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Preliminary Needs Assessment

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In 1979, Surgeon General Julius Richmond wrote a article considered historic with the title: "Healthy People: Report of the Surgeon General on Health Promotion and Disease Prevention." This report was aimed at preventing deaths and injuries that could largely be avoided if certain parameters and lifestyles were followed. There, Dr. Richmond defined measurable, quantifiable, and very ambitious objectives that sought to achieve, within a decade and as a maximum time limit the end of the 1980s, the national goals for health promotion and disease prevention in the United States. Joined.

Since then, the project has been updated every decade with the release of the updated 10-year Healthy People goals and objectives (Healthy People 2000, Healthy People 2010, and Healthy People 2020).

Healthy People has become a national effort that sets goals and objectives to improve the health and well-being of people in the United States. Currently, Healthy People 2030 is the fifth edition of this initiative. It points to new challenges and builds on the lessons learned from its first four decades.

Healthy People 2030 sets, over the next decade, data-driven national goals to improve health and wellness.

Healthy People 2030 includes 358 cores, or measurable, goals, as well as research and development goals. (National Library of Medicine, 2019)

Public health professionals and stakeholders are beginning work to determine the top health concerns and solutions facing the United States for the fifth edition of the federal Healthy People 2030 plan.

This strategy brings together professionals and chiefs from several subjects to notify the progress of a common set of public health targets and purposes for the country over the next decade.

As promoters of Healthy People 203 has pinpointed, the health improvement goals and goals will assistance initiative activities at the state and local levels, which will provide a springboard to expose a new idea for community wellbeing in our state to expand the health and well-being of all individuals in our state. The United States.

With the new update, Healthy People 2030 now contains targets that highlight how the social factors of health (collected into five groups) affect people's health. These include social and society context, monetary strength, locality and developed nature, access to and quality of learning, and approach to and excellence of health care.

Importantly, some of the greatest modifications from Healthy People 2020 to Healthy People 2030 is that the quantity of goals has been lowered to decrease overlapping and prioritize the most important public health issues.

Considering this, the Florida Department of Health Office of Chronic Disease Prevention has set up targets and aims to address some of the Healthy People 2030 focus areas.

· Arthritis Goal: Decrease the amount, weakening, activity restriction, and limitation in societal involvement due to arthritis and other rheumatic conditions.

· Cancer Goal: Through early confirmation and access to state-of-the-art drugs, they want to minimize mortality and morbidity from cancer in Florida.

· Diabetes Objectives: Decrease the problem of diabetes mellitus and the associated health problems between individuals in Florida. Moderate health inequalities among people with diabetes so that property health care is easy to use.

· Heart Disease & Stroke Prevention.

Objective: Stimulate weight management; better eating habits and nutrition; eradicate cigar use; prevent and monitor high blood pressure; check and lower high cholesterol; and the prevention and control of diabetes to reduce cardiovascular disease and increase quality of life.

· Nutrition & Overweight.

Objective: Reduce heart disease and improve quality of life by promoting recommended levels of physical activity; promoting weight management; improving diet and nutrition; eliminating tobacco use preventing and controlling high blood pressure; preventing and reducing elevated cholesterol; and preventing and controlling diabetes. Reduce the prevalence of obesity among Florida's kids and adults.

· Tobacco Use Among Adults.

Objective: To reduce the problem of chronic diseases associated with the consumption of and exposure to tobacco smoke.

· Epilepsy Objective: Achieve a better wellbeing and efficiency for Floridians suffering from epilepsy through care to increase seizure control, training to eradicate the stigma of epilepsy, and conscience to stop damages that can lead to epilepsy. (Florida Department of Health in Miami-Dade County, 2021).

Despite this, it is worth asking: what incidence do these diseases really have on the population of the county and the state of Florida in general to establish them as priorities for inclusion in the Healthy People 2030 Plan for the Sunshine State?

According to the Centers for Disease Control and Prevention, the values that allow determining the relevance, pertinence and social impact of hospitalization and general repercussion on the health of the North American population as a nation (and at the same time, in a more concrete and territorial way) can be obtained from the implementation of the Behavioral Risk Factor Surveillance System (BRFSS).

In 1984, the Centers for Disease Control and Prevention (CDC) initiated the state-based Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional telephone survey that state health departments conduct monthly through landlines and cell phones with a standardized questionnaire and technical recommendations and CDC methodological assistance.

BRFSS is used to collect prevalence data among US adult residents regarding their risk behaviors and preventive health practices that may affect their health status. Respondent data is sent to the CDC to be aggregated for each state, returned with standard tabulations, and released at the end of the year by each state. (Centers for Disease Control and Prevention, 2022)

In 2011 alone, more than 500,000 interviews were conducted in participating states, the District of Columbia, US territories, and other geographic areas.

Among the main targets to focus on for our state of Florida for Healthy People 2030, we can start with arthritis.

The Behavioral Risk Factor Surveillance System (BRFSS) is the best source for state-specific arthritis prevalence estimates.

At least 1 in 6 adults in every state report arthritis. In the 15 states with the highest prevalence, arthritis affects up to 1 in 4 adults. In the state of Florida, the Age-Adjusted Prevalence of Doctor-Diagnosed Arthritis Among US Adults by 2015 was among the lowest in the country with a 21.5%, considering states as West Virginia, Alabama, Tennessee and Kentucky showed percentages over 30% and the lowest ones were California, Guam and Hawaii around 18%. (Centers for Disease Control and Prevention, 2021)

Nevertheless, the age-adjusted prevalence of arthritis-attributable activity limitations among adults with arthritis is substantial. In every state, at least 1 in 3 adults with arthritis reports arthritis-attributable activity limitations.

Florida is among the worse states with more than half of arthritis patients suffering from activity limitations. (Centers for Disease Control and Prevention, 2021)

Talking about cancer is another major concern for Floridians.

For the 2020, our state showed a controversial performance versus most of U.S states on cancer-related indices since for Age-Adjusted Death Rates took the 11th place with a 136.3 death rate, but was second nationwide on deaths (45800), only behind California with almost 60000 deaths related to the illness. (Centers for Disease Control and Prevention, 2022)

Talking about Diabetes, it is necessary to pinpoint that according to the most recent Behavioral Risk Factor Surveillance System (BRFSS) data, West Virginia has the highest adult rate of diabetes at 15.7%, and Colorado has the lowest at 7.5%. Between 2019 and 2020, the adult rate of diabetes increased in Montana and decreased in Idaho and South Dakota. Eleven of the 16 states with the highest type 2 diabetes rates are in the South.

Florida ranks 17th on this list with 11.2% of adult population afflicted with diabetes (State of Childhood Obesity, 2021)

According to data obtained in a separate NCHS survey in 2019, 4.6% of American adults have been diagnosed with coronary heart disease. Coronary heart disease, also called coronary artery disease or ischemic heart disease, is the most common type of heart disease in the United States.

In 2019, about 361,000 Americans died from this type of cardiovascular disease. The number of deaths and complications related to cardiovascular diseases are numerous. Out of 100,000 American adults 35 and older:

52.4 die from acute myocardial infarction (heart attack)

177.6 die from heart failure

317.4 die from heart disease

419.2 die from cardiovascular disease (Lambright Black, 2022)

The state of Florida ranked on 36th place (5.6%) for coronary heart disease rate among adults 18 and older, but fortunately was the lowest for Percentage of adult population younger than 65 with a 74.80% (Lambright Black, 2022)

While talking about nutrition and overweight and according to the most current data from the Behavioral Risk Factor Surveillance System (BRFSS), obesity in adults is greater than 35% in 16 states.

Mississippi has the highest adult obesity rate at 39.7% and Colorado has the lowest at 24.2%, while our Sunshine State ranked 42nd on this list with just a 28.4% obesity rate in 2020.

During 2019-2020, the percentage of overweight in adults has increased in Alabama, California, and Iowa. As 2015, the adult obesity rate has grown drastically in 26 states.

However, Florida is one of the states where 15.8% of young people between 10 and 17 years old suffer from obesity. (State of Childhood Obesity, 2021)

The affections of tobacco are well known by now. But talking about tobacco use is not pointless.

The highest rate of tobacco use is west Virginia at 26%. According to a study by the American Lung Association, rural communities consume more tobacco and tend to smoke more than 15 cigarettes a day.

The 10 states with the smallest percentages of tobacco use, in order, are: Utah (8.90%), Puerto Rico (11.30%), California (11.30%), Connecticut (12.70%), Hawaii (12.80%), Washington (13.50%), Massachusetts (13.70%), New Jersey (13.70%), Maryland (13.80%), and New York (14.10%). Utah has the lowest rate of tobacco use in the United States at 8.9%. Utah is the only state to have a tobacco usage rate in the single digits. Florida ranks 23, with 19.7%.

Epilepsy is another serious issue affecting Floridians.

CDC reports for 2015 show that about 3 000 000 U.S. adults and 470,000 children suffered from active epilepsy. In most states, epilepsy prevalence estimates did not exist. The projected number of active epilepsies ranged from 5,900 people with epilepsy in Wyoming to more than 427,000 in California. The number of individuals with active epilepsy grew compared to prior years, due to community growth.

Unfortunately, the State of Florida third in projected records of active epilepsy cases, by state and age group in 2015, with 223900 cases. Only behind Texas (292900 cases) and California (429700 cases). (Centers for Disease Control and Prevention, 2022)

An analysis of the leads us to the conclusion that issues such as cancer and epilepsy are among those that most harm the state of Florida nationally, seconding in both cases only the state of California in a disastrous ranking of deaths from the first illness and the global number of people affected in the case of epilepsy.

Therefore, it is necessary to work on the development of programs and strategies to combat two ailments that hit the Floridian community with greater force at population level.

Cancer and its treatment can alter many aspects of quality of life. Not only physical, but also psychological and social. That is why from Psycho-oncology we dedicate some time to evaluating, together with the patient and his family, how we can recover the lost quality of life, or at least a part of it. We do not intend to improve it compared to how it was before the disease, but to recover as much as possible of what has been lost. Cancer certainly has a lot of negative influence on people who suffer from it. Pain, mood, anxiety, nutritional and self-respect changes are some of them.

Pain is a very disabling symptom: The presence of pain stops many other things from being done. Evaluating it and treating it correctly are priorities for health professionals. In addition, some patients interpret pain as a sign of worsening of the disease, which generates great concern. The sum of this concern makes the pain become suffering.

Pain control is achieved with analgesics of different potency (from the mildest, such as paracetamol, to the strongest, such as morphine or oxycodone). Some studies have shown how certain psychological techniques can increase the effect of these medications.

Mood can be quite variable throughout the oncological process. The diagnosis is usually experienced with shock, anger, sadness, fear and uncertainty. During the treatment there can be a certain hope because the patient has the feeling of doing something against the disease. The end of treatment is viewed with some fear by some people since they feel unprotected by leaving a medical environment in which they felt well cared for and controlled.

If there is a recurrence of cancer, the predominant reaction is despair: the patient appreciates that the treatment she had undergone has been useless and that she will have to start over. And if the disease progresses and you must prepare for the end of life, fear, sadness, and anger also predominate.

However, as with other aspects of health-related quality of life, reactions to each phase are highly subjective. Each one experiences the disease in its own way, and it is good to respect the right of each person to choose how they want to face it.

The anxiety that accompanies the disease in many cases makes it difficult to rest at night. Between 30% and 50% of people with cancer have insomnia, and this translates into greater fatigue during the day. In addition, insomnia feeds on itself, since the concern about not being able to sleep maintains a vicious circle that makes falling asleep even more difficult.

The improvement of sleep and rest is achieved by changing habits during the day (with physical exercise and restriction of exciting drinks, such as those containing caffeine) and establishing a bedtime ritual. It is also important to always keep the same times of getting up and going to sleep, regardless of the hours we have slept.

In the nutritional aspect of quality of life in people who have cancer, it should be noted, on the one hand, how nausea and vomiting associated with chemotherapy and radiotherapy alter the diet. The change in habits and the use of antiemetic medications will help alleviate this side effect.

On the other hand, we health professionals also stress the recent appearance of certain diets announced as miraculous but without proven efficacy and that even have some risks, such as the alkaline diet or the sugar-free diet.

A person's physical appearance can change because of many cancer treatments: hair loss, weight gain, scarring from surgery, etc. In oncological diseases that affect parts of the body that define identity (such as breast cancer in the case of women, or testicular cancer in the case of men), this is especially serious.

Adaptation to bodily changes is slow, and often requires the support of people you trust (especially your partner). Patients must relearn to recognize themselves in the mirror and accept the differences in their body.

On the other hand, epilepsy is a central nervous system (neurological) disorder in which normal brain activity is disrupted, causing seizures or periods of unusual behavior and sensations, and sometimes loss of consciousness.

Having seizures at certain times can lead to dangerous circumstances for you or others.

Falls. A fall during a seizure can led to a broken head or bone.

He drowned. If you have epilepsy, you are 13 to 19 times more likely to drown while swimming or taking a shower than the general people, due to the risk of having a seizure while in the water.

Car accidents. A seizure that produces loss of perception or self-control can be serious if you are driving a car or using machinery.

Several states have driver's license limitations associated to a driver's capacity to manage seizures and impose a minimum amount. of seizure-free time, ranging from months to years, before driving is permitted.

Complications in pregnancy. Seizures during pregnancy are often dangerous for both mother and baby, and certain antiepileptic medications increase the likelihood of birth blemishes. Women who have epilepsy and want to become pregnant, should talk to their doctor while planning their pregnancy. (MAYO Clinic, 2021)

What health behavior changes could be recommended to face the threats posted by these illnesses?

We can reduce your chance of several common types of cancer by getting healthy choices. Screening tests can find some cancers early when treatment is most effective. Shots can help avert various types of cancer.

Screening tests. Getting screened regularly helps detect breast, cervical, and colorectal (colon) cancer early, where treatment is much more effective. Screening is recommended for people with high lung cancer risks.

Shots: Vaccines also decrease the hazard of cancer. The human papillomavirus (HPV) shot helps prevent most cervical cancers and several other types of cancer. The hepatitis B shot can decrease the possibility of liver cancer.

Healthy decisions. You can minimize your risk of cancer by making beneficial choices like maintaining a healthy weight, avoiding tabaco, limiting the amount of alcohol you drink, and protecting your skin. (Centers for Disease Control and Prevention, 2022)

For epilepsy, we need to know that sometimes can be prevented. The following are some of the most common ways to reduce risk of developing epilepsy:

The health checkups you and your family get help you prevent and detect illness. At these checkups, you can talk with your doctor about information about screening tests, immunizations, and other health care that can help you take charge of your health and the health of your family.

Be safe in vehicles. Use seat belts, child safety seats, air bags, bicycle and motorcycle helmets to reduce motor vehicle and other traffic injuries.

Step carefully. Falls are the leading cause of brain injuries. Older adults and children are more likely to sustain brain injuries from falls.

Seek help if you have a traumatic brain injury. The chances of having epilepsy are high with traumatic brain injuries. Taking good care of the injury can help prevent epilepsy.

Reduce your possibilities of having strokes and heart disease. Take the necessary precautions every day to minimize your chances of stroke and heart disease. These measures include eating well, exercising, and not smoking. These health measures can avoid epilepsy later.

Get immunized defend yourself and your family from illness. Vaccines reduce your probabilities of getting infections that can occasionally lead to epilepsy. Look at the CDC Suggestions on vaccination.

Rinse your hands and prepare food carefully. The infestation called cysticercosis is the very popular cause of epilepsy worldwide. A parasite causes this infestation that is avoided by maintaining excellent hygiene and safe food processing practices. Soon treatment and detection of cysticercosis can prevent epilepsy.

References Centers for Disease Control and Prevention. (2021, September 23). Centers for Disease Control and Prevention. Retrieved from Arthritis Data and Statistics: https://www.cdc.gov/arthritis/data_statistics/state-data-current.htm Centers for Disease Control and Prevention. (2022, February 28). Centers for Disease Control and Prevention. Retrieved from Cancer Mortality by State: https://www.cdc.gov/nchs/pressroom/sosmap/cancer_mortality/cancer.htm Centers for Disease Control and Prevention. (2022, May 19). Centers for Disease Control and Prevention.com. Retrieved from How to Prevent Cancer or Find It Early: https://www.cdc.gov/cancer/dcpc/prevention/index.htm Florida Department of Health in Miami-Dade County. (2021, October 01). Florida Department of Health in Miami-Dade County. Retrieved from Healthy People 2030: https://miamidade.floridahealth.gov/programs-and-services/community-health-planning/healthy-people.html Lambright Black, M. (2022, February 07). ValuePenguin.com. Retrieved from Most Heart-Healthy States in the U.S.: https://www.valuepenguin.com/heart-healthy-states-study MAYO Clinic. (2021, October 07). MAYO Clinic. Retrieved from Epilepsy: https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093 National Library of Medicine. (2019, May 23). National Library of Medicine. Retrieved from Appendix E Healthy People 2030 Framework: https://www.ncbi.nlm.nih.gov/books/NBK552645/ State of Childhood Obesity. (2021, September 21). State of Childhood Obesity. Retrieved from Diabetes in the United States: https://stateofchildhoodobesity.org/states/fl/