Friday, October 11, 2019
Basic Life Support Essay
Basic Life Support or BLS is that level of medical care for those in a life-threatening situation until the arrival of proper medical care. BLS can be provided either by emergency medical personnel, trained medical professionals or by laymen trained in BLS. The techniques in BLS are mainly focused on airway maintenance, breathing and circulation. Use of automated external fibrillator or AED for defibrillation is a recent advance in BLS and has resulted in improved cardiac survival in cardiac arrest cases. This new intervention is important because majority of the deaths in cardiac arrest cases are due to ventricular fibrillation which can be reverted using a defibrillator in the electrical phase of ventricular fibrillation. Thus, basic life support consists of chest compressions and ventilations and also early defibrillation. Advanced Life Support or ALS is that form of medical care prior to reaching hospital and which can be delivered only by trained medical personnel or paramedics. This form of medical care involves many invasive and non-invasive procedures like transcutaneous pacing, intravenous cannulation, cardiac monitoring cardiac defibrillation, intraosseous infusion, needle or surgical cricothyrotomy, , advanced medications through enteral and parenteral routes and endotracheal intubation. Whether BLS or ALS is critical in improving outcomes in cardiac patients is a much debated topic. According to a multicentric controlled study conducted by Stiell et al (2004) on the benefits of advanced life support in out-of-hospital cardiac arrest patients, advanced life support interventions did not have any added advantage over basic life support. The study revealed that when compared to BLS with rapid defibrillation programs, ALS programs did not have any added benefits. The authors recommended that cardiopulmonary resuscitation by bystanders and rapid-defibrillation responses must be encouraged and should be a priority for EMS resources. The study concluded that though advanced life support increased the rate of admission to hospital significantly; the rate of survival did not improve, placing more importance on basic life support. In a recent study by Markel et al (2009), the authors aimed to study the outcomes in cardiac arrest patients after they were delivered with basic life support and advanced life support. Their study revealed that BLS-to-ALS survival was an important predictor of survival to hospital discharge. Every minute of decrease in the arrival of ALS following delivery of BLS was associated with 4% decrease in survival chances. The authors concluded that shorter BLS-to-ALS time is associated with increased survival chances and hence ALS interventions must be utilized for additional benefits. However, the researchers pressed the need for early CPR and defibrillation which is BLS. Different reports were produced by an old study by Bissell et al (1998). This study reviewed extensive literature pertaining to delivery of ALS and BLS to cardiac arrest patients. Of the 51 articles reviewed, eight articles reported that ALS was in no way better than BLS; seven reported that ALS was effective in some application and the remaining articles concluded that ALS was superior to BLS. The researchers concluded that ALS may be clinically superior to BLS in some patients with certain pathologies. Despite different clinical opinions, it can be said that BLS plays a critical role in the survival chances of a cardiac arrest patient. There are 2 reasons for such an impression. 1. Any bystander can provide BLS if he or she has received some amount of training in BLS. 2. Most of the cardiac arrest cases are due to ventricular fibrillation and defibrillation is ââ¬Å"the treatmentâ⬠for that condition Current studies being conducted into new methods, drugs and/or equipment being studied to improve cardiac survival. Over the past few decades, many new methods, drugs and interventions have been introduced to provide optimum support for patients with cardiac arrest so that the chances of survival are enhanced. Every year, newer approaches are coming up to provide the best possible care for cardiac patients. This article explores the recent trends in cardiopulmonary resuscitation of cardiac patients in a prehospital setting. Latest international guidelines for cardiopulmonary resuscitation have stressed the need uninterrupted cardiopulmonary resuscitation or CPR so that there is continuous delivery of adequate coronary artery perfusion pressure which is one of the key determinants for return of spontaneous circulation. To facilitate uninterrupted CPR, a new concept of ââ¬Å"hands onâ⬠defibrillation has been developed. Research has shown that when CPR is continued with gloved hands during defibrillation, there is absent or minimal shock to the resuscitator (Roppolo et al, 2009). According to the American Heart Association (2005), in children, the chest compressions must be provided at the rate of 100 per minute without any interruption for respiration. According to a study by Bobrow et al (2008), implementation of minimally interrupted cardiac resuscitation increases the survival-to-hospital discharge in those who suffered cardiac arrest out of the hospital. A recent research proved that ââ¬Ënoise reductionââ¬â¢ automated external defibrillator and cardiac monitoring analysis can allow certain advanced devices to distinguish a CPR infarct from V-fib (Roppolo et al, 2009). Another new approach aimed at cardiac survival is the cardiocerebral resuscitation or CCR. This method is mainly composed of 3 aspects: continuous chest compression by bystander, new EMS algorithm and vigorous post-resuscitation care. There is no mouth-to-mouth breathing in this approach. The approach also favours defibrillation, either in the early or late stages (Ewy and Kern, 2009). Recently an automated, load-distributing band chest compression device has been introduced for cardiac resuscitation in a prehospital setting. Ong et al (2006) compared the outcomes of resuscitation between manual and automated cardiac resuscitation. Their study concluded that automated cardiac resuscitation use by EMS is associated with better outcomes. The previous decade has seen much research in the combined use of active compression decompression CPR and impedance threshold device. Frascone et al (2004) reviewed literature pertaining to this emerging therapy. The authors concluded that use of this new technology should be encouraged as this combination therapy provided optimum vital organ blood flow. References American Heart Association. (2005). 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life support. Pediatrics, 117(5), e989-1004. Bobrow, B. J. , Clark, L. L. , and Ewy, G. A. (2008). Minimally interrupted cardiac resuscitation by emergency medical services for out-of-hospital cardiac arrest. JAMA, 299(10), 1158-65. Bissell, R. A. , Eslinger, D. G. , and Zimmerman, L. (1998). The Efficacy of Advanced Life Support: A Review of the Literature. Prehospital and Disaster Medicine, 13(1), 69- 79. Ewy, G. A. , and Kern, K. B. (2009). Recent advances in cardiopulmonary resuscitation: cardiocerebral resuscitation. J Am Coll Cardiol. , 53(2), 149-57. Frascone RJ, Bitz D, Lurie K. (2004). Combination of active compression decompression cardiopulmonary resuscitation and the inspiratory impedance threshold device: state of the art. Curr Opin Crit Care, 10(3), 193-201. Markel, D. T. , Gold, L. S. , Farenbuch, C. E. , and Eisenberg, M. S. (2009). Prompt Advanced Life Support Improves Survival from Ventricular Fibrillation. Prehospital Emergency care, 13(3), 329- 334. Ong, M. E. , Ornato, J. P. , Edwards, D. P. (2006). Use of an automated, load-distributing band chest compression device for out-of-hospital cardiac arrest resuscitation. JAMA, 295(22), 2629-37. Roppolo, L. P. , Wigginton, J. G. , and Pepe, P. E. (2009). Minerva Anesthesiol, 75301-5. Stiell, I. G. , Wells, G. A. , and Field, B. (2004). Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest. The New England Journal of Medicine, 351, 647- 656. Appendix Please download articles from these links provided: http://www. ncbi. nlm. nih. gov/pubmed/16651298? ordinalpos=1&itool=EntrezSystem2. PEntrez. Pubmed. Pubmed_ResultsPanel. Pubmed_DiscoveryPanel. Pubmed_Discovery_RA&linkpos=5&log$=relatedarticles&logdbfrom=pubmed
Thursday, October 10, 2019
Developing a Coordinated School Health Approach to Child Obesity Prevention Essay
Introduction Obesity is now become an epidemic among school going young adolescence in developed countries. The prevalence rate of childhood obesity is considerably high in developed countries. Similarly, prevalence rate of obesity is increasing in developing countries too (James 2004). It is estimated that there are 250 million adult obese people live worldwide (Seidell 1999). Obesity is associated with many chronic diseases like hypertension, heart diseases, diabetes type 2 and even cause cancer. So, increase prevalence of obesity means increase global burden of chronic diseases which indirectly affects the status of global economy. Obesity caused about 9% of total annual medical expenditure in the US in 1998 (Finkelstein, Fiebelkorn and Wang 2003). According to Ogden et al. (2006), 19% of children aged 6 to 11 years are obese and 18% are overweight in the US. Given the wide array of devastating health, social and economic consequences of obesity, the continuing escalating rates of childhood ob esity, not least among rural dwellers in the USA, is a great public health concern. Consequently, lot of attention has been paid to the need for effective preventions programmes. Of such programmes is ââ¬Å"Winning with Wellnessâ⬠programme in Appalachia- a rural area in the US. Based on the evaluation report of the programme by Schetzina et al (2009), this paper reviews activities, approach, framework and theories of the programme. ââ¬ËWinning with Wellnessââ¬â¢ Programme The school-based health programme ââ¬Å"Winning with Wellnessâ⬠was introduced as a pilot project in an elementary school in rural Appalachia as a way to promote healthy eating and physical activity for elementary school children (Schetzina et al. 2009). The programme was based upon the coordinated school health (CSH) approach that was developed in 1988 (TN Gov 2010). The aim of the pilot programme was to prevent obesity which is a major problem, particularly in rural areas in the US (Schetzina et al. 2009). The programme was supported financially by community collation and it was implemented together with the school based programme in Tennessee (TN Gov 2010). There are eight different components to improve the lifestyle of students and their families: health education; health services; counselling, psychological and social services; nutrition; physical education; school staff wellness; healthy school environment, and student, parents and community involvement (CDC 2008). The s chool authority established indoor and outdoor walking trails to enhance physical activity among students. Teachers received a training to guide the students properly in such physical activity. A proper nutrition service to promote healthy eating among students was installed such that a registered dietician was assigned to develop ââ¬ËGo, Slow and Whoaââ¬â¢ programme which categorized the foods according to their nutritional value and advised the school food service coordinator to supply light diets. Teachers were responsible to provide information about the ââ¬ËGo, slow and Whoaââ¬â¢ to students to improve their knowledge about nutritional value of the food and this kind of lesson enable a student to identify healthy and unhealthy diet. School administration also encouraged parents to help their children to choose the healthy diet during lunch in school or at home. Besides students, this health promotion intervention also advocated teachers and staffs to lead a healthy life by increasing physical exercise and taking healthy diet. A counselling and psychological service was available to develop personal skill among the students about physical exercise and active lifestyle. This health promotion intervention maintained all kind of ethical issues such as consent were taken from both students and parents to participate into this pilot project (Schetzina et al. 2009). Third and fourth graders participated in the programme, in total 114 children. Model As stated before in the evaluation report by Schetzina et al. (2009) ââ¬ËWinning with Wellnessââ¬â¢ Programme was based on the Co-ordinated School Health (CSH) model. The latter was based on the traditional three-component model, where a school health program is defined in terms of health instruction, health services, and a healthful environment. This model was expanded and eight essential components were suggested: nutrition services, health education, physical, education, school health services, counselling and psychological services, healthy school environment, health promotion for school staff and participation of community. Diane Allensworth and Lloyd Kolbe first proposed a health promotion model for school health in a professional literature in 1987 which is now known as Coordinated School Health (CSH) model (CDC 2008). This model placed emphasis on creating supportive environments for students by different measures and the new version has been used and adopted in many health prevention programmes (Schetzina et al. 2009). The CSH model is not based upon the Tannahill Model of Health Promotion where health promotion is defined in terms of health education, health protection, and ill-health prevention. Similarly, CSH model is not based upon the Tones Model of Health Promotion which considers empowerment as the main theme of health promotion practice. According to the Ottawa Charter for Health Promotion (WHO 1986), health promotion strategies should be adapted to the local needs, although there are similarities with the CSH, this approach was not based upon the Ottawa Charter. The CSH offered a way to change the school and ideas were explored and altern ative solutions and approaches could be examined in the classroom. Teachers understood and examined the realities of childrenââ¬â¢ circumstances and choices and the understanding provided a change to bring and implement better choices for the children. Approach According to Schetzina et al. (2009), community-based participatory research (CPBR) approach was used in ââ¬ËWinning with Wellnessââ¬â¢ health promotion programme. CBPR is a collaborative approach and this approach is now seen as an alternative to the traditional research approach (Tandon et al. 2007). In this programme, a collaboration of teachers, health care providers, parents, community members and researchers was established to make the following obesity prevention programme effective and evaluate outcome of the programme precisely (Schetzina et al. 2009). Some researchers suggest that in rural areas, parents and community involvement in an important element in an obesity intervention (Hawley, Beckman and Bishop 2006) because of scarcity of resources for health promotion in rural elementary schools (Nelson et al. 2006). To compensate the shortness of healthcare facilities, it is obviously a good decision to choose CPBR which ensures multiple level of influence from individ ual behaviours to family settings, local community and health care services to decrease rate of overweight and obesity among children (Filbert et al. 2009). The approach of this school health promotion encourages children into taking action, and it brings materials and information into the classroom (Collins et al. 2002). The idea of involving parents, families, and school is described as a way of increasing the commitment and ensuring positive educational and health outcomes (TN Gov 2010). Approaches that use several different strategies and include several different people are more successful than an approach that relies on health information and instruction (Collins et al. 2002). The approach created a new cultural norm where healthy and physical activity was promoted and encouraged. The approach also included many different people and resources. The approach opened up ways for new ideas about how to make health promotion a part of changes in school and improvements in the school environment (Veugelers and Fitzgerald 2005). Furthermore, it lowered the risk for chronic disease in adulthood, and helped to promote healthy behaviour that might lead to life-long habits. This health approach can also reduce absenteeism, reduce classroom behaviour problems, improve performance, and prepare students to be productive members of the community (TN Gov 2008). In addition, the approach supports teacher and staff to improve their health and act as role models for the children. However, such kind of programme requires extensive planning and funding and cannot be considered as a short-term approach (TN Gov 2010). Moreover, the success of a school-based programme relies on the cooperation and positive attitude of several groups of professional, as well as parental involvement in the ââ¬ËWinning with Wellnessââ¬â¢. Programme was more expensive when compared to health promotion programmes that solely focus on health information and instruction (Schetzina et al. 2009). However, changes are not easy to achieve and there is no simple formula. The approach might need to be adapted and changed to suit the needs of specific commun ities (Summerbell et al. 2005). Though this approach has many advantages, it takes longer to implement in new schools, and preparations are needed in order for the approach to be successful in new areas. Theory A theoretical framework helps an individual to focus and clarify intentions and desires with a certain health promotion approach (Naidoo and Wills 2000). Furthermore, a theoretical framework offers a foundation upon which to explain the approach and the benefits that can be expected from a certain approach. Theory of Planned Behaviour (TBP) was used in this programme (Schetzina et al. 2009). This theory is often used to predict positive health behaviours, and it is based on cognitive processing and level of behaviour change. The TBP is used for assessing factors influencing behavioural motivation and action that may be used to exploring and predicting intention related to diet (Conner et al. 2003). Analysis of factors related to beliefs underlying diet and health choices can be examined, and the model can be used for explaining human behaviour (Ajzen and Fishbein 2005). Three different predictors of health behaviour are used: attitude, subjective norm, and perceived behavioural control (Nejad, Wertheim and Greenwood 2005). Health behaviours are influenced by the individualsââ¬â¢ personal emotion and affect-laden nature; however, a weakness of the TBP theory is that it does not take emotions into account (Dutta-Bergman 2005). Nevertheless, the TBP can be used to understand p eopleââ¬â¢s volitional behaviour, and it can explain the relationship between behavioural intention and actual behaviour. Furthermore, it has improved the predictability of exercises and diet (Baranowski et al. 2003). The theory also takes into account the individualââ¬â¢s social behaviour by considering social norm. Research suggests that this theory is good at explaining intention, and perceived behavioural control (Godin and Kok 1996). Critical analysis of the programme: Traditionally, school-health approaches have focused on knowledge rather than attitudes and skills (Naidoo and Wills 2000). The co-ordinated school health approach challenges the view that pupils will change their behaviour when they have information and knowledge. The CSH works on several different levels in order to promote physical activity and healthy eating (TN Gov 2010). The CSH approach is an ongoing process and the success relies on successful communication between the different groups, professionals, and individuals involved in the programme. A common goal and vision is important and the responsibilities and accountability are shared between the participating groups (Fetro 2005). Even though the groups may support each other, they also function independently. The question is whether a school-based health programmes ââ¬Å"go beyond the intended function of schoolsâ⬠(Miller 2003 p.7). It could be argued that knowledge about health lays the foundation for successful schooling (Miller 2003). However, introducing more programmes into the curriculum is always difficult and schools often have problems to link and include health services and the community in their programmes (Miller 2003). The co-ordinator has the ultimate responsibility for implementing the CSH approach, and it is not recommended that this position is held by the school nurse, unless there is a small school system (TN Gov 2010). A school nurse provides an important link between school, home and the community, and he/she also provides counselling to the pupils. However, the co-ordinator has a wide range of responsibilities: liaison; facilitator; partnership-builder; data collector; report writer; public awareness developer; advocate, information sharer, and overall school system organiser (TN Gov 2010). The co-ordinator develops healthy school teams, and facilitates a system-wide school advisory council. Thus, the responsibility for the successful implementation lies mostly on the co-ordinator. The school nurse is responsible for assessment, planning, and direct care of the children. In addition, the co-ordination between the school and community health care professionals ensures early intervention. The idea is that the health education is implemented into the daily school life, and the education is provided by health educators, teacher, school counsellors, school nurse, dieticians, and community health professionals. During the school years the foundation for lifelong habits are laid, and it is crucial to help children develop healthy habits (Lynagh, Schofield and Sanson-Fisher 1997). An advantage with using school based health approaches is that existing structures and systems are already in place (Miller 2003). Schools have a curriculum into which a health programme can be implemented. Furthermore, using existing structures are cost effective and schools have also been screened for acceptability. Moreover, a school based approach reaches the staff and the people working at school. Teachers and staff may change their own behaviour and become more aware of their eating and exercise habit. School based approaches reach all children in society and the approach can be targeted at specific minority populations. The nutrient programme is developed in the school; consequently, changes can be implemented when the children, teacher and their families are ready and motivated for the change. Policies regarding vending machines, the food and drink children bring to school, can be discussed and evaluated together with the co-ordinator, nurse, and school board (NICE 2006). Advice and care should be non-discriminatory and culturally appropriate, and the character of the CSH approach allows for schools and communities to implement approaches that are adapted to students with disabilities and from ethnic minorities (Naidoo and Wills 2000). Physical education and fitness activities are planned according to the national curriculum (TN Gov 2010). A recent report suggests that more time spent on physical activity does not impair academic attainment (Murray et al. 2007). The CSH approach is flexible in the sense that more physical activity can be added without changing the curriculum, for example, lunch or morning activities (TN Gov 2010). The role of parents and community is to be involved, and school administrator teachers and school health staff actively try to involve the family in the health promotion (TN Gov 2010). The CSH approaches were developed to be a long-term approach where funding was guaranteed (Warwick, Mooney and Oliver 2009). In some cases it may be difficult to receive funding especially since the success of the programme is difficult to evaluate, partly because there are a wide range of programmes and ways to implement the CSH approach (Warwick, Mooney and Oliver 2009). Teachers could be considered as weak link in the programme; however, research suggests that teachers often support programmes (TN Gov 2010). There might be conflicting interest, and teachers who play a vital role in a school-based health promotion programme, may focus on knowledge that can be gained from including health in the curriculum. In contrast, the school nurse may emphasise reducing health risks associated with overweight and obesity (St Leger et al. 2007). Thus, the approach relies on the co-ordinator, head teachers, and the school to identify and agree on the most useful and fruitful outcomes for their programme (Warwick, Mooney and Oliver 2009). There are likely to be variations in programme implementation; every co-ordinator works together with the school and different solutions to reach the goal may be used (Warwick, Mooney and Oliver 2009). Although, a flexible approach has its advantages it can also mean that some schools may integrate concern for health widely across the curriculum, whereas other may choose to focus on specific health issues. As a consequence it is difficult to evaluate the success of the programme. The strength of the approach is that every school has different programmes and services and the solutions and approach are developed to suit a specific school or area. A school can examine their specific needs and resources, although, many programmes are related to the eight components. The full benefit of the CSH approach is perhaps not possible unless you also involve parents (Veugelers and Fitzgerald, 2005). Choices and activities after school influence a childââ¬â¢s chances of becoming obese, and a healthy lifestyle may be difficult for children to change the food and beverage intake at home. Furthermore, if the family is not physically active it may be difficult for children to change the pattern. However, here BMI Index was used as the measurement of obesit y of students. There are several problems related to BMI and some of these could be related to the received result in the programme. There are several limitations with the use of BMI index and the index is sometimes combined with a measurement of the waist circumference. The index does not measure fat itself and it does not take into account the skeletal size, amount of body water or muscle mass (EUPHIX 2009). Moreover, the measurement does not reflect body changes when a person is changing his or her height over time. Thus, the index underestimates the degree of overweight in short children and overestimates overweight in tall children. Considering that the programme involved young children it would have been preferable to use some more measurement to examine any changes in body fat percentage. The location of the fat is important, and the children might have lost fat around the waist and gained in muscle strength, which would have an effect on the body fat percentage (BNET UK 2010 ). Recommendations: There are several advantages with using the CSH model to health promotion. This model provides a wide range of opportunities for children to learn and experience healthy lifestyle choice and activities by concentrating and integrating a wide range of people and resources both inside and outside the classroom (TN Gov 2010). This type of studies needs to be combined with studies exploring what choices children makes after the school day. By limiting the intervention and evaluation of the approach to the school day, it is difficult to first of all evaluate the program, but also to determine the best strategies towards helping children. It is possible the children compensated the healthier choices with an increase in unhealthy behaviours after school. A review of health programmes suggests that the most effective programmes involve parents (Oââ¬â¢Dea 1993). Working together with parents to promote healthy food choices at school is not always easy; however, it is vital to include parents and many parents pack their children school lunches (KidsHealth 2010). Furthermore, there are problems linked to promoting physical activity with children walking to and from school as parents are reluctant to let their children walk and play outside after school. Conclusion: Health promotion deals with ââ¬Å"raising the health status of individuals and communitiesâ⬠(Ewles and Simnett 2003 p. 23). However, it is often used to refer to planned activities or programmes (Tones and Tilford 2001). This programme was based on theory of planned behaviour, Co-ordinated School health model, and school-setting approach. The programme provided a way to help children to make healthier lifestyle choices, and the children in the study changed some of their choices related to food. They were also more physically active. The CSH model provided a framework for the school health programme in rural Appalachia and the results suggests that this may be valuable. In addition, the approach provides teacher and children with knowledge that can be used to change the school and ideas can be explored and alternative solutions and approaches can be examined in the classroom. Health promotion in school is one step in the right direction to solving problems related to the growt h of childhood obesity. A broad holistic approach is recommended which encourage physical, social, spiritual, mental, and emotional wellbeing of both children and the staff at school (LTS 2010). N.B.: TN Gov ââ¬â Tennessee Government CDC ââ¬â Centers for Disease Control and Prevention REFERENCES: Ajzen I, and Fishbein M (2005) The influence of attitudes on behaviour. In Albarracin D, Johnson B T, Zanna M P (Eds.) The handbook of attitudes pp. 173-222. Mahwah NJ: Lawrence Erlbaum Associates. Allensworth D D and Kolbe L J (1987) The comprehensive school health program: Exploring an expanded concept. Journal of School Health 57(10): 409ââ¬â411. Baranowski T, Cullen K W, Nicklas T, Thompson D and Baranowski J (2003) Are Current Health Behavioral Change Models Helpful in Guiding Prevention of Weight Gain Efforts? Obesity Research 11: 23ââ¬â43. BNET UK (2010) [online] Retrieved 15.07.2010 from: http://findarticles.com/p/articles/mi_m0846/is_2_24/ai_n6203894/ CDC (2008) Healthy Youth: Coordinated School Health Program [online] Retrieved 14.07.2010 from: http://www.cdc.gov/HealthyYouth/CSHP Collins J, Robin L, Wooley S, Fenley D, Hunt P, Taylor J, Haber D and Kolbe L (2002) ââ¬Å"Programs-that-work:â⬠CDCââ¬â¢s guide to effective programs that reduce health risk behaviour of youth. Journal of School Health 72(3): 93-99. Conner M, Kirk S F, Cade J E and Barrett J H (2003) Environmental influences: factors influencing a womanââ¬â¢s decision to use dietary supplements. Journal of Nutrition 133(6) 1978S-1982S. ââ¬Å½Dutta-Bergman M J (2004) Health attitudes, health cognitions, and health behaviors among Internet health information seekers: population-based survey. Journal of Medical Internet Research 6(2):e15 [online] Retrieved 15.07.2010 from: http://www.jmir.org/2004/2/e15/ EUPHIX (2009) Limitations of BMI as a measure of overweight and obesity [online] Retrieved 15.07.2010 from: http://www.euphix.org/object_document/o4852n27195.html Ewles L and Simnett I (2003) Promoting health: A practical guide. London: Baillià ¨re Tindall. Fetro J V (2005) Step by step to health-promoting schools: Program planning guide. Santa Cruz, CA: ETR Associates. Filbert E, Chesser A, Hawley S R and St. Romain T (2009) Community-Based Participatory Research in Developing an Obesity Intervention in a Rural County. Journal of Community Health Nursing, 26:35ââ¬â43 Finkelstein E A, Fiebelkorn I C and Wang G (2003) National medical spending attributable to overweight and obesity: how much, and whoââ¬â¢s paying? Health Affairs Jan-Jun(SupplW3): 219-226. Godin G and Kok G (1996) The theory of planned behaviour: a review of its applications to health-related behaviours. 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[online] Retrieved 23.07.2010 from: http://www.schoolhealthresearch.org/downloads/miller.pdf Murray N G, Low B J, Hollis C, Cross A W and Davis S M (2007) Coordinated school health programs and academic achievement: A systematic review of the literature. Journal of School Health, 77(9): 589-600. Naidoo J and Wills J (2000) Health Promotion: Foundation for Practice. London: Baillià ¨re Tindall. Nelson M C, Gordon-Larsen P, Song Y and Popkin B M (2006) Built and social environments associations with adolescent overweight and activity. American Journal of Preventive Medicine, 31:109ââ¬â117. Nejad L M, Wertheim E H and Greenwood K M (2005) Comparison of health behaviour model and the theory of planned behaviour in the prediction of dieting and fasting behaviour. E-Journal of Applied Psychology 1(1): 63-74 [online] Retrieved 15.07.2010 from: http://ojs.lib.swin.edu.au/index.php/ejap/article/viewFile/7/16 Nicklas T A, Baranowski T, Cullen KW and Berenson G (2001) Eating patterns, dietary quality and obesity. Journal of the American College of Nutrition, 20:599-608 Oââ¬â¢Dea J A (1993) School-based health education strategies for the improvement of body image and prevention of eating problems: An overview of safe and successful interventions. Health Education, 105(1): 11ââ¬â33 Ogden C L, Carroll M D, Curtin L R, McDowell MA, Tabak C J and Flegal K M (2006) Prevalence of overweight and obesity in the United States, 1999-2004. Journal of the American Medical Association 295: 1549-1555. Schetzina K E, Dalton W T, Lowe E F, Azzazy N, VonWerssowetz K , Givens C, Pfortmiller D T and Stern P H (2009) A coordinated school health approach to obesity prevention among Appalachian youth. Family Community Health, 32(3): 271-285 Seidell J C (1998) Obesity: a growing problem. Acta Paediatrica Supplimentum 88(428):46-50. Summerbell C D, Waters E, Edmunds L, Kelly S, Brown T and Campbell K J (2005) Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews 3:1ââ¬â88. Tandon D, Phillips K, Bordeaux B, Bone L, Brown P B, Cagney K, Gary T, Kim M, Levine D, Price E, Sydnor K D, Stone K and Bass E B (2007) Vision for Progress in Community Health Partnerships. The Johns Hopkins University Press [online] Retrieved 26.07.2010 from: http://www.press.jhu.edu/journals/progress_in_community_health_partnerships/1.1tandon.pdf Tennessee Government (2010) [online] Retrieved 15.07.2010 from: http://www.tennessee.gov/education/schoolhealth/aboutcsh.shtml Tones K and Tilford S (2001) Health promotion ââ¬â effectiveness, efficiency and equity. Delta Place, Cheltenham: Nelson Thorns Ltd. Veugelers P J and Fitzgerald A L (2005) Effectiveness of school programs in preventing childhood obesity: a multilevel comparison. American Journal of Public Health 95(3): 432ââ¬â435. Warwick I, Mooney A and Oliver C (2009) National healthy school programmes: Developing the evidence base. London: TCRU. WHO (1986) The Ottawa Charter for health promotion [online] Retrieved 20.04.2010 from: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
Wednesday, October 9, 2019
Internet law Essay Example | Topics and Well Written Essays - 500 words
Internet law - Essay Example It is capturing that the company has already received more than 41.000 requests and even hired a department of specialists responsible for removal. The title of the innovative policy explains its cause quite clearly - a person has a private right to be anonymous which prevails public right for information. The protesters of this step, however, claim that it puts Google into a very difficult position of a censor allowing its employees to decide which information has to be shown and which has to be hidden.à Thus, European society had to face a now new stage of information privacy in the Internet development and deal with it before other continents. But the tendency spreads really fast - Yahoo and Bing have already claimed that they would follow Google`s example. Moreover, there were request to make this policy global not to concentrating on Europe solely. Japan and Canada will probably join to Europe soon. This innovation will certainly do much good to the numerous users who had their name posted in some irrelevant blog posts, social networks, and awkward advertisements. First case of removal can serve as a perfect example of what ââ¬Å"the right to be forgottenâ⬠actually means. Mario Gonzalez, Italian entrepreneur, requested deleting the advertisement of his long-resolved debt from the search engine data. Obviously, nobody wants his friends, partners or possible employers see such irrelevant and outdated information on the Internet since it can only cause harm to the reputation. à Most of us, peopleà posting something on the Internet daily, often forget that our name can appear out of nowhere in a Google search and show some negative or dubious aspect of our lives. It is much like the photos on which we look bad or funny, that we often hide. This information is personal, and the viewers can create wrong assumptions regarding our real personalities. Human brain eradicates unnecessary memories or at least puts them in the distant places of our mind. The
Tuesday, October 8, 2019
Why a Human Mind Seeks Attraction to a Beach Essay
Why a Human Mind Seeks Attraction to a Beach - Essay Example Every human mind is related with nature at a certain plane. And not a single person can ignore its mighty existence and unending influence on the mind and life of a man. Some people are attracted to mighty snowââ¬âcapped mountains, some to green vales. Some minds get lost in the mystery of the woods and some lose their heart at the roaring waves of an ocean which crushes at the beach and to touch their feet. The beauty of a golden beach lying as a stretch on the bank of a sea or an ocean is always attractive for most of the people. It does not captivate the obscurity of woods and hardship of mountains. For a perfect destination to relax, rejuvenate and feel the mirth and warmth of life, beach is the best resort. It does not involve any physical hardship to stay or reach a beach. And the beauty of a beach is always more exploring with the progress in the hour clock. The color scheme of the stretch of land changes with the changing season. This glorifies the aura of the beach attra cting millions of tourist across the world every year. Thesis Statement This essay intends to analyze and explore the reasons why a human mind seeks attraction to a beach and tries to describe the beauty and blessings of nature bestowed upon this physical feature on earth. Beauty of a Beach To many people it might seem at the outset that a stretch of land covered with sand and rock cannot seem actually beautiful. However, to many others who have been attracted, enchanted and mesmerized with the glory, charm and enigma of a beach know that what fascinates them towards the stretch of land in reality. The golden sand dunes and the rocky cliffs situated at the shore of a vast water-body yielding magnificent and gigantic waves is a sight to watch from a considerable distance. The gigantic waves roar like thunder and then crush and efface on the banks. It seems that their mighty existence somewhere fall short, minor and tiny in front of the golden stretch of land (United Nations Education al, Scientific and Cultural Organization, ââ¬Å"When Sand Dunes Have Been Destroyedâ⬠). The beach that is rocky or has cliffs is just another beautiful spectacle of nature. The waves evolving from the middle of the ocean, takes a magnificent aura before crushing down to the rocks and cliffs on the beach. It seems that those cliffs are the ring master of a circus taming a lion, making it ready for the show. The beast may roar, deny, show its magnanimity but before the rock-solid existence of the ring master and his agile hunter, the beast is ought to succumb and break down. The same spectacle evolves before the eyes of a person who stands at the rocky beach and watches the waves crushing down before the Rocky Mountains situated at the beach. The crushing of the waves produces beautiful foam which seems like some cluster of stray clouds on a blue sky. The poetic mind which operates above the mundane scientific theories of daily life perceives it as a reflection of the phenomena taking place up in the sky (United Nations Educational, Scientific and Cultural Organization, ââ¬Å"When Sand Dunes Have Been Destroyedâ⬠). Sunrise and sunset both occur with vivacity and grandeur at the beach. Sun and the sand play all through the day changing mood and color with the passing season. With its first ray the sun turns the beach into a casket of red light. The air gets warm slowly and the waves dance with the rays of the sun
Monday, October 7, 2019
Business for Social Responsibility (Environment study) Essay
Business for Social Responsibility (Environment study) - Essay Example This happened prior to the emergence of modern multinational corporations. The most renowned philosophers of that time, Thomas Hobbes, Jean Rousseau and John Locke introduced the concepts of responsibilities and rights of government to its people and citizens to fellow citizens (White 2007 p.13). This line of thinking became the idea behind the modern concept of a democratic state and democracy at large. This was a situation whereby the ultimate power rested on the citizens. However, the citizens are willing to delegate authority to the state. Through this, individuals could participate in social activities that enhance a shared future in a defined territory or community. The basics of social contracts are clear although the emphases and assumptions may vary. The modern day pluralistic society discourages a few people to use power to oppress the majority (Buchholtz & Carroll 2012 p19). These basics have not changed for centuries notwithstanding the huge shift from agrarian societies to complex industrialized societies which are dominated by the global economy (White 2007 p. 8). According to White (2007), this facilitated the shift from a life of endless conflicts over control of assets like water and land. These assets are considered to be common. The rights became defined. Citizens accepted to respect the rights of their fellow citizens with the assurance that their own rights will be protected. Penalties for those who violate the rights of others were introduced (White 2007 p. 8). The foundation of social contracts lies behind the principle of shielding or protecting human rights by means of individuals giving authority or state willingly. The scope of human rights has been rapidly expanding, but the underlying principle remains the same. Social contract is the awareness that the government is supposed to serve the people. With that understanding, the people own all the political power, but in most cases they delegate it to government officials. The people ca n give or opt to withhold power (Buchholtz & Carroll 22). Social contract theory urges that people can exchange power with authorities so that their rights can be protected. In this process, people surrender some of their freedoms and submit to an authority for protection (White 2007 p.16). The relationship between legal and natural rights becomes a vital aspect of the social contract theory. Members of the society decide to cooperate so that the entire society can benefit. A social contract is a general agreement between members of a society of with the government that explains how the rights of the society shall be protected in a sustainable manner. This agreement is not written, but it is known to exist between the state and individuals. In case of mature democracies, the rights are delegated to elected officials and the leaders are held accountable. Impacts of the iron law of responsibility and social contract. Property rights assist people with the atmosphere to nurture wealth which is supposed to enrich and improve their productivity. According to Thomas Paine, a philosopher in the 18th century, natural property comes from God, who is the Creator of the universe. Therefore, it should not be used for just personal and private needs. The impact of social contracts is increasingly being felt. A society which allows incursions into communal resources to benefit a few cannot have true democracy (White 2007). The level to
Sunday, October 6, 2019
The Great Migration, Cause and Effect Essay Example | Topics and Well Written Essays - 1500 words
The Great Migration, Cause and Effect - Essay Example The first great wave of migration began during the period of World War I. The manufacture of war supplies had demanded increased production while the draft, and disruption of immigration, left the factories short of much needed labor. As the pool of labor dwindled, companies began to look elsewhere for workers to fill the positions. The southern African-American population made up a substantial resource for unskilled workers and northern companies made extraordinary efforts to recruit them. Companies sent agents to the South and offered the African-Americans high paying jobs, transportation north, and housing arrangements upon arrival at their new location (Crew). The economic and social climate in the South during this period made the offers too good to resist and set off the first great wave of migration. The opportunity for greater wealth was a powerful motivation for the migration during the war. Blacks were leaving behind the rural life they knew to seek a new destiny. Many were leaving behind their families, wives, and children with the hope of creating a better future, and the opportunity for more money did not disappoint them. While most laborers in the South were earning little more than $2,00 per week, a letter published in 1919 explains to his friends back home, "Never pay less than $3.00 per day [...] Remember this is the very lowest wages. Piece work men can make from $6 to $8 per day " ("Don[']t Have to Mister"). Spurred by these tales of high pay, people left behind their social ties and the only way of life they knew with the promise of one day sending for those they left behind. If money had been the only factor, their decision to leave might have been more difficult, but there were other considerations in the South. The social and political climate in the South made the African-Americans even more eager to leave their rural way of life. The constitutional amendments passed after the Civil War that were to protect the rights of blacks were largely ignored in the South. Local laws, hostile prejudice, and Jim Crow laws left them vulnerable to violence, imprisonment, and death. The economics of sharecropping had also taken its toll on the farm workers. Bad crops, low prices, and unpredictable weather had left most of them in debt to the white landowners (Crew). By 1910, emancipation had a hollow meaning and the living condition of the former slaves were no better than they had been 50 years earlier. Migrating north offered them an escape from the ever-present oppression and the economic means to finally carve out their own identity. It is estimated that by 1919, the number of Blacks that had migrated north numbered near 1 million. Most settled in the industrial cities such as Chicago, Detroit, Washington DC, and Pittsburgh. Many of the new arrivals found the promise of better pay and human dignity a reality and were pleasantly surprised to find that the letters they read from people who had migrated before them had been accurate about the opportunities for work. They also enjoyed a new sense of identity, in a new place with attitudes more sensitive to their condition. In a letter dated 1917, a worker in Philadelphia expresses the simple joy of even the most modest
Saturday, October 5, 2019
Budget Essay Example | Topics and Well Written Essays - 1000 words
Budget - Essay Example ncreased interest in research on this topic, and to analyze whether the current approaches of budgeting hinder the effectiveness of modern organizations. Dynamic Business Environment: The present business environment presents a very dynamic situation in front of the managers. In this scenario, budget is seen as a constraint rather than as a planning tool. As a result of this dynamic business environment, the relevancy of the budget is very short lived. Budges result in centralization of the decision making process. This delays the decision making and reduces and organizationââ¬â¢s ability to respond to changing environment. The concept of how a successful company operates in the information age is shifting from ââ¬Å"make-and-sellâ⬠to ââ¬Å"sense-and respondâ⬠(Haeckel, 1999). Budgeting done in isolation: Many managers who are against budgeting believe that budgeting encourages a myopic planning horizon indicating a delinking of the budget and strategy (Shastri, 2008). Budgets are done in isolation and are not aligned to company strategy and goals. Moreover, the budgeting horizon is not linked to the business cycle resulting in long budgeting periods in rapidly changing industries and short budgeting periods in extremely dynamic industries. Hinders Innovation: The bureaucracy and controls created as a result of the budgeting process stop the culture of challenging the status quo. Most of the units focus on operating within the budget thereby reducing the chances of innovation. Most of the subunits focus on operating within their own budgets and hence do not take innovation as a philosophy (Hope and Fraser, 2001). Expensive: It is often argued that the budgeting process followed at organizations is inefficient. This results in the wastage of time of the senior management. Budgeting is also an expensive exercise in terms of capital required for the budgeting purpose. Sophisticated Budgeting Techniques: With the drawbacks of the budget and the budgeting techniques,
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