NUR 261

Sunday 1 June 2008

NUR 261 Essay WIP

UNIVERSITY OF PLYMOUTH

FACULTY OF HEALTH AND SOCIAL WORK



Diploma in Higher Education - Nursing


Module NUR 261

Public Health / Health Promotion

Adult Nursing

20 Credits at Level 2

September 2006 Cohort


ASSESSMENT OF COURSEWORK


Aim: The aim of this assignment is to allow you an opportunity to examine public health and health promotion concepts relevant to adult nursing practice.









STUDENT NAME: Alan P Jack

STUDENT ID: 001255

PERSONAL TUTOR/MODULE SPECIFIC TUTOR: Kim Young

SUBMISSION DATE: 2 June 2008

COHORT: 0609
TEACHING BASE: The Knowledge Spa, Truro, Cornwall.




WORD COUNT: words




Module Leader


Margaret Wade

Lecturer (Nursing)

Faculty of Health & Social Work

The Knowledge Spa

Royal Cornwall Hospital

Treliske

Truro

Cornwall TR1 3HD


01872 256466 / 256450

mwade@plymouth.ac.uk


Table of Contents

Section

Page number

Front Page


1

Table of Contents


2

Statement of Confidentiality


3
Assignment Guidelines


4
Scenario 


10

Assignment


11

References

12

Reading List


13

Definitive Module Record NUR 261





Statement of Confidentiality



Assignment Guidelines


20 credits: Level 2


Aim: The aim of this assignment is to allow you an opportunity to examine public health and health promotion concepts relevant to adult nursing practice.


Assessment Mode: A 2,500 word essay in which you will explore ONE of the scenarios introduced in the module analysing specific public health and health promotion issues.


Assessment Criteria: You will be required to:

  1. explain how the particular health need has been identified using demographic and epidemiological data to support your discussion

  2. apply health promotion theory to explore possible health promoting activities

  3. identify possible evaluation methods to demonstrate the effectiveness of health promotion interventions


Assignment profile


Section

Content

Suggested word limit

(approximate)


Introduction


Identify the scenario and outline the particular aspects you will be exploring




250


Main body of essay


Explore the following:


  • Assessment of health needs using epidemiological and demographic data


  • Health promotion interventions with individuals and populations


  • Evaluation of health promotion interventions with individuals and populations






500






1,000






500


Conclusion


Provide a summary of your work. Include implications for practice, with recommendations if appropriate.



250

Please ensure anonymity is maintained throughout your assignment in accordance with ‘Assess’ documentation in your programme handbook.






Please refer your programme student handbook for information on the University of Plymouth’s marking criteria, referencing and correct presentation.


Word Limit: 2,500 words (+/- 10%). Work in excess of the word count will not be read or marked.


Assignment hand in date (theory): 2 June 2008


Provisional Results: 1st July 2008



Scenario Outline

Jack Ford is 72 years old and has lived in and around Welbourne all his life. He has been married and divorced twice, but at present lives alone in a flat in the social housing development. Jack has had a variety of occupations over the course of his life, including farm labourer, factory worker and mechanic. He has smoked, both cigarettes and a pipe for most of his adult life.

Jack ford has recently been gaining weight significantly and is classified as obese. He has presented at the GP surgery with symptoms of type 2 Diabetes.


What public health and health promotion issue would you want to consider?



Assignment


The World Health Organisation defines Diabetes as "... a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces"  (World Health Organisation on-line 2008a).  It goes on to suggest that it accounts for 5% of global deaths annually and that 80% of diabetic are inhabitants of low or moderate income countries.  The Organisation elsewhere differentiates between type one diabetes, where insufficient insulin to support life is excrete, type two, where inappropriate somatic responses to insulin production and Impaired Glucose Tollerance and impaired fasting glycaemia where blood glucose is raised but to below that which would be indicate a diabetic diagnosis.




There are several types of Diabetes.  Historically, Diab
etes Mellitus tended to be classified by depending on insulin administration or the lack of it.  In more recent times, it is accepted the disease is more complex.  Type 1 Diabetes refers to


Type 2 refers to where insulin is produce which


This has previously been referred to as Non-Insulin Dependent Diabetes Mellitus as well as Maturity Onset Diabetes Mellitus.  The latter name has been challenged as the number of individuals under 16 is now significantly




Because the symptoms of Diabetes Mellitus type 2, individuals may be going undetected.  On a global scale, this could include


In the United Kingdom, the "missing Million" is the subject of some debate.  This, until now, could have included Jack. 


This could have many implication as individuals may not have any idea that, as they have no symptoms, that they are do not have the disease and so do not feel that they need to alter any


Pre-diabetis, also referred to Metabolic Syndrome and formally called Glucose Intolerance in now the subject of much research.


Diabetes Insidus is a condition which is not related to insulin production and is






The symptoms with which Jack could be presenting numerous. These could include the passing of large volumes of undiluted urine (polyuria) and an excessive thirst (polydipsia) (Marib and Hoehn, 2007). Both these symptoms are caused by hyperglycaemia in that the excessive glucose in the blood has an osmotic effect on the kidney tubule inhibiting them reabsorbing water that thus causes vast quantities of urine which then results in reduced circulating volume causing dehydration which activates the hypothalamic thirst centres causing polydipsia.  As the large ammounts of glucose can not enter cells as insulin is not fascilitating this, the lack of energy causes hunger (polyphagia). The NHS Direct Website (2008) mentions also that tiredness,  and less commonly genital itching, frequent Thrush infections and blurred vision





Jack exhibits a number of demographic and lifestyle factors which may affect his disease experience.  Smoking tabacco can result in vascular compromiseation can compund the changes which are caused by Diabetes Mellitus




The aim of this assignment is to allow you an opportunity to examine public health and health promotion concepts relevant to adult nursing practice.

  1. explain how the particular health need has been identified using demographic and epidemiological data to support your discussion

  2. apply health promotion theory to explore possible health promoting activities

  3. identify possible evaluation methods to demonstrate the effectiveness of health promotion interventions



Intro: Identify the scenario and outline the particular aspects you will be exploring (250 words)
This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practioner with the symptoms of diabetes (see appedix 1).  Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changable and some which are not.  A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to  explore how the risk factor of obesity can impact upon the development of this disease and how its reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation.

Three degrees of helath promotion have been identified.  Primary health promotion pertains to that which is undertaken to prevention of the commencement of health consequense occuring.  This is exemplified as health eating campagnes in schools which can help to decrease the onset of diabetes ().  Secondary health promotional activity aims to prevent any adverse health consequence from deteriating further.  This would include teaching foot care techniques to newly diagnosed diabetics.  Tertiary health promotion is concerned with 

DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) is a national education program taylored for individuals with Diabetes type 2.  Being primarily pioloted by 15 English Primary Care Trusts (PCTs) from 2004 and is now being tested via a 1000 subject randomised control trial in selected English and Scotish PCTs.

Taking its lead from the National Institute for Health and Clinicle Excelence guidance

Jack is affected by several National Service frameworks.  These include those for Elderly People,

Body Mass index (BMI), the calcuation of weight divided by height squared, has been widely used as an indicator of obsesity, normal weight and under weight.  It is one of the factors that is included in several nutritional scores.  It can provide a basic analogue of whether any weight management activities need to be implicated.  However, it is limited in that it does not take into account any risk factors.  Moreover, there is now much research which brings into question the validity of BMI.  Waist measurement is now bieing mooted as a more reliable predictor of risk with regard to weight. 









The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs.  However, much has been written about prejoritive attitudes of Nurses and other health care professionals. 

If







The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs.  However, much has been written about prejoritive attitudes of Nurses and other health care professionals


Diabetes Mellitus- 09:39

The incidence of diabetes is increasing in all age groups. .... Welcome to DiabetesUK. Acknowledgements EMIS is grateful to Dr Hayley Willacy for writing ...
www.patient.co.uk/showdoc/40000914/ - 57k - Cached - Similar pages - Note this

Rising Incidence of Type 2 Diabetes in Children in the U.K....

Rising Incidence of Type 2 Diabetes in Children in the U.K.. Linda Haines, MSC1, Kay Chong Wan, DPHIL1, Richard Lynn, MSC1, Timothy G. Barrett, ...
care.diabetesjournals.org/cgi/content/abstract/30/5/1097 - Similar pages - Note this
[PDF]

Diabetes: State of the Nations 2006

File Format: PDF/Adobe Acrobat - View as HTML
areas of Diabetes UK: early identification of. diabetes, psychological and emotional ...... Rising incidence of insulin-dependent diabetes in children ...
www.diabetes.org.uk/Documents/Reports/SOTN2006_full.pdf - Similar pages - Note this

NLH - Diabetes - Incidence and prevalence of diabetes

10 Jun 2007 ... Numerous studies have shown that there is a rising incidence of diabetes and it's complications in all age groups, both in the UK and ...
www.library.nhs.uk/diabetes/ViewResource.aspx?resID=261624 - 67k - Cached - Similar pages - Note this
[PDF]

NHS Diabetes

File Format: PDF/Adobe Acrobat - View as HTML
Incidence of new ischaemic heart disease in Type 2. 3.2% per annum. Cardiovascular disease as cause of death. 55%. Number of people with diabetes in UK...
nchod.uhce.ox.ac.uk/diabetes.pdf - Similar pages - Note this

ScienceDirect - The Lancet : The rising incidence of childhood ...

The incidence of childhood type 1 diabetes has risen over the past 50 years. ....Diabetes UK and the Wellcome Trust funded the Bart's-Oxford study and ...
linkinghub.elsevier.com/retrieve/pii/S0140673604173571 - Similar pages - Note this
[PDF]

Improving Diabetes Services: The NSF Four Years On

File Format: PDF/Adobe Acrobat - View as HTML
8 Mar 2007 ... The Diabetes UK award for outstanding contributions to ..... It was established that the recorded incidence of diabetes was 3.93%, while ...
www.diabetes.nhs.uk/downloads/the_way_ahead_the_local_challenge.pdf - Similar pages - Note this

Lifestyle Interventions to Prevent Diabetes [February 2006; 144-5]

The other outcome was diabetes incidence. Subjects had to have impaired glucose ... The incidence of diabetes reported in five studies lasting one to six ...
www.jr2.ox.ac.uk/bandolier/band144/b144-5.html - 10k - Cached - Similar pages - Note this

Prevalence and Incidence of Diabetes - WrongDiagnosis.com

Prevalence and incidence statistics for Diabetes covering estimated populations and ... Estimated 1.35 million diagnosed cases of diabetes in the UK 2003 ...
www.wrongdiagnosis.com/d/diabetes/prevalence.htm - 61k - Cached - Similar pages - Note this

Cancer incidence and mortality in patients with insulin-treated ...

We conducted a cohort study of 28 900 UK patients with insulin-treated diabetes followed for 520 517 person-years, and compared their cancer incidence and ...
www.nature.com/bjc/journal/v92/n11/abs/6602611a.html - Similar pages - Note this

It goes onto discuss three other phenomena.  Type 1 diabetes (formerly known as insulin-dependent) in which the beta cells in the islets of langerhans cell in the pancreas fails to produce the insulin which is essential for survival. The onset of this type of diabetes was more prevelant in childhood or adolesence but this pattern is now changing.




Type 2 diabetes (formerly named non-insulin-dependent) which results from the body's maladaptive response to the action of insulin and accounts for approximately 90% of all diabetes worldwide. The onset of this type of dabetes has also changed in that from being a disease of adults, it is becoming more prevelent in children.

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) refer to levels of blood glucose concentration above the normal range, but below those which are diagnostic for diabetes. Subjects with IGT and/or IFG are at substantially higher risk of developing diabetes and cardiovascular disease than those with normal glucose tolerance. The benefits of clinical intervention in subjects with moderate glucose intolerance is a topic of much current interest.


Although not at a level that would constitute diabetes, individuals with Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) demonstrate elevated blood glucose levels which seems to place them at higher risk of developing both cardiovascular disease as well as diabetes.













   




This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practioner with the symptoms of diabetes (see appedix 1).  Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changable and some which are not.  A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to  explore how the risk factor of obesity can impact upon the development of this disease and how the reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation from a public health prespective.  Research will involve the types of helath promotional services available at both a micro and macro level. This will be followed by an evaluation of these.



It must be noted that jack is a smoker.  This could have an impact on his disease experience as nicotine has an

poor

fat and diet...



dietietic

locus of control







The World Health Organization (World Health Organisation on line (2008), defines diabetes as:

"Diabetes mellitus is a chronic disease caused by inherited and/or acquired deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin produced. Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves."

It goes onto describe four phenomena namely type one Diabetes mellitus where little or no insulin is produce, type two  
which results from the body's maladaptive response to the action of insulin and Impaired Glucose Tollerence and Impaired Fasting Glycaemia where elevated blood glucose levels which seem to place them at higher risk of developing both cardiovascular disease as well as diabetes. 


It is significant that the incidnece of diabetes type two is increasing. 


There are seveveral significant dimension to this increase. 


The overal global incidence has increased.  


The disease in now presenting at a younger age. 


This seems to be varying directly with the increase in obesity.  




diabetetes fat relationship....


Randomised control tries have ini



Asseement of health needs



Randomised controlled trials have shown that (diabetes prevention research group, 2002 Lindström et al, 2003).  The diabetes prevention programme found that weight loss of between 5% and 7% of total body weight accompanied with moderate physical activity of half an hour five times per week proved to be almost doubly effective as the use of the glucose lowering medication namely Metformin (diabetes prevention research group, 2002).


The Diabetes Prevention Research  Group (2002) and the Finnish Diabetes Prevention Study (Lindström et al, 2003) carried out randomised controlled trials which have indicated that diabetes can be delayed or even prevented with moderate increases in physical activity and improvements in diet.  The former showed that found that weight loss of between 5% and 7% of total body weight accompanied with moderate physical activity of half an hour five times per week proved to be almost doubly effective as the use of the glucose lowering medication namely Metformin.  The latter compared an intervention group against an interventions group but only of 40 to 64 year olds where as the former investigated subject of 25 years and older.  More research may bring forth some more answers, especially if it were longitudinal in nature.






From a global incidence, Wild et al (2004) have projected that dabetic incidence could more than double from its 2000 level of 171 million to that of 366 million by the year 2030.  As the United kingdom as a whole,


c


 

 

 

 

 

 

 

 

 

 

 






This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practitioner with the symptoms of diabetes (see appendix 1).  Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changeable and some which are not.  A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to  explore how the risk factor of obesity can impact upon the development of this disease and how its reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation.











This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practitioner with the symptoms of diabetes (see appendix 1).  Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changeable and some which are not.  A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to  explore how the risk factor of obesity can impact upon the development of this disease and how the reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation from a public health perspective.  Research will involve the types of health promotional services available at both a micro and macro level. This will be followed by an evaluation of these






The World Health Organisation defines Diabetes as "... a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces"  (World Health Organisation on-line 2008a).  It goes on to suggest that it accounts for 5% of global deaths annually and that 80% of diabetic are inhabitants of low or moderate income countries.  The Organisation elsewhere differentiates between type one diabetes, where insufficient insulin to support life is excrete, type two, where inappropriate somatic responses to insulin production and Impaired Glucose Tolerance and impaired fasting glycaemia where blood glucose is raised but to below that which would be indicate a diabetic diagnosis.


The symptoms with which Jack could be presenting numerous. These could include the passing of large volumes of undiluted urine (polyuria) and an excessive thirst (polydipsia) (Marib and Hoehn, 2007). Both these symptoms are caused by hyperglycaemia in that the excessive glucose in the blood has an osmotic effect on the kidney tubule inhibiting them reabsorbing water that thus causes vast quantities of urine which then results in reduced circulating volume causing dehydration which activates the hypothalamic thirst centres causing polydipsia.  As the large amounts of glucose can not enter cells as insulin is not facilitating this, the lack of energy causes hunger (polyphagia). The NHS Direct Website (2008) mentions also that tiredness,  and less commonly genital itching, frequent Thrush infections and blurred vision

Body Mass index (BMI), the calculation of weight divided by height squared, has been widely used as an indicator of obesity, normal weight and under weight.  It is one of the factors that is included in several nutritional scores.  It can provide a basic analogue of whether any weight management activities need to be implicated.  However, it is limited in that it does not take into account any risk factors.  Moreover, there is now much research which brings into question the validity of BMI.  Waist measurement is now being mooted as a more reliable predictor of risk with regard to weight. 



The Diabetes Prevention Research  Group (2002) and the Finnish Diabetes Prevention Study (Lindström et al, 2003) carried out randomised controlled trials which have indicated that diabetes can be delayed or even prevented with moderate increases in physical activity and improvements in diet.  The former showed that found that weight loss of between 5% and 7% of total body weight accompanied with moderate physical activity of half an hour five times per week proved to be almost doubly effective as the use of the glucose lowering medication namely Metformin.  The latter compared an intervention group against an interventions group but only of 40 to 64 year olds where as the former investigated subject of 25 years and older.  More research may bring forth some more answers, especially if it were longitudinal in nature.







Three degrees of health promotion have been identified.  Primary health promotion pertains to that which is undertaken to prevention of the commencement of health consequence occurring.  This is exemplified as health eating campagnes in schools which can help to decrease the onset of diabetes ().  Secondary health promotional activity aims to prevent any adverse health consequence from deteriorating further.  This would include teaching foot care techniques to newly diagnosed diabetics.  Tertiary health promotion is concerned with


DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) is a national education program tailored for individuals with Diabetes type 2.  Being primarily piloted by 15 English Primary Care Trusts (PCTs) from 2004 and is now being tested via a 1000 subject randomised control trial in selected English and Scottish PCTs.

Taking its lead from the National Institute for Health and Clinical Excellence guidance on diabetes, 


DESMOND is a form of secondary health promotion in that the individuals have already been diagnosed so the emphasis is on preventing the


Prior to 2003 when the diabetes National service framework and the National Institute for health and clinical excellence published their guidance on diabetes, there was no benchmark by which education schemes could be validated.  Desmond Caulfield's all

By its very design, Desmond has been tailored to meet the standards laid in out in these policies. 



Beginning with a programme primarily for individuals who had just been diagnosed with diabetes, Desmond progressed

Has progressed to developing pathways of care for individuals for the whole of their disease journey. 




DESMOND's education groups are based on Leventhal's common sense theory,where

the dual process theory,


and the social learning theory which



on of the advantages of DESMOND is that it is very client focused, tailoring its imput to the individual concerned.  At the very heart of the orgnaisation are both healthcare professionals as well as individuals with diabetes thus integrating scientific knowledge base with clincial experience and the lived experience of those with the disease.

Conversely,



Desmond is an example of secondary prevention in that the aim of the intervention is a the emphasis is on the

However,

Desmond is an example


Both secondary and cursory attention encompassed within the Desmond ideology in that

The secondary prevention

The secondary preventive ethos is that of aiming to prevent the progression of diabetic process

Prevention of the progression of the disease process or of her unwonted state through early detection when this favourably affects outcome

The cursory element

The cursory prevent the development of his concerns with the prevention of avoidable complications of panic irreversible, manifest disease or prevention of the the occurrence of an illness or other unwonted phenomenon

Downey, beginning with a programme before diabetes



Beginning with a programme primarily for individuals who had just been diagnosed with diabetes, Desmond progressed

Has progressed to developing pathways of care for individuals for the whole of their disease journey.  Although this




















The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs.  However, much has been written about pejorative attitudes of Nurses and other health care professionals



The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs.  However, much has been written about prejoritive attitudes of Nurses and other health care professionals



There are several types of Diabetes.  Historically, Diabetes Mellitus tended to be classified by depending on insulin administration or the lack of it.  In more recent times, it is accepted the disease is more complex.  Type 1 Diabetes refers to


Type 2 refers to where insulin is produce which


This has previously been referred to as Non-Insulin Dependent Diabetes Mellitus as well as Maturity Onset Diabetes Mellitus.  The latter name has been challenged as the number of individuals under 16 is now significantly


Jack exhibits a number of demographic and lifestyle factors which may affect his disease experience.  Smoking tobacco can result in vascular compromisation can compound the changes which are caused by Diabetes Mellitus





Wordings

 

 

 





References


World Health Organisation [on-line] (2008)a. Programes and Projects: Diabetes. http://www.who.int/diabetes/en/ visted 24th April 2008
World Health Organisation [on-line] (2008)b. Diabetes Action On-line. http://www.who.int/diabetesactiononline/diabetes/en/ visited 5th May 2008
http://www.framinghamheartstudy.org/index.html
framingham http://www.framinghamheartstudy.org/index.html

Fenn, P. (2007) Assessment and managment of abdominal obesity in patient with type 2 diabetes.  Nusing Standard 21, 25, 37-44

Fenn, P. (2007) Assessment and managment of abdominal obesity in patient with type 2 diabetes.  Nusing Standard 21, 25, 37-44
Brown, I., Stide, C., Psarou, A., Brewins, L., Thompson, J. (2007) Management of obesity in primary care: nurse's practice, belief and attitudes.  Journal of Advanced Nursing 59 (4), 329-342
Marieb E. N. and Hoehn, K. (2007) Human Anatomy and Physiology: Pearson International Editional Edition. 7e. San Francisco: Benjamin Cummings

http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=128&sectionId=10


 

http://www.eatlas.idf.org/Diabetes_Atlas___Executive_Summary_download/#EN

http://www.eatlas.idf.org/Obesity_and_type_2_diabetes/

Lindström, J., Louheranta, A., Mannelin, M., Rastas, M., Salminen, V., Eriksson, J., et al. (2003). The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care, 26(12), 3230–3236

http://care.diabetesjournals.org/cgi/content/full/26/12/3230


 

Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of Type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346(6), 393–403.
http://content.nejm.org/cgi/content/full/346/6/393

 

Downie, R., Tannahill, C. and Tannahill, A. (1996) Health promotion: models and Values. Oxford Oxford medical publications


Department of Health (2004) Choosing Health: making healthier choices easier.


Leddy Kun, S. (2006)  Integrative Health Promotion: Conceptual Bases for Nursing Practice, Second Edition. Boston :  Jones and Bartlett

Green, L. (1977) Education and measurement: some dilemmas for health education. American Journal of Public Health 67: 155-162
Backett, K., Davison, C. and Mullen, K. (1994) Lay evauaiton of health and healthy lifestyles evidence from three studies.  British Journal of General Practice 44, 277-280

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1238902

Ewles, L. and Simnett, I. (2004) Health promotion: a practical guide. 5e.

Oxford: Balliere Tindall

http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/print.html

http://scholar.google.co.uk/scholar?hl=en&lr=&cluster=3564791000148442555

http://scholar.google.co.uk/scholar?hl=en&lr=&cluster=2449456301460039406

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2258400

http://www.aihw.gov.au/publications/health/ah96/ah96-x04.html

Davis, M.J., Heller, S., Skinner, T. C., Campbell, M. J., Carey, M. E., Cradock, S., Dallosso, H. M., Daly, H., Doherty, Y., Eaton, S., Fox, C., Oliver, L., Rantell, K., Rayman, G. and Khunti, K. (2008) Effectivents of the diabetes education and self managment or ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. British Medical Journal 336(7642): 491–495.































Obesity: in statistics

Global obesity forecast graphPeople are getting fatter almost everywhere in the world.

The World Health Organization predicts there will be 2.3 billion overweight adults in the world by 2015 and more than 700 million of them will be obese.

Figures for 2005 show 1.6 billion adults were overweight and 400 million were obese.

Map of global obesity

Obesity is a modern problem - statistics for it did not even exist 50 years ago.

The increase of convenience foods, labour-saving devices, motorised transport and more sedentary jobs means people are getting fatter.

The body mass index (BMI) is the most commonly-used way of classifying overweight and obesity in adult populations and individuals.

BMI is defined as a person's weight in kilograms divided by the square of their height in meters (kg/m2).

Each BMI figure is classified within a range, eg 18-25 is ideal and over 30 is reckoned to be obese.

According to a survey of bodyshapes conducted in the UK in 1951, a woman's average waist size was 70cm (27.5in). A 3-D survey carried out by SizeUK in 2004 found the average woman had a waist measurement of 86cm (34in) and a BMI of 24.4, just inside the ideal range.

There was no comparative data for men in 1951, but the SizeUK survey showed the average man in 2004 had a waist of 94cm (37in) and a BMI of 25.2, technically just outside the ideal range.

changing shape of Britons graphic

But obesity is not just a problem for adults - the spread of obesity among children is also alarming experts.

At least 20 million children under the age of 5 years were overweight globally in 2005, according to the WHO.

Map showing prevalence of diabetes

Measuring children, aged 5 to 14 years, who are overweight or obese is challenging because there is not a standard definition of childhood obesity applied worldwide. Figures for children in England are shown here.

Childhood obesity is a big problem in the United States. The following graph shows the trend in a number of countries around the world.

child obesity in England

Experts are worried that the increase in obesity will lead to more health problems as people who are overweight have a higher risk of heart disease, Type II diabetes and other diseases including some cancers.

As most data sources do not distinguish between Type I and II diabetes in adults, it is not possible to present the data separately. The map below shows the prevalence of diabetes throughout the world in 2007.

Graph showing increase in overweight children in the world

Even if the prevalence of obesity remains stable until 2030, the American Diabetes Association, says that the number of people with diabetes will more than double.

It says the increase may be "considerably higher" than this if, as expected, the prevalence of obesity continues to rise around the world.



































 
 
 
 
 
Obesity is one of the principal risk factors for type 2 diabetes. An excess of body fat, especially when concentrated within the abdomen, has a range of potentially harmful consequences. Classified as a disease, obesity diminishes both quality of life and life expectancy, but it is also a common risk factor for a number of other diseases from osteo-arthritis to heart disease and some types of cancer.
Overweight and obesity lead to adverse metabolic effects on blood pressure, cholesterol, triglycerides and insulin resistance. Risks of coronary heart disease, ischaemic stroke and type 2 diabetes increase steadily with increasing body mass index (BMI). Type 2 diabetes - confined to older adults for most of the 20th century - now affects some obese children even before puberty. Modest weight reduction reduces blood pressure and abnormal blood cholesterol and substantially lowers risk of type 2 diabetes.
The link between obesity and type 2 diabetes
Obesity and type 2 diabetes are causally linked. Weight gain leads to insulin resistance through several mechanisms. Insulin resistance places a greater demand on the pancreatic capacity to produce insulin, which also declines with age, leading to the development of clinical diabetes. Physical inactivity, both a cause and consequence of weight gain, also contributes to insulin resistance.
Analyses by the International Obesity Task Force (IOTF), undertaken for the World Health Report 2002 and associated WHO Global Burden of Disease research, indicate that approximately 58% of diabetes mellitus globally can be attributed to BMI above 21 kg/m2. However in western countries, around 90% of type 2 diabetes cases are attributable to weight gain, as shown in the figure below, and childhood overweight and obesity are now leading to an unusual pattern of premature type 2 diabetes, which is particularly difficult to manage once established1James WPT, Jackson-Leach R, Mhurdu CN, Kalamara E, Shayeghi M, Rigby N, Nishida C and Rodgers A. Overweight and Obesity. In Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors, eds. Ezzati M, Lopez AD, Rodgers A, Murray CJL. WHO, Geneva, 2003..
Childhood obesity is a relatively recent phenomenon, which poses a critical threat to health. Significant prevalences exist in both developing and developed countries. An IOTF analysis (see figure below)  has shown that overweight and obesity affects one in 10 children worldwide, but the rate is double in Europe and three times as great across the entire Americas2IOTF. Childhood Obesity - The New Crisis in Public Health. International Obesity Task Force, London, 2003. . The emergence of type 2 diabetes in childhood is a serious development. In the USA it has been noted that up to 45% of children with newly diagnosed diabetes have type 2 diabetes and most are overweight or obese at diagnosis3American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000; 3:381-389..
Reducing obesity and development of type 2 diabetes
Among adults, clear evidence exists that surprisingly modest weight reductions can markedly reduce the development of type 2 diabetes, if not prevent it completely, in susceptible individuals, and that weight loss can reverse the type 2 diabetic state. The remarkable effect of weight loss through diet and increased activity has been demonstrated in the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Diabetes Prevention Programme in the USA to benefit particularly the over-60s, in whom nearly three-quarters of new cases of diabetes were prevented.
This and other studies provide hope to those with impaired glucose tolerance (IGT) and a susceptibility to diabetes. Dietary and activity changes to produce a 5-7% weight loss can successfully reduce the incidence of type 2 diabetes; reductions in fat and calorie intake accompanied by half an hour's extra walking or other exercise each day have been demonstrated to lower the incidence by 58%. Great success has been achieved among people over 60 years, reducing the development of diabetes in that high-risk age group by 71%4Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393-403.. Similar data have emerged from China, Scandinavia and other European studies.
WHO recommendations for dietary improvements and increased levels of exercise across entire populations provide the basis for the development of global strategies to challenge the rise in obesity along with other diet and activity related chronic diseases, including type 2 diabetes5WHO/FAO. Diet, Nutrition and the Prevention of Chronic Diseases. Technical Report Series no. 916. WHO, Geneva, 2003. (www.who.int/hpr/NPH/docs/who_fao_expert_report.pdf). However even if the WHO recommendations, including those to reduce fat, sugar and salt consumption, were to be implemented, it would be some considerable time before the benefits were reflected in a reduction of obesity and co-morbidity rates.
Back to Top
    * (1) James WPT, Jackson-Leach R, Mhurdu CN, Kalamara E, Shayeghi M, Rigby N, Nishida C and Rodgers A. Overweight and Obesity. In Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors, eds. Ezzati M, Lopez AD, Rodgers A, Murray CJL. WHO, Geneva, 2003.
    * (2) IOTF. Childhood Obesity - The New Crisis in Public Health. International Obesity Task Force, London, 2003.
    * (3) American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000; 3:381-389.
    * (4) Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393-403.
    * (5) WHO/FAO. Diet, Nutrition and the Prevention of Chronic Diseases. Technical Report Series no. 916. WHO, Geneva, 2003. (www.who.int/hpr/NPH/docs/who_fao_expert_report.pdf)
© 2005 International Diabetes Federation - info@idf.org
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Contact webmaster












NUR 261 Essay WIP

UNIVERSITY OF PLYMOUTH

FACULTY OF HEALTH AND SOCIAL WORK



Diploma in Higher Education - Nursing


Module NUR 261

Public Health / Health Promotion

Adult Nursing

20 Credits at Level 2

September 2006 Cohort


ASSESSMENT OF COURSEWORK


Aim: The aim of this assignment is to allow you an opportunity to examine public health and health promotion concepts relevant to adult nursing practice.









STUDENT NAME: Alan P Jack

STUDENT ID: 001255

PERSONAL TUTOR/MODULE SPECIFIC TUTOR: Kim Young

SUBMISSION DATE: 2 June 2008

COHORT: 0609
TEACHING BASE: The Knowledge Spa, Truro, Cornwall.




WORD COUNT: words




Module Leader


Margaret Wade

Lecturer (Nursing)

Faculty of Health & Social Work

The Knowledge Spa

Royal Cornwall Hospital

Treliske

Truro

Cornwall TR1 3HD


01872 256466 / 256450

mwade@plymouth.ac.uk


Table of Contents

Section

Page number

Front Page


1

Table of Contents


2

Statement of Confidentiality


3
Assignment Guidelines


4
Scenario 


10

Assignment


11

References

12

Reading List


13

Definitive Module Record NUR 261





Statement of Confidentiality



Assignment Guidelines


20 credits: Level 2


Aim: The aim of this assignment is to allow you an opportunity to examine public health and health promotion concepts relevant to adult nursing practice.


Assessment Mode: A 2,500 word essay in which you will explore ONE of the scenarios introduced in the module analysing specific public health and health promotion issues.


Assessment Criteria: You will be required to:

  1. explain how the particular health need has been identified using demographic and epidemiological data to support your discussion

  2. apply health promotion theory to explore possible health promoting activities

  3. identify possible evaluation methods to demonstrate the effectiveness of health promotion interventions


Assignment profile


Section

Content

Suggested word limit

(approximate)


Introduction


Identify the scenario and outline the particular aspects you will be exploring




250


Main body of essay


Explore the following:


  • Assessment of health needs using epidemiological and demographic data


  • Health promotion interventions with individuals and populations


  • Evaluation of health promotion interventions with individuals and populations






500






1,000






500


Conclusion


Provide a summary of your work. Include implications for practice, with recommendations if appropriate.



250

Please ensure anonymity is maintained throughout your assignment in accordance with ‘Assess’ documentation in your programme handbook.






Please refer your programme student handbook for information on the University of Plymouth’s marking criteria, referencing and correct presentation.


Word Limit: 2,500 words (+/- 10%). Work in excess of the word count will not be read or marked.


Assignment hand in date (theory): 2 June 2008


Provisional Results: 1st July 2008



Scenario Outline

Jack Ford is 72 years old and has lived in and around Welbourne all his life. He has been married and divorced twice, but at present lives alone in a flat in the social housing development. Jack has had a variety of occupations over the course of his life, including farm labourer, factory worker and mechanic. He has smoked, both cigarettes and a pipe for most of his adult life.

Jack ford has recently been gaining weight significantly and is classified as obese. He has presented at the GP surgery with symptoms of type 2 Diabetes.


What public health and health promotion issue would you want to consider?



Assignment


The World Health Organisation defines Diabetes as "... a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces"  (World Health Organisation on-line 2008a).  It goes on to suggest that it accounts for 5% of global deaths annually and that 80% of diabetic are inhabitants of low or moderate income countries.  The Organisation elsewhere differentiates between type one diabetes, where insufficient insulin to support life is excrete, type two, where inappropriate somatic responses to insulin production and Impaired Glucose Tollerance and impaired fasting glycaemia where blood glucose is raised but to below that which would be indicate a diabetic diagnosis.




There are several types of Diabetes.  Historically, Diab
etes Mellitus tended to be classified by depending on insulin administration or the lack of it.  In more recent times, it is accepted the disease is more complex.  Type 1 Diabetes refers to


Type 2 refers to where insulin is produce which


This has previously been referred to as Non-Insulin Dependent Diabetes Mellitus as well as Maturity Onset Diabetes Mellitus.  The latter name has been challenged as the number of individuals under 16 is now significantly




Because the symptoms of Diabetes Mellitus type 2, individuals may be going undetected.  On a global scale, this could include


In the United Kingdom, the "missing Million" is the subject of some debate.  This, until now, could have included Jack. 


This could have many implication as individuals may not have any idea that, as they have no symptoms, that they are do not have the disease and so do not feel that they need to alter any


Pre-diabetis, also referred to Metabolic Syndrome and formally called Glucose Intolerance in now the subject of much research.


Diabetes Insidus is a condition which is not related to insulin production and is






The symptoms with which Jack could be presenting numerous. These could include the passing of large volumes of undiluted urine (polyuria) and an excessive thirst (polydipsia) (Marib and Hoehn, 2007). Both these symptoms are caused by hyperglycaemia in that the excessive glucose in the blood has an osmotic effect on the kidney tubule inhibiting them reabsorbing water that thus causes vast quantities of urine which then results in reduced circulating volume causing dehydration which activates the hypothalamic thirst centres causing polydipsia.  As the large ammounts of glucose can not enter cells as insulin is not fascilitating this, the lack of energy causes hunger (polyphagia). The NHS Direct Website (2008) mentions also that tiredness,  and less commonly genital itching, frequent Thrush infections and blurred vision





Jack exhibits a number of demographic and lifestyle factors which may affect his disease experience.  Smoking tabacco can result in vascular compromiseation can compund the changes which are caused by Diabetes Mellitus




The aim of this assignment is to allow you an opportunity to examine public health and health promotion concepts relevant to adult nursing practice.

  1. explain how the particular health need has been identified using demographic and epidemiological data to support your discussion

  2. apply health promotion theory to explore possible health promoting activities

  3. identify possible evaluation methods to demonstrate the effectiveness of health promotion interventions



Intro: Identify the scenario and outline the particular aspects you will be exploring (250 words)
This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practioner with the symptoms of diabetes (see appedix 1).  Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changable and some which are not.  A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to  explore how the risk factor of obesity can impact upon the development of this disease and how its reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation.

Three degrees of helath promotion have been identified.  Primary health promotion pertains to that which is undertaken to prevention of the commencement of health consequense occuring.  This is exemplified as health eating campagnes in schools which can help to decrease the onset of diabetes ().  Secondary health promotional activity aims to prevent any adverse health consequence from deteriating further.  This would include teaching foot care techniques to newly diagnosed diabetics.  Tertiary health promotion is concerned with 

DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) is a national education program taylored for individuals with Diabetes type 2.  Being primarily pioloted by 15 English Primary Care Trusts (PCTs) from 2004 and is now being tested via a 1000 subject randomised control trial in selected English and Scotish PCTs.

Taking its lead from the National Institute for Health and Clinicle Excelence guidance

Jack is affected by several National Service frameworks.  These include those for Elderly People,

Body Mass index (BMI), the calcuation of weight divided by height squared, has been widely used as an indicator of obsesity, normal weight and under weight.  It is one of the factors that is included in several nutritional scores.  It can provide a basic analogue of whether any weight management activities need to be implicated.  However, it is limited in that it does not take into account any risk factors.  Moreover, there is now much research which brings into question the validity of BMI.  Waist measurement is now bieing mooted as a more reliable predictor of risk with regard to weight. 









The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs.  However, much has been written about prejoritive attitudes of Nurses and other health care professionals. 

If







The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs.  However, much has been written about prejoritive attitudes of Nurses and other health care professionals


Diabetes Mellitus- 09:39

The incidence of diabetes is increasing in all age groups. .... Welcome to DiabetesUK. Acknowledgements EMIS is grateful to Dr Hayley Willacy for writing ...
www.patient.co.uk/showdoc/40000914/ - 57k - Cached - Similar pages - Note this

Rising Incidence of Type 2 Diabetes in Children in the U.K....

Rising Incidence of Type 2 Diabetes in Children in the U.K.. Linda Haines, MSC1, Kay Chong Wan, DPHIL1, Richard Lynn, MSC1, Timothy G. Barrett, ...
care.diabetesjournals.org/cgi/content/abstract/30/5/1097 - Similar pages - Note this
[PDF]

Diabetes: State of the Nations 2006

File Format: PDF/Adobe Acrobat - View as HTML
areas of Diabetes UK: early identification of. diabetes, psychological and emotional ...... Rising incidence of insulin-dependent diabetes in children ...
www.diabetes.org.uk/Documents/Reports/SOTN2006_full.pdf - Similar pages - Note this

NLH - Diabetes - Incidence and prevalence of diabetes

10 Jun 2007 ... Numerous studies have shown that there is a rising incidence of diabetes and it's complications in all age groups, both in the UK and ...
www.library.nhs.uk/diabetes/ViewResource.aspx?resID=261624 - 67k - Cached - Similar pages - Note this
[PDF]

NHS Diabetes

File Format: PDF/Adobe Acrobat - View as HTML
Incidence of new ischaemic heart disease in Type 2. 3.2% per annum. Cardiovascular disease as cause of death. 55%. Number of people with diabetes in UK...
nchod.uhce.ox.ac.uk/diabetes.pdf - Similar pages - Note this

ScienceDirect - The Lancet : The rising incidence of childhood ...

The incidence of childhood type 1 diabetes has risen over the past 50 years. ....Diabetes UK and the Wellcome Trust funded the Bart's-Oxford study and ...
linkinghub.elsevier.com/retrieve/pii/S0140673604173571 - Similar pages - Note this
[PDF]

Improving Diabetes Services: The NSF Four Years On

File Format: PDF/Adobe Acrobat - View as HTML
8 Mar 2007 ... The Diabetes UK award for outstanding contributions to ..... It was established that the recorded incidence of diabetes was 3.93%, while ...
www.diabetes.nhs.uk/downloads/the_way_ahead_the_local_challenge.pdf - Similar pages - Note this

Lifestyle Interventions to Prevent Diabetes [February 2006; 144-5]

The other outcome was diabetes incidence. Subjects had to have impaired glucose ... The incidence of diabetes reported in five studies lasting one to six ...
www.jr2.ox.ac.uk/bandolier/band144/b144-5.html - 10k - Cached - Similar pages - Note this

Prevalence and Incidence of Diabetes - WrongDiagnosis.com

Prevalence and incidence statistics for Diabetes covering estimated populations and ... Estimated 1.35 million diagnosed cases of diabetes in the UK 2003 ...
www.wrongdiagnosis.com/d/diabetes/prevalence.htm - 61k - Cached - Similar pages - Note this

Cancer incidence and mortality in patients with insulin-treated ...

We conducted a cohort study of 28 900 UK patients with insulin-treated diabetes followed for 520 517 person-years, and compared their cancer incidence and ...
www.nature.com/bjc/journal/v92/n11/abs/6602611a.html - Similar pages - Note this

It goes onto discuss three other phenomena.  Type 1 diabetes (formerly known as insulin-dependent) in which the beta cells in the islets of langerhans cell in the pancreas fails to produce the insulin which is essential for survival. The onset of this type of diabetes was more prevelant in childhood or adolesence but this pattern is now changing.




Type 2 diabetes (formerly named non-insulin-dependent) which results from the body's maladaptive response to the action of insulin and accounts for approximately 90% of all diabetes worldwide. The onset of this type of dabetes has also changed in that from being a disease of adults, it is becoming more prevelent in children.

Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) refer to levels of blood glucose concentration above the normal range, but below those which are diagnostic for diabetes. Subjects with IGT and/or IFG are at substantially higher risk of developing diabetes and cardiovascular disease than those with normal glucose tolerance. The benefits of clinical intervention in subjects with moderate glucose intolerance is a topic of much current interest.


Although not at a level that would constitute diabetes, individuals with Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) demonstrate elevated blood glucose levels which seems to place them at higher risk of developing both cardiovascular disease as well as diabetes.













   




This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practioner with the symptoms of diabetes (see appedix 1).  Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changable and some which are not.  A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to  explore how the risk factor of obesity can impact upon the development of this disease and how the reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation from a public health prespective.  Research will involve the types of helath promotional services available at both a micro and macro level. This will be followed by an evaluation of these.



It must be noted that jack is a smoker.  This could have an impact on his disease experience as nicotine has an

poor

fat and diet...



dietietic

locus of control







The World Health Organization (World Health Organisation on line (2008), defines diabetes as:

"Diabetes mellitus is a chronic disease caused by inherited and/or acquired deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin produced. Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves."

It goes onto describe four phenomena namely type one Diabetes mellitus where little or no insulin is produce, type two  
which results from the body's maladaptive response to the action of insulin and Impaired Glucose Tollerence and Impaired Fasting Glycaemia where elevated blood glucose levels which seem to place them at higher risk of developing both cardiovascular disease as well as diabetes. 


It is significant that the incidnece of diabetes type two is increasing. 


There are seveveral significant dimension to this increase. 


The overal global incidence has increased.  


The disease in now presenting at a younger age. 


This seems to be varying directly with the increase in obesity.  




diabetetes fat relationship....


Randomised control tries have ini



Asseement of health needs



Randomised controlled trials have shown that (diabetes prevention research group, 2002 Lindström et al, 2003).  The diabetes prevention programme found that weight loss of between 5% and 7% of total body weight accompanied with moderate physical activity of half an hour five times per week proved to be almost doubly effective as the use of the glucose lowering medication namely Metformin (diabetes prevention research group, 2002).


The Diabetes Prevention Research  Group (2002) and the Finnish Diabetes Prevention Study (Lindström et al, 2003) carried out randomised controlled trials which have indicated that diabetes can be delayed or even prevented with moderate increases in physical activity and improvements in diet.  The former showed that found that weight loss of between 5% and 7% of total body weight accompanied with moderate physical activity of half an hour five times per week proved to be almost doubly effective as the use of the glucose lowering medication namely Metformin.  The latter compared an intervention group against an interventions group but only of 40 to 64 year olds where as the former investigated subject of 25 years and older.  More research may bring forth some more answers, especially if it were longitudinal in nature.






From a global incidence, Wild et al (2004) have projected that dabetic incidence could more than double from its 2000 level of 171 million to that of 366 million by the year 2030.  As the United kingdom as a whole,


c


 

 

 

 

 

 

 

 

 

 

 






This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practitioner with the symptoms of diabetes (see appendix 1).  Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changeable and some which are not.  A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to  explore how the risk factor of obesity can impact upon the development of this disease and how its reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation.











This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practitioner with the symptoms of diabetes (see appendix 1).  Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changeable and some which are not.  A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to  explore how the risk factor of obesity can impact upon the development of this disease and how the reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation from a public health perspective.  Research will involve the types of health promotional services available at both a micro and macro level. This will be followed by an evaluation of these






The World Health Organisation defines Diabetes as "... a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces"  (World Health Organisation on-line 2008a).  It goes on to suggest that it accounts for 5% of global deaths annually and that 80% of diabetic are inhabitants of low or moderate income countries.  The Organisation elsewhere differentiates between type one diabetes, where insufficient insulin to support life is excrete, type two, where inappropriate somatic responses to insulin production and Impaired Glucose Tolerance and impaired fasting glycaemia where blood glucose is raised but to below that which would be indicate a diabetic diagnosis.


The symptoms with which Jack could be presenting numerous. These could include the passing of large volumes of undiluted urine (polyuria) and an excessive thirst (polydipsia) (Marib and Hoehn, 2007). Both these symptoms are caused by hyperglycaemia in that the excessive glucose in the blood has an osmotic effect on the kidney tubule inhibiting them reabsorbing water that thus causes vast quantities of urine which then results in reduced circulating volume causing dehydration which activates the hypothalamic thirst centres causing polydipsia.  As the large amounts of glucose can not enter cells as insulin is not facilitating this, the lack of energy causes hunger (polyphagia). The NHS Direct Website (2008) mentions also that tiredness,  and less commonly genital itching, frequent Thrush infections and blurred vision

Body Mass index (BMI), the calculation of weight divided by height squared, has been widely used as an indicator of obesity, normal weight and under weight.  It is one of the factors that is included in several nutritional scores.  It can provide a basic analogue of whether any weight management activities need to be implicated.  However, it is limited in that it does not take into account any risk factors.  Moreover, there is now much research which brings into question the validity of BMI.  Waist measurement is now being mooted as a more reliable predictor of risk with regard to weight. 



The Diabetes Prevention Research  Group (2002) and the Finnish Diabetes Prevention Study (Lindström et al, 2003) carried out randomised controlled trials which have indicated that diabetes can be delayed or even prevented with moderate increases in physical activity and improvements in diet.  The former showed that found that weight loss of between 5% and 7% of total body weight accompanied with moderate physical activity of half an hour five times per week proved to be almost doubly effective as the use of the glucose lowering medication namely Metformin.  The latter compared an intervention group against an interventions group but only of 40 to 64 year olds where as the former investigated subject of 25 years and older.  More research may bring forth some more answers, especially if it were longitudinal in nature.







Three degrees of health promotion have been identified.  Primary health promotion pertains to that which is undertaken to prevention of the commencement of health consequence occurring.  This is exemplified as health eating campagnes in schools which can help to decrease the onset of diabetes ().  Secondary health promotional activity aims to prevent any adverse health consequence from deteriorating further.  This would include teaching foot care techniques to newly diagnosed diabetics.  Tertiary health promotion is concerned with


DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) is a national education program tailored for individuals with Diabetes type 2.  Being primarily piloted by 15 English Primary Care Trusts (PCTs) from 2004 and is now being tested via a 1000 subject randomised control trial in selected English and Scottish PCTs.

Taking its lead from the National Institute for Health and Clinical Excellence guidance on diabetes, 


DESMOND is a form of secondary health promotion in that the individuals have already been diagnosed so the emphasis is on preventing the


Prior to 2003 when the diabetes National service framework and the National Institute for health and clinical excellence published their guidance on diabetes, there was no benchmark by which education schemes could be validated.  Desmond Caulfield's all

By its very design, Desmond has been tailored to meet the standards laid in out in these policies. 



Beginning with a programme primarily for individuals who had just been diagnosed with diabetes, Desmond progressed

Has progressed to developing pathways of care for individuals for the whole of their disease journey. 




DESMOND's education groups are based on Leventhal's common sense theory,where

the dual process theory,


and the social learning theory which



on of the advantages of DESMOND is that it is very client focused, tailoring its imput to the individual concerned.  At the very heart of the orgnaisation are both healthcare professionals as well as individuals with diabetes thus integrating scientific knowledge base with clincial experience and the lived experience of those with the disease.

Conversely,



Desmond is an example of secondary prevention in that the aim of the intervention is a the emphasis is on the

However,

Desmond is an example


Both secondary and cursory attention encompassed within the Desmond ideology in that

The secondary prevention

The secondary preventive ethos is that of aiming to prevent the progression of diabetic process

Prevention of the progression of the disease process or of her unwonted state through early detection when this favourably affects outcome

The cursory element

The cursory prevent the development of his concerns with the prevention of avoidable complications of panic irreversible, manifest disease or prevention of the the occurrence of an illness or other unwonted phenomenon

Downey, beginning with a programme before diabetes



Beginning with a programme primarily for individuals who had just been diagnosed with diabetes, Desmond progressed

Has progressed to developing pathways of care for individuals for the whole of their disease journey.  Although this




















The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs.  However, much has been written about pejorative attitudes of Nurses and other health care professionals



The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs.  However, much has been written about prejoritive attitudes of Nurses and other health care professionals



There are several types of Diabetes.  Historically, Diabetes Mellitus tended to be classified by depending on insulin administration or the lack of it.  In more recent times, it is accepted the disease is more complex.  Type 1 Diabetes refers to


Type 2 refers to where insulin is produce which


This has previously been referred to as Non-Insulin Dependent Diabetes Mellitus as well as Maturity Onset Diabetes Mellitus.  The latter name has been challenged as the number of individuals under 16 is now significantly


Jack exhibits a number of demographic and lifestyle factors which may affect his disease experience.  Smoking tobacco can result in vascular compromisation can compound the changes which are caused by Diabetes Mellitus





Wordings

 

 

 





References


World Health Organisation [on-line] (2008)a. Programes and Projects: Diabetes. http://www.who.int/diabetes/en/ visted 24th April 2008
World Health Organisation [on-line] (2008)b. Diabetes Action On-line. http://www.who.int/diabetesactiononline/diabetes/en/ visited 5th May 2008
http://www.framinghamheartstudy.org/index.html
framingham http://www.framinghamheartstudy.org/index.html

Fenn, P. (2007) Assessment and managment of abdominal obesity in patient with type 2 diabetes.  Nusing Standard 21, 25, 37-44

Fenn, P. (2007) Assessment and managment of abdominal obesity in patient with type 2 diabetes.  Nusing Standard 21, 25, 37-44
Brown, I., Stide, C., Psarou, A., Brewins, L., Thompson, J. (2007) Management of obesity in primary care: nurse's practice, belief and attitudes.  Journal of Advanced Nursing 59 (4), 329-342
Marieb E. N. and Hoehn, K. (2007) Human Anatomy and Physiology: Pearson International Editional Edition. 7e. San Francisco: Benjamin Cummings

http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=128&sectionId=10


 

http://www.eatlas.idf.org/Diabetes_Atlas___Executive_Summary_download/#EN

http://www.eatlas.idf.org/Obesity_and_type_2_diabetes/

Lindström, J., Louheranta, A., Mannelin, M., Rastas, M., Salminen, V., Eriksson, J., et al. (2003). The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care, 26(12), 3230–3236

http://care.diabetesjournals.org/cgi/content/full/26/12/3230


 

Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of Type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346(6), 393–403.
http://content.nejm.org/cgi/content/full/346/6/393

 

Downie, R., Tannahill, C. and Tannahill, A. (1996) Health promotion: models and Values. Oxford Oxford medical publications


Department of Health (2004) Choosing Health: making healthier choices easier.


Leddy Kun, S. (2006)  Integrative Health Promotion: Conceptual Bases for Nursing Practice, Second Edition. Boston :  Jones and Bartlett

Green, L. (1977) Education and measurement: some dilemmas for health education. American Journal of Public Health 67: 155-162
Backett, K., Davison, C. and Mullen, K. (1994) Lay evauaiton of health and healthy lifestyles evidence from three studies.  British Journal of General Practice 44, 277-280

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1238902

Ewles, L. and Simnett, I. (2004) Health promotion: a practical guide. 5e.

Oxford: Balliere Tindall

http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/print.html

http://scholar.google.co.uk/scholar?hl=en&lr=&cluster=3564791000148442555

http://scholar.google.co.uk/scholar?hl=en&lr=&cluster=2449456301460039406

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2258400

http://www.aihw.gov.au/publications/health/ah96/ah96-x04.html

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Obesity: in statistics

Global obesity forecast graphPeople are getting fatter almost everywhere in the world.

The World Health Organization predicts there will be 2.3 billion overweight adults in the world by 2015 and more than 700 million of them will be obese.

Figures for 2005 show 1.6 billion adults were overweight and 400 million were obese.

Map of global obesity

Obesity is a modern problem - statistics for it did not even exist 50 years ago.

The increase of convenience foods, labour-saving devices, motorised transport and more sedentary jobs means people are getting fatter.

The body mass index (BMI) is the most commonly-used way of classifying overweight and obesity in adult populations and individuals.

BMI is defined as a person's weight in kilograms divided by the square of their height in meters (kg/m2).

Each BMI figure is classified within a range, eg 18-25 is ideal and over 30 is reckoned to be obese.

According to a survey of bodyshapes conducted in the UK in 1951, a woman's average waist size was 70cm (27.5in). A 3-D survey carried out by SizeUK in 2004 found the average woman had a waist measurement of 86cm (34in) and a BMI of 24.4, just inside the ideal range.

There was no comparative data for men in 1951, but the SizeUK survey showed the average man in 2004 had a waist of 94cm (37in) and a BMI of 25.2, technically just outside the ideal range.

changing shape of Britons graphic

But obesity is not just a problem for adults - the spread of obesity among children is also alarming experts.

At least 20 million children under the age of 5 years were overweight globally in 2005, according to the WHO.

Map showing prevalence of diabetes

Measuring children, aged 5 to 14 years, who are overweight or obese is challenging because there is not a standard definition of childhood obesity applied worldwide. Figures for children in England are shown here.

Childhood obesity is a big problem in the United States. The following graph shows the trend in a number of countries around the world.

child obesity in England

Experts are worried that the increase in obesity will lead to more health problems as people who are overweight have a higher risk of heart disease, Type II diabetes and other diseases including some cancers.

As most data sources do not distinguish between Type I and II diabetes in adults, it is not possible to present the data separately. The map below shows the prevalence of diabetes throughout the world in 2007.

Graph showing increase in overweight children in the world

Even if the prevalence of obesity remains stable until 2030, the American Diabetes Association, says that the number of people with diabetes will more than double.

It says the increase may be "considerably higher" than this if, as expected, the prevalence of obesity continues to rise around the world.



































 
 
 
 
 
Obesity is one of the principal risk factors for type 2 diabetes. An excess of body fat, especially when concentrated within the abdomen, has a range of potentially harmful consequences. Classified as a disease, obesity diminishes both quality of life and life expectancy, but it is also a common risk factor for a number of other diseases from osteo-arthritis to heart disease and some types of cancer.
Overweight and obesity lead to adverse metabolic effects on blood pressure, cholesterol, triglycerides and insulin resistance. Risks of coronary heart disease, ischaemic stroke and type 2 diabetes increase steadily with increasing body mass index (BMI). Type 2 diabetes - confined to older adults for most of the 20th century - now affects some obese children even before puberty. Modest weight reduction reduces blood pressure and abnormal blood cholesterol and substantially lowers risk of type 2 diabetes.
The link between obesity and type 2 diabetes
Obesity and type 2 diabetes are causally linked. Weight gain leads to insulin resistance through several mechanisms. Insulin resistance places a greater demand on the pancreatic capacity to produce insulin, which also declines with age, leading to the development of clinical diabetes. Physical inactivity, both a cause and consequence of weight gain, also contributes to insulin resistance.
Analyses by the International Obesity Task Force (IOTF), undertaken for the World Health Report 2002 and associated WHO Global Burden of Disease research, indicate that approximately 58% of diabetes mellitus globally can be attributed to BMI above 21 kg/m2. However in western countries, around 90% of type 2 diabetes cases are attributable to weight gain, as shown in the figure below, and childhood overweight and obesity are now leading to an unusual pattern of premature type 2 diabetes, which is particularly difficult to manage once established1James WPT, Jackson-Leach R, Mhurdu CN, Kalamara E, Shayeghi M, Rigby N, Nishida C and Rodgers A. Overweight and Obesity. In Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors, eds. Ezzati M, Lopez AD, Rodgers A, Murray CJL. WHO, Geneva, 2003..
Childhood obesity is a relatively recent phenomenon, which poses a critical threat to health. Significant prevalences exist in both developing and developed countries. An IOTF analysis (see figure below)  has shown that overweight and obesity affects one in 10 children worldwide, but the rate is double in Europe and three times as great across the entire Americas2IOTF. Childhood Obesity - The New Crisis in Public Health. International Obesity Task Force, London, 2003. . The emergence of type 2 diabetes in childhood is a serious development. In the USA it has been noted that up to 45% of children with newly diagnosed diabetes have type 2 diabetes and most are overweight or obese at diagnosis3American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000; 3:381-389..
Reducing obesity and development of type 2 diabetes
Among adults, clear evidence exists that surprisingly modest weight reductions can markedly reduce the development of type 2 diabetes, if not prevent it completely, in susceptible individuals, and that weight loss can reverse the type 2 diabetic state. The remarkable effect of weight loss through diet and increased activity has been demonstrated in the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Diabetes Prevention Programme in the USA to benefit particularly the over-60s, in whom nearly three-quarters of new cases of diabetes were prevented.
This and other studies provide hope to those with impaired glucose tolerance (IGT) and a susceptibility to diabetes. Dietary and activity changes to produce a 5-7% weight loss can successfully reduce the incidence of type 2 diabetes; reductions in fat and calorie intake accompanied by half an hour's extra walking or other exercise each day have been demonstrated to lower the incidence by 58%. Great success has been achieved among people over 60 years, reducing the development of diabetes in that high-risk age group by 71%4Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393-403.. Similar data have emerged from China, Scandinavia and other European studies.
WHO recommendations for dietary improvements and increased levels of exercise across entire populations provide the basis for the development of global strategies to challenge the rise in obesity along with other diet and activity related chronic diseases, including type 2 diabetes5WHO/FAO. Diet, Nutrition and the Prevention of Chronic Diseases. Technical Report Series no. 916. WHO, Geneva, 2003. (www.who.int/hpr/NPH/docs/who_fao_expert_report.pdf). However even if the WHO recommendations, including those to reduce fat, sugar and salt consumption, were to be implemented, it would be some considerable time before the benefits were reflected in a reduction of obesity and co-morbidity rates.
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    * (1) James WPT, Jackson-Leach R, Mhurdu CN, Kalamara E, Shayeghi M, Rigby N, Nishida C and Rodgers A. Overweight and Obesity. In Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors, eds. Ezzati M, Lopez AD, Rodgers A, Murray CJL. WHO, Geneva, 2003.
    * (2) IOTF. Childhood Obesity - The New Crisis in Public Health. International Obesity Task Force, London, 2003.
    * (3) American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000; 3:381-389.
    * (4) Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393-403.
    * (5) WHO/FAO. Diet, Nutrition and the Prevention of Chronic Diseases. Technical Report Series no. 916. WHO, Geneva, 2003. (www.who.int/hpr/NPH/docs/who_fao_expert_report.pdf)
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