Discuss how events in history influence the current global burden of disease and how the MDG's and the SDG's are being used to address these burdens. Below are the required learning resources for this week. Global Health History This site gives an overview of global health history through a brief outline of global health efforts and discusses how historical forces and events, such as colonialism and the discovery of penicillin, have shaped global health today. http://www.uniteforsight.org/global-health-history/ Eradication: Lessons from the Past This article discusses the success of the smallpox eradication program and the use of disease eradication as a public health strategy. Eradication: Lessons from the Past The Declaration of Alma-Ata Read the original Declaration of Alma-Ata on the WHO website. http://www.who.int/publications/almaata_declaration_en.pdf Global Social Policy Forum: Introduction: Reclaiming Primary Health Care - Why Does Alma Ata Still Matter? Or Can We Still Speak of the Relevance of Alma Ata? This article explores the legacy of Alma Ata and its relevance to global health today. Global Social Policy Forum: Introduction: Reclaiming Primary Health Care - Why Does Alma Ata Still Matter? Or Can We Still Speak of the Relevance of Alma Ata? Forty Years After Alma?Ata: At the Intersection of Primary Care and Population Health The article focuses on the declaration of Alma-Ata after forty years at the Global Conference on Primary Health Care in October 2018. http://ezproxy.umgc.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=heh&AN=136857253&site=eds-live&scope=site Millennium Development Goals (MDGs) Fact Sheet. http://www.who.int/mediacentre/factsheets/fs290/en/ From MDG's to SDG's the Full Report. http://apps.who.int/iris/bitstream/10665/200009/1/9789241565110_eng.pdf?ua=1 Monitoring Health for the SDG's Explore the WHO site on SDGs https://www.who.int/gho/publications/world_health_statistics/2016/EN_WHS2016_Chapter6.pdf?ua=1 Nursing and Sustainable Development: Furthering the Global Agenda in Uncertain Times (2019). https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-24-2019/No2-May-2019/Nursing-and-Sustainable-Development.html Health and Human Rights Learn more about the WHO's work in health and human rights. http://www.who.int/hhr/en/ A method for measuring spatial effects on socioeconomic inequalities using the concentration index (2020) This study aimed to decompose and estimate the contribution of spatial effects on inequalities in uptake of HIV tests in Malawi.

Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction Laureate Education (2016c). Case study: A Puerto Rican woman with comorbid addiction [Interactive media file]. Baltimore, MD: Author Note: This case study will serve as the foundation for this Assignment. https://mym.cdn.laureate-media.com/2dett4d/Walden/... To prepare for this Assignment: Review this week’s Learning Resources. Consider how to assess and treat adolescent clients requiring therapy for impulsivity, compulsivity, and addiction. ACTUAL ASSIGNMENT PLEASE Addressed each of the following bullets with a subtopic, include references; in-text citation in each paragraph. Please use my articles and any additional one should come from USA and must be within last five years only that is from 2014 to 2018. Please do not begin a paragraph with author name(s) (PLEASE USE parenthetical/in-text citations) Thanks The Assignment Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. At each decision point stop to complete the following: Decision #1Which decision did you select?Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?Decision #2Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?Decision #3Why did you select this decision? Support your response with evidence and references to the Learning Resources.What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. BACKGROUND Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office today due to a rather “embarrassing problem.” SUBJECTIVE Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past two years and she is concerned about the negative effects of the cigarette smoking on her health. She states that she attempts to abstain from drinking but that she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much” but enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much- she currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight. Mrs. Perez is quite concerned today because she has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money. MENTAL STATUS EXAM The client is a 53 year old Puerto Rican female who is alert, oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. As you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation & self-reported mood. She visual or auditory hallucinations, no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact, however, impulse control is impaired. She is currently denying suicidal or homicidal ideation. Diagnosis: Gambling disorder, alcohol use disorder Decisions Made and Outcomes (Needed to formulate the paper) Choices for Decision 1: Select what the PMHNP should do: Decision Point One Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeksAntabuse (Disulfiram) 250 mg orally dailyCampral (Acamprosate) 666 mg orally three times/day My decision Decision Point One: Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks RESULTS OF DECISION POINT ONE Client returns to clinic in four weeksMrs. Perez said that she felt “wonderful” as she has not “touched a drop” to drink since receiving the injectionClient reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also have her concerned Choices for Decision 2: Select what the PMHNP should do next: Add on Valium (diazepam) 5 mg orally TID/PRN/anxietyRefer to a counselor to address gambling issuesAdd on Chantix (varenicline) 1 mg orally BID My decision: Add on Valium (diazepam) 5mg orally TID/PRN/anxiety Outcome: RESULTS OF DECISION POINT TWO: RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Mrs. Perez reports that when she first received the valium, it helped her tremendously. She states “I was like a new person- this is a miracle drug!” However, she reports that she has trouble “waiting” between drug administration times and sometimes takes her valium early Client is asking today for you to increase the valium dose or frequency Choices for Decision 3: Select what the PMHNP should do next: Continue current dose of Vivitrol, increase Valium to 10 mg orally TID/PRN/anxiety. Refer to counseling for her ongoing gambling issueContinue current dose of Vivitrol, decrease/taper Valium with the goal of discontinuation in the next 2 weeks. Refer to counseling for her ongoing gambling issueContinue current dose of Vivitrol and maintain current dose of valium. Refer to counseling for her ongoing gambling issue My decision: Continue current dose of Vivitrol, decrease/taper Valium with the goal of discontinuation in the next 2 weeks. Refer to counseling for her ongoing gambling issue Guidance to Student Anxiety is a common side effect of Vivitrol. Mrs. Perez reports that she is doing well with this medication, and like other side effects, the anxiety associated with this medication may be transient. The psychiatric mental health nurse practitioner should never initiate benzodiazepines in a client who already has issues with alcohol, or other substance dependencies. Additionally, benzodiazepines are not to be used long-term. Problems associated with long-term benzodiazepine use include the need to increase the dose in order to achieve the same therapeutic effect. This is what we are seeing in Mrs. Perez’s case. The most appropriate course of action in this case would be to continue the current dose of Vivitrol, while decreasing the Valium with the goal of discontinuation of the drug within the next two weeks. At this point, we need to evaluate whether or not the side effect of anxiety associated with Vivitrol persists. Increasing the dose of Valium would not be appropriate, neither would maintaining her on the current dose of Valium. Additionally, the client should be referred for counseling to help with her gambling addiction, as there are no FDA approved medications gambling disorder. Medication should never be added treat side effect of another medication, unless that side effect is known to be transient (for instance, benzodiazepines are sometimes prescribed to overcome the initial problem of “activation” associated with initiation of SSRI, or SNRI therapy). However, in a client with multiple addictive disorders, benzodiazepines should never be used (unless they are only being used for a limited duration of therapy such as acute alcohol detoxification to prevent seizures). Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and should also be encouraged to establish herself with a local chapter of gamblers anonymous. The PMHNP needs to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health. References/Resources Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. Chapter 14, “Impulsivity, Compulsivity, and Addiction” Stahl, S. M., & Grady, M. (2012). Stahl’s illustrated substance use and impulsive disorder New York, NY: Cambridge University Press. To access the following chapter, click on the Illustrated Guides tab and then the Substance Use and Impulsive Disorders tab. Chapter 10, “Disorders of Impulsivity and Compulsivity”