Study on the effects of occupational therapy

Study on the effects of occupational therapy Occupational therapy (OT) is about helping people of all ages conduct and improve their ability to perform their daily activities that occupy their time in their environment (Hussey, Sabonis-Chafee, OBrien, 2007). The environment to which individuals may wish to perform tasks could be in home, work, school or community settings (Hagedorn, 2000). The roles of occupational therapists (OTs) are to work with individuals to help them achieve a fulfilled and satisfied state in life (Crepeau, Cohn, Schell, 2009). Activities or interventions may be used to achieve functional results that promote health, prevent injury or disability so that individual may become independent as a result. OTs work with a range of people that may have conditions that are mentally, physically, developmentally, socially or emotionally disadvantaged (Crepeau, et al., 2009). Therefore they help individuals to develop, recover or maintain their skills to be able to conduct activities that they deem important. The reason why OTs wants to find out about a persons occupation is to determine what is important to the individual and how they may conduct these occupations and how all these occupations contribute to the greater good of health. A persons occupational performance is influenced by their health and the need for personal satisfaction in what they do (Crepeau, et al., 2009). This is why OTs may conduct interviews before implementing interventions. It is a way for OTs to collect informed information regarding to the needs of individuals and what they find important in their lives. The initial interview would be about gathering basic information about the individual and going through name, age, occupation and what important roles they have in their lives. As OTs, it is very important that focus is client-centred and allow clients to evaluate their performance and the importance of roles in their lives. The Person-Environment-Occupation-Performance (PEOP) model is a client-centred model that is used to improve the performance of individuals in their daily lives (Christiansen Baum, 2005). The model was developed in 1985 and was first published in 1991. The PEOP model includes the interactions of occupation, performance and participation that are involved between the person and environment when they carry out their activities in their daily lives. The model talks about the personal factors and environmental factors that support enable or restrict the performance of individual to their activities, tasks and roles that are present in their lives. In the PEOP model, OT intervention is a method of using a wide range of client-centred strategies that connect the individual or group to develop or use sources that enable them to successfully perform necessary and significant occupations. It takes into account that satisfaction of performing occupations is related to the individual or group goals and environmental factors that may or may not inhibit participation. The PEOP model has four major components. These four components are occupations, performance, person and environment (Christiansen Baum, 2005). It describes what people want or need to do in their daily lives (occupation), the act of performing the occupation (performance), and how psychological, physiological, neurobehavioral, cognitive and spiritual factors (person) combine with the location the occupation is conducted (environment) influence success. The individual ability or skills is what determine whether the individual is competent to do what they must to meet personal needs. The individual must make use of resources that are available within the environment to effectively meet these needs. The model also has the belief that the situations where people feel success also help them feel good about themselves. Therefore it acts as a motivator to allow individuals to face challenges with confidence. It is said in Christiansen Baum, that fulfilment comes both from feelings of mas tery as well as the accomplishment of goals that have personal meaning (Christiansen Baum, 2005). This indicates that individual will feel more accomplished doing occupations that they like doing and is important to them, rather than something they dont find important. According to Henry Kramer, interviewing is a shared verbal experience, jointly constructed by the interviewer and the interviewee, organized around the asking and answering of questions (Crepeau, et al., 2009). Asking good questions is not a natural phenomenon and requires practice (Miller, 2009). This is why communication skills are essential in interviewing. Interviewing requires three key elements, questioning, active listening and interpreting body language (OToole, 2008; Williams, 1997). The aim of an interview is to collectively obtain information, offer advice, support and discuss treatment (Williams, 1997). Through the process, OTs is able to establish and maintain a relationship with the client. It is important in any interview to be prepared and consider that the location where the interview will take place will set the mood. If the interview is conducted in an office, it can give feeling of formality and if the interview is conducted in a clinic, it can be associated with illness. Individuals response to these different settings may be associated to previous experiences that they may have encountered in the past. Their reaction can vary and as an interviewer, awareness should be recognized. The location of the interview can also give the purpose of the interview so it is important that suitable location be chosen. There are three phases to an interview; phase 1 is the introductory phase, phase 2 is the working phase and phase 3 is the termination. Effective communication requires mutual understanding from both interviewer and interviewee. Health professionals must ensure that clients understand the meaning and purpose of interview and why it is conducted. The interview requires that information be shared, there is a goal to reach same understanding, understanding of background and culture, a willingness to understand points of view, respect for self and other and show empathy when appropriate (Higgs, Ajjawi, McAllister, Trede, Loftus, 2008). Communication skills required in an interview include verbal communication, non-verbal communication and active listening. An example of verbal communications is the effective use of speech to ask appropriate questions and the structure of language used (Williams, 1997). The structure of the language is the way that words are put together to form sentences to give information or seek information. Verbal communications are ways of individuals expressing their ideas, concepts and emotions, give description, provide information and solve problems (OToole, 2008; Stein-Parbury, 2006; Williams, 1997). Non-verbal communication is communicating without using words to express oneself. These could include eye-contact, facial expression, body postures and behaviours, voice and volume alterations and physical space (Egan, 2007; OToole, 2008; Stein-Parbury, 2006; Williams, 1997). Active listening requires interviewer to actively listen and give verbal and non-verbal responses to show that they ar e listening. Interviewer can use non-verbal responses known as SOLER to engage in the interview. SOLER stands for sit squarely, open posture, lean toward the client, eye contact and relax. Prompts can also be used in non-verbal response to encourage interviewee to talk further or know that you are present. Verbal response includes using the three Rs; restatement, reflection and re-clarification. Phase 1 of the interview is the introductory phase. This is where introductions and purpose of the interview is explained. Permission was asked to use clients first name to be more comfortable and to create a relax environment. In this phase of the interview, the client and interviewer is sitting squarely facing each other in a small quiet room. The client is actively listening to the information told. Her actions included eye-contact, sitting squarely, using prompts such as nodding and yep as indications. There was a bit of closed postured, clasped hands and fidgety shown by client at the start that could be attributed to nervousness and uncertainty of interview. As the interviewer, verbal communication is essential in relaying the information about the purpose of the interview. This is where effective verbal communication comes into play. Effective use of speech was present but the structure of language needs to be improved. After explanation of what an OTs does, interviewer asked Do you kind of get what Im trying to say? in an uncertain voice. Interviewer could have rephrased it in a more confident reassurance voice and asked if the client understood the information and whether shed like to ask any questions. The style of language used here could be differences between social contexts. The use of formal language may not be used frequently in daily lives which make the interviewer structure of language seem a bit informal when asked. Being unsure of your own questions also leads client to perceive that it was okay to agree since it is an uncertain question. The object of an interviewer is to be confident and be able to express clearly and concisely the questions asked. Interviewer showed facial expressions and hand gestures while explaining. This could be an indication of nervousness or a habit that the interviewer may possess. Even though eye-contact was made with client, SOLER was not effectively used. At the start, interviewer is sitting squarely, leaning forward and maintained eye-contact but was not in an open relaxed posture. This was attributed to nervousness as interview progress; interviewer became more open and relaxed. Phase 2 of the interview is involved in asking relevant questions to get a clearer picture of clients occupation and history. It is where most information is collected and requires the use of a range of communication skills. SOLER was maintained throughout the interview by the interviewer and verbal prompts was used at appropriate situations to verify information that client had said. Nodding and hand gestures were used quite often to encourage client to continue talking and sharing information. In an interview, a range of questioning style is used. An example of an open question is How do you feel having to travel one and half hour to get to uni? These types of open questions allow clients to elaborate more on details and give indication to their emotions. Even though closed questions are not desirable, interviewer did make use of them. One of such is How long do you drive to uni? There is only one answer possible and does not make use of client views or feelings in this situation. Probing questions was also lacking in this interview, interviewer did not make use of this questioning style to seek out specific information. One example that is viewed is Is that the only problem you have as being a student? The question is used to question client whether the particular problem given was the only one present to being a student. Reflective questions was used to reflect a topic back for clarifications, So far youve told me that you are a student, girlfriend and you also like to keep active, is there any other activities that you enjoy doing? Some bad examples of questioning styles that should be avoided that was used in the interview was multiple and leading questions. Do you have any other career path you want to take after studying this degree? Or do you want to just find a job afterwards and be happy with that? The questions does not allow client to answer and also leads them to answer in a certain way that you have asked. Non-verbal communication skills is seen in eye-contact, facial expression, gestures, body postures and head movements. Throughout the interviewing process, eye-contact was maintained in client and interviewer. In some culture, eye-contact is not seen as appropriate when talking to elders (Crepeau, et al., 2009). Eye-contact can also become uncomfortable if used with strangers and you are expected to maintain focus for a period of time. As OTs, it is appropriate to keep an open view of clients and know that depending on their culture and values, they may conduct and act in different ways. Facial expressions on the other hand are what characterise a person. It is an important aspect of expressing emotions and expressing how we feel. Client used smile as a positive feedback when talking about her family and boyfriend. It is indications that these are the things that the client values and find enjoyment in. When she was unsure of her answers, her eyebrows would be raised upwards. Facial expression belongs to individuals and each person has their own way of expressing themselves. Gestures are also a form of communication and are seen in the movement of head, hands and body parts. It just acts as ways that individual may use these parts to emphasise and reinforce information. Body postures refers to the position of the body and limbs (Williams, 1997). The postures adopted by the client was slightly leaned forward back with arms placed together in front of her laps. The interviewer on the other hand has her body leaned forward towards the client and arms resting on legs to cater for the book in front of her. The importance of postures can give indications to individual emotions. A slump shoulder and crossed arms could indicate lack of interest or boredom. Phase 3 is the termination where information is summarized and clarified, client is thanked and ending of interview. Interviewer successfully used all mentioned techniques in this last phase but the language and structure of speech used could be improved. This could come with practice and experience. The voice used in the interview also gives indication to the emotions that is conveyed by clients and should be picked up when possible. The rate of speech or tone of voice express emotion and convey information about attitudes to certain things. Each individual have their characterised voice that distinguished us from someone else. It is with our voice that we can allow our emotions and feelings be conveyed. Interviewing requires multiple communication skills and practice to execute a good interview. Communication skills are not always verbal but include the non-verbal communication that is expressed through facial expression, gestures and eye-contact. Each individual have their own way of expressing themselves whether verbally or non-verbally. It is a good interviewer that is able to pick up on cues to allow them to adjust to client when interviewing. Interviewing requires interviewer to actively listen, question and empathize with clients. Through the use of PEOP model, the interview is able to be carried out and informed information is collected on the person, occupation, environment and performance.

Anaemia

Abstract Background: Anaemia is common worldwide specially in developing countries where nutrient deficiencies are prevalent. It is a common problem in the outpatient set but it’s always neglected and taken lightly which can cause hyperdynamic circulation disturbances and raise the rate of morbidity and mortality. Aim: To determine the prevalence of microcytic Hypochromic anaemia in medicine emergency room casualty in academy teaching hospital. Method: This is a descriptive cross-sectional study which was done in the Academy Teaching Hospital in which 75 of the emergency room patients participated in the study.The state of nutrition of the patients was evaluated by a questionnaire answered by the patients. Chapter One Introduction and Literature Review 1. 1 Introduction Anaemia Anaemia is defined as the reduction in the oxygen-transporting capacity of blood, which usually stems from a reduction of the total circulating red cell mass to below normal amounts. Blood haemoglobi n level is below 13. 5 g/dl in an adult male and below 11. 5 g/dl in an adult female. (1) Classification: Classified according to: 1. Causes: a. Inadequate production of RBC. b. Blood loss anaemia: * Acute: due to acute hemorrhage. * Chronic: due to GIT bleeding, menorrhagia. . Excessive destruction of RBC (haemolysis). 2. Morphology: a. Microcytic: * Iron deficiency. * Thalassemia. * Sideroblastic. b. Microcytic: * Folate deficiency. * B12 deficiency. c. Normocytic: * Aplastic anaemia. * Myelodysplastic anaemia. There are many undiagnosed cases of anaemia that if left undetected can lead to several complications, those include: (2) 1. Infections: people with the anaemia are more susceptible to getting infections from viruses and bacteria. 2. Severe bleeding: if bleeding is severe, internal and excessive then death can ensue if a blood transfusion is not given and the cause of the bleeding is not treated. . Stroke: if haemoglobin is defective, it can damage the walls of the red bloo d vessels and this can result in narrowing or even blockages in the brain, which can lead to serious, life threatening strokes. (2) Microcytic Hypochromic Anaemia Microcytic anemia is a blood disorder characterized by small red blood cells (erythrocytes) which have insufficient haemoglobin and hence have a reduced ability to carry oxygen through the body. The red blood cells are small due to a failure of haemoglobin synthesis or insufficient quantities of haemoglobin available. (3) Classification: 1. Iron deficiency anaemia . Sideroblastic anaemia. 3. Thalassemia. Iron deficiency anaemia It’s estimated to be the main cause of anaemia affecting about 10% of the population in developed countries and 25-50% in developing countries. The prevalence of iron deficiency anemia in the United States was 2 percent in adult men, but was found to be more common in child-bearing women age. (4) Total body iron content is about 2gm for females, and 6gm for males. Most of the iron within the body is found in hemoglobin within erythrocytes (80%), with the remainder being found in myoglobin and iron containing enzymes.Iron is stored in liver, spleen, bone marrow and skeletal muscle. This iron storage pool contains on average 15-20% of total body iron. (4) Iron is transported in the plasma by an iron binding protein called transferrin. In normal individuals, transferrin is about 33% saturated with iron. Dietary iron is obtained either from inorganic sources or animal sources. Dietary iron enters intestinal cells via specific transporters. The iron is then used by the cell, stored as ferritin or transferred to the plasma. (4) Erythropoiesis is the development process in which new erythrocytes are produced, through which each cell matures in about 7 days.Through this process erythrocytes are continuously produced in the red bone marrow of large bones, at a rate of about 2 million per second in a healthy adult. The blood's red color is due to the spectral properties of the he mic iron ions in hemoglobin. The red blood cells of an average adult human male store collectively about 2. 5 grams of iron, representing about 65% of the total iron contained in the body. (5)(6) Causes: * Poor intake. * Decreased absorption (celiac disease, gastrectomy). * Increased demand in growing adolescents and pregnancy. * Blood loss from GIT due to: * Hookworm infestation. Erosions associated with NSAID, peptic ulcer or neoplastic disease. * Hemorrhoids. * Blood loss from irregular or excessive menstruation. Symptoms and signs (7) Symptoms may include: * Fatigue. * Shortness of breath * Lightheadedness. * Palpitations. * Dizziness. * Chest pain. * Blurred vision. * Sleep disturbance. Signs may include: * Rapid heart rate. * Low blood pressure. * Rapid breathing. * Pale conjunctiva. * Cold skin. * Enlargement of the spleen. Diagnosis of iron deficiency anaemia: * Complete blood count and color: with iron deficiency anaemia red blood cells are smaller and paler in color than n ormal. Hematocrit: This is the percentage of blood volume made up by red blood cells. Normal levels are generally 41% for adult women and 47% for adult men. These values may change depending on your age. * Haemoglobin: Lower than normal hemoglobin levels indicate anemia (12-16 g/dl in an adult male and 13. 7-17. 5 g/dl in an adult female). * Ferritin: This protein helps store iron in your body, and a low level of ferritin usually indicates a low level of stored iron. Some tests might be done to detect the underlying cause, like: * Endoscopy: Often to check for bleeding from a hiatal hernia, an ulcer or the stomach. Colonoscopy: To rule out lower intestinal sources of bleeding. * Ultrasound: Women may also have a pelvic ultrasound to look for the cause of excess menstrual bleeding, such as uterine fibroids. (8)(9) Sideroblastic anaemia It is a disease in which the bone marrow produces ringed sideroblasts rather than healthy red blood cells (erythrocytes). [10] In Sideroblastic anemia , the body has iron available but cannot incorporate it into hemoglobin, which red blood cells need to transport oxygen efficiently.Sideroblasts are atypical, abnormal nucleated erythroblasts (precursors to mature red blood cells) with granules of iron accumulated in perinuclear mitochondria. [11] Sideroblasts are seen in aspirates of bone marrow. Causes: * Failure to completely form heme molecules, This leads to deposits of iron in the mitochondria that form a ring around the nucleus of the developing red blood cell. * Toxins: lead, copper or zinc poisoning * Drug-induced: ethanol, isoniazid, chloramphenicol, cycloserine, Oral Contraceptives * Nutritional: pyridoxine (Vitamin B6) or copper deficiency * Diseases: Rheumatoid arthritis, or multiple myeloma Genetic: ALA synthase deficiency (X-linked, associated with ALAS2)[12] Symptoms and signs: * Pale skin, eyelids and lips. * Fatigue and weakness. * Dizziness. * Enlarged liver and/or spleen. Diagnosis: Ringed sideroblasts are seen i n the bone marrow. Laboratory findings: * Increased ferritin levels * Normal total iron-binding capacity * Hematocrit of about 20-30% * Serum Iron: High * High transferrin saturation * The mean corpuscular volume or MCV is usually normal or low. * With lead poisoning, see coarse basophilic stippling of red blood cells on peripheral blood smear * Specific test: Prussian Blue stain of RBC in marrow.Shows ringed sideroblasts. * can also cause microcytic hypochromic anemia. (12) Thalassemia It is a group of inherited autosomal recessive blood disorders that originated in the Mediterranean region. In Thalassemia the genetic defect, which could be either mutation or deletion, results in reduced rate of synthesis, or no synthesis of one of the globins chains that make up hemoglobin. This can cause the formation of abnormal hemoglobin molecules, thus causing anemia, the characteristic presenting symptom of the Thalassemia. (13) Symptoms and signs: * Fatigue and weakness. * Shortness of brea th. * Pale appearance. Irritability. * Yellow discoloration of the skin. * Facial bone deformities. * Slow growth. * Abdominal swelling. * Dark urine. (14) Diagnosis: * Blood tests. * Prenatal screening. (14) Laboratory findings: * A low level of red blood cells * Smaller than expected red blood cells * Pale red blood cells * Red blood cells that are varied in size and shape * Red blood cells with uneven hemoglobin distribution, which gives the cells a bull's-eye appearance under the microscope. (14) 1. 2 Literature Review A study was done in Italy about prevalence and incidence and types of mild anaemia in the elderly.The objectives of this study were to estimate the prevalence and incidence of mild grade anemia and to assess the frequency of anemia types in the elderly. Design and Methods: This was a prospective, population-based study in all residents 65 years or older in Biella, Italy. Results: Blood test results were available for analysis from 8,744 elderly. Hemoglobin concent ration decreased and mild anemia increased steadily with increasing age. Mild anemia (defined as a hemoglobin concentration of 10. 0-11. 9 g/dL in women and 10. 0-12. 9 g/dL in men) affected 11. % of the elderly included in the analysis, while the estimated prevalence in the entire population was 11. 1%. Before hemoglobin determination, most mildly anemic individuals perceived themselves as non-anemic. Chronic disease anemia, Thalassemia trait, and renal insufficiency were the most frequent types of mild anemia. (15) A study was done in emergency ward, Mulago Hospital, Uganda. Anaemia is a common problem in Africa, with prevalence ranging from 21. 1% to 64. 4% 16-21 and a significant impact on morbidity and mortality. 22,23 in patients with AIDS low haemoglobin levels are associated with poor outcomes. 4-27 However, anaemia in Africa has multiple causes, with infectious diseases such as HIV, tuberculosis and malaria contributing significantly to the anaemia burden. 28 Hookworm is a major contributor to anaemia and even light hookworm loads are associated with low haemoglobin levels, 29-33 although Lewis et al. reported that hookworm was not a common cause of anaemia among medical patients in Malawi. In a cross-sectional descriptive study 395 patients were recruited by systematic random sampling and their socio-demographic characteristics and clinical details collected.A complete blood count and peripheral film examination were done and stool examined for hookworm ova.. Of the patients 255 (64. 6%) had anaemia. The prevalence was higher among males (65. 8%) than females (63. 7%). Fatigue (odds ratio (OR) 2. 1, confidence interval (CI) 1. 37 – 3. 24), dizziness (OR 1. 64, CI 1. 07 – 2. 44), previous blood transfusion (OR 2. 83, CI 1. 32 – 6. 06), lymphadenopathy (OR 2. 99, CI 1. 34 – 6. 66) and splenomegaly (OR 5. 22, CI 1. 78 – 15. 28) were significantly associated with anaemia. Splenomegaly, low body mass index (BMI) (

The Pain of Possible Thematic Essay Topics

The Pain of Possible Thematic Essay Topics Even in the event you don't understand what things to begin with, write anyway. Thematic essays are extremely hard to write for most students. Geography essays are known to cause a great deal of headaches to students. Once you are finished with your reading, another question may appear. For this reason, you should pick an appropriate topic, counting on a possible reader. The function of the test is to assess personality along with other test. Personality tests have developed through the years but the Thematic Apperception Test is still being used. The Benefits of Possible Thematic Essay Topics Taking notes as you go over it's always advisable as it will allow you to paint a clearer picture of a message. For example, you will need an outline. Thematic essays are usually somewhat long, so it's not unusual to get many unique paragraphs to go over lots of unique points. Generally speaking, a thematic essay is merely an outline of the primary points. Our world-class faculty permits you to create the skills you must play a crucial part in any knowledge-intensive industry. Students must list the tasks that will need to be dealt with. Also, each student should try to remember the requirements so he can independently navigate the writing of the job. Some students make two or even 3 drafts before they are sometimes happy with their work, as a consequence they get good marks. Whenever you have the info, you've got to organize it. The given above information is truly valuable. The libraries holdings can be found the UCLA Online Catalog. On our website, you will locate the expert services of skilled essay writers with examples of excellent works. Vital Pieces of Possible Thematic Essay Topics Naturally, you shouldn't utilize texts which you will discover. With us, you're going to be a pro in writing, and you'll never get stuck on the best way to compose a geography paper. The subject of the thesis has to be in the huge region and need to reveal independent investigation and comprehension of the methods of scholarship. As a way to compose a masterpiece, it's important to follow along with a particular workflow with several stages. The Tried and True Method for Possible Thematic Essay Topics in Step by Step Detail Theme essays are thought to be the simplest to write. Last, you should put a together a thesis statement that's in agreement with the central topic of your paper. Proofreading and editing are a crucial portion of thematic essay writing. After the stated theme, students receive a task that they must complete in essay format concerning the theme. 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End the intro by means of your thesis statement the point you're likely to be making throughout the essay, and the remainder of the essay will be supporting. It is essential to pick the main idea depending on the prompt. When in doubt look for the most regularly brought up talking point, and you'll get the heart of the essay. The War Against Possible Thematic Essay Topics Commonly, the thematic essay is related to social problems in distinct periods of human civilization. It is essential to learn them all and fulfill it as required.

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