Menopause experiences of women living in karachi pakistan

Menopause experiences of women living in karachi pakistan This chapter presents the background of the study and the significance of the study to nursing. The study purpose, objectives and the study question are also mentioned in this chapter. Background of the Study World Health Organization (1990) reported that by the year 2030, about 1.2 billon women in the world will be at least 50 years old. It seems that in future we will have more women of old age. According to National Centre for Health Statistics (2003) womens life expectancy is now 79.8 years. Womens life expectancy has increased but their health status and quality of life is in question. To enhance their health status, the National Institute of Health (1991) developed an agenda for womens health research. The first National Institute of Working Conference (1993) recommended for research on menopause as menopause has become a dominant issue in the womens health and the quality of life of woman with menopausal symptoms is affected in various ways. In 1999, the National Institute of Health research agenda included attention to diverse population of women. After that, there was a breakthrough in researches on various aspects of menopause such as staging in menopausal transition, physiology , symptoms of menopause and their relationship. This therefore draws attention to the need to conduct more studies on the menopausal experiences of women living in developing countries, because women spend about one-third of their lives in the post menopausal period. Menopause is a physiological process, which takes place universally in all women who reach midlife. According to World Health Organization (1990) It is an important event that occurs within a long process of menopausal change, the period immediately prior to menopause (when the endocrinological, biological, and clinical features of approaching menopause commence) and at least the first year after the menopause (WHO 1980: 10), in which women move from the reproductive to the post reproductive phase of life as a part of the aging process (Kaufert, 1990; Lock, 1986). Menopause refers to the depletion of ovarian function which leads to stop menstruation and indicates the end of fertility (Lyons Griffin, 2003). All women in their midlife experience menopause but are difficult to determine what are their perceptions and experience as it is affecting womens life in various ways. Womens experience depends upon their socio-cultural norms and personal knowledge (George, 2002). Kaufert (1996) stated that menopause experience also depends on womens health at menopause that can be determined by various factors. These factors include: cultural attitudes towards health, disease, and medical treatments, their reproductive histories, the environmental conditions under which they were born and lived, their exposure to disease. According to the bio-cultural perspective, although menopause is defined as a biological event, the experience of this biological event is shaped by physiological and cultural factors (George, 2002). According to Lock (1986) menopause is of biological and socio-cultural significance; culture provides the ground where values, attitudes, and beliefs about mid-life are transmitted and where the woman attaches meaning to her experiences. Eastern women consider menopause as a natural process and view this life phase more positively as compared to Western women. According to Hafiz and Eden (2007) the differences in attitude between Eastern and Western women can be attributed to more cultural factors than to biological factors. Menopausal women from Asia experience less menopausal symptoms because their social status is raised in older age that the older women in the family are respected as wise matriarchs. They therefore develop positive attitudes toward the incidence of menopause. This is unlike the experience of European and North American women who report more menopausal symptoms and visit health practitioners more frequently. In their experience, the social status of older women in the West declines with age. Therefore, they lose their self-confidence and develop negative attitude. Women living in rural areas have unique needs associated with menopausal experience (Price, 2007 1m, 2008). Geographical and socio- cultural environment is quite different from urban population so they need special attention. Women living in rural areas are often ignored, isolated and have limited health care facilities. Pakistani women lack awareness of menopausal symptoms as well as its long term effects and outcomes but view it as natural and normal process of their life (Malik, 2008; Nusrat, et al, 2008). Although the literature revealed many key characteristic of menopause experience of women in general, there is limited information about the menopause experience of women living in Pakistan. In Pakistan few quantitative studies have been conducted on age, pattern, characteristics, attitude and symptoms experience of menopausal women under the umbrella of menopause (Malik, 2005 Nusart et al, 2008; wasti 1992; Qazi, 2006; Yahya Rehman, 2002). These all studies have utilized the survey questionnaire as data collection tool. In my limited search, none study has been conducted yet by using qualitative approach. Therefore, there is a dire need of qualitative approach to develop in-depth insight of menopause experience of women in Pakistan. Significance of proposed study to Nursing Life expectancy of women has increased and it seems that it will continue to rise because of the development of modern technology and scientific advancement. Menopause is inevitable for women who live long enough. This study would add knowledge in previously existed knowledge about the menopause experience of women living in Karachi, Pakistan. This study will enable nurses to understand menopausal women in better way and teach them the management of their menopausal symptoms and their effects as well as maintenance of their health status during this phase of life. Nurses would also be able to understand the contributing factors which can influence their experience. Working in different areas in different status, nurses, health workers, and LHVS nurse practitioner will be able to provide health education according to their socio-cultural context, arrange sessions on sharing the experience and guide them in managing their menopausal symptoms. Nurses who are working in the hospital or o ther health institute must make them aware of menopausal symptoms of in their middle age so they would be prepare to understand and able to manage their menopause successfully. It would add in previous research on menopausal symptoms experience and can expend the research and may help other in further research if they want to search some other aspects of menopause in the same context/ area of interest to search. Study Purpose The study intends to explore the menopause experience of women living in Karachi, Pakistan. Study Objectives The study objectives include: Firstly, to gain insight about the perceptions of women related to menopause. Secondly, is to find out the impact of menopause on women life. Thirdly, to explore the challenges menopausal women face and finally, to find out the strategies used to manage the challenges. Study Question What is the menopause experience of women living in Karachi, Pakistan? CHAPTER TWO Literature Review Menopause is naturally occurring process which all women throughout the world experience in their midlife. Menopause refers as the depletion of ovarian function which leads to cessation of menstruation and indicates the end of fertility (Lyons Griffin 2003). This section provides an overview of the literature reviewed, relevant to the study and highlights the research carried out on this topic. The forth coming literature is divided into different sections. First, is the physiology of human menstrual cycle and mechanism initiating menopause. Second, is the historical development of research support on menopause? Third, are the concepts or meanings of menopause? Fourth, is the factors affecting and influencing the menopause experience and finally, the comparison of studies undertaken in USA and South Asia. Physiology of Human Menstrual Cycle and Mechanism Initiating Menopause There are four (4) events involving in the hypothalamic pituitary-ovarian axis that control the human menstrual cycle: First, the secretion of follicle-stimulating hormone (FSH), responsible for the development of ovarian follicles and production of estradiol (Hiller, Reichert Van 1981). Throughout the menstrual cycle, estrogen maintains low gonadotrophin levels via its negative feedback effect on hypothalamic gonadotrophin releasing hormones and consequently lutenizing hormone (LH) and FSH secretion. (Yen,Tsai,Vandenberg Rebar 1972). Second, the FSH-induced increase in ovarian estrogen secretion to trigger an LH surge that is called positive feedback (Young Jaffe, 1976). Third, is the LH surge, a hypothalamic pituitary response to the estrogen stimulus? This positive feedback response of estrogen on LH secretion has been used as a test of hypothalamic pituitary function (Weiss, Nachtigall Ganguly, 1976). Final event is ovulation and leutinization of the follicles, triggered by LH surge, forming a corpus luteum. This is an ovarian response that results in progestrone secretion necessary for the establishment of a pregnancy (Vande et al, 1970). The onset of human menopause is thought to be caused by ovarian failure and follicles depletion. However, clinical symptoms and some of the recent data on menopausal woman suggest central nervous system involvement. (Weiss et al, 2004). The Study of Womens Health across the Nation (SWAN) was conducted to determine if the modification of hypothalamic-pituitary response to estrogen feedback mechanism occur in older reproductive-age women as a mechanism of onset of menopause. Three groups of women were studied who had estrogen increased and on LH surge, estrogen increased without on LH surge and neither estrogen increases on LH surge. Anovulatory cycles with high estrogen were frequent in older reproductive age women and there was an evidence of failure of the estrogen positive feedback on LH Secretion to initiate and stimulate ovulation. In anovulatory cycles follicular estrogen levels did not lower LH secretion as it was in younger reproductive age, there was decreased estrogen-negative feedback on LH secretion. It was concluded that there was hypothalamic-Pituitary insensitivity to estrogen, in aging perimenopausal women. Historical Development of Research Support on Menopause In 1993, the first National Institute of working conference recommended for research on menopause and in 1999, NIH research agenda included attention to diverse population of women. Seatle Midlife Womens Health Study was a longitudinal study conducted from 1990 2000 to study the FSH by Menopausal transition stages early, middle and late transition by the use of menstrual cycle calendar. Comparison of reproductive age and peri-menopausal womens cycles. Urinary estron and FSH level by menopausal transition stages late reproductive, early menopause transition and post menopause transition. Study of Womens Health Across the Nation (SWAN) began in September 1994. The purpose of the study was to describe the chronology, the biological and psycho-social characteristics of menopausal transition and the other purpose was to describe the effects of this transition on health and risk factors for age related chronic conditions. The emphases placed on multiethnic samples and community or population based samples. Swan study included daily hormone study over multiple years and annuals blood draws, interview, clinical exams and questionnaire. Multiple ethnic groups of women Africans, Chines, Japnese, Hispanis and White American were included in this study. The stages of reproductive aging work shop (STRAW) was held in Park city USA in 2001. The purpose of this workshop was to develop the staging system for the menopause transition. The benefits of this system are that the researches and clinician can compare cases and data across studies. Women would understand the timing and duration of the transition. This system has seven stages. Five precede and two follow the final menstrual period. Stages from -5 to -3 encompass the Reproductive Interval; stages from -2 to -1 the Menopausal transition and +1 to +2 the post Menopause (Soules et al, 2001). March (2005) A conference on management of menopause related symptoms was held by office of medical applications of research in USA to understand the symptoms and their correlation with menopause transition stage. Seatle midlife womens health study on charting the course of the natural transition to menopause for a population based sample of 35 55 years old white, Asian and African, American women ( n=375) in longitudinal study begun in 1990 and followed until 2006. Women provided daily health diary recording for 3 days per month. Monthly early am urine sample for endocrine analyses and annual health update symptoms rated from 0 (absent) to 4 (extreme). It was estimated that severity of hot flashes increased after the last menstrual period (FMP).There was an association between hormonal changes during menopause transition and the symptoms experienced by the women such as: hot flashes, sleep disturbance, depressed mood, anxiety, fatigue and vaginal dryness. There were some other factors associated with these symptoms severity. As physiology change so there are chances of developing the medical problems. SWAN studies ruled out the other diseases associated with menopause such as cardiovascular disease, osteoporoses. In the period of late and early menopausal transition there may be the the chances that the lumen size of the carotid artery becomes larger (Wikdman et al, 2008).Women experience a high incidence of depressed mood during late menopausal transition (Bromberger, 2007 ; woods et al, 2008). Concepts or Meanings of Menopause Menopause is a complex and significant phase of life that affects womens life in different ways globally. It is a life event that leads to physical as well as emotional challenges (George 2002; Lyons Griffen 2003). One can realize its impact on womens life as was identified by McCrea (1983) stated that in Victorian era menopausal women were used to view as aging women, with a decomposing body and an evil mind suffering from foolishness. All women experience menopause between the ages of 48 and 55 years (George, 2001), but it is difficult to determine how it is perceived by women. What does it mean to her? There is a dilemma attached to it whether it is consider as medical problem or as a life transition (James Deborah, 1997; Lyons Griffen, 2003). There are four main meanings or notions about menopause. First, is the biological or biomedical? Second, is the developmental and natural event? Third feminist notion, as natural female process and fourth, post modern which is related to physiological, social and cultural dimensions. (Gosden, 1985). A biologic definition of menopause refers to permanent cessations of menstruation resulting from loss of ovarian follicular activities and indicates the end of fertility. (Gosden1985). The last menstrual flow is the biologic marker that refers to a woman transition from a productive to non productive phase. Symptoms which are experienced by the women such as: hot flashes, perspiration, palpitation, vaginal dryness, sleep disturbance, forgetfulness, difficulty in concentrating and irritability also describes the menopause. Another aspect of biologic or biomedical view is the disease orientation to menopause which supports the use of hormonal replacement therapy (George, 2002). Changes in physiology seem to be experienced as symptoms that may require medical treatment. Until recently menopause has been viewed from a medical perspective (James Deborah, 1997). It seems that physician view menopause as a disease that must be treated. Menopause as a developmental and natural event considers as a part of womens life and taken to be normal. Menopause is often stressful but it doesnt mean that it is a disease. It should be perceived as a part of the normal developmental cycle. Life expectancy of women has increased now which indicates that menopause will now be seen as a normal event not a medical condition but as it is associated with specific health risks (osteoporoses and cardiac diseases) it is likely that physicians will continue to treat it and its symptoms. Menopause as a feminist notion that emphasizes that it is a natural female process. It can be taken as a change. If a woman understands this period as a change in her life pattern and she would try to adjust and cope with it (Lyons Griffen, 2003). Menopause as post modern notion believes that it is related to physiological, social and cultural dimensions. The meaning of menopause may be positive or negative it depends on the womans culture, the status of the women in the society as well as the physiological change that occurred as a result of menopause. Lyons and Griffen (2003) introduced another meaning and that is confusing and it is between the natural and disease construction. A woman has uncertainty about the menopause and it is the result of lack of knowledge and understanding. If menopause as taken confusing it produces anxiety and uncertainty which further complicate the complexity of menopause. Surgical meaning of menopause refers to the menopause as a result of surgical intervention (oophractomy and or hysterectomy) but the symptoms are same as natural menopause, however, the onset is abrupt and symptoms are more severe as compared to natural menopause moreover, physical and psychological symptoms are due to sudden hormonal change (Park 2005). Menopause may be viewed by women as natural or medical event; it may be confusing or challenging. The way it is perceived ultimately affects womans experience. There are many factors which can be attributed in the menopause experienced by the women. Factors Affecting or Influencing Menopause experience Menopause is a bio-cultural experience therefore bio-cultural factor such as environment, diet, fertility and genetic differences may be involved in the variations of menopausal experience (Beyene, 1986). Furthermore James and Deborah (1997) explained that a womans culture teaches her how she should respond to this event in her life. If a womans role is child bearing by her culture then she perceives her-self unimportant as menopause means the end of her role. George (2002) asserted that the menopause and how women experience it depends on her cultural norms, social influences and personal knowledge about menopause which influence the womans ability to cope with the menopausal period. Elliot, Berman and Kim (2005) added culture is embedded in all aspects of ones life and affects ones ideas, beliefs and ultimately affects on the menopause experiences. Ellen (2005) stated that women with infertility problem experiences menopause as normal and natural event after futile struggle for so long to become productive. Infertility was an abnormal event as it interfered with normal phase in life and menopause for them is a normal event that is supposed to happen so they take it positively. It is believed that each woman experiences the menopausal symptoms in a same way; however this is not the case. Avis (2002), Flint (1975), and Yahyeh and Rehan (2006) asserted that cultural differences also affect menopausal symptoms experience. The pattern and frequency of menopausal symptoms vary from culture to culture. Avis (2002) conducted a large cross sectional study for women aged 40-55 years across racial or ethnic groups of women in the United States for the comparison of menopausal symptoms. Result showed that across all five groups two consistent factors emerged. One was hot flashes and night sweats and the other psychological and psychosomatic symptoms. Caucasian women reported more psychosomatic symptoms; African American women reported more vasomotor symptoms. The pattern of finding argues against a universal menopausal symptoms syndrome consisting of vasomotor and psychological symptoms. On the other hand Im, Liu, Dormire, and Chee (2008) identified that white women b elieve that generational and life style differences are much more important than ethnic differences in menopausal symptoms experience. In a study of Indian women, Flint (1975) found that few women had any problem other than cycle changes. Lock (1986) found that Japanese Women did not have depression and also having low rates in vasomotor symptoms as compare to western culture women. In a cross cultural comparison of menopausal symptoms Avis (1993) reported the rate of almost every symptoms were lower in the Japanese than US and Canadian women. Price, Storey, and Lake (2007) identified that living in isolated environment and lack of social support system; women experienced more severe menopausal symptoms and experienced the loss of control on physical as well as psychological symptoms. It is conclude that the experience of menopausal symptoms is not same for each and every woman. They are influenced by ones socio-cultural back ground (environment, life style, knowledge, values, beliefs and the meaning of menopause perceived). It also affects the overall menopause experience of women. If the meaning of menopause taken negatively, the women will have more intense symptoms and face difficulty in managing herself as well as seek for medical treatment and experience menopause as a threat. Comparison of Researches: USA and South Asia. George (2002) conducted a study to explore the experiences of American women from diverse ethnic and socio-cultural environment. He found that the experiences of American women were not similar; they were all unique in their experiences. Some of them were having high intensity of menopausal symptoms but some did not experience any menopausal symptoms, some of them were confused as they were unaware of what to expect. Some experienced depression but some were feelings of relief from child bearing and monthly periods. Some were looking forward to future. In another online study of white midlife women Im, Liu, Dormire, and Chee (2008) identified that white women believe that generational and life style differences are much more important than ethnic differences in menopausal symptoms experience they are optimistic and try to cope with the symptoms. Women needed assistance with the menopause symptoms and were not satisfied with the guidance of the physicians use humor as coping strategy for menopause to increase their inner strength and motivate them to go through the hardship. Price, Storey, and Lake (2007) conducted a study on experiences of women living in a rural area of Canada. Researchers identified that women considered it as a change of life, and showed high concern about their general health and the changes their bodies under going. The women described the need to understand the intensity of menopausal symptoms (physical, psychological and social), including changes to their physical and mental well being. They need to receive reliable information. Menopause had significant impact on their personal relationships as they were unable to share their experiences with their husbands. Their coping strategies were social support and humor. Elliott, Berman, and Kim (2002) conducted a study on Korean Canadian women on menopause experiences. He found that they view menopause as a natural process and wanted to be fully aware about all aspects of menopause in order to control and cope with this phase of life. They were having difficulties in communication with health care professionals. They were reluctant to share their experiences with their husbands but they expressed the need to share their feelings with someone. Hafiz, Liu and Eden (2007) conducted a study on the experiences of menopause among Indian women. They identified that because of their positive socio-cultural ideas and attitude towards menopause they were not concerned about becoming menopausal and believe that it is a natural event same as birth and death. They experienced more physical and psychological symptoms rather than vasomotor (hot flashes and might sweat). He revealed that physical and psychological symptoms were higher in Asian women. Researches in Pakistan In Pakistan few quantitative studies have been conducted on age, pattern, and characteristics, attitude and symptoms experience of menopausal women (Malik, 2005 Nusart et al, 2008; wasti 1992; Qazi, 2006; Yahya Rehman, 2002). No qualitative studies have been conducted on menopause experience yet. Wasti et al (1993) conducted a study on the characteristics of menopause in three socio-economic urban groups in Karachi. The total samples size was 750 menopausal women. He found one in five women were symptomatic to poorest group but one in two the other groups. He found that fewer women had menopausal symptoms in his study but he admitted or hypothesized that menopausal problem will be most probably increase as life expectancy of women is increasing. He found mean age of natural menopause was 47 years of age. Yahya and Rehan (2002) conducted a study on age; pattern and symptom of menopause among rural women of Lahore will sample size of 130 women from 20 villages. He found mean age at menopause was 49 Â ±3. 6 years. Moreover the common symptoms were lethargy 56.4%) forget fullness (57.7%) urinary symptoms (56.2%) agitation (50.8%) depression (38.5%) insomnia (38.5%) ht flushes (36.2%) and dysparunea (16.9%). He concluded that the mean age of menopause was lower than the reported for Caucasian, but similar to Africa and South America but higher than Iran, Egypt and UAE. The frequency of symptoms was lower than observed among Caucasians, he suggested further studies on local buologies and understanding the socio cultural basis of these differences. Malik (2005) conducted a study on knowledge, attitude towards menopause and Hormonal Replacement Therapy (HRT) among postmenopausal women in Karachi. The sample size was 102 post menopausal women. She found mean age at menopause was 147.4Â ±3 years. She found most of the respondent had positive attitude towards menopause and consider menopause as natural event lacked sufficient knowledge our menopause and HRT. Qazi (2006) conducted a study on age, pattern, symptoms and associated problems among urban population of Hyderabad. Sample size was 800 menopause women. He found mean age at menopause was 47.16. the marked climacteric symptoms were low backache headache, tiredness, lump pain, sleep disturbance and might swats were common menopause associated problems include Ischemic Heart Disease, Hypertension, Diabetes mellitus, post menopause that the symptoms and problems were different from other studies reported with in the country and abroad which may revealed socio cultural and dietary differences. Nusrat et al (2008) conducted a study on knowledge attitude and experience of menopause. The sample size was 863 menopausal women. She concluded that majority women consider menopause as natural event and have positive attitude but majority of the women were unaware of menopausal symptoms and health effects, the bothered by symptom but did not sought for treatment. The age at natural menopause according to Pakistani studies is between 45-51 years; mean age is 48 years (Malik, 2008, Qazi, 2006; Yahya Rehan, 2006). Some of the findings were similar in the studies which have been conducted in Pakistan. Pakistani women consider menopause as natural and normal phase of life and aging process. They have positive attitude to words menopause (Malik, 2005; Nusart et al, 2008; Yahya Rehman, 2002). These findings are similar with the findings of studies have been conducted in other Eastern countries women such as India, China, and Korea. The other finding that the Pakistani women are not fully aware of the menopausal symptoms and its health implication or its long term consequences on quality of life (Malik, 2008. Nusrat et al, 2008; Yahya Rehan, 2006). Majority of the women bothered with the menopause symptoms but because of positive attitude, poverty, and due to lack of awareness they do not go for treatment or consultation. Malik, 2008; Nusrat et al , 2008). Qazi (2006) identified many differences in his study especially in the prevalence of symptoms reported with in the country and assumed that these are because of socio-cultural and diet differences. In rural areas of Lahore, Yahyeh and Rehan (2006) found the prevalence of various symptoms comparatively lower than other Caucasian. Researcher suggested the need for studying local biologys and understanding of socio-cultural bases of these differences. Summary of the Literature The literature revealed important information about the physiology as well as the initiation process of this phenomenon. The various concepts and meanings perceived by different school of thoughts. The historical development in the research on menopause is also addressed. Factors which are closely involved in influencing menopause experience as well studies conducted on this topic are also highlighted. The Eastern women conceptualize menopause as natural process thats why they have positive attitude towards it as compare to Western women. They bothered by menopause symptoms but try to cope with it positively. In Pakistan quantitative studies have been conducted on this topic but this approach did not provide insight in to a womens understanding the need of qualitative research is required to explore the women experience related to this phenomenon. (George, 2002). CHAPTER THREE Study Design and Methodology This chapter focuses on the approach to conduct this study, the study design and rationale of the design, the study population, study setting as well as sample and sampling. Data making, data management, data analysis, study rigor and the study limitations will also be the part of this chapter. Study Design The study design which is selected for this study is qualitative descriptive-exploratory. According to Polit and Beck (2008) qualitative approach involves naturalistic pattern. Naturalistic methods of inquiry deal with the experiences of human complexity by exploring it directly. It emphasizes on understanding the human experience as it is lived. Qualitative study required for in-depth and rich information to understand the phenomenon. Furthermore Holloway and wheeler (2002) concluded that qualitative research is an objective way to gain knowledge about the subjective and holistic nature of human. Burns and Grove (2007) stated that the purpose of exploratory study is to investigate a specific concept about which little is known. It emphasizes on identification of factors related to a phenomenon of interest. As this study aims to explore the menopause experience, which is lived experience and there would not be one reality as each women experience would be different. Therefore a quali tative exploratory descriptive design is best suited to this study. Study Population The study population would be all women who are in their menopausal period, coming to Obstetric and Gynecologists outpatient department of Pakistan Naval Ship hospital, Karachi. The target population will be all the menopausal women who will meet the inclusion criteria, will be coming to Obstetrics and Gynecology OPD. Setting Pakistan Naval Ship hospital, Karachi will be selected as data collection site. Obstetric and Gynecologists OPD will be utilized for this purpose. This hospital was established in 1963. It is classified as a class A Pakistan Navys hospital. The total bed stren

Identification of Morphological and Physiological Characteristics of Unknown Bacteria Essay

Obesity is a word that everyone is currently familiar with. The media and health professionals have been working tirelessly to make the general public aware of its prevalence and detriments to society. With the staggering statistics of 32.2% prevalence in adults and a range of 13.9% to 18.9% prevalence in children and adolescents, these outstanding numbers stand out for themselves. (1) Increasing rates of obesity are associated with higher risk factors for other diseases such as; Type 2 diabetes mellitus, cardiovascular diseases, colon cancer, diverticulitis, cancer of the endometrium, and breast cancer. (2) Knowing how to combat obesity will lead to decreased complications of the condition as well as a lower risk factor for other diseases. In light of these significant numbers, our group chose to explore the relationship of dietary fiber to aid in the prevention and treatment of obesity, therefore also reducing the incidence other diseases. Our focus was on making a hot meal with a simple modification to increase the dietary fiber available. The original recipe is a white rice pilaf with the adjustment being made with a substitution of brown rice. This change will boost the fiber intake from 0.8g per serving to 2.6g per serving. The represents a substantial jump in accessibility to a vital part of our diet. We expect favorable results in the acceptance of our modification. The texture is a bit hardier, cooking time is longer, and cost is slightly higher, but we believe the benefits outweigh these variables. The RDA recommends between 25g-30g a day, but the average American receives only 12g-13g per day.(3) With this easy alteration, we hope to increase these low numbers that the average American receives up to the reco mmended levels. Purpose The purpose of our research study is to substitute brown rice for white rice in a pilaf. This pilaf can be eaten for lunch or dinner as a hot side dish or main dish. It is intended to introduce a serving of a whole grain in the diet and with it bring an increase dietary fiber. Literature Review Introduction The frequent occurrence of this disease, as mentioned above, has produced many scientific research studies concentrating on remedying and reversing the trend. Finding and interpreting the results was uncomplicated. I used the online databases; Google Scholar, Medline, and Cinhal to gather my data. My keywords included obesity and dietary fiber. I assembled strong studies that encompassed sample sizes ranging from 11-74,091 participants, with timelines up to twelve years, and accommodating populations in the United States, Spain, Finland, Brazil, Italy, Greece, the former Yugoslavia, Japan, Serbia, Belgrade, and The Netherlands. These studies centered on three different aspects of the relationship between dietary fiber and weight. These are expanded upon below. A synopsis of the reviewed studies can be found in Appendix 1. Correlations of the Development of Obesity Seven out of the ten studies compared the connection between dietary fiber intake and the development or current status of obesity. (2, 4-9) All studies included self reported questionnaires to collect sociodemographic, health history, physical activity, anthropometric, bowel movements, and dietary data. The most common dietary form used was the Food Frequency Questionnaire, with six complying. (2, 4-5, 7-9) The last study utilized twenty-four hour recalls. (6) Other measurements included height, weight, and subscapular skinfold thickness. The entire body of findings revealed that higher fiber intake was inversely related to long term weight gain and increased body fat. Reporting measures were diverse but included the same positive trend. Higher fiber intake equated to an average weight of 1.52kg less, a 48-49% lower risk of weight gain, and a BMI that was 1.5 less when compared to low fiber intake. Some studies investigated other variables in addition to increasing fiber. One study addressed physical activity in addition to increased fiber as a therapy. (5) This study along with another explored the incorporation of a low fat diet along with the high fiber diet. In both, dietary fat was not directly associated with reduction of body fat or obesity but showed a compounding result when correlated with higher fiber. A lower BMI difference of 2.75 was established on a low fat and high fiber diet. (6) Development of Diseases related to Obesity Two studies were taken on to look into the increased use of fiber to decrease the risk of obesity leading to Type 2 diabetes. (10, 11) In a large cohort with a sample size just under 36,000, self reported dietary and weight figures were collected. (10) After six years of follow up, the statistics were analyzed and the results showed a 22% lower risk of the development of diabetes from the highest quintile of dietary fiber intake. These optimistic results were in consensus with the other study. This study had more stringent controls and divided participants into two groups. (11) One received standard care and the other received intensive exercise and dietary counseling. Oral glucose tolerance tests and body composition measurements were calculated. After a four year follow up, the high fiber group gained 75% less than their low fiber counterparts, 0.7kg gain versus 3.1kg gain, respectively. Treatment of Obesity The last study out of the ten engaged the most scientific disciplines. (12) The sample was already obese. They participated in controlled feeding in a metabolic kitchen. The cross over design allowed for six weeks on either a low or high fiber diet with a six week washout period in between them. Daily logs were kept and an OGTT and Euglycemic hyperinsulinemic clamp was used every two weeks for measuring results. At the conclusion, fasting insulin was 10% lower, the AUC was lowered, and the rate of glucose infusion was higher after the higher fiber diet. Limitations All of the studies employed self reporting figures in some form, whether the basis of all of their information or for at least some part. This may lead to underreporting, overreporting, or misinterpretation. The definition of a whole-grain or high fiber food varied among studies. Recipe and ingredient databases or non-comprehensive food frequency questionnaires may aid in inaccurate recordings of intake. Although the study utilizing the metabolic kitchen was the best scientific representation among the studies it is worth mentioning that it was sponsored and funded by the General Mills Corporation. This could lead to a possible conflict of interest and hence a limitation to the studies findings. Conclusion The complete compilation of studies supports the purpose of our recipe modification. Each emphasized the importance of replacing low fiber foods with fiber rich foods to help prevent or reduce weight gain. The significant correlation between fiber and obesity has been established in this review. The protective role of fiber, along with physical activity and dietary fat, should be included in advice and management therapies tailored to this condition and other related to it. Materials and Methods For our subjective evaluation we designed three separate score cards; demographic, evaluation, and preference. Samples of the score cards can be found in Appendix 2. Sociodemographic For the demographic background we included questions regarding age range, household income range, ethnicity, and educations. We also included six questions probing background information on exposure and open-mindedness of our products.

Argumentative Essay: Should Organs Be Sold or Donated Essay

For over centuries mankind have been suffering from organ failure. Even since before B.C., the organ transplant is widespread (History.com Staff, 2012). As a result of the improvements of this procedure to be more safer and ubiquitous, nowadays there are less patients with transplant rejection. It is a known fact that people are more likely to need a transplant than donating bodily parts. The British Government highlights an average of 18 people die each day waiting for transplants that cannot take place because of the organ shortage. Unfortunately, this number is increasing (Clark and Clark, 2013). 90% of the UK citizens believe in organ donation but only 30% of this number had actually taken action by registering for organ donation (Clark and Clark, 2013). It is proven that in general, the system in most nations fails to decrease the number of people who are on the waiting list, suffering each day. Therefore, the government should take precautions in trying new developments in order to change this situation. Currently, there is a debate on whether organs should be donated or legalizing organ selling. This essay would give a close look between the pros and cons of both sides, showing that a well regulated organ trade might work more efficiently than the other. All of the religions support living or deceased organ donation and even sometimes encourage people while some of them leaves the decision to individuals (NHS Blood and Transport, 2005). The reasons for most religions to accept the idea of organ donation are: 1) it will help the recipient with positive assurance 2) it does not cause damage to the donor 3) the donor can donate the organ or tissue willingly and without commercial profit. (Budiani and Shibly, 2006). According to these reasons, a compromise can be seen with some ethical compensations for donation in order to find a benefit for the patient. Pope John Paul II indicates †buying and selling human organs violates the dignity if the human.† (Friedman and Friedman, 2006). When it has been looked closely in more patients interest, it can be seen a support has been given to donation; however, because of the moral issue of giving a price to human body, the same support cannot be given for legalizing the trade and finding a matching donor for people in a  shorter period of time. Despite the fact that there is a significant increase in organ donors, the number of people are on the list is rising with a bigger proportion which indicates that a patient on the waiting list will wait longer than it used to be (Cohen, 2006). For a person who is fighting a problem with malfunctioning an organ, every second is important. These people are constantly in pain and every passing second red uces their chances (Friedman and Friedman, 2006)†¦ Every religion is against leaving people in misery for such a long time while the pain can be eased. Selling organs would take less time to find a compatible donor and patients would spend less time in misery. For example, patients with kidney failure are suffering everyday while they are trying to live with dialysis. It causes not only physical and psychological pain but also economical obstacles (Peers, 2007). The thought of people with financial means further exploiting underprivileged people and leaving them suffering is rather unethical. It brings out the possibility of poor man can experience injustice in the future due to lack of organs with a chance of not gaining enough money they predicted they would. Certain patients may suffer from fatigue and other debilitating symptoms associated with patients with only one functioning kidney. This means people’s health would be in danger for a minor benefit (Ang, 2007). Even though this might cause a problem in the future for the people who sell their bodily parts, the black markets are still currently available. The same complication might come up to the surface although it is illegal and it has been highly regulated (Scheve,2008). It is almost impossible to fully exterminate this black marketing but making it legal and giving the control of this trade to licensed professionals to evaluate donor-patient compatibility will help taking the organs and tissues out without any safety risk for the donor (Peers, 2012). It is an undeniable fact that if there is a market, the majority would want to profit while saving someone else’s life. However, the waiting list will not disappear but according to the predictions, it will surely reduce the number of people on the list. Additionally making this as a legal trade, it would prevent desperate patients from being cheated or from paying more money than they might have to when possessing from the black market (Peers, 2012). Iran proves these provisions. Even though it’s system have been criticised by many experts, their system works under the  state’s regulation and non-profit organisations as CASKP and the Charity Foundation for Special Diseases which facilitate the process by helping the trade and are checking the eligibility as well as ensuring a fair commerce (Dehghan, 2012). Many will protest that an organ market will lead to exploitation and unfair advantages for the rich and powerful. People are only considering the benefits of rich people would get. But these are the characteristics of the current illicit organ trade (Gregory, 2011). Living people can donate part of the lung, liver, intestines, or pancreas. Even though there is some financial pressure on people who wants to sell their organs, in the end it is a choice which has been given by free will. It would improve the financial stability of many. The wealthy would not be the only ones benefitting (Libertarian Jew,2013). To conclude, due to the length of this essay only major aspects of both sides can be considered. Donation would be more ethical and fair compared to selling but sometimes in order to save a patient’s life only medical ethics can be fallowed. During this essay, the ethical issues which refuses the legalization of trade market was actually due to religious beliefs. The medical ethics would be only giving the best treatment and health care to the general public. Selling would also decrease the poverty and the misery of donor-recipient respectively. If it is controlled a trading market might give benefits to both sides. REFERENCES: Ang, A (20 March 2007) Selling One’s Organs: The Pros and Cons, Retrieved from: http://voices.yahoo.com/selling-ones-organs-pros-cons-243748.html [Accessed at 2 March 2014] Budiani, D. Shibly, O. (October 2006) Islam, Organ Transplants, and Organs Trafficking in the Muslim World: Paving a Path for Solutions, Retrieved from: cofs.org/home/wp-content/uploads/2012/06/Budiani_and_Shibley.doc [Accessed at 1 April 2014] Clark, M. Clark, T. (13 June 2013) Selling Your Organs: Should it be Legal? Do You Own Yourself?, Retrieved from: http://www.forbes.com/sites/marciaclark/2013/06/13/selling-your-organs-should-it-be-legal-do-you-own-yourself/ [Accessed at 2 March 2014] Cohen, E. (June 2006) Organ Transplantation: Defining The Ethical and Policy Issues, Retrieved from:https://bioethicsarchive.georgetown.edu/pcbe/background/staff_cohen.html [Accessed at 1 April 2014] Dehghan, S.K. (27 May 2012) Kidneys for sale: poor Iranians compete to sell their organs, Retrieved from: http://www.theguardian.com/world/2012/may/27/iran-legal-trade-kidney [Accessed at 28 March 2014] Friedman, E.A. Friedman, A.L. (15 February 2006) Payment for donor kidneys: Pros and cons, Retrieved from: http://www.nature.com/ki/journal/v69/n6/full/5000262a.html [Accessed at 17 March 2014] Gregory, A. (9 November 2011) Why Legalizing Organ Sales Would Help to Save Lives, End Violence, Retrieved from: http://www.theatlantic.com/health/archive/2011/11/why-legalizing-organ-sales-would-help-to-save-lives-end-violence/248114/ [Accessed at 17 March 2014] History.com Staff (21 February 2012) Organ Transplants: A Brief History, Retrieved from: http://www.history.com/news/organ-transplants-a-brief-history [Accessed at 2 March 2014] Libertarian Jew (17 April 2013) Making a Case for Legalizing a Market in Human Organ Sales, Retrieved from: http://libertarianjew.blogspot.co.uk/2013/04/making-case-for-legalizing-market-in.html [Accessed at 17 March 2014] NHS Blood and Transport (February 2005) General leaflet on religious viewpoints, Retrieved from: http://www.organdonation.nhs.uk/how_to_bec ome_a_donor/religious_perspectives/index.asp [Accessed at 24 March 2014] Peers, R. (16 November 2012) Pro/Con Selling Organs, Retrieved from: http://prezi.com/ujelpfbdbe5u/procon-selling-organs/ [Accessed at 2 March 2014] Scheve, T. (7 May 2008) How Organ Donation Works, Retrieved from: http://health.howstuffworks.com/medicine/modern-treatments/organ-donation.htm [Accessed at 28 March 2014]

Essay on Was Andrew Jackson a good president - 966 Words

Was Andrew Jackson a good president Andrew Jackson was born in a backwoods settlement in the Carolinas in 1776. His parents, Scotch-Irish folk, came to America two years before his birth. His mother was widowed while pregnant with him. At age 13, Andrew joined a regiment. He and his brother were both captured and imprisoned together by the British. Their mother got them released, but his brother died on the long trip home. During his independent days, he lived in a tavern with other students. He gained a reputation for charisma, and wildness and hooliganism (Morris, Introduction). After practicing law for a few years in North Carolina, he took up a job as public prosecutor. And after another several years of practicing law, he†¦show more content†¦The bank provided credit to growing enterprises, issued bank notes which served as a dependable medium of exchange throughout the country, and it exercised a restraining effect on the less well manages state banks. Nicholas Biddle, who ran the Bank, tried to put the institution on a sound and prosperous basis. But Andrew Jackson was always determined to destroy it (Brinkley, 249). The Bank had two opposition groups: the â€Å"soft-money† faction and the â€Å"hard-money† faction. Soft money advocates objected to the Bank of the United States because it restrained the state banks from issuing notes freely. Hard money advocates believed that coin was the only safe currency, and they condemned all banks that issued bank notes. Although Jackson was a hard money supporter, he was sensitive to his many soft money supporters, and made it clear that he would object to renewing the charter of the Bank of the United States, which was due to expire in 1836. When Jackson could not legally abolish the Bank of the United States before the expiration of its charter, he weakened it by removing the government’s deposits from the bank. 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