Monday, January 27, 2020

Non-communicable diseases Diseases of Excess

Non-communicable diseases Diseases of Excess Non-Communicable diseases often referred to as Diseases of Excess or Diseases of Affluence are increasing in both rich and poor countries. What factors are contributing to this trend? What are the implications for public health policy? Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 1948) where as Disease is a condition where any deviation from or interruption of the normal structure or function of any body part, organ, or system that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown (Dorlands Medical Dictionary, 2007). Disease can be divided broadly into two categories as Communicable and Non Communicable Diseases (on the basis of its spread). Communicable disease is a disease which can spread from one individual to other through any carrier/organism (Malaria, HIV/AIDS, etc). It is also known as Infectious or Contagious disease. There are many factors responsible for the cause of communicable diseases like social, environmental, sanitation and education. Non Communicable disease is a disease which is not communicated from one individual from another (Hypertens ion, Cancer, etc). It is also known as Chronic diseases because these diseases takes lot of time to show the sign and symptoms within an individual. The major causes for NCDs are lifestyle, habits like smoking and alcohol, inadequate diet and physical inactivity. Communicable diseases was reported to be the major cause of death in earlier time where as Non Communicable diseases(NCDs) are of major threat in current era except in some countries like Africa where still people die out of infections. In some countries like USA, the leading cause of death in 1900s was tuberculosis and pneumonia where as these diseases are secondary nowadays and their places are acquired by the cardiovascular diseases on the top and cancer being the second. The main reason for the reduction in communicable diseases are the improvement in diagnosis, treatment, sanitation, nutrition, housing, working conditions, preventive measures such as immunization, evolution of life saving drugs like antibiotics and sulpha drugs. Non-Communicable diseases or Non-Infectious diseases are caused by factors mainly behavioural, lifestyle and heredity and which cannot be transmitted to other individual. It is also caused as the Disease of Affluence or the Disease of Excess as it is caused due to negligence or disturbance caused in the normal routine lifestyle which is mainly found in the upper class of the society where there is more chances of misbalance between diet and work can be seen. Few of the examples which come under non communicable diseases are Heart diseases, Stroke, Obesity, Diabetes, Cancer, etc. Acc. to WHOs statistics in 2008, Heart Stroke has become the leading cause of death globally leaving behind the infectious diseases like HIV/AIDS, TB, Malaria, etc. In 2003, there was an estimated 56 million death globally, out of which 60% death was supposed to be due to non-communicable diseases (WHO, 2003). Among NCDs, 16 million deaths resulted from cardiovascular disease (CVD), especially Coronary Heart Disease (CHD) and Stroke; 7 million from Cancer; 3 ·5 million from Chronic Respiratory Disease; and almost 1 million from Diabetes (Ibid). Apart from these, mental health problems are also the leading contributors to the burden of disease in many countries nowadays and play a major role in contributing to the severity and incidence of other NCDs. NCDs are now considered to be the major threat contributing 59% of death in 2000 and predicted to account for 73% by 2020 (WHO, 2002). NCDs are also termed as a Disease of Affluence due to incidence and prevalence mainly in the developed countries (Anand K et al, 2007). But according to them, this seems to be a misleading term as the NCD trend is increasing at a higher pace in middle and low income countries leaving them in a double burden of Communicable diseases as well as NCDs. It can more appropriately be labelled as Disease of Urbanisation (Ibid). Several studies done by them have proved that the NCDs and its risk factors are found in higher proportion among urban population than rural population. Their study shows that urban population has increased during past decade due to migration where as urban growth is stabilized at 3%. Contrary to it, the urban slum growth rate has doubled which has made the situation worse as these migrated poor people living in urban areas will adopt the NCD lifestyle but will not be in a condition to access the healthcare due to their poor purchasing ability. Study shows a high prevalence of NCDs risk factor in the urban slums of Haryana, India. The population residing in the slums is at high risk than the urban population due to poor access as well as no social and health support system for them. This requires an urgent intervention which can work at national, community as well as local level. A framework of the policy is required at national level which has tobacco and alcohol control measures, promotion of good diet and involvement of proper exercise. Simultaneously, reorientation and strengthening of the governments health system is needed to face the challenge of NCDs community level efforts to create an environment which promotes adoption of healthy behaviors. To overcome this situation, government has started the Integrated Disease Surveillance Programme (IDSP) which provides a rational basis for decision making and impl ementing public health interventions and also ensures involving the slums as well (Ibid). A survey was being conducted by Anand et al in urban areas slums of Faridabad District, Haryana, India, in February 2003 to June 2004 for checking out the prevalence of NCDs in urban poor people. Their study followed the STEPS approach of WHO where questions related to tobacco use, alcohol intake, diet, physical activity were included and history of treatment for hypertension, diabetes, physical values like height, weight, waist circumference and blood pressure were also measured. They surveyed 1260 men and 1304 women of age 15-64. The result came out of this survey was very alarming. The rate of smoking and alcohol drinkers were high among urban slums male population. Almost one third of the population had at least one risk factor. Alcohol consumption among younger population indicates gradually falling economy of the country in the coming future. The table 1 (Appendix) shows that NCDs are the leading cause for the death in both developed and developing countries except some countries like Africa where still today, there is more number of death due to communicable diseases than NCDs. In 2003, 2 ·8 million CVD deaths occur in China and 2 ·6 million in India. NCDs contributed substantially to adult mortality with central and eastern Europe having the highest rates (WHO, 2003). The Table 2 (Appendix) shows that the developed countries have seven NCDs out of ten leading risk factors which are contributing to the global burden of disease, where as six and three out of ten with low and high rates of mortality respectively, in the developing countries. These NCD risk factors are increasing at a higher rate in the developing countries and assumed to continue in the same manner for the next two decades. Chronic diseases attribute to the 46% of the global burden of the disease, Cardio Vascular Diseases (CVDs), in particular. Although some of the communicable diseases are still prominent in the some parts of the Africa, Asia and Latin America, deaths mainly due to chronic diseases were reported in five out of the six WHO regions (Africa, America, South east Asia, Eastern Mediterranean, Western Pacific and Europe). In developing countries also, 79% of the deaths are reported due to the chronic diseases. Incidence and prevalence of obesity, diabetes, cancers, respiratory diseases and other NCDs are increasing all over the world (Murray and Lopaz, 1996). Developing country like China has experienced an epidemiological transition shifting from the infectious to the chronic diseases in much shorter time than many other countries. The pace and spread of behavioral changes, including changing diets, decreased physical activity, high rates of male smoking, and other high risk behaviors, has accelerated to an unprecedented degree. As a result, the burden of chronic diseases, preventable morbidity and mortality, and associated health-care costs could now increase substantially. China already has 177 million adults with hypertension; furthermore, 303 million adults smoke, which is a third of the worlds total number of smokers, and 530 million people in China are passively exposed to second-hand smoke. The prevalence of overweight people and obesity is increasing in Chinese adults and children, because of dietary changes and reduced physical activity. Emergence of chronic diseases presents special challenges for Chinas ongoing reform of heal th care, given the large numbers who require curative treatment and the narrow window of opportunity for timely prevention of disease (Gonghuan Y et al, 2008). Common Non-Communicable Diseases Cardiovascular diseases include all the heart diseases like hypertension, stroke, atherosclerosis, etc. Annually, 17 million deaths are reported mainly due to the CVDs globally out of which 80% are reported in low and middle income countries with a continuous increasing trend (Reddy and Yusuf, 1998). Acc. to Lenfant, CVD will be the leading cause of the death by 2010 in the developing countries due to changes brought about by urbanization and industrialization. Due to costly and prolonged treatment cost of CVDs, developing countries are at greater prevalence for the risk factors, higher incidence of disease and higher mortality (Reddy, 2002). Diabetes is increase in blood sugar level in a person. International Diabetes Federation has released the statistics in 2003, according to which diabetes patients will going to increase from 194 million in 2003 to 330 million in 2030 and at that time every 3 out of 4 living person will be diabetic. The age of diabetic patients in developing countries is comparatively more than developed countries. The cases found in developing countries are above the age of retirement which may lead to conditions like blindness, amputations, kidney failure and heart diseases (Boutayeb and Twizell, 2004). Cancer and its type are increasing at an alarming rate worldwide. It is known to be the major cause for the mortality and morbidity. More than 10 million new cases and over 7 million deaths from cancer occurred in 2000 (Shibuya et al., 2002). Developing countries contributed by 53% in incidence and 56% in deaths. By 2020, there will be an increase of around 29% cases in developed countries and 73% in developing countries (Mathers et al., 1999). Lung, breast, stomach, colorectal and liver cancer are the most frequent in developing countries. Cancer and its related types can be treated on a preventative basis. Early detection and control of risk factors like tobacco and alcohol can be said to be the cornerstones in this process because it is estimated that over one third of the cancer types are preventable and around one third are potentially curable if they are detected early (Alwan, 1997). Other NCDs includes chronic respiratory diseases like asthma and chronic obstructive pulmonary diseases, mental and depressive disorders, osteoarthritis, hearing loss and disorder of vision (WHO, 2003). They all contribute mainly to the burden of disease in developing countries. Conditions such as obesity and high blood pressure also has a double impact, either as a disease or as a risk factor for other NCDs (WHO, 2004). Risk Factors The life expectancy at birth has increased since 1970 in all the high, middle and low income countries (UNDP, 2005). Due to this factor, longer life span has resulted in the predominance of the chronic diseases in the population. The epidemiological transition has resulted in the higher proportion of the adults population due to decline in fertility rates and the infant mortality rates. The behavioural risk factors like smoking and nutritional transition towards diet having high fat, high sugar with low carbohydrates and fruits along with the physical inactivity and increase in alcohol consumption have become the greatest health challenge in the 21st century (Magnusson, 2007). The environmental causes are also responsible for the emergence of NCD as an epidemic. These factors have brought up the nutrition transition by industrialisation of the food production, expansion of the market economies in the developing countries, the growth of the complex supply chain management at a global level, rapid growth of supermarket in the developing world and the growing concentration of global food manufacturers (Ibid). Some other key factors like rising incomes, production of cheap and low energy-dense foods, growing urbanisation and increase in growth in demand for pre-packed food are also the major risk factors for NCDs (Ibid). The evolution of NCDs has put up a double burden on low and middle income countries. Diabetes and lung cancer are also reflecting rise in the rate of smoking and obesity which are called to be the major risk factors for the NCDs (Leeder, 2004). In the year 2001, 17 million people died due to heart diseases where as 3 million people died due to AIDS (Ibid). During this year, heart disease and stroke were the leading cause of death in both high income and low-middle income countries, accounting for 27 and 21% population respectively. Out of all, 83% of death occurred in the developing countries (Ibid). Evidence has shown that CVD occurs at an early age in developing countries, consuming their productive years of life. Globally, obese people are also increasing at a higher pace with a far higher number overall in developing countries. Due to this, diabetic patients are also increasing with more number falling in the 45-65 age group (Ibid). Tobacco causes 4.8 million premature deaths in the year 2000, half of which were in the developing world (Ezzati and Lopez, 2003). Since 1975, cigarette consumption has decreased sharply in the developed countries, but it is continuously rising in developing countries due to the rapid increase in population. More than 1 billion smokers lives in the developing counties out of 1.3 billion smokers globally which indicates that forthcoming threat of tobacco related epidemic will impact the developing world. Even after non smoking awareness programme through out the world, there will be around 1.45 billion smokers in 2025 (Guindon and Boisclair, 2003). Tragically, half to two third of the chronic smokers will die out of their habit (Jamison et al, 2006). Peto and lopez has estimated that if this trend continues, 10 million people will die every year because of tobacco where 7 out of 10 will be from the developing countries resulting in around 150 million death till 2025. The ageing of populations, mainly due to falling fertility rates and increasing child survival, are an underlying determinant of non-communicable disease epidemics. Additionally, global trade and marketing developments are driving the nutrition transition towards diets with a high proportion of saturated fat and sugars. This diet, in combination with tobacco use and little physical activity, leads to population-wide atherosclerosis and the widespread distribution of non-communicable disease. Globally, many of the risk factors for heart disease, diabetes, cancer and pulmonary diseases are due to lifestyle and can be prevented. Physical inactivity, Western diet, alcohol and smoking are prominent causes for the NCDs and its risk factors. Tobacco is number one enemy of public health (WHO, 2000). It is the most important established cause of cancer but also responsible in CVDs and chronic respiratory disease. In the twentieth century, approximately 100 million people died worldwide from tobacco-associated diseases such as cancer, chronic lung disease, diabetes and CVDs. Half of the 5 million deaths attributed to smoking in 2000 occurred in developing countries where smoking prevalence among men is nearly 50%. Today, 80% of the 1.2 billion smokers in the world live in poorer countries and, while tobacco consumption is falling in most developed countries, it is increasing in developing countries by about 3.4% per annum. However, albeit these striking facts, the majority of developing countries which signed the Framework Convention on Tobacco Control (FCTC) (Joossens, 2000) remain passive about the control of smoking. Obesity and dietary habits represent potential risk factors for CVDs (Kenchaiah et al., 2002), type 2 diabetes (Drewnowski and Specter, 2004), and some types of cancer (Key, 2002), especially in absence of physical activity (Derouich and Boutayeb, 2002 and WHO, 2003b). Fish is considered to be a useful food intake to prevent CVDs and reduction of CVD associated deaths (Stampfer, 2000). Similarly, intake of an adequate quantity of fresh fruit and vegetables is recommended to help reduce the risk of coronary disease, stroke and high blood pressure (WHO, 2002). But, developing countries finds it more fruitful to export most of the quality fruits and vegetable production in exchange of the foreign currency. Alcohol causes more than 2 million deaths every year in the world. It is particularly associated with liver disease and esophageal cancer. The increase in alcohol consumption in developing countries will add other hazards caused by violence and road accidents to the burden of disease. Public health policy and its implications Lee, Fustukian and Buse provide a helpful framework for disentangling four dimensions of global health policy-making (Lee et al, 2002) as:- * Policy Actors They are the power (political) who can drive the policy and decision making at a global level. In case of NCDs, United Nations, WHO, FAO, WTO, World bank, Codex Alimentarius Commission, etc. * Policy Process Process through which policy is developed and implemented. Interactions and relationship between policy actors. * Policy Context For NCDs, its global. * Policy Content Effective strategy should address universal prevention , selective or primary prevention for high risk group and targeted or secondary prevention and treatment for those with existing conditions. It is pretty clear that NCDs has its roots in unhealthy lifestyles or adverse physical and social environments. Risk factors like unhealthy nutrition over a prolonged period, smoking, physical inactivity, excessive use of alcohol, and psychosocial stress are among the major lifestyle issues. Now to our understanding, it is known that what has to be done so we have to work more on how to do it (Aulikki et al, 2001). Well planned community programmes can be a successful step towards this process. Several factors like cultural, psychological, political and economical factors has created a gap between what needs to be done and day to day happening in the developing countries because of which major health challenges cannot be achieved. So, a community programme will help in bridging this gap and also helps in changing the NCD related lifestyles (Ibid). . The policies made at an international level also require global processes which can help to achieve a stable policy change at a country level, thus reducing the long term harm associated with it. International law is an example for this type of process. Multilateral agreements contain legally binding obligations, such as the WHOs Framework Convention on Tobacco Control (FCTC). FCTC includes hard law conventions. FCTC is an evidence-based treaty that identifies core areas of agreement over regulatory measures that involved countries are leally required to implement within their own domestic systems (WHO, 2005). Apart from FCTC, there are some soft law resolutions and declarations too, like United Millennium Declaration and WHOs Global Strategy on Diet, Physical Activity and Health (GSDPAH). WHO also worked in the area of chronic, lifestyle related diseases through Global Strategy on Diet, Physical Activity and Health (GSDPAH, 2004). It works on a strategy which builds on the role of t obacco, unhealthy diet and physical inactivity in the most NCDs. GSDPAH works in close relation with the UN agencies, the WTO, World Bank, other Development banks, Codex Airentarius Commission (WHO, 2004). One of the most significant health development programs within the United Nations system is the Millennium Development Goals (MDGs). The MDGs are a global partnership embracing ambitious goals to be achieved collectively within 15 years timeframe from 2000-2015 (Magnusson, 2007, p 6). The MDGs and FCTC serve as helpful models when considering ways of strengthening the global response to non-communicable diseases. The ideal step for developing countries to overcome the NCD epidemic and they have to plan and implement accordingly to control NCDs. Each community based prevention programmes require the same principles to be followed. As an example, The North Karelia Project in least developed areas of Finland which was based on low cost lifestyle modifications and community participation (Puska P et al, 1981). The reason to follow the general principle can be the collaboration between countries and different international organizations working on the similar fields and projects like WHOs countrywide Integrated Non Communicable Disease Intervention (CINDI, 1985). Even these sort of integrated programmes like CINDI were implemented in developed countries; they are now followed by the developing countries too. Many of these programmes are carried out in conjunction with the WHO integrated programmes, which was started in 1986. After the success of CINDI programme, American regional office had also l aunched CARMEN (AMRO) programme in 1990s. With the regional development experience, WHO has launched similar programme in Asian and African networks. In Latin America, Cuba is carrying out the NCD prevention programme from long time with the collaboration with the WHO activities where Havana and Cienfuegos as the main sites. Chile also participated in the Interhealth Programme CARMEN and was the first Latin American country to join this programme and many other countries followed it. Argentina has started PROPRIA heart health intervention as an active network at various demonstration sites (Aulikki, 2001). Africa has started community based CVD prevention programme long time back. Nigeria, Mauritius and united republic of Tanzania participated in Interhealth Programme and gained the positive responses. Mauritius intervention programme recorded considerable effect of nutrition policy and education interventions on diet and serum cholesterol levels, although rates of obesity and diabetes increased (Dowse G et al, 1995). Asias community-based initiatives have been initiated in Sri Lanka, Thailand, Singapore, India, Pakistan, Malaysia, Iran and other countries. Particularly active development has taken place in China, where the Interhealth Programme was involved in initiatives in Tianjin and Beijing (Tian et al, 1995) . The Tianjin project in China was one of the major project launched in 1984 in China. This project was also cooperating groups in Finland, China and USA for NCD control since 1989. This project focused on 4 leading NCDs of China, i.e. stroke, coronary heart disease, cancer and hypertension. The aim of this project was to reduce sodium intake in the population, decrease smoking especially among men and provide hypertension care by reorganizing the existing primary health care services. The result of this project shows a significant reduction in the sodium intake after three years and also reduction in number of patients of Obesity and hypertension among 45-65yrs old after five years of the intervention. Smoking cases were also reduced among men, especially those with the higher education (Aulikki et al, 2001). Health education and the media campaigns also play an important role in the community programmes. Media campaigning although leaves the less impact on the population, it is one of the effective measure in the comprehensive package. Health service intervention such as primary care centre in the long run can also be one of the most effective intervention tools. This strategy can more appropriately work where certain biological risk factors such as hypertension and high blood pressure are dealt with. Primary health care workers played an important role in both North Karelia project and Tianjin project (Ibid). The North Karelia project worked on a concept of Community organization where various sectors of the community were collaborated and involved. It involved many non governmental organizations (NGOs), such as Housewives` organizations. It is not easy to collaborate with the industries and businesses at a small community but a classic example for it is finlands cholesterol level, which reduces with the support and collaboration of the food industries, who supported the policy decisions (Puska P et al, 1986). Aulikki et al had made some recommendations for a successful NCD prevention program which must include the following factors. A good understanding of the community, close collaborations with the various community organisations and the involvement of the local population is important for any community intervention programme. It should combine well planned media and provide some communication messages in the community activities. It should involve different elements such as primary health care workers, food industries and supermarkets, voluntary organisations, schools work places, and local media for its success. It should be cost effective, mainly in the developing countries. For this reasonable outcome, effective dose intervention is a very important requirement (Aulikki et al, 2001). The increasing NCDs burden should be controlled by the developed and developing countries as a global health priority. International organisations with the national, regional and each individuals contribution can make these programme a success. Controlling of risk factors like smoking, alcohol, obesity, diet and inactivity, sexual and environmental factors are must and should be considered seriously and worked upon to treat it. The poverty and the high cost of prevention and treatment of chronic diseases causes burden on many countries and thus demands for international solidarity and public private partnership. The coordination of health decision makers, non-governmental organizations, research institutions, community groups and individuals is must for controlling the incidence of diseases, preventing the spread of epidemics and regulate the health management of human and material resources (Boutayeb, 2005). WHO is a political champion for coordinating global response. The developin g countries face problem in the implementation and enforcing the policies that are set up by the international legal standards which have a normative role and also these legal standards are not self executing, so compliance can be monitored by the NGOs and government. A global approach in a way like this could reduce health inequalities (Magnusson, 2007). REFERENCES  · Anand K, Shah B, Yadav K, Singh R, Mathur P, Paul E, Kapoor S K (2007), Are the urban poor vulnerable to non-communicable diseases? A survey of risk factors for non-communicable diseases in urban slums of Faridabad, The National Medical Journal of India, Vol. 20, No. 3,   p 115-120.  · Aulikki Nissinen, Ximena Berrios, Pekka Puska (2001), Community-based non-communicable disease interventions: lessons from developed countries for developing ones, Bull World Health Organvol.79no.10.  · Beaglehole R, Yach D (2003), Globalization and the prevention and control of non-communicable disease: the neglected chronic diseases of adults, The Lancet; 362: 903-08. * Boutayeb Abdesslam (2006), The double burden of communicable and non-communicable diseases in developing countries, Royal Society of Tropical Medicine and Hygiene, Volume 100, Issue 3, Pages 191-199 .  · Countrywide integrated non-communicable diseases intervention (CINDI) Programme. Copenhagen, WHO, Europe, 1995. * Dowse G (1995), Changes in population cholesterol concentrations and other cardiovascular risk factor levels after five years of the non-communicable disease intervention programme in Mauritius, British Medical Journal, 311: 1255 ¾1259. * Ezzati M, Lopez A (2003), Estimates of Global Mortality Attributable to Smoking in 2000. TheLancet, 362:847-852. * Guindon G, Boisclair D (2003), Past, Current and Future Trends in Tobacco Use-Health, Jamison D, Breman J, Measham A, Alleyne G, Claeson M, Evans D (2006), Priorities in Health, Washington DC, World Bank.  · Horton Richard (2005), The neglected epidemic of chronic disease, The Lancet, Volume 366, Issue 9496, Page 1514. * Lee K, Fustukian S, Buse K (2002), An Introduction to Global Health Policy, Health Policy in a Globalising World, Cambridge, Cambridge University Press; 2002:3-17. * Leeder S, Raymond S, Greenberg H, Liu H, Esson K (2004), A Race Against Time: The Challenge of Cardiovascular Disease in Developing Economies, New York, Columbia University. * Magnusson R S (2007), Open Access Non-communicable diseases and global health governance: enhancing global processes to improve health development, Globalisation and health; 3:2.   (http://www.globalizationandhealth.com/content/3/1/2). * Mehan M B, Srivastava N, Pandya H, (2006), Profile of noncommunicable disease risk factor in an industrial setting, J Postgrad Med;52:167-173. * Miranda J J, Kinra S, Casas J P, Smith G D , Ebrahim S (2008), Non-communicable diseases in low- and middle-income countries: context, determinants and health policy, Trop Med Int Health; 13(10): 1225-1234. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687091). * Murray J L and Lopez A D (1996), The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020, Harvard School of Public Health, Cambridge, MA.  · Puska P (1981), The North Karelia Project: Evaluation of a comprehensive community programme for control of cardiovascular diseases in North Karelia, Finland, 1972-1977, Copenhagen, WHO, Europe. * Semenciw R M, Morrison H I, Mao Y, Johansen H, Davies J W , Wigle D T. (1988), Major Risk Factors for Cardiovascular Disease Mortality in Adults: Results from the Nutrition Canada Survey Cohort, International Journal of Epidemiology, Vol.17, No.2, p 317-324.  · Reddy K S (2002), Cardiovascular diseases in the developing countries: dimensions, determinants, dynamics and directions for public health action, Public Health Nutrition 5, pp. 231-237.  · WHO (2002), Reducing Risk: Promoting Health Life, World Health Organization, Geneva, Annual Report. * WHO (2003b), Diet, Nutrition and the prevention of Chronic Diseases, World Health Organization, Geneva, Technical Report Series No. 916.  · WHO (2004), Global Strategy on Diet, Physical Activity and Health, WHA57.17.  · WHO (2005), WHO Framework Convention on Tobacco Control, WHA56.1 * Yusuf S, Reddy K S, Ounpu S, Anand S (2001), Global burden of cardiovascular diseases: Part I: General considerations, the epidemiological transition, risk factors, and impact of urbanization, Circulation 1

Sunday, January 19, 2020

Meaning of Irish Place Names and Surnames

A little bit about the history of Irish place names. It may come as a surprise, but only a small portion of names comes directly from English language. The big majority of names here are anglicisations of Irish (Gaeilge) names and few names come from Old Norse. The name of Ireland itself comes from the Gaeilge name Eire, added to the Germanic word land. In mythology, Eire was an Irish goddess of the land and of sovereignty. My boyfriend? s surname is Doyle, the twelfth most common surname in Ireland. Now we know that the statement that the name is derived form the Irish word Doibh (meaning dark, gloomy, melancholy) can be disregarded as it is generally accepted that the correct derivation is dhubh-ghall, meaning Norse invader or dark foreigner. Its variations in English are Doyelle, Doyley, MacDowell or O Dubhghaill in Irish. One of my best friend ? s surname is Ruane. It is an anglicized form of the Old Gaelic â€Å"_O'Ruadhain_†, which translates as â€Å"the descendant of the red one†. We don’t know whether â€Å"Ruadhan† (red) refers to complexion of skin or red hair, or to some event relating to the abilities as a warrior but it is a descriptive nickname from the pre-medieval period. I have to note here that my friend Aidan is neither ginger nor a warrior. Overall, all I have to admit is that I had great fun discovering facts about origin of Irish place names and surnames. I have a better understanding about the importance of Irish language and the heritage it brings. I got to know Irish history better and will definitely keep eyes open even more next time when travelling around Ireland. References: The internet surname database – www. surnamedb. com The internet Library database – www. libraryireland. com The internet place names database – www. logainm. ie The internet database to find Irish roots – www. youririshroots. com The internet Irish friend – www. dochara. ie The internet Learn Irish – http://talkirish. com/ The Irish times – www. irishtimes. com

Saturday, January 11, 2020

Jeffrey Dahmer’s Childhood and Capture Essay

â€Å"His behavior didn’t change. The object changed.† This is what psychologist at George Washington University, David Silber, stated when asked about the relation between Jeffrey Dahmer’s childhood activities and his unspeakable crimes later on in life that traumatized civilians and Milwaukee’s finest law enforcement. The name â€Å"Jeffrey Dahmer† conjures images of his numerous brutal murders. However, as his violence was believed to be spurred by his childhood experiences, his court case and his capture involved some of the best, and worst, work done by the American justice system. As a young child, Jeffrey Dahmer had a considerably unusual childhood. In 1964, at the age of four, his father, Lionel Dahmer, noticed Jeffrey was developing an interest in the remains of small animals; while he was sweeping some out from underneath his house and placing them in a bucket, Jeff was thrilled by the sound they made (â€Å"Jeffrey Dahmer’s Childhood†). That same year, according to a â€Å"Twisted Minds† web page article, he underwent a double hernia operation, which left him vulnerable and scared for he did not understand what was going on. By age six, Jeff and his family moved to Doylestown, Ohio, where his younger brother, David, was born and, according to Radford University, his teachers began reporting him feeling neglected. Only two years later, his family moved to Bath Township, Ohio, where his father claimed he had been sexually abused by a neighborhood boy (â€Å"Dahmer’s Compulsions†). Such a traumatic experience as this most likely would follow him throughout the rest of his life. By age ten, his hobbies evolved into somewhat of an addiction. Jeff had begun collecting road kill, bleaching chicken bones, decapitating rodents, and even taught himself how to use acid to strip the meat of dead animals from their bones (â€Å"Childhood†). During his teenage life, those around Jeff began to notice some distressing changes occurring within him. According to Radford University, Jeff discovered alcohol at thirteen, and, by the time he was sixteen, he was sneaking scotch into his morning classes. He most likely took to alcohol because he felt unaccepted, as his peers began viewing him as desperate and lonely. His parents, Joyce and Lionel Dahmer, constantly quarreled and, just like any other teenager, he took their arguments to heart (â€Å"Childhood†). In 1978, the same year Jeff graduated high school, his parents divorced and his mother gained custody of Jeff’s younger brother, David (â€Å"Dahmer’s Compulsion†). Former neighbor Susan Lehr spoke on his attitude and personality when these events were occurring, stating that, â€Å"something devastating [was] going on in his life and there wasn’t anybody there to help him,† (â€Å"Cannibal†). This could have possibly been what sparked him to become the monster that the public know him as today. Jeff took his parents’ divorce extremely hard. According to Los Angeles Times, his mother and brother moved to Wisconsin while his father stayed at a motel, leaving him alone in his house, feeling abandoned and developing an intense fear of loneliness. While alone in his house, Jeff claimed his first victim, hitchhiker Steven Hicks (Newton 46). When asked about the incident thirteen years later, 31-year-old Dahmer told police that â€Å"[Hicks] wanted to leave and I didn’t want him to leave,† so, as a result, he killed him in order to keep him from doing so (â€Å"Cannibal†). Jeffrey Dahmer first came to authority’s attention in October 1981 when he was placed under police custody for public intoxication and disorderly manner at a Ramada Inn (Yusof). According to Newton’s serial killer encyclopedia, he was also arrested in 1982 for indecent exposure at the Wisconsin State Fair and again in 1986 for similar charges (47). At this point, his attraction to young individuals was becoming more and more noticeable. On September 26th, 1988, Dahmer was charged for sexually assaulting a thirteen-year-old Laotian boy at his Milwaukee apartment (Newton 47). During trial, Assistant District Attorney Gail Shelton urged to get Dahmer imprisoned for five to six years, saying that â€Å"it [was] absolutely crystal clear that the prognosis for treatment of Mr. Dahmer within the community [was] extremely bleak†¦ and just plain [was not] going to work.† However, Judge William D. Gardener refused to send him to prison where psychiatric help was not available, and, instead, sentenced him to a one-year work release program at the Franklin House of Corrections for the rehabilitation of sex offenders (Yusof). On May 16th, 1991, police were informed about a naked and bleeding boy, named Konerak Sinthasomphone (coincidentally the brother of the Laotian boy of 1988), stumbling through the Milwaukee streets that lead back to Dahmer’s apartment (Newton 47). According to Newton’s serial killer encyclopedia, Dahmer falsely told Officers John Balcerzak, Richard Porubcan, and Josheph Gabrish that Konerak was his nineteen-year-old lover who had drank a little too much which resulted in an argument between the two. After a bit of contemplation, the officers returned Konerak to Dahmer’s custody and considered it just a conflict between two homosexual lovers (Yusof). However, law enforcement had no idea that they would find one of the most gruesome scenes at that same location only two short months later. Tracey Edwards approached a Milwaukee police vehicle on July 22nd, 1991, hand-cuffed, drugged, and frightened, claiming to have escaped from Jeffrey Dahmer’s apartment (Montaldo). Arriving at his apartment a few moments later, the calm demeaned Dahmer tried to convince the officers that it was only a misunderstanding between him and Edwards. The officers, almost believing him, just narrowly returned Tracey to Dahmer, but, spotting Polaroid photos of bodies in various states of dismemberment, the shocked officers placed him under arrest instead (â€Å"Cannibal†). According to The History Channel Website, authorities found a house of horrors within the walls of the one-bedroom apartment: two human heads in the freezer and refrigerator, a fifty-seven-gallon drum of human torsos, limbs, and other various parts decomposing in acid, evid ence of cannibalism, and much, much more. A sight that startled, sickened, and scarred those investigating it for the rest of their lives. Later, Police Chief Philip Arreola of the Milwaukee Police Department and Mayor John O. Norquist launched an internal investigation, firing officers Balcerzak and Gabrish for failing to perform their police duties properly (in the case of Konerak Sinthasomphone), keeping officer Porubcan under close observation (Yusof). Standing trial in early 1992, of the courtroom’s one hundred seats, thirty four of them were reserved for Dahmer’s victims’ mourning family members, twenty three seats for reporters, and the remaining forty three seats were open to the public while Dahmer was separated from the rest of the gallery by an eight-foot barrier, constructed out of bullet resistant glass and steel (Bardsley). It definitely was not the â€Å"normal† courtroom setting that most legal systems were accustomed to. Partaking in the legal drama was Judge Laurence C. Gram, Jr. , District Attorney Michael McGain, and defense lawyer Gerald Boyle who had defended Dahmer on prior occasions of his offenses (Bardsley). The Majority of the testimony was based on Dahmer’s one hundred and sixty-page confession where he acknowledged that he knew his actions were wrong, coming at a great expense, but, at the same time, was still uncertain of why he did them (Montaldo; â€Å"Confession†). While Boyle stressed that the gruesome nature of his client’s crimes was part of a strategy that only an absolute lunatic were capable of committing, the prosecution labeled Dahmer as â€Å"cold-bloodedly sane† and reasonably frightened of being discovered as he went to great length to avoid detection for so many years (Yusof). There was no question that he was aware of the consequences of his actions. According to the article â€Å"Jeffery Dahmer’s Confession†, Dahmer agreed to help the police in any way he possibly could to identify his victims in order to make restitution for the victims’ families. On January 30th, 1992, according to Montaldo’s article â€Å"Profile of Serial Killer Jeffrey Dahmer†, Jeffrey Dahmer pleaded guilty by reason of insanity before Judge Laurence C. Gram, Jr. However, as he was found sane enough to stand trial, Dahmer then pleaded not guilty despite the fact that he had already confessed to seventeen murders (Yusof). On February 15th, 1992, after deliberating for over five hours, the jurors found Dahmer fully responsible for his actions and guilty of first-degree intentional homicide on fifteen of the seventeen accounts (â€Å"Childhood†). According to â€Å"Jeffrey Dahmer Case File†, after his sentencing, Dahmer begged to be executed. After the horror he caused, hundreds of others would have been pleased with thtis outcome, as well. However, as Wisconsin had abolished capital punishment years prior to Dahmer’s case, he was instead sentenced to fifteen life sentences (a minimum of 936 years) without parole which he wo uld serve at the Columbian Correctional Institute in Portage, Wisconsin (Newton 48; â€Å"Profile of Serial Killer†). At first, Dahmer was separated from the general population for his own safety, but, despite the many threats against his life, he refused protective custody (â€Å"Profile of Serial Killer†; Newton 48). Later, Dahmer probably should have reconsidered this decision. According to the Encyclopedia of Serial Killers, the first attempt on Dahmer’s life was on July 3rd, 1994, when another inmate tried to slash his throat while he was praying in the prison chapel. Although this attempt failed and he walked away with only minor scratches, the story would not be the same for the next. On November 28th, 1994, only six months later, while Dahmer was cleaning a bathroom near the prison gym, twenty five-year-old inmate Christopher Scarver acquired an iron exercise bar and attacked Dahmer, crushing his skull and killing him (Newton 48). At first, according to Newton’s Encyclopedia of Serial Killers, it was believed that Scarver murdered Dahmer for racial purposes as he, along with the majority of Dahmer’s victims, was African American. However, later, it was proven that this notion was untrue. Scarver was deranged, believing he was on a mission from God and performing his â€Å"Father’s† orders (Newton 48). Jeffrey Dahmer was an extremely, if not the most, notorious serial killer who conducted his misconducts in the United States. Not only did he rape, murder, and dismember his multiple victims, but he also admitted to sampling cannibalism. From experimenting on small animals as a child to doing the same to humans as an adult, some believe that his intense fear of loneliness, derived from his parents’ divorce, drove him to commit these atrocious crimes, while others simply view him as a cold-blooded monster with the intention of destroying lives. Thanks to Wisconsin’s legal system, along with determined police assistance, the clever, resourceful, and calm demeaned Jeffrey Dahmer who had floated through life, undetected for so many years, was incarcerated, removed from a position where he could do additional harm to society.

Friday, January 3, 2020

Analysis of the Truth of the Restrains Between Foods - Free Essay Example

Sample details Pages: 2 Words: 526 Downloads: 7 Date added: 2019/04/01 Category Society Essay Level High school Tags: Truth Essay Did you like this example? According to a recent done survey, nearly 90% of Chinese have heard about a statement that we cannot eat some kinds of food together otherwise we will be sick. A picture which tells the restrains between foods and is said to be made by China Public union of Nutrition has gone viral through social media. And some so-called experts said the statement is supported by TCM (traditional Chinese medicine). Don’t waste time! Our writers will create an original "Analysis of the Truth of the Restrains Between Foods" essay for you Create order However, most statements lack experimental evident and CCTV has refuted the rumors before. So, in this essay, I am going to discuss if the restrains between foods exist and if not what are the real causes of sick. There are usually two statements on how restrains between foods affect our health. It is said that some kinds of foods cause illness and intoxication while eaten together. For example, eating lily root and pork together will lead to diarrhea. But survey of the literatures and the experiment study about mutual restrained food combinations has done some experiments on guinea pigs and prove eating lily root and pork did no harm to their health, the same to sesame seeds and chicken, cucumber and peanut. Actually, food is full of nutrients that human beings need. Just mixing the nutrients is definitely unable to poison someone. More conditions such as environment and large amount are required. There is another statement claiming that eating some foods together will destroy some beneficial nutrition component. As professor Liu from Chinese Agriculture University said, some component will be broken after boiling and will not destroy the beneficial nutrient. Besides, the content of some nutr ient such as mineral and vitamin is so few that the influence can be ignored. Whats more, volunteers that are offer to try the dubious recipes did not feel ill. In conclusion, restrains between foods do not exist. So why there are still some people insist that they get ill after eating two kinds of foods together? Here are my guesses. Firstly, about milk with many foods. Lots of people feel uncomfortable after drinking milk and then owl it to restrains between milk and other food. In fact, it is likely because they are lactose intolerance. Secondly, improper edible way such as eating too much and cooking the food in the wrong way is one of the reasons too. Thirdly, IBS (irritable bowel syndrome) sufferers may mistake the real reason of their sick. Lastly, allergies to nuts, beans, seafood are probably the reason why so many people believe they cannot be eaten together. Though restrains between foods do not exist, food pyramid is reliable considering healthy eating. We can still make some improvement on our diet to have a balanced and nutrient-rich diet. After all, health is wealth. Reference List 1. ZHANG yin-hongDENG li-liWANG yuYUE liZHAO Jin-sheng, Ge ke-you. Apr,2011. Survey of the literatures and the experiment study about mutual restrained food combinations . Acta Nutrimenta Sinica, Vol.33 No.2 2. YUE Li, ZHAO Jin-sheng, WANG Yu. Recognition of mutual restriction between foods and practice of diet arrangement among undergraduates. Mar, 2010. China Public Health Vol.26No.3 3. Yu Rui-Min,Yang Junyun. Survey of common 30 mutual restrained food combinations. Centre for diseases Prevention and control of Beijing military region.