Hills like White Elephants Essay Example for Free

Hills like White Elephants Essay Ernest Hemingway published â€Å"Hills like White Elephants† in 1927. The narrative is a young couple is sitting at a train station near the Ebro Valley in Madrid, Spain to highlight the fact that their relationship is at a crossroad. Hemingway expresses many themes and literary elements throughout this short story. A plot is a dynamic element in fiction, a sequence of interrelated, conflicting actions and events that are typically build to a climax and bring about a resolution (Clugston, 2010). The couple sits at a table to have a couple of beers and a conversation. At first the girl talks about what they should have to drink and what she sees outside. You can tell that it is more going on at least in their feelings or its more going on in the story. From (Line 41) â€Å"It’s really an awfully simple operation, Jig† the man said. â€Å"It’s not really an operation at all. This explains why their conversation they were having earlier been awkward. The seemingly petty conversation here about hills and drinks and an unspecified operation is in actuality an unarticulated but decisive struggle over whether they continue to live the sterile, self-indulgent, decadent life preferred by the man or elect to have the child that Jig is carrying and settle down to a conventional but, in Jig’s view, rewarding, fruitful, and peaceful life (Holladay, 2004). The American was asking his girl to have an abortion without using the word so others would not be entertained or concerned at all. Hemingway knows how to raise suspense to the readers. The point of view is how the action is presented to the reader (Clugston,2010). Although â€Å"Hills like White Elephants† is primarily a conversation between the American man and his girlfriend, neither of the speakers truly communicates with the other, highlighting the rift between the two. Both talk, but neither listens or understands the other’s point of view. Frustrated and placating, the American man will say almost anything to convince his girlfriend to have the operation, which, although never mentioned by name, is understood to be an abortion. He tells her he loves her, for example, and that everything between them will go back to the way it used to be. Another literary element is character. A character is an imaginary person in a piece of literature (Clugston, 2010). In â€Å"Hills like White Elephants† there are three characters. The American, who is the male protagonist of the story. His name is never revealed throughout the story. He also tries to convince the girl to have the operation and he does not care what she does. He disconnects his self from the surroundings and not listening and understanding what the girl is saying. The Girl, who is the female protagonist of the story. The American calls the girl, Jig. She alternates the conversation to talk about the operation then avoids it altogether. The thing she says does not clearly defines her emotions or personality. Jig is more of a realistic character. She has issues and behaviors of real people. The bartender is a woman who served drinks to the American man and the girl. The bartender only speaks Spanish. The characters add so much to the theme of the story. A theme in a story is associated with an idea that lies behind the story. In other words the theme in a story is a representation of the idea behind the story (Clugston, 2010). The theme of â€Å"Hills like White Elephants† involves a question of responsibility. The theme of a piece of fiction is its controlling idea or its central insight, and the unifying statement about life implied in the story (Arp Johnson, 2006). Hemingway does this in describing the couple’s dilemma about Jig’s pregnancy. The theme exists when an author attempts to record life as it happens. â€Å"Hills Like White Elephants† centers on a couple’s verbal duel over, as strongly implied by the text and as widely believed by many scholars, whether the girl will have an abortion of her partner’s child. Jig, clearly reluctant to have the operation, suspects her pregnancy has irrevocably changed the relationship but still wonders whether having the abortion will make things between the couple as they were before. The American is anxious that Jig have the abortion and gives lip service to the fact that he still loves Jig and will love her whether she has the procedure done or not. As the story progresses, the power shifts back and forth in the verbal tug-of-war, and at the end, though it is a topic of fierce debate among Hemingway scholars, it seems that Jig has both gained the upper hand and made her decision. The theme of the story is revealed through the couple’s dialogue and through symbolism. Symbolism is something that has a literal identity but also stands for something else (Clugston, 2010). â€Å"Hills like White Elephants† is filled with symbolism. The narrator describes the character symbolic. Jig is called a girl throughout the story to represent her naive behavior, immaturity and lack of confidence about her opinion. The American is called a man throughout the story, representing his position about his opinion on the abortion. The bags they carry have tags on them displaying all of the hotels that the couple has stayed in. This shows that the couples are not serious about a child, still want to have fun and be sex animals. The setting of the story is symbolic. The story takes place at a train junction. This setting represents the fact that their decision can change the direction of their lives. It is less important that we know the course chosen than the significance of the two choices. The rootless barren life, devoid of responsibility represented by the dry hills (Fletcher, 1980). The other side of the valley is green and has a river. The two sides symbolize the decision that Jig has to make. The green side represents fertility, life, hope and the hot, brown side represents sterility. There is several more symbolism in the story, let’s move on to the next literary element. Tone is the attitude reflected by the author in a literary work; it identifies the author’s approach to the subject a story deals with. The tone in â€Å"Hills like White Elephants† The narrator is very controlled, giving us a bare minimum of information outside of the conversations between the man and Jig, or between the man and the woman serving the drinks. This narrator controls the tendency in narrators to tell what the story means. This is giving the readers lots of credit for being intelligent, but can also make for rough reading. We aren’t used to stories being told mostly in dialogue. Speaking of dialogue, both Jig and the man are having a rather controlled conversation. The fact that they are having this conversation in a public place might or might not contribute to this control. â€Å"Hills like White Elephants are very interesting and have many literary elements. From the plot to the tone, Hemingway was very brilliant how privatized his conversation and still managed to get his point across. The symbolism made it seem as if we were there with him and Jig.

Essay --

In Black Swan, a ballet dancer named Nina is casted to play both the White Swan and the Black Swan in the famous ballet titled Swan Lake. In the well-known opera, a princess is turned into a White Swan, who falls in love with a prince but then commits suicide when she finds out that the prince confessed his love to the Black Swan. In the movie Black Swan, Nina has to deal with the challenges that arise from trying to accurately portray both characters whom are completely opposite. It is easy for Nina to be the White Swan. She is innocent and controlled. However, it was very hard for her to become the dark, seductive, and mysterious Black Swan. To fully become this character, Nina has to deal with the struggles of becoming the opposite of who she really is. This results in many hallucinations that involve harming herself. She also starts to imagine things that are not really happening. Eventually, Nina has psychotic episodes when she truly becomes the Black Swan. Whenever she takes a step into her transformation, she has hallucinations such as having black feathers come out of her skin. It also seems as if Nina is obsessed with perfection because she even tries to kill herself. The true reality is not what she sees because she is so trapped in the world of Swan Lake. Nina fits the mold of many different mental disorders. I, however, personally think that Nina portrays the symptoms of a person with schizophrenia. In the DSM-5, it states that schizophrenia is characterized by delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction. It is required that a person have at least two of these symptoms. It is clear throughout the movie that Nina has hallucinations that ... ... the mold of a dancer. The fact that Nina has an eating disorder shows that it is not rare for people with schizophrenia to display symptoms of another disorder. One of the myths displayed in Black Swan is about how people with schizophrenia are all paranoid. Throughout the movie, Nina becomes more paranoid about losing her leading role and even stabs herself with a piece of glass, believing that she stabbed Lily. People with schizophrenia are not all paranoid. Overall, I think Black Swan was very intriguing and proved to be an accurate display of psychotic dysfunction, particularly schizophrenia. This movie required critical thinking in order to be able to put together the pieces and to understand the depth of schizophrenia. Even though this movie showed the darker side of schizophrenia, I still recommend it to anyone who has an interest in this mental disorder.

Disease Specific Program

In this paper, we would be discussing the application of self-management concepts involved in improving the health and quality of life for people with chronic Diabetes Mellitus. Diabetes Mellitus is a complex disorder of carbohydrate, protein, and fat metabolism in which a relative or absolute insulin deficiency is the essential feature, Drury (1986). Diabetes is recognized as a model of broader based communicable disease control programs, WHO (1991 – 1998).The metabolic derangement is frequently associated with permanent and irreversible functional and structural changes in the cells of the body, those of the vascular system being particularly susceptible. The changes lead in turn to the development of well-defined clinical entities, the so-called ‘complications’ of Diabetes which most characteristically affect the eye, the kidney and the nervous system. Introduction It is not too distant past one of the critical tests of the skill of a nurse was the ability to m eet the needs of a patient with an acute infectious disease such as Typhoid fever or pneumonia.When the patient recovered, the nurse could rightly take credit for having made an important contribution. As infectious diseases have been brought under control, the incidence of chronic illness has risen so that they now account for a significant portion of morbidity and morality. Chronically ill patients often have a wider range of problems and need a greater variety of services than are needed to meet the needs of the acutely ill.Res ¬toration of the patient to optimum status and preven ¬tion of progress of the illness often demands the con ¬tinued efforts of the patient, family, nurse, physician, and other health and welfare personnel as well as the members of the community. With patients in whom progress toward recovery is slow and in whom control or prevention of the progression of disease is the goal rather than complete recovery, the nurse may not be able to see immediate re sults of her or his efforts. Instead of a relatively brief and intense relationship in which the patient is dependent on the nurse, the nurse often has a more or less pro ¬longed relationship.This relationship with the pa ¬tient changes from time to time, from dependence to independence to interdependence. To meet the needs of the patient, the nurse should be able to identify clues indicating the type of relationship best suited to the needs of the patient at a given time and to adapt her or his behavior accordingly. A Clinical Nurse Specialist (CNS) is described as an administrator, leader, manager, collaborator, practitioner, advanced clinician, consultant, educator and researcher (Wilson-Barnett, 1994; Dunne, 1997; McCarthy, 1996).Literature Review Today the test of the skill of the nurse is the ability to meet the needs of the chronically ill patient. If a single disease was to be selected as the modern day test of nursing knowledge and skill, diabetes mel ¬litus would und oubtedly receive many votes. There are many reasons that this is true. Diabetes mellitus has a relatively high incidence. It affects all age groups. Its complications are many and serious. There are, however, effective means for its detec ¬tion, diagnosis, and treatment.With modern methods of therapy, persons with diabetes mellitus can live almost as long as those who do not have diabetes. Even more important, they can have full and useful lives with few restrictions on their activi ¬ties. Persons with diabetes mellitus have been Rhodes scholars, mountain climbers, hockey players, television stars and statesmen. They marry, bear and rear children, and can lead successful, vigorous, productive, lives-a far cry from the predictable fate of the diabetic before the era of insulin therapy. The nurse is always concerned about the epide ¬miology of disease.Understanding the distribution and dynamics (epidemiology) of a disease serves as a basis for meeting objectives of disease detec tion and for education of patient, family, and community. Because diabetes and other chronic diseases are not reportable, they are not subjected to the type of surveillance used for communicable diseases. As sur ¬veys and techniques of detection and diagnosis im ¬prove, reporting will increase and it may be possible to identify and to improve preventive measures.According to the 1975 National Health Interview Survey, a rate of 20.4 per 1,000 population or an estimated 4. 8 million persons in the United States reported diagnosed dia ¬betes. Between 1965 and 1975, the prevalence of diabetes increased by 50 per cent in the United States (Guthrie & Guthrie, 2002; Flarey & Blancett, 1996). There is some question if there is a true in ¬crease in the frequency. The data may represent an increase in recognition due to increased use of automated blood chemistry laboratory techniques.Diabetes mellitus occurs in all age groups and in both sexes. The prevalence rate increases with age, from 1.3/1,000 (1 in 77) for persons under 17 years of age to 78. 5/1,000 (1 in 12) in persons over the age of 65. Diabetes is reported more frequently in females (2. 4 per cent) than in males (1. 6 per cent). Females have a prevalence rate of 24. 1/ 1,000. This is a 50 per cent increase from 1965 data when it was 16. 1 /l, 000. The prevalence rate for males is 16. 3/1,000. The most dramatic changes in preva ¬lence of reported diabetes is the increase of diabetes in nonwhites under the age of 45. This group has a percentage change of 150 per cent.Non ¬whites are 20 per cent more likely than whites to have diabetes (Dunning, 2003). Incidence is the frequency of new cases of a disease developed during a specified time period. In 1963, 17 years after the first Oxford study, 65. 7 per cent of the residents aged 34 to 55 years who lived in Oxford during the first study were re ¬studied. The percentage of diabetics was found to be the same in the second as in the first study (O†™Sulli ¬van, 1969). In the 1930s and 1940s there was marked improve ¬ment in the life expectancy of diabetics. Since that time, there has been little improvement.This may be due to the fact that Diabetes patients are living long enough to develop the more dangerous concomitants (Kessler, 1971). Reasons for failure to prevent the concomitants of Diabetes are one of the problems being studied intensively today. The Management of Diabetes Mellitus The ideal treatment for diabetes would allow the patient lead a completely normal life to remain not only symptom-free but in positive good health, to achieve a normal metabolic state, and to escape the complications associated with long-term diabetes.Nowadays diabetic patients rarely die in ketoacidosis in any number, but the major problem which has emerged is the chronic invalidism, due to disease of both large and small blood vessels, of many of those whose duration of life has been extended. It is well known that diabetics show an i ncreased propensity to fall due to visual impairment and neuropathy, as well as foot problems (Wallace et al, 2002; Keegan et al, 2002) and presumably accelerated cognitive decline (Gregg et al, 2000).Data from clinical studies strongly suggest that although genetic factors affect the susceptibility to develop complications, the incidence of serious retinopathy is related to the degree of diabetic control achieved (Clark & Cefalu, 2000). It is therefore incumbent on all those who are involved in looking after diabetic patients to strive in every way to achieve as good control as is practicable in terms of blood glucose concentration. The management of diabetes demands a broad range of professional skills, which include communication, counseling, leadership, teaching and research to name but a few.The Diabetes Nurse Specialist has the expertise and specialist knowledge to incorporate these skills into practice and so develop standards of care that benefits the patient (Daly, 1997). T he Diabetes Nurse Specialist (DNS) plays a pivotal role within a multidisciplinary team. The recognition of the contribution of the Diabetes Nurse Specialist in helping patients achieve good diabetes control highlights his/her essential role in diabetes care, (DCCT,1995; UKPDS, 1998). Metcalfe (1998) states that a Diabetes Nurse Specialist works in collaboration with a team to ensure continuity of care, lends towards more successful management.Types of Treatment There are three methods of treatment, namely diet alone, diet and oral hypoglycemic drugs and diet and insulin. Each obliges the patient to adhere to a life long dietary regimen. Approximately 60% of new cases of diabetes can be controlled adequately by diet alone, about 20% will need an oral hypoglycemic drug and another 20%, mainly younger patients, will require insulin (Long, et al, 1995). A patient may pass from one group to another – temporarily or permanently. Role of the Nurse in Prevention and DiagnosisNurses have numerous opportunities to assist the identification of persons who either have diabetes or are potential diabetics. The CNS is prepared beyond the level of a generalist (The Report of The Commission on Nursing, 1998). Review of the etiologic factors gives the nurse clues as to the target populations. In addition she or he, regardless of the field of practice, must always be alert to the signs and symptoms of diabetes. Any individual with symptoms suggesting diabetes mellitus should be encouraged to seek medical attention. The Suspicion of the school nurse should be aroused when a child develops polyuria and polydipsia.The public health nurse who visits in the home should be alert to the possibility of diabetes in family members. Some patients are discovered to have diabetes after they are admitted to the hospital. Most hospitals have a rule that before a patient can undergo any type of surgical procedure, the urine must be checked for glucose. The nurse can also assist in commu nity screening programs. In addition to opportunities for the nurse to participate in programs for the identification of persons who have diabetes mellitus, nurses have a role in the prevention of the disease.Because of the frequency with which diabetes in the middle-aged person is associated with obesity, individuals are encouraged to avoid overweight by diet and exercise. The preventive aspects related to genetic counseling are less clear. Persons with diabetes or persons with families in which there is a known history of diabetes should be acquainted with the risks involved when planning marriage. Psychological Aspects Fink (1967) has proposed a model of the processes of adaptation to stressful situations. He proposes that psychological phases follow a sequential pattern as follows:Stage 1: Shock; in this phase the person's cognitive structure is characterized by disorganiza ¬tion. There is inability to plan or to reason. Stage 2: Defensive retreat characterized by denial. Stag e 3: Acknowledgment, giving up the past, and starting to face reality. Stage 4: Adaptation, acceptance. of the modification in health. Planning to care for self and to prevent complications. When a person learns that he or she has diabetes mellitus, even when its presence was suspected, he or she experiences disbelief and then grief. The degree of shock will depend on the individual and what the diagnosis and treatment mean to him or her.Any preexisting problem can be expected to be intensified. The pa ¬tient and family can be expected to react to knowl ¬edge of the diagnosis as they do to other crisis situa ¬tions in life. The patient compares dia ¬betes with health and prefers health. The nurse can usually be of more help to the patient if she or he can help in identifying and expressing feelings rather than telling the patient how lucky he or she is. During the period immediately following diagnosis, the patient and family require psychological support. This should start with the patient’s admission to the office of the physician, to the clinic, or to the hospital.The type and amount of support will vary with each individual. Both the patient and family have a right to expect professional personnel to try to understand their feelings and to accept their behavior as having meaning (Otong, 2003). The nurse should try to convey to the patient that, while understanding or trying to understand his or her feelings, the patient will be able to learn to do what must be done and will be provided with the necessary assistance. Control of Diabetes Mellitus Successful management of diabetes mellitus depends on the intelligent co-operation of the patient and the family.Unlike recovery from an acute infectious disease, recovery from Diabetes does not follow a period of acute illness. Diabetes Mellitus is permanent. Remissions can and do occur, but even these patients should not think of themselves as cured. The fundamental methods used in the treatment are diet, insulin or hypoglycemic agents, exercise, and education. The continued management and con ¬trol of diabetes mellitus depend on the patient. Edu ¬cation as to the nature and behavior of the disease is required so that the patient understands the rea ¬sons for what he or she must do and develops the skills required for it.Diet The keystone for management of the diabetic is dietary control. In most respects the goals of the diet for the diabetic patient are similar to those for the non-diabetic. They are to provide sufficient calories to establish and maintain body weight. The number will vary with the age, sex, body size, activity, and growth and development requirements along with an adequate intake of all nutrients, including minerals and vitamins. Modifications in amounts and types of foods as required in the control of complications of diabetes and other diseases.Meal spacing so that absorption coincides with peak levels of insulin in the blood and protects from hypog lycemia during the night. For patients on intermediate-acting insulin, food is usually dis ¬tributed in five meals-three main meals with a small meal about 4 P. M. and another at bedtime. For the patient who is taking insulin, it is essential that a regular meal schedule be observed. Integration of exercise and diet with medications is essential. Most diabetic diets contain 50 to 60 per cent carbohydrates with 10 to 15 per cent in the form of Disaccharides and monosaccharide.Fats should comprise no more than 35 per cent of the total calories. The remaining calories are protein (Arky, 1978). Patients are encouraged to select unsatu ¬rated fats as recommended by the American Heart Association. Concentrated sweets and refined sugars should be avoided. Insulin Treatment with exogenous insulin is indicated in the following situations: diabetic ketoacidosis, juvenile diabetes, diabetes developing before the age of 40, unstable diabetes, oral hypoglycemic failure, diet therapy failures , and during stress of pregnancy, infections, major surgery.For the ketosis-prone individual and the unstable adult an exogenous insulin supply is always required. For the others it may be an intermittent requirement (Bonar, 1977) that is required during periods of stress. In the non-diabetic, insulin is released in response to food intake. The beta cells have the ability to release approximately 40 units daily, and there are another 200 units stored for emergency (Ellenburg et al, 2002). The diabetic does not have an endogenous supply, and an exogenous form is provided. Various types of insulin preparations have been developed.They fall into three general categories: fast-acting (regular and semilente), intermediate (NPH and lente), and long-acting (PZI and ultra lente). The actions of each preparation vary as to time of onset, duration of action, and peak activity time. Hypogly ¬cemic reactions are most likely to occur at time of peak action. Regular insulin is the only form giv en intravenously, and it has a clear appearance. The other insu ¬lin preparations have a turbid appearance. Each type of insulin comes in three concentrations; U-40, U-80, and U-I00. This refers to the concentration of insulin per milliliter.U-40 has 40 units per ml, U-80 has 80 units per ml, and U-100 has 100 units per ml. Syringes are specially calibrated for each concentration. Eventually, the only concentration available will be the U-100 strength (Joshu, 1996). This will decrease confusion and cut down on errors. The objective of insulin therapy is to enable the individual to utilize sufficient food to meet nutri ¬tional needs and, within limits, the desire for food. For many patients this objective can be achieved by a single injection of protamine zinc insulin or one of the intermediate-acting insulin, either alone or in combination with crystalline insulin.The ideal preparation of insulin would be one in which the insulin is released in response to hyperglycemia. At this time there is no such preparation. Persons who require less than 40 units of insulin per day often do very well on a single injection of Protamine Zinc Insulin. Insulin-Equipment and Administration The patient must know the type of insulin, concen ¬tration (U-80, U-100), and the prescribed dosage. It is essential that the appropriate syringe be used for the insulin concentration prescribed.Diabetic pa ¬tients on insulin may use either disposable or reusa ¬ble syringes. The former are used one time only and then discarded. Patients find them highly desirable because they do not require sterilization. Although minimal, cost may be considered a disadvantage. If reusable syringes and needles are used they should be sterilized by boiling before each injection. Boiling is simplified by placing the separated barrel and plunger of the syringe and the needle in a metal strainer. The strainer is placed in a saucepan of cold water and boiled for 5 minutes.When the syringe is removed fro m the water, care should be taken not to contaminate any part of the needle or syringe that comes in contact with the insulin or is intro ¬duced into the patient. When the syringe and needle are kept in alcohol, the alcohol container should be emptied, washed, and boiled at the time the syringe is sterilized. Before the syringe is filled with insulin, alcohol should be removed from the barrel by mov ¬ing the plunger in and out of the barrel a number of times. The skin over the site of injection should be clean, and just before the injection is made, it should be cleansed with alcohol.The hour at which the patient takes the insulin will depend on the type of insulin, the severity of the diabetes, when blood sugar is highest, and the practices of the physician. The most common time is 20 to 30 minutes before breakfast for patients re ¬ceiving one injection a day. Modified insulin con ¬taining a precipitate should be gently rotated until the sediment is thoroughly mixed with th e clear solu ¬tion. Vigorous shaking should be avoided to prevent bubble formation. Insulin, though usually called a protein, is a poly ¬peptide and is digested in the alimentary canal. It must therefore be administered parenterally.The usual method is by subcutaneous injection into loose subcutaneous tissues. Because daily, or more fre ¬quent, injections are required over the lifetime of the individual, care should be taken to rotate the sites, so that one area is not used more often than once each month. Conclusion The nurse has major responsibilities in the care of the diabetic patient. She or he must provide instruction, guidance and understanding for the control and management of the condition. The nurse must be prepared to provide nursing care for the patient if acute or chronic complications should occur.Last but not least, the nurse must recognize that the diabetic is not exempt from other diseases. She or he must be prepared to evaluate the impact of a concurrent illn ess on the diabetes and the impact of the diabetes on the concurrent illness. The sick diabetic has all the problems of any person who is ill and they are compounded by the diabetic state. The special needs of the diabetic must be recognized and met. The nurse who assists in the care of the diabetic patient has the satisfaction of knowing that the quality of life of the diabetic can be improved by intelligent nursing care. References Arky, R.A. 1978. â€Å"Current Principles of Dietary therapy of Diabetes Mellitus,† Med. Clin. North Am., 62, 655-62. Bonar, J. 1977. Diabetes: A Clinical Guide, Flushing, N.Y.: Medical Exam Publishing Co, pp.20-22. Clark, Nathanial Goodwin & Cefalu, William T. 2000. â€Å"Medical Management of Diabetes Mellitus,† CRC Press. Daly F. 1997. â€Å"The Role of the Diabetes Nurse specialist,† Irish Medical times, 14(17), 18. Diabetes Control and Complications Trial (DCCT). 1995. â€Å"Annals of Internal Medicine,† 122: 561-568. Drury. 1986. â€Å"Diabetes Mellitus,† 2nd Ed, Blackwell & Scientific Publications. Dunne L.1997. â€Å"A literature review of advanced clinical nursing practice in the United States of America,† Journal of Advanced Nursing, 25: 814-819. Dunning. 2003. â€Å"Care of People with Diabetes: A Manual of Nursing Practice, p.65-69.† Ellenberg et al. 2002. â€Å"Ellenberg and Rifkin's Diabetes Mellitus,† McGraw-Hill Professional, p.82. Fink, SL. 1967. â€Å"Crisis and Motivation: A Theoretical Model,† Arch. Phys. Med. Rehab., 592–97. Flarey, Dominick L & Blancett, Suzanne Smith. 1996. â€Å"Case Studies in Nursing Case Management: Health Care Delivery in a World of Managed Care,† Jones and Bartlett Publishers. Gregg et al. 2000. â€Å"Is diabetes associated with cognitive impairment and cognitive decline among older women?† Study of Osteoporotic Fractures Research Group, Arch Intern Med, 160:174–180. Guthrie, Richard A & Guthrie, Diana W. 2002. â€Å"Nursing Management of Diabetes Mellitus: A Guide to the Pattern Approach,† Springer Publishing. Joshu, Debra Haire. 1996. â€Å"Management of Diabetes Mellitus: Perspectives of Care across the Life Span,† Mosby, 2nd ed. Keegan et al. 2002. â€Å"Foot problems as risk factors of fractures,† Am J Epidemiology, 155:926–931. Kessler, IJ. 1971. â€Å"Mortality experience of diabetic patients,† Am.J.Med., 51, p.724. Long, Barbara C et al. 1995. â€Å"Adult Nursing: A Nursing Process Approach,† Elsevier Health Sciences. McCarthy. 1996. â€Å"Advantages and Disadvantages of Specialism in nursing,† Paper presented to An Bord altranais Conference, Continuing Education for Nurses. Metcalf L. 1998. â€Å"Ensuring continuity of care for diabetic patients attending hospital,† Journal of Diabetes Nursing, 2(5):135-138. O’Sullivan, JB. 1969. â€Å"Population re-tested for diabetes after 17 years: New Prevalence Study,† Diabetologia, 5:4, 211-14. Otong, Deoborah Antai. 2003. â€Å"Psychiatric Nursing: Biological and Behavioral Concepts,† Thomson Delmar Learning. Report of the Commission on Nursing. 1998. â€Å"Government Publications,† Section 6.33, page 105. United Kingdom Prospective Diabetes Study (UKPDS). 1998. British Medical Journal 317(7160): 703-713. Wallace et al. 2002. â€Å"Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer,† Diabetes Care, 25:1983–1986. Wilson-Barnett J & Beech S. 1994. â€Å"Evaluating the Clinical Nurse Specialist: A review,† International Journal of Nursing Studies, 13 (6): 561-571. World Health Organization Publications.1991-1998.

Childhood Obesity The Prevalence Of Obesity - 1525 Words

In recent years, the world’s prevalence of obesity in children has increased alarmingly in most of the countries. It is estimated that 170 million of children under 18 years old are overweight, in the US there is a 30% prevalence of obesity, similarly 27% of children in Mexico are obese (OCDE, 2014; Gutià ©rrez et al., 2012). In some countries like East Germany, New Zealand, the Netherlands and Canada the prevalence of overweight children had risen by one percentage point each year (Wang Lobestein, 2006). According to an OCDE report obesity rates have grown more rapidly with low socioeconomic and education (OCDE, 2014). Childhood obesity is of concern because obese children are more likely to keep excess weight in adulthood increasing their risk of developing chronic diseases such as diabetes, hypertension or cardiovascular diseases (Currie et al., 2012). Currently, cases of children and adolescents with insulin resistance, diabetes, dyslipidemia or hypertension, obesity-related conditions have been reported (Pires et al, 2014; Sorof and Daniels, 2002). The causes of childhood obesity can be attributed to various factors such as a higher calorie intake, especially from fat and sugar, a marked decrease in physical and other social factors such as food advertising, sedentary lifestyles, agricultural and health policies, built in environment, transportation, food availability and education among others (WHO, 2015; Robinson, 1999). The World Health Organization also recognizesShow MoreRelatedThe Prevalence Of Childhood Obesity Essay1860 Words   |  8 PagesThe prevalence of childhood obesity in the United States has greatly increased in the past two to three decades 1, while incidence of obesity has doubled worldwide since 1980 2. Today, the World Health Organization (WHO) estimates over 170 million children and adolescents worldwide are overweight. Particularly in the United States, prevalence of obesity in children has increased from 13.9% in 1999 to 31.8% in 2010 3. After nearly two decades of increase, the rates have started to plateau 4. ThresholdsRead MoreThe Prevalence Of Childhood Obesity1678 Words   |  7 PagesThe prevalence of childhood obesity has remained a serious matter in the United States over the years despite its recent decline (Centers for Disease Control and Prevention, 2015). Children who are obese can experience the same devastating health effects as adults who are obese – car diovascular issues, diabetes, breathing problems, and so forth. In addition, children who are obese are more than likely to become obese as adults, therefore the development of a health fair that would highlight increasedRead MoreThe Importance Of Childhood Obesity In Canada1072 Words   |  5 PagesThe prevalence of childhood obesity is growing at a frightening rate. By definition, children ages 2-17 years of age that are at, or above the 95th percentile for BMI are obese (Centers for Disease Control and Prevention, 2017). On the global scale, Canada is ranked eleventh highest for childhood obesity (OECD, 2014) with more than one in four children in Canada being obese (Public Health Agency of Canada, 2012). 31.5% of Canadian children aged 5 to 17 were overweight (19.8%) or obese (11.7%) inRead MoreEssay on Childhood Obesity1599 Words   |  7 PagesChildhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily aff ecting many low- and middle-income families particularly in the United States. The socioeconomic status of these families contributes to the childhood obesity epidemic. Summary of Article 1 The article, â€Å"Beliefs about the Role of Parenting in Feeding and Childhood Obesity among Mothers of Lower Socioeconomic Status† is a study that was conducted by Alison KalinowskiRead MoreChildhood Obesity Is A National Epidemic1406 Words   |  6 PagesChildhood obesity is a national epidemic. Nearly 1 in 3 children (ages 2-19) in the United States is overweight or obese, putting them at risk for serious health problems. Studies show that overweight kids are likely to become overweight and obese adults. This is a significant issue in the U.S. and needs to be monitored closely. Some parents are in denial that their children are obese and do not do anything to help or prevent it. When obesity is a problem at a young age it is very easy to have, itRead MoreSurgeon General Project: Childhoudd Obesity1734 Words   |  7 PagesSURGEON GENERAL PROJECT Childhood Obesity Over the last few decades the prevalence of obesity in children and adolescents has been steadily increasing in the United States drawing immediate concern for the coming generations and the overall health and well-being for society. While addressing this concern, a matter of significance has to be reviewed to undoubtedly warrant the attention of the nation and propose factors of government, community, organizational, and individual involvement. AccordingRead MorePrevalence Of Overweight And Obesity Essay1249 Words   |  5 PagesThe aim of this study was to investigate the prevalence of overweight/obesity among parents of children entering childhood obesity treatment and to evaluate changes in the parents’ weight during their child’s treatment (Trier, 2016). The study included the parents of 1,125 children and adolescents (aged 3-22) who were enrolled in a children obesity treatment program. They began by taking the heights and weights of the children and the BMI scor es were calculated. After 2.5 years of treatment, theRead MoreThe World Health Organization (Who, 2016) Has Recognized1510 Words   |  7 Pages The World Health Organization (WHO, 2016) has recognized childhood obesity as one of the most significant public health issues of the 21st century. In 2011-2014, the prevalence of obesity among children living in the United States aged 2-19 was 17% (Ogden, Carroll, Fryar, Flegal, 2015). While this percentage has stabilized in the past 10 years, millions of children are affected by this disease and at risk for chronic comorbities (Shapiro, Arevalo, Tolentino, Machuca, Applebaum, 2014). UnfortunatelyRead MorePreventing Chilhood Obesity : Parenting Programme For Early Years1073 Words   |  5 PagesCHILHOOD OBESITY – PARENTING PROGRAMME FOR EARLY YEARS BACKGROUND Obesity, defined as ‘an excessive amount of body fat relative to body weight’ (Heyward, 2010, p.232) has reached global epidemic proportions and it is the fifth leading risk for global deaths with 2.8 million adults dying every year (World Health Organization, 2013). In addition, worldwide, more than 40 million children under the age of 5 were overweight in 2011 (World Health Organization, 2013a). Consequently, childhood obesity is becomingRead MoreChildhood Obesity Is Becoming A Major Public Health Problem1367 Words   |  6 PagesOver the past decade, there has been a rise in the prevalence of overweight and obesity in children and adolescents, In 2013, the number of children (under 5 Years) said to be overweight was over 42 million with 31 million of them living in developing countries. (WHO, 2015), and if not properly handled, could lead to serious health problems like cardiovascular disease. (Owen et al., 2009). Childhood Obesity is becoming a major public health p roblem and if not properly talked could lead to serious