Impact of Directly Observed Treatment on Tuberculosis

Impact of Directly Observed Treatment on Tuberculosis Description of the condition Multidrug-resistant tuberculosis (MDR TB) is defined as Mycobacterium tuberculosis strains with in vitro resistance to at least both isoniazid (INH) and rifampicin (RFP) (Johnston 2009;WHO;WHO 2013). Emergence of this strain since the 1980s has represented a major barrier towards successful TB control (Johnston 2009;WHO 2013). Among the newly diagnosed TB patients in 2012, 3.6% had MDR TB while the percentage was approximately six times higher among those previously treated cases (20.2%) (WHO 2013).In 2012, it was estimated that 450000 incident cases and 170000 mortality cases of MDR TB occurred globally (WHO 2013). Compared with drug-susceptible strains, treatment of MDR TB is much more complex. According to the WHO guidelines, MDR TB treatment regimen requires a minimum duration of 18 months with two treatment phases, the intensive and the continuation phase (WHO). The first six months of treatment is usually considered the intensive phase since a patient needs to receive both oral and injectable drugs (WHO). After this period, the injectable agent is discontinued and patients receive the oral drugs for another 12-18 months (termed as the continuation phase) (WHO). Management of MDR TB is challenging for that patients are normally in advanced stages of disease with thick-walled cavities and chronic lung lesions which are hard for the drugs to penetrate (Orenstein 2009). Also, the longer treatment duration, high out-of-pocket cost, together with the more frequent adverse reactions that are associated with second line drugs are all contribution factors to poor treatment adherence (Bassili 2013;Toczek 2012;Volmink 2007). As a result, treatment success rate of MDR TB was much lower compared to drug sensitive strains. According to the WHO, the pooled treatment success rate of MDR TB patients diagnosed in 2009 was about 48%, whereas it exceeded 85% among non-MDR TB patients (Johnston 2009). Description of the intervention Directly observed treatment (DOT) refers to the use of an appointed agent (a professional health worker, a community volunteer, or a family member) to directly monitor people taking their anti-tuberculosis drugs (Mukherjee 2004). Initially, this concept was proposed as a key component of Directly Observed Therapy, Short Course (DOTS) by the WHO in 1994 to ensure cure of TB (WHO). In addition to the provision of standardized 6-8 months short-course directly observed chemotherapy regimen, other components of DOTS include: political commitment, case detection through quality-assured bacteriology, maintenance of an effective drug supply and management system, and evaluation of performance and impact (WHO). Implementation of DOTS in non-MDR TB treatment demonstrates significant effectiveness, as the strategy has helped to treat 37 million TB cases and cured more than 80% of them by 2007(WHO 2013). However, the standardized short-course chemotherapy is usually not applicable to cases of MD R TB. To improve patients’ adherence to MDR TB treatment, in 2000, WHO and its international partners further developed DOTS-Plus strategy by adding the components of MDR-TB diagnosis, treatment and management into the DOTS (WHO 2008;WHO 2011). In this DOTS-Plus strategy, DOT is highly recommended by the WHO to be delivered to all MDR-TB patients (WHO 2008;WHO 2011). However, treatment of MDR-TB patients requires at least 18 months, therefore, delievering DOT to MDR-TB patients would be more challenge than for drug-suspectible TB patients. There are two types of DOT according to its implementation length. In full DOT, anti-TB drugs were administered under direct observation throughout the treatment duration (including both the intensive and continuation phase) whereas it is directly observed only during the intensive phase for partial DOT (WHO 2008;WHO 2011). Effectiveness of DOT is commonly demonstrated through comparison with SAT, a traditional management modality in which anti-TB drugs were self-administered by patients without any observation (WHO 2008;WHO 2011). Currently, many countries have incorporated full DOT into their national TB control programs (NTPs) according to suggestions from the WHO guidelines (Bassili 2013). However, there are still countries that adopt partial DOT or even self-administrated treatment (SAT) as the management modality in their NTPs. How the intervention might work A better understanding of how DOT improves treatment outcomes of MDR TB could have important management implications. First, knowing the type(s) of DOT provider and location that is associated with a higher treatment success rate could allow one to make evidence-based decisions when designing DOT for MDR TB treatment. Second, studying the influence of other characteristics on successful treatment outcomes of MDR TB could provide a conservative yet more objective conclusion of the effectiveness of DOT. Third, comparing DOT with other strategies for the improvement of treatment adherence could advise policy makers to balance resources between DOT and these other strategies so that treatment could be delivered in a more cost-effective way. Why it is important to do this review Impact of DOT on successful TB treatment has been controversial throughout the years. Previous observational studies suggested that DOT ensured timely adherence management as well as day-to-day monitoring of adverse effects (Orenstein 2009). One meta-analysis revealed that treatment completion rate among pulmonary TB patients could exceed 90% when DOT was implemented throughout the treatment course(Bassili 2013). However, results from a recent meta-analysis of randomized controlled trials showed no significant difference in treatment success rate between DOT and SAT among drug-susceptible TB cases(Mukherjee 2004). Moreover, previous meta-analyses almost exclusively focused on the role of DOT in the treatment of non-MDR TB; little has been examined systematically regarding its role in effective MDR TB treatment.

“Girl” Jamaica Kincaid Essay

The short story of â€Å"Girl† by Jamaica Kincaid is about a mother and her relationship with her daughter. It is a harsh one sided conversation between the narrator and her mother, with the mother doing all the talking. The story gives a rich description of what her mother expects from her in all aspects of her life, from chores, to how she plays, to what she sings in church. From each line you see the viewpoint of how her mother sees the world, what is proper in her eyes and her expectations for her daughter. Throughout the story the symbolism gives deeper meaner to every verse and shows deeper insight to their realsonship. One of the first symbols is in the first line is the color white. The use of the color white is foreshadowing the tone for the whole short story. White represents pure, virgin, and clean. The mother is reprimanding her child for the way she walks â€Å"on Sundays try to walk like a lady and not like the slut you so bent on becoming† (380). The narrator’s mother already has concerns of her daughter becoming sexually promiscuous and tarnishing her reputation. The mother’s tone is harsh throughout the whole short story. She is demanding her daughter does these things as she dictates. This is not a sweet moment between a mother and her daughter. The conversation is laced with insults and fears. The mother also warns her daughter about eating on the street â€Å"don’t eat fruit on the street-flies will follow you† (380). Flies are seen as bottom feeders, dirty and irritating and when flies are surrounding an animal it is seen as filthy. She is telling he r daughter that she will be seen as dirty if her fruits are out for everyone to see. This has to do with being covered and not letting everyone stare at you. This supports her idea that her daughter will become promiscuous and not respectable. Another symbol example is the importance on clothing. The mother cautions â€Å"when buying cotton to make yourself a nice blouse, be sure that it doesn’t have gum on it, because that way it won’t hold up after a wash† (380). The mother’s emphasis on clothing highlights her view of how  you dress is a reflection of you as a person. Its gives insight to your character and personality that you take pride in how you look. Clothing is used cover your body, when you are covered you are seen as respectable in her community. In the conversation â€Å"this is how to hem a dress when you see the hem coming and so to prevent yourself from looking like the slut I know you are so bent on becoming† (380) This is the second time that her mother accuses her of turning in a slut. The hemming of the dress is no longer a lesson in how to sew, but the act itself has tuned into being seen as respectable and that reinforces her mother’s view. In addition, â€Å"Benna† is also a symbol in the text. The word benna is one of the cultural symbols she uses. It gives insight to where the story is taking place. It also gives the reader the first response to her mother who has been talking the whole time. â€Å"I don’t sing benna on Sundays at all and never in Sunday School† (Kincaid 380). Why did the narrator feel compelled to finally speak up for herself in this moment? What did her mother mean by accusing her of this that the narrator feel she had to defend herself? From this short sentence the reader can assume that something that has changed culturally. If the daughter is implying that singing Calypso music is frowned upon and considered taboo that means singing it i n Sunday school would be a grave disrespect. The other aspect of the sentence is the use of Sunday school, the introduction of Christianity has added to the mother’s fears of her daughter being respectable. The mother is also going through changes culturally and that has influence her concerns for her daughter. Another example of cultural symbolism is the â€Å"this how you set a table for tea† (381). This line in the story shows a reference to Britain through tea. The reader can accept that what has been going on culturally is in reference to Britain. There are foreigners in her country who could be judging the country as they interact with the natives. Her constant fear of her daughter becoming a slut is stemming from what the mother now views as proper behavior. They are many symbols that come from food. The use of food in this short story has a small number of layers. There is the superficial layer that acts as a cultural symbol in her use of her native dishes in the text. It also adds depth to the short story and shows the reader where the narrator and her mother are living â€Å"this is how to make bread pudding, this is how to make doukona, this is how to make pepper potà ¢â‚¬  (381). The reader  has only seen the mother in the fierce, menacing tone. Upon further analysis of the symbolism, it shows that her mother doesn’t want her to forget her cultural heritage among all the changes going on currently in her life with Sunday school and the British being in her country. She wants her daughter to learn how to cook these native dishes as a way of passing down her legacy. Another layer is the mother finds cooking to being part of being a respectable women. Cooking is something the mother puts value on. She believes that a woman who can cook is valuable to their society. Over the course of the text she come back to instructing on how to cook. The reader is also able to see it in the beginning, middle and end of the short story. It is not just being able to make these dishes, but the whole act itself â€Å"cook pumpkin fritters in very hot sweet oil† (380). The mother believes that cooking strengths the bond her daughter will have with her family and with the community. The last symbol in food is the when the mother tell her how to she is to squeeze the bread â€Å"always squeeze bread to make sure it’s fresh; but what if the baker won’t let me feel the bread?; you mean to say that after all you are really going to be the kind of woman who the baker won’t let near the bread† (381) This goes back to the overall theme of the entire story. Her mother wants her be the kind of lady that the baker lets squeeze the bread. The word squeeze is suggestive in a way that the mother doesn’t want her daughter to allow anyone to â€Å"squeeze† her. It also reinforces that her daughter should not become a slut or she will be not be a functioning member of society. Sluts and wharf-rat boys are not part of their society; her mother warns â€Å"you mustn’t speak to wharf-rat boys† (380). They are outcast, if she becomes a slut the baker will not allow her to touch the bread and she will be an outcast like the wharf-rat boys. The final symbol is housework; the importance of it is seen throughout the short story. The narrator’s mother makes many references toward housework, â€Å"Wash the white clothes on Monday and put them on the stone heap; wash the color clothes on Tuesday and put them on the clothesline to dry† (380). She sees housework as a way of keeping busy so her daughter doesn’t become promiscuous. It also establishes her role as women taking care of her house. In their culture this seen a respectable and earns them respect from their community. This short story looks like a simple stern lecture from a mother to daughter. When you look at each sentence in-depth, you see mother has  fears that are based not in anger but in reality due to all the changes going on in their culture. These fears are expressed sometimes harshly by calling daughter a slut, and her tone throughout the story. At the end it is just a mother being concerned with her daughter and wanting the best life possible for. The symbolism gives more insight than what the reader can read just on the surface. It shows a whole different character for the mother and sheds light as to why the mother has these expectations and fears. What people fear shapes them and their relationships Works Cited Kincaid, Jamica. Literature A Portable Anthology. 3rd ed. Boston, MA: Bedford St Martins, 2013.

People Management And Development - Free Essay Example

Sample details Pages: 5 Words: 1643 Downloads: 1 Date added: 2017/06/26 Category Management Essay Type Analytical essay Did you like this example? Introduction Human resource management uses strategy to accomplish its aspects, policies and practices through strategic sectors such as job analysis, staffing, training and development, maximize performance, compensation management, HRM service delivery, gender equality and achieve success in the long run. Human Resources Management definition HRM is ascertained as the approach employees are recruited, organized, developed, appraised, motivated and maintained. It is a method of maximizing economic return from labor resource by integrating HRM into business strategy.(Keenoy, 1990, p.3 found at Alan Price 2004, p33). The procedure of managing human talent is to fulfill an organizations objectives. Successful organizations are particularly accomplished at gathering different kinds of people to achieve a common aim. This is the main aspect of human resources management. (Scott Snell, George Bohlander 2010, p.4) Don’t waste time! Our writers will create an original "People Management And Development" essay for you Create order Strategic Human Resources Management definition and objectives Companies in developing countries can enhance financially by strategically lining up and investing in their HR policies and practices. Strategic HR orientation is denoted as the combination of HR planning, selection, performance evaluation, compensation, development and training practices with the business strategies of the organization.(Emerald, Source: Human Resources Management Digest Vol:12,2004) A strategy is a way of planning and scheduling before acting. It usually involves the creation of an objective and a set of action plans for accomplishment. It implies consideration of the competitive forces at work in managing an organization and the impact of the outside environment on organization actions.(William P. Anthony et al, p.9, 1999) The environment within which an organization functions is active. External and internal forces are changing the standards of the game, and the organization must improve or affiliate new strategies to remain competitive. An alternation in strategy will find out the direction of its operation within the organization containing the human resource management function.(William P. Anthony et al, p.3, 1999). The traditional role of HR is the attraction, retention, motivation and development of human resources according to current and future requirements. However, HR can also develop and sustain competitive advantage. This suggests that the head of the HR function should be included in strategic decision-making by senior management. This will enable the HR director to formulate strategies that support organizational strategies.(Emerald, Source: Human Recourses Management Digest Vol:12 , 2004) Strategic human resource management approach has many functions in the organization. In the field of planning and strategy formulation, it participates in formulating overall organizational strategic plan and combining human resource operations with company strategy. Moreover, has high status and authority for top personnel officer . Its area is to concern with all managers and employees. Also, is involved in making strategic decisions. Another function is that it is fully integrated with other organizational functions: marketing, finance, legal and production. While, allocates all human resource activities (e.g. training, recruitment, staffing, Equal Employment Opportunity). Organizations are designed to accomplish certain goals. Strategic thinking concentrates on these long-term objectives. Thompson and Strickland (1998) provide a model for strategic management based on five major actions that incorporate objective setting: Deciding the kind of business in which the organization will operate, developing a strategic vision and creating a set of values with a general strategy. Recognizing the strategic issues for the business and placing strategic goals. Developing strategic action plans. Carrying out and enforcing strategic action plans for units within the business. Estimating, adjusting an d refocusing strategy for the future. (Alan Price 2004 p.299) HRM Strategies sectors The HRM Strategy is composed by sub-strategies, the aims of which are described as follows: A. Job analysis is the process of acquiring information about jobs by determining the duties, the tasks, or activities, the qualifications of a job and the proper individual that suits to that position. (Scott Snell and George Bohlander 2010, p.152.) It is followed by a job description with a list of a jobs duties, responsibilities, reporting relationships, working conditions, and supervisory responsibilities-one product of a job analysis (Dessler 2005) combined with a job specifications list of a jobs human requirements that is, the requisite education, skills, personality (Dessler 2005). The job descriptions and job specifications disclosed through job analysis should be as accurate as possible if they are to benefit to those who make HRM decisions. The main goal of job analysis is to improve organizational performance and productivity. Planning. Strategic planning includes a set of processes for reaching decisions about the organizations long term goals and strategies. Human resources planning are the process of assuming and providing for the actions of people into, within, and out of an organization. Strategic human resources management connects Strategic planning and HR planning. It can be thought of as the pattern of human resources as effectively as possible, where and when they are needed, in order to accomplish the organizations goals. (Scott Snell and George Bohlander 2010, p.50). The first step in strategic planning is to set up a mission, vision, and values for the organization. The mission is the basic intention of the organization, likewise its area of operations. It is a statement of the organizations reason for existing. The mission is often written in terms of general clients it services. According to the scope of the organization, the mission may be expansive or restricted and limited. The strategic vision of the organization overlaps the mis sion statement to determine a perspective on where the company is headed and what the organizations can be transformed into in the future. Even though the terms mission and vision often are used interchangeably, the vision statement specifies the long-term direction of the company and its strategic purpose. Organizational core values are the strong enduring beliefs and principles that the company uses as a foundation for its decisions. Values are also positioning limits on what act is taking into account as ethical and acceptable. (Scott Snell and George Bohlander 2010, p.51-52 ). B. Staffing(selection-recruitment-placement). Support the organization with an acceptable, adequate, motivated, and changeable workforce, thus certifying that knowledge is contained and improved in the organization. Selection. In addition to job specifications, managers and supervisors use job descriptions to select employees and orient them to jobs. Employers must be able to show that the job specif ications used in selecting employees for a particular job relate specifically to the duties of that job. (Scott Snell,George Bohlander 2010, p.151). Recruitment is a process of locating potential individuals who might join an organization and encouraging them to apply for existing or anticipating job openings. (Scott Snell, George Bohlander 2010, p.188). C. Training and Developing. The goal of training and development programs of all organizations should be to maintain or improve the performance of individuals and, in so doing, that of the organization. Training. Training refers to providing instruction to develop skills that can be used immediately on the job. It has a narrow focus and should provide skills that will benefit the organization rather quickly. Human resource development on the other hand has a broader scope. It involves developing knowledge that may be used today or sometime in the future. It is more focused on meeting the organizations general long-term n eeds. The pay-off is less direct and can be measured only in the long term. (William P. Anthony et al 1999 p. 337 ) D. Performance management-Performance appraisal. The strategic process it increasing the effectiveness of organizations by improving the performance of the employees and by developing the capabilities of teams and individual contributors.(Armstrong and Baron, 1998, found at Alan Price 2004) Performance appraisal can be denoted as a procedure designed to help employees understand their roles, aims, expectations and performance success. (Scott Snell, George Bohlander 2010, p.362). Appraisals are useful tools not only for estimating the work of employees but also for developing and motivating employees. By showing an individual where his/her strengths are and underlining points that stills need improvement. Additionally, augmenting behaviors that have created strong positive results should motivate the individual to continue to perform in his manner. It is also a way to help individuals manage their performance and a human resource objective that determines who should promote, demote, transferred or even terminated. (William P. Anthony et al 1999) .The appraisal system must be flexible enough to combine different management philosophies, employee subcultures, and geographic locations. Diversity system management and its proper handling among different cultures and education of employees lead to innovation which is a competitive advantage that achieves long-term success. E. Compensation Management ( classification system ,pay and benefits) Create a competitive, motivating and cost-effective system that amplifies the organizations ability to pull and absorb high-ability staff, recognizes group and individual contributions and certifies all positions are allocated at appropriate levels in accordance with objective equal principles and the labor law. F. HRM service delivery in the organization offices through supporting HRM services that are clear, flexible, reliable, confidential and empowering via the development of HRM capacity and efficient HRM policies, processes and systems. G. Gender Equality. Cultivate measures to enhance the gender balance especially among senior staff and create policies to promote and reinforce women. 5. Epilogue Strategic Human Resources Management through its process has as a main goal to make the best handle of its employees issues (selection-recruitment-training-development-compensation-appraisal) and to achieve the best results as possible. According to literature and articles, the leadership has to make a balanced combination of culture with using clear communication of job possibilities and strong human resources policies for compensation, promotion, development and training, of employee involvement giving more responsibility and accountability. Furthermore, leadership has to be committed to organization, its mission and vision and to employees and follow them appraising peoples skills, motivate and challenge its workers and keeping them productive. Thus, top management it is essential to develop organizations objectives and then find a way to improve the needs and rights of each generation into these goals resulting from all these a strong workplace diversity system. This diversity system empowering and motivating employees leads to innovation, the innovation leads to competitive advantage and finally organization will have the long-run success achievement. (William P. Anthony et al 1999)

Diversity And Its Impact On Diversity - 975 Words

Diversity Diversity represents the â€Å"multitude of individual differences and similarities that exist among people† (Kinicki Kreitner, 2013). It pertains to the host of individual differences that make all of us unique and different from one another. Diversity in an organization continues beyond hiring employees of numerous backgrounds, but involves embracing and empowering all minorities. Thankfully, globalization and strategic alliances have transformed business economies drastically to set up complex business environments. These environments include inter-cultural, inter-departmental, cross functional, and inter-disciplinary people working together, as a part of a large team, towards a common goal. The importance of these workgroups can be understood by the strategic role they play in determining organizational effectiveness. Workgroup diversity as a concept has caught the scholarly attention of researchers and academicians as many companies have expanded their business es to new foreign territories. For the success of these new business ventures they seek greater local participation in their workforce, with respect to the people who are well-acquainted with the culture, ethic, local languages, tastes, preferences and other features unique to these new markets. This has eventually led to the establishment of people from different communities, ethno-socio-economic-politico backgrounds, and cultures to take part equally at a common platform. The manifestation of workforceShow MoreRelatedThe Impact Of Diversity On Workforce Diversity Essay1993 Words   |  8 Pageson Workforce diversity is the aim of most organisations today. However, workforce diversity presents both opportunities and challenges in organisations as ideas and practices from different backgrounds combine together, sometimes causing challenges such as communication and benefits such as productivity and creativity. This essay will further analyse the opportunities and challenges that are present in today’s organisations due to workforce diversity. Understanding workforce diversity is crucialRead MoreThe Impact Of Diversity On The Workplace1609 Words   |  7 Pages3.2. Positive impacts The diversity has always been a concern for businesses and governments because the minority can feel sometimes left out and excluded for the employment sector. Therefore it has always been a priority for any government. They want to prove that they have been elected and are representing the entire population not just a group of people. Also businesses want to send a good image to their customers that they care about everyone even the minority. First of all, Kirton and GreeneRead MoreDiversity And Its Impact On Society2310 Words   |  10 Pagesincreasing education, and improving relationships between different races, in turn, decreasing racism. Diversity plays a key role in the economy of major cities. With cultural diversity comes different ideas and innovations and people with different skills that can each contribute in different ways to the community. In a research paper done by Philipp Agner and Markus Bruckner titled Cultural Diversity and Economic Growth: Evidence from the US during the Age of Mass Migration, they explore the affectsRead MoreThe Impact Of Globalization On Cultural Diversity1394 Words   |  6 PagesNowadays, the traditional cultures are disappearing since diverse cultures play a critical role in the society. Many people have been experiencing the negative effects of the globalization process. This paper will be focused on the impact of globalization on cultural diversity. First, it is about the concept of multiculturalism which is an adequate concept of culture today. Second, it will be explained about the difference of cultures which are supposed to considered equal by defining the term minorityRe ad MoreThe Impact Of Workplace Diversity On The Workplace997 Words   |  4 Pages Workplace diversity is a term which describes the inclusion of people in the workplace regardless of their cultural differences such as gender, race and sexuality. Rather than disregarding them, diverse workplaces utilise these differences to widen the range of experiences and skills among their employees as stated by the Australian Breastfeeding Association (2012). Some professions, however, are more diverse than others. According to the Diversity Inclusion: Unlocking Global Potential - GlobalRead MoreThe Impact Of Diversity On Strategic Marketing1556 Words   |  7 PagesThe impact of diversity in strategic marketing in today’s society has increased in the American population. Before we get in depth with this let’s find out what is diversity marketing according to (diversity marketing) Customers in different cultures have different values, experiences, expectations, and ways of interacting. Even within a culture, such differences will be apparent between different s ubgroups not just ethnicity, but also age, gender, profession, religion, family size, physical environmentRead MoreImpact Of Diversity On Academic Achievement Essay1267 Words   |  6 PagesMany people have come to realize that diversity has an impact on academic outcomes, and yet many people still believe that the impact of diversity is negative due to the understanding that students of different cultures tend to have generally lower scores on standardized test. What many don’t know is that diversity can have a positive impact on students’ academic achievement, rather than a negative. Exposure to diversity has a positive impact on academic achievement in many ways, through advancedRead MoreThe Impact Of Diversity On The Workplace886 Words   |  4 Pages Diversity in the workplace, in terms of gender, race, and other factors, is helpful, necessary, and even profitable, as shown by the four, black female engineers who accepted an award for the tech company Slack for TechCrunch’s â€Å"fastest rising startup.† No person’s physical identity should affect whether they get hired or not by an organization or business. In terms of getting hired, a person’s gender or race should not matter, as long as he or she has the right skills and tools for the job. InRead MoreThe Impact of Diversity on Individual Behavior1275 Words   |  6 PagesThe Impact of Diversity on Individual Behavior The concept of diversity has broadened in scope in the recent past, evolving from the concept of mandated quotas and affirmative action, to the reality of a diverse workforce being capable of providing quantifiable business value. A variety of external factors have influenced the conceptual evolution of diversity within the workplace. For example, globalization of markets has provided the concept of diversity with an opportunity to demonstrate a clearRead MoreDiversity Impact on Individual Behavior876 Words   |  4 PagesDiversity Impact on Individual Behavior Behavior refers to the actions or reactions of an object or organism, usually in relation to the environment. Behavior can be conscious or unconscious, overt or covert, and voluntary or involuntary. Behavior is controlled by the nervous system; the complexity of the behavior is related to the complexity of the nervous system. Generally, organisms with complex nervous systems have a greater capacity to learn new responses and thus adjust their behavior.