Wealth As Determinant Of Health Health And Social Care Essay

Wealth As Determinant Of Health Health And Social Care Essay.
There is a phenomenon in the United States that illustrates how wealth is a cardinal determiner of wellness. Wealth affords those who attain it, certain societal benefits which include entree to high quality instruction, employment, lodging, child care, recreational chances, nutrition, quality medical attention, and safer and cleaner vicinities. In 1985, the U.S. Department of Health and Human Services ( HHS ) constructed the Secretary ‘s Task Force Report on Black and Minority Health. The study was more typical than old studies, comparing four minority groups in the United States every bit good as the White population. In add-on, A it utilised aA statisticalA presentation of A ” inordinate deceases ” instead than the usual decease rates. This attack emphasized the fact that lives that were lost would non hold been lost had minority decease rates been the same as for the White population. These differences were subsequently coined as wellness disparities. As a consequence of the forceful nature of this study and the demand forA integrating of wellness promotion/disease bar schemes into these populations, the Office of Minority Health was established within HHS.
Since the origin of the Office of Minority Health research has shown that disparities exist in the population on the footing of both wellness position and wellness attention bringing. These disparities are the consequence of assorted variables. The lexicon of Public Health defines wellness disparities as “ differing degrees of wellness indexs like life anticipation, baby and perinatal mortality rates, that are observed among sections of a population, discernable in the size of the wellness spread between the highest and lowest section of the population, that frequently correlate with economic indexs, educational degree, employment and lodging conditions. ” There are differing theoriesA orA premises usedA to explicate why wellness disparities plague certain populations. What both of these theories lack is the causalA mechanism by whichA the disparities occur.
The historical context of attending to wellness disparities began with W.E.B. Du Bois. The being of wellness disparities in America was foremost documented in 1906 by W.E.B. Du Bois. Fueled by the averment that Negroes were an inferior race, Du Bois used nose count and disease informations from the late 1800s to document widespread disparities in bosom disease, infant deceases, maternal deceases, TB, and pox. Based on these observations, Du Bois asserted that such wellness disparities had nil to make with lower status and were strongly associated with multiple factors such as poorness, deficiency of instruction, and societal factors. A

The taking wellness disparities include: entree to care, quality of wellness or wellness position, cardiovascular disease, malignant neoplastic disease, diabetes, HIV/AIDS, asthma, infant mortality, and mental wellness. Quality of attention in peculiar, has shown to hold significant spreads among populations. As it relates to disparities in quality of attention, the Agency for Healthcare Research and Quality “ Quality wellness attention means making the right thing, at the right clip, in the right manner, for the right people-and holding the best possible consequences. ” ( Q ) Quality wellness attention is effectual, safe, seasonably, patient centered, just, and efficient. In 1999, Congress commissioned the Institute of Medicine ( IOM ) to look into wellness and wellness attention among racial/ethnic minorities. The consequences of the survey conducted, entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, demonstrated that minorities had poorer wellness and were systematically acquiring lower-quality attention even when factors such as insurance position and income were n’t involved ( Smeadley, Stith, & A ; Nelson 2003 ) . Despite paces towards extinguishing disparities, they still persist.
Health attention disparities in quality of attention are found among several mark populations. These populations include: racial and cultural minorities, those of a certain socioeconomic position, occupants of rural countries, low-income groups, adult females, kids, the aged, and individuals with disablements. An copiousness of grounds demonstrates that as a consequence of several factors, a huge bulk of people in these mark population groups do non have high quality wellness attention. Perceived supplier favoritism has both direct and indirect effects on wellness attention use and wellness position. Surveies such as those conducted by Van Houtven et Al. and Blanchard and Lurie found that persons who perceived supplier favoritism significantly delayed wellness attention use ( 10, 15 ) . The biopsychosocial theoretical account explains how stereotyping or bias can bring on emphasis in those who experience it and as a consequence have a negative impact on wellness position. Patient-provider miscommunication has several branchings such as medical mistakes, deficient medical attention, and even decease. This type of miscommunication is the consequence of cultural and linguistic communication barriers. Bettering lingual and cultural competence can be accomplished by increasing the proportion of underrepresented clinicians in wellness systems and in medical instruction. Technology lacks in health care seem to besides bring on lacks in quality of attention provided to many of persons in the mark population. Suppliers in rural and destitute countries are holding troubles because they lack the wellness information engineering that their opposite numbers have in the urban and more flush countries.
Differential entree to care can take to disparities in quality of wellness attention. Deriving entree to wellness attention is so an of import requirement to obtaining quality wellness attention. Minorities and low-income groups are less likely to hold wellness insurance and are more likely to hold public insurance. Payment rates for Medicaid are significantly lower than for Medicare, hence, minorities having Medicaid or that are uninsured receive attention in different scenes than in private insured or Medicare patient. Evidence suggests that entree to a regular and usual beginning of attention can greatly cut down wellness disparities. Transportation barriers, distance to clinics, or a deficiency of cognition about supplier locations have besides threatened entree to care.
In 2003, the Agency for Healthcare Research and Quality, as directed by the Healthcare Research and Quality Act of 1999, presented Congress with the first one-year National Healthcare Disparities Report and the National Healthcare Quality Report. Among the many findings as it relates to healthcare and healthcare quality disparities, the studies found that inequality in quality exists. Key findings in the 2009 National Healthcare Quality Report found that attempts to cut down disparities have had an impact, nevertheless, disparities still exist. In the study, it was found an estimated cost $ 65-130 billion can be attributed to premature decease and lower wellness position among uninsured people. The study besides focuses on several scientifically supported nucleus quality measures that autumn into two classs, either process steps or result steps. When compared to White persons: Blacks received worse attention for 50 % and better attention for 15 % of nucleus steps ; Asians received worse attention for 30 % and better attention for 40 % of nucleus steps ; American Indians and Alaska Natives ( AI/ANs ) received worse attention for 45 % and better attention for 25 % of nucleus steps ; Hipics received worse attention for 70 % and better attention for 20 % of nucleus steps. ( Q )
Associating to income disparities, hapless people received worse attention than high-income people for 75 % and better attention for 5 % of nucleus steps. ( Q ) When comparing the spread in disparities with findings from old old ages, 66 % of nucleus steps have non improved for Blacks, Asians, and Hipics ; ensuing in a dead or increased spread. For inkinesss in peculiar, the spread seems to somewhat be shuting with an betterment in approximately 20 % of the disparities steps. For AI/ANs there is an betterment of approximately 40 % of disparities steps. However, when reexamining these findings, one may ask whether or non utilization patterns among these groups were taken into consideration besides.
Extinguishing or cut downing healthcare disparities will necessitate statute law and action. Health policies and enterprises are made on three degrees of authorities, federal, province, and community-based. An illustration of a large-scale federal-level policy is REACH 2010. Reach 2010 is the CDC ‘s attempt to extinguish racial and cultural disparities. The CDC has awarded grants to 40 community-based alliances countrywide to implement a community-based plans and culturally-appropriate intercessions in the riddance of disparities. An illustration of a state-level policy is the Colorado Turning Point Initiative ( CTPI ) . The CTPI has set up informations aggregation plans to supply a standardised comparing of wellness indexs by race and ethnicity. Systems have besides been created to work towards its intended end of wellness disparities riddance. Such as the development of a province Office of Health Disparities and an betterment in linguistic communication aid for those who lacks English proficiency. An illustration of a community-based disparities enterprise is the Florida Community-Based Participatory Research ( CBPR ) Initiative in Reducing and Eliminating Health Disparities. This inaugural supports disease intercession research in disparities utilizing community-based participatory research which is conducted by communities and research workers.
There are several possible policy options for work outing the job of wellness attention disparities in quality of attention. As many persons in the mark populations are uninsured or underinsured, entree to wellness insurance by manner of policies such as the Healthcare Reform may hold a great impact on wellness disparities. For minorities and other mark groups, Healthcare Reform will take down costs for households, provide greater and more low-cost insurance picks, increase entree to care, advance primary attention, and command chronic disease. Another possible option is the Institute of Medicine ‘s Model of entree to wellness Services. A last possible policy option is acceptance of Health Information Technology ( HIT ) by manner of policies such as the Health Information Technology for Economic and Clinical Health ( HITECH ) ACT.
The preferable policy option for work outing the job of wellness attention disparities in quality of attention is wide acceptance of HIT. This option should particularly be implemented in destitute and rural countries. The policy ‘s standard should include: acceptance of wellness IT, quality wellness services provided, an impact on wellness disparities, coverage of quality informations, and political feasibleness. The degree of engineering is sufficient to implement this policy option. Presently, there are several types of wellness IT technologies, which includes: electronic wellness records ( EHRs ) , E-health, electronic medical records ( EMRs ) , and computerized supplier order entry ( CPOE ) . Barriers to acceptance may show themselves in the signifier of: cost/lack of capital to put among suppliers, inability to incorporate the HIT with current systems, offline clip, lost of productiveness or income during passage, preparation, and hardware/software ascents.
By implementing the HIT acceptance policy the spreads in quality of attention created by wellness disparities can be decreased. Broad acceptance of HIT will greatly even out the industry for all suppliers. Those suppliers in rural or destitute countries, such as Community Health Centers ( CHCs ) , in peculiar will hold the greatest impact on wellness disparities. “ Given that CHCs sever about 14 per centum of the state ‘s uninsured people, 11 per centum of Medicaid enrollees, and 10 per centum of minorities, puting in spread outing CHC ‘s wellness IT capacity seems a valuable scheme to farther cut down wellness disparities for a significant figure of financially vulnerable patients ” ( Shields 2007 ) . An of import characteristic of Health IT such as EHRs is the clinical supplier support interface that several systems contain. This characteristic provides recommendations on diagnostic and screening trials. “ This Fosters just intervention for diverse populations by extinguishing any possible racial or cultural prejudice form the wellness attention supplier that might impact clinical judgement ” ( Custodio 2009 ) . The system will to boot help in the decrease of medicine mistakes and inauspicious drug effects with its medicine faculty. This faculty can urge dose, interaction information of several drugs, and generic options.
The interoperability of wellness IT technologies such as EHRs will greatly increase functionality and as a consequence, the quality of attention provided. As many in the mark populations may be uninsured, lack the cognition of available resources, may populate far from a individual entity supplier, are hesitating to seek medical attention until something is incorrect, and miss a medical place, they tend to use hospital exigency suites more frequently than needed for medical attention. Health It such as EHRs will let suppliers from assorted clinics or infirmaries, entree a patient ‘s medical records, which will assist to cut down duplicate of services and medical mistakes. EHRs to boot, let for easier coverage of quality informations and public presentation monitoring. The information provided from the coverage will ease enterprises with a end of quality improvements. “ An electronic wellness record that includes certification of demographics, including race and ethnicity, hazard facto appraisals, and preventative and chronic disease direction determination support, enables the clinician to pull off more efficaciously the complex wellness attention demands of our vulnerable populations ” ( Custodio 2009 ) . Health IT is a valuable tool in the attempt of battling wellness disparities.
The political feasibleness associated with the wide acceptance of wellness IT involves several involvement groups or stakeholders. Government bureaus such as the Commission to End Healthcare Disparities ( The Commission ) have taken an active function in this issue and will interest in the result of this policy alteration. The Commission is a federal undertaking force focuses on quality, physician leading, and systems as a agency to extinguishing disparities. Community organisations besides play a critical function in the issue as they are the 1s that have direct contact with those in the mark population. This policy alteration will let them to come in the community and be a liason between suppliers and the mark population. The mark population groups have the most at interest when it comes to the policy alteration seeing that they are the 1 ‘s straight affected by the disparities. Healthcare suppliers or health care organisations besides have a interest in the policy alteration since they will be buying the systems needed to implement the alteration. Employers and concerns such as insurance or wellness IT software/hardware companies will besides hold a interest in this policy alteration with both perchance benefiting from the alteration. The stakeholders in support of the policy alteration include: authorities bureaus, community organisations, mark population, and the HIT software/hardware companies. The group that would perchance oppose the alteration is the health care providers/healthcare organisations. Countrywide several little doctor groups that service the rural or impoverished countries have been loath to follow HIT. Hospitals have besides been hesitant in their acceptance because of the associated barriers. This policy would be supported by Democrats. Recently the two such policies aimed at HIT execution, the HITECH Act and the Healthcare Reform, have been passed under a democratic disposal.
Economically, the execution of HIT comes with a brawny monetary value ticket. The Congressional Budget Office ( CBO ) conducted a survey sing EHRs execution and associated cost. The CBO found that the cost of execution for primary practician offices ranged between $ 25,000-50,000 per doctor. ( perot ) Additionally, one-year operating, licensing, and care costs ranged between $ 3,000-9,000 per doctor. Execution costs for infirmaries averaged $ 14,500 per bed with one-year operating costs of $ 2,700 per bed. ( Perot ) The HITECH Act was enacted as portion of the American Recovery and Reinvestment Act of 2009 with an purpose of exciting the acceptance of wellness IT and the meaningful usage of HER systems. In the act, the authorities allocated $ 19 billion to set towards the execution of EHRs countrywide. The authorities will supply Medicare or Medicaid reimbursements and $ 44,000 discount as inducements to follow EHRs between 2011-2015. After 2015 any wellness attention organisations that have failed to follow a system and pattern their meaningful usage will confront punishments. As portion of the Healthcare Reform, the Patient Protection and Affordable Care Act, contains several commissariats for acceptance of HIT and betterment in entree to care for the uninsured and underinsured. The overall jutting cost of the Healthcare Reform is $ 940 billion for the first decennary. The gross to implement the recommended policy alteration will come from revenue enhancements and supplier capital.
Equally long as the policy is implemented right, the benefits of the policy alteration will be every bit accessible among the mark population. Harmonizing to the HITECH Act, by 2015, all health care suppliers are expected to implement wellness IT. In order to guarantee successful execution a mechanism should be used to supervise whether disparities increase with the wide acceptance of EHRs or other wellness IT. Fraud nevertheless, may happen in the signifier of a security breach of the HIT system. “ Internal breaches of security continue to be the primary security concern identified by health care IM/IT executives ” ( book ) . There is besides the potency for gross misdirection or waste of ARRA financess.
In order to implement this policy efficaciously, a strategic execution program must be in topographic point. Collaboration among most if non all stakeholders must take topographic point, peculiarly between suppliers, authorities, and community-based organisations. Diversity and competency within the health care system and its work force must be improved. A quality-based reimbursement system for authorities operated insurances should be in topographic point. A undertaking force should be created in order to promote suppliers in rural countries to follow EHRs and other HIT. Health disparities should be included in the quality steps reported by suppliers to CMS in order to be eligible for meaningful usage inducement payments. State degree schemes should include: preparing or updating the province route map for HIT acceptance, set uping a province leading office, and set up chances for wellness IT preparation and instruction. Federal-level schemes occur in an ongoing three phase attempt. Stage one begins in 2011 and dressed ores on electronically entering wellness information in coded format. Stages 2 and 3 will be occur between 2013-2015 and expands on aims and steps, concentrating chiefly on the interoperability of HIT and it ‘s associate betterments in public wellness.

Wealth As Determinant Of Health Health And Social Care Essay

Individualized Developmental Care Practices Health And Social Care Essay

Individualized Developmental Care Practices Health And Social Care Essay.

Abstraction
Aim and nonsubjective. This research aimed to measure the consequence of individualised developmental attention patterns on the growing and hospitalization continuance of prematures.
Background: It is known that individualised developmental attention patterns enable premature babies to hold rapid weight addition, intensive attention complications to diminish, to hold earlier discharge from the infirmary, and the related cost to cut down.

Design. The survey used an experimental design.
Methods. The survey was carried out with prematures who received intervention and attention in the NICU ( N=97 ) . Babies were randomized into three groups ; mother ‘s aroma, flexure and control. Babies were monitored every attention hours of each twenty-four hours until the discharge and the measurings were recorded. The informations obtained were analyzed by t-test, per centum distributions, agencies, chi-square trial, analysis of discrepancy, and Bonferroni trial.
Consequences. It was determined in the survey that there was a important difference between experimental and control groups in footings of agencies of their discharge weight and tallness and this difference was associated with the mother-scent group ( P & lt ; 0.05 ) . While the within-group difference between hospitalization and discharge weight means was important merely in the mother-scent group ( P & lt ; 0.05 ) , the within-group difference between hospitalization and discharge tallness agencies was important in all three groups ( P & lt ; 0.05 ) . Even though the within-group difference between agencies of hospitalization continuance of premature babies was undistinguished ( p & gt ; 0.05 ) , means in the experimental groups were determined to be lower than the agencies in the control group.
Decision. Since the methods of female parent ‘s odor and flexure place intercessions support premature babies ‘ growing and shorten their hospitalization continuance, it is of import to utilize routinely them at NICU.
Relevance to Clinical Practice: NICU nurses might put the premature infants down in the flexure place and do them feel their female parent ‘s aroma in order to speed up their growing and shorten their hospitalization continuance.
Cardinal Wordss: Individualized Developmental Care, Premature Baby, NICU, Nursing
Introduction
Prematureness is the most of import ground for neonatal mortality and morbidity in the development states ( Yurdakok 2005, Beck et Al. 2010, Simmons et Al. 2010 ) . The life of premature babies who are born early is tried to be survived in the Newborn Intensive Care Units ( NICU ) . A important lessening has been achieved in infant mortalities with the aid of the advanced technological tools and standardized attention techniques in NICUs. Furthermore, it is observed that while lasting neurodevelopmental jobs, larning and behavioural upsets, and motor accomplishments lessening, other developmental jobs addition ( YA±ldA±rA±m 2001, Vandenberg 2007, CiAYdem 2011, Brown & A ; Heermann 1997 ) . Bing extremely different from the intrauterine environment, the NICU obstructs accommodation of the baby to the new life, since it can non exactly run into the developmental degree and demands of a premature baby. In these units, the inauspicious effects could be minimized by doing some alterations on the environment ( TarA± & A ; CiAYdem 2008 ) .
In add-on to environment, the nursing attention besides has a high efficiency for premature babies to be affected positively/negatively. The consequences of NIDCAP ( Newborn Individualized Developmental Care and Assessment Program ) patterns, which have been executed in NICUs in recent old ages, have been positive both in footings of both the baby and clinic facet ( YA±ldA±rA±m 2001, TarA± & A ; CiAYdem 2008 ) .
Sing the individualism and behavioural organisation of the neonate ; the attack of IDC ( Individualized Development Care ) is consisted of commanding and set uping the environmental factors, nearing the attention needs as baby-centered and using them in such a manner to back up the development of the baby in order to enable version of the neonate to the excess uterine life ( Vandenberg 2007, Brown & A ; Heermann 1997, Als 1982, Symigton & A ; Pinelli 2006 ) . When the IDC is practiced, it could enable the stabilisation of physiological and behavioural maps of the premature, and contribute to his/her healthy growing and development ( CiAYdem 2011 ) . Some advantages of the IDC are as follows ; rapid weight addition, lessening in intensive attention complications, earlier discharge from the infirmary and a important lessening in the cost ( TarA± & A ; CiAYdem 2008 ) .
The nursing attention patterns provided in NICUs have been arranged all around the universe since 1980s in line with NIDCAP plans ( Brown & A ; Heermann 1997, Symigton & A ; Pinelli 2006, Gibbins et Al. 2008, Coughlin et Al. 2009, Als et Al. 1994, Holsti et Al. 2004, Wielenga et Al. 2009, Maguire et Al. 2009 ) . There have been a limited figure of surveies, which assess the consequence of IDC in footings of different topics, in Turkey. TarA± and CiAYdem ( 2008 ) determined that the IDC, which is executed in passage to bottle-feeding in preterm babies, increases the organic structure weight in babies and enables earlier discharge of them. In their survey which evaluated the efficiency of the odor of chest milk in passage from forced feeding to entire unwritten eating in premature babies, YA±ldA±z et Al. ( 2011 ) determined that the stimulation by the odor of chest milk accelerated the passage to entire unwritten eating and shortens the hospitalization continuance. Akcan et Al. ( 2009 ) investigated the consequence of kangaroo attention on diminishing the hurting during the invasive intercessions, and found that babies, to whom kangaroo attention was applied, felt less pain compared to those in the control group. The survey conducted by AydA±n ( 2006 ) determined that while the classical music that is played for premature babies had no consequence on the growing parametric quantities and hospitalization continuance of babies, it was effectual on diminishing emphasis degrees. In Turkey there has been no survey that investigates the consequence of supplying female parent ‘s aroma and the place that supports the flexure, sing the IDC patterns. The IDC patterns that will be performed in line with the consequences obtained from these intercessions are thought to be perchance supportive for the attention of premature babies.
The intent of this survey was to measure the consequence of IDC patterns on the growing and hospitalization continuances of premature babies in NICUs.
Hypothesiss of the Study
Hypothesis 1. The growing of babies in groups to which IDC is applied ( flexure and female parent ‘s aroma ) is faster compared to those in the control group.
Hypothesis 2. The hospitalization continuance of babies in groups to which IDC is applied is shorter compared to those in the control group.
Hypothesis 3. The growing and hospitalization continuance of babies in groups to which IDC is applied are different from each other.
Methods
Study Design
The survey used an experimental design.
Sample
The survey was conducted in Ministry of Health, Provincial Directorate of Health of Kars, Kars State Hospital, Newborn Intensive Care Unit between September 2010 and May 2012.
Harmonizing to the standards of the T.R. Ministry of Health, the unit where the survey was conducted is a second-level NICU. The unit has 16 brooders and 10 unfastened beds, 8 nurses and 7 baby doctor, and 3-4 babes per nurse. Babies, who require a more advanced attention, are transferred to closest infirmaries with advanced third-level newborn intensive attention unit. Harmonizing to the records, 1163 neonates were admitted to the unit in the twelvemonth of 2010. 132 of these neonates were consisted of premature babies.
The state of Kars is geographically located in a rural country in the East of Turkey. It has a distance of about 200 kilometers from a general infirmary with a third-level NICU.
The population of the survey was consisted of premature babies, who received intervention and attention in the NICU between May 2011 and April 2012, and met the choice standards. 1383 neonates were brought to the unit between the specified day of the months. 162 of these babes were premature. As a consequence of the power analysis performed to put the sample size, the sample size was determined to be a sum of 83 premature babies in order for the power of the trial to be 0.90 at the significance degree of 0.05 and the medium-effect degree. The survey was conducted with 97 premature babies in three groups, which included 30, 32, and 35 babies, utilizing the method of random assignment. It is stated that there is a demand to analyze with at least 30 participants in order to make the sample size in experimental surveies ( A-zdamar 2003 ) .
Inclusion standards
Having a gestational age below 36 hebdomads and 6 yearss
Having a weight of 1000 gms and above
Having a stable wellness status within 24 hours after the birth
Bing breastfed
Having no inborn anomalousnesss
Having an indirect hematoidin degree below 15 mg/dl
Having a female parent who is unfastened to communicating and cooperation
Data Collection
The informations were obtained between May 2011 and April 2012. Descriptive information signifier of the premature baby was filled out with the aid of information obtained from the files of the babies, nurse observation signifiers and their female parents. Measurements were performed by the research workers.
Descriptive Information Form of the Premature Infant: This signifier, which was prepared by the research workers by reexamining the relevant literature ( TarA± & A ; CiAYdem 2008, Maguire et al.2009, YA±ldA±z et Al. 2011, Westrup et Al. 2000 ) , has 8 descriptive and open-ended inquiries related to the baby ( gestational age, gender, day of the month of birth, birth weight, tallness, caput perimeter, day of the month and hr of entree to the unit, and day of the month and hr of discharge ) .
Premature Follow-Up Form: It is the signifier in which the measurings ( weight and tallness ) of babies are recorded.
Material of Baby Bendy Bumper Positioning: It is a flexible place stuff, which is used in continuing the flexure place of the premature baby and for him/her to accommodate a comfy physiological place, has a metal that could be shaped harmonizing to the demand of the baby, and is covered with a froth organic structure. The baby could be placed in Bendy Bumper in a prone, supine or side-lying place. The froth organic structure has a washable and reclaimable screen. Three Bendy Bumper stuffs and, disposable external screens that are produced specifically for the stuff non to have on out or go an infection factor were used in the survey.
Ookie Mom-Scent Doll: The word Ookie means “ small, bantam ” in Dutch linguistic communication. Ookies have been used for neonates since 1997. It is a doll with satin borders, which is made of 100 % cotton flannel, has sizes of 35cmx40cm and assorted colorss. It is easy to rinse, dry and sterilize the doll owing to its quality. Ookie does non hold any individuality like face, race, and gender. It is a convenient tool to supply the female parent ‘s aroma, which is the best aromatherapy, for babes, who get separated from their female parent at place or are required to be cared in some other environment, and the hospitalized babies. In order to convey the female parent ‘s aroma, female parent and the Ookie doll should kip together for one dark after the birth and so it should be placed near the babe. Two Ookie dolls were used for each premature baby in the survey.
Intervention
The premature babies, in conformance with the choice standards of the survey, were waited for acquiring stabilised. Interviews were conducted with the households of babies, who were stabilised during the first 24 hours, and they were informed about the survey. Written permissions of these households, who accepted to take part in the survey, were obtained and their babes were included in the survey. Families were informed that the informations would be kept confidential and be used merely for this survey.
Before the survey NICU nurses and female parents were informed about the survey and intercessions to be conducted. Three hours ( 0900-1200-1500 ) among the intervention and attention hours given by nurses in the NICU within the twenty-four hours were selected and measurings were performed harmonizing to this order ; babies were non touched in any other clip. The Premature Follow-Up Form was completed by the research workers and all processs were continued until the discharge of babies.
While the first group that was included within the range of the survey constituted the control group, the 2nd group was the flexure group and the 3rd group was the mother-scent group. Group agreement was determined by pulling tonss. Each baby that was admitted to the unit was included in groups harmonizing to this agreement. When the Ookie doll and place stuffs were being used, the assignment continued with the following group.
The intercessions, which were applied to premature babies that constituted the control group and experimental groups of the survey, are as follows.
Premature Babies in the Control Group: Premature babies in this group received the everyday attention of the clinic. Routine attention includes the intervention, eating and hygiene patterns of babies and no nursing intercession was applied except for them. They were at the same time followed with those in the experimental groups until the discharge.
Premature Babies in the Flexion Group: Flexion places of premature babies in this group were supported throughout the twenty-four hours. In the clinic where the pattern was performed, the babies were laid down in the prone, supine and by and large side-lying places harmonizing to the status of each baby. Their flexures were preserved with a nesting supportA without altering their ain prevarication place. Bendy bumper positioning stuff, which is placed under the pelvic girdle and pess as “ U ” form on the side of shoulders, was used for this place. The place of the baby was rearranged during each eating and care hr, and this process was sustained until the discharge of the baby. The positioning stuff was covered with a unfertile screen. The screen was changed as it got soiled and was about to be used for another baby.
Premature Babies in the Mother-Scent Group: An Ookie doll was given to the female parent of each premature in this group and her were asked to maintain the doll on her thorax for one dark ( about eight hours ) , in such a manner to do it touched with their bare tegument. By this manner, Ookie absorbed the female parent ‘s aroma owing to its smell-absorbing nature and so was placed in the brooder near the baby the following twenty-four hours. Two Ookie dolls were used for each baby in this process ; one for the female parent and the other for the baby in the brooder
Bing kept in brooders for 24 hours, Ookie dolls were changed at 0900, the first attention hr, every twenty-four hours and this process was continued until the discharge of premature babies. Dolls were labelled harmonizing to their signifier Numberss and changed with the female parent in order to forestall confusion. Ookie dolls, which were used for each dismissed premature baby, were sterilised in the sterilization unit of the infirmary ( at 121 A°C in sterilizer for 1 hr ) within disposable sterilization bags.
In the specified NICUs, the premature babies are followed on unfastened beds for certain periods of clip after being taken out of the brooder and they are discharged when they no more need the support of the infirmary in term of prolonging their physiological demands. The premature babies who were involved in the survey were followed in the same manner until their discharge from the infirmary ; before being discharged, their weight, and height steps every bit good as discharge day of the months were recorded in order to find their growing provinces.
Ethical Considerations
Equally good as a legal permission from the relevant establishment, ethical consent ( dated 31.12.2010 and numbered 2010.6.1/7 ) was received from the Ethics Committee of Ataturk University, Institute of Health Sciences in order to carry on the survey. The households of premature babies, who complied with the standards of the survey group, were informed about the intent of the survey, their inquiries were answered and written consents were received. The parents were explained that the information they gave would be kept confidential, would non be used in anywhere else and they had the right to retreat from the survey at any clip. None withdrew from the survey.
Statistical Analysis
The informations were assessed by utilizing appropriate statistical analyses in the package plan of SPSS ( Statistical Package for Social Sciences ) 18.0. Percentage distributions, mean, standard divergence, and chi-square trial were used to statistically analyse the obtained informations ; one-way analysis of discrepancy for between-groups comparings, t trial for within-group comparings, and Bonferroni trial, which is an advanced station hoc analysis, for mated comparings were used.
Consequences
The survey determined that premature babies in control group and experimental groups were similar in footings of agencies of gestational age, birth weight, birth length, birth caput perimeter, weight in hospitalization, tallness in hospitalization and caput perimeter in hospitalization every bit good as gender ( p & gt ; 0.05, Table 1 ) .
It was specified that the difference between experimental groups and control group in footings of agencies of discharge weight was important, and this difference was associated with the mother-scent group. While a important difference was observed between the hospitalization and discharge weight means in the mother-scent group ( P & lt ; 0.05 ) , the difference between the flexure group and control group was undistinguished ( p & gt ; 0.05, Table 2 ) .
The difference between experimental groups and control group in footings of agencies of discharge tallness was important ( p & lt ; 0.05 ) , and this difference was caused by the mother-scent group. Besides the difference between the hospitalization and discharge tallness agencies was important within each of all three groups ( P & lt ; 0.05, Table 2 ) .
The difference between experimental groups and control group in footings of agencies of hospitalization continuance was undistinguished ; nevertheless, the hospitalization continuance of experimental groups was shorter ( P & gt ; 0.05, Table 3 ) .
Discussion
NICU scene is an environment that lacks parent contact and stimulation for a premature baby when he/she is non developmentally ready, and a topographic point where the baby is exposed to stressors such as disease, noise, visible radiation, repeated painful processs and medicines, and inordinate stimulations ( Erdeve et al. 2008 ) . It is known that conditions in this environment, which provides a long-run intervention and attention and animal injury adversely affect development of the nervous system of the babe ( Erdeve et al. 2008, KarataAY 2011 ) . The aim of IDC is to set up the stimulations ( sound, visible radiation, odor, contact of the health professional, conversation, societal interaction ) in the environment where attention is given during this critical and long procedure as similar to the intrauterine environment and implement the attention in such a manner to back up the development of the newborn ( Symigton & A ; Pinelli 2006, KarataAY 2011, Legendre et Al. 2011 ) .
The survey assessed the consequence of female parent ‘s aroma and flexure place on the growing and hospitalization continuance of premature babies.
Environmental and societal stimulations in the NICU environment cause the babe to devour greater energy. However, energy is required for the growth-development of these babes and their attempts of version to the external universe. The attack of developmental attention purposes to utilize the energy at minimal degree and shop it to be used for the growth-development every bit much as possible ( YA±ldA±rA±m 2001, TarA± & A ; CiAYdem 2008, KarataAY 2011, Als 1998 ) . It was reported that babies who received IDC gained greater weight compared to other babies ( Brown & A ; Heermann 1997, TarA± & A ; CiAYdem 2008, Symigton & A ; Pinelli 2006, YA±ldA±z et Al. 2011, Als 1998, Als et al.1996, Ballweg 2001, Chen et al. 2000 ) . It was determined in the survey that there was a important difference between the groups in footings of discharge weight agencies of babes and this difference was associated with the mother-scent group. Upon within-group comparing of hospitalization and discharge weight agencies of experimental and control groups, there was a important difference in the mother-scent group ( P & lt ; 0.05 ) , and an undistinguished difference between the flexure and control groups ( P & gt ; 0.05 ) . This consequence was partly supported by the hypothesis, “ The growing of babies in groups to which IDC is applied ( flexure and female parent ‘s aroma ) is faster compared to those in the control group ” . In their survey which assessed the efficiency of the odor of chest milk during the forced feeding eating in prematures, YA±ldA±z et Al. ( 2011 ) reported a important addition on discharge weights of babes, to whom the odor stimulation was applied. In their survey which compared the traditional and developmental attention methods practiced during the passage to bottle-feeding in premature babies, TarA± and CiAYdem ( 2008 ) determined that the weight addition was greater in babies, to whom IDC was practiced. In their survey, Brown and Heermann ( 1997 ) applied IDC to 25 premature babies under 1500 gms, and reported that the discharge weights, and difference between hospitalization-discharge weight of babies were important, which is line with the findings of this survey. In the surveies conducted by Als et Al. ( 1994 ) and Chen et Al. ( 2000 ) , they examined the IDC pattern on premature babes in the NICU and as a consequence of their surveies ; they determined an addition in the day-to-day organic structure weight. Consequences of the survey support the consequences of these surveies.
It was determined that the difference between the groups in footings of agencies of discharge tallness of premature babies was statistically important ( p & lt ; 0.05 ) and this difference was related with the mother-scent group. As a consequence of the within-group comparings, the difference between their agencies of hospitalization and discharge tallness was statistically important within each of all three groups ( P & lt ; 0.05 ) . Findingss obtained in footings of the growing parametric quantities are complicated in surveies on the efficiency of IDC in NICUs in literature. In a randomized-controlled survey conducted by Als et Al. ( 2003 ) , it was reported that the premature babes in the experimental group had a faster day-to-day weight addition and growing. In the randomized-controlled survey of Westrub et Al. ( 2000 ) , IDC was non effectual on growing. In their survey which compared the criterion attention and IDC methods on 164 premature babes who were younger than the gestational hebdomad 32, Magiure et Al. ( 2009 ) reported that there was non a important difference between experimental and control groups, in footings of weight, tallness and caput perimeter. The consequences of the survey are in parallel with the consequences of the survey conducted by Als et Al. ( 2003 ) .
Premature babes could be hospitalized for a long clip, due to grounds such as the badness of their diseases, malformations or earlier gestational age. Extended hospitalization might do nosocomial infections, extension of the recovery period, negative psychosocial effects associated with the long-run separation from the household and high medical costs ( YA±ldA±z 2002, Legendre et Al. 2011 ) Some surveies reported that individualized developmental attention patterns decrease the hospitalization continuance ( Brown & A ; Heermann 1997, TarA± & A ; CiAYdem 2008, Symigton & A ; Pinelli 2006, Als et al 1994, YA±ldA±z et Al. 2011, Westrup et Al. 2000, Chen et al. 2000, Als et Al. 2003 ) . The survey revealed that the mother-scent group had the shortest hospitalization continuance, which was followed by the flexure group, and the control group had the longest hospitalization continuance ; the difference between the groups was undistinguished ( p & gt ; 0.05 ) . Compared to the control group, the hospitalization continuance was 3 yearss shorter in the mother-scent group and 2 yearss shorter in the flexure group. This consequence was supported by the hypotheses, “ The hospitalization continuance of babies in groups to which IDC is applied is shorter compared to those in the control group ” and “ growing and hospitalization continuance of babies in groups to which IDC is applied is different from each other ” .
In their survey which assessed the efficiency of the odor of chest milk during the forced feeding eating in premature babes, YA±ldA±z et Al. ( 2011 ) determined that babes in the experimental group were discharged from the infirmary earlier. In their survey, TarA± and CiAYdem ( 2008 ) compared the traditional and developmental attention methods applied during the passage to bottle-feeding in premature babes, and determined that babes to whom IDC was executed were discharged from the infirmary earlier. In the survey conducted by Als et Al. ( 1994 ) they examined the consequence of IDC pattern on premature babes in the NICU and specified that premature babes in the experimental group were hospitalized for a shorter period and there was a lessening in the attention cost. In add-on to these surveies ( TarA± & A ; CiAYdem 2008, 1994, Als et al. , YA±ldA±z et al 2011 ) , other surveies ( Brown & A ; Heermann 1997, Chen et al. 2000, Als et Al. 2003, Wielenga et Al. 2007 ) besides determined that IDC patterns shortened the hospitalization continuance of premature babes. Study consequences show a similarity with these consequences.
Decision
Since the intercessions of female parent ‘s aroma and flexure place support the growing and shorten the hospitalization continuance, they could be used routinely in premature babes with a stable status. Parents could be trained for the saving of the flexure place at place, following the discharge. It is required to measure the intercessions of female parent ‘s aroma and flexure place in premature babes with non-stable conditions, non suckling, full-term babes and those with anomalousnesss, and besides analyze the efficiency of different IDC patterns.
Relevance to clinical pattern
NICU nurses might put the premature infants down in the flexure place and do them feel their female parent ‘s aroma in order to speed up their growing and shorten their hospitalization continuance.

Individualized Developmental Care Practices Health And Social Care Essay

Informative Essay on Health and Social Care

Informative Essay on Health and Social Care.
London Churchill College Topics: Psychology for Health & Social Care Practice (Unit 15) BTEC Higher National Diploma (HND) in Health & Social Care QCF Level 4 [A study of Psychology in Health & Social Care] By: Shah Shamima Begum To: Suzanne Lutchmun ID: LCC-20123434 Group A 1. 1 Compare different psychological theories of lifep dependent Answer to the question no 1. 1 Developmental theories provide a set of guiding principles and concepts that describe and explain human development. Some developmental theories focus on the formation of a specific quality, such as Kohlberg’s theory of moral development.
Other developmental theories focus on growth that happens throughout the lifep, such as Erikson’s theory of psychosocial development. Grand theories are those comprehensive ideas often proposed by major thinkers such as Sigmund Freud,Erik Erikson and Jean Piaget. Grand theories of development include psychoanalytic theory, learning theory and cognitive theory. These theories seek to explain much of human behavior, but are often considered outdated and incomplete in the face of modern research. Psychologists and researchers often use grand theories as a basis for exploration, but consider smaller theories and recent research as well.
Minitheories Minitheories describe a small, very specific aspect of development essay writer world. A minitheory might explain fairly narrow behaviors, such as how self-esteem is formed or early childhood socialization. These theories are often rooted in the ideas established by grand theories, but they do not seek to describe and explain the whole of human behavior and growth. Emergent Theories Emergent theories are those that have been created fairly recently and are often formed by systematically combining various minitheories. These theories often draw on research and ideas from many different disciplines, ut are not yet as broad or far-reaching as grand theories. The sociocultural theory proposed by theorist Lev Vygotsky is a good example of an emergent theory of development. 1. 2 Which psychological theories and concepts are related to which life stages Answer to the question no 1. 2 Jean Piaget’s Background Jean Piaget was born in Switzerland in 1896. After receiving his doctoral degree at age 22, Piaget formally began a career that would have a profound impact on both psychology and education. After working with Alfred Binet, Piaget developed an interest in the intellectual development of children.

Based upon his observations, he concluded that children were not less intelligent than adults, they simply think differently. Albert Einstein called Piaget’s discovery “so simple only a genius could have thought of it. ” Piaget’s stage theory describes the cognitive development of children. Cognitive development involves changes in cognitive process and abilities. In Piaget’s view, early cognitive development involves processes based upon actions and later progresses into changes in mental operations. 2. 1 What are the social and biological factors that influence human behaviour?
Answer to the question no 2. 1 Human behavior includes all patterns of behavior attributable to the human species as a whole and of individual people. It is studied by a range of natural and social sciences such as biology, neuroscience, psychology, anthropology and sociology. Human behavior is influenced by culture and tradition, as well as by human physiology and genetic factors. Collective human behavior is a separate subject of study, mostly concerned with population-scale phenomena such as evolutionary and emergent effects.
In their book The Material Life of Human Beings: Artifacts, Behavior and Communication, Andrea R. Miller and Michael Brian Schiffer provide two definitions of human behavior. First, behavior can be defined on a relational basis, as any activity of a person, involving the consequential manipulation of at least one “interactor”, taken to mean a physical object in the person’s environment or another person. This definition is appropriate for simple performance actions such as writing a letter or engaging in dialogue, but it leaves out complex or introspective human activities.
The second, broader definition is that human behavior consists of “all interactions in a given behavioral system. ” According to Miller and Schiffer such a broad definition of behavior is important because it unites various aspects of human actions, which have been studied in isolation in different fields. Thus, the primary focus of biologists on a range of reflexes and muscular motions as the basis of behavior and the main emphasis of sociologists on interpersonal relationships as its foundation can be united in one logical framework.
One of the most important scientific investigations with respect to human behavior focuses on identifying the primary factors that determine it. Recent findings in fields such as human genomics, cognitive and information sciences shed new light and improve our understanding of the ways, in which genes and learning influence behavior. What is more, investigations of complex social and ecological processes have revealed feedback mechanisms, in which collective human behavior itself may be responsible for changing the genetic makeup of the population over generations.
Such findings and the current state of the emerging field of behavioral genetics are summarized by the distinguished academics Cynthia Coll, Elaine Bearer and Richard Lerner, editors of the compendium Nature and Nurture: The Complex Interplay of Genetic and Environmental Influences on Human Behavior and Development. The conclusion seems to be that there is no clear divide between the formative influences of genetic makeup and environmental influences on human behavior. Gene-environment interplay starts to affect the behavior and development of humans and animals from the embryonic phase and continues throughout their life experience.
Expression of the genotype, or the coded programming of the human genes, is often flexible and very much affected by the environmental context. Heredity alone cannot explain behavioral or developmental differences among different groups of people. There are instances where collective human behavior may have profound consequences, which are unintended on an individual level. Many major advances in human civilization are likely the result of what biophysicist Harold Morowitz calls “synergistic interactions” of individuals’ actions. Thus, collective adaptive behavior such as settling may lead to a population-wide trend such as urbanization. . 2 What is the importance of social roles in the context of a health and social care setting? Answer to the question no 2. 2 One of the main challenges facing leaders and managers within the health and social care arena is in understanding the role of the broader environment in determining policy formulation and implementation. This award explores not only the substance of relevant health and social care policies, but also the key factors which impact upon the policy making and practice. In particular, this award explores the impact of economic social and cultural, political, and factors.
A deeper understanding of how reforms are made and implemented is vital if you make a contribution to policy formulation and to how it is translated into practice. You need to understand and participate in the major debates in health and social care policy. The award develops your understanding and the skills needed to comprehensively and critically explore the economic, social, and political and cultural contexts within which health and social care policies are implemented. You also gain an in-depth critical understanding of the impact of the health and social care policies themselves. What you study
Award content includes: * historical development of the NHS and the conception of social care * economic, political and social context of health and social care * key concepts in health and social care policy * funding and resource allocation * public health and inequality * consumerism, citizenship and public and patient involvement * the role of the professions * health care systems * matching demand for care with supply – needs assessment and commissioning. * accountability, quality and standards 3. 1 Analyze the application of psychological theories to individuals experiencing elevated levels of stress.
Answer to the question no 3. 1 The recent literature on carers’ burden in mental disorders is reviewed. Families bear the major responsibility for such care. Carers face mental ill health as a direct consequence of their caring role and experience higher rates of mental ill health than the general population. The production of burden in carers is a complex process and is related to gender, age, health status, ethnic and cultural affiliation, lack of social support, coping style, in addition to the stressors of the disorder itself.
Carers appear to suffer from at least moderate levels of psychological symptomatology. The behavioural problems associated with mental disorders further increase the stress levels of carers. The findings from the review afford a comprehensive understanding of the care-giving situation with its outcomes, and its practical application in devising effective support strategies for family carers. KEYWORDS:  Carers, caregivers, care recipients, psychological distress, burden, stress, mental disorders. | Introduction Carers play a vital role in supporting family members who are sick, infirm or disabled.  There is no doubt that the families of those with mental disorders are affected by the condition of their near ones. Families not only provide practical help and personal care but also give emotional support to their relative with a mental disorder. Therefore the affected person is dependent on the carer, and their well-being is directly related to the nature and quality of the care provided by the carer. These demands can bring significant levels of stress for the carer and can affect their overall quality of life including work, socializing and relationships.
Research into the impact of care-giving shows that one-third to one-half of carers suffer significant psychological distress and experience higher rates of mental ill health than the general population. Being a carer can raise difficult personal issues about duty, responsibility, adequacy and guilt. 2 Caring for a relative with a mental health problem is not a static process since the needs of the care recipient alter as their condition changes. The role of the carer can be more demanding and difficult if the care recipient’s mental disorder is associated with behavioural problems or physical disability.
Over the past few decades, research into the impact of care-giving has led to an improved understanding of this subject including the interventions that help. It has now been realized that developing constructive working relationships with carers, and considering their needs, is an essential part of service provision for people with mental disorders who require and receive care from their relatives. The aim of this review was to examine the relationship between caring, psychological distress, and the factors that help caregivers successfully manage their role. Family burden’ – The role of families as carers Caring for someone with a mental disorder can affect the dynamics of a family. It takes up most of the carers’ time and energy. The family’s responsibility in providing care for people with mental disorders has increased in the past three decades. This has been mainly due to a trend towards community care and the de-institutionalization of psychiatric patients. 3 This shift has resulted in the transferral of the day-to-day care of people with mental disorders to family members.
Up to 90% of people with mental disorders live with relatives who provide them with long-term practical and emotional support. 4, 5 Carer burden increases with more patient contact and when patients live with their families. 6Strong associations have been noted between burden (especially isolation, disappointment and emotional involvement), caregivers’ perceived health and sense of coherence, adjusted for age and relationship. 7 ‘Family burden’ has been adopted to identify the objective and subjective difficulties experienced by relatives of people with long-term mental disorders.  Objective burden relates to the practical problems experienced by relatives such as the disruption of family relationships, constraints in social, leisure and work activities, financial difficulties, and negative impact on their own physical health. Subjective burden describes the psychological reactions which relatives experience, e. g. a feeling of loss, sadness, anxiety and embarrassment in social situations, the stress of coping with disturbing behaviours, and the frustration caused by changing relationships. 9 Grief may also be involved.
This may be grief for the loss of the person’s former personality, achievements and contributions, as well as the loss of family lifestyle. 10 This grief can lead to unconscious hostility and anger. 9,10 The impact of caring on carers’ mental health The vehicles of psychological stress have been conceptualized as adjustment to change,11 daily hassles,12 and role strains. 13 Lazarus and Folkman (1984)14 define stress as ‘a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well being. The association between feelings of burden and the overall caregiver role is well documented. 15 Caregivers provide assistance with activities of daily living, emotional support to the patient, and dealing with incontinence, feeding, and mobility. Due to high burden and responsibilities, caregivers experience poorer self-reported health, engage in fewer health promotion actions than non-caregivers, and report lower life satisfaction. 16, 17 3. 2 How do psychological theories relate to behaviour disturbance? Answer to the question no 3. 2 Behavioural psychology refers to the study of behaviour change.
It is based on the assumption that behaviour change signi? es that learning has taken place. Behaviourists did not concern themselves with mental processes since these could not be directly observed. From its beginnings with the work of Pavlov in the early twentieth century, behaviourism grew to prominence during the 1940s to 1970s under the in? uence of B. F. Skinner, whose theories predicted a direct relationship between behaviour and its consequences in given situations. Behavioural psychology declined in popularity during the latter part of the twentieth century.
Research with animals became unacceptable and some psychologists argued that human mental processes are qualitatively different from those of animals. Most disliked its ‘deterministic’ principles, which contradicted the notion of free will. But by then, behavioural research had become more sophisticated and enabled psychologists to draw inferences about the thought processes involved in behaviour change, most notably perceptions of control. These aspects were incorporated into cognitive science and remain in? uential. Behaviourism’s greatest impact has been the development f therapies for fears and phobias (Chapter 5), anxiety disorders (Chapter 6), the management of unwanted or challenging behaviours (Chapter 5), and its contribution to CBT (Chapters 8, 9 and 10). 6 Psychology for nurses and the caring professionsPage 7 Page 7 Psychodynamic psychology Psychoanalysis was founded by Sigmund Freud as a method of inquiry, a theory of mind, and a mode of treatment for complex psychological problems. Freud was a medical doctor who studied neurological problems, moving on to treat physical illnesses that were believed at the time to be manifestations of psychological problems.
The correct term for this is psychogenic illness (physical illness that has a psychological cause), as distinct from a psychosomatic disorder, which refers to a physical illness that has a psychological in? uence, or vice versa. Central to Freud’s theory was the proposition that certain experiences during childhood are too uncomfortable to remember and are unconsciously ‘repressed’. According to Freud, these repressed thoughts, which he proposed were commonly of a sexual nature, eventually give rise to a state of anxiety or depression which may be expressed in terms of physical symptoms.
Repressed thoughts may be revealed through dreams, word associations and slips of the tongue. Their release (termed catharsis) is an aim of the psychoanalyst. The terms ‘denial, repression and ego’ entered everyday conversation, but are actually theoretical concepts and not veri? ed facts. Freud’s ideas have been in? uential in psychiatry, clinical psychology and counselling. But many aspects of psychoanalytic theory have been dif? cult to prove or disprove using scienti? c methods. Psychoanalytic explanations are usually offered ‘post hoc’ (after the event) and some would argue that psychoanalytic theory is therefore unable to ful? the primary purpose of a theory, which is to predict outcomes. This has led to attack from members of the scienti? c community who regard psychoanalysis as a ‘pseudoscience’. Following Freud’s death, psychoanalysis largely gave way to what was termed ‘ego’ psychology. This gave rise to a number of important developmental and cognitive theories, including theories of lifep development and attachment (Chapter 3), loss (Chapter 6) and coping (Chapter 8). Psychodynamic psychotherapy evolved from psychoanalysis under the in? uence of Melanie Klein and others.
It retains the notion that many emotional problems are caused by unresolved dif? culties in attachment relationships formed in childhood (Chapter 3), and clients are helped to retrieve and resolve dif? cult or traumatic memories. This approach to therapy has given rise to some concerns about the possibility of introducing false memories (see Chapter 4). Psychodynamic counselling is currently one of the most popular approaches, in western societies, for the treatment of anxiety and depression The number of psychologists working in health and social care and other ? elds has increased considerably over the last few decades.
Their tasks focus on preventing, assessing, treating and/or helping individuals to manage emotional, behavioural and cognitive problems using psychological theory and research. They also work alongside, or provide consultancy to, other health professionals. It is helpful to be able to distinguish between the skills available to different types of therapists who use psychology. De? nitions of psychologists given below are based on those provided by British Psychological Society (BPS): www. bps. org. uk from where further details of their work and training requirements can be obtained. All chartered psychologists have a ? st degree in psychology and further training to masters or doctoral level that includes practice placements. All undergraduate and postgraduate education must be approved by the BPS. • Clinical psychologists aim to reduce psychological distress and enhance and promote psychological well-being. They work with people with mental or physical health problems, including anxiety and depression, serious and enduring mental illness, adjustment to physical illness, neurological disorders, addictive behaviours, childhood behaviour disorders, personal and family relationships. They work with people throughout the life p, sometimes specializing in ? lds such as learning dif? culties. • Health psychologists apply psychological research and methods to the strategic prevention and management of disease, the promotion and maintenance of health, the identi? cation of psychological factors that contribute to physical illness, and the formulation of health policy. As examples, they study why and when people seek professional advice about their health, why they do or do not take preventative measures, how patients and health care professionals interact, how patients adapt to illness, and the links between perception, health behaviour and physical functioning. Counselling psychologists apply psychology to working collaboratively with people across a diverse range of human problems. This includes helping people manage dif? cult life events such as bereavement, past and present relationships and mental health problems such as depression. Counselling psychologists accept subjective experience as valid for each person, explore underlying issues and use an active collaborative relationship to empower people to consider change. Counselling psychologists adopt a holistic stance, which involves examining issues within the wider context of what has given rise to them.
The roles of psychologists overlap with the roles of other health care professionals who have similar aims, including: • Counsellor. Similar to a counselling psychologist, except that anyone can describe themselves as a counsellor. Training courses vary from a few days to several years. There are short courses that provide a certi? cate Psychology in the context of health and social care 15Page 16 Page 16 of attendance, longer courses that provide a ‘certi? cate’ or ‘diploma’ (though the academic level may be unspeci? d), and MSc programmes that include a period of supervised training. Some training programmes offer an eclectic mix of psychological approaches, though most follow a particular psychological model such as Rogerian or psychodynamic counselling. • Psychoanalyst. Someone who has trained in psychoanalysis under the supervision of an approved psychoanalyst. All approved psychoanalysts can trace the provenance of their trainers back to those who were trained by Freud himself. All analysts undergo psychoanalysis themselves as part of a lengthy period of training. Psychodynamic psychotherapist. A therapist who has undergone a period of intensive training, including personal analysis and supervised practice, and who bases their approach on a psychodynamic model. • Psychiatrist. A medical doctor who, since qualifying, has specialized in the diagnosis and treatment of people with mental health disorders. They may use a range of psychological therapies, but these usually include drug treatments which they have the right to prescribe. They sometimes use physical interventions such as electroconvulsive therapy (ECT).
They are in charge of psychiatric beds and have the authority to admit people to hospital for treatment on a voluntary or compulsory basis. They usually assume the clinical lead of a multiprofessional mental health team that includes clinical psychologists, mental health nurses and social workers. • Cognitive behaviour therapist. A quali? ed health or social care professional, such as a mental health nurse, who has completed undergraduate or postgraduate specialist training in CBT for the treatment for such disorders as depression, psychosis or obsessive-compulsive disorders.
All clinical psychologists are trained to offer CBT. 3. 3 How does psychological theory inform our understanding of mental health disorders? Answer to the question no 3. 3 Obsessions are unwelcome thoughts, idea or urges that repeatedly appear in your mind; for example, thinking that you have been contaminated by dirt and germs, or worrying that you haven’t turned off the oven. These obsessions are often frightening or seem so horrible that you can’t share them with others. The obsession interrupts thoughts that you would rather have, and makes you feel very anxious.
Often it will make you worry that you or other people are going to be harmed. Compulsions are repetitive activities that you feel you have to do. This could be something like repeatedly checking a door to make sure it is locked or washing your hands. The aim of the compulsion is to ‘put right’ the distress caused by the obsessive thoughts and relieve the anxiety you are feeling. You will be unlikely to feel any pleasure from carrying out the compulsion but you might find yourself doing it again and again.
Most people with OCD experience both obsessions and compulsions, but some people experience only obsessive thoughts, and some people have compulsions without knowing why. If you have OCD, you know that the obsessional thoughts are your own. This makes it different to a psychotic disorder, such as schizophrenia, where people feel that certain unwelcome thoughts and ideas come from outside themselves. OCD is described as an anxiety disorder. Other anxiety disorders include phobias and panic disorder which can share symptoms with OCD such as recurrent intrusive thoughts and fear.
OCD is also known to have a close association with depression, and some people find obsessions appear or get worse when they are depressed. How common is OCD? Minor obsessions and compulsions are common. We all worry, occasionally, about whether we’ve left the gas on, or the locked the door, and we describe people as being obsessed with work or football. However, these are not normally unwanted thoughts and they do not interfere with daily life. Many people also carry out small, everyday rituals like not stepping on cracks.
These rituals might help people feel safe, but are not normally considered problems. If you are diagnosed with OCD, the problems are so severe that they have stopped you from being able to live your life the way that you want to. You may understand that the way you are behaving is irrational, and feel ashamed and alone because of it. This shame often stops people from asking for help, and can lead to a delay in diagnosis and treatment. Many people try to cope alone until the symptoms are so severe they can’t hide them any more. You may not realise how common such problems are.
It is thought that 1 to 2 per cent of the population have OCD that is severe enough to disrupt their normal life, and it can affect people of all ages and from all backgrounds; however, the onset of OCD symptoms is normally in early adulthood, with most cases emerging before the age of 25. 3. 4 Evaluate the application of psychological principles to affecting behaviour change in health and social care settings. Answer to the question no 3. 4 Although most Extension educational programs seek to increase knowledge, a more compelling goal is to create and sustain a desired set of health and ersonal behaviors, such as physical activity, healthy eating, effective parenting practices, or positive family communication patterns. Actual behavior change in these areas is likely to include cognitive, social, psychomotor, and affective/emotional dimensions (Boone & Boone, 2005). Nevertheless, Extension programs typically target and measure only cognitive behaviors–knowledge and information. Thus the first step toward more powerful behavior change education is to acknowledge the importance of social, psychomotor, and affective/emotional dimensions of change.
An example of an Extension program that addresses psychomotor skills is Strong Women (Nelson, 2000) a free weight exercise program designed to improve bone health and reduce the risk of fractures. Used by the Extension Service in several states, this program introduces participants to the concept (knowledge) of building strength through the use of weights and then teaches specific (psychomotor) skills associated with lifting small weights correctly. A second step is designing educational programs based on solid principles of behavior change.
Psychological and educational research has shown that behavioral change occurs and is maintained when interventions incorporate particular principles of behavior change. Although some of these principles are frequent elements of Extension education programs, others will be newer ideas for Extension educators. 3. 5 Analyze how psychological theories enhance our understanding of relationships in health and social care. Answer to the question no 3. 5 Why is psychology important in health and social care?
Those of us who work in the caring professions spend most, if not all, of our working lives interacting with other people. A key part of our job is to promote health and well-being. Many people are familiar with the following broad definition of health: ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO 1946). If this is seen as an important goal, those working in health and social care need the knowledge and skills to help people work towards achieving it.
There are many ways in which psychological theory and research can contribute to improvements in health and social care. They can help us to: l appreciate how people’s understandings and needs vary, so that we can try to ensure that the individualized care we provide is both appropriate and optimal; l understand how our own thought processes can sometimes lead us to incorrect assumptions about others; l gain a better understanding of communication processes so that we can identify ways of improving the therapeutic relationship and work more effectively in inter-professional and inter-agency contexts; identify factors that affect how people cope with such situations as acute and chronic illness, pain, loss, and the demands of everyday life, so that we can help them, and ourselves, to cope better and reduce the risks of stress-related illness; l inform us about factors that influence people’s lifestyles and what makes it so hard for people to change health-related behaviours, such as smoking, diet and exercise; l apply evidence-based interventions to enhance health, well-being and quality of life.
 

Informative Essay on Health and Social Care

Concept Of Promoting Healthy Ageing Health And Social Care Essay

Concept Of Promoting Healthy Ageing Health And Social Care Essay.
Ageing is non an event that can happen over a period of clip but a procedure which begins at construct and continues throughout the life ( Crandell 1980 ) . Harmonizing to Cheng ( 2006 ) & A ; Baltes ( 1990 ) , ageing is more than the series of biological alterations. Ripening can be defined by gender, category, societal standing, and civilization instead than twelvemonth alone.Ageing is an inevitable and irreversible procedure ( Brown 1994 ) . Shukla and Brooks ( 1996 ) province the constituent of successful ripening. Harmonizing to them successful ageing depends in the capacity of the person to accommodate, version to alterations in the bodily map, to relationships and to alterations in outlook and resources. The paradigm definition of healthy ageing harmonizing to Lin ( 2006 ) , as healthy independency, household, fiscal security, life adaptation, personal growing and friends/relative relationship. Harmonizing to single perceptual experience, ageing is regarded as something unpleasant, utile, and unneeded and above all, unwanted ( Mesec,2000 & A ; ; Zupancic,2004 )
Rountree ( 2010 ) describes the ageing procedure. Rountree ( 2010 ) in his article told that as the age increases, the organic structure bit by bit loses the ability to react to environment abuses. This lead to effects on a cellular and molecular degree, such as dislocation of cell organs, membranes and enzymes in the organic structure. In the scientific term, this biological procedure of ripening is called Senescence. Senescence leads to loss of organ revere ; diminishing the ability to react to emphasize ; loss of flexibleness ; decelerating of cognitive procedures ; degenerative joint disease ; diminishing centripetal sharp-sightedness ; loss of tolerance to trouble or temperature alterations ; impaired alimentary soaking up ; worsening immune responses and other alterations. These Physiologic alterations in bend, consequence in an increased hazard for common disease, such as coronary artery disease, diabetes, dementedness, malignant neoplastic disease, degenerative arthritis ( OA ) , autoimmunity and others.
Rountree ( 2010 ) describes the assorted internal and external factors that leads to Aging. In molecular degree, everybody tonss of tissue, mundane tonss of tissue harm takes topographic point. This all consequences in the release of free groups. Further will damage DNA and the delicate membranes in our cells and cell organs particularly chondriosomes. The Elaborate system of enzymes will assist us to neutralize free groups and mend the harm to our cells and tissues. As age increases the system of enzymes become inactive and familial look of these enzymes diminutions. This all consequences in relentless weariness, decreased staying power, stiffness and achings and strivings that occur after reasonably everyday exercising. External factors include things like fume, firing organic stuffs, ultrasound ( UV ) radiation and other signifiers of ionising radiation. Even medical look into up or testing trials such as X raies, bone scans and computed axial imaging ( CAT ) scans generate free groups that will ensue in harm of tissue, which leads to long term effects ( Rountee,2010 ) .

Rountee ( 2010 ) besides states that presences of sugar/glucotoxity is besides one of the factors that causes ageing. Every clip we eat tonss of sugar, the chondriosome leaks alots of free groups that damage tissue. Besides, high degree of fruit sugar are converted in the liver to triglycerides. These triglycerides normally pack the liver with fat and hence interfere with insulin sensitiveness. So, glucotoxicity and lipotoxicity will take to increased redness in the organic structure. When we are immature, the inflammatory procedure heals rapidly. The relentless low- class redness induced by bad diets and unhealthy life style actively contributes to the wear and tear of the system over clip ( rountree,2010 ) . It means toxic chemicals and metals are the root cause of accelerated ripening. Westendorp ( 2006 ) states some of the reasons/ factors that lead to additions in chronic lessening. They are increasing life anticipation along with better sanitation, interventions for infective disease, and improved entree to medical attention, understanding of wellness hazards and modified hazard factors.
Research based lifestyle recommendations to keep physical and cognitive verve include womb-to-tomb acquisition and rational stimulation, regular exercising, ongoing societal activities, emphasis reduction patterns, sound slumber with graphic dreaming ; emotional fluidness and look ; regular sexual activity, optimum nutrition with appropriate Calories intake. Kaw & A ; Colleagues ( ) stated that the mortality hazard for people who are non tobacco users, who exercise on a regular basis, have a moderate intoxicant consumption and who have a plasma Vitamin C & gt ; 50 mmol/L ( bespeaking fruit and vegetable consumption of at least five helpings a twenty-four hours ) was the equivalent of being 14 old ages younger in chronological age, compared with people who engaged in none of these behaviors. So that means by following simple four things like exercising, make non smoke, devour low to chair sum of intoxicant, eating an copiousness of fruits and veggies in their repasts will assist to better their opportunities of life thirster and healthier
In the scenario, Dorris wellness was all right before the decease of her hubby. She has enjoyed comparatively good wellness over the old ages and have no important episodes of sick wellness. Used to make house keep plants. But after the decease of her hubby she lost involvement, finds hard to get by with mundane life. Dorris wellness was deterioting as she was non eating decently, non keeping hygiene, non making any activity. She has besides become physically frail and was sing mild confusion and freak out. Dorris should be explained the significance of self-care. Traditionally, self-care is defined as activities associated with wellness publicity ( Backman, Hentinen 1999 ; Backman, 2003 ) . She should be encouraged to take part in activities of day-to-day life, such as exercising, nutrition and relaxation, in order to advance or reconstruct their wellness.
Stanner and Denny ( 2009 ) has summarised the cardinal findings in relation to some common diseases in ulterior life and provides an overview of dietetic steps that can be put into advancing healthy ripening. Kirkwood ( 2006 ) associated the biological alterations with ageing as a consequence of a long life accretion of molecular harm in the cells and variety meats that constitute the human organic structure, finally interrupting the cells ability to do the energy they need to work. Kirkwood ( 2006 ) besides province that cistrons and perchance foods supply can act upon fix to this harm and diet, lifestyle and environment all have the possible to determine the rate at which harm to cells is accumulated.
Harmonizing to National Statistics ( 2004 ) , the morbidity informations from the UK general study indicated that, in 2004, prevalence rates of bosom and go arounding system status were 340 per 1000 population for grownups aged 75 old ages and over compared with 280 per 1000 population. The prevalence rate of long standing musculoskeletal conditions were 296 per 1000 population for grownup aged 75 old ages and over, compared with 274 per 1000 population for grownups aged 65-74 old ages ( Office for National Statistics 2004 ) .National Health Service ( NHS ) ( 2007 ) estimated that about 6 in 100 people over the age of 65 will develop some grade of dementedness and this figure increases to about 20 in 100 among those over the age of 85 old ages.
Coronary Vascular Disease ( CVD ) and shot are the major cause of decease in aged work forces and adult females ( Stanner and Denny 2009 ) . That means ripening is clearly an of import hazard factor. The younger age group have the similar hazard factor as the older grownups because of fleshiness, dyslipidaemia, Hypertension, smoke, low degree of physical activities and diabetes ( Stanner 2009 ) .World Health Organisation ( 2003 ) clearly mentioned that the diet for the people who have an increased hazard of developing CVD and other chronic disease. That includes diet that is energy-dense, high in fat and salt and low in complex saccharides, fruits and veggies. Stanner ( 2005 ) advised some important nutrient material that will assist in protection against CVD. They are integrating non-hydrogenated unsaturated fatty acids as prevailing signifier of fat, whole grains as the chief signifier of saccharide, an copiousness of fruits and veggies, equal Z 3 fatty acids and non excessively much salt. Besides with diet physical activity, reasonable imbibing wonts, turning away of smoke and care of healthy organic structure weight may forestall bulk instances of CVD in western population.
Cognitive diminution is besides the most common disease that occurs in the ulterior portion of life. It means mental damage and dementedness ( Stanner 2009 ) . It occurs as the consequence of chronic degenerative encephalon disease. It has a great impact on a individual liberty and independency. That ‘s why there is a great demand of forestalling or proroguing cognitive damage ( WHO, 2002 ) . By following many facets of life styles including the increased physical activity rational mental stimulation, turning away of smoke and assorted facets of life have been associated with healthy ripening ( Clarke, 2009 ) . The hazard of cognitive diminution and shot include high consumption of Na ( salt ) , fat, energy and intoxicant. Stanner and Denny ( 2009 ) province that under nutrition and nutritionary lacks in older grownups besides are a beginning of concern in relation to cognitive diminution. The Hazard of Dementia and Alzheimer ‘s disease increases as the addition in the degree of sulfur incorporating aminic acids additions. To forestall the hazard of Alzheimer ‘s disease the Mediterranean diet, which contains plentifulness of fruits and veggies, leguminous plants, unsaturated fatty acids and fish, can be helpful ( Scarmeas, Stern & A ; Tang, 2006 ) .
Osteoporosis and arthritis are besides one of the jobs that ageing people has to endure. Stanner and Denny ( 2009 ) mentioned the consciousness sing the bone wellness and bar in osteoporosis. As current figures estimate that one in three adult females and one in 12 work forces over the age of 55 old ages will endure from osteoporosis. In order to forestall osteoporotic break, equal consumptions of Ca and vitamin D are cardinal to guarantee optimisation of peak mass attainment ( Loveridge & A ; Lanham – New, 2009 ) . Lack of vitamin D position is besides one of the causes of falls ( Finch & A ; Doyle, 1998 ) . A diet that contains equal protein and vitamin K is rich in fruits and veggies and low in salt may besides assist to detain bone ageing. Avoiding fleshiness will assist in order to forestall degenerative arthritis and weight loss will move as an effectual manner of cut downing hurting and disablement in patients with knee degenerative arthritis ( Dieppe, 2009 ) .
Oral wellness is besides one of the of import points to be kept in head to advance healthy ageing. In the UK 58 % of grownups aged 75 old ages and over have no natural dentitions and rely on dental plates ( Steele, Sheiham & A ; Marcenes, 1998 ) . The older people holding tends to eat un healthy diet holding low in fruit and veggies, low in of import foods such as vitamin C and potentially higher in fat ( Walls, 2009 ) . There are so many factors that will in tooth loss. One of the most common grounds is nutrition on dentitions that result in development of dental cavities and therefore consequence in tooth loss ( Moynehan & A ; Petersen, 2004 ) . The frequence of sugar consumption ( in the signifier of sugar incorporating medical specialty ) is one of the common grounds of holding dental cavities.
That ‘s why dentist normally recommended restricting consumption of sugar incorporating nutrients and drinks to four occasions per twenty-four hours ( Moynehan & A ; Petersen, 2004 ) . Besides some minerals such as Ca, Zn, Mg, Sr and fluoride are involved in remineralisation of dentitions and can assist protect against cavities. Besides Fe, vitamin B12 and foliate may assist in building in the immune system and assist them from unwritten infection and protect unwritten wellness.
In the scenario, Dorris have age of 87years.She is populating entirely. Her hubby died some 6 months ago because of MI Core. Earlier when she was populating with her hubby the wellness was good. As shortly her hubby died, she was non at all making anything merely sitting on the chair. She was non at all taking attention of her nutritionary position. She lost 13 kilogram of weight in the past 6 month. Her hubby had a history of MI Core. So she must be advised sing the diet healthy for her bosom, as she is excessively holding a hazard of holding CVD. The diet must incorporate energy-dense, high in fat and salt and low in complex saccharides, fruits and veggies. Besides, she must be encouraged to take part in physical activity, reasonable imbibing wonts, turning away of smoke and care of healthy organic structure weight.

Concept Of Promoting Healthy Ageing Health And Social Care Essay

Rapid Urbanization Upsurge Noncommunicable Diseases Health And Social Care Essay

Rapid Urbanization Upsurge Noncommunicable Diseases Health And Social Care Essay.

Rapid urbanisation, modernisation and population growing in developing states has led to an rush of non-communicable diseases which are associated with important morbidity and mortality. Metabolic Syndrome besides described as “ Deadly Quartet ” and X syndrome ( 2, 3 ) is one of these disease entities defined by bunch of cardiovascular hazard factors which to a greater extent is influenced by ethnicity/race. This encompasses atherogenic dyslipidemia, high blood pressure, dysglycemia and splanchnic fleshiness and pro coagulator province. Apart from increasing prevalence, the age of oncoming is besides worsening among South Asiatic ( SA ) population due to familial sensitivity, ingestion of easy available energy dense nutrients from an early age. This tendency has got major wellness deductions since South Asians constitute one fifth of population all over the universe ( 4 ) and the wellness attention system is non really fit to cover with this medical crisis. Evidence suggests that it non merely amplifies the hazard of coronary bosom disease ( 5 ) but besides gives rise to cerebrovascular diseases.
Five diagnostic standards have been put frontward since the origin of this syndrome which has created perplexity among practicians. In 1998, World Health Organization ( WHO ) ab initio proposed a definition for metabolic syndrome ( 6 ) with chief accent on gluco-centricity. In 1999, the European Group for the survey of Insulin Resistance ( EGIR ) recommended more or less similar standards with lower cut offs for high blood pressure ( 7 ) .
Thereafter in 2001, National Cholesterol Education Program Adult Treatment Panel III ( NCEP ATP III ) proposed another definition for the diagnosing of metabolic syndrome with less focal point on insulin opposition as compared to WHO standards but non turn toing separate cut off points of waist perimeter for Asiatic population ab initio ( 8 ) . In 2003, American Association of Clinical Endocrinologist ( AACE ) proposed another set of standards for the diagnosing of metabolic syndrome. The chief restriction of the above mentioned standards is that the diagnosing is based on clinical judgement alternatively of presence of specific figure of hazard factors ( 9 ) .

Sing that SA have a higher per centum of organic structure fat chiefly in the signifier of abdominal adiposeness at a lower BMI in comparing with other population, International Diabetes Federation ( IDF ) in 2005 suggested separate cutoff points of waist perimeter for Asiatic population and defined cardinal fleshiness as waist perimeter of more than 80 centimeter for adult females and 90 centimeter in work forces based on local statistics from the corresponding country ( 10 ) . The revised NCEP ATPIII modified for South Asiatic population incorporated the same cut off points for Asiatic population as given by IDF ( Table 1 ) . Apart from the cut off differences, NCEP ATP III gives equal weight to each constituent of metabolic syndrome as compared to IDF for which abdominal fleshiness remains a requirement for the diagnosing ( 10 ) . Furthermore, microalbuminuria which is a controversial variable of WHO criteria is non included in other definitions. Among these definitions, WHO, NCEP ATPIII & A ; IDF have been the chief 1s which are used most widely ( Table 1 ) .
Type 2 diabetes is besides emerging as a planetary epidemic with increasing prevalence in developing states. Pakistan is among top 10 states estimated to hold the highest figure of diabetics busying 6th place on the diabetes prevalence naming presently ( 11 ) and it is estimated that prevalence would be doubled by 2025. Metabolic syndrome in combination with diabetes increases the hazard of both macro vascular, micro vascular complications and coronary artery disease patterned advance due to associated high blood pressure, lipoprotein abnormalcies and splanchnic fleshiness ( 12 ) .
There are surveies that have looked into the differences in most widely used definitions of metabolic syndrome in general ( 13-17 ) , but merely few surveies have compared these definitions in the diabetic population ( 18-20 ) . Therefore we decided to find the frequence of metabolic syndrome in Type 2 diabetics harmonizing to NCEP ATPIII, IDF and WHO definitions and so to compare and contrast these traits within Pakistani population.
Methods:
This survey was conducted at the out-patient clinics of one of the big third attention infirmaries at Karachi, Pakistan. Data was collected retrospectively of type 2 diabetic patients sing clinics between June till November 2008 by utilizing a questionnaire which included demographic features and single constituents of metabolic syndrome i.e. weight, tallness, waist perimeter and BMI etc. Both hip and waist perimeter were recorded in centimetres and waist/hip perimeter was calculated ( WHR ) . BMI was calculated as a ratio of weight in kilogram to height in metres squared.
Lab checks:
All the research lab trials which are routinely done for patients with type 2 diabetes including triglycerides and high denseness lipoprotein ( HDL-C ) were recorded. Patients already on anti hypertensive and anti lipid medicines specifically in the signifier of fibric acid derived functions and nicotinic acids were taken as instances of high blood pressure and hypertriglyceridimia severally irrespective of their blood force per unit area and lipid degrees. Since all the patients in the survey were diabetics, insulin degrees were non taken into history.
Statistical Analysis:
The information was analyzed individually harmonizing to NCEP ATP III, IDF and WHO definitions and the consequences were so compared. The frequence of Metabolic syndrome was calculated with 95 % CI based on three different standards ‘s. The informations were presented as the mean A± SD or per centum ; uninterrupted variables were compared by agencies of independent sample t-test and categorical variables were compared by chi-square. All analyses were conducted by utilizing the statistical bundle for societal scientific disciplines SPSS 14. A kappa trial was done to find the concurrency between three definitions. In univariate analyses, comparing between metabolic syndrome and without metabolic syndrome was done for each variable of involvement. Multivariable logistic arrested development analysis was conducted to place the factors associated with metabolic syndrome. All P values were two tailed and considered statistically important ifA a‰¤ 0.05.
Out of entire 210 type 2 diabetic patients, 112 ( 53.3 % ) were males and 98 ( 46.7 % ) were females. Their average age ( standard divergence ) was 53.35 A± 11.46 old ages. The mean ( SD ) continuance of diabetes mellitus was 8.48 A± 7.18 old ages. One hundred and ninety three ( 91.9 % ) were found to hold metabolic syndrome harmonizing to NCEP ATP III in comparing to 182 ( 86.7 % ) based on IDF standards. Lower frequence was documented with WHO standards of 171 ( 81.4 % ) . The frequence increased to 179 ( 85.2 % ) by WHO by utilizing the new cut offs for specifying corpulence ( BMI of 23 vs. 30 ) .
The grade of understanding ( kappa statistic ) between WHO and ATP III and WHO and IDF definitions were 0.436 95 % CI 0.26-0.60 and 0.417 95 % CI 0.25-0.57respectively. In contrast kappa statistic between IDF and ATP III definitions was found to be 0.728 95 % CI 0.57-0.87.The overall understanding between three definitions was 0.37 ( 95 % CI 0.26-0.51 ) .The cardinal fleshiness was present in 162 patients ( 77 % ) by WHO followed by 197 ( 90.5 % ) based on IDF & A ; NCEP ATP III. Hypertension was found in 116 patients ( 55.2 % ) harmonizing to WHO in comparing to 147 ( 70 % ) by NCEP & A ; IDF cut off of blood force per unit area. Presence of low HDL cholesterin once more differed being present in 77 ( 36.7 % ) when WHO definition was applied and 144 ( 68.6 % ) by ATP III and IDF.
Furthermore, gender wise dislocation of frequence of metabolic syndrome by WHO showed that 84 ( 85.7 % ) of females suffered from metabolic syndrome as compared to 87 ( 77.7 % ) in males a difference non statistically
important ( p=0.13 ) . However, by all other standards metabolic syndrome was significantly more common among females as compared to males, 95.9 % vs. 88.4 % ( p=0.04 ) by ATP III & A ; 95.9 % vs. 78.6 % ( p & lt ; 0.001 ) by IDF.
For prevalence of hypertriglyceridemia, no statistically important difference between both genders was found. However, for low HDL cholesterin, prevalence was higher in males 44 ( 57.14 % ) than in females 33 ( 43 % ) by WHO standards ( P & lt ; 0.001 ) . In contrast on the footing of ATP III and IDF definitions, prevalence of low HDL cholesterin degrees was higher ( p=0.009 ) in females 77 ( 57.46 % ) than in males 57 ( 42.53 % ) . Likewise, cardinal fleshiness was found to be more common among female patients based on IDF & A ; NCEP ( ATPIII ) cutoffs 64.8 % females vs. 35.2 % ( & lt ; 0.001 ) but demoing rearward form with WHO criteria,57.14 % males vs. 43 % females ( p-value & lt ; 0.001 ) .
Discussion:
Our survey showed a high frequence of metabolic syndrome in type 2 diabetics based on NECP ( ATPIII ) and IDF standards. This frequence was rather high ( 91.9 % ) as compared to 46 % found in another infirmary based survey from Pakistan ( 21 ) . This difference could non be merely attributed to the different waist cutoffs used based on modified NCEP ( ATPIII ) in our survey because even comparing with WHO categorization revealed important difference between two surveies from the same part. This difference in frequence is really interesting maintaining in position that both of these surveies were done in the same part but different vicinities. The disparity could be due to low frequence of fleshiness found in the old survey ( 30 % ) in comparing to our survey ( 90.5 % ) . It is speculated that this intra regional difference could be due to the fact that certain communities have high inclination to develop fleshiness and metabolic syndrome despite of belonging to the same state due to differences in life manner, eating wonts and degree of physical activity. On the other manus, another infirmary based survey another metropolis revealed comparable frequence of metabolic syndrome harmonizing to NCEP standards ( 22 ) .
In infirmary based survey from Iran the prevalence in type 2 diabetics on footing of NCEP ( ATPIII ) standards utilizing BMI alternatively of waist perimeter was found to be 65 % ( 23 ) .This difference highlights the importance of abdominal adiposeness which is a better marker of metabolic syndrome as compared to BMI. A multicenter infirmary based survey in Brazil showed instead close frequence ( 85 % ) in type 2 diabetics ( 24 ) although the survey population was rather different being white people of European descent. Likewise, in Finnish survey prevalence was found to be 91.5 % in diabetic work forces and 82.7 % in adult females ( 25 ) . Our information was besides consistent with Indian survey demoing prevalence of 91.1 % ( 16 ) utilizing the same NCEP ( ATPIII ) definition. However, separate constituents of metabolic syndrome were found to be more common in our population as compared to South Indians ( 16 ) . The higher frequence of metabolic syndrome in diabetic population found in our survey is a beginning of major concern since diabetes itself is an of import hazard factor for atherosclerotic cardiovascular disease ( ASCVD ) and presence of metabolic syndrome in combination plants as a two border blade.
Evidence suggests that combination of the constituents of the metabolic syndrome is associated with both micro and macro vascular complications and distal neuropathy in patients with type 2 diabetes mellitus ( 24 ) . In position of the high frequence, type 2 diabetic patients should non merely be screened for this deathly syndrome but besides offered intensive direction in order to avoid complications.
Similarly highly high frequence of cardinal fleshiness ( 90.5 % ) in our diabetic population is besides unreassuring since there is ample grounds associating cardinal fleshiness with coronary bosom disease ( 26 ) and insulin opposition is besides significantly associated with waist girth ( 27 ) .
The higher frequence of metabolic syndrome in adult females harmonizing to all standards besides consistent with other surveies from South Asiatic states ( 28 ) could be attributed to less physical activity in adult females due to cultural and cultural limitations on out-of-door activities. This besides highlights the importance of instruction of our adult females in footings of bar of the development of metabolic syndrome with life manner intercession which would indirectly act upon life manner and eating wonts of whole household.
The presence of multiple definitions of metabolic syndrome has been really confusing and argument ever exist which standards should be used in footings of diagnosing of metabolic syndrome particularly in diabetic patients.
The somewhat higher prevalence of metabolic syndrome by ATP III definition in comparing to IDF ( 91.9 % vs. 86.7 % ) was likely due to the comparative flexibleness of the ATP III definition in footings of non taking abdominal fleshiness as a requirement for the diagnosing.
Except for this difference the ATP III and IDF definitions are basically indistinguishable reflected in the grade of understanding ( kappa statistic ) between the two definitions which was in a good scope at 0.728. Harmonizing to this, NCEP ( ATPIII ) and IDF are the most dependable standards ‘s for naming metabolic syndrome in type 2 diabetic patients, with NECP capturing more patients in comparing with IDF definition. In contrast WHO showed lower frequence of metabolic syndrome due to different cutoffs used for HDL degrees and fleshiness. This difference remained important even after seting it with BMI cutoffs for Asiatic population of 23 vs.30 endorsed by WHO expert audience every bit good ( 29, 30 ) pointing towards the fact that waist perimeter or cardinal fleshiness is more valuable tool for sensing of metabolic syndrome in Asiatic population.
Decision:
On the footing of these findings NCEP ( ATPIII ) modified standards should be sooner used in Pakistani population since doing waist perimeter as an obligatory standard would still lose out 5.2 % of the instances of metabolic syndrome harmonizing to our survey. But to farther validate these recommendations we need surveies to gauge the prognostic power for micro vascular and macro vascular complications to set up the most appropriate definition of metabolic syndrome to be used in South Asiatic population with a diagnosing of type 2 diabetes. The alarmingly high frequence of metabolic syndrome in type 2 diabetes found in our survey points towards the fact that our wellness attention system needs to take emergent stairss in bar of this syndrome through life manner intercession plans.

Rapid Urbanization Upsurge Noncommunicable Diseases Health And Social Care Essay

Assessment of Financial Health

Assessment of Financial Health.
Reocities Home Neighborhoods Making Of Cases in Finance – Final Project Report Friendly Cards, Inc. (1988) Gary Cao Noah N Flom Robert Harris Srini Pidikiti May 1997 TABLE of CONTENTS 1 Assessment of Financial Health & Pro Forma Financial Statements 1. 1 Review of History and Statement of Financial Health 1. 1. 1 Industry 1. 1. 2 Friendly Cards History 1. 1. 3 Friendly Financials 1. 2 Review and Evaluation of Pro Forma Statements 1. 3 Financial Policy / Covenants 2 Beaumont’s Decisions 2. 1 Envelope Machine Proposal 2. 1. 1 Evaluation 2. 1. 2 Financial Effect of Investment 2. 1. Recommendation 2. 2 Evaluation of West Coast (new equity offer) 2. 2. 1 Advantages 2. 2. 2 Disadvantages 2. 3 Valuation of Creative Designs, Inc. 2. 3. 1 Capital Structure Argument 2. 3. 2 Weighted Average Cost of Capital Assumptions (WACC) 2. 3. 3 Cash Flows, Terminal Value, Equity Value Valuations 2. 4 Pooling Implictions (Friendly + CD) 2. 5 Friendly Cards Stock Valuation 3 Overall Assessment 4 Goals for the Financial Structure of Friendly Cards, Inc. ——————————————————————————- PART 1. Assessment of Financial Health & Pro Formas 1. Review of History and Statement of Financial Health Wendy Beaumont, president of Friendly Cards, Inc. , has rapidly expanded her greeting card business through internal growth and acquisitions. Ms. Beaumont realizes that money is currently tight, however, she is adamant about future growth and has sought our opinion as to determine her best course of action. In presenting a decision we will first conduct an analysis of the industry, then give a short history of Friendly Cards, Inc. (Friendly), and then examine Friendly’s financial statements to determine the financial health of the company.
Industry Information The greeting card industry is dominated by three large companies, (Hallmark, American Greetings, & Gibson), which are referred to as ‘The Big Three’. ‘The Big Three’ dominate market share, and the remaining competitors are predominantly small private and family owned firms. The greeting card industry is characterized high fixed costs due to: large inventory costs, large investment costs in the establishment of efficient distribution lines, and the need for a highly diversified product lines. Market leaders enjoy great economies of scale which tends to hinder new ntrants into the market. As a result, the card industry is capital intensive and very competitive. The number of firms competing in the industry has decreased by an annualized rate of 15% over the last three decades. Exiting firms were typically smaller in size, the majority of which had less than 50 employees. Additionally, the competitive nature of the market results in a high degree of price sensitivity which culminates in smaller margins on sales. Sales tend to be very seasonal in nature with peaks during major holidays.
There is trending toward a larger variety of card offerings (increasing inventories), shorter carrying/selling periods, increased diversification of product lines, and an increase in sales of everyday cards as compared to holiday cards. Friendly Cards, Inc. Beaumont Greeting Card Co. was founded by Wendy Beaumont in 1978, in New York City. She later acquired Lithograph Publishing Co. and took these companies public a year later for $3 a share under the name Friendly Cards, Inc. Friendly has rapidly expanded by acquiring Glitter Greetings of Lansing, Michigan (for cash and equity), whose primary market was selling cards to supermarkets.

Soon thereafter, it acquired Edwards & Co. of Long Beach, New York (for cash), whose primary market was selling juvenile valentines through chain, drug, variety, and discount stores, as well as, to wholesalers and supermarkets. These acquisitions greatly enhanced Friendly’s distribution line expanding it to a regional power. Later Friendly acquired a California firm (Friendly Artists) which extended the distribution line to a national basis. Friendly Artists’ primary market was prepackaged cards direct to the warehouse.
Twenty-five percent of Friendly’s sales are prepackaged boxes, which have a higher margin than regular cards due to lower return rates and lower handling costs. Currently, Friendly appears to be a niche player in the prepackaged box cards market and has avoided entry into the premium card market, thus, avoiding direct competition with the ‘Big Three. ‘ Friendly’s sales are more concentrated than the industry with the majority of sales occurring near Christmas at 30% (vs. Industry 32%), and Valentines Day at 25% (vs. Industry 7%). Thus, over 55% of sales occur within a 3 month period.
Plants at Friendly are being used at capacity thus, growth would necessitate further additions or acquiring contract services. Friendly’s distribution line is effective for a smaller firm due to its structure. Of twenty salesmen, one-third work on commission thus lowering Friendly’s costs. However, one problem with using salesmen on commission and having such a small sales force is the tendency to sell to rack jobbers and wholesale distributors. This decreases the potential margin on cards by two-thirds. Friendly’s Financials Sales have increased by over 50% between 1985 to 1987.
Cost of goods sold has decreased as a percentage of sales in each of those years thus, producing an increasing margin ( 29. 36% in 1985 to 35. 15% in 1987). The rapid growth by acquisition and the national distribution channels that were accomplished by it, have affected the number slightly. In 1986 selling and delivery expenses increased by 1. 45% and this leveled out in 1987. G&A expenses also spiked in ’86, reflecting the recent purchase of another company, and then settled back in 1987. However, while sales may have grown rapidly they have not matched the increase in asset growth, which nearly doubled in 1986.
Growth in this company is being funded by improving margins and by increasing leverage, as indicated by the Dupont Data. Although the acquisitions were acquired by both cash and equity, the majority were debt financed, which explains why the ROE figures have increased so dramatically (almost 16%) in the last three years. The activity ratios indicate that the receivable to payable were in arrears by 36 days in 1985 increasing to 52 days in 1987. This is probably a result of increased sales to less creditworthy individuals or inattention to collections. Inventory turnover umbers are shrinking due to the continually larger inventories being carried. Net fixed asset turnover has decreased by 2. 3% between 1985 and 1987. This can be explained by higher growth in assets than in sales. The liquidity ratios indicate that the asset to liability ratio for this company is trending down. The current ratio indicates that the company is becoming slightly more insolvent with a current ratio of 1. 18 during ’87. However, by looking at the Quick ratio and discounting for the affect of inventory in the asset number, the company is dramatically less liquid at 0. 67 in 1987.
This indicates that the company is very highly leveraged and is using its large inventory levels in order to support its substantial borrowing needs. Friendly’s actual growth rate exceeded the sustainable growth rate in 1986 and was equivalent in 1987. This difference in 1986 produced a need for added debt to finance growth. However excess funds were not needed to fund additional growth in 1987 since the actual rate of growth did not exceed the sustainable rate of growth. This can also be seen in the total debt to equity ratio which increased from 3 in 1985 to 5. 21 in 1986 and reduced to 4. 1 in 1987. The leverage ratios indicate that the bank loans to debt are fairly well matched, with loans being less than receivables, however, increasing in percentage. Interest bearing debt jumped dramatically in 1986 as a result of debt funded acquisitions but continues to level off along with total debt to equity figures in 1987. Finally, debt to assets has increased dramatically in the last three years, increasing by 7. 5% to 82. 5% in 1987. Thus Friendly Cards seems to be very highly leveraged, even more so than other firms in the industry although the trend is to increase debt.
This highly leveraged position coupled with the high fixed costs and low margins characteristic of the industry, exposes Friendly as extremely susceptible to fluctuations in the market. Therefore, further debt growth may not be advisable–especially since it is currently violating its existing debt covenants. However, Continued growth, however, is needed as to allow the company to further take advantage of its existing distribution lines and realize further economies of scale. 1. 2 Review and Evaluation of Pro Forma Statements The parameters that Ms.
Beaumont has set for the pro formas seem reasonalbe for the most part. There are, however, some questionable numbers. For instance, all the forecasts are based on continued sales growth at 20% per year. When compared to astronomical growth rates of 58% in 1986 and 27% in 1987, these estimates appear almost conservative. The majority of the growth in the past, however, were associated with major acquisitions which served to inflate the sales numbers. The historical reluctance to use equity to grow would serve to limit growth if continued into the future.
Furthermore, it may be difficult to continue to grow at such a high rates in an increasingly competitive market. Holding costs of goods runs at 65% of sales and may also present a problem depending on whether the company can continue to manage its costs as it continues to grow. It could be argued that the reason CGS has dropped recently is due to the acquisition of Friendly Artists and the increasing reliance on a sales mix made up of low cost prepackaged boxes of cards. A shift in the mix away from these items could increase costs. Also, further acquisitions will serve to push up delivery and selling costs.
For our purposes, however, holding them flat seems reasonable. The tax rate seems low at 38% but, depending on the new volume of sales and the maximum tax rate for a corporation, this rate could be even higher. And while the rest of the numbers seem to follow their previous assumptions, the inventory turnover, debt to asset, and interest rate assumptions could be assumed differently. As a result of increased competition in the industry, increasing variations of cards as well as shorter holding duration, it is very unlikely that inventory turnover would improve to 1. 1, and it may very well drop well below this number, possibly to 1. 75. Since growth is likely to continue into the future, an increased amount of inventory will be needed for new market areas. Debt to assets needs to decrease, but this will be difficult to do without funding growth by equity rather than debt. The large sales growth assumptions are directly related to acquisitions, thus increasing assets. If this is done through equity, this number is very realistic. Finally, there may be a problem with the assumption that interest rates on LTD will be 11%.
The Monetary Policy Report to Congress indicates that rates should tend to decrease in the future so this rate may be attainable even to such a highly leveraged firm as Friendly. Without more information this estimate seems fine. 1. 3 Financial Policy / Covenants Friendly’s apparent financial policy is rapid growth by debt. This debt-financed growth may be due to a ownership issues that could affects Ms. Beaumont’s control over her company. The financials indicate that growth is also taking place at the expense of margins, as indicated by the Dupont data.
The company believes in the economies of scale of the industry and appears to be establishing a national distribution network. While costly in the short run, this strategy may enable a viable and profitable position in the industry. The elements of Friendly’s financial policy appear to be the following. Friendly’s capital structure mix is governed by a debt orientation. Its debt/assets ratio is currently at 82. 5% which places is significantly below the AAA rate. AAA bonds are listed at 9. 7% while Friendly can only borrow at 11. 5%.
While equity has been used in recent acquisitions there is a strong preference by management to use debt funding. Without question, Friendly is at an integral juncture. Existing lines of credit are maxed out and the bank is imposing new covenants on future loans: bank loans ; 85% of AR and liabilities not to exceed three times the BV of the company. Friendly currently has a $6. 25 million line of credit. Under the current structure Friendly will be in violation in 1987 with bank loans at 87% of AR and debt to equity is at 3. 13 times.
Significantly, bank and trade credit for Friendly is expected to reach over $9 million in Dec. ’87. Long term and short term debt are both fueling growth. The basis is assumed to be the prime rate (which is 8. 5%) plus 2. 5% points. This is assumed to be a fixed rate established at the time of borrowing. The company’s currency is the U. S. dollar and the company does not have any exotica policy to mention. Control of the company rests solely with Ms. Beaumont as she is both the president and the leading shareholder, possessing 55% of the stock. An additional 20% of the stock is owned by employees and officers of the company.
Finally, earnings are retained for future growth and meeting current obligations. There are no dividend payments and the stock has depreciated in value from a high of $15 a share. PART 2. Decisions faced by Ms. Beaumont 2. 1 Envelope Machine Investment Evaluation of the Envelope Machine We do not agree that the investment in the envelope machine will result in a return of 31%. The reason for this is that the working capital needed to fund the machine would be funded by additional debt by the company. The interest on the debt needs to be considered before evaluating the total return on the investment.
Under this scenario, and considering that Friendly Cards’ interest on debt is 11% the interest expense is $22,000 per year before taxes. Our Estimated Annual savings from Operation of Envelope Machine, Years 1 through 8 ( Dollar figures in thousands) is as follows: Savings: Outlays for envelopes purchased in 1987 $1,500 Incremental expenses from manufacturing envelopes: Materials$ 902 Warehouse 94 Labor 91 Depreciation 62 Total Expenses $1,149 Increase in Profit before Taxes (decrease in COGS) 351 Interest Expense on Working Capital 22
Actual Increase in Profit before Taxes 339 Increase in Income Taxes @. 38 125 Increase in profit after taxes $ 204 The projected Cash flows for the investment in the machine are: (attachments). Based upon the cash flows projected in the above Table the internal Rate of Return on the investment is 26%. Based upon Friendly Cards Cost of Equity which is 20% (Appendix WACC) buying the machine with all equity at 20% or debt at 11% is recommended Financial Effects of Investment The Financial effects of buying the envelope machine are can be examined in detail in Appendix Machine.
The activity ratios for Friendly if the investment in the machine is made are: (attachments). The investment in the machine has the following effects: * Decreases Cost of Goods Sold by about 1. 5 % which in turn increases the Gross Margins * Decreases Inventory Turnover from 1. 91 to 1. 86 * Increases Funds needed in 1988 by $418,000, in 1989 by $323,000 and in 1990 by $112,000. * Earnings per share increase to $2. 89 in 1990 from $2. 53 in 1990 without investment * By making the investment in the machine Friendly would not be able to meet both of the covenants required by the bank The ratio of the bank loans to receivables exceeds . 85 in all three periods. * Ratio of Friendly’s total liabilities to the book value of the company’s net worth exceed 3 in 1988 and 1989 which do not meet the covenant but in 1990 the ratio drops down to 2. 94 where it meets the covenants. 2. 2 Evaluation of West Coast Offer (New Equity) We agree with Ms. McConville’s conclusion that Friendly should accept the offer from the West Coast Group at the terms stated if that was the only option available to Friendly Cards. The advantages of this proposal would be: Agency costs will be only 5% compared to the actual costs if an investment bank was used to sell securities of the company in a public offering. * The infusion of equity would enable Friendly to meet all the covenants required by the banks (Appendix WC) enabling Friendly to continue its rapid growth without any financial restrictions from the bank. * The equity infusion would enable Friendly to invest in the envelope making machine and reduce its cost structure and still meet all covenants required by the bank. * The uncertainty about how many securities will be sold if a public stock offering is held is eliminated. Continuing rapid growth would enable Friendly to retain most of the sales representatives who might shift to a competing firm if growth is slowed to enable Friendly to meet its financial covenants * The price that Friendly is getting is more than reasonable based upon the present value of the discounted cash flows as shown in (Appendix Valuation) Disadvantages of accepting the proposal would be: * Loss of control. Ms. Beaumont’s who presently owns 55% of the outstanding shares would own 40. 37% of the company after the equity infusion.
Even though along with the employees of the company she would own 60% of the company she would not be able to make unilateral decisions. * The West Coast Investors who would own 26% of the company would have a significant say in how the company should be run which may affect the current management structure and aversely effect their ability to mange the company as they wish. * Reduction of EPS. Earnings per share would be reduced to $2. 29 per share from the projected $2. 89 per share in 1990 with the purchase of the machine and without equity infusion due to the dilution effect of the new shares.
This earnings dilution would probably result in a lower share price. (Approximately $18. 32 instead of $23. 12 considering a price multiple of 8). 2. 3. Valuation of Creative Designs, Inc. Capital Structure Argument Ms. Beaumont had been considering a possible acquisition of Creative Designs, Inc. (CD), a small mid-western manufacturer of studio cards. She had examined the details of CD’s operations for four months, and believed that under her management, CD could immediately reduce cost of goods sold by 5%, and reduce other expenses by 10%.
If Friendly acquires CD in early 1988, assumptions are made that CD’s sales would stay flat during 1988 but would grow at 6% per year thereafter. Based on the following table from case facts, there is a wide range of Debt-to-Equity Ratios for the four companies within the same industry. American Greetings'(AG) D/E ratio increased from 0. 35 in 1985 to 0. 63 in 1987. The reason for this upward trend was that American Greetings had diversified its business segments; from solely relying on greeting card sales AG expanded into gift wrap and stationary goods, such as playing cards, gift-books, and college study guides.
Such diversification efforts demanded higher debt levels. In addition, AG was a large company with annual sales of $1,174 million in 1987, up 16% from 1985. Gibson Greeting’s (GG)D/E ratio decreased from 0. 71 in 1985 to 0. 49 in 1987. The reason for this downward trend was that Gibson was a relatively small company, with annual sales of $359 million in 1987, an 8. 8% increase from 1985. GG’s growth rate was significantly lower than American Greetings. The total debt-to-equity ratio of Creative Designs would decrease over the next several years.
Since CD’s sales in 1987 was $5 million, it was much smaller than the above two companies. Based on the pro forma financial statements for the period of 1988 to 1990, we see growing sales and EBIT. As a small-size manufacturer, the best capital structure would be: financing its operations mainly by internal growth and a significant reduction in the company’s debt levels. Ms. Beaumont wanted to acquire CD for the following reasons: * In the highly competitive market with high cost in distribution and low margin, Friendly had to grow in order to survive, and CD was a good target; Since CD’s shareholders agreed to the acquisition by stock-exchange, “pooling of interests” accounting method would be used, and the consolidated financial statements more attractive than without CD, and Friendly need not record goodwill (if any) and avoid amortization of goodwill; * Since CD had a relatively low debt level and a very low “bank loan to receivable ratio”, while Friendly had difficulty meeting its bank borrowing restrictions, acquiring CD would make possible for Friendly to meet the covenants; Friendly can easily integrate CD to its high growth strategy, and expand Friendly’s market presence in the mid-western region. Weighted Average Cost of Capital Assumptions (WACC) Based on the case facts that the premium for equity risk was 6% on long-term governmental bond rate of 8. 37%, we may calculate the unleveraged beta for American Greetings and Gibson Greeting, and use a derived estimate as a proxy for CD’s unleveraged beta. 1987 Financial Data for Two Large Publicly Traded Companies To be conservative, we assume the unleveraged beta for CD is 0. 77.
Since the cost of debt was 11% and the tax rate was 38%, we calculated CD’s cost of equity is 13. 97% in 1988, and the weighted average cost of capital (WACC) is 11. 07%. Over the next five years, CD’s WACC would increase to 11. 92% in 1992 due to the decreasing D/E ratio and therefore the tax shield effect. Cash Flows, Terminal Value, Equity Value Valuations In addition to the above information on WACC and sales growth rate, we have made the following assumptions: * Sales will stay flat in 1988, but will grow at 6% per year after 1989. * Cost of goods sold will stay at 55. 2% of sales level. * Depreciation, “Selling, delivery, and warehousing expenses”, and “general and administrative expenses” will grow proportionately to sales growth. * Increased Retained Earnings will be used to reduce long-term debt. * Prepaid expenses will increase by a small amount each year. * Interest expenses will decrease over the period since the debt level will decrease. * No dividend will be paid after 1988. Based on the above assumptions, we found that the total present value for CD was $4. 349 million. Adjusting for the interest-bearing loans totaling $1. million, the net worth of CD would be $3. 049 million, $1. 168 million higher than the calculated value of the stock exchange ($1. 881 million). This indicates that acquiring CD is a good transaction for Friendly. 2. 4 Pooling Implications (Friendly + CD) By using the “pooling of interests” accounting method, we constructed the Friendly and CD consolidated financial statements. (see Appendix Valuation – Friendly + CD) The impact on 1988 pro forma financial statements is as follows: * New bank loans needed decreased from $1. 585 million to $1. 357 million; * EPS increased from $1. 7 to $1. 73; * Net profit margin increased from 4. 96% to 5. 49%; * Assets turnover increased from 1. 01 to 1. 03; * ROA increased from 5. 01% to 5. 49%; * ROE decreased from 25. 23% to 20. 5%; * Days in Receivable reduced from 157 to 149; * Bank loan to receivable ratio decreased from 0. 9 to 0. 74; * Interest bearing debt to equity ratio decreased from 2. 62 to 1. 92; * Total debt to equity ratio decreased from 4. 04 to 2. 62. The overall impact of acquiring CD to CF is positive. The result of pooling is in line with Friendly Cards’ financial strategy.
In the long run, acquisition of CD would become an integral part of Friendly Cards’ strategic plan for the next few years to achieve a higher growth rate and increased market share. In the short run, acquisition of CD would meet Friendly Cards’ immediate financial needs enabling the company to meet the bank’s covenants, specifically, to reduce the “bank loan to receivable” ratio to an estimated 0. 9 in 1988 to 0. 85 or lower, and to decrease “total liabilities to equity ratio” from an estimate 4. 04 in 1988 to 3 or lower. The result of pooling shows that these two requirements are met. 2. 5 Friendly Cards Stock Valuation
Assumptions: Capital structure Based upon the pro forma financial statements and the bank covenants’ requirements, we assume the capital structure to be 75% debt and 25% equity. Any other capital structures with the reduction of debt would make it more difficult to get additional capital through equity. We need the debt financing to be able to meet Ms. Beaumont’s growth requirment. Discount rates We assume the cost of debt to be 11%. This is based upon the following facts: In early 1988, interest rates were declining, the 10-year Treasury Notes rate declined from 9. 52% in October 1987 to 8. 9% in January 1988; even though the short-term Prime Rate increased to 9. 07% by October 1987, it had decreased to 8. 5% by January 1988; furthermore, the Federal Reserves Monetary Policy Report(Jan. 1988) stated that “high rates of capacity utilization and low unemployment suggest the needs in maintaining progress toward price stability”, indicating that interest rates would stabilize at the present level. Also the need to reduce the trade deficit, business and labor would continue to exercise restraint in price and wage behavior, indicating the Fed would hold interest rate at the present level, or even reduce them.
We assume the interest rates would hold stable at the present level of 8. 5% and that the lending institution will continue its premium of 2. 5% over prime. We assume all the funding for the debt to be short term as most of the debt would be used to fund the current assets (receivable and inventories). This would be a proper matching of funds. Based on the valuation of Friendly Cards, we found that * FCFE Method (Free Cash Flows for Equity): the valuation was -$ . 95 per share ; * Free Cash Flow for Capital: the valuation was -$5. 5 per share ; * Book Value Method: using 11/2 times Book Value the valuation was $7. 40 ; * P/E ratio (multiple) method: using the industry average P/E ratio of 7, the valuation was $9. 50 per share. (Please refer to appendix Valuation – Friendly Cards, Inc. ) The only way the company’s stock price was worth $8 to $9. 50 per share was that West Coast Investors and Creative Designs valued the company using a Price to Earnings multiple method. **Note** We attempted to back out a discounted cash flow model that would justify an $8 or $9. 50 share price.
By altering certain assumptions, most specifically the sales growth rate we can achieve positive valuations of the stock price. Slower growth in sales PART 3 Overall Assessment Our recommendation to Ms. Beaumont is to (1) First, acquire CD with a stock exchange of 198,000 shares at $9. 5/share, (2) With the additional leverage obtained by the CD acquisition, purchase the envelope machine. As evidenced by the above matrix and graphs, even though Friendly Cards would achieve a higher EPS by not acquiring CD but buying the machine, it would not meet the bank covenants.
Advantages of our recommendation: * Meet all of the bank’s covenants; * Meet Ms. Beaumont’s growth needs; * Meet Ms. Beaumont’s requirement on D/E ratio of 2 by 1990; * Maintain a relatively high level of control for Ms. Beaumont over the company; * Position the company for future growth by providing a more favorable D/E ratio. Disadvantages of our recommendation: * EPS dilution by acquiring CD from $4. 64 per share in 1992 as compared to $4. 15 with the CD acquisition; * Reduce Ms. Beaumont’s control from currently 55% to 41. 5% with CD acquisition.
PART 4 Goals for the Financial Structure of Friendly Cards, Inc. 4. 1 Friendly Cards capital structure consideration Our recommendation is that Ms. Beaumont to move Friendly Cards’ capital structure closer to 60% debt and 40% equity (a D/E ratio of 1. 5). Our reasoning for such a recommendation is as follows: Flexibility: For future growth and possible acquisitions, Funds for acquiring more assets (another envelope machine! ) to reduce costs. Risk: Ability to deal with possible adversity into the future (i. e. , low sales) Lower risk level than current D/E ratio Income:
Future growth in earnings due to ability to acquire market share through acquisitions. Further exploit the economies of scale to reduce CGS, Handling and Distribution Costs Control: Maintain controlling interests in the company Timing: Having a higher D/E Friendly can issue equity at more favorable terms at a later date when EPS is higher, the market environment is “friendlier”, and the company will be in a better financial position. Our recommended target capital structure for Friendly Cards, Inc. of 60/40 D/E is realistically attainable within 3-4 years (mid 1991). Friendly Cards Case Attachments

Assessment of Financial Health

The Catwoe Analysis System Health And Social Care Essay

The Catwoe Analysis System Health And Social Care Essay.
Sweden is the 3rd largest state in Western Europe. It is a comfortable and sophisticated state and provides a criterion of wellness attention that is admired by many international health care suppliers and it has on a regular basis ranked at or near the top of most comparative analyses of international wellness attention systems ( Sweden Association of Local Authorities and Regions, 2005 ) .
Sweden is a constitutional monarchy based on a parliamentary democracy. The proprietors of the public wellness system are the state ‘s three democratically elected degrees of authorities. Parliament passes statute law, decides on province gross and outgo and has overall duty for development in wellness attention. Administration is decentralised and the wellness attention bringing system is managed by 21 county councils. Based on geographic locations, the councils are responsible for the wellness of the population in their several countries. This involves non merely the proviso of wellness attention but besides wellness publicity and disease bar ( European Observatory on Health Systems and Policies, 2005 ) . County councils besides regulate private wellness attention ( Mighealth, 2009 ) . The 290 local councils ( urban countries ) are responsible for aged attention and nursing places, including people with physical or psychological disablements.
Transformations: Sweden operates a individual remunerator, decentralised, publically owned theoretical account, supplying wellness insurance to every person. Overall 85 % of wellness attention comes from public support. County councils are responsible for the majority of support and operations. Over 90 % of county gross goes to wellness attention, which is funded chiefly from revenue enhancement levies. The municipalities are responsible for the support and bringing of long term attention and societal services. Both the county councils and the municipalities have the right to impose relative income revenue enhancements. Even though persons enjoy cosmopolitan wellness insurance they are still capable to little co-payments and fees for hospital visits, pharmaceuticals and other services. County councils besides regulate private wellness attention. A private wellness attention supplier must hold an understanding in order to be reimbursed by societal insurance, therefore private wellness attention ( with a few exclusions ) is publicly funded in footings of insurance ( Mighealth, 2009 ) . Private insurance is really limited and merely about 2.3 % of persons chose to buy private auxiliary programs ( European Observatory on Health Systems and Policies, 2005 ) . Servicess are by and large limited to those non available in the public wellness attention system.

Most wellness attention is provided in wellness Centres where the histrions are the people who deliver services are the multidisciplinary squad. Around 25 % of these wellness Centres are in private run endeavors that are commissioned by county councils. There are around 60 infirmaries countrywide with a little figure of them being regional infirmaries that offer extremely specialised attention. The county councils employ the bulk of doctors through a salary or on a capitated rate. Doctors can work outside the public wellness system wholly but patients have to pay the full costs.
Swedish wellness attention consumes about one ten percent of the state ‘s entire resources. Therefore it is important that the resources be used sagely and be efficaciously. Environmental restraints faced by Sweden include the two rule factors that are giving rise to increased wellness attention outgo internationally. First there is the demand to equilibrate cost effectivity with increased public demands based on progresss in engineering and intervention. These increased demands equate to lifting wellness attention costs which may be unacceptable to the population who already pay higher revenue enhancements than many other European states. Additionally Sweden, like the remainder of the Western universe has an increasing ageing population. 17 % of its citizens are over 65 old ages of age ( Gennser, 1996 ) . There are two typical schools of idea sing how the addition in the aged population will impact public wellness attention. One position is that the future growing of the aged population will bring forth major additions in wellness outgos which are non likely sustainable given the current administration and support of wellness attention. The contrasting position suggests that wellness attention outgos will increase as a consequence of the growing in the aged population, but most of the growing in wellness attention outgos will be manageable because of some combination of the reallocation of outgos from the immature to the old, attendant additions in productiveness and beginnings ensuing from new engineerings and efficiencies betterments within the wellness attention sector. Whichever position is favoured there is still an increased demand for healthcare intercessions in footings of intervention, attention and bar likewise.
Sweden compares favorably in a universe position of wellness attention systems. Whereas in most European states at that place has been an addition in disbursement as a per centum of GDP, Sweden has been the exclusion as it has fallen over a figure of old ages. The last two decennaries have seen many European states set up wellness system reforms aimed at controling the lifting rate of disbursement growing, increase efficiency and widen pick and reactivity and all this at a clip when the sum of attention to be delivered is get downing to transcend the available resources. Sweden has worked at run intoing these purposes whilst still being committed to cosmopolitan entree and equity in service proviso.
Part Two: Analyse the key reforms that have been implemented in this wellness system
over the past decennary.
Although the cardinal construction of the Swedish wellness system has remained reasonably consistent over the last half century, negative tendencies in the economic system which were rendering the system unsustainable in the late 1980 ‘s led to a turning discontent amongst the populace. After three decennaries of rapid economic growing, the economic system was decelerating down. As a consequence of this in the 1990s major reforms evolved in many countries of Sweden, where wellness suppliers experimented with new economic inducements among wellness attention suppliers. These included the debut of the purchaser/provider split, DRG-based reimbursements and extended patient pick. The DRG monetary value mechanism was introduced in 1990 and by basically attaching an official monetary value ticket to every infirmary intervention, authorities budget shapers enabled suppliers both to better their public presentation and to switch the system ‘s focal point to the demands of health-care consumers. In a single-payer theoretical account without monetary values the mission of health-care workers is to make everything possible to handle patients successfully, and people who need intervention be given to drench the system with demand. Funders constricted by budgets so seek to command runaway costs by seting a ceiling on the volume of attention, an action which creates deficits and waiting lists. When compensation beyond the bound is reduced or withdrawn, the production of services slows down and even Michigans. Puting monetary values back into the equation in Sweden changed inducements. Not merely was hospital support improved by the increased production of services, but besides private suppliers were available to execute interventions on an equal footing. This stimulation to productiveness required that reimbursement degrees be transparent, stable and dependable. The fairness implicit in the DRG pricing system and the information it conveyed enabled buyers to be split from suppliers within publically funded health care ( Hjertqvist, 2002 ) .
Patient rights were besides really much in focal point during the 1890ss, there were alterations in waiting list warrants both in 1992 and 1997 and as the Patients ‘ Rights Reform came approximately in 1999, although there were alterations to the latter some old ages subsequently. They have shown a turning committedness towards wellness publicity. Preventive attention potentially offers a cost-efficient alternate to high-cost engineering and medical attention.
Part Three: Explain how one of these chief reforms could be applied within the Maltese system in order to either contain public outgo or increase quality and efficiency.
Mental ailment wellness is noted as one of the largest public wellness jobs in Sweden. It excessively is an country that has been capable to the purchaser/provider attack. Dr Thomas Flodin, a board member of the Swedish Medical Association, said he did non hold any expostulation to increased usage of the private sector. “ What is of import is non who provides the attention, but that it remains available to everyone. ” And this seems to be one of the underlying features of the Swedish system ( cited by Triggle, 2005 ) .
Presently in Malta private mental wellness service suppliers are limited to Consultant Psychiatrists who although seeing patients in private, finally rely on public services for attention and intervention or likewise para-professional such as psychologists. With merely one psychiatric infirmary and centrally managed para-services there is a monopoly on mental sick wellness service proviso. If this theoretical account was to be adopted so market inducements could be introduced into a system that is presently publically managed. The production of services would go the exclusive concern of supplier organic structures. This may non needfully mention to ‘new ‘ suppliers but may besides include infirmaries, nursing places and community wellness Centres, who would no longer keep a budget and make up one’s mind how it should be spent. Cardinal budgets are a tool to cut down costs during times of economic diminution. Servicess are reduced and activity slows down ( e.g. deficiency of community mental wellness services, bed barricading due to deficiency of services to ease flow of patients ) . Alternatively, gross would depend on contracts from buyers. Buyers would non be consumers or patients, but buying governments established to purchase ( but non bring forth ) wellness services. The buying governments would be commissioned to procure betterments in wellness for defined populations ( people with mental sick wellness ) , and do so by measuring their population ‘s wellness attention demands, finding the most cost-efficient agencies of run intoing these demands, and undertaking suppliers to provide the services required. Cardinal to the purchaser/provider separation is the procedure of competitory tendering, or catching, designed to promote competition among suppliers. Introducing competition would add pluralism to what is now a set, restricted group of services. Having estimated which and how many services are needed, the buying authorization would ask for suppliers to subject stamps for contracts to provide them. These contracts would include stipulate the type and sum of attention to be supplied, the quality of the service, and the contractual period. Once these were awarded, suppliers would be able to concentrate on the proficient facets of proviso, taking to carry through their contractual duties at lowest cost. Competitive tendering forces suppliers to continually seek to better the efficiency of their productive procedures. The more efficient will win more contracts by being able to subject lower commands than their rivals. They will besides be able to spread out into new countries of service bringing.
The buying authorization would be good placed to change the mix of services available by moving in the involvements of their populations and exerting their purchasing power. Released from the influence of suppliers, buying governments are able to replace traditional attention attacks with advanced services and guarantee that services are received in their most appropriate scenes, and contract for cost effectual signifiers of proviso. Furthermore, given their duty to procure mensurable wellness betterments it is in their involvement to guarantee a greater co-ordination of attention for single users. Suppliers will ever appreciate that efficiency will ever be better paid than inefficiency. This would hold a monolithic impact on patients who at nowadays have to accept attention and intervention that is normally generalized and to a great extent based on tradition and administered in a grossly paternalistic civilization of the adviser ever being right and hence the exclusive writer of their intervention bundle. Making a market environment breaks up traditional beaurocratic attacks. In Sweden many former public service employees became enterprisers by choosing to run as private suppliers and working conditions of wellness attention employees and improved as they ‘voted with their pess ‘ . This excessively would be possible in Malta.
Cardinal authorities need non play a major portion in the twenty-four hours to twenty-four hours running of the wellness system. After set uping regulative maps, and apportioning population weighted budgets to buying governments, the market can be left to itself, with the cardinal authorities curtailing itself to the fiscal and public presentation audit of buyers. Government sections may publish guidelines and directives to accomplish a grade of consistence in buying determinations, and to guarantee that the wellness system contributes to national aims and precedences. Government can concentrate on stand foring the population by explicating a vision for mental wellness in Malta. Implementing such a wellness attention reform in Malta addition handiness, competition and patient pick.
Mentions
European Observatory on Health Systems and Policies ( 2005 ) Health Systems in Transition. Hit Drumhead: Sweden. Writer.
Gennser, M. ( 1996 ) Sweden ‘s Health Care System: Swedish attitudes about wellness attention. In Healthy Incentives: Canadian Health Reform in an International Context. Edited by: McArthur W, Ramsay C and Walker M. Vancouver. The Fraser Institute.
Hjertqvist, J. ( 2002 ) Health Care Treatment Prices In Swedish Hospitals: DRGs are a cardinal to performance-based wellness reform. Available from hypertext transfer protocol: //www.fcpp.org/pdf/Policy % 20Frontiers % 206 % 20- % 20DRG % 20Prices % 20in % 20Sweden % 20including % 20appendix % 20final.PDF
Mighealth ( 2009 ) Introduction to Swedish Health Care. Available from hypertext transfer protocol: //mighealth.net.se/index.php
Swedish Association of Local Authorities and Regions ( 2005 ) Swedish Health Care in an International Context – a comparing of attention demands, costs, and outcomes. Available from hypertext transfer protocol: //www.swedishhealthcare.se/swedenshealthcaresystem.html
Triggle, N. ( 2005 ) Keeping Healthy, the Swedish manner. Available from hypertext transfer protocol: //news.bbc, co.uk/go/pr/fr/-/2/hi/health/4461098.stm

The Catwoe Analysis System Health And Social Care Essay

The Children’s Health Fund of New York City

The Children’s Health Fund of New York City.
The Children’s Health Fund is a national non-profit organization that was founded on providing health care to the nation’s needy and underprivileged children. The CHF began over 25 years ago by reaching out to homeless kids in New York City and delivering health care through a mobile medical clinic (MMC) driven around the city to locations and neighborhoods seeking out children to provide basic health care to.
Over the years, the organization has expanded across the country with MMCs in different cities with the CHF offering a full range of programs, from not only children healthcare, but healthcare for needy families, health education and preventative care, to the diagnosis and management of acute and chronic diseases (“Health Care for Kids” n. d. ). More recently, the CHF and MMCs have expanded their service to include mobile clinics in response following national disasters and crisis events.
The CHF and the mobile health care service it provides has had its number of challenges in implementation over the years. With the main challenge of reaching out and expanding coverage to help those of need, there are several other areas that challenge the organization and its operation. The MMCs face the challenge of accommodating the proper amount of space and medical equipment needed to provide high quality healthcare. This challenge is a goal of each MMC to provide a central home for individuals to receive care and come back to for continued treatment.

With this concept presents another challenge in that each MMC need of keeping up to date, and secure medical records for those who visit, so that they may continue to come back for care and treatment when the MMC comes back to their neighborhood or area (Brown, DeHayes, Hoffer, Martin, & Perkins, 2012). In order to accomplish the goals of meeting these challenges, the CHF must have network systems that can support the operations of running medical equipment and communications networks needed to operate a MMC.
That is why over the years CHF has been working to continue to upgrade and keep their MMCs up to date with the latest technology and communication that can power these mobile healthcare hubs. According to Healthcare IT news, the CHF has recently partnered with Verizon to create its first telemedicine clinic in providing 4G LTE wireless broadband connections to new mobile sites (Monegain, 2013). The CHF and Verizon plan to continue forward in the coming months and continue to deliver new uses of technology to mobile units across the nation.
For the CHF to be able to roll out new technology and software to support their mobile units, the organization naturally needs strong financial support. The CHF is very fortunate to have a number of private individuals and corporate partners who help secure funds for the organization. However, a large quantity of financial aid comes from Congress and other government programs. One such government program is the HITECH stimulus. The stimulus is for healthcare providers that exhibit having meaningful use of certified electronic health records (“Healthcare IT Index” n.d. ).
With EHRs already a practice of the MMCs, the CHF should be entitled to financial assistance that can continue to facilitate software and technology improvement. A common concern with many organizations is whether or not the implementation of new technology and software will cause a loss workers or staff, or if conditions will emerge that will render parts of their operation obsolete. In dealing with the CHF and doctors offices, this is not believed to be the case.
With new software applications, doctor office staffs and MMCs will not become obsolete, but will have their jobs reinforced with easier ways to handle patient information and documents (Brown, DeHayes, Hoffer, Martin, & Perkins, 2012). With help in this area, the staff can shift attention to more important areas such as giving patients the personal care and treatment they need. Overall, the CHF is a successful organization that provides valuable services and assistance to many citizens of need in our nation.
With its continued focus on quality service, growth, and improvement over the last 26 years, the CHF is a well known entity that many people depend on. With the CHF prepared to continue its legacy and service in years to come, recommendations could be made regarding their future efforts. Continued expansion of their crisis and natural disaster mobile assistance would be desirable action. Just like with the number or under privileged children and their families, natural disaster events will continue to be unfortunately present, and it’s important to help others rebuild and get the necessary assistance when nothing else is available.
Also, the CHF as it continues to grow and expand across the US into new cities, the organization needs to continue partnerships with local corporations and medical institutions. These corporations can offer their services and expertise to possibly facilitate the MMCs operations, and working with local medical institutions can help staff MMCs and other locations with med students, nursing students and others in a partnered-learning environment.

The Children’s Health Fund of New York City

What Is Personal Health Responsibility?

What Is Personal Health Responsibility?.

The essay discusses whether health is ultimately the responsibility of the individual. The essay looks at the problems that health care systems face, in terms of needing to ration scarce resources, and then moves on to look at arguments for an individual vs. societal responsibilities for health. Aristotle’s principle of justice is then applied to the discussion. The issue of social justice in welfare states is then discussed in detail, with particular regard to the issue of freedom. The essay concludes that health is, ultimately, a personal responsibility, given the burden that individuals with self-inflicted health problems place on the welfare state.
Introduction
The essay will discuss the issue of whether health is ultimately an individual responsibility, looking, firstly, at the economic problems facing the health services of many countries with welfare states and then moving on to discuss the arguments for and against the idea of societal vs. individual responsibility for health. The essay then looks at the idea of social justice, within a welfare state such as Britain, and how this relates to personal freedom, drawing conclusions based on the discussions presented within the essay.

Healthcare resources are becoming increasingly scarce and rationing is now a reality in many health care systems (Scheunemann and White, 2011; p. 1625). The ethical distribution of scarce resources in health care is problematic, however, as it can be argued that all individuals, regardless of the reasons for their illness, have a right to access healthcare. The NHS (2012) clearly states that, “Anyone who is deemed to be ordinarily resident in the UK is entitled to free NHS hopsital treatment in England”. The constitution of the World Health Organisation (2012) states that “…the highest attainable standard of health is one of the fundamental rights of every human being”, where “right” can be understood as the Government (by virtue of the taxes collected from society) providing guarantees that all individuals in society will be able to access some certain basic level of health care.
Health can, however, be argued to be an individual responsibility. Individual health is affected by many factors, including the presence of hereditary conditions and the lifestyle of the individual: an individual who smokes and is overweight, through lack of exercise or a poor diet, for example, is more likely to become ill than an individual who makes healthier lifestyle choices. As Sharkey and Gillam (2010; p. 662) discuss, there is an argument to be made that patients with self-inflicted illness should receive lower priority access to healthcare than individuals whose illness is not self-inflicted.
As Golan (2010; 683) discusses, Aristotle’s formal principle of justice has a role to play in this debate: Aristotle stated, “equals must be treated equally and unequals must be treated unequally, in proportion to the relevant inequality”, with lifestyles that equate to risk-taking behaviour having the potential to limit an individual’s right to receive priority treatment. Even if the illness was caused by the individual engaging in risk-taking behaviours that affected their health, this cannot necessarily be regarded as a ‘relevant inequality’. It is virtually impossible to prove that an individual’s behaviour was directly responsible for their poor health, making it impossible to argue, ethically, that an individual should receive lower priority treatment if they took part in risky behaviours that more than likely caused their illness.
Even if individuals took part in risky behaviour which more than likely caused their ill health, the principles of social justice dominate, meaning that these individuals have a moral right to access healthcare in societies in which health care is provided to all citizens (Olsen et al., 2003; p. 1163). The fact that these individuals engaged in risky behaviours that probably caused them to develop an illness is not sufficient per se to form the basis of denying these individuals access to health care.
It is important that individual responsibility for health be stressed within the broader context of social responsibility (Minkler, 1999; 122). Ideas of social justice, in regards to health, however, need to be understood within the context of two distinct viewpoints: the Government’s responsibility for providing health care, as a basic human right, and the individual’s responsibility for maintaining their own health, as a responsibility to themselves (to be healthy) and to society (to not become a burden).
In a welfare state such as the UK, where the state aims to play a key role in the protection and promotion of the economic and social well-being of its citizens (Baldock et al., 2011; 361), individuals are accustomed to receiving health care even if they themselves caused their ill health. Welfare states therefore remove the need for individuals to be personally responsible for their own health and well-being. Without personal responsibility, however, there can be no freedom: if an individual needs looking after by another, they are not free, and if one individual has to subsidise the self-inflicted ill health of another, that individual is also not free. Failing to assume personal responsibility for health therefore leads to a two-way loss of freedom.
The corollary to this argument is that in order to be able to exercise freedom, individuals need to have a certain level of health and well-being that allows them to contribute to society. The welfare state, in its purest form, ideally provides for those who are ill and need help, because their illness prevents them from actively contributing to society. The welfare state has, however, in Britain, been abused by ‘benefits cheats’ who claim benefits when they have no valid basis for doing so. These ‘benefit cheats’ cost the NHS money, making the already tight budget even tighter (NHS Business Services Authority, 2008). The issue of how to deal, in a welfare state, with individuals who do not want to contribute to society is complex. Political parties have had a hard time developing effective policy in this area and it is debatable as to whether David Cameron’s Big Society idea, which is based on the Wisconsin model (Alfred and Martin, 2007; p. 3), will be able to help to solve the problem of ‘benefit cheats’ in the long term (Evans, 2008; p. 98).
Conclusion
The issue of whether health is ultimately the responsibility of the individual depends on your particular viewpoint regarding the issue of welfare and how far the state should be responsible for individuals. My own viewpoint is that welfare should be available to those who genuinely need access to this but not for individuals who attempt to take advantage of the welfare system. For me personally, health is an individual responsibility and those who fail to assume this responsibility should be required to assume a portion of the costs of the treatment for their subsequent ill health.
References
Alfred, M.V. and Martin, L.G., 2007. The development of economic self-sufficiency among former welfare recipients: lessons learned from Wisconsin’s welfare to work program. International Journal of Training and Development, 11, pp. 2-20.
Baldock, J., Mitton, L., Manning, N. and Vickerstaff, S. eds. 2011. Social Policy. Oxford: Oxford University Press.
Evans, M. 2008. Cameron’s competition state. Policy Studies, 31, pp. 95-115.
Golan, O. 2010. The right to treatment for self-inflicted conditions. Journal of Medical Ethics, 36(11), pp. 683-686.
Minkler, M. 1999. Personal responsibility for healthA review of the arguments and the evidence at century’s end. Health Education Review, 26(1), pp. 121-141.
NHS. 2012. Eligibility for free hospital treatment under the NHS [online]. Available at: [Accessed 17th October 2012].
NHS Business Services Authority. 2008. NHS Counter Fraud Service FAQs. Available at: [Accessed 18th October 2012].
Olsen, J.A., Richardson, J., Dolan, P. and Menzel, P. 2003. The moral relevance of personal characteristics in setting health care priorities. Social Science and Medicine, 57(7), pp, 1163-1172.
Scheunemann, L.P. and White, D.B. 2011. The ethics and reality of rationing in medicine. Chest, 140(6), pp. 1625-1632.
Sharkey, K. and Gillam, L. 2010. Should patients with self-inflicted illness receive lower priority in access to healthcare resourcesMapping out the debate. Journal of Medical Ethics, 36, pp. 661-665.
Tinghong, G., Carlsson, P. and Lyttkens, C.H. 2010. Individual responsibility for what– a conceptual framework for exploring suitability of private financing in a publicly funded health-care system. Health Economics, Polict and Law, 5(2), pp. 201-223.
World Health Organisation. 2012. Health and human rights [online]. Available at: [Accessed 17th October 2012].

What Is Personal Health Responsibility?

Aspect For Mentally Ill Patients Health And Social Care Essay

Aspect For Mentally Ill Patients Health And Social Care Essay.
Health is a resource for mundane life, non the aim of life. It is an optimistic construct, give accent to personal and societal resources every bit good as physical abilities ( WHO, 1984 ) . Furthermore, mental wellness is a relation of an person with environment. Shives ( 2002 ) states that mental wellness is a positive province in which 1 is responsible, displays self – consciousness, is self-directive, is moderately worry free, can get by with usual day-to-day tensenesss and life satisfaction. Beginning of twenty-first century, a particular attending is for the bar of mental unwellnesss and publicity of good being. Occupational therapy comes under the umbrella of mental wellness recovery. It is an advantageous usage of mundane life activities for affecting client in functions which gives significance to your life and assorted state of affairss at place, university, work topographic point, society and other scenes ( Delany 2010 ) . AOTA ( 2004 ) states that “ Occupational therapy addresses the physical, rational, psychosocial, and other facet of therapy is to back up battle in mundane life activities that affect wellness, good being, and quality of life ” . In add-on, College of Occupational Therapists ( 2003 ) states that Occupational therapy helps client to achieve wellness, life ‘s satisfaction and wellbeing through engagement in business ( Creek & A ; Lougher, 2008 ) . So, occupational therapy is a procedure of engagement into a purposeful activity that contributes towards an person ‘s wellness, well-being and self-respect.
Occupational therapy is an indispensable facet for mentally sick clients within socio-cultural context to heighten societal ability, personal direction and appropriate usage of leisure clip. It besides builds societal interaction and eliminates societal phobic disorders by deviating head towards utile waies therefore, makes a better personality. Creek ( 2003 ) the major end of occupational therapy is to accomplish fulfilling public presentation and efficaciously usage of clip that will back up in recovery and societal engagement. Goals includes procedure end, such as constructing a curative relationship and result end, such as brand possible to return place after a stay in infirmary ( Creek & A ; Lougher, 2008 ) . Psychiatric clients may acquire an chance to be after a better hereafter, as it provides chances as good.
During my rotary motion to Karwan-e-Hayat infirmary, 56 old ages old female, diagnosed with schizophrenic disorder. She is widow and has 4 measure boies and her hubby died 3 old ages back, her in-laws think that she is huffy, they do n’t desire her to populate with them and they besides sent her to panah shelter place. Where she feels really disquieted and misses her boies really much. She does n’t speak to anyone and gets aggressive whenever person comes to speak to her. But her aggression subsides, when she gets involved into the activities like flower agreement, pulling and jewellery devising in occupational therapy. These activities help in modifying her aggressive behaviour into relaxation as she participates in these activities with great involvement.

The originative ability theoretical account for psychosocial occupational therapy as described by De Witt ( 2005 ) is based upon the theory of originative ability developed by Vona du Toit, 1960s and 1970s. Creative ability theoretical account facilitate healers in measuring client ‘s occupational public presentations based on the accomplishments they achieved. This helps clients to show oneself, without vacillation or anxiousness. Chiefly, model work on three characteristics ; originative response-an expectancy of pleasance despite anxiousnesss about capableness or result, originative participation- taking portion in activities that challenges clients abilities and originative act-end merchandise of the originative response and originative engagement. Individual ‘s originative capableness forms ain ability within his confine originative potency. Basic construct of theoretical account is will ; farther consist of two constituents that is motive, an internal strength that initiate person ‘s occupational behaviour and action which is the transmutation of motive into mental or physical attempt taking to an occupational behaviour. Model reflects motive is dynamic as it footing at different phases of occupational development. Sequentially divides motive into 6 degrees that are tone, self-differentiation, engagement, self-presentation, part and competitory part. Similarly, action is divided into 10 degrees including pre-destructive, destructive, incidental constructive action, exploratory, original, experimental, imitative, merchandise centered, society centered and state of affairs centered. As degree advancements, clients get diverse accomplishments and occupational behaviours. Environment is considered to be powerful linked with the development of originative ability. De Witt ( 2005 ) emphasizes on the premise of theoretical account, activities are purposeful when they meet up client ‘s demands, felicity, abilities and aim within life and supply equal chance for development and alteration. This theoretical account supports client in different countries like personal direction, societal interaction and productive usage of leisure clip. Stress plays a important function in de-motivating, prosecute into negative ideas and finally stoping up in reduced self-efficacy and low productiveness of work. As in above scenario, adult female is aggressive, remains stray and does non desire to speak to anyone but occupational therapy makes her emotionally stabilized. And provides opportunity to deviate her psychic and physical urges off from stressors and helps to concentrate on her positive potencies. In instance of abnormal psychology, the healer may command symptoms by prosecuting client in meaningful and well-organized activities. Harmonizing to a survey it indicates positive betterment in psychologically hard-pressed clients have entree to occupational therapy services. ( Kohn, Hitch, & A ; Stagnitti, 2012 ) .
Therese Schmid ( 2005 ) emphasized that province of wellbeing is a subjective experience consisting of: feeling of pleasance, or a scope of feeling of felicity, comfort and wellness, which can differ from single to single. Occupational therapy give an opportunity to rectify client ‘s negative and defective thought as its presence addition maladaptive behaviours, including self-abusive and non caring for others. Mental wellness in relation to business affect client in important functions ( e.g. , friend, pupil, household member ) , activities ( e.g. , athleticss or avocations ) which enhances clients emotional wellbeing, societal competency, aid to get by with life passages, achieve personal end and life satisfaction ( AOTA, n.d. ) . Psychological, biological and societal factors are constantlyA influence and modify person ‘s wellness ( Matthews & A ; Barr, 2010 ) . These factors influence mental wellness of single and communities, including both single header mechanism and societal support. Occupational therapy is one facet which improves quality of life.
Occupational therapy aims to beef up the ability of an person to get by with nerve-racking events which may impact their mental wellbeing. Diversion activities which increase their ego regard, senses of well-being, better feeling of satisfaction, beef uping the balance of physical, societal, religious and psychological wellness and hike up single ‘s resiliency. Harmonizing to Mental Health Commission of Canada ( 2008 ) focal point on mental wellness and construct wellness system for mental sick client in order to pattern client centered attack, legion activities enhance clients self-governance, interpersonal, judgement and psychomotor accomplishments would assist client to stay emotionally and mentally healthy. These activities include carom board, ONO, football and computing machine games, it is easy to understand their regulations and need less concentration p. Therapists can besides integrate activities like music which helps client to review his head and supply relaxation. Furthermore, societal assemblage facilitates clients to halt believing about defective ideas and engage in positive facet of life. Finally skill edifice activities including flower agreement, sewing, personal training, art and trade will non merely assist client in psychomotor accomplishments but besides provide an chance to be after for better hereafter so.
In decision, Occupational therapy is the most indispensable therapy for mental recovery of mentally sick client as it affect client into recreation activities to heighten their quality of life. It besides promotes qualities with regard to socio-cultural context including independence, self-esteem, societal engagement and accomplishment heightening chances. Creative ability theoretical account assists client to work efficaciously and present himself without anxiousnesss by originative response, engagement and action. It includes assorted activities therefore, assist client to change over their negative ideas and alter it towards important intents such as treatments, games and end focal point interaction. It enriches client ‘s rational, interpersonal and psychomotor accomplishments. Occupational healer demand to advance recreation activities for mentally sick client in our society.
American Occupational Therapy Association. ( 2004 ) . Policy 5.3.1: Definition of occupational therapy pattern for State Regulation. American Journal of Occupational Therapy, 58, 694-695.
American Occupational Therapy Association ( n.d. ) . Mental Health in Children and Youth: The Benefit and Role of Occupational Therapy. The American Occupational Therapy Association, Inc. Retrieved from
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Canadian Association of Occupational Therapists. ( 2008 ) . Occupational Therapy and Mental Health Care. Canadian Association of Occupational Therapists. Retrieved from hypertext transfer protocol: //www.caot.ca/default.asp? pageid=1290
Creek J 2003 Occupational therapy defined as a complex intercession. College of Occupational Therapists, London
Creek, J. , & A ; Lougher, L. ( 2008 ) . Occupational positions on mental wellness and wellbeing. In S.E.E. Blair. , C.A. Hume & A ; J. Creek ( Eds. ) , Occupational therapy and mental wellness ( 4thA ed. , pp.A 18-27 ) . Edinburgh, London: Churchill Livingstone.
Delany, J. V. ( 2010 ) . Standards of Practice For Occupational Therapy. Standards of Practice the American Occupational Therapy Association. Retrieved from
hypertext transfer protocol: //www.aota.org/about/core/36194.aspx
De Witt, P. 2005. Creative Ability- a theoretical account for psychiatric occupational therapy. In Crouch, R. & A ; Alers, V. ( explosive detection systems ) . Occupational Therapy in Psychiatry and Mental Health. 4th Edition. London and Philadelphia: Whurr Publishers.
Kohn, M. , Hitch, D. , & A ; Stagnitti, K. ( 2012 ) . Better entree to mental wellness plan: influence of mental wellness occupational therapy. Australian Occupational Therapy Journal, 59, 437-444. Department of the Interior: 10.1111/1440-1630.12005
Saint matthews, M. K. , & A ; Barr, J. ( 2010 ) . Theory, definitions and context for mental wellness publicity. In Best pattern guidelines for mental wellness publicity plans: Older grownups 55+ .
Therese.S. ( 2005 ) Promoting wellness through creativeness: an debut. In T.Schmid ( Eds. ) , Promoting wellness through creativeness for professionals in wellness, humanistic disciplines and instruction, Whurr, London.
Shives, L. R. ( 2002 ) . Basic constructs of psychiatric mental wellness nursing ( 5th ed. ) . Philadelphia: F.A Davis.
World Health Organization ( 1986, November 21 ) . Ottawa Charter for Health Promotion First International Conference on Health Promotion. NASPA – Student Affairs Administrators in Higher Education. Retrieved from hypertext transfer protocol: //www.naspa.org/2012_Chicago_Hdts_1 % 281 % 29.pdf

Aspect For Mentally Ill Patients Health And Social Care Essay