Increased Risk of Cardiovascular Disease in Middle-Aged

Increased Risk of Cardiovascular Disease in Middle-Aged Community Care Plan: Increased Risk of Cardiovascular Disease in Middle-Aged to Elderly Populations in Mesquite Assessment Community Nursing DX: Increased risk for cardiovascular disease in middle aged to elderly populations in the Mesquite (75150) related to the behavioral health habits as evidenced by leading cause of mortality statistics (heart disease, dshs.state.tx.us), higher rates of smoking/excessive alcohol consumption relative to state (countyhealthrankings.org), increased rate of physical inactivity relative to state (countyhealthrankings.org), prevalence of sedentary occupations (factfinder2.census.gov), the inadequacy of nutritional status and fitness facilities (city-data.com; countyhealthrankings.org), and a lack of programs that offer educational materials about the disease [no programs found in Mesquite (75150) via online search]. Community Goal: There will be a decrease in Dallas County (which includes 75150) in behavioral risk factor surveillance percentage for cardiovascular disease from 8.6% (in 2010 survey) to 8.0%. Nursing Interventions Rationale Community Outcome Criteria Evaluation Possible Solutions Leading cause of mortality is heart disease; 3,218 deaths/13,966 from all diseases; behavioral risk factor surveillance for 2010 for MI 4.5 % which is highest of all metropolitan areas in TX; for CV disease 8.6%, which is within the top 3 (dshs.state.tx.us) Management, business, science and art occupations constitute 27.8% of occupations; sales and office occupations constitute 30.4% (other occupations more active than these sedentary occupations; factfinder2.census.gov); 9 parks in 75150 (city-data.com) Adult smoking- 16%, BMI over 30 31%, persons over 20 years reporting no leisure time physical activity 25% binge plus heavy drinking 14% (countyhealthrankings.org) Need more information to assess nutrition besides income ($46,788; residents below poverty level 12.1%, city-data.com); data needed in regards to city rather than county access to recreational facilities 7, limited access to healthy foods 8%, fast food restaurants 53% (countyhealthrankings.org) 8.3% unemployed; 82.5% high school or higher; 19.4% bachelors or higher; 5.8% graduate/professional degree (city-data.com); Preventable hospital stays -59 | ratio of residents to PCPs 1,585:1 | uninsured 31% (countryhealthrankings.org) Assess for for risk factors such as family history, sedentary lifestyle, lack of physical activity, imbalanced diet, smoking, access to appropriate medical care, and health literacy level; also provide primary prevention by assessing middle aged and older populations without cardiovascular disease. Assessment of risk factors is essential for early detection of heart disease. Hearts For Life: A Community Program on Heart Health Promotion (2003). Retrieved from http://health.mo.gov/ data/interventio nmica/HeartDisea seandStroke/3118 .pdf Residents will be screened for factors contributing to cardiovascular disease at local churches, senior centers, nursing homes, assisted living, libraries, recreation centers, etc. Nurses will provide proper follow up and referral for results of concern as well as provide education in regards to specific risk factors and how to control modifiable risk factors. Middle-aged and elderly residents will be asked about their known risk factors on initial screening during Fall 2014. Residents will also be asked about how they can personally change their modifiable risk factors in regards diet, behaviors, exercise. Will request follow up on health status at next available screening time (every 6 months at a specific location; varied locations for screenings and assessments throughout the year). Will also request that families attend with younger members to initiate primary prevention and aid in care and involvement in elderly residents health. Residents at higher risk will be assessed further and provided with references to a preferred clinic site or physician depending on each residents financial status. Refer to assessment data above; More information needed on specific HTN prevalence, high cholesterol prevalence; Personally observed data at CC-Young Retirement Community: Many residents unaware of what medication they are taking, especially if they are not self-administering, some even unaware of having HTN or high cholesterol. Conduct blood pressure screenings at local churches, senior centers, nursing homes, assisted living, libraries, recreation centers, etc. Reducing risk factors for CV disease include evaluation of BP. Example of Evidence Based Interventions at a Glance (n.d.). Retrieved from http://health.mo.gov/ data/interventionmica/Heart DiseaseandStroke/index_5.html Residents will be screened regularly at listed locations on a monthly basis for blood pressure. Resident will be told and educated about normal and abnormal ranges, signs and symptoms to watch out for (chest pain, SOB dizziness, fatigue, sweating), and how to self-assess with a sphygmomanometer if at higher risk/have abnormals. Residents will also be provided follow up and referral locations if higher risk/have abnormals. Residents will be quizzed verbally on normal/abnormal blood pressure readings at the end of screenings on that same day. They will also be able to list at least 3 adverse signs and symptoms associated with cardiovascular disease, at the end of screening that day. For higher risk residents, will have them demonstrate how to take blood pressure. Will request resident to bring family members to come to next screenings so they can also learn to take blood pressure. Those residents at higher risk will be assessed further and provided with references to a preferred clinic site or physician depending on each residents financial status. If possible with funding for supplies, provide free supplies for self-checking. More information needed about programs offered at said locations, need to advertise to public. 9 parks in 75150 (city-data.com); 4 recreation centers in Mesquite (cityofmesquite.com) Exercise programs offered at local churches, senior centers, nursing homes, assisted living, recreation centers, fitness centers, etc. FAME fitness program show to be effective in reducing CV risks. Example of Evidence Based Interventions at a Glance (n.d.). Retrieved from http://health.mo.gov/ data/interventionmica/Heart DiseaseandStroke/index_5.html Residents will be able to participate in exercise programs and calculate a target heart rate and taking pulse for exercise. Instructors will provide evaluations of exercise skills taught during classes as well as surveying the frequency of residents personal exercise schedule. Residents will be evaluated of their physical progress over a 6 week time span for achieving their target heart rate during exercise. Provide incentives to return to exercise classes, such as rewards for achieving target rate like gift cards or prizes. Refer to assessment data above; More information needed on specific nutritional food access, dietary choices, height/weight, daily food consumption. 1 Wal-Mart, 1 Kroger, 1 Albertsons in 75150; other listed business include many fast food restaurants (city-data.com) Dietary education at local churches, senior centers, nursing homes, assisted living, recreation centers, libraries, fitness centers. CARDES dietary programs have shown to be effective in decreasing rates of CV disease. Example of Evidence Based Interventions at a Glance (n.d.). Retrieved from http://health.mo.gov/ data/interventionmica/Heart DiseaseandStroke/index_5.html Residents will be able to give 24 hour recall for assessment of diet and be recommended appropriate portions and amount of food based off of MyPlate. Portions, ingredients, etc. will be modified for those with HTN and diabetes. Will also offer referrals to dieticians. Residents will give an example of a healthy meal by drawing and/or verbalizing their own MyPlate. Residents will inform on how the food was prepared, where the ingredients would be bought and if those ingredients are within their budget. For those who may not be able to afford at the typical grocery, will offer information on local food banks and food stamp programs. Finding locations where nutritional foods are offered. Assessing locations that give away free food such as churches and senior centers for nutrition is important; providing instruction about preparation of food in a healthy manner is critical to dietary health. Refer to data from above in regards to smoking rate in Dallas county; More information needed on tax funds used from cigarette purchases and accurate pricing of average cost of cigarettes. Cheaper brands of cigarettes, ~$4; more expensive brands ~$5 (city-data.org/forum) Work with law makers to increase prices of cigarettes and use of increase in net tax for antismoking education campaign. Study of the impact of $0.25 increase in price with California Tobacco Program that allocated $0.05 for anti-tobacco educational campaign. Showed a decrease of 2.93 deaths per 100,000 per year and decrease in amount of packs smoked to 2.72. New York Academy of Medicine (n.d.). A compendium of proven community- based prevention programs. Retrieved from http://healthyamericans.org /assets/files/NYAM_Compendium.pdf Residents who smoke will cut down the amount of packs of cigarettes bought per week. In an anti-smoking campaign, will educate residents on how much money could be saved by cutting down. Will also offer education of alternatives for quitting in antismoking campaigns like nicotine patches and gum. Referring to local government data on cigarette sales to evaluate the amount of sales (if not decreased), noting for the increase in price, and use of net tax funds for allocation of educational programs. Petitioning with support of local residents for distribution of tax funds towards educational programs on smoking. Also working with public health center to work with government to offer incentives to cigarette companies to raise prices can be a possible solution. Personal experience of finding information and programs offered regarding CV disease and health in 75150 and Mesquite: poor, not much information via internet, radio or TV; only current mass public media span observed regarding health are acetaminophen precautions. More information needed on listings in local newspapers. Mass media campaign; commercials about health statistics regarding CV disease, educational programs, aspirin/NTG medication education over billboards, radio, TV, newspaper, internet. The Stanford Five-City Project mass media program along with other programs saw decreases in BMI, HTN, glucose and CV risk factors. New York Academy of Medicine (n.d.). A compendium of proven community- based prevention programs. Retrieved from http://healthyamericans.org/assets/files/NYAM_Compendium.pdf Residents will be more informed about reducing CV risk via information through the media about dietary changes, exercise, etc. Evaluation via use of government data on decrease in mortality rates, statistics. Also if using online media, provide surveys for feedback of helpfulness. Increased awareness in the media driven society can affect peoples perspectives on health. Currently there is only a ban on just bars and restaurants in Mesquite; there is no state wide regulated ban on workplace (no-smoke.org; smokefreetexas.org); More information needed on lists of specific businesses and workplaces that do allow smoking. Working with lawmakers to ban smoking within all enclosed workplaces. A worksite intervention program targeting individuals who smoke saw a decrease in the amount of people who smoked, reduction in diastolic BP and reduction in cholesterol. New York Academy of Medicine (n.d.). A compendium of proven community- based prevention programs. Retrieved from http://healthyamericans.org /assets/files/NYAM_Compendium.pdf There will be a decrease in the prevalence of smoking in the workplace. Evaluation will not be done if enacted into law; evaluation by law enforcement and fines. There are surveys and petitions that can be taken in support of banning smoking in all workplace facilities; there is a current survey that indicates widespread support of state wide law (smokefreetexas.org)

Neighborhoods and Crime

This article, which consists of an examination of data gathered from the Project on Human Development in Chicago Neighborhoods, is aimed at gaining a complete picture of the neighborhood in Chicago. It is based on the spatial definition of neighborhood as â€Å"a collection of people and institutions occupying a subsection of a larger community.† The data gathered and the analysis based on such data are used to test the hypothesis that collective efficacy has a connection with reduced violence in neighborhoods. Collective efficacy refers to the social cohesion among people belonging to a neighborhood that is influenced by the willingness to act to promote the common good. The hypothesis was formulated based on the premise that crime rates vary in different neighborhoods, and such variation may be attributed to social and organizational characteristics extant in such social groupings. Moreover, it is assumed that there are factors at play other than those attributed to demographic characteristics of individuals. The article also makes use of two concepts of efficacy, namely, individual efficacy and neighborhood efficacy. It suggests that these two constructs are related in their similar means of activating processes such as social control, which encourage people to act in protection of the neighborhood’s well being. The question sought to be answered by the article revolves around the factors that influence collective efficacy. Again, this question has an assumption, which is that collective efficacy does not exist in a vacuum and is affected by various factors such as political economy and various contexts. Using a five-item Likert-type scale, subjects of the study were asked various questions about the social interaction observed within the neighborhood, such as whether there is a general feeling of trust in favor of neighbors or whether there is a likelihood of intervention in certain circumstances. On the other hand, violence was measured through questions about the frequency of occurrence of violent behavior and personal experience of violent incidents. Moreover, the survey measures were juxtaposed with independent records of violent incidents. After extensive analysis and presentation of data, the article concludes that collective efficacy may be measured at the neighborhood stage, mainly through the conduct of surveys. Moreover, neighborhood variation in collective efficacy is largely explained by three factors, namely, immigration concentration, concentrated disadvantage, and immigration concentration. In sum, the article was able to find data to prove its hypothesis that factors other than demographic characteristics of the individual residents of a neighborhood affect collective efficacy. Nevertheless, the article is quick to note that the study has inherent weaknesses, and suggests that further studies be conducted to explore other possibilities.

Edward Snowden Essay

Does anybody like to be watched? At face value, nobody wants other people to know their secrets and possibly use those secrets against them and surely nobody want all their online information recorded and their phone call wired. So why is the National Security Agency (NSA) carefully taking down everything we do with their giant yeottabyte-computers deep in the Utah Desert? We know about this NSA scheme because of the leaker Edward Snowden who has been recently granted a one-year temporary asylum by the Russian government. Why Russia granted the asylum and why Snowden is even there can be tied to three basic concepts of intercultural communication, those of culture & social group, perspective, and cultural relativism. Edward Snowden was a â€Å"security contractor at the NSA for the last four year, employed by several private contractors† (Economist 8840, 23). After announcing that he leaked the information that the NSA is using a program code-named PRISM, which collects an unknown quantity of e-mails, internet phone-calls, photos, videos, file transfer, and social-networking data from the technology giants such as Google and Facebook, Snowden boarded a plane flight to Hong Kong. According to his followers, Snowden first fled into the arms of the Chinese and then the Russian because of the harsh treatments Private Bradley Manning, the leaker of military secrets to WikiLeaks, received. On August 1, Snowden â€Å"finally managed to break free of his confinement at the transit zone of Moscow’s international airport† after he received his asylum on Thursday. In theory, this event is deeply connected to three concepts of communication: culture & social group, perspective, and cultural relativism. The three concepts are all concepts that are based on an intercultural point of view, because they all represent our culture and the dif ferences it has with other cultures. Our culture is as distinct from other cultures as two different people, they think differently, and interpret and act in accordance only to their own maxims and perspectives. The government’s perspective is very different from Snowden’s perspective, without their perspective being different, Snowden would not have done what he did, or the U.S. would not be chasing him around the globe. In addition, if the Russian Government did not recognize cultural relativism, Snowden could never dream of getting an asylum from Russia. Our culture is a key factor of why the Snowden affair even began. Because our culture can be considered quite a zealous security culture, we impose such rules that social communities and  other culture may not approve. After â€Å"September 11th 2001, George Bush tipped the balance too far from liberty toward security† and the balance stayed off ever since (Economist 8847, 11). Due to the common American way of life, people prefer a way of living in which they receive the most amount of comfort. If you walk up to an American and ask him what he thinks is important in life, one of his many answers will be the enjoyment of life. Snowden is no exception, and thought that doing something that would potentially stop the government from watching us and make himself feel more comfortable when he use a phone is totally acceptable. While the government is thinking about tracking down potential criminals, Snowden is thinking about why he is being watched and record and wired every second of his life except when he is asleep. Snowden’s perspective is the same as the government in that they both want the best for the people, but they differ widely on how that is to be achieved. Snowden believes that in order for the people to be free and genuinely happy, they must be given the right of doing what they want without certain constrains such as having their telephone record collected when they are not suspected of crimes. On the other hand, the government believed that the more America knows, the better it is at defending itself. Due to the fact that Snowden had a different perspective from the government, he â€Å"handed over ‘thousands’ of classified documents† and showed Americans what the government is doing behind their backs and in front of their faces (Economist 8840, 23). Even though there has been questions regarding why Russia granted Snowden the asylum, it can be explained easily by the communication concept of cultural relativism. Cultural relativism recognizes that cultures vary in how they think and behave as well as in what they believe and value. This clarified the point that Russians do not think as Americans and their gover nment functions differently. If Russia were to think like the American government, it would have never looked for â€Å"trouble† with Snowden. Americans consider their own welfare above all other things; due to that, when the American government grants asylums to â€Å"criminals† desperately wanted elsewhere, the government rarely think about how it is affecting the other countries. Now, when the American government is put in this situation, it automatically assumes that all action done for Snowden’s benefit is for American’s detriment. On the Russian point of view, what they are doing may actually be a way to keep the  Ã¢â‚¬Å"Security-Prioritized Americans† from going to war with others for no good reason. It is posisble that Russia thinks that it is wrong for a country to be a hypocrite, and that the American government should â€Å"learn a little lesson† from Russia’s asylum grant. Edward Snowden would not have done what he did without his culture, his social group, and his perspective. On the other hand, Russia would not grant an asylum if they did not recognize cultural relativism. Over all, the Snowden affair has been a controversy between the people and the government. The people have to apply all the communication concepts to use in order to make the future of America the best possible, and the government has to make its best judgments based on the people’s decisions. Therefore, people should all learn be better communicators, thus become better citizens, and help their country at such times of need as this.

Essay on Legal Writing Graded Project 2 - Petitioner

Brown v Board of Ed. Topeka Kansas (1954) by Alexes Mercado http://www.watson.org/~lisa/blackhistory/early-civilrights/brown.html The 14th Amendment states: All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the state wherein they reside. No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws. In the early 1950s, racial segregation in public schools was normal all across America. Although all the schools were†¦show more content†¦Another main argument was that â€Å"separate but equal doctrine† was not effective because the accommodations for blacks’ educational institutions were far inferior to those of white. Expert witness, Dr. Hugh W. Speer testified as follows: ...if the colored children are denied the experience in school of associating with white children, who represent 90 percent of our national society in which these colored children must live, then the colored childs curriculum is being greatly curtailed. The Topeka curriculum or any school curriculum cannot be equal under segregation. The Board of Educations defense was that segregated schools simply prepared black children for the segregation they would face during adulthood. The Board further argued that segregated schools were not necessarily harmful to black children because many great African Americans, such as Booker T. Washington, and George Washington Carver had overcome more than just segregated schools to achieve what they achieved. They also added that even though the 14th Amendment did not specifically include a ban on segregated education, at the time it was enacted, there was no public education system in the country at the time. Therefore, they would argue that the 14th Amendment would naturally not have addressedShow MoreRelatedLegal Writing Graded Project 2 - Petitioner1229 Words   |  5 PagesRE THE MARRIAGE OF SALLY BRIGHT PETITIONER V. MEMORANDUM JOHN BRIGHT RESPONDENT Comes Petitioner, by counsel, and for her Memorandum states as follows: I. FACTS Sally Bright (Petitioner), filed for divorce and custody of 14 year old daughter, Chastity. John Bright (Respondent) also requested custody. The court ordered temporary custody of the minor child to Petitioner and visitation with Respondent every weekend. Petitioner will be moving to another part of the countryRead MoreSexual Harassment Awareness And Prevention7457 Words   |  30 PagesWorkplace 22 DUTIES BEFORE AND AFTER A CLAIM 23 How do I stop sexual harassment? 23 1. First, tell the offender to stop! 29 2. Keep documentation 29 3. Review the Company’s policies 29 4. Report the offense 29 EASY ORDER FORM 34 Final Exam Information 34 Final Exam for Sexual Harassment Awareness 36 Course Objectives: In Sexual Harassment Awareness Prevention, we discuss the legal and ethical duties to those with whom you work to promote and provide a workplace free from all forms of harassment. After