Law Corporation free essay sample

This does not mean that he/she cannot hire employees and/or have someone ‘manage’ the business. The final line is though; the owners’ decisions are the final word. | A sole proprietorship dissolves upon the owners’ death or selling of the business. Even if the spouse or other person is given rights to operate the business after the owners’ death, a new sole proprietorship has legally been started. | Owners of sole proprietorships are going to have a difficult time acquiring capital for the business. Such as a member deciding they do not want to be in the company any longer| Limited liability companies have a great deal of access for capital. An LLC has more of a chance because of the owner’s personal property not being in the equation. | The LLC does not pay taxes itself. The taxes are paid through the partners of the entity. The basis is the investment percentage that each owner has is what percentage each owner reports. We will write a custom essay sample on Law Corporation or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page | C Corporation| There can be numerous owners as the owners are considered as shareholders. Usually the individual who holds the majority of the shares would be considered the individual who has control and therefore could be considered as the only owner. The key benefit of it is that the business owners and their assets are protected from liability for business debts and judgments. Shareholders of an S corporation may consist of estates and trusts, which is not allowable for a sole proprietorship. Owners of an S corporation must be citizens or resident aliens of the United States. | When you enter into business debt with your S corporation, you do not have personal liability for it. One of the advantages of incorporating your business is that it provides you with limited personal liability. When you incorporate your business, it creates a separate business entity. Because of this, debts accumulated in the name of the business are not your own debts. This means that creditors cannot file lawsuits against you personally or come after your assets. | | No. The majority of the companys shareholders must agree to dissolve an S corporation.

Bullying Debut Albums and Big Idea free essay sample

I have to write an argumentative essay about a big idea. My paper is on how parents can help to stop and prevent bullying. My big idea that I am completing is a blob that offers a lot of information along with links to resources. I have my final due in two weeks but this week we have to revise our opening and closing statements and I do not know where to strap and could really use some help.Introduction: The saying, if sticks and stones will break my bones, but words will never hurt me was ever true, it sure isnt true today (Gaul, 2010). Bullying in and out of schools is getting out of control. Statistics have shown that one third of teens are bullied at school and 4 percent also report that they were also victims of cyber bullying (Bullying Statistics, 2009). Parents really need to take a stand against bullying to help prevent it and to stop it. We will write a custom essay sample on Bullying: Debut Albums and Big Idea or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page We as parents need to be a part of the solution, not the problem. Conclusion: No matter what end of the bullying your child Is on, you need to make sure that you are doing your part to prevent and stop this. Bullying is a serious matter, weather we like it or not. If you do not think that you can handle the situation on your own, there is no harm In asking for help. You can find help In a variety of places, even with In your own family.

Analysis of North and South by Elisabeth Gaskell Essays

Analysis of North and South by Elisabeth Gaskell Essays Analysis of North and South by Elisabeth Gaskell Essay Analysis of North and South by Elisabeth Gaskell Essay Galleys novel comes to term with the loss of an idealized rural past, and the ascendancy of the urban. The book has It all: class conflict, policy, religion, womans right, society. Through the story of Margaret Hale, the middle-class Ethernet who moves to the northern industrial town of Milton, Seashell skillfully explores issues of class and gender in the conflict between Margaritas ready sympathy with the workers and her growing attraction to the charismatic mill owner, John Thornton. Although we have quite a few themes to examine In the Victorian age. The working class people, north and south division, class and gender issues will be elaborated especially. It was In Queen Victorians reign that merchants, manufacturers and bankers started to gain political power, and began to exert pressure on the legislative body, he Parliament. We can understand the gravity of the situation through some professional information. Furthermore, Many of the established landed elite not only prospered through the effects of general economic expansion on their estates, which generated buoyant incomes and capital appreciation that were welcome financial sustenance in keeping up their position, but also themselves formed part of the leading edge of economic development by undertaking or encouraging the building of docks, harbors, railways, mines, or housing estates. They did not, therefore, present a blankly hostile OFF or Allen race to ten capitals entrepreneurs, even IT no memoir AT ten relocate would have cared to be classed as a businessman (153). The condition of working and middle class people can be learned from both novels like Galleys and other books examining that time. As Rutgers states in his book; Working class people could make upward or downward movement within their class only. Movement from working class to middle class was almost impossible. Again, the social mobility depended on education. For many working class families, however, education was a luxury. The system of that time is also stated by Mr.. Thornton and Mr.. Hale when they all sit including Margaret; Mr.. Hale states Is there a necessity for calling it a battle between the two classed? And Mr.. Thornton answers It is true ; and I believe it to be as much a necessity as that prudent wisdom and good conduct are always opposed to, and doing battle with, ignorance and improvidence. It is one of the greatest beauties of our system, that a working-man may raise himself into the power and position of a master by his exertions and behavior ; that, in fact, every one who rules himself to decency and variety of conduct and attention to his duties, comes over to our ranks ; it may not be always as a master, but as an overlooked, a cashier, a book keeper, a clerk, one on the side of authority and order'(96). Another theme to argue is gender in North and South In recent years, psychologists and historians have been exploring gender and its effect both men and masculinity should be approached as femininity is. We can see clear examples of this issue in the novel. Mr.. Thornton states that I take it that gentleman is a term that only describes a person in his legislation to others ; but when we speak of him as a man, we consider him not merely with regard to his fellow-men, but in relation to himself-to life-to time-to eternity. A castaway, lonely as Robinson Crusoe- a prisoner immured in a dungeon for life-nay, even a saint in Pathos, has his endurance, his strength, his faith, best described by being spoken of as a man I am rather weary of this word gentlemanly, which seems to me to be often inappropriately used, and often, too, with such exaggerated distortion of meaning, while the full simplicity of the noun man, and the adjective manly, is unacknowledged?that I am induced to class it with the cant of the day (194). And as Ginger S. Frost states in her book Courtship, Class and Gender in Victorian England men were expected to be brave, facing the consequences of their actions. For one thing, men were cowardly to refuse go through with bargain (42). And in the same book she says probably the most interesting insight into masculinity from breach-of-promise cases was the courts reaction to male sexuality. Once a man had sex with a woman, he was responsible for her. In this way the action undermined the harsh Victorian strictures on female chastity (44). We can say that the possible marriage between John and Margaret could be affected by all the gender and social Issues. The last theme we will examine is the north and south divide, while analyzing the social, intellectual and artistic developments in Victorian Britain, we must mainly think of the Industrial Revolution, the economic factors and the rise of the middle classes which radically altered the means of production, the politics, the customs, and culture. In a conversation between Mr.. Higgins and Margaret, she states; You must not go to South said Margaret, for all that. You could not stand You would not bear the dullness of the life; you dont know what it is; it would eat you away like rust. Those that have live there all their lives are used to soaking in the stagnant water. They labor on from day to day, in the great solitude of steaming fields-never speaking of lifting up their poor, bent, downcast heads. The hard spade- work robs their brain of life; the sameness of their toil deadens their imagination; hey dont care to meet to talk over thoughts and speculations, even the weakest, wildest kind, after their work is done; they go home brutishly tired, poor creatures! Caring for nothing but food and rest. You could not stir them up any companionship, which you get in a town as plentiful as the air you breathe, whether it be good or bad (364). In the novel, John works hard to earn the respect of his workers and tries to comprehend the life conditions. This is probably a good idea because Karl Adamant states in his book As the inner city grew more congested, the homes of the manufacturers and merchants, no longer used as places of business, migrated up the hillsides in order to escape the filth disease and noise of the city(103). Consequently, we can say that Elizabeth Seashell combines the themes of that time brilliantly and renders the issues visible for all trying to figure out Victorian Era. Primary Source: Seashell, Clincher Elizabeth. North and South. Oxford University: Chapman and Hall, 1855. Secondary Sources: Frost, Ginger Suzanne.

Free Essays on Internet Communication

â€Å"It is the sense of Congress that providers of electronic communications services and manufacturers of electronic communications service equipment shall ensure that communications systems permit the government to obtain the plaintext contents of voice, data, and other communications when appropriately authorized by law.† (Baase, 2003) This excerpt was initially taken from Senate Bill 266 in 1991 and articulates the goal of governmental agencies since that time. The U.S. Government has since tried to pass legislation to control the encryption used by software manufacturers relating to information communicated over the internet. Through research and analysis I will define the encryption standards, explore the legislation that the government is trying to put in place and determine if government involvement in encryption standards is if fact necessary. Encryption is defined as a process of translating a message, called the Plaintext, into an encoded message, called the Ciphertext. The Ciphertext is encoded text, after it has been passed through an Encryption algorithm and is the product of Plaintext after Encryption. A Cipher is a computer software algorithm used for Encryption. Encryption is usually accomplished using a secret key and a cryptographic Cipher. Two basic types of Encryption that are commonly used are Symmetric Encryption, where a single secret key is used for both encryption and decryption or Asymmetric Encryption, where a pair of keys is used, one for Encryption and the other for Decryption. The first encryption algorithm to be developed was known as DES and was presented by IBM to the National Security Agency (NSA) for review and approval in the 1970’s. â€Å"The National Security Agency (NSA) was formed in 1952 by a secret presidential order.† (Baase, 2003) Using the most powerful computers in the world, the NSA is responsible for monitoring communications between the U.S. and other countries. DES, a conve... Free Essays on Internet Communication Free Essays on Internet Communication â€Å"It is the sense of Congress that providers of electronic communications services and manufacturers of electronic communications service equipment shall ensure that communications systems permit the government to obtain the plaintext contents of voice, data, and other communications when appropriately authorized by law.† (Baase, 2003) This excerpt was initially taken from Senate Bill 266 in 1991 and articulates the goal of governmental agencies since that time. The U.S. Government has since tried to pass legislation to control the encryption used by software manufacturers relating to information communicated over the internet. Through research and analysis I will define the encryption standards, explore the legislation that the government is trying to put in place and determine if government involvement in encryption standards is if fact necessary. Encryption is defined as a process of translating a message, called the Plaintext, into an encoded message, called the Ciphertext. The Ciphertext is encoded text, after it has been passed through an Encryption algorithm and is the product of Plaintext after Encryption. A Cipher is a computer software algorithm used for Encryption. Encryption is usually accomplished using a secret key and a cryptographic Cipher. Two basic types of Encryption that are commonly used are Symmetric Encryption, where a single secret key is used for both encryption and decryption or Asymmetric Encryption, where a pair of keys is used, one for Encryption and the other for Decryption. The first encryption algorithm to be developed was known as DES and was presented by IBM to the National Security Agency (NSA) for review and approval in the 1970’s. â€Å"The National Security Agency (NSA) was formed in 1952 by a secret presidential order.† (Baase, 2003) Using the most powerful computers in the world, the NSA is responsible for monitoring communications between the U.S. and other countries. DES, a conve...

Vicale Had Propelled His Business above Other Potential Competitors in Essay

Vicale Had Propelled His Business above Other Potential Competitors in the Market - Essay Example The studies represented by the case study are descriptive and survey studies. In study data retrieved from the research is used to make conclusions and decision-making purposes on the report. From the case study, Vicale’s hobby was transformed into a business that rapidly grew due to the research he carried out on the modern day action figures. The constant demand for action figures from friends and visitors to his office, and with the research he conducted on the internet increased his urgency to start the business. Exploratory research conducted enabled him to evaluate the potential market for his goods. He was able to compare his product to the products available in the market. He found that his products were unique and easy to manufacture compared to other products. The competitive advantage Vicale had propelled his business above other potential competitors in the market. His products were modern day heroes compared to the conventional fictional heroes in supernatural sto ries. Their uniqueness enables Vicale to have a competitive product for his e-commerce business (Cooper & Schindler, 2010). The first step is the identification of the business idea to be researched. The creation of action figures was Vicale’s hobby and he had made some for himself before friends urged him to make more. The research question thus arises on the clientele that would buy the product produced by Vicale. Vicale decided to search the internet as his first source of information due to its accessibility. From the internet, he discovered that many companies were in the market producing similar products. The difference was the end product and the technology used. The action figures produced by Vicale were easy to produce because the action figure heads were fitted on a uniform body. He later expanded his sample size by taking his research to the market. In the market, he found that most of the toys in stores were action figures. The action figures had a high market compared to other toys on the market and they could suit both genders. Implementation of his findings is the final step in Vical e’s research where he evaluates his findings and implements (Cooper & Schindler, 2010).

See instructions below CJ220 wk 5 Research Paper

See instructions below CJ220 wk 5 - Research Paper Example Previously, in the early times of policing, officers were not well paid by their respectful departments. The plea of policing lay in the prospect to benefit from the corruption and gratuities that were presented to the police. During the â€Å"professional period,† ranging from 1920-960, this practice distorted. Through the initiative of police unions and the creation of other civil service transformation, police officers received benefits and better pay. This made some changes in this sector. Police officers who may probably fall into the corruption temptation (especially those on drug details and vice) should be routinely transferred to different beats or assignments. The disadvantage of this measure is that it can demolish the human resource expertise, which has been accrued by specific officers. To avoid this loss, administrators only alter a handful of police officers in specific considerations in each rotation. This department exists to ratify a measure of responsibility and quality control on actions of police officers. The department attains information by civilian review boards, criminal investigation of police officers, and public complaints. The creation of correctly functioning internal affairs unit lessens the frequency hiring of corrupt police personnel. These units are restricted solely by resources at their disposal and by the administrators’ relationships with the police

Prevalence Of Diabetes Mellitus Health And Social Care Essay

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