Public Health Disease Management of Tuberculosis

Public Health Disease Management of Tuberculosis This essay critically examines the effectiveness of policy frameworks and assessment tools in public health disease management of tuberculosis. The essay discusses the role of the community nurse and multidisciplinary teams in empowering individuals and populations in reducing health inequalities. The essay also explores the nursing and public health frameworks that assist in holistic assessment, planning implementation and the evaluation of care in the community, primary and public health sector. The essay also discusses how environmental, epidemiological and demographic data can influence policies and tackle the underlying social determinants of the health of populations. The essay also discusses strategies that enable the empowerment of individuals and groups, to make them responsible for their own health. The essay also identifies key issues emerging from the health and well-being of communities and discusses the impact that these will have on the role of the nurse and the multid isciplinary team. The main policy framework that has been put forward to combat tuberculosis is contained within the 2004 Department of Health document entitled Stopping tuberculosis in England: An Action Plan from the Chief Medical Officer, which outlines the goals of the programme, namely the long-term reduction and ultimately elimination of tuberculosis from England, with the immediate aims of reducing the risk of people being newly affected by tuberculosis, providing high quality treatment for all people living with tuberculosis and maintaining low levels of drug resistance to tuberculosis, through careful usage of antibiotics (DoH, 2004). This framework has dictated how health professionals treat cases of tuberculosis but has, in practical terms not stopped the drastic rise in tuberculosis in England: in 2002, for example, 6638 people were diagnosed with tuberculosis (DoH, 2004), whereas in 2005, the number of people infected by tuberculosis rose by 10.8% to 8113 (HPA, 2005; BBC, 2006), with the largest increases being in inner cities, particularly London (HPA, 2005; BBC, 2006). The public health management of tuberculosis includes: vaccinating uninfected at-risk groups; minimizing the chances of spreading the infection through minimizing contact of humans with cattle, for example; actively seeking infected individuals from within those groups most at risk; thoroughly investigating outbreaks of the disease when they occur; having appropriate measures in place to ensure that those with the disease do not infect health professionals; developing more rapid diagnostic techniques and creating an effective and easy-to-use national monitoring and surveillance system which functions within a legal framework (NICE, 2006). The spread of tuberculosis is not, seemingly, therefore being effectively managed as per the outlines in the policy framework in the 2004 Department of Health document entitled Stopping tuberculosis in England: An Action Plan from the Chief Medical Officer nor by the public health management schemes that are currently in place. Increases in tuberculosis are consistently most notable in the poorest sectors of the population (Bhatti et al., 1995), and for this reason, tuberculosis has been described, as it was historically, as a disease of the poor. There is, therefore, a massive socioeconomic influence over the spread of tuberculosis (Bhatti et al., 1995). Given this, then, it is important that the community nurses working in the ‘poorer’ sections of inner city areas are fully trained in how to diagnose, and how to best treat, tuberculosis, within the general framework as specified by the Department of Health (2004) policy document. In terms of the role of the community nurse and multidisciplinary teams in empowering individuals and populations in reducing health inequalities, as identified by Palacios et al. (2003), nurses play a key role in the management of tuberculosis cases in the community, with nurses being responsible for, amongst other things, identifying patients, evaluating patients prior to treatment starting, managing emergencies, educating patients and other health professionals, and providing coordination, for example overseeing other health workers and communicating between the members of a multidisciplinary team. Not only do the community nurse and the multidisciplinary teams they are involved with have a duty to identify and treat tuberculosis cases, but there is also an implicit obligation (built in to the framework for controlling tuberculosis as outlined by DoH (2004)) that health professionals should also educate individuals at risk as to how to minimize the risk that they would contract tu berculosis. Health inequalities, such as the greater likelihood of contracting tuberculosis if one comes from a poor background, need to be first recognized by health professionals and then treated, through treating the diseases as they manifest themselves, and through education programmes, which would aim to minimize the risks of contracting such diseases. Obviously this is approach does not treat the root causes of the inequalities, which is a political matter. In terms of exploring the nursing and public health frameworks that assist in holistic assessment, planning implementation and the evaluation of care in the community, primary and public health sector, there is a national framework for dealing with tuberculosis which offers guidelines as to how tuberculosis should be managed on the ground as it were (Singh et al., 2002). Tuberculosis care is generally undertaken on an out-patient basis with only emergency (usually previously undiagnosed) cases being dealt with on an in-patient basis (White et al., 2002). There is a system in place that ensures that any patients with suspected tuberculosis are seen by a tuberculosis team as soon as possible, following their first presentation to a health care professional, and that the presence of tuberculosis is noted on the national database and then managed according to national guidelines (i.e., those from the British Thoracic Society) (DoH, 2004). This national database of tuberculosis cases is p art of the Health Protection Agency’s surveillance scheme for tuberculosis, through the Statutory Notification of Infectious Diseases (NOIDs) scheme. The current best practice in terms of managing tuberculosis is the allocation of the patient with tuberculosis to a named case manager, who provides routinely supervised care to ensure that the medication is taken correctly and that the disease is being managed properly (DoH, 2004). In terms of how environmental, epidemiological and demographic data can influence policies and tackle the underlying social determinants of the health of populations. There are many organizations that collect data on various diseases that are present in the UK, and who then relate this data to socioeconomic factors. The Rowntree Foundation is one such organization, for example. Tuberculosis is a pertinent example of how environmental, epidemiological and demographic data can be used to effect changes to the political structures in place. As has been seen, it is known that socioeconomic variables can predict the presence of tuberculosis in the population, with those individuals from poorer areas more likely to suffer from a higher incidence of tuberculosis than those individuals from more affluent areas (Bhatti et al., 1995). The fact that there are still such diseases, with a strong socioeconomic aspect, present in the UK is cause for concern, and as many reports from the Joseph Rowntree Foundation have pointed out (for example, North et al., 2007; Dorling et al., 2007), the UK is facing higher levels of inequality than for four decades, which has major health implications for those living in the poorer sectors of society. These studies have been listened to, as the Government embarks on their social justice programme that aims to provide social equality for all members of society, in terms of health and education, for example. Thus, the use of environmental, epidemiological and demographic data can be responsible for directly influencing policies and tackling the underlying social determinants of the health of populations. If, for example, the poorer sectors of society were lifted out of this poverty, it is likely that ‘diseases of the poor’ such as tuberculosis would decline in frequency i n the UK. In terms of strategies that enable the empowerment of individuals and groups, to make them responsible for their own health, such strategies take many and varied forms, according to the disease under consideration. For tuberculosis, this entails, amongst other things, educating the patients as to why it is important to continue to take their medication even when they ‘feel’ better, to ensure that the disease does not recur and, more importantly, that antibiotic resistance is not developed. Most strategies for patient empowerment are based around patient education, in terms of bringing about changes in their immediate environment, or in their patterns of thinking, that will effect changes to their lifestyle and the ways in which they view their lives and, through this, will effect direct positive changes to their health; patient empowerment is generally a necessity for preventative medicine to be fully effective (Wensing, 2000). Empowering patients through education and t hrough better communication in the media, for example can lead to much higher levels of conformity with healthcare plans and to greater adherence to preventative medicine schedules (Wensing, 2000) which, in a disease like tuberculosis, which is notoriously difficult to treat if medicine schedules are not followed, is crucial to gaining control of the disease. In terms of the key issues emerging from the health and well-being of communities and the impact that these will have on the role of the nurse and the multidisciplinary team, it has been seen that tuberculosis is a disease of the poor, occurring most commonly in poorer areas in inner cities. Firstly, these health professionals have to recognize the socioeconomic aspect of such diseases, and to work within this context. For health professionals working in such situations, it is imperative that these health professionals are aware of all the current guidelines and policy frameworks with regards to such diseases, to ensure that they are aware of the necessity of conforming to these guidelines and frameworks. The impact that this has on the role of the nurse and the multidisciplinary team is to focus the health professionals attention to the diseases that are associated with poverty, and to focus their attention on treating these diseases in the optimum manner, and to empower their patie nts, in an attempt to manage, as effectively as possible, the incidence of such diseases. In conclusion, this essay has looked at the issue of tuberculosis in the UK, finding that whilst there is a policy framework in place aimed at reducing the incidence of tuberculosis, this is not wholly effective. The socioeconomic aspect of tuberculosis was discussed, as were the treatment options, the need for patient empowerment and the ways in which treating tuberculosis impacts health professionals. It is recognized that dealing with the root cause of diseases such as tuberculosis, which are generally known as ‘diseases of the poor’ is a political and not a health, matter, in terms of smoothing the inequalities that lead to the conditions where such diseases develop. References BBC (2006). Sharp rise in tuberculosis cases. 2nd November 2006. Available from http://news.bbc.co.uk/2/hi/health/6109228.stm [Accessed on 27th January 2008]. Bhatti, N. et al. (1995). Increasing incidence of tuberculosis in England and Wales: a study of the likely causes. BMJ 310, pp.967-969. DoH (2004). Stopping tuberculosis in England: An Action Plan from the Chief Medical Officer. Department of Health. Dorling, D. et al. (2007). Poverty, wealth and place in Britain, 1968 to 2005. Joseph Rowntree Foundation. Available from http://www.jrf.org.uk/bookshop/eBooks/2019-poverty-wealth-place.pdf [Accessed on 26th January 2008]. HPA (2005). Annual report on tuberculosis cases reported in England, Wales and Northern Ireland. Available from http://www.hpa.org.uk/infections/topics_az/tb/pdf/2003_Annual_Report.pdf [Accessed on 26th January 2008]. NICE (2006). Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. Available from http://www.nice.org.uk/nicemedia/pdf/CG033niceguideline.pdf [Accessed on 26th January 2008]. North, D. et al. (2007). Interventions to tackle the economic needs of deprived areas: analysis of six policy case studies. Joseph Rowntree Foundation. Available from http://www.jrf.org.uk/bookshop/ebooks/2137-devolution-governance-deprivation.pdf [Accessed on 27th January 2008]. Palacios, E. et al. (2003). The role of the nurse in community-based treatment of multidrug-resistant tuberculosis. The International Journal of Tuberculosis and Lung Disease 7(4), pp.343-346. Singh, S. et al. (2002). Tuberculosis in primary care. British Journal of General Practice 52, pp.357-358. Wensing, M. (2000). Evidence-based patient empowerment. Quality in Healthcare 9, pp.200-201. White, V. et al. (2002). Management of tuberculosis in a British inner-city population. Journal of Public Health Medicine 24(1), pp.49-52.

Graduation Speech :: Graduation Speech, Commencement Address

As you look back on the last four years I'm sure you'll all remember them differently. Some of you will think of them as the best four years of your life and others, the worst. Some of you will think of them as the most fun you've ever had. Some of you will remember the friendships you've created, or all the things you've learned and will carry with you wherever you go. Most of all I think we should remember and be thankful for the fact they've been a relatively safe four years. We've had our share of bumps and bruises, but nothing really major. I am saying this mainly because in the past few months, especially, other schools have not been so fortunate. When they look back on their high school years, their memories shall forever be tainted by unspeakable acts of violence and rage. As you know, I'm referring to the 12 students and one teacher killed by two crazed gunmen. In the aftermath of these tragedies people have searched for someone or something to blame. They've gone from video games to the availability of guns, to the lack of attention by parents, teachers, and counselors, and even to the Internet, but finger pointing will not solve the problem. I can't say that I have all the answers but I know there are some things we can do. The problem, I believe, starts and ends with us. Those two students, from Columbine High School were outcasts and constantly teased. The sad truth about that tragedy is that it could have happened here. Honestly, we've all made fun of someone at some time, but toward the end of the year it seems as though we're all being nicer to each other, mainly because we're not going to be here much longer and we realize it simply isn't worth it. I think it would have been much better to have had this attitude at the beginning of high school instead of at the end. As we go through our lives we should not forget what we've learned. We are the future and we're responsible for the next generation. It is our job to teach them to be nicer to each other and more tolerant of their differences. We have to teach them not to solve their problems through guns or violence. That truly is the only way to prevent these senseless tragedies from occurring.

Explorers, Or Boys Messing About? Essay

In this article the writer, Steven Morris is very critical of the explorers behaviour. How does he make his opinions clear? In the article published by the Guardian and written by Steven Morris, we get an immediate critical vibe towards the explorers and the situation they were in. Morris has rather sarcastically spoken about the events in a clever way, in which he manages to slate the explorers subtly without being too blunt. We see in just the first paragraph the two explorers are seen as childish in the writer’s choice of view, by using the word ‘farce’. The use of this word creates the idea of ridiculous and so foolishly amusing behaviour, which seems uncaring in an article based on something rather serious. This has given us an automatic feel that Steven wants to portray them as immature and a joke. Throughout the article there are many other times the men are shown as juvenile by the writer. By choosing to use the quote from one of the explorer’s wives saying they were just ‘boys messing about with a helicopter’, they are once again shown as callow. As well as it referring to fully grown men as boys, ‘messing around’ with a thing as serious as a helicopter in extreme conditions, it also makes Morris look as though there are many people on his side. The fact that he has a second opinion that what they did was stupid makes himself look far more relia ble. Steven Morris also expresses his negative opinion of the explorers through the engaging way of irony and sarcasm. He uses phrases such as ‘their trusty helicopter’, putting invert commas around the word trusty himself. This makes the reader think that their helicopter was in fact the very opposite. Furthermore, he highlights their ironic failure in the fact that in one of their failed expeditions they wanted to demonstrate ‘how good the relations between the east and west had become.’ He puts this in to show another mission they had failed to complete when they were not allowed to cross the Russian borders. He too used a pun, by calling Mr Smith ‘Q’, a character from James Bond. This once again gives the idea that they were silly explorers living a fantasy world, like children pretending to be characters, in a humorous way again. In addition, Steven has also very cleverly used the use of experts in order to make his opinion clear and article more reliable. A successful explorer quote is included saying that surviving the accident was ‘nothing short of a miracle’. This shows just how drastic the situation was, from a reliable source. That statement in itself works well to juxtapose his opinion that even though the situation was so serious he was still amused and able to make the jokes. Further on in the article he uses a helicopter expert’s quote saying, ‘I wouldn’t use a helicopter like that’. This highlights their stupidity in his opinion, once again backed up by someone who knows exactly what they’re talking about. The last two paragraphs of the article are extremely important in him making his opinion clear as well as making people want to agree with him. By including what was said by The Ministry of Defence, ‘the taxpayer would pick up the bill’, the reader is automatically involved in the article on a personal level. By using this in the article he is getting everyday people to be on his side, and trying to make them see that they too are facing consequences from ‘ boys messing about’. This supports his opinion well in making it look as though he cares for the everyday people(taxpayers) and they are part of the reason he is against what the explorers did. The closing sentence saying ‘they’ll probably have their bottoms kicked and be sent home the long way’, is a good way to close his article, leaving it in the readers mind that these people were immature, shown by the fact that they have been implied to have a childish punishment, once again to show how the writer is highlighting them in an immature and foolish way, as it becomes evident he thinks that they are.

Ar 670-1 - 117328 Words

Army Regulation 670–1 Uniforms and Insignia Wear and Appearance of Army Uniforms and Insignia Headquarters Department of the Army Washington, DC 3 February 2005 UNCLASSIFIED SUMMARY of CHANGE AR 670–1 Wear and Appearance of Army Uniforms and Insignia This rapid action revision of 3 February 2005-o Updates figures throughout the regulation (throughout). o Clarifies the definition of unauthorized tattoos while wearing the class A uniform (chap 1). Identifies officials responsible for making initial entry determinations on tattoos and brands (chap 1). Delegates the authority to MACOM commanders to grant exceptions to policy or discharges on initial entry soldiers with tattoos (chap 1). Clarifies the definition of a privately†¦show more content†¦o Deletes the temporary wear of the Joint Meritorious Unit Award (chap 29). The revision of 1 July, 2002 -o Updates wear of religious items and jewelry; sets grooming, hair, fingernail, and cosmetics policies; defines eyeglasses and sunglasses standards; adds policies on tattoos, body piercing, and the carrying of civilian bags; sets standards for contact lenses; authorizes pagers and cell phones; sets standards for s tarching and creasing battle dress uniforms; and exempts males from wearing headgear to evening events (chap 1). Updates responsibilities and administrative information, prohibits seasonal wear dates, and adds requirements for ceremonial units (chap 2). o o Updates the battle dress uniform and authorized accessories (chap 3). o Authorizes personal hydration systems (chaps 3-6). o Adds wear of the Army black beret and updates wear of maroon, tan (Ranger), and green berets (chaps 3-17). o Updates the maternity work uniform (chap 4). o Updates the desert battle dress uniform and authorizes sew-on insignia (chap 5). o Adds a new aircrew battle dress uniform (chap 6). o Updates the extended cold-weather clothing system (Gortex) parka and requires wear of nametape on the Gortex parka (chap 7). o Updates the hospital duty and food service uniforms and adds wear of white unisex cardigan (chaps 8-11). 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