Etiology

The term dementia refers to an umbrella term that describes conditions that affect several aspects of cognition due to neurons in the brain (Alzheimer’s Association, 2014). Specifically, dementia refers to a progressive condition in which a variety of symptoms exist, including: memory loss, expressive language impairments, impaired communication, ability to reason, mood, and personality (Alzheimer’s Society, 2013). It is a major health concern for the population affected (Fredriksen-Goldsen, Jen, Bryan & Goldsen, 2018). Alzheimer’s is the most commonly seen type of dementia, with the estimation of prevalence being 5.4 million Americans (Alzheimer’s Association, 2016). Globally, the estimated prevalence is 35.6 million, with the population of patients expected to double every 20 years (Prince et al., 2013). Currently, there is no cure for dementia (Livingston and Frankish, 2015).

The focal types of dementia include Alzheimer’s, which becomes more severe over time, and Lewy body dementia that is commonly associated with Parkinson’s disease and which may cause the patient to suffer from vivid hallucinations. Sleep disturbances are also characteristic of dementia (Walker et al, 2015). In 2016, it was estimated that 236 billion dollars was spent on treatment and care for patients that suffered from Alzheimer’s disease and other dementias. This makes Alzheimer’s disease and other dementias the most expensive diseases in America (Alzheimer’s Association, 2016). There are several neurobehavioral and language characteristics that are associated with dementia.

Neurobehavioral and language characteristics

Each type of dementia presents with varying degrees of communication deficits. These deficits can be in the areas of expressive or receptive language, voice fluency, or the social use of language, which is referred to as pragmatics. These deficits can advance to a point in which the patient loses all functional communication abilities (Woodard, 2013). This can negatively impact the patient’s quality of life and escalate the burden that caregivers often undertake. Responsive behaviors such as violent behavior, foul language, and repetitive questioning may be a result of the frustration caused from losing the ability to functionally communicate (Savundranayagam, Hummert, & Montgomery, 2005). As the dementia progresses in severity, these responsive behaviors can increase. Treatment from a speech-language pathologist can prove very beneficial in treatment for dementia patients.

Treatment as it applies to the field of speech/language pathology

Intervention conducted by a speech-language pathologist may enrich function communication abilities of a person with dementia. Speech-language pathologists play a vital role in functional communication treatment as dementia progresses (Alzheimer’s Association, 2014). It has been reported by speech-language pathologists that the knowledge they possess to aid in treatment of patients with dementia is underutilized. Other health professions do not recognize the wealth of knowledge that a speech-language pathologist possesses (Swan et al., 2018). It is up to the professionals of speech-language pathology to utilize evidence based practice and provide sufficient data that supports functional communication growth following treatment by a speech-language pathologist.

It is important to take into consideration the patient’s wants, needs, abilities, strengths, and level of support care when the subject of treatment is discussed. It is just as important to realize that treatment for mild-moderate dementia will vary from treatment for severe dementia. The appropriateness and effectives of intervention approaches should be analyzed before treatment begins (Swan et al., 2018).

Intervention approaches have been recently classified as cognitive training, cognitive rehabilitation, and cognitive stimulation. Cognitive training utilizes a restorative strategy; cognitive rehabilitation utilizes a mixture of restorative and compensatory strategies; while cognitive stimulation utilizes interventions that provide gratifying stimulants that promote socialization and a feeling of enjoyment (Swan et al., 2018). Several studies have been conducted that delve into treatment approaches provided by a speech-language pathologist for patients with dementia. Positive outcomes have been reported using cognitive training, cognitive rehabilitation, and cognitive stimulation approaches (Swan et al., 2018).

Frattali (2004) conducted a study that utilized a cognitive training approach of individual naming therapy. An errorless naming approach to naming was employed. The goal of the study was to improve naming of semantic categories using a conversational approach. Word retrieval tasks were influenced to create errorless learning. Forty picture card stimuli were organized according to categories. The treatment was comprised of 12 sessions, divided into two phases. The first phase consisted of noun training and generalization to untrained verbs. The second phase consisted of noun training, generalization to untrained verbs, and maintenance of performance for previously taught verbs. Conversational exchange was employed to discuss the semantic properties of each card.

The results of this study were very similar to other studies of this nature. They imply that the benefits gained from this study were largely due to the naturalistic, conversational approach of the treatment sessions. The nature of exchanges between the patient and clinician were natural and evenly divided among participation. Additionally, pragmatic exchanges made between the patient and clinician were evenly divided in participation, and allowed for naturalistic, rather than clinically structured communication exchanges (Frattali, 2004).

Overall, gains were made in vocabulary skills and quality of life in patients with dementia. Though, despite gains made during active treatment periods, at a follow up assessment three months after the initial intervention took place, all skills had been lost. This implies that for the knowledge gained during treatment to remain in working knowledge, treatment has to be ongoing (Frattali, 2004).

In a study conducted by Spector, Thorgrimsen, Woods, Royan, Davies, Butterworth, and Orrell (2003), the hypothesis of using cognitive stimulation therapy would reap benefits for geriatric patients with dementia. A single-blind, randomized selection and intervention process was utilized. One hundred fifteen patients participated, of which, 89 were of the control group. Fourteen sessions of interventions designed using cognitive stimulation took place. Topics of the sessions included money, famous familiar faces, and word retrieval games. The sessions included a “reality orientation board.” The purpose of the board was to remind participants of the nature of their work. A small group session was found to be beneficial for participants. The intimate, close-knit environment allowed the participants to exercise communication skills that have not been utilized in quite some time (Spector, et al., 2003).

Sessions were focused on themes that allowed the participants to reminisce, but still be reminded of present-day topics, such as childhood and food. Sessions encouraged the participants to process information rather than recite from long-term memory. The Mini–Mental State Examination, a test of cognitive function, was utilized as a primary measure to assess cognition. Various secondary measures, such as quality of life, communication, behavior, global functioning, depression, and anxiety were utilized as well. The study found that participants showed significant growth in both cognition and quality of life. No changes in behavior were noted, though there were positive trends noted in the area of communication (Spector, et al., 2003).

In a recent systematic review of speech-language pathologist interventions for communication in moderate to severe dementia patients conducted by Swan, Hopper, Wenke, Jackson, Till, and Conway, 2018, evidence for direct and indirect services was analyzed. Direct intervention referred to interventions that were face to face with the person with dementia, while indirect intervention referred to interventions that addressed activities related to communication. Some inclusion criteria included communication interventions provided by a speech-language pathologist, outcome measures based on overall communication efficacy, and participants with a diagnosis of moderate-severe dementia. The studies included had to meet all of these criterion to be included in the study.

Interventions were conducted in a variety of settings, with both direct and indirect modes of treatment. The vast majority of direct intervention services were conducted via cognitive stimulation approaches. All of the studies included in the systematic review concluded with improvements in overall communication efficacy for the patients with dementia. Those with language impairments showed improvements via cognitive stimulation group treatments. Individual naming therapy via cognitive training approach showed communication increases as well. Efficacy was measured through assessment of communication skills via language and communication subtests of various cognitive tests (Swan et al., 2018).

The vast majority of indirect services were conducted via communication partner training. The mean words per topic used by the person with dementia were increased, as well as reduction in the number of topic needed to fulfill a 15 minute conversation with the trained communication partner. Conclusively, although the studies reviewed varied in settings and modalities, all studies reported a positive outcome of speech-language pathologist provided treatment in cases of those with moderate-severe dementia. Though results revealed progress in the studies reviewed, follow up evaluations yielded loss of skills (Swan et al., 2018). This further indicates that interventions must be on-going to be truly effective.

This review provided evidence that overall, the quality of life and communication of a patient with dementia can be positively affected by direct and indirect meaningful communication interventions (Swan et al., 2018). Patients with dementia deserve the best quality of life possible. A key factor in preserving quality of life is communication. Communication skills can help to allow the patient to have their wants and needs met, along with the basic need of humanity, functional relationships.

Conclusion

In conclusion, dementia refers to a progressive condition in which a variety of symptoms exist, including: memory loss, expressive language impairments, impaired communication, ability to reason, mood, and personality (Alzheimer’s Society, 2013). Speech language pathologists play an essential role in treatment of dementia. It is essential to communicate, support, and advocate for patients who suffer from dementia (Butcher, 2018.)

Intervention approaches include cognitive training, cognitive rehabilitation, and cognitive stimulation (Swan et al., 2018). These three intervention approaches have proven efficient in improving communication skills and quality of life for patients with dementia. Currently, though, there is no cure for dementia (Livingston and Frankish, 2015), these interventions help patients with dementia to preserve the necessary skills to retain functional communication abilities and quality of life.

References

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• Fredriksen-Goldsen, K. I., Jen, S., Bryan, A. E. B., & Goldsen, J. (2018). Cognitive Impairment, Alzheimer’s Disease, and Other Dementias in the Lives of Lesbian, Gay, Bisexual and Transgender (LGBT) Older Adults and Their Caregivers: Needs and Competencies.
  
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Evidence based practice in health care is a process of finding evidence or efficiency of different treatment options as well as determining its relevance to a particular client’s situation (liamputong, 2010, P. 270). It is decision or practice based on evidence which consist of research evidence, clinical expertise, and preferences of patient, goal and appropriate circumstances to implement the action, population needs, priorities and resources (Wood & Haber, 2006).

Before evidence best practice the ill person was seen as having spiritual failing or being possessed by demon. Prehistoric man looked upon illness as a spiritual event. Research done before the twentieth century was more anecdotal, consisting of descriptions of patients or pathological findings. They used to rely just on well experienced senior as an information source (Taylor, Kermode, & Roberts, 2006).

It is important to healthcare practice because it is an approach to decision making in which the practitioner use the reliable evidence that affect the care of individual patients. That information is carefully considered according to all relevant and valid research in order to make plan which is best suitable for that patients. Evidence based practice in nursing care is based on solid evidence that is up to date and well researched. Evidence based practice provides the best care to patient and family which gradually leads to improved patient outcomes and patient and family satisfaction with care. To support clinical decision, evidence from research is used to evaluate efficiency of intervention and outcomes. Evidence based practice has increased accountability in nursing research (Hammell & Carpenter, 2004).

Fundamentally, evidence-based practice in the area of health care refers to the process that includes finding empirical evidence regarding the effectiveness and efficacy of various treatment options and then determining to relevance of those options to specific clients (liamputong, 2010, P. 270).

Quantitative research is a valid tool and can assist evidence based practice. Quantitative research is the “…science of numbers” (Landorf, 2010) and uses data to investigate relationships. Quantitative research can help to explain “why” things happen with minimal bias due to its high dependence on numbers and facts. However, there are issues with quantitative research. It will not always “give” a clinician clear answer. It can show you relationships but will not always explain why these relationships exist or why they do not. Quantitative research can also have issues with bias and it is essential to investigate and analyse all data presented in any study..

Cox (2008) conducted quantitative research in the form of a Randomized Controlled Trial that was performed, at the Primary Care Organisation (PCO) level in relation to falls one of the primary causes of accidental death and fragility fractures in older adults. In, order to assess the weather specialist osteoporosis nurses delivering training to care home staff can reduce fractures and improve the prescription of treatments to reduce fractures versus usual care.

“The randomized controlled trial is one of the simplest but most powerful tools of research. In essence, the randomized controlled trial is a study in which people are allocated at random to receive one of several clinical interventions.” (Norman, Stolberg, Trop. 2006, p. 1539) There are different forms of randomization (Landorf, 2010). This research can be considered as blocked randomization since there are equal-sized blocks of participants. The use of blocked randomization is valuable to the quantitative researcher because it enables an equal assessment of equal numbers of participants. The use of large equally sized groups is advantage of quantitative research. It can assess the effectiveness of practice on larger groups of people, thus making it more effective.

Interventions can be divided into three categories specifically, single, multiple and multi-factorial. In the given research article, it can be concluded that multi-factorial intervention was used where different participants receive different combination of interventions based on an individual assessment (Gillespie, Robertson, Gillespie, Lamb, Gates, Cumming, Rowe, 2003). The interventions were given very clear and were designed to be easily accessed by all participants. The interventions were also based on strategies deemed to be primary care level and cost-effective. The interventions included different methods such as verbal and written training, risk factors for falls and fractures, methods used for risk assessment and prevention of fractures in the workplace. This is strength of Quantitative research. Data can be clearly assessed to see if one or a combination of these interventions would decrease the likelihood of falls. This is an excellent example of how quantitative can inform evidence based practice.

The strength of Quantitative research is the clear conclusions it can draw. The trial gave an answer. The answer informed clinicians about the practice of interventions in reducing falls in older people. That was that these interventions were ineffective. However, there was no explanation as to why the trial was so ineffective. There were hypotheses presented, such as participants being “more aware” of falls, but there was no definitive answer.

A computer program and a biostatical were used to randomly allocate patients to the control group which is called as usual care or the Intervention Protocol (IP). This is another strength of Quantitative research techniques. That is that computers can be used to randomly allocate groups. There can be no bias when a computer separates groups.

In the research article 242 excluded patients, it has been mentioned that not enough time to gain ethical approval and research governance The reason behind the numerous people refusing to participate in the research has not been mentioned. This is a weakness of Quantitative research. The article does not clearly state this and it is not mentioned in the conclusion. It is only shown in the flow diagram, so it could be easily missed. The emotions, feelings, insights, motives, intents, views & opinions of the subject are not taken into account

Additionally, out of the 58 actual participants, 29 participants were grouped under Intervention Protocol (IP), whereas the remaining 29 participants were grouped under control group. The most frequent utilized method for identifying participants is never discussed in the research article. This once again is a weakness of quantitative research.

However, at this 6 month stage the clinicians involved in the trial knew that the interventions had been unsuccessful. This is because they could not be blinded to the results. It can then therefore be questioned as to how effective the treatment the second group received was. It could be argued that it would be difficult to stay motivated if the clinicians already knew that the trial had been unsuccessful. This in turn could bias the second group of usual care patients in the study. This analysis then demonstrates another issue with quantitative research techniques.

According to Sackett and Associates (1996, p. 71), evidence-based practice is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” The above analysis demonstrates that Quantitative research has much strength and can assist clinicians in determining the best practice to obtain the best outcomes for their patients. However, a well-informed researcher and clinician will always be aware of the bias that can exist when presented with information in a trial using quantitative research techniques.

Refrences

Gillespie LD., Gillespie WJ., Robertson MC. et al. (2009). Intervention for preventing falls in older people living in the community (Review), (4), 1-25. The Cochrane Collaboration: John Wiley & Sons, Ltd. Retrieved from http://www.thecochranelibrary.com.

Landorf, K. (2010). Clinical Trials : The Good, the Bad and the Ugly. In Liamputtong, P. (Ed.). Research methods in health: foundations for evidence- based practice. (Chapter 15, pp. 252-266). South Melbourne: Oxford University Press.

Norman, G., Stolberg, H.,Trop, I. (2006). Fundamentals of Clinical Research for Radiologists. Randomized Controlled Trials. 1539-1544. Canada: AJR. Retrieved from

http://www.ajronline.org/cgi/reprint/183/6/1539.

Sackett,D.L., Rosenburg, W.M., Gray Muir, J.A., Haynes, R.B. & Richardson, W.S. (1996).

Evidence based medicine: What it is and what it isn’t. British Medical journal, 312,

Cox, H., Puffer, S., Morton, V., Cooper, C., Hodson, J., Masud, T., & … Torgerson, D. (2008). Educating nursing home staff on fracture prevention: a cluster randomised trial.Age & Ageing, 37(2), 167-172

Wood, G. L., & Haber, J. (2006). Nursing Research: Methods and Critical Appraisal for Evidence -Based Practice (6th ed., p.295-288). Missouri: Mosby Elsevier

Hammell, K., & Carpenter, C. (2004). Qualitative Research in Evidence-Based Rehabilitation (pp.1-89). London: Elsevier.

Liamputtong, P., (2010). Research methods in health: Foundations for evidence-based practice. Australia and New Zealand: Oxford University Press.

Taylor, B., Kermode, S.& Roberts, K, (2006)., Research in nursing and health care: evidence based practice, Thomson, Australia.

A study on drug addiction in Pakistani youths

Drug addiction is a state of periodic or constant intoxication produced by the repeated consumption of a drug. Its characteristics include Uncontrollable desire to continue taking the drugs, a tendency to increase the dose after interval of time, a psychological and physical dependence on drugs, effects of drugs on individual and society.

Drug addiction is an abnormal condition which arises due to frequent drug use. The disorder of addiction involves the progression of sensitive drug use to the development of drug-seeking behavior, the openness to decline and the decreased, slowed ability to respond to naturally rewarding stimuli.

Drug addiction is basically a chronic disease affecting the brain, heart and other parts of body. Youngster start taking drugs at their teen ages and the first step of addiction to drugs is

smoking

. Drugs affect different people in different ways. One person can take and abuse drugs, yet never become addicted, while another merely has one experience and is immediately hooked. It can be said that dugs addiction is just a state of mind. Drug addiction is often overshadowed by many of the country’s other human development problems, such as poverty, illiteracy, and lack of awareness and basic health care center. But the fact is that drug addiction is rapidly growing among the youth of Pakistan.

Drug addiction is a complex brain disease. It is characterized by compulsive, at time uncontrollable, drug craving, seeking and use that persist even in the face of extremely negative consequences. Drug seeking becomes compulsive, in large part as a result of the effect of prolonged drug use on brain functioning and also on behavior. For many people, drugs addiction becomes chronic, with relapses possible even after long period of abstinence.

I chose this topic because I think it is necessary for today’s society which is taken over by the curse of drugs, mostly High School and university students are involved in it. It the main reason, today youth is distracted from their ambitions, and due to it today Pakistan, even after 63 years of independence, is 3rd world country. One of the reasons is that some people who want to quit but due to the lack of health care centre, they are unable to quit. Some people also involve in illegal activities to take drugs because they are not financially strong. This study will help us analyze the effects of drug addiction and will help us find better alternatives.

Drug addiction is a state in which the body feel relax and comfortable. Drug addiction among youngsters is increasing day by day, which have a very negative effect on our society.

Review of Literature

This study help us to examine that individual who are addicted to drugs are viewed negatively overall in the society. This research indicate that negative attitude are clear among young generation and it gradually increase with the age, so that the literature review indicate that level and accuracy of knowledge about mental illness increase from childhood through adolescence, negative attitude in youth also raise with the passage of time. On the other hand, adolescence is often accompanied by peer pressure or by other recourses. According to the study, it is also found that current users Marijuana says that it is less dangerous than other drugs. The study show that drug addiction is found in males as well as females and this trend is gradually increasing especially in females, and it is also shown in the study that trend of drugs among adolescent is also increasing in urban and rural schools. Results show that age-stigma association is quite independent of sex and residence. It also shows one of a factor that who are addicted to drugs are due to their close friends or you can say due to bad company.

This study shows the reasons and causes by which teenagers are motivated toward drugs. It show that who use drugs on a regular or occasionally are strongly supportive by personal choice due to lack of concentration from their parents and for enjoyment with their friends to eliminate their boredom. The reasons which are not using drugs in this study include lack of interest and fear from drugs and also from their parents and opposite reaction of their elders. The main purpose of this study is to emphasize the significance of parents in this regard. This research show the fact that increasing majority of children reported using drugs because they enjoyed them or they were bored and they want themselves to remain busy in some other alternative activities. The use of illegal drugs in children and teenagers are gradually increasing day by day. Result of this study showed that the main reason by which youth is motivating toward drugs is due to the peer pressure and their friends which were involved in such illegal activities. The other aspect to conduct this research was to finds the reasons that why some children do not use drugs. The first reason was lack of interest in the effects of drugs. Other main reasons included fear of immediate effect of substance, fear of physical and psychological harm and fear of becoming addicted to drugs. The finding and conclusion of this study is to get the reasons behind drug related decision especially in children and teenagers. Both who use drugs and who do not give lot of explanation and reasons. Children who do not use drugs reported that they are not involved in drugs are due to lack of interest in this activity, worries about the cost of getting caught by police or their parents.

As we all know the health hazards of smoking. Everyone is familiar from this fact but this curse is rapidly increasing among youngster. The main objective of this study is to investigate the signs of tobacco use, smoking as well as snuffing, at the age when most of the young generation is diverted toward this curse. In this study, it is found that now a day, smoking is becoming very common in girls as well. Sweden has the highest frequency of smoking all over the world. It is found in the study that frequency of snuffing among teenagers has amplified since the early 1970s, whereas the graph of smoking has reduced slightly during last decade. The purpose of this research is to explore teenager’s thinking of tobacco use, their shared ideas and images, how these design are reflected in their report about their own and other people tobacco use and also the ways understandings of tobacco use are related to the teenager’s development of a gender identity. It is found in the study that smoking cigarette offered males as well as females a short break from their daily routine and strains of family life. According to teenagers, smoking will ultimately lead to the break-down of the whole body. They also explain that invisible process inside the body, when smoking, will gradually be visible on the outside of the body. This research shows that youngsters think that snuffing has a positive effect as they increase their sports performance. But the fact is something else. Smoking and snuffing is just a mind satisfaction activity, as it affects lung and heart. On the other hand, it also affect externally like u see that the color of lip and teethes and even the color of face of smokers are also changed after a period of time. Some people are attracted to danger, and want to face risk, which is one of the reasons for them to start smoking. In addition, it is examined in the study that tobacco use is basically based on human nature. Smoking is a part of teenage lifestyle, such as being together with friends for hangout, parties etc. It is concluded from the analysis that now a days, new generation is well aware from all illegal activities such as, smoking, snuffing, drinking etc.

This research paper shows the planned use of prescription drugs of intoxicating properties other than physician’s description of specific drugs for intoxicating means or for bona fide medical condition, which is dangerous for human health. Research shows the rapidly increasing rate of abuse of such drug among youth, especially teenager. Such type of abuse of drugs is one of the biggest and main sources of drug addiction. In 2003, approximately 15 million US citizens were involved in using of prescription drugs for its intoxicating quality. For minimizing the rate of prescription drug misuse, government is making strategies to identify the early signs and effective clinical practices to prevent people from getting into it to avoid from massive problems in future.

The most abundantly used drug in UK is Alcohol and teenagers use it more than the limit described for health which 21 and 14 units per week for males and female respectively. Those who are new to alcohol must use bellow the limit for the safe side. This study is about the relationship between excessive use of alcohol and its affect on human memory. It is identified from surveys among excessive use and low-dose user that those who use alcohol in excess amount face everyday memory errors than low-dose. Excessive use of alcohol has a direct relation on memory errors and neuropsychological deficits. Alcohol is very harmful for heart, liver and other sensitive parts of human body.

The finding of this study is that use of substance is highly common among homeless and street-involved young people. Study confirmed that variables measuring psychological dysfunction and homeless culture predicted alcohol addiction, while institutional disaffiliation and homeless culture predicted drug addiction. Findings affirm distinct patterns of division related to alcohol compared to drug addiction. As homeless, street-involved young people continue to use drugs and alcohol as a strategy to cope with the various detrimental experiences associated with living on the streets, the result is often further societal estrangement. This study also show that engaging in criminal behaviors has been identified as an indicator of disaffiliation, especially among homeless population. Seeking drug-using friends and involvement in social networks that reinforce drug-related choices, attitudes and behaviors increases youths’ assimilation into homelessness culture. The purpose of this study was to determine whether domains of social estrangement are associated with homeless youths’ alcohol and drug addiction. Results show that specific domains of social estrangement do predict addiction, while others prevent from this activity.

Purpose to conduct this study is to estimate the incidence rate of initiation into drug injection and to identify predictors of initiation into drug injection separately among street girls and boys. This research show that that injected drugs are rapidly increasing day by day in street youth of Northern America and Canada. This situation represents a significant public health issue as young injection drug users are known to be the population at highest risk for HIV and HCV infections. This is the first study to measure incidence rates of initiation into drug injection by gender among youth at risk. Observed incidence rates are similar for boys and girls, results found having no association between gender and having ever injected drugs. In a study of young Canadian offenders, more girls aged 16-19 injected than their male counterparts of the same age. In this study, it is noticeable that girls were more likely to report having started injection using heroin while more boys reported having used cocaine as their first drug of injection. Results show that recent heroin use and recent cocaine use respectively tripled and doubled the risk of initiation for both girls and boys.

Objective of this study is to observe social contexts and processes influencing evolution to drug injection among street youth. This study show that some combinations of street life and drug use trajectories seem to contribute to injection among street youth. This study clearly shows the pertinence of examining how drug use practices are influenced by the individuals’ relations with their social environments. This study is the first qualitative investigation of the social processes that lead street youth to adopt drug injection. One of main finding is that the manner in which drug injection inserts itself into a youth’s life trajectory varies depending on when youth come into contact with the street, as well as their relations with the street scene and drug use. In this respect, it should be pointed out how diverse the trajectories of street youth are. While it is not possible to state with certainty that a youth will never inject drugs, it appears that certain youth have trajectories that are more prone to injection drug use than others.

This study is conducted on street youth on adolescent and young adults who spend their most time living and working on the streets. This socially and economically disadvantaged population is marked by perilous living conditions, including poverty, homelessness, and drug use. In study of homeless youth, the odds of an earlier suicide attempt were nearly four times greater among youth with an active diagnosis of depression, and nearly two times greater among youth who reported symptoms of hopelessness. In addition, depression is associated with high-risk behaviors, such as injection drug use and unprotected sexual intercourse that predispose youth to human immunodeficiency virus (HIV) infection. HIV infection is itself a well recognized risk factor for mortality among street youth. We observed a very high frequency of depressive symptoms among street youth, with more than four in 10 street youth reporting CES-D score _22. The greatest number of depressive symptoms was observed among weekly heroin users, followed by weekly crystal methamphetamine users, then weekly cocaine/crack users, and finally, daily marijuana users.

The research paper was on the impact of maternal alcohol and illicit drug use on children’s behavior problem and the objective of this study is to use a large, national sampling of mothers and children to test for evidence of casual relationship between maternal alcohol, marijuana and cocaine use and its effects on children’s health problem. This study provides some evidence that maternal substance use may be linked causally to children’s behavior problems. Although TSLS results are challenging due to the poor performance of the identifying instruments, OLS models, family fixed-effects models, and mother-child fixed-effects models all suggest that maternal marijuana and cocaine use are associated with increases in 4-15-year-old children’s BPI scores. Maternal alcohol use, as measured by the number of days the mother used alcohol in the past month, appears to affect behavior problems. This result is sensitive, however, to the addition of maternal depression and smoking measures. Moreover, the magnitude of this effect is very small, and maternal indulge drinking had no constant impact on children’s behavior problem.

This study is about the depression and participation of youth in selling and use of illicit drugs. The argument starts with the theory that drug selling and drug use augment each other, both at the individual level and at the aggregate level. For example, someone who sells drugs has relatively cheap access to drugs. And, someone who uses drugs may sell to help finance his/her use. The conceptual framework postulates that a recession would have direct positive effects on the prevalence of youth drug selling but ambiguous direct effects on youth drug use. The conceptual framework also postulates that drug selling and drug use are inter-connected at the individual level and the cumulative level. Thus, any effect of a recession on one would likely affect the other in the same direction. The limited empirical evidence indicates that both drug selling and drug use among youth is higher when the economy is weaker. The current economic crisis will likely increase both youth drug selling and drug use relative to what they would have otherwise been.

As we all are familiar that humans are routinely exposed to a vast array of environmental neurotoxicants, including pesticides, endocrine disrupters, and heavy metals. The long term consequences of exposure have become a major human health concern as research has indicated strong associations between neurotoxicants and a variety of dopamine-related neurological disorders. This study was conducted to know the effects of environmental neurotoxicants on the dopaminergic system and the possible role in drug addiction. A large variety of studies have demonstrated that a vast assortment of environmental neurotoxicants have deleterious effects on the dopaminergic system, consequently enhancing or impairing DA neurotransmission and disrupting DA-associated behaviors including motor control, motivation and attention, and potentially, vulnerability to drug addiction. Pesticides and insecticides, such as dihedron, parquet, and rotenone, tend to decrease DA activity and can lead to diseases such as PD, which are characterized by dopaminergic neurodegeneration. Studies appear to express a link between environmental neurotoxicity exposure and drug addiction although much work needs to be done to further identify and characterize the underlying mechanism involved.

Bupropion is an effective medication in smoking cessation and has a good safety and side effect profile. The effects of bupropion on extracellular dopamine levels in the striatum were investigated using raclopride positron emission tomography (PET) imaging in rats administered saline, bupropion and in healthy human volunteers administered. A cognitive task was used to stimulate dopamine release in the human study. In rats, bupropion significantly decreased raclopride specific binding in the striatum, consistent with increases in extracellular dopamine concentrations. In man, no significant decreases in striatal raclopride specific binding were observed. Levels of dopamine transporter occupancy in the rat at bupropion were higher than predicted to occur in man at the dose used. Thus, these data indicate that, at the low levels of dopamine transporter occupancy achieved in man at clinical doses, bupropion does not increase extracellular dopamine levels. These findings have important implications for understanding the mechanism of action underlying bupropions’ therapeutic efficacy and for the development of novel treatments for addiction and depression.

For a long period of time, China implemented restraining drug policies to cope with drug-related problems but on the other hand, the situation of drug addiction has rapidly worsened since the early 1990s. For example, the number of registered illicit drug users in the country increased from approximately 70,000 in 1990 to 1.16 million by the end of 2005. This paper is projected to intricate on the general principles of China’s latest Drug Control Law from the point of view of scholars who are involved in the field of drug addiction research and treatment in China. This paper also discussed the challenges we are currently facing, based on the observations and practical experiences the authors have obtained in China. It is hoped that by addressing these issues, we will be able to implement the new Drug Control Law more successfully and ensure that we deal more effectively with drug addiction in China.

Methodology:

This drug addiction survey is based on questionnaire from age (12 to 19) years, which is derived from 2005 cycle of Ontario student drug use survey. This research is conducted through questionnaire as mentioned above and the items of questionnaire are (1) Would you be afraid to talk or interact someone who is addicted to drugs. (2) Would you make friend someone who is addicted to drugs? (3) Would you feel embarrassed or ashamed if your friend knew that someone in your family was addicted to drugs? In this research, Ordinary least square regression is used to oversee and examine the relationship between age, sex, urban city, individuals and peer groups. Quadratic and linear age terms are included in this model. In this methodology, age variables were centered in order to reduce the correlation between the linear and quadratic term and interaction term.

The data on which this study is based was collected under large study of pre-teenagers and schoolchildren’s attitude and behavior toward illegal drugs and their experience. This research had both quantitative and qualitative components Data is basically collected by the survey which depends on questionnaire. Data is also gathered by interviews of individual to understand the thoughts and perception about drugs in children. Basically, the sample of this study is school in Glasgow and Newcastle. The quantitative element consisted of a survey of 2382 between ten to twelve year old children in 47 schools of Glasgow.

To capture teenager’s concepts of tobacco use, a qualitative approach with focused group interview was conducted for this research. Group discussion is the most useful and helpful way of sampling. The sample on which the research is conducted with 43 ninth grade students having age between 14 to 15 years old at two schools in inner Stockholm. Interviews are based on eight themes those are; (1) health and tobacco use, (2) the age limit of tobacco purchase, (3) school and tobacco use, (4) media and tobacco use, (5) the aesthetics of tobacco use (6) the ”pointless” tobacco use, (7) presentation of self, peers and adults as tobacco-users, (8) presentation of self and peers who do not use tobacco. The majority of the 25 non-tobacco-users had tried smoking earlier, 12 boys and one girl had tried snuffing. Among the 18 tobacco users more girls than boys use tobacco on a daily basis.

This research is conducted with the help of scientific questions. In this study, group discussion and interview are also conducted to read the state of minds of drug user that how these drugs affect their health and brain. Scientific questions highlights the need for research into the effects of prescription drugs on the developing brain, using both vitro and vivo models. Sample of this research is teenagers of United States.

In this study, existing -groups design was adopted to compare existing groups of excessive alcohol users and low dose user. The sample on which this research is conducted is the students of colleges and universities of North-East of England and each participant was tested individually at their respective college and university. Forty-five participants were identified as ‘excessive alcohol users’ having 28 females, 17 males, mean age of the participants is 17 years. Sixty-three were identified as ‘low-dose/no-alcohol users having 41 females, 22 males and mean age is 16 years. Alcohol and other drug use were assessed using Recreational Drug Use Questionnaire. Prospective memory Questionnaire (PMQ) was administered first, followed by the drug-use questionnaire and the whole testing time per participant was approximately 25 minutes.

Sample selected to conduct this research is three U.S. cities are Los Angeles, CA; Austin, TX and St. Louis, MO. Participate in the study, had to be 18-24 years old, have spent at least 2 weeks away from home in the month before the interview, and provide written informed consent. The dependent variable for the current study reflected alcohol or drug addiction as measured by the Mini International Neuropsychiatry Interview. Addiction to alcohol and various substances was measured by participant responses to a series of yes/no questions that identified those meeting criteria for abuse or dependence. Analyses were performed using SPSS, version 16 with statistical significance. In this study, chi-square, t-test and regression model is also used as a methodology.

Data were collected using semi-annual interviewer-administered questionnaires. Variables from the following domains were considered in Cox regression models: socio-demographic characteristics, early and current substance abuse, marginalization, childhood traumatic sexual events and injection exposure. The sample on which this research is conducted is some specific areas of North America, Canada, Baltimore and Thailand. In this 95% confidence intervals were based on the Poisson distribution. Unvaried and multivariate Cox regression models with time-varying covariates were used to examine predictors of initiation into drug injection.

The sample for this study is 42 street youth who participated in in-depth interviews. A typology of experiences was built founded on youth’s street life and drug use trajectories. The transition to drug injection was examined through these experiences. This research is conducted by a qualitative study grounded in symbolic interactions, a theoretical perspective through which, to understand the evolution of human behaviors, subjects are considered as creative social actors in their world. The study sample was composed of 42 street youth aged 15-25 years. 16 participants were girls, and 26 were boys. At the time of the interview, 17 of them had never injected drugs. Of the remaining 25 who had injected drugs, 8 had tried injection without pursuing it further, 8 had stopped after having injected regularly, and 9 were actively injecting, 1 of whom had been doing so for less than a year. Semi-structured, in-depth interviews were conducted in this research plan.

This study was conducted between October 2005 and November 2007, data were collected from a cohort of street recruited youth aged 14-26 residing in Vancouver, Canada, for the At-Risk Youth Study. Active drug users were classified by predominant substance of use: daily marijuana use, weekly cocaine/crack use, weekly crystal methamphetamine use, or weekly heroin use. Adjusted mean number of depressive symptoms (measured by the Center for Epidemiological Studies Depression [CES-D] scale) was compared among the four groups using multiple linear regressions. Logistic regression was also used to assess adjusted odds of CES-D score _22.

In this research paper, the child mental health production function is represented empirically by Equation. BP Iijt = α0 + α1Ajt + α2Xit + α3Xjt + α4ui + α5uj + εijt. The other equation for maternal demand for substances like alochal is: Ajt = β0 + β1Pt + β2Yjt + β3uj + ωjt.

Bupropion administration was calculated as:

Occupancy ¼ SBRvehicle−SBRbupropion h I =SBRvehicle – 100

Ten healthy participants were recruited by public advertisement (80% male; 90% right handed; average age: 47±6.7 years; age range 37-58 years). Nine of the 10 subjects were nonsmokers; the single participant who smoked consumed ∼10 cigarettes/day. None of the participants were currently taking any prescribed medication. All participants gave their written, informed consent to be included in the study.

Reflection is an important and powerful strategy for the use of development in professional skills; as it enables the link between the practice and theoretical aspect of learning to help moving from a beginner to a skilled practitioner. Reflection should enhance self-awareness, identifying personal strengths and weakness as well as help in the improvement.

In the world of definitions and explanations, there are different professors, author, and editors e.t.c and their different knowledge of understanding.

Dewey defined reflective thought as ‘active, persistent, and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusions to which it tends’ (Dewey 1933: 118). He set out five phases or aspects.

1. Suggestions, in which the mind leaps forward to a possible solution.

2. An intellectualization of the difficulty or perplexity that has been felt (directly experienced) into a problem to be solved.

3. The use of one suggestion after another as a leading idea, or hypothesis, to initiate and guide observation and other operations in collection of factual material.

4. The mental elaboration of the idea, or supposition as an idea or supposition (reasoning, in the sense in which reasoning is a part, not the whole, of inference).

5. Testing the hypothesis by overt, or imaginative action

In every case of reflective activity, a person finds himself confronted with a given, present situation from which he has to arrive at, or conclude to, something that is not present. This process of arriving at an idea of what is absent on the basis of what is at hand is inference. What is present carries or bears the mind over to the idea and ultimately the acceptance of something else. (Dewey 1933

Donald Schön (1983) suggested that the capacity to reflect on action so as to engage in a process of continuous learning was one of the defining characteristics of professional practice. He argued that the model of professional training which he termed “Technical Rationality”-of charging students up with knowledge in training schools so that they could discharge when they entered the world of practice, perhaps more aptly termed a “battery” model-has never been a particularly good description of how professionals “think in action”, and is quite inappropriate to practice in a fast-changing world.

Goodman (1984, cited by jasper 2003 p9) suggests that there are three levels of reflection which you are likely to move through during your education. However it is not helpful to think that you are at level 1 in year 1, level 2 in year 2 e.t.c. which level you achieve will depend on your skill and ability and should not be restricted to the level which has the same number as your year of study.

Doing a general investigation on a word, a methodology, hypothesis, summary and conclusion on a laboratory practical would have being easier as I would have being confident enough to do a write up on what I did, should have done, and reasons why a certain error happened and how it could have being avoided. This is something that could be done as it has been done previously with my course at college. Writing a reflection on a work experience is different but similar to writing or doing an investigation on a laboratory practical, so the techniques of writing a laboratory practical can be used to write a reflection as well as the guidance notes posted on the blackboard.

The medical field had ran in my family right from my oldest sister to my older sister as Nurses and now to me as a Radiography (student)I didn’t choose to be a radiographer in order not to break the medical chain or because my sisters being nurses, but ever since I visited my oldest sister while she was on a work placement I saw other radiographers, how they operated the radiography machine in taking various x-rays; was breathe taken and wondered how the radiography machine makes use of its infrared without harming the human skin to get the image of the endo-skeleton. Since then I have being interested in the machines and in other get closer to it and find out how it works was to become its operator (radiographer).

Queen Mary Hospital, Sidcup was a marvellous place to work/experience what it is like to be a radiographer, as well as being much more hygienic and patience than I was; as there were lots of precautions done before and after taking an x-ray such as the use of disinfectants before and after dealing with a patient and the accurate use of the radiography machine which requires lots of concentration and patience because a slight mistake could cause a life or make the situation of the patient worse.

It was really nice meeting other radiography students but known and unknown, we were taken on a tour around the hospital by other senior radiography students then we were introduced to our various supervisors, my supervisor was a lovely lady who seem to be very experienced, she knew what she was doing and also what she was talking about, patient and confident.

The first week of the experience was very nerve racking and it was knackering, we were technically a full time working class radiographers (9am – 5pm) every day. I got used to the fatigue on the second week but was still nervous that I was going to make a mistake at some point while with a patient either theory wise or practical wise. With the help of the supervisor and the senior colleague I gained a little bit of confidence, was corrected before making and after making a mistake and was checked upon on a regular basis in order to be up to standard and produce distinctive results.

Before allowed use of the radiography machine we had to get use to the environments such as being like receptionists, calling out the patient’s names, checking their information and details making sure that it’s the right person; this was practically interesting because I got to meet different people with different characters. Then I was given the opportunity to work in the CT (computerised tomography) scan briefly, was thought the basics of the machine, what it scans the body for, how it detects the diseases and how it is maintained. This was time consuming and required a lot of patience. It was quite boring at this point. But came to realise that I was no longer interested in radiography because of the machines, but interested in it because I like to be of help in anyways I can to the people and community.

In the medical world mainly the National Health Services, UK there are various sections in each hospital, some hospitals specialised in something specific and some are specialised in everything, but a thorough medical check-up is not complete without some sort of scan which is where the radiographers and radiography comes in.

Radiography is the use of X-rays to view a non-uniformly composed material such as the human body. By utilizing the physical properties of the ray an image can be developed displaying clearly, areas of different density and composition.

A heterogeneous beam of X-rays is produced by an X-ray generator and is projected toward an object. According to the density and composition of the different areas of the object a proportion of X-rays are absorbed by the object. The X-rays that pass through are then captured behind the object by a detector (film sensitive to X-rays or a digital detector) which gives a 2D representation of all the structures superimposed on each other. In tomography, the X-ray source and detector move to blur out structures not in the focal plane. Computed tomography (CT scanning) is different to plain film tomography in that computer assisted reconstruction is used to generate a 3D representation of the scanned object/patient. Radiography was not only used on living being (medical reasons) also industrial purposes such as fitting shoes.

X-ray photons used for medical purposes are formed by an event involving an electron, while gamma ray photons are formed from an interaction with the nucleus of an atom. In general, medical radiography is done using X-rays formed in an X-ray tube. Nuclear medicine typically involves gamma rays.

The types of electromagnetic radiation of most interest to radiography are X-ray and gamma radiation. This radiation is much more energetic than the more familiar types such as radio waves and visible light. It is this relatively high energy which makes gamma rays useful in radiography but potentially hazardous to living organisms.

Gamma rays are indirectly ionizing radiation. A gamma ray passes through matter until it undergoes an interaction with an atomic particle, usually an electron. During this interaction, energy is transferred from the gamma ray to the electron, which is a directly ionizing particle. As a result of this energy transfer, the electron is liberated from the atom and proceeds to ionize matter by colliding with other electrons along its path. Other times, the passing gamma ray interferes with the orbit of the electron, and slows it, releasing energy but not becoming dislodged. The energy released is usually heat or another, weaker proton, and causes serious biological harm to the body such as skin cancer and other form of endo cancer.

Radiography is a very important technique in the medical world but also dangerous if not used correctly on a patient. Before using one of the machines we had to disinfect ourselves, tie up loose hair, cover the ones that couldn’t be tied up and wear protective clothes such as coveralls eye goggles and gloves. I was introduced to all the patients by my supervisor as a radiography student; some of them I took their x-ray with supervision and some I watched as theirs were taken and some were done with both my supervisor and I. the ones I did by myself with supervision I had to ask for their consent before doing anything on them some of them weren’t sure and some had no problem, for those who weren’t sure were the ones that was done with the supervisor and I; and for those who had no problem, I asked for their consent personally and was still feeling that in case the patient decide to take action against me I may be in danger of laws such as the right to self-determination in which adults have the right to determine what is done to their bodies and touching a person without consent is basically unlawful and can amount to trespass to them or, more rarely, a criminal assault Griffith, R., Tegnah, C. (2008) this made me really nervous and coming up with different thoughts of thing going wrong and might do something slightly wrong and end up becoming really disastrous. The analysis of the reflective process, the need to attend to feelings and attitudes (making use of positive feeling and then dealing with negative feeling) was apparent throughout and required self-awareness.

The relieving aspect of the experience was the fact that all the patients I dealt with, with or without supervision fully co-operated without any difficulty and technicality, as they didn’t have much choice to decline task I was going to do for them but to consent to the treatment because it was in their best interest; but they still had to be respected as patients and clients’ autonomy and their rights to decide whether or not to undergo any health care with use of medical equipments/machine intervention-even where a refusal may result in harm or death to themselves, unless a court of law orders to the contrary.

The other option I had was not to personally asked patients that were dealt with by me for their consents and carry on with my task at the risk actions taken against me. “Imposition of treatment upon a competent patient against their wishes may constitute inhuman or degrading treatment or punishment”. Such option might have been counterproductive and detrimental to my career in the invent that any of the patients decide to take legal action against me” (Tingle .J. and Cribb .A. 2007).

I was classified as a very good and hardworking student, who was always willing to work at all times but needed to adjust on certain aspects such as hygiene skills and patience i.e. doing things properly without rushing them through, which I did improve on eventually; didn’t get a few task done in the theoretical aspect but when it came to the practical aspect I was always willing to learn something new. Even in the practical I was still a bit shaking; but if I was to come back for another work placement and was told to do some if not most of the things I had done in my previous placement I believe there would be more care as I have gained more experience and knowledge of how to go about it. Reflection helps the practitioner to gain insight into self, be empowered to respond more effectively in similar situation in the future and realise your vision as a lived reality. In addition to that, reflection leads to learning certain skills and knowledge and development of attitudes and attributes effective to make positive difference to the client

To conclude, it has now become clear that reflection is a way to learn through experience and this helps the practitioner to gain insight or change his perception of himself or his practice. It is a good tool to describe, analyse and evaluate practice experience for future learning. Its major role in professional programme is learning but is also good for professional development and identifying learning needs. This essay has also made me to be aware of the factors that inhibit observation such as attention or its deficit, know-how, working condition and the need to know. It has made me to be aware of the fact that professional issues are normally composed of various important and co-relating issues.

Issues

There were lots issues faced while working at the hospital, mainly with the patients; most of the issues were to do with the reaction of people when it comes to the pronouncing of the names/surnames, some were just naturally mischievous and the rest were to do with unnecessary questions being asked and their slow rate of understand when explaining something to them. These issues were dealt with by just adapting to the environment as well as the different type of people that came; this has helped massively outside of the hospital.

Another issue was between me and my supervisor we did have a few misunderstanding when it came to getting work done properly and in time, been told off several times, embarrassed in front of other colleagues e.t.c but the only way out was to do what the supervisor wanted which was getting work done and up to standard as well as punctuality.

Issue between other colleagues and I; I made new friends tried to be social with everybody in class, never had any grudge against anybody but some did. Which I ignored and tried as much as possible to stay away from them because didn’t want anything hindering or standing between me and my degree in order to ruin my career. Whenever we needed to work in pair on a task I made sure I worked with the one that I social with the most and not the ones that had the grudge; the last thing needed while working in a hospital was conflict and being hypocritical.

The major issue of all was doing course work while doing the work experience; during the 2 months work experience we were at some point required to get some course work / power point presentations created more pressure on us. We worked from 9am – 5pm, knackered for the rest of the night so had to rest but not in this situation on some nights had to get some the coursework / presentation done. It was all down to time-management more work and less socialising, Monday to Friday 9am-5pm, work an hour off each night was for investigations and the type up of the coursework, weekends most of the works were done including the rehearsal of the presentation as well as revision for upcoming examinations

Dewey (1933)

Donald Schön (1983)

Goodman (1984, cited by jasper 2003)

Griffith, R., Tegnah, C. (2008)

Tingle .J. and Cribb .A. ( 2007).

http://en.wikipedia.org/wiki/Radiology

http://www.learningandteaching.info/learning/reflecti.htm

http://www.infed.org/biblio/b-reflect.htm

http://en.wikipedia.org/wiki/Radiography