Medical study of type 2 diabetes in sub-saharan africa The WritePass Journal

Medical study of type 2 diabetes in sub-saharan africa Introduction Medical study of type 2 diabetes in sub-saharan africa IntroductionEpidemiologyRisk FactorsComplicationsTreatmentMajor Challenges and SolutionsConclusionsRelated Introduction In recent times there has been a surge in non-communicable diseases, especially Type 2 diabetes mellitus (T2DM), in sub-Saharan Africa (SSA). This is an extra burden upon the healthcare systems, which already have to cope with the high prevalence of communicable diseases such as HIV/AIDS, tuberculosis and malaria. I chose to read up on this issue as it is a topic that is not really addressed in the field of diabetes. Epidemiology There were approximately around 200 million people with diabetes worldwide. This figure is on the rise and has the potential to reach around 380 million in the year 2025. This huge increase also is expected to be seen in Africa and Asia. T2DM is the most common form of diabetes with around 90% of diabetic patients. The current prevalence of T2DM in SSA is only a third of the HIV prevalence, however it is estimated to reach the same as current HIV prevalence by 2025. The prevalence is around 1.4% or lower in most SSA countries, however it is raised to around 3% in South Africa. There is also a greater prevalence of the disease in urbanised areas, as apposed to the more rural locations. It has been. The prevalence of diabetes in Africa was around 3 million in 1994, rising to 7.1 million by the year 2000. In 2010 the figure was around 12 million and is set to rise up to around 24 million by the year 2030. This phenomenon may be due to the rapid urbanisation these countries are facing. Risk Factors These factors can be split into modifiable (i.e. can be changed) and non-modifiable. Modifiable risk factors include the rise in obesity seen in SSA. This rise can be attributed to the rapid urbanisation of SSA countries. A study in 2002 showed the extent of clinically overweight/obese people in South Africa to be 56% for females and around 29% for males. Other studies have shown diabetic patients in SSA have a higher BMI than non-diabetic patients. However, one may argue that it is truncal obesity, which is more closely linked to T2DM than BMI. One study has shown the level of truncal obesity in Cameroon to be 18% in males and 67% in females. This may be due to the consensus that women who are larger are deemed healthier and richer, especially in countries where HIV is prevalent. The diet of the people of SSA is becoming more westernised including the rise of saturated fats, sugars and lower levels of fibre. This paired with rapid urbanisation leading to a more inactive lifestyle is likely to contribute to the rise in T2DM seen. Countries of SSA are also increasing their GDP and so are becoming more prosperous. This is linked with the urbanisation, which has been mentioned. This has lead to the rise in processed foods consumed, inactive lifestyle and inevitable increase in obesity. Non-modifiable risk factors include age and ethnicity. The most common age group for T2DM was 45-65 year. Some studies showed that more women had T2DM than women in certain SSA countries. There is also an effect from ethnic origin, for example some countries have a higher population of Indian people, where the prevalence of T2DM is higher. Other risk factors include TB or the use of antivirals, which may increase the likelihood of contracting T2DM. Complications Complications arising from T2DM can either be classified as macrovascular or microvascular. Macrovascular complications include cardiovascular disease and stroke. Microvascular complications include nephropathy, neuropathy and retinopathy. Patients from developed countries have greater macrovascular morbidity, whereas in SSA the opposite is true. In developed countries T2DM mortality is due to CVD and renal complications, however in SSA the mortality is greatly due to infections and metabolic problems. Infections include sepsis and TB. Metabolic problems are usually keto-acidosis and hyperosmolar non-ketotic coma. However there is still a lot of un-obtained data, which is due to the poor documentation of the cause of death. It is one of the challenges to increase the number of deaths reported, and also to report it accurately. Treatment The key to decreasing the morbidity and mortality associated with T2DM is to maintain good control over the blood glucose levels. This can be achieved using a diet management plan, exercise and, if needed, the use of appropriate medication. Drugs, which can be administered, include sulphonylureas, which promote insulin secretion after a rise in glucose levels. Meglitinides, which are insulin secretagogues. Biguanides such as Metformin, decrease the rate of gluconeogenesis and thus lower blood glucose. Insulin can also be used as a last resort in T2DM to maintain good glucose control. A study has highlighted the poor blood-glucose control for patients with T2DM in SSA. These were patients who were on various different treatment regimens ranging from sulphonylureas to insulin. This maybe due to lack of availability of drugs, high cost of drugs/lack of funds, lack of adherence, lack of patient education and late presentation. One paper showed that a few health care settings in Tanzania only had a couple of sulphonylureas and insulin in their drug stores. Major Challenges and Solutions To understand why there is poor care of patients with T2DM in SSA, one has to identify the problems that are faced in order to create a solution. The economy of these countries is already stretched and so have low healthcare budgets. This means that there is not enough money to purchase drugs and provide optimal healthcare to T2DM patients who require chronic care. This problem is exacerbated due to the fact that communicable diseases such as HIV take up more of the budget, leaving a decreasing amount of money to be spent on non-communicable chronic conditions. There is also a lack of qualified healthcare providers and so insufficient manpower. This maybe due to the lack of training and courses in order to create these qualified healthcare providers. There are also poor healthcare referral systems. This inevitably shows the lack of organisation within the healthcare systems in SSA. This needs to be tackled by reorganising the healthcare infrastructure and create/improve training programmes for the staff. Greater drug supply is also essential. One study showed that there was a lack of insulin in some SSA countries such as Mali. There also needs to be improved access to care, as many patients can’t reach the required level of care in order to manage their T2DM well. There is also poor patient education in SSA, and so this leads to poor adherence of treatments as well as poor glycaemic control. T2DM is a chronic disease and so patient education is key in good management of the disease in order to decrease complications arising. Greater primary and secondary prevention strategies need to be established, as this will be economically beneficial. Interventions need to be cost effective as there are limited resources and funds. A lot of the data collected regarding T2DM care is inaccurate or just simply not collected. In order to assess the characteristics of the disease in SSA, better data collection methods need to be initiated. Poor record keeping is detrimental to the care of the T2DM patient, where glucose monitoring ensures stable control. An example to follow is the National Diabetes and Hypertension Program in Cameroon. This initiative saw the coming together of health-care providers, policy-makers and people from the community in order to tackle the growing epidemic of T2DM in SSA. Strategies are shown in figure 2. This program ensured greater monitoring, documentation as well as better interventions which all lead to better care for T2DM patients. Conclusions With the rapid urbanisation and greater prosperity seen in sub-Saharan Africa, T2DM is becoming an underestimated epidemic. With the focus on communicable diseases, the care of T2DM is not improving, as seen by the multitude of problems faced in SSA. Strained healthcare budgets mean that it is necessary, more than ever, to produce cost-effective initiatives. Governments need to understand the dangers of communicable diseases as well as non-communicable diseases. Better primary and secondary prevention strategies need to be created to target issues such as the rising levels of obesity. Governments need to issue better guidelines, training and promote policymaking. Initiatives such as National Diabetes and Hypertension Program in Cameroon have had very positive feedback and have set the standard for other governments within SSA. If this problem is not addressed, there will be a negative impact on T2DM morbidity and mortality. This will inevitably reduce the socioeconomic growth in SSA countries, which is vital for the prosperity of the country.

Number of Supreme Court Nominees By President - List

Number of Supreme Court Nominees By President - List President Barack Obama successfully chose two members of the U.S. Supreme Court and has a chance to nominate a third before his term ends after 2016. If hes able to push a candidate through what can be a politically charged and sometimes lengthy nomination process, Obama will have chosen a third of the nine-member court. So how rare is that? How many times has a modern president gotten an opportunity to choose three justices? Which presidents have nominated the most Supreme Court justices and had the largest impact on makeup of the highest court in the land? Here are some questions and answers about the number of Supreme Court nominees by president. How did Obama get the chance to nominate three justices? Obama was able to nominate three justices because two members of the Supreme Court retired and a third died in office. The first retirement, that of  Justice David Souter, came a short time after Obama took office in 2009. Obamas chose Sonia Sotomayor, who later become the first Hispanic member and third woman justice to serve on the high court. A year later, in 2010, Justice John Paul Stevens gave up his seat on the court. Obama picked Elena Kagan, a former Harvard Law School dean and solicitor general of the United States who was widely seen as a consensus-building liberal. In February 2016, Justice Antonin Scalia died unexpectedly. Is It Rare For a President to Get to Nominate Three Justices? Actually, no. Its not that rare. Since 1869, the year Congress increased the number of justices to nine, 12 of the 24 presidents preceding Obama successfully chose at least three members of the Supreme Court. The most recent president to get three justices on the high court was Ronald Reagan, from 1981 through 1988. In fact, one of those nominees, Justice Anthony Kennedy, was confirmed in a presidential-election year, 1988. So Why Were Obamas 3 Nominees Such a Big Deal? That Obama had the opportunity to nominee three Supreme Court justices was not, in an of itself, the big story. The timing - his final 11 months in office - and the impact his choice would have on setting the ideological course on the court for decades to come made his third nomination such a big news story and, of course, a political battle for the ages. Related Story: What Are Obamas Chances of Replacing Scalia? Which President Has Chosen the Most Supreme Court Justices? President Franklin Delano Roosevelt got eight of his nominees on the Supreme Court over the course of just six years in office. The only presidents who have come close are  Dwight Eisenhower, William Taft and  Ulysses Grant, whom each got five nominees on the court. So How Does Obamas 3 Picks Compare to Other Presidents? With three picks for the Supreme Court, Obama is exactly average. The 25 presidents since 1869 have gotten 75 nominees on the high court, meaning the average is three justices per president. So Obama falls right in the middle. Here is a list of presidents and the number of their Supreme Court nominees who made it to the court since 1869. The list is ranked from presidents with the most justices to those with the least. Franklin Roosevelt: 8 Dwight Eisenhower: 5 William Taft: 5 Ulysses Grant: 5 Richard Nixon: 4 Harry Truman: 4 Warren Harding: 4 Benjamin Harrison: 4 Grover Cleveland: 4 Ronald Reagan: 3 Herbert Hoover: 3 Woodrow Wilson: 3 Theodore Roosevelt: 3 Barack Obama: 2* George W. Bush: 2 Bill Clinton: 2 George H.W. Bush: 2 Lyndon Johnson: 2 John F. Kennedy: 2 Chester Arthur: 2 Rutherford Hayes: 2 Gerald Ford: 1 Calvin Coolidge: 1 William McKinley: 1 James Garfield: 1 * Obama has not yet nominated a third justice, and it remains uncertain whether his choice will will confirmation.

Business Ethics Essay Example | Topics and Well Written Essays - 750 words - 10

Business Ethics - Essay Example The most common conflicts that arise in any organization is the inter and intra group conflicts. They may involve individuals or the whole company or sometimes the management. The differences that arise between the two employees can result from the difference in their approaches towards the work and environment in which they come across. As they both have different personalities, attitudes and also different families, their objective or vision may differ from the objective of the company or from the management under which they are working (Srinivasan). Apart from that, these conflicts can be developed between the two teams or groups of an organization. These conflicts arise when one of the teams feels differently about the other. Sometimes the member of any group raises some issues about another group or team. On this basis, rather to stay in his team and work, he prefers to leave it due to inter and intra group conflict. According to the survey conducted by Kathleen Cox, B. PhD, RN, intra group conflicts severely affect the functioning of the employees. It has the negative effect over the performances of team as well as on individuals. According to her research, it is important for the management to build an administration that can work to overcome the agitated environment of the company while maintaining the significance of team working (Cox). The culture and diversity in an organization can be defined or seen as the â€Å"beliefs, norms, or values† that allow the members of an organization to work accordingly. The diversity is referred to the identification of difference in opinions and cultures or behaviors among the people and then enables them to work under one roof. There are differences between employees but to maintain a better workplace and to build an effective team or corporation is what the culture and diversity all about. However, it is difficult to manage an organization with diversified ideas and approaches (Williams). As

Monetary Policy Coursework Example | Topics and Well Written Essays - 8000 words

Monetary Policy - Coursework Example This paper examines the relationship that exists between the monetary policies and the stock market bubbles and concludes that the monetary policies can be varied to have very little control on the stock market movements, as monetary policies like change in the interest rates would be slow in acting on the bubble price movements. However such change in the policy may restrict the influence of the financial instability on the economy that immediately follows the bubble. This paper concludes that the central banks should adopt standard monetary policy or bubble policy depending on the circumstances and the extent of the macroeconomic consequences of the stock bubble price movements. In the process of the study of the impact of the monetary policies on the stock market bubbles the paper also details some of the historic bubbles and crashes. Expanded spells of rapidly appreciating equity, housing, and other assets prices in any country since the twentieth century have brought the impact of monetary policies on the asset market prices to the fore and to the attention of the economists to analyze the phenomenon. The analysis includes the response of the asset market booms as a result of the changed monetary policies. It is the argument from some of the economists that the nature of the financial markets tends to be volatile inherently and that the market prices often go tangentially to fundamentals. Hence they argue that it is possible for the policymakers can improve the welfare activities of the economy by adopting measures to deflate the asset price booms, especially under circumstances where the sudden declines in the asset market prices will have the effect of depressing the economic activity to the advantage of the country. There are other economists who believe that the financial markets are efficient in processing the information provided to them. These economists argue that it is not possible for the policymakers to determine the point of time when the assets are mispriced and hence they cannot adopt policies which will have the effect of improving the welfare of the nation by reacting to the asset price movements. However the stock market boom in the United States in the late 1990s has been found to arise during a

The Many Benefits of Hunting Essay -- Hunting Debate

When a Minnesota dentist killed a prized African lion named "Cecil" he received an onslaught of criticism and reignited the debate concerning hunting. Those who oppose hunting often have no understanding of the many benefits provided by hunting. Hunting provides free census animal data, as well as money to sustain clean rivers and forests and to manage wildlife populations. Animals are treated more humanely by a hunter’s bullet than by a slaughterhouse’s blade. There are two categories of hunters, the poachers and the traditionalists. However, people seem to classify hunters only by the practices of poachers. At first, I use to be one of them (people with no knowledge about the positive effects of hunting). I thought hunting was a merciless sport. Killing an animal for its antlers, fur, or their body parts. I saw hunters as unethical humans and so did most of the people I ran into. Then again this was before I did my research on hunting. After my research, I found some facts that were compelling. Hunting after all was not what I had perceived it to be. Nevertheless, there are still people that have the wrong impression about hunting because they don’t fully understand its meaning. Hunting has been around as long as humanity has existed. Hunting has played a key role in humanities fight for survival. Without hunting our ancestors may not have been able to survive. In his article, â€Å"Hunting and Human Values† author Paul Shepard states, that hunting may be a behavior that is inherent and about 95 percent of the time humanity has existed we have been hunters. Hunting has formed humanity and to take it away would take away a significant part of history and heritage. Hunting should be protected by laws such as Bill 273 s... ...nd a way for one to connect with nature in this modern world. Hunting has a positive impact on the wildlife and economy helping sustain animal populations while maintaining clean forests and rivers. It also helps the economy by generating revenue through hunting tags and permits. Works Cited "Division of Wildlife Resources Financial Overview." Utah Division of Wildlife Resources. 5 Oct. 2014. Web. 08 Mar. 2015. Paul Shepard. â€Å"Hunting and Human Values.† Rhetorical Choices. Charles I. Schuster, Deborah H. Holdstein, Keith Gilyard. Second Edition. New York: Penguin Acdamics, 2013. 568. "What's Mad Cow Disease?" KidsHealth Kids Health. Web. 06 Mar. 2015. Van de Pitte, Margaret. "The Moral Basis for Public Policy Encouraging Sport Hunting." Journal of Social Philosophy 34.2 (2003): 256-266. Religion and Philosophy Collection. EBSCO. Web. 9 Mar. 2015.

Movie Review of Secret (2007 Taiwanese Film) Essay

Casts: * Jay Chou as Ye Xianglun – A music student majoring in piano and lives with his father * Kwai Lun-mei as Lu Xiaoyu – A music student who lives with her mother * Anthony Wong Chau-sang as Xianglun’s father – Xianglun’s father and the discipline teacher at his school * Alice Tzeng as Qing Yi – Xianglun’s classmate who is in love with him * Yuhao Zhan as Yu Hao – A music student and talented piano player, nicknamed â€Å"Prince of the piano†, he had a â€Å"piano battle† with Xianglun Secret is an amazing movie to look at and to listen to. The film tells a â€Å"simple but very beautiful† love story which is tied between past and present. The story, the music, the talent – you’ll really be amazed and be in love with it when you see it yourself. You can’t imagine that it would be magical. It’s a unique story, unpredictable and interesting. What’s more interesting is there is more to it than what meets the eye. Careful attention must be paid to all scenes, or else the story won’t click and the end won’t be as good. Here’s the spoil. Ye Xianglun is a budding musical genius whose way with piano keys makes him a hit with the ladies, and even the guys, who recognize talent when they see it. Ye arrives at Tanjiang Art School and already he’s being watched, but his eyes and heart are immediately stolen by Lu Xiaoyu, an elegant, charming flirt who first happens upon Ye in the school’s aged piano r oom. The two begin a cute, casual romance that’s defined by secrets. Basically, Lu keeps them, starting with her name, then extending them to other things like where she goes, what she does, and why she’s always absent from class. Since she’s so effervescent and attractive, Ye is immediately smitten. Ye has a secret too, but I’ll give it away: his dad is a teacher at the school, and he’s played by Anthony Wong in an amusing performance that’s vintage Wong. Ye also has some friends at school who aren’t as amusing, and even qualify as annoying and bothersome. Some of these characters are played by Chou’s Taiwanese pop music pals. Since this is a Jay Chou (Ye Xianglun) production (besides starring and directing, he penned the original story and contributed the music), it’s only understandable that Chou make room for some of his buddies  as well as his pet obsessions, especially music. Ye becomes the class celebrity when he kicks ass in a â€Å"piano battle†, which is as entertaining as it i s patently manufactured. Basically, Ye outfoxes his opponent on the ivory keys, winning the hearts of the girls and the guys, while still remaining cool and sheepish in that inimitable Ye Xianglun way. Chief among his admirers is the pretty Qing Yi, who starts to crush on Ye big time. But Ye only has eyes for Lu. Or does he? Despite getting along swimmingly with Ye, Lu soon gets the idea that Ye is two-timing her with Qing. This is due to your standard crossed wires and mistaken circumstances, but the misinterpreted event is enough to throw a massive crush-killing wrench into their puppy love. That would probably be a terrible thing to behold if not for the fact that the relationship up until then was hardly inspiring. Ye Xianglun and Lu Xiaoyu have decent chemistry, but the relationship between their characters never seems that deep. There’s a manufactured quality to the dialogue that makes their supposed love a bit unconvincing, and without more acute emotions the film begins to drag. Sadly, part of this is the fault of Ye Xianglun, the actor. Ye possesses a certain likable charm, but his presence hardly screams â€Å"passion.† His demeanor is just too remote; Ye tr ies hard, but he can’t convey a complete range of emotions. Shoring things up, however, is Lu Xiaoyu. When she initially appears, she acts too much like an idealized good girl flirt to be real; it’s like she’s some manufactured idea of what perfect high school romance should be. However, as it turns out, there’s a reason for her bizarre flirtatious behavior, and as the film divulges more of the how’s and why’s, Lu is given a chance to convey emotions that prove heartbreaking. Her screen presence is refreshing and her emotion’s genuinely moving; if Secret manages to affect, Lu Xiaoyu is a large reason why. The revelation of the film’s eponymous secret is what gives Lu the chance to really affect the audience – and yet it’s also when the movie starts to lose its credibility. The mechanism behind the film’s secret is never known, but the logic of how it works is explained explicitly, such that every incident and action in the film needs to fit a set of rules explained by the characters and depicted by the events thems elves. But the film ultimately doesn’t adhere to its convictions, eventually twisting events to fit desired emotions and skirting around the rules that they’ve laid out for us. The film gives us a denouement, but it’s  only touching because it fits some sort of predetermined audience expectation, and not because it surprises or really affects. Some people may be happy with how Secret ends. But does the film earn its ending? I don’t think that it does. At least Secret is a very pretty ride. On artifice alone, the film is aces, serving up beautiful art direction, cinematography and music. Ye Xianglun (Jay Chou) really knows how to compose a tune; the film’s original music is genuinely stirring, and preexisting pieces are well-chosen and evocative of the film’s innocent romantic mood. Secret serves the senses exceptionally well – so much so, that it’s almost tragic when it ultimately throws logic out the window. Ye Xianglun and company have created a nice little valentine, but their desire to give the film more weight eventually leaves it adrift. The film barrels towards its intended goal with little regard for common sense, leaving the audience with nothing besides the pretty pictures and people to shore it up. Amazingly, that gambit is more successful than not, and Lu Xiaoyu (Kwai Lun-mei) practically drags the film across the finish line herself. Without her the film would probably sink beneath its own self-importance, as its manufactured sheen and occasionally miscalculated choices render the film little more than a superficially gorgeous pure love diversion for teen girls and the boys they drag to the cinema along with them. That’ll probably do just fine for most, since â€Å"manufactured diversion† seems to be a standard expectation for many modern moviegoers. Secret will probably score well with its intended teen audience, especially if they take in the film as a single, one-off experience. Further viewings would only reveal the film’s holes to be gaping and perhaps intolerable, but upon first glance, Secret is pretty and polished enough to charm. You should watch it too!

Clothing Is Essential For All Members Of The Uk - 761 Words

Clothing is essential for all members of the UK population, which creates a constant demand for clothing to be retailed in the UK. London is a leading fashion industries in the world, which makes fashion and clothing a key trend for English consumers with the UK being a fashion capital, London, tourists from all over the world visit the UK specifically for its clothing retailers; which has allowed the market to continuously do well. Consumers in Britain require different types of garments for various occasions, for example job related attire, gym attire and special occasions, the market has a wide range of segmentations for different trends and faces a constant demand for new products especially as consumers change fashion through seasonal†¦show more content†¦Leading retail stores such as Topshop have already begun on using this new technology to gain more in store customers â€Å"as they screened its Topshop Unique catwalk show at the Oxford Circus flagship store. The sto re featured a vending machine that dispensed free beauty gifts. All customers had to do is tweet to @Topshop using #topshoptreats and the machine dispensed their free gift.’’ (Retail Innovation from London Fashion Week) The ongoing rollout of Internet access and social media networking is providing clothing retailers with new means of targeting and selling to consumers.†¨The popularity of British brands is giving UK clothing retailers a base from which to launch into new international markets.†¨As male fashion becomes more popular, retailers have the potential to tap into this currently underdeveloped market.†¨Retailers can benefit from participating in discounting days, such as Black Friday, as a means to encourage a surge in spending among shoppers. As online retailers are increasingly emerging offering more convenient of click-and- collect and home-delivery services, the physical retailers on the high street are in danger of becoming irrelevant in the changing marketplace. 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