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Critical Evaluation of Association between Sodium Intake and Change in Uric Acid, Urine Albumin Excretion, and the Risk of De
Critical Evaluation of Association between Sodium Intake and Change in Uric Acid, Urine Albumin Excretion, and the Risk of Developing Hypertension -Cohort study
Research questionThe primary objective of the study was to establish if consumption of high sodium diet is associated with effects on blood pressure as well as hypertension if consumed in a chronically manner. The hypothesis that the researcher employed in the study was “Chronically high intake of sodium would be associated with an increase in endothelial dysfunction especially serum acid denoted as (SUA) and urine albumin excretion (UAE) and the high intake of Na would also be related with chances of hypertension among individual with higher UAE and SUA .” The study lacked the secondary objectives however based on the results provided it was evident that secondary or sub-objectives could play a significant role in refining the results down. This could also help or encourage the use of small sample, which offer high reliability of the information as well as boost the level of accuracy. This secondary objective should have been designed to cater on specific demographic (Between people 16-50 years and those between 51 and above). The study for example could use the following secondary objectives:i. To determine how high consumption of Na diet is associated with both blood pressure and hypertension among individuals aged 16-50 of both sexesii. To evaluate how high consumption of Na diet is associated with both blood pressure and hypertension among individuals aged 51 and above of both sexesStudy design:A prospective cohort study design was used to gather or collect blood pressure and hypertension data recorded from paramedic sheets and blood pressure and hypertension logs. Complete follow-up information was available for more than ten years since the first study employed was done between 1997 and 1998 and the other between 2003 and 2006 meaning that this information was available for research (Salluh 2010). Based on the nature of the diseases being examined in the study, this research design was employed because it can assist determined the risks factors associated with chance of new diseases. This is because prospective cohort studies have longitudinal observation time as well as the collection of results and information or data is at regular intervals hence reduction of recall error.In addition, the design was used since several outcomes that the study expected could be measured for one exposure, it is possible to measure the prevalence, and an incidence arising from the study as well as the design allows exposure to be measured before the start of disease or condition (hypertension and blood pressure). However, the study failed to state in the limitation section that the research design had some weaknesses such as costly and time-consuming (the previous studies indicated took a longer period to reach to concluded outcomes 1997 to 1998 and 2003 to 2006). In addition, the design did not also offer classification of individuals based on demographics and on exposure and outcome status since this can be affected by changes in diagnostic procedures.Subjects without prior prevalent hypertension were selected for the study. Among them, those that available for measurements were considered. In addition, an exclusion criterion was used in the study; those who were taking antihypertensive medication were excluded. The study was limited to 5556 participants; 4062 were considered in SUA analysis and 4146 subjects were inclusive in the analysis of UAE. The retention rate for the study was about 97%.Explanatory variableThe main exposure variable used in the study is the intake of sodium. The study measured the effects of the consumption of Na and its relationship to both blood pressure and hypertension. There were only two levels of exposure classified in the study however the study is considered to have limited itself to the two and in such cases it leads to limited evaluation and analysis of results. Exposure of Na intake to SUA and to UAE to hypertension and blood pressure conditions. With the level of biasness is data collection, the study did not ascertain accurate results but a generalization of the exposure result and outcome were employed (Grove & Lambert 2010)Study outcomeOver time, it was noted that higher intake Na is related with an increase in UAE and SUA. Among people with higher levels of SUA and urine UAE, higher Na intake is an exposure risk factor for contracting or developing hypertension. The case that the study used in the epidemiologic investigation is “It may be of interest to determine if higher intake of Na affects patients with higher UAE and SUA levels, but these changes with age.” The case is classified as suspected for reporting purposes (Brown & Derkits 2010). The outcome of the study is considered relevant since it addressed all the pending questions and critiques of most of the past studies. In addition, based on the data from the participants, this information was worth as it was evident that most of them faced hypertension complication yet they did not know the cause. To avoid “missing events” the data from the participants were analyzed independently and not repetition was allowed.
Measures of frequency and/or association
It is evident from the cohort study that there was no evidence of prevalence and incidence used to determine the estimates of the exposure of the outcome of the study; this is because the study did have new cases with a specified period of time as excepted of an incidence study. Among all the 5558 participants, there was not any new case over the population at risk. Based on the literature available it is evident that the study did not employ both the above conditions. However, it is clear that the study should have been under incidence study. This is because, if the study could have employed more demographics in the sample, such as younger population and the elderly above 65 years, new cases could have been evident within a specified period and it could offer a more accurate outcome as the one the study has indicated. According to the exposure risks evident, the study employed direct causal association since despite the fact that the high rates of Na caused hypertension and in some cases blood pressure, other conditions could have affected the analysis of the results.
There were cases of confounding in the study since in both cases; there were high risks of conflicting effects of the exposure rates. It is clear that people could be affected by high intake hence lead to both hypertension and blood pressure. Therefore, it is clear that the study employed SPSS sorting of data skills to avoid such cases. However, I consider that this was not the best statistical technique to be used. This is because sorting of data in using SPSS sorting methods could lead to biasness of results hence compromise the findings of the study hence the outcome. The best techniques that should have been used are to avoid duplication of data from the participants as well as the use of multivariate analysis could offer the same service.
There was a true association between the exposures and the effects. The confounding factor was age produced an observed estimate of association between higher intake of sodium and hypertension. The association was very strong since the results indicated a more protective effect. The estimates could be considered as over-estimates because of the stronger association. The results could be interpreted as generally accurate since it offered a more correlated results as indicated in previous results.
Sources of error
There were two sources of random error in the study. The first is that there could be sampling errors. Having had a sample of more than 5000 participants, there was high chances of taking part in random errors (Beuther & Sutherland 2007). The second source of random error is individual biological variation. Not all the participants exposed the same results because of varied biological reactions to the tests among others hence the error. However, the extent of random error was limited. There are two potentials source of bias such as mistakes in data collection. Based on the date offered the results ought to be generalized, this was true since the study did the same.
Statistical analysis
It is evident that the results were done using SPSS data analysis package. The was not relationship between participants with SUA since the p-value was greater 0.001 but that of UAE indicated that there was a strong relations p- 0.03 for participant with hypertension exposure. The analysis was true since it was able to be in line with previous literature.
Conclusion
The study was able to meet the central objective of the study; in addition, it was also able to support the hypothesis of the study. The study was able to shows that higher intake of Na lead to blood pressure and hypertension among patients with SUA and UAE. However, future study should consider undertaking studies with different demographics such as sex, gender, and age.
References
Beuther, D. A., & Sutherland, E. R, 2007. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. American journal of respiratory and critical care medicine, 175(7), 661-666.
Brown, A. S., & Derkits, E. J., 2010. Prenatal infection and schizophrenia: a review of epidemiologic and translational studies. American Journal of Psychiatry, 167(3), 261-280.
http://journals.psychiatryonline.org/article.aspx?articleid=102128
Grove, K. A., & Lambert, J. D, 2010. Laboratory, epidemiological, and human intervention studies show that tea (Camellia sinensis) may be useful in the prevention of obesity. The Journal of nutrition, 140(3), 446-453.
http://jn.nutrition.org/content/140/3/446.short
Salluh, J. I., Soares, M., Teles, J. M., Ceraso, D., Raimondi, N., Nava, V. S., … & Rocha, M. G, 2010. Delirium epidemiology in critical care (DECCA): an international study. Crit Care, 14(6), R210.
http://www.biomedcentral.com/content/pdf/cc9333.pdf
Diet and Carbohydrate Food Knowledge of Multi-Ethnic Women: A Comparative Analysis of Pregnant Women with and without Gestational Diabetes Mellitus
Research questionThe primary objective of the study was to establish if pregnant women and non-pregnant women with GDM could be affected with Gestational Diabetes Mellitus and how dietary therapy would reduce the rates of Gestational Diabetes Mellitus . The study did not have an hypothesis rather is used the research questions to get the results of the study right. This is not considered as the best way that the research could have employed since critics will come and state that they research was not up to standard as there was nothing being proved in the study yet it was an epidemiology research. The study lacked the secondary objectives however based on the results provided it was evident that secondary could play a significant role in refining the results down. I agree with the researcher that there was no need of a secondary variable as the paper only needed to indicate how dietary therapy was helpful to both pregnant and not pregnant women in order to avoid Gestational Diabetes Mellitus. The outcome of the study was that there is urgent need to offer nutrition =al education for all the group of women in United Arab Emirates . Study design:A cross-sectional comparative design was used to gather information about women without and those with pregnancy with GDM and possibilities of contracting Gestational Diabetes Mellitus . Complete follow-up information was not available since the study was done in a year. Based on the nature of the diseases being examined in the study, this research design was employed because it can assist determined the risks factors associated with chance of Gestational Diabetes Mellitus . This is because cross-sectional comparative design studies have vertical observation time as well as the collection of results and information or data is at regular intervals hence reduction of random and systematic error.In addition, the design was used since several outcomes that the study expected could be measured for one exposure, it is possible to measure the prevalence, and an incidence arising from the study as well as the design allows exposure to be measured before the start of disease or condition (Gestational Diabetes Mellitus) (Grove & Lambert 2010). The design did not also offer classification of individuals based on demographics and on exposure and outcome status since this can be affected by changes in diagnostic procedures. The retention rate for the study was high. There were various. In addition, the decision of the study to use the above design was that it offered a chance for the researchers to consider undertaking various follow ups to ensure the validity of information offered by the participants. The other reason why the study considered using the above design was that the study used a small sample size hence it offered a significant sample analysis. There were various strengths of using the research design. One of the strengths is that it offers an evaluation strategy for the study hence able to validate data. As far as the information was mostly quantitative, the design offered a chance to undertake critical regression analysis of the results and as well as the correlations between pregnant women and non-pregnant women and their exposure to Gestational Diabetes Mellitus. However, the study showed various weakness. The design was not able to cover the small sample a better analysis of the findings. Explanatory variableThe main exposure variable used in the study is the intake of carbohydrates. The study measured the effects of the carbohydrates and its relationship to both Gestational diabetes mellitus. There were only two levels of exposure classified in the study however the study is considered to have limited itself to the two and in such cases it leads to limited evaluation and analysis of results. With the level of biasness is data collection, the study did not ascertain accurate results but a generalization of the exposure result and outcome were employed.
Study outcomeThe study shows that that it is for women to take dietary therapy to avoid Gestational diabetes mellitus, this to both women without pregnancy and those pregnant. The case that the study used in the epidemiologic investigation is “It may be of interest to determine if how both type of women with GDM ought to take nutritional training to avoid Gestational diabetes mellitus . The case is classified as suspected for reporting purposes. The outcome of the study is considered relevant since it addressed all the pending questions and critiques of most of the past studies. In addition, based on the data from the participants, this information was worth as it was evident that most of them did not face Gestational diabetes mellitus . To avoid “missing events” the data from the participants were analyzed independently and not repetition was allowed.
Measures of frequency and/or association
It is evident from the a cross-sectional comparative study that there was evidence of incidence used to determine the estimates of the exposure of the outcome of the study; this is because the study did have new cases of women with the problem of Gestational diabetes mellitus emerged during the study. However, it is clear that the study should have not have been under incidence study since the outcome of the study was affected by the new cases. According to the exposure risks evident, the study employed direct causal association since despite the fact that the number of Gestational diabetes mellitus women patients increased other conditions could have affected the analysis of the results rather than limited carbohydrate foods.
There were no cases of confounding in the study since in both cases; there were no risks of conflicting effects of the exposure rates. It is clear that women who take less carbohydrate may lead to Gestational diabetes mellitus. Therefore, it is clear that the study employed SPSS multivariate analysis to avoid such cases. However, I consider that this was the best statistical technique to be used.
There was a true association between the exposures and the effects. The confounding factor was age of the women produced an observed estimate of association carbohydrate and Gestational diabetes mellitus multivariate. The association was very strong since the results indicated a more protective effect. The estimates could be considered as under-estimates because of the weak association.
Sources of error
There were one sources of random error in the study. There was random error cause is individual biological variation (Salluh et al., 2010). Not all the participants exposed the same results because of varied biological reactions to the tests among others hence the error. However, the extent of random error was limited. There are one possibilities source of bias such as mistakes in data collection and analysis of results hence the weak outcome. Generalized results were the best and the study offered the same.
Statistical analysis
It is evident that the results were done using SPSS data analysis package. There was relationship between women with GDM and Gestational diabetes mellitus disease since the p-value was greater 0.012.
Conclusion
The study was able to meet the central objective of the study; in addition, it was also able to support the hypothesis of the study. The study was able to shows that higher women should be advised on the dietary intake such as carbohydrate to avoid Gestational diabetes mellitus However, future study should consider undertaking studies with different demographics such women of age.
References
Grove, K. A., & Lambert, J. D, 2010. Laboratory, epidemiological, and human intervention studies show that tea (Camellia sinensis) may be useful in the prevention of obesity. The Journal of nutrition, 140(3), 446-453.
http://jn.nutrition.org/content/140/3/446.short
Salluh, J. I., Soares, M., Teles, J. M., Ceraso, D., Raimondi, N., Nava, V. S., … & Rocha, M. G, 2010. Delirium epidemiology in critical care (DECCA): an international study. Crit Care, 14(6), R210.
http://www.biomedcentral.com/content/pdf/cc9333.pdf
CRITICAL CARE OF A RENAL PATIENT
Critical Care Of A Renal Patient
Name
Institution
The article from the Nephrol Dial Transplant Journal is a representation of the works of Jeremy B. Levy, E. Joanna Chambers, and Edwina A. Brown in regards to supportive care for the renal patient. The article is keen to point out that end-stage renal disease is rampantly occurring worldwide, thus, calling out for relevant measures to curtail the problem. The article also records that patients suffering from kidney problems do undergo dialysis, which is a life prolonging process and not a life-supporting plan. Indeed, dialysis is used as a means of extending one’s life whilst suffering from kidney problems but ignores the fact that one is suffering on the side. Facing renal failure is one of the problems the article points out as a problem kidney patients are suffering from, despite their participation in dialysis (Levy, Chambers, and Brown, 2004).
Patients suffering from end-stage renal disease, otherwise referred to as ESRD, are supposed to be placed under supportive care. In addition, the article names pruritus, neuropathy, fatigue, cramps, and constipation as some of the symptoms one may possess when suffering from ESRD. Pain is a symptom that highly occurs among patients with ESRD and its cure is well elaborated in the article. Appropriate drug dosage is the most appropriate means of reducing the pain faced by renal failure patients. Administering paracetamol, adjuvants, and non-steroidal anti-inflammatory agent forms the initial step to undertake in reducing the occurrence of pain in patients suffering from ESRD. Dosing a patient with codeine and tramadol forms the second step to undertake when dealing with renal failure. Oxycodone, morphine, and buprenorphine are utilized in stage three, but this is in case the pain is too severe for the patient to persevere (Levy, Chambers, and Brown, 2004).
Interacting with patients suffering from renal failure is important as it helps them comprehend the treatment they are about to receive. Therefore, it is the senior nurses’ duty to take the initiative and make crystal explanations about the treatment following renal failure. In turn, this prepares patients psychologically.
Reference
Levy, B. J., Chambers, J. E. and Brown, E. A., (2004). Supportive care for the renal patient. Nephrol Dial Transplant, 19, 1357-1360. Retrieved from >http://ndt.oxfordjournals.org/content/19/6/1357.extract<
Critical Book Review of Web of Smoke
Critical Book Review of Web of Smoke
This paper entails a book review of Webs of Smoke by Kathryn Meyer and Terry Parssinen. The book contains a fascinating history concerning the international drug trade during the first half of the 20th century. The history follows various stories of American gangsters and narcs, Japanese spies, warlords of China, and fortune soldiers whose livelihoods depend on opium. The books shows clearly the way the world was linked by drugs with the drug supply and markets spreading across nations both in the West and in the East. It is clear that the drug trade was centered in China.
China was the world’s largest market for narcotics before the fall of 1949. This could provide a clue on why China has been too strict whenever it comes to drug trafficking or abuse. Various personalities that are extraordinary are depicted through the authors’ stories. It is very shocking that such drug trade was facilitated by key personalities in both Chinese government and other key global figures as depicted in this review. The scandal crossed all the way from the United States, Europe, to Asian countries, especially China. Such aspects are so unique and fascinating in showing how the market for drugs had unveiled throughout East Asia with respect to the East Asian history.
This book contains over 300 pages that provides all historical information concerning drug trafficking and the drug market before the 1950s. The author states clearly that campaigns against opium were popular among many officials as well as intellectuals during the time. In contract to this popularity among officials and intellectuals, the campaign was hardly popular among the peasants. Peasants found it possible to have better lives through the cultivation of poppies. Such a case is the basis of the book but can still apply in the present world of drugs trafficking and market. Only some aspects have changed such the laws against such drugs and markets, the markets, and the motives of engaging into the business. This implies that the book is applicable in the world of drug abuse today. The authors intended to show the way different interests as well as interest groups clashed with each other in the modern drugs history. Such groups and interests are taken into consideration irrespective of races, nationalities, social interests, economic aspects, or political drives. It is evident in the book that every actor depicted in the history had some similarities in terms of programs or beliefs. Only a few people seemed to corporate with international bodies in an effort to curb or demolish the international narcotics trafficking. The book is adequately clear on the processes both the war against the drug trafficking and the barriers to the respective efforts. The book is also clear on who held the drug trafficking and kept it going. Co-operations were also involved in the smuggling. Liaisons and various associations of drug trafficking kept the trade alive.
The book is very detailed to provide the reader with everything that happened to facilitate the drug trafficking and the entire system alive for such a long time. The subject matter is however hardly human since it involves a class of various commodities. In some cases, the authors give the reader a nuance picture of the various groups that acted on the two sides of the law at the time. These contradicting cases are seen to have been happening concurrently. They authors are able to sketch out vividly the individuals or organizations that populated global drugs market. These were warlords, Nouveaux riches, Merchants, Bureaucrats, solders, and spies with Americans forming the majority of the most involved individuals. The only problem with depicting such groups or individuals is the authors’ abilities to reveal the actual identities of the key actors. Conversely, such parties or matrix provides the reader with a full sense of the way various kinds of people got involved in this type of illegal trade. Such a clue also shows how it was difficult to prevent the growth of such commerce as time went by.
A major setback in the book is the amount of repetition of various issues. The actors seem to float at some point thereby continually requiring re-introduction. To the readers, it becomes rather difficult to follow since the chapters are not historically sequential. Instead, the chapters overlap freely. The books employs complex strands, which are drawn together to show the various dimensions of this illegal trade. Individual personalities are taken to be crucial but not all cases depict individual personalities. Again, only the large companies and the key national figures could be identified. While many organizations could have participated, only large companies are depicted. One of the most prominent companies identified is the European manufacturers. The book seems to concentrate on the most important events but like any other aspects of historical information, minor participants are not vividly identified and the role each played. This is perhaps acceptable in writing since extreme details could destroy the real flow of the book. This argument could be strengthened by the sense that the historical events indicated in the book are already complex and hardly arranged in a chronological manner. Some key personalities seem to be generalized to other key individuals representing top countries and the world at large. The case of personalities like Delevinge, the English statesman shows how key individuals with the similar racial origins were highly involved in the drug trade.
The book however shows some of the most vital events that contributed to the growth of the drug trafficking business. Events like both the World War I and the World War II contributed a lot to the growth of this drug business. Many factors associated with the two great wars accelerated the growth of drugs market but the book is hardly capable of addressing all of them. Another major event contributing to the growth of the drug business and market is the 1929 Depression. The contribution of this great economic depression is also explained in the book in terms of the way it contributed or affected the drug trade around the world. The book also shows that the power of capitalism was a major aspect and contributor of the drug trade. Again, national governments had their unique roles to play to either promote the business or curb the problem. The contribution of the government could have been varied since different countries today employ different laws and policies to solve the drug trade problem. The authors try to bring out a story about the drug business that has been extended to the world of business today but their story is created during a time when there were great shifts in political climates. Such political climates also acted as a catalyst to the market growth. As far as political climates and national governments were concerned, the authors portray a mixture of opinions and intentions. While some of the national governments were working hard to stop the harmful world business, other nations were reluctant in stopping the drug trade business due to both economic and social reasons. While the book does not show these disparities clearly, the key players are adequately tackled in the book.
Generally, the book is great since it gives the reader a broad perspective of the drug business as it happened during the first half of the 20th century. Readers are able to understand about the various players and their contribution towards the growth of the global drugs business or towards the end of the business. Major events such as the World War I, World War II, and the Great Depression of 1929 are clearly explained and how they are linked to the drug trade. The only thing that seems to confuse the reader is the book title, which appear to depict a history of the global drug trade while in real sense the book concentrates mainly on the drug business in East Asia, with a few cases of links drawn to European manufacturers and the Americans. Areas like South East Asia, Latin America, and Africa among other regions are shallowly explained or are not explained at all. The real picture of the global history on drug trade is not fully brought out but the book is good enough to show the key players, who could have had great influence on the international drug trade in today’s world.
Works Cited
Meyer, Kathryn and Terry Parssinen. Webs of Smoke: Smugglers, Warlords, Spies, and the History of the International Drug Trade. Lanham: Rowman & Littlefield Publishers, 2002. Print.