Demographic Profile of Diabetic Patients

Demographic Profile of Diabetic Patients INTRODUCTION Background of the Study In the last few decades, the world prevalence of diabetes among adults have increased more than twice, and expected to ascend to 380 million by 2030, according to a report from the InternationalDiabetes Institute.1 About 3.4 million, roughly 4.6 percent of the total population in the Philippines are diabetics. This figure is expected to rise to 7.8 million in the next 15 years.2 Despite such high incidence, awareness on diabetes, its complications and treatment remain major challenges, particularly in developing countries such as the Philippines. Prevention through patient education is imperative because the burden of disease on healthcare and its economic implications are of great magnitude. There is a significant amount of evidence that patient education is one of the most effective way to lessen the complications of diabetes. 3,4,5,6 When coupled with appropriate medications, it is associated with decreased morbidity and mortality.3 Patient education is more likely to be effective if we know the characteristic of the patients in terms of what they know about their disease, their attitude towards it and what they practice in their medications, diet and lifestyle. Very few studies has been made on our country to find the prevailing awareness, attitudes and practices among diabetic patients, 7,8,9 which can aid in the development of future health education interventions targeting the disease. In this study, we will determine the demographic characteristics of diabetic patients consulting at the Diabetes Clinic of a tertiary hospital in Davao City and assess their level of knowledge, attitude and practices (KAP) towards Diabetes Mellitus (DM) and the relationship of KAP and glycemic control among type 2 diabetic patients in an urban health care facility. REVIEW OF RELATED LITERATURE In the Philippines, the prevalence of diabetes according to the NNHES (National Nutrition Health Survey) study is approximately 4.6-7.2%. This figure expands to 17.8% after adding those who have pre-diabetes (impaired fasting glucose or impaired glucose tolerance or both) which has a prevalence of 10.6%. 2Therefore, one out of every 5 Filipino could potentially have diabetes mellitus or pre-diabetes. As such, the increasing trend of its incidence rate is causing alarm among medical practitioners, and among affected patients as well. In the context of an alarming increase in the magnitude of type 2 diabetes mellitus in our country, the prevailing knowledge, attitudes and practices of these diabetic patients assume immense importance in the control of the disease. Across the globe, a number of studies have been done about perception and practice of diabetic patients10-14, especially in third world countries. An Indian study made by Mukhopadhyay, et al 2010, looked into the perceptions and practices of patients with Diabetes Mellitus Type II in a tertiary hospital.11 In the Philippines, a similar study was done in the rural community of San Juan, Batangas, Philippines. A total of 156 diabetic residents were included as participants of the survey. Knowledge scores were relatively low, with an overall mean of 43%. There were also poor positive responses to attitude scale. The study emphasized the importance of evaluating knowledge, attitudes and practices as crucial means to understand observed behaviors and guide behavioral change.7 According to the American Diabetic Association, self management education is defined as the process of providing the person with diabetes the knowledge and skill that is needed to perform self care, manage immediate concerns and make life style changes. 3 To achieve such effective self care, diabetic patients and their doctors should work hand-in-hand together. Some studies have shown that self-care among individuals with type 2 diabetes had improved glycemic control and reduced complications 15, 16, 17. For people with diabetes, self-management education training is vital since diabetics and their families provide most of their care themselves. It is imperative that regular patient counseling and group education at follow-up visits by health care professionals to help in improving patients’ knowledge and ultimately modify their practices. 19 However, in our setting, adequate diabetes self-management education programs are lacking or weak in most government hospitals in tertiary care. Hence, results of this study could help us design our education programs targeting certain groups or issues that needs further strengthening. Research Question What is the level of knowledge, attitudes, and practices and its association with glycemic control among persons with type 2 diabetes in the Diabetes Clinic of Southern Phiilppines Medical Center? Significance of the Study The study will contribute to the understanding of the current status of diabetes care in our local setting, and help in the implementation of programs that would address pressing needs in our patient education and management, based on their knowledge, attitude and practices. It will also help us identify the association of KAP and glycemic control, and further assess the impact of diabetes self-management in disease control. Objectives: General Objective: 1. To determine the knowledge, attitudes, and practices of patients with type 2 diabetes in the Diabetes clinic of a tertiary hospital. Specific Objectives: To determine the demographic profile of the diabetic patients in the Diabetic clinic of a tertiary hospital in Davao City, in terms of : Age Gender Highest level of educational attainment Employment status Duration of diabetes Antidiabetic medications Co-morbidities To determine the association between patient factors such as age, sex, level of education, employment status, duration of diabetes, antidiabetic medications and co-morbidities and their level of knowledge, attitudes, and practices (KAP) regarding diabetes To establish the association between the patients’ KAP and their corresponding glycemic control based on HBA1c levels METHODOLOGY Research Design: The study will employ a clinic-based, cross-sectional analytic study design. Research Setting: This study will be conducted at the Diabetes outpatient clinic of a tertiary hospital in Davao City, from May 2014 to June 2014. Participants: All patients who are diagnosed with type 2 Diabetes Mellitus type 2 (T2 DM) who are seeking consult at the Diabetes Clinic in a tertiary hospital for the period of May to June 2014. Inclusion Criteria: Patients must be a diagnosed case of Diabetes Mellitus type 2 based on the following criteria: Plasma glucose > 126 mg/dL (7.0 mmol/L) after an overnight fast Fasting is defined as no caloric intake for at least 8 hours up to a maximum of 14 hours, or Two-hour plasma glucose > 200 mg/dl (11.1 mmol/l) during an Oral Glucose Tolerance Test The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water after an overnight fast of between 8 and 14 hours, or A random plasma glucose > 200 mg/dl (11.1 mmol/l) in a patient with classic symptoms of hyperglycemia (weight loss, polyuria, polyphagia, polydipsia) or with signs and symptoms of hyperglycaemic crisis. Patient must have informed consent. Exclusion Criteria: Patients who does not meet the criteria for T2 DM but are seeking consult at the Diabetes clinic: Impaired fasting glycemia and Impaired glucose intolerance. Patients who have intellect impairment and could not participate in the survey Sampling Procedures All the DMT2 patients visiting the diabetes centre during this period will be identified using the convenient sampling method. Assuming that the prevalence of knowledge among Filipinos is 43% 7 and estimating the proportion within 95% confidence interval with 5% error, the sample size is 168( Raosoft Sample size formula). Data Collection: The data will be collected by giving out pretested predesigned questionnaire to participants with informed consent. Pre-testing of the questionnaire will be done prior to the research proper. Relevant information from the participants will be gathered including: age, gender, highest educational attainment, employment status, duration of diabetes, antidiabetic medications and co-morbidities. Questions pertaining to their knowledge, attitudes and practices will be given in order to assess their corresponding levels. The KAP questionnaire will be adapted from a Malaysian study by Shu Hui Ng et al 15, â€Å"Reality vs Illusion: Knowledge, Attitude and Practice among Diabetic Patients†. The questionnaire has been used in previous KAP studies among diabetics and has proven to be a reliable tool. The self-administered questionnaire had a total of 25 questions (knowledge-14, attitude-5, and practice-6). Each correct answer will be given a score of ‘one’ and the wrong answ er was given a score of ‘zero’. Good knowledge attitude and/or practice will be considered if a patient attains >50% of the total score for each domain. To assess the relationship between KAP towards DM and the actual disease control, most recent(4 +/- 2 weeks) levels of HbA1c will be obtained from the patient records. HbA1C > 7% is considered to have poor control of DM. A. Independent Variables Independent Variables include: sex, age, educational attainment, current employment status, co-morbidities, latest hba1c result. B. Dependent Variables Dependent Variables include: levels of knowledge, attitude and practices Data Handling and Analysis: The principal investigator will ensure that all data collected in the study were of utmost confidential nature. Data analysis will be performed to ensure quality results using frequency, percentage, and statistical analysis. The chi-square test will be used to determine the relationship between KAP and t-test to assess the association between KAP and diabetes control. Spearman correlation test will be used to determine the association between knowledge and attitude, and between knowledge and practice. The level of statistical significance will be set at p

Karl Marx And The Communist Manifesto Essay -- Communist Manifesto Essa

Karl Marx And The Communist Manifesto Because the first printing of the Communist Manifesto was limited and the circulation restricted, the Manifesto did not have much impact on society after it was written in 1848. This meant that there were not many people who had access to the document. It wasn’t until 1871, when the Paris Commune occurred, that the Communist Manifesto began to have a huge impact on the working class all over the world.[i] The Paris Commune, which was the insurrection of Paris against the French government, resurrected the idea of communism that had been banished for good just a few years after the Manifesto’s publishing. It created widespread interest of the Manifesto among the dominant classes as well as in the labor movement. In their 1872 introduction to the Communist Manifesto, Marx and Engels acknowledged the important influence of the Paris Commune on their thinking: â€Å"One thing especially was proved by the Commune, viz., that ‘the working class cannot simply lay hold of ready-made state machinery, and wield it for its own purposes.’"[ii] The Manifesto would soon become the most widely read publication of the modern working class (Proletariat) movement. By the late 19th century, through the influence of the Internationals (communist organizations), Marx’s ideas had become popular with the European trade movement, and the major socialist parties were committed to his ideas in theory if not in practice. A major separation occurred, however, between those socialists who believed that violent revolution was inevitable, and those, most notably Eduard Bernstein, who argued that socialism could be achieved by evolution. Both groups could cite Marx as their a... ... on humans all over the world. Notes [i] Bob Jessop, The Communist Manifesto as a Historical Document, <http://members.jcom.home.ne.jp/katori/Jessop_on_CM.html> (21 March 2002). [ii] Karl Marx and Frederick Engels, Preface to the German Edition of 1872, in Manifesto of the Communist Party, (New York: Pathfinder, 1987), 13. [iii] Paul Dorn, Two Months of Red Splendor: The Paris Commune and Marx’ Theory of Revolution, <http://userwww.sfsu.edu/~pdorn/Marx.html> (21 March 2002) [iv] Dorn [v] Dorn [vi] Paul Lewis, For Many, Marx’s Manifesto Remains Relevant, The New York Times (Sept. 21, 1997). [vii] Lewis [viii] Jessop [ix] Philip J. Kain, Marx and Modern Political Theory, (Maryland: Rowman and Littlefield Publishers, Inc., 1993), 360. [x] Kain, 360

Crime and punishment morally ambigous character Essay

Several morally ambiguous characters played different vital roles in Crime and Punishment by Fyodor Dostoevsky. In fact, most characters illustrated in this twisted novel can be evaluated as possesing â€Å"good† and â€Å"evil† qualities. Sonia Marmeladov is especially ambiguous and important in this novel. Her contradicting social and moral statuses along with her contrasting roles as a saintly liberator and sinner allowed Sonia to play a crucial role throughout the novel. Not only that but her character further strengthens the theme of religious awakening. At times Sonia’s character becomes hard to categorize as â€Å"good† or â€Å"evil† because of her actions. The first descriptions the reader gets of Sonia are from her drunk father, Marmeladov. She has lived her life with little money, poor housing conidtions described as having â€Å"every sign of povery† (294). Sonia tries to make an honest living by making linen shirts but â€Å"do you suppose that a respectable poor girl can earn much by hard work? Not fifteen farthings a day can she earn†(15). Not merely enough to support a family along with her drunk father’s habits. So Sonia eventually becomes a prositute in order to to support her family and gains a â€Å"yellow ticket† (16) This is what gained Sonia her title as a sinner and which puts her character at question. However, Marmeladov explains to Raskolnikov how Sonia goes to them â€Å"mostly after dark, she comforts Katerina Ivanorna and gives her all she can†( 16). This part of Sonia’s character depicts her as a loving daughter willing to sacrifice herself to save her family. This portrayal in some ways resembles Christ as â€Å"He himself bore our sins† in his body on the cross, so that we might die to sins and live for righteousness. † He sarcrificed himself as she sacrifies herself. Does that change the fact that she is committing a sin? No of course not and that is exactly where the conflict of her morality takes place. The world sees her in â€Å"such an attire†(163)which puts her to shame in her â€Å"guady finery† (163) Yet the reader sees a young, timid girl who was pushed to take drastic decisions in her life. It is Sonia’s actions which are â€Å"evil† but her purpose and pure soul make her more saintly than most of the character’s in the novel. Because her character plays this role, it is her who helps Raskolnikov find his religious faith and who leads him to finally come clean later on in the book. Another circumstance where Sonya is morally ambiguous is where she has to decide to either have a relationship with Raskolnikov, or leave him out of the picture when he tells her that it is he who murdered the pawnbroker. Sonya knows that it is right to help Raskolnikov because he could be lost and go even deeper into his madness. However, Sonya knows that Raskolnikov is a killer and it would be wrong to be associated with somebody who knowingly commits sins as extravagant as murder. Sonya is also aware that Raskolnikov has issues and his madness could drive him to do other things that could lead to even worse consequences. Sonia does tell Raskolnikov that he must turn himself in and confess his sins but she also hugs him and kisses him as to comfort him. Her odd response is to tell Raskolnikov â€Å"I will follow you, I will follow you everywhere†¦Ã¢â‚¬ ¦ I’ll follow you to Siberia† (407). As she tries to find a valid excuse as to why he killed those women, she finds that there was no good intentions in his mind, yet she still sticks by Raskolnikov’s side. This response leaves the reader wondering whether Sonia is doing this to help a lost soul and play her role as a saintly liberator or does her love blind her and is she simply not caring that what Raskolnikov committed was murder. However, even though the last part of the book depicts Sonia as an accomplice to a morally wrong crime, the epilogue illustrates her as a saintly liberator. In Siberia, the image which she carried back in part one and part two of the book are stripped and she is loved by the prisoners in the camp. They even called her â€Å"little mother Sofya Semyonovna†(538), and although it is clearly stated that Sonia herself did nothing special to be liked, their preference for her depicts that they sensed her moral â€Å"goodness. † Without direct statement, Sonia herself was the reason why Raskolnikov felt in some way his religious reawakening. Through her unconditional love, she and her role made this â€Å"story of a gradual renewal of a man† (542) happen. Dostoevsky theme of religion was carried on and developed by Sonia’s character through her moral ambiguity. Though her character appears to be immoral in several cases, in the epilogue the reader sees how it all comes together and how Doestoevsky uses Sonya illustrates important social and political issues that were of concern to him, such as the treatment of women, the effects of poverty, the importance of religious faith, and the importance of devotion to family.

Freedom essays

Freedom essays Recently, there have been many crimes that have put our nation in a state of fear. School and work shootings, the 09/11/01 terrorists attacks, recent sniper shootings, and highly publicized kidnappings have had such a large impact on us that one is almost forced to feel that increased security is a necessity. How much security can be enforced before the risk of stepping on someones liberties becomes the new problem? If we do tighten security, how many liberties are we as a nation prepared to let go of? Also, before we agree to sacrifice too many of the rights that our forefathers fought for to guarantee us to be free, can you ever completely make a situation perfect? Is tightening security truly going to make our nation safe or will it make our nation controlled? Although it does not put our liberties at risks, think about how much privacy we really have in this day in age. There are very few stores that do not have cameras installed or people hired to follow their customers throughout the store. Most federal buildings look at your personal belongings through a machine. If we consider the personable content that women often carry in their purses it will be easy to see how awkward this can feel to a woman. Even if we take it to a basic level, in our homes we are often not even assured privacy. Many people have the knowledge to listen to our telephone conversations and to continuously monitor our activity on the computer. Many of these liberties are being threatened already. A perfect example of restriction of liberty in an attempt to have a stricter security is the situation with the schools not allowing parents in the classrooms. I recall when I was a young child and my mother would pick me up from school. It was a very simple process. She would let the secretary in the principals office know that she was there to pick me up and go to my classroom to get me. However, when I pick my child up from school, I do ...

Free Essays on Fire Safety At The Ocean Deck

The Ocean Deck Bar and Restaurant is a staple in the Daytona Beach community. Located on the beach at 127 South Ocean Avenue, the ocean deck provides many customers with an exciting array of food, drink and activities. Other than the social atmosphere at this Caribbean themed restaurant, Fire protection is also on the priority list of its proprietors. The Ocean Deck is a 2 story structure whose primary building material is wood. The upstairs primarily serves as a restaurant while the downstairs serves it’s purpose as a full bar and entertainment area, including a stage for karaoke and bands and a dance floor. During the warmer times of the year, the ocean facing doors of the bar and restaurant are opened to allow for its customers to enjoy the beach while enjoying the facilities. There are five (5) exits spread throughout the building, which provide an easy route for escape in case of an emergency. All exits are properly marked and are kept unobstructed by employees of the establishment nightly. The exits are also well lit, and are supplied with only outward swinging doors to make exiting the building as easy as possible. After speaking with Robert Bergen, an employee of the Ocean Deck’s night shift, we found that fire emergencies are not to be handled by the employees. The employees are informed where to direct patrons in a time of an emergency. They are also knowledgeable in the location of handheld fire extinguishers and manual alarm system actuators. Robert also informed us that during the night shift, when the bar is mostly crowded, the employees must take extra caution due to the fact that many patrons have been consuming alcoholic beverages, which can hinder their ability to act responsibly in the event of an emergency. (Bergen, 2004) To make the Ocean Deck safer and more enjoyable they have put into place, a 177 person maximum occupancy. Although this limit is effective, overcrowding can still become a ... Free Essays on Fire Safety At The Ocean Deck Free Essays on Fire Safety At The Ocean Deck The Ocean Deck Bar and Restaurant is a staple in the Daytona Beach community. Located on the beach at 127 South Ocean Avenue, the ocean deck provides many customers with an exciting array of food, drink and activities. Other than the social atmosphere at this Caribbean themed restaurant, Fire protection is also on the priority list of its proprietors. The Ocean Deck is a 2 story structure whose primary building material is wood. The upstairs primarily serves as a restaurant while the downstairs serves it’s purpose as a full bar and entertainment area, including a stage for karaoke and bands and a dance floor. During the warmer times of the year, the ocean facing doors of the bar and restaurant are opened to allow for its customers to enjoy the beach while enjoying the facilities. There are five (5) exits spread throughout the building, which provide an easy route for escape in case of an emergency. All exits are properly marked and are kept unobstructed by employees of the establishment nightly. The exits are also well lit, and are supplied with only outward swinging doors to make exiting the building as easy as possible. After speaking with Robert Bergen, an employee of the Ocean Deck’s night shift, we found that fire emergencies are not to be handled by the employees. The employees are informed where to direct patrons in a time of an emergency. They are also knowledgeable in the location of handheld fire extinguishers and manual alarm system actuators. Robert also informed us that during the night shift, when the bar is mostly crowded, the employees must take extra caution due to the fact that many patrons have been consuming alcoholic beverages, which can hinder their ability to act responsibly in the event of an emergency. (Bergen, 2004) To make the Ocean Deck safer and more enjoyable they have put into place, a 177 person maximum occupancy. Although this limit is effective, overcrowding can still become a ...

The Sensual Culture Reader Essay Example | Topics and Well Written Essays - 500 words

The Sensual Culture Reader - Essay Example The rise of consumer capitalism initiated several great changes within Western societies. One such transformation was the shifted emphasis from production to distribution, as the distributor got a higher role than the manufacturer and the consumer, because the growing production requires adequate sales. Therefore, it has become necessary to spur consumption by products replacement, when the notion of obsolescence artificially shortens economic cycles in different markets. As a side effect, to the material concerns of people a new factor of mass concern had been added - the visual confirmation of the social status. Another development was the subordination of visual art to the capitalistic institutions. In part, this has been done through sacralization of the art and isolation it in museums, where works of art serve as modern icons, but lose their intersensoriality, which is an active connection between senses needed for the wholeness of experience (Howes 2005, pp.318-334). Such trend s influenced our senses as a cultural frame of our perception because we almost never perceive the world immediately but rather sense it stereotypically.

Racial Prejudice in Cuba Essay Example | Topics and Well Written Essays - 1750 words

Racial Prejudice in Cuba - Essay Example The idea race was used to reconcile the ideology â€Å"All men were created equal but sanctioned slavery† because, at the time, most of the American slaves were African who supplied labor to the superior whites. In this case, the word race was constructed to explain why one group (African) labeled the inferior group was destined to slavery against one group (whites) labeled the superior group.2 Response to Question 3 The distinction between the races was initially created by the European when they conquered the new world and the American slave system. Thomas Jefferson (the man known to be the apostle of freedom) who was a slaveholder was famously known for being the first ever American public figure to justify between races through articulating the theory that supported the natural Africans’ inferiority (California Newsreel, episode3). Following the establishment of racial hierarchy in the American society the ethnics of the Jews, Italians, and other Europeans immensely benefited from the Federal policies and funding. It is noted that the real estate practices, as well as the regulations of the Federal government, gave directions that so white homeowners benefit from government-guaranteed loans. This made them increase in equity and wealth following increased wealth in their homes. Additionally, the white race enjoyed the services of the black slaves who worked on their coffee firms as laborious and home guards. The white race, as well enjoyed all the freedom, liberty, freedom, and democracy at the expense of the slaves who were predominantly of other inferior race. The distinction between races brought about both individual and institutional discrimination. In this respect, the unmarked race â€Å"white race† had accrued benefits not necessarily because of their merit or hard work, but because the laws, customs, courts and housing were all racial based. The Congress came up with laws that discriminated persons of an inferior race. For inst ance, the 1790 Naturalization Act, which made naturalization of citizenship mean free white heavily, discriminated against other groups destined not to be whites. Additionally, the Courts being institutions of justice were also discriminative. For instance, the Supreme Court discriminated against the Japanese when they acted against the naturalization act when it ruled that the Japanese was not white basing their ruling on science that classified the Japanese as Mongoloid but not Caucasian. It was the very court that had contradicted itself the year before, by ruling that the Asian Indians were not whites, even when according to science they were in the Caucasian category. There are various notable instances where individual discrimination was practiced. The first instance happened when Cherokee families were evicted from their own homes in Georgia which is to the west of Mississippi. This made one person out of the four evictees to die a long way. This showed clearly showed that pr esident Andrew Jackson as a representative of the executive discriminates against individuals since he defended the move claiming that it not the white settler’s greed that brought about the policy but the fate of the inferior race that was established midst the superior race. The ruling made by the Supreme Court in 1922 in Takawa Ozawa against the Japanese immigrant was also a clear demonstration of individual discrimination. There were various racial policies that were created to perpetuate white supremacy. One such dominant is the 1790 Naturali