Paper Planes

A striking intro together with a captivating chorus that harmoniously complements every line from the verse are some of the usual elements that make a song popular.However, while elements, such as lyrics, contribute to a song’s appeal to the mass audience, elements can also serve as tools to state a singer’s opinion on relevant social matters.   The song Paper Planes by singer M.I.A, for instance, uses the song’s lyrical content to attack the established systems that have become destructive for humankindSuperficially, the song infers to the absurdity of the unyielding problem of prejudice in the dominant western world.   The words such as if you catch me at the border, I got visas in my name, in the first two verses of the song blatantly brings forth the most unimaginable a person can have in a in a foreign land.   Particularly in the United States where immigrants are stereotypically associated to criminal activities such as terrorism, murder, violence, an d illegal substance transactions.The sound of four consecutive gunshots intertwined with a ring of a cash register and a choral of children most blatantly serves Paper Planes’ attack on the immorality of racial prejudice.   The infusion of the aforementioned sound effects with the lines all I wanna do is, and take your money, the song disparages the prevalent collective neurosis that most robberies and crimes perpetrated across the United States are done by foreigners.However, the song goes deeper than the literal meaning of the words used in its lyrics.   As much as Paper Planes blatantly hints at the prejudice within American soil, it also criticizes the violence and the exploitation of human achievements such as technology to spread chaos, two destructive acts that has become rampant in modern society.  M.I.A. has stressed on such disparagement through the words no one in the corner has swagger like us, hit me on my burner, prepaid and wireless.   We pack and deliv er like UPS trucks, already going hell just pumping that gas.Likewise, M.I.A’s Paper Planes also manifests an opposition against the alleged good qualities of capitalism and consumerist culture that ignores the actual human condition while tolerating war and violence.The interwoven sounds of gunshots, singing children, and cash register ring together with the repeated verse lines express the futility of war, the degenerative tendency of the predominant practice of private enterprise, as well as psychological effects of violence on adults and children.Unlike other songs that seek the appreciation of the general populace, the lyrical content of Paper Plains metaphorically attacks the current prevalent social norms.   The only problem is that the message it aims to disseminate becomes misconstrued by the very public it wishes to reach out to.   

Effect van EPO

InleidingHet hoofddoel new wave dot onderzoek is onderzoeken wat het consequence new wave EPO is op je sportprestaties. Dit zal worden onderzocht met behulp new wave een aantal deelvragen. Ten eerste zal Er worden gekeken naar het consequence new wave EPO op heated menselijk lichaam. Ten tweede zal Er antwoord worden gegeven op hoe EPO je sportprestaties be & amp ; iuml ; nvloed. En tot slot kijken we bij welke sporten EPO het meeste consequence heeft. Door het beantwoorden new wave deze vragen zal Er antwoord worden gegeven op de hoofdvraag ; Wat is heated consequence new wave EPO op je sportprestaties? Er wordt straks eerst een kleine uitleg gegeven over wat EPO nou eigenlijk is, en wat voor consequence EPO op je lichaam heeft. Vervolgens wordt Er uitgelegd wat de gevaren van EPO zijn en hoe ze in topsport de controle uitvoeren op het gebruik new wave EPO. Daarna zal Er uitgelegd worden hoe je op andere manieren ook hetzelfde consequence van cre & A ; euml ; ren ALSs dat EPO op je lichaam heeft. In hoofdstuk 6 zal kort worden aangetoond digital audiotape Er verschillende soorten EPO zijn, van verschillende generaties. In heated laatste hoofdstuk zal Er worden gekeken bij welke sporten EPO nou het meest effectief is en zullen Er enkele voorbeelden new wave EPO gebruikers worden gegeven. Tot slot volgt Er een conclusie met heated antwoord op de deelvragen en de hoofdvraag.EPOEPO, ook wel Erytropo & A ; euml ; tine of hematopoietine genoemd. is een hormoon digital audiotape in de nieren en lever wordt geproduceerd en dat de aanmaak van rode bloedcellen stimuleerd. EPO is een glycoprote & A ; iuml ; Ne. Erytropo & A ; euml ; tine wordt door het menselijke lichaam gemaakt, maar kan ook in laboratoria gefabriceerd worden, en is dan een vorm new wave rhEPO ( recombinante humane erytropo & A ; euml ; tine ) bekend onder merknamen ALSs Eprex, Mircera etc. Menselijke nieren maken de stof ALSs reactie op een lage zuurstofspanning zoals bij anemie wordt gezien. Oorspronkelijk werd de stof dan ook gesynthetiseerd ALSs geneesmiddel voor mensen met niet goed functionerende nieren, die ondanks kunstnierbehandeling bijna allemaal bloedarmoede kregen door een gebrek aan epo. Door dot Te geven kon de bloedarmoede worden gecorrigeerd. Ook kankerpati & A ; euml ; nten kunnen tijdens de chemokuur epo toegediend krijgen tegen bloedarmoede, dot is nodig omdat door de chemokuur rode bloedlichaampjes in het lichaam kapot worden gemaakt.Wat doet EPO?Bloed bestaat uit rode bloedcellen, witte bloedcellen, bloedplasma en nog enkele andere deeltjes. EPO stimuleert de aanmaak van rode bloedcellen en verhoogt h eated totale bloedvolume ; EPO zorgt dus voor meer bloed in het lichaam. Rode bloedcellen zorgen voor het conveyance new wave zuurstof in het hele lichaam. Een rode bloedcel bevat bepaalde structuren, die hemoglobines worden genoemd. Deze structuren in de bloedcel binden zuurstof aan zich ( figuur 2 ) . Sporters met veel rode bloedcellen voorzien Hun spieren dus beter new wave zuurstof. Als je gaat sporten, wordt er door je spieren melkzuur gemaakt. Melkzuur wordt vooral aangemaakt onder anaerobe omstandigheden. Anaeroob betekent zonder zuurstof. De spieren zorgen dus voor energie om Te bewegen, zonder digital audiotape ze daarbij zuurstof gebruiken. Dit gebeurt alleen ALSs het bloed niet genoeg zuurstof kan vervoeren naar de spieren, want het is erg ongunstig. Een sporter kan hierdoor namelijk verzuren. Bij verzuring is heated gehalte melkzuur in de spieren zo hoog, digital audiotape je spieren eigenlijk niet meer willen bewegen. Dit kan leiden tot vermoeidheid en kramp. Spieren gaan dus alleen anaeroob werken ALSs het genuine moet. Een sporter dice EPO gebruikt, kan meer zuurstof vervoeren en zal dus minder snel verzuren dan een sporter dice geen EPO gebruikt. De spieren krijgen meer zuurstof aangeleverd en hoeven dus niet anaeroob Te werken. Als het totaal aan rode bloedcellen en heated totale bloedvolume stijgt, heeft dat ook enkele voordelen voor het lopen of fietsen new wave wedstrijden bij warm weer. Als je intensief beweegt terwijl het erg warm is, koelt het lichaam zichzelf af door meer bloed naar de oppervlakte van de huid Te laten gaan. Doordat het bloed meer aan de oppervlakte pimple, koelt heated sneller af dan digital audiotape het in heated dieper in het lichaam pimple. Dit bloed, aan de oppervlakte, gaat 10 koste new wave het bloed dat zuurstof naar de spieren moet vervoeren. Er is dus tekort bloed beschikbaar om de spieren van voldoende zuurstof Te voorzien. EPO zorgt ervoor digital audiotape het lichaam meer bloed tot zijn beschikking heeft, zodat de spieren, zelfs in de hitte, nog wel zuurstof krijgen. Een ander voordeel is dat er meer H2O in het lichaam is. Bloedplasma bestaat vooral uit H2O, en maakt deel uit new wave het bloed. Dus ALSs het bloedvolume groter is geworden door het gebruik new wave EPO, is ook de hoeveelheid H2O in het lichaam groter. De waterreserve, dice wordt gebruikt bij wedstrijden, is dus groter. Een sporter dice EPO gebruikt kan dus beter tegen de hitte dan een sporter dice niet gebruikt om twee redenen. De eerste is dat hij minder snel verzuurt doordat Er nog genoeg bloed is om zuurstof Te vervoeren. De tweede reden is dat hij meer H2O heeft in zijn lichaam en dus minder snel uitdroogt. Het consequence new wave EPO kan ongeveer drie maanden duren.Gevaren new wave EPOAls je meer vaste stof aan een oplossing toevoegt, wordt de oplossing dikker. Als er nu meer rode bloedcellen worden gemaakt ( een vaste stof ) , wordt het bloed ( oplossing ) dikker.Het bloed new wave een sporter dice EPO gebruikt wordt dus dikker. Het bloed moet door allerlei hele dunne aders in het lichaam, ook naar de hersenen en het Hart. Als het bloed nu heel dik is, kan het niet meer goed door de aderen stromen en hoopt het op. De gevolgen hiervan kunnen zeer ernstig zijn. De sporter kan een hartaanval krijgen of een beroerte en dood gaan. Dit is al een enkele keren gebeurd. In heated jaar digital audiota pe EPO voor het eerst in Europa Te krijgen was, 1987, zijn er vijf nederslandse wielrenners gestorven. Ook in de rest new wave Europa zijn er doden gevallen. Als er sprake is van een hogere temperatuur ontstaat Er een ander gevaar. Als de sporter zweet verliest hij vocht waardoor het bloed N & A ; oacute ; g dikker. Hierdoor wordt de kans op een hartaanval of beroerte voor de EPO gebruiker dus N & A ; oacute ; g groter wordt. Als het erg warm is, verliest het lichaam veel H2O. Het bloed wordt dan peg dikker en het risico new wave een hartaanval of beroerte is dan zoals net ook Al genoemd nog groter.Hoe controleert work forces op heated gebruik new wave EPO?EPO lijkt ALSs twee druppels H2O op het echte hormoon.Het EPO-molecuul is exact hetzelfde aan het hormoon digital audiotape in de nieren wordt geproduceerd. Bij toediening new wave EPO aan een pati & A ; euml ; nt treedt er dan ook geen afweerreactie op, omdat deze stof Al lichaamseigen is, er worden dus ook geen antistoffen tegen EPO gevormd en het medicijn heeft ook nauwelijks bijwerkingen. Bovendien is heated gebruik new wave EPO al na drie dagen niet meer Te achterhalen. Er zijn gee n stoffen meer in de piss of in het bloed Te vinden. Het is dan ook ook erg moeilijk het gebruik Te controleren. Daarom heeft de Medische Commissie new wave het IOC, het Internationaal Olympisch Comite, iets anders bedacht om het gebruik tegen Te gaan. Er wordt een ‘gezondheidscontrole ‘ gedaan. Er wordt bij sporters voor de wedstrijd bloed afgenomen en daarvan bepaalt work forces het per centum rode bloedcellen. Bij een normaal persoon ligt het per centum rond de 42 % . Als heated per centum bij een sporter hoger is dan 50 % , mag hij om twee redenen niet starten. Ten eerste is heated gevaarlijk om met zo'n hoog per centum Te starten. Het risico new wave een hartaanval of beroerte is te groot. Ten tweede is heated zo ongewoon hoog, digital audiotape het zeer waarschijnlijk is dat de sporter EPO heeft gebruikt. Sommige sporters beweren dat ze new wave nature zo'n hoog per centum rode bloedcellen hebben en worden dus onterecht bestraft. In bovenstaande bron is te zien wat de samenstelling is van heated bloed new wave een normaal persoon. We zien dat het gemiddelde per centum rode bloedcellen ongeveer 43 % is. Als er na heated afnemen van heated bloed new wave een sporter blijkt digital audiotape het per centum rode bloedcellen hoger is dan 50 % , mag de sporter niet meer deelnemen aan de desbetreffende wedstrijd, en zal er een onderzoek worden gestart. Omdat ALSs het per centum rode bloedcellen boven de 50 % ligt dan is er een kans dat de sporter EPO heeft gebruikt, ook is heated gevaarlijk om Te starten. Een hoog per centum aan rode bloedcellen vergroot namelijk het risico op een hartaanval en een beroerte. Vele sporters protesteren hiertegen omdat een hoger per centum aan rode bloedcellen ook iets zijn wat bij Hun aangeboren is, maar ook door veel op hoogte Te trainen kan je je per centum rode bloedcellen verhogen. Dit maakt het beleid natuurlijk erg lastig. Vooral omdat het per centum rode bloedcellen ook dus op een andere manier kan stijgen. Een verboden middel ALSs EPO is dus niet verboden ALSs je er een beetje new wave gebruikt, terwijl een spoortje Anabole stero & A ; iuml ; den Al voor een schorsing zorgt. Dit zorgt natuurlijk voor veel discussie in de sportwereld. Om toch de gezondheid new wave sporters in de gaten te houden is de gezondheidscontrole ingevoerd. Zolang er nog geen manier is gevonden om EPO gebruik aan Te tonen, is dit de enige manier om het gebruik proberen Te beperken.Vervangers van EPOEr zijn ook andere manieren om dezelfde effecten van EPO Te krijgen zonder de nadelen die eraan vastzitten. Zoals voorgenoemde, heated leven en trainen op een hoogte.Door de lagere hoeveelheid zuurstof in de lucht, stimuleert het lichaam de aanmaak van excess rode bloedcellen. Echter niet zoveel ALSs EPO digital audiotape doet en het bloed wordt ook niet dikker. Daarnaast worden de longen en het Hart sterker door het trainen op hoogte, ze moeten op hoogte namelijk harder werken om genoeg zuurstof Te blijven geven aan het lichaam om inspanning blijven te verrichten.Verschillende soorten EPO– Eerste generatie Ontwikkeld in 1977, werd uit urine gehaald. – Eerste generatie Ontwikkeld in 1977, werd uit urine gehaald.Twee generatieDeze discrepancy werd vanaf 1987 gebruikt, hieraan overleden vijf Nederlandse wielrenners. Deze variant werd met behulp new wave genetische technieken geproduceerd. Door deze genetische technieken kon EPO in grote hoeveelheden geproduceerd worden.Derde generatieDeze generatie kwam in 2007 op de markt, Cera. Het is de afkorting new wave â€Å" uninterrupted erythropoiesis receptor activator † . En is een middel digital audiotape wordt gebruikt ALSs geneesmiddel bij bloedarmoede of ter voorkoming new wave bloedarmoede bij kankerpati & A ; euml ; nten tijdens de chemokuur Een voordel new wave dot middel is dat je het maar een ke er in de drie & A ; aacute ; vier weken hoeft Te gebruiken.Vierde generatieEr is een vierde generatie new wave EPO op komst, dot middel zou ontraceerbaar zijn. Het gaat hierbij om een vorm new wave gentherapie.In welke sporten wordt EPO het meest gebruikt?EPO wordt het meest gebruikt bij duursporten zoals wielrennen en marathonlopen. Voor sprinters heeft heated gebruiken new wave EPO geen nut omdat dice sowieso verzuren tijdens heated sporten. Dit gebeurt doordat zij in een zeer korte tijd zoveel inspanning leveren, de spieren hebben in & A ; eacute ; & A ; eacute ; n keer heel veel zuurstof nodig, hier kan het bloed ALSs het ware niet tegen transporteren. Het gebruik new wave EPO heeft dus weinig consequence voor sprinters omdat die Al onder anaerobe condities rennen. Sprinten is heel explosief, opeens hebben de spieren heel veel zuurstof nodig. Het bloed kan nooit zoveel zuurstof vervoeren. Ook niet met behulp new wave EPO.Voorbeelden new wave EPO gebruikersOok aan de manus new wa ve deze voorbeelden zien we dat EPO voornamelijk wordt gebruikt bij duursporten.ConclusieHet hoofddoel new wave dot onderzoek was onderzoeken wat het consequence new wave EPO is op je sportprestaties. Dit werd onderzocht met behulp van de volgende deelvragen.Wat is heated consequence new wave EPO op heated menselijk lichaamHoe EPO je sportprestaties be & amp ; iuml ; nvloed.Welke sporten EPO het meeste consequence heeft.Het antwoord op de eerste vraag, Wat is heated consequence new wave EPO op heated menselijk lichaam? EPO is een hormoon digital audiotape de productie van rode bloedcellen in de lever en nieren stimuleert. Het zorgt er dus voor de je lichaam meer zuursof kan opnemen. De tweede vraag was hoe be & amp ; iuml ; nvloed EPO je sportprestaties? Het is gegeven digital audiotapes een sporter dice EPO gebruikt, meer zuurstof kan vervoeren en zal dus minder snel verzuren dan een sporter dice geen EPO gebruikt. Het zorgt Er dus voor digital audiotape je het ALSs EPO gebruikende sporter langer vol kan houden dan de sporter dice geen EPO gebruikt. De laatste deelvraag was op welke sporten EPO het meeste consequence heeft. Het antwoord op deze vraag is bij duursporten, denk aan wielrennen en ski & A ; euml ; n, zoals in de voorbeelden ook Te zien is. Bij sprinters heeft het geen consequence omdat sprinten heel explosief is, de spieren hebben op korte tijd heel veel zuurstof nodig. Het bloed kan nooit zoveel zuurstof vervoeren. Ook niet met behulp new wave EPO. Het antwoord op de hoofdvraag, Wat is heated consequence new wave EPO op je sportprestaties? Hangt dus ook af new wave wat voor soort athletics je beoefend. Als je een sprinter set zal EPO geen consequence hebben op je sportprestaties. Maar ALSs je een wielrenner of een andere duursporter set zal EPO wel degelijk consequence hebben op je sportprestaties. Je spieren zullen door het gebruik new wave EPO minder snel verzuren en zo zal je langer in staat zijn optimale inspanning te leveren. Maar je moet jezelf natuurlijk afvragen of winnen met heated gebruik new wave doping je wel voldoening brengt.BronvermeldingWordlingo:hypertext transfer protocol: //www.worldlingo.com/ma/enwiki/nl/Erythropoietin # cite_note-Haroon_2003-1Kennislink:hypertext transfer protocol: //www.kennislink.nl/publicaties/dossier-epoRice:hypertext transfer protocol: //www.rice.edu/~jenky/sports/epo.htmlMedical Footings:hypertext transfer protocol: //www.medterms.com/script/main/art.asp? articlekey=7032hypertext tran sfer protocol: //www.medicinenet.com/erythropoietin/article.htmKennislink:hypertext transfer protocol: //www.kennislink.nl/publicaties/epo-doping-in-toomRTL:hypertext transfer protocol: //www.rtl.nl/ % 28/actueel/rtlnieuws/buitenland/ % 29/components/actueel/rtlnieuws/2007/ 05_mei/24/buitenland/0524_1330_wat_is_epo.xml

The essentials of international marketing in the context of a UK-based Essay

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Self-Learning and Development - Essay Example To acquire these skills and abilities and succeed in the 21st century the youth should dedicated to learn new skills and improve their efficiency and performance. These skills and abilities cannot be learned form the classroom studies, they need to learn from the environment and circumstance where they live or work. There are wide range of answers to the question of what are the skills and abilities required for the students to succeed in the future. This mainly depend on the characteristics of the individual and the education what they are acquiring from the studies. The four major categories where the students should improve are the communication skills, abilities to apply new technologies, critical thinking and multicultural awareness. The students learn the formal education from the classroom and informal learning from the world where thy live and work. (Walsh & Paul, 1986) The current scenario in the professional world is more competitive. Those who have the skills and ability will be move ahead and survive in the industry. The people need to learn themselves from the work environment and improve their skills and ability. The people should take responsibility to learn and develop themselves. The self-learning and development will enhance the individual performance as well as the organization performance. The Human resource department in the organization make arrangement for the self learning infrastructure to the employees, so that they can improve them selves and indirectly it will help to improve the performance of the organization. The people are learning one or another in their entire life in every situation or circumstance, which they faced in the everyday life. The continuous learners are always founds and successful persons. The continuous learners are considered more responsible and they can remain employable and marketable by themselves. The 21st century is the period of more challenges, global competition and advanced technology. So those who have resource of skills and ability will move ahead. More than educational qualification the employer will look into the skills and qualities of a person before taking him for the employment. The organization will look into the cost efficiency and effectiveness. (Arnold, 1997) The students need to develop the communication skills through which they can exchange the thoughts and ideas by speech or writing. Multicultural awareness will help them to understand and work with diversity. They should have the management skill to guide or organize the people and implement the ideas and policies. The ability to work in-group and adapt to the situation are the major qualities, which a students should develop in his college days. The work ethics, self-discipline and responsibility are the major factor through which a person will be judged and appraised in the organization. The discriminative thinking and analytical reasoning will enchance the performance of the person. (Hoare, 2006) These skills and abilities you cannot find the curriculum, but to be successful in the future the students should develop themselves by self-learning. Those who self-learners and improve their efficiency will move ahead in not only in his professional career but also in his life. So the self-learning is an art, every body should develop this by their own to succeed in life. In this century, the competition are higher in every

Reading For Student with Hearing Impairment Term Paper

Reading For Student with Hearing Impairment - Term Paper Example The lesson lists out the typical obstacles and challenges in the reading process and also triggering the kids to find more quality time for expansive reading. The lesson also attempts to further the desire amongst the kids who already have shown the urge for picking books and reading on their volition. In the end, the main objective of the lesson is to create a challenge aimed at aiding in the motivation of all kid to the reading cultures. The objective also outlines the main challenges, missions, and timeline for gaining of certain traits in the reading culture. It also outlines and creates ample time for the teachers to read to this kid while using hearing aid thus aiding in the pronunciation of vocabularies.  The lesson lists out the typical obstacles and challenges in the reading process and also triggering the kids to find more quality time for expansive reading. The lesson also attempts to further the desire amongst the kids who already have shown the urge for picking books a nd reading on their volition. In the end, the main objective of the lesson is to create a challenge aimed at aiding in the motivation of all kid to the reading cultures. The objective also outlines the main challenges, missions, and timeline for gaining of certain traits in the reading culture. It also outlines and creates ample time for the teachers to read to this kid while using hearing aid thus aiding in the pronunciation of vocabularies.   The literacy lesson notes hearing impairment as the main hindrance to normal learning.

Employment Law Issue Essay Example | Topics and Well Written Essays - 500 words

Employment Law Issue - Essay Example Sexual harassment usually involves males who are at higher positions and they harass their subordinate women in order to get sexual favors by threatening them of getting fired from the job. It is not only a form of unlawful employment discrimination that is based on sex but also it violates title VII of the civil rights act 1964. If we talk about harasser, we can say that at any specific workplace, the harasser and the victim can be an employee, an employer, supervisor, a person from the management staff, and even the boss. Some cases of sexual harassment may involve such homosexual men who are at higher positions and they harass their subordinate heterosexual men in order to get sexual favors. Conte (2000) found that in some cases, the victims of sexual harassment make complaint to the higher officials regarding offenses and in some cases they don’t want to expose the situation because of the society and the relatives. In such cases, sexual harassment gets increased and the victim sometimes gets in more trouble instead of coming out of the unwanted situation. The strategy which our company’s manager has implemented regarding the prevention of sexual harassment involves privacy of the victim. If a case of sexual harassment occurs in our company, the victim writes the incident on a paper and submits it to the manager instead of telling him by words. Then the manager calls the offender and the victim in a separate room in order to settle down the issue and take the required action against the offender. â€Å"It is the organizations responsibility to encourage staff to report incidents of sexual harassment by making the process accessible to all and by being approachable and dealing allegations in a sensitive and confidential manner† (Dawkins, 2007). At present, the management of the companies focuses on the privacy of the victim in order to

Strategic Management Coursework Example | Topics and Well Written Essays - 500 words

Strategic Management - Coursework Example Coca Cola itself has stated growth rates with the gradual diversification policy. According to its reports for the year 2013 and third quarter, the overall sales rose by a figure of 2 percent and this was largely attributed to the policies in context of diversification (Trefis, 2013). This in turn brought about a balance to the company’s standing and performance with regard to the previous quarter’s performance.. Diversification is a process when the given company changes its focus from one particular product or item to multiple items and services. This brings along various considerations, challenges and questions with regard to future trends, policies, and actions along with marketing patterns that are needed to be kept intact. This scrapbook looks into these dimensions in case of two globally recognized brands of beverages namely Pepsi Co and Coca Cola. Each has over period of time moved from single item to diversified product and service delivery. Coca Cola’s diversification plan and products delivery came about in the form of Coke Diet, Fanta, Sprite, Mineral water and various other side products that have given Coca Cola an impetus in the market in terms of sales (Volkman, 2014) Such a process of diversification brings along strategic management principles and actions with itself. These include the concept of layout, feasibility against the new product and the communication, promotion and marketing strategy against the given items that are aimed at for expansion. Coca Cola’s diversification plan and products delivery came about in the form of Coke Diet, Fanta, Sprite, Mineral water and various other side products that have given Coca Cola an impetus in the market in terms of sales (Volkman, 2014) The process of diversification opens with itself the new horizons of expanded market. The expanded market in turn leads to increased demand, expanded supply chain network and insuring the timely delivery of products and services.

The use of current cultural ideas and beliefs Essay Example for Free

The use of current cultural ideas and beliefs Essay The media today has learned that the use of current cultural ideas and beliefs is a strong way to get the consumers attention as well as get their point across. Marketing firms, networks, and production companies have learned that if they culturally relate their product or story to the public, then that would attract more viewers and attention, which in return is money for them. There are many different examples of how marketing firms do this, but is there a movie, show, ad, or song that is just for entertainment only. It is very hard to find a part of the media that is Entertainment Only and not trying to portray a part of our cultural beliefs. The media has a way of portraying what they believe is a problem or their side of an issue. This procedure can sometimes cause the wrong impression or idea within a persons mind. This is not just in the news media; this is also in music, movies, or books. There are many different types of media. The media can range from music, movies, television, books, newspapers, etc. The area that I believe shows the least amount of issues is the music industry, and more specifically the country music industry. Cultural imperialism is defined as the cultural aspects of imperialism. Imperialism, here, is referring to the creation and maintenance of unequal relationships between civilizations favoring the more powerful civilization. Many scholars employ the term, especially those in the fields of history, cultural studies, and postcolonial theory. The term is usually used in a pejorative sense, often in conjunction with a call to reject such influence. Cultural imperialism can take various forms, such as an attitude, a formal policy, military action, so long as it reinforces cultural hegemony. The term emerged in the 1960s. and has been a focus of research since at least the 1970s. Terms such as media imperialism, structural imperialism, cultural dependency and domination, cultural synchronization, electronic colonialism, ideological imperialism, and economic imperialism have all been used to describe the same basic notion of cultural imperialism. Definition Various academics give various definitions of the term. American media critic Herbert Schiller wrote: The concept of cultural imperialism today [1975] best describes the sum of the processes by which a society is brought into the modern world system and how its dominating stratum is attracted, pressured, forced, and sometimes bribed into shaping social institutions to correspond to, or even promote, the values and structures of the dominating centre of the system. The public media are the foremost example of operating enterprises that are used in the penetrative process. For penetration on a significant scale the media themselves must be captured by the dominating/penetrating power. This occurs largely through the commercialization of broadcasting. Tom McPhail defined Electronic colonialism as the dependency relationship established by the importation of communication hardware, foreign-produced software, along with engineers, technicians, and related information protocols,that vicariously establish a set of foreign norms, values, and expectations which, in varying degrees, may alter the domestic cultures and socialization processes. Sui-Nam Lee observed that communication imperialism can be defined as the process in which the ownership and control over the hardware and software of mass media as well as other major forms of communication in one country are singly or together subjugated to the domination of another country with deleterious effects on the indigenous values, norms and culture. Ogan saw media imperialism often described as a process whereby the United States and Western Europe produce most of the media products, make the first profits from domestic sales, and then market the products in Third World countries at costs considerably lower than those the countries would have to bear to produce similar products at home. Downing and Sreberny-Mohammadi state: Imperialism is the conquest and control of one country by a more powerful one. Cultural imperialism signifies the dimensions of the process that go beyond economic exploitation or military force. In the history of colonialism, (i. e. , the form of imperialism in which the government of the colony is run directly by foreigners), the educational and media systems of many Third World countries have been set up as replicas of those in Britain, France, or the United States and carry their values. Western advertising has made further in roads, as have architectural and fashion styles. Subtly but powerfully, the message has often been insinuated that Western cultures are superior to the cultures of the Third World. Cultural Imperialism Culture is not static; it grows out of a systematically encouraged reverence for selected customs and habits. Indeed, Webster’s Third New International Dictionary defines culture as the â€Å"total pattern of human behavior and its products embodied in speech, action, and artifacts and dependent upon mans capacity for learning and transmitting knowledge to succeeding generations†. There is today a heightened sense of connectedness and familiarity with people, events and cultural ways of living in distant places due to the capabilities brought about by the advancements in information and communication technologies. The television in particular global media, have not only made it possible but also fairly easy the interaction with other cultures through the availability of global communicative networks and social structures. These media organisations not only support but make it possible to bring distant images and content from one part of the globe to another within seconds. These immediate mediated experiences have led to the reduction in distance between individuals, society and nation states in terms of both time and space. Inadvertently, this process plays a significant role in cultural globalization by providing an extensive transnational supply of cultural media products from an international media culture and presents a challenge to existing local and national cultures. The proponents of cultural imperialism and media imperialism have long argued that global media with their continuous supply of western-based cultural content and their extensive structure promote a restructuring of cultural and social communities in developing countries. As such, global media is purported as having a crucial role in cultural globalization with their tendency toward homogenizing communities. Nevertheless, to assume cultural globalization as replacing the local ways of living is to presuppose the lack of resilience and creativity on the part of local cultures and also to overstate the role of the media technologies in shaping societies. It cannot be denied that of late there is an ever-growing increase and tendencies toward the consumption of transnational economic and cultural products. It is inevitable that the future years will see a greater struggle between the tensions toward globalization and the attempts to maintain and consolidate national communities. Media may have either a temporal or spatial bias, either making communication more durable over time or expanding the space across which communication may take place. The scope of such a bias can shape social, political and cultural relations as well as institutions. The development of communication technologies in the past few decades shows a tendency for spatial bias, resulting in greater ease in reaching remote parts of the world and crossing visible and invisible barriers. As a result, new communication technologies have proven effective in closing gaps in communication by ignoring national or communal boundaries as well as social differences. The consequence of adopting a new communication technology often goes beyond its basic function as a communication tool. Quite often, controversy arises over the impact of new technologies, which have been described as tools both to strengthen and weaken democratization, and both to liberalize and control the information flow. Excessive generalizations about the impact of media technologies, such as techno-positivism, techno-neutralism and techno-negativism, often fail to take into account various differences in social environments in which the technologies operate. Comments The issue of cultural imperialism emerged largely from communication studies. However, cultural imperialism has been used as a framework by scholars to explain phenomena in the areas of international relations, anthropology, education, science, history, literature, and sports. Censorship is a growing issue in Malaysia as it attempts to adapt to a modern knowledge-based economy. Malaysia has one of the worlds strictest forms of media censorship, with nearly a hundred movies banned in this decade alone on the pretext of upholding morality. The Internet however remains unfettered in line with upholding civil liberties and maintaining democratic spaces. In 2010, Malaysia was ranked 141st in the Worldwide Press Freedom Index by Reporters Without Borders. It was also given a Partly Free status on the Freedom in the World report by Freedom House in 2008. On the Freedom in the World index, graded on a scale of one to seven, with one being the most free and seven being the least, Malaysia obtained four points for both political rights and civil liberties. Unlicensed use or possession of a printing press is illegal under the Printing Presses and Publications Act of 1984. Journalists are frequently given guidelines by the Prime Ministers Office when reporting sensitive issues, and media self-censorship is encouraged. The Film Censorship Board of Malaysia is the government agency responsible for granting licenses to the films for viewing. Malaysias censorship guidelines started out relatively lax. The guidelines were tightened in 2003 amid rising Islamic conservatism: kissing scenes and cleavages were censored, nudity and sex scenes were cut, and many movies were banned altogether. Censorship guidelines for local movie productions were subsequently eased in March 2010. After the negative reactions towards the censoring of an article concerning the 2011 Bersih 2. 0 rally, in mid-August 2011, Prime Minister Datuk Seri Najib Tun Razak stated that media censorship is no longer effective and that the government will review its current censorship laws. In today’s digital society, the increasing use of the internet had penetrated into many aspects of the civil society worldwide. One of the usages that are of concern is the emergence of social media in public discourse. The social media provides citizens with a medium that is relatively easy to access and free from government control. As such it becomes a space for public opinion expression, sharing of information, criticizing the status quo and voicing concerns on matters of personal and public interest. This study is interested in describing the potential role of the social media in breaking the hegemonic dominance of the mass media in Malaysia. Malaysians ability to communicate in real time in a borderless world with the aid of communication technology had redefined space and time where immediacy and transparency in global connections is heightened (Palmer, 2007). Access to information benefits the citizenry, as it would enable them to obtain as much information as possible to make appropriate decisions on matters of importance to them. Access to information also means access to sources in the Internet that may be placed by normal citizens who have their own views on current issues.  Participation here means the rights of citizens to air their views, their grievances and placing their stand on issues. Social media also encourage active discussions of issues. Conclusion The social media in a way functions like that of a normal mass media, containing information that is newsworthy to citizens. It enables the flow of information that is freer, more diversified and more immediate. This is said to be the equilibrium function of social media as it enables active citizens that are denied access of information to set up their own medium such as blogs and thus enabling others to have access to the information contained in them. Access to citizen information is the participative function of the social media. Citizens, through their ability to form information centers, to transmit information, and to share information, will feel a sense of participation in society particularly in the political discourse. If they have an opinion toward a certain issue they would get others to sympathize with them in efforts to win them to their side. It is also a forum for citizens who share the same perspectives to â€Å"gather† and interact without actually meeting face-to-face.

Prevalence Of Diabetes Mellitus Health And Social Care Essay

Prevalence Of Diabetes Mellitus Health And Social Care Essay INTRODUCTION DIABETES MELLITUS Diabetes is a syndrome that is caused by a relative or an absolute lack of insulin. It is characterized by symptomatic glucose intolerance as well as alterations in lipid and protein metabolism. Over the long term, these metabolic abnormalities, particularly hyperglycemia, contribute to the development of complications such as retinopathy, nephropathy and neuropathy. Approximately 5% to 10% of the diagnosed diabetic population has type 1 diabetes mellitus (Koda-Kimble et al., 2005). Most of the diabetic patients have type 2 diabetes mellitus, a heterogeneous disorder that is characterized by obesity, ÃŽ ²-cell dysfunction, resistance to insulin action, and increased hepatic glucose production. 1.2 PREVALENCE OF DIABETES MELLITUS Diabetes Mellitus is a chronic disease and is no longer an epidemic that can be ignored. It is confirmed that diabetes is increasing rapidly in every parts of the world (IDF, 2009). The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030 (Wild et al., 2004). In South-East Asia region, the number of people with diabetes will reach 101.0 million by year 2030 which show an increase of 72.1% compared to 58.7 million in year 2010 (IDF, 2009). While in Western Pacific region, the number of people with diabetes will reach 112.8 million people by year 2030 compared to 76.7 million people in year 2010, which show an increase of 47.0%. WHO predicts that in Asia and Australia region the prevalence of diabetic will reach 190.5 million in year 2030 (WHO, 2004). Similarly in Malaysia, the diabetes epidemic shows an increase trend over the years. The number of people with diabetes will increase to 2.74 million by year 2025 compared to 1.53 million in year 2007. The national prevalence of diabetes was estimated to be 12.3% in year 2025 (IDF, 2009). Approximately 1.2 million people in Malaysia have diabetes and more than half of them are not aware of it. The third National Health and Morbidity Survey (NHMS III) shows that there was an increasing trend in prevalence with age; from 2 percent in the 18-19 years old to an alarming prevalence ranging between 20.8 to 26.2 percent among those 50-64 years old. Those with primary education or less have a higher prevalence. The national prevalence of known and newly diagnosed diabetes above 30 years old rose from 8.3 percent in NHMS II to 14.9 percent in NHMS III. This shows that the prevalence of diabetes has increased by 80 percent over a decade with an average of 8 percent per year. The diabetes in Malaysia has almost doubled in magnitude over the last decade (NHMSIII, 2006). The main factors that contribute towards the increase in the risk of diabetes are socioeconomic influences, BMI, effects of urbanization, and familial aggregation. In socioeconomic influences, it shows that lower educational status and the lack of health care facilities in the rural areas delay the diagnosis of diabetes. More than 70% of diabetes subjects in India remain undiagnosed in rural area (Deo et al., 2006). Moreover, this study also observed that people of the lower socioeconomic status had lower BMI. Furthermore, urbanization leads to unhealthy lifestyle changes which affect the metabolic changes. The high prevalence of diabetes also found associated with increasing family history of diabetes. High prevalence of diabetes in the first degree relatives which is commonly seen in Asian Indians (Deo et al., 2006). A comparative epidemiology study was conducted among Japanese immigrants in United States living around Hawaii and Los Angeles and among Japanese living in Hiroshima. Results showed that the Japanese who lives in United States are in higher prevalence of getting diabetes compared to the Japanese in Hiroshima due to the westernized lifestyle (Hara et al., 2004). 1.3 COMPLICATIONS OF DIABETES MELLITUS Uncontrolled diabetes mellitus will leads to multiple complications. In Malaysia, only 6.1% among the 30 49 year age groups of diabetes mellitus patients were under control. This reflects the lack of concern for risks and complications among the young patients. A total of 1 in 4 diabetics in the 30-39 age group already show complications of the disease (Chua, 2006). Moreover, patients with uncontrolled diabetes mellitus, regardless of the type of diabetes, exhibit significantly increased odds of surgical and systemic complications, higher mortality and increased length of stay during hospitalization (Marchant et al., 2009). Individuals with pre-diabetes, undiagnosed type 2 diabetes, and long-lasting type 2 diabetes are at high risk of all complications of macrovascular disease, coronary heart disease (CHD), stroke, and peripheral vascular disease (Laakso, 2010). Moreover, M Lgaakso also indicates that more than 70% of type 2 diabetes patients die of cardiovascular causes. Hence, the epidemic of type 2 diabetes followed by an epidemic of diabetes-related cardiovascular diseases (CVD). Diabetes patients present a two to four time greater risk for coronary artery disease (CAD) than non-diabetes individuals (Protopsaltis et al., 2004). The data obtained from UKPDS 23 indicated that for each 1% increment of HbA1c there was a 1.11-fold increased risk of CAD, whereas for each 1-mmol/l increment in LDL concentration, there was a 1.57-fold increased risk. A study carried out among African American with diabetes showed that the major risk factors such as hypercholesterolemia, hypertension and smoking are important determinants of CVD in African Americans with diabetes. Moreover, other blood markers of hemostasis or inflammatory response and elevated serum creatinine proved to be CVD risk factors in African Americans with diabetes (Adeniyi et al., 2002). Retinopathy is the most common microvascular complication of diabetes, which results in blindness for over 10,000 people with diabetes per year (Fong et al., 2004). A study done among Australian population showed that the prevalence of retinopathy was 21.9% among known type 2 diabetes and 6.2% in those newly diagnosed type 2 diabetes. Generally, 15.3% of diabetes patients have retinopathy (Tapp et al., 2003). A prospective cohort study showed that the presence of diabetic retinopathy was associated with a two-fold higher risk of incident CHD events and a three-fold higher risk of fatal CHD (Cheung et al., 2007). Hence, the microvascular diseases do play a role in the pathogenesis of CHD in diabetes. Amputation is one of the major complications that should be taken into consideration among diabetes patients. Diabetes is the cause of 50 % of all the non-traumatic amputations in the United States. Among all the diabetic amputations, 24 % amputations are the toe, 5.8 % are mid foot, 38 % are below the knee, and 21.4 % are above the knee, and the remaining 10 % include the hip, pelvis, knee and other sites (Levin, 2002). One study reported an 8 % increase in amputations from 61 of 10,000 patients with diabetes in 1990 to 66 of 10,000 patients with diabetes in 1995. After diabetic patients undergo amputation, their risk of developing a foot ulcer or of requiring a second amputation increases dramatically. A total of 50 % of patients with diabetes die within 5 years after amputation (Peters et al., 2001). In Malaysia, among 203 patients that underwent amputation, 66 % of the patients were diabetics and amputations performed were related to diabetic foot conditions. Among them, 17.2 % patients underwent above knee amputation, 32.8 % underwent below knee amputation and 50 % underwent local foot amputation. About 59 % patients underwent amputation due to diabetic complication were less than 60 years old (Yusof et al., 2007). A study done involving Korean type 2 diabetic patients showed that the HbA1c is significantly associated with carotid plaque and peripheral arterial disease (PAD) (Choi et al., 2010). A cross sectional study was conducted, and it shows that the glycemic control was poor with 53.6% of the patients having HbA1c above 8% and 24% of them had microalbuminuria (Chan et al., 2005). 1.4 MANAGEMENT OF DIABETES MELLITUS 1.4.1 Controlling Glycemic Level Tight control of blood glucose levels offers primary and secondary prevention for the development of diabetic kidney disease (Stanton, 2008). By lowering glycated hemoglobin value to 6.5% or less, a 10% relative reduction was observed in the combined outcome of major macrovascular and microvascular events. Moreover, there was also a 21% relative reduction in nephropathy (Patel et al., 2008). A study carried out in the United Kingdom showed that intensive blood glucose control in type 2 diabetes patients significantly increased the cost of treatment, but the cost of complication was reduced and increased the time free of complication (Gray et al., 2000). Although good controlling on blood glucose will benefit the diabetes patients, the potential benefits of glycemic control must be balanced against factors that either preempt benefits (limited life expectancy, comorbid disease) or increase risk (severe hypoglycemia, weight gain) (Woolf et al., 2000). 1.4.2 Pharmacological Treatment According to the Malaysian Clinical Practice Guidelines Management of Type 2 Diabetes Mellitus 4th Edition (2009), the first line therapy for oral agent is Metformin, while other oral agents are acceptable as alternatives. However, usage of Thiazolidinediones (TZDs) has been found to have greater durability in glycemic control compared to Metformin and Sulphonylurea (SU). Currently there are five classes of oral hypoglycemic agents, which include ÃŽ ±-glucosidase inhibitors (AGIs), Biguanides, Dipeptidyl petptidase-4 (DPP-4) inhibitors, Insulin Secretagogues (Sulphonylurea and Non-Sulphonylurea / Meglitnides) and Thiazolidinediones (TZDs). Factors that are taken into consideration when selecting the treatment include the patients clinical characteristics, such as degree of hyperglycemia, weight and renal function (Walker and Whittlesea, 2007). Scheen and Lefebvre (1998) suggested that the selection of oral antihyperglycemic agents as first-line drugs or combination therapy should be based on both pharmacological properties of the compound (efficacy and safety) and the clinical characteristics of the patient (stage of disease, body weight). Furthermore, each antihyperglycemic agent may also be combined with insulin therapy to improve glycemic control after secondary failure to oral treatment. A systemic review on the effectiveness and safety of oral antihyperglycemic agents showed that most oral agents improved glycemic control to the same degree as sulfonylureas, though nateglinide and ÃŽ ±-glucosidase inhibitors may have slightly weaker effect (Bolen et al., 2007). Other than that, this review also showed that most agents other than metformin increased body weight by 1 to 5 kg. In terms of safety, sulphonylureas and repaglinides were associated with greater risk for hypoglycemia, thiazolidinediones with greater risk for heart failure and metformin with greater risk for gastrointestinal problems. Another systemic review and meta analysis on the effect of oral hypoglycemic agents on HbA1c levels showed that most OHAs lowered HbA1c levels by 0.5 to 1.25 % whereas thiazolidinediones and sulfonylureas lowered HbA1c levels by 1.0 to 1.25 % (Sherifali et al., 2010). This review also concluded that the benefit of initiating an OHA is most apparent within the first 4 to 6 months . A meta analysis on comparison of different drugs as add-on treatment to metformin in type 2 diabetes showed that sulphonylureas, ÃŽ ±-glucosidase inhibitors and thiazolidinediones induced reduction of HbA1c of 0.85, 0.61 and 0.42 respectively (Monami et al., 2007). In direct comparisons, sulphonylureas induced a greater reduction of HbA1c than thiazolidinediones. For the treatment with ÃŽ ±-glucosidase inhibitors (AGIs) acarbose, a meta-analysis showed favourable trends towards risk reduction for myocardial infarction and any cardiovascular event (Hanefeld et al., 2004). The meta-analysis also revealed that acarbose treatment also significantly improved glycemic control, triglyceride levels, body weight and systolic blood pressure. 1.4.3 Non Pharmacological Treatment Exercise Exercise plays an important therapeutic role in the management of type 2 diabetes and usually is prescribed along with dietary therapy and pharmacologic therapy. The benefits of exercise are observed through the lowering of blood glucose concentration during and after exercise (Najim, 2008). Physical activities are able to reduce the risk of progression from impaired glucose tolerance (IGT) to type 2 diabetes mellitus by 58% (Sigal et al., 2006). There is evidence that showed the relation between the exercise and the HbA1c level, where exercise training reduced HbA1c by an amount that should decrease the risk of diabetic complications (Boule et al., 2001). b. Dietary Control Obesity and weight gain contributes to the development of diabetes. The impact of obesity will put the diabetic patients on risk of coronary heart disease (CHD) (Anderson et al., 2003). Hence, decreasing the weight will decrease the risk for developing diabetes. Despite that, glycemic control also will be well controlled. A meta-analysis on restricted-carbohydrate diets in type 2 diabetic patients showed that there is an improvement in HbA1c, fasting glucose, and some lipid fractions (triglycerides) with lower carbohydrate-content diets (Kirk et al., 2008). A study conducted to assess the effects of high dietary fiber intake in type 2 diabetic patient shows that high intake of dietary fiber, particularly the soluble type, improves glycemic control, decreases hyperinsulinemia and also lowers plasma lipid concentrations (Chandalia et al., 2000). The Malaysian Clinical Practice Guidelines for Management of Type 2 Diabetes Mellitus 4th Edition (2009) suggests that a balanced diet consist ing of 50-60% (Carbohydrate), 15-20% (Protein) and 25-30% (Fats) are encouraged. However, these recommendations must be individualized based on glucose and lipid goals. 1.5 MANAGEMENT OF CHRONIC DISEASES IN PRIMARY HEALTH CARE In United States, there is an estimated of 99 million Americans living with a chronic illness. This becomes one of the major challenges faced by the U.S. health care system today and in the future. However, the defining features of primary care which includes continuity, coordination and comprehensiveness, are well suited to the care of chronic illness (Rothman and Wagner, 2003). In the WHOs World Health Report 2008: Primary Health Care Now More Than Ever shows that the primary-care team becomes the mediator between the community and the other levels of the health system, helping people navigating through the maze of health services and mobilizing the support of other facilities by referring patients or calling on the support of specialized services (WHO, 2008). Evidence has shown that with a better primary care, especially coordination of care could reduce avoidable hospitalization rates, especially for individuals with multiple chronic conditions (Wolff et al., 2002). In Thailand, the patient satisfaction toward primary care units has improved when compared to public hospitals out-patients-department. An evolutionary change, as the patients in Thailand started to have confidence in local facilities such as primary care units for monitoring of chronic diseases (Pongsupap et al., 2005). 1.5.1 The Management of Chronic Diseases in Primary Health Care Centers in Malaysia Chronic diseases are the major cause of death and disability in Malaysia, accounted for 71% of all deaths and 69% of the total burden of disease. Preliminary data from Malaysian Non-Communicable Disease (NCD) Surveillance 2005/06 estimated that approximately 11.6 million Malaysian adults aged 25-64 years were having at least one risk factor for chronic diseases and only about 3% did not have any risk factor. (Ramli and Taher, 2008). A study carried in an urban primary health care setting in Sarawak shows that the poor glycemic control (HbA1c > 7.5%) is about 38%. Wong and Rahimah (2004) suggested that reasonable glycemic control can be achieved in the primary health care setting in Sarawak. A study was carried out to evaluate the status of diabetes care and prevalence of diabetic complications among the diabetic patients in primary private health care Malaysia. Majority of diabetic patients treated at the primary care level were not satisfactorily controlled and were associated with a high prevalence of complications (Mafauzy, 2005). Hence, there is a need on putting on more efforts in order to achieve clinical targets. 1.6 MEDICATION ADHERENCE A literature review showed that the adherence rates for patients with type 2 diabetes have ranged from 65 % to 85% for OHA and 60 % to 80 % for insulin (Kenreigh and Wagner, 2005). A survey was done in the United States to assess medication adherence, knowledge of therapeutic goals and goal attainment for adult patient with diabetic. The result showed that 48 % of patients were medication non-adherent and most frequently reported reasons for non-adherence were forgetfulness (34 %) and too expensive (14 %). This study also shows that the patients at HbA1c goal were more adherent than patients not at goal (Whitley et al., 2006). A study was carried out by Tan and Judy, on self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control. The result showed that only 53 % subjects scored below 50 % in their diabetes-related knowledge, subjects with medication non-adherence, 46 % tended to have higher fasting blood glucose levels and only 15 % of the subjects practiced SMBG (Tan and Judy, 2008). Patients which non adherent to the drug regimen was found to be at higher risk of hospitalization. The study on this showed that patients with type 2 diabetes mellitus who did not obtained at least 80% of their antihyperglycemic medications across a year were at a higher risk of hospitalization in the following year (Lau and Nau, 2004). 1.6.1 Factor Affecting Non-Adherence in Diabetes Mellitus Drug non-adherence is a major concern in patient management, especially in individuals with diabetes, which makes the glycemic control difficult to attain. Adisa et al. (2009) stated that the commonly cited intentional nonadherence practice included dose omission, 70.2%. Almost 50 % respondents were fed up with daily ingestion of drugs and 19.8% of the respondents stated that it was inconvenient to take the medications outside. Furthermore, forgetfulness (49.6%) and high cost of medication (35.5%) were also reasons for non adherence. Another factor that influenced the non adherence were patient-related factors (96%) and health care system-related factors (79%) (Ratsep et al., 2007). Ratsep et al. stated that the patient-related factors include patients awareness regarding diabetes and its complications, patients motivation to change their lifestyle, non-compliance with medical regimen, patients financial problems and their non-attendance. Health care system-related factors include th e lack of special diabetes education for nurses, underfunding and an inadequate number of patients educational materials. 1.7 PHARMACISTS INTERVENTION Health coaching which relies on frequent contact and ongoing intervention has emerged in recent years as part of disease management initiatives (Melko et al., 2010). This has been promoted as an effective method for improving health outcomes and patient compliance with medication. A pilot study done by Melko et al. (2010) has shown that health coaching combined with tools do increased medication adherence. In United States, the adherence to OHA therapy ranged from 36 to 93 % in patients remaining on treatment for 6 to 24 months. Electronic monitoring identified poor compliers for interventions that improved adherence,61 to 79 % (Cramer, 2004). A study has shown that, HbA1c levels decreased significantly in the intervention group after the 4th month and remained lower than in the control group until the 12th month (Scain et al., 2009). Moreover, a decreased of HbA1c by 0.16% was observed with each 10% increased in drug adherence (Schectman et al., 2001). With every 1 % reduction in updated mean HbA1c was associated with reductions in risk of 21 % for any end point related to diabetes, 21 % for deaths related to diabetes, 14 % for myocardial infarction and 37 % for microvascular complications (Stratton et al., 2000). A review of the literature on the role of pharmacists indicates that there is a potential benefit of pharmacist interventions to improve medication adherence in diabetes, especially focusing in providing patient education (Lindenmeyer et al., 2006). A study on Latino patients with uncontrolled diabetes (Hemogloblin A1c ≠¥ 8.0%) showed that intervention from the pharmacist and health promoter team management of uncontrolled diabetes appears to be a feasible approach in order to improve the medication management (Gerber et al., 2009). Marcio Machado and his team found that there is a significant reduction in HbA1c levels in the pharmacists intervention group but not in the control group which is without pharmacists intervention (Machado et al., 2007). In the journal which discussed the role of pharmaceutical care in diabetes management, there were evidences suggesting that the pharmacists efforts in optimizing the pharmacotherapy can prove a valuable component in community-based multi disciplinary diabetes care (Davis et al., 2005). A meta analysis carried out by Conn et al. (2009) which investigated the effectiveness of interventions to improve medication adherence in older adults suggests that interventions increase medication adherence in older adults. The types of interventions include pill count, electronic medication -event monitoring device (MEMS), diabetes education, medication counseling, monitoring and insulin initiation and/or adjustments. In comparison of MEMS and pill count, MEMS data resulted in different numbers and types of recommendations than pill counts (Matsuyama et al., 1993). Hence, the pharmacists then could make specific recommendation regarding patient educations. A Cochrane review stated that almost all of the interventions that were effective for long term care were complex, which include combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up and supportive care (Haynes et al., 2008). However, there is no conclusion about the effectiveness of the interventions that could lead to large improvement in adherence and treatment outcomes. An earlier meta analysis of studies conducted reported that chronic disease patients including those with diabetes and hypertension, as well as cancer patients and those with mental health problems benefited from interventions such as prescription refills, pill counts and electronic monitoring (Roter et al., 1998). 1.8 RESEARCH OBJECTIVES The primary health care settings play an important role in primary steps in order to prevent the development of chronic diseases. In Malaysia, there were a number of people who have chronic diseases that received treatment in the primary health care settings. Hence, research should be carried out in order to assess the medication adherence among diabetic patients in the primary care settings in order to achieve better therapeutic outcome. 1.8.1 General Objective To assess the impact of pharmacist counseling on medication adherence among the diabetic patients in primary care centre 1.8.2 Specific Objectives To assess patients blood glucose level and knowledge, before and after counseling. To evaluate patients medication adherence, before and after intervention. To correlate the medication adherence with counseling.