Research Korner: Diabetes Term Papers

Attitudes and Beliefs of African American women after Gestational Diabetes Mellitus

Attitudes and Beliefs of African American women after Gestational Diabetes Mellitus     Background Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset or first recognition during pregnancy, is the most common metabolic disorder of pregnancy ( and , 2002, ). People with glucose intolerance have blood glucose levels that are consistently above normal because they do not have enough insulin or they can not properly use the insulin they have. Insulin, hormone produced by the pancreas, allows cells to take glucose from the blood, so it can be used for energy (, 2005). Approximately 7 percent of pregnancies are complicated by GDM, with prevalence estimates ranging from 2 percent to 14 percent (, 2004). The variation in rates can in part, be attributed to the number of differing criteria that are used in diagnosing GDM; including guidelines published by the American Diabetes Association, World Health Organization, National Diabetes Data Group and the Carpenter and Coustan criteria (, 2003).   Rationale The core rationale is the indication, recognition and assessment of diagnosis of gestational diabetes mellitus as pregnant women are routinely screened for GDM around 24-28 weeks of pregnancy. While there is currently no consensus on the guidelines to use for screening patients, it appears that some type of screening for GDM is practiced by most prenatal care health practitioners (, 2003,, 2003). The National Diabetes Data Group serves as the major Federal focus for the collection, analysis, and dissemination of data on diabetes and its complications and lay individuals to better understand diabetes (, 2005).   Method The applied research project is appropriate as such semi structured interview method applies for this research study and survey technique is more desirable for this research investigation and will be in qualitative assimilation. The interview can be just in simple undertaking, to interview about 5-10 African American women in Gainesville Florida, Univer of Florida, Women's Clinic and asking respondents several questions such as the following: What was your attitude and beliefs towards knowing your diagnosis of gestational diabetes? Did you adhere and follow to dietary and insulin medication for your diabetes? How did you feel about your diagnosis before and after your pregnancy?  The sample format and statements below can be applied in the study and will be the founding basis of data analysis and research outcomes as one important factor for the completion and finalization of the study.      No STATEMENTS           1 The attitudes, whether disapproving or approving, and practices of husband, partners, and family members were very important influences on the attitudes and practices 1 2 3 4 5 2 Positive attitudes toward women’s physical activity in the community and social support from partners, other family members, friends are important influences on health related behavior 1 2 3 4 5 3 Fear of appearing to be sexually available a reason given for not engaging in recreational activity, particularly alone outside home 1 2 3 4 5     No STATEMENTS           1 Beliefs about causes of diseases as diabetes, personal susceptibility, modifiability of risk, including cognitive links between physical activity and disease, may influence women’s motivation to undertake new activities 1 2 3 4 5 2 Women believe diabetes as primarily related to heredity and diet but not to physical activity 1 2 3 4 5 3 Exercise reduce stress and improve general health 1 2 3 4 5     Research questions <li class="MsoNormal" style="line-height: 150%"> What is meant by Gestational Diabetes Mellitus? How is it manifested in pregnant women? Elaborate several diagnosis of such gestational diabetes are as backed up with literature and several studies? </li> <li class="MsoNormal" style="line-height: 150%"> How gestational diabetes occur in African American women? Provide stats and prevalence of gestational diabetes as experienced by the latter and women in general </li> <li class="MsoNormal" style="line-height: 150%"> What are some attitudes and beliefs of women regarding gestational diabetes? Support the question with first hand and direct information through survey interviews</li> <li class="MsoNormal" style="line-height: 150%"> What are the ways and how gestational diabetes be prevented in accordance to attitudes and beliefs to be known about? Explain </li>   Significance The research will be significant to health care workers such as nurses and clinicians who can responsible for the women care upon post pregnancy cases of gestational diabetes mellitus thus, significant to academic authorities and students being part of the medical profession mostly those that caters to gestational diabetes care and management. For future research purposes, can serve as one good material for reference and other relative matters.     References

Attitudes and Beliefs of African American women after Gestational Diabetes Mellitus

Attitudes and Beliefs of African American women after Gestational Diabetes Mellitus Background Gestational diabetes melli...

Why is the disease model of alcoholism/addiction controversial?

BACKGROUND             The disease model of alcoholism has a history dating back more than two hundred years, and is considered by many to be the dominant paradigm guiding scientific inquiry and treatment approaches for much of the 20th century (Bride & Nackurd, 2002). An early proponent was the physician Benjamin Rush in 1795. The concept gained popularity through its promotion by Alcoholics Anonymous (A.A.) founded in 1935. It received additional popularity following a 1946 study by E. M. Jellinek (Heath, 1995, p.302).             The disease model of alcohol dependence, or “alcoholism”, remains the dominant conceptual model or paradigm of both alcohol and drug treatment, especially in the USA. However, this situation is changing in response to empirical evidence, managed care cost containment policies and greater pressures to demonstrate treatment efficacy and effectiveness (Heather & Stockwell, 2004, p.71). As articulated by Jellinek, the new paradigm of alcoholism posited a sharp distinction between "normal" drinkers and "alcoholics," whose addiction was evinced by an intense craving for drink and a complete loss of control over drinking. Alcohol, that is, was seen to be addictive only for a certain group: those who developed an increased tolerance, who experienced withdrawal symptoms if they tried to quit drinking, and who exhibited bodily deterioration as a result of heavy and habitual consumption. The "disease" of alcoholism was thought to be progressive (it moved from psychological to physiological dependence) and irreversible (the alcoholic could never safely return to normal drinking). The only effective treatment, according to the Alcoholism Movement, was lifelong abstinence (Crowley, 1994, p.146).             This disease concept has continued to compete with moralistic characterizations that maintain that chronic drunkenness is sinful and can only be corrected by the individual through an act of personal willpower (Wilcox, 1998, p.7). The disease model of alcoholism views craving as a result of acute withdrawal or an internal physiological need for alcohol (Heather & Stockwell, 2004, p.92).             An important motive in promoting the idea of alcoholism as a disease was to decriminalize alcoholic behavior and increase the probability that alcohol abusers would seek help. Alcoholics would be seen as victims of a disease rather than individuals with a bad habit, weak willpower, or a moral failing. Another motive was to make treatment eligible for financial support through medical insurance. Society is generally willing to help people with a disease (which is "not their fault"), whereas those with a bad habit, weak will, or a moral failing are expected to accept responsibility for their behavior and to fend for themselves (Heath, 1995, p.303).             Today, a treatment industry based on the disease theory generates more than billion a year in revenues, and both supports and serves hundreds of thousands of individuals who have an emotional commitment (in the case of alcoholics) or an economic commitment (on the part of treatment providers) to the medical model of alcoholism (Heath, 1995, p.303). MAIN SUPPORT FOR THE DISEASE MODEL             Jellinek is generally credited with the development of a disease model of alcoholism that was sufficiently rigorous to stimulate intensive scientific work based on the model, and many researchers have carefully investigated his various hypotheses and made necessary refinements to the disease concept of alcoholism. Much of the work in alcohol studies over the past 35 years has been specifically addressed to whether or not alcoholism can be considered a disease (Wilcox, 1998, p.7).             Jellinek, in summarizing his own research, indicated that the three most commonly occurring behaviors that characterized "alcohol addiction" are blackouts, loss of control, and benders. Blackouts are given additional importance because in the "great majority" of "alcohol addicts," they mark the initial phase, occurring prior to loss of control and benders by many months or years.             Jellinek's model has made important contributions both in terms of its acceptance and influence in the literature and its acceptance by practitioners working with individuals who have drinking problems. "Virtually every book or pamphlet, lay or professional, published in the last 25 years on the manifestations of alcoholism has presented the Jellinekian phases as unchallenged fact". Some authors like Pattison, Lender, Pokorny and Kanas view Jellinek's phase model and disease definitions of alcoholism as the most profound influence on the alcoholism field to date. Another author regards the phase model as "the most comprehensive and clear-cut ordering of characteristic experiences of alcoholics” (Rudy, 1986, p.83). STRENGTHS OF THE MODEL             Clearly, a strictly medical model is not sufficient to explain the multivariate, behavioral manifestations of alcoholism. Some of the appeal of the disease model is that it accommodates well the observations that drug abuse is not normal that it is a special type of behavior that does not seem to follow normal rules. Because it is a disease state, the usual rules that govern behavior do not apply to the behavior of addicts, at least as far as their use of drugs is concerned.             The disease model also fits well with the observation that some people become addicted and others do not in the same way that a disease may strike only some. Thinking about drug abuse as a disease also has profound implications for therapy. At the heart of the issue is whether the addict really has any control over drug taking. If the abuse of drugs can be considered a sickness rather than an immoral or criminal activity, it is therefore beyond the control of the abuser, who then requires treatment rather than punishment. Furthermore, there are numerous examples that show "how the beliefs of people about alcohol and alcohol consumers influence the assumptions about etiology.” Most studies now recognize the "bio-psycho-social" complexity of alcoholism, and although the disease concept that Jellinek described has been amended, it is still one of the most important considerations in any discussion of alcoholism. His ideas that alcoholism was characterized by a loss of control, and a progressive nature have been refined, but they are still regarded as essentially productive (Wilcox, 1998, p.8). ALCOHOLICS ANONYMOUS AND THE DISEASE MODEL             Alcoholics Anonymous (A.A.) has been in existence since the 1960s, it is an institution that deals with education, prevention and treatment of alcohol and drug abuse. Jellinek's phase model of alcoholism and the A.A. model of alcoholism are one and the same and that they are constructions or reifications of A.A. values (Rudy, 1986, p.107).             Jellinek's model of alcoholism "has been the standard textbook description of the alcoholism process. It has essentially gone unchallenged until recently". Jellinek's model and his other writings on alcoholism, specifically The Disease Concept of Alcoholism, have highly influenced most conceptualizations of alcoholism and its treatment within the past several decades. The phase model reflects Jellinek's assessment and interpretation of data collected by the Grapevine, the official organ of A.A. The initial study was based on ninety-eight usable questionnaires from a "sample" of more than sixteen hundred A.A. members (Rudy, 1986, p.81).             The phase model characterizes the "alcoholic" as generally passing through four phases. These include the prealcoholic symptomatic phase, the prodromal phase, the crucial phase, and the chronic phase. Within these four phases, Jellinek described a list of forty three behaviors that occur in a somewhat determinant sequence.             Members of A.A. believe alcoholism to be a progressive and eventually fatal disease that follows a progressive series of stages that lead to institutionalization in a mental hospital, jail, or death. While cultural variations (as well as the assumption that “alcoholism” is a social construction that emerged during a specific historical period) should be acknowledged, it should also be pointed out that the “disease” model of AA has been applied cross-culturally. One might argue that the “disease” model must have some material validity for so many members in so many different cultures to find it descriptive of their own experiences (Jensen, 2000, p.140). CRITICISMS TO THE DISEASE MODEL Although most alcoholism counselors argue that it is a disease, alcoholism is clearly unlike other known diseases. There is no alcoholism virus, fungus, or germ. It is not caused by parasites. It is not caused by any physical accident or injury. Even those who support the theory cannot explain what causes the alleged disease, how it operates, or where it is located in the body (Heath, 1995, p.303).             As early as the 1960s, the disease model came under attack due to the emergence of unusual scientific and clinical findings. Outside of the United States, the disease model is considered by many to have been discredited, and has long been abandoned in favor of alternative models (Bride & Nackurd, 2002).             Several studies disputed the position by Jellinek that blackouts are the major symptom of alcoholism. Of the one hundred hospitalized "alcoholics" in their research, one third never experienced a blackout. Additionally, among those who reported blackouts, these generally occurred "well along in the course of alcoholism rather than at an early stage", and they occurred after heavy drinking--"frequently after several days." Other aspects criticized involve the ambiguous nature of the research questioning concerning blackouts as well as the occurrence of benders, tremulousness, and severe repercussions from drinking prior to the occurrence of blackouts (Rudy, 1986, p.84). If alcohol abuse isn't a disease, what is it? According to them, it is a habit, a learned behavior that is frequently repeated. In psychological terms it is a pattern of excessive alcohol consumption which produces maladaptive behavioral changes in which drinking can become the central activity in an individual's life, usually after many years of heavy consumption (Kishline, 1996).             According to the criticisms, perhaps the most persistent anomaly of the disease paradigm is the repeated finding, in violation of the entrenched expectations of irreversibility and loss of control, that persons diagnosed as alcoholic can sometimes return to normal, controlled patterns of drinking (Bride & Nackurd, 2002).             Other authors, while still somewhat supportive, have questioned various aspects of the Jellinekian model. Some authors view Jellinek, A.A., and the National Council of Alcoholism (NCA) as cornerstones of a traditional model of alcoholism that is factually inaccurate but ideologically powerful. Noticeably more critical is the following attack by Cahalan: “Despite Jellinek's regard for the right of the individual drinker, his conceptions appear to have been subtly influenced by the Protestant ethic. His phases of alcohol addiction, with its orderly--and, inferentially, irreversible--progression of malign symptoms, through the prealcoholic phase, the prodromal phase, the crucial phase, and finally the chronic stage is of a piece with Hogarth's famous illustration of a drunkard's progress on the downward path to perdition. While Jellinek does not say that the phases of alcohol addiction always occur in the same order, his vivid descriptions of the progress of alcoholism are so well attuned to the values of the middle-class Western physician and welfare worker that his cautions are largely overlooked by those who apply his conceptions and by the many writers who repeat his early concepts.”             Much of the speculation that alcoholism could be explained by biochemical disorders involving hypoglycemia, vitamin deficiencies, metabolic pathways, or an allergy to alcohol were quickly put to rest. Nor, despite intensive efforts, has any single allele been discovered as an alcoholism gene. Numerous studies strongly support the hypothesis that some individuals are genetically predisposed to alcoholism, but these studies can only account for a small proportion of alcoholism in the general population (Wilcox, 1998, p.7). Such evidence does not address many etiological questions regarding the disease concept of alcoholism. Naturally, the excessive use of alcohol can cause a broad range of diseases, but heavy drinking results from learning rather than from disease. People must voluntarily consume alcohol before they can abuse it and have drinking problems. These and other obvious inadequacies of the disease model have led increasingly in recent years to statements that the "disease" of alcoholism is a myth (Heath, 1995, p.303). STANTON PEELE’S VIEWS ON DISEASE MODEL             Dr. Stanton Peele, author of The Truth About Addiction and Recovery and a leading expert in the field of addiction, agrees that “Every major tenet of the `disease' view of addiction is refuted by both research and everyday observation” (Kishline, 1996). “There's no such thing as a genetic cause of alcoholism," announces Stanton Peele said. "The best predictors of alcoholism are all psychosocial factors--who you hang out with, whether you have a job. The whole genetic argument is misguided and unjustified." According to Peele, the genetic-based argument makes people victims and gives them an excuse for self-destructive behavior. He believes that moderating drinking is the wave of the future for treatment (Judge, 1997). Peele argues that AA and for-profit alcohol treatment centers promote the "myth" of alcoholism as a lifelong disease. He contends that the disease concept "excuses alcoholics for their past, present, and future irresponsibility" and points out that most people can overcome addiction on their own. He concludes that the only effective response to alcoholism and other addictions is "to recreate living communities that nurture the human capacity to lead constructive lives. CONCLUSION AND SUMMARIZATION             The disease model of Jellenik views the problem of alcoholism as a disease with aberrant behaviors and physical symptoms. The basis for his conclusions about the disease model is his researches. In the disease model, the alcoholic is not seen as morally weak but rather viewed as sick and the victim of a disease – that of alcoholism. The disease model has its share of supports and strengths. There are some problems with the disease model though. The disease model of alcoholism is controversial and not without critics. Many authors dispute the disease model of alcoholism. One of the most well-known author who disputed the disease model is Peele. The main reason for the controversy is that the nature of the disease has never been identified. There have been a number of attempts to explain the use and abuse of specific drugs in terms of a disease process but such attempts have been limited to a specific drug only and have never been thoroughly convincing that alcoholism in itself is a disease. Credit:ivythesis.typepad.com

Why is the disease model of alcoholism/addiction controversial?

BACKGROUND The disease model of alcoholism has a history dating back more than two hundred years, and is considered ...

Healthcare Organization and Delivery

Healthcare Organization and Delivery MT-371 Midterm Project by Stephanie Selvidge In what two ways have each of the following impacted the cost of health care in the United States? 1. Health insurance The assortment of components of health care cost increases are not independent but interact. But a main cause of the increased cost of medical care is clearly the growth of third-party payments, including private health insurance and various government programs, of which Medicare and Medicaid are the most important (Stewart, 1995). Third-party payments affect all the other causes of health care cost increases. In majority of cases, payment for healthcare services and products are provided by a third-party. Many of working-age persons have their healthcare services and products paid for by their employer. Payments from third-party increase the amount of medical services demanded by consumers by making them insensitive to the prices. This increased demand in turn allows the physicians to increase the supply of services rendered and to also increase their fees and earnings, attracting malpractice lawyers and tempting dissatisfied customers. Pharmaceutical companies and suppliers of medical technical equipment are encouraged to increase their research spending, their advertising, prices, and sales also at the same time. Even if pharmaceutical drugs are not covered in many insurance contracts, the fact that other medical costs are covered makes the consumer more willing to pay high prices for the medicines. These effects are made worse by tax subsidies for health insurance obtained through employers that lead to the purchase of insurance that is excessive in quantity and inaccurate in coverage (Stewart, 1995). Health insurance coverage is currently the primary means for access to medical services when unexpected medical crises arise and for everyday health concerns. The high costs of health insurance and medical services has led to reliance on (1) employer-provided health insurance coverage, and (2) federal- and state-funded Medicare and Medicaid programs (Hong & White-Means, 1999). 2. Advances in medical care Rapid advancements in science and technology, along with investor dollars, have created major advances in medical care. These emerging technologies in medicine, which were increasingly housed in hospitals and physicians' offices, not only laid the groundwork for the coming shift in the way health care was delivered, but also increased healthcare costs. Technology standards like electronic information and other tools have significantly increased healthcare costs. Strongly associated with technological advances is also the issue of how quickly new treatments are made available to the general public (Thomas, 1993). Although of course this is beneficial for the consumer, this would mean increased healthcare cost on their parts. Indeed all these advances have helped improve health care services for the consumers, but it also added extra payment or cost on their part. Advances in medical care also made way for the provision of healthcare services to the financially less privileged. Hospitals began generating capital funds from paying patients who in the past had been treated at home. The importance of admitting privileges rose along with the criteria for receiving these privileges. Many physicians began making deals with the hospitals to admit their private patients. The hospitals in effect became the workshop for physicians where their private patients would pay the hospital charges and physician fees. In turn, this arrangement enabled both the physician and hospital to provide free care for the poor in the hospital dispensaries. Seriously ill poor patients were generally admitted to both municipal and private hospitals as "service cases," where they were supervised by attending and cared for by students and house officers (Marsh & Yarborough, 1990). 3. Aging demographics in the U.S. The growing elderly population is largely the outcome of new technology, public health as well as medical technology, saving lives and postponing death. The introduction of Medicare and Medicaid in 1965 improved access to medical care for the poor and many of the elderly, contributing to life extension past age sixty-five (Stewart, 1995). This age group uses an uneven share of medical resources. In the elderly group, the social and personal requirements of residents who need some assistance with daily activities and health care are emphasized. Its an important distinction, in that the design of housing, services, activities, employee training, and such is truly customer-centered, or in other words, suited to their age group/population. At present there are many institutions or organizations that are specifically for the elder populations in the United States. For Americans aged over 65 years and certain disabled persons, the federal government program Medicare pays for the majority of hospital and physician services consumed. The growth in the number of elderly, coupled with the previously-mentioned large increases in the cost of health care, are making long-term care for the elderly populations very expensive (Thomas, 1993). Although many of the most promising medical innovations will result in better health and longer life for the elderly populations, they will also increase--not decrease—healthcare costs and spending. 4. Government support for healthcare Local government is a large portion of the overall health care safety net in the United States, providing direct-care services and funding such items as public hospitals, transportation, educational outreach, and housing subsidies (Ketchum, 2001). As stated at the start of the paper, various government programs have contributed to the rising cost of health care in the US. The social awakening of the 1960s brought the introduction of Medicare and Medicaid as a means to give adequate healthcare to the poor. Its effect on the overall health care system in America was overwhelming (Marsh & Yarborough, 1990). Americans belonging to the low-income brackets can enroll in a state-administered Medicaid program that pays for select healthcare services. The role of the government in regulating health care providers will be limited to ensuring that providers and payers do not engage in anticompetitive practices and that the safety of consumers and patients is protected (Hackey, 1998). This means that the government tries its best to reduce the healthcare costs at all levels for the consumer’s benefits. 5. Consumer expectations Almost all healthcare consumers would want to go to the “best” hospital in town, see their own doctor, and have access to the same new medicines. When one falls ill, gets a certain level of medical care, and tells the neighbor about it, the other's expectations are raised accordingly (Kleinke, 2001). Each individual consumer shares a common need for health and a desire for the absence of illness through the demand for health care services and products. This in return affects the healthcare costs. Since consumers expect so much of healthcare, the healthcare providers are pushed to offering consumers a range of choices. Consumer expectations are fueling demand for health information that they can understand and services that they want. Consumers would want to know what their care options are and what health plans are available to them. By offering consumers a choice of healthcare services and plans, various healthcare organizations encourage the development of price competition among competitors. Price competition among healthcare providers could generate in a cost reduction of a range of healthcare services. The empowerment of the consumer is perhaps the most exciting and potentially the most threatening of all the developments in healthcare. In a consumer-empowered marketplace, once dominant, name-brand players compete on a level playing field with those with a fresh approach and a strong customer focus. In a consumer-empowered marketplace, information flows freely, facilitating comparisons of quality, value, and price. In a consumer-empowered marketplace, there is less reliance on "experts" to make decisions because consumers have the information to participate actively in those decisions (Clarke, 2000). Credit:ivythesis.typepad.com

Healthcare Organization and Delivery

Healthcare Organization and Delivery MT-371 Midterm Project by Stephanie Selvidge In what two ways have each of...

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