated in Department of Defense Directive 6205. 3 unless medically deferred. Some examples of soldiers who will be deferred are pregnant soldiers, and soldiers who are HIV positive. Family members will not be required to receive the vaccination and there is no plan to vaccinate them at this time. Withdrawing them from the region will be the first resort ( DefenseLINK a. 18JUN98). The majority of service members that have been required to receive the vaccination have done it.

Sixteen service members, 14 Navy, and 2 Air Force have refused to ake the vaccination. Two sailors have been discharged and the rest have received disciplinary action. A Fort Stewart, Georgia soldier is facing a probable discharge after choosing to go AWOL rather than take the required series of shots. It is conceivable that the number of refusals could rise when the program spreads to troops who dont feel an immediate threat said Secretary of Defense William H. Cowan (D. Funk, Army Times, 8-31-98). A total of six vaccinations will be administered in order for the series to be complete.

Three vaccinations will be given 2 weeks apart from each other initially. It will be followed by 3 additional vaccinations given at 6, 12, and 18 months. A booster shot annually will be given afterwards (ProMED(03), PRO/AH). While the entire vaccination series is 6 shots, military officials think it is possible service members dont need that many shots. Research to determine that is continuing, said Rear Admiral Michael Cowan, deputy director of medical readiness for the Joint Staff. Until we know for certain that it is safer to give fewer shots, well go with standardization, approved series,he said (D. Funk, Army Times, 8-31-98).

The cost to immunize an estimated 2,400,000 military personnel will be approximately 130,000,000 million dollars(DefenseLINK News 8-14-98). The estimated 130,000,000 dollars needed to vaccinate all active duty, reserve, and national guard forces against anthrax is wasted money, said Victor Sidel, a physician at the Albert Einstein College of Medicine in New York and co-president of International Physicians for the Prevention of Nuclear War, which won the Noble Peace Prize. It is a snare and delusion, said Sidel of troops taking the vaccination.

Theres very kind of evidence that this material is ineffective against the strains that are likely to be used. And there is evidence that the material causes adverse reactions (D. Reichman, Army Times, 3-9-98). In conclusion, the best believed defense available to the United States military is the anthrax vaccination. Studies against the vaccination have not been conclusive enough to persuade me to trust this vaccination 100 percent. It should be handed down to an independent research team outside the Department of Defense for further study. If the choice was mine to make today, I would not take the vaccination.

There are a number of ways in which the increasing socio-economic development of a nation can help improve the health of the population.

1. There is a correlation between mortality rates in the developing countries, especially amongst children, and the level of education of the parents of the children. For example, in Morocco, a mother who has completed 4-6 years of schooling, their child is 45% less likely to have died by the age of 2, compared with child’s mother who has had no school (Book 3, Page 54). Education improves the overall knowledge of looking after oneself and others, but also enables people to gain higher income levels, and thus, acquire purchasing power to buy the goods (if available), which will help them improve their quality of life.

2. Food provisions are a necessity to maintaining a healthy population. There are many facets to food, mainly the distribution and supply of food, and the quality and nutritional ingredients of food. Food needs to be of good, sustainable quality so that it provides people with the basic supply of vitamins and minerals to live, and has to be easily accessible so that everyone in the nation can benefit.

Developed countries have pioneered the way of preserving food for longer (i.e. use of plastics), and developing countries have benefited from this, but the developed world has also introduced new fear factors regarding food such as contamination (BSE, Salmonella etc) and additives, and, the long term effects of such advancements is beginning to materialise (Book 3, Page 306-307). Developing nations need to maintain a balance of growth, by producing enough food for the nations own consumption, but also growing food for exportation, which will improve their GNP and their overall growth as a nation.

3. Reducing the gap between the social classes will provide a better overall health and wealth of a nation. Those living in the lower social classes have a lower life expectancy than those in higher social classes (Book 3, Page 216). There are many tools and precautions that may be used to bridge the gap. Occupations within the social classes tend to be more manual and risk-based occupations such as mining or engineering. In recent times, Acts of Law have been passed by Governments to protect employees, and as such limit the risk involved in the work practices. By reducing the risk, the Government can enable the employees to work in a safe environment thus providing a longer and healthier work and social life.

Screening for Down syndrome is available to about 53. 5% of mothers on a maternal age basis, and the remaining 46. 5% of health boards provide serum screening for all ages. There are several methods used in prenatal screening, these are usually used separately, and a number of factors are taken into account to determine which method should be used. Amniocentesis has been around for 20 years and is probably the most well known screening method. It involves testing a sample of the amniotic fluid surrounding the foetus, ultrasound is used to guide a needle through the abdomen, into the womb and a small amount of amniotic fluid (20ml) is removed.

The procedure is usually carried out at 14-16 weeks. Amniocentesis tests for chromosome disorders, and is 99. 8% reliable for chromosome number, there is however a risk of miscarriage (usually 1/250 or less) after the procedure. This is one of the reasons why amniocentesis has only been offered to over 35’s (since they have a much higher risk of having a Down syndrome child)(Webb 1990). Previous studies on amniocentesis concentrated on problems that might arise during pregnancy or immediately after, these studies found that children whose mothers had amniocentesis are more likely to have breathing problems in the first few days after birth.

A study performed by Jo-Anne Finegan in Toronto followed 88 women who had, had amniocentesis, there was an increased incidence of ear infection in this group. Finegan tested the stiffness of the eardrum and found children in the amniocentesis group were more than three times as likely to have abnormal readings. It is thought that there is a disruption of the delicate balance of pressure across the eardrum when the amniotic fluid is removed, which could cause the problems(Webb 1990).

Chorionic villus sampling is another form of sampling, it involves taking a small piece of placenta and genetic testing is carried out on it, there is a slightly higher chance of foetal loss with this procedure (Dick 1996). A more recent form of prenatal testing involves serum markers. Blood is taken from the pregnant women and the maternal blood is tested for three hormones, this test is called the ‘triple screen’ test. The three hormones tested are alpha foeto-protein (AFP), human chorionic gonadotrophin (HCG) and oestradiol (E3).

AFP is based on the fact that Down syndrome foetuses tend to be smaller on average, have smaller placentas and thus secrete less AFP. All three hormones can be tested individually, but are not so reliable this way. AFP results detect 20%-25% if carried out alone (Cuckle 1984), tests combining more than one measure detected 48%-91%. A study using AFP and HCG detected 90% of cases in women over 35 and 43% in women under 30, it also found that detection rates were better when the test was performed before week 17 (Gouldie et al 1995).

Prenatal sonography looks at the foetus using ultrasound, by measuring the iliac angle in the pelvis the risk of Down syndrome can be measured. A study performed shows that the mean iliac angle is 60o for normal foetuses and 75o in foetuses with Down syndrome, by measuring the iliac angle in foetuses the liklihood of Down syndrome can be worked out, for example if the iliac angle is 50o the liklihood is 1/588 of the foetus having trisomy 21, if however the angle is 80o then the chance is 1/50. This type of prenatal testing although not as reliable as amniocentesis is much safer.

Saridogan et al 1996 pointed out a number of reasons why Down syndrome may not be detected, first of all women may decline the test, this may be due to ignorance of the test or to cultural/religous reasons. Another reason may be due to the late presentation of the woman, as stated above testing before week 17 gives the best results. The triple test is not 100% reliable, there are incidences when there is a negative test, and the child is born with Down syndrome the reason for this is not always known. Prenatal Screening Procedures In an uncomplicated pregnancy, expect about a dozen doctor visits

First VisitBlood tests: To check the woman’s blood group and sometimes, to check for presence of hepatitis B virus, which might be transmitted to the baby. Cervical smear test: To test for an early cancer of the cervix (if a test has not been performed recently). Also called a Pap smear. First Visit and Throughout the PregnancyBlood tests: To check for anemia in the woman, and in women with Rh-negative blood groups, to look for the presence of Rhesus antibodies. Urine test: To check for proteinuria, which could indicate a urinary tract infection or preeclampsia. Blood and urine test: To check for diabetes mellitus.

Blood pressure check: To screen for hypertension, which interferes with blood supply to the placenta and is a sign of preeclampsia. First Visit and After ANY InfectionBlood tests: To screen for rubella, which can cause defects in the baby, and for syphilis and HIV (the AIDS virus) which can also be passed on. First 12 WeeksChorionic villus sampling: May be performed if there is a risk of certain genetic (inherited) disorders being passed on. 16 to 18 WeeksUltrasound scanning: Is carried out to date the pregnancy accurately and to detect any abnormalities present in the fetus.

Amniocentesis: Carried out on older women and those with spina bifida or Down’s syndrome to detect possible abnormalities in the fetus. Blood test: In some cases, the amount of alpha-fetoprotein in the blood is tested to determine whether the baby has spina bifida. Fetoscopy and fetal blood sampling: In some cases, these are carried out if there is doubt about the normality of the baby. High-risk or overdue pregnancies Blood and urine tests: To assess placental function and fetus health. Electronic fetal monitoring: To check on the fetal heart beat.

“Anemia can be defined as a decrease in the oxygen-carrying capacity of the blood caused by low hemoglobin concentration” (“A Practical Guide”, 1). “Cells in the body require oxygen to fully utilize fuels. The oxygen is transported from the lungs to tissues throughout the body via red blood cells. Oxygen binds to hemoglobin, a specific molecule within each red blood cell. This molecule consists of heme, which is a red pigment, and globin, which is a protein.

If the amount of functioning hemoglobin is reduced, a condition known as anemia arises” (“Anemia”, 1). “The anemia that may result can take many forms, including that caused by a low iron level (iron deficiency anemia), a vitamin deficiency (megaloblastic anemia), a thyroid deficiency, the premature destruction of red blood cells (hemolytic anemia), replacement of normal bone marrow cells by cancer cells or leukemia (myelophthisic anemia), injury to bone marrow (aplastic anemia), and inborn structural defect in red blood cells (e. g. ckle-cell anemia), inhibition of erythropoietin production by the immune system (anemia of chronic disease), and a normal or high iron level but an inability to manufacture hemoglobin or make use of the iron (sideroblastic anemia)” (“Anemia”, 2).

There are also several other less common types of anemia including: aplastic anemia, Thalassemia, acquired hemolytic anemia, inherited hemolytic anemia, sickle cell anemia, and anemia caused by miscellaneous factors (“Anemia”, 3-4). All of these different types of anemia can be grouped into categories according to their causes and treatments.

In all, more than 400 different forms of anemia have been identified, many of them rare. An anemic person often appears pale and weak and may feel breathless, faint or unusually aware of a pounding heart. The disorder may arise from a number of underlying conditions, some of which may be hereditary, but in many cases poor diet is to blame. Although some forms of anemia require supervised medical care, those stemming from improper nutrition can typically be treated at home once a physician has determined the cause”(“Anemia”, 1-2).

Anemia induced by poor nutrition encompasses a large part of the disease. It is important to investigate anemia related to nutrition, because it is a problem that is present in our lives and there is a lot of action we can take to prevent and treat this disease. The most common forms of nutritional anemia are iron-deficiency anemia, folic-acid deficiency anemia, and Pernicious anemia, which is commonly known as anemia caused by a vitamin B12 deficiency. There is an abundant amount of information available on the various types of nutritional anemia and treatments for those diseases.

International Nutritional Anemia Consultative Group was established in 1977 in response to the need for developing a worldwide awareness of the problem of nutritional anemia and the need for an infrastructure that could assist in dealing with this problem”(ilsi. org, 1). “The International Nutritional Anemia Consultative Group network provides consultative services and advice to operating and donor agencies seeking to reduce nutritional anemia and its accompanying adverse physiological consequences” (ilsi. org, 1).

Anemia is not itself a disease, rather it is a set of signs and symptoms which represent some other pathology. Because anemia affects oxygen transport, fuel utilization is affected. Thus a common symptom in mild anemia is fatigue. Other symptoms may include: shortness of breath pale skin, heart palpitations, noises in the ear, excessive thirst, weight loss, memory problems, or even jaundice, which is characterized by yellowish skin due to liver enzyme problems” (“Anemia”, 1)wellweb. “Because anemia is a hematologic (involving the blood) problem, the most basic testing involves a Complete Blood Count (CBC).

This can provide much of the needed information, including: a white blood cell count (cells important to fighting infection), and the hematocrit, which is the ratio of volume of the red blood cells (erythrocytes) divided by the complete blood volume. In addition, a blood smear is an important diagnostic test. As the name implies, this involves inspection of a sample of blood under the microscope to locate abnormalities within the structure of the cells. To be labeled anemia, the red blood cell count must be less than 4. 5 million/microliter for men, or less than 4 million/microliter for women. Normal levels are approximately 5. illion/microliter for men and 4. 8 million/microliter for women” (“Anemia, 1)wellweb.

“It’s fairly easy to recognize when a patient is anemic. Generally far more complex and costly-though it doesn’t have to be-is the task of defining precisely why the disorder exists. Yet an accurate diagnosis is essential for specific treatment to be started promptly” (Burns, 10). “Recent advances in blood-count automation, however, now enable the primary care practitioner to analyze the results of a complete blood count (CBC) and formulate a logical plan for diagnosing the cause of anemia with only a small number of inexpensive tests” (Burns, 10).

The condition of anemia can exist in three different ways including: decreased red-cell production, increased red-cell destruction, or loss of blood through hemorrhage. The three forms of nutritional anemia in this study are all a product of decreased red-cell production (Burns, 10-12). “The most common type of anemia is iron-deficiency anemia” (“Anemia”, 1). “Iron-deficiency is defined as anemia with biochemical evidence of iron deficiency” (Dreyfuss, background). “Iron deficiency anemia is the most common micro nutrient deficiency in the world today.

It impacts the lives of millions of woman and children contributing to poor cognitive development, increased maternal mortality and decreased work capacity. Yet with appropriate public health action, this form of micro nutrient malnutrition can be brought under control” (Dreyfuss, preface). “Iron deficiency anemia significantly impairs mental and psychomotor development in infants and children. Although iron deficiency can be reversed with treatment, the reversibility of the mental and psychomotor impairment is not yet clearly understood” (“Anemia and Iron status”, 1).

Although nutritional iron-deficiency has declined in industrialized nations, 500 to 600 million people (one-sixth of the world’s population) are still affected by this problem worldwide. Even in the U. S. , iron deficiency is the most prevalent nutritional deficiency” (“Anemia, 7) webmd. Iron deficiency anemia is characterized by an inadequate amount of red blood cells caused by a lack of iron. It’s very prevalent in less-developed countries, but is still considered to be a problem in developed countries (Dreyfuss, background).

This type of anemia is most prevalent in young children, ages 6-24 months, and in women of reproductive age. Older children, adolescents, adult men, and the elderly have also been found to have iron deficiency anemia (Dreyfuss, background). “Iron deficiency generally develops slowly and is not clinically apparent until anemia is severe even though functional consequences already exist” (Dreyfuss, background). “There are several main causes of the deficiency, including insufficient consumption of iron-containing foods, poor absorption of iron by the body, and loss of blood” (Mayo, 957).

Poverty, abuse, and living in a home with poor household conditions also place children at risk for iron deficiency anemia” (“Anemia and iron status”, 1). Iron-deficiency anemia is suspected to exist when blood smears show pale-colored and extremely small cells that are uneven in shape. After a blood smear yields these results, iron levels are checked. If they are low, physicians measure ferritin, which is a protein that binds iron. If ferritin levels are low, the diagnosis of iron-deficiency anemia is confirmed (“Anemia, 11)webmd.

A varied array of interventions exist that are designed to prevent and correct iron deficiency anemia. These include dietary improvement, fortification of foods with iron, iron supplementation, and other public health measures, such as helminth control” (Dreyfuss, 4). Supplementation of iron is one approach to treating this disease. “In many populations, the amount of iron absorbed from the diet is not sufficient to meet many individuals’ requirements. This is especially likely to be true during infancy and pregnancy, when physiological iron requirements are the highest.

If the amount of absorbable iron in the diet cannot be immediately improved, iron supplementation will be a necessary component of programs to control iron deficiency anemia” (Dreyfuss, 4). “Iron supplements are essential for the rapid treatment of severe iron deficiency anemia in all sex and age groups” (Dreyfuss, 4). “A daily protocol of iron supplementation is recommended for treatment and prevention in the priority target groups. Numerous studies have evaluated whether the frequency of iron supplementation can be reduced from daily to twice or once per week without compromising the efficacy of supplementation.

The efficacy of once-or twice-weekly supplementation in school-age children, adolescents, and nonpregnant women is promising, and the operational efficiency of intermittent dosing regimens if being evaluated. While research is ongoing to evaluate these regimens in different population groups, the current recommendation remains daily supplementation for young children and pregnant women” (Dreyfuss, 5). “In industrialized countries nutritional anemias have been reduced dramatically. Food fortification is the most beneficial preferred way of preventing nutritional anemia.

In developing countries food fortification programs have been demonstrated to be efficient, yet the incidence of nutritional anemia is high. Inadequate and poor quality of the diet, in conjunction with the high incidence of infection, are the most common immediate causes of nutritional anemias. These factors are linked to socioeconomic development. Long term reduction in the prevalence of nutritional anemias will not occur unless direct methods of control are complemented by improvements in socioeconomic conditions” (Haschke, 18-20).

Fortification of suitable food vehicles with absorbable forms of iron is a highly desirable approach to controlling iron deficiency. If a fortifiable food exists that is consumed by many people at risk of iron deficiency, fortification is likely to be the most cost-effective component of its control” (Dreyfuss, 5). “There are many possible strategies for iron fortification. One approach is to fortify a staple food that is consumed in significant quantities by most of the population” (Dreyfuss, 5).

In the Caribbean, South America, North America, and Great Britain this approach has been a success using wheat flour (Dreyfuss, 5-6). A second approach that has been a success, using fish sauce, curry powder, salt, and sugar, is the fortification of condiments that are frequently used (Dreyfuss, 6). Another method used to combat this type of anemia is diet improvement. “The amount of iron absorbed from the diet is highly dependent on the composition of the diet, namely, the quantities of substances that enhance or inhibit dietary iron absorption” (Dreyfuss, 6).

Foods rich in iron that your body can readily absorb include meats (especially liver), fish, poultry, eggs, legumes (peas and beans), potatoes, and rice” (Mayo, 957). “The highest sources of iron are in red meats, but also in chicken, seafood (notably cooked clams), dried peas and beans, dried fruits, dark leafy vegetables, molasses, wheat bran and wheat germ, oatmeal and soybean flour” (Blood disorders, 1). These food sources, along with Vitamin C-rich foods promote the absorption of iron (Dreyfuss, 6).

There are also foods that reduce your body’s ability to absorb iron: large quantities in the diet of bran, calcium, tea, excessive zinc and a compound called phytate (found in unleavened bread, unrefined cereals and soybeans) block the entry of iron into your digestive system. Spinach and lentils contain iron, but very little of it gets absorbed because these vegetables also contain phytate” (intelihealth, 2). Males require approximately one gram of iron each day. Pregnant, lactating, or menstruating women and growing children require approximately 1. 5 to 2 grams each day (Blood disorders, 1).

However, only about 10 percent of the iron you eat is actually absorbed by your body, so the average man would need to eat about 10 grams of iron per day. Your body absorbs iron in different quantities from different foods” (“Blood Disorders”, 1). “Eating plenty of iron-containing foods is particularly important for people who have high iron requirements, such as children and pregnant or menstruating women. It is also crucial for those whose diets are low in iron, including strict vegetarians, people on weight-reduction diets, and infants” (Mayo, 957).

Pneumonia and tuberculosis have been plaguing the citizens of the world for centuries causing millions of deaths. This occurred until the creation and use of antibiotics become more widely available. These two respiratory infections have many differences, which include their etiology, incidence and prevalence, and many similarities in their objective and subject indicators, medical interventions, course, rehabilitation and effects. To explore the relationship between pneumonia and tuberculosis we will examine a case study.

Joan is a 35 year old women who was feeling fine up till few weeks ago when she develop a sore throat. Since her sore throat she had been experiencing chest pain, a loss of appetite, coughing and a low fever so she went to visit her doctor. Her doctor admitted her to the hospital with bacterial pneumonia and after three days of unsuccessful treatment it was discovered that she actually had active tuberculosis. This misdiagnosis shows the similarities between the two diseases and how easily they can be confused.

Pneumonia Pneumonia is a serious infection or inflammation of the lungs with exudation and consolidation. Pneumonia can be one of two types: lobar pneumonia r bronchial pneumonia. Lobar pneumonia affects one lobe of a lung while bronchial pneumonia affects the areas closest to the bronchi (O’Toole, 1992). In the United States over three million people are infected with pneumonia each year; five percent of which die. Etiology There are over 30 causes for pneumonia however there are 4 main causes which are bacterial, viral, mycoplasma and fungal (American Lung Association, 1996).

Bacterial pneumonia attacks everyone from young to old, however “alcoholics, the debilitated, post-operative patients, people with respiratory isease or viral infections and people who have weakened immune systems are at greater risk” (American Lung Association, 1996). The Pneumococcusis bacteria, which is classified as Streptococcus pneumoniae, causes bacterial pneumonia and can be prevented by a vaccine. In 20 – 30% of the cases the infection spreads to the blood stream (MedicineNet, 1997) which can lead to secondary infections.

Viral pneumonia accounts for half of all pneumonia cases (American Lung Association, 1996) unfortunately there is no effective treatment because antibiotics do not affect viruses. Many viral pneumonia cases are a result of n influenza infection and commonly affect children, however they are not usually serious and last only a short time (American Lung Association, 1996). The “virus invades the lungs and multiplies, but there are almost no physical signs of lung tissue becoming filled with fluid. It finds many of its victims among those who have pre-existing heart or lung disease or are pregnant” (American Lung Association, 1996).

In the more severe cases it can be complicated with the invasion of bacteria that may result in symptoms of bacterial pneumonia (American Lung Association, 1996). During World War II mycoplasma were identified as the “smallest free- living agents of disease in humankind, unclassified as to whether bacteria or viruses, but having characteristics of both” (American Lung Association, 1996). Mycoplasma pneumonia is “often a slowly developing infection” (MedicineNet, 1997) that often affects older children and young adults (American Lung Association, 1996).

The other main cause of pneumonia is fungal pneumonia. This is caused by a fungus that causes pneumocystic carinii pneumonia (PCP) and is often “the first sign of illness in many persons with AIDS and can be successfully reated in many cases” (American Lung Association, 1996). In Joan’s case bacterial pneumonia was suspected because her immune system was weakened by her sore throat and her signs and symptoms correlated with pneumonia. Tuberculosis (TB) Tuberculosis was discovered 100 years ago but still kills three million people annually (Schlossberg, 1994, p. ).

Cases range from race and ethnicity. In 1990 the non-Hispanic Blacks had 9, 634 cases while the American Indians and Alaskan Natives had 371 cases (Galantino and Bishop, 1994). It is caused by bacteria called either Mycobacterium tuberculosis or Tubercle bacillus. Tuberculosis can infect any part of the body but is most often found in the lungs where it causes a lung infection or pneumonia.

Etiology There has been a resurgence of TB due to a number of factors that include: 1. the HIV / AIDS epidemic, 2. the increased number of immigrants, 3. he increase in poverty, injection drug use and homelessness, 4. poor compliance with treatment regiments and; 5. the increased number of residents in long term facilities (Cook & Dresser, 1995). The tuberculosis bacteria is spread through the air however transmission will only occur after prolonged exposure. For example you only have a 50% chance to become infected if you spend eight hours a day for six months with someone who has active TB (Cook & Dresser, 1995). The tuberculosis bacteria enters the air when a TB patient coughs, sneezes or talks and is then inhaled.

The infection can lie dormant in a person’s system for years causing them no problems however when their immune system is weakened it gives the infection a chance to break free. Types of TB Treatments Types of treatment will depend on whether the patient has inactive or active tuberculosis. To diagnose active TB the doctor will look at the patients’ ymptoms, and outcomes of the skin test, sputum tests, and chest x-rays. A person has active tuberculosis when their immune system is weakened and they start to exhibit the signs and symptoms of the disease.

They also have positive skin tests, sputum tests and chest x-rays. When this occurs the treatment is more intense. The disease is treated with at least two different types of antibiotics in order to cure the infection. Within a few weeks the antibiotics will build the body’s resistance and slow the poisons of the TB germ to prevent the patient from being contagious. An example of treatment would be short- course chemotherapy, which is the use of isoniazid (INH), rifampin, and pyrazinamide in combination for at least six months (Cook & Dresser, 1995).

The drugs need to be taken for six to twelve months or there may be a reoccurrence. Failure to take the antibiotics consistently will result in a multi-drug resistant TB (MDR TB) which “is much harder to treat because the drugs do not kill the germs. MDR TB can be spread to others, just like regular TB” (American Lung Association, 1996). Inactive tuberculosis is when a person is infected with the tuberculosis acteria, but their immune system is able to fight the infection, therefore only showing a positive skin test and a negative x-ray and sputum test.

The patient may be infected but they are not contagious which means the doctor will start a preventative treatment program. This program includes the use of the drug isoniazid for six to twelve months to prevent the TB from becoming active in the future. Once the treatment for Joan’s pneumonia was unsuccessful it was rediagnosed because she remembered her exposure to TB when her grandfather contracted it when she was seven years old. She has been unaware that she has een caring the infection in a dormant state for 28 years.

Due to her sore throat, which weakened her immune system, her TB became active therefore she was given a new treatment plan. This plan included the use of isoniazid, rifampin, and pyrazinamide. Objective and Subjective Indicators Tuberculosis and pneumonia have similar objective and subjective indicators because they both cause infection of the lungs. Because of theses similarities in the indicators Joan’s case was easily misdiagnosed without the information of the TB exposure. The subjective indicators are chest pain, headaches, loss of appetite, ausea, stiffness of joints or muscles, shortness of breath, tiredness and weakness.

The patient has to be able to tell the doctor these symptoms in order for the correct diagnosis to be made because of the overlap between the two diseases. The objective indicators include coughing, chills, fever, night sweats and blood-streaked or brownish sputum. These signs will be observable by the doctor. Medical Interventions The diagnostic procedures for pneumonia and tuberculosis is also similar. The usual procedure is for the doctor to get a previous medical history along with a history of possible exposure and onset of symptoms. From there a physical examination will occur.

The doctor will listen to the patients chest for crackles. After that, tests such as the CBC blood test, x-rays, blood and sputum test, biopsy or a bronchoscopy can confirm an infection of the lungs. A tuberculosis specific test is the Mantoux test which is a skin test that confirms the presence of the TB bacteria in the patients system. A conservative treatment would include antibiotics such as penicillin and isoniazid (INH) that would treat the infection in the lungs. Or bronchodilators may be used to help keep the airways open. Other treatments may include a proper diet or bed rest.

There are not many choices when it come to surgical management for pneumonia or tuberculosis. In fact there is usually only one that is often used. That surgery is thoracentesis and it is used to remove the pleural effusion from the lungs. The Course The course of pneumonia and tuberculosis can vary from person to person. In general the course begins with the development of symptoms and the visit to the doctor. After the visit to the doctor tests and examinations will occur to confirm the presence of pneumonia or tuberculosis. Once the infection has been confirmed medication may be prescribed along with possible bed rest.

A prompt recovery can occur if: 1. they are young, 2. their immune system is working well, 3. the disease is caught early and; 4. they are not suffering from other illnesses. Most patients will be able to respond to the treatments and begin to improve within a couple of weeks. Throughout the treatment medical evaluation, drug monitoring and bacteriology is completed. They will check the sputum twice monthly for TB until the smear is negative and the patient is asymptomatic which usually occurs ithin the first three months (Galantino and Bishop, 1994).

For both diseases they will also watch the patient for drug side effects, resistance and compliance. In Joan’s case the TB infection was caught too late to use preventive treatments but once it turned active it was discovered after two weeks. Bio-Psycho-Social Effects There are many secondary biological effects from pneumonia and tuberculosis. Tuberculosis and Bacterial Pneumonia can enter the body’s blood steam and cause damage or further infection to any part of the body, which includes the kidney, joints, bones, liver, brain, reproductive organs or urinary ract.

Other secondary problems that may arise from either disease include anemia, pleurisy, lung abscess, pulmonary edema, chronic interstitial pneumonia, acute respiratory failure, empyema, slowing of the intestines or hyponatremia which is low blood sodium (National Jewish Center for Immunology and Respiratory Medicine, 1989). The patient may also suffer from psychological and social problems throughout the course of the disease. In extreme cases patients may be unable to participate in physical, recreational, or normal day activities which may cause social deprivation or depression.

However most patients can expect to keep their jobs, stay with their families throughout the treatment and lead normal lives. In Joan’s case she was hospitalized so had become socially deprived and was becoming very depressed. This is in part due to the fact the her treatment was ineffective for the first three days from the misdiagnoses. Goals and Interventions for the Pneumonia or Tuberculosis Patient To facilitate the recovery of patients who have pneumonia or TB there will be interventions from the Physical Therapist, Respiratory Therapist and Social Worker.

Each profession will have roles in motivating , supporting and increasing the functional capability of the patient. The most common objectives of treatment include: 1. to decrease discomfort, 2. to facilitate the exchange of oxygen and carbon dioxide in the lungs, 3. to prevent atrophy from the increased bed rest, and 4. to prevent social withdrawal.

Rehabilitation Goals and Interventions 1. Maintain or increase muscle strength during decreased activity -provide a progressive resistive exercise program -promote weight bearing activities, engage in recreational activities and self care activities

2. Maintain or increase mobility of soft tissue and joints during bed rest and decreased level of activity – provide passive and active range of motion -recreational activities combining aerobic, stretching, and strengthening

3. Develop, improve, restore or maintain coordination – practice skills with walking, dressing, hygiene and standing

4. Promote psych-social adaptation to disability and prevent social withdrawal – educate to adapt lifestyle – get involved in support groups and social interactions – body positions that decrease discomfort – Social Worker may help here

5. Alleviation of chest pain and aid in respiration – use chest physio, oxygen treatments and respiratoy therapy – teach effective breathing techniques and postural drainage to keep airways open

6. Prevention of reoccurrence – preventive therapy that includes education on proper diet Joan was referred to see a Physical Therapist, Respiratory Therapist and Social Worker. Her goals where to decrease her discomfort, education to adapt her lifestyle and in different body positions that will promote easier breathing. The Social Worker was also there to encourage her to join a support group to elp her cope with the restraints from her disease.

Every year millions of people throughout the world are affected by the pneumonia and tuberculosis disease. These two respiratory infections have similarities and differences. These similarities stem from the fact that both diseases attack a persons lungs causing inflammation and consolidation. In fact tuberculosis is a chronic infection that can affect the lungs and cause pneumonia. Since both infections cause consolidation indicators like coughing, chest pain and shortness of breath are found in pneumonia and tuberculosis.

The roblem with these similarities, as was seen in Joan’s case, is that it can be easily misdiagnosed when the proper tests are not used. The differences in the two infections are mainly just in their etiologies. For pneumonia there are over 30 different causes but the four main categories are bacterial, viral, mycoplasma and fungal while tuberculosis is only caused by a bacteria called Tubercle bacillus. Fortunately pneumonia and tuberculosis can be kept under control with the use of antibiotics and the earlier that the infection is caught the better chance of a prompt recovery.

Many influences such as cultural background, values, morals, and beliefs bring great force to bear upon almost every decision a person must make throughout an average day whether it be a choice, idea , or action. These influences are used in the formation of attitudes about ones self in general, and about right or wrong. All people have these childhood influences to credit for our attitudes, choices, ideas, and even beliefs that are held dear. Attitudes developed during childhood and throughout life play a key role in the way people interact with one another, handle crises, or even deal with day-to-day problems that occur in their lives.

These beliefs are central to every human whether they be carpenter, politician, or registered nurse. So enmeshed in our daily lives are these values, that very often their role in the decision process goes unnoticed. In fact, one can live their entire life and never have awareness as to what triggers certain emotions, feelings toward the other sex, or even what drives the direction of thought. Yet, they are passed on to every generation often blindly, with every gesture, every arched eyebrow, and every fairy tale. The awareness of their presence is secondary to the need to have them.

They are the thread that stitches communities together, brings people to a common ground, and gives many a purpose for living. Attitudes about death and dying are derived from a lifelong process of experiencing life and the beliefs about death that one accepts as their own. In many cultures beliefs and issues surrounding death are the ones held dearest and closest to oneself. Many, if not all, cultures accept that death is but another step in the process of life. However, differences in how one may choose to welcome or elude death are varied and many.

How one chooses to face death, what instrumentation, and even where to die (when one has the choice) are all matters of personal preference. Use of Do Not Resuscitate (DNR) orders or exhaustive measures are also matters of preference ( when there is a living will and these decisions are made ahead of time), and these preferences affect many lives ranging from friend to caregiver. As a caregiver, the nurse must deal with death and those that are dying on an almost daily basis. As a nurse, one must be aware of his or her own personal feelings and beliefs regarding death and be prepared to respect the wishes of the patient regarding this issue.

More often, the nurse will be the very person to carry out a DNR order. This means that the nurse may have to stand and watch or take the hand of a patient while he or she dies. The decision that a nurse will make will be based on attitudes toward death and dying, as well as the very notion of the DNR order. Some nurses may perceive a DNR order as an easy way out of expensive medical bills and a direct hand in the death of the patient, while others may see it as a merciful end to a painful and tormented existence.

When confronted with the legality of DNR orders and the humanity of caring and wanting to preserve life, the nurse is often confronted with a dilemma. The nurses decision can be one that can affect her career as well as the wishes of the patient. Whatever the nurses feelings are, they must be addressed in order to better serve the patient and to ensure that the patients rights and best interests are at the center of the concern. By addressing the nurses issues with DNR orders or just death itself, the patient benefits from the knowledge that the nurse has an understanding of why he or she may feel a certain way about a particular topic.

Understanding of where our values, beliefs, and perception originate can only serve to, help us become stronger, more compassionate, and wiser. Researchers of this study believe that results will contribute to the already vast body of nursing knowledge by delivering an article that when read, may aid the readers to look within oneself and determine what beliefs, or lack of, are governing their actions. In addressing this issue, the researchers feel that a nurse will gain valuable insight which may help him or her to better cope with the issues surrounding a patient that is near death and has a DNR order attached to his or her chart.

The researchers will also present information on the process whereby formation of these attitudes or beliefs occurs and in doing so will provide source from whence changes and or understanding of what we believe can be achieved. Furthermore, the researchers believe that the extent to which these findings can be generalized are not just limited only to certain floors or departments within a hospital setting but, are available to everyone with the desire to understand what makes them care about certain issues. Still, these findings can be useful in areas of oncology, pediatrics, geriatrics, and or any area where DNR orders are in place.

Also, these findings can be useful in palliative, as well as curative settings, within the home health community, and the retirement community. In general, the researchers hope that this information which may aid anyone in their search for understanding of who and what they are, will also serve as a tool to affect a change in how those that read this study treat one another as well as what one says and does. Theoretical Framework Kohlbergs Theory of Moral Development will be used as a conceptual framework for this study (Wong, 1995).

Kohlbergs theory consist of three levels. Within each level are two distinct stages of moral development. Within level one, the Pre-moral level, are the stages one and two which state that a person obeys rules to prevent punishment or to bring about reward respectively. Within Kohlbergs level one is Piagets stage one of moral reasoning called Moral Realism from which attitude formation, and attitudes about death and dying are formulated ( Coffey & March, 1983). The second Kohlberg level is known as the Pre-Conventional level. Within this level are stages three and four .

Stage three addresses the method whereby individuals pursue the approval of others by portraying themselves as good. Stage four states that people have respect for authority and social order and that people are oriented toward duty and respect for authority. Also within this level is Piagets second stage of moral reasoning called Morality of Cooperation which deals with the way cooperation is achieved in moral development and its implications on developing morals and attitudes. The last level of Kohlbergs model is the Post-Conventional level. Within this level are the fifth and sixth stages.

Stage five addresses that people are receptive to obeying democratically accepted laws and rules of behavior, while stage six implies that morality is individual conscience. Within this section studies will be presented that state that nurses function at this level of Kohlbergs Theory of Moral Development. It is because of this level that one can be in touch with the emotions and attitudes that are responsible for how people feel and act regarding a specific subject. These actions and the attitudes behind them are the foundations for what makes something right or wrong (at least in the mind of the person or persons involved).

Kohlbergs model will be used to explain the actions of individuals based on the level of development previously stated by the many levels of Kohlbergs model. It has been stated that nurses function at the stage 6 level that states morality is individual conscience. With all the stages having been laid out quite specifically, a researcher should be very capable of assigning a specific subject to a specific stage of development and also be able to determine with some degree of accuracy the attitudes held by that person by the way a set of questions are answered (Kohlberg, 1969).

Problem Statement What factors, moral and ethical, influence nurses attitudes and decisions regarding patient care of a client with DNR orders? Statement of Purpose The researchers believe that independent variables such as patient demographics, as well as physiological aspects ranging from age and sex to acuity and nature of disease will have an affect on the dependent variable, the nurses attitude on death and dying.

This study will explore the nurses attitudes about death and dying as well as specific issues about DNR orders which may have deep rooted origins and may be affected by various factors such as familial wishes and cultural issues that are out of the control of the nurse. In this descriptive study, the researchers will attempt to add to the vast body of nursing knowledge by exploring the attitudes that nurses have toward death and dying as well as their attitude toward the DNR order itself.

The researchers believe that by investigating the origins of ones values and beliefs the nurse will become a better nurse and a better person . This insight into oneself will allow the nurse to deliver better patient care and develop a sense of who they are and where they come from. Research Question What factors that affect nurses attitudes toward death, the dying, and the DNR order can be discovered and identified in a descriptive study by the use of a subject specific questionnaire such as a DNR questionnaire? Definition of Terms Theoretical Definitions

DNR Order: “A note written in the patient record and signed by a qualified, usually senior or attending physician, instructing the staff of the institution not to attempt to resuscitate a particular patient in the event of cardiac or respiratory failure. This instruction is usually only given when a person is so gravely ill that death is imminent and inevitable” (Mosbys Medical & Nursing Dictionary, 1996). Attitude: “State of mind, behavior, or conduct regarding some matter, as indicating opinion or purpose” (Britannica World Language Dictionary, 1995).

Nurse: “A person educated and licensed in the practice of nursing; one who is concerned with “the diagnosis and treatment of human responses to actual or potential health problems” (American Nurses Association). The practice of the nurse includes data collection, diagnosis, planning, treatment, and evaluation with men in framework of the nurses singular concern with the persons response to the problem rather than to the problem itself. The concerns of the nurse or thus broader and less discrete and circumscribed than the traditional concerns of medicine.

In a cooperative participatory relationship with the client or patient, the nurse acts to promote, maintain, or restore the health of the person; wellness is the goal. A collegial collaborative of relationship with other health professionals who share a mission and a common data base furthers the practice of nursing. Guided by a humanitarian, ethical principles, the nurse practices in a personal, nurturing, and protective manner that promotes health in all ways.

The nurse may be a generalist or a specialist and, as a professional, is ethnically and legally accountable for the nursing activities performed and for the actions of others to whom the nurse has delegated responsibility” (Mosbys Medical & Nursing Dictionary, 1996). Questionnaire: A written or printed form comprising a series of questions submitted to a number of persons in order to obtain data for a survey or report ” (Britannica World Language Dictionary, 1995).

Operational Definitions DNR order: An order made by a physician (of one of the three hospitals involved in the UCO DNR study) after consultation with family members which entails the lack of effort to revive a patient that has naturally ceased to breath or has experienced cardiopulmonary arrest. Attitude: An inner personal feeling toward a certain subject, person, or philosophy that could be positive or negative held by one or more nurses involved in the UCO descriptive DNR study.

Nurse: A graduate of a one (Licensed Practical Nurse), two, or a four year, accredited nursing program, or a graduate of a certificate program and licensed by any state to practice as a nurse and currently employed at any one of three metropolitan hospitals in the Southwestern United States which are currently assisting with the UCO DNR research project. Questionnaire: The tool used to ascertain attitudes and acquire information about DNR orders from participating nurses employed at one of the three Southwestern United States Hospitals involved in the UCO DNR study.

America has a highly developed health care system, which is available to all people. Although it can be very complex and frustrating at times it has come a long way from the health care organizations of yesterday. Previously most health care facilities were a place where the sick were housed and cared for until death. Physicians rarely practiced in hospitals and only those who were fortunate could afford proper care at home or in private clinics. Today the level of health care has excelled tremendously. Presently the goal of our health care is to have a continuum of care for the patient, one which is ntegrated on all levels.

Many hospitals offer a referral service or discharge plan to patients who are being discharged. Plans for the patient are discussed with a discharge planner. The discharge planner is a person who is trained in assessing what the patient’s requirements for health care will be after discharge from the hospital. This enables the patient to continue ! their care at a level which is most appropriate for them. Items reviewed for discharge planning include but are not limited to therapies, medication needs, living arrangements and identification of specific goals.

A few of the options that are available for persons being discharged from an acute care hospital can include home health care, assisted living facilities, long term care or hospice Home Health Care According to Growing Old in America (1996), “Home health care is one of the fastest growing segments of the health care industry” (p. 114). Alternatives for home care can meet both the medical and non-medical needs of a patient. These services are provided to patients and their families in their home or place of residence. Home care is a method of delivering nursing care and other therapies as required by the patient’s eeds.

Numerous alternatives are available for persons seeking health care at home. With transportable technologies such as durable medical equipment, oxygen supply and intravenous fluids there are countless possibilities for treatment within the home setting. As stated in The Continuum of Long Term Care “Home health programs range from formal organizations providing skilled nursing care to relatively informal networks that arrange housekeeping for friends” (p. 185). This has allowed for home care to quickly become an essential component of the health c! are delivery system in the United States.

In a ome health care situation the primary care giver is usually not the physician. The physician is communicated with by phone and with documentation from the caregivers. The primary caregivers are usually the nurses and other team members who are involved directly with the patient’s care. Although, the original order to begin home care must be initiated by the physician if skilled care is to be obtained. According to the 1995 Guide to Health Insurance for People with Medicare “Medicare pays the full cost of medically necessary home health visits by a Medicare-approved home health agency”.

This overage must meet specific criteria, but it can be a relief to family members to know that their loved ones can be taken care of at home without worrying about the expenses. Unfortunately, if the care to be given within the home is termed “not medically necessary” the expense is not covered. This can include items such as meal and medication delivery, a percentage of necessary durable medical equipment, personal care and homemaker services. My employment within a home health care agency has allowed for review of services that are not covered by Medicare and/or private insurance.

Health care services hat are not included can become quite numerous. It is often difficult for family members to understand why specific services are not covered especially when they appear to be necessary for the care of the patient. These costs can add up quite quickly and the impact of the cost can become quite distressing for family members and patients on a limited budget. In these cases a Social Worker is usually provided to help the patient and family explore other avenues which may enable them to cover their health care costs.

Assisted Living Assisted living is an arrangement to residents of a facility that enables them to omplete certain daily activities while remaining independent. The services provided enable the resident to achieve maximum function of their activities of daily living. The services are unskilled and non-specialized personnel provide the activities essential to the care of the resident. These services help assist the aged, blind, disabled, and other functionally limited individuals with necessary daily activities which they require help with or are unable to perform on their own.

An example of some of the services which may be available are light housekeeping, meal preparation, medication reminders and personal care. The personal care does not include specific health oriented services which would require the services of a certified or licensed professional. It is stated well in Aging “Although the level of services provided may vary, assisted living communities all share a common goal: e! nabling people to live as active and independent a life as possible” (p. 212). The goal of an assisted living facility is to have the residents feel independent within their own home.

According to the article Assisted Living’s Future In Michigan Debated “Assisted living facilities can offer consumers a great pportunity to get personalized care in a comfortable setting” (p. 2). Currently there is some controversy surrounding the different types of assisted living facilities. In Michigan facilities termed assisted living have no real legal meaning and are not required to be licensed under this name. According to the article Assisted Living’s Future In Michigan Debated “Unlicensed facilities, unsubsidized care, untrained staff, and unmet promises make some places seem more like un-assisted living”.

Unfortunately many facilities are misleading as to what level of care they are providing. Both the government and national organizations are currently addressing this issue. My own experience with an assisted living facility has been quite good. Formerly my grandmother was a resident of an assisted living facility. The facility was specifically built for seniors and was that of an apartment like structure. The facility provided social and recreational activities on a continual basis. There was also transportation service available for residents who wished to use it.

My grandmother thoroughly enjoyed living in an assisted living facility where she had the opportunity to make numerous riends, participate in activities and remain independent. Long Term Care Long-term care patients are categorized by having a chronic condition and/or disease. The long-term care facility can be either hospital-based or freestanding. It consists of an organized medical staff, which provides continuous nursing services under professional nurse direction. The patient’s status is reviewed on a regular basis to determine if they meet criteria to remain at the facility.

The long-term care facility is regulated by state licensure regulations, federal regulations and Joint Commission on Accreditation of Health Care Organizations (JCAHO). State licensure is mandatory, Federal regulation is only necessary if the facility participates with Medicare and Medicaid, and JCAHO standards are voluntary. Long term-care is very expensive and it often becomes a financial catastrophe for the elderly person and their family. Private insurance is unlikely to cover the full cost of care and Medicare only pays for a limited amount.

The person usually must eliminate a substantial amount of their assets to become eligible for Medicaid which covers long term care. According to Growing Old In America “In order for elderly ersons to qualify for nursing home care under Medicaid, they usually must reduce their personal financial status to the poverty level (p. 119-120). Regretfully, the cost is not the only disturbing factor of a long-term care facility. A family decision to place my grandfather who was suffering from Alzheimer’s disease into a nursing home was a very difficult and emotional experience for everyone involved.

Regular visits by all family members continually raised concerns about the quality of care that he was receiving. Staffing was also a concern for our family. It seemed there as not enough staff to meet the needs of the patients within the facility. Although licensing agencies regulated these aspects, this was not comforting to our concerns. Fortunately, we were able to move my grandfather to a different facility. The nursing home was newer and better staffed and all family members felt more comfortable about the care he was receiving.

The experience of placing a loved one into a long term care facility is one I would prefer to not experience again. It is comforting to know that there are good facilities availab! le and caregivers that really care about the patient’s needs. These aspects are very important for families to understand before making a final decision when they must place a loved one into a facility. Hospice Unfortunately the last resort for some patients may be hospice care. Hospice is an organized program that offers dying persons and their families an alternative to traditional care for terminal illness.

As stated in Aging “Hospice care is exclusively for dying people. It therefore brings expertise to helping patients and their families face issues specific to death and dying” (p. 180). Hospice enables the patient to receive palliative medical care, while meeting the sychosocial and spiritual needs of the patient, their family and friends. Hospice programs also offer bereavement services for 13 months (or beyond if required) following the patient’s death for any family members or friends who wish to receive the service.

The article The Continuum of Long term Care emphasizes “The philosophy of hospice is that terminally ill individuals should be allowed to maintain life during their final days in as natural and comfortable a setting as possible” (p. 198). The quality of life of the terminally ill patients relies heavily on the psychosocial skills of their health care team. The health care team consists of a physician, nurse, social worker, chaplain, home health aide and volunteers.

The team develops an individual care plan which will provide an appropriate support system for the patient and their family up to and beyond the patient’s death. Weekly meetings allow the team to focus on the changing needs of the patient and make adjustments to their plan. Hospice care can be received in a variety of organizational settings. The most preferred setting is of course within the patient’s own home, but nursing homes, hospitals and long term care facilities are a few who can also provide hospice care. Hospice care is a covered benefit under Medicare and most private insurance companies.

The regulating agencies that set the standards for hospices are Medicare, the National Hospice Organization, Joint Commission on Accreditation of Health Care Organizations (JCAHO) and state hospice agencies. I have found that the medical record content in a hospice program contains an extensive amount of identifying information in regards to the patient and their primary caregiver(s). All aspects of patient care are well documented and assure well-coordinated, continuous care. The medical record acts as a communication tool between he different team members and is used on a continuous basis throughout the patient’s care.

Conclusion Although there are many options other than those listed for health care after discharge from a hospital, The most important aspect for a person is to be well informed and knowledgeable about the variety of options available. It can be very confusing, especially to an elderly person when talk of finances, regulations and covered and non-covered items are discussed. It is our responsibility as future health care administrators to provide adequate information to the person who is opting for alternatives to health care.

America has a highly developed health care system, which is available to all people. Although it can be very complex and frustrating at times it has come a long way from the health care organizations of yesterday. Previously most health care facilities were a place where the sick were housed and cared for until death. Physicians rarely practiced in hospitals and only those who were fortunate could afford proper care at home or in private clinics. Today the level of health care has excelled tremendously. Presently the goal of our health care is to have a continuum of care for the patient, one which is ntegrated on all levels.

Many hospitals offer a referral service or discharge plan to patients who are being discharged. Plans for the patient are discussed with a discharge planner. The discharge planner is a person who is trained in assessing what the patient’s requirements for health care will be after discharge from the hospital. This enables the patient to continue ! their care at a level which is most appropriate for them. Items reviewed for discharge planning include but are not limited to therapies, medication needs, living arrangements and identification of specific goals.

A few of the options that are available for persons being discharged from an acute care hospital can include home health care, assisted living facilities, long term care or hospice Home Health Care According to Growing Old in America (1996), “Home health care is one of the fastest growing segments of the health care industry” (p. 114). Alternatives for home care can meet both the medical and non-medical needs of a patient. These services are provided to patients and their families in their home or place of residence. Home care is a method of delivering nursing care and other therapies as required by the patient’s eeds.

Numerous alternatives are available for persons seeking health care at home. With transportable technologies such as durable medical equipment, oxygen supply and intravenous fluids there are countless possibilities for treatment within the home setting. As stated in The Continuum of Long Term Care “Home health programs range from formal organizations providing skilled nursing care to relatively informal networks that arrange housekeeping for friends” (p. 185). This has allowed for home care to quickly become an essential component of the health c! are delivery system in the United States.

In a ome health care situation the primary care giver is usually not the physician. The physician is communicated with by phone and with documentation from the caregivers. The primary caregivers are usually the nurses and other team members who are involved directly with the patient’s care. Although, the original order to begin home care must be initiated by the physician if skilled care is to be obtained. According to the 1995 Guide to Health Insurance for People with Medicare “Medicare pays the full cost of medically necessary home health visits by a Medicare-approved home health agency” (p. ).

This overage must meet specific criteria, but it can be a relief to family members to know that their loved ones can be taken care of at home without worrying about the expenses. Unfortunately, if the care to be given within the home is termed “not medically necessary” the expense is not covered. This can include items such as meal and medication delivery, a percentage of necessary durable medical equipment, personal care and homemaker services. My employment within a home health care agency has allowed for review of services that are not covered by Medicare and/or private insurance.

Health care services hat are not included can become quite numerous. It is often difficult for family members to understand why specific services are not covered especially when they appear to be necessary for the care of the patient. These costs can add up quite quickly and the impact of the cost can become quite distressing for family members and patients on a limited budget. In these cases a Social Worker is usually provided to help the patient and family explore other avenues which may enable them to cover their health care costs.

Assisted Living Assisted living is an arrangement to residents of a facility that enables them to omplete certain daily activities while remaining independent. The services provided enable the resident to achieve maximum function of their activities of daily living. The services are unskilled and non-specialized personnel provide the activities essential to the care of the resident. These services help assist the aged, blind, disabled, and other functionally limited individuals with necessary daily activities which they require help with or are unable to perform on their own.

An example of some of the services which may be available are light housekeeping, meal preparation, medication reminders and personal care. The personal care does not include specific health oriented services which would require the services of a certified or licensed professional. It is stated well in Aging “Although the level of services provided may vary, assisted living communities all share a common goal: e! nabling people to live as active and independent a life as possible” (p. 212). The goal of an assisted living facility is to have the residents feel independent within their own home.

According to the article Assisted Living’s Future In Michigan Debated “Assisted living facilities can offer consumers a great pportunity to get personalized care in a comfortable setting” (p. 2). Currently there is some controversy surrounding the different types of assisted living facilities. In Michigan facilities termed assisted living have no real legal meaning and are not required to be licensed under this name. According to the article Assisted Living’s Future In Michigan Debated “Unlicensed facilities, unsubsidized care, untrained staff, and unmet promises make some places seem more like un-assisted living” (p. ).

Unfortunately many facilities are misleading as to what level of care they are providing. Both the government and national organizations are currently addressing this issue. My own experience with an assisted living facility has been quite good. Formerly my grandmother was a resident of an assisted living facility. The facility was specifically built for seniors and was that of an apartment like structure. The facility provided social and recreational activities on a continual basis. There was also transportation service available for residents who wished to use it.

My grandmother thoroughly enjoyed living in an assisted living facility where she had the opportunity to make numerous riends, participate in activities and remain independent. Long Term Care Long-term care patients are categorized by having a chronic condition and/or disease. The long-term care facility can be either hospital-based or freestanding. It consists of an organized medical staff, which provides continuous nursing services under professional nurse direction. The patient’s status is reviewed on a regular basis to determine if they meet criteria to remain at the facility.

The long-term care facility is regulated by state licensure regulations, federal regulations and Joint Commission on Accreditation of Health Care Organizations (JCAHO). State licensure is mandatory, Federal regulation is only necessary if the facility participates with Medicare and Medicaid, and JCAHO standards are voluntary. Long term-care is very expensive and it often becomes a financial catastrophe for the elderly person and their family. Private insurance is unlikely to cover the full cost of care and Medicare only pays for a limited amount.

The person usually must eliminate a substantial amount of their assets to become eligible for Medicaid which covers long term care. According to Growing Old In America “In order for elderly ersons to qualify for nursing home care under Medicaid, they usually must reduce their personal financial status to the poverty level (p. 119-120). Regretfully, the cost is not the only disturbing factor of a long-term care facility. A family decision to place my grandfather who was suffering from Alzheimer’s disease into a nursing home was a very difficult and emotional experience for everyone involved.

Regular visits by all family members continually raised concerns about the quality of care that he was receiving. Staffing was also a concern for our family. It seemed there as not enough staff to meet the needs of the patients within the facility. Although licensing agencies regulated these aspects, this was not comforting to our concerns. Fortunately, we were able to move my grandfather to a different facility. The nursing home was newer and better staffed and all family members felt more comfortable about the care he was receiving.

The experience of placing a loved one into a long term care facility is one I would prefer to not experience again. It is comforting to know that there are good facilities availab! le and caregivers that really care about the patient’s needs. These aspects are very important for families to understand before making a final decision when they must place a loved one into a facility. Hospice Unfortunately the last resort for some patients may be hospice care. Hospice is an organized program that offers dying persons and their families an alternative to traditional care for terminal illness.

As stated in Aging “Hospice care is exclusively for dying people. It therefore brings expertise to helping patients and their families face issues specific to death and dying” (p. 180). Hospice enables the patient to receive palliative medical care, while meeting the sychosocial and spiritual needs of the patient, their family and friends. Hospice programs also offer bereavement services for 13 months (or beyond if required) following the patient’s death for any family members or friends who wish to receive the service.

The article The Continuum of Long term Care emphasizes “The philosophy of hospice is that terminally ill individuals should be allowed to maintain life during their final days in as natural and comfortable a setting as possible” (p. 198). The quality of life of the terminally ill patients relies heavily on the psychosocial skills of their health care team. The health care team consists of a physician, nurse, social worker, chaplain, home health aide and volunteers.

The team develops an individual care plan which will provide an appropriate support system for the patient and their family up to and beyond the patient’s death. Weekly meetings allow the team to focus on the changing needs of the patient and make adjustments to their plan. Hospice care can be received in a variety of organizational settings. The most preferred setting is of course within the patient’s own home, but nursing homes, hospitals and long term care facilities are a few who can also provide hospice care. Hospice care is a covered benefit under Medicare and most private insurance companies.

The regulating agencies that set the standards for hospices are Medicare, the National Hospice Organization, Joint Commission on Accreditation of Health Care Organizations (JCAHO) and state hospice agencies. I have found that the medical record content in a hospice program contains an extensive amount of identifying information in regards to the patient and their primary caregiver(s). All aspects of patient care are well documented and assure well-coordinated, continuous care. The medical record acts as a communication tool between he different team members and is used on a continuous basis throughout the patient’s care.

Conclusion Although there are many options other than those listed for health care after discharge from a hospital, The most important aspect for a person is to be well informed and knowledgeable about the variety of options available. It can be very confusing, especially to an elderly person when talk of finances, regulations and covered and non-covered items are discussed. It is our responsibility as future health care administrators to provide adequate information to the person who is opting for alternatives to health care.

The anthrax vaccination is the only known defense available for United States Troops against the deadly anthrax virus. Many experts have said it is not effective against inhalation anthrax. Studies have not been conclusive in their findings. The chance of living if you have received the anthrax vaccination seems better. More studies should be conducted outside the Department of Defense, with their cooperation, before the process to vaccinate troops continues. Anthrax is a disease normally associated with plant eating animals (sheep, goats, and cattle) caused by the bacterium Bacillius anthracis.

It is now controlled through vaccination programs throughout the world including the United States. Human infection with anthrax usually results from contact with infected animals or products. Anthrax was discovered by Robert Koch in 1876. An effective vaccine for animals was developed in 1881 by Louis Pasteur. In humans, the disease appears in both external and internal forms. The external form is contracted through cuts and breaks in the skin. The internal form is caught by inhaling anthrax spores, which invade the lungs and intestinal tract (Funk and Wagnalls New Encyclopedia, 1996).

Russian scientists have created a new form of the anthrax virus by genetic engineering. Col. Arthur Friedlander , chief of the bacteriology division at the U. S. Army Medical Research Institute states, The evidence that they presented suggested that it could be resistant to our vaccine (Riechman, Army Times 03-09-98). When anthrax is used as a biological weapon, people become infected by breathing the spores released in the air. Anthrax is 100,000 times deadlier than the deadliest chemical warfare agent. It is the preferred biological agent because it is easy to produce in bulk and the materials are low in cost.

Dr. Jose Ramero Cruz, of the World Health Organization states,Because anthrax spores are resistant to dryness and heat, they are relatively easy to grind and store. U. S. officials say that as many as 12 countries including Russia, Iraq, and North Korea, have established capabilities to produce and load deadly anthrax spores into weapons (D. Funk, Army Times, 3-19-98). An anthrax loaded scud missile could kill 100,000 people in an urban area according to a 1993 study, Proliferation of Weapons of Mass Destruction: Assessing the Risks, (J. Erlich, Army Times, 9-8-97).

No country is known to have released the biological agent during wartime. Anthrax has the potential to cover large areas of the battlefield. It is not known what branch of service, front line, or rear area troops would be at greater risks. Defense Secretary William Cohen stated, Anthrax is the poor mans atomic bomb (D. Funk, Army Times,1-12-98). The anthrax vaccine is used to protect against anthrax. It contains only dead organisms. Human vaccination was developed in England and the United States in the 1950s and early 1960s.

The vaccination was licensed and approved by the United States Food and Drug Administration in 1970. The vaccination is produced by Michigan Biologic Products Institute located in Lansing, Michigan. It has been administered to veterinarians, laboratory workers, and livestock handlers safely for over twenty five years (D. Funk, Army Times, 8-31-98). The anthrax vaccination prevents illness by stimulating the bodys natural disease fighting abilities. It has not been proven whether the vaccination will work against inhaled anthrax. The informational insert that usually comes with the vaccine could not be obtained.

I did find that according to the Michigan Department of Public Health in Lansing, Michigan there are no references for using the vaccine for inhaled anthrax (Joyce, AGWVA). Chairman of the Joint Chiefs of Staff, General Henry H. Shelton says we have stockpiled a safe and effective vaccine to protect our forces against anthrax (DefenseLINK a. , 18June98). There are many views and arguments to this statement. One that may not be resolved until further research can be done or anthrax is used against roops who have received the vaccination.

Almost all cases of inhalation anthrax in which treatment was started after symptoms began, have resulted in death, regardless of treatment afterwards. Being vaccinated greatly increases your chances of surviving an exposure to anthrax. Without the vaccination or protection (MOPP gear) it has a ninety-nine percent death rate to unprotected persons (PROMED (03) PRO/AH). From this point of view, it would beneficial to receive the vaccination. Since 1970, there have been no known long term side effects associated with the anthrax vaccination.

Reported side effects to the vaccine are mostly limited to local reactions. They include, sore arm, redness, and slight swelling at the injection site in 30 percent of recipients. Severe local reactions such as swelling that may extend from the elbow to the forearm are rare (Arnot Ogden Medical Center, 1998). Minor adverse reactions can include, but are not limited to flu like symptoms. Out of 133,870 immunizations, only seven (. 005 percent) severe reaction cases have been reported. Six were found to be minor effects and all service members were returned to duty.

Only one service member had a more severe illness (Guillain-Barre Syndrome) that occurred after receiving his third dose of anthrax vaccination. He began recovery one month after onset of the illness (D. Funk, Army Times, 8-31-98). No studies have been conducted to determine if the anthrax vaccination causes cancer, induces genetic mutation, impairs fertility, or causes fetal harm ( Joyce, AGWVA). Service members have already begun the immunization process against anthrax. Phase I of the immunization process began with all service members expected to be going to a high threat area on

August 16, 1998. Those already in Korea will begin September 9,1998. Service members serving in the Persian Gulf began in early March of 1998. About 48,000 have begun the series. Phase II will be for units first to deploy (XVIII Airborne Corps and subordinate units) in the event of a military incident. It is scheduled to begin in fiscal year 2000. Phase III will include the remaining forces and new recruits by fiscal year 2003. All 2,400,000 active duty, reserve, and national guard members will be vaccinated (D. Funk, Army Times,8-31-98).

All service members will be required to take the vaccination as stated in Department of Defense Directive 6205. 3 unless medically deferred. Some examples of soldiers who will be deferred are pregnant soldiers, and soldiers who are HIV positive. Family members will not be required to receive the vaccination and there is no plan to vaccinate them at this time. Withdrawing them from the region will be the first resort ( DefenseLINK a. 18JUN98). The majority of service members that have been required to receive the vaccination have done it.

Sixteen service members, 14 Navy, and 2 Air Force have refused to ake the vaccination. Two sailors have been discharged and the rest have received disciplinary action. A Fort Stewart, Georgia soldier is facing a probable discharge after choosing to go AWOL rather than take the required series of shots. It is conceivable that the number of refusals could rise when the program spreads to troops who dont feel an immediate threat said Secretary of Defense William H. Cowan (D. Funk, Army Times, 8-31-98). A total of six vaccinations will be administered in order for the series to be complete.

Three vaccinations will be given 2 weeks apart from each other initially. It will be followed by 3 additional vaccinations given at 6, 12, and 18 months. A booster shot annually will be given afterwards (ProMED(03), PRO/AH). While the entire vaccination series is 6 shots, military officials think it is possible service members dont need that many shots. Research to determine that is continuing, said Rear Admiral Michael Cowan, deputy director of medical readiness for the Joint Staff. Until we know for certain that it is safer to give fewer shots, well go with standardization, approved series,he said (D. Funk, Army Times, 8-31-98). The cost to immunize an estimated 2,400,000 military personnel will be approximately 130,000,000 million dollars(DefenseLINK News 8-14-98).

The estimated 130,000,000 dollars needed to vaccinate all active duty, reserve, and national guard forces against anthrax is wasted money, said Victor Sidel, a physician at the Albert Einstein College of Medicine in New York and co-president of International Physicians for the Prevention of Nuclear War, which won the Noble Peace Prize. It is a snare and delusion, said Sidel of troops taking the vaccination.

Theres very kind of evidence that this material is ineffective against the strains that are likely to be used. And there is evidence that the material causes adverse reactions (D. Reichman, Army Times, 3-9-98). In conclusion, the best believed defense available to the United States military is the anthrax vaccination. Studies against the vaccination have not been conclusive enough to persuade me to trust this vaccination 100 percent. It should be handed down to an independent research team outside the Department of Defense for further study. If the choice was mine to make today, I would not take the vaccination.

Illnesses caused by microorganisms and transmitted from an infected person or animal to another person or animal. Some diseases are passed on by direct or indirect contact with infected persons or with their excretions. Most diseases are spread through contact or close proximity because the causative bacteria or viruses are airborne; i. e. , they can be expelled from the nose and mouth of the infected person and inhaled by anyone in the vicinity.

Such diseases include diphtheria, scarlet fever, measles, mumps, whooping cough, influenza, and smallpox. Some infectious diseases can be spread only indirectly, usually through contaminated food or water, e. g. , typhoid, cholera, dysentery. Still other infections are introduced into the body by animal or insect carriers, e. g. , rabies, malaria, encephalitis, Rocky Mountain spotted fever. The human disease carriers, i. e. , the healthy persons who may be immune to the organisms they harbor, are also a source of transmission.

Some infective organisms require specific circumstances for their transmission, e. g. , sexual contact in syphilis and gonorrhea, injury in the presence of infected soil or dirt in tetanus, infected tranfusion blood or medical instruments in serum hepatitis and sometimes in malaria. In the case of AIDS, while a number of different circumstances will transmit the disease, each requires the introduction of a contaminant into the bloodstream.

A disease such as tuberculosis may be transmitted in several waysby contact (human or animal), through food or eating utensils, and by the air. Control of communicable disease depends upon recognition of the many ways transmission takes place. It must include isolation or even quarantine of persons with certain diseases. Proper antisepsis (see antiseptic ) should be observed in illness and in health. Immunologic measures (see immunity ) should be utilized fully. Some sexually transmitted infections are associated with cancer (cervical or penile).

Education of the population in rules of public health is of great importance both in the matter of personal responsibility (disposal of secretions, preventing contact with the blood of others, proper handling and preparation of food, personal hygiene) and community responsibility (safe water and food supply, sterile blood supply, garbage and waste disposal). Animal and insect carriers must be controlled, and the activities of human carriers must be limited. Non-communicable diseases are also called chronic Chronic diseasessuch as heart disease, cancer, and diabetesare the leading causes of death and disability in the United States.

These diseases account for 7 of every 10 deaths and affect the quality of life of 90 million Americans. Although chronic diseases are among the most common and costly health problems, they are also among the most preventable. Adopting healthy behaviors such as eating nutritious foods, being physically active, and avoiding tobacco use can prevent or control the devastating effects of these diseases. CDCs National Center for Chronic Disease Prevention and Health Promotion is at the forefront of the nation’s efforts to prevent and control chronic diseases.

The center conducts studies to better understand the causes of these diseases, supports programs to promote healthy behaviors, and monitors the health of the nation through surveys. Critical to the success of these efforts are partnerships with state health and education agencies, voluntary associations, private organizations, and other federal agencies. Together, the center and its partners are working to create a healthier nation. SARS stands for Severe Acute Respiratory Syndrome. It’s a new disease that began in south China. Symptoms include a fever of over 100 degrees and a cough.

Scientists think SARS may be caused by a new virus, and they’re working hard to stop it. Most people who get SARS have been in very close contact with someone else who has the disease. Doctors treating SARS and family members of SARS patients are at risk, but the disease doesn’t seem to be spread by casual contact. So there’s no reason to panic, but if you’re worried about SARS, talk to your parents and your doctor. SARS Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV).

SARS was first reported in Asia in February 2003. Over the next few months, the illness spread to more than two dozen countries in North America, South America, Europe, and Asia before the SARS global outbreak of 2003 was contained. This fact sheet gives basic information about the illness and what CDC has done to control SARS in the United States. To find out more about SARS, go to CDC’s SARS website and WHO’s SARS website. The SARS outbreak of 2003 According to the World Health Organization (WHO), a total of 8,098 people worldwide became sick with SARS during the 2003 outbreak.

Of these, 774 died. In the United States, only eight people had laboratory evidence of SARS-CoV infection. All of these people had traveled to other parts of the world with SARS. SARS did not spread more widely in the community in the United States. For an update on SARS cases in the United States and worldwide as of December 2003, see Revised U. S. Surveillance Case Definition for Severe Acute Respiratory Syndrome (SARS) and Update on SARS Cases — United States and Worldwide, December 2003. Symptoms of SARS In general, SARS begins with a high fever (temperature greater than 100.

F [>38. 0C]). Other symptoms may include headache, an overall feeling of discomfort, and body aches. Some people also have mild respiratory symptoms at the outset. About 10 percent to 20 percent of patients have diarrhea. After 2 to 7 days, SARS patients may develop a dry cough. Most patients develop pneumonia. How SARS spreads The main way that SARS seems to spread is by close person-to-person contact. The virus that causes SARS is thought to be transmitted most readily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes.

Droplet spread can happen when droplets from the cough or sneeze of an infected person are propelled a short distance (generally up to 3 feet) through the air and deposited on the mucous membranes of the mouth, nose, or eyes of persons who are nearby. The virus also can spread when a person touches a surface or object contaminated with infectious droplets and then touches his or her mouth, nose, or eye(s). In addition, it is possible that the SARS virus might spread more broadly through the air (airborne spread) or by other ways that are not now known.

Rheumatoid arthritis is a chronic syndrome that is characterized by inflammation of the peripheral joints, but it may also involve the lungs, heart, blood vessels, and eyes. The prevalence of this autoimmune disease is between 0. 3% to 1. 5% of the population in the United States (Feinberg, pp 815). It affects women two to three times more often than men, and the onset of RA is usually between 25 and 50 years of age, but it can occur at any age (Reed, pp 584). RA can be diagnosed by establishing the presence of persistent joint pain, swelling in a symmetric distribution, and prolonged morning stiffness.

RA usually affects multiple joints, such as the hands, wrists, knees, elbows, feet, shoulders, hips, and small hand joints. RA is usually characterized by the inflammation of the synovium, which lines the joints and tendon sheaths of the body. The etiology of this disease is unknown. There are multiple factors involved in this disease, including autoimmune reactions and environmental factors. There is also a genetic predisposition that has been identified that can be related to the cause of RA. Rheumatoid arthritis develops as a result of an interaction of many factors.

Much research is going on now to understand these factors and how they work together. Rheumatoid arthritis is one of several “autoimmune” diseases because a person’s immune system attacks his or her own body tissues (Gordon, pp 16). A feature of rheumatoid arthritis is that it varies a lot from person to person. For some people, it lasts only a few months or a year or two and goes away without causing any noticeable damage. Other people have mild or moderate disease, with periods of worsening symptoms, called flares, and periods in which they feel better, called remissions.

Still others have severe disease that is active most of the time, lasts for many years, and leads to serious joint damage and disability. Rheumatoid arthritis occurs in all races and ethnic groups. Although the disease often begins in middle age and occurs with increased frequency in older people, children and young adults also develop it. In 1987, the American Rheumatism Association developed seven criteria to define RA. First, morning stiffness in and around joints lasting at least one hour before improvement.

Second, there is arthritis of three or more joint areas. Third, there is swelling of at least one wrist, MCP, or PIP joint. Fourth, there is simultaneous symmetrical swelling in joints. Fifth and sixth, there are subcutaneous rheumatoid nodules and presence of rheumatoid factor. Lastly, there are radiographic erosions and/or Perarticular osteopenia in hand and/or wrist joints (Ryan, pp 57). Diagnosing and treating rheumatoid arthritis is a team effort between the patient and several types of health care professionals.

When assessing a patient with RA, the professional should be looking at their activities of daily living, productivity skills and interests, leisure skills and interests, active and passive range of motion, muscle strength, hand functions, endurance, and cognitive features. Some psychosocial areas to be aware of are self-concept, coping skills, interpersonal and social skills, communication skills, and support systems. Occupational therapy for an individual with RA will help the patient understand his or her disease and its effects on his or her life.

The Occupational therapist will help the patient to improve his or her ability to perform daily activities, prevent loss of function, and direct successful adaptation with the disease. The Occupational therapist will also help the patient to develop problem-solving skills needed to make adaptations throughout one’s life. The Occupational therapist will also treat the physical and psychosocial difficulties that may limit the patient’s occupational performance (Fienberg, pp 816).

The Occupational Therapist will review, observe and interview the patient, as well as administrating screening tests, to determine the capabilities and limitations of the patient’s occupational performance. Some assessment tests that can be done to determine areas of occupational dysfunction important to the person are the Canadian Occupational Performance (COPM) interview, the Robinson Bashall Functional Assessment, the Stanford Health Assessment Questionnaire, the Assessment of Motor and Process Skills (AMPS), manual muscle tests, the goniometer, and the dynamometer and pinch meter (Hammond, pp 257).

The Robinson Bashall Functional Assessment, as well as the Stanford Health Assessment Questionnaire, is a functional assessment that allows the therapist to get a better understanding of the practical capabilities of patients that are suffering from RA. The Assessment of Motor and Process Skills allows an accurate estimate of ability to do IADLs based on performance of three tasks. Treatment addresses the problems identified by evaluation of the patient, and often are guided by the progression of the disease.

Some specific goals to work on with an individual with RA may be to maintain joint mobility, prevent joint deformity, maintain or increase strength and functional ability, balancing activity with rest, develop problem-solving skills to modify daily activities at home and at work to protect joints and preserve energy, and especially promote psychosocial adaptations to deal with their chronic disability. (Pisetsky, 2789). There are various drugs to treat RA and can be divided into four different classes.

These classes are nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and analgesics. The drugs from the first three classes can reduce the number of painful and tender joints, duration of morning stiffness, and indicators of inflammation. NSAIDs are useful for their treatment of RA due to their anti-inflammatory and analgesic actions. These medications will improve mobility and strength, but they will not stop disease progression.

DMARDs alter the course of RA, although they do not prevent bone erosion. Methotrexate (Rheumatrex) is the most frequently prescribed drug for the initial treatment of moderate to severe RA. Some other DMARD drugs that are used are Sulfasalazine (Azulfidine), Hydroxychloroquine (Plaquenil), Cyclosporine (Neoral), Azathioprine (Imuran) (Pisetsky, 2792). Among the newest therapies that are being used to treat RA, ‘biologics’ act on altering the normal immune response by blocking the inflammatory process.

These drugs, Etanercept (Enbrel) and Infliximab (Remicade), are administered intravenously and subcutaneously, so that it binds to tumor necrosis factor (TNF), blocking its interaction with cell surface receptors (TNFR). These drugs reduce the signs and symptoms of moderately to severely active RA (Pisetsky, pp 2793). A person with arthritis may state independence in a given activity but it may be difficult or painful to complete. An individual with RA may experience problems in various areas of living.

Self-care is one area in that the patient may be experiencing difficulty, such that the person may be unable to perform ADLs because of motor limitations. These limitations may be related to those of bending, reaching, lifting, and carrying. The Occupational therapist may provide the patient with self-help devices, if needed, and instructions on how to use them. This may allow the individual to perform his or her ADLs so that he or she is able to keep his or her body clean and managed.

Another area that the RA patient may have difficulty is in productivity. The person may be unable to perform some job tasks when pain and swelling intensify. These job tasks may involve bending, reaching, lifting, or carrying. With such demands, his or her productivity skills may be impaired and need to be adapted to fit his or her needs. An Occupational therapist may suggest modifications or adaptations in the workplace that will help the person to perform his or her job tasks.

The OT may also suggest modifications or adaptations in the home that will improve safety and help the person to perform household tasks. The person may also be limited to the leisure activities that he or she can participate in due to their physical limitations, so the OT may explore interests and develop leisure activities that are based on the patient’s interests and physical abilities. An Occupational therapist may also help the patient to deal with sensorimotor issues that the RA patient deals with.

The person may have limited ROM of the major joints, muscle weakness in the large muscle groups, swelling in the major joints, and joint deformities, especially in the hand and wrist. The person may also experience stiffness in the morning, feelings of constant fatigue, and also may experience pain and tenderness in the joints. The Occupational therapist must work on all these areas to improve and increase mobility in the joints. The OT may consider splints to maintain wrist extension of the hand or even knee splints to maintain knee extension.

The OT would work on increasing or maintaining muscle strength, positioning, and even improving functional ability and endurance. All these interventions would help the person to maintain or increase their function in their joints, so that he or she can be more productive in his or her meaningful daily activities. The person may also experience some psychosocial areas of difficulty that may need to be addressed to the Occupational therapist.

The person suffering from RA may experience feelings of hopelessness and helplessness and may have a poor self-concept. He or she may have anxiety or become depressed. Lastly, the person may exhibit manipulative behavior. The OT may address these problems by promoting acceptance of this chronic disability, so that he or she can live with this disease. The OT may also provide stress management techniques so that the person’s tension can be released in more positive ways rather in a harmful manner towards himself/herself or towards others.

The OT may also promote the person to participate in more social activities to get him or her to feel more competent and increase one’s self-esteem. Persons with arthritis often do not comply with treatment and management routines, so the Occupational therapist may need to provide him or her with good learning or teaching techniques. The OT must also share with the patient the expectations about treatment and management, encourage personal responsibility for his or her care, and maintain a relaxed environment to encourage communication with other professionals and loved ones.

The OT must also be cautious of any other health concerns that may arise due to the progression of the illness or even side effects from the medications. There are so many affected by Rheumatoid Arthritis and it is a growing illness that has been seen across the United States. In the future of medicine, more and more research will be done to find the cure to this illness, but for now, such treatment like Occupational therapy will further advance the lives of those living with RA.

Wisconsin has a problem on its hands and it is not being dealt with in the right manner. The problem keeps getting bigger and bigger everyday. Instead of giving treatment to the mentally ill, hospital facilities have pushed thousands of mentally ill people on to the street. The idea behind this is to give those with mental illness, a freedom that has been taken from them since they were institutionalized. This plan has a lot of great qualities that would help a lot of people. But there are some serious repercussions because of it.

The problem is simple; the law that released thousands of mentally ill people is too vague. The law should have put the individual hospital in charge of stating who is safe to live in the general public, and who is not yet ready. The term mental illness stands for a vast variety of illnesses. This could be anything from chronic depression, schizophrenia, or even posttraumatic stress; the list goes on and on. Some disorders cause people to have unexpected mood swings. Collins a Lt on the police force said We dont know what they will do from one minute to the next(14a)

This causes a cycle to start forming in which the individual(s) goes in and out of prisons. Like it did to Karen Grayson who is expects to get out sometime this month. She blames her crimes on her disease along with two psychiatrists, a judge, and three psychologists. Collins states We take them out to the county health complex to get them some help, only to be turned away. They say theyve got no room. Often, we have no choice but to arrest them(14a). This only makes the situation that much worse. Karen sits there, growing sicker and sicker(Gene Braaksma 14a)

Now theyre stuck in a place that not only makes their disease worse but also doesnt have the right facilities or staff to help control the illness. The 42% of mentally ill prisoners held in Wisconsins maximum-security prisons receive limited care for their dieses. One of the worst things you can do for a mentally ill person is take them out of society. This will only cause the illness to worsen at a quicker pace. Chances are if you stick a mentally ill person in todays prison they will spend less time interacting with others and more time by themselves. Statistics will show that this cycle keeps growing and growing.

This is a huge factor of overpopulation in prisons. Politicians had the right idea but jumped to quickly on the matter, rather then thinking through all the repercussions. Many of the patents released are doing well I would think, enjoying their new freedoms. I think the law should have taken into consideration each disease and its affect on the individual. What I mean by this is, two individual can react differently to the same disease. This is depending on the strength of the disease, the individuals background, and if the individual has any other mental illnesses.

A Vitamin is any organic compound required by the body in small amounts for metabolism, to protect health, and for proper growth in children. Vitamins also assist in the formation of hormones, blood cells, the chemicals of the nervous-system, and genetic material. The various vitamins are not chemically related, and most differ in their physiological actions. They generally act as catalysts, combining with proteins to create metabolically active enzymes that in turn produce hundreds of important chemical reactions throughout the body. Without vitamins, many of these reactions would slow down or stop.

The intricate ways in which vitamins act on the body, however, are still far from clear. The 13 well-identified vitamins are classified according to their ability to be absorbed in fat or water. The fat-soluble vitamins A, D, E, and K are generally consumed along with fat-containing foods, and because they can be stored in the body’s fat, they do not have to be consumed every day. The water-soluble vitamins, the eight B vitamins and vitamin C, cannot be stored and must be consumed frequently, preferably every day. The body can manufacture only vitamin D, all others must be derived from the diet.

Lack of them causes a wide range of metabolic and other dysfunction’s. In 21″the U. S. , since 1940, the Food and Nutrition Board of the National Research Council has published recommended dietary allowances for vitamins, minerals, and other nutrients”. Expressed in milligrams or international units for adults and children of normal health, these recommendations are useful guidelines not only for professionals in nutrition (Pg 18) but also for the growing number of families and individuals who eat irregular meals and rely on prepared foods, many of which are now required to carry nutritional labeling.

A well-balanced diet contains all the necessary vitamins, and most individuals who follow such a diet can correct any previous vitamin deficiencies. However, persons who are on special diets, who are suffering from intestinal disorders that prevent normal absorption of nutrients, or who are pregnant or lactating may need particular vitamin supplements to bolster their metabolism. Beyond such real needs, vitamin supplements are also often believed to offer ocureso for many diseases, from colds to cancer; but in fact the body uickly eliminates most of these preparations without absorbing them.

In addition, the fat-soluble vitamins can block the effect of other vitamins and even cause severe poisoning when taken in excess. Vitamin A is a pale yellow primary alcohol derived from carotene. It affects the formation and maintenance of skin, mucous membranes, bones, and teeth, vision, and reproduction. An early deficiency symptom is night blindness which is the difficulty in adapting to darkness.

Other symptoms are excessive skin dryness, lack of mucous membrane ecretion, causing susceptibility to bacterial invasion, and dryness of the eyes due to a malfunctioning of the tear glands, a major cause of blindness in children in developing countries. The body obtains vitamin A in two ways. One is by manufacturing it from carotene, a vitamin precursor found in such vegetables as carrots, broccoli, squash, spinach, kale, and sweet potatoes. The other is by absorbing ready-made vitamin A from plant-eating organisms.

In animal form, vitamin A (Pg 19) is found in milk, butter, cheese, egg yolk, liver, and fish-liver oil. Although one-third of American children are believed to consume less than the recommended allowance of vitamin A, sufficient amounts can be obtained in a normally balanced diet rather than through supplements. Excess vitamin A can interfere with growth, stop menstruation, damage red blood corpuscles, and cause skin rashes, headaches, nausea, and jaundice. Known also as vitamin B complex, these are fragile, water-soluble substances, several of which are particularly important to carbohydrate metabolism.

Thiamine, or vitamin B1, a colorless, crystalline substance, acts as a catalyst in arbohydrate metabolism, enabling pyruvic acid to be absorbed and carbohydrates to release their energy. Thiamine also plays a role in the synthesis of nerve-regulating substances. Deficiency in thiamine causes beriberi, which is characterized by muscular weakness, swelling of the heart, and leg cramps and may, in severe cases, lead to heart failure and death. Many foods contain thiamine, but few supply it in concentrated amounts.

Foods richest in thiamine are pork, organ meats such as liver, heart, and kidney, brewer’s yeast, lean meats, eggs, leafy green vegetables, whole or enriched cereals, wheat germ, berries, uts, and legumes. Milling of cereal removes those portions of the grain richest in thiamine; consequently, white flour and polished white rice may be lacking in the vitamin. Widespread enrichment of flour and cereal products has largely eliminated the risk of thiamine deficiency, although it still occurs today in nutritionally deficient alcoholics.

Riboflavin, or vitamin B2, like thiamine, serves as a coenzyme, one that must combine with a portion of another enzyme to be effective, in the metabolism of carbohydrates, fats, and, especially, respiratory proteins. It Pg 20) also serves in the maintenance of mucous membranes. Riboflavin deficiency may be complicated by a deficiency of other B vitamins; its symptoms, which are not as definite as those of a lack of thiamine, are skin lesions, especially around the nose and lips, and sensitivity to light.

The best sources of riboflavin are liver, milk, meat, dark green vegetables, whole grain and enriched cereals, pasta, bread, and mushrooms. Niacin, or vitamin B3, also works as a coenzyme in the release of energy from nutrients. A deficiency of niacin causes pellagra, the first symptom of which is a sunburnlike eruption hat breaks out where the skin is exposed to sunlight. Later symptoms are a red and swollen tongue, diarrhea, mental confusion, irritability, and, when the central nervous system is affected, depression and mental disturbances.

The best sources of niacin are liver, poultry, meat, canned tuna and salmon, whole grain and enriched cereals, dried beans and peas, and nuts. The body also makes niacin from the amino acid tryptophan. Megadoses of niacin have been used experimentally in the treatment of schizophrenia, although no experimental proof has been produced to show its efficacy. In large amounts it reduces levels of cholesterol in the blood, and it has been used extensively in preventing and treating arteriosclerosis. Large doses over long periods cause liver damage.

Pyridoxine, or vitamin B6, is necessary for the absorption and metabolism of amino acids. It also plays roles in the use of fats in the body and in the formation of red blood cells. Pyridoxine deficiency is characterized by skin disorders, cracks at the mouth corners, smooth tongue, convulsions, dizziness, nausea, anemia, and kidney stones. The best sources of pyridoxine re whole (but not enriched) grains, cereals, bread, liver, avocados, spinach, green beans, and bananas. (Pg 21) Pyridoxine is needed in proportion to the amount of protein that is consumed.

Cobalamin, or vitamin B12, one of the most recently isolated vitamins, is necessary in minute amounts for the formation of nucleoproteins, proteins, and red blood cells, and for the functioning of the nervous system. Cobalamin deficiency is often due to the inability of the stomach to produce glycoprotein, which aids in the absorption of this vitamin. Pernicious anemia results, with its characteristic symptoms of ineffective production of ed blood cells, faulty myelin (nerve sheath) synthesis, and loss of epithelium the membrane lining of the intestinal tract.

Cobalamin is obtained only from animal sources such as liver, kidneys, meat, fish, eggs, and milk. Vegetarians are advised to take vitamin B12 supplements. Folic acid, or folacin, is a coenzyme needed for forming body protein and hemoglobin; its deficiency in humans is rare. Folic acid is effective in the treatment of certain anemias and sprue. Dietary sources are organ meats, leafy green vegetables, legumes, nuts, whole grains, and brewer’s yeast. Folic acid is lost in foods stored at room temperature and during cooking.

Unlike other water-soluble vitamins, folic acid is stored in the liver and need not be consumed daily. Pantothenic acid, another B vitamin, plays a still-undefined role in the metabolism of proteins, carbohydrates, and fats. It is abundant in many foods and is manufactured by intestinal bacteria as well. Biotin, a B vitamin that is also synthesized by intestinal bacteria and widespread in foods, plays a role in the formation of fatty acids and the release of energy from carbohydrates. Its deficiency in humans is unknown.

This well-known vitamin is important in the formation and maintenance of collagen, the protein that supports many body structures and plays a major (Pg 22) role in the formation of bones and teeth. It also enhances the absorption of iron from foods of vegetable origin. Scurvy is the classic manifestation of severe ascorbic acid deficiency. Its symptoms are due to loss of the cementing action of collagen and include hemorrhages, loosening of teeth, and cellular changes in the long bones of children. Assertions that massive doses of ascorbic acid prevent colds and influenza have not been borne out by carefully controlled experiments.

In other experiments, however, ascorbic acid has been shown to prevent the formation of nitrosamines which are compounds found to produce tumors in laboratory animals and possibly also in humans. Although unused ascorbic acid is quickly excreted in the urine, large and prolonged doses can result in the formation of bladder and kidney stones, interference with the effects of blood-thinning drugs, destruction of B12, and the loss of calcium from bones. Sources of vitamin C include citrus fruits, fresh strawberries, cantaloupe, pineapple, and guava.

Good vegetable sources are broccoli, Brussels sprouts, tomatoes, spinach, kale, green peppers, cabbage, and turnips. This vitamin is necessary for normal bone formation and for retention of calcium and phosphorus in the body. It also protects the teeth and bones against the effects of low calcium intake by making more effective use of calcium and phosphorus. Also called the sunshine vitamin, vitamin D is obtained from egg yolk, liver, tuna, and vitamin-D fortified milk. It is also manufactured in the body when sterols, which are commonly found in many foods, migrate to the skin and become irradiated.

About one-third of Americans are extremely over-weight, which may be why crash dieting is beginning to plague America. It’s estimated that Americans alone spend 80-100 billion dollars on weight loss tactics. People go on these diets to get quick results but are these results hurting them more than helping? The answer is Yes! The only way to safely and effectively lose weight is through old-fashioned exercise and the right diet. You cannot successfully lose weight by simply cutting food from your diet or taking some pills, it is necessary to work for your results.

Without depriving your body of necessary nutrients through dieting, you can lose fat and get the body you’ve always dreamed of, or at least one you’re more comfortable with. The quote “The effects of the current obsession with dieting can be devastating”, said by Mr. Woodworth, a long time exercise and nutrition expert, summarizes the dangers of dieting. The many dangerous methods of losing weight: so called “dieting” or starvation/fad diets, pills and drugs, over-exercising, surgery, and eating disorders, have taken many casualties.

Many people go on “diets”, a word so commonly misused, to get quick results of weight loss. Perhaps the most common is minor starvation and fad dieting. This method is when people become over concerned with calorie intake. Many deaths have been associated with low calorie diets. By trying to shed pounds simply by cutting all fat from the diet greatly increases the risk of getting cancer, heart disease, and other health problems. That “low-fat” trap gets people hooked on reduced-fat snacks or possibly not eating at all.

So now the body is being deprived of necessary nutrients not available in any pill or liquid form. Yes cutting fat and cholesterol reduces the risk of heart disease and diabetes, but nutrient poor diets have an even larger risk of getting those diseases along with many others. Of course a large percent of dieters will lose weight but they will feel depressed afterward and gain back even more than before they started the diet. The reason why is because they are losing “healthy” weight along with the fat they were hoping to rid of.

In an infomercial with Tony Little, he showed a graph of what the body loses when someone goes on a diet. By cutting back on foods, the body becomes deprived of very important nutrients. Then when it seems you are losing weight, what you are actually losing is fat AND MUSCLE. Many times, more lean muscle than fat will be lost. And although they may look slimmer because their size is smaller, they are actually weaker and more susceptible to injuries due to losing “healthy” weight. Healthy weight is muscle and bone weight, the things that support your structure and enable you to perform rigorous activities.

A lot of the time “healthy” weight is misinterpreted, especially in females. Which leads to an amazing fact that 62% of women and 44% of men that are dieting aren’t even overweight! But they are misled when they step on the bathroom scale and “My God” look what it says! They are not realizing that muscle outweighs fat over 2:1. Therefor, many people may think they are fat even though they may be healthy. I myself am an example of that. On a height and age chart it says my ideal weight for my height is 155 pounds. I am 168, so does that mean that I am overweight? Not necessarily.

Charts and stuff are made for averages and trends because when doing a body fat testing I had only 10. 8% body fat which is below the average for people my age and size. So the bathroom scale scares many people into believing that they need to lose weight when it may not be necessary. On top of overweight people dieting we also have healthy people dieting, both of which are extremely dangerous. Thus, the fad diet/starvation method should be completely avoided because simple “dieting” is just a stepping stone that may lead to much more serious things that become life changing or life threatening..

What started as a simple “diet” may have progressed into another dangerous way of losing weight through pills or drugs and eating disorders. How wonderful it would be if we could all take a couple of pills a day and not worry what else we may eat all while obtaining that body we yearn for. Unfortunately, we don’t have that pill and probably never will so avoid the dangerous imitations out there. What is not told about these miracle pills that make you have the body of your dreams is that they cause fatigue, hyperphagia, insomnia, mood changes, irritability and if really abused psychosis.

While claiming to boost your metabolism, reduce fat, and suppress your appetite they may become addicting and your body may eventually depend upon them. Many of these pills contain untested chemicals and slip by the FDA by claiming that they are food supplements not drugs. And while each year many deaths are due to these products they are still being used by seven percent of adolescent girls in the U. S. and thirty-four percent have at least tried them. Furthering the risk of complications in life and leading many times to death along with dieting.

People with eating disorders are believed to be the result from the 70 million Americans who diet each year, lose the weight, regain the weight, and then diet again. They, instead of going back to dieting once more, become anorexia nervosa or bulimia nervosa. Anorexia is when an individual is more than 15 percent under expected weight, fears gaining weight, females have amenorrhea (males lose sex drive) and abnormal eating habits. They simply restrict food because the pleasure in eating food is overwhelmed by guilt and anxiety.

About 1 in every 100 girls between 12-18 years of age are affected. The complications of anorexia are dehydration, gastrointestinal bleeding, chest pain, low heart rate, abnormal temperature, bone growth retardation or osteoporosis, infertility, dry skin and hair, constipation, epileptic seizures, the list still goes on. An awful lot just to lose some weight don’t you think? Many people who simply use the fad diet method get the urge to lose more weight and that is when they resort to the life threatening disorder of anorexia. Approximately one-third of anorexics become bulimia nervosa’s.

These are people who binge eat then purge themselves by vomiting. They become isolated and depressed and have a low self-esteem. What’s worse though is that physically these people seem healthy but if you look close they develop finger calluses or lesions, puffy cheeks , and erosion of enamel on their teeth due to the stomach acids so frequently eating away at it. It is in everyone’s best interest to avoid dieting and the other methods of losing weight that come with it because there is a major difference between dieting and having a healthy diet (food choice).

To overcome these weight problems and lead a healthier life you need look no further than a couple isles over from where you usually shop in the market and a little bit of good old exercise. First off there is one important thing you must know abut trying to lose weight the correct way, it’s just like trying to become a millionaire, it takes some work and some time. Losing weight the correct way will take longer than a crash diet but it is a much safer method not to mention more permanent. This may be the tricky part for most people, laying of the junk food.

It is ok to have junk food occasionally but making it an everyday thing will really lengthen the weight loss process especially if you are older. The main entre needs to be starchy foods. It has been said that breads are fatty but they contain no more calories per gram than lean meat. These foods tends to expand once in your stomach making you feel a little more full and giving you less of an urge to eat and really stuff yourself. When you stuff yourself your stomach grows just like when you exercise a muscle, the next time you will need more food to satisfy it.

Avoid the breads made with lots of oil or butter and ones you need to put spreads on for flavor. It is wise to include a variety of fresh fruits and vegetables into your diet. Greener foods tend to help metabolism (the chemical that helps you break down food) better and are recommended. Although McDonalds has Americas favorite fries, you better avoid that and any other type of fried potato including potato chips. Even though they are vegetables they have been doused with fatty oils. Dairy products are necessary foods so opt for the skim milk, nonfat yogurt, and low-fat cheese.

You’ll acquire a taste for them and appreciate it in the long run. Protein is another necessary food that you must watch carefully. Trim all visible fat off before steaming, grilling, baking or poaching. Notice I did not say frying! Frying requires oil and oil is a main ingredient you want to avoid. Cutting down on fats is the best approach when you are attempting to make an appropriate diet. You do not want to eliminate all fats but minimizing them helps. Calories are too often worried about. It’s like saying, don’t fill up the car past of a tank because it might not run as well.

Calories are energy and energy is necessary. Now that doesn’t mean fill up the car so much it starts spilling out on the ground and flooding the parking lot. With the exercise you plan to incorporate in this weight loss program you will use all of those calories and burn the existing “fat” calories stuck on you body. By adapting this plan into your meal plan you are very unlikely to put on any more weight unless all you do is sit on your couch all day watching TV (it burns calories just not enough). Fat calories are the calories you want to avoid.

Any snacks that are high in saturated fat and have a lot of total calories from fat. Now, to rid of your existing excess weight there is one and only one way, by continuous aerobic exercise. In order for the body to begin burning fat calories, which have a different make up of carbohydrate and protein calories, the body must believe it needs to use the larger amount of calories. For most activities in life your body uses calories from carbohydrates or proteins for quick energy.

Once you have been performing an activity using your legs, i. e. gging, biking continuous swimming, etc. , for 12 minutes your body begins to use the fat calories to conserve on carbohydrates. Thus, after 12 minutes of aerobic exercise (which is defined as having your heart rate between 80-110 b. p. s) you begin to burn fat from your body and sweat it through your skin cells. So recommended duration for exercise is 20 minutes for beneficial results. Performing this activity once a day would probably show results more rapidly but it is recommended you do it 3-5 times a week especially if you don’t regularly exercise.

There is a note of caution for people who are extremely over weight to not try and over do it. Over exercising can cause heart attacks so you should ease your way into exercising. Maybe start just by walking, then a combination of walking and jogging, don’t try and over do it hoping to get results instantly. All good things take time. So with determination and persistency you can be on your way to a healthier lifestyle by incorporating a healthy and plentiful diet with essential exercise.

Without dieting, you’re capable of sculpting a body more desirable for yourself and staying in good health. Without buying pills and drugs and little gimmicks you can make it much cheaper to take of that unwanted fat. Take yourself out of that statistic that one-third of Americans are extremely over-weight driving them into crash dieting. Through daily exercise and the right diet gradually lose the weight which doesn’t put you at such great risks. The truth is dieting destines you for death, while dedication destines you for doggedness.

Insulin infusion pump technology has been around for quite a few years but has been very slow to gain popularity among the diabetic community. In the past several years however it has caught on, and many who have chosen to make the investment have discovered an enormous advantage, in terms of health and well-being. A simple device that more closely mimics natural pancreatic cycles than traditional insulin injections can make a huge difference in a person’s life when constant disruptions from high and low blood sugars are quickly removed.

Unfortunately, even as the popularity of the insulin pump is spreading, not veryone who could potentially benefit from insulin pump therapy has access to it. An insulin pump costs $4000. 00, and most insurance companies do not cover it, and with accompanying medical supplies costing an average of $187. 00 per month, pump therapy is not financially feasible to most diabetics. The pump as a technology is incredibly innovative and cost efficient, because the increased control over blood sugars prevents complications from diabetes and costly surgeries to fix them.

Technically, the device is not very complicated and shouldn’t be expensive to manufacture. The high cost f a pump is largely due to the fact that the company who developed it, Minimed, must pay for its years of research and development, clinical trials, as well as turn a profit, and Minimed is also one of only two companies in the world who produce insulin pumps. Minimed as a company and the insulin pump as a technology are not very different from other biotechnology development firms and other new medical technologies.

The trends in the industry are essentially the same; huge amount of capital are necessary to fund the prolonged process of developing, testing, and getting FDA approval on new medical technologies; hence private firms have merged as lead developers of biotechnology. In the following discussion, I will use Minimed and the insulin pump as a sort of case study, or platform for which to discuss medical technology and its facets; the industry, development, government approval and regulation, technology assessment and ultimately, distribution.

Unlike other types of technological innovations, medical technology is subject to strict regulation by the Food and Drug Administration. Beginning with the Medical Device Amendments of 1976 and subsequent Congressional mandates, new medical technologies have been subjected to the ame strict regulations that all other new medicines and food additives are, if not even stricter review, since technological innovation is difficult to asses. The FDA has in fact created a department specifically devoted to medical devices, The Center for Devices and Radiological Health (CDRH).

Currently under review by the CDRH is a exciting new and greatly improved insulin pump, one that will actually continuously measure blood glucose, administer insulin and automatically adjust insulin dosage to the level of blood glucose (as opposed to the insulin pump that is currently on the market, which only administers insulin). This new device will be, in effect, an artificial external pancreas. The CDRH has published a guideline for medical device manufacturers to provide information to the administration during pre-market release review2.

Devices will receive extra scrutiny by the administration when they meet one or more of the following criteria: Device features or methods of using it are new Information provided by the device is crucial to the safety of the patient Device performs tasks which are crucial to patient safety Evidence exists of errors with similar devices (or device components) Device operation or characteristics is complex, unusual or otentially dangerous, or, Device will be used by patients or lay-users These criteria were adopted by the CDRH’s Division of Device User Programs and Systems Analysis in order to weigh human error likelihood of a new device into the approval or rejection decision.

A recent report of patient death by accidental morphine overdose highlights the importance of incorporating human factors3 and user interface4 considerations into the design of medical devices. The device which the patient was using was similar in concept to an insulin pump: a patient-controlled subcutaneous morphine infusion device. The error apparently occurred when the patient was programming the pump; when entering the concentration of morphine, the device’s default concentration was set at the lowest possible concentration. Thus, if a patient accidentally left the programmed concentration at 0. 1 mg/mL, when in fact the actual concentration of morphine was 1 mg/mL, the patient would receive a ten-folddose of morphine.

Speaking from the perspective of someone with personal experience with infusion pumps, this type of error is very easy to make (in fact I’ve made the same error myself), however it is completely voidable by setting defaults so that an error in programming would have less disastrous effects. Such foresight involves paying careful attention to user interface which is exactly the kind of precaution that criteria number six is intended to address. Of the criteria that is listed above the new glucose-monitor-and- insulin- pump-in-one meets all six; hence, while the technology for an artificial external pancreas exists now, such technology will probably not be on the market for at least another five years.

Federal regulations are not the only factor that has sl owed down the development and introduction of medical technologies. The technology to develop the modern insulin pump for example, has been around since the late 70’s5. The medical technology industry however has faced unique challenges that developers of other types of technology have not had to deal with. The first is the one discussed above: the fact that developers of medical technology face far more stringent regulations than those of nonmedical technology. A second challenge unique to the medical technology industry is that development requires multidisciplinary expertise. That is, medical devices are not usually developed by an entrepenuar who single- handedly invents and patents something.

Development of the insulin pump for example probably involved a doctor or scientist, who foresaw the medical utility and specifications of the device; an electronics engineer, who designed the motor, circuitry and perhaps casing; a software engineer, who programmed the device to respond to commands as well as programmed the device to be programmed, and perhaps a human factors expert, who specified the user interface. Some technologies however, are so complex and advanced that at least part of the design of the device must be contracted out to specialized firms that are leaders in specific types of technology (but not necessarily edical technology). One such company, LRE Technology Partner GmbH (Nrdlingen, Germany) specializes in building products around optical components; such products have both non medical and medical applications6.

The technology LRE developed is used in machines such as blood-sugar measurement devices, which use the color of a blood sample to determine a patient’s blood glucose level; LRE applied the same technology to develop a water-purity monitor. Development firms like LRE run up against additional roadblocks when they take on medical technology projects, especially as mall companies encounter unfamiliar regulations written specifically for the medical field. For example, ground leakage current has to be lower on medical instruments that on commercial equipment to reduce danger to the patient. Development of medical technology is substantially set back when different parties from different professional cultures are forced to interact with one another and participate simultaneously in the design process.

The sort of conventional method of technology development has traditionally been that engineers would come up with paper-and-pencil sketches that would be tossed to others for feedback; physicians however ay not comprehend such highly technical drawings. One solution development firms have begun to employ is to contract consulting services from other medical device manufactures who have more experience with medical device regulations. Another strategy is to use 3-D CAD, which allows all groups involved in the design phase of a project to have the same picture of the developing product. In the US, approval of a new device by the FDA by no means guarantees that it will be offered those who could benefit from it.

Although the US leads the world in expensive diagnostic and therapeutic procedures7, urrently we have no comprehensive universal health care system; 43. 4 million Americans, or 16. 1 percent of the total population have no health coverage8. Industrialized nations have basically two policy options on how to treat health care. The first is to regard health care like any other commodity in a free market, such as housing, and the second is to universalize health care and control expenditure via central government. The policy option one believes in depends largely on whether one regards health care as a good or service like any other, or one regards health care as a fundamental service that should be guaranteed.

The US is the last highly developed industrialized nation to not have some sort of universal or near universal health care plan in place; Canada, France, Japan, Sweden, and the United Kingdom, all cover over 98% of their populations via public health care, and Germany covers 92. 2% of its population. Suprisingly even though only 84% of the population is covered by some form of health insurance, health care expenditure as a percentage of gross domestic product is far higher in the U. S. (13. 5% in 19949) than in the countries listed above. The gap between the US’s expenditure and that of other ountries has been growing since the 1960’s, and the gap is expected to widen further, with expenditure hitting over 16% of GDP in 2010, when the baby boomers hit retirement10. The US however is not alone in its trend of rising health care costs.

The pinch is being felt throughout industrialized nations, in part because of the growing size of the aging population, but according to the NY Times, “about half the growth in real per-capita health costs is associated with medical technology. “11 Paradoxically, while technological innovation is usually thought of as reducing cost and increasing efficiency, in health are, new technology is often less invasive and less costly, which results in the technology being applied to larger groups of people and raising overall costs. For all our spending on health care and technology, the health of the average American, as measured by life expectancy and infant mortality is actually lower than the nations listed above.

Even for the 84% of Americans counted as having health coverage, the fact alone does not guarantee access to new medical technologies that they could benefit from. HMO’s, the fastest spreading form of health insurance in the US, have ssentially no legal responsibility for providing the latest developed medical technology and procedures to their members. In deciding whether or not to approve new technologies for coverage, HMO’s typically rely on panels of experts for recommendations, but then weigh cost-effectiveness into the decision of whether or not to approve a new technology, and ultimately the HMO itself, not a government regulatory agency or any other centralized authority, has the discretion of whether or not to approve a new technology.

Under the free-market ideology of health care it is reasoned that embers (consumers) of health care plans will shop around and buy the plan that offers the best benefits at the lowest price, and this process will keep prices down and efficiency up. However health care differs from other consumer goods on a number of points. Many are excluded from buying health care altogether because of preexisting conditions. Also, it is often difficult to predict future illnesses; one cannot evaluate plans by examining each and every procedure they do and do not cover. In addition, many consumers have no choice over the plan they buy; the choice is made for them by their employer. For these reasons consumers are not as likely to shop for plans and hence, prices are not kept down and efficiency is not kept up.

Government subsidized health care such as Medicare is pretty straightforward: there is a list of approved medicines, technologies and procedures that are covered and those that are not on the list are not covered; additions to the list are passed by the Senate. On March 15, 1999, Senator Susan Collins (R-ME) introduced Senate Bill S. 2292,12 which will extend Medicare coverage to the insulin pump for seniors with type I diabetes. A similar House Bill HR. 3814 introduced in 1998 failed. Collins argues for her bill by asserting that coverage of the insulin pump will actually save Medicare money by preventing complications associated with poor blood sugar control in diabetics. Treatments for complications such as diabetic retinopathy, nueropathy, kidney and liver failure and gangrene can become very costly indeed.

The irony of Collins’ bill, indeed of the whole American health care system is this; an insulin pump for type I diabetic aged 65 or over is like throwing a dixie cup full of water on Hell. Type I diabetes means that a person has had diabetes at least since adolescence, and complications from diabetes arise from poor lood sugar control over a span of many years. Giving a senior type I diabetic and insulin pump will not prevent complications from arising if that person has had poor control all their lives; giving a newly diagnosed young person an insulin pump will save the government a fortune. But there is no comprehensive health care system in place to ensure that cost- effective technology will be delivered to those who need it at the appropriate time.

The same concept applies to many other forms of preventative health care, and is a major reason why health care costs in this country are so high. The government will pay to ensure that major ealth problems are treated, but it is much more effective and cost- efficient to prevent those problems from ever occurring in the first place. It has been suggested that perhaps the US, with its free-market system of healthcare, plays a major role in providing financial incentive to private firms to develop new medical technologies. Since HMO’s and health insurance companies in the US have far less bargaining power with biotech firms than do centrally planned universal health care systems in other industrialized nations.

In response to this I would like to point out that in most countries with universal systems, private care is still vailable to those who are willing to pay for it. However on the whole, compensations to biotech firms in countries with universal care is still far less than in the US Thus this is a valid argument, and the true answer to the dilemma requires a value judgement; that is, is it more important for us as a nation to continue developing high tech medical solutions that will only benefit a portion of the population, or is it better for us to guarantee health care to our citizens as a fundamental right while at the same time accepting a slower pace of medical technological innovation?

Here we are going to discuss about the relevance and effects of health drinks and soft drinks like coke. We have explained in our study the advantages and disadvantages of these drinks. What are the ingredients of these drinks? How are they affecting every age group in the 21st century? Should they be used or not and if used in what amounts. The importance of these drinks help us to peep into their world and the drinking habits developed by people. According to a study 33% of U. S. adults that are 20 years of age or older are estimated to be overweight.

Furthermore, over 58 million Americans weigh at least 20% or more than their ideal body weight. With exhaustion and high stress levels due to hectic lifestyles, many people are relying on energy drinks to give them that second wind. Whether they help to stay awake through a test that day, or revive you for a party that night, energy drinks are much appreciated, and are becoming quite popular. With energy drinks increase in popularity, and high demand, many companies have decided to come out with one. Companies such as SoBe, have SoBe Adrenaline Rush, Starbucks DoubleShot espresso and cream, and Mountain Dews AMP energy drink.

Other popular energy drinks include, Red Bull and Rockstar. SoBe Adrenaline Rush has the familiar tangy taste of a grapefruit with a light yellow color. It contains 1000 mg taurine, 500 mg d-Ribose, 250 mg L-Carnitine, 100 mg Inositol, 50 mg Guarana, and 25 mg Panex Ginseng. This drink including many others is not recommended for children, pregnant women, or persons sensitive to Caffeine. Starbucks DoubleShot espresso and cream in caramel in color, and tastes very similar to the coffee frappuccinos Starbucks has in the glass bottles.

It is definitely a great drink to waken up with in the morning. AMP energy drink (from Mountain Dew) contains matodextrin, Ginseng, Taurine, B vitamins and Guarana. It is sour and tangy and tastes like fruit snacks. Like mountain dew, AMP is a lime green color. Red Bull is a yellow drink with a sour, tart taste. that includes, 1000 mg taurine, 600 mg glucuronolactone, and 80 g of caffeine. The benefits you get from drinking a Red Bull include, improving your performance, concentration, and reaction speed, vigilance, emotional status.

It stimulates your metabolism as well. Rockstar tastes and looks very similar to Red Bull. However, according to the can, not only is Rockstar bigger, stronger, and faster, but one is able to party like a rockstar too. It is the most healthy out of the five energy drinks, and contains the least amount of calories and sugars. Now the problems with the consumption of regular soda beverages like coca-cola and Pepsi. Americans drink more soda pop than ever before: These popular beverages account for more than a quarter of all drinks consumed in the United States.

More than 15 billion gallons were sold in 2000. That works out to at least one 12-ounce can per day for every man, woman and child. Kids are heavy consumers of soft drinks, according to the U. S. Department of Agriculture, and they are guzzling soda pop at unprecedented rates. Carbonated soda pop provides more added sugar in a typical 2-year-old toddler’s diet than cookies, candies and ice cream combined. Fifty-six percent of 8-year-olds down soft drinks daily, and a third of teenage boys drink at least three cans of soda pop per day.

Nearly everyone by now has heard the litany on the presumed health effects of soft drinks: Obesity Tooth decay Caffeine dependence Weakened bones Obesity: One very recent, independent, peer-reviewed study demonstrates a strong link between soda consumption and childhood obesity. One previous industry-supported, unpublished study showed no link. Explanations of the mechanism by which soda may lead to obesity have not yet been proved, though the evidence for them is strong. Many people have long assumed that soda — high in calories and sugar, low in nutrients — can make kids fat.

Researchers found that schoolchildren who drank soft drinks consumed almost 200 more calories per day than their counterparts who didn’t down soft drinks. That finding helps support the notion that we don’t compensate well for calories in liquid form. Tooth Decay: Here’s one health effect that even the soft drink industry admits, grudgingly, has merit. In a carefully worded statement, the NSDA says that “there’s no scientific evidence that consumption of sugars per se has any negative effect other than dental caries.

But the association also correctly notes that soft drinks aren’t the sole cause of tooth decay. In fact, a lot of sugary foods, from fruit juices to candy and even raisins and other dried fruit, have what dentists refer to as “cariogenic properties,” which is to say they can cause tooth decay. But sugar isn’t the only ingredient in soft drinks that causes tooth problems. The acids in soda pop are also notorious for etching tooth enamel in ways that can lead to cavities. “Acid begins to dissolve tooth enamel in only 20 minutes,” notes the Ohio Dental Association in a release issued earlier this month.