CHAPTER ONE
1.0 INTRODUCTION
Life styles of people have dramatically changed over the years and this has invariably increased the risk of diabetes and hypertension.
1.1 GENERAL PERSPECTIVE
The cause of most disease cannot be enumerated, but factors that enhance the effect of the disease can be typically analyzed. People from different backgrounds have different life styles that can either contribute positively or negatively to their health (Apochi, 2004) A big question is, “How do people manage stress”, and “How often do people eat fruits and vegetable” Stress basically increases the sugar level in blood; sugar are among the basic energy storage molecule in the body (Raven & Johnson 1996). Imperatively, how often do people go for medical check up? Is our environment conducive for living, and have we considered the environmental risk factors responsible for certain ailment like Diabetes and hypertension? Well, Drugs, hectic life style, food type, environmental condition, habits and more could be leading factor linked to high blood pressure, Diabetes and many other infections. Considering Diabetes and hypertension genetics cannot be disregarded as most of such ailment could be inherited (www.bhf.org.uk).
A simple questionnaire containing information that will aid a simple statistical analysis which will further “breed” an hypothesis on whether or what causes Diabetes, hypertension, stress and effect of antioxidant on these issues. Antioxidants basically are found in fruits and vegetable they help in the reduction of oxidative stress, which may also be a link to both hypertension and Diabetes (Health Monitor, 2006).
Aim of this data collection
The data collection is to aid the processing and derivation of information leading to drawing out a hypothesis relating to lifestyle, feeding habit, as related to stress-linked hypertension and diabetes and or genetically inherited diabetes and hypertension plus the effective role of antioxidant or the principle of antioxidant in curbing such issues. Information regarding genetics as conflicted to causes of hypertension and diabetes will be compared to physical data collection and correlation of this data to brood an effective link/cause of both diabetes and hypertension amongst adult workers.
Facts were drawn from Victoria Island, Ikeja and Gbagada; Bankers, Traders, Doctors, Nurses, Insurance Company workers, Business men & women and more gave information on their life style as related to their health issues. A little bit controversial, people from both angles (Diabetic, hypertensive and non Diabetic and hypertensive) gave information similarly regarding their life style and living conditions. But, with the help of a statistical analysis we will be able to draw a conclusion and simple hypothesis on this issue.
1.2 HYPERTENSION
Experts know that many different factors are linked to high blood pressure, but experts do not still fully understand the exact cause.
Factors that are linked to high blood pressure include:
Aging
Drinking more than 2 alcohol drinks a day for men and more than one alcohol drink a day for women.
Eating a lot of sodium salt
Being over weight or obese
Having high cholesterol
Not exercising
Being under a lot of stress.
Eating Diets low in potassium, magnesium and calcium
Being insulin resistant.
On the generality of this, blood pressure is the measure of the force that the blood applies to the walls of the arteries as it flows through them. It is normal for blood pressure to increase when you exert yourself, or when you feel stressed or anxious. But if your blood pressure is consistently higher than normal at rest, this is high blood pressure, also known as hypertension. Statistics has it that about 3 in 10 adults have high blood pressure in the UK. It is much more common in older people: 7 out of 10 people in their 70s have high blood pressure (www.bpassoc.org.uk). In Gbagada, Victoria Island and Ikeja we will find out the rate at which people have high blood pressure.
Blood is pumped normally around the body by the heart carrying oxygen and nutrients. As a result of the pumping action of the heart and the size and flexibility of the arteries that carry blood, the blood is under pressure. This blood pressure is an essential and normal part of the way the body work.
High blood pressure will develop if:
The walls of your layer arteries lose their elasticity and become rigid.
The small blood vessels become narrower (ww.bhf.org.uk)
It is important for people to do medical check-up on blood pressure regularly. It is very dangerous if it is not properly controlled. How can it be controlled if you don’t check it up to know your blood pressure status? However, blood pressure is measured with a monitor called Sphygmomanometer. This is a digital box attached to a tube with a cuff on the end. The cuff is placed around the upper arm and inflated to a certain level, then deflated slowly. A sensor in the cuff provides information about the blood pressure or a Doctor or Nurse will listen to the blood flow using a stethoscope. The result is expressed as two numbers such as 120/80 mm GH (“One Hundred and Twenty over Eighty Millimeters of Mercury”).The top figure is the systolic blood pressure: A measure of pressure when your heart muscle is contracting and pumping blood. This is the maximum pressure in your blood system. The bottom figure is the diastolic blood pressure, this is the pressure between the heart beats when the heart is resting and filling with blood. This is the minimum pressure in your blood system. If you suffer from diabetes is even more important that your blood pressure is lower than this- ideally less than 130/80mmh.
Types of High Blood Pressure
Primary hypertension and Secondary hypertension.
Primary Hypertension: More than 9 in 10 people with high blood pressure have what is called “Primary” or essential hypertension. This means that there is no single clear cause of it. Like I said previously the exact cause of high blood pressure is not fully understood. It is known that some factor to do with your life style can contribute (OLayinka, 2003).
Secondary Hypertension: Around 1 in 20 people with high blood pressure have “secondary hypertension”. This means your condition can be linked to a recognized cause-in fact, it may be a symptom of another underlying disease or factor such as:
Kidney disease
Endocrine disease
Narrowing of the aorta
Steroid medicines
The contraceptive pill
Pregnancy, which can cause pre-eclampsia.
You may also need some test to see if high blood pressure is having an effect on the rest of your body. These may include:
An analysis of urine (protein in your urine may be the first sign of kidney problem).
A blood test, to check your cholesterol and blood sugar levels as well as the condition of your kidneys.
An ECG (Electrocardiogram), which record the electrical changes happening in your heart.
Monitoring
24hrs Ambulatory monitoring. You may need 24-hours testing to measure your blood pressure over 24-hours.
Treatment
Slightly raised blood pressure may not be treated so aggressively, but regular monitory is important. If you have a very severe high blood pressure, you may need to go to hospital for treatment. But it is much more likely that you will be cared for by a Nurse. (www.bpassoc.org.uk, www.bhf.org.uk)
1.3 DIABETES
Diabetes mellitus occurs when the pancreas doesn’t make enough or any of the hormone insulin, or when the insulin produced doesn’t work effectively. In diabetes, this causes the level of glucose in the blood to be too high. Diabetes can also be viewed from this perspective: Diabetes mellitus is a heterogeneous group of disorders characterized by persistent hyperglycemia (Dorman, 2004).
There are two main common forms of diabetes, these are the type one diabetes and type two diabetes, and these were initially called the insulin dependent diabetes and non insulin dependent diabetes respectively.
In Type 1 diabetes the cells in the pancreas that make insulin are destroyed, causing a severe lack of insulin. This is thought to be the result of the body attacking and destroying its own cells in the pancreas – known as an autoimmune reaction. It’s not clear why this happens, but a number of explanations and possible triggers of this reaction have been proposed. These include:
Infection with a specific virus or bacteria;
Exposure to food-borne chemical toxins; and
Exposure as a very young infant to cow’s milk, where an as yet unidentified component of this triggers the autoimmune reaction in the body.
However, these are only hypotheses and are by no means proven causes. Type 2 diabetes is believed to develop when: The receptors on cells in the body that normally respond to the action of insulin fail to be stimulated by it – this is known as insulin resistance. In response to this more insulin may be produced, and this over-production exhausts the insulin-manufacturing cells in the pancreas; there is simply insufficient insulin available; and the insulin that is available may be abnormal and therefore doesn’t work properly.
The following risk factors increase the chances of someone developing Type 2 diabetes:
Increasing age;
Obesity; and
Physical inactivity.
Rarer causes of diabetes include:
Certain medicines;
Pregnancy (gestational diabetes); and
Any illness or disease that damages the pancreas and affects its ability to produce insulin e.g. pancreatitis.
What doesn’t cause diabetes?
On the cause of this research we will find out what may possibly not cause diabetes and what facilitates diabetes. Many scientists believe that eating sweets or wrong kind of food does not cause diabetes, but obesity instead. However according to our findings obesity is associated with people developing type two diabetes. Further more they also believe that stress does not cause diabetes, although it may be a trigger for the body turning on itself as in the case of Type 1 diabetes. It does, however, make the symptoms worse for those who already have diabetes.
Diabetes is not contagious. Someone with diabetes cannot pass it on to anyone else (Hicks, 2004).
What causes diabetes? It is believed that some drugs could lead to the cause of diabetes. Drugs such as steroids, Dilantin, and others may elevate the blood sugar through a variety of mechanisms. Certain other drugs, such as alloxan, streptozocin, and thiazide diuretics, are toxic to the beta cells of the pancreas and can cause diabetes. Certain syndromes (for example, Prader-Willi, Down’s, Progeria, and Turner’s) may result in a hyperglycemic state; if this state is prolonged, the result can be permanent diabetes. (Guthrie, 2003).
Diabetes resulting in an insulin-dependent state is classified as Type 1 diabetes. While Type 1 diabetes affects only between 5 to10 percent of the diabetic population, its effects on the body can be worse than other forms of diabetes. In the past, Type 1 has been known as juvenile or juvenile-onset diabetes (because it is usually diagnosed in those under thirty), brittle diabetes, unstable diabetes, and ketosis-prone diabetes. People in this classification more frequently exhibit the classic symptoms, usually with ketones present in blood and urine. A blood-sugar level of 800 mg/dl (44 mmol) or more, especially if ketones are not present, indicates a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (a state in which the body is extremely dry (dehydrated), the chemicals in the body are concentrated, and the blood sugar is high). As stated before, diabetes is a syndrome or group of diseases (rather than one disease), leading to the prolonged hyperglycemic state. Type 1 is most associated with the killing of the beta cells, most likely by the body’s own immune system. Either the immune system cannot kill an infecting agent, which then kills the beta cells, or the immune system itself goes “wild,” attacking the body’s own tissue and destroying the beta cells. The cells of the islets of Langerhans are inflamed, resulting from an infectious-disease process (for example, mumps) or, more commonly, from an autoimmune (allergic to self) response.
The autoimmune process results in the circulation of antibodies that may either cause or be caused by beta-cell death. If it is found that the antibodies cause beta-cell destruction (the body fighting what it now considers foreign to itself), the body’s response to the Type 1 diabetes is much less severe (i.e., easier to control) with treatment. Until then, the outcome is a lack of available insulin. While the onset is said to be sudden, changes resulting in decreased insulin availability may have occurred over a longer period of time. In short, insulin-dependent diabetes mellitus is an inherited defect of the body’s immune system, resulting in destruction of the insulin-producing beta cells of the pancreas. (Guthrie and Guthrie, 2003).
1.4 STRESS RELATED DIABETES
Stress, both physical and mental, can send your blood sugar out of whack (Nelson, 2004).
It’s hard to dispute that most of us live life at breakneck speed. It’s the nature of a fast-paced society, where numerous family, social, and work obligations can easily overpower your precious time and resources. But for people with diabetes, both physical and emotional stress can take a greater toll on health (Nazario, 2004).
This is a simple biological phenomenon that when a person is undergoing stress, the persons blood sugar level rises. During stress hormones like epinephrine (A substance produced by the medulla (inside) of the adrenal gland. The name epinephrine was coined in 1898 by the American pharmacologist and physiologic chemist (biochemist) John Jacob Abel) and cortisol (the primary stress hormone. Cortisol is the major natural GLUCOCORTICOID (GC) in humans) becomes active as their major function amongst others is to raise blood sugar level which, helps to boost energy when needed. Emotional and physical trauma keeps these hormones working as they are designed to aid you when you are stressed. Logically they want to give you energy to fight the cause of such stress, but, the adverse effect becomes eminent. People who aren’t diabetic have compensatory mechanisms to keep blood sugar from swinging out of control. But in people with diabetes, those mechanisms are either lacking or blunted, so they can’t keep a lid on blood sugar, says (David, 2004). When blood sugar levels aren’t controlled well through diet and/or medication, you’re at higher risk for many health complications, including blindness, kidney problems, and nerve damage leading to foot numbness, which can lead to serious injury and hard-to-heal infections. Prolonged elevated blood sugar is also a predecessor to cardiovascular disease, which increase the risk of heart attacks and strokes.
In diabetes, because of either an absolute lack of insulin, such as type 1 diabetes, or a relative lack of insulin, such as type 2, there isn’t enough insulin to cope with these hormones, so blood sugar levels rise (Richard, 2004).
Anything upsetting like going through a breakup or being laid off is certainly emotionally draining. Being down with the flu or suffering from a urinary tract infection places physical stress on the body. It’s generally these longer-term stressors that tax your system and have much more effect on blood sugar levels. Since stress has virtually become a way of life, you may not even notice you’re frazzled. A lot of people will identify stressors such as an illness in the family (something large) but may not recognize the stress of the holidays or a hectic time at work (something smaller or shorter in duration).
1.5 STRESS RELATED HYPERTENSION.
Reducing stress can help lower blood pressure. Stress is a normal part of life. But too much stress can lead to emotional, psychological and even physical problems — including coronary artery disease, high blood pressure, chest pains or irregular heart beats. When you are exposed to long periods of stress, your body gives warning signals that something is wrong. These physical, cognitive, emotional and behavioral warning signs should not be ignored. They tell you that you need to slow down. If you continue to be stressed and you don’t give your body a break, you are likely to develop health problems. You could also worsen an existing illness. (Curtis, 2007)
If stress itself is a risk factor for heart disease, it could be because chronic stress exposes your body to unhealthy, persistently elevated levels of stress hormones like adrenaline and cortisol. Studies also link stress to changes in the way blood clots, which increases the risk of heart attack.
1.6 GENETICS AND DIABETES
type one diabetes: it is believed that diabetes is likely to be inherited amist the other possible links and cause. In families it is studied that first degree relatives have a higher risk of developing type one diabetes than unrelated individuals from the general population (approximately 6% vs <1%, respectively) (Dorman and Bunker, 2000). These data suggest that genetic factors are involved with the development of the disease. At present, there is evidence that more than 20 regions of the genome may be involved in genetic susceptibility to type one diabetes. However, none of the candidates identified have a greater influence on type one diabetes risk than that conferred by genes in the HLA region of chromosome 6. This region contains several hundred genes known to be involved in 4 immune response. Those most strongly associated with the disease are the HLA class II genes (i.e., HLA-DR, DQ, and DP). IDDM1. The HLA class II genes, also referred to as IDDM1, contribute approximately 40-50% of the heritable risk for T1D (Hirschhorn et al., 2003).
Type two diabetes: It has long been known that Type two diabetes is, in part, inherited. Family studies have revealed that first degree relatives of individuals with Type two diabetes are about 3 times more likely to develop the disease than individuals without a positive family history of the disease (Flores et al., 2003; Hansen 2003; Gloyn 2003). It has also been shown that concordance rates for monozygotic twins, which have ranged from 60-90%, are significantly higher than those for dizygotic twins. Thus, it is clear that Type two diabetes has a strong genetic component. One approach that is used to identify disease susceptibility genes is based on the identification of ca n d i d a t e g e n e s ( B a r r o s o e t a l . , 2 0 0 3 ; S t u m v o l l , 2 0 0 4 ) . C a n d i d a t e g e n e s a r e s e l e c t e d b e c a u s e t h e y a r e t h o u g h t t o b e i n v o l v e d i n p a n c r e a t i c ² c e l l f u n c t i o n , i n s u l i n a c t i o n / g l u c o s e m e t a b o l i s m , o r o t h e r m e t a b o l i c c o n d i t i o n s t h a t i n c r e a s e T y p e t w o d i a b e t e s r i sks (e.g., energy intake / expenditure, lipid metabolism). To date, more than 50 candidate genes for Type two diabetes have been studied in various populations worldwide.
However, results for essentially all candidate genes have been conflicting. Possible explanations for the divergent findings include small sample sizes, differences in Type two diabetes susceptibility across ethnic groups, variation in environmental exposures, and gene-environmental interactions. Because of current controversy, this review w i l l f o c u s o n l y o n a f e w o f t h e m o s t p r o m i s i n g c a n d i d a t e g e n e s . T h e s e i n c l u d e P P A R ³, A B C C 8 , K C N J 1 1 , a n d C A L P N 1 0 .
S e v e r a l T y p e t w o d i a b e t e s S u s c e p t i b i l i t y G e n e s
R R = r e l a t i v e r i s k
U P P A R ³ ( p e r o x i s o m e p r o l i f e r a t o r s – a c t i v a t e d r e c e p t o r – ³) U . T h i s g e n e h a s b e e n w i d e l y s t u d i e d b e c a u s e i t i s i m p o r t a n t i n a d i p o c y t e a n d l i p i d m e t a b o l i s m . I n a d d i t i o n , i t i s a t a r g e t f o r t h e h y p o g l y c e m i c d r u g s k n o w n a s t h i a z o l i d i n e d i o n e s . O n e f o r m o f t h e P P A R ³ g e n e ( P r o ) d e c r e a s e s i n s u l i n s e n s i t i v i t y a n d i n c r e a s e s T y p e t w o d i a b e tes risks by several folds. Perhaps more importantly is that this variant is very common in most populations. Approximately 98% of Europeans carry at least one copy of the Pro allele. Thus, it likely contributes to a considerable proportion (~25%) of Type two diabetes that occurs, particularly among Caucasians.
Maturity-Onset Diabetes of the Young: An uncommon form of T2D (accounting for <5% of all T2D cases) that generally occurs before age 25 years is MODY. MODY is characterized by a slow onset of symptoms, the absence of obesity, no ketosis, and no evidence of beta cell autoimmunity. It is most often managed without the need for exogenous insulin. MODY displays an autosomal dominant pattern inheritance, generally spanning three generations (Stride and Hattersley, 2002).
1.7 GENETICS AND HYPERTENSION
Scientists at the University of Virginia and Georgetown University in Washington, D.C., have discovered three variants in a kidney gene that indicate the most common type of hypertension. Their findings, the result of “18-year” collaboration between the two schools, are allowing development of the first predictive medical test for high blood pressure, according to an article in the March 19 issue of Proceedings of the National Academy of Sciences (PNAS).
The researchers report that these gene variations, either by themselves or through interaction with variations of other genes, are associated with essential hypertension in several populations: Caucasian American, Ghanaian and Japanese. The presence of these gene variants, also called polymorphisms, can be determined by a simple genetic test used to assess an individual’s risk of developing high blood pressure (hypertension). The test is based on detection of inherited gene variations that encode for a protein called G protein coupled receptor kinase type 4 (GRK4). GRK4 variations are associated with an inability to eliminate sodium from the body. This discovery has led to a high quality test that should be suitable for screening a large number of patients based on a fluorescent molecular beacon assay, and will aid physicians in their diagnosis of genetic forms of hypertension, (Robin, 2002).
The genetic information disclosed by the new test will allow physicians to provide guidance to patients with a family history of hypertension who wish to know if they should modify their lifestyles to help prevent the debilitating consequences such as kidney failure, heart failure, stroke, blindness or high blood pressure, (Felder, 2002).
Essential hypertension – a type that classifies 50 percent of hypertension – affects 25 percent of the world’s adult population and is a major risk factor for stroke, myocardial infarction and heart and kidney failure. Although scientists have believed this condition to be hereditary, determining the genetic cause of essential hypertension was previously difficult because blood pressure level results from a combination of hereditary and environmental factors.
Patients with even a single GRK4 variation have a significant lifetime risk for developing hypertension, said Dr. Pedro A. Jose, professor of pediatrics and of physiology and biophysics at Georgetown University, and senior author of the journal article. We have now identified the genetic abnormalities that cause this error and so we have a better idea of the impact of these gene variations in the development of hypertension in three distinct racial groups.
Identification of this leading cause of hypertension should lead to improved medical treatments for the disease but, the belief of these scientists is it really true?
1.8 PRINCIPLES OF ANTIOXIDANT IN DIABETES AND HYPERTENSION
Very simply put, an antioxidant is something that prevents or slows down oxidization. This can be very beneficial to the health, for instance the cholesterol in our bodies is not necessarily harmful until it becomes oxidized, which then causes it to start clinging to our blood vessels which as you know can then lead to some serious health related heart problems. Antioxidants can help to prevent this and thus make a very positive contribution to your overall general state of health and physical well being (Gorman, 2003)
Have you had your lycopene today? If you ate a green salad with fresh chopped tomatoes, then you not only got a healthy dose of this powerful antioxidant, but you have also taken significant action toward lowering your blood pressure.
A recent double-blind study conducted in Israel has confirmed what hearth-healthy Italians have enjoyed for centuries – tomatoes (and tomato sauce) lower blood pressure and the risk of heart disease (Paran, 2007). Tomatoes are so effective at lowering blood pressure because they contain lycopene. This potent antioxidant is even the focus of some hybrid tomatoes processed by Tomatoes Company in Nigeria (Gino tomatoes).
Long-Term Antioxidant Intervention Improves Myocardial Microvascular Function in Experimental Hypertension (Martin, 2003). Hypertension increases oxidative stress, which can impair myocardial microvascular function and integrity. However, it is yet unclear whether long-term antioxidant intervention in early hypertension would preserve myocardial perfusion and vascular permeability responses to challenge. Pigs were studied after 12 weeks of renovascular hypertension without (n=8) or with daily supplementation of antioxidants (100 IU/kg vitamin E and 1 g vitamin C, n=6), and compared with normal controls (n=7). Myocardial perfusion and microvascular permeability were measured in vivo by electron beam computed tomography before and after 2 cardiac challenges (intravenous adenosine and dobutamine). Basal left ventricular muscle mass was also obtained. Mean arterial pressure was significantly increased in both groups of hypertensive animals (without and with antioxidants, 123±9 and 126±4 mm Hg, respectively, versus normal, 101±4 mm Hg; both P<0.05), but muscle mass was not different among the groups. The impaired myocardial perfusion response to adenosine observed in hypertensives (normal, +51±14%; P<0.05 versus baseline; hypertension, +14±15%; P=0.3 versus baseline) was preserved in hypertensive pigs that received antioxidants (+44±15%; P=0.01 compared with baseline). Long-term antioxidant intervention also preserved subendocardial microvascular permeability responses in hypertension. On the other hand, antioxidant intervention had little effect on the hypertension-induced myocardial vascular dysfunction observed in response to dobutamine. This study demonstrates that the impaired myocardial perfusion and permeability responses to increased cardiac demand in early hypertension are significantly improved by long-term antioxidant intervention. These results support the involvement of oxidative stress in myocardial vascular dysfunction in hypertension and suggest a role for antioxidant strategies to preserve the myocardial microvasculature. (Krier et al, 2003).
Most of the food that many people eat, such as fast food and other food sources high in processed carbohydrates sugars and fat, contain very low levels of antioxidants. As well as being low in antioxidants, these items actually increase your cholesterol level; this can lead to some serious health issues that pose serious health risk. (Heath monitor, 2006).
1.9 HYPOTHESES
H0: Stress is not linked with hypertension
H1: Stress is linked with hypertension
H0: Stress is not linked with diabetes
H1: Stress is linked with diabetes
H0: Antioxidant cannot curb hypertension
H1: Antioxidant can curb hypertension
H0: Antioxidant cannot curb diabetes
H1: Antioxidant can curb diabetes
H0: Hypertension is not hereditary
H1: Hypertension is hereditary
H0: Diabetes is not hereditary
H1: Diabetes is hereditary
CHAPTER TWO
2.0 MATERIALS
The major materials used were: a comprehensive questionnaire and data analysis software. These two materials are very effective in processing information for statistical analysis. Biological raw data can be mathematically analyzed, computed and intensely verified for effective result. Different people have different believes and tenets, but, such believes have to be reasonable hypothesis and proven.
2.1 REVIEW OF HYPOTHESIS
H0: Stress is not linked with hypertension
H1: Stress is linked with hypertension
H0: Stress is not linked with diabetes
H1: Stress is linked with diabetes
H0: Antioxidant cannot curb hypertension
H1: Antioxidant can curb hypertension
H0: Antioxidant cannot curb diabetes
H1: A ntioxidant can curb diabetes
H0: Hypertension is not hereditary
H1: Hypertension is hereditary
H0: Diabetes is not hereditary
H1: Diabetes is hereditary
2.2 DATA COLLECTION (QUESTIONNAIRE)
Data are research facts that are based on respondents’ answers to questions. There are types of data like parametric and non parametric data; the former is in numerical values while the later is the type I am applying in this research which is nominal or ordinal like sex, age, nationality and more (Oludotun, 2007). Information are processed data while a questionnaire is a form of mechanism for obtaining information, data to be processed and opinions of people about certain issues. Questionnaires have a number of advantages and disadvantages when compared with other evaluation tools. The key strengths and weaknesses of questionnaires are summarized in bullet points below. In general, questionnaires are effective mechanisms for efficient collection of certain kinds of information. They are not, however, a comprehensive means of evaluation and should be used to support and supplement other procedures for evaluating and improving research hence an evaluating soft ware is also utilized in this research as indicated above.
2.3 ADVANTAGES OF QUESTIONNAIRES:
They permit respondents time to consider their responses carefully without interference from, for example, an interviewer.
Cost: It is possible to provide questionnaires to large numbers of people simultaneously.
Uniformity: Each respondent receives the identical set of questions. With closed-form questions, responses are standardized, which can assist in interpreting from large numbers of respondents.
Can address a large number of issues and questions of concern in a relatively efficient way, with the possibility of a high response rate.
Often, questionnaires are designed so that answers to questions are scored and scores summed to obtain an overall measure of the attitudes and opinions of the respondent.
They may be mailed to respondents although this approach may lower the response rate.
They permit anonymity. It is usually argued that anonymity increases the rate of response and may increase the likelihood that responses reflect genuinely held opinions.
The responses are gathered in a standardized way, so questionnaires are more objective, certainly more so than interviews.
Generally it is relatively quick to collect questions using a questionnaire.
Potential information can be collected from a large portion of a group. This potential is not often realized, as returns from questionnaires are usually low. However return rates can be dramatically improved if the questionnaire is delivered and responded to in time.
2.4 DISADVANTAGES OF QUESTIONNAIRES
Questionnaires, like many evaluation methods occur after the event, so participants may forget important issues.
Questionnaires are standardized so it is not possible to explain any points in the questions that participants might misinterpret. This could be partially solved by piloting the questions on a small group of people or at least friends and colleagues. It is advisable to do this anyway.
Open-ended questions can generate large amounts of data that can take a long time to process and analyze. One way of limiting this would be to limit the space available to students so their responses are concise or to sample the people and survey only a portion of them.
Respondents may answer superficially especially if the questionnaire takes a long time to complete.
People may not be willing to answer the questions. They might not wish to reveal the information or they might think that they will not benefit from responding perhaps even be open by giving their real opinion. People should be told why the information is being collected and how the results will be beneficial. They should be asked to reply honestly and told that if their response is negative this is just as useful as a more positive opinion.
2.5 LOCATION IN VIEW
The locations considered: Ikeja, Gbagada, Victoria Island. These areas are both industrial and residential areas. Majority of people in these areas have different life styles and different ways of attending to health issues.
2.6 CATEGORIES OF PEOPLE IN VIEW
People, who take taxies to work, some take private cars, public buses and even bikes. Many of them spend long time in traffic, and even spend long time at work.
2.7 METHOD OF DATA PROCESSING
There are so many methods applied in investigation of statistical analysis among these are design and survey which are the two methods used. The software used in the analysis of the data collected from the questionnaire is the statistics package for social scientist (SPSS). Based on the fact that the data collected through the questionnaire are non-parametric, they are first analyzed into percentile, mean, mode and median. Furthermore a correlation is made between related information coined from the data in the questionnaire and chi square test into symmetric measure which shows Pearson’s ranking and spearman correlation to produce an efficient result to test if the null hypothesis is accepted or the alternative hypothesis is accepted.
CHAPTER THREE
3.0 RESULT
The questionnaires were collected and analyzed using statistical package for social scientist (SPSS), these were tabulated as percentile, mean and modal information that was further correlated with cross-tabulation, chi square test and symmetric measure. The result shows that stress increases diabetes and hypertension. Antioxidants reduce the effect of diabetes and diabetes and hypertension are both hereditary.
3.1 SECTION A: BIO-DATA
The three locations (Gbagada, Victoria Island and Ikeja) were fused together in a tabular form depicting information in quantity (mode) and in percentage. The tables below are results from the fusion of data from Gbagada, Victoria Island and Ikeja based on some related question on the questionnaire.
Table 1: Age of Respondent
Table 1 shows 56.3% of workers fell in the lower category of age while 43.8% fell in the higher category of age; 18-25 and 26-33 respectively.
Table 2: Marital Status
In table 2, a large number of the respondents are single (94.9%) while the rest were either married or divorced.
Table 3: Nature of Job
Table 3 shows the kind of jobs the respondents do, there were more people on the white collar jobs.
Table 4: Family History of Hypertension
Table 4 shows that many hypertensive people had traces of family members that were hypertensive.
Table 5: Family History of Diabetes
Table 5, 12% were found to be valid for diabetic traces in their families.
Table 6: Distance to Workplace shows 30.4 valid percent of people living very far from their workplaces.
Table 7: Conditions of the Roads
Table 7 verifies that 51.7% go to work on bad roads.
Table 8: Duration of time spent in Traffic Daily
Table 8, indicates that a higher percent of workers spend about 2hours in traffic.
Table 9: Transportation system to Workplace
Table 9 shows that 43.8 go to work on bike, 36.9 go to work in private cars, 1.1 use commercial buses.
3.3 Section C: Use of Fruits and Vegetables
Table 10: Respondents cook and eat vegetables outside those incorporated into food
In table 10, 62.5% against 29.5% respondents eat vegetables outside those incorporated into food.
Table 11: Respondents eat fruits often
Table 11 depicts that a high frequency of respondents eat fruits.
Correlation/cross-tabulation of parameters closely investigated hypothesis. Samples from the cross relationship showed 13 respondent who were hypertensive out of 35, they spend about 2hours in traffic while 10 out of 34 respondent who were hypertensive spend lesser time in traffic; that is to say stress aggravates diabetes.
For diabetes majority of people who spend more time at work did not respond well to treatment. The chi-square test gave 0.508 which is greater than 0.05 this accepts the alternative hypothesis. Results show that antioxidants curb both diabetes and hypertension, 54 respondents, 17 are hypertensive and eat enough vegetable, but 37 people of the 54 respondents are not hypertensive but eat enough vegetables. More respondent have family members that are both hypertensive and diabetic.
Table 12: Effect of stress on hypertensive patience
CASESCORRELATED QUESTIONSVALIDMISSINGTOTALNPERCENTNPERCENTNPERCENTTRAFFICADURATION OF TIME SPENT IN TRAFFIC DAILY* ARE YOU HYPERTENSIVE?6939.2%10760.8%176100%BDURATION OF TIME SPENT IN TRAFFIC DAILY* WHEN LAST DID YOU CHECK YOUR BLOOD PRESSURE?6335.8%11364.2%176100%CDURATION OF TIME SPENT IN TRAFFIC DAILY* KIND OF MEDICATION(S) USED?5631.8%12068.2%176100%DDURATION OF TIME SPENT IN TRAFFIC DAILY* ANY IMPROVEMENT?3821.6%13878.4%176100%WORKEDAILY TIME AT WORK* HYPERTENSIVE?6838.6%10861.4%176100%FDAILY TIME AT WORK* CHECK OF BLOOD PRESSURE?6436.4%11263.6%176100%GDAILY TIME AT WORK* KIND OF MEDICATION USED5631.8%12068.2%176100%HDAILY TIME AT WORK* ANY IMPROVEMENT?3821.6%13878.4%176100%
CHAPTER FOUR
4.0 DISCUSSION
The level of stress back in the days of our fathers compared to the present life style was relatively small.
Physical and mental stress increase the blood sugar level which in turn increases the pressure the blood exerts on the walls of the blood vessels. When the rate or speed of blood pumping from the heart around the body increases consistently then you are susceptible to high blood pressure (Olayinka, 2003). The primary hypertension is more common; about nine in ten people suffer from that primary hypertension. There is virtually no clear cause of that one.
The secondary hypertension is more critical with one person in twenty people suffering from it; its cause could be linked to other underlying diseases (www.bhf.org.uk). We have been able to show that People who spent 10hours at work could trigger or aggravate the incidence of high blood pressure. Unsatisfactory job conditions and long time in traffic also triggered the incidence of hypertension. We could show that about 2% of hypertensive people spent less than and equal to 30 minutes in traffic while about 3% of hypertensive people spent about 2hours in traffic. These facts prove that stress leads to high blood pressure.
A large percentage of people with essential hypertension have genetic abnormalities of their peripheral arteries (arterioles) — the small arteries that supply blood to the body’s tissues. This genetic abnormality makes the walls of the arteries stiff so there is greater resistance to the blood flowing through them. (www.medicinenet.com).
A higher number of those with high blood pressure had members of their family with high blood pressure (13 out of 21 respondents that are hypertensive have family members that are hypertensive from the result). Genetic factors may contribute to an estimated thirty percent of cases of essential hypertension (high blood pressure of unknown cause). In the United States, high blood pressure occurs more frequently among African Americans than among white or Asian Americans. Adult African American men are most at risk for developing hypertension and cardiovascular diseases. The reason remains unknown, especially since non-American adult African men have very low occurrences of hypertension. One of the relating factors to high blood pressure is sodium salt; this was sited previously. Some scientist believe that the black American adult suffering from high blood pressure can be linked to the time of the slave trade, when they were crossing the see they must have been affected by the high sea concentration of salt. This is just an assumption. (www.webmd.com).
Diabetes is mainly in two forms except for other minor but important types like MODY: maturity onset diabetes in youth and more (Dorman, 2004). The insulin dependent diabetes which is also called the type one diabetes is when all the cells responsible for the production of insulin has been totally destroyed by the body’s own immune system; the non-insulin dependent diabetes also called type two diabetes this is when the receptors responsible for the stimulation of the cells that produces insulin fails this is also called insulin resistance. In response to this excess insulin produced, over time the cell loses the ability to produce enough insulin to control the blood sugar. Cortisol and epinephrine are triggered to produce excess sugar for energy when a person encounters stress (health monitor, 2006). When there is not enough insulin to control the sugar level, diabetes is worsened (McElroy, 2007). It was clearly discovered that those undergoing certain stressful life style were diabetic with poor response to treatment which is another major connection between stress and diabetes (1.1% of those who spent hours in traffic do not respond to diabetic treatment against 0.44% of those who spent lesser time in traffic). Stress makes diabetes worse; even if you are doing everything you can to control your condition (Tennen, 2007).
At present, there is evidence that more than 20 regions of the genome may be involved in genetic susceptibility to type 1diabetes. The genes strongly associated with the disease are the HLA class II genes (i.e., HLA-DR, DQ, and DP). IDDM1. The HLA class II genes, also referred to as IDDM1, contribute approximately 40-50% of the heritable risk for T1D (Hirschhorn et al., 2003).
It was discovered that those that diagnosed their diabetes between the ages 0-20 had more family members with diabetes. It has long been known that “Type two diabetes” is, in part, inherited. Family studies have revealed that first degree relatives of individuals with “Type two diabetes” are about 3 times more likely to develop the disease than individuals without a positive family history of the disease (Flores et al., 2003; Hansen 2003; Gloyn 2003).
Antioxidants reduce hypertension as the rate of vegetable consumption increases. Out of 54 people 37 who consume a very high amount of vegetables reported not to be hypertensive anymore against the remaining 17 people. This simple indication shows that these vegetables help the body in the reduction of hypertensive risk.
Studies on oxidative stress, antioxidant treatment, and diabetic complications have shown that oxidative stress is increased and may accelerate the development of complications through the metabolism of excessive glucose and free fatty acids in diabetic and insulin-resistant states. However, the contribution of oxidative stress to diabetic complications may be tissue-specific, especially for micro-vascular disease that occurs only in diabetic patients but not in individuals with insulin resistance without diabetes, even though both groups suffer from oxidative stress. Although antioxidant treatments can show benefits in animal models of diabetes, negative evidence from large clinical trials suggests that new and more powerful antioxidants need to be studied to demonstrate whether antioxidants can be effective in treating complications. Furthermore, it appears that oxidative stress is only one factor contributing to diabetic complications; thus, antioxidant treatment would most likely be more effective if it were coupled with other treatments for diabetic complications (www.joslin.harvard.edu).
Those workers that indulge in adding extra vegetables to their meal and eating fruits regularly responded to diabetic treatment properly. This only indicates that since vegetables and fruits are good sources of antioxidant, it has positive effect on diabetic patients. Hence the alternative hypothesis is accepted that antioxidants help in curbing diabetes.
Conclusions
Finally we can confidently say that, “stress is related to hypertension, stress is related to diabetes, antioxidant can ameliorate the risk of developing hypertension and diabetes. Hypertension and diabetes are both hereditary these indications are possible because, haven tested the strength and direction of variables and observed the effect of one variable on the other; the alternative hypotheses were now accepted.
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Apochi Vaughn Taghogho
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