• Briefly describe the availability of and access to mental health care in your community and geographical area.

The Massachusetts population is about 6.7 million people. About 3.71% of adults living with serious mental health like depression, bipolar disorder, and schizophrenia. Public mental health services are provided by the department of mental health. While substance use and addiction treatment are seen by the bureau of substance abuse services. 53.8% of adults with mental illness receive treatment from a private or public provider. While 46.2% have no access to mental health (https:\/\/www.rtor.org\/author\/interact-marketing\/#author, 2019). Senate passed a bill that guarantees Massachusetts residents access to annual mental health wellness checks at no cost. The bill calls for an expanded diverse practitioner workforce, and a rate floor to pay mental health providers the same as primary care providers. The division of insurance will ensure that the insurance companies handle mental health coverage equally. Prior authorization will no longer be needed for inpatient psychiatric hospitalizations. (Chris Lisinski, State House News Service, 2020)

• How has the Covid-19 Pandemic revealed equity issues in certain communities?

It’s clear that not everyone was impacted by covid-19. Cases in New York were 20 times more in west Virginia. Studies have shown that racial and ethnic minorities may be at increased risk of contracting covid 19, being hospitalized, or dying from the disease. An essential worker who is disproportionally black is at increased risk of covid. In April 2020, Massachusetts began publishing data on confirmed cases and positive cases were associated with lack of insurance, poverty, unemployment, median income, and employment in health care. (Hawkins, 2020).

• What do you see as the greatest barrier to access and how do you feel this would be best addressed? Be specific in regard to addressing this issue in your “community” or geographical area. Do you believe that private or public entities are best suited to address this? How do other countries address these issues?

The greatest barrier to health care is the high cost of health insurance. One of the ways this will be addressed is by allowing dependents to be under their parent’s insurance until 30. Expand the Medicare and Medicaid programs to provide services for incomes of 40,000 or less. Yes, private and public entities would address this issue by lowering their fees. One of the ways the Nigerian government improve access to care was to provide public funds which spring forth a lot of private sectors.

Reference:

Hawkins D. (2020). Social Determinants of COVID-19 in Massachusetts, United States: An Ecological Study. Journal of preventive medicine and public health = Yebang Uihakhoe chi, 53(4), 220–227. https://doi.org/10.3961/jpmph.20.256

https:\/\/www.rtor.org\/author\/interact-marketing\/#author. (2019, August 16). Mental Health Resources in Massachusetts | Resources to Recover. Resources To Recover. https://www.rtor.org/directory/mental-health-massachusetts/

Chris Lisinski, State House News Service. (2020, February 14). Mass. Senate Passes Bill To Boost Mental Health Care Access. News. https://www.wgbh.org/news/local-news/2020/02/14/mass-senate-passes-bill-to-boost-mental-health-care-access

1. Thyroid hormones exert their effects on cells in a manner similar to steroid hormones; describe the mechanism of action of thyroid hormones.
2.  
3. 1.Why would an imbalance in thyroid hormones have such widespread effects on the body?
4.  
5. 2.Why was goiter observed in George’s case?
6.  
7. 3.Why would calcium homeostasis be impaired in response to removal of the thyroid gland?
8.  
9. 4.What could be used to specifically destroy the thyroid gland and have minimal effects on other cells and tissues in the body?

Answer questions please in essay form

Case Study:

George is a thirty five year old hardware clerk. During his routine physical he casually mentions to his physician that he seems to be sweating more profusely than normal and most rooms that once were comfortable are now too “hot”. At home a room that his wife and children find to be comfortable causes him to sweat profusely. George also reports that he seems to be losing weight even though his appetite has increased. He also complains that he has a shortened attention span and that he always wants to be moving around. Despite the fact that he feels fatigued, George claims to have difficulty sleeping and seems to have more frequent bowel movements, occasionally accompanied by diarrhea. The physician discovers George has lost 15 pounds since his last physical. In checking his chart, the physician finds that George has a negative history for chronic illnesses, does not smoke, and has a low risk for cardiovascular disease. He does however have a positive family history for autoimmune diseases. His father suffers from idiopathic thrombocytopenia, his mother has been diagnosed with rheumatoid arthritis and his oldest sister was recently diagnosed with systemic lupus erythematosus.

Results of George’s physical examination were within normal ranges with the exception of the following: he demonstrated tachycardia, loud heart sounds, and apparent cardiac arrhythmias accompanied by slight hypertension. These arrhythmias were confirmed by electrocardiogram to be supraventricular in origin. George’s eyeballs appeared large and protruding and his hair was fine and soft. He was also beginning to demonstrate some degree of alopecia. George was also observed to have palmar erythema. palpation of the neck revealed the presence of goiter. Results of blood tests indicated elevated concentrations of thyroid hormones (thyroxin and triiodothyronine), hypercalcemia, and decreased circulating concentrations of lipids. Based on the physical characteristics and the results of the blood tests, George’s physician suspected that George was suffering from some form of hyperthyroidism and sent him to an endocrinologist to confirm the initial diagnosis.

Following the initial consultation and examination, the endocrinologist ordered tests to determine whether George was indeed hyperthyroid. The test results indicated an elevation in the concentration of thyroid hormones in the blood and the presence of thyroid-stimulating antibodies. These antibodies specifically stimulate the thyroid gland by binding with the thyroid stimulating hormone receptor located on the plasma membrane of the follicular cells of the thyroid gland. Based on these results, the endocrinologist concluded that George had Grave’s disease, a form of hyperthyroidism believed to be autoimmune in nature. George was presented with a number of possible treatment options. These included treatment with chemicals (propylthiouracil and methimazole) that decrease the production of thyroid hormones by the thyroid gland, radioisotopic destruction of the thyroid gland by the use of 131I, and surgical removal of the thyroid gland. After considering all the options, especially the possible effects of radiation on gamete development, George chose surgery. Following successful surgery, George was prescribed synthetic thyroid hormone to ensure that his body was receiving adequate thyroid hormone and told to return within 2 months for a follow-up evaluation of circulating thyroid hormone concentrations. He was also cautioned to carefully monitor his calcium intake.