• Subject Code : PUBH6301
  • Subject Name : Nursing

Table of Contents

Question 1.

Question 2.

Question 3.

Question 4.


Chronic Disease and Injury Control - Question 1

Upstream policy associated with the issue related to lack of nutrition leads to chronic disease like obesity. It is very important to control obesity as it relates to further health complications like high BP, heat diseases, diabetes and other diseases. It is very much important to focus on the improvement of basic socio-economic structures so that obesity can be controlled. The upstream program of CHAMPS II allows the people to achieve their full health potential (Stewart, et al., 2001). These factors are overarching and are outside the individual's control. They do possess a significant amount of downing effects on an individual which are more proximal and are considered to be the determinants of public health like class sex gender and socio-cultural aspects. These upstream based particulars affect the mid and downstream of community life and also possess lasting and far-reaching effects on them (Salmond & Allread, 2019).

Midstream policy associated with the issue related to lack of nutrition leads to chronic disease conditions like obesity. Obesity is very much influenced by the physical environment of the patient. It refers to the aspect of the housing environment, the mentality of the patients to use the dietary plans, the means of transportation they opt to carry out their daily terms, and lastly the segregation of the obese people within a community. This also refers to some of the behavioral approaches like smoking, nutrition, aspect of physical activities as well as the indulgence of the instigating factors like mental and physiological tension, degrading socio-economic conditions, etc (Islam et al., 2020).

Downstream policy associated with the issue related to lack of nutrition of chronic disease conditions like obesity can also be a result of being obese or living in a community of obese. These describe the various aspects of the diseases (increased BP, being diabetic, and less of life expectancy rate), and the injuries (wearing out of hip and joint's, pain in lower pelvic joints, and frequent accidents due to this) caused by the obesity. The patient as described in this paper make some interventions and strategies (conducting Walking audits, manifestations of Walkable streets) in the direction of focusing on providing more equitable access in regards to the providing of care and associated services to mitigate these negative impacts of obesity on the community's health. The associated disadvantages refer to the public health-based downstream determinants capable of seeing them in the form of an outcome due to an up and midstream factors including the variables. These downstream determinants are easily mitigated or prevented by the individuals, like changed eating habits or reducing risk heart's risk (Liu et al., 2019).

Chronic Disease and Injury Control - Question 2

  1. This intervention helped in achieving the study goals associated with the program as it leads in the direction of an increase in physical activity. Personalized programs are instrumental in helping a patient in the direction of encouraging lifestyle changes. In the case of older adults, it can be effective as well as applicable in context to their health care sector within a community setting. This article is instrumental in examining the effectiveness of CHAMPS II (Community Healthy Activity Model Program) in context to the seniors. It is a lifestyle based program associated with a personal lifestyle based choices and the model promotes increased physical activity levels (Stewart, et al., 2001).
  2. Strengths were instrumental in including a randomized controlled design as well as helps in gaining of high-level of subject retention up to 95%. It is therefore attributed in the direction of attaining minimal subjective loss. In which the subjects did not require in the direction of participating in any physical activity. They were encouraged in the direction to conduct a complete physical assessment. Another point refers to the relatively higher enrolment rate associated with those who were eligible in 33 percent HMOs. This rate is instrumental in considering the attainment of high levels of information in comparison to other studies. These studies were known to use a population-based recruitment strategy with a mandatory one-year commitment. It is in the direction of completing a monthly form as well as requires quarterly assessments. Representing a wider age range from 65 years to 90 years it refers to all-inclusive eligibility criteria that are in context to the health aspects. Indeed, the people's proportion associated with various chronic diseases is approximately comparable in the direction of the older adult population's proportion. These features are instrumental in making this program suitable in context to older Americans (Stewart, et al., 2001).
  • The limitation of the CHAMPS II study is related to the sampling process. It did not include many minority participants (due in the direction of their limited representation in context to the local population). The study is conducted within a high-quality health care facility. It is, therefore, the program that may not be generalizable in the direction of more vulnerable populations (Stewart, et al., 2001).

Chronic Disease and Injury Control - Question 3

i) Obesity is a disease in which an excessive amount of body fat is accumulated in the body and leads to other complicated diseases. Reducing Obesity and its associated problems are very important. Improving the target behaviour is considered to be very important as the obesity-diseases' consequence includes the rise in BP and attracts other cardiovascular problems (heart attacks, strokes), even let to diabetes(type II). This is instrumental in the direction of increasing healthcare-related costs. Additional problems are created by excessive weight including their heart as well as blood vessels getting overloaded with fact concentrations. They also suffer from bone-joints issues like arthritis or those of other joint pain (lower back pain) (Chooi, Ding & Magkos, 2019).

ii) Obesity measurements are important and are measured by comparing their BMI with those of a healthy non-obese person. Deriving body mass index is easy, as one can divide the body weight by the height into their respective units of measurement (pounds, square inches) then need to multiply the result with 703.

Given Below are some examples:

<18.5 -Underweight

>18.5 to 24.9 -Normal

=25.0 or <29.9 -Overweight

30.0 or higher refers to Obesity

BMI reasonably measures body fat. On the other hand, they directly (BMI) measures the body fat, so in many muscular athletes possess a high BMI but don't have body fat in excess.

iii) Behavioural modification is important in the direction of improving this condition. One needs to exercise regularly, engage themselves in moderate to high-intensity activity for 150-300 minutes a week. Intense workouts include sprint, brisk walking as well as swimming. Moreover while preventing weight gain one needs to focus on maintaining a strict dietary regimen or a healthy-eating plan. This should include low-calorie intake with nutritious meals like fruits, vegetables, as well as whole grains with less sugar high glucose intake. Frequent weight monitoring can help people who are obese. People who monitor their weight are successful in managing weight as compared to the ones who do not. Monitoring regularly says weekly, can provide information in regards to the application's and programs apt working as well as help in the identification of weight gaining issues beforehand (Blüher, 2019).

Chronic Disease and Injury Control - Question 4

Walking audits systematically identifies barriers or challenges in the direction of walking within the community corridor. Cities as well as communities are instrumental in using audits in the direction of locating waking hazards as well as hardships of the generalized population. Walk audits develop communities in which the members participate in describing the application and creation procedure of a healthy living visionary with aspects like healthy and safe walkable passes on the streets. The streets that are fit for walking make this healthy living initiative of walkability with the communities as a beneficial behavioural aspect. This can help in the direction of allowing the kids to walk to and fro to their schools from their respective houses also contributing toward reduced traffic and pollution's congestion. Walk streets ensure road safety to te passers and let neighbours meet each other, and are instrumental in providing a pleasant place in context to physical activity, dog's roaming, or jogging. With peoples living in walker communities, they remain healthier as well as healthier with a normalized weight with reduced traffic and pollution issues and prevention of asthma rates (Ussery et al., 2019). 

A walk audit can bring positive changes in the community that leads to a safe-accessible, walking environment comfortably. Different reasons for a walk audit can occur and can be used in the direction of documenting on the reviews of a walkable route. It helps in the identification of walking barriers and increases community benefits within a community. It lets the community members from different walks of life discuss problems and find a solution by quantifying disparities. This helps in the assessment of different neighbourhoods within a walking environment and determines the easily fixable problems with needed improvements on board. This also includes funding assistance and hence requires a plan for its successful running. This project engages elected as well as appointed officials to find solutions to a problem like street renovation. This also helps in the direction of assessing the effects of improvements (Brookfield & Tilley, 2016).

References for Global Epidemiology and Pathogenesis

Blüher, M. (2019). Obesity: global epidemiology and pathogenesis. Nature Reviews Endocrinology15(5), 288-298.

Brookfield, K., & Tilley, S. (2016). Using virtual street audits to understand the walkability of older adults’ route choices by gender and age. International journal of environmental research and public health13(11), 1061.

Chooi, Y. C., Ding, C., & Magkos, F. (2019). The epidemiology of obesity. Metabolism92, 6-10.

Islam, A. R. M. T., Hasanuzzaman, M., Islam, H. T., Mia, M. U., Khan, R., Habib, M. A., ... & Rashidc, M. B. (2020). Quantifying Source Apportionment, Co-occurrence, and Ecotoxicological Risk of Metals from Upstream, Lower Midstream, and Downstream River Segments, Bangladesh. Environmental toxicology and chemistry.

Liu, J., Li, N., Zhang, W., Wei, X., Tsang, D. C., Sun, Y., ... & Hou, L. (2019). Thallium contamination in farmlands and common vegetables in a pyrite mining city and potential health risks. Environmental Pollution248, 906-915.

Salmond, S., & Allread, V. (2019). A population health approach to America's opioid epidemic. Orthopedic nursing38(2), 95.

Stewart, A. L., Verboncoeur, C. J., McLellan, B. Y., Gillis, D. E., Rush, S., Mills, K. M., ... & Bortz, W. M. (2001). Physical activity outcomes of CHAMPS II: a physical activity promotion program for older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences56(8), M465-M470.

Ussery, E. N., Omura, J. D., Paul, P., Orr, J., Spoon, C., Geremia, C., & Carlson, S. A. (2019). Sampling methodology and reliability of a representative walkability audit. Journal of Transport & Health12, 75-85.

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