Sports And School (My Experience) Essay Example for Free

Sports And School (My Experience) Essay School starts at a young age for most kids. They go to learn Arithmetic, English, History, and get a general education for life. They also learn to deal with others outside of their family and close friends. Such was the case for myself. I lived on a farm where my neighbor was my best friend till he moved away. I then had one year till school would start for me, which I would spend with my family, and one or two friends who I would see occasionally. When school finally started for me I had no friends I already knew. It only took me a few days of watching the older kids playing soccer to learn the game and I eventually started playing with them. They learned my name and I learned theirs, soon I was friends with most of the kids in the school (somewhere around 45 kids, K-6). The next year I was sent to a new school in Monticello. Again I made friends quickly and we would spend recesses playing tag and running around. As I entered the fourth grade professional sports entered my life. I had been wrestling long before I entered school and played baseball when I was old enough to enter tee-ball, but professional sports never occurred to me until football. From fourth grade to sixth I came to school in the fall and spring to play football. As I grew up and graduated elementary school I faced new options. I could now participate in regulated Jr. High teams. I chose football, wrestling and baseball. I had played all of these before, but this was high school sports where you had stands full of people to watch you. You now had pads to play football and your games were official. Life in wrestling would become more competitive and baseball would be as hard as ever and so far my experience has only been beneficial. I am now a senior in high school and my football career is over, but I along with others was able to bring home a state championship trophy. I?m doing great in my last wrestling season and will soon begin my final sport in high school. I lived for football and I am living wrestling. Every time I hear someone say sports should be discontinued from public school I feel as if they are trying to cripple students like my self who live for sports in high school. I came to school to get an education, after school I invoke my education to work for me in sports. Otherwise I would go home sit in front  of a T.V. or help my dad when needed. I could stay in town every now and then to hang out with friends, but I would mostly be confined to the barren area around my house. Now while playing sports I work hard to get through the school day (It seems to make time go faster) and then work hard at sports. I got in a habit of working hard while I?m awake so now everything I do I try to do right and I work hard at doing it. People say that students focus more on sports than they do their school work and classes. May be true in a few cases, but was never true in my case. I worked hard in school so I could be the best at both school and sports. I strove for success in tagging girls in elementary school so I also strove for success in my schoolwork. In high school you had to keep your grades up to play. I along with the majority of my fellow teammates went beyond meeting the requirements for not getting an F in any class, but in getting A?s in all of our classes. A coach once said to my brother, ?Work hard on and off the field.? I have lived my career so far off that saying. I?ve told others that and others have told me that. First hand I have seen students who can?t or don?t care to keep their grades up. They just slide from one class to the next working just enough to pass. They then were invited to come play a sport or do and activity with friends after school. They learned how much fun playing sports could be so they picked up their grades so they could play football, or wrestle. Even after the season was over they decided they wanted to keep their grades up and it wasn?t that hard to do it in the end. School sports also help those who don?t play. While keeping kids who play off the streets and away from bad influences it also motivates others to do the same. When school figures are supported and kids want to be like them they want to be great and will change a lot to be like the one they admire. For the most part those who play sports can?t do well if they are doing activities not suitable for students their ages (drugs, alcohol, violence, crimes.) so they are almost forced to set a good example while playing a sport. A winning sports season in a school-supported sport also raises the moral and efficiency of students. They become proud of their school and what they have done and want to keep the good name they have earned. Students  will talk about the season and have better memories of school. Ten years later a reunion will echo with, ?Do you remember instead of having a reunion where no one shows up because they felt as if they were not a part of their school or they had no me mories they wished to remember with their class. Above all you cannot end school sports for the minority of people who disagree with having sports sponsored by schools. Those few may have had a bad experience with sports and find it hard to fit in with those who?ve had good experiences. If you end it all for a few people everyone will become like those few people and sports as a whole may disappear, competition will disappear, initiative will disappear and people will have to find other paths to take to gain these skills so badly needed in life. Some of these paths taken will not be well chosen and can lead people astray in life. Again leading to crimes, drugs, alcohol, and other illegal activities. Baseball, movie shows, singers, and others helped cheer those in both the world wars. It kept American moral up and lead people to a time of prosperity and relaxation after World War II. Soldiers would talk about the World Series while they sat in their trenches rooting for a team. They would go watch a boxing match to take their mind off of what lay ahead for the time. With out these activities soldiers would have had to turn their attention elsewhere. Probably back to fighting which was the only thing they didn?t want to think about. Sports helped in the war effort so why can?t it help in the school effort.

Framework for Safeguarding Confidentiality in Children

Framework for Safeguarding Confidentiality in Children When dealing with adults who lack capacity and children, a medical professional often has to make a difficult choice between safeguarding confidentiality and making disclosures to protect the particular patients welfare. CRITICALLY DISCUSS the extent to which the legal framework has so far succeeded when addressing the balancing exercise referred to above and whether confidentiality for these groups of patients is sufficiently safeguarded. Introduction: In this paper, through reference to the jurisprudence of the courts of England and Wales, the author will critically discuss the extent to which the law has managed to strike an appropriate balance between protecting the rights of children and adult patients who lack capacity, on the one hand; and, allowing medical professionals to make disclosures when such disclosures are deemed to be in the best interests of their patients, on the other. The structure of this paper will be as follows: First, the author will examine the legal basis for any rights to confidentiality and non-disclosure that are conferred on children and adult patients who lack capacity, by the law of England and Wales. Second, the author will identify the legal provisions and/or common law decisions which purport to allow medical professionals to act in contravention of these rights, when to do so is deemed in the best interests of their patients. Third, the author will perform a review of the jurisprudence of the courts of England and Wales to determine the legal scope of these justified derogations. Fourth, the author will perform a literature review to indentify the extent to which medical professionals, in practice, manage to apply their discretion appropriately. Finally, the author will review the various mechanisms in place, if any, to review the conduct of medical professionals and hold accountable any medical professionals who fail to adhere to the limits of the discretion conferred upon them by the law of England and Wales. What is/are the legal basis/bases for the right to confidentiality enjoyed by children and adult patients who lack capacity? 2.1 Children patients who lack capacity and their ‘right(s)’ to confidentiality: Before the rights of this select group of patients to confidentiality are examined, it is first important to define what is meant by ‘children patients who lack capacity’. In this context, we are referring to the ‘capacity’ to provide legally valid consent to their doctors or other medical professionals to disclose their confidential medical information to third parties. Under statute, a child patient will be presumed to possess sufficient capacity to consent in the regard the moment that they have attained the age of 16 years. This is provided by section 8 of the Family Law Reform Act 1969, subsection (1) of which provides: â€Å"The consent of a minor who has attained the age of sixteen years to any surgical, medical or dental treatment which, in the absence of consent, would constitute a trespass to his person, shall be as effective as it would be if he were of full age; and where a minor has by virtue of this section given an effective consent to any treatment it shall not be necessary to obtain any consent for it from his parent or guardian.† Of course, this is merely a presumption. A particular child patient may have characteristics which invalidate this consent, even though they are over the age of 16. For example, if they qualify as a person who lacks consent under section 2 of the Mental Capacity Act 2005, which provides that: â€Å"[A] person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain.† It matters not whether this ‘impairment’ or ‘disturbance’ is temporary or permanent[1], but assessments must be made on the basis of the actual decision-making capacity of the individual[2], rather than through reference merely to the type of condition or impairment which that child is suffering from[3]. Such assessments are to be made on the balance of probabilities[4], i.e. a child patient who is between 16 and 18 years old wi ll be deemed to lack the necessary capacity to consent if it is more likely than not that he or she is unable to fully appreciate the implications of the decision which needs to be made. A child over the age of 16 may also be deemed to lack capacity to consent when they are physically unable to provide consent; for example, if they are unconscious[5]. Similarly, the presumption that a child under the age of 16 lacks the necessary capacity to consent can be rebutted if, upon an assessment of the decision-making ability of that patient, it is deemed that he or she â€Å"[has] achieve[d] a sufficient understanding and intelligence to enable him or her to understand fully what is proposed.[6]† A minor who possesses this required threshold of understanding and intelligence will be said to be ‘Gillick competent’. However, it is highly unlikely that a child under the age of 13 will ever be deemed so competent[7]. In conclusion, in this paper, when referring to child patients who lack capacity, we are referring (1) to minors who are under the age of 16 but who are not deemed to be Gillick competent; and, (2) to children who are 16 or 17 years of age, but who lack the necessary capacity to provide informed consent, perhaps because they are deemed to fail the test provided by section 3(1) of the Mental Capacity Act 2005; or, perhaps because they are unconscious, and are therefore physically unable to provide any consent whatsoever. Having established the categories of patient to which we are referring, now let us examine the legal bases for their ‘right’ to confidentiality: One such legal basis is provided by the Data Protection Act 1998, which was enacted to give effect to European Council Directive 95/46/EC. This Act creates a legal presumption that personal data may not be processed unless it is lawful to do so[8], it is processed fairly[9] and certain conditions are satisfied. In regard to the conditions which must be satisfied: Schedule 2 and 3 of the 1998 Act provide a list of conditions and, in order for information to be processed in accordance with the Act, at least one condition from both sections must be satisfied[10]. These conditions will be discussed at length in section 3 of this paper, when we turn to examine under what circumstances a medical professional is lawfully justified to make disclosure when it is deemed in the best interests of a patient’s welfare. In regard to the requirement of fairness, in the medical context, Stauch et al (2002) write: â€Å"To be ‘fair’ the data must, in general terms, have been obtained from the patient honestly or in accordance with a legal obligation; the patient must have been told the purposes for which the information is to be processed; and the rules for providing access to the data subject must also have been observed.[11]† In regard to when it is deemed unlawful to process personal medical information, no definition of lawfulness is provided by the Data Protection Act 1998[12]. One can only assume that this refers to the legal requirements provided under the common law and also under the Human Rights Act 1998. Article 8 of the Human Rights Act 1998 provides: â€Å"(1) Everyone has the right to respect for his private and family life, his home and his correspondence. (2) There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.† In the recent case of Rose v. Secretary of State for Health [2002][13] it has been held that this right is conferred on all citizens, including children. However, from the wording of the Article, in particular Article 8(2) it is immediately clear that this right to confidentiality is subject to a broad public policy category of exception. The category of exception will be analysed in greater detail in section 3 of t his paper, when we turn to examine under what circumstances a medical professional is lawfully justified to make disclosure when it is deemed in the best interests of a patient’s welfare. In regard to the common law right to privacy, this right is based upon equitable principle and therefore a breach of this right gives rise to a civil law cause of action only. Similar, but distinct, from the law of tort, one of the requirements which needs to be established before a common law right to confidentiality can be deemed to have arisen in any given case is a duty of confidentiality. This might arise from a contractual relationship between the parties or, in the medical context, simply from the fact that medical professionals are duty bound to respect the confidentiality of their patients[14]. However, this duty is also subject to a public interest exception: In this case of W v Edgell [1990][15], it was held by Lord Justice Bingham, who provided the leading judgment in this case, that: â€Å"the law treats such duties not as absolute but as liable to be overridden where there is held to be a stronger public interest in disclosure.[16]† To what extent the welfare of a child patient who lacks capacity to consent can serve as such a ‘public policy’ justification for derogation of this duty by medical professionals will form part of the subject of discussion in section 3 of this paper, below. 2.2 Adult patients who lack capacity and their ‘right(s)’ to confidentiality: An adult patient will be deemed to lack capacity either where he or she is unable, physically, to provide consent to disclosure; or, where that patient is deemed to lack capacity in accordance with the assessment criteria established under section 3 of the Mental Capacity Act 2005. This group of patients enjoy the same rights to confidentiality as the children discussed in the previous subsection of this section of the paper; namely, they have a right under the Data Protection Act 1998 to have their personal data processed fairly and lawfully and only where certain pre-defined conditions has been satisfied; the right to privacy as provided by Article 8(1) of the Human Rights Act 1998 (but, likewise, subject to the public policy exceptions provided by Article 8(2) of that Act); and, the common law right to confidentiality. What is/are the legal basis/bases on which medical professionals are entitled to derogate from the right to confidentiality otherwise enjoyed by their children and adult patients who lack capacity, when derogation is deemed to be in the best interest of their patients’ welfare? In the previous section of this paper, we established that each of the various legal bases for the right to confidentiality and non-disclosure of children and adult patients who lack capacity are subject to exceptions. In regard to the Human Rights Act 1998 and also the common law duty to maintain patient confidentiality, the exception is one based upon considerations of ‘public policy’. In regard to the Data Protection Act 1998, the ‘exceptions’ are provided by Schedule 2 and 3 of the Act which set out a list of conditions, at least one from each schedule of which must be satisfied in order for a medical professional to be deemed entitled to disclose (i.e. ‘process’) the confidential information of his or her patients to 3rd parties. Let us now turn to examine to what extent ‘the welfare of these patients’ can be deemed a legitimate public policy justification for derogating from these patients’ right to confidentiality and also to what extent the conditions provided in schedule 2 and 3 of the Data Protection Act 1998 might be capable of being satisfied by considerations of patient welfare. Before we embark upon this analysis, it is important to remind ourselves of the practical circumstances with which a medical professional might be confronted when treating children or adult patients who lack capacity: First, it should be remembered that such medical professionals will not be able to ask these patients for consent, because they, by definition, are either physically or mentally incapable of providing such consent; and, second, in the context of children patients who lack consent and who are under the age of 16, medical professionals are required by law to involve the parents or legal guardians of those patients in any decision-making processes pertaining to the treatment of their children—therefore issues of disclosure to these types of third party are irrelevant[17]. Bearing these limitations in mind, let us examine the various categories of exception which operate to allow medical professionals to make disclosures in the absence of any consent (but not where consent has been withheld by the parents or legal guardians of the patients in question). The first point to note is that medical professionals are fully entitled to disclose medical information to other medical professionals who are also involved in the treatment of a child or adult patient who lacks capacity. Such disclosure is permissible under the Data Protection Act 1998 because one condition from Schedule 2 and one Condition from Schedule 3 are both satisfied; namely, the condition provided by s6(1) of Schedule 2 to the Act, which staes that, â€Å"[t]he processing is necessary for the purposes of legitimate interests pursued by the data controller or by the third party or parties to whom the data are disclosed, except where the processing is unwarranted in any particular case by reason of prejudice to the rights and freedoms or legitimate interests of the data subject;† and, the condition provided by s8(1) of Schedule 3 to the Act, which provides: â€Å"[t]he processing is necessary for medical purposes and is undertaken by— (a) a health professional , or (b) a person who in the circumstances owes a duty of confidentiality which is equivalent to that which would arise if that person were a health professional..† Such disclosures are made in the interests of the welfare of the patient, although assessments do not need to be made on a case-by-case basis as it is generally assumed that disclosure across medical professionals is legitimate and that consent for such disclosures would not be withheld. In regard to making disclosures to other non-medical parties: The various exceptions identified in the previous section of this paper all depend upon derogation being justified in the ‘public interest’. In regard to Article 8(2) of the Human Rights Act 1998, the words â€Å"necessary in the interests of the protection of health or morals,† does seem to suggest that derogation on grounds of the welfare of a particular patient would be deemed justified. This has been confirmed by the courts in the case of Z v Finland (1998)[18]. In regard to the common law duty to maintain patient confidentiality, we have already cited the case of W v Edgell [1990][19] as providing authority for the assertion that this duty can be overridden by competing public interests. It is highly unlikely that the Courts would wish to undermine the decisions of medical professions in this regard; after all, medical professionals are best qualified to determine how important disclosure is in any given case and therefore whether the duty of confidence should be overridden. As Bainham (2005) writes: â€Å"[I]t is debateable how far the courts would want to question, retrospectively the clinical judgment of the medical profession.[20]† In regard to making disclosures to non-medical 3rd parties under the Data Protection Act 1998, while little direct guidance can be found within the wording of the 1998 Act itself, the General Medical Council (2000), at paragraph 27 of its official publication entitled ‘Confidentiality: Protecting and Providing Information’, seems to suggest that disclosure on grounds of patient welfare will be considered a justified processing aim under the Data Protection Act 1998: â€Å"Disclosure of personal information without consent may be justified in the public interest where failure to do so may expose the patient to risk of death or serious harm. Where the patient [is] exposed to a risk so serious that it outweighs the patient’s privacy interest, you should seek consent to disclosure where practicable. If it is not practicable to seek consent, you should disclose information promptly to an appropriate person or authority.† It must be noted that this guidance notes does not suggest that disclosure will be justified where the risk to the patient is only minor, but provides no insight into how to assess the seriousness of any given welfare risk. Of course, if death is a risk faced by the patient if disclosure is not made, then this will automatically be deemed sufficiently serious. The legal framework: How have the courts of England and Wales purported to strike an appropriate balance between protecting the rights (to confidentiality) of children and adult patients who lack capacity, on the one hand; and, allowing medical professionals to make disclosures when such disclosures are deemed to be in the best interests of their patients, on the other? Much of this analysis has already been conducted in the previous sections of this paper, when determining the extent of patients’ rights to confidentiality and also the extent of medical professionals’ duties of confidentiality to their child and adult patients who lack capacity. However, one key fact has been omitted: Throughout this paper we have seen how many of the exceptions available at law to patients’ rights to confidentiality depend upon a notion of the ‘public interest’. It should be noted that the courts have been reluctant to provide any categorical definitions of this phrase. Rather, they have approached the matter on a case by case basis, with pragmatism. Those cases in which the Courts have held disclosure to be in breach of patients’ rights to confidentiality generally have involved circumstances where information has been released for interests other than those pertaining to the welfare of particular patients. For example, in the case of X v Y [1988][21] Rose J held that the disclosure of medical information for the purposes of protecting other employees was not a sufficient ground upon which to invoke the public interest defence. In cases where the disclosure was made in the interests of that patient, particularly, then the Courts are therefore likely to be more willing to allow the public interest defence to succeed. This makes sense, when one considers that the Courts are generally concerned with the harm or potential for harm caused by a disclosure to the patient over which the sensitive medical information pertains[22]. The Courts and medical professionals should also take into account that it is in the public interest to protect patients’ rights to confidentiality wherever possible. As Leung (2000) notes, if the right to confidentiality is not protected, then this could have far-reaching adverse consequences on the level of healthcare which is able to be provided by the National Health Service—patients will be less willing to be open and honest about sensitive facts, and therefore it may be less easy to diagnose and treat such persons[23]. What, if any, mechanisms are in place to review the conduct of medical professionals and hold accountable any medical professionals who fail to adhere to the limits of the discretion conferred upon them by the law of England and Wales? Of course, the primary mechanism which is in place is the right to private law action which patients are entitled to pursue in the event of a perceived breach of their data protection or privacy rights. The result of such actions will depend upon whether or not, in any given case, the court deems it appropriate to allow the defendant medical professional(s) to enjoy the protection afforded by the public interest defence. As we have argued in the previous section of this paper, where the reasons for disclosure were based solely on considerations of the particular patient’s welfare, then it is highly likely that the claimant’s case will fail. However, not every victim of breach will decide to take legal action and therefore it is not wholly appropriate to rely upon this mechanism to ensure that medical professionals remain compliant with their data protection and confidentiality duties. That having been said, this author can find no evidence of any other mechanisms which have been developed to measure compliance in this regard. Conclusions: The statement at the top of this paper suggests that it is difficult for medical professionals to decide whether or not to disclose personal information of children and adult patients who lack capacity to 3rd parties, when to do so is in the interests of the welfare of their particular patients. In fact, as we have seen, so long as the interests contemplated really are based upon considerations of patient welfare, then this decision is not a difficult one at all: Disclosure is such cases should be made. The fact that the patients themselves are unable to provide consent or, more importantly, withhold it, makes this assessment all the more easy. In regard to how well the law manages to safeguard the rights of children and adult patients who lack capacity to confidentiality: These rights are all, without exception, conditional and capable of being overridden in the public interest. While the Courts do seem to approach determinations of when the public interest defence should be allowed to succeed in a pragmatic and sensible way, taking into account the harm caused by each breach in question; it is arguable that some form of monitoring and accountability mechanism should be introduced at the practitioner level, to ensure that medical professionals are remaining compliant even where their patients, for whatever reasons, do not decide to take legal action for perceived breaches of their data protection and privacy rights. References: The Data Protection Act 1998 The Data Protection Directive, European Directive 95/46/EC The Human Rights Act 1998 The Mental Capacity Act 2005 Rose v. Secretary of State for Health [2002] 2 F.L.R. 962 Bainham, A. (2005) Children: The Modern Law. Jordan Publishing. Gillick v West Norfolk and Wisbech Area Health Authority [1985] 3 All ER 402 GMC (2000) Confidentiality: Protecting and Providing Information. Available online at http://www.gmc-uk.org/guidance/current/library/confidentiality.asp W v Edgell [1990] 1 ALL ER 835 Z v Finland (1998) 25 EHRR 371 X v Y [1988] 2 All ER 648. Devereux, J., and Moore, R. (2002) Medical Law. Routledge and Cavendish Publishing, 2002. Stauch, M., Wheat, K., and Tingle, J. (2002) Sourcebook on Medical Law. Routledge Publishing,2002. Bailey, P. Harbour, A. (1999) The law and a child’s consent to treatment (England and Wales). Child Psychology and Psychiatry Review, 4, 30–34. Wei, G. (2002) An Introduction to Genetic Engineering, Life Sciences and the Law. NUS Press Publishing, 2002. Leung, W. (2000) Law for Doctors. Blackwell Publishing, 2000. Footnotes [1] Section 2(2) of the Mental Capacity Act 2005. [2] The applicable criteria are provided by section 3(1) to (4) of the Mental Capacity Act 2005. [3] Section 2(3)(2) of the Mental Capacity Act 2005. [4] Section 2(4) of the Mental Capacity Act 2005. [5] Not merely asleep! [6] Gillick v West Norfolk and Wisbech Area Health Authority [1985] 3 All ER 402, per Lord Scarman. [7] Bailey and Harbour (1999) p32 [8] Schedule 1, Part 1, section 1 of the Data Protection Act 1998. [9] Schedule 1, Part 1, section 1 of the Data Protection Act 1998. [10] Schedule 1, Part 1, section 1(a) and (b) of the Data Protection Act 1998. [11] Stauch et al (2002) p282 [12] Ibid. [13] Rose v. Secretary of State for Health [2002] 2 F.L.R. 962 [14] For example, [15] W v Edgell [1990] 1 Ch 359. [16] Cited by Devereux and Moore (2002) p343 [17] As Bainham (2005) p330 writes: â€Å"But what of immature children who would fail the test of Gillick competence? Here, the obvious implication of Gillick was that the parent’s right to give or withhold consent would remain intact, and this has been confirmed by the later Court of Appeal decisions. Are there, then, any circumstances under which a doctor may act against parental wishes because he judges it in the clild’s best interests to do so? It must be said that, as the law stands, this would be a precarious course of action† [18] Z v Finland (1998) 25 EHRR 371 [19] W v Edgell [1990] 1 Ch 359. [20] Bainham (2005) p331 [21] X v Y [1988] 2 All ER 648. [22] Wei (2002) p95 [23] Leung (2000) p45

Health Essays Chronic Disease Management

Health Essays Chronic Disease Management Chronic Disease Management Chronic diseases have an effect on all countries, and the augment in their prevalence is to a great extend attributed to varying demographics, improved life expectancy, changing lifestyles, better disease management and management and a better understanding of the factors that cause poor health and disease. Laboratory, clinical and population-based research has revealed that a few risk factors are responsible for the prevalence of most chronic diseases: unhealthy diet and high energy ingestion, lack of physical activity and use of tobacco. Alcohol intake, environmental pollutants, age and hereditary factors also play a role. These risk factors are the same in men and women and across all regions in the world. The associated healthcare, financial and social burden of chronic diseases, which include diabetes mellitus, coronary heart disease, asthma, chronic obstructive airway disease, hypertension, chronic depression, osteoporosis, end stage renal failure and stroke, are progressively on the increase. In the US alone to be specific, some 125 million people now suffer from at least one chronic disease. Chronic diseases are a tremendous burden to individuals and to countries and the available traditional healthcare methods are not able to meet the requirements for preventing and reducing this burden. It is because of this problem that chronic disease management has emerged as a new approach towards caring for patients with chronic diseases. Chronic disease management in clinical circles can be defined as an elaborate, systematic, multicomponent strategy to delivering healthcare while involving all members in the population or community who suffer from similar infections. Cardiovascular disease is chronic and is the first cause of death among the elderly in all countries. This observable fact was evident even 60 years ago, as Roberts noted that diseases of the circulatory system and pneumonia were the first causes of death among the aged in Jamaica in 1950. These diseases are to some extent the sequelae of advancing age. As life expectancies are increasing the prevalence of all noncommunicable disease is also increasing. Thus, one could adopt the approach that these are an foreseeable consequence of ageing and the focus therefore has to be on simply treating them when they do occur and applying the acknowledged interventions for secondary prevention once the first disease episode has occurred. It is possible to reduce the mortality from chronic diseases in general. Some of the developed countries such as Canada, Australia and the United States have succeeded in reducing mortality by applying preventive measures. Meeting the multifaceted needs of patients with chronic diseases is the single supreme challenge facing our healthcare system in most countries today. With the increasing numbers of patients suffering from chronic diseases, it is of the essence that clinicians, healthcare administrators and health policy makers plan and ensure that the healthcare delivery system is tailored to provide care for these patients across the band of their healthcare needs. Chronic disease management has been known to be the best and most comprehensive approach for providing holistic and comprehensive care for patients with chronic illnesses. The Kaiser Permanente care triangle has frequently been used to conceptualize Chronic disease care at three main levels Supporting self-care for patients suffering from chronic disease who are at low risk of complications and hospitalization. Disease management for people who are in need of regular routine follow-up and are at high risk of chronic disease. Case management for people who have complex needs and those who are high-intensity users of unplanned less important care. Managing chronic diseases at the system level has been the focus of many latest publications.1-4 In the US, the recent Institute of Medicine Report – Crossing the Quality Chasm – focused on the need to reorganize care delivery to meet the healthcare demands of populations of patients who suffer from chronic illnesses. In October 2001, the British Medical Journal and the Western Journal of Medicine both published special issues focusing on the problem of chronic diseases and tinted how various nations are dealing with this ever rising epidemic. It is therefore timely that all nations focuses on coming up with a better program to address the needs of patients with chronic disease, on the advances in clinical and non-pharmacological management, and the challenges faced in ensuring that patients receive optimal care meeting the needs at the various stages of their disease. Programme for chronic disease management A successful chronic disease management program should be designed while considering fundamental factors that are critical to its sustainability. First of all the program should be aimed at a certain specific condition within the population suffering. Then the nest important factor concerns the availability of evidence on which its functions should be based. A good program has to keep in its consideration the existence of obstacles which may be a hindrance to its successful implementation. Adequate measures should be put in check to ensure that there is a balance between quality and the economic of the objectives of the care to be given United States In the United States chronic disease management programs, also known as chronic care management, have become extensive. They are being favored by employer groups, health-care organizations and health payers, these programs are being increasingly raising concern because very little scientific evidence is available to justify their effectiveness and economic impact. Disease management was introduced and launched in 1990 by drug companies for the purpose of helping patients to comply with various medications and also to increase their sales. This programs have developed in the private sector to become such a competitive industry that these companies contract health plans to offer comprehensive care to various groups. They are then paid a fee by the health plans to guarantee a saving. Disease management programs are wide in the private sector; they offer care and support as part of benefits and support from physicians. Some programs have been organized in such a way that the physician can receive alerts whenever the patient needs medical attention or even when the services for preventing chronic diseases are long overdue. Some use professional clinical information systems which can integrate participant’s data for instance data which concerns claims data or self reports. This can be even acquired from multiples sources. However there is only a small number of beneficiaries who suffer from chronic illness and therefore account for the unproportionate share of medical expenditure. This results in such patients receiving fragmented care from a number of site providers and to add on the insult they receive repeated and costly hospitalization. The manifestation project was endorsed by the Medicare, Medicaid,and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA). In adding together to the BIPA projects, there arenumerous of other coordinated care demonstrations approvedby Congress in the Balanced Budget Act of 1997, a capitatedDM demonstration recently initiated by the Bush administration,and an end-stage renal disease management demonstration. People are demandingto figure out ways to do disease management in the public sector that act in responseto patient-privacy concerns and that admiration the traditionalrole of the physician. Disease management programs have no effect on the state budget as they pay for administrative services while they are guaranteed by the government a savings offset in form of claims reduction. It is important to point out that even though the opportunities for cost savings and step up inhealth outcomes is great, the challenges of introducing disease management onwide scale in the Medicare program are momentous The patients increasing population is likely to bring up challenges which are not found in the private sector. France In France studies have shown a tremendous improvement in the state of health and quality of life for chronic illness patients. There has also been significant reduction in costs due to the implementation of coordinated networks for the treatment of asthma. The reduction in costs cannot be attributed to spontaneous national changes in management but rather it can be explained by the effect of the intervention program. This initiative can be said to be the first attempt towards implementation ofa disease management program in France. Italy In Italy the health system is aiming at utilizing Information technology tools to manage chronic diseases. In this country the population f over 65 years has be noted to be on the rise. What is worrying is that the number of chronic diseases also increases with this range of age. Approximately 90% of the aged people are suffering form chronic diseases and something has to be done in effect to prevent further repercussions. In the past Italian doctors have raised concern over the time that is used in treating patients with chronic diseases and therefore cam up with a resolution to use community care which such a program there is a shift from hospital based care to community based care. Such a program aims at reducing on the number of patients admitted with chronic diseases, removes patients out of hospital quicker and improving on the network for helping people with chronic diseases. This is to be done while the records are kept centrally and monitored while the services are moved to the community. In Italy there is also another program being put in place and it is called sole project as it is aiming at networking all hospitals with communities to give the citizens services. The program is also aiming at controlling flow of information so as to help the elderly patients. The idea must have been copied from the UKs pathways to telecare. Germany In German two laws were passed in the year 2001 to address the main problems in the healthcare system. Despite advance which have been made in diagnosis and treatment of diabetes, patients still experience secondary complications, The purpose of disease management program in Germany is to avoid repetition of diagnostic testing, by specialists or in hospitals thus assisting in containing the cost. In Germany chronic diseases management programs have a legal basis under which they operate. For instance in the year 2002 there was a reform law which laid down a complicated procedure for the establishment and implementation of disease management programs. These procedures included the characteristic features of a disease which qualifies to be included in the management programs. Implementation of disease management programs in Germany has been influenced by politics which is not like in the other countries. Germany has a longer experience with disease management programmes than the United States. The healthcare system in Germany has characteristics which have seen the introduction of disease management programs. This includes the free choice of the non-profit sickness funds who have to strike a balance between spending and income. There are also issues regarding to efficiency and quality on the side of those who are chronically sick The ministry of health in Germany anticipated that disease management programs will help to reorganize the fragment care for people suffering from chronic illnesses. The main challenge towards implementation of the programs regards to the defining of the minimum standards proves to be contentious and time consuming as people continue to suffer. Another challenge has been on implementing the program for Diabetes whose care requirements has been attacked by more than ten scientific societies. These scientists argue that the government and the sickness funds favored a minimal program which was created basing on studies with the highest level of evidence. Some claim that the programs were created under extreme time pressure. (R. Busse 2001) By way of the German-style DM programs the government anticipated a radicalGordian explanation to a knot of disheveled problems. While theauthentic experience with DM programs is by a long way larger and longerin the United States than in Germany, the German strategy couldbe of interest in the United States, where we have cream skimming andadverse selection having in fact blocked managed care infiltrationinto the Medicare population. One observable difference is theownership of the DM programs; in the United States they are to some extent connected with pharmaceutical companies or special DMP vendors. Whendisease management came up in Germany, analogous companies appearedon the market, with the hope for commercial triumph. Some sicknessfunds contracted them to assist them in preparing DM programs, but suchcompanies have more or less disappeared from the market The UK According to statistics in the U K lack of proper care to manage chronic diseases on a day today basis can lead to unnecessary complications and premature death. Children also suffer from chronic diseases for instance children below five years account for 15% of the cases(General household survey 2002) Self care has sometimes been ignored in the UK but it is a well proven approach to improving the situation of chronic diseases. According to data from the Department of Health’s Economic and Operational Research the effects of self care include; Reduced to visits to GP Sby over 40% for the high risk cases. Reduction in admissions to hospitals by about 50% in a Parkinson’s diseases The length of stay in hospitals for mental health problems reduce. Off work days can reduce by even more than 50% for patients suffering from arthritis Self care or management is not just an issue of providing information to the patients but it involves a range of other things to make it workable. Patients need care education regarding to self management of their sickness by helping stand what they ought to do and how to make adjustments towards their medical dosage and how and when they need healthcare. They also need quick reminders of when they should be attending to certain measures concerning their health. They need support from knowledgeable patients or even an expert in their disease and broader networks which can include attending to group practices involving the same kind of health condition. Their s uncertainty as regarding to self care however it is likely to improve in relevance because of the following: The increase of information that is availed to the patients. The ability of information technology to support self care. The possibility of having reliable and accurate home monitoring systems. The greater anticipation by many patients to be the locus of control. In the UK the main providers of care for chronic diseases are the primary care teams. They include community nurses, pharmacists, dieticians, opticians, podiatrists, and physiotherapists. Barriers for implementing disease management programs One major factor which hinders the implementation of these programs is the lack of proven after investment. This has tended to limit the health plan and interest of the disease management organization. Future of Disease management programs There is no acceptable best way to chronic disease management. Evidence that has been observed throughout the world brings out clearly that, to be successful, policy-makers should put into consideration: Providing well-built leadership and vision at the national, regional or organizational level which should oversee all that is required for the programs to succeed. They should ensure full-bodied collection of information and data-sharing among all the stakeholders in the health sector. Care should be provided based on people’s needs and an ability to identify people with different levels of need; They should also put in place measures that target key risk factors, including widespread disease prevention initiatives. Growing towards supporting self-management and empowerment of people with chronic diseases Policy brief should involving a wide range of stakeholders such as individuals, the voluntary and community sector, clinicians, private industry and public services. Future Disease management programs should be tailored to reduce the costs associated with care for people suffering from chronic illnesses. The growing costs of operations such as dialysis are still a major concern in most countries. But with the Disease management programs in place these costs are expected to decline and lead to improved care even through public health for chronic disease cases. However reducing the costs with DM programs has been successful in some areas but the drug treatment especially in diabetic cases seems to be an area where the growing costs are inevitable.

The Nature of Space in Kafkas The Castle :: Kafka Castle Essays

The Nature of Space in Kafka's The Castle    From the end of the nineteenth century to the outbreak of World War I, great developments in technology and knowledge brought about significant changes in the way man viewed time and space. The necessity of clear train schedules led to the development of World Standard Time and the plurality of private time. In regards to space, with which this paper deals, man moved into other subjective realms beyond the two and three dimensions described by Euclid. In fact, with Einstein's theory of relativity, the number of spaces inherent in life increased beyond calculation to equal the number of moving reference systems of all the matter in the universe. This theory echoes Nietzche's contemporary philosophical theory of perspectivism, where space only consists of points of view and interpretations, not objective facts. Thus, these two doctrines signaled a breakdown of the old notion that there is a single reality, a single, absolute space. Space became subjective and relative, man could not be sure of what it was that actually surrounded him and made up his physical world.    Creative artists, painters and novelists, attempted to deal with this new concept. Attacks were made on traditional notions that there is only one space and that a single point of view is equal to an understanding. Writers, specifically, responded with multiple perspectives depicting different views of the same objects in space in order to demonstrate that the world is always different as it is perceived by various observers at varying times. Man had to come to grips with the fact that with such a plurality of space, he cannot know, understand, or even see the physical world completely.    Thus, it is not surprising that Kafka's final work, The Castle, which emerged out of the pluralism and confusion of this age, deals with this new notion of space, this new relativity of the world surrounding man. While the book can be looked at on a spiritual level, with the castle symbolizing divinity or the ultimate spiritual meaning of man's existence, in regards to space, the castle could also symbolize the actual literal, physical world. Through the nature of K. and his quest, the different ways the Castle is perceived by K. from various viewpoints along his quest, and the inability of anyone to know the true nature of the castle officials, Kafka

Angina: Diagnosis and Treatment Options :: Health Medicine

Angina: Diagnosis and Treatment Options Angina refers to the pain arising from lack of adequate blood supply to the heart muscle. Typically, it is a crushing pain behind the breastbone in the center of the chest, brought on by exertion and relieved by rest. It may at times radiate to or arise in the left arm, neck, jaw, left chest, or back. It is frequently accompanied by sweating, palpitations of the heart, and generally lasts a matter of minutes. Similar pain syndromes may be caused by other diseases, including esophagitis, gall bladder disease, ulcers, and others. Diagnosis of angina begins with the recognition of the consistent symptoms. Often an exercise test with radioactive thallium is performed if the diagnosis is in question, and sometimes even a cardiac catheterization is done if the outcome is felt necessary to make management decisions. This is a complex area which requires careful judgment by physician and patient. Angina is a manifestation of coronary artery disease, the same disease leading to heart attacks. Coronary artery diseas refers to those syndromes caused by blockage to the flow of blood in those arteries supplying the heart muscle itself, i.e., the coronary arteries. Like any other organ, the heart requires a steady flow of oxygen and nutrients to provide energy for rmovement, and to maintain the delicate balance of chemicals which allow for the careful electrical rhythm control of the heart beat. Unlike some other organs, the heart can survive only a matter of minutes without these nutrients, and the rest of the body can survive only minutes without the heart--thus the critical nature of these syndromes. Causes of blockage range from congenital tissue strands within or over the arteries to spasms of the muscular coat of the arteries themselves. By far the most common cause, however, is the deposition of plaques of cholesterol, platelets and other substances within the arterial walls. Sometimes the buildup is very gradual, but in other cases the buildup is suddenly increased as a chunk of matter breaks off and suddenly blocks the already narrowed opening. Certain factors seem to favor the buildup of these plaques. A strong family history of heart attacks is a definite risk factor, reflecting some metabolic derangement in either cholesterol handling or some other factor. Being male, for reasons probably related to the protective effects of some female hormones, is also a relative risk. Cigarette smoking and high blood pressure are definite risks, both reversible in most cases.

President Franklin D. Roosevelts New Deal Essay examples -- Franklin

On October 24, 1929, a day historically known as â€Å"Black Thursday†, the United States stock market crashed due to investors in the market starting to â€Å"sell off their shares, which resulted in a decline in stock prices.† (Dau-Schmidt, pg 60) This economic downturn in the market gave birth to financial ambivalence in the country, increasing unemployment, as well as other consequences on the landscape of international economics. When President Franklin D. Roosevelt took over as president in the year of 1933, â€Å"The country was in its depth of the Great Depression.† (Neal, 2010) Roosevelt’s New Deal consisted of implementing relief programs such as the Work Progress Administration and the Civil Works Administration, which aimed at revitalizing the U.S. labor market. However, these programs were short-lived due to insufficient funding. Although these programs were effective, their short life span only sought temporary remedy. The on again off again pattern of these programs existence caused a cyclical trend in the increase and decrease of unemployment. â€Å"John M. Keynes born on June 5, 1883 was one of the most influential economists of the Twentieth Century.† (Pettinger, pg 1) Keynes argued that the doctrine of the New Deal was a slow remedial procedure to restoring the economy. Although, Roosevelt’s efforts helped reduce unemployment in spurts, it was ultimately an ineffective plan because according to Keynes, to restore the economy during the Great Depression, there had to of been deep government spending and increased high taxes. When President Roosevelt took office, he had to fulfill his ideas he had proposed to the citizens while campaigning for presidency. One of his ideas and that he fulfilled, was the Works Progress Administrati... ...n Kantor. "The Dynamics Of Relief Spending And The Private Urban Labor Market During The New Deal." Journal Of Economic History 70.1 (2010): 195-220. Academic Search Complete. Web. 7 Mar. 2013. Powell, Jim. "The Unemployment President." Cato Institute. The Washington Times N.p., 4 Aug. 2010. Web. 17 Mar. 2013. Pettinger, Tejvan. "Biography of John M Keynes", Oxford, www.biographyonline.net 3 Feb. 2013 Rauchway, Eric. "Learning From the New Deal's Mistakes." The American Prospect. The American Prospect, 19 Dec. 2008. Web. 02 Apr. 2013 Winkler, Allan M. "The New Deal: Accomplishments and Failures." Speech. Testimony before the U.S. Senate Committee on Banking, Housing, and Urban Affairs. Oxford,Ohio. 31 Mar. 2009. Web. 2 Apr. 2013. Winkler, Allan M., and Robert M. Collins. Keynesian Economics. The Web Chronology Project, n.d. Web. 04 Apr. 2013.

Fish Oil Health Benefits

Fish oil health benefits are exaggerated, says a new study appearing in the Canadian Medical Association Journal. And yet, it warns, increased consumer demand for fish oil is pushing fish populations to the brink. Medical scientists from St. Michael's Hospital and the University of Toronto have teamed with researchers from the University of British Columbia's Fisheries Centre and author Farley Mowat to closely examine the effects of health claims with regard to seafood. For years, international agencies concerned with health and nutrition have promoted seafood consumption. â€Å"Our concern is that fish stocks are under extreme pressure globally and that studies are still urgently required to define precisely who will benefit from fish oil,† says Dr. David J. A. Jenkins, a doctor at St. Michael's Hospital and a professor at the University of Toronto Faculty of Medicine's Department of Nutritional Sciences. Further, if we decide that fish oil supplementation is necessary for good health, then unicellular sources of ‘fish oil' like algae, yeasts, etc, should now be used, as they are in infant formula,† adds Dr. Jenkins. While some studies have reported fish oil health benefits healthy benefits, others have failed to show a significant effect. But these negative studies are often ignored and the result has been increased demand for seafood by consumers in the developed world, often at the expense of food security in developing nations. Governments and industry tell consumers to eat more fish because it is healthy,† explains Rashid Sumaila, director of the Fisheries Economics Research Unit at UBC Fisheries Centre and study co-author. â€Å"But where do we get these fish? They are increasingly coming from the waters around Africa and other places where food security is a problem. † At best, fish oils are just one factor out of many that may reduce ailments such as heart disease and researchers found that people who do not eat fish, such as vegetarians, are not at increased risk of illness. Furthermore, dietary recommendations to consume more fish are incompatible with the sustainability of ocean ecosystems, according to a concurrent study recently published in the International Journal of Epidemiology. â€Å"For people in Canada or the US, or in the EU, eating fish is one of many possible options, both in terms of a tasty meal, and in terms of a balanced diet,† says UBC fisheries researcher Daniel Pauly. â€Å"For many people in developing countries, fish is often their only source of protein. It would be irresponsible for us to ‘triage' food sources without verifying that fish oil indeed promotes human health. † Farley Mowat, co-author on this study, adds: â€Å"In the immediate future, human beings are going to have to find better ways to live. Our rape and pillage of the environment has to end before it becomes our end. The damage we have already done to life in the oceans is a prime example of our idiocy, and a last warning that we had better change our ways. â€Å"