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Diabetes is a hyperglycaemic metabolic disease arising from abnormalities in insulin action and secretions.  The chronic type is characterized by dysfunction, damage, and organs failure, particularly for the eyes, heart, kidney, nerves, blood vessels and lungs. Diabetes is mainly caused by activities of several pathogens which may destroy the functioning ability of β-cells in the pancreas, therefore affecting insulin secretion and function. Insulin deficiency and dysfunction lead to abnormal metabolism of carbohydrates, protein, and fats (Ahmed, 2002: 373). Diabetes is broadly categorized into two; type one and type-two, where the classification is based on the hyperglycaemia pathogenesis. This paper will discuss the type two diabetes; causes, prevention, treatment, and impacts on the Mexican population in comparison with the United Kingdom.

                        Type 2 diabetes in Mexico and the United Kingdom

            Type-2 diabetes is common in 90-95% of diabetes cases reported in both Mexico and the United Kingdom. A recent survey indicated that cases of diabetes reported in health centres are at 1.2%; this figure is mainly from the young population. The aging population has not considered the essence for diagnosis, and this has resulted in increased diabetic-related deaths at the age of 55 to 57 years. It has been estimated that over 1.7 million people have diabetes in Mexico; this number is lower that of the United Kingdom where people diagnosed with the disease is estimated to be over 3.5 million. This variation is mainly as a result of preference in lifestyle, where people in the UK have been reported to be less considerate with the type of food they consume and do not do any exercises (Hu, 2001: 790).  According to the World Health Organization (2010), diabetes is among the top five causes of deaths in Mexico. From these findings, the Mexican government has invested heavily in medication and control of the disease putting aside over US$430 million for metabolic and other health services. Type 2 diabetes is insulin independent, and therefore, the patient may not depend on the administration of insulin therapy for treatment. The patient's β-cells are not destroyed in this type of diabetes, but rather other abnormalities such as the unusual distribution of fat, disorders such as anxiety and stress may be the leading causes of the disease. A Patient with this type of diabetes can go for several years without detecting the disease particularly when β-cells are generally functioning.

                                                            Causes            

            Type-two diabetes is more of a lifestyle-related disease than type 1; these lifestyle factors include physical in-activities, cigarette smoking, sedentary lifestyle, high alcohol consumption, and obesity. In Mexico, the leading causes are excessive smoking and inactivity. Over 55% of type 2 diabetes cases are obesity-related; this is as a result of the failure of doing some exercises (McCarthy, 2010: 2339). Also, toxicity in the environment has been listed among other causes of type 2 diabetes, where recent research has indicated the presence of biphenyl a compound in the urine of some patient; this compound is a constituent in some plastics dumped in the environment. Another cause of type 2 diabetes is the genetic inheritance; in this case, the parent with the disease is likely to pass the disorder to one of their children. The risk of inheriting the disease in a monozygotic twin is 100% due to the presence of some shared genetic traits. Some of the transmitted genes associated with type two diabetes include PPARG, TCF7L2, FTO, NOTCH2, KCNJ11, WFS1, IGF2BP2, CDKAL1, SLC30A8, HHEX, and JAZF1. The KCNJ11 is a rectifying route for encoding potassium in the ATP, and regulates the expression of proglucagon genes which enhance the production of peptides; these genes when transcribed by TCF7L2 become inheritable. Other medical factors that cause type two diabetes include hyperlipidaemia, hypertension, syndrome X (Metabolic syndrome), and Cushing's syndrome, pheochromocytoma, cancer, chronic pancreatitis, acromegaly, thyrotoxicosis, and drugs. Aging is another factor that accelerates the risk of getting type two diabetes in Mexico and the United Kingdom. Type-two diabetes associated with hyperlipidaemia and chronic pancreatitis is as a result of the insensitivity of insulin due to resistance, low production, and pancreatic cells failure. As a result, a decline in the transportation of glucose to the muscles, liver, and fats cells occur.

                                                            Diagnosis

            The Mexican department of health has invested heavily in the screening of diabetes in various health centres. Positive screening is considered as the best pre-diagnosis for treatment of type-two diabetes. According to the American Diabetic Association (1996), 25% of patients diagnosed with the disease also have some micro vascular complications; an indication that they have been living with the disease for more than five years. At this stage of diagnosis, patients have a raised level in polyuria, polyphagia and polydipsia symptoms; they also record a significant loss in body weight. Diagnosis of type two diabetes can be done by measuring the fasting plasma glucose (FPG) - 7.0 mmol/L, and oral glucose tolerance test (OGTT) - 11.1 mmol/L. These two criteria are the most commonly used parameters to determine the level of blood sugar in the body. According to International Expert Committee (2009), fructosamine and glycated haemoglobin (HbA1c) are another two parameters also used in determining those in high risk of developing the disease, where people with HbA1c levels of 6.0% and less than 6.5% are most likely to develop the disease.  The committee further indicated that necessary actions should be considered to cut off the points for HbA1c, therefore reducing the stigma arising from mistakes of identifying people as diabetic when their HbA1c levels are below 6.5%.

                                                 Management and treatment

            The disease can be managed through the enhancement of individual lifestyle. Also, modification of diets has proved successful in managing the disease. Maintaining the body mass index (BMI) at 25kg/m2 (Baffetta et al.2011), taking food with high fibre content, unsaturated fat, diets with low trans-fat, exercises, taking low amount of alcohol, and abstaining from smoking are some of the essential lifestyle modifications people living with the disease require. Also, patients should regularly get an evaluation of the diet they are taking from nutritionists for better control of the disease. However, recommendations for the diets should consider the functional and physical ability of the patient.

                                                        Treatment

            Medical treatment of type-two diabetes is mainly done using pharmacological agents such as sulfonylurea, meglitinides, thiazolidinedione’s, alpha-glycosidase inhibitors, incretion therapies, dipeptidyl-peptidase IV inhibitors, insulin, and bromocriptine.

Sulfonylurea                  

            Treatments trigger insulin secretion but pose hypoglycaemia risks where the elders are at high risks than children. This risk can lead to renal dysfunction, and therefore, prolonged exposure to sulfonylurea should be avoided in the elderly (Shorr et al., 2010: 751).   

Meglitinides

            This treatment triggers the beta cells to release insulin and facilitate its proper functioning. This treatment is preferred due to the quick action of meglitinides once administered; this after that reduces the hypoglycaemia risk. The treatment is administered before meals to onset blood control of glucose (Blickle, 2006: 113). In cases where the meals are skipped, administration of pre-prandial is considered to reduce risks of hypoglycaemia.

Thiazolidinedione’s

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Abstract

Many parents embrace the decision to manage and treat the condition affecting their children as individuals to prevent unnecessary delays, unpredictable services, and chances of failure. However, the experiences among parents in managing and treating ASD condition differ across races and cultures. Numerous African American parents face challenges in ensuring their children receive proper and timely management and treatment of ASD. Most of the challenges are associated with the socio-economic status and the historical experiences among the African American race. Delayed individual decisions, cultural divergence and differences, lack of resources and connection affect African American parents in the urban settings as they look for support or services to manage and treat the ASD condition with their children. This dissertation aims to analyze the experiences that the African American parents go through while managing the ASD conditions in children aged 5-6 years. The study presents findings which will help in reducing the challenges faced by the African American parents as well as improving their experience in managing and treating ASD in their children.

Key words: autism spectrum disorder, behavioral health services, race, cultural differences, African American parents.

 

 

Problem Statement

According to the Autism and Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators and Centers for Disease Control and Prevention (CDC), early diagnosis and treatment of the autism spectrum disorder (ASD) conditions translates into effectiveness in the process as well as a better experience among parents and families (2014). As a mental health condition, ASD affects the social, cognitive, and communication skills development among children. Timely diagnosis of the condition prevents severity and complications of the condition and, consequently, heavy investments among parents and families with children suffering from ASD. However, according to research, high rates of late ASD diagnoses among African Americans have been observed with most of the children being diagnosed with the condition two years later as compared to the white people (Burkett, Morris, Manning-Courtney, Anthony, & Shambley-Ebron, 2015). Usually, African American children are diagnosed with ASD at the age of 4-6 years. With early diagnosis of ASD being critical to ensure proper and timely treatment and healing, African American children and their parents encounter more challenges as compared to children of other races (Bonis, 2016). Furthermore, late diagnosis of the condition translates into issues experienced by the parents in providing care regarding attention, medication, and education to the affected children. It also complicates treatment options among the black children and leads to an increased severity of the symptoms that emerge in the later stages (Abramov, 2017).

Despite the advancement in detecting signs and symptoms of autism before three years of age, there have been various factors limiting the timely diagnosis of African American children with the condition. In most of the urban settings, African American parents with children diagnosed with ASD at 5-6 years encounter challenges associated with giving their children the required attention (Autism and Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators & Centers for Disease Control and Prevention (CDC), 2014). Therefore, children encounter problems in receiving play therapy through the behavioral health services in the urban residential areas. This study aims at determining the experiences that the parents of the African American children with the ASD condition face in receiving play therapy in urban settings. Thus, the results of the study will present information about the current situation among the African Americans in dealing with ASD as a way to aid in implementing strategies to improve the current experiences.

Literature Gap

There is a limited amount literature addressing the issue of racial or ethnic differences regarding the ASD condition in the United States. In most cases, researchers have focused on the average age for ASD diagnosis. However, in the recent past, there has been a concern on the issue of autism and how it affects the life experiences of the parents and families among various races in the country. Particularly, there has been insufficient research addressing the experience of the African American parents as they attend children suffering from autism in the urban areas. Although different studies showcase the cultural differences in diagnosis as well as the treatment and management of ASD, many researchers have not yet shifted their attention to the black community’s experience in seeking healthcare services for the treatment and management of the condition. According to Pearson and Meadan (2018), many African American parents encounter challenges associated with finances, social connection, delayed decisions, and cultural differences as they engage in looking for solution and support for their children. Lovelace, Tamayo, and Robertson (2018) focused on the experiences faced by African American mothers of sons with ASD. Numerous studies display concern on the issue of ASD among races in the U.S. Therefore, this study aims at exploring the issue by examining the actual experience of African American parents in the urban setting.

Literature Review

A child with autism spectrum disorder (ASD) causes issues that have significant impact on the family. The challenges increase with the delay in diagnosis as the complications associated with the conditions intensify. In the U.S., ASD diagnosis is relatively equal to the same number of autism cases being reported among all the races. However, African Americans also encounter issues associated with diagnosis and treatment due to socio-economic challenges (Parks, 2017). Particularly, the African American children receive diagnosis two years later as compared to those of the white people. Most of the challenges arise as a result of delayed decision to seek diagnosis, cultural differences, lack of resources, and poor social connections (Parks, 2017).

According to Zuckerman, Lindly, Bethell, and Kuhlthau (2014), the presence of an autistic child in a family leads to serious impacts on the health, experiences, and wellbeing of other members of the family. According to Pearson and Meadan (2018), autistic children’s parents spend most of their time finding out answers from professionals and physicians regarding the condition and the possibility of a practical solution to help their children. Consequently, parents undergo a period associated with stress and uncertainty about the future of their children as well as their families (Pearson & Meadan, 2018). Parents engage in looking for answers about the intensity of the condition, duration of assessment or treatment, and the predictability of the results of treatment. Such experiences are challenging to parents as they shift the focus from their occupations and families into caring for the specific child with the ASD condition (Lovelace, Tamayo, & Robertson, 2018). At the same time, parents encounter problems while trying to find the adequate health services and therapists to help their children manage the condition (Pearson & Meadan, 2018). For the African American parents, such experiences together with the socio-economic challenges result in impeded processes in finding solutions for their children (Zuckerman et al., 2014). With the rate of autism occurrence being similar across all the races (at 1 in every 500 children), there are difficulties among the parents who are socio-economically unstable (Lovelace, Tamayo, & Robertson, 2018). According to Lovelace, Tamayo, and Robertson (2018), some African American parents and families are affected by their perception towards their encounters in the United States such as socio-economic instability, racism, discrimination, and unequal distribution of resources. As a result, the individual judgments add on to their challenges and problems in finding solutions for their children with developmental disabilities associated with communication and cognition (Lovelace, Tamayo, & Robertson, 2018), which delays the assessment activities such as diagnosis and appropriate recommendations. Some of the perceptions with the parents and families of color affect their ability to find professional physicians and therapists with empathy, trustworthiness, and competency to manage their situation effectively (Lovelace, Tamayo, & Robertson, 2018). At the same time, the history of challenges that the African American people face while seeking services for mental health may also affect the experience in attending to their children with ASD and finding the appropriate health services for them (Lovelace, Tamayo, & Robertson, 2018). African American parents may feel that the discrimination and racism that occurred in their experience will also replicate in the case of their children and therefore, the services will not be beneficial to their children (Longtin & Principe, 2016). In evaluating their decisions and ideas, parents may impede the process of connecting their children with therapies and mental health services. The delay in time translates into the severity of the symptoms and more complications.

As a result, the diagnosis of African American children may take place later as compared to white children. According to Abramov (2017), African American children require more detailed and intensive approach or intervention in diagnosis and detectio

STIs are prevalent in young adults of ages 15 – 24 with gonorrhea rates being twice as high as compared to young adults above the ageof 25 in Florida (http://www.floridaheath.gov/diseases-and-conditions/sexually-transmitted-diseases/). Research and studies have indicated this fact is related to behavioral activities among the group. The adventurous attitude among the young adults of this age group prevents them from placing importance to the available information about STI and HIV/AIDS. Further analysis of the situation has shown that out of 3 reported cases of STIs in Florida, 2 were under the age of 25. Additionally, having an STI increases the chances of an individual acquiring HIV (http://bmb.oxfordjournals.org/content/58/1/129.full). Irrespective of whether the STI was treated properly with subsequent follow ups to ensure its clearance, an individual still has a higher chance of getting infected to HIV compared to individuals who have never had an STI. According to World Health Organization (WHO) seeking strategies of managing STIs have been known to reduce HIV infection by 40%; therefore, as a strategy to reduce new infections in Florida stakeholders should focus on managing STIs.

            The correlation between STIs and the high infection rates of HIV has played a major role in the high rates of HIV infections in Florida. In thirty-three reported cases of STIs in the general Florida’s population one also has HIV; this shows that there is a large number of people that have both other STIs and HIV at the same time. According to Mete et al. (2008), stakeholders in the medical industry should focus on the risky sexual behaviors that a majority of young adults exhibit. Fortunately, there is adequate information available for the youth on the subject and ways of increasing personal responsibility should be assessed.

 

Annotated Bibliography

Ashton-Chess, J. M. & Spolders, H. & Fert, V. (2011). Market access challenges in the EU for high medical value diagnostic tests. Future Medicine. 2011(82): 77 -111.

            The article focuses on the diagnostic equipment that is expensive. Investors are not getting returns for their investments. Therefore, for people with limited resources the equipment is out their reach. The equipment is only accessible to a few affluent people.

Bloom, E. D., Cafiero, E. & Jane-Llopis, E. (2012). The Global Economic Burden of Non-Communicable Diseases. Economic Literature: PGDA Working Progress.

            The main argument in the article is the responsibility policy makers have in reducing poverty and equally distributing resources. Non-Communicable Diseases are a real threat that requires the attention of the relevant stakeholders as they prevent productive people from being part of communities.

Brundisini, F., Giacomini, M., DeJean, D. & Vanstone, M. (2013). Chronic Disease Patients’ Experiences with Accessing Health Care in Rural and Remote Areas: A Systematic Review and Qualitive Meta-Synthesis. Ontario Health Technology Assessment Series. 13(15): 1- 13.

            People with chronic diseases are vulnerable and the situation is worse is they live in the rural areas. The article focuses on the challenges these vulnerable people face while living in te rural areas and the strategies that could improve their situation.

Capolongo, S., Bottero, C. M., Lettieri, E. & Buffoli, M. (2015). Healthcare Sustainability Challenge. Improving Sustainability During Hospital Design and Operation. 1- 19.

            The main focus in the article is the impacts of the energy invested in healthcare. Financial burdens are some of the impacts that have negatively affected the lives of people. Re-designing policies of significant important to the issue as it has the potential of leading to solutions.

Coovadia, H., Jewkes, R. & Barron, P. (2009). The health and health system of South Africa: historical roots of current public health challenges. The Lancet. 374(9692): 817- 834.

            The authors of the article focus on the impacts of poor leadership on the implementation of policies process. However, impacts of historical injustices have infiltrated modern world and prevented equal treatments in the medical industry. A complete overhaul of the leadership would salvage the situation.

Davies, A. A., Basten, A. & Frattini, C. (2009). Migration: A Social Determinant of Health of Migrants. International Organization for Migration: Assisting Migrants and Communities.

            The basis of the argument in the article is the challenges that immigrants face and the fact that the policy making processes should consider them. The barriers that the migrants face range from economic, social to cultural. However, the policies ought to consider them.

Faulkner, E., Annemans, L. & Helfand, M. (2012). Challenges in the Development and Reimbursement of Personalized Medicine-Payer and Manufacturer Perspectives and Implications for Health Economic and Outcomes Research. A Report of the ISPOR Personalized Medicine Special Interest Group. Journal of Value in Health. 15(8): 1162-1171.

            Economic gaps in the health perspectives of manufacturers and that of patients is due to the differences of the interest in the industry. The perspectives create a gap that requires a strategy that would marry the two attitudes and provide a unique union.

Foldes, E. M. & Covaci, A. (2011). Research on Roma health access to healthcare: State of the art and future challenges. International Journal of Public Health. 57(1):37-47.

            The article bases its conclusions from research conducted on the people of Roma as they experience poor health and unhealthy living conditions. The poor health experience of people in Roma is associated to economic and social determinants of the population.

Huseveau, D., Drummond, M., Petrou, S. & Carswell, C. (2013). Consolidates Health Economic Evaluation Reporting Standards (CHEERS) Statement. Cost Effective and Resource Allocation.

The CHEERS statement finds ways of bringing together evaluations from previously done reviews with current ones to produce a reliable guidance. The statement creates a clear picture of the issue on the ground on the matter of healthcare and this is the basis of the argument in the paper.

Idemyor, V. (2010). Diabetes in Sub-Saharan Africa: Healthcare Perspective Challenges and the Economic Burden of the Disease. Journal of the National Medical Association. 102(7): 650 – 663.

            The article focuses on the increasing rates of reported cases of diabetes in Sub-Saharan Africa. The causes are poor diets and inactivity. Unfortunately, the region is not equipped enough to handle the cases which has led to loss of lives and financial destruction of families.

Iriart, C., Franco, T. & Merhy, E. E. (2011). The creation of the health consumer: Challenges on the health sector regulation after managed care era. Globalization and Health. 7(2).

            The major issue in the article is challenges that regulatory agencies are facing in a bid to control the health sector. However, private pharmaceutical companies have transformed the industry as they have provided the relevant equipment and drug to handle the chronic illnesses.

Kim, Y. J., Farmer, P. & Porter, E. M. (2013). Redefining global health-care delivery. The Lancet. 382(9897): 1060 – 1069.

            The article suggests the use of a framework that will focus on the health-care delivery in the world. The framework focuses on the HIV/AIDs infections. Insistence is based on ensuring the available resources in form of manpower and major economies are appropriately used to ensure quality service provision.

Lopes, L. G., Souza, J. & Barrinos, C. (2013). Access to cancer medications in low-and middle-income countries. Nature Reviews Clinical Oncology. 10(2013): 314-322.

            Cancer patients in low and middle-income countries have no access to cancer treatments and do not benefit from the major breakthroughs in the treatment of the condition. The article highlights the pooling of resources strategies that has allowed patients from these countries to afford the treatments.

McKeary, M. & Newbold, B. (2010). Barriers to Care: The Challenges for Canadian Refugees and their Health Care Providers. Journal of Refugee Studies. 23(4):523 – 545.

            The medical challenges that refugees face while trying to access healthcare in the region are not covered by research. The article therefore provides insights that would increase the understanding of the challenges and play a role in finding a solution.

Notara, V., Koupidis, S. & Vaga, E. (2010). Economic crisis and challenges for the Greek healthcare system: the emergent role of nursing management. Journal of Nursing Management. 18(5): 501-514.

            The article focuses on the impacts of the economic crisis that prevented people from accessing proper healthcare. Additionally, there is a consideration of the healthcare strategies used to mitigate the issue and protect the needs of the people.

Perez-Escamilla, R. (2009). Health Care Access Among Latinos: Implications for Social and Health Care Reforms. Journal of Hispanic Higher Education. 69(184): 146 – 159.

            Research on the matter indicates that 34% of Latinos lack health covers. The issue prevents them from accessing healthcare an issue that leads to reduction in the quality of lives. The article highlights the challenges they face in a bid to acquire health services on an out-of-the-pocket basis.

Quinn, C. & Kumar, S. (2014). Health Inequalities and Infectious Diseases Epidemics: A Challenge for Global Health Security. Bio-security and Bioterrorism; Bio-defense Strategy  Practice and Science. 12(5): 0032.

            Poverty is one of the major reasons there are high number of people with lack of access to health care. The article offers solutions in the sense that consolidating financial and social reforms will increase people’s interest in seeking medical care.

Rechel, B., Mladvsky, P., Ingleby, D. & Mackenbach, P. J. (2013). Migration and health in an increasingly diverse Europe. The Lancet. 381(9872): 1073 – 1084.

            The conclusions in the article base the argument on the barriers migrants in Europe face while trying to access healthcare. The prior

Canadian population is comprised of a large number of immigrants. The Immigrants tend to in better health than the native population because of the rigour in carrying out the selection process for immigration. Only healthy applicants get Canadian  Citizenship.  However, many studies have shown that with the long match of time, the health of those immigrants and their families deteriorate significantly. Social exclusion causes the declining health of immigrants. This paper is therefore aimed at explaining how social exclusion has been a determinant on the health and wellbeing of immigrants and their families in Canada. The paper will go further and try to discuss on the various struggles that immigrants to Canada undergo as they try to find a home away from home, and provide a few examples of other determinants that affect immigrants to Canada other than social exclusion.

Social determinants of health, as defined by Chapman (2010) encompass the conditions in which a person is born, grows, stays, works, and becomes old, and which give direction to their health status. The World Health Organization formed the Commission on Social Determinants of Health (CSDH) in 2005 to collect evidence on measures to be taken to ensure equity in health and push for a global program to realise health equity. CSDH hypothesise social determinants of health concerning a recent consideration made by the social medical literature which views social determinant as a community role, and a factor affecting the health status of an individual. CSDH concludes that the poor condition of people and the social gradient existing in a county or community are caused by immediate and visible traits in the lives of the people. Alluding to CSDHs finding, the apparent differences in Canadian immigrants and the natives range from financial endowment whereby most immigrants are destitute job seekers to social variations in race, colour and language which leads to sidelining by society and suffering from the immigrants on the hands of the natives. Therefore, Social exclusion of immigrants to Canada forms the main point of discussion for this paper.

Social Exclusion and Health Outcomes

The detachment of immigrants from engaging in social institutions has been instrumental in deteriorating their health and wellbeing. Social isolation, psychological isolation and Economic segregating have been mention by Oxman‐Martinez et al. (2012) as agents of deteriorating healthcare and welfare of immigrants to Canada. Social isolation, which involves exclusion to marginalised areas leave immigrants with poor and crowded housing (Hiebert et al. 2005). According to Hiebert et al. (2005), some immigrants are discriminated in the housing department, or sent to deprived neighbourhoods with limited social resources and housing. Poor communities and poor housing increase the chances of poor health contributes further to seclusion and raises the risk of homelessness. The study by Oxman‐Martinez et al. (2012) also revealed that the general wellbeing of immigrant children, especially those of school going age is affected by social isolation. Isolation occurs both in school and out of school where peers seclude each other based on colour, origin and language. 

Psychological exclusion, according to Oxman‐Martinez et al. (2012) is caused by social exclusion. For instance, the report by Oxman‐Martinez et al. (2012) reveals that immigrant school going children are psychologically affected by perceiving their teachers treating them differently from the indigenous Canadian children. Regarding this, the report indicates that 74% of school going children responded in favour of the variable for feeling like strangers at school. Additionally, immigrant students reported being sidelined in groups and club participation. Perceived discriminatory behaviours, as presented in the research showed teacher treatment to students by the length of time stayed in Canada, ethnicity, level of education of the parents, and single parenthood. Besides, Immigrant parents alike face the same psychological discrimination. For instance, Armstrong (2012) reports that employers treat employees based on their race.

Attachment to the labour market is an indicator of full citizenship. However, Immigrants from Canada undergo Economic exclusion. Labour market exclusion takes the form of excessive recruitment of immigrants to low-income sectors and occupations of the economy, very low chances of employment in high-income sectors and professions, and high rates of unemployment and underemployment. According to Brown (2018), economic exclusion has born racialization of poverty which encompasses powerlessness, voicelessness, insecurity and vulnerability on the hands of the native Canadians. Brown (2018) defines the racialization of poverty as a process of increasing social exclusion of immigrant communities by ensuring disproportionate and persistent low pay among racial groups. Economic exclusion hurts the health of immigrants. Brown (2018) states that many racialised workers are forced to work where they face poor or sometimes hazardous working conditions that affect their health.

Struggles of Immigrants in finding a Home in Canada

The immigrants, as presented by a research conducted by Gingrich, and Lightman (2015) have shown outstanding effort in trying to lead comfortable lives in Canada. This struggle is both at the individual and the societal level. On an individual level, Gingrich, and Lightman (2015) reports a trend of immigrants holding multiple jobs. Unable to get well-paying jobs, immigrants opt to hold more than a single job to subsidise on the low pay. Besides, immigrants have embraced business entrepreneurship and self-employment. Unemployed immigrants or those unable to find better-paying jobs have involved themselves in businesses. An example exists in Ontario where immigrants dominate flea markets.

On a societal level, as presented by Gingrich, and Lightman (2015), immigrants have formed ethnic clusters. In the clusters, immigrants live close to members of their ethnic groups. Ethno- specific neighbourhoods enables immigrants to express their culture and speak in their native languages. Gingrich, and Lightman (2015) reports that in some instance, such as in Vaughn municipal, members of a similar ethnic group bought land, built houses and social amenities. Ethnic clusters, therefore, have served to improve on the wellbeing of the immigrants. Besides, Immigrants have formed ethnic specific organisations. These groups, as presented by Gingrich, and Lightman (2015) have been instrumental in fighting for the rights of the immigrants.

Other Determinants affecting Canadian Immigrant Health and Wellbeing

According to research conducted by Fuller-Thomson, Noack, and George (2011), Immigrant women are prone to more health issues and depression than men. Loss of family and friends is blamed for the occurrence, and because of women's tendency to developing strong bonds. The decline in health is attributed to age in the report. Fuller-Thomson, Noack, and George (2011) explain in the report that as people become old, their immunity goes down. Low immunity puts them at a higher risk of facing more ailments and chronic diseases. Additionally, Language is mentioned in the report as a factor for the decline in Immigrant health. The main effect of the language barrier is isolation which leads to loneliness and depression. Besides, access to healthcare centres may be curtailed by language barrier.

             Also mentioned is perceived discrimination which has both a direct and indirect effect on Canadian immigrants. Perceived bias within and outside health centres discourage people from using healthcare services. Income levels, as outlined in the report is associated with declining in mental health. Majority immigrants, as described in the report by Fuller-Thomson, Noack, and George (2011) are presented as optimists who are struggling to earn a bright future. When they experience low income, they are affected mentally and are prone to depression.

Conclusively, Knowledge about Social exclusion is essential to healthcare practitioners. Majority of the problems experienced by immigrants are health-related. Psychological, economic or social exclusion cause immigrant health issues. The complications range from diseases due to lack of proper housing, poor working conditions and sanitation, and depression due to mistreatment at the workplace and in society.  For instance, language barrier leads to lack of medical access, lack of cultural sensitivity in service delivery by health practitioners, systemic barriers to access healthcare service such as insurance cover needed for treatment, and inadequate funding for community health services. All the mentioned shortcomings in healthcare lead to a need for healthcare practitioners to show remorse, support and humane treatment to Immigrants. To further raise awareness on Social exclusion as a causative agent of ailments on Canadian Immigrants, I recommend for the healthcare providers to be in the forefront in pushing for changes in the treatment of Immigrants in healthcare centres because they know the implications that social exclusion has on the health of any human being. Therefore, I challenge healthcare practitioners to use the old saying, “Worry Kills” in advocating for the happiness and wellbeing of Immigrants to Canada.

 

Tuberculosis is a chronic debilitating disease that poses a high health risk to the healthcare workers and the community in general. In one of my nursing shifts, a 75-year-old African-American man presented at the out-patient clinic with a history of the night sweating, persistent productive cough for two weeks, and chest pains. On examination, he had swollen cervical lymph nodes. Imaging and laboratory findings showed that the patient was suffering from tuberculosis. On further investigation, the patient disclosed that he had been diagnosed with Diabetes Mellitus and has been on medication for five years.

Diabetes Mellitus is one of the chronic diseases that render a patient immune-compromised (Yan, Gao, Trinh & Grant, 2017). In elderly patients, lowered immunity increases the chances of contracting opportunistic infections that are hard to treat given the nature of medication and drug adherence required to clear the causative organism from the body. Precisely, elderly patients on oral diabetic drugs may fail to adhere to the stringent regimen administered for the treatment of Tuberculosis. Other physiologic alterations that result from Tuberculosis are acute renal failure, liver damage, and spinal diseases.

In renal injury, the dissemination of Mycobacterium tuberculosis may cause the fibrosis and calcification of kidney interstitium (Wagaskar et al., 2015). The damage of the kidney by the infection goes undetected for a long time, and it is only discovered when patients with pyuria fail to respond to conventional antibiotics (Wagaskar et al., 2015).  The colonization of the liver by the bacteria may also cause granuloma formation in the hepatocellular bed. Spinal tuberculosis is an everyday life threatening complication of Tuberculosis (Choi et al., 2015). In this condition, the bacteria colonization causes caseous necrosis of vertebral disc. If the disc tissue dies, the vertebra is narrowed, and the spinal cord is damaged through compression (De la Garza et al., 2015).

 

 

Today, type 2 diabetes is one of the killer disease terminating several lives across the globe. It typically comes as a result of the body either failing to use insulin to breakdown glucose in the blood or pancreases secreting insufficient insulin to assist the body breakdown glucose and starch.  In either case, breakdown glucose in the blood stream is disrupted thereby causing blood sugar levels to rise. Majorly, this condition is caused by poor eating habit, lack of exercise and polycystic ovarian infection in women. For that very reason, various treatment options have always been used to either stimulate pancreas to release more insulin or breakdown fats and calories in the blood stream. At present, there is no exact treatment for this condition. But doing regular exercise, eating healthy foods, using diabetes medication, administering insulin therapy and monitoring blood sugar levels has proven positive in patients with this condition (Marín-Peñalver, 2016). In this light, the paper discusses how each option works in managing type 2 symptoms.

According to a report by MFMER (2019), eating healthy foods is defined to be the most effective option for managing type 2 diabetes.  It simply means taking foods rich in fiber in moderate amounts as well as sticking to specific mealtimes. Example of foods rich in fiber include parts of plants which the body cannot digesting. In most cases, fiber is taken alongside other meals such as beans and oats to reduce their digestion. In other words, fiber is not digestible in the human’s body. Instead, it goes through stomach to the small intestine to the colon and finally out through the anus. Healthy diet, especially use of foods with high fiber contents in right amounts is good in reducing amount of glucose in the blood stream (MFMER, 2019). Because food passes through the digestive tract without being digested to completion. Thus reducing the chances of more glucose accumulating into blood stream to the point of causing the disorder. 

Another management option that works similar to eating healthy food is regular exercise. Exercise enables the body burn down fat and calories that might have accumulated in the blood stream. Mostly, people suffering from type 2 diabetes have too much glucose in their blood streams, either because glucose level is not controlled or pancreas is not stimulated to release enough insulin. In either case, exercise works effectively in reducing the amount of glucose in the blood stream (Marín-Peñalver, 2016). While doing exercise the body will demand for energy to support muscular movements such as stretching and relaxation of the joints. In which more of the glucose in the blood stream is the first source of energy. The glucose are broken down through the process of aerobic respiration to release energy in the form of ATP which can be easily absorbed into the muscles. In so doing, glucose in the blood stream is eliminated thus lowering the possibility of blood sugar levels increasing from normal rate to higher rates.

For effectiveness, eating healthy foods exercising regularly works much better when combined with diabetic medications that entails a wide range of drugs, administered orally or by injection, to stimulate insulin so it breaks down glucose. Some of these drugs include SGLT2 inhibitors, DPP-4 inhibiters and meglinitides, The SGLT2 inhibitors includes dapagliflozin, caagliflozin and empaglifozin; and they block kidney from absorbing sugar into the blood. Functionally, the kidney filters blood before sending it back to the heart.  In using the SGLT2 inhibitors, kidney gets blocked from filtering blood to enable sugar and waste pass out through the urine. In so doing, accumulation of glucose is tampered with such that most of the glucose comes out of the system in the urine. The DPP-4 inhibitors consist of oral hypoglycemic that works by blocking dipeptidyl prptidase-4 from destroying the hormone incretin.  Functionally, Incretins assists the body produce additional insulin when needed as well as decrease glucose coming from the liver when not needed. Therefore the DPP-4 inhibitors assists the body to either produce more insulin or decrease amount of glucose produce from the liver. In both cases, glucose is eliminated from the system thus reducing its accumulation in the blood stream (MFMER, 2019).

.           However, there are cases when proper dieting, physical exercise and other medications may fail to reduce the symptoms of type 2 diabetes. For instance, muscular complications in patients to the extent that absorption of regular human insulin becomes very slow. In such a case, there is need to introduce an artificial insulin into the body system through injection or by using an insulin pen (AAFP, 2018). The aim of introducing insulin is to maintain the blood sugar levels in a standard range as much as possible. In so doing, the body gets additional insulin that works directly on the blood surface to breakdown the accumulated glucose in the blood. In other word, the artificial insulin lowers the concentration of glucose just like the normal insulin produced in the pancreas. There are four types of artificial insulin dependent on their speed of action. The first set is rapid acting insulin such as insulin lispro, insulin glulisine and insulin aspart. They usually start working in about 15 minutes from the time they are taken and lasts for about 3-5 hours. The second set include short-acting insulin such as regular insulin. They often start working in about a half an hour to an hour from the time they are taken and can last for about 5-8 hours. The third set is intermediate-acting insulin such as insulin NHP and usually takes about 1-3 hours to start working. They are powerful and can last for about 12-16 hours. The fourth set is long-acting insulin such as insulin detemir and insulin glargine. In most cases, they take about 1 hour to start working and can last for about 20-26 hours. (AAFP, 2018)

            On balance, type 2 diabetes is a killer disease in today’s society caused by poor eating habits as well as lack of exercise. Although no exact medication has been established for this condition, several options has been used in the past and proven positive in minimizing symptoms related to type 2 diabetes. Among them are healthy eating, regular exercise, medications and insulin therapy. Regular exercise, healthy eating and medication use each works differently in helping the patient cope up with the disease in reducing symptoms associated with this condition. However, in complicated cases where reducing the glucose levels does not bring about any positive impact; insulin therapy is introduced. In which an artificial insulin is injected or adminstred into the body system to help control blood sugar levels.

 

 

 

Part A.

Description of the Healthcare Problem

Today, hepatitis C infection is one of the major problems in the healthcare sector claiming about 495,000 lives throughout the world (De Weggheleire, 2017).  In United States, about 75% of people with history of injections seems to be the most affected with this disease. The reason is because this infections is spread through coming into contact with contaminated blood. For instance, sharing of contaminated needles and unscreened bloods among hospitalized patients, thus, creates room for the virus to spread from one patient to another. In most cases, the infection is seen in patients who gets treatments related to blood transfusions as well as those that require injection. In a case where a patient contacts the disease, it affects his/her liver; and if not controlled in time, might leads to chronic diseases such as liver inflammation or liver cancer. For this very reason, it is very crucial for professionals in the healthcare sector to attend to these patients with a lot of professionalism. That is to say, they need to consider good hygiene and proper cleaning of all equipment in the hospitals as part of the daily routine. As a result, the number of patients suffering from hepatitis c virus infection will vastly reduce by a bigger percentage. In this study, hepatitis c viral infection will be discussed at length with focus on how to use safe injection to reduce its spread among hospitalized patients.

Significance of the Problem

Hepatitis C virus infection is a blood-borne problem that usually spreads following exposure to small quantities of contaminated bloods. It may happen where a patient is exposed to unsafe injection practices as well as transfusion of unscreened blood and other related products. In either case, it is evident that the equipment are contaminated and therefore justifying the need for using clean and safe injection apparatus. To mean, the syringes,  needles and all other apparatus used in blood related practices ought to be pure and free from any contamination, that would otherwise contaminated another patients system. By so doing, a higher percentage of blood transfused will be clean and free of virus that causes hepatitis c infection. As a result, the number of incidences relating to contaminated bloods among hospitalized patients, especially the hepatitis c infection, will reduce to almost zero percent.

Current Healthcare Practices Related To the Problem

Currently, unsafe injection is most common in blood transfusion and drug injection practices. The liver is a very important organ in the body since it helps the body synthesize plasma protein such as albumin and other clotting factors. It also helps in the activation of enzymes and secretion of bile. In a case where a patients is hospitalized because of hepatitis C infection, he/she is most likely to be added more blood or injected with drugs that would assists the liver to perform these duties. Because the infection affects the liver and therefore there is chances that the body could be deprived of these services. In either case, the person attending to the patient will most likely use a syringe, a needle and other related blood transfusion apparatus. If not safely used, that is to say, the apparatus used with some of them having contamination of bloods, then the patients are most likely to develop blood borne complications such as hepatitis c infection. The most likely to contribute to this are inadequacy of funds to purchase enough apparatus as well as job dissatisfaction. When the hospital is short of resources to buy more needles and syringes for each patients then there is likelihood that one syringe and one needle could be used to serve more than one customer. On the other side, when the professionals in the healthcare sector feels that they are not properly treated by the management team, there is likelihood that they will serve patients unprofessionally. For instance, putting into attention on the sanity of the apparatus they are using.  

How the Problem Affects the Organization and Patients’ Cultural Background

Consequently, the problem affects both the organization and the patient in different ways. In a case where a healthcare center is known of unsafe injection practice, several people would be scared of going for treatment therein. Ideally, people love to associate themselves with good things, especially good hospitals that they are sure will treat them professionally. Meaning, unsafe injection practices will portray some sort of unprofessionalism in the public domain so that many people will prefer getting medications elsewhere to the entity in question. Furthermore, other people would even move their hospitalized relatives from the entity to somewhere they believe would help their member(s) recover. As a result, the entity will experience a shortage of patients to treat thereby end up making less or no profits in the long run. Also, their reputations in the public domain will be vastly destroyed and be considered as a pool of unprofessional people who don’t understand what they are expected to do as per the standards of the healthcare system.

Part B

Literature Review

 Several studies ranging from research evidences to non-research evidences have discussed the issue of unsafe injection and how it related to the spread of hepatitis C infection among hospitalized patients. Using the google scholar search engine, a total of four studies will be reviewed. The first part consists of the research evidence studies and the second part consists of the two nonrearch evidence studies. To begin with, about 1.1 % of the world’s population which estimates to 80 million people suffer chronic conditions and about 495,000 deaths resulting from such conditions are associated with hepatitis C virus infection (De Weggheleire et al., 2017). Infact, the author claims that Cambodia alone has about 70,000 adults suffering the disease and about 82% of the 70,000 got the infection through unsafe injection. Similarly, Werb et al., (2016) argues that about 15.9 million people inject drugs on average across the globe. Out of this number, about three million end up with hepatitis C infection. The two studies share the fact that several people suffer hepatitis infection which is mostly caused by unsafe injection practices in the hospitals. On the other side, Culbert et al., (2015) argues that sharing of injection apparatus such as needles among prisoners led to more prisoners contacting the infection. Manns et al., (2017) explains further that hepatitis C infection affects the functioning of liver in an individual. Infact the authors claim that it unsafe drug injection and unsterilized medical apparatus can result into many people contacting the disease thus developing liver related complications.

Part C

Pico Question

 Each of the articles discussed relates to hepatitis C infection and how unsafe injection propel its spread among hospitalized patients. In this light, the study develops a PICO question: “can safe injection be used to reduce the spread of hepatitis c viral infection among hospitalized patients in a period of 6 months?”  In which P refers to the hospitalized patients, I refers to the intervention strategy which is safe injection. C refers to the comparison group which will be patients subjected to low standards of hygiene. Then lastly O which refers to the outcome and in this case the expected outcome will be a reduced incidence of hepatitis C infection.

Part D (attached separately).

Part E

Recommendation

            To this point, I think that safe injection can be used to reduce the prevalence of hepatitis C infection among hospitalized patients. Infact Dolan et al. (2016) holds that hepatitis c infection is common among prisoners since most of the time those who fall sick are treated with same injection apparatus. Out of 10.2 million prisoners, about 1546500 prisoners were suffering from hepatitis C infection. In other words, the author is saying that sharing of needles, syringes and other related add to the spread of these infection. In the same line of argument, Otiashvil et al. (2016) and Werb et al. (2016) agree that sharing of injection equipment such as needles and syringes are the chief causes of hepatitis c infection. In the two different studies, sharing of medical equipment, especially needles and syringes resulted into more people contacting the infection. For this very reason, the hospitals should make efforts to use sterilized medical apparatus and ensure that they screen every blood before it is transfused. According to Horyniak et al. (2017), practicing safer injection reduces the risk of putting pathogens related to hepatitis C infection into ones system. In their study, they found out that 95% of 576 people tested HCV negative following safer injection; which represents a bigger percentage of people benefiting from safe injection. Also, (De Weggheleire et al., 2017) support the idea of safer injection in reducing the prevalence of this infection. To them, safe injection works best irrespective of ART programs and therefore all people irrespective of their ages, should be given safe injections so to reduce the chances of spreading the infection. In their study, 157 patients developed hepatitis C infection following sharing of medical apparatus simply because they shared medical apparatus.

Stem cell research revolves around the process of extracting cells from a part of the human body (e.g., skin) and proceeding to transform them into other cell types, like those of the brain, heart, lungs, or muscles, etc. These cells can then be used for curing disease and developing therapies for health issues such as macular degeneration, heart disease, diabetes, etc. Although it was unthinkable a few decades ago, the use of stem cells is revolutionizing and opening up new avenues in medicinal research albeit it is still subject to ethical and moral issues (ResearchSEA). Human embryos constitute a source of stem cells, which has given rise to the ethical and moral controversies stem cell therapy and research has been subject to. There has indeed been a widespread agreement among the researchers that 'human embryo' deserves respect as it is a form of 'human life'. However, a consensus has not been reached regarding the type of respect that should be accorded (Childress). Consequently, scientists have resorted to alternate stem cell sources; one of them being induced pluripotent stem cells (IPC), which are programmed to act like stem cells (ResearchSEA). By obtaining stem cells from alternative sources the ethical issues can be bypassed, although it entails a greater research effort since the specific source of stems cells has to be determined in a case by case basis.

Nevertheless, stem cells have the unique capability of copying themselves and changing into any other type of cell. The capacity of differentiating themselves into any kind of cell is what grants stem cell therapy its enormous potential. For example, eventually, stem cells will allow for the development of human organs, thus reducing the pressure on organ donor supplies. Furthermore, these stem-cell derived organs would result in rejection-free transplants (ResearchSEA). Notably, this is only one of many cases in which stem cell therapy represents a major solution to the great health issues humanity faces, thus making research and advancement on this field of paramount importance in spite of the controversies this therapy may present.

In 1992, scientists created an entire mouse from stem cells in a petri dish as a way of showing that embryonic cells had the full potential of making every type of cell. The IPCs allowed scientists to continue research away from the controversy (ResearchSEA). Despite this, the use of stem cells in therapies is still not a simple issue.

Embryonic stem cells (ES), as well as adult stem cells, have both advantages and disadvantages related to their potential use in cell-based therapies.  These two stem cell types differ in the differentiated cell types they give rise to. Embryonic stem cells are inherently pluripotent being able to become any cell type; on the other hand, in the case of adult stem cells, there could be a degree of plasticity. While a large number of ES could be grown in culture, the same is not true for adult stem cells; and it is essential to note that for therapies, a large number of cells are required (Velasco I) and that stem cells derived from a donor usually risk transplant rejection. At present, there is ongoing research regarding the rejection ES; however, a conclusion has not yet been reached (Zoloth). Therefore, there is not a single source of stem cells, but several, each of which entails a different degree of controversy; some, like ES, being very controversial, and some that are devoid of any controversy.  These various stem cell sources are listed below along with their potential use as well as the moral and ethical aspects related to them for both research and therapies.

Stem cells sourced from embryos are created in vitro at an early stage. There is, however, controversy regarding this. A second source is through the vitro fertilization process (Hughes), which is still controversial but to a lesser degree. Bone marrow, blood, as well as adipose tissue are the sources for harvesting adult stem cells. Notwithstanding, the number of stem cells that can be collected from blood is low. A way of tackling this issue is the use of cytokines. Cytokines are peptides instrumental in stimulating blood cell growth, and can also be given to the patient in order to increase his/her circulating stem cells, thus allowing for larger quantities to be extracted. This process is referred to as stem cell mobilization. Stem cells have been collected from none marrow since the seventies (Saegusa).

The third source for adult stem cell harvesting is the adipose tissue, commonly known as fat tissue, which has the advantage of containing large numbers of stem cells. Liposuction is the primary method for collecting human adipose tissue-derived adult stem cells. Interestingly, some fat tissue-derived stem cells have multipotent activity (Zuk PA), and can then be easily reprogrammed into other cell types required for the concerned therapy, such as cartilage, muscle and even the bone cells (Fakruddin Md.).  This represents an incredible usage of these cells and promises to completely revolutionize medical treatment.

There are many potentials uses of stem cells as far as their therapeutic applications are concerned. One of these applications is integrative medicine which utilizes the stem cells for tissue generation capable of repairing a patient’s failing organs. The practice of integrative medicine carries the immense benefit of treating such diseases as well as curing them. This use of stem cells can actually be used in a vast span of regenerative medicinal applications and can be extremely beneficial in treating and curing a wide range of debilitating diseases (Barry FP). There are many types of such applications and are broadly classified below.

Stem cell research and the ensuing application in therapy tend to portend very well for people with heart-related issues. As an example, people who suffer from congestive heart failure have their heart muscle damaged and, as a result, the functional tissue in their heart gets replaced by non-functional scar tissue. This significantly reduces the heart's ability to contract properly. Muscle cells can be developed from ES and have a strong potential to replace the scar tissue in cardiac patients (Barry). This is an exciting application as it would not only be beneficial to heart patients throughout the world but would result in increasing the average lifespan as well.

            Insulin-dependent diabetes mellitus could be treated similarly. There are millions of diabetic patients around the world who are entirely dependent on daily insulin intake. These daily injections tend to tire the patient down and have a significant impact on the patient’s quality of life. Embryonic stem cells (ES) can be differentiated to insulin-secreting cells that can then be transferred to diabetic patients. Experiments have already been carried out on diabetic animals and have resulted in a fantastic restoration of glucose balance within just one week (Dor Y).  This augurs very well for the millions of people across the world who are forced to take daily insulin injections causing them to remain stressed due to such a prolonged and never-ending treatment.

            Remarkable results have been obtained in stem cell treatment of both mice and rats for Parkinson's disease, as well as spinal cord injuries. This entails a massive step towards the restoration of normal brain functions of patients afflicted by such debilitating issues. Transdifferentiated ES can reduce Parkinson’s disease in rats by at least four-fifths (Fallon J). Spinal injury treatment in rats is equally promising (Ramón-Cueto A). These neural functions are incredibly complicated to treat with such success in rats and portends very well for future research directed at curing human brain neural functions as well.

            Stem cells hold a high potential as far as trying to understand the development of complex organisms from a fertilized egg. The scientists are in fact able to follow the stem cell division process and observe how cells progress into their specialized stage which ends up with their differentiation to bone, brain, skin or other types of cells. This enables researchers to identify the signals as well as the mechanisms which either allow stem cells to replicate themselves or otherwise differentiate into specialized cell types. Scientists would also be able to study the process of how the development proceeds in the normal way (Davila JC).  These types of studies would have been impossible to conduct with such clarity in the absence of stem cell research and the resulting applications of this research on mammals.

The ability of the stem cells to replace damaged cells in a human body is already being brought to good use in the case of patients who have had extensive burns, as well as in the restoration of the blood system in patients who have leukemia or any other blood-related disorder. The same ability could be extrapolated in the future to replace human body cells that have been lost a result of potentially devastating diseases which at present are basically uncurable or have no sustainable cures. At present, tissues and organs are donated to replace the damaged ones, but, it is crucial to consider that the recipients might reject the donated organs and that the high demand of organs and their short supply has given rise to international organ trade which carries severe ethical and moral risks.

The stem cells hold the strong potential of being transformed into the required cell types and then used as tissues or full-fledged organs. Such transplantations wo