Prevalence of Asthma and Chronic Obstructive

Question: Examine about the Prevalence of Asthma and Chronic Obstructive. Answer: Presentation Indigenous Australians keep being a regressive class with high occurrence of sick health(Katzenellenbogen, 2010). Factual examination of wellbeing among indigenous and non-indigenous people demonstrates that Aboriginal and Indigenous Australians endure more wellbeing and related sicknesses prompting high confirmation rates in medical clinics. Because of the area in remote spots of these native individuals there is a hole in the wellbeing administrations got by them and rest of the Australians. The high weight of sicknesses among Aboriginal can likewise be because of liquor, tobacco, medicate misuse, high weight, inadequate physical exercises, hypertensions, elevated levels of cholesterol, low leafy foods consumption, perilous sex, accomplice viciousness, kid sexual maltreatment cases, etc. The investigation underneath portrays the complexity between indigenous Australians and non-native Australians. Examination Dissimilarity in wellbeing among Aboriginal and non-Aboriginal Australians show that clinic confirmations among native Australians is 25% more contrasted with those of non-aboriginals(Bradshaw, 2010). The couple of principles against which wellbeing can be looked at is hospitalization rate, future, spending on wellbeing, wellbeing status, wellbeing elements, etc. An indigenous Australian is relied upon to be hospitalized at a 2.3 occasions more when thought about against the rate of infections. Most extreme number of patients conceded among indigenous individuals is because of renal dialysis. Future among indigenous and non-indigenous individuals is just about multi year time span. Because of the undesirable way of life and low access to wellbeing offices an indigenous Australian is relied upon to bite the dust previously and a common Australian. Australian administrative wellbeing spending on aboriginals vis- - vis conventional Australians likewise reflected unmistakable distinction. Consumption on indigenous individuals was relied upon to be 1.5 occasions higher when contrasted with use on any Australian(Kariminia, 2007). Examination of itemized wellbeing status of aboriginals versus standard Australians reflects higher commonness of type-2 diabetes, malignant growths, baby mortality, psychological well-being, oral wellbeing infections and pneumococcal ailments. High rate of sicknesses and power of different sick wellbeing mirrors that general Aboriginal and Torres Strait Islander individuals experience encounters less fortunate wellbeing when contrasted with that of common Australians(Petheram, 2010). The different reasons credited to the factor is packed lodging, low instruction levels, lower joblessness, insufficiency of lodging or infrastructural offices contrasted with different Australians. End Predominant conditions impactsly affect strength of Aboriginal Australians which is again ascribed to irresistible infections, less than stellar eating routine, high corpulence levels, etc. For the most part low quality eating regimen is the explanation that raises chance variables and frequency of infections altogether. There is a related elevated level of consumption on drinks and sugar improved refreshments contrasted with products of the soil. Research likewise portrays a shifted sort of hazard factors related with native individuals. There are an entirety of 11 hazard factors that are related with weight of ailments related with them. Among sicknesses there is a significant level of preventable ailments among them that can be extemporized by methods for appropriate eating routine. Such critical elements are being exploration with the end goal that general soundness of Aboriginal and Torres waterway individuals can be ad libbed. References Bradshaw, P. J., Alfonso, H. S., Finn, J., Owen, J., Thompson, P. L. (2010). The utilization of coronary revascularisation systems in urban Australian Aboriginals and a coordinated all inclusive community: coronary methodology in Aboriginals.Heart, Lung and Circulation,19(4), 247-250. Ospina, M. B., Voaklander, D. C., Stickland, M. K., King, M., Senthilselvan, A., Rowe, B. H. (2012). Pervasiveness of asthma and incessant obstructive aspiratory ailment in Aboriginal and non-Aboriginal populaces: a deliberate survey and meta-investigation of epidemiological studies.Canadian respiratory journal,19(6), 355-360. Kariminia, A., Butler, T., Levy, M. (2007). Native and non?Aboriginal wellbeing differentials in Australian prisoners.Australian and New Zealand Journal of Public Health,31(4), 366-371. Katzenellenbogen, J. M., Sanfilippo, F. M., Hobbs, M. S., Briffa, T. G., Ridout, S. C., Knuiman, M. W., ... Thompson, S. C. (2010). Rate of and case casualty following intense myocardial dead tissue in Aboriginal and non-Aboriginal Western Australians (20002004): a connected information study.Heart, Lung and Circulation,19(12), 717-725.

Rock island chocolate free essay sample

This contextual analysis is charged to determine an internet based life issue which conflicted with their own organization Rock island chocolate. I am here to think of a procedure and help my organization to escape the online life issue as the executive of an organization and attempt to change over the terrible comments of internet based life to great comments. In this developing world and innovation, internet based life has gotten one of the solid wellspring of correspondence. Online networking has a decent contact with the crowd which matters the most for any association on the planet. This reality cannot be disregarded, so as the Companys Director I might want to audit the blog in detail and locate some great arrangement in brief timeframe. As we probably am aware particularly from recent years the informal organization has developed monstrously. informal community destinations, for example, face book , twitter are live models for this development. We will compose a custom paper test on Rock island chocolate or on the other hand any comparative subject explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page I might want to follow step shrewd system in which I would finish one work and afterward go for another. From the outset I might want to make a face book page with a fresh out of the box new logo and great inventive idea and afterward I would recommend all the workers to participate in it and make it a famous gathering among their known network of individuals. On the off chance that we can go through cash carefully and do great promoting for it this methodology will unquestionably turn out to be as we probably am aware the intensity of person to person communication destinations and after this procedure I might want to include all the staff individuals to effectively partake in a conversation over the blog as an obscure client and remark on it emphatically. We realize that sites would some be able to time make a major issue and here and there it can simply cease to exist if there is no fact or backing in it. The individuals do become overly energetic with the remarks and on the off chance that they feel the vast majority of the remarks are certain, at that point consequently the blog just blurs away. I have a model guess you need to purchase an item from Amazon, there are two fundamental things the buyer might want to check one is the expense and the something else is the clients survey in the event that they feel both of these are sensible, at that point they will without a doubt purchase the item. Similarly if the blog has more positive remarks than the negative ones it wont inconvenience for additional time as it will vanish. Along these lines the blog issue will be settled and the organization will get a positive reaction over a specific timeframe.

The story of an ant

The story of an ant One morning I wasted nearly an hour watching a tiny ant carry a huge feather across my back terrace. Several times it was confronted by obstacles in its path and after a momentary pause it would make the necessary detour. At one point the ant had to negotiate a crack in the concrete about 10mm wide. After brief contemplation the ant laid the feather over the crack, walked across it and picked up the feather on the other side then continued on its way.I was fascinated by the ingenuity of this ant, one of Gods smallest creatures. It served to reinforce the miracle of creation. Here was a minute insect, lacking in size yet equipped with a brain to reason, explore, discover and overcome. But this ant, like the two-legged co-residents of this planet, also shares human failings. After some time the ant finally reached its destination a flower bed at the end of the terrace and a small hole that was the entrance to its underground home. And it was here that the ant finally met its match. Ho w could that large feather possibly fit down that small hole? Of course it couldnt. So the ant, after all this trouble and exercising great ingenuity, overcoming problems all along the way, just abandoned the feather and went home.The ant had not thought the problem through before it began its epic journey and in the end the feather was nothing more than a burden. Isnt life like that! We worry about our family, we worry about money or the lack of it, we worry about work, about where we live, about all sorts of things. These are all burdens the things we pick up along lifes path and lug them around the obstacles and over the crevasses that life will bring, only to find that at the destination they are useless and we cant take them with us. Author Unknown

Essay about The Phenonmeon of Teen Mom - 1606 Words

Teen Mom II is the second incarnation of MTVs number one rated reality series 16 and Pregnant. The show documents the lives of four teenage mothers as they struggle to cope with the burden of childrearing in a financially demanding society while trying to navigate through the journey of adolescence. Once catering to a music oriented teenage consumer, MTV has reinvented itself as a teen reality television powerhouse, with many of its reality shows, including Teen Mom II, consistently dominating in the ratings. Although advertisers eagerly race to gain the attention of the much sought after 18-49 demographic, critics question the stereotypes that may be reinforced through the television program and the negative sociological effects, the†¦show more content†¦In episode seven of the series, â€Å"Switching Gears,† teen mom Kailyn, is desperate to attain some sort of independence from her baby fathers family and decides to move out on her own. When she makes her announceme nt, Jo the father of her baby, responds with cruel messages filled with vicious and horrid words by way of text message. He states, using many four-letter words, how he regrets having a child with her. The behaviors portrayed in Teen Mom II while horrendous, makes for great television. Martin Kaplan, media professor at the University of Southern California school of Communication, states â€Å"the appeal of these shows is that the producers and casting directors have figured out we have reptile brains, and that there is stuff that we can’t resist because of the species we are.† While the entertainment factor can’t be denied, the stereotypes reinforced by Teen Mom II and the effects it may have on viewers cannot be dismissed. A study done by Margaret J.Hefner and Jamie Comstak titled Compliance Gaining on Prime Time Family Programing states â€Å"individual’s stereotypes, role learning, aggression and world views can be influenced by observing life on tel evision.† Shows like Teen Mom II that are dedicated to featuring the difficulty teens face while raising aShow MoreRelatedEssay on The Phenonmeon of The Teen Mom1110 Words   |  5 PagesTeen Mom II is the second incarnation of MTVs number one rated reality mini-series 16 and Pregnant. The show documents the lives of four teenage mothers as they struggle to cope with the every day challenges, financial and emotional, a woman faces while raising her first infant child. All while trying to navigate through the journey of adolescence. Once catering primarily to the music oriented teenage consumer of the 1980s and 1990s, MTV has since reinvented itself as a reality television repository

Essay Mill on Liberty - 1913 Words

In Chapter 2, Mill turns to the issue of whether people, either through their government or on their own, should be allowed to coerce or limit anyone elses expression of opinion. Mill emphatically says that such actions are illegitimate. Even if only one person held a particular opinion, mankind would not be justified in silencing him. Silencing these opinions, Mill says, is wrong because it robs quot;the human race, posterity as well as the existing generation.quot; In particular, it robs those who disagree with these silenced opinions. Mill then turns to the reasons why humanity is hurt by silencing opinions. His first argument is that the suppressed opinion may be true. He writes that since human beings are not infallible, they†¦show more content†¦Furthermore, the truth of a belief is integral to whether it is desirable for it to be believed. Mill observes that the assumption of infallibility about a certain question implies that one not only feels very sure about a belief, but also includes the attempt to try to decide that question for other people. It is in stifling dissenting opinions in the name of social good that some of the most horrible mistakes in human history have been made. Mill writes about Socrates and Jesus Christ, two illustrious figures in history, who were put to death for blasphemy because their beliefs were radical for their times. Mill then considers whether society should be able to censor an opinion that rejects a common moral belief or the existence of God and a future state. He gives the example of Emperor Marcus Aurelius, a just and kind man who still persecuted Christianity, failing to see its value to society. Mill argues that if one is to accept the legitimacy of punishing irreligious opinions, one must also accept that if one felt, like Marcus Aurelius did, that Christianity was dangerous, o ne would also be justified in punishing Christianity. Third, Mill considers the criticism that truth may be justifiably persecuted, because persecution is something that truth should have to face, and it will always survive. Mill replies that such a sentiment is harshly unfair to those who actually are persecuted for holding true ideas. By discovering something true, these people haveShow MoreRelatedThe Mill s On Liberty Essay2249 Words   |  9 PagesPositive Liberty in Mill’s On Liberty On his well-known work, On Liberty, John Stuart Mill starts by clarifying that the subject of his essay is Civil or Social liberty: â€Å"the nature and limits of the power which can be legitimately exercised by society over the individual,† (Mill, 5). Though some would see this as evidence for Mill’s grasp of liberty as something that is primarily concerned by the absence of constraints, that is negative liberty, Mill also engages in arguments and discussions thatRead More`` On Liberty `` By John Stuart Mill1458 Words   |  6 PagesJohn Stuart Mill was an English philosopher and a progressive in British politics during the 17th century. He lived during a time of political transformation in England caused by the Industrial Revolution. The Industrial Revolution brought social mobility to the middle and lower class, along with more political participation. With this newfound freedom, the people of England felt their liberties were being diminished because they had the a bility to accomplish all the more but in some cases, couldRead MoreCritical Analysis Of Mill On Liberty1074 Words   |  5 Pagesthe conception of liberty is? Liberty had the ability to challenge ideas of the past into new ones. Mill expressed his understanding about liberty in several ways in his essay named, On Liberty. In this paper, I will strongly explain the significance of the quotation, assumptions mills argument depends upon, limitations in the right of free speech, and agreement with Mill’s points of view. Without further ado; let me activate the critical analysis of Mill’s approach regarding liberty. To commence,Read MoreThe On Liberty By John Stuart Mills2164 Words   |  9 Pages ON LIBERTY In John Stuart Mills’ profound work, On Liberty he preaches against the conformity of the nations and outwardly encourages and restlessly defends voice of the individual. The philosopher expresses the importance of individuality by warning against forces such as the government and other citizens silencing their opinion. Though Mill’s gives due recognition to virtues such as free speech, liberty and individualism he also rightly places limitations on our freedoms to ensureRead MoreJohn Stuart Mill s On Liberty1700 Words   |  7 PagesStuart Mill’s â€Å"On Liberty† essay, published in 1859, portrays Mill’s perception of liberty with an emphasis on individuality. He explicitly states at the start of the essay that the main point is to â€Å"govern absolutely the dealings of society with the individual in the way of compulsion and control† (5). His push to establish the basic guidelines for the relationship between authority and liberty is a r esult of his ethical theory of utilitarianism. Throughout the course of this essay, Mill provides theRead MoreIndividualism And Liberty By John Stuart Mill1196 Words   |  5 Pages In the essay, Liberty, written by John Stuart Mill, Mill states that individualism is the theory that â€Å"[o]ver himself, over his own body and mind, the individual is sovereign† (7). Before coming to this conclusion, Mill first explains that individualism and liberty were defined in ways far different from definitions now and that true individualism did not exist until later in history. It takes him several paragraphs and even chapters to finally suggest that a man, by himself, is free to do whatRead MoreThe Value Of Liberty ; Rousseau Vs. Mill1536 Words   |  7 PagesThe Value of Liberty; Rousseau v. Mill The views and conceptions of what liberty is have continued to change over time as society changes. Freedom is defined as the right to do â€Å"act, think, and speak as one wants† without anyone or anything infringing on that right, but there exists types of freedoms or liberties. Fyodor Dostoevsky, Jean-Jacques Rousseau, Stuart Mill, and Thomas Jefferson all give their conceptions of what liberty is and while all of them believe government should not have so muchRead MoreWithin On Liberty By John Stuart Mill1312 Words   |  6 PagesWithin On Liberty by John Stuart Mill, the notion of individuality and one s abilities to make choices for himself contradicts the notion of evolution within Edward O. Wilson’s Consilience. Mill’s beliefs derive from social interaction and experience in which the individual can decide for himself what is right versus what is wrong and can act upon what he believes to be the best option. Whereas, Wilson’s views coincide with the idea that individuals generate decisions based off of historically discoveredRead MoreComparing Rousseau And Mill On Liberty Essay1838 Words   |  8 Pages The term â€Å"civil or social liberties† is one that garners a lot of attention and focus from both Rousseau and Mill, although they tackle the subject from slightly different angles. Rousseau believes that the fundamental problem facing people’s capacity to leave the state of nature and enter a society in which their liberty is protected is the ability to â€Å"find a form of association that defends and protects the person and goods of each associate with all the common force, and by means of which eachRead MoreJohn Stuart Mill on Liberty and Freedom of Expression1388 Words   |  6 PagesInhibition of ones liberty, such as their liberty of conscience (i.e. freedom of speech), is unjust by Millian principles, unless the persons use of deliberation is to voice hate speech. So what is hate speech? Hate spee ch is directed towards a member of a group, or the group as a whole, that vilifies on the basis of the subjects beliefs. In comparison to discriminatory speech, hate speech does not invoke mere offense, but in most cases is traumatic, and severely impair one’s deliberative capacities

Advanced Paramedical Science Free Essays

string(58) " and vomiting are commonly encountered clinical problems\." Nausea and vomiting is a commonly encountered problem in the emergency department as it accompanies a multitude of conditions ranging from seemingly benign conditions such as migraine and gastroenteritis to potentially lethal conditions such pancreatitis and the acute abdomen. Studies from the U.S have shown that each year, almost 8 million individuals present to the emergency department with complain of nausea and vomiting, either as a principal complain or as a part of another disease etiology (Braude, Soliz, Crandall, Hendey, Andrews, Weichenthal, 2006, p. We will write a custom essay sample on Advanced Paramedical Science or any similar topic only for you Order Now 77). Nausea and vomiting are not distinct disease entities. Rather, they are symptoms which can be present in a wide range of disease conditions and are considered to be the ‘end-points’ of several pathological processes (Klosterhalfen and Enck cited in Kowalski, Rapps, Enck, 2006 p.28). The term nausea refers to the subjective feeling or the urge to regurgitate gastric contents (Kuver, Sheffield, McDonald, n.d.). From a physiological point of view, this is associated with reduced gastric motility and increased smooth muscle tone of the small intestine. Moreover, there might also be the presence of reverse peristalsis in the small intestine, which can cause the feeling of imminent regurgitation (Bowen, n.d.). On the other hand, vomiting refers to ‘the forceful discharge of gastric contents’ (Kuver, Sheffield, McDonald, n.d.) which is meant to serve the purpose of protecting the gastrointestinal tract from potentially harmful substances by preventing their entry and transit through the gastrointestinal tract (Kuver, Sheffield, McDonald, n.d.). Vomiting, if persistent can have several potentially hazardous consequences such as dehydration, electrolyte imbalances, metabolic derangements, manifesting as alkalosis and even bleeding and esophageal perforation (Kuver, Sheffield, McDonald, n.d.). Moreover, from the patient’s perspective, nausea and vomiting can be distressful and thus appropriate and timely management of these two conditions is imperative. The Physiology of Nausea and Vomiting – an overview of the stimuli and pathway involved For several decades now, it has been established that the chemoreceptor trigger zone in the brain which is responsible for emesis is the area posterema. This is a region located at the dorsal surface of the medulla oblongata near the caudal end of the fourth ventricle. It is one of the ‘circumventricular organs’ and by the virtue of possessing a relatively permeable blood-brain barrier, is sensitive to a variety of stimuli (Sanger Andrews, 2006, p. 5). Thus, it plays an important role in emesis. Studies have shown that there are five main kinds of stimuli which can trigger nausea and vomiting via different pathways viz. the presence of toxic materials within the gut lumen, presence of toxins in the blood, a pathology within the gut, a central nervous system (CNS) stimulus or disturbances in the vestibular system (Sanger Andrews, 2006, p. 5). The mechanism whereby each of these stimuli brings about nausea and vomiting is discussed below. The presence of toxic materials within the gut lumen: The presence of toxins, such as drugs has been shown to stimulate the enteroendocrine cells, such as the enterochromaffin cells, located in the gut mucosa and result in the release of several mediators such as 5HT3, Substance P and CCK. This results in the stimulation of vagal afferent neurons which are located in the abdomen. These neurons traverse through the nucleus tractus solitarius (NTS) and are projected to the dorsal brainstem, with some projection in to the area posterema (Sanger Andrews, 2006, p. 5). Presence of toxins in the blood Toxins which have been absorbed and are circulating in the bloodstream can directly stimulate the area posterema and cause induction of emesis (Sanger Andrews, 2006, p. 5). This is the most common mechanism whereby ingested or parenterally administered drugs, such as chemotherapeutic agents and other toxins such as drugs of abuse, invoke the emetic response. Gastrointestinal tract pathologies Certain pathologies of the gastrointestinal tract, such as gastritis or hypertrophic pyloric stenosis can stimulate the vagal afferents or directly activate the pathways leading to emesis (Sanger Andrews, 2006, p. 6). Central nervous system (CNS) stimuli Certain stimuli such as intense fear, anticipatory anxiety, injury to the brain or a sudden increase in the intracranial pressure can induce emesis (Sanger Andrews, 2006, p. 6). The mechanism involved in such a response has not yet been elucidated clearly. Disturbances in the vestibular system Amongst other manifestations of disturbances in the vestibular system, such as dizziness, nausea and vomiting is also an important symptom. The vestibular system has been shown to directly stimulate the pathways involved in the emetic response and hence produce nausea and vomiting (Sanger Andrews, 2006, p. 6). All these stimuli have been shown to stimulate various pathways which have one common outcome viz. the stimulation of the emetic center in the area posterema. (Kuver, Sheffield, McDonald, n.d.). Several receptors, both central and peripheral, have been implicated in bringing about emesis. Amongst these the most pertinent ones are Dopaminergic receptors (particularly D2), Histaminergic receptors (especially H1), Muscuranic receptors (including M3/M5), 5-hydroxytryptamine receptors, in particular, 5-HT3 and the neurokinnin receptor, NK1 (Sanger Andrews, 2006, p. 8) Once any of the above mentioned stimuli are encountered, an afferent response as discussed above is generated. This results in the activation of the chemoreceptor trigger zone in the area posterema. Subsequently, a motor response is generated, whereby efferent pathways involving the cranial nerves V, VII, IX and X are activated. Moreover, autonomic responses are also generated (Kuver, Sheffield, McDonald, n.d.). The vagal efferents to various muscle groups such as those located in the esophagus, stomach and the intestine are activated bringing about stimulation of these muscles (Sanger Andrews, 2006, p. 6). Moreover, abdominal muscles, phrenic muscles and the diaphragm are also stimulated to bring about the required increase in the intra-abdominal pressure. The combination of both these effects leads to the regurgitation of the gastric contents. Moreover, this is also accompanied by various other manifestations such as an increase in salivation, brought about by the stimulation of the chorda tympani branch of the facial nerve, autonomic stimulation of the cardiovascular and respiratory systems and vasoconstriction of skin vessels (Sanger Andrews, 2006, p. 6). Antiemetic drugs used in pre-hospital care Nausea and vomiting are commonly encountered clinical problems. You read "Advanced Paramedical Science" in category "Papers" Over the years, several anti-emetic medications have been discovered to effectively alleviate the symptoms of nausea and vomiting. These drugs work by blocking the pathways involved in the initiation and production of emesis. Various drugs have been developed which block the different receptors, both central and peripheral, involved in producing emesis. The anti-emetic medications which are used in common clinical practice can be grouped in to seven major categories according to their mode of action. These include anti-cholinergics, antiserotonins, antihistamines, Benzamides, Butyrophenones, Phenothiazines and steroids (Scuderi, 2003, p. 43). The mechanism of action and the dosages of the four main anti-emetics used in Ambulance Services in Australia are discussed below: 1.  Ã‚  Ã‚  Ã‚  Ã‚   Metoclopramide (Maxolon): Metoclopramide has been used in clinical practice for several decades now as an antiemetic and a prokinetic agent (Walkembach, Bruss, Urban, Barann, 2005, p. 50). These antiemetic functions are thought to be brought about by the antagonistic actions of Metoclopramide on the dopamine (D2) receptors, both central and peripheral, and also on the 5HT3 receptors (Walkembach, Bruss, Urban, Barann, 2005, p. 50). On the other hand, the prokinetic action of Metoclopramide are brought about by the relaxation of the pyloric sphincter, the increase in the strength and frequency of peristalsis and an increase in the tone of the lower esophageal sphincter (Australasia, 2008). This drug is available in both tablet (white, round, 7mm in diameter) and injection (colorless, aqueous solution) forms (Australasia, 2008). The maximum dose of Metoclopramide commonly used in all age groups is up to 0.5 mg/kg body weight. The recommended dosage regimen for adults is 10mg three times daily while for children it varies between 2.5mg-5mg   three times daily (Australasia, 2008). The metabolism of Metoclopramide takes place in the liver and it is eliminated from the body predominantly via the kidney. (Australasia, 2008) 2.  Ã‚  Ã‚  Ã‚  Ã‚   Prochlorperazine (Stemetil) Prochlorperazine is a phenothiazine which has been shown to block the dopamine receptors (D2) in the chemoreceptor trigger zone located near the area posterema. By blockage of these receptors, Prochlorperazine exerts its antiemetic actions. The recommended dosage of Prochlorperazine in is 10 mg intravenously (Goodman and Gilman’s: The Pharmacologic Basis of Therapeutic cited in Ernst, Weiss, Park, Takakuwa, Diercks, 2000, p. 92). In emergency practice, IV administration of 2.5-10 mg of Prochlorperazine at a rate of up to 5mg/min is recommended for adults. The maximum dose should not exceed 40mg per day. Moreover, IM injections of this drug are also available. They are administered at a dose of 5-10 mg every 3-4 hours (Bartlett, 2009, p. 861). 3.  Ã‚  Ã‚  Ã‚  Ã‚   Ondansetron (Zofran) Ondansetron is a carbazole derivative and is a potent antiemetic drug which is widely used in alleviating the symptoms of nausea and vomiting associated with chemo- and radio- therapies and also in the management of post-operative nausea and vomiting (Scuderi, 2003, p. 59). Its proposed mechanism of action is via selective antagonism at the level of the 5 HT3 receptors (Scuderi, 2003, p. 59). Chemotherapeutic agents are thought to bring about nausea and vomiting via the stimulation of enterochromaffin cells in the gut mucosa leading to 5HT3 production and subsequent vagal stimulation. This pathway is blocked by 5HT3 antagonists such as Ondansetron. Ondansetron has been shown to have a short half life of approximately 3 to 5 h (Ho Gan, 2006, p. 607). The recommended dosage of Ondansetron varies between 8-16 mg twice daily (Bartlett, 2009). 4. Promethazine (Phenergan) Promethazine is also a phenothiazine but is shown to have dual modes of action. It not only blocks the dopamine receptors (D2) but has also been shown to have anti-H1 histamine receptor effects. It is used for a wide range of purposes including in the treatment of motion sickness, vertigo and even allergies (Bartlett, 2009, p. 869). The recommended oral dose of Promethazine is 25 mg twice daily. It can also be administered intravenously at a dose of 12.5-25 mg every four hours. The maximum dose is 150 mg/day (Bartlett, 2009, p. 869). PART II There are several clinical conditions which can present with the symptoms of nausea and vomiting. Amongst these the most common condition is gastroenteritis, migraines and pancreatic amongst others. The adequate and timely management of patients with nausea and vomiting has posed a challenge for the clinicians for several decades and although several effective anti-emetics have been discovered, there has been a quest for a single anti-emetic which is efficient, fast acting and relatively safe. In the practice of ambulance services and emergency situations, different anti-emetics are commonly used including Metoclopramide, Chlorpromazine, Ondansetron and Promethazine. Amongst these, in my opinion, the most suitable drug for use in the ambulance service and emergency departments is Metoclopramide. This is because on comparing the onset of action, clinical efficacy and side effect profiles of the most common anti-emetic agents, it is apparent that Prochlorperazine is superior to all other agents used. Moreover, its cost, availability and easy administration make it suitable for use in the emergency practice. Following is a comparison of the four most commonly used anti-emetic drugs. A common concern with the use of any drug is its safety and side effect profile. Safety becomes more important while dealing with patients in the emergency or ambulance care since limited resources, time and personnel are available in such settings, and the prime concern is the stabilization of the patient and alleviation of his symptoms. Drugs which have potentially unsafe need to be administered with caution and the patients need to be monitored for the occurrence of adverse effects. This is not feasible in emergency and ambulance practice and thus the ideal drugs for use in such settings are those which have no or minimal side effects. With Metoclopramide, there is a 10-20% incidence of side effects and these side effects are mild. The most common side effects observed with this drug are CNS effects such as anxiety, restlessness and insomnia which can vary in severity (Australasia, 2008). Moreover, it has also been shown to cause fatigue and occasionally can cause extrapyramidal side effects. Another relatively common side effect of Metoclopramide is gynecomastia which occurs as a result of enhanced prolactin secretion (Kuver, Sheffield, McDonald, n.d.). A rare complication associated with the use of Metoclopramide is Neuroleptic Malignant Syndrome which is a medical emergency and can lead to death. However, it is observed in only less than 1 in 10,000 cases (Australasia, 2008) . On the other hand, the phenothiazines including Prochlorperazine and Promethazine have been shown to have a greater number of side effects. Amongst these the ones which arouse the most concern are extrapyramidal symptoms. Extrapyramidal symptoms can range from tremor to akathisia and the potentially hazardous tardive dyskinesias (Australia, 2009). Moreover, they can also manifest as dystonic reactions are similar to the manifestations of Parkinson’s disease. Less commonly, Neuroleptic Malignant Syndrome, which is a medical emergency, can also result from the use of these drugs. These effects are thought to be caused due to the central antidopaminergic properties of the phenothiazines on the dopamine receptors. The occurrence of these symptoms is noticed most commonly within 36 hours of initiation of treatment. However, these symptoms are reversible and once the drug is discontinued, they disappear within 24 hrs (Australasia, 2008). It is important to note that with Metoclopramide, the occurrence of extrapyramidal side effects is not very common. On the other hand, the phenothiozones such as Prochlorperazine and Promethazine have a much greater incidence of these side effects. Drotts and Vinson (1999) in their study showed that with the use of Prochlorperazine, incidence of akathisia was 44% within 1 hour and 5% within 48 hours. (Braude, Soliz, Crandall, Hendey, Andrews, Weichenthal, 2006, p. 181). Other studies, such as those of Ernst et. al., have supported these findings. These extrapyramidal symptoms, if severe, have to be treated with intravenous infusions of an anti-cholinergic agent such as diphenhydramine (Ernst, Weiss, Park, Takakuwa, Diercks, 2000, p. 92). Other common side effects of phenothiazines include constipation, blurred vision, mild elevation of the hepatic enzymes (if the patient develops cholestatic jaundice), ECG changes, arrhythmias and hypotension (Australia, 2009). Hypotension in patients who are already dehydrated due to vomiting can lead to significant patient distress and is also important from the point of view of health care professionals, as it poses difficulties in patient management in emergency and ambulance settings. Moreover, most phenothiazines, in particular Promethazine are known to cause sedation due to histamine blockade. Promethazine has also been shown to reduce the seizure threshold. Due to the multitude of serious adverse effects of Promethazine the Food and Drug Administration (FDA) has restricted its use in children under two years of age (DeCamp, Byerley, Doshi, Steiner, 2008, p. 859). As compared to Metoclopramide, Ondansetron has relatively lesser side effects. The most commonly encountered adverse effects of this agent include headaches, constipation and mild elevation of serum transaminases (Kuver, Sheffield, McDonald, n.d.). But this drug is not preferred over other anti-emetic agents due to its cost and availability issues (Ernst, Weiss, Park, Takakuwa, Diercks, 2000, p. 92). Moreover, it is used more commonly to prevent post-operative nausea and vomiting and in patients receiving chemotherapy and its role in acute settings has not been extensively studied. Pregnancy is one of the most common conditions which present with nausea and vomiting.   Amongst the commonly available anti-emetics only a few are safe to use in pregnancy. Studies have shown Metoclopramide to be safe for use during pregnancy and this drug has not been shown to cause any long term complications in children of mothers using it during pregnancy (Sà ¸rensen, Nielsen, Christensen, Tage-jensen, Ekbom, Baron, 2000). Similarly the safety of Ondansetron has also been proven by several studies conducted recently (Einarson, Maltepe, Navioz, Kennedy, Kennedy, Koren, 2004, p. 940). However, both Promethazine and Prochlorperazine belong to Category C and thus   have limited use in pregnancy (Australia, 2009). Another advantage of Metoclopramide is its ability to provide faster relief from the symptoms of nausea and vomiting. Metoclopramide has been shown to have a rapid onset of action. Following IV administration, its effects start manifesting in around 1 to 3 minutes, whereas following intramuscular administration, 10 to 15 minutes is required (Australasia, 2008). This rapid action makes it suitable for use in emergency practice, Although there is a paucity of studies comparing the cost effectiveness of Metoclopramide with other antiemetics, studies comparing the cost-effectives in patients undergoing chemotherapy have shown that Metoclopramide to be more cost effective than Ondansetron (Ballatori, et al., 1994). Thus, in conclusion, keeping the side effect profiles, the availability and cost effectiveness of all the anti-emetics in view, in my point of view Metoclopramide is best suited for use in ambulatory settings. Metoclopramide has several benefits over other anti-emetics. It has a fast onset of action which makes its practical for use in emergency settings. Moreover, it has lesser and milder adverse effects as compared to other anti-emetics. In addition, it can be used in all age groups and is safe in pregnancy. Thus, all these properties make Metoclopramide ideal for use in ambulatory care settings. References Australasia, V. P. (2008, October 22). Metoclopramide hydrochloride-Data sheet. Retrieved May 1, 2009, from Medsafe-INFORMATION FOR HEALTH PROFESSIONALS: http://www.medsafe.govt.nz/Profs/datasheet/m/Maxolontabsyrinjsupp.htm Australia, S.-A. (2009). Sanofi-Aventis Australia. Retrieved May 1, 2009, from Product Information: http://www.sanofi-aventis.com.au/products/aus_pi_phenergan.pdf Ballatori, E., Roila, F., Berto, P., De Angelis, V., Neri, C., Olivieri, A., et al. (1994). Cost and cost-effectiveness analysis of ondansetron versus metoclopramide regimens: a hospital perspective from Italy. Pharmacoeconomics , 227-37. Bartlett, J. . (2009). 2009 Nurse’s Drug Handbook . Jones Bartlett . Bowen, R. (n.d.). Physiology of Vomiting. Retrieved May 1, 2009, from The Stomach: http://www.vivo.colostate.edu/hbooks/pathphys/digestion/stomach/vomiting.html Braude, D., Soliz, T., Crandall, C., Hendey, G., Andrews, J., Weichenthal, L. (2006). Antiemetics in the ED: a randomized controlled trial comparing 3 common agents. American Journal of Emergency Medicine , 177–182. DeCamp, L. R., Byerley, J. S., Doshi, N., Steiner, M. J. (2008). Use of Antiemetic Agents in Acute Gastroenteritis:A Systematic Review and Meta-analysis. Archives of pediatric and adolescnet medicine , 858-865. Drotts, D. L., Vinson, D. R. (1999). Prochlorperazine Induces Akathisia in Emergency Patients. Annals of Emergency Medicine . Einarson, A., Maltepe, C., Navioz, Y., Kennedy, D., Kennedy, D., Koren, G. (2004). The safety of ondansetron for nausea and vomiting of pregnancy:a prospective comparative study. BJOG: an International Journal of Obstetrics and Gynaecology , 940–943. Ernst, A. A., Weiss, S. J., Park, S., Takakuwa, K. M., Diercks, D. B. (2000). Prochlorperazine Versus Promethazine for Uncomplicated Nausea and Vomiting in the Emergency Department: A Randomized,Double-Blind Clinical Trial. Annals ofEmergency Medicine , 89-94. Ho, K.-Y., Gan, T. J. (2006). Pharmacology, pharmacogenetics, and clinical efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting. Current Opinion in Anaesthesiology , 606–611. How to cite Advanced Paramedical Science, Papers

Public Health free essay sample

Well being in terms of health status is one of the basic needs of humans. The well being ad health of citizens is a clause that is embedded in the constitution and the state and federal governments are charge with that responsibility. It is crucial to comprehend the functions of the public health which have been assigned to the grassroots public health departments. Assessment Assessment in public health entails collecting of data, analyzing it and finally disseminating the health information. Assessment is instrumental in pinpointing the environmental, physical and mental issues concerning health. Information is gathered during assessment. One of the agencies charged with the responsibility of conducting assessment includes Center for Disease Control and Prevention. Assessment is done to ensure that health practices are proper in the hospitals country wide. There are various practices and processes which are expected in the assessments exercises. Some of the information collected during assessment includes the health well being of various societies in the country. We will write a custom essay sample on Public Health or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Therefore, various health problems, their causes and probable measures data are collected. There is also investigation of the health problems and dangers which the community is exposed and the diagnosis measures. Other miscellaneous parts of the assessment include investigation of the prevailing environmental conditions and the waste handling and management. Sanitation is also taken into consideration the assessment is subjective when it comes to health parameters ‘health. After the information is gathered, it is used to address the societies’ needs as far as public health is concerned. Numerous indicators of health are analyzed. Prevalence of common sicknesses and control measures are also established (Chin, 2000). Policies There are policies which have necessitated the availability of surveillance systems to address any form of danger to public with urgency and speed. Policies and laws in the pubic heath are important. Preventive and monitoring measures have been put in for both communicable and non communicable diseases. Health promotions are conducted to ensure that public environment is conserved by ensuring the wastes products are disposed in a manner that will not affect the public health. Goals of various different health centers have been realized effectively due to public regulations. Therefore, policies are formulated in order to oversee the realization of goals and objectives of public health. For provision of better services to general public, laws and regulations should be formulated in order to address the major issues of concern the public health sector (Eastman, 2000). Assurance Numerous health promotions are conducted for better public health. Some of these promotions include medical checkups which are free of charge and monitoring of citizens to maintain and ensure stability of their health. Quality is securitized through constant monitoring of the health facilities in the country to ensure that health service are rendered in a professional and competent manner. Drugs and health equipments are tested to ensure that they do not pose health hazards to the patients. Ways have been devised to investigate the probable hazard such as physical and mental hazards. Some of these ways includes the technical epidemiology. Health care plan has achieved its objectives by offering education to the public and giving them proper methods on how to acquire proper heath care by improving their living standards (Gostin, 2000). Conclusion Assessment in public health entails collecting of data, analyzing it and finally disseminating the health information.