Demographics And Epidemiological Transition Health And Social Care Essay

Demographics And Epidemiological Transition Health And Social Care Essay Bangladesh is experiencing the third phase in demographic transition that has produced a big number of youthful population and increasing population of older population (Razzaque et al., 2010). At present, the population of Bangladesh is 152518015 million, where percentage of the 60+ elderly populations is more than 6.7 (BBS, 2010). The median age is 23.3. The life expectancy at birth is 70 years for the total population (Index Mundi, 2012). Epidemiologic transition generally refers to the shift from acute, infectious and deficiency diseases to chronic, non-communicable diseases (NCDs). This is usually reflected in the mortality and morbidity pattern. A study done at Matlab, a rural area of Bangladesh by Karar et al. (2006) found that in 20 years (1986-2006), there has been a massive alteration in mortality profile from acute infectious and parasitic diseases to NCDs, degenerative and chronic diseases. During this period there was great reduction in mortality due to diarrhea and dysentery and respiratory infections (except tuberculosis) and increase in mortality due to NCDs such as cardiovascular and cerebrovascular diseases and malignant neoplasms. It has been predicted further that the mortality due to NCDs will increase greatly in the next two decades whereas number of deaths due to communicable diseases will decrease. The reduction in the child and infant mortality was explained by improvement in maternal education, primary health care services, water and sanitation practice, use of oral rehydration solution and high immunization coverage. The rise in mortality due to NCDs was explained by possible change in diet and lifestyle (Karar et al., 2006) Due to demographic and epidemiologic transitions, elderly population has rapidly increased and so has their morbidity (Biswas et al.,2006). As Bangladesh is going through both epidemiologic and demographic transitions, there are being reductions in fertility and mortality rates that have resulted in increased life expectancy among the population. This means there are increase in older people in the population and increase in prominence of chronic conditions among these elderly. Chronic diseases usually accumulate with ageing and are presented as multiple morbidities. Multimorbidity in the same person refers to co-occuring of various harmful medical conditions. Khanam et al( 2011) found higher prevalence of multimorbidity among elderly (>60years old) in a rural place in Bangladesh called Matlab. It was around 53.8% among the study population. Arthritis and hypertension occurred the most commonly. Multi-morbidity was higher in women than men and in non-poorest (Not poorest. Socio-econo mic status was divided into two parts: poorest and non-poorest). The same study found that multimorbdity can also be affected by living and working environment, lifestyle pattern, socio-economic status, behavioral risk factors and gender. From the prevalence rate, one can estimate the real burden in the general rural population. It shows every elderly in the population is suffering from at least one chronic condition. This means the health sector of Bangladesh should be prepared to deal with the increasing NCD cases. Through improved diagnostic facilities and better referral system, NCD patients can be helped. Health policy should be updated accordingly to allocate bigger budget to facilitate health services for the elderly (Karar et al, 2009). Formal and informal care Study by Biswas et al. (2006) focused on strategies elderly people use to cope in case of illnesses. As perception of ill health and severity of illness varied from one elderly to another, this study revealed that elderly people avoided visiting a qualified doctor until severity of illness deteriorated because of the associated cost. Even in situations when these qualified doctors are consulted, there are rare follow up visits, again due to the financial barrier. Therefore, elderly people often prefer going to traditional healers (eg. Kobiraj). Huge trust is placed on this type of healers treatments. Often when these treatments bear no result, trust is not lost and the lack of result is often attributed to ill fate (Biswas et al., 2006). On the other hand, if the disease is assumed to be of low severity, self-care is practiced, that is home remedies are undertaken and drugs are bought over the counter at the drugstore by a family member. However decision making process comes into play if severity of the disease increases and is influenced by various factors such as decision about where to take the patient, who to go with the patient and how to manage money. Out of all these factors, the financial issue grabs the bigger priority. Usually a service provider that can ensure flexibility in the treatment cost and payment options is picked. Payment is done with the help of savings, loan from adult children, friends or relatives or sometimes NGO and selling of livestock and poultry (Biswas et al,2006).. In Bangladesh, elderly people depend largely on care provided by the family members. Its a common practice for family members to look after elderly persons. Sometimes even when theres a will, family members cannot take proper care of the elders due to financial constraints. Furthermore, adult children of that family often migrate somewhere else to find work, leaving the elderly behind. In urban areas, this scenario is worse. Along with the men of the family working, theres womens participation in labor force due to which the elderly are also neglected. (Jesmin Ingman, 2011). There is stigmatization of Older women who visit male doctors (who arent direct family members) due to which women stay back home even when they are ill and suffer even more. From the governments side there is meager amount of Old Age allowance and pension for the elderly. This amount hardly covers up treatment costs. There are institutional cares provided by the NGOs in different parts of Bangladesh. But this are being unable to meet the increasing demands of increasing number of the aged people (Hossain et al, 2006). We can see that modernization and urbanization results in migration of young adults and inclusion of women labour force. Elderly people are neglected. There is poor health care service for them. Financially they become weak. They begin to lose their functional ability with age and become dependent on others. But ageing is a natural process for which they are not responsible. Therefore its our duty to provide them with utmost care, respect and security. Ageing population and functional ability: When we talk about functional ability of elderly population, we mean if the elderly person is functionally able to perform daily tasks. We draw conclusions based on physical and cognitive incompetence. But we often neglect the context to which the person belongs. Its environmental and socio-cultural factors. Urban and rural areas vary highly in terms of these factors. There are also gender differences as to certain tasks performed by men and women are bound by social norms and generally dont overlap. Domestic work typically belongs to womens domain and public chores belong to men (Kabir et al., 2001). If we picture a rural context, we can understand how environment plays a role as a barrier to functional ability. Toilets are usually placed outside the home, at a distance and water source is far from toilet. An elderly person has to go a nearby pond or have someone carry the water to them (Ferdous et al., 2009b). Older women who visit male doctors (who arent direct family members) are stigmatized (Biswas et al.,2006). Therefore theres a tendency of women staying home and not seeking help. As a result, with time, they become more ill and functionally disable to perform daily activities. Studies have shown elderly women to have higher prevalence of illness then elderly men (Kalam et al., 2006). Studies done on nutritional status of elderly people have found nutrition to play a vital role in performing daily activities. Elders with poor nutritional status have more limitations in their physical function than elders who are well nourished. Good nutritional status has been associated with better cognitive function as well. (Ferdous et al., 2009a). As the elderly population is increasing in number, its our responsibility to see how they can achieve healthy ageing. There can be many suggestions like having high nutritious diet, improved infrastructure like building ramps in hospitals, treatment at early stage etc but whether these can or will be implemented is highly d ubious. Bangladesh is poverty stricken country and inspite of National Elderly Policy being present, its goals of protecting elderly are inactive (Unnayan Onneshan, 2011). Poverty is beyond our control but policy is something we can take care of. Policies incorporating elderly issues should be implemented and our approaches towards the ageing population should be in such a way that this population is benefited, secured and meets demand of basic needs. The Prevention of Diabetes, Bangladesh Program from life course perspective In the developing countries, there is a growing concern and awareness of the increasing incidence of Non Communicable Diseases (NCDs) (Darton-Hill et al., 2004). More than 40% of all people with diabetes in least developed countries live in Bangladesh (Novonordisk, 2012). Type 2 Diabetes Mellitus (T2DM) is highly preventable and its occurrence can be delayed. The main focus of prevention of this disease is mostly on modification of lifestyle patterns of adults. Behavior such as unhealthy diets and lack of physical activity particularly receives high attention. But there is huge evidence now that supports the fact that a lot of the risks associated to T2DM arise during fetal stages of life. At this stage, these factors are characterized by maternals nutritional status, presence or absence of diabetes and fetal and post-natal environment. This indicates that disease process advances throughout life course. There are also evidences showing that these risks begin during fetal stage and p rogresses till old age (Darton-Hill et al., 2004). A study on genetic changes has revealed high chances of diabetes being activated in the womb. As environmental, genetic and biological factors can be passed from generation to generation, a life course approach is therefore critical to lessen this intergenerational transmission of diabetes. (IDF, 2011a). The primary prevention of diabetes, Bangladesh is a program by the World Diabetes Foundation, partnering with Diabetes Association of Bangladesh (DAB). The program ran for 4 years 10 months (January 2007-October 2011).The objective of the program was to  define and pilot strategies for lifestyle intervention in the primary prevention of diabetes in Bangladesh and to develop guidelines for a long term National Diabetes Prevention Programme (http://www.worlddiabetesfoundation.org/composite-1144.htm). The program will be elaborately discussed from a life course perspective in the following sections. The main focus of this program was on lifestyle interventions. They produced six leaflets that described steps of prevention of diabetes at different levels of society. The levels targeted were individual, family and friend, social/cast level, health service provider, employer and media. Messages about risk factors of diabetes were recorded and used during training sessions. Folk singers, school teachers and religious leaders were involved in delivering messages. Doctors, community counselors, employees and employers were trained in diabetes awareness and lifestyle interventions. Around 87 students took part in diabetes educator program (where the students got trained on educating others about diabetes and the associated life style interventions). All these activities suggest that the focus has been on adults. Though it has not been mentioned which risk factors this program considered, but hoping they have included the three most common behavioral risk factors such as obesity, lack o f physical activities and smoking. Numerous studies have shown these risk factors to be associated with type 2 diabetes. From Fig. 1 (Annex) it can be seen that in adult life, the risk is the risk that accumulates from fetal life, infancy and childhood, adolescence. This accumulated risk is a cumulative risk, which means the consequences are even getter and detrimental. The figure also shows that the risk actually begins before conception of the life. Therefore, interventions should be focused on mothers planning to conceive, alongside focusing on every stage of the life of a person from fetal to adult. This program has not focused on pregnant mothers, let alone pre-conception stage. For preconception phase, the women could be educated that pregnancy can act as a risk factor for the development of diabetes. They could be advocated to take balanced nutrition and refrain from smoking. They could also help their partners to stop smoking. In pregnancy phase, there could be intervention regarding uptake of appropriate nutrition. There could be intervention regarding management of gestational diabetes to lessen the transference of T2DM to the fetus. Mothers with gestational diabetes and the ones with child of low birth weight could also be suggested to have follow-up check-ups (IDF, 2011b) There were no interventions for infancy and childhood period in this program as well. As part of this program, exclusive breastfeeding could be promoted for the first six months. Mothers could be educated and supported on appropriate nutrition for their infants. For school going children, exercise and healthy eating could be promoted (IDF, 2011b). This program also didnt incorporate interventions targeting the adolescence. Adolescents are important group of people who practice unhealthy eating, physical inactivity and lead a sedentary life style. Smoking among adolescents is very popular among Bangladesh. They also should have been a target of this prevention program. Studies have shown that the age of onset of diabetes has shifted from working age group to adolescents. Therefore more women that belong to reproductive age group are having diabetes and their pregnancies are being complicated by diabetes (International Diabetes Federation, 2011b). Therefore lifestyle interventions shou ld have been applied to this population. Healthy diets and awareness about smoking could be promoted at schools and through educational programs. Alongside anti-smoking programs, awareness regarding illicit drug use and alcohol could be built up as well. Adolescents could be well informed about the consequences of consuming alcohol. To combat drug use, children and adolescents could be informed about the physical, psychological and social effects of using drugs. Both adolescents and adults could be taught ways to build confidence and self esteem, which can empower them to say no to drugs (WHO, 1999). At every stage of life, there could be strong emphasis on physical activity. Lack of it, along with other factors, can predispose an individual to T2DM. It has also been shown to reduce gestational diabetes (Dornhorst et al., 1998). The program could encourage physical exercise in children by accommodating it in the school curricula and family activities. Also supportive environments could be helped to be built for all ages to engage in physical activity. Some life course factors such as socio-economic cannot be changed. Behavioral risk factors can be changed. This program should have aimed at all the stages of life course model to be able to cover wider population and reach greater success in preventing diabetes.

Bull Fighting Essay -- essays research papers

Bull Fighting   Ã‚  Ã‚  Ã‚  Ã‚  The immediate reaction of many non-Spanish people to bull fighting is that it is sick, animal killing, unmoral entertainment. To many others around the world, though, bull fighting is a sport which involves courage, skill, and power, in a struggle between man and beast. This purpose of this paper is not to discuss the moralities of bullfighting though, it is to give some information on a sport which is loved by many throughout the world.   Ã‚  Ã‚  Ã‚  Ã‚  A bull fight, or corrida de toros, consists of three matadors, and six matches, which each take about 20 minutes to complete. These fights take place in a bull fighting arena, or plaza de toros. The least experienced matador will take the first and fourh matches, and the best matador will fight in the third and last matches.   Ã‚  Ã‚  Ã‚  Ã‚  The matadors are not alone. They are accompanied by three banderilleros and two picadores. The matador wears a brightly colored costume known as the suit of lights. His assistants wear less flashy costumes.   Ã‚  Ã‚  Ã‚  Ã‚  The movement from act to act in the bull-fight is divided by a trumpet blast. The first trumpet signals the paseo, or march of the bull-fighters. The second trumpet proclaims the entrance of the bull. The matador first watches his chief assistant perform some passes with the yellow and magenta cape, in order to determine the bull's qualities and mood, before taking over himself. Du...

Indian Premier League Essay

Cricket is a very fast-paced, high-energy sport but it’s also big business. Professional teams that belong to the Indian Premier League pay each of their players, the estimated value that could range from INR 20 lakh (INR 2 million) to INR 2 crore (INR 20 million) per year depending on his experience and stature. For that amount of money, member teams expect a great deal and are constantly on the watch for ways of improving their performance. During a 59-game season, every nuance a coach can pick up about a weakness in an opponent’s offense or the shots of one of his own players will translate into more runs on the scoreboard, more wins, and ultimately more money for the team. Traditional cricket game statistics failed to capture all of the details associated with every play and was not easily related to videotapes of games. As a result, decisions about changes in tactics or how to take advantage of opponents’ weaknesses were based primarily on hunches and gut instincts. Coaches could not easily answer questions such as â€Å"Which types of plays are hurting us? † Now professional cricket coaches and managers are taking their cues from other businesses and learning how to make decisions based on hard data. The software available with the Indian Team was very generic and did not produce any analytical information. For the same reason, John Wright wanted to have quite a few reports to help him make decisions based on the statistical data. A company called Sports Mechanics has found a way to collect and organize fine-grained statistical data and relate the data to associated video clips. Sports Mechanics employs just 5 people to match up video of each play with statistical information about every ball bowled within the match. For example, who bowled it, who is the batsman, who is the non-striker, where did the ball pitch, what did the ball do, where was the ball hit, how many runs were scored off it, who fielded it, how did he field it, which end did he throw, what was the outcome of the ball, etc. Once the tagging is done, when the query is done according to the tag, then the relevant video plays. Queries can be done by multiple layers of filters by bowler, by batsman, by type of ball, etc. Each game is dissected and tagged, play by play, using hundreds of descriptive categories and these data are linked to high-resolution video. Coaches then use an index to locate the exact video clip in which they are interested and access the video at a protected Web site. Within seconds they are able to watch streaming video on the protected site or they can download it to laptops, iPods, play stations, etc. For example, if the Kolkata Knightriders have just lost to the Rajasthan Royals and gave up too many runs, Knightriders coach can use Sports Mechanics’ service to see video clips of every Rajasthan Royals’ batting performance in the game. He can also view every Kolkata Knightriders transitional situation for the entire season to see how that game compared with others. According to Kolkata Knightriders owner Shahrukh Khan, â€Å"the system allows us to look at every play, in every way, and tie it back to stats. So we can watch how we played every ball, track our success rate, and see how other teams are doing it. The service helps coaches analyze the strengths and weaknesses of individual players. For example, Sports Mechanics’ system has recorded every offensive step of the Kolkata Knightriders’ Shoaib Akhtar since he joined IPL. The system can show how successfully he is blowing in either home or away games, with the ability to break games and player performance into increasingly finer-grained categories. If a user clicks on any statistic, that person will find video clips from any of the games of any season of IPL that show Shoaib’s particular bowling move. Mr. S. Ramakrishnan, the Indian Cricket Team Analyst and the founder of Sports Mechanics has since 2003 helped over 5,000 cricketers and provided analysis and soft ware to ICC and 21 countries. About 7 teams in the IPL; all except Royal Challengers have already signed up for the Sports Mechanics’ service, and are using it to help them scout for promising national and international players. Although nothing will ever replace the need to scout players in person, the service has reduced IPL teams’ skyrocketing travel costs. Sources: Sports Mechanics; Base 1 USD = 50 INR as of 11, January, 2009 The challenges facing IPL teams show why information systems are so essential today. Like other businesses, professional cricket faces pressure from high costs, especially for team member salaries and travel to search for new talent. Teams are trying to increase revenue by improving employee performance, especially the performance of cricket team members. The chapter-opening diagram calls attention to important points raised by this case and this chapter. Management was unable to make good decisions about how to improve the performance of teams and of individual players because it lacked precise data about plays. It had to rely on â€Å"best guesses† based on videotapes of games. Management found a new information system to provide better information. The information system is based on a service provided by Sports Mechanics. Sports Mechanics’ staff members break down each game into a series of plays and then categorize each play by players, type of play, and the outcome. These data are tagged to the videos they describe to make the videos easy to search. IPL coaches and management can analyze the data to see which offensive and defensive moves are the most effective for each team player. Team members themselves can use laptops, play stations, iPods, etc to download the videos to help them prepare for games. This innovative solution makes it possible for basketball management to use objective statistical data about players, plays and outcomes to improve their decision making about what players should or shouldn’t do to most effectively counter their opponents.

Agency Relationship Within Business Finance Essay - Free Essay Example

Sample details Pages: 4 Words: 1066 Downloads: 10 Date added: 2017/06/26 Category Finance Essay Type Research paper Did you like this example? Question 1 Agency-Relationship is a relationship in which one person has legal authority to act on behalf of another. Agent has a legal and ethical responsibility to make decision that furthers the interests of the shareholders. When the interests of the agents and shareholders conflicts each other, an agency problem will be appeared. Don’t waste time! Our writers will create an original "Agency Relationship Within Business Finance Essay" essay for you Create order There are several examples of companies which had serious Agency-Relationship problems and resulted their Chief Executive Officers sent to jail. For the first example, a former chairman and a executive director of publicly listed Field Group Holdings Limited, charged by Hong Kongs Independent Commission Against Corruption, have been convicted at the District Court of conspiracy to defraud shareholders of the company and the Stock Exchange of Hong Kong (SEHK) in relation to a fake joint venture in a gas pipeline project in Chongqing, Mainland China and of money laundering in relation to the proceeds. To complete the fraudulent scam, the CEOs further caused the SEHK and the shareholders of Field Group Holdings Limited to approve the issue and allotment of the shares to the shareholders. They were found guilty of two counts of conspiracy to defraud. To prevent this kind of agency-relationship problem, first, is to encourage employees to identify the risk and notify to the ma nager. The management should develop and implement control over these kinds of circumstances. For the second example, a former research executive at a biotech company has pleaded guilty to one count of conspiracy to defraud shareholders that she and others caused the biotech company to issue false claims about a test to detect Down syndrome. The crime carries a maximum sentence of 25 years in prison along with fines potentially reaching hundreds of thousands of dollars. The problem in this case is Elizabeth Dragon who knew the truth about the test, but she told the public it was a near-perfect success. She misled investors with overstated information about a significant new product that never to be made. Investors interest was harmed as they were believed in those fault information. As a result, the company image was damaged as well. Public will lost their faith in the company. To prevent this kind of agency-relationship problem, the management should implement a set of mon itoring employee to handle research and development test data and result. Limit few employees can be accessed to the important data base. For the third example, a toy holdings company and its CEO had announced that it had purchased majority share interest in a manufacturing company. The Purchase price was to be large amount in stock and cash. The facts was the CEO and the toy holdings company has only paid half of the cash amount to the exiting majority shareholder of which the CEO had to burrow the funds from an investor. The CEO had expressed to the exiting shareholder that he needed to have control of the entity before he could secure the rest of the funds needed to complete the transaction. No other monies have ever been paid. The CEO finally has pleaded guilty of defrauding shareholders. The Company has lost all credibility due to unpaid invoices with wholesalers. The interest of the shareholders was not secured. To prevent this kind of agency-relationship problem, the management should reconcile bank statement within a month of receipt in order to detect any irregularities. Periodic reviews of contracts, financial documents, and accounting policies should be keeping checking so as to detect any irregularities. Some control plan can be set by the management for detecting and preventing fraudulent activities in the company. The management should be monitored the control plan regularly to ensure the control plans are effective and working. Question 2 Assuming our company ABC has the initial investment and cash flow as below table. We are going to demonstrate the estimate cash flows for the first 5 years by several investment appraisal methods for Project A. Estimate Cash flowÃÆ' £Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬ Year Project A 0 -100000 1 60000 2 40000 3 30000 4 30000 Assume the initial investment amount is $10,000. Estimate cash flow is as the table shows. Net Present Value (NPV) Suppose the desired interest rate of return is 10% per annum. Year Discount factor Cash flow PV 0 1 -100000 -100000 1 0.909 60000 54540 2 0.826 40000 33040 3 0.751 30000 22530 4 0.683 10000 6830 ÃÆ' £Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬ ÃÆ' £Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬ NPV 16940 The NPV is $16,940 which is positive. The returning on the investment is over the interest rate 10 per annum. The investment project should be taken. Advantage NPV can provide us absolute value when considering taking the project or not. It considers the time value of money that irrespective of the exact time at which the cash flow is made. Disadvantage NPV cannot apply on intangible benefits. The size of the investment has not been measured. Internal Rate of Return (IRR) The NPV at 10% is $16,940. If now the rate of return is 20%, the NPV will be $-70. Year Discount factor Cash flow PV 0 1 -100000 -100000 1 0.833 60000 49980 2 0.694 40000 27760 3 0.579 30000 17370 4 0.482 10000 4820 ÃÆ' £Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬ ÃÆ' £Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬ NPV -70 The estimated IRR is 19.96%. (Formula: 10+(16940)x(20-10)/(16940+70)=19.96%) If we need 12% return on the investment, the project should be taken. Advantage it is a simple way to communicate the value of the investment to people who doesnt know the estimation details. Disadvantage Unrealistic rates of return are given. For the above case, the investment is financially attractive and should be taken immediately. But in the real world, IRR of 19.96% implies there is an opportunity to reinvest future cash flows at 19.96%, rather than an actual return of 19.96%. IRR approach cannot be applied on mutually exclusive projects. The Payback Period Year Project A Cumulative Cash Flow 0 -100000 0 1 60000 60000 2 40000 100000 3 30000 130000 4 10000 140000 The payback period is 2 years. The investment project is acceptable. Advantages It is easy to calculate and simple to use. Profitable opportunities for long-term investment will not be overlooked as they involve a shorter wait for revenues to flow. Disadvantage Time value of money and inflation are not considered. It only concerns the liquidity of the cash flow, not the effect on business profitability. It ignores cash flows beyond the cutoff date. It biased against long-term projects, such as research and development. The Profitability Index (PI) According to the above calculation, we are using the figures to calculate the PI as shown in the table below. Initial investment $100,000 NPV 16940 PV $116,940 The profitability index is 1.1694. (Formula: (116940/100000)) Since the PI greater than 1.0, which means this project has positive NPV, the project should be taken. Advantage It is easy to understand and communicate. It considers all cash flows of the investment and the time value of money. Disadvantage It only can be used for divisible projects. It ignores the size of the investment.