Evaluation of Public Health Agenda in Community: Obesity

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

Fires on the Plain: a Reflection

Fires on The Plain: A Reflection Fires on the Plain is truly the most depressing, haunting, and sad story I have ever endured reading. The complete abandonment of the Japanese soldiers on the island of Leyte by the Japanese Army is revolting, as well as the complete disregard for each others well being among them. It becomes a battle between one another for survival. The lack of comradery among the Japanese soldiers is dumbfounding, and leads me to believe that it may very well have been there demise.The weaknesses we see in Tamura and the other soldiers not only have a great impact on their unfortunate outcome, but are also a result of a weakness within the Japanese Army itself. The awful fate of these soldiers, at the hands of their own command, is infuriating. Shohei's story holds powerful, and several dangerous implications of what war is like and what it's effects can be on those who fight in them. I would like to start by talking about comradery. Comradery can be defined as the spirit of friendship and community in a group, like a group of soldiers.Tamura's story shows zero evidence of any sort of comradeship, he even describes the way in which it he saw it disappear on Leyte, â€Å"Before long any comradeship that we once felt for each other had virtually disappeared. †(pg. 9). I could also see this in the way they treated each other. Initially, Yasuda and Nagamatsus' relationship could be mistaken for comradeship, but I realized that they were only using each other and did not care at all about the others well being. Which becomes quite clear at the end of the book.I have no doubt that this complete lack of comradery was mostly a result of their horrific situation, but I also believe that it could have existed before it. The way in which Tamura laughed while watching his fellow soldiers run around like â€Å"insects†(pg. 59), and the fact that Nagamatsu would hunt, kill, and eat his fellow soldiers are disturbing examples of the complete d isregard they had for one another. These instances serve as proof to me that there couldn't possibly have been much of a comradeship between these men at any point. One dangerous implication that this story holds expressed directly byShohei, â€Å"For people like us, living day and night on the brink of danger, the normal instinct of survival seems to strike inward, like a disease, distorting the personality and removing all motives other than those of sheer self-interest. †(pg. 9). While this certainly seems true for the Japanese soldiers in this story, I refuse to believe it to be true for all men. My personal experiences from being a Marine and doing two tours in Afghanistan have showed me what true comradery is. My fellow Marines and I would have gladly died for one another, and some did.In class, we discussed how the way in which these Japanese soldiers turned on one another when torn down to their most animalistic nature, could be true of all men or soldiers when under the same circumstances. The fact that somebody could believe that to be true is not only offensive, but scary. It is scary to me that examples from a book written by someone who is clearly insane, could be generalized to all men or all soldiers of every kind. What really irks me about this is that Shohei, portrayed through Tamura, shows absolutely no characteristics of a soldier.I think his most accurate depiction was when he said they resembled domestic animals â€Å"helplessly uprooted and perplexed†(pg. 35). I believe that he portrays someone with certain mental weakness. He wonders about the island countryside, it seams, waiting for his death to come. He has no plan but death. I understand that his circumstances are beyond my understanding, but they way in which he so easily abandons any hope of surviving, and doesn't put up any real fight for his survival, doesn't sit with me.It makes me realize that this weakness is most likely due to reasons beyond his control, such as the way in which, and the culture in which, he was brought up. As well as the poor military training and/or lack there of, did not properly prepare him for the nightmare of a situation he was put in. Which forces me to re-evaluate my initial reaction to write him off as a pathetic, weak individual who should have shot himself right then and there after he murdered the Filipino women.I am sympathetic for poor Tamura, who was drafted into the army and clearly given incredibly insufficient training. Tamura did not belong there and, I feel, none of them belonged there. The infuriating part of this story is the way in which these men were sent to what any person with intellect could tell was a certain, horrific death. Not only were they ordered to go that island, to that shit hole of a situation, it seams as if the people who ordered them there just left them for dead. Even his commanding officer told him that the best thing he could for his country was kill himself.They were given abso lutely no support against an enemy whose support was rivaled by none. Which resulted in them fighting each other for survival. Fires on the Plain is a very disturbing story from a war that resulted in many awful things. It has many implications of what war can be like, but I want to emphasize that not all wars are the same, and the men and women who fight in these wars certainly are not either. I would hope that those who read this understand that they shouldn't generalize the behavior of these poor Japanese soldiers to all soldiers or fighting men.I believe that the circumstances surrounding this horrific example of what war can be like are incredible and the ingredients that went into making this shit sandwich are hard to come by all at the same time. My final thoughts of this story are wrapped around Shohei's idea that life is nothing more than â€Å"a mere succession of chances†(p. 233). I have been debating over this idea with myself ever since I came back from my last t our in Afghanistan, and I can't say that Shohei's story has helped me in making a decision.

Analysis Of The Book Learning From The Reformation

Laura Womack April 24, 2015 Dr. Crutcher Special Topics E-Book Essay: â€Å"Learning from the Reformation† The Reformation is still influencing our lives today whether we know it or not. The arguments that come from this era are still present in today’s society, which include and range from theology, economy, politics, and family life. Motivation for the Reformation came from the ancient world. The thinkers of this time sought to restore the spiritual purity of early Christianity. Some of the leading people in this time of the Reformation include Desiderius Erasmus, Martin Luther, Ulrich Zwingli, Ignatius Loyola, John Calvin, Henry VIII, Leo X, and Elizabeth I. The Reformation which took place mostly during the 1500s is yet still in many ways contributing to the influence of modernism. In this essay one will look at the impact of some of the comprehensive strokes that the Reformation continues to have in today’s society. 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Vacation Cologne, Germany Vs. Kingston, Jamaica - 969 Words

Vacation: Cologne, Germany vs. Kingston, Jamaica Each and every person has their own idea of paradise. Millions of vacations are taken on every continent each year, and each country, state, and town holds an entire different world of adventure. For some, a beach with a calm breeze maximizes relaxation, for others, it may be a frigid mountain top. I, on the other hand, enjoy all sorts of vacation types. I enjoy fast pace adventure just as much as I enjoy slow pace admiration. Both Cologne and Kingston will most definitely provide me with the vacation of a life time, but my overall experience with each will differ in the way that I will travel, the excursions I will take, and the food that I will eat. Traveling to Cologne is the same as traveling to Kingston, but upon entering the towns, transportation takes a very different turn. Cologne is a more modernized area, and many well organized bus routes are driven every hour on the hour. Bus Passes in Cologne are offered for only $1 1.99 a day; this price is far more inexpensive than renting a car or calling five taxis a day. Travel with a bus pass is very simple, and there is most definitely a bus route that will take one wherever they wish to go (â€Å"Transportation†). Kingston, on the other hand, is at a far faster pace. Bus stops are overcrowded, and one could possibly be forced to wait up to an hour to even catch a ride. Kingston offers taxis and rental cars just as every other place, but if one is on a tight budget,