Quackery Treatments for Hypertension

Last year, I started experiencing dizziness and severe headaches. Upon consultation with my physician, my blood pressure was 210130, a sign of severe hypertension. Lab tests showed elevated blood cholesterol and sodium levels. I was prescribed antihypertensive, diuretic and lipid reducing drugs. I was also advised to adopt a low fat, low sodium diet. After a few months of taking these drugs, my blood pressure remained at 140100. I decided to explore other treatments in the hope of further reducing my blood pressure. Inquiries at a health food store and searching the internet revealed the following products widely regarded as alternatives to synthetic drugs in the management of hypertension.
Garlic (Allium sativum)
   
At a natural food store, garlic was the most recommended product for hypertension and came in various forms  roasted chopped garlic, pickled garlic, garlic oil, garlic powder, aged extract and fresh, organic garlic. The owner stated that all products can reduce blood pressure and cholesterol levels. Garlic is also believed to be an antioxidant and has a thinning effect on the blood to prevent clot formation and heart disease. It is further recommended for persons with diabetes or cancer. Additionally, garlic also has bactericidal effects and can boost the immune system. As such, it is used to treat infections such as cough and gastroenteritis. Finally, it can be used as remedy for inflammation, impotence, acne, tooth aches and wounds.
For hypertension, the store owner strongly suggested raw organic garlic as this has a higher potency in blood pressure reduction. He mentioned allicin as the main anti-hypertensive component of garlic although he had no idea about the amount of allicin per clove of garlic much less according to size and variety.

The maintenance dose was 2-3 crushed or minced cloves of garlic a day to be eaten. However, I was advised to take the same dose immediately if I were to start feeling the symptoms of severe hypertension. It was not stressed that blood pressure needs to be measured to diagnose symptoms as those of severe hypertension or that hypertension often does not present with any sign or symptom until complications occur. Because it is a natural remedy and had been used for its medicinal properties since ancient times, it was assumed to be safe even without physician supervision. This meant that I would not have to worry about drug interactions, contraindications or side effects. In terms of cost, a pound or 37 cloves of fresh organic Brown Tempest garlic costs 19.95 and amounts to 146 if used for 3 months at 3 cloves a day.

Hawthorn (Crataegus oxyacantha)  
Another herb claimed to lower blood pressure is the hawthorn and its leaf, flower and berry extracts are processed into capsule form. A particular brand is Natures Way Hawthorn Berry that comes in 510mg doses divided into 300mg standard extract and 200mg of berry. The recommended daily dose is 3 capsules thrice daily with food. The active ingredient is 1.8 - 2.2 vitexin, a flavonoid. Product information on the Hawthorn Berry label is limited to recommended dosage, supplement facts and its general indication as cardiovascular tonic and for achieving wellness. There was no mention of contraindications, drug interactions, safety information, money back guarantee or the need to consult a health care provider prior to use.

Information in websites promoting and selling hawthorn supplements reveal that it is can be used to treat other cardiovascular disorders besides hypertension and includes angina pectoris, high blood cholesterol, arterial diseases, heart arrhythmias and weakness of heart muscles. The specific health benefit for hypertensive persons is derived from the herbs capacity to inhibit the angiotensin converting enzyme and relax blood vessels. The effect is supposedly a mild decrease in blood pressure after a few weeks of use. Considering costs, a 100-capsule bottle is worth 8.49. For 3 months of continuous use, this will amount to 69. 

Biofeedback
    Advocates of biofeedback refer to this as a therapy where hypertensive patients learn to control internal mechanisms that regulate blood pressure. It is assumed that stress contributes significantly to or aggravates hypertension and the ability to will ones body to completely relax will eventually decrease high blood pressure. Machines measure muscle tension, brain waves or temperature through electrodes attached to specific sites on the body. Changes in these measurements in the course of practicing relaxation techniques serve as feedback for the effectiveness of efforts to relax. Besides hypertension, biofeedback is also a suggested treatment for 18 other illnesses including diabetes, depression, asthma, chronic pain and epilepsy according to the website consulted. There are no contraindications for this treatment and is considered safe and effective when provided by a qualified practitioner. One session per week is recommended and takes about an hour. Optimum effects are observed after 20 weeks. Each session costs an average of 60 so that 20 weeks will cost 1,200.
   
The range of alternative treatments for hypertension encountered includes plant products, supplements and relaxation techniques. Since hypertension is a major risk factor to heart disease and may lead to fatal complications, self medication is not advisable considering that many of these treatments are falsely promoted as effective when such claims are not strongly or consistently supported by scientific evidence. As such, the products are marketed with incomplete product information and appear as cure-alls without regard for severity, possible causes or existing comorbidities. While these treatments may be promising and are the focus of further studies, their utilization should complement the more established pharmacologic therapies under the supervision of a physician. More importantly, it should be in conjunction with appropriate lifestyle changes.

Selected Disease Breast Cancer

Breast cancer is the uninhibited development of a malignant tumor in the breast. Prospectively, the growth of these abnormally changing breast cells is dangerous to the patient because they are cancerous and may spread to other parts of the body. It can be otherwise described as the faulty printing or replication of new genes as they continue divide and grow into new cells. To confirm its alarming incidence, 1 in 8 (about 13) women in the United States suffer from breast cancer according to breastcancer.org.
   
Furthermore, breastcancer.org reveals that accurately, 1 in 8 women in the U.S. who reach the age of 80 can expect to develop breast cancer. This is to say that generally, breast cancer is more common among women than in men. Although risk factors should be considered, the onset of the disease varies from one individual to another as each has its own personal history, familial or racial background, reproductive history, lifestyle practices, environmental conditions, and other concerns.
   
As to its signs and symptoms, it may include typical lumps or cysts, breast changes and discharges, infections, swellings, pain, unexplained weight loss and skin changes. Lumps or lymph nodes in the axillary region may also indicate breast cancer.
Regular self-breast examination is recommended because the earlier that the disease is detected, the better the chances of overcoming it. The woman may feel lumps or any irregular growths in the area.
   
There are also clinical breast exams to screen, diagnose and monitor breast cancer. To detect, the earliest way is through mammogram, advisable yearly especially for active women. There is also breast magnetic resonance imaging (MRI), biopsy and fine needle aspiration cytology for diagnosis. For treatment, there are required surgeries, drug therapy, chemotherapy, and radiation therapy among others.

Part II Short Talk
Opening Remarks Good morning God is goodall the time. Life is beautiful. In all the challenges that God gives us, we can always learn from them in the right places at the right time. I am here today to discuss one of the most dreaded health ailments in the world today, BREAST CANCER.

Outline of Talk
Definition of Cancer                VI. Causes
Incidence and Prevalence            VII. Diagnosis
Classification                    VIII. Screening
Signs and Symptoms                IX. Treatment
Risks and Risk Factors            X. Prognosis

Materials to be used Pamphlets and posters with photos containing information about breast cancer will be useful. These shall be printed. Then videos on patient-conduct screening will be borrowed or rented from doctor-friends, depending upon availability. Mannequin can be rented or borrowed from medical clinics, if allowed.
There will one practice session.

Areas of Responsibility for Healthcare Educators

Knowledge is power. This famous line greatly exemplifies the important role of information dissemination in the lives of individuals, especially when it comes to empowering them to make a wise decision and right action. The aforementioned adage is greatly applicable in the field of healthcare education wherein health professionals have the responsibility in informing the general public about the different diseases that threatens their health and well-being as well as the corresponding prevention and cure that are necessary in order to address these illnesses. However, the task of information dissemination is not an easy thing to do, especially in educating the illiterate part of the population. An individual with no formal education will find it difficult to understand the explanation of healthcare professionals about diseases or wrong practices that they should avoid in order to take care of their health. Being the case, the help of the mass media has an essential part in order for healthcare educators to properly send their message to the general public. The use of advertisements like posters, articles, videos, and other materials substantially help in informing the public of how to properly take care of themselves.
   
In relation to this, drug abuse is one of the most pressing healthcare threats that result to many other adverse consequences in the well-being of individuals. The people who are getting addicted to drugs do not only involve the adult population of the society but it is also affecting the ways of life of adolescents. Being the case, it is essential that drugs abuse should be properly addressed and one of the ways is through the creation of advertisements. A certain poster that advocates fighting drug abuse, which could be seen in this website. 

The poster that I have chosen talks about addressing the problem of drug addiction among the youth. This is a 51 x 43 cm. print advertisement is set in a white background that has black text. The poster also contains the color photos of seven students who are playing the cello, singing the gospel, playing tennis together with a kid, photographing, reading, and watching the stars (United States Department of Health and Human Services, 1992).

The first thing that caught my eye in this poster is the statement line that says we have better things to do than drugs. This statement is written in big, bold and all capital letters. I became interested in the poster because it explicitly and directly send the main message that it wants to impart to the people that will see the poster and that is to stop and not engage in drugs abuse. In relation to this, the use vibrant colors as well as the inclusion of photos of young adults that are doing various activities also made the poster more attractive to the people who will see it. If the poster is randomly posted on the streets, passersby would take notice of it because its colors and design made it catchy to the eye.

The United States Department of Health and Human Services (DHHS) is the one responsible in producing and publishing the poster. The main message that the organization wants to impart is that people should stop and even prevent being addicted to drugs because there are still other productive activities that people could do. In line with this, the photos of the young adults in the poster also presented the idea that the main target of the print advertisements is young adults. DHHS wants the adolescents in America to realize that drug addiction is not their only option because there are different activities that they could engage in, which is worth more of their time and effort.

The strategy that is applied by the DHHS in their advocacy of fighting drug abuse is in the form of information dissemination. The organization used print advertisement because it is one of the most effective ways that will get the attention of the young adults of the population. DHHS wants to convince teenagers that they should not waste their youth because there are many opportunities that are in store for them, which will help them hone their skills and develop themselves into better individuals.

The poster has the main objective of informing young adults that there are more productive things to do than engaging in drug abuse. The use of print advertisement by the DHHS is effective in capturing the attention of young adults, especially since it incorporates in the poster the necessary factors that would make teenagers take notice of the poster, specifically the use of color, photos, and a strong statement. Nevertheless, there are still some improvements that the DHHS and other health organizations could do. Young adults nowadays are more receptive to videos and networking sites in the Internet. Being the case, it s more advantageous and effective for that these health organizations use this form of information dissemination because more young adults would be informed about the harsh effects of drug abuse through these methods.

The poster made by the DHHS is under the education and information part of the four major health promotion settings. The main purpose of the poster is to inform young adults of the other productive activities that they could do with their lives instead of using drugs. In this sense, the poster indeed has the function of education and information. Furthermore, this print advertisement also aims to convince young adults to broaden their horizons because they have a lot of potential, which they could use for their self-development rather than easting it on abusive habits like drug addiction, which would not do them any good in life.

Edutainment and Sexual Health

Edutainment refers to the use of performing arts to educate people so that they can change their behaviors. The concept of edutainment combines entertainment and education to improve the lives of people through change of behavior (Scanlon  Buckingham, 2003). Edutainment involves working with the society, other organizations, government bodies and other stakeholders to initiate behavioral change in the society. The message content of articles of art is not enough to make change to the people who receive it. There are professional requirements that have been placed to ensure that people make the appropriate change after receiving messages from the art works. Government must work with the theatre performers to initiate change in the society. In the developing countries, governments have failed to cooperate due to the rigid bureaucracy that restricts many art performers. Some edutainment programs being used to educate about sexual health and particularly to combat HIVAIDS are music, puppetry and theatre, drama, theatre and peer-to-peer education (Macdonald, 1998).

Music as a program being used to promote Sexual Health Exchange involves developing songs which focus on educating people about their sexual behavior and informing them on preventive measures to reduce the spread of HIVAids disease (Stanton, 2004). The program uses music to pass HIVAids prevention messages to people. For example, Africa Alive is an organization that is promoting behavior change among people so as to combat the spread of HIV Aids in Africa through traditional and modern music (Scanlon  Buckingham, 2003).

Edutainment as a strategy for health education can be effective. Many people like music and they are willing to listen to the message contained in it. The youths, who are mostly affected by HIVAids, are eager to listen to music. Music can reach people at all levels of age, gender, race, or any other social grouping. Music can be fabricated to send messages to some people in the society. People find it fun to listen to music. Other people listen to music due to curiosity while others use it as a leisure tool. Musicians are popular and many people like seeing or listening to them. Sexual health messages can be passed on to the target group of people more easily through the use of music. All classes of people listen to music and no person can be left out in the campaign against some sexual health behaviors in the society (Macdonald, 1998).

Edutainment can also be used on other Healthy People 2010 leading health indicators. Some of these indicators are advocacy for the rights of women and gender equality. In addition, it can be used to empower economic, health and political issues affecting people all over the world. Edutainment can be used in a wide variety of ways to educate people on leadership and personality development. Empowering women through literacy programmes and vocational training can be some of the aspects that edutainment can be of great benefit to the society (Stanton, 2004).

Edutainment is an effective method of educating people about the best sexual behaviors. It combines entertainment and education to deliver messages of behavioral habits which are healthy. People like being entertained and will acquire some messages from edutainment programs. The government ought to support edutainment programs so as to reduce some unhealthy sexual behaviors that people continue to practice either because of ignorance or lack of adequate knowledge. Edutainment can be used on a number of ways to educate people about social aspects that affect them.

Access to Care

Among the most pressing needs for the health care system in the United States is the provision of quality health care to all with the aim of improving quality of life as well as life expectancy. With these in mind, the Healthy People 2010 aims at improving four major components of healthcare each serving to better the health needs of the United States citizens. These include clinical preventive care which aims at taking preventive actions as well as recognizing risks for certain health conditions in a stage that is early enough to enable successful treatment or prevention. Diseases that are best suited here are sexually transmitted diseases and cancers primary care which deals aims at ensuring that every one is able to access a usual health care provider more so the minorities who have been poorly represented in the past emergency services to act as stabilizers in cases of severe illnesses so as to give time for provision of comprehensive care and long-term care and rehabilitative services for persons who need rehabilitation and self-care services such as the aged or physically and mentally ill persons.

Some facts on access to care
    For one to have the most accurate measure on how access to care has been specifically in the four areas, health insurance cover best suits this. The number of persons with health insurance has been increasing from the 1990s with more uninsured persons standing at 44.3 million persons in 1997. Preventive care services have been largely ignored by the health insurance companies. Even those who are insured, affordability and accessibility is not guaranteed by the insurers. Quality of health care has been an issue with a 1999 report on the same indicating errors in provision of care (Healthy People 2010, 2001).
   
A broad section of the society has experienced challenges in accessing care as due to lack of the services and finances to facilitate the same among other reasons. Disabled persons are particularly affected due to physical accessibility and attitudes of health care providers. Primary care access to the Hispanics as well as the young adults is also as poor as in uninsured persons. As of 1998, the Mexican Americans were the most uninsured persons. Poverty is also a major reason for lack of insurance. Belonging to a certain ethnic group is therefore a factor that determines access to care. According to 1997 National Health Interview Survey for instance, while 87 of Whites had access to care, only 61 of Mexican had access to health care (Healthy People 2010, 2001). Persons with persistent conditions like diabetes also face the challenge of being covered by insurance companies.
   
Even with the above challenges in access to health care, Health People 2010 is still conscious of its responsibility for a healthy America and for that reason, it seeks to ensure that health insurance coverage reaches 100 percent i.e. total coverage across ethnic groups, states and age sets. It is also the objective of Healthy People 2010 to increase the number of health care professionals across all sectors of health care more so in groups of population that have under-representation. This is to be achieved by increasing educational facilities and access to the same among the minorities.
   
In conclusion, non profit organizations have a very crucial role in ensuring comprehensive access to care. The American Holistic Medical Association (AHMA) (www.holisticmedicine.org) is for instance aimed at ensuring that the whole person i.e. mind, body and spirit is catered for to ensure healthy lives which is in tandem with the goals of Healthy People 2010.

Substance Abuse

Substance abuse in the United States society is a major health and social problem contributing to about a hundred thousand deaths every year. The problem associated with substance abuse cost the United States economy billions of dollars due to the extra burden in the health care system. A survey carried out in 1992 indicate that over 82 million of Americans have taken at least 12 drinks over the period of one with 46 of these drinkers having reached intoxication level at least in one incidence and 4 weekly. Almost 10 of drinkers in America have been reported to be dependent on alcohol while 7 are alcohol abusers. There are increased cases of drinking among the adolescence increasing the possibility of alcohol dependence at later stages. Although moderate drinking may be beneficial to the elderly, heavy drinking is associated with heath complications such as hypertension, arrhythmias, stroke, cardiomyopaty and cancers. Heavy drinking is also the major cause of liver complication such as cirrhosis. It is also associated with increased risk of accidents, criminal activities and immoral behaviors (Healthy people 2010, 2001).
   
In 1995, it was estimated that there were about 4.4 million people who were addicted to hard drugs with about 3.6 million being cocaine addicts and about eight hundred thousand abusing heron. The disorder associated with these drugs is far reaching where the user engage in crime and other self destructive activities. The use of these drugs especially among the young people is associated with criminal activities, risky behaviors which may result into injuries and reduced productivity. They are also associated with the increased transmission of HIVAIDS, heart diseases, memory deficits and depression. Dependence on tobacco and other substances has also been reported to be responsible for several cancers which were thought to be unrelated (Healthy people 2010, 2001). 
   
Drug abuse affects the whole population with the young adults and youth being most affected. Statistics indicate that whites and Hispanics abuse alcohol and illicit drugs more than African Americans while the African Americans abuse tobacco more than other races. Men are more likely to abuse drug when compared to women. Increased substance abuse among the adolescence especially drinking is attributed to their peer influence in schools and residential area, media influence and availability of illicit drugs among them. Individuals with families with history of drug dependence are at an increased risk of drug addiction incase they start using them. Moreover frequent drinkers have a higher risk of dependence compared to occasional drinkers.
   
To deal with this problem health people 2010 came up with several objectives. The primary purpose of these objectives was reduction of substance abuse especially among the young in order to safeguard their health and safety. These objectives include reducing negative effects of substance abuse such as motor vehicle carnage, substance abuse related crimes and deaths. Another objective is rehabilitation of substance abuser by providing treatment to illicit drug users, those who are alcoholic and in correctional facilities (Healthy people 2010, 2001).

The United Nation Office on Drug and Crime is an international agency which works together with other organizations and agencies in different parts of the world in dealing with substance use and crime. With the help of NGOs and civil society communities in different countries UNODC is able to achieve its mandate all over the world (UNODC, 2010).

Obtaining Drugs from Canada

Over the past two to three American regimes, American health debates has been heating up in the recent past. A huge part of that debate in Washington now is whether the prescription drug prices in America will be lowered substantially or whether the potent pharmaceutical industry will go on with charging the Americans the worlds highest prices for their medicines. It has become quite exorbitant that the country is almost crippled by declaring most Americans bankrupt. This was however rescued by the overwhelmingly bipartisan majorities in both houses, when the senate voted to add some voice to the agriculture bill which allowed both the pharmacists and the wholesalers to import prescription drugs from outside countries at a significantly lower prices as long as they meet the Food and Drugs Administration safety standards.
   
Among the leading countries that Americans have a tendency of importing considerably cheap prescription drugs from include Canada. Canadian medicine are said to be significantly cheap compared to the American prices. As (Kaiser 2009) writes After investigating several Canadian pharmacies, my wife and I paid 624.77 for a three-month supply of drugs at an online Vancouver registered pharmacy. These same drugs cost us 1,208.04 buying at Walgreens, Target, and Kmart where we shopped for the lowest prices. This meant that they saved at least 624.77 inclusive of shipping expenses. The importation of prescription drugs from Canada can save from 25-80  of dollars compared to purchasing similar prescriptions in America.

Benefits of importation of drugs from Canada to individual Nurses
The importations of prescription drugs from Canada is of great importance to individual nurses since it aids in ensuring that the patients under their care are able to access all their medications on time at an unlimited supply. This is vital since that individual nurse is usually held responsible incase the patient doesnt get all the medical attention that they require while under their care. These importations also spare individual nurses the task of telling their patients that the only medicine that can help improve their health is not affordable to them in their own countries though manufactured there.

Benefits of importation of drugs from Canada to the nursing profession   
Importation of drugs from Canada has also positive and negative impacts to the nursing profession. One of them is that according to the Food and Drugs Association, the Canadian Drugs are safe. This is because the rules and regulations in Canada are very strict as those in America and so far there are no statistics indicating any loss of life that has resulted from taking prescription drugs from Canada. This is rather important to the nursing profession because it ensures that all the patients are able to access healthy and affordable drug supply. (Adams 2004)
   
It is also important since it maintains a steady supply of drugs in both the government and private hospitals at reasonable prices. It also makes available rare medicines for deadly diseases for instance, One of the starkest examples was Tamoxifen, a widely prescribed breast cancer drug, which sells for one-10th the price in Canada it sells for in the United States. But it is not just Canada. While Americans pay 1 for a prescription drug, that same drug is sold in the United Kingdom for 65 cents, France for 57 cents, and Italy for 51 cents, even though many of these drugs are manufactured right here in the United States. (Sanders 2000) This simply means that hospitals can be able to access such drugs affordably for their patients.
Benefits of importation of drugs from Canada to the societys health
   
The American society are the most affected group of people affected by the importation prescription drugs from Canadian that, many people in America are paying too much money for their prescription drugs and therefore the people opt to take a road trip to Canada or by the dugs online since the drugs in Canada on average costs one-third as much as they cost in the U.S. there is an palpable opportunity slash costs and perhaps save lives.

There is also the argument that importation is free trade. This is because it is unavoidable and posses beneficial outcome to globalization and technology. In addition to that, most of the drug companies are seen to be evil by the Americans. (Bast 2004) This is evident by the rate that they are growing. They exploit taxpayers investments through medical research and they spend more on marketing. On the other hand, importation of drugs from Canada can have dire consequences to the Society. For instance, not all drugs in Canada come from Canada. Some of the drugs come from second and third world countries which have less protection laws than the ones in USA and Canada. Another limitation to the importation of drugs to the society is that the drug supply in Canada is not enough to satisfy the U.S demand. Furthermore, not all the Canadian pharmacists are approved by the FDA. This therefore makes it possible for counterfeit drugs to fall in the hands of unsuspecting Americans. (Partnership for Safe Medicines 2008)

In conclusion, in order for the nursing medical field and the society at large to benefit from the imported drugs from Canada, there must be an introduction of tighter regulations on the safety of these drugs. Moreover, the Federal Government needs to come up with ways of controlling these prices and make these prescription medicines more affordable and available for the majority of the people.

Program Planning

The intervention level will focus on Community Mobilization and Public Health Awareness Programs to reduce youth tobacco smoking in United States. Combined and coordinated community levels of action have proved to be successful in reducing access to tobacco and stoppage to smoking. The community-based interventions mentioned by CDC (2007) involve initial awareness on prevention on initiation of tobacco among the young people through school based programs, increasing the price on narcotics, anti tobacco campaigns creating non-smoking zones to protect against secondary smoke and creating attitudes and behavior norms that will lead to change.

Mobilization of venders to restrict access to tobacco by the youth and under aged would reduce cases of tobacco among the youth considering denied access is as good stopping the desire over time. Public health institutions should also form a strong approach in public awareness in reducing the usage of tobacco by displaying and educating about the diseases caused by continuous use of tobacco and the adverse health effects like cancer, heart disease and respiratory complications that eventually lead to death due to poor diets.

In as much as the cessation program focusing on the individual is important, it is critical for the public to be involved in reducing the tobacco intake by social collective responsibility because a unified approach provides a greater effect. These efforts have proved successful as compared to group or individual therapy. Individual therapy is effective as well and would go side by side with the community mobilization. But government funding and public policy and laws should regulate the manufacturer and seller of tobacco. Government budgets should be allocated to public intervention programs that deal communities and the anti-tobacco campaigns. Massive education at grassroots is important if the war on youth tobacco usage will be stopped.

Community health promotion by preventing tobacco use.

To prevent the youth from starting to use tobacco, to encourage and help users of tobacco to stop using it, to eliminate and identify disparities arising from tobacco use  and to lower involuntary secondary smoke exposure.

What risk factors did the program address
The risk factors addressed by the program included poor nutrition, smoking, inadequate physical activity, noncompliance to policies and predisposing environmental factors.

How was the program implemented
For effective implementation, the program was divided into different functions each of which was headed by a committee. These committees worked in conjunction with the corresponding local agencies and this helped to minimize expenses, staff and efforts.

What do the health educators mean when they say the program is multilevel
It means that the design of the program incorporated different levels of people. Other than the target group, there were other three levels. The first level comprised of school children, university students, worksite employees and clients of local health department and minority groups
(Bajracharya,  Bowler, 2004). Second level comprised friends and relatives of the target groups and the third level comprised of counselors, school teachers and youth advocacy program coordinator.

What do these health educators recommend for successful implementation
They recommend that first the program organizers should try to win the confidence of communities in which they seek to implement the program in. This ensures the communitys good will and it goes a long way in making the program to be accepted by those communities it is intervening for. Any sort of program rejection or objection by those it targets can result into unforeseen hurdles hence causing project failure and a loss of resources. The programmer should also include everyone in the program and should involve community programs in the society that could be interested. This makes every one feel as if they own the program and it is an important factor in program success. Another important thing is to allocate tasks based on a members area of expertise or interest, this ensures that every one contributes constructively to the program. And above all, each members contribution should be recognized and their successes celebrated to maintain enthusiasm and active participation.

In terms of the 7 Areas of Responsibility for Health Educators, what was the health educators role in this program Please specify which areas apply, and comment briefly to say why you think so.
Responsibility to implement strategies, programs and interventions for health education. This is shown by hiring of a full time health educator to coordinate health education programs (National Commission for Health Education Credentialising, Inc. (2006). The other area is responsibility to plan programs, interventions and strategies for health education. This is illustrated by the development of an anti smoking television advert by Youth Advocacy Program coordinator who worked alongside health education coordinator. The above roles were designed to make this program a success. Often, programs and projects which fail to spell out duties and roles of various stakeholders end up failing.

The selected program, Smoking Cessation Program was implemented as planned by the strategists and planners. Several strategies and methods were deployed and implemented to ensure that the goals and objectives of the program would be achieved. Some of the strategies designed to ensure maximum achievement of the programs goals include the adoption of different types of sessions to be conducted in the course of the program implementation deploying volunteers trained in psychology and health offering the programs sessions to groups of prospective participants and providing incentives to those with progress and improvement in attendance (Moadel, A.  Lukoschek2009).

The program is comprehensive enough considering the nature and scope for a health program. By far, all tasks vital to the design, implementation and monitoring of the program are established. The parameters for monitoring the program are also in place (McKenzie et.al.,2004).

The program has already been implemented, the results having been reflected in the introductory part. The strategies designed and applied for the program are aforementioned. Basically, the stages of the program include the determination of the scope in terms of nature of the program, demographic factors, cultural factors and the basic facets of human nature such as cognitive, behavioral and physiological factors. The stages of the implementation are fairly appropriate to the programs goals and targeted participants.  (Moadel, A.  Lukoschek2009).

I believe that there are no negative legal or ethical issues that may arise with this program. Legally-speaking, there are positive effects if the program would be implemented. As it is geared towards minimizing, or even to totally eliminating smoking habits among the target participants, this could reinforce anti-smoking regulations, policies, laws or ordinances as applicable to different types of communities. (Issel 2004)
Ethically, I see more benefits than adverse impacts because the traditional society actually abhors smoking in public, especially in work places. Some non-smokers could be offended or harmed by smokers (especially in public places or workplaces).  By cutting down on smoking, this ethical issue could also be eliminated.

MHM 522 Legal Aspects of Health Administration SLP

Healthcare provision is a critical service which ought to be carefully regulated by the relevant authorities in order to reduce or curb cases of malpractices that lead to losses of lives and revenue. Operating a healthcare facility is therefore subject to statutory regulation, and one has to comply with these laws in order to be allowed to operate. The laws vary from state to state though the basic ones are set on a federal level and as such are applicable to all states (AHCA, 2010). This case is focused on the state of Florida.

Applicable Statutes and the Licensing Process
The state of Florida has different procedural orders for licensing people or organizations to offer health care services. These depend on the particular service to be offered. Considering a hospital, the licensing procedure entails first applying to the Agency for Health Care Administration (AHCA) (Barnes, 2001). Usually, application for this license ought to be made first and its receipt confirmed before any organization can be allowed to advertise for the services being offered by the hospital. This rule is provided for under chapter 395, the first part of the Florida Statutes, as well as the second part of Chapter 408 of the Florida Statutes (Barnes, 2001). The hospital is usually required to maintain its current license although it is allowed to apply and be considered for Medicare Certification and then become an accredited hospital (AHCA, 2010).

In order to be compliant with licensure, an accredited hospital will have to meet the requirements of Chapter 59A-3.253(3) of the Florida Administrative Code (Barnes, 2001). Since such hospitals are compliant with certification and licensure requirements, they are usually exempt from the on-site surveys that are usually done routinely. However, every hospital has to be inspected for the Life-Safety Code. The procedure involves first applying for a Certificate of Need from the Financial AnalysisCertificate of Need Unit in order for a review of the project to be done. On receipt of the certificate, the Office of Plans and Construction must be notified to issue a plan review before any building is constructed (AHCA, 2010). With these applications must accompany a licensure application fee and the relevant documentation for support. Finally, upon approval of these, a licensure survey is conducted. A license is issued only if the survey is successful (Barnes, 2001). 

The State Survey Agency in Florida and the Conditions for Certification
The State of Floridas Survey Agency is called the Florida Agency for health CARE Administration (AHCA). Its criteria for certification include analysis of the organizations ability to comply with the applicable laws and regulations. One important area is the ability to adhere to state and federal laws that require that the requirements of the following chapters are met Chapter 395 Part 1 and Chapter 408 part II both of the Florida statutes, and Chapter 59A-3 of the Florida Administrative Code (AHCA, 2010). These statutes, among other provisions, outline the need for an operator of a facility to prove that all the safety requirements as well as the good practices codes are guaranteed (AHCA, 2010).

They require that an applicant for a license must be evaluated on the basis of proof of not only understanding these statutes but also ability to do as they require. The hospital also ought to be surveyed in accordance with the provisions of the Centers for Medicare and Medicaid Services. There has to be conducted two surveys, one before the beginning of the operations and the other after the hospital has begun operating on a full scale. A very important criterion entails having the organization have all the supporting documentation to prove that all the necessary legal and statutory requirements have been met (AHCA, 2010).

Adult Day Care.

Adult Day Care Services can be defined as organizations or centers that are designed to provide care for the senior members of the society who requires some assistance andor supervision during the day. This program is meant to relieve family members or rather care givers to these elderly people granting them the freedom to be able to attend to their personal duties. There are two main types of adult day care which include Adult social day care and the Adult day health care programs. The Adult social day care program is designed to provide social facilities, meals, recreation, and limited health-related services to the elderly. On the other hand, the Adult day health care program has been designed to offer services that are inclined towards health issues like the provision of therapeutic and social services to senior members of the society with severe medical concerns and those in need of nursing home care. Adult day care centers are usually opened during the working hours of the day (Bryce, 2000).
Where it begun
   
The majority of home care providers to the elderly members of the society are generally adults andor spouses. These groups of care givers are very crucial to the economic development of our country and therefore require some assistance in caring for their loved ones as they continue to drive our economic growth. Care giving has been identified as an enormous task both in financial and time wastage terms. Adult day care therefore offers a timely intervention to provide the much needed relief from care giving and this may also reduce the need for a nursing home care that could be quite expensive. According to the 2000 census, the number of adult day centers in the United States was estimated to be 3,407 which primarily served individuals with dementia and the frail elderly who were not suffering from dementia. Experts however argue that more than 5000 centers would be required in the coming years to cope up with the aging population (Eure, 2005). Thus with a witnessed growth in both demand and interest for alternatives in community care services, adult day care services are increasingly becoming the best alternative in the provision of health and general care. The adult care centers do not provide curative services but may engage in the provision of the required health care and social support to the elderly.

General trends
Adult care centers also referred to as adult care services have been active for a period exceeding twenty years. It is approximated that 80 of the adult care centers are for non profit, 10 for profit, and the remaining 10 funded from the public funds. According to Whirrett, in 1978, there were an estimated 300 adult care centers in the United States and by 1980s the number had swollen to reach 2100 centers. The National Adult Services Association puts the number of the adult centers at 4000. The rapid growth in the number of the centers has been attributed to the ever increasing demands for home and community based services. This has also been attributed to the new funding openings such as the Medicaid waiver programs which have gone along way in support of alternatives to the institutional long term care and rehabs. The adult health care programs have moved away from the traditional adult care relief by providing therapeutic care to elderly with both cognitive and physical impairments in addition to the general provision of relief to family care providers (Whirrett, 2002).

Belmonte has defined an adult day care center as composed of a planned program of activities that are designated to enhance the well-being of the elderly via the established social and health services. She goes further to elaborate that these centers are functional at day time and during weekdays. They operate in what has been referred to as safe, supportive and cheerful environments. Meals with a high nutritive value are usually offered to accommodate special diets accompanied by a snack in the afternoon. These centers can be publicly owned or private. In general, the adult day care serves two main purposes which include the provision of an opportunity for the adults to experience a different environment from home and this serves them nice as they receive both mental and social stimulation.

The other function these centers have is in regards to primary caregivers who require a break in order to attend to personal obligations, or have time for resting andor relaxation. Adult care centers is befitting to senior members of the society who have the ability to benefit from the friendship and functional assistance that are offered at these centers. Those who are physically andor cognitively challenged but do not require a 24 hour surveillance are also eligible. The other seniors that could benefit from the services associated with the adult day care centers are those individuals in early stages of Alzheimers illness. Those who qualify for adult day care are expected to be able to move around with minimum assistance. In this regard, the elderly should be able to be self sufficient in mobility may be with some assistance from a cane, walker, or wheelchair. They also need to be continent (Belmonte, 2009).

Demography of the Adult Day Care Centers
As the United States population ages, adult day care centers are becoming an integral part of services offered to the elderly. They provide a variety of services including both social and medical to cognitively and physically challenged senior members of the society. Typically, the demography of the adult day care participants were regarded to be frail elderly members who are not in need of a 24-hour institutional care, but at the same time requires some health related services. The majority of participants in the adult day care centers are those who have attained the age of 65 and above. Studies have shown that participants especially in the adult day health care (ADHC) centers are those with cognitive impairment, those suffering from different forms of dementia and therefore are in need of significant supervision. Other conditions that are commonly associated with ADHC participants include chronic mental problems, physical conditions relating to heart diseases, diabetes, e t c. These are ailments that are mostly associated with old age (Moore, Geboy  Weisman, 2006).

Services provided by the Adult Day Care Centers
Adult day care centers provide a variety of services that are focused on benefiting of the participants life in general. Such programs are centered on skills, knowledge, strength, and unique abilities of the seniors that are the main point of focus. These care centers provide customized plans in order to meet the needs of their participants. Such services include recreational activities such as arts and crafts for the elderly, musical entertainment, games for mental stimulation, local outings, simple exercises, and holiday and birthday celebrations, among other activities. Apart from the recreation activities, these centers give emotional support, mental simulation, personal care such as bathing and shaving to the participants. Some adult day care centers provides for the transport cost to and from the center. They also offer social services including counseling services and support groups for care givers. They also at times offer some health services including monitoring of the blood pressure and vision screening (U.S. Health and Human Services, 2010).

General Advantages
When our parents become frail due to the effects of aging, we would really want to provide them with any assistance that will enable them to stay for long and as happy as possible. But keeping our parents in homes has come with great challenges. Most elderly have come to live in these homes as disgruntled members of the society in which case they are more often isolated, lonely, and resorts to sleeping all day long. They spent most of their lives waiting for appointments from the doctor. The idea of a day care center comes in handy to address the issue of loneliness of the elderly in the homes as they are stimulated back to life through social and physical stimulation. It has been established that even elderly individuals with moderate form of dementia who seems to suffer memory lapse responds in a better way when they are socially and physically stimulated.

Such patients can be said to be living from moment to moment and therefore the quality of the individual moments collectively impacts on their overall health and happiness (Dabelko  Decoster, 2007). It should also be noted that the adult day care centers are designed to meet the daily socialization needs of the elderly as well as providing respite to the weary caregivers in the home. The elderly with dementia are known to sleep very little and this may leave the care givers exhausted since their sleep is usually interrupted by the suffering senior members of the family. In such a case, the adult day care center will provide the caregivers with an opportunity to run errands and have rest. In the event that the care giver is a spouse, then the care giver needs time to attend to social functions, attend to physician appointments and be able to maintain their own health and contentment (Kobrin, 2010).

Studies have continued to show that the main beneficiaries of the day care services are the care givers and the professionals. The former often appreciate day centers since they provide respite care under a different name. Adult day care centers can be considered as a blessing to many elderly people. Several communities are engaged in the provision of adult socialization and activity through the adult day care centers. Adult day care centers actually provide a variety of services that are of great benefit to the senior members of the society. Some parents also value the perceived security and reliability that accompanies the services that are usually offered in these centers. From the agencys point of view, day care centers are predictable and easier to run than any other organization. For instance, in case of staff shortage, two activity groups can be merged and coordinated by a single member of staff (Clark, 2001).

The adult day care centers thus produce a winwin situation in the sense that everyone becomes a beneficiary. To the caregiver, the centers provide the relief from the burden of taking care of the elderly while to the elderly, the benefits include safe and secure environment in which to spend the day, enjoyable and educative activities, enhanced independence, socialization and peer support and an improvement in both the mental and physical health. The elderly are also put on nutritious diets which is good to their health (Belmonte, 2009). In summary, adult day care centers usually provides a relief to family members from committing all their time to caring for the elderly. They also provide social interaction, health services, customized exercises, crafts, and meals to the elderly (Blanchard, 2010).

When and how to call for Adult Day Care Services
The decision to enroll a senior member of the family is not easy to come by. To the elderly, it becomes a challenge especially if the individual has a high degree of independence and was involved in the caring for others. To the care givers, the idea of giving out your beloved member of the family to strangers is not comfortable (Belmonte, 2009). You would rather have the senior member of the family under your care than throw all the caution to the wind and hand him or her to the strangers.

However, there comes a time to let go when it is destined to work in both the interest of the care giver and the senior member. Experts advise that one should consider using the adult day care services when the elderly member of the family exhibits certain characteristics. Such indicators includes when one cannot structure his or her own daily activities, feels isolated and is in need of company, cannot safely be left behind at home, and when the caregivers work station is away from home. With such challenges, then one might consider tapping on the services that are provided by the adult day care centers (Cohen-Mansfield, Taylor  Werner, 1998).

Before one identifies the right adult care center for the senior member of the family, there are certain considerations that one has to keep in mind. The first thing to consider will be the specific services that are needed by the care giver and the elderly. You also need to know whether social activities are the primary needs that the elderly needs. Explore the other needs that the participant may be requiring which may include assistance in walking, eating, medications, exercises, or mental stimulation among others. Caregivers may be requiring some free time and some facilitation with transport being offered to the participants. With the above in mind, one will be able to comfortably choose the type of the adult day care center that will be appropriate. In addition to the above, one can acquire some resource and reference from the family doctor, the local social services or health department, local senior centers, and even the yellow pages that are under the adult day care (Belmonte, 2009).

Choosing the Adult Day Care Center
One is required to conduct some research in order to be able to determine which center is the right choice for a loved one. There are certain basic features that one should look for when choosing an appropriate adult day care center for the senior members of the family. One needs to carry out an assessment of individual needs before admission in order to determine the persons range in terms of abilities and needs. You also need to develop customized treatment plan for the participating individuals and monitor it regularly offering the necessary adjustments.

The best day care centers for adults should be able to provide referrals to other needed community services. You also need to determine whether the care center has the ability to meet the social, recreational, and rehabilitative needs of the participant. Good day care centers also need to have clear criteria for service and guiding principles regarding termination that are based on the participant. They also should provide a full package of in-house services which may include but not limited to personal care, meals, rehabilitative services, educational programs among other services. The environment should also guarantee some safety to the participants. The personnel in these day care centers need to be well trained professionals and qualified staff. Above all, the day care centers should be registered by the authorities for legality (Whirrett, 2002).

Types of Adult Day Care Services
 There are three different types of adult day care models which include the social model, the medical model, and the specialized model. The social model is engaged in the provision of social services which includes activities of daily living and therapeutic services that are designed to aid the participants with mental and physical well being. The medical models on the other hand are designed to advance on the social model through the provision of skilled nursing and rehab services. Such services include the occupational and physical therapy, speech and language therapy, among other services that are related to health issues. Services offered by the medical model are partially funded by the Medicaid since most of these services are health related. Lastly, the specialized model specializes in the provision of services that targets a specific group with unique demands. These groups may include the individuals with HIVAIDS, those with brain injuries, those suffering from mental problems, and those with multiple sclerosis. The California state is known to run special programs for those suffering from dementia and Alzheimers disease. Those with development disabilities have also been provided with specialized care (Health Management Associates, 2007).

The term Adult Day Health Care (ADHC) is most commonly used to refer to the medical and the specialized models. The difference of the two models when compared to the first one lies in the provision of the health services. The provision of the medical services have enabled the adult day care to benefit from the Medicaid system thereby receiving payments for the services offered under Medicaid waiver programs designed for home care. Medicaid has recognized the major contribution that is brought in by these day care facilities which include offering of rehabilitation and curative services that form the best alternative to nursing homes. Medicaid has the objective of promoting the keeping activeness in individuals and teaching them the skills that will prevent them from institutionalization. At the same time, Medicaid has offered an avenue through which care givers are provided with relief in the home by enhancing the provision of these services outside the home. ADHC have continued to benefit from Medicaid and this has impacted on the general trend in the Adult day care as most have converted to include the provision of the health care services in their programs in order to be able to tap from Medicaid and other government funding (Day, 2010). The table below shows the percentage of adult day care centers in relation to the services being provided.

Table 1 Percentage of Adult Day Centers That Provide Specific Service

Type of service of CentersTherapeutic Activities97Personal Assistance96Meals84Social Services82Health-related Services74Medication Management70Transportation68Personal care60Rehabilitation Therapy28
Source Thomas Day About Adult Day Care, 2010

Adult Day Care Services A blessing to government, community, and the individual
The elderly population in the United States is rapidly growing. It is estimated that by the third decade in the new millennium, the number of those aged 65 years and above will have increased with two folds totaling to about seventy million. Between 50 and 80 of these individuals are believed to be in need of some sort of long term care due to disability, functional limitation, cognitive impairments plus other chronic health care problems. This definitely is going to be a burden to the government in its quest to provide for the basic services especially those related to health matters. Health care costs are on an upward trend whereas the number of the skilled and legitimate workers is on the downward trend. Most Americans are familiar with the nursing and private home health workers. However, little has been explored regarding the adult day care services which have been expanded to include what is referred to as the adult day health care services (ADHC). This sub-section of the adult day care engages in the provision of health and long-term care services to the seniors including those with medical conditions (Health Management Associates, 2007).

ADHC comprises of a full package of comprehensive medical services targeting low income seniors including those with chronic health problems. Common services being offered under the ADHC includes several therapeutic measures, skilled nursing care, and customized dietary and nutrition services. ADHC thus deals with patients who require considerable assistance with the daily activities and also faces health care challenges which do not require an admission in 24-hour health care facility. ADHC can therefore be said to be model to serve the chronically ill elderly population when one considers the multi-disciplinary approach it takes in handling the needs of the geriatric individuals. It has been established that ADHC allows the participants to remain in the homes or society settings thereby delaying admission to nursing and any other health institutions. The model also provides high quality and cost effective health care services (Burke  Laramie, 2004).

Many states in the United States have opted to cover ADHC via the Medicaid state plan. It is therefore imperative that policy makers, health care providers, and all stakeholders to have a clear understanding of the important role played by the ADHC for it to become a respected and valuable resource in the society. The table below shows the implementation of the ADHC program in six states including California, Maryland, New Jersey, New York, Texas, and Washington.

Source   Health Management Associates, July 23, 2007
Notes
a). Assessment is done by a multidisciplinary team (MDT), which includes at minimum a nurse, a therapist, the participant, and the ADHC program director. Additional members may also be involved depending on the providing facility.
b). Census Bureau, March 2005 and 2006 Current Population Survey, Annual Social and Economic Supplement
c). ADHC utilization is the population 65divided by the number of individuals participating in an ADHC Program.
 
Health services provided in these adult day care centers includes several therapeutic measures involving physical, occupational, speech, and language therapies. They may also offer psychological and psychiatric services, podiatric and vision care to the participants. The nursing services that are availed to the participants involve the evaluation, treatment, and the provision of health education. The ADHC are also engaged in the coordination and monitoring of the health situation extending the emergency and personal caring services to the participants. Some ADHC centers may offer more advanced health care services to the participants which include supplementary services such as laboratory services, EKGs and X-rays, and specialized clinics.

The services are designed in the sense that they meet the varied needs of the participants. ADHC employs flexibility approach to invoke elasticity in the provision of health care services and in the long run providing excellent services that are rarely available in other long-term care centers. It can be argued that the regularity of attendance in the ADHC centers and the multi-disciplinary nature of the provided services guarantee some safety net for the participating seniors. This enables the team involved in the provision of the services to hastily gather around patients when their conditions alter or deteriorates. ADHC has been a neglected area when it comes to long term care giving but as we can see, it has a rich history and therefore should be recognized as one of the pillars in the provision of health care services that are designed to cater for the fragile elderly members of the society (Health Management Associates, 2007).
   
ADHC participants are associated with chronic health problems that may include cognitive and mental health conditions. Others are physical conditions that are linked to stroke, heart ailments, diabetes, etc. Such diseases are categorized as top causes of disability in the seniors and therefore the ADHC becomes a very essential component of the society in addressing health issues of the elderly. This is due to the functions that the ADHC plays in the prevention of these complications and co-morbidities among the participants with such conditions. In most cases, the ADHC participants may require assistance with between one and three activities of daily living (ADLs). It has been observed that the number of ADLs in which a participant would require some assistance could be used as a yardstick for nursing home admission.

According to a study done in 2007, having three or more dependences meant that the individual is highly in need of a nursing home admission. Further research on the behavioral and psychological indicators of nursing home entry has shown that participants who receive community based care aimed at the improvement and maintenance of their physical and cognitive functioning have recorded a considerable delay in nursing home admission. Most ADHC participants are known to live with either a spouse or some other relatives. Others however may be living on their own andor rely on caregivers who are either formal or informal. Therefore, ADHC definitely comes in handy to provide some relief to these caregivers who are considered to be the backbone of the countrys long term care system. It has been established that in the United States, over seven million Americans are involved in the provision of 120 million hours of care to an approximated 4.2 million elderly people, with an unprecedented economic value of between 45 and 96 billion dollars per annum (Health Management Associates, 2007).
   
The ADHC related programs are designed to provide for health care to a very high-needs section of the population which has varied medical conditions at reasonable costs. The cost of the ADHC services is generally lower compared to those charged by the nursing homes. There is profound evidence that ADHC plays a crucial role in the prevention and delay of admission to more costly health institutions through the provision of a wide range of integrated services enabling the individuals to remain in the community setting. A survey that was carried out in the six states clearly demonstrates that ADHC bundled services are less costly compared to the nursing home care. This has been well elaborated in the table below

Table 3 Daily Rates and Monthly Reimbursement for ADHC versus Nursing
Facilities in 6 States
StateADHC Bundled ReimbursementNursing Home ReimbursementDailyMonthlyDailyMonthlyCalifornia76 914 152 4,562 Maryland65 808 208 6,240 New Jersey79 992 255 7,650 New York142 1,703 192 5,760 Texas26 520 83 2,476 Washington52 475 119 3,575
Source   Health Management Associates, July 23, 2007
Notes
a). Monthly rate based on average monthly use of 12.5 days. Data provided by each states Adult Day Health Service Organization.
b). The daily nursing home reimbursement rate is the monthly rate divided by 30 days
c). ADHC organizations 2006
d). ADHC participants in Texas attend an average of 5 days per week, which accounts for a monthly rate that appears higher than the other states.
  
With the ADHC area in the provision of long term care having been sidelined from research activities, much of the information on the subject has been dependent on surveys. However, in recent times, researchers have been interested in finding out the impacts that the ADHC have on the health outcomes. This has greatly leaned towards the effectiveness of ADHC in delaying the admission of participants in costly nursing institutions. Recent studies have suggested that generally, adult day care centers enable informal care providers to continue with the provision of care in the homes hence causing a delay and to some extent prevention of institutionalization. Several other researches have been launched to establish the cost-saving aspect of the ADHC. For instance a study has been conducted by the National Multiple Sclerosis Society to establish cost savings that result from the ADHC services even though the sample sizes were too small. Previous research had shown that ADHC participants had improved health outcomes in comparison to those in nursing homes. They showed higher rates in client satisfaction and also recorded lower mortality rates (Health Management Associates, 2007).

Though nursing facilities may be a compulsory option to some individuals, a simple delay to admission into these facilities may go along way in cutting down the overall cost that could have been spent on the patient. Apart from the preventive and even the avoidance impacts ADHC has on the admission of participants to the nursing homes, timely engagement of ADHC services has also been identified as having beneficial health consequences to the care givers. Research done to establish the effects of community based programs to care providers showed that timely engagement of the ADHC services was imperative to the reduction of the care givers burdens and despair. These services also encourage some independence on the part of the participants and this will enable them to live happily as they are not subjected to control by another person. They are able to socialize and interact with their peers and this works well for their social and psychological well-being (Beisgen  Kraitchman, 2003).

Possible reasons as to why Adult Day Care Centers are avoided
The Adult day care services have been hailed as a valuable component of care provision but still remain the most underutilized. There are very limited data and information if any in regard to the issue and this has led to the perpetual theorizing of the possible causes of this phenomenon. An argument has been advanced saying that care recipients may not be pleasant with the concept. In many surveys carried out, it has been established that a majority of the care recipients happen to be afraid to leave their homes. They seem to fear change of environment that comes with the day care centers. They may also not be pleased with the type of activities that are associated with the day care centers and would rather spend the day at home than at the center. On the part of the primary caregiver, they might be reluctant to surrender their loved ones to the day care centers for lack of trust in the day care centers.

They might also lack the fee that is charged by these day care centers and thus opting to have the senior members of the family in the home and not at the centers. There is a misconception that a loved one might suffer in the day care centers which is to the contrary. Many care givers would be heard threatening the elderly that they would be taken to the day care centers incase they misbehave. Another speculation would be that most care givers are not familiar with the services being offered at the centers. May be if the people are educated about the benefits and the general services that are stationed at the day care centers, then we would see a surge in the number of those who would prefer  the use of these services. Lastly, we can say that perhaps the adult day care programs might be regarded as their very worst enemy. Since most of them are non-profit in their orientation, they could be too lenient and this can easily compromise their sustenance. When they do not survive the test of time, public confidence is greatly hampered and this negatively impacts on recruitment. When arguing out this point, one has to be careful since if these care centers were to overcharge, the practice can easily drive away possible clients at the same time (Day, 2010).

Funding for Adult Day Care
    According to a survey done in the year 2001regarding the average daily cost of adult day services, the average figure was estimated to be around 56 dollars. The prices have considerably gone higher since then and it should be expected that the prices are determined by the living index of the area. This means that areas with high living standards will charge highly for adult care services compared to those areas with moderate and low cost of living (Day, 2010). Medicare does not address the costs of the day care services. However, as seen earlier Medicaid can chip in and provide all the payments in a licensed adult day care centers that are run on a medical model. Medicaid has recognized these services as providing good alternatives to the nursing home care. Some day care facilities may charge using the slide fee scale whereby one pays for the services depending on his or her income. Private medical insurance policies may at times partially cover the adult day care costs if the personnel involved in the care are registered and licensed. Depending on the policy, long-term care insurance policies may at times pay for the adult services. Also designed to cater for the adult care payments is the dependent tax credits which may be availed to the care givers (Whirrett, 2002).  The pie chart below gives some insight on who shoulders the responsibilities of paying for the adult care services

Source Thomas Day About Adult Day Care, 2010  
Adult day care services should be a welcome move for those individuals who have other obligations or rather would want to have a rest from the tiresome responsibilities that are associated with care giving. This offers them with some freedom away from a loved one to be able to accomplish their duties, socialize, and refresh. Adult day care centers have also been identified as beneficial to the participants given that they willingly appreciate being part of the day care centers. This is essential since when they accept to be part of the experience, they are psychologically and emotionally sound and this would work well for their adaptation capabilities. Adult day care has also been identified as a possible alternative to the costly nursing home facilities through its cost effective services to those participants with chronic illnesses. As we have seen, day care centers comes with a range of benefits that can be of value to virtually everyone including the caregivers, the participants, the government, and the community at large.

Health

The health of an individual is very vital especially when it comes to dieting, lifestyle and wellbeing. An individual is expected to eat and live healthy in order to be active in daily chores. However, some aspects of life contribute towards health living by an individual. Lifestyle is one of the most common aspects of life that is connected to health. As an introductory part the author of this essay paper is impressed to define lifestyle as an issue in relation to health.
   
 Life style is the way an individual lives in the society and this basically constitutes the behaviour of a person that impresses him or herself and other members of the society. Dress code, social gatherings or relations, entertainment such as drinking or smoking and consumption are some of the common aspects of live that constitute to lifestyle. These are some of behaviors and practices that affect the health of an individual and will be discussed in the main section of this paper.
   
Wellbeing is used to refer to quality of life as is concerned with healthcare. The quality of life does not necessarily include such concepts like wealth or education but it means that an individual is mentally and physically fit. The lifestyle of an individual can influence his or her wellbeing in some aspect thus there is a link between lifestyle and wellbeing (Wiseman, 2008).
   
Health is very much linked to lifestyle and the wellbeing of an individual. To humans, health can be defined as the functioning of body organs in a good way. In other words it is the mental, social and physical wellbeing of human body. Individual lifestyle such as consumption, dieting, hygiene, management of stress and exercise are some of the aspects that contribute to good health. These definitions clearly bring out the context of the entire discussion in relation to the impact of individual lifestyles on health and well being.
   
Individual lifestyles like the use of drugs and other behavioral practices of individuals are considered to be one of the major causes of health problems. Material factors such as the quality of living standards or environment and psychological factors such as risk taking or stress are considered to be the major impacts on the health of a person. According to LaLonde report that was released in 1974, the presence of pharmaceutical, hospital and physician services does not guarantee a health living (Whiteman, White, 1999). The report identified four main key health issues that are responsible for the health of a person. The four fields are human biology, environment, health care organizations and lifestyle. The major concern of this report is lifestyle.
   
Health centers are very essential when it comes to treatment of an individual but lifestyle is the common area that must be checked to enhance proper health. In real life an individual has the right to do what he or she feels like doing and this is very risky because many individuals opt to engage in unhealthy lifestyles which cause illness and to large extend death. It is known that smoking has negative impacts on the body health of an individual but people choose to do it in the name of lifestyle. For instance smoking is associated with cancer and infertility both in men and women. Women who have a lifestyle of smoking have high chances of being infertile and have a risk of not getting a child. This means that life expectancy is reduced by a certain percentage (Wiseman, 2008). Smoking as a health problem causes asthma, lung cancer and cardiovascular diseases. These are some of the issues that must be handled by health organizations as a way of promoting health living.
   
Lifestyle such as drug taking has a very big impact on the health of individuals. When drugs are taken in large quantities it becomes a problem of addiction and this has a very devastating impact on the health of individual, family and the entire community. Individuals engage in a lifestyle of alcohol taking which leads to addiction and it becomes a health problem. Taking drugs excessively leads to poor dieting because the drunker abuser has no appetite hence he or she is at the risk of contaminating serious diseases. Alcohol is the most abused drug substance which leads to infection of the liver. Liver is the most sensitive body organ and once it has been affected the body becomes very weak and is subjected to health problems. The health of individual is very important but once it has been affected due to engagement in various lifestyles it becomes a major problem and can lead to premature death (Whiteman, White, 1999).

The teenagers are the common victims of alcohol abuse and they have been subjected to health related diseases and body injuries caused by violence. Drinking has posed mental, physical and social health problems that must be checked to reduce the rate of premature deaths. Nutrition is another major area that has an impact on the health and wellbeing of an individual. The eating habits of individuals have been a challenge especially during this time of economic challenges. Many families have no full potential of providing a balanced diet and this has led to health problems. Many developing nations who depend on donations can only afford cheap foods such as ugali which when consumed for a long period of time can lead to kwashiorkor. Consumption itself is an element of lifestyle and it is only the rich who can afford a whole meal.
   
Lifestylism is based on the choices an individual makes about lifestyle or to an extend it is related to medical doctrine that is related to health living. It is true that lifestylists are only concerned about their way of living and they dont concentrate much on their nutrition and health. Their common way of live is basically based in politics and material things which adversely affect their health (Wiseman, 2008). This focus by many individuals who adore lifestyle leads to environmental and structural factors such as pollution and excess exploitation of resources. The health and wellbeing of an individual is mostly influenced by structural factors such as exercise, good rest and management of stress. Every individual is encouraged to live health by putting into practice these factors. In addition, environmental factors such as dieting, reduction of pollution and conservation of environment must be focused on lifestylism.
   
The focus of individual lifestyle can be connected to victim blaming whereby an individual is held responsible for any unfortunate incident that has happened to another persons life. Victim blaming has occurred in several cases relating to lifestyle and health or wellbeing. For instance people in developing countries hold their government responsible for lack of sufficient food or drugs that lead to poor health. In another case, lifestyle is taken as an influence by people of the same peer pressure groups. When an individual engages in behavioral practices so as to fit in a particular social group, and he or she is affected health wise, then it becomes a blame game. It is advisable therefore to make sure that an individual is very careful when indulging in groups that may lead to engaging in activities that will cause health problems. A good example about victim blaming and lifestyle in relation to health and wellbeing is a case where youths are influenced by their friends to indulge in sexual activities that leads to contraction of AIDS (Wiseman, 2008).

Once they notice they have been infected, the victim starts to blame their friends and this has been a major challenge to health living. Nutrition is another key area that is related to lifestyle and its impact on health and wellbeing. Every individual must have a lifestyle of accessing balanced diet that will keep him or her both mentally and physically fit. Individual lifestyle has led to health complications to many people because those who are obsessed to a particular lifestyle have time to attend to their own issues thus they forget about health living. The concerned parties must put measures such as organization of health seminars to enlighten people about the benefits of health living.
   
Lifestyle is one major area that has brought a lot of problems to the health and wellbeing of individuals in the modern society. The world is changing at a very fast speed and the introduction of information technology has also influenced the way of life. This has posed a lot of challenge in administration of individual health. The health of any particular individual is very important and the way an individual lives determines a lot about his or her health and wellbeing.

 It is therefore, very important to make the right choice when it comes to lifestyle. There should be no blame game because an individual must be concerned with individual health living. Smoking is one lifestyle practice that has led to health complications among women and men and should be reduced whenever it is possible. Health organizations must give guidelines and rules that relates to smoking so as to reduce cancer diseases and other health complications. Rules governing drug abuse and addiction must be provided. Individuals who have been addicted by drugs must be taken to rehabilitation centers for reformation.

Reading Response

The primary strengths of the quasi-experimental design is its attempt to reflect geographic dispersion and its narrow audiencespecifically, public health practitioners. The primary weakness, in my view, is that of the narrow audience, there is too much of an emphasis on tech-savvy workersmany graying eminences in this field are less likely to react to CD-Rom inquiries, ask for technical advice, or even attend the (increasingly techno-centric) world of conferences.         

As mentioned above, the primary strength of the quasi-experimental design is its admirable attempt to get a diversity of respondents from a diversity of locations. Though my criticism remainsthat, specifically, the nature of the dissemination narrows down the field theyve attempted to broadenthe attempt at diversity is often overlooked in modern studies.         

With this in mind, I feel the research projects validity was heightened by the use of the experimental design. Experimental research remains highly effective, and the attempt to randomize respondents in order to get a greater breadth of answers is something thats not always easy (or even feasible) within the realm of public health.  And though some critics such as Sandra Soo-Jun Lee (2005, p .2133) think the notion of personalized medicine is more rhetoric than fact, the attempt at personalization is, currently, the way to patient satisfaction on both the treatment and marketing aspects of medicine.          

I feel that the best strategy for dissemination would be a tiered approach targeting newer hires, midrange employees, and upper management. As mentioned above, I feel this dissemination is more likely to get younger, tech-friendly employees. To this experimental design, I would add informal paper surveys distributed to a variety of agencies. I feel this would address one of the weaknesses of the original studynamely, that state respondents were more likelyto have a shorter tenure in their agency. (Brownson et al., 2007, p. 1903) With my addition to the quasi-experimental design structure, I feel a greater breadth of longer-term employees would be reflected in the results.

MRI Thermal effect

Magnetic Resonance Imaging has been in place for nearly forty years and is one of the fastest growing technologies in radiography.  Since it was discovered that radiology can play a role in imaging numerous steps have been adopted with the aim of developing a thorough understanding and improving Magnetic Resonance Imaging (MRI) (Dick et al 2002).  The greater contrast attained in differentiating soft tissue through MRI relative to computed tomography (CT) is the main reason why MRI is the preferred imaging technology in neurological, cardiovascular, muscoskeletal and oncological imaging.  Radio frequencies are used in aligning the hydrogen nuclei which are detectable by a scanner.  It is noteworthy that by adding the magnetic field an image of a body can be constructed (Stoianovici et al 2007 Craciunescu et al 2001).  Since magnetic resonance imaging is a relatively new technology, there are a number of areas that are yet to be harnessed.  MRI does not use ionising radiation thus it is considered safer than CT.  However, there are multiple reported cases of accidents in MRI.  Most accidents in MRI are a result of its use in patient with metallic implants. In general patients with metallic implants are prevented from having MRI scan (Samset 2006).

Intra-operative thermometry is gaining audience in research due to increased adoption of minimally invasive techniques.  For a minimally invasive technique to be preserved, the temperature mapping should not contribute to the invasiveness of the procedure.  It is noteworthy that Magnetic Resonance Imaging is characterised by multiple unique properties that enable non-invasive 3D temperature mapping (Smith et al 2001).  Appreciation of the heating effect of MRI is a critical aspect in the management of MRI and could play a role in reducing incidences associated with the imaging technique (McDannold 2005).  Though use of MRI as a thermo therapeutic tool has been compelling due to its non-invasive nature and applicability in cases where surgery may not be an option, management of the temperature remains a critical success factor (Diederich et al 2004).  In imaging, extensive temperature rises could result in permanent tissue damage which is fatal.  Temperatures over 60 degrees Celsius can result in extensive permanent tissue damage whereas lower temperatures may also be lethal depending on the tissue type (McNichols et al 2004).  Systems that reduce tissue temperature beyond freezing point may results in tissue destruction (Hynynen  McDannold 2004).  It is therefore evident from the extensive literature review that management of temperature and the thermal effect of MRI is a vital aspect in its usage.

Rationale
It is evident that radiology is extensively used in thermo therapeutic techniques for instance ablation.  Understanding the thermal effect of MRI in this context plays a vital role in management of medical conditions.  It is further apparent from the literature review that management of temperature is a vital success factors in MRI.  Failure to effectively manage temperature changes due to the thermal effects of MRI could result in tissue damage and fatal accidents that have been reported in some cases of MRI use (Das, Jones  Samulski 2001 Cerrato et al 2005).  Understanding the factors that influence temperature changes in MRI and the nature of their relationship with temperature would help improve MRI and its use in healthcare management.  Such a development would help improve the quality of health care and reduce prevalence of accidents in using MRI.  These are the main reasons for carrying out the proposed study.

Aims and Objectives
The following are the aims and objectives that will guide the study
To determine if MRI has heating and cooling effect in MRI.
Nearly all MRI parameters are temperature sensitive thus management of temperature is a critical success factor in MRI (Lafon et al 2007). Attainment of this objective will be aided by the research question Does
MRI has cooling and heating effect

To determine if the thickness of body tissue affects the heating and cooling effect in MRI.
Understanding the specific nature of the relationship between thickness of body tissue and thermal effect is important.  This objective will be attained with the aid of the following research question Does thickness of body tissue affect the heating and cooling effect of MRI
To determine if room temperature and time spend in MRI influence the thermal effect of MRI. Temperatures above 60 degrees Celsius could result in ablation which is undesired in cases where MRI is not being used for therapeutic reasons.  Moreover low temperatures could be fatal on a patient.  Determination of the values of the operational variables that would result in desired temperature levels is thus vital in addressing and harnessing the thermal effect of MRI.  This will be attained with the aid of the research question Does room temperature and time spend in MRI influence the thermal effect of MRI

Research Plan
MRI use in humans is associated with multiple health and professional requirements.  It is therefore highly unlikely that subjects will willingly engage in the study.  Furthermore, the study seeks to determine variables that influence the thermal effects of MRI and could therefore result in temperatures that may be detrimental on human tissue.  Therefore the use of live human subjects in the study may not be possible thus the pure experimental approach adopted in the study. The research involves the development of data that influence the requirements in MRI.  Therefore the use of a quantitative research methodology will be in order considering that there are different factors influencing the thermal effect of MRI.

Methods and Approaches
There are three main research questions that will be addressed in the study.  It is further noteworthy that the research questions build on each other and therefore share a lot with respect to the preliminary procedures.  The study will use agar gel, water and oil to determine the thermal effect of MRI.  The use of agar gel is mainly because the study adopts an experimental approach and agar gel displays behaviours that are similar to that of a normal tissue.  Fibre optic thermometer will be used in the study due to its compatibility with a MRI scanner (Busch et al 2005).  Use of olive oil and water is aimed at determining if these lubricants have any effect on the effect of MRI on temperature changes in the tissue and facilitates MRI since the existence of hydrogen ions is a prerequisite for MRI.  Other equipments that will be used in the study include three beakers, a scanner and a stop watch.  The specific procedure that will be used in the study is three beakers containing agar gel that is mixed with olive oil and water the mixture is placed in a scanner and a thermometer appended and recording the temperature started immediately.  Three beakers are used because the experiment is repeated three times for varying thickness of the mixture so as to minimise the effects of random errors on the results.  Spin echo sequence, IR, gradient echo and IR will all be used and results from the different sequences compared. 

Participants
The study is experimental and does not involve human subjects.  However, the presence of a researcher and an MRI specialist or a radiographer is a requirement in carrying out the study.  Since the study is experimental, to ensure consistency of the findings and minimise experimental errors repetition will be used.  Every experiment will be repeated three times.

Data Analysis
Analysis of the first research questions will be done via descriptive analysis of the recorded data.  By using tables and graphs a clear picture of the variables that affect the thermal effects of MRI will be developed.  This will mainly involve assessing differences in thermal changes resulting from change in thickness of mixture and room temperature.  The second research question will be analysed with the aid of regression analysis where thermal effects is assumed to be a linear function (Polgar  Thomas 2000).  Regression analysis is based on correlation inferential statistics and is adopted under the assumption that there is a linear relationship between the test variables
YA1X1A2X2A3X3 E, Where A1, A2 and A3 are coefficients, E is the error term, Y is change in temperature and X1, X2 and X3 are the dependent variables thickness of mixture, room temperature and time spent in scanner.

This is a form of quantitative analysis which aids generate relationship between multiple predictors and a dependent variable (Grbich 2009).  Thickness of the mixture (assumed to be indicative of thickness of tissue) room temperature and time are considered to be the predictors (independent variables) and change in temperature is considered the dependent variable. Statistical analysis will help determine the value of the coefficients and therefore the nature of relationship between the dependent and the independent variables. It is noteworthy that graphing the results and use of tables constitutes descriptive analysis whereas regression analysis is a form of inferential analysis.  To ensure accuracy of the results, SPSS will be used in regression analysis.

Ethical Consideration
An important ethical consideration in the study is non-inclusion of human subject since the study may affect their health.  Another ethical consideration is involvement of a MRI specialist who will help enforce rules required in MRI rooms and minimise risks of accidents in the study.
Project Management
Management of the project mainly involves consideration on budgetary requirements and the transition between activities required in carrying out the project.  The following are tabular presentations of the budget and work plan.