Tuesday, August 6, 2019
The Lack of Resources for Education Essay Example for Free
The Lack of Resources for Education Essay It is always been said that one of the main barometer of success of a country is its people. People that are always look forward in providing their own expertise and skills only for their mother country and always ready to enriched more only for the success of its local economy. But this sometimes just goes on banners only and not happening in real sense. The reason is that governments do not also give more priority to its people. Government must always understand that people are the most important asset of the country and to be able to attain economic progress and development there should be initiatives that would somehow effectively help the people in achieving their goals.  One of the main factor that should start by government in education, it is one of the most important factor that the government should focus on.            Take for instance what the Koreans and now India has done so far in terms of their educational system. What they actually did is that, they have upgraded their public school system and the government has provided enough budgets in order to uplift the standards and be able to compete with the private schools. They even encourage students to perform their best, by giving scholarships and exchange student grants for those deserving students who really excel well in school. Like in the case of India, now they are considered one of the most desirable employees in terms of Information technology, the main reason is that the government has supported all its Tertiary graduate students, most especially in IT to immediately take a Certification exam, in order for them to be well equipped and at the same time highly competitive in the IT Job Workforce. With their skills already being prepared and most especially the cost of labor is also not that high against their competitor country that makes them one of the most likable staffs in most industries. In the side of Korea, what they did is that, they have sent scholars in other countries, provided a support for the studies of these extra ordinary intelligent students to further enriched their knowledge and skills in both Europe and the US. And by the time they came back, they have further developed the skills and knowledge they gain from the abroad. That is also the reason what now they are considered already as the most â€Å"high tech†country in the world, developing their own products, from cell phone, high tech appliances, up to cost efficient cars, and a lot more. That is not only popular in Asia but now has gained respect and popularity all over the world. All of these success was not actually far different from the objective of every government in the world, what makes it different is that the government persevere and apply these objective into realization and has made a deep prioritization as well and not just something that can be seen in the banners and ads which are sometimes not that convincing for many people. Unfair Distribution of Workloads            It is very common nowadays that most schools are now becoming more commercialize and forgetting the main purpose or in other words defeating the main purpose that education must focus more on providing quality education. Lack of education resource can also be attributed by the lack of professionals that are handling classes in schools. This problem has also provided different reasons and one of the main reason most especially for developing and underdeveloped countries is that, the benefits and compensation is not enough for education professionals to accept the job offer. There are even times that because of the problem being faced, they are even just hiring teachers that are not only qualified to teach because of lack of experience or somebody who does not have high educational attainment. With this result it became a perennial problem in the world right now since most of these highly qualified education professionals either shift from a more rewarding jibs, like in IT or Medical Profession, or for some upgrading their studies more in order to be hired abroad for better pay. That is mostly the reason nowadays, and these has to be addressed primarily with the government , since it will create more and more difficult problems ahead and the educational system is one of the most important factor for the country’s progress. The future of the next generation will be affected.            Like in Australia, the main reason that they faced in their educational system that drives teachers away are lack of funds and too much workloads assign for the teachers. And in the country itself, has resulted on most survey that they would even push to change profession just to have a better career and to support well enough their families, since in Australia the cost of living is also a big drive for them to do it.            Budget really is one of the main reasons why most schools are not really providing the right resource in all of its schools. Like currently the annual budget for public education are receiving $1 billion less per year than if 1996, which means that there are tremendous challenge for the educational sector to be contented with the decrease of the budget which is not in line with the economic change like increase in most infrastructural and technological requirements as well as providing additional education professionals or even improving the current compensation packages of the teachers which would somehow help in enticing more highly qualified educational professionals to provide its service in public education.            And what is more alarming is that in Australia alone as based on the research conducted, that the country in order to effectively manage its educational system $2.9 billion is needed in order to meet school needs. (New Survey: Lack of Resources, Workload Driving New Teachers Away, 2007). Lack of Resources for Education a Dilemma for Supporting Public Education            The competitiveness that private education has provided in the way they have implemented their system to its customers has generated big presence of challenge for public education which governments sometimes not been able to compete.            Considering in terms of statistical studies most especially in developing countries which are far different to highly developed countries, where the latter has focused on implementing better educational system through its political and government policies like having to include it in their local tax system has generated an effective and efficient process of providing quality education, whereas in the public education, that is being experienced in developing and underdeveloped countries, since the government has to settle for more foreign investment which gives additional earning for the government and be used for infrastructure and mostly economic development for the country. But the problem arises when these foreign investors will not be controlled by the government b y not affecting the local businesses and one of which is the influence of foreign investment in the educational system, like in terms of putting up privately own schools which are mostly pattern to foreign system, and this will eventually affects the current public school system in terms of standards of delivery where private schools are more of the real world approach, and since due to lack of research and development which will help the public education system to apply and implement what is in the global standard is not happening due to lack of support and budget given by the government.            Consider one good example is in Lagos, Nigeria, where most families would always strive hard in working their way just to send their children in private school. This is because the government does not put more attention on the concern of most families, which are not only lack of financial capacity to send their children to private school. In other words the government has left the problem, seems like unattended and the people has recognized it in a way that it is actually the same old problem every year.            And what is not actually right is that before there were experiences that some of the public school has fees during enrollment of students. This only means that even these public schools which are supposed to give all its free service for its people has defeats its purpose and instead they were forced to ask for even a small fees just to sustain the need of the schools to operate and continue its operations, like most importantly maintaining its teachers and be paid what is sometimes not enough compensation that these hard working teachers deserves. Not only that, the need for infrastructure improvements like additional classrooms and hiring more qualifies teachers are becoming a common problem every year, and with that the school has to continue its operation with problems continues to affect its way of delivery, like teachers teaching outside classrooms, lack of qualifies teachers to hire, over-load assignment for teachers, which definitely affects their teaching, just take for instance a class of 50 students, and every one in the class must need to be attended with, and the number of classes per day, is too much for them to handle most especially if the compensation is also the issue.            Actually the main concern of most underdeveloped countries started with the very lowest and initial requirement of education and that is the basic education and that is why countries like Africa, these problems continues to hit the country, and since this is the primary needed education, it becomes alarming because if children will not be given this basic education, they can already be considered uneducated in their entire life, most especially if children already reach adolescent age where primary and basic education are supposed to be not anymore their levels to achieve but due to lack of attention their age do not match the educational requirement, most children either being ashamed of themselves in going to school or sometimes do not anymore have the willingness to go to school instead do work for the family. (Olore, T, 2005).            Actually in every country in the world the dilemma is really about economy versus education. And for government to survive the economy must go first, it is like people primary and most important need is food and that is why we cannot argue by the fact that country have to prioritize economic growth before education. And since most of the budget has been relied into continuous development of the economy it needs to allocate big budget for it and what is left is allocated to education and other priorities as well.  So for public education, they have to settle for what the government has given them. But it is all about educating the people as well, like take for instance the scenario, a country that is trying to keep its government to settle with what they only can provide, but does not educate its people how to control population. It is like a conflict of interest, too much population means too much demand, and if the supply which is the budget is less, then that starts the problem. That is why for government to survive in these challenging worlds. It has to well educate its people about its main priorities and how they can achieve it and the country must provide a strict guideline in order to have it materialized.            That is also why western developed countries have set most of their countries, they control the population and with that they can give enough benefits and resources for its people, unlike for most underdeveloped and few developing countries, having to prioritize population was always a failure and these has brought out a lot of problems in the economy. World Educational Statistics            In order to see how the world has allocated resources for its educational system. It will show has the different region has allocated in the educational needs of its respective countries. This is just to provide trending on how public education is supported. (See Figure 1 to 4). The figures above are just to provide the trends in public education allocation for most countries around the world, since it can show how basically countries have allocated enough budgets to meet the resources needed by the local public schools. And it only shows that most of the highly developed countries have provided more than enough in supporting their public education system while for less developed countries it has been a struggle as seen in the figures that were presented above.            In this paper it clearly shows that the need for resource allocation for most public education in the world is becoming a very alarming and these can only be addressed if government will have to do something about it, either realign its priority and have to allocate more budget in the educational sector or to find ways in soliciting support in other countries. Another important action that needs to be addressed is the problem regarding population, because as studies shows, most underdeveloped and few of developing countries has impacted the education priority because of it’s over population, too much children were sent to schools which in the other hand government where not expecting.  Educating people on the real impact of over population most especially in the country side will be an added possibility of in addressing the problem. And, in order to solve these issues government must not only allocate budget but also provide a meaningful process that will focus on providing better compensation package for qualified teachers since this is one of the main cause, second is to provide support on material and other needs in the delivery of education, and lastly is to help provide a continuous research and development program that will help these public school to compete above par with the private schools. Reference â€Å"New Survey: Lack of Resources, Workload Driving New Teachers Away.†Education Research Report. Retrieved February 2, 2007, from http://educationresearchreport.blogspot.com/2007/02/new-survey-lack-of-resources-workload.html Olore, T. (2005). â€Å"Lack of Resources Threaten UBE.†NEWSFrom AFRICA. Retrieved January 15, 2005, from http://www.newsfromafrica.org/newsfromafrica/articles/art_9114.html â€Å"World Education Statistics.†Retrieved n.d, from http://72.14.253.104/search?q=cache:ec5OkrDRxvgJ:www.princeton.edu/~ina/thematic_presentations/WorldEducationalStatistics.ppt+World+Education+Statisticshl=tlct=clnkcd=11gl=ph
Monday, August 5, 2019
Prevalence Of Diabetes Mellitus Health And Social Care Essay
Prevalence Of Diabetes Mellitus Health And Social Care Essay INTRODUCTION DIABETES MELLITUS Diabetes is a syndrome that is caused by a relative or an absolute lack of insulin. It is characterized by symptomatic glucose intolerance as well as alterations in lipid and protein metabolism. Over the long term, these metabolic abnormalities, particularly hyperglycemia, contribute to the development of complications such as retinopathy, nephropathy and neuropathy. Approximately 5% to 10% of the diagnosed diabetic population has type 1 diabetes mellitus (Koda-Kimble et al., 2005). Most of the diabetic patients have type 2 diabetes mellitus, a heterogeneous disorder that is characterized by obesity, ÃŽ ²-cell dysfunction, resistance to insulin action, and increased hepatic glucose production. 1.2 PREVALENCE OF DIABETES MELLITUS Diabetes Mellitus is a chronic disease and is no longer an epidemic that can be ignored. It is confirmed that diabetes is increasing rapidly in every parts of the world (IDF, 2009). The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030 (Wild et al., 2004). In South-East Asia region, the number of people with diabetes will reach 101.0 million by year 2030 which show an increase of 72.1% compared to 58.7 million in year 2010 (IDF, 2009). While in Western Pacific region, the number of people with diabetes will reach 112.8 million people by year 2030 compared to 76.7 million people in year 2010, which show an increase of 47.0%. WHO predicts that in Asia and Australia region the prevalence of diabetic will reach 190.5 million in year 2030 (WHO, 2004). Similarly in Malaysia, the diabetes epidemic shows an increase trend over the years. The number of people with diabetes will increase to 2.74 million by year 2025 compared to 1.53 million in year 2007. The national prevalence of diabetes was estimated to be 12.3% in year 2025 (IDF, 2009). Approximately 1.2 million people in Malaysia have diabetes and more than half of them are not aware of it. The third National Health and Morbidity Survey (NHMS III) shows that there was an increasing trend in prevalence with age; from 2 percent in the 18-19 years old to an alarming prevalence ranging between 20.8 to 26.2 percent among those 50-64 years old. Those with primary education or less have a higher prevalence. The national prevalence of known and newly diagnosed diabetes above 30 years old rose from 8.3 percent in NHMS II to 14.9 percent in NHMS III. This shows that the prevalence of diabetes has increased by 80 percent over a decade with an average of 8 percent per year. The diabetes in Malaysia has almost doubled in magnitude over the last decade (NHMSIII, 2006). The main factors that contribute towards the increase in the risk of diabetes are socioeconomic influences, BMI, effects of urbanization, and familial aggregation. In socioeconomic influences, it shows that lower educational status and the lack of health care facilities in the rural areas delay the diagnosis of diabetes. More than 70% of diabetes subjects in India remain undiagnosed in rural area (Deo et al., 2006). Moreover, this study also observed that people of the lower socioeconomic status had lower BMI. Furthermore, urbanization leads to unhealthy lifestyle changes which affect the metabolic changes. The high prevalence of diabetes also found associated with increasing family history of diabetes. High prevalence of diabetes in the first degree relatives which is commonly seen in Asian Indians (Deo et al., 2006). A comparative epidemiology study was conducted among Japanese immigrants in United States living around Hawaii and Los Angeles and among Japanese living in Hiroshima. Results showed that the Japanese who lives in United States are in higher prevalence of getting diabetes compared to the Japanese in Hiroshima due to the westernized lifestyle (Hara et al., 2004). 1.3 COMPLICATIONS OF DIABETES MELLITUS Uncontrolled diabetes mellitus will leads to multiple complications. In Malaysia, only 6.1% among the 30 49 year age groups of diabetes mellitus patients were under control. This reflects the lack of concern for risks and complications among the young patients. A total of 1 in 4 diabetics in the 30-39 age group already show complications of the disease (Chua, 2006). Moreover, patients with uncontrolled diabetes mellitus, regardless of the type of diabetes, exhibit significantly increased odds of surgical and systemic complications, higher mortality and increased length of stay during hospitalization (Marchant et al., 2009). Individuals with pre-diabetes, undiagnosed type 2 diabetes, and long-lasting type 2 diabetes are at high risk of all complications of macrovascular disease, coronary heart disease (CHD), stroke, and peripheral vascular disease (Laakso, 2010). Moreover, M Lgaakso also indicates that more than 70% of type 2 diabetes patients die of cardiovascular causes. Hence, the epidemic of type 2 diabetes followed by an epidemic of diabetes-related cardiovascular diseases (CVD). Diabetes patients present a two to four time greater risk for coronary artery disease (CAD) than non-diabetes individuals (Protopsaltis et al., 2004). The data obtained from UKPDS 23 indicated that for each 1% increment of HbA1c there was a 1.11-fold increased risk of CAD, whereas for each 1-mmol/l increment in LDL concentration, there was a 1.57-fold increased risk. A study carried out among African American with diabetes showed that the major risk factors such as hypercholesterolemia, hypertension and smoking are important determinants of CVD in African Americans with diabetes. Moreover, other blood markers of hemostasis or inflammatory response and elevated serum creatinine proved to be CVD risk factors in African Americans with diabetes (Adeniyi et al., 2002). Retinopathy is the most common microvascular complication of diabetes, which results in blindness for over 10,000 people with diabetes per year (Fong et al., 2004). A study done among Australian population showed that the prevalence of retinopathy was 21.9% among known type 2 diabetes and 6.2% in those newly diagnosed type 2 diabetes. Generally, 15.3% of diabetes patients have retinopathy (Tapp et al., 2003). A prospective cohort study showed that the presence of diabetic retinopathy was associated with a two-fold higher risk of incident CHD events and a three-fold higher risk of fatal CHD (Cheung et al., 2007). Hence, the microvascular diseases do play a role in the pathogenesis of CHD in diabetes. Amputation is one of the major complications that should be taken into consideration among diabetes patients. Diabetes is the cause of 50 % of all the non-traumatic amputations in the United States. Among all the diabetic amputations, 24 % amputations are the toe, 5.8 % are mid foot, 38 % are below the knee, and 21.4 % are above the knee, and the remaining 10 % include the hip, pelvis, knee and other sites (Levin, 2002). One study reported an 8 % increase in amputations from 61 of 10,000 patients with diabetes in 1990 to 66 of 10,000 patients with diabetes in 1995. After diabetic patients undergo amputation, their risk of developing a foot ulcer or of requiring a second amputation increases dramatically. A total of 50 % of patients with diabetes die within 5 years after amputation (Peters et al., 2001). In Malaysia, among 203 patients that underwent amputation, 66 % of the patients were diabetics and amputations performed were related to diabetic foot conditions. Among them, 17.2 % patients underwent above knee amputation, 32.8 % underwent below knee amputation and 50 % underwent local foot amputation. About 59 % patients underwent amputation due to diabetic complication were less than 60 years old (Yusof et al., 2007). A study done involving Korean type 2 diabetic patients showed that the HbA1c is significantly associated with carotid plaque and peripheral arterial disease (PAD) (Choi et al., 2010). A cross sectional study was conducted, and it shows that the glycemic control was poor with 53.6% of the patients having HbA1c above 8% and 24% of them had microalbuminuria (Chan et al., 2005). 1.4 MANAGEMENT OF DIABETES MELLITUS 1.4.1 Controlling Glycemic Level Tight control of blood glucose levels offers primary and secondary prevention for the development of diabetic kidney disease (Stanton, 2008). By lowering glycated hemoglobin value to 6.5% or less, a 10% relative reduction was observed in the combined outcome of major macrovascular and microvascular events. Moreover, there was also a 21% relative reduction in nephropathy (Patel et al., 2008). A study carried out in the United Kingdom showed that intensive blood glucose control in type 2 diabetes patients significantly increased the cost of treatment, but the cost of complication was reduced and increased the time free of complication (Gray et al., 2000). Although good controlling on blood glucose will benefit the diabetes patients, the potential benefits of glycemic control must be balanced against factors that either preempt benefits (limited life expectancy, comorbid disease) or increase risk (severe hypoglycemia, weight gain) (Woolf et al., 2000). 1.4.2 Pharmacological Treatment According to the Malaysian Clinical Practice Guidelines Management of Type 2 Diabetes Mellitus 4th Edition (2009), the first line therapy for oral agent is Metformin, while other oral agents are acceptable as alternatives. However, usage of Thiazolidinediones (TZDs) has been found to have greater durability in glycemic control compared to Metformin and Sulphonylurea (SU). Currently there are five classes of oral hypoglycemic agents, which include ÃŽ ±-glucosidase inhibitors (AGIs), Biguanides, Dipeptidyl petptidase-4 (DPP-4) inhibitors, Insulin Secretagogues (Sulphonylurea and Non-Sulphonylurea / Meglitnides) and Thiazolidinediones (TZDs). Factors that are taken into consideration when selecting the treatment include the patients clinical characteristics, such as degree of hyperglycemia, weight and renal function (Walker and Whittlesea, 2007). Scheen and Lefebvre (1998) suggested that the selection of oral antihyperglycemic agents as first-line drugs or combination therapy should be based on both pharmacological properties of the compound (efficacy and safety) and the clinical characteristics of the patient (stage of disease, body weight). Furthermore, each antihyperglycemic agent may also be combined with insulin therapy to improve glycemic control after secondary failure to oral treatment. A systemic review on the effectiveness and safety of oral antihyperglycemic agents showed that most oral agents improved glycemic control to the same degree as sulfonylureas, though nateglinide and ÃŽ ±-glucosidase inhibitors may have slightly weaker effect (Bolen et al., 2007). Other than that, this review also showed that most agents other than metformin increased body weight by 1 to 5 kg. In terms of safety, sulphonylureas and repaglinides were associated with greater risk for hypoglycemia, thiazolidinediones with greater risk for heart failure and metformin with greater risk for gastrointestinal problems. Another systemic review and meta analysis on the effect of oral hypoglycemic agents on HbA1c levels showed that most OHAs lowered HbA1c levels by 0.5 to 1.25 % whereas thiazolidinediones and sulfonylureas lowered HbA1c levels by 1.0 to 1.25 % (Sherifali et al., 2010). This review also concluded that the benefit of initiating an OHA is most apparent within the first 4 to 6 months . A meta analysis on comparison of different drugs as add-on treatment to metformin in type 2 diabetes showed that sulphonylureas, ÃŽ ±-glucosidase inhibitors and thiazolidinediones induced reduction of HbA1c of 0.85, 0.61 and 0.42 respectively (Monami et al., 2007). In direct comparisons, sulphonylureas induced a greater reduction of HbA1c than thiazolidinediones. For the treatment with ÃŽ ±-glucosidase inhibitors (AGIs) acarbose, a meta-analysis showed favourable trends towards risk reduction for myocardial infarction and any cardiovascular event (Hanefeld et al., 2004). The meta-analysis also revealed that acarbose treatment also significantly improved glycemic control, triglyceride levels, body weight and systolic blood pressure. 1.4.3 Non Pharmacological Treatment Exercise Exercise plays an important therapeutic role in the management of type 2 diabetes and usually is prescribed along with dietary therapy and pharmacologic therapy. The benefits of exercise are observed through the lowering of blood glucose concentration during and after exercise (Najim, 2008). Physical activities are able to reduce the risk of progression from impaired glucose tolerance (IGT) to type 2 diabetes mellitus by 58% (Sigal et al., 2006). There is evidence that showed the relation between the exercise and the HbA1c level, where exercise training reduced HbA1c by an amount that should decrease the risk of diabetic complications (Boule et al., 2001). b. Dietary Control Obesity and weight gain contributes to the development of diabetes. The impact of obesity will put the diabetic patients on risk of coronary heart disease (CHD) (Anderson et al., 2003). Hence, decreasing the weight will decrease the risk for developing diabetes. Despite that, glycemic control also will be well controlled. A meta-analysis on restricted-carbohydrate diets in type 2 diabetic patients showed that there is an improvement in HbA1c, fasting glucose, and some lipid fractions (triglycerides) with lower carbohydrate-content diets (Kirk et al., 2008). A study conducted to assess the effects of high dietary fiber intake in type 2 diabetic patient shows that high intake of dietary fiber, particularly the soluble type, improves glycemic control, decreases hyperinsulinemia and also lowers plasma lipid concentrations (Chandalia et al., 2000). The Malaysian Clinical Practice Guidelines for Management of Type 2 Diabetes Mellitus 4th Edition (2009) suggests that a balanced diet consist ing of 50-60% (Carbohydrate), 15-20% (Protein) and 25-30% (Fats) are encouraged. However, these recommendations must be individualized based on glucose and lipid goals. 1.5 MANAGEMENT OF CHRONIC DISEASES IN PRIMARY HEALTH CARE In United States, there is an estimated of 99 million Americans living with a chronic illness. This becomes one of the major challenges faced by the U.S. health care system today and in the future. However, the defining features of primary care which includes continuity, coordination and comprehensiveness, are well suited to the care of chronic illness (Rothman and Wagner, 2003). In the WHOs World Health Report 2008: Primary Health Care Now More Than Ever shows that the primary-care team becomes the mediator between the community and the other levels of the health system, helping people navigating through the maze of health services and mobilizing the support of other facilities by referring patients or calling on the support of specialized services (WHO, 2008). Evidence has shown that with a better primary care, especially coordination of care could reduce avoidable hospitalization rates, especially for individuals with multiple chronic conditions (Wolff et al., 2002). In Thailand, the patient satisfaction toward primary care units has improved when compared to public hospitals out-patients-department. An evolutionary change, as the patients in Thailand started to have confidence in local facilities such as primary care units for monitoring of chronic diseases (Pongsupap et al., 2005). 1.5.1 The Management of Chronic Diseases in Primary Health Care Centers in Malaysia Chronic diseases are the major cause of death and disability in Malaysia, accounted for 71% of all deaths and 69% of the total burden of disease. Preliminary data from Malaysian Non-Communicable Disease (NCD) Surveillance 2005/06 estimated that approximately 11.6 million Malaysian adults aged 25-64 years were having at least one risk factor for chronic diseases and only about 3% did not have any risk factor. (Ramli and Taher, 2008). A study carried in an urban primary health care setting in Sarawak shows that the poor glycemic control (HbA1c > 7.5%) is about 38%. Wong and Rahimah (2004) suggested that reasonable glycemic control can be achieved in the primary health care setting in Sarawak. A study was carried out to evaluate the status of diabetes care and prevalence of diabetic complications among the diabetic patients in primary private health care Malaysia. Majority of diabetic patients treated at the primary care level were not satisfactorily controlled and were associated with a high prevalence of complications (Mafauzy, 2005). Hence, there is a need on putting on more efforts in order to achieve clinical targets. 1.6 MEDICATION ADHERENCE A literature review showed that the adherence rates for patients with type 2 diabetes have ranged from 65 % to 85% for OHA and 60 % to 80 % for insulin (Kenreigh and Wagner, 2005). A survey was done in the United States to assess medication adherence, knowledge of therapeutic goals and goal attainment for adult patient with diabetic. The result showed that 48 % of patients were medication non-adherent and most frequently reported reasons for non-adherence were forgetfulness (34 %) and too expensive (14 %). This study also shows that the patients at HbA1c goal were more adherent than patients not at goal (Whitley et al., 2006). A study was carried out by Tan and Judy, on self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control. The result showed that only 53 % subjects scored below 50 % in their diabetes-related knowledge, subjects with medication non-adherence, 46 % tended to have higher fasting blood glucose levels and only 15 % of the subjects practiced SMBG (Tan and Judy, 2008). Patients which non adherent to the drug regimen was found to be at higher risk of hospitalization. The study on this showed that patients with type 2 diabetes mellitus who did not obtained at least 80% of their antihyperglycemic medications across a year were at a higher risk of hospitalization in the following year (Lau and Nau, 2004). 1.6.1 Factor Affecting Non-Adherence in Diabetes Mellitus Drug non-adherence is a major concern in patient management, especially in individuals with diabetes, which makes the glycemic control difficult to attain. Adisa et al. (2009) stated that the commonly cited intentional nonadherence practice included dose omission, 70.2%. Almost 50 % respondents were fed up with daily ingestion of drugs and 19.8% of the respondents stated that it was inconvenient to take the medications outside. Furthermore, forgetfulness (49.6%) and high cost of medication (35.5%) were also reasons for non adherence. Another factor that influenced the non adherence were patient-related factors (96%) and health care system-related factors (79%) (Ratsep et al., 2007). Ratsep et al. stated that the patient-related factors include patients awareness regarding diabetes and its complications, patients motivation to change their lifestyle, non-compliance with medical regimen, patients financial problems and their non-attendance. Health care system-related factors include th e lack of special diabetes education for nurses, underfunding and an inadequate number of patients educational materials. 1.7 PHARMACISTS INTERVENTION Health coaching which relies on frequent contact and ongoing intervention has emerged in recent years as part of disease management initiatives (Melko et al., 2010). This has been promoted as an effective method for improving health outcomes and patient compliance with medication. A pilot study done by Melko et al. (2010) has shown that health coaching combined with tools do increased medication adherence. In United States, the adherence to OHA therapy ranged from 36 to 93 % in patients remaining on treatment for 6 to 24 months. Electronic monitoring identified poor compliers for interventions that improved adherence,61 to 79 % (Cramer, 2004). A study has shown that, HbA1c levels decreased significantly in the intervention group after the 4th month and remained lower than in the control group until the 12th month (Scain et al., 2009). Moreover, a decreased of HbA1c by 0.16% was observed with each 10% increased in drug adherence (Schectman et al., 2001). With every 1 % reduction in updated mean HbA1c was associated with reductions in risk of 21 % for any end point related to diabetes, 21 % for deaths related to diabetes, 14 % for myocardial infarction and 37 % for microvascular complications (Stratton et al., 2000). A review of the literature on the role of pharmacists indicates that there is a potential benefit of pharmacist interventions to improve medication adherence in diabetes, especially focusing in providing patient education (Lindenmeyer et al., 2006). A study on Latino patients with uncontrolled diabetes (Hemogloblin A1c ≠¥ 8.0%) showed that intervention from the pharmacist and health promoter team management of uncontrolled diabetes appears to be a feasible approach in order to improve the medication management (Gerber et al., 2009). Marcio Machado and his team found that there is a significant reduction in HbA1c levels in the pharmacists intervention group but not in the control group which is without pharmacists intervention (Machado et al., 2007). In the journal which discussed the role of pharmaceutical care in diabetes management, there were evidences suggesting that the pharmacists efforts in optimizing the pharmacotherapy can prove a valuable component in community-based multi disciplinary diabetes care (Davis et al., 2005). A meta analysis carried out by Conn et al. (2009) which investigated the effectiveness of interventions to improve medication adherence in older adults suggests that interventions increase medication adherence in older adults. The types of interventions include pill count, electronic medication -event monitoring device (MEMS), diabetes education, medication counseling, monitoring and insulin initiation and/or adjustments. In comparison of MEMS and pill count, MEMS data resulted in different numbers and types of recommendations than pill counts (Matsuyama et al., 1993). Hence, the pharmacists then could make specific recommendation regarding patient educations. A Cochrane review stated that almost all of the interventions that were effective for long term care were complex, which include combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up and supportive care (Haynes et al., 2008). However, there is no conclusion about the effectiveness of the interventions that could lead to large improvement in adherence and treatment outcomes. An earlier meta analysis of studies conducted reported that chronic disease patients including those with diabetes and hypertension, as well as cancer patients and those with mental health problems benefited from interventions such as prescription refills, pill counts and electronic monitoring (Roter et al., 1998). 1.8 RESEARCH OBJECTIVES The primary health care settings play an important role in primary steps in order to prevent the development of chronic diseases. In Malaysia, there were a number of people who have chronic diseases that received treatment in the primary health care settings. Hence, research should be carried out in order to assess the medication adherence among diabetic patients in the primary care settings in order to achieve better therapeutic outcome. 1.8.1 General Objective To assess the impact of pharmacist counseling on medication adherence among the diabetic patients in primary care centre 1.8.2 Specific Objectives To assess patients blood glucose level and knowledge, before and after counseling. To evaluate patients medication adherence, before and after intervention. To correlate the medication adherence with counseling.
Sunday, August 4, 2019
Evita Peron Essay -- essays research papers
Evita Peron In 1949 the most familiar scene in Argentina was the one played out almost daily at the Ministry of Labor in Buenos Aires. There, under the glare of camera lights, a former radio star and movie actress, now the most powerful woman in South America, would enter her office past a crush of adoring, impoverished women and children. Evita Peron, the wife of President Juan Peron, would sit at her desk and begin one of the great rituals of Peronism, the political movement she and her husband created. It was a pageant that sustained them in power. She would patiently listen to the stories of the poor, then reach into her desk to pull out some money. Or she would turn to a minister and ask that a house be built. She would caress filthy children. She would kiss lepers, just as the saints had done. To many Argentines, Evita Peron was a flesh-and- blood saint; later, 40,000 of them would write to the pope attesting to her miracles. She was born on May 7, 1919, in Los Toldos, and baptized Maria Eva, but everyone called her Evita. Her father abandoned the family shortly after her birth. Fifteen years of poverty followed and, in early 1935, the young Evita fled her stifling existence to go to Buenos Aires. Perhaps, as some have said, she fell in love with a tango singer who was passing through. She wanted to be an actress, and in the next few years supported herself with bit parts, photo sessions for titillating magazines and stints as an attractive judge of tango competitions. She began frequenting the offices of a movie magazine, talking herself up for mention in its pages. When, in 1939, she was hired as an actress in a radio company, she discovered a talent for playing heroines in the fantasy world of radio soap opera. This was a period of political uncertainty in Argentina, yet few people were prepared for the military coup that took place in June 1943. Among the many measures instituted by the new government was the censorship of radio soap operas. Quickly adapting to the new environment, Evita approached the officer in charge of allocating airtime, Colonel Anibal Imbert. She seduced him, and Imbert approved a new project Evita had in mind, a radio series called Heroines of History. Years later, people would say that Evita had been... ...cancer had spread. In June 1952, Peron's congress named Evita the Spiritual Leader of the Nation. Her own final contribution to that deification came in her will, in which she wrote that she wanted "the poor, the old, the children, and the workers to continue writing to me as they did in my lifetime." She died on July 26, 1952, at the age of 33. A specialist was brought in to embalm the body and make it "definitively incorruptible." Evita's body lay in state for 13 days-and even then the crowds showed no sign of diminishing. In the decades that followed, Peronism continued to occupy a place in Argentine political life, taking the form mainly of anti-government terrorism. In 1971, after a number of demands by terrorists, the Argentine government agreed to return Evita's body. It was shipped to Peron in Spain. That year, Peron was allowed to return to Argentina; two years later he was president again. He died in office, and it was his wife and successor, Isabel, who brought Evita's body back to Argentina, in the hope that the aura of a saint would again dazzle the public.
Saturday, August 3, 2019
The Narrative Voice in Araby, Livvie and The Yellow Wallpaper
The Narrative Voice in Araby, Livvie and The Yellow Wallpaper I hadn't really considered the importance of the narrative voice on the way the story is told until now. In "Araby", "Livvie" and "The Yellow Wallpaper" the distinctive narrative voices and their influences shed light on hidden meanings and the narrator's credibility. In "Araby" the story is told from the point of view of a man remembering a childhood experience. The story is told in the first person. The reader has access to the thoughts of the narrator as he relives his experience of what we assume is his first crush. We do not know how the girl feels about him. The narrator's youth and inexperience influence his perspective. His love for her is deep and innocent. As an adult, the narrator recollects his emotions for the girl with fondness, but the reader also detects a hint of regret as well. The narrator tells us that their first communication takes place when he goes to the back drawing room where the priest had died. There, in that sacred place, he spoke with the girl and made a promise that he would get her a gift if he was able to go to Araby. Soon after, "as a creature driven by vanity", he fails to retrieve a gift for her and is humiliated. I wonder if the narrator is implying that his true devotion to her was somehow blessed in the room where the priest died and when he allowed his sinful vanity to penetrate that love, he lost her. In "Livvie" the story is relayed by an omniscient third person narration. The narrator in this case provides insight into each of the characters, yielding to no one inparticular. The narrator uses subtle patterns in association wit... ...ten seen as representing an imaginative or "poetic" view of things that conflicts with (or sometimes compliments) the American male's "common sense" approach to reality". When society "values the useful and the practical and rejects anything else as nonsense", (feminine) imagination and creativity are threatened. Much like our narrator, women of that time were directed to suppress their creativity as it threatened the dominating male's sense of logic and control. "Perhaps the story was unpopular (at first) because it was, at least on some level, understood all too clearly, because it struck too deeply and effectively at traditional ways of seeing the world and woman's place in it". Works Dited Shumaker, Conrad. "'Too Terribly Good to Be Printed': Charlotte Gilman's 'The Yellow Wallpaper'." Journal of American Literature 57.4 (1985): 588-599.
Friday, August 2, 2019
Comparing the Struggle for Freedom in Adventures of Huckleberry Finn an
Struggle for Freedom in Adventures of Huckleberry Finn and Native Son Throughout history, great authors have served as sentinels for racism and prejudice in American society. The Mark Twain novel, Adventures of Huckleberry Finn, a graphic story of 1840s America that depicts the plight of an uneducated black slave named Jim moved many to empathize with African-Americans. Compassion against the evils of slavery soon spread across the country. A war-torn America abolished slavery in 1865. However, Richard Wright’s 1940 novel, Native Son, a compelling story of the life and death of another black man, Bigger Thomas, makes a convincing argument that slavery in America was still very much alive during that period. Civil rights legislation and enforcement would not come until years later. A generation apart, Jim and Bigger embody the evolution of the black man struggling to be free in American society. On Twain’s Mississippi of the 1840’s, slaves are regarded more as property than human there is no freedom for the black man. Jim is trapped in a society that trumpets racial hatred; for example, Huck’s father said, â€Å"they told me there was a state†¦where they’d let the nigger vote†¦I says I’ll never vote again†(Twain 35). Early in their travels, Jim and Huck mirror the chasm in black and white relations that plagues America at the time. Blinded by prejudice, Huck seems incapable of recognizing that, much like himself, Jim is scared and running from a life of few choices, towards a dream of independence. Instead, he can only see what society allows him toâ€â€the blackness of Jim’s skin. He is reluctant to be seen with Jim because he knows â€Å"People would call [him] a low-down Abolitionist and despise [him] for keeping mum†(50). Even afte... ...e and what kind of work he [can] do†(Wright 394). Bigger’s society collectively denies him freedom to better his life with â€Å"restrictions placed upon Negro education,†authorities â€Å"that make it plain in their every act that they mean to keep Bigger Thomas and his kind within rigid limits,†and real estate operators who have â€Å"agreed among themselves to keep Negroes within ghetto-areas of cities†(394). Unlike Jim, Bigger can’t escape his slavery by running to the free north. His slavery is all-encompassing. Jim only sees freedom at face value, so his can be achieved. He can only hope for freedom in its simplest form†¦ release from the physical shackles of slavery. Bigger’s freedom begins where Jim’s leaves off. Works Cited Twain, Mark. Adventures of Huckleberry Finn. New York: Harper & Row, 1885. Wright, Richard. Native Son. New York: Harper & Brothers, 1940.
Million Dollar Baby
The theme of this story is achieving the American Dream of riches and fame, it’s also about the need for love and support. Frankie is a brilliant but unsuccessful boxing trainer who train a lot of excellent boxers but lack of success. Maggie is a natural boxer who tirelessly trains each day in Frankie’s gym even though he has rejected her requests that he trains her. She is at the age of 32 believes she has one last chance to make a life for herself in boxing. They are the loneness people that try to find meaning in their life. Both of them want success! Frankie is estranged from his daughter, who returns his many letters that all are unopened. Beneath his crusty exterior is a man crying for the love and acceptance of his daughter, so he goes to church every single day. There is an aching void in his heart. Maggie is a waitress from a white trash family. Her mother only cares about her welfare. Nobody cares about her in the family. She also lack of family love but she treats her family very well because of her strong will. Maggie dedication and hard work influence Frankie’s mind and he agrees to train her, but only in the basic and then he will turn her over to another trainer. At this point Frankie is still afraid to open himself up to Maggie who follows every word of his advice. As Maggie fights her way up in her boxing, Frankie establishes a parental relationship with Maggie. While Maggie’s mother ridicules her success is the ring, Frankie eventually arranges a million dollar fight for Maggie and they actually success. Also the movie always mentions the guy who is called Danger. He is a innocent and optimistic young boy who always come to Frankie’s gym to practice but is not a nature boxer. Being successful in boxing is also his dream. The remorseless fact blows him into the depth of despair. Although he comes to the gym every day to practice, he can’t even fight back to the black guy. Now he know boxing is not as easy as his imagination. For this reason he disappears some days. But eventually, he comes back with his confidence. This is the irony in this story, even though you work hard, it’s not always a good outcome. He realized that he is not suit in boxing but the worshipful part is he still coming to practice tireless when he is awakened by Mr. Scrap. At least he flights for his dream and doesn't live in a ordinary life like Maggie’s mother. Maggie’s mother doesn’t have a job because she is lazy and she lives on the welfare. She doesn't have a dream and doesn't care about her own daughter. The only thing she concerns is money even though her own daughter is on the verge of death. At the top of the life of Maggie’s boxing, she is being a paralytic by the accident. The pain is intolerable for Maggie, she ask for ending her life. She does the most valuable thing in her life that she is satisfied with the brilliant achievements in the twinkling of an eye. She enjoys the process of boxing that she has never ever been regret of being a boxer. Lying on the bed is against to her believe – never have a original life. People in the world all are never and ever be the same because of difference dreams. They are finding the meaning of their lives. Maggie chooses to end of her life to wind up her finally dream. This story tell us, everyone has a right to pursue the dream. Just go for it, it might be failure but at least we try and our life will be unordinary. If we keep proceeding in the way of our dream, even though we fail we still get more than the other who live in an ordinary life.
Thursday, August 1, 2019
Pythagoras
Pythagoras must have been one of the world's greatest men. However, he wrote nothing and it is unknown how much of the doctrine of Pythagoras is due to the founder of society and how much is later development. Sometimes he is represented as a man of science, a mathematician, and even as a preacher of mystical doctrines. None of these traditional views, however, should be rejected, for he contributed his genius in each field. Pythagoras lived from about 569 BC to about 475 BC. His father was Mnesarchus, a merchant from Tyre; his mother was Pythais, a native of Samos. Pythagoras spent most of his early years in Samos but traveled with his father. He was taught by the Chaldeans and the learned men of Syria. Among his teachers, there were three philosophers who influenced Pythagoras while he was a young man, Pherekydes, Thales, and Aleximander. They influenced Pythagoras' interest in geometry and cosmology, encouraging him to pursue his studies in Egypt. In 535 BC, Pythagoras went to Egypt where he visited many temples and took part in many discussions with priests. Then, after his journeys to Samos and Crete, Pythagoras founded a philosophical and religious school in Crotona. He was the head of the society with an inner circle of followers known as mathematikoi. Pythagoras influenced a group of early Greek scientific and religious thinkers, the Pythagoreans. They believed that the soul was immortal and separable from the body. Because they believed that the soul was reincarnated in different animal bodies, they practiced vegetarianism. The group was almost cult-like in that it had symbols, rituals and prayers. In addition, Pythagoras believed that â€Å"Number rules the universe,†and the Pythagoreans gave numerical values to many objects and ideas. These numerical values, in turn, were endowed with mystical and spiritual qualities. The Pythagoreans discovered irrational numbers. If an isosceles right triangle is taken with legs of measure 1, the hypotenuse will measure square root of 2. However, because this number cannot be expressed as a length that can be measured with a ruler divided into fractional parts, it deeply disturbed the Pythagoreans who believed that â€Å"All is number. †They called these numbers â€Å"alogon,†which means â€Å"unutterable. So shocked were the Pythagoreans by these numbers that they put to death a member who dared to mention their existence to the public. There are a couple of theorems attributed to Pythagoras or rather, more generally, to the Pythagoras. I. The sum of the angles of a triangle is equal to two right angles. II. For a right-angled triangle, the square of the hypotenuse is equal to the sum of the squares on the other two sides. In ancient times, the Egyptians used t heir knowledge of the Pythagorean Theorem to construct right angles. They knotted ropes with units of 3, 4, and 5 knot spaces. Then, using the three ropes, they stretched them and formed a triangle. They knew the triangle would always end up having a right angle opposite the longest side (32+42=52). Pythagoras and his followers also constructed figures of a given area and the five regular solids. In astronomy, Pythagoras taught the Earth was a sphere at the center of the universe. He recognized that the orbit of the moon was inclined to the equator of the Earth; and, he was one of the first to realize that Venus as an evening star was the same planet as Venus as a morning star. Finally, Pythagoras went to Delos in 513 BC to nurse his old teacher Pherekydes who was dying. He remained there for a few months until the death of his friend and teacher and then returned to Crotona. In 510 BC Crotona attacked and defeated its neighbor Sybaris and became involved in the dispute. Then in around 508 BC the Pythagorean Society at Crotona was attacked by Cylon, a noble from Crotona itself. Pythagoras escaped to Metapontium and died there, some claiming that he committed suicide because of the attack on his Society. Iamblichus quotes one version of events: Cylon, a Crotoniate and leading citizen by birth, fame and riches, but otherwise a difficult, violent, disturbing and tyrannically disposed man, eagerly desired to participate in the Pythagorean way of life. He approached Pythagoras, then an old man, but was rejected because of the character defects just described. When this happened, Cylon and his friends vowed to make a strong attack on Pythagoras and his followers. Thus, a powerfully aggressive zeal activated Cylon and his followers to persecute the Pythagoreans to the very last man. Because of this Pythagoras left for Metapontium and there is said to have ended his days. The evidence is unclear as to when and where the death of Pythagoras occurred. Certainly, the Pythagorean Society expanded rapidly after 500 BC, became political in nature and also spilt into a number of factions. In 460 BC the Societywas violently suppressed. Its meeting houses were everywhere sacked and burned; mention is made in particular of â€Å"the house of Milo†in Crotona, where 50 or 60 Pythagoreans were surprised and slain. Those who survived took refuge at Thebes and other places
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