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

Interracial Adoption Essay -- Social Issues, Foster Care, Racial Relat

Imagine being a child without a family, longing for to be living in place to call home you, and feeling incomplete because you do not have a place where you belong. Many children in foster care or orphanages are faced with similar feelings. Children who live in the United States often wait years to be adopted and in most cases, the minority children wait twice as long to be placed with families of their own ethnic background. One article by Linda Johnson Price, the president and CEO of Ebony magazine and a woman who was also adopted, discussed the fact that there are around 500,000 children in foster care waiting to be placed into a home and that close to 45 percent of those children are black (Rice, 2007). She also specifies that the Department of Health and Human Services has studies that show that African Americans wait longer than any other race and that adoption experts say that black children are deemed special needs children and it does not necessarily have to do with their me ntal or physical capabilities (Rice, 2007). The number of minority children waiting to be adopted will continue to rise unless we come up with a solution. One way to address the issue with the long wait process that these children experience is to consider interracial adoption. This type of adoption refers to potential parents who choose to adopt a child or children of a different race, culture, or ethnicity from their own. In order to address the disproportion of minority children who wait to be adopted, we must first consider the requirements one faces to be able to be a perspective adopting parent. The adoption process starts off by choosing an adoption agency. Next, the agency will send someone to the prospective parents’ home to gather informat... ...ion will say that parents who adopt children of different ethnicities are not capable of caring or educating the child simply because of the cultural differences. The critics opinion has merit in the since that the parents cannot teach the child to be their race but they can provide love and raise them to be responsible adults. In the end we must consider which is more important, being able to find a child a loving family when race is not a factor or waiting for an indefinite time to try to find a family of the same race. If you are thinking about which is more important remember that for every twenty children who are in foster care at least nine of them wait an extended amount of time to be adopted. All children deserve a loving home and although we live in an imperfect society our children should not have to experience the feeling of not being wanted or loved.

Defining ‘Multicultural Education’ and the Need for It in Singapore

Increasingly insensitive, crude and discriminatory racial remarks about ethnic groups other than their own have been heard to escape the lips of our young preschoolers at an alarming frequency and with a degree of nonchalance that is disconcerting. A good number of young children in the local childcare scene reveal a warped impression of other races, especially those of darker skin tones, as they pass comments such as, â€Å"Eee†¦ Indians are so smelly,† or create verses to juvenile games like, â€Å"A, E, I, O, U; ‘Mangkali’ (referring to Indians) love you! Dr. Darlene Powell Hopson, co-author of Different and Wonderful: Raising Black Children in a Race-Conscious Society explains that because of their advancing perceptual skills, children are increasingly able to recognize the apparent outward differences in people- varying skin tones, facial and bodily features, hair textures, and eye colors. With this enhancing perceptual ability follows the development o f children’s individual character.As each child’s sense of identity and interpersonal skills begin to mature, his individual preferences, likes and dislikes, as well as his own opinions begin to form and become established in him. A sense of autonomy naturally unfolds along with the urge to exercise and assert this newfound personal right to make one’s own views heard and known. This implies that the child will begin to form opinions and judgments of a person based firstly on the most obvious aspect of the other party- the outward appearance.The child will decide if what he sees appears pleasing to his eyes. Because preschoolers also develop a desire for social acceptance, peer pressure will majorly influence his final decision of whether he will open his arms in approval, acceptance and favor of that individual. Retaining a discriminatory attitude toward someone because of his/her race causes serious obstacles to young children’s healthy development. â⠂¬Å"[T]hey end up with a warped perception of the realities and demands of everyday life. (Veel, E. Singapore’s Child: Celebrating Diversity (July 2008), pg. 29. ) If Feng Kai, a child with a bias against other races, is given the opportunity to make a choice between partnering with Govindasamy and Mei Ling, thinks to himself, ‘I don’t want to hold hands with Govinda. I don’t want my hands to become dirty,’ and ends up choosing Mei Ling instead, Feng Kai deprives himself of the chance to become better acquainted with Govindasamy and to benefit from his association.In judging Govindasamy by a baseless biasness, Feng Kai chooses to stop himself from making a friend. If this misconception is not corrected, Feng Kai will learn to allow the superficial aspects of things to influence his daily decision-making significantly. In teaching Feng Kai to look beyond the obvious outward differences of skin color, and into Govindasamy’s values and personali ty instead, we help Feng Kai to develop the ability to recognize and appreciate actuality beyond superficiality – an ability that will help him function effectively as a person.Dr. Roy Kaplan, executive director of the Tampa Bay chapter of the National Conference for Communities and Justice, comments, â€Å"Nobody’s born a bigot. † Evidence shows that prejudices which exist within the young are nurtured primarily by the influences that children are exposed to most often and most extensively. Principally, these include their home environment, the behavior of family members and close friends (including the peer pressure they are subject to in school), as well as the childcare setting.While the moral education children receive from home and the examples that family members and friends set that influence children most profoundly are factors beyond our power to control, the childcare setting is the only aspect in this, our cause to foster racial awareness, which lies within our ability to manage and steer in the direction of our objectives. It is essential for children to learn that they must overcome racism and all forms of bigotry; for if not, our society’s rising generation will grow up o sow racial discord which could reap very adverse repercussions for Singapore: a breakdown of societal unity and a rise of internal contention and dissensions could very possibly ensue. But in order to achieve this democracy in the childcare sector, children must first understand why they ought to overcome racial biasness and look beyond the differences that exist within them. This is where our action research entitled ‘Multicultural Education through Creative Drama’ comes into play in the picture, to facilitate the conversion of racial disharmony to racial unity among young children in Singapore.

10 Easy Ways for Students to Save Money

10 Easy Ways for Students to Save Money While you are in school, and maybe even right after you graduate, you are going to be on a tight budget. Looking for little ways that you can save money will prove to be very important during your school years and beyond. Lets explore 10 easy ways for students to save money. Stop Buying on Impulse Impulse shopping can be very tempting while out and about. The problem with this is that you end up blowing money on stuff you dont really need, and sometimes on stuff you dont really want. Before making a purchase, make sure it is truly necessary.   Dont Use Credit Cards Credit card companies love giving cards to young people. Many students give into the temptation to buy now and pay later. Unfortunately, these spending habits can come back to bite you. If you find that you cant use credit cards responsibly, hide the plastic until you learn a little restraint. Give Up Your Worst Habit Everyone has at least one bad habit. Maybe you smoke, drink Cosmos like no tomorrow, or buy expensive coffee before class. Whatever it is, cut it out. Youll be surprised at how much money you save. Dont Try to Keep Up With People Who Are Richer Than You Just because your roommate or your pals down the hall have a seemingly endless allowance, it doesnt mean you do too. Try to avoid keeping up with the people you hang out with and stay true to your budget.   Bargain Hunt Every Time You Shop When shopping, look for clearance items or two-for-one bargains, buy used books instead of new, and order the special instead of something off the menu. If you can find a bargain every time you have to buy something, the savings will add up.  Ã‚   Buy Machine Washable Clothes Youre in college. You dont need a dry cleaning bill! Buy clothes that you can wash yourself.  If you must buy dry clean only clothes, try to limit how often you wear them and find ways to cut dry cleaning costs.   Take Hand-Me-Downs Whether it is a used book or previously worn clothes, there is no shame in taking hand-me-downs. If somebody offers you something and you can use it, take it gratefully. When youre making more money, you may be able to someday do the same thing for someone else who will be just as grateful. Stay Home While it can be nice to get out of the dorm every now and then, staying at home is much cheaper. Instead of going out for the night, invite a few friends over for movies, games, gossip, or snacks. You might also want to give staycations a try.   See a Matinee Movie watching is a big part of American culture, but going to the movies with a few friends can be an expensive outing. Instead of going at night, try catching a matinee. Daytime shows are usually half the price of their nighttime counterparts and can be just as much fun.   Use the Library Most libraries offer you the chance to check out DVDs, CDs, and other forms of entertainment free of charge. Taking advantage of this resource, you can eliminate the money you spend on buying CDs and renting movies. Here are 12 ways to save money at the library.

Analysis of the Stylistic Features in “Poetry” by Marianne Moore

Analysis of the Stylistic Features in â€Å"Poetry† by Marianne Moore Analysis of the Stylistic Features in ?Poetry? by Marianne Moore ?Poetry?, is one of Marianne Moore?s most famous poems. In it Moore starts out, ?I too, dislike it.? referring to poetry. However, this does not mean that Moore believed in practicing her poetry half-seriously. She simply believed that in order to create great poetry one would enjoy reading the work spiritually and physically. Moore has had several incarnations of the poem ?Poetry?, including one as short as four lines and one as long as thirty-eight lines. The four-line version was so brief that it allowed for a misinterpretation. However, the longer version defines the poem with her famous phrase, ?imaginary garden with real toads in them.? Moore?s poem, ?Poetry?, is a concrete poem in which Moore?s describes how when poetry is to abstract, it becomes ?self-destructive?. This is because the reader has to analyze the poem so much they lose the experience of reading and enjoying it.English: Alexander Blok's poem 'Noch, ulica, fonar...Her poetry is vivid and gives the reader a sense of experiencing the topic with imagery usage, especially when she describes the animals in ?Poetry?. Her contrast between having a poem being genuine and then another being raw makes the poem dramatic and appealing. The majority of her poem talks about what makes a good poem. This has to do with the poets? imaginary ability when writing a poem. Letting their imagination go but at the same time making it seem realistic. Moore?s state?s her idea in a loose style. The sentences are not choppy or right to the point rather they are long and descriptive. Moore?s stanzas are broken up in the middle of sentences and Moore?s third stanza is part of a sentence that doesn?t end till the following paragraph.Moore?s poem, ?Poetry?, is very unique because in it she...

International Entrepreneurship Essay Example | Topics and Well Written Essays - 2000 words

International Entrepreneurship - Essay Example People often misunderstand the terms entrepreneurs and leaders, it is perceived that both the terms are synonymous but in reality it is not so. The traits of an entrepreneur are quite similar to that of a leader but it is unfair to say that both the terms are synonymous. This paper is going to deal with the risks which the entrepreneurs take and the dividends the same pays at a later stage. The word seminal means original and influential. These two are the most important qualities expected of any entrepreneur. It is very important that an entrepreneur sustains the growth of the company and at the same should look forward to increasing the same and it becomes highly imperative that the company uses innovation and creativity. An entrepreneur is expected to have a drive which can take the company to another level altogether. The hunger of the entrepreneur should reflect in the activities of the company. Entrepreneurship is considered to be very risky and trick, simply because many new ventures fail to perform as expected. "Most commonly, the term entrepreneur applies to someone who creates value by offering a product or service. Entrepreneurs often have strong beliefs about a market opportunity and organize their resources effectively to accomplish an outcome that changes existing interactions." ( Wikipedia, August 21, 2008). People who think out of the box, in the sense that, those who are able to see an oppurtunity and react according to the situation usually become entreprenuers. Eutreprenership contributes immensely to economy of that particular country, it also creates many job openings for the people. There are many views of the entrepreneurs for instance the classical view, the psychological etc, innovation falls under classical view of the entrepreneurs and it is based on the assumption that the entrepreneur is doing rather than owning. Innovation provides the entrepreneur with a great start and enables early growth in the organization. The risk faced by the international entrepreneurs is much high than the domestic entrepreneurs. This is also because the activities of a foreign market are much more complex than the domestic market. The international entrepreneurs take full advantage of their access to the foreign markets and availability of cheap labor but everything comes at a price, they also have to adjust to the foreign culture quickly, failing to do so would go on to produce undesirable results for sure. The market power of an entrepreneur is increased by the movement in the market power. The same helps the entrepreneur in spreading the risk and leveraging faster returns on new products. To be an entrepreneur one needs to have greater independence and self -fulfillment. When a person becomes an entrepreneur, he/she becomes self employed and it is

Marketing Communication High School Essay Example | Topics and Well Written Essays - 750 words

Marketing Communication High School - Essay Example - whatever communication marketing plans are made to direct and control the marketing operation, they must be flexible, as there are many outside factors which can easily affect the plans, e.g. government legislation; The forth stage is implementation and control of the campaign. Research has shown that over 95 percent of people forget the exact message within six weeks of seeing it. That is why repetition in promotion campaign is so important as the promotion itself (Stone Jacobs 2001). The main activities for advertising agencies have some peculiarities in contrast to traditional marketing communication. But, still, marketing communication mix is the most powerful tool to reach the wide audience in a short period of time. It will include: Incentive schemes. These should be tailored to the needs of a retailer's sales staff and may also include competitions, particularly for sales staff. Competitions linked to generating window displays make a good example of use here, with prizes such as holidays being regularly used. On-line type of promotion. It is featured at the location where many of the final decisions and actual purchases are made. Techniques used here include: temporary price reductions; extra value offers, including offers relating to future purchase; premium offers (incentives), including free mail-in premiums, self-liquidating premiums and banded free gifts (relevant for electronic services). Immediate benefit promotions. A consumer is rewarded for purchasing is immediate, and, as with most incentives, the sooner the reward can be expected and received after the qualifying action, the greater will be the positive effects of that incentive in stimulating purchase action. Included in this promotion category are: price reductions; free gifts (which can be additional service - such as two for the price of one) banded pack offers(service plus discount); economy (special proposition) (McDonald, Christopher 2003). The choice of medium is clearly closely intertwined with the distribution strategy. Today, in rapidly changing environment these communication methods become more varied and sophisticated because of technological innovations borrowed by marketers and the level of competition which forces companies within advertising industry to look for new effective ways to attract customers (Rich 2000).