Chronic Disease In St Lucia Health And Social Care Essay

Chronic Disease In St Lucia Health And Social Care Essay Chronic disease is a disease of a long duration and generally slow progression (WHO, 2010). The U.S. National Center for Health Statistics states that a chronic disease is one lasting 3 months or more. These chronic diseases normally cannot be prevented by vaccines or cured by medication, nor do they just vanish. Chronic diseases are mainly caused by three major risk factors tobacco use, poor eating habits and physical inactivity. Majority of these risk factors are themselves worsened by poor socioeconomic determinants, such as lack of education and poverty. Most often these determinants are a indication of the main forces driving social, economic and cultural transition, including globalisation, urbanisation and an aging populations. Chronic diseases are affecting population health as the epidemiological transition progresses and are the lead cause of mortality worldwide and pose increasing problems for the burden of disease and quality of life in developed and developing countries (WHO, 2003). Non communicable diseases include a broad range of conditions, including cardiovascular disease, diabetes, cancers, chronic respiratory disease, mental-health problems and musculo- skeletal disorders. The first four mentioned above account for approximately 50% of mortality globally, and share behavioural risk factors, such as excess calorie consumption, diets high in saturated and transfatty acids, excessive intake of alcohol, physical inactivity, and tobacco smoking. Approximately 35 million people have died from heart disease, stroke, cancer and other chronic diseases in the year 2005. The burdens of these diseases are equally shared among men and women, and are more prevalent in people under the age 70 (WHO, 2004). 80% of chronic disease deaths occur in low and middle income countries. Figure 1: Global distribution of total deaths (58 million) by cause in 2005. The age-specific death rates between the years 2005 2015 are projected to fluctuate slightly, Nevertheless, the ageing populations will result in an overall increase in chronic disease death rates for all ages combined. In 2005, all chronic diseases account for 72% of the total global burden of disease in the population aged 30 years and older. The total lost years of healthy life due to chronic diseases, as measured by DALYs, are greater in adults aged 30-59 years than for ages 60 years and older. More than 80% of the burden of chronic diseases occurs in people under the age of 70 years. Table 1: Projected global deaths and burden of disease due to chronic disease by age 2005- 2015 Deaths (Million) DALYs (millions) Deaths per 10000 DALYs per 100000 2005 2015 2005 2015 2005 2015 2005 2015 0-29 years 17 15 220 219 48 40 6320 5994 30-59 years 7 8 305 349 311 297 13304 13375 60-69 7 8 101 125 1911 1695 27965 26396 à ¢Ã¢â‚¬ °Ã‚ ¥70 20 24 99 116 6467 6469 32457 31614 All ages 35 41 725 808 549 577 11262 11380 World Health Organization projects that, globally, NCD deaths will increase by 17% over the next ten years. The greatest increase of 27 %and 25 % respectively will be seen in the African region and the Eastern Mediterranean region (WHO,) 1.2 Types of chronic diseases 1.2.1Cardiovascular disease Cardiovascular disease CVD is the term used by the scientific community to embrace not just conditions of the heart [ischemic heart disease (IHD), valvular, muscular, and congenital heart disease but also hypertension and conditions involving the cerebral, carotid, and peripheral circulation. The risk of CVD is related to diet, physical activity, and body ( ). The patterns of food supplies and of food and nutrition that modify the risk of CVD are also well known. Whereas CVD was once largely confined to high-income countries, it is now the number one cause of death worldwide as well as in low- and middle-income countries, where 80 percent of the worlds 13 million annual CVD deaths occur. And at least 21 million years of disability-adjusted life years (or DALYs, a measure of future productive life) are lost globally because of CVD each year. The vast majority of CVD can be attributed to conventional risk factors such as tobacco use, high blood pressure, high blood glucose, lipid abnormalities, obesity, and physical inactivity. Cardiovascular diseases are major cause of chronic disease death and were accounted for of 17 million deaths in 2002. It is estimated that by the year 2030, 24 million will die of CVD, of which 80% will occur in low and middle income countries (5). 1.2.2 Cancer Cancer is a major and growing disease burden worldwide. The number of new cancer cases is projected to increase from 10 million in 2000 to 15 million in 2020, 9 million of which would be in developing countries. The epidemiology of cancer in developing countries clearly differs from that in developed countries in important respects. While developed countries often have relatively high rates of lung, colorectal, breast, and prostate cancer (some of which is tied to tobacco use, occupational carcinogens, and diet and lifestyle), up to 25% of cancers in developing countries is associated with chronic infections. Seven types of cancers account for approximately 60 percent of all newly diagnosed cancer cases and cancer deaths in developing countries: cervical, liver, stomach, esophageal, lung, colorectal, and breast. 1.2.3 Respiratory Diseases Chronic adult respiratory diseases-such as chronic obstructive pulmonary disease (COPD) and asthma-are a major and growing burden in terms of morbidity and mortality in the developing world. COPD (which includes emphysema, chronic bronchitis, and obstructive airways disease) is largely linked with cigarette smoking as well as exposure to unvented coal-fired cooking stoves; it accounts for 2 percent of lost DALYs on a worldwide basis. 1.2.4 Diabetes Mellitus Diabetes affects people worldwide and is one of the oldest diseases known. There are two common types of this disease: type 1and type 2 diabetes. Type-1 diabetes accounts for 5-10% of all diagnosed diabetes. Type-2 diabetes is the most common form of diabetes. It accounts for 90-95% of diagnosed diabetes. The World Health Organization (WHO) estimated the worldwide prevalence of diabetes in adults to be around 173 million in 2002 and predicted that there will be at least 350 million people with Type 2 diabetes by 2030. At present about two-thirds of persons with diabetes live in developing countries and the majority of new cases will originate from these areas. The global increase in the incidence of diabetes is related to high levels of obesity associated with a change from traditional diets, diminishing levels of physical activity, population ageing and increasing urbanization. Diabetes Mellitus is the most prevalent form of diabetes on the global scale (6). For the past few decades, Diabetes Mellitus has reached epidemic proportions in many parts of the world. The World Health Organization (WHO) has predicted the global prevalence of all Diabetes will increase from 194 million in 2003 to 330 million in the year 2030 (7). 1.2.5 Hypertension Another commonly occurring chronic disease is hypertension. High blood pressure increases the risk of heart disease and stroke. Hypertension is sustained high blood pressure (à ¢Ã¢â‚¬ °Ã‚ ¥140/90mmHg). Blood pressure itself is the pressure exerted by the blood on the walls of the blood vessels. Each time the heart beats (about 60-70 times a minute at rest), it pumps blood into the arteries. Blood pressure is at its highest when the heart beats, pumping the blood. This is called systolic blood pressure. When the heart is at rest, between beats, blood pressure falls. This is diastolic pressure. Blood pressure itself is not harmful it is essential as it is the force that drives blood through the blood vessels to supply oxygen and nutrients to the bodys organs and tissues and carry away waste materials. However, when blood pressure becomes too high it has damaging effects on almost every part of the body and can lead to serious illness and death. Hypertension is an important public health challenge worldwide because of its prevalence and its role as a risk factor for cardiovascular disease. Some of the risk factors of hypertension include obesity, alcohol, family history, and smoking. There are two types of hypertension, namely primary hypertension and secondary hypertension. Primary hypertension is more common, occurring in 90-95% of the hypertension population. There is no identifiable cause and it develops gradually over many years. Secondary hypertension occurs in 5-10% of the hypertension population. () In the year 2000 it was estimated that the total number of adults with hypertension was 972 million. Of these, 333 million were estimated to be in developed countries and 639 million in developing countries (0). Kearney PM et al., predicted that by the year 2025, the number of people with hypertension will increase by approximately 60% to a total of 1.56 billion. (Kearney PM et al., 2005) the reasons are the continuing population increase and changes in lifestyle, which includes a diet high in sugar and high-fat processed foods and sedentarism. 1.3 Impact of chronic disease in the Caribbean Caribbean countries are in epidemiological transition, where not only nutritional deficiencies have considerably declined but infectious diseases have also been disappearing. However, over the last thirty years, nutrition-related chronic non-communicable diseases have slowly emerged as the major public health problems. Non-communicable diseases (NCDs) have gradually displaced communicable diseases in the Caribbean. Rates of chronic non-communicable disease such as diabetes, hypertension, cardiovascular disease and cancer have been increasing in the Caribbean and are the leading cause of mortality and mobility in the region (Ragoobirsinghet al., 1995, 2002; Wilkset al., 1998, 1999; Figueroaet al., 1999; Rotimi et al., 1999; Cruickshanket al., 2001, Figueroa, 2001; Sargeantet al., 2001; Henniset al., 2002a,b; Corbinet al., 2004; Wolfeet al., 2006). Of concern is the fact that while the prevalence and mortality rates of these diseases are highest in the elderly, they are not restricted to any one age group. An estimated 10% to 20% of the Caribbean population over 20 years of age suffers from diabetes and hypertension, respectively, with prevalence more than doubling at older ages (Hennis et al., 2002a, b). Hypertension and diabetes rank as the two leading chronic disorders among Caribbean populations and are also major risk factors for other diseases such as cerebrovascular disease (stroke) and coronary heart disease. Prevalence of chronic diseases in the Caribbean region over the pass 3 decades Another striking epidemic among the Caribbean population is the high prevalence of overweight [body mass index (BMI) >25 kg mà ¢Ã‹â€ Ã¢â‚¬â„¢2] and obesity (BMI >30 kg mà ¢Ã‹â€ Ã¢â‚¬â„¢2). Approximately half of the adult Caribbean population is overweight and 25% of adult Caribbean women are obese (Henry, 2004). The escalating trend in obesity is considered to be a major causative factor in chronic disease prevalence in the region. The increasing obesity levels, mainly among women, maybe associated with the changes in traditional diets and the adoption of sedentary lifestyles. In some the islands more than half of adult women are reported to be obese. Data from Barbados highlights the importance of obesity as a risk factor in chronic diseases. Based on available evidence, obese persons, (BMI>30) of 40-79 years had a 2.6 times greater risk of hypertension than persons with BMI 1.4 Impact of chronic disease in St. Lucia St. Lucia has undergone a significant demographic transition in the last 3 decades (Wilks, et al., 1998). Some features of this transition include the rise in the median age of the population from 20 years to 15 years between 1970 and 2010, the doubling of the proportion of persons older than 60 years old from 5000 to over 17,000 and the increase in life expectancy at birth from less than 50 years in 1950 to greater than 73 years in 2010 (World population prospectus, 2008). As a result, the main causes of illness and death in St. Lucia and many other Caribbean islands and regions at a similar state of development are the chronic non-communicable diseases (Sargeant et al., 2001). There is an increased prevalence of diet-related chronic non-communicable diseases, such as cardio-vascular diseases, diabetes and obesity. (Wilks et al., 1998). Between 1992-1999 in St. Lucia, preventable chronic diseases such as cardiovascular and circulatory systems accounted for 20.8% of deaths, with the major causes being cerebrovascular disease, ischemic heart disease, and hypertensive disease. Other major causes of death were cancers (14.5%), disease of the digestive system (8.7%), and diabetes (7.2%) (8). Approximately 1,304 deaths were due to diseases of the circulatory system and was accounted for 33% of all reported deaths, death due to cerebrovascular was (35.9%), hypertensive disease (14.8%), and ischemic heart disease (13.6%) (Health in America, 1998). There were 731 deaths due to cardiovascular disease from 1996 to 1999, accounting for 19% of all deaths and 53 % of deaths ratio of 5.8:1. Most (21 or 62%) occurred in the 15-44 years age group, and had a male-female ratio of 9.5:1. Cardiac arrest caused 268 cardiovascular deaths (37%), ischemic heart disease 174 (24%), pulmonary circulation and other forms of heart disease 134 (18%), and heart failure 153 (21%). Females accounted for 359 (49%) of deaths due to cardiovascular disease, and persons 60 years of age or older accounted for 588 deaths (80%). (WHO statistics). Based on PAHO statistic St. Lucia is the tenth leading island in the Caribbean with high rates of non- communicable chronic disease, accounting for approximately 63%. Over the years prevalence of non communicable diseases have been increasing, in a survey done by the Kairi consultants limited in association with the national assessment team of St. Lucia concluded the following findings for the year 2005 to 2006 for the distribution of chronic disease in St. Lucia. Irrespective of per capita consumption quintile, high blood pressure was the most prevalent lifestyle disease affecting persons with diseases in St. Lucia. In every quintile group, it also shows that the prevalence of diabetes ranks second to high blood pressure as a life time disease affecting persons with diseases in St. Lucia. In each of the quintile groups, more than three fifths of the persons with diseases reported suffering from high blood pressure while more than one quarter reported suffering from diabetes. In the year 2007 diabetes and Hypertension were the two the most pervasive and worsening health problems facing the island of St Lucia. The diseases afflict a broad swath of people, young and old. St. Lucia has a population of approximately 160,000 thousand people, and of this 28.1%of the population have abnormal blood glucose or high blood sugar and 8.1% have diabetes (Graven et al., 2007). 20% of people over 40 years of age suffer with the disease (the ministry of health 2007). At least 35% of those with Type 2 Diabetes Mellitus do not know that they have the condition (The Ministry of Health, 2008). In rural area of St. Lucia the proportion with undiagnosed diabetes is considerably higher (St. Lucia Diabetic Society, 2008). At the time of diagnosis, every tenth person with diabetes has already developed one or more micro- or macro-vascular complications (Ministry of Health, 2008). Diabetes is among the leading cause of death. If inadequately treated, diabetes can cause blindness, kidney disease, nerve disease, amputations, heart disease, and stroke. Even conscientious and well-treated diabetics frequently suffer from these complications and have above-average medical costs. If observed, the Native St. Lucian has many barriers to health education, which basically involves their culture, lifestyle, accessibility and socio-economic status. For instance, St. Lucian is currently experiencing a crisis of poverty. People from lower socioeconomic status have poorer health than those in higher socioeconomic positions. Various studies have reported the relationship between low socioeconomic status and the development of chronic disease ((Lynch et al, 2000; Stelmach et al, 2009; Supriya et al, 2009). Recent poverty assessments in St. Lucia estimate that 18.7% of households and 25% of the population live in poverty. Income inequality is high, with 26% of the population characterized as chronically poor (MPDEH, 2003). That same report estimated that a decade later in 2005/06 the poverty rate had increased to 28.8% of the population( Government of St. Lucia( GOVST), The assessment of Poverty volume1, 2006) .The highest poverty rates in2005/06 were in the districts of Anse La Raye/Canaries (44.9%), Micoud (43.6%),Soufriere (42.5%) and Laborie (42.1%). The poverty gap and poverty severity also occurred in these same districts (GOVST, 2006) Furthermore, because of poverty and living in rural areas, most people consume less expensive and often high fat foods, and less fruits and vegetables (Henchy et al, 2000). Brown et al, (2005) described how socioeconomic position influences health among persons with diabetes. Diabetes is twice more prevalent in low income populations compared to wealthy populations (Stelmach W et al; 2009). Some explanations for this increased risk among people of low-income or resource-poor areas include increased stress, low access to medical and preventive care, and poor environment. 1.5 Diet, nutrition and chronic diseases There are clear associations between the various biomedical and behavioural chronic disease risk factors, and it is well established that diet quality and healthy eating practices play an important role in both preventing and managing chronic diseases and the factors that increase their risk (Kant A.K, 2004). The links with food and nutritional status are especially strong in the case of cardiovascular disease, diabetes and their risk factors (metabolic syndrome, obesity, hypertension and hyperlipidaemia). The food we eat, in all cultural selection, defines ones health, growth and development. Risk behaviours, particularly smoking and sedentarism, alter the result (). All this takes place in a social, cultural, political and economic environment that can exacerbate the health of populations. Diet is a key component in predisposing to chronic disease, mainly where diet is energy dense causing positive energy balance and obesity. Adoption of western diet which are high in fats , aminal protein, refined carbohydrates and low in fibre, fruits and vegetable can further increase one risk of developing no of more chronic disease(). Several studies have demonstrated a prudent diet rich in fruits, vegetables, fish and wholegrain to be associated with a decline in chronic disease risk such as diabetes (Van Dam et al., 2002; Anne-Helen Harding et al., 2004) Carbohydrates Carbohydrates food source are the most important source of calories for the worlds population mainly because of their low cost and wide availability (). Although Carbohydrates is easily accessible and widely eaten carbohydrate is a key dietary component affecting insulin secretion and postprandial glycemia and is implicated in the etiology of many chronic diseases (Brand-Miller JC et al., 2004). Both the quantity and type of carbohydrate eaten have consequences on insulin secretion and postprandial glycemia. Foods with a rich glycemic index (or glycemic load) produce high rates in blood glucose.  Diets including large quantities of high GL foods increase the risk of diabetes, breast cancer, colorectal cancer, endometrial cancer, and overall chronic disease (Barclay AW et al., 2008). Dietary fibres Epidemiological evidence has shown that foods rich in fibre help glycaemic control in diseases such as type 2 diabetic patients(). A diet high in fibre helps in control blood sugar levels in those with type 2 diabetes. It also helps with colon health as the high fibre diet with smoothing the stool and facilitates to weight loss (). Fats Dietary fat is one of the most influential nutrients in health. Fats has many functions in the human body, As well as to providing more than twice the energy supplied by carbohydrates and proteins and supplying essential fatty acids, fats slows digestion of carbohydrates in order to fuel the brain he fats serve as carriers for fat soluble vitamins (A, D, E and K) and as parts of cell membranes(). The overconsumption of fat, mainly saturated fat, has been linked to six of the 10 leading causes of death worldwide ().Coronary heart disease and cancer ().There is a strong link between dietary fat consumption and risk of chronic diseases such as cancer, such as colon, breast, prostate, and ovary cancer (). Several studies over the past 30 years have verified the relationship of high dietary fat intake with higher mortality due to various cancers (). Some saturated fatty acids raise blood cholesterol levels and, thus, increase the risk of atherosclerosis (). High fat, intake is a main cause of obesity, hypertension, diabetes, metabolic syndrome and gallbladder disease (). Studies have show that countries with higher per capita intakes of fat, especially animal fat, have higher incidence rates of certain cancers, including breast, colon, prostate, and pancreas.[41] Migrational studies show that when individuals move from a country of low fat intake to one of high fat intake, the risk of some cancers increases [42] . Vitamins Vitamins are essential nutrients hey are required in small amounts, but have important and specific functions such as promoting growth, reproduction and the maintenance of health. Nutritionally, they form a cohesive group of organic compounds that are required in the diet in small amounts (micrograms or milligrams per day) for the maintenance of normal health and metabolic integrity. They are thus differentiated from the essential minerals and trace elements (which are inorganic) and from essential amino and fatty acids, which are required in larger amounts. Vitamin deficiency however, may increase the risk of chronic diseases (). Suboptimal folic acid levels, along with suboptimal levels of vitamins B(6) and B(12), are a risk factor for cardiovascular disease, neural tube defects, and colon and breast cancer() and low levels of the antioxidant vitamins (vitamins A, E, and C) may increase risk for several chronic diseases. . Nutritional Transition There are now approximately 350 million obese and more than 1 billion overweight people in the world, living in both developed and developing nations. Previously, underdeveloped nations grappled with undernutrition. Now many of these countries like St. Lucia are in a transitional state and are dealing with the twin evils of under- and over nutrition. In the Caribbean nations between the 1970s and 1990s, the prevalence of overweight/obesity increased from 7% in men and 20% in women in the 1970s to 22% in men and 58% in women (Ragoobirsingh D et al., 2004). The global prevalence of overweight amongst preschool children is estimated at 3.3%. Within the Caribbean region and St. Lucia has one of the highest incidences for this age group with St. Lucia having 2.5% of the 0-5 yr. population ( De Onis M et al.,October 2000) .Obesity in children and adolescents is known to have significant impact on both physical and psychosocial health, these soaring rates of obesity leads to an increase in hyperlipidaemia, hypertension, insulin resistance and abnormal glucose tolerance later in life (Reilly et al., 2003; Weiss et al., 2004). Urbanization, industrialization and transformation processes have been the main cause of this public health accomplishment. In modern cultures, demographic factors interact with social and economic factors and lead to changes in the patterns of health and diseases as hypothesized by Omrans epidemiological transition theory in the early 1970s (Orman et al., 1971). Omrans theory describes the changing pattern of mortality from the predominant communicable diseases to the emerging non-communicable diseases. In his study, Omran defined three stages of epidemiological transition, i.e. the age of pestilence and famine, the age of receding pandemics, and the age of degenerative and man-made diseases (Orman et al., 1971). 1.6 Dietary habits of St. Lucians Food habits reflect the plantation past: the typical diet contains a lot of starches, animal protein content that varies by location, and until recently, little in the way of green vegetables. Starches include various kinds of yams, dasheen, eddos, bananas and plantains, sweet potatoes, cassava and breadfruit. Most of these are boiled, served with some kind of stewed fish or meat, and accompanied by a sauce. Pepper (capsicum) sauce is always present at the table, as most dishes are not prepared spicy hot. Animal protein sources reflect the historical scarcity of this element: pork hocks, pig tail (fresh and salted), chicken back, and saltfish, (cod) salted beef, fish (tuna, flying fishing, red snapper, barracuda, sharke, sardines, jack fish). Most of the dishes are prepared with fats such as; coconut oil, lards, yellow butter. As much as St. Lucia has a wide variety of fruit they are only eaten Fruits such as; mangoes, golden apple, papaya, grapefruit, oranges, cherries, cashew, suga r apple(love apple).Main dishes are accompanied by vegetables such as, avocado, calaloo, spinach, tomatoes, okras, carrots, pigeon peas and lentils, Imported processed foods have been available for decades, but more recently account for larger parts of many meals. Foods such as pasta, rice, 1.7 Cause for chronic non-communicable diseases in St. Lucia Chronic diseases have numerous risk factors, which function at different levels, from the most proximal (i.e. biological), to the most distal (i.e. structural). These risk factors can be classified as modifiable and non-modifiable risk factors. Modifiable determinants include factors that can be altered, such as individual and community influences, living and working conditions and socio-cultural factors, non-modifiable determinants include those factors that are beyond the control of the individual, such as age, sex and hereditary factors. 1.7.1 Biological factors Some populations are susceptible to chronic disease because of inherited genes. In a south Africa a tribal group Afrikaners have been found to have familial hypercholesterolemia, a rare genetic disorder, characterised by very high low-density lipoprotein, cholesterol and early cardiovascular disease.( Steyn K et al.,1996). Genetic and lifestyle factors are considered to be the main contributors in causing type 2 diabetes (ORahilly et al; 2005). The genetic makeup of a person is as essential to the development of the disease but a person lifestyle and environmental factors can contribute significantly. Some of the major contributing factors include overweight, abdominal obesity and physical inactivity and to lesser extent intrauterine and early childhood factors (Alberti et al, 2007) 1.7.2 Early life origin The time between intrauterine growth and the development is the most vulnerable period in the life cycle and places major physiological, metabolic and psychological demand on the mother to support the growth and the development of the fetus (Allen, 2001). Good growth and development is dependent on a sufficient supply of energy and nutrients. Under nourishment during pregnancy is linked with poor pregnancy and neonatal outcomes which can have negative long term implications for the infant such as a reduction in intelligence, growth disorder, low immunity, increased morbidity, mortality and the development of a range of diseases during adulthood (Rasmussen, 2001) It is proposed that type 2 diabetes results from relative intrauterine malnutrition and the latter leads to lifelong programming (Baker et al; 1986). Children with low birth weight are most likely to experience growth restraint, whether due to intrauterine nutritional restriction or genetic predisposition to low birth weight; similar associations of low birth weight have been made for the development of diabetes (Lindsay et al; 2001). Babies who are born low birth weight tend to grow fast after birth catch-up growth, often become overweight as young children. They are most likely to develop high blood pressure and abnormal blood glucose level early in life, which future increase their risk of developing chronic diseases, such as heart disease and diabetes (Barkeret al., 1997). The prevalence of Low Birth Weight (LBW) is approximately 6 and 9% in the Caribbean. The association between low birth weight and adult disease makes urgent the concern of these high LBW prevalence rates in the Caribbean (Henry; 2000). An under-nourishes child is normally a smaller and shorter child (0) Stunting is an indication of long standing mal and under-nutrition and is often accompanied by fat deposition, particularly around the abdominal section when faced with food in abundance. Predisposing individuals to obesity in adulthood. () Likewise children who are born to large mother and are large for their gestational age are most likely to induce insulin resistance and type 2 diabetes later in life (Bennett et al; 2002). In Jamaica children shortness at birth and increased current weight are independent predictors of insulin resistance (Bennett et al; 2002). There is significant amount of evidence, mainly from developed countries, that states intrauterine growth retardation is connected with an increased risk of coronary heart disease, stroke, diabetes and elevated blood pressure (WHO, 2002; Godfrey et al., 2000; Forsà © et al., 2000). It may be the pattern of growth, i.e. restricted fetal growth followed by very fast postnatal catch-up growth that is vital in the underlying disease pathways. Likewise, large size at birth is also associated with an increased risk of diabetes and cardiovascular disease (McCance DR et al., 1996; Leon DA et al., 1998). Behavioural risk factors (lifestyle factors) Lifestyles play an important role in determining chronic diseases and lifestyle changes are likely to be responsible for a significant proportion of their increase over time. 1.7.3 Poor diet Nutrition is a major modifiable determinant of chronic diseases, with scientific evidence supporting the view that modifications in diet have effects on health outcome of a person. Non-communicable diseases are linked to high consumption of energy dense foods, made of animal origin and of foods processed or prepared with added fat, sugar and salt.() St. Lucia is undergoing rapid nutritional transition (Boyne, 2008). There has been an increase of fast-food restaurants, and an increased in the consumption of meals high in fat, sugar, and salt and a reduction in the consumption of cereals, grains, fruits, vegetables, tubers, and legumes (Jacoby et al.,2008). The increased consumption of imported foods high in fat and sodium has led to a decline of the health status of people throughout the region, with an increase in health problems such as obesity and diabetes (Report from WHO, 2003). 1.7.4 Physical inactivity Physical inactivity and sedentary lifestyle is linked with increased levels of obesity, breast cancer, colon cancer

Belong: Charlie Day and Jasper Jones

Hello all, I am here to put forth my ideas about my perception of belonging via reading Jasper Jones by Craig Silvey, and The Happiest Refugee by Anh Do. But first off, what is Belonging? Belonging I feel, is when you have your mates around you, and you're having a good time, knowing who everyone is, fitting in basically. But there can be other parts of belonging when you don't really know people. For example, belonging to a school, but whilst belonging to it, you could still be bullied or harassed.Whilst I was reading Jasper Jones, I came to notice that Carlie, the main character and narrator of this story, belonged to his own world inside his head, where he stores words, as if it's a prize, but he cannot flaunt them, for the town is a mining town, and it would seem that he is trying to be better than them, just because he seeks education. But back to Charlie, he loves to read, and express his feelings on paper, where he can just dive into his own pool of creative ideas, and that's where he truly feels he belongs.Then I go over to The Happiest Refugee and delve into it's bindings, and try to find out if Anh belonged in the Australian culture, and whilst there was was some ups and downs for him, he finally came to. He met a girl, they shared intimacy and he had his local sports footy club, where he belonged to both. But did Charlie feel as if he belonged to his family? I didn't think so. His mother acted as if she she just had to put up with them, because of her secret love life from afar with another man.She didn't think they were worthy of her presence, and if you read the book, you could see the dialogue in which the mother and father had intensive arguments about not talking to each other, the father drifting away and just locking himself in his room. There is also a video which I think is interestign to watch, it was called Who do you think you are? And this episode was for Christine Anu's family, and her search for her family heritage.After she was famous and now considerably old, she is now just beginning to wonder who her other family members are, thinking she does not feel as if she belongs to anything, as she has no idea what her family was like. So they go off an an adventure, and discover the family members, and Christine get's emotional for each member found, and it is a fascinating watch. But to her, as I said, to belong was for knowing who her family members were, what they did, what they acted like.Now back to Anh, and his belonging to his football club, at first in school, some people tried to outcast him, make him feel bad, and that was one of the teachers for Anh's classes, where they were supposed to make posters about how they hated the asian race, despite Anh being there. But I don't think it phased him as much as the teacher wanted it to, in fact, he strived to make himself belong further, to make the teacher accept him, and he eventually did, but Anh didn't feel right about it.And there was one bit in the book, whe n a member from the other football side they were playing called him a ‘gook', and Anh's team mates heard him say that and went on to thump that player as much as they could every time he got the ball in his possession. So that showed his belonging to the team, whilst when they finish the match, they go off on their different ways a bit like Jasper Jones.Now I don't think Jasper Jones ever truly belonged to everyone, I don't believe he had any friends, the whole town hated him, perhaps for his race, or the fact that he steals, and they then push all blame onto him. Then when Jasper found the horrifying scene in the glades, and came to Charlie for help, I think that is when he genuinely had someone to belong to, to confide in, to tell him things, to let it all out.I mean, all the boys grudgingly admired his footy skills, and the girls were all wild about him in secret, but still nobody approached him, just as no one approached Charlie, and that is probably what compelled Jasper to knock on his window that night, to share with him all those things, to take the adventure together. This is my perception of belonging, and I will most likely never understand the concept of it completely, but I have typed out what I think of it, throughout the three texts that I have had to talk about.

Critical analysis of subjects noted in LLB (Learning Log Book) - Free Essay Example

Sample details Pages: 5 Words: 1513 Downloads: 2 Date added: 2017/06/26 Category Management Essay Type Analytical essay Did you like this example? Strategy is one of those aspects associated with an organization that not only shapes its orientation, but also takes care of its operational aspects. It is strategy that decides fate of an organization during various dynamics of the corporate world. Strategy is the basic parameter that could enhance performance of the organization by taking all the factors concerned into account and making best possible decision in this regard. Don’t waste time! Our writers will create an original "Critical analysis of subjects noted in LLB (Learning Log Book)" essay for you Create order This case depicts four phase model in synchronization with spiral dynamics in order to make sure that best possible outcome in terms of performance could be attained. This model is based over four innovative outcomes which will ensure that every possible outcome will not lead to organization productivity in appropriate harmonization with organization strategy and vision. It will act as a roadmap for improving both organizational as well as individual performance. These four phases are vitalizing, optimizing, shifting, and transforming in such a manner that organizational goals could be achieved in both efficient as well as effective way without any ambiguity. Also orderly combination of all these phases is an essentiality as without it, this strategy will lose its essence. Key Learning Points With constantly changing external environmental conditions, it has become inevitable for the companies to exist without following a dynamic strategy. Companies have to comply with both corporate sustainability as well as responsibility to ensure their profitable existence. Four phase model made an inclusion of core assets, i.e. material asset, commercial asset, socialization asset, and intellectual asset. All these assets interact with each other at one point or the other which finally helps in identification of factors like cost revenue at organizational level and input and output at individual level. These assets in harmony with organizational goals helps in focusing of both internal and external issues associated with the organizational functioning by orienting the strategies. Strategic orientation includes effectiveness, i.e. market based approach directed to raise effectiveness of the organization, efficiency, i.e. orienting productivity to raise efficiency of organizat ional working, flexibility, i.e. orienting human resource to raise flexibility of organizational functioning, and creativity, i.e. orienting innovation to raise creativity of the organizational functioning. This model makes an inclusion of various features, because of which it may also have several reverse effects that must be taken into consideration. If level of efficient performance is pushed beyond a particular limit, it will result into rigid organization, if flexibility of pushed beyond a limit, it results into anarchy, if creativity is pushed beyond certain point, it results into amateurism, and pushing effectiveness beyond that limit leads to segregated organization. It is highly necessary to maintain control of all these parameters so that organization could function profitably. This can be done by defining specific priority for all the interventions. There are 32 basic interventions that can be considered as significant for the organization and have to be taken care of. It is also important to identify the timing associated with all these interventions as all of them are not important at the same time and their significance vary in accordance with time. There are certain bottlenecks in organizational functioning which ultimately define the pace and orientation of organizational functioning. It is extremely necessary to identify those bottlenecks in order to enhance organizational performance. It can also be backed up by Theory of Constraints by Eli Goldratt that performance of an organization as a system is impeded by a single parameter. It is highly important to identify that factor as without proper identification of that factor, any improvement in organizational performance will not bring much difference. Whenever working cycle of an organization is taken into account, we come across a fact that it will certainly reach a stage of maturity, i.e. organizations continuously enters into new domain that makes an impact over their strategies and the manner in which they are applied. Value system acts as a fundamental entity that defines performance over the period of time. It is primarily derived from external conditions, i.e. confronts and risks. it also has personal aspect related to it, i.e. impact from historic events, societal conditions, location, and existential problem. But development of a value system is a monotonous process that occurs in a fixed manner, i.e. survival safety energy and power order triumph society synergy holistic life system For entire discussion performed above, there are certain challenges that have to be dealt appropriately, like operations should be managed properly to retain margins, conversion of effective innovations and ideas into market acceptable goods and services, employees should be adequately motivated towards their work as they are most crucial elements in defining success of an organization, and continuous monitoring of the environment is necessa ry as organizational work is highly dependent over environmental conditions that changes very fast with time. With the help of four distinct strategies and four contexts, a mixed strategy could be formulated that will help in appositely channelizing organizational strategy and working. This can be with the help of a 4*4 matrix that contain all the elements. there are several benefits associated with it, like It depicts basic objective of four phase model as well as spiral dynamics. Matrix acts as a framework for designing business strategies and policies by keeping academics literature as its basis. Different level of complexities could be well depicted with the help of this matrix. Scanning of strategy is done a regular basis and this matrix provides a basis to perform that action without any ambiguity. It is required as it helps in formulation of further strategies. Matrix also helps in identification of performance cycle which ultimately define a roadmap followi ng which all the pre-defined goals of the organization could be achieved. Relevant Statements to the session Following are the relevant statements, In practice, the Four Phase ModelÂÂ ® has appeared an effective model for managers and management consultants to analyze the present state of organizations and to determine the most likely strategy to further improve their organizations. Ideal type interventions can be plotted in the basic graph of the Four Phase Model: four assets, four quadrants (result areas) and two dichotomies (orientations) makes 32 interventions. A metaphor can explain this in more detail: a top in-door cyclist engaged in a sprint duel can be forced to a standstill sur place as he does not want to take lead position. In cycling this is a strategic option. It takes great skills to remain on one spot, but he cannot stay there forever. Inevitably, in order to prevent from tumbling when his skills are fading or when his adversary was finally forced to take the lead, he moves his cycle downward while building up speed, heading for the finish line. Critical Analysis This case has presented a comprehensive study of the strategy formulation and various aspects related to this particular feature. It has defined and related almost all the parameters that are present in the vicinity and interact at various level of management and affect the strategy of an organization. But this case lack explanation through practical and real time examples of several concepts that are mentioned in it. Mixed strategy has always produced better results in most of the situation, but it could also fail deliberately in certain condition which makes it necessary to portray both the circumstances that may incur into such outcome. This case does contain an explanation through a metaphor, but it is quite idealistic. Author could have specified more practical aspects to the strategy formulation for the purpose of implementing sustainable performance. Practical Implications Organization: Etisalat Etisalat is a telecommunication major based on Middle-East. Telecommunication has emerged as a sector with one of the highest echelon of competition for which continuous growth is the only option. It has made inevitable for Etisalat to follow a single strategy to enhance its performance, which resulted into following a mixed strategy. It has to follow a mixed strategy as it is facing competition from global players, like Airtel (India) as well as local vendors. Following a mix strategy it is expanding its domain and has recently stretched a fiber optic from India to Europe which will provide its customers with high speed network. Its geographic location, i.e. center of the world provides it a strategic advantage over its rivals and also one of the best possible business examples suitable with given case. (Etisalat, Airtel launch fibre optic cable from India to Europe, 2010) Learning Reflections Strategy is an entity that defines working of an organization irrespective of its scale and level of operation. Thus it is highly mandatory that it should be made in compliance with all the factors that could enhance the performance of the organization and provide it with maximum benefit. For this reason following single strategy to enhance profit would not provide best performance returns as compared to a mix of strategy in a scenario like present which is highly dynamic in nature. This case depicts four phase model along with spiral dynamics that results in a strategy matrix that finally helps in attaining the desired objectives, i.e. vitalizing, optimizing, shifting, and transforming.

Is Stem Cell Reasearch and Treatmetn Ethical - Free Essay Example

Sample details Pages: 5 Words: 1370 Downloads: 8 Date added: 2019/06/19 Category Biology Essay Level High school Tags: Stem Cell Essay Did you like this example? Bethesda, MD. Stem Cell Basics I. National Institutes of Health, U.S. Department of Health and Human Services, 2016, https://stemcells.nih.gov Don’t waste time! Our writers will create an original "Is Stem Cell Reasearch and Treatmetn Ethical?" essay for you Create order Accessed 25 November 2018 The source gives an introduction to stem cells, explaining what they are and their importance. The source continues to go into information on different types of stem cells, including where they are located and what they are used for. The source also includes the uses of stem cells and obstacles that doctors face while using them. This source will help me give background information on stem cells that I will need to tie into the ethical issues surrounding stem cells and their uses. King, Nancy Mp and Jacob Perrin. Ethical issues in stem cell research and therapy Stem cell research therapy vol. 5,4 85. 7 Jul. 2014, https://www.ncbi.nlm.nih.gov Accessed 25 November 2018 The source gives information on stem cell research, the different types of stem cells, and the clinical trials they are used in. This source ties in the ethical issues and concerns that come with each type and how animal clinical trials could help avoid issues. The source includes information on the uncertainty of it all but how the positive outcome of using stem cells outweighs it. I am planning on using this source because of this as it will give information on ethical issues with stem cell research and clinical trials for therapy. Lo, Bernard and Lindsay Parham. Ethical issues in stem cell research Endocrine reviews vol. 30,3 (2009): 204-13, https://www.ncbi.nlm.nih.gov. Accessed 25 November 2018 This source digs deeper into the ethical issues surrounding the different types of stem cells in research. The source will help me get a better understanding of the issues surrounding the topic.The source also gives information on different types of stem cells and their uses and ties in the ethical issues with each. I am planning on using this source to help me add more information to the ethical issues with stem cells and how to avoid some of them. Mayo Clinic Staff. Stem Cells: Frequently Asked Questions about Stem Cell Research. Mayo Clinic, Mayo Foundation for Medical Education and Research, 24 Oct. 2018, www.mayoclinic.org Accessed 25 November 2018 The source gives information on what stem cells are, their uses, and the different types. Controversy, where stem cells are from, and why they are used is included as well. All of the information though, I have found in other sources and it is just repeating the same topics. As a result, I do not plan on using this source for my essay but it was a good starting point. Nine Things To Know About Stem Cell Treatments. A Closer Look at Stem Cells, INTERNATIONAL SOCIETY FOR STEM CELL RESEARCH, www.closerlookatstemcells.org. Accessed 25 November 2018 This source gives information on important details about stem cell treatments and applications. The source dives into the problems behind treatments that are not well developed and how people should be weary of it. There is also details on how current treatments do not match clinical trials and how not many have been proven to be safe. I will use this source to give more information on how stem cells treatment is still growing and that a chance for change could happen. Resnik, J.D., Ph.D., David B. What Is Ethics in Research Why Is It Important? National Institute of Environmental Health Sciences, U.S. Department of Health and Human Services, 1 Dec. 2015, www.niehs.nih.gov. Accessed 27 November 2018 The source gives information on the ethics used to help research and the principles to be addressed in research. The source also gives details on how ethical norms help research progress. This source explains the principles to keep in mind and why they are important to be aware of during research. I am planning on using this source to give me a better understanding of the ethics behind scientific research. Siegel, Andrew. Ethics of Stem Cell Research. Stanford Encyclopedia of Philosophy, Stanford University, 25 Apr. 2008, https://plato.stanford.edu Accessed 25 November 2018 The source covers information on the ethics of stem cells, specifically embryonic stem cells. The source includes the ethics of destroying embryonic cells, of using them, and creating them for research and therapy. The source also touches upon how scientist are using stem cells to derive gamete to create these embryonic cells and the problems behind it. I will use this source as it gives information on the ethical problems behind embryonic cells which is one of the types of stem cells I will be focusing on in my paper. Stem Cell Transplantation and Regenerative Medicine. Types of Stem Cell Transplantation. EHR National Symposium, https://med.stanford.edu Accessed 25 November 2018 The source gives information on the different types of stem cell transplant and a brief explanation on how they are collected. It explains each process and where the cells are collected from for the transplant. I will use this source to give information on the transplantation of stem cells. This information can tie into ethical problems involved in stem cell research. The Stem Cell Debate: Is It Over? Nutrition the Epigenome, Genetic Science Learning Center, 10 July 2014, https://learn.genetics.utah.edu Accessed 25 November 2018 The source gives details on the problems surrounding newer stem cells research and treatments. The source only focuses on embryonic cells and the ethical problems involved. I do not plan on using this source as the information is limited to only embryonic cells which I cover in a different source. The other source gives a better in depth explanation of it which I why i am choosing it over this one. Types of Stem Cell Transplant. Dana-Farber Cancer Institute, Dana-Farber Cancer Institute, www.dana-farber.org Accessed 25 November 2018 The source goes into the many different types of transplants that doctors use with stem cells that could be helpful in explaining the need and use of stem cells. The source also explains how they are collected for transplant for use. I might use this source as it gives more background into how stem cells are used for therapy and transplant. Though, at the same time it is about some of the information that I have already collected in other sources. Types of Stem Cell | Stem Cells | University of Nebraska Medical Center. UNMC, University of Nebraska Medical Center, www.unmc.edu Accessed 25 November 2018 The source gives details on the few different types of stem cells and where they are located or how they are created. The source only cover these topics which I cover in other sources. As a result, I do not plan on using this source. The source does not give me new information or information that I can get from other sources. Volarevic, Vladislav et al. Ethical and Safety Issues of Stem Cell-Based Therapy International journal of medical sciences vol. 15,1 36-45. 1 Jan. 2018, https://www.ncbi.nlm.nih.gov Accessed 25 November 2018 I will not be using this source as it mostly talks about topics I am not planning to include in my paper. It briefly touches upon the ethical issues of stem cell therapy but includes more about the therapy and its safety issues. Two of my previous sources from the same webpage cover my topic better and can fill in for this source. What Happens during the Stem Cell Transplant Process? Dana-Farber Cancer Institute, Dana-Farber Cancer Institute , www.dana-farber.org Accessed 25 November 2018 I do not plan on using this source as it does not give enough information on what I am looking for. It gives a brief explanation on what happens during the stem cell transplant process. Which I may need but I cover this in other sources. Otherwise, the source goes into topics that I am not including in my paper. These topics include chemotherapy and white blood cells that I do not need information about for my paper. What Is a Stem Cell Transplant (Bone Marrow Transplant)? Dana-Farber/Boston Childrens Cancer and Blood Disorders Center, Dana-Farber/Boston Childrens, www.danafarberbostonchildrens.org Accessed 25 November 2018 I might use this source to give information on the process of stem cells transplant. This source covers the process but only specifically bone marrow transplants. The source is limited and might not give me the information I need for the direction my paper is planning to go in.