Lectures on

Seminars in community health

Master degree 2nd Semester

Under supervision of

Prof/ dr. Manal Mansour

prof /dr. Sharbat Thabet
prof dr./ Amany Gomaa
Collected by\
Reda Salah

1
 2023-2024
Index

No. Topics Page

1 Community diagnosis 3-10
2 Environmental assessment 11-
20
3 Data collection & Analysis 21-
27

4 Care of Families 28-

34
5 Meeting health need of women 35-
43

6 Profiling Population 44-

50

7 Health Promotion For Population Health 51-

56
8 Meeting health need of men 57-
69

2
 9 Meeting health need of child and adolescents -70-
80

Community diagnosis
Objective:

By the end of the lecture nurses should be able to:

 Define the community

 Define the core

 Define the community diagnosis

 Know the Purpose of community diagnosis

 Know the types of community diagnosis
 Know the process of community diagnosis
 Know Basic data in community diagnosis
 Know the steps of community diagnosis
 Know the role of nurses in nursing community diagnosis

3
Introduction to community diagnosis:

 The term (diagnosis) comes from the Greek word (diagignoskein)meaning to

distinguish .this term was derived from (dia)meaning through apart and from
(gignoskein)
 community diagnosis is also called community assessment or situational
analysis. Its process involves the collection of data about the community
to identify the different factors that may directly or indirectly affect the
health of the people and analyzing and seeking explanations for the
occurrence of health needs or problems of the country.

Definition of community

 Community is cluster of people with at least one common

characteristic (geographic location ,occupation ,ethnicity, housing
condition

. OR

 Group of people with common characteristic or interest living together

within a larger society comprises community

Community core:

Community core: history, socio-demographic characteristics , vital statistics,

values/beliefs/ religions. core

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OR
The core of the community is its people: history, values, characteristics and
beliefs.

Definition of Community Diagnosis

Community diagnosis generally refers to the identification and quantification of

health problems in a community as a whole in terms of mortality and morbidity
rates and ratios, and identification of their correlates for the purpose of defining
those at risk or those in need of health care

OR Is comprehensive assessment of health status of the community in relation

to its social , physical and biological environment

Purpose of community diagnosis

1-Identification and quantification of health problem

2-identification of those who at risk

3-Identification of community needs and problems

4-Determine available resources

5-Set priorities for planning

6-It helps to find the real problems of the community people which might not
have perceived by them as problems.

7-It helps to impart knowledge and attitudes to turnover people’s problems

towards the light of solution.

Type of community diagnosis:

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 1- Comperhensive community diagnosis:

Aim to obtain general information about community

Meaning, it takes the community as a whole and gives emphasis on all of

its aspects, its strengths and weaknesses — everything

2- Problem oriented community diagnosis

Responds to a particular need

, on the other hand, deals with problems that are readily seen and should be
acted upon immediately. For example, if there’s an epidemic in the
community, what you should make is a problem-oriented diagnosis.

— The Community Diagnosis Process

— The process of community diagnosis involves four stage

— The process of community diagnosis involves four stage

— 1-Initiation
— 2.Data collection and analysis
— 3.Diagnosis
— 4.Dissemination
— 1.Initiation
— In order to initiate a community diagnosis project, a dedicated committee
or working group should be set up to manage and coordinate the project.
— The committee should involve relevant parties such as government
departments, health professionals and non governmental
organizationsparties such as government departments, health professionals
and non governmental organizations
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— 2.Data collection and analysis
— The project should collect both quantitative and qualitative data.
Moreover, Population Census and statistical data e.g. population size, sex
and age structure, medical services, public health, social services,
education, housing, public security and transportation,

— 3.Diagnosis:
— Diagnosis of the community is reached from conclusions drawn from
the data analysis. It should preferably comprise three areas:
— - health status of the community
— - determinants of health in the community
— - potential for healthy city development
— 4-Dissemination
— The report can be disseminated through the following channels:
— presentations at meetings of the health boards and committees, or
forums organized for voluntary organizations and local community
groups .
— *Basic Data in community diagnosis process*
— 1. Background/ Setting
— 1. Local history
— 2. Geography – Part of which Region,
— Municipality/ City – Boundaries whether land
— locked, coastal or both – Land area
— Subdivisions, political, economic or social
2. Demography
— 1. Geographic distribution Age – sex
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— structure (Population pyramid)
— 2. Factors such as: Migration; Age
— , Birth/death rate.
— 3. Economic status
— 1. Sources of income
— 2 . Indications of economic status:
— Employment; Income per capita; Poverty
— level; Economic organizations
— 4. Social Indicators
— Education Housing, Communication,
— Transportation, Sources of health care
— and health information Public assistance
— Leadership pattern.
—

*Steps of community diagnosis*:

— 1. Establishing the assessment team.

— The best efforts risk failure if they are not properly supported with
appropriate local organization
— 2. Identifying and securing resources.
— Identify staff, financial and technical resources needed
— Develop budget to support, implement and evaluation plan
— Identify existing resources
— Secure identified resources, and develop alternative resources
— 3 .Identifying and engaging community partners.
— Design strategy for engaging partners
— Define useful roles for partners
— Develop accountability and evaluation plans

8
— Develop communication strategies
— Reassess and evaluate partner involvement and statisfaction in plan
development
—
— 4. Collecting, Analyzing, presenting data.
— Collect and analyze the county health data
— Collect and analyze the Community Data
— Put it together, and interpret the available data
— Summarize and present the county health profile
— 5. Setting Health Priorities.
— Set criteria for establishing potential priority or focus area
— Establish process for determination of priorities
— Deciding health priority or focus areas.
— 6. Clarifying the Issue.
— Collect additional data on indicator based on priority questions:
— Hypothesize causes and contributing factors
— Collect evidence to prove or disprove selected hypotheses
— Collect input from stakeholders in relation to hypotheses
— Identify a small number of high-impact causes to address
— 7. Setting Goals and Measuring Progress.
— Review state and national health goals related to priorities
— Identify target objectives for meeting these goals
— 8. Choosing the Strategy.
— Collect successful strategies data from other communities
— Review research-based strategies that address the problem
— Choose strategies
— Develop evaluation design
— Identify activities that will support thestrategy

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— Identify people responsible for implementing tasks
— Identify staff development needs
—
— 9. Developing the Community Health Assessment document.
— 10- Managing and sustaining the process.
— Reassess role and responsibilities of CHA Team.
— Assess progress.
— Revise the plan.
— Make changes.
— Role of community nursing in nursing in community diagnosis:
—1- Provide direct nursing intervention to individual, families or population
groups.
—2- Facilitates learning for positive health behavior change
—3- Advocate, speaks or acts on behalf of clients who cannot dose for
themselves
—4- The primary role of community health nurse is to provide treatment to
patient. Additionally community health nurse offer education to
community members about maintaining their health so that they can
decrease the occurrence of disease and deaths
—5- Community nurse create programs that promote community health and
collect data to identify community needs
—6- The nurse can be assessment finding by diagnostic reasoning
—7- adiagnosis the patient situation and needs by serving to direct during
components of the nursing process, they are planning, implemention and
evaluation
—

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 Environmental and Nutritional assessment

ObJectives:-
At the end of this lecture all participants will be able to:
 Define nutrition and nutritional assessment.
 Identify the adequate amount of intake for adults.
 Describe importance of nutritional assessment.
 Define nutritional screening.
 Identify target group of population for nutritional assessment.
 Discuss frequency of nutritional assessment.
 Distinguish the factors affecting nutritional status.
 List sign and symptoms of nutritional deficit.
 Compare between methods of nutritional assessment.
10.Apply role of the community health nurse in nutritional
assessme .

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 Introduction
Food and nutrition are basic indispensable needs of humans. Nutrition plays a
critical role in maintaining the health and well-being of individuals and is also an
essential component of the healthcare delivery system. The nutritional status of
individuals affects the clinical outcomes. Essential nutrients are classified into six
groups, namely carbohydrates, proteins, lipids, minerals, vitamins, and water.
Nutritional requirements of healthy individuals depend on various factors, such as
age, sex, and activity

 Definition of nutrition
Nutrition is defined as the process of taking in food and converting it into energy
and other vital nutrients required for life.
 Definition of nutritional assessment:
Nutritional assessment is the systematic process of collecting and interpreting
information in order to make decisions about the nature and cause of nutrition related
health issues that affect an individual (British Dietetic Association (BDA),
 Importance of nutritional assessment :
 Nutritional assessment in clinical medicine has three primary goals:
1-to identify the presence and type of malnutrition,
2-to define health-threatening obesity,
3-to devise suitable diets as prophylaxis against disease later in life.
4-diagnose malnutrition
5-identify underlying pathologies that lead to malnutrition, and plan necessary
intervention.

 Daily intake of nutrition(calories):-

 Within a healthy, balanced diet the man needs around 10,500kJ (2,500kcal) a day.
the woman needs around 8,400kJ (2,000kcal) a day.
 these values can vary depending on age, metabolism and levels of physical
activity, life style, weight, height and any disease.
 Reference intakes explained(4.2kilojoule=1kcal)
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 Daily reference intakes for adults are:
 Energy: 8,400kJ/2,000kcal
 Total fat: less than 70g
 Saturates: less than 20g
 Carbohydrate: at least 260g
 Total sugars: 90g
 Protein: 50g
 Salt: less than 6g
 The reference intake for total sugars includes sugars from milk and fruit, as
well as added sugar
 BMI
 Formula: weight (kg) / [height (m)]2

With the metric system, the formula for BMI is weight in kilograms divided by
height in meters squared. Because height is commonly measured in centimeters,
divide height in centimeters by 100 to obtain height in meters.

Example: Weight = 68 kg, Height = 165 cm (1.65 m)

Calculation: 68 ÷ (1.65)2 = 24.98
Below 18.5= underweight
18.5 – 24.9= healthy weight
25.0 – 29.9= overweight
30.0 and Above= obesity

 Nutrition screening:-
Nutrition screening is the first step in identifying patients who are at risk for nutrition
problems or who have undetected malnutrition.

13
It allows for prevention of nutrition-related problems when risks are identified and
early intervention when problems are confirmed..
 Target group for nutritional assessment
 Children under 2 years of age, especially if they are not breastfed.
 Women who are pregnant or up to 6 months postpartum.
 People who report unintentional weight loss.
 People who have been prescribed specialized food products to treat malnutrition.
 People with disease-related symptoms that can be managed through diet.
 People with HIV, tuberculosis (TB), or other chronic diseases.
 The frequency of nutritional assessment
 The frequency of nutritional assessment depends on a client’s age and pregnancy
and disease status and on national policies..
 Pregnant/postpartum women: On every antenatal visit
 Infants 0–< 6 months of age: At birth and on every scheduled postnatal visit
 Infants 6–59 months of age: During monthly growth monitoring sessions for
children under 2 and every 3 months for older children
 Adolescents and adults: On every clinic visit
 People with HIV: On every clinic visit and when initiating or changing
antiretroviral therapy (ART)

 Factors Influencing Nutritional status:

Nutritional intake depends on many factors like: appetite, taste, availability, and mood

 Adequate amount of food intake is essential for optimal nutritional

status.
 Excessive intake can lead to obesity .
 Decreased intake leads to under nutrition.
 co-morbid Diabetes and other conditions.
 Chronic and acute infections
 Emotional factors like mood and taste can also affect appetite and food intake.
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  Cultural factors like festivals
 Economic factors are very important elements that affect nutritional status of a
population.

 Symptoms and Signs of Nutritional Deficit .

 pallor, or pale skin.
 fatigue
 weakness
 trouble breathing
 hair loss
 constipation
 sleepiness
 heart palpitations
 feeling faint or fainting
 depression
 menstrual issues, such as missed or very heavy periods.
 poor concentration

 What are the nutritional health problem

 Cancer:
 Diabetes mellitus .
 Digestive Disorders including constipation, gallstones, heartburn
 Eating Disorders such as anorexia nervosa.
 Heart disease
 High Blood Pressure.
 Kidney Disease.
 Overweight and Obesity.
 Osteoporosis.

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 Nutritional assessment methods for adult
These are summarized as( ABCDE).
 Anthropometric methods.
 Biochemical, laboratory methods.
 Clinical methods.
 Dietary evaluation methods.
 Environmental and Economic factors

 Anthropometric methods:
Anthropometry is a latin word in which (anthropo) means human and( metry ) means
measure .
Anthropometry is the measurement of body parameters to indicate nutritional status
Common anthropometric measurements include circumference,
 Height
 Wei ght
 Body mass index(BMI)
 BMI is an anthropometric indicator based on weight-to-height ratio.
 Calculate BMI= Weight (kg) / Height (m)2

Skinfold thickness : it is a common method for determining

body fat composition .
 Standard Skin-fold Sites :
 Triceps
 Biceps
 Iliac Crest
 Supraspinale
 Thigh
 Calf
 Subscapular
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 Abdominal
 Chest
 Abdomen

 Mid-arm muscle circumference

Mid-arm muscle circumference (MAMC) has been used for reflection of muscle
protein reserves.

 Biochemistry
Biochemical assessment means checking levels of nutrients in a person’s blood, urine,
or stools.

Lab test results can give trained medical professionals useful information about
medical problems that may affect appetite or nutritional status:-
 Haemoglobin (Hb) to assess iron status or indicate anaemia
 Albumin A low level may indicate inflammation or infection is present.
 Reactive Protein (CRP) This is an inflammatory marker which is raised when
infection or inflammation is present.
 White cell count (WCC) Immune system marker; is raised if infection is present.
 Glycated Haemoglobin (HbA1c) Indicates an average blood sugar level over a
period of months.
 Sodium (Na) This is an indication of hydration status and kidney function. A
raised sodium level may indicate dehydration.
 Urea (Ur) Used to assess kidney function.
 Calcium and Phosphate
 Magnesium Likely to be low if there are large Gastero intestinal GI losses.

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 C-Clinical
History including:
 medical diagnoses and hospitalizations.
 changes in appetite,
 availability and preparation of food, -medications.
 details regarding weight change.
 physical examination Attention should be directed toward
 findings of soft-tissue wasting,
 hydration status,
 evidence of vitamin and mineral deficiencies, - height, weight, and body mass
index (BMI).
 clinical features of malnutrition.
 As mentioned before.
 Dietary assessment
 estimating nutrient intakes from evaluations of diets, food availability, and food
habits.

 Several methods can be used for dietary assessment:

 24-h recalls self-administered instrument.
 Dietary records
 Food frequency questionnaires (FFQ)—This approach depends on respondent
memory and uses fixed lists of foods.
 E- Environmental and social factors
 polluted water
 Use of pesticides.
 Size, income and housing of the family .
 food safety , quality and availability.
 food processing, food storage, and food preparation at home.
 Cultural influences and Religious causes

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 Role of community health nurse
Nursing care plan for patiant with obesity
imbalanced nutrition more than body requirements
related to
 excess intake of food
 unhealthy food choices
-evidenced by:
 ntake of more than daily recommended calories
 eating in response to emotions
 eating large portions
 obese body mass index
Planning
-short term goal
after one week of nursing intervention
*patient will identify times, settings and emotions that induce over eating
*patient will verbalize healthier food choices in place of processed foods
- long term goal:
after one month of nursing intervention patient will be able to attain desirable body
weight with optimal maintenance of health
Assessment
*assess for conditions contributing to obesity
*assess the patient's avarage daily intake
*assess the patient's BMI
*assess the patient's daily exercise

Intervention
start with small changes such as adding anew vegetable every week
*educate on nutrient requirements
*provide education and written materials to guide the patient in smarter food choices
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 *educate on reducing sodium and increasing vitamin D and protein
*treat health conditions
*weight only weekly
*measure body fat
*emphasize the importance of avoiding fat diet
*determine current activity levels and the plan a progressive exercise program
*emplasize the importance of avoding tension at meal times and not eating too
quickly
*discuss restrictions of salt intake and diuretic drugs if used
*encourage the client to eat only at a table or desgnated eating place and avoid
standing while eating

Evaluation
after one week of nursing intervention patient become able to state measures needed
to reduce weight, demonstrate appropriate selection of meals that would lead to
weight reduction and being an appropriate program of exercise as tolerated and
indicated

 Nursing care plan

 Primary prevention

 Clinical History:
 Once patient identification markers (name, age, sex) are noted, take a detailed
history of chief complaints.
 If not mentioned in chief complaints, ask for other constitutional symptoms,
such as fever, fatigue, malaise, loss of appetite, or sleep disturbances. The
presence of these symptoms can be an indication of underlying pathologies.
For example, fever suggests active infection or inflammation.
 Inquire about the patient’s usual weight and ask if there have been any
weight changes. Weight loss of >10% of body weight can signify underlying
pathology. Weight gain can be suggestive of various underlying endocrine

20
 pathologies.
 Ask if there are any symptoms suggestive of malnutrition other than weight
changes, such as rashes, sores in the mouth, dryness of skin and eyes, loss of
night vision, hair loss, bleeding gums, poor healing of wounds, swelling of
extremities, tingling, or numbness.Ask about eating habits and dietary
preferences. For example, ask about the number of meals eaten in a day,
approximate portion sizes, whether they are following any restrictive diets,
whether they are vegan or vegetarian or if they are allergic to any food
items.
 A detailed dietary assessment is also warranted and is discussed below. If
patients are on parenteral or enteral diets, they should be interviewed
accordingly.
 Ask about any factors affecting food intake, like poor dentition, ulceration in
the oral cavity, difficulty in swallowing, loss of appetite, heartburn, nausea,
and/or vomiting. Further, inquire about bowel habits, which help assess the
general functioning of the gastrointestinal system. Also
 , ask if there is any abdominal pain, abdominal distention, diarrhea,
flatulence, or constipation, which can indicate by

underlying gastrointestinal pathologies that affect nutritional status.

 Ask about any current major clinical or surgical illnesses, including mental
illnesses. Also, ask if they are taking any medications, either prescribed or
over the counter.
 Ask if there is any history of chronic illnesses, hospitalization, trauma, or
malignancies. The impact of current or past illnesses on nutritional status is
discussed below.
 General condition

 Vital signs: Vital signs (body temperature, pulse, blood pressure, and
respiratory rate) should be checked. Temperature > 100.4 degrees Fahrenheit
or 38 degrees Celsius can signify active inflammation/infection.
Hypothermia (temperature < 95 degrees Fahrenheit or 35 degrees Celsius)
can be associated with conditions causing impaired nutritional status, such
as sepsis, trauma, burns, stroke, alcohol intoxication, and metabolic
disorders like hypothyroidism, adrenal insufficiency, and Wernicke
encephalopathy.[12] High pulse rates, apart from cardiac conditions, can
indicate hyperdynamic circulation. Some causes of hyperdynamic
21
 circulation that are associated with altered nutritional status are fever,
anemia, pregnancy, hyperthyroidism, septic shock, Beriberi, and anxiety.
High blood pressure or hypertension is one of the risk criteria for metabolic
syndrome. Abnormal rate and patterns of respiration can be indicative of
various pathologies. For example, Kussmaul's breathing is associated with
diabetic ketoacidosis (DKA).

Height and Weight: Measure the height and weight of the patient. Body mass index
(BMI) calculated from these variables can help determine whether an individual is
undernourished or overnourished

Eyes: Look for pallor, which may be indicative of various nutrient deficiencies
(iron, vitamin B12, folic acid, vitamin B6, vitamin C, or protein deficiency), as
well as various chronic illnesses. Look for icterus, suggesting metabolic
disturbances associated with the hepatobiliary system.

Oral cavity and perioral region: Assess the general health of the oral cavity and
look for pathologies that can affect the adequate intake of nutrients. Also, look for
glossitis, angular stomatitis, and cheilosis, which can indicate vitamin B complex
deficiency. Bleeding gums and gingivitis are suggestive of vitamin C deficiency.
Again, look for pallor.

Skin: Assess the general health of the skin. Xeroderma (extremely dry skin) can
signify vitamin A and/or essential fatty acid deficiencies. Petechia, purpura, and
ecchymosis may be associated with vitamin C and vitamin K deficiencies. Vitamin
C deficiency can also present with perifollicular hemorrhage. Poorly healed
wounds indicate vitamin C, protein, and/or zinc deficiencies. Pigmentation and
rashes in sun-exposed areas (around the neck and on extremities in glove and
stocking patterns) can be due to niacin deficiency.

Hair: Various nutrients are required to maintain the health of hair and hair follicles.
Dry hair can be a sign of vitamin A or vitamin E deficiency. Biotin deficiency can
make hair brittle. Severe undernutrition, especially protein deficiency, can lead to
discolored and easily pluckable hair, eventually resulting in hair loss. Rapid hair
loss can also be indicative of underlying systemic illnesses.

Nails: Assess the general health of nails and nailbeds. Dry and brittle nails can be
associated with various nutritional deficiencies, such as deficiencies in biotin, zinc,
and proteins. Discoloration of nails is another sign of poor nutrition.[15]
Koilonychia can be a sign of iron deficiency anemia. While clubbing is associated
with many pathologies, it may also be observed with malnutrition, chronic alcohol

22
use disorder, and chronic laxative use, often seen in individuals with eating
disorders.

Extremities: Examine all extremities carefully. Protein or thiamine deficiency can

lead to edema. Vitamin B12, thiamine, vitamin E, and vitamin B6 deficiencies can
present with paresthesia and muscle weakness. Loss of vibration and position
sensation can also be observed in individuals with vitamin B12 deficiency.

1. Scondary
 Laboratory Tests

1) Routine clinical tests: Routine clinical tests can help evaluate the patient's
overall status (as well as nutritional status.
2) These include serum electrolytes, blood urea nitrogen (BUN), creatinine,
blood glucose levels, lipid profile, liver enzymes, and complete blood count.
Serum electrolytes and hydration status may be deranged in malnourished
individuals.
3) BUN and serum creatinine are also predictors of nitrogen balance along with
being indicators of renal function, and lower levels of these can be seen in
malnourished patients. Low levels of serum creatinine can be indicative of
lower muscle mass. Both BUN and creatinine levels, however, can be
affected by hydration levels and kidney function. Elevated blood glucose
levels
4) and lipid profile (triglycerides and cholesterol) levels are indicators of
metabolic syndrome. Hyperglycemia can also be a nonspecific indicator of
the inflammatory response.
 Visceral proteins:Levels of visceral proteins such as albumin, prealbumin,
transferrin, and retinol-binding protein can help evaluate nutritional status.
However, none of these tests alone are specific for detecting malnutrition,
and their levels can be affected by multiple factors. For example, low serum
albumin levels suggest protein deficiency due to malnutrition and other
pathologies that affect the protein status, such as liver cirrhosis or nephrotic
syndrome. High levels of serum albumin could be associated with
dehydration.
1- micronutrient levels can be measured. For example, levels of B vitamins
(thiamine, riboflavin, niacin, pyridoxine, folic acid, B12), vitamins A, C, D,
E, and K, iron, zinc, selenium, homocysteine, etc., can be measured. More
specific tests such as the Schilling test for B12 deficiency or iron panel to

23
 differentiate between different types of anemia can also be performed based
on clinical presentation.

- Bioelectrical impedance analysis (BIA): This helps analyze the body

composition based on the ability of different body tissues to conduct
electricity. Conductance is higher in tissues with more water and electrolytes
(for example, blood) and less in adipose and bone tissues. This is an easy,
non-invasive test that can be done at the bedside using low-cost equipment.
However, in patients with extremely high BMI or fluid overload, the results
may be less accurate.

 identify Factors Affecting Nutritional Status

 Physiological factors: Physiological factors such as age, sex, growth,

pregnancy, and lactation can influence nutritional needs and should be
considered while performing a nutritional assessment. For example, as a
child grows, its nutritional requirements will increase. The recommended
nutritional requirements for male and female children of the same age are
equal early in life, but as they approach adolescence, males require
additional nutritional intake. On reaching adulthood, the rise in nutritional
requirements of individuals plateaus off in their respective ranges. However,
the caloric and nutritional needs of females increase during pregnancy and
lactation. Hence, along with a balanced diet, a pregnant or lactating mother
may also require additional supplementation of micronutrients, such as iron,
folic acid, calcium,
 Genetics: Genetics play a significant role in maintaining an individual's
nutritional status. Genetic predisposition combined with lack of physical
activity and a high-energy diet can lead to obesity and metabolic syndrome,
thus putting individuals at higher risk of developing cardiometabolic
diseases. In various genetic disorders, multiple factors could be responsible
for the pathogenesis of malnutrition. For example, in cystic fibrosis,
malabsorption of nutrients results from decreased uptake by the intestines
and reduced secretion of pancreatic enzymes. This, coupled with increased
energy needs, can contribute to malnutrition in these patients.[27] Similarly,
many other genetic disorders, such as phenylketonuria, Prader-Willi
24
 syndrome, maple syrup urine disease, abetalipoproteinemia, and lysosomal
storage disorders, significantly affect the nutritional status of individuals.
1. Infections: Malnourished individuals are more susceptible to infections
and related complications. Interestingly, both acute and chronic infections
adversely affect the nutritional status of individuals and can precipitate
malnutrition. For example, in measles, an acute viral infection, severe
deterioration of the nutritional status of children is observed due to acute
inflammatory response, increased energy needs, and decreased intake of
nutrients due to sore throat or oral lesions. The coexistence of malnutrition
increases the severity of measles infection, susceptibility to secondary
infections, and mortalitMedical and surgical illnesses.

1- Surgery: Malnutrition before surgery can increase the risk of

complications, including increased need for ICU admission, longer recovery
time, infections, and higher rates of morbidity and mortality. Hence, a
nutritional assessment before surgery is crucial. Surgery alone can be a risk
factor for malnutrition due to various factors, such as pre- and post-operative
fasting, hypermetabolism, adverse effects due to drugs, pain, and other
factors specific to the type of surgery.[33][34][33]
Trauma: Severe trauma cases, including head injuries, burns, and multiple
fractures, can put patients at high risk of malnutrition. The initial acute
inflammatory response and increased energy needs following trauma lead to
a hypermetabolic phase.

 Malignancies: Malnutrition in malignancies is multi-factorial.

Inflammatory mediators, increased energy needs, adverse effects of
drugs/therapy (like mouth ulceration, nausea, and vomiting), mental stress,
anxiety, and depression can lead to deterioration of nutritional status.
Furthermore, malnutrition can inhibit the effectiveness of therapy and
worsen the prognosis of the disease.[37]
 Medications: Adverse effects of various drugs, such as nausea, gastric
irritation, or loss of appetite, can contribute to decreased food/nutrient
intake. Commonly taken over-the-counter (OTC) drugs, such as NSAIDs,
can lead to gastrointestinal irritation. Similarly, iron tablets can also cause
gastrointestinal irritation and constipation as side effects. Some medications
can lead to specific deficiencies, such as the drug isoniazid, which can lead
to vitamin B6 (pyridoxine) deficiency. Hence, detailed drug-related history
is needed as some drugs can cause drug-nutrient interactionClinical
25
 Significance.Imbalanced nutritional status adversely affects the health and
wellness of individuals. By evaluating the nutritional status of individuals
early on, nutritional screening and assessment allow for timely intervention
and thus help maintain the health and wellness of individuals and improve
quality of life. Timely interventions, especially in specific groups of
individuals, such as infants, growing children, pregnant and lactating
mothers, etc., help prevent long-term complications.

 tertiary prevention
 Enhancing Healthcare Team Outcomes
 Malnutrition adversely affects the health status of individuals, clinical
outcomes, and overall healthcare costs. Since malnutrition is a public health
concern, it should be addressed accordingly. To prevent this condition,
efforts should be made at multiple system levels (public health, community,
and individual). Establishing sustainable food systems
 educating individuals about healthy diets and lifestyles, maintaining
governmental and local food assistance programs, and arranging nutritional
screening programs at schools, housing shelters, nursing facilities, and
retirement homes, are just a few ways to improve nutritional status and
reduce the burden of malnutrition on the healthcare system.

 Nutrition specialists/technicians and dietitians also play vital roles in

nutritional assessment. For example, dietetic technicians, registered (DTRs)
are qualified to assist with general nutrition screenings and may also assist
dietitians and other members of the healthcare team with identifying patients
at risk for malnutrition in the clinical setting. Clinical dietitians or RDNs are
trained to perform medical nutrition therapy (MNT) using the Nutrition Care
Process (NCP), which includes nutrition assessment as the first step in
identifying potential nutrition problems in patients, such as the risk factors
of malnutrition mentioned throughout this article. Many of the components
of nutritional assessment in the NCP are synonymous with those mentioned
above.
 The five domains of nutrition assessment outlined in the NCP include 1)
food or nutrition-related history, 2) biochemical data, medical tests, and
procedures, 3) anthropometric measurements, 4) nutrition-focused physical
findings, and 5) client history.[39] By being involved in the diagnostic
26
 process and contributing to the planning and monitoring of steps of the
intervention, nutrition specialists/technicians and dietitians help enhance
overall healthcare outcomes.
 Nurses also help with early nutritional screening to identify nutrition risk
factors and monitor the patient's condition to maintain timely documentation
records of clinical status. Pharmacists may also provide information about
potential drug side effects or conditions that may impact the risk of
malnutrition. They may also provide suggestions to help prevent drug-
nutrient interactions that could influence a patient's nutrition status (i.e.,
antiepileptic drugs and potential impact on vitamin D levels).

27
 Data collection & Analysis
Objectives:
 Introduction
 Define of Data collection
 Describes of Data Collection Methods
 Describe data collection tools
 Describe Ethical considerations involved in data collection in survey
research.
 Describe Common Challenges in Data Collection
 steps in the Data Collection Process
 Define of Data Analytics
 Explain Process of Data Analytic
 Define Type of Data Analytics
 Describe Benefits of Data Analytics
 Describe Method of data analysis

28
Introductionss
The community health nurse is ready to determine the community’s needs.
Assessment for nurses means collecting and evaluating information about a
community’s health status to discover existing or potential needs as a basis for
planning future action
Assessment involves two major activities. The first is collection of pertinent data,
and the second is analysis and interpretation of data.
o Defination of Data: A set of values of qualitative or quantitative variables.
o Qualitative Variables: Words, images, observations, conversations,
photographs
o Quantitative Variables: Numbers, tests, counting, measuring
o Defination of Data collection: is the process of collecting and evaluating
information or data from multiple sources to find answers to research problems,
answer questions, evaluate outcomes, and forecast trends and probabilities.

*Data Collection Methods*

1. Primary Data Collection:

Primary data collection involves the collection of original data directly from the
source or through direct interaction with the respondents.

There are various techniques for primary data collection, including:

a. Surveys and Questionnaires: Researchers design structured questionnaires or
surveys to collect data from individuals or groups. These can be conducted through
face-to-face interviews, telephone calls, mail, or online platforms.

b. Interviews: Interviews involve direct interaction between the researcher and the
respondent.
c. Observations: Researchers observe and record behaviors, actions, or events in
their natural setting..
d. Experiments: Experimental studies involve the manipulation of variables to
observe their impact on the outcome

29
e. Focus Groups: Focus groups bring together a small group of individuals who
discuss specific topics in a moderated setting.
2.Secondary Data Collection:
Secondary data collection involves using existing data collected by someone else
for a purpose different from the original intent.
Secondary data can be obtained from various sources, including:
a. Published Sources: Researchers refer to books, academic journals, magazines,
newspapers, government reports, and other published materials that contain
relevant data.
b. Online Databases: such as research articles, statistical information, economic
data, and social surveys.
c. Government and Institutional Records: Government agencies, research
institutions, and organizations often maintain databases or records that can be used
for research purposes.
d. Publicly Available Data: Data shared by individuals, organizations, or
communities on public platforms, websites, or social media can be accessed and
utilized for research.
e. Past Research Studies: Previous research studies and their findings can serve as
valuable secondary data sources.

*Data Collection Tools*

1. Word Association

The researcher gives the respondent a set of words and asks them what comes
to mind when they hear each word.
2. Sentence Completion

Researchers use sentence completion to understand what kind of ideas the

respondent has. This tool involves giving an incomplete sentence and seeing
how the interviewee finishes it.
3. Role-Playing

Respondents are presented with an imaginary situation and asked how they
would act or react if it was real.

30
4. In-Person Surveys

The researcher asks questions in person.

5. Phone Surveys

No researcher can call thousands of people at once, so they need a third party to
handle the chore. However, many people have call screening and won’t answer.
6. Observation

Sometimes, the simplest method is the best. Researchers who make direct
observations collect data quickly and easily, with little intrusion or third-party
bias. Naturally, it’s only effective in small-scale situations.

*Ethical considerations involved in data collection in survey

research.*
 Transparency: Survey researchers should be transparent about how they
collect and use data..

 Consent: Individuals should have the right to consent to data collection.

 Security: Survey researchers should take steps to protect the security of the
data they collect.

 Accountability: Survey researchers should be accountable for their data

collection practices.

 User rights: Individuals should have certain rights over their data, such as the
right to access their data, the right to correct their data, and the right to delete
their data. Survey researchers should respect these rights.

 Privacy laws – Many countries and jurisdictions now have privacy laws that
researchers should carefully consider and incorporate in their data collection
projects..

.
*Steps of the Data Collection Process*

In the Data Collection Process, there are 5 key steps. They are explained briefly
below -

31
1. Decide What Data You Want to Gather
The first thing that we need to do is decide what information we want to gather.
We must choose the subjects the data will cover, the sources we will use to gather
it, and the quantity of information that we would require.
2. Establish a Deadline for Data Collection
The process of creating a strategy for data collection can now begin. We should set
a deadline for our data collection at the outset of our planning phase. Some forms
of data we might want to continuously collect. We might want to build up a
technique for tracking transactional data and website visitor statistics over the long
term.
3. Select a Data Collection Approach
We will select the data collection technique that will serve as the foundation of our
data gathering plan at this stage. We must take into account the type of information
that we wish to gather, the time period during which we will receive it, and the
other factors we decide on to choose the best gathering strategy.
4. Gather Information
Once our plan is complete, we can put our data collection plan into action and
begin gathering data.
5. Examine the Information and Apply Your Findings
*Definition Data Analytics*
Data analytics : is the science of analyzing raw datasets in order to derive a
conclusion regarding the information they hold.
*Process of Data Analytics*
Below are the common steps involved in the data analytics method:
Step 1: Determine the criteria for grouping the data
Data can be divided by a range of different criteria such as age, population,
income, or sex. The values of the data can be numerical or categorical data.
Step 2: Collecting the data
Data can be collected through several sources, including online sources,
computers, personnel, and sources from the community.

32
 Step 3: Organizing the data
The data must be organized after it is collected so that it can be examined. Data
organization can take place on a spreadsheet or other type of software that is
capable of taking statistical data.
Step 4: Cleaning the data
The data is first cleaned up to ensure that there is no overlap or mistake. Then, it is
reviewed to make sure that it is not incomplete. Cleaning the data helps to fix or
eliminate any mistakes before the data goes to a data analyst for analysis.

Data Analytics Types

1-Descriptive Analytics : describes the happenings over time, such as

whether the number of views increased or decreased and whether the current
month’s sales are better than the last one.
2 -Diagnostic Analytics :focuses on the reason for the occurrence of any event.
3 -Predictive Analytics : focuses on the events that are expected to occur in the
immediate future. Predictive analytics tries to find answers to questions
4. Prescriptive Analytics : indicates a plan of action.

Methods of data analysis (data presentation):

1-TABULAR METHODS (FREQUENCY DISTRIBUTION)

A frequency distribution is a table showing how often each value (or set of
values) of the variable in question occurs in a data set.

33
A frequency table is used to summarize categorical or numerical data.
Frequencies are also presented as relative frequencies, that is, the percentage of
the total number in the sample.
2-GRAPHICAL METHODS:
Types of graphs:
1-Bar graph
A bar graph is a way of summarizing a set of categorical data. It displays the
data using a number of rectangles, of the same width, each of which represents a
particular category.

2 - A histogram
is a way of summarizing data that are measured on an interval scale (either
discrete or continuous). It is often used in exploratory data analysis to illustrate
the features of the distribution of the data in a convenient form.
3-Pie chart
A pie chart is used to display a set of categorical data. It is a circle, which is
divided into segments.`z
4-Line graph
A line graph is particularly useful when we want to show the trend ofa variable
over time.

34
 Care of Families
Objectives:

Introduction .
Define family.
Explain function of the family .
Enumerate the characteristics of a healthy family.
Assess factors affecting family health.
Define family nursing
Describe the four approaches of family nursing.
Enumerate competencies required for family health nurse.
Discuss and apply role of family nurse.
Discuss family nursing process.

Introduction:
The family is the unit of service in all health care delivery. The health of one
member affects the welfare of other members in the family. Every family is unique
and it is affected by every aspect of community life. The health service providers
has to understand family ways, traditions, customs and beliefs of the family.
Definition:
Family is a fundamental social institution consisting of a group of individuals
connected by blood, marriage, or adoption. Families typically live together in the
same household and share emotional bonds, responsibilities, and support for each
other. Families play a crucial role in the socialization of individuals, providing
them with love, security, and guidance as they navigate through life. Family
dynamics and structures can vary greatly across cultures and societies.

35
Functions of the family:
The function of the family can vary based on cultural, social, and individual
factors. However, some common functions of the family include:
1. Providing emotional support :
Families often serve as a source of emotional support and comfort for their
members.
2. Socialization :
Families play a crucial role in teaching and socializing children, passing down
cultural values, norms, and beliefs.
3. Economic support :
Families often provide financial and material support to their members, ensuring
their well-being and stability.
4. Caregiving :
Family members may take on caregiving responsibilities for young children,
elderly relatives, or family members with disabilities or illnesses.
5. Identity formation :
Family helps individuals develop a sense of identity and belonging within the
family unit and the larger community.
6. Transmission of values :
Families pass on traditions, rituals, and moral values from one generation to the
next, shaping the values and beliefs of family members.
7. Providing a sense of security :
Families can offer a sense of security and protection, creating a safe and stable
environment for their members. These are just a few examples of the functions of
the family, and the significance of each function may vary depending on the family
structure and cultural context.
Characteristics of healthy family:
A healthy family typically exhibits the following characteristics :
1. Open communication:
Members are able to communicate their thoughts, feelings, and needs openly and
honestly without fear of judgment.

36
2. Supportive relationships:
Family members support and encourage each other through both good times and
challenges.
3. Boundaries and respect:
Healthy families have clear boundaries and respect each other's individuality,
privacy, and personal space.
4. Active listening :
Family members actively listen to each other and take time to understand each
other's perspectives.
5. Shared values and goals :
A healthy family shares common values, beliefs, and goals that guide their actions
and decision-making.
6. Conflict resolution :
Healthy families are able to resolve conflicts in a constructive manner, focusing
on finding solutions rather than assigning blame.
7. Quality time together:
Spending quality time together, such as sharing meals, engaging in activities, and
having meaningful conversations, helps strengthen family bonds.
8. Emotional support:
Family members provide emotional support and comfort to each other during times
of stress, sadness, or challenges.
9. Flexibility and adaptability:
Healthy families are able to adapt to changes and challenges, remaining resilient
and supportive of each other.
10. Positive reinforcement:
Encouragement, praise, and positive reinforcement help promote a sense of self-
worth and confidence within the family unit. These characteristics contribute to a
strong and healthy family dynamic that fosters emotional well-being, mutual
respect, and overall happiness.
Factors affecting healthy family:
There are numerous factors that can affect the health and well-being of a
family. Here are some key factors to consider:
37
1. Healthy Lifestyle Choices :
Encouraging healthy habits such as regular exercise, balanced nutrition, and
sufficient sleep can contribute to the overall health of family members.
2. Emotional Well-being :
Providing a supportive and nurturing environment where family members feel
loved, respected, and emotionally secure is essential for mental health.
3. Effective Communication :
Open and honest communication within the family can foster understanding, trust,
and strong relationships.
4. Stress Management :
Helping family members learn to manage stress through healthy coping
mechanisms can improve overall well-being.
5. Financial Stability:
Adequate financial resources can reduce stress and enable families to access
healthcare, nutritious food, and other essentials for good health.
6. Access to Healthcare :
Ensuring that family members have access to medical care, vaccinations, and
preventive services can support their physical health.
7. Social Support :
Strong social connections and a supportive network of friends and family can
provide emotional support and help families cope with challenges.
8. Education and Awareness :
Providing information on health issues and promoting health literacy within the
family can empower members to make informed decisions about their health.
9. Environment :
Creating a safe and healthy living environment free from hazards can protect the
health of family members.
Define family nursing :
Family nursing is a specialized field of nursing that focuses on delivering
comprehensive and holistic care to families as a unit. It involves addressing the
health needs of all family members, taking into account the relationships,
dynamics, and interactions within the family system. Family nurses work to
promote the health and well-being of families by providing education, support, and
interventions that consider the family as a whole. They often collaborate with other
healthcare professionals to develop personalized care plans that meet the unique
needs of each family. Family nursing emphasizes a family-centered approach to
healthcare, recognizing the important role that families play in the health of
individuals.

38
approaches of family nursing :
1. Family as context:
In this approach, the nurse focuses on the individual family members and their
relationships within the family unit. The nurse considers how the family's
dynamics, structure, and interactions impact the health and well-being of each
member. By understanding the family context, the nurse can provide tailored care
that addresses the unique needs of each family member.
2. Family as a client:
In this approach, the family itself is considered the primary focus of care. The
nurse works with the family as a whole to promote health and well-being, prevent
illness, and manage health challenges. The nurse collaborates with the family to set
goals, develop care plans, and provide support to enhance the family's overall
health and functioning.
3. Family as a system:
This approach views the family as a complex system with interconnected parts
that influence each other. The nurse assesses the family's structure, roles,
communication patterns, and decision-making processes to understand how these
factors impact the family's health outcomes. By working with the family as a
system, the nurse can identify areas for intervention and support to improve family
functioning.
4. Family as a resource:
In this approach, the nurse recognizes the strengths, resources, and resilience of the
family. The nurse collaborates with the family to build on their existing assets and
support their capacity to manage health challenges effectively. By empowering the
family to utilize their strengths and resources, the nurse can promote a sense of
agency and self-efficacy within the family unit.
competencies required for family health nurse :
1. Assessment skills:
Family health nurses must be able to conduct comprehensive health assessments of
individuals and families to identify their needs, strengths, and potential risks.
2. Health promotion and education:
Family health nurses play a crucial role in promoting health and preventing illness
by providing education and resources to empower families to make healthy
lifestyle choices.
3. Care coordination:
Family health nurses work collaboratively with other healthcare providers and
community resources to coordinate and manage the healthcare needs of families.
4. Cultural competence:
Family health nurses must be culturally competent and able to provide culturally
sensitive care to families from diverse backgrounds.
39
5. Advocacy:
Family health nurses advocate for the health and well-being of families by
promoting policies and practices that support healthy environments and access to
healthcare services.
6. Ethical and legal considerations:
Family health nurses must adhere to ethical standards and legal regulations in their
practice to ensure the safety and well-being of their patients.
7. Continuous learning:
Family health nurses should engage in ongoing professional development to stay
current with best practices and advancements in the field of family health nursing.
8.Crisis intervention: Family health nurses are prepared to respond to crises and
provide support to families facing emergencies or challenging situations.
9.Communication skills: Effective communication is essential in building trusting
relationships with families and assisting them in understanding their health
conditions and treatment plans.
10. Collaboration and teamwork: Family health nurses often work as part of
interdisciplinary teams, requiring the ability to collaborate with other healthcare
professionals to deliver comprehensive care to families.
These competencies are essential for family health nurses to effectively support
and empower families in achieving optimum health outcomes.
Roles of family nurse :
1. Health Promotion and Disease Prevention:
Family nurses work with individuals and families to promote healthy lifestyles,
prevent diseases, and manage chronic conditions. They provide education on topics
such as nutrition, exercise, immunizations, and screening tests to help families stay
healthy.
2. Disease Management:
Family nurses assist individuals and families in managing acute and chronic health
conditions. They develop care plans, provide medications, and offer guidance on
managing symptoms and adhering to treatment plans.
3. Advocacy and Support:
Family nurses act as advocates for their patients and families, helping them
navigate the healthcare system, access resources, and make informed decisions
about their care. They provide emotional support and counseling to help families
cope with health challenges.
4. Care Coordination:
Family nurses collaborate with other healthcare providers, community resources,
and social services to ensure that patients receive comprehensive care. They help
coordinate appointments, referrals, and follow-up care to promote continuity and
quality of care.
40
5. Family-Centered Care:
Family nurses recognize the importance of the family unit in promoting health and
well-being. They involve family members in care decisions, seek to understand
family dynamics and values, and support families in addressing health concerns
together.

Family nursing process :

1. Assessment:
Collecting comprehensive data about the family's health history, structure,
dynamics, strengths, and challenges.
2. Diagnosis:
Analyzing the assessment data to identify actual or potential health problems
within the family.
3. Planning:
Collaborating with the family to set goals, develop a care plan, and prioritize
interventions to address the identified health needs.
4. Implementation:
Providing nursing interventions and working with the family to implement the care
plan.
5. Evaluation:
Assessing the effectiveness of the interventions and making adjustments to the care
plan as needed.
Throughout the family nursing process, nurses work closely with families to
empower them to make informed decisions about their health and well-being.
The goal is to promote family health, prevent illness, and enhance the family's
overall quality of life.

41
 Meeting health need of women

 Objective:

By the end of the lecture the learner will be able to:

 Define meaning of women’s health.

 Explain promoting women's health to achieve the 2030 Sustainable

Development Goals.
 Discuss women’s life stages:
o Infancy and childhood (0-9 years).
o Adolescence (10-19).
o Reproductive age (15-44 years).
o Older women (60 years and over).
 Explain preventive care and screening.
 Discuss dimension of wellness.

 Introduction:
women play a critical role in maintaining the health and well-being of their
communities. Also in development of their society. The health of families and
communities are tied to the health of women – the illness or death of a woman has
serious and far-reaching consequences for the health of her children, family and
community. So women are the counter stones of families. They are the primary
protectors, educators, and the main source of stability in the family. Dependently,
the medical community has come to see women as a distinct patient group that has
unique health concerns over a lifetime.
 Definition:
 Women's health: it refers to the branch of medicine that focuses on the
treatment and diagnosis of diseases and conditions that affect a woman’s
physical and emotional well-being.
42
 Promoting women's health to achieve the 2030 Sustainable
Development Goals:
 This conference provides the opportunity to exchange the best experiences
and practices at the Arab level in this important issue, and she confirmed
that Egyptian women are currently receiving special and direct attention
from the political leadership of Mr. President Abdel Fattah El-Sisi, the
President of the Republic who believes in the importance of the role of
women in society, which has been reflected in the strengthening of their
role and status. Pointing to the initiative to support Egyptian women’s
health, which was launched by President Abdel Fattah El-Sisi under the
slogan “The Egyptian woman is the health of Egypt,” and aims to pay
attention to the health of Egyptian women, early detection of breast
cancer through oncology treatment centers, and providing free treatment,
In addition to full awareness of the causes of the disease and self-
examination mechanisms for beneficiaries.
 A strategy ensures that women's health is a reflection of the health and
stability of society. Women are the pillar of the family, and attention to
their health reflects greatly on their ability to give and carry out their
multiple roles inside and outside the home, as well as it reflects positively
on their psychological health, which enables them to better support their
family and community.
 A strategy may be identified to develop systems of social incentives to
encourage women to organize childbearing while spacing births to
preserve mother and child; Regarding the issues of elderly women and
expanding awareness programs on how family members deal with elderly
women in a way that contributes to improving their quality of life; In

43
 addition to developing health services for women that take into account
the basics of elderly women; And increasing the environment conducive
to the lives of older women by completing the neural cognitive codes and
the necessary infrastructure for them.

 Women’s life stage:

 Infancy and childhood (0-9 years):
 Both death rates and the causes of death are similar for boys and girls during
infancy and childhood. Premature, birth asphyxia and infections are the main
causes of death during the first month of life, which is the time of life when
the risk of death is the highest.
 Adolescence (10-19):
 Mental health and injuries:
 Self-inflicted injuries, road traffic injuries and drowning are among the main
causes of death worldwide in adolescent girls.
 Depressive disorders and – in adolescents aged 15-19 years, schizophrenia –
are leading causes of ill health.
 Adolescent pregnancy:
 Early childbearing increases risks for both mothers and their newborns.
Although progress has been made in reducing the birth rate among
adolescents, more than 15 million of the 135 million live births worldwide
are among girls aged 15-19 years.
 Pregnant adolescents are more likely than adults to have unsafe abortions.
 Substance use:
 Adolescent girls are increasingly using tobacco and alcohol, which risks
compromising their health, particularly in later life. For example, in the
WHO Region of the Americas, 23% of boys and 21% of girls aged 13-15
reported that they used tobacco in the previous month.
 Nutrition:
 In 21 out of 41 countries with data, more than one third of girls aged 15-
19 years are anemic. Anemia, most commonly iron-deficiency anemia,
increases the risk of hemorrhage and sepsis during childbirth. Women
and girls are most vulnerable to anemia due to insufficient iron in their
diets, menstrual blood loss and periods of rapid growth.

44
  Uterine fibroids:
 Uterine fibroids are the most common noncancerous tumors in women of
childbearing age. Fibroids are made of muscle cells and other tissues that
grow in and around the wall of the uterus, or womb. The cause of fibroids
is unknown. Risk factors include being African-American or being
overweight.

 Reproductive age (15-44 years)

 Violence:
 Violence against women is widespread around the world. Recent figures
indicate that 35% of women worldwide have experienced either intimate
partner violence or non-partner sexual violence in their lifetime. On
average, 30% of women who have been in a relationship experienced
some form of physical or sexual violence by their partner.
 HIV/AIDS:
 In 2011, about 820 000 women and men aged 15-24 were newly infected
with HIV in low- and middle-income countries; more than 60% of them
were women.
 Globally, adolescent girls and young women (15-24 years) are twice as
likely to be at risk of HIV infection compared to boys and young men in
the same age group.
 Depression and suicide:
 Women are more susceptible to depression and anxiety than men.
Depression is the leading cause of disease burden for women in both
high-income and low- and middle-income countries. Depression
following childbirth, affects 20% of mothers in low- and lower-middle-
income countries, which is even higher than previous reports from high-
income countries.
 Irregular Menstrual Cycles:
 Most women with a regular cycle have between 11 and 13 menstrual
periods each year. However, from time to time, every woman suspects
that her menstrual cycle is abnormal for one reason or another.
 Chronic obstructive pulmonary disease (COPD) :
 Tobacco use and the burning of solid fuels for cooking are the primary
risk factors for chronic obstructive pulmonary disease – a life-threatening
lung disease – in women. One third of all of the COPD deaths and
disease burden in women is caused by exposure to indoor smoke from
cooking with open fires or inefficient stoves.
45
 Adult women (20-59 years) :
 Breast Cancer:
 Second only to skin cancer, breast cancer is the most common cancer in
women. In fact, women have a 12 percent chance of developing breast
cancer in their lifetime.
 Monthly self-examinations can help you identify any changes in your
breasts to share with your primary provider.
 Gynecologic Cancer:
 Each year, more than 82,000 women in the United States are diagnosed with
cancers affecting the reproductive organs, including cervical, endometrial,
ovarian, vaginal and vulvar cancers.

 Cervical cancer:
 Cervical cancer is the second most common type of cancer in women
worldwide, with all cases linked to a sexually transmitted genital infection
with the human papillomavirus (HPV). Due to poor access to screening and
treatment services, more than 90% of deaths occur in women living in low-
and middle- income countries.
 Endometriosis:
 Endometriosis occurs when cells from the lining of the uterus grow in
other areas of the body, like the ovaries, bowel, rectum, bladder and pelvic
area.
 Urinary tract infections:
 Urinary tract infections (UTIs) occur when germs get into the urethra and
start to multiply. They are particularly common in women, as they have a
shorter urethra than a man does. This decrease the length bacteria have to
travel in order to reach the bladder.

 Gestational diabetes:

 Is a condition that can occur during pregnancy in which your glucose

level goes up and other complications develop. This occurs in at least 3 in
100 women, and treatment may include a careful diet, exercise, blood
glucose monitoring, insulin injections and oral medication.

46
  Older women (60 years and over) :
 Heart disease:
 Heart disease is the No. 1 cause of death for women.
 Over 60 million women in the United States have some form of heart
disease. This disease is the leading cause of death for women, and it can
affect women of all ages.
 The most common types of heart disease in women are:
o Coronary artery disease
o Heart failure
o Arrhythmia
 Stroke:
 More women than men suffer a stroke each year; some risk factors are
unique to women. These include: (Taking birth control pills, being
pregnant, using hormone replacement therapy).
 Diabetes:

 Although diabetes is certainly not exclusive to women, it does increase

the risk for heart disease by four times in women. Women are also
more susceptible to diabetes-related complications, such as blindness,
kidney disease and depression.

 Osteoporosis:
 Osteoporosis is a disease that causes your bones to weaken, making them
susceptible to fractures. Postmenopausal women are at higher risk for
fractures associated with osteoporosis. Other risk factors can include
certain medications, early menopause, a low body mass index (BMI),
cancer treatment and genetics.
 Alzheimer’s disease:
 Alzheimer’s disease is a form of brain degeneration in which abnormal
particles called neurofibrillary tangles and plaques form in the brain and
destroy healthy brain cells. Of the 5 million living with Alzheimer’s
disease, more than two-thirds are women.

47
 Preventive care and screening:
 Breast care services:
 Breast biopsy.
 Breast MRI scan.
 Breast ultrasound Genetic testing and counseling for women with a family
or personal history of breast cancer.
 Hormonal therapy, radiation therapy, and chemotherapy.
 Mammography.
 Mastectomy and breast reconstruction.
 Women’s sexual health services:
 Birth control (contraceptives).
 Prevention, diagnosis, and treatment of sexually transmitted illnesses.
 Therapies to help with problems with sexual function.
 Gynecology and reproductive health services:
May include the diagnosis and treatment of various conditions and
diseases, including:
 Abnormal Pap smears.
 Abnormal vaginal bleeding.
 Endometriosis.
 Heavy menstrual cycles.
 Irregular menstrual cycles.
 Ovarian cysts.
 Pelvic inflammatory disease.
 Pelvic pain polycystic ovary syndrome (PCOS).
 Uterine fibroids.
 Uterine and vaginal prolapse.
 Premenstrual syndrome (PMS).
 Pregnancy and childbirth services:
 Planning and preparing for pregnancy, including information about proper
diet and prenatal vitamins.
 Prenatal care, delivery, and postpartum care.
 High-risk pregnancy care (maternal-fetal medicine).
 Breastfeeding and nursing.

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  Other women’s health services:
 Cosmetic surgery and skin care, including skin cancer.
 Diet and nutrition services.
 Psychological care and counseling for women dealing with abuse or sexual
assault.
 Sleep disorders services.
 Smoking cessation.
 Violence against women.

 Dimension of women’s wellness:

 You know what wellness feels like. It’s not just physical health; it
includes overall well-being for a better quality of life. There are a lot of
factors that can affect the quality of life.
 The six dimensions of wellness are: physical, emotional, spiritual,
intellectual, occupational and social.

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1. Physical: The physical dimension recognizes the need for regular physical
activity. Optimal wellness is met through a combination of regular exercise
and healthy eating habits. The physical benefits of looking good and feeling
great most often lead to the psychological benefits of improved self-esteem,
self-control, determination and a sense of direction.

2. Emotional: The emotional dimension recognizes awareness and acceptance

of one’s feelings. Emotional wellness includes the degree to which one feels
positive and passionate about one’s self and life. Having the ability to
understand your own emotions and finding healthy outlets for those feelings
helps you to cope with daily issues.

3. Spiritual: The spiritual dimension recognizes your search for meaning and
purpose in human existence. Spiritual moments may occur in many
environments like visiting any spiritual place, on a walk in the woods, while
meditating, on a run.

4. Intellectual: The intellectual dimension recognizes one’s creative,

stimulating mental activities. Keep your mind stimulated by learning
something new every day, whether it is related to your professional interests or
your personal interests. Be sure to fill your mind with stuff that is true and
accurate.

5. Occupational: The occupational dimension recognizes personal satisfaction

and improvement in one’s life through work. The choice of profession, job
satisfaction, career ambitions, and personal performance are all important
components of your occupational wellness.

6. Social: The social dimension encourages contributing to one’s environment

and community. Social wellness is about relating, interacting and
communicating well with others. Keep a close circle of friends. Support
systems enable people to sail across through life’s highs and lows.

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 PROFILING POPULATION

objectioves:
At the end of this lecture student will be able to :
* define of profiling and population profiling
*discuss purpose of population profiling
* define the population Pyramids
* discuss the profiling process
*list type of profiling practice
*identify pattern of population change
* identify health indicator
*discuss common problem related to profiling population
* identify role of nurse

51
Introduction:
Community (or stakeholder) profiles are a useful way of developing an
understanding of the people in a geographical area or a specific community of
interest. This understanding can assist in the development of a community
engagement plan and influence who the key stakeholder groups are and how a
project develops. Profiles can illustrate the make-up of a community and could
include information about the diversity within the community, their history, social
and economic characteristics, how active people are (i.e. the groups and networks
used) and what social and infrastructure services are provided. A community
profile can also provide information on the level of interest community members.

Definition of profiling:
Profiling refers to the process of construction and application of profiles generated
by computerized data analysis .This involves the use of algorithms or other
mathematical techniques that allow the discovery of patterns or correlations in
large quantities of data, aggregated in databases. When these patterns or
correlations are used to identify or represent people, they can be called profiles.
Population profiling:
Population profiling is a technique for comparing the morbidity patterns of one or
more groups or regions. By taking into account the differences in illness burden
among different patient populations.
Purpose of population profiling:
1) A profile is an effective way of gathering information about the diversity of a
community and the potential stakeholders that may otherwise not be recorded.

2) Profiles can highlight the gaps in our understanding of a community.

3) Profiles can encourage broader thinking about ‘who’ a community is and

‘who’ is involved in a project and ‘how’………....files can help determine
who is likely to be influenced by change or affected by a project.
4) Developing a profile can be used as a means to develop relationships in a
community.
5) The process of profiling can in itself raise awareness, interest and build the
capacity of members in the community.
6) Profiles are a means to gather community intelligence over time.

52
Difinition population pyramids:
. It graphically display the population’s age and sex composition in a bar chart.
 The base width: young age group proportion.
 The top width :old age group proportion.
 The height : average duration of life expectancy.
 The symmetry: the similarity or differences in proportion of males and
females in the different age group
 The shape of the sides: may be smooth with depressions or with bulging.

The profiling process

 The profiling process starts with a specification of the applicable problem
domain and the identification of the goals of analysis.
1) Data collection: The target dataset or database for analysis is formed by
selecting the relevant data in the light of existing domain knowledge and data
understanding.
2) Data preparation: The data are preprocessed for removing noise and reducing
complexity by eliminating attributes.
3) Data mining: The data are analyzed with the algorithm or heuristics developed
to suit the data, model and goals.
4) Interpretation: The mined patterns are evaluated on their relevance and validity
by specialists and/or professionals in the application domain (e.g. excluding
spurious correlations).
5) Application: The constructed profiles are applied, e.g. to categories of persons,
to test and fine-tune the algorithms.
6) Institutional decision: The institution decides what actions or policies to apply to
groups or individuals whose data match a relevant profile.

53
Types of profiling practices :
1) Supervised and un supervised learning:
A) supervised learning (top-down profiling):
This is similar to the methodology of traditional scientific research in that it starts
with a hypothesis and consists of testing its validity. The result of this type of
profiling is the verification or refutation of the hypothesis.
B) unsupervised learning:
Profiles can be generated by exploring a data base, using the data mining process
to detect patterns in the data base that were not previously hypothesized. In a way,
this is a matter of generating hypothesis: finding correlations one did not expect or
even think of. Once the patterns have been mined, they will enter the loop –
described above – and will be tested with the use of new data.
2) Individual and group profiles:
Profiles must also be classified according to the kind of subject they refer to.
This subject can either be an individual or a group of people.
A) Individual profiling:
When a profile is constructed with the data of a single person. This kind of
profiling is used to discover the particular characteristics of a certain individual, to
enable unique identification or the provision of personalized services.
B) group profiling:
refer to the result of data mining in data sets that refer to an existing community
that considers itself as such, like a religious group, a tennis club, a university, a
political party etc. In that case it can describe previously unknown patterns of
behavior or other characteristics of such a group (community).

3) Distributive and non-distributive profiling :

Group profiles can also be divided in terms of their distributive character:
A ) group profile is distributive:
When its properties apply equally to all the members of its group: all bachelors are
unmarried, or all persons with a specific gene have 80% chance to contract a
specific disease.

54
B) profile is non-distributive:
When the profile does not necessarily apply to all the members of the group the
group of persons with a specific postal code has an average earning capacity of
XX, 37% to contract a specific disease. Note that in this case the chance of an
individual to have or the category of persons with blue eyes has an average chance
of a particular earning capacity or to contract the specific disease will depend on
other factors, e.g. sex, age, background of parents, previous health, and education.

Pattern of Population Change:

1) The world’s total Population is rising rapidly, not all countries are
experiencing this growth.
2) Population increase.
3) Birth rate more than. Death rate.
4) Population decrease.
5) Death rate more than birth rate.
6) Population stays the same.
7) Birth rate and death rate are same.

Health indicator
Avariable can measured used to describe one or more aspects of the health
of (indvidual or Population environment

A) Mortality Indicator:

1) Crude death rate.

(CDR) Total resident death/total population X100,000

2) Proportionate mortality rate.

(PMR) Numberof death(Certain disease/total
Number of death (all cases)x1000

3) Case fatility rate (CFR)

Number of deaths(Certain disease)/(total number of caseX100

55
 (B) morbidity indicator:

The occurance of disease is also an indicator of health.

1) Incidence rate
2) Prevalence rate
3) Notification rates

Incidence rate : the number of new cases occuring in adefined

Population during aspecified Period of time

Prevalence rate: all current Cases (old and New) existing at agiven
Point of time in agiven Population.

Notification rates :Calculated from the reporting to Public

authoritis of certain disease.

Common problem related to profiling population:

The impact of COVID-19 on small business outcomes and expectations

Drawing on a survey of more than 5,800 small businesses, this paper
provides insight into the economic impact of coronavirus 2019 (COVID-19)
on small businesses. The results shed light on both the financial fragility of
many small businesses, ...To explore the impact of coronavirus disease
2019 (COVID-19) on small businesses, we conducted a survey of more than
5,800 small businesses between March 28 and April 4, 2020. Several
themes emerged. First, mass layoffs and closures had already occurred .

Factors that contribute the problem:

Identify personal factors that may contribute to the problem.
Whether the problem involves individual behavior or community conditions,
each individual affected by it brings a whole collection of knowledge (some
perhaps accurate, some perhaps not), beliefs, skills, education, background,
experience, culture, and assumptions about the world and others, as well as
biological and genetic traits. Any or all of these might contribute to the problem or
to its solution...or both.
56
A few examples:
Genetic predisposition for diabetes and other conditions. Lack of knowledge about
healthy nutrition.
Lack of knowledge/ skills for preparing healthy foods.
Sample environmental factors:
1- Poverty.
2- Lack of employment and hope for young men in low-income neighborhoods.
3- Lack of availability of healthy food in low-income neighborhoods
4- General availability – at school as well as elsewhere – of snack foods high in
salt, sugar, and fat.
Role of Nurse:
1) Formulate plan for different problems for the community and solutions.
2) Analyze the root causes of the problem
3) Identify personal factors that may contribute to the problem.
4) Identify environmental factors that may contribute to the problem.
5) Control the sensitive data within the community setting. Daily work sheet,
diaries and patient record.
6) Identifing the needs of the teem and supporting staff to develop.
7) Understanding local demographic and determinants of health.
8) Promoting equality in service delivery.
9) Collaboration between diffirent services.
10) Communication vital between different serves

57
 Health promotion
Objectives
At The End Of the lecture The student will be able To:

 Define of health promotion for population health

 Discuss Important of health promotion
 List Principles of health promotion .
 Identify Health promotion approach
 List Strategies of health promotion program
 IdentifyNursing role in health promotion

58
 Introduction

Health promotion is the process of enabling people to increase control over, and to
improve, their health. It moves beyond a focus on individual behaviour towards a
wide range of social and environmental interventions.

Definition

Health promotion is the development of individual, group, institutional,

community and systemic strategies to improve health knowledge, attitudes, skills
and behavior

Importance of health promotion

 Health promotion enhances the quality of life for all people.
 Health promotion reduces premature death.

 Health promotion reduces the costs.

 Health promotion enhances the quality of life for all people.

 Principles of Health Promotion

The principles of health promotion are the foundation of any successful
health promotion program. These principles are based on the understanding that
health is a complex issue that is influenced by a variety of factors, including
individual behavior, social and environmental conditions, and access to healthcare.
The following are key principles of health promotion:
 Health is a positive concept: Health is not simply the absence of disease. It is
a state of complete physical, mental, and social well-being.
 Health is influenced by a variety of factors: Health is not simply a matter of
individual choice. It is also influenced by social and environmental conditions,
such as poverty, discrimination, and access to healthcare.
 People have the right to make decisions about their own health: People
should be empowered to make informed decisions about their own health.
 Health promotion is a shared responsibility:- Health promotion is not the
responsibility of any one group or individual. It is a shared responsibility of
individuals, communities, and governments.

59
  Health promotion is an ongoing process:- Health promotion is not a one-time
event. It is an ongoing process that requires continuous evaluation and
improvement.
*Here are some examples of how the principles of health promotion
can be applied in practice:
 A health promotion program aimed at reducing smoking among
adolescents might use the following strategies:
 Provide information about the harmful effects of smoking.
 Offer smoking cessation classes.
 Create a smoke-free environment in schools and workplaces.
 A health promotion program aimed at increasing physical activity among
older adults might use the following strategies:
 Provide information about the benefits of physical activity.
 Offer walking groups and other physical activity classes.
 Create a more walk able environment by adding sidewalks and trails.
Health promotion approach
.There are several different approaches to promoting health
These include medical, behavioral, educational, empowerment, social
.asapproaches
1-medical approaches
Aim
To reduce morbidity and premature mortality
To ensure freedom from disease and disability
Activity‡
Uses medical intervention to prevent ill-health±
.or premature death
,Eg. - Immunization, screening‡
2- behavioral approach
A behavioral approach to health aims to inspire individuals to adopt healthy
lifestyle behaviors, to use preventive health services, and to take responsibility for
their own health.

60
3- Educational approach
The purpose of the educational approach is to provide information and knowledge
and to develop relevant skills so that individuals can make knowledgeable choices
about their health-
4 -empowerment approach
Aim
±Helps people to identify their own needs
and concerns, and gain the necessary skills
and act upon them.
- to control and manage their health and things affecting their health.This method
focuses on helping people develop decision-making and problem-solving skills .
5 -social approach
- the social change approach focuses on changing societal behavior (physical,
economic, and social environments).
The social change approach is concerned with adjusting the physical, social, and
fiscal environment to create enabling environment for building health promotion
capaci

 Strategies for health promotion:

1- Health communication
2-Health education
3-Health policy
4-Environmental
5) Strategies Health communication:
Health communication strategies can inform and influence large numbers of people
on ways to improve their health.
2- Examples of media strategies to convey health messages:
- Radio
- Television
- Newspaper

61
- Internnet
6) Health education:-
involves teaching individuals and giving information to the public to achieve
better health.
 Examples of health education activities include:
2. Lectures.
3. Courses.
4. Workshops.
5. Classes.
3)Health policy:-
can be defined as the "decisions, plans, and actions that are undertaken to achieve
specific healthcare goals within a society".
2- Examples of health policy:
 Smoke free policy.
 Vaccination programs.
4) Environmental strategies for health promotion
2. Examples of environmental strategies for health promotion include:
 the number of parks, green-ways,
 Increasing the availability of fresh,
healthy foods.

*Nurse Role in promoting health*

 Health Assessment: Nurses perform comprehensive health assessments of
individuals and communities to identify their specific health needs, risk

 Health Promotion Programs: Nurses actively participate in developing,

implementing, and evaluating health promotion programs These programs may
focus on subjects such as smoking cessation, weight management, sexual
health, mental health, and substance abuse prevention.

62
 Health Education and Counseling: Nurses are responsible for providing
health information to individuals and communities. They educate people about
healthy lifestyle choices, such as nutrition, physical activity, smoking cessation,
and stress management.
 Disease Prevention: Nurses are participate in various disease prevention
activities, including immunizations, screenings, and early detection of health
problems. They promote vaccinations to prevent infectious diseases and ensure
that individuals and communities are aware of the recommended immunization
schedules. Nurses also conduct screenings for conditions such as cancer,
hypertension, diabetes.

 Advocacy: Nurses act as advocates for individuals and communities, promoting

health by raise thier awareness about social determinants of health, such as
poverty, , education, which significantly impact health outcomes. Nurses are
ensuring equitable access to healthcare services for all members of the
population.

 Health Promotion through Technology: With the advancement of

technology, nurses utilize various digital tools and platforms to promote health
at the population level. They may engage in telehealth services, where they
provide virtual consultations, health education, and monitoring of individuals
remotely.

 Evaluation and Outcomes Measurement: Nurses are responsible for

evaluating the effectiveness of health promotion interventions and programs.
behavior change, and overall well-being.

63
 Meeting health need of men
Objectevies:

 Define of men health

 List 6 Ways men can take better care of their health
 Identify Men health tips
 Know Men’s health week-top tips
 Discuss Common men’s health issues
 Discuss The ministry of health role of health screening program for
men

64
introduction
Men's health is a state of complete physical, mental, and social well-being, as
experienced by men, and not merely the absence of disease
.[1][failed verification] Differences in men's health compared to women's can be
attributed to biological factors, behavioural factors, and social factors (e.g.,
occupations)
.[2] Men's health often relates to biological factors such as the male reproductive
system or to conditions caused by hormones specific to, or most notable in, males.
Some conditions that affect both men and women, such as cancer, and injury,
manifest differently in men
.[3] Some diseases that affect both sexes are statistically more common in men. In
terms of behavioural factors, men are more likely to make unhealthy or risky
choices and less likely to seek medical care.

*definition*
Men's health refers to the state of physical, mental, and social well-being of
men, and encompasses a wide range of issues that are unique to men or that affect
men differently than women. This can include issues related to reproductive health,
sexual health, cardiovascular health, mental health, and cancer prevention and
treatment. Men's health also encompasses lifestyle factors such as diet, exercise,
and stress management, as well as access to healthcare and preventative measure

*6 ways men can take better care of their health*

65
66
*men health tips*

A-Z Men Health Tips — Nutritional Needs, Body Fitness &

Healthy Sex

67
“To keep the body in good health is a duty…otherwise we shall not be able to keep
our mind strong and clear. ’’ All men should remember these wise words from
Buddha. With growing awareness, many of us are realizing the importance of
health. However, many men neglect their health, citing paucity of time as an
excuse. But one should remember that men’s health is as important as women’s
health.

egular exercise is a must if you want to be physically fit, and keep health problems
at bay. Regular exercise, workout, etc have many physical, mental and emotional
benefits. It keeps your body fit and in shape, reduces the risk of high blood
pressure, obesity, diabetes and osteoporosis, and reduces cholesterol level too. It
also guards you against depression, and is an instant mood maker.

Weight Management

68
Being overweight or obese can lead to many health issues, and can be fatal too. So
this should be first priority when it comes to men health tips. Exercising regularly is
important, but with that one should eat healthy and balanced food, and say a big NO
to junk foods and sugary drinks. A recent study said that obesity is responsible for
about 3,50,000 deaths every year in America.

Quit Smoking, Drink Moderately

InAmerica about 400,000 people die due to smoking. This indicates that smoking is
the top reason for death among men. It leads to various respiratory diseases,
including lung cancer. Smoking is considered to be a major reason for oral cancer
too. Heavy drinking is not safe either. Excessive drinking is bad for liver, kidney
and heart. It affects mental health and fertility too. Heavy drinking tends to spoil
your social life and increase the risk of road accidents leading to death. On the other
hand, moderate drinking reduces the risk of coronary artery diseases.

69
Regular Checkups, Tests

Body checkup is one of the most important among men health tips. You should go
for regular cholesterol and blood pressure checkups, as these two are considered
silent killers- they damage heart and arteries. On other hand, after a certain age
every man should go for colonoscopy and prostrate serum antigen testing. Colon
and prostate cancer are two of the most common are common diseases among men.
They are curable if diagnosed early, so regular testing helps. Men should also get
regular glaucoma screening after an age. Glaucoma is the leading cause for
blindness. This is important as Glaucoma is spreading fast.

Watch Your Diet

70
Itis very important for every man to eat balanced and healthy diet. Men need
adequate amount of nutrients to keep them fit, maintain muscle mass, prevent
diseases and for a healthy sex life. Men health tips are the best way to know how to
take care of yourself. So here are diet tips — it is important for you to increase good
fats and carbs in your diet. Go for omega-3 fats, whole grains, etc, and banish
saturated fats and refined grains for a healthy body and life. Foods like oysters,
nuts, fatty fish, bananas, red-orange veggies, berries, cherries, etc are good for men.

Me Time Is Important

Metime is also important for men, so always find some time for yourself. You can
meditate or practice relaxation exercise, go for a movie, indulge yourself in a hobby
or a favourite activity. You may go for a weekend trip with male friends or family.
Solo trip is the best. Doing so reduces your stress level, and makes you calm, more
creative and productive .This is good for emotional, mental health and stability too.

Sex Life

The next on the list of men health tips is practicing safe sex for happy, healthy and
pleasurable sex life. Safe sex is important to prevent sexually transmitted diseases,
infertility, unwanted fatherhood, etc, and to do so condoms are the best safeguard.
Exercise, healthy diet and decent lifestyle help you to have better sex life. Want

71
exercise and pleasure combo, then indulge yourself in morning sex. It has been
proven as the best workout.

Looks Matter

Beauty and taking care of your skin is not restricted to women only. It is part of the
men health tips too. So men should not forget to take good care of their skin. Use
sunscreen before stepping out in sun, it saves your from suntan, skin issues and skin
cancer. Use herbal and sweat proof sunscreen. You should also practice good
personal hygiene — from body care to beard, to hair, skin, nails, etc.

*men’s health week-top tips*

72
 *common men’s health issues*

1. Birth control
Dr. Nangia says they have seen a massive increase in consultations
for vasectomies over the last year. There may be many reasons for that, but the
doctors say it has been correlated with increased restrictions on abortion. While
many men are looking for a vasectomy to be birth control for now – and reversed
later – the doctors say vasectomies should be viewed as permanent birth control.

“We do have this ability to reverse it, but just because we can doesn't mean we
should. That's where the real challenge and the shared decision-making has to
come in,” says Dr. Parker.

Dr. Fantus cited research on vasectomy regret among men who were talked into
getting one. So, if you are investigating a vasectomy procedure, expect to have an
in-depth discussion with your urologist about your reasons for wanting one and
your future reproductive plans

Aside from vasectomy, men tend to rely on condoms for birth control. But we
continue to investigate additional options. For example, the health system has been
participating in National Institutes of Health trials for men’s hormonal birth
control. In the future, there may be a true reversible form of contraception for men,
much like what exists for women.

2. Enlarged prostate, or BPH

BPH stands for benign prostatic hyperplasia. It simply means an enlarged
prostate. It affects up to 50% of men by the age of 50 and almost all men over the
age of 70. A common BPH symptom is frequent urination or trouble with
urination. BPH can be treated with lifestyle changes, medications to shrink or relax
the prostate and even surgical procedures to trim the prostate. This includes the
latest minimally invasive robotic procedure called Aquablation therapy. It uses a
heat-free water jet to remove prostate tissue with minimal irreversible side effects.

73
 3. Low testosterone
“It’s really important that we have a conversation about your symptoms, things like
problems with erections or sex drive, loss of muscle mass or osteoporosis," says
Dr. Fantus.

If you are reporting those symptoms, you may get screened for testosterone
deficiency. That looks for a low testosterone level on 2 morning tests.

However, even if you have low testosterone, you may not be treated with hormone
supplements. That’s because testosterone can do things like shut down the body’s
ability to make sperm. So, if you are still interested in having children, testosterone
medications may not be the solution.

“People focus so heavily on testosterone being the be-all and end-all of their
problem. It isn't. It's their overall health, weight, diet, sleep, exercise and stress,”
says Dr. Nangia.

4. Erectile dysfunction
Many people like to blame erectile dysfunction on low testosterone. But Dr.
Fantus says the causes are multifactorial, or caused by several different things. For
example, aging, hardening of the arteries, high blood pressure, high cholesterol,
diabetes and obesity can all contribute to erectile dysfunction. Additionally, there
is also psychogenic erectile dysfunction or performance anxiety.

Because of all this, it’s not common to go straight to medications. Dr. Fantus says
the No. 1 treatment is lifestyle modifications, which include weight loss, diet and
exercise as appropriate. He says that men who lose up to 10% of their body weight
will generally have some reversal of their erectile dysfunction symptoms.

If that is not successful, there are medications – like Cialis, Viagra and others – or
injections, vacuum devices and surgeries to correct erectile dysfunction. One
example is that Dr. Fantus performs a minimally invasive procedure to insert
inflatable penile prosthetic devices, which offers a permanent treatment for ED.

5. PSA testing
The American Cancer Society estimates that 1 in 8 men in the U.S. will
get prostate cancer. A prostate-specific antigen (PSA) test is a blood test that is
used to screen for prostate cancer. Dr. Parker says he recommends men start
getting their PSA levels tested in their 40s. However, not all providers will offer it,
so you may need to request it specifically.

74
“There's this myth out there that you die with prostate cancer, not from it,” says Dr.
Parker. “Prostate cancer kills a lot of men every year. That's a potentially avoidable
outcome with early detection screening.”

In addition to a PSA test, your doctor will also likely complete a digital rectal
exam.

6. Prostate cancer treatment

Unfortunately, getting treatment for prostate cancer can lead to many of the
common men’s health issues explored here. During treatment, you’re given
medication to block testosterone. That can mimic symptoms of menopause, like
hot flashes, fatigue and brain fog, in addition to urinary incontinence and erectile
dysfunction. Learn more about prostate cancer treatment options.

7. Self-checks and testicular cancer

Testicular cancer is the most common cancer for young men aged about 15 to 40.
Like breast cancer, teaching self-exams has been somewhat controversial, says Dr.
Nangia. The United States Preventative Services Task Force doesn’t recommend
self-checks because there’s concern about causing undue anxiety. However, Dr.
Nangia says that proper education around self-exams is a useful, free way to catch
testicular cancer early.

“Testicular self-exam is easy. You should be feeling your testicles in the shower.
See what things feel like,” says Dr. Parker. “But the most important thing is to not
be afraid of what you feel and seek the advice or evaluation of a doctor if you’re
concerned.”

There’s a common misconception that the “turn-your-head-and-cough” test

in a doctor’s office is part of a testicular exam. Dr. Fantus says it’s
actually to look for a hernia, especially if you are having urinary pain or
pain in the scrotum

**The ministry of health role of health screening program for men

**

Some key aspects of the Ministry of Health's role in health screening

programs for men include:

75
1. Developing guidelines: The Ministry of Health develops guidelines for
health screening programs tailored specifically for men. These guidelines outline
the recommended age at which men should start screening for various health
conditions, as well as the frequency of screenings.
2. Promoting awareness: The Ministry of Health raises awareness about the
importance of health screening among men through various channels, such as
public health campaigns, educational materials, and social media.
3. Providing access to screening services: The Ministry of Health ensures
that men have access to affordable and convenient health screening services. This
may involve partnering with healthcare providers, clinics, and hospitals to offer
screenings at reduced costs or through government-funded programs.
4. Monitoring and evaluating programs: The Ministry of Health monitors
and evaluates the effectiveness of health screening programs for men to ensure that
they are meeting their objectives and reaching the target population. This may
involve collecting data on screening rates, outcomes, and follow-up care.
5. Collaborating with other stakeholders: The Ministry of Health collaborates
with other government agencies, healthcare providers, non-profit organizations,
and community groups to coordinate efforts and maximize the impact of health
screening programs for men.
Overall, the Ministry of Health plays a critical role in promoting and
implementing health screening programs for men to help prevent and detect
health conditions early, ultimately improving men's health outcomes and
quality of life.

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 Meeting health need of child and adolescents
Objectevies:

At the end of the lecture the lerner will be able to:

Define of child health

Discuss Life span development

Identify Post natal period (New born & infancy) needs, problems, care

Identify Early childhood (toddler &preschool)

List School needs ,problems, care

Identify Adolescents needs, problems

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Introduction

Children and adolescent have specific health needs and problems that
can be addressed by community health nurse.

Children cannot achieve optimal health alone they are dependent upon
adults in their family and community to provide them with an
environment in which they can learn and grow successfully .

Life span development

1- Prenatal period : from conception to birth

2 - Infancy : from birth to 12 or 18 months

A-Neonatal: Birth to 28 days

B-Infancy: 1 to approximately 12 months

3-Early childhood : from 1 to 6 years

A- Toddler: 1 to 3 years

B-Preschool: 3 to 6 years

4- Middle childhood : from 6 to 11 or 12 years (school age)

5- Later childhood : from 11 to 19 years

A-Pre-pubertal: 10 to 13 years

B-Adolescence: 13 to approximately 18 years

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Definition of child health

Child health is a state of physical, mental, intellectual, social, and

emotional ,psychological and spiritual well-being and not merely the
absence of disease of infirmity.

1_Post natal period

A) Newborn stage:

Newborn stage is the first 4 weeks or first month of life. It is a transitional

period from intrauterine life to extra uterine environment.

*Basic needs of normal newborn*

1-Maintaining a clear airway.

2-Achieving and maintaining adequate respiratory exchange.

3-Warmth.

4-Protection from infection.

5-Love and security (attachment).

6-Nutritional needs

Problems of new born

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A-Problems that are considered normal:

 Mild degree of nasal obstruction and snoring.

 Occasional regurgitation or vomiting (once or twice daily).
 Inverted sleep rhythm: sleeping during day hours is usually better than during
night.
 Straining, even during sleep is normal.
 Variable bowel movements: the normal average is 1-2 motions per day.

 However, passage of 5-6 motions per day often following each feed is normal
and not diarrhea on the other hand passage of one motion every 3-4 days is also
normal and not constipation.

B-Problems that necessitate medical consultation

_Poor or absent sucking.

_Appearance of yellow coloration of eyes and skin.

_Significant repeated vomiting

_Rapid or difficult respiration or Fever

_Appearance of whitish sport or patches on the tongue or oral mucosa.

C-Weight gain:

Normally the newborn doses not gain weight except after the first 7-Odays. The
normal rate of weight gain is about 200gm / week

B) Infancy Stage

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Infancy period starts of the end of the first month up to the first year of life.
Infant's growth and development during this period are characterized by being
rapid.

Basic need of infants

1. Love and security.

2-feeding

3. Sucking pleasure.

4. Warmth and comfortable

5. Sensory stimulation

Problems of infants:

1- Psychological problems

Anxiety due to:

- 1- Frustration in feeding or sucking

2- Lack of parental love and frustration

3-Stranger anxiety and loss of mother

4- Child abuse

5-Malnutrition due to disturbed mother child relation

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II- Health problems

1_ Malnutrition

2- Infection

Routine and Care of the Toddler and preschool child

1. Nutrition: Similar to those for toddler, daily caloric requirement 1300-1800

calories and fluid requirement may decrease slightly to about 90ml/kg/day. Parents
sometimes worry about the quantity of food but the quality is much more important
than the quantity.

2. Sleep and activity: Average sleeping hours about 12 hours a night and
infrequently takes day time naps. Activities continue to be in high levels.

3. Dental care: Dental care is essential habits, he still require assistance and
supervision with brushing by parents.

4. Injury prevention: Poisoning is still a danger, motor vehicle injuries increase

from activities such as playing in street, riding tricycles or forgetting safety
regulations when crossing streets.

3- Middle childhood

School Age

from 6 to 11 or 12 years the age at which a child may or must begin to attend
school. the years during which attendance at school is required or customary

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Needs of school age:

1-Bathing

2- Sleep and rest.

3-Dental health

4- Exercise and activity

5-Education:

a- Sex education.

b-Religious education

6-Nutrition: Nutritional requirement: The aged 7 to 10 years old require (80)

calories per kilogram, 34 gm protein, 800 mg calcium, 10mgiron& 400IU vitamin
D.

Problems of School

1-School problems age

A_ School phobia : All organic cause must be ruled out. The most common
complaints are abdominal pain, headache, vomiting, and regression enthusiasm and
leads the child into learning rather than punishing the child.

B-Learning difficulties : The learning difficulties are represented in variety of

specific learning disabilities in children. The difficulties are in reading, writing,
and understanding. Those children need special attention

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2-Behavioral problems

Children sometimes employ aggressive, negative or disobedient behavior in an

attempt to feel important and control others. The forms of aggression are:

a-Lying

b-Stealing

c-Cheating

3-Sexual problems

Anxiety from parents toward these points

4-Nutritional problems

A - Overfeeding (obesity)

B- Underfeeding

5-Communicable diseases

Ex.: Diphtheria, Typhoid fever, Hepatitis A virus.

6-Allergy & infectious diseases:

Bronchial asthma, sinusitis, urticaria.

Streptococcus infection as tonsillitis, rheumatic fever S

taphylococcus infection as nephritis

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7-Dental problems

Good oral hygiene habits and brushing should be done after meals , referral to
dentist every period for dental check-up

8-Skeletal problems

A-Bone fracture

9-Accidents

a- Motor cars accident

B-Scoliosis.

b- Drowning.

c-Electric shock

Routine and Care of School age

1- Bathing, dressing and toileting

2- Sleep and rest
3- Safety measures include accidents prevention and sex education.
4- Nutrition during the school age caloric requirements per unit of body weight
continue to decrease, but the nutritional requirements remain relatively greater
than in a mature person.
5- Play and work
6- Health: preschool health examination and school health program exercise and
activity, television, sports

3- Later childhood
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 A -Pre-pubertal: 10 to 13 years

B-Adolescence: 13 to approximately 18 years

Puberty and Adolescent Age Child

Period of rapid physical growth when secondary sex characteristics appear (the
girl begins to menstruate and the boy begin to produce spermatozoa), it ends when
somatic growth is completed and the individual psychologically mature and able to
take his place in society as contributing member.. It is a transitional period from
childhood to adult hood; it is start when secondary sex characteristics appear.

Basic needs of puberty and adolescent

1-Emotional support: Parents' words and actions should facilitate adolescents'

trust, respect, self-esteem, and, ultimately, independence.

2-Education: Make sure your kids get the best possible education for their future.
This, of course, includes school. But it also includes the invaluable lessons about
life that you provide during the time you spend together.

3- Independence: adolescents need to know their parent(s) have confidence in

them and will help them develop their ability to do good things for themselves and
others

4-Stability: Stability comes from family and community. Ideally, a family remains
together in a stable household.

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problem in puberty and adolescent age :

1-Early pregnancy and child birth: Complications linked to pregnancy and

childbirth is the second cause of death

2- HIV: More than 2miilions of adolescent are living with HIV.

3 _Mental health :Depression is the top cause of illness and disability among
adolescents and suicide is the third cause of death.

4_ Alcohol and drugs :Harmful drinking among adolescent is major concern in

many countries.it reduces self-control and risky behaviour.

5 _ Tobacco :use The vast majority of people using tobacco today begin when
they were adolescent.

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